Tying-up is a broad term used to describe a variety of muscle disorders that can affect the performance horse. Other names given to this syndrome include exertional rhabdomyolysis, Monday morning disease, and azoturia.

Heart valve damage, which is also called valvulopathy, is the most common damage caused by the combination of phentermine and fenfluramine. In most cases, this occurs when the heart-valves do not close properly, which causes a leakage of blood at the valve (also known as regurgitation). While this is not usually a serious problem, if the valves are badly damaged by the Phen Fen, pulmonary hypertension may result. This type of hypertension is known as SPH or Secondary Pulmonary Hypertension.

Heart valve damage ("valvulopathy") is the most common injury from the use of fen-phen. Valvulopathy occurs when the heart-valves (typically the aortic and mitral valves) do not open and close properly, causing regurgitation of blood. If the valves are seriously impaired, secondary pulmonary hypertension may result.

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Tying-up can be subclassified as either sporadic or chronic exertional rhabdomyolysis. Sporadic exertional rhabdomyolysis applies to horses that, on rare occasions, experience an episode of generalized tying-up. A common cause of sporadic tying-up is exercise that exceeds the level of fitness. Electrolyte imbalances, especially low sodium, and deficiencies of vitamin E and/or selenium may predispose a horse to tying-up.

The answer is, it depends on the situation and the anatomy found at surgery. This question first arose when some surgeons using low-power optical loops began claiming they were doing “microsurgery.” The use of only a few larger sutures was the tip-off, as microsurgery uses finer and more numerous sutures. Read more ...

Clinical signs vary depending on the severity of the episode. In mild cases, affected horses may be slightly stiff after exercises. At the other end of the spectrum, pain may be so intense that affected horses may be unable to stand and bear weight. Exercise may elicit a short, stiff stride. Following rest, horses may be reluctant to move and may adopt an unusual stance; males often posture as if to urinate. Horses may also sweat liberally and more than the degree of exertion would dictate.

The muscles of the hindquarters are the most severely affected. The muscles are typically firm and painful on palpation. Cramping of the muscle may also occur during palpation.

Depending on the type of damage, your doctor may prescribe different types of treatment. For valve injuries, some are treatable. For example, a slight valve impairment might result simply in getting yearly echocardiograms to ensure that the problem is not worsening.

In many cases we perform no-stitch cataract surgery at Ocala Eye. If the doctor feels it is beneficial to the patient, the doctor may use a suture, though usually just one. This suture, if needed, is buried and slowly absorbable, so our patients are unaware that it is there. The cataract will not grow back, but at a later time the tissue behind the lens implant may become clouded. This condition is known as capsular fibrosis and it can be painlessly treated with a laser.

In the case of an extensive repositioning of the nipples a reduction of the breastfeeding function can result. It is advisable to discuss details with your surgeon in order to minimize repositioning of the nipple if you intend to breastfeeding.

Unlike conventional sutures which are smooth, patented Contour ThreadsT have tiny teeth-like barbs or cogs that are spaced evenly apart. Once inserted under the skin, they are fixated with tension that creates a suspension effect that gently lifts sagging tissues.

Dermal adhesives and staples are good options to sutures, particularly in certain circumstances. Dermal adhesives should not be used over joints; on hands, feet, lips, or mucosa; on infected, puncture, or stellate wounds; or in patients with poor circulation or a propensity to form keloids.

Most surgeons use sutures that are dissolvable and never need to come out. However, if permanent (i.e. non-dissolvable) sutures are used, they can usually be removed at approximately 7 to 10 days postoperatively.

Diagnosis of tying-up is confirmed by detection of elevated serum activities of creatine kinase (CK) and aspartate aminotransferase (AST) in the blood. CK and AST are muscle proteins that are released into circulation when muscle cells are damaged. Elevations in CK increase quickly following an episode of tying-up; peak values usually occur four to six hours following the attack. Trends in AST are realized more slowly with levels remaining elevated for seven to 10 days following an episode.