IRAP Equine Lameness Therapy: Two Veterinarians, Two Videos to Show and Tell the Treatment's Story

Interleukin-1 Receptor Antagonist Protein therapy (IRAP™) for equine lameness came on the scene a few years ago and seemed to be the province of university and referral hospitals. It was first discussed on this blog back in May of 2007, in New Lameness Treatments: IRAP™ Therapy.

Fast forward to 2011 and IRAP has become a word you'll overhear trainers using at the racetrack, and dressage riders quipping about as they compare notes on their horses' injuries. IRAP may not be an overnight sensation, but it would be close to the equivalent and if you haven't had first-hand experience with a case yet, just hang on--you will. Or, you may even be around horses that have undergone IRAP therapy and you didn't even know it: there are no scars, no bandages, no clipped hair.

But horse owners still call here and ask for advice: what is it? what can go wrong? who's had it done? It's true; some owners can't quite catch the name or the concept, and think of IRAP as just a very expensive joint injection. But they are usually pretty happy with the results.

IRAP isn't a treatment with a lot of drama or big equipment or flashing lights. It is simply a treatment of a sample of the horse's own blood, creating an enriched serum which contains anti-inflammatory proteins. These proteins are very specifically targeted to block the harmful effects of interleukin-1, an inflammatory mediator that accelerates the destruction of cartilage.

Will IRAP help every horse? Will it reverse the degenerative effects of years of arthritis? As the numbers of treatments increase, veterinarians are becoming more specific about ideal cases and potential benefits.

For the horse, the treatment consists of just two injections: first the drawing of a vial of blood, then the enriched serum is injected back into the horse at the site of the injury. Because the serum is autologous, or derived from the horse’s own blood, there is only a minimal risk of an adverse reaction.

When I went looking for a video about IRAP, I thought I would share two instead of one, because together they tell a good deal about IRAP. The two videos are similar, but show a lot of details about the process. Dr. McKee of McKee Pownall Equine Services has a Standardbred racehorse on hand as a patient, while Dr. Charlene Cook of Central Georgia Equine Services has a pleasure horse on the cross ties.

This may seem like too much information...until the day comes when you need to know about IRAP. 

Melissa McKee DVM of McKee Pownall Equine Services in Ontario, Canada leads the horse world through the demystification of many horse diseases and problems through her practice's YouTube channel. In this video, Dr McKee's straightforward explanation of IRAP should put horseowners at ease when their vets recommend the treatment. Thanks to McKee Pownall for their ongoing excellence in client education. Via YouTube and Facebook, they are educating many more of us than just their clients!

If you or one of your clients would like to read more about IRAP on paper, we have a link to an excellent document download, IRAP Therapy for Equine Osteoarthritis, created by Amanda House DVM of the University of Florida's College of Veterinary Medicine's Extension Service.

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.
 

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Global Hunter Takes a Detour to the Winner's Circle, Via Surgery at Alamo Pintado

It was a game finish to the American Handicap at California's Hollywood Park on the Fourth of July. While the rest of us were on the barbeque and fireworks circuit, a nice racehorse was being pulled up after winning the race by a neck. They called it a "bad step" in the racing press. In spite of the win, a nice horse became a statistic, and almost a fatality.

Global Hunter never made it to the winner's circle. The veterinarians took over and the Grade 1 stakes winner was vanned that night to Dr. Doug Herthel's Alamo Pintado Equine Medical Center in Los Olivos, California. That's a long van ride; Los Olivos is north of Santa Barbara. But it was worth the trip.

Radiographs apparently showed that the horse dislocated his fetlock but did not actually fracture his leg, although I am sure more detailed images have been taken now, and the surgeons may have found some damage. Virtually all the racing publications, web sites and TVG reported that the horse went into surgery at Alamo Pintado under the care of Dr Carter Judy, and that he seemed to recover well afterwards and was standing on all four legs. Dr Carter's surgical repairs used plates and screws to realign and stabilize the lower limb.

Now begins the vigil. A Global Hunter Facebook page immediately popped up and will hopefully keep a flow of news available to those who care about the horse

Global Hunter is a seven-year-old Argentine-bred son of Jade Hunter who has done well racing in California. The Grade II American Handicap was a turf race.

About the joint: The fetlock, or metacarpophalangeal joint,  is a relatively straightforward joint that flexes and extends with the changing segments of the horse's stride. The cannon (third metacarpal) bone meets the long pastern bone (proximal phalanx) and the knob-like proximal sesamoids to form this joint. A small sagittal ridge between the condyles (rounded ends) of the cannon bone creates a sort of stabilizing bar within the joint so that it only opens and closes in a flex-extend acceptable range of motion. This ridge and the condyles of the cannon bone sit perfectly into the joint cavity created by the long pastern bone. Such a nicely designed joint architecture is held in place by a network of short, tight ligaments that prevent both side-to-side motion and dangerous knuckling forward of the joint. In addition, the two proximal sesamoid bones are points of attachment for the branches of the suspensory ligament (interosseous) and the deep digital flexor tendon rides across the back of the two sesamoids. In summary, the fetlock is much more than a mere joint: it is an intersection of both soft and bony tissue and one of the most critical structures for both weightbearing and locomotion.

Global Hunter will no doubt remain at Alamo Pintado for the time being. The hospital made this video available about its fracture repair services. While Global Hunter's injury may not technically not a long-bone fracture, the process to repair it is similar to the fracture repair and surgical processes detailed in this video, so I thought I would share this. He is a lucky horse, but we will find out in the weeks to come just how lucky. Maybe someday he'll make it back to the winner's circle at Hollywood Park for his win photo from the Fourth of July.

To learn more: An excellent paper on the structure and function of the fetlock joint and the how-and-why of injuries in racehorses is Articular Fetlock Injuries in Exercising Horses by Elizabeth M. Santschi DVM of the College of Veterinary Medicine at The Ohio State University. It is published in Performance Horse Lameness and Orthopedics, Volume 24 No. 1 (April 2008) of Veterinary Clinics of North America: Equine Practice.

Video courtesy of Alamo Pintado Equine Medical Center in Los Olivos, California

Fran Jurga's Hoof Blog at Hoofcare.com
© Fran Jurga and Hoofcare Publishing


Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

Favorite Photos: Coffin Joint Pressure Test

Yesterday, I announced on this blog that we had a few copies of the Proceedings and Summary Book + CD-ROM of the 4th International Equine Conference on Laminitis and Diseases of the Foot.

Today, the shelf is almost empty. Thanks to everyone who has helped support the conference with their purchase.

The book is filled with the "greatest hits" images from the speakers' slides, if they were able to provide high enough resolution files.

This one was a big hit with me. It was taken at Rood and Riddle Equine Hospital's Podiatry Center, by Dr. Scott Morrison. Regional perfusion of the distal interphalangeal (coffin) joint is pretty routine there but he just happened to have his camera aimed at the foot and it was set on a fast shutter speed. It caught the spurt of fluid exiting the joint in mid-air.

If you double click on the image, you can see it at full size (on most computers, using most browsers).

But don't even think of right-clicking on it. This image is the property of Dr. Scott Morrison and is protected under international copyright by both the Laminitis Conference and Hoofcare Publishing.

But it is a great shot, don't you agree?

Click here for information about ordering the summary book and/or proceedings CD-ROM or just scroll down to Wednesday's post. Don't wait too long!

© Fran Jurga and Hoofcare Publishing. No use without permission. Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please visit our main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found.