EGUS Series Part 3: Management of the horse with Equine Gastric Ulcer Syndrome (EGUS)

So, we now know how to recognize horses afflicted with EGUS and also the proven therapeutic methods used to treat such horses.  This begs the question, how do we manage these ulcer patients?   Numerous studies have shown that intense training and competition schedules, frequent shipping, high concentrate (starch) diets, decreased availability of pasture and insufficient ingestion of hay are all common contributing factors to the development of EGUS.  Our goals as veterinary professionals are multifaceted and include neutralization of acid, promotion of mucosal repair, and the improvement of management processes. 

Photo Courtesy Public Domain Photos via Flickr

Knowing that the equine stomach produces 1.5L of acidic stomach juices on an hourly basis, we can already begin to recognize the benefits of having a constant input of hay into the horse’s GI tract. Additionally, if your horse can handle some alfalfa in his diet, there are several benefits to ingesting this leafy legume.  When compared to timothy, brome and orchard grass, alfalfa is higher in calcium and protein, both of which act as literal chemical buffers to stomach acid.  Additionally, if we consider that alfalfa often has a coarser texture, this means the horse is required to take more chews before swallowing the feed.  As the horse masticates, he produces saliva.  This gooey substance is high in bicarbonate, a chemically basic molecule which also aids in the neutralization of stomach acid.  If your horse is an easy keeper or has some metabolic/nutritional restrictions, high quality straw can also be incorporated into the horse’s forage regime to provide valuable roughage without adding starch or calories.  

Why do we avoid diets high in starch?  As starch is broken down in the stomach, it is fermented by the resident bacteria into volatile fatty acids and lactic acids, all of which contribute to the already acidic environment of the stomach.  If your horse is in an intensive training program and consuming large amounts of grain, breaking the total volume of grain into multiple small feedings throughout the day will help to reduce the amount of acid produced at the time of ingestion.  Additionally, fats can be substituted for starches in the form of rice bran, bean meal, and oils as a means to provide calories without the detrimental by-products of starch fermentation. 

In addition to the continuous ingestion of fiber products, care should also be taken to reduce the stresses of competition and travel.  For those equine athletes where the stresses of competition are unavoidable, the use of PPIs or H2 blockers to prevent the development of gastric ulcers is highly recommended.  Finally, while there is no direct link today between the use of probiotics and the prevention of gastric ulcers, such products may be helpful in maintaining hindgut health in stressed equines. 

Other ulcer-inducing risk factors in an equine life may include aggressive pasture/stall mates, lack of turnout, consistent loud noises, persistent radios, systemic illness, chronic pain, long term use of NSAIDs (bute, banamine, etc), intensive breeding programs and routine training on an empty stomach. 

In conclusion, EGUS is a clinical condition requiring both medical and long term nutritional management.  The continuous ingestion of fiber products is by far one of the most important aspects to managing a horse with clinical signs of ulcers, and in achieving long term optimal GI health.

EGUS Series Part 2: Common (Proven) Treatment Methods of horses with Equine Gastric Ulcer Syndrome (EGUS)

Let’s say you’ve just indulged in a rich gourmet meal complete with red wine and a decadent chocolate dessert.  An hour or so later, you’re regretting that decision as some pesky heartburn keeps you awake.  Eventually you swallow some Tums©, Tagamet©, Zantac© or even Nexium© and breathe a sigh of relief as those clinical signs abate and you drift off to sleep.  Believe it or not, many of the medications we use to treat our own heartburn work on horses as well.  The goal of EGUS therapy is not to treat the ulcer itself, but to decrease the acidity of the horse’s stomach to allow its natural healing mechanisms the opportunity to repair the damaged mucosal lining.

The gold standard in the treatment of EGUS is omeprazole, sold under the trade name Gastroguard©.  This product stops the production of gastric acid at the immediate source, and is known in the chemical world as a proton pump inhibitor (PPIs).  By stopping the production of gastric acid, the mucosal lining of the stomach is allowed to heal, which can take anywhere from a couple days to multiple weeks, depending upon the size, severity and location of the ulcer within the stomach.  UlcerGuard© is another omeprazole product, given at a quarter of the dose of Gastroguard©, and utilized in the prevention of gastric ulcers.  Both of these products are given once a day, and elicit the best response when given in the morning on an empty stomach.  They are most effective in the first eight hours after administration.  It must be noted that long term use of PPIs has been shown to impair the digestion of protein, an integral component to a horse’s nutritional demands.  PPIs are safe for use up to 90 days (so your 4 weeks of omeprazole therapy is perfectly safe) but relying on them for longer periods of time is not recommended. 

Ranitidine (Zantac©) and cimetidine (Tagamet©) have also been used routinely in the prevention and treatment of gastric ulcers.  Both drugs are considered H2 receptor antagonists, or H2 blockers.  Where omeprazole prevents the production of gastric acid directly at the source, H2 blockers are one step removed from that process and prevent the H2 signaling molecule (histamine) from binding to the receptor which activates the production of gastric acid.  Sounds complicated, right?  My goal in providing readers with such information is not to overwhelm you, but instead, to illustrate why veterinarians consistently turn to omeprazole when faced with EGUS; it halts the production of acid at the source and has a longer duration of efficacy compared to H2 blockers.  Sometimes, though, weeks of omeprazole therapy are not a viable, financial option for clients, so we may turn to the H2 blockers to help try to achieve similar results in the reduction of clinical signs of EGUS.  For the best efficacy, H2-blockers must be given three times a day, making them slightly more challenging from a management perspective.

Sucralfate is another product occasionally used as a protective agent in horses with ulcers located in the glandular region of the stomach.  When exposed to such acidic environments, this fluid is converted into a sticky substance which coats the lining of the stomach and binds to preexisting ulcerations to form a protective barrier.  This product must be given on an empty stomach (which we try to avoid in horses with EGUS) and may prevent the uptake of other drugs administered simultaneously.  While effective, the size of the dosage and the duration of therapeutic programs often makes this product cost prohibitive. 

A phenomenon which must be mentioned in this discussion is that of rebound acid hypersecretion.  Long term use of PPIs followed by abrupt discontinuation of therapy has been shown to cause a consistent increase in gastric acid production, often worse than the initial stomach condition.  When using PPIs, it is important to wean the horse off of medication using progressively lower doses over the course of 10 days.  There are several studies demonstrating the beneficial effects of using sea buckthorn in the prevention of rebound acid hypersecretion. 

Stay tuned for Part 3 of Dr. Hartman’s blog regarding the management of horses with EGUS!

EGUS Series Part 1: What’s the fuss over gastric ulcers?

Be it in the show ring or over dinner with horse friends, the topic of gastric ulcers always seems to elicit sentiments of frustration and misunderstanding.  What causes these pesky ulcers and what can we do as horseman to combat them?

To start, it’s important to understand that before horses were domesticated by humans, they spent their days slowly grazing across the plains and grasslands.  The slow ingestion of fibrous plant products creates an integral part of the horse’s digestive mechanism called a fiber mat, which naturally floats on the top of the stomach contents. 

Why is this fiber mat so important?  The horse’s stomach is separated into two regions, glandular and non-glandular.  The glandular region is responsible for the production of gastric acid which is necessary for the digestion of forage.  To avoid self-destruction, the glandular region of the horse’s stomach has protective mechanisms that keep the gastric acid from digesting the very tissue that produces it.  Unfortunately, the non-glandular region does not possess such protection and is susceptible to the destructive effects of the acidic stomach contents.  This is where the fiber mat comes into play.  Horses that graze throughout the course of the day are continuously adding plant fiber to the fiber mat which serves as a protective boundary between the acidic gastric contents and the non-glandular portion of the stomach. 

Let’s jump ahead to our typical domesticated horse which lives in a commercial boarding situation.  These horses are usually fed twice a day, often going more than twelve hours between their evening meal and breakfast.  The detriment here is without the continual ingestion of hay, that fiber mat is quickly digested and sent past the stomach into the rest of the GI tract.  This leaves the non-glandular portion of the stomach exposed and susceptible to the deleterious effects of the acidic stomach juices, as these secretions are produced on a continual basis.  Now, let’s say we decide to ride this horse without his fiber mat and the increased activity level causes more splashing of the stomach contents onto that already sensitive region.  As the acid begins to eat away at the lining of the non-glandular region of the stomach, the horse is thrown into a downward spiraling scenario that, without medical intervention, is quite difficult to recover from. 

How do you know if your horse has ulcers?  Common clinical signs of a horse with ulcers are aversion to tightening of the girth, sensitivity to grooming (especially behind the elbows), finicky eating habits or changes in behavior both on the ground or under saddle.  The only guaranteed diagnostic method to confirm the presence and severity of gastric ulcers is by passing an endoscope into the horse’s stomach and visualizing the integrity of the gastric mucosal lining.  For many of our clients, this is not a viable diagnostic mechanism, so instead, we assess the horse’s response to medical therapy for ulcers.  If there is a vast improvement in clinical signs over the course of therapy, the likelihood of gastric ulceration is high and we can continue with medical intervention and nutritional management. 

Stay tuned next month for part 2 of our blog discussing the treatment and management of horses with Equine Gastric Ulcer Syndrome (EGUS)!

Summer Skin Conditions

What a year here in Colorado!  From fetlock deep mud in the spring to humidity, summer storms and a fly plague of biblical proportion…. No wonder our horses are struggling to keep their skin intact and healthy this year!

When mammalian skin spends a prolonged period subjected to constant moisture, its natural, inherent defense mechanisms become weakened, making them susceptible to any number of dermatological conditions.  For horses this year, the most common skin issue we encountered was pastern dermatitis, commonly known as “scratches”.  This condition presents as an accumulation of scabs in the horse’s pastern region.  It can be quite painful to palpation and even present as a source of lameness.  Once the condition has been identified, the next step is softening the scabs enough so that they can be removed with as little discomfort to the horse as possible. 

My tried and true remedy for scratches is a 50:50 combination of Extra Creamy Desitin (zinc oxide) and nitrofurazone.  (With the mention of nitrofurazone, it is paramount to note that this is the ONLY time I ever recommend using nitrofurazone.  Nitrofurazone has been shown to slow wound healing and tissue regeneration, so I never promote its use on wounds or any other skin lesions).  Once you’ve mixed up a hefty amount of this magical combination product, you’ll want to slather the scabs with a thick coat of this goop and let sit for at least twelve hours.  The zinc oxide is an excellent skin protectant and the nitrofurazone helps to rehydrate the scabs and hamper microbial growth. 

Once the scabs have been softened, you can begin removing as many of them as possible.  Keep in mind that the skin underneath is quite sore and painful so work slowly and gently to keep your horse compliant over the next few days of scab removal.  Once you’ve removed as many scabs as possible that day, gently scrub the area with betadine scrub, rinse, dry and reapply the magical goop.  You’ll repeat this process every 24 hours until all the scabs have been removed.  At that point, it is safe to cease the betadine scrubs and just rinse, dry and reapply a light layer of the magic goop for another 5-7 days until the skin is soft and comfortable.  Scratches can be prevented by keeping the legs dry and clean during the muddy season; easier said than done in many situations!

With the onslaught of flies this summer, we’ve seen many horses struggling with insect bite hypersensitivity reactions.  These present as circular swollen regions and can be found all over the horse’s body and along their underbelly.  In moderate to severe situations, horses may develop hives associated with this hyperactive immune response.  Our initial response to a horse with insect bite associated hives is to address the excessive histamine production with an antihistamine, usually hydroxyzine, although cetirizine has also been shown to be effective in horses.  If this medication is not enough to curb the immune response in the horse, steroids can also be utilized, but in select cases as some patients are at a higher risk of steroid induced laminitis with certain concurrent metabolic diseases. 

Cold hosing, soothing shampoos containing oatmeal and topical over the counter steroid creams can also prove helpful.  For long term management and prevention, Equishield SA has proven to be a highly effective oral supplement in our practice that promotes skin and coat health and well as supports and appropriate immune response.  With the fly populations this year, the use of fly sheets, fly boots and fly masks has certainly helped to preserve the sanity of our equine patients as well!  In patients who are refractory to all forms of treatment and management of allergic skin conditions, allergy testing has proven to be an effective option, although that’s a whole new topic for a separate blog!

Ataxia: Is my horse demonstrating signs of neurologic deficits?

Over the past several months our practice has aided in the diagnosis, treatment, and management of several patients with neurologic disorders.  Horses with neurologic deficits can be dangerous to themselves, other horses, humans and surrounding property.  They can be extremely reactive and unpredictable so the identification of neurologic disease in horses is imperative on the part of the owner, barn manager, rider and trainers in order to secure the patient in a safe place and to avoid injury to horse and human alike. 

Ataxia is demonstrated by poor voluntary muscle control.  Ataxic horses will stumble, stagger, wobble and present an overall presentation comparable to an intoxicated human.  Unlike humans, many horses with neurologic deficits will appear normal when standing due to the intrinsic mechanism of the stay apparatus.  This series of muscles, ligaments and bones enables the horse to sleep standing up without utilization of energy.  As such, an ataxic horse can often stand quietly until asked to perform a voluntary movement.

The severity of the clinical presentation of an ataxic patient is dependent upon the chronicity of the disease process, the severity of the injury to the central nervous system and the specific systems involved in the disease process.  Below are several videos detailing different stages of neurologic symptoms in equine patients.  The purpose of this blog is to educate clients on common presentations of neurologic deficits to enable early identification in the field.  Click on the images to view the videos.

Example one: Mild Sidewinder – this is a general term for a horse who physically cannot move their front and hindlimbs in the same tracks.  Notice here how this patient’s haunches deviate to the right but he is still able to walk in a specific direction without stumbling or falling.  This horse is in minimal distress but a thorough work up of his ataxia is required to ascertain the potential progression and severity of his neurologic disorder. 

Example Two: Severe Sidewinder – notice here that this horse’s haunches are moving around his front end almost without his consent.  He does not have control over his intentional, voluntary movements and he cannot ambulate in a normal fashion.  While he can stand quietly, his hind end appears weak and the first few steps out of standing position demonstrate the most instability. 

Video courtesy Dr. Amber Bowen, V.I.P. Equine Services

Example Three: Moderate Ataxia – note here that initially, this horse looks fairly normal, but, when he shakes his head, he stumbles and struggles to maintain his balance.  He makes large movements to accommodate for his lack of neurologic competence.

Example Four: Severe Ataxia –   this horse has little to no control over his own body.  He struggles to remain standing and is forced into unintentional voluntary movement by the malfunctioning aspects of his central nervous system.  These patients are incredibly unpredictable and extremely dangerous as they cannot demonstrate normal avoidance behavior to avoid collisions.  They also usually demonstrate abnormal, hyperreactive responses to innocuous audio, visual and mechanical stimuli. 

Recumbence is the most severe form of neurologic deficiency  These horses cannot stand and often thrash, paddle and tremor on the ground.  They may flop about like a fish out of water and they have very little to no control over their limbs, trunk, neck or head.  Humane euthanasia is usually the only kind option available to these patients. 

Stringhalt is a neuromuscular deficit that results in involuntary exaggerated upward movement of one or both of the hindlimbs.  It is usually most pronounced at the walk and while backing.  The movement lessens in the trot and is almost always absent in the canter.  This is not known to be a painful disorder in horses and the horse can remain serviceably sound and rideable in most situations. 

Video courtesy UC Davis Center for Equine Health

Neurologic disorders in horses are always complex and require in-depth analysis and neurologic testing to attempt to determine the etiology.  Prognosis is always dependent upon etiology and progression. 

What’s All the Talk About Insulin? Hyperinsulinemic Associated Laminitis

Thirty years ago, laminitis was usually a career-ending diagnosis, if not a life-ending one.  Aside from mechanical support and pain management, little was known about the contributing factors associated with laminitis and the multitude of clinical factors that affect the severity, outcome, and likelihood of recurrence.  Today, we know a great deal more about metabolic laminitis and specifically the role that insulin plays in mediating this disease process. 

Current data shows that horses with an elevated baseline insulin value are at a higher risk of developing hyperinsulinemic associated laminitis (HAL).  The ability to establish a direct relationship between elevated serum insulin levels and the onset of laminitis has enabled veterinary practitioners to make great strides in combating this disease process. 

Hyperinsulinemic Associated Laminitis Diagnosis and Treatment

When presented with a patient suffering from HAL, the first step is to determine just how high the insulin values are.  Seasoned practitioners can usually estimate the severity of hyperinsulinemia by assessing the extent of regional adiposity (fat deposition in the horse’s body).  The most common site of regional adipose tissue deposition are the crest of the neck, on either side of the withers, along either side of the horse’s topline, and on either side of the tail head.  The greater the accumulation of fat in these areas, the higher the baseline insulin value in that patient.  Bloodwork, in the form of a metabolic panel, is then used to quantify those observations to establish an appropriate therapeutic regimen and track progress throughout the treatment period. 

If the patient is actively suffering from HAL, all therapeutic methods are implemented in an attempt to slow down the damage associated with the laminitic process.  In addition to dietary management and the eradication of starch from the horse’s feed, medical intervention with metformin has proven to be a very successful strategy in our practice. 

Metformin increases tissue sensitivity to insulin in the patient. Insulin is a signaling molecule which instructs cells to recover glucose (starch/sugar) from the GI tract to use to power cellular processes.  In horses with hyperinsulinemia, the tissues of the body aren’t responding to the insulin currently being produced, so, the body produces more insulin, leading to a hyperinsulinemic state. 

The physiologic process by which elevated insulin values lead to laminitis are still unknown.  However, current research shows that insulin is capable of binding to receptors in lamellar epithelial cells which stimulates excessive growth of the horn tubules, leading to the traditional elongated hoof structure of chronically laminitic feet.  Metformin helps to increase tissue sensitivity to insulin which in turn down regulates the body’s natural production of insulin. 

Hyperinsulinemic Associated Laminitis Treatment Outcomes

The success of treatment of horses with insulin dysregulation is highly dependent upon the severity of the HAL, the chronicity of the disease process, and the condition of the hoof capsule.  Optimal outcomes are associated with high compliance on the part of the horse owner when it comes to implementing therapeutic regimens and dietary management, as well as the employment of a farrier who is willing to work with your veterinarian when making strategic decisions around trimming and shoeing your horse. 

These patients require several series of radiographs over the course of their case in order to ensure optimal trimming is being performed in addition to tracking the sole depth of the patient.  Most cases, when identified in their chronic stages, usually require many months to restore physiologic function of the hoof capsule and achieve an acceptable level of comfort on the part of the patient.  Depending upon the integrity of the hoof capsule, metabolic stability, and comfort of the patient, these patients can sometimes return to their previous level of work.  While not all cases have the perfect outcome, with the knowledge and medical advancements the veterinary profession has seen over the past few decades, it is absolutely worth trying to combat hyperinsulinemia associated laminitis. 

Emerging Infectious Diseases: What you need to know

Ten years ago, it was quite uncommon to order diagnostic testing for Equine Protozoal Myeloencephalitis (EPM) in horses demonstrating signs of neurologic disease in Colorado.  Additionally, it was rare to evaluate equine patients for Lyme Disease in Western states.  That all appears to be changing. 

Lyme Disease

Lyme Disease is a tick transmitted infection caused by the bacteria Borellia burgdorferi, and to a lesser extent, Borellia mayonii.  Historically, only the tick species Ixodes scapularus and Ixodes pacificus(black legged ticks)were known to carry these bacteria, and neither of these species were found in Colorado.  While there have only been seven cases of Lyme Disease reported to the CDC in Colorado since 2019, there is a high probability that a lack of biosurveillance and underreporting have resulted in an underrepresentation of Lyme Disease in the state.  According to the CDC, all seven cases of Lyme Disease in 2019 originated from outside of Colorado.

Black Legged (Deer) Tick

The black legged tick resides mostly along both coasts of the United States, as well as all Midwestern states from as far north as Minnesota and as far south as Texas.  Many of these ticks have been found in Utah as well, Colorado’s most immediate western neighbor.  As our climate begins to change so too will the tick populations within the western states.  The most important thing horse owners can do to protect their horses from tick borne disease is to perform thorough examinations of your horse’s legs and underbelly, neck, armpits, and chest for any evidence of ticks.  Initially they may feel like a small growth or skin tag, but upon further examination, it will become apparent that it’s actually an external parasite.  Care should be exercised when removing these creatures from your horse’s skin to ensure that the head is grasped tight enough to facilitate removal along with the body but not too tight to cause premature squishing of the tick prior to detachment.  Tick bites usually result in a local inflammatory response so evidence remains even after natural detachment in the form of a small scab. 

Testing for Lyme Disease is via a simple blood test which is then sent to Cornell University.  The current test in use is called a Lyme MultiPlex Assay and enables us to differentiate between acute and chronic infections.  This information in turn is used to pursue the optimal treatment option for each individual case.  Horses can never be cured of Lyme disease, but through prolonged treatment regimens, clinical symptoms can often be put into remission.  Patients with previous exposure to Lyme disease are always susceptible to relapse.  Symptoms of Lyme disease include lethargy, a history of poor performance, ventral limb edema, shifting leg lameness and a multitude of other nonspecific clinical signs.

Equine Protozoal Myeloencephalitis

Equine Protozoal Myeloencephalitis (EPM) is another disease that is associated with a varying array of clinical signs.  Mild symptoms can be as vague as a history of poor performance.  More severe signs are associated with neurologic deficits and can even progress to recumbency.  EPM is found in the feces of opossums infected with the protozoa parasites Sarcocystis neurona and Neospora hughesi.  When horses ingest the feces of infected opossums, there exists a significant risk of the establishment of infection with the protozoa in the horse’s central nervous system.  Currently, the opossum population in Colorado does not carry the protozoa responsible for EPM, but, horses that travel outside of Colorado into EPM endemic areas are at an increased risk of exposure and development of EPM. 

Like Lyme Disease, horses infected with EPM will always have a risk of relapse of clinical symptoms, even after extensive therapy.  There is no permanent cure.  Diagnosis is achieved through blood testing as well as the acquisition of a sample of cerebral spinal fluid (CSF).  CSF is more specific than blood in confirming a diagnosis of EPM but the risks associated with the collection of a CSF sample are far greater.  Treatment of EPM does not offer a cure for the disease but instead aims to decrease the severity of clinical signs.  Usually, we anticipate an improvement of one grade of ataxia on Mayhew’s grading scale for ataxia after completion of a therapeutic regimen.  As such, if a horse has a starting ataxia grade of 1/5, the prognosis for return to work after treatment is optimistic.  If a horse is starting at an ataxia grade of 3 or 4/5 prior to treatment, the prognosis for a full return to work is much more grave. 

While we are seeing an increase in both Lyme disease and EPM in our patients, the risk of contracting either disease if your horse never leaves Colorado is still quite low, but not impossible.  We as equine practitioners will continue to think outside the box and ensure that all possible explanations for your horse’s clinical signs have been pursued and ruled in or out. 

Equine Strengthening Exercises and Pitfalls to Avoid

Wait!  Come back!!  Even though your horse is currently sound and healthy, many of the topics in this blog are still applicable to you and your riding partner!!

My purpose in writing this blog is to broaden the minds of my readers into better understanding what modalities are available as it pertains to building a stronger and sounder equine partner.  Just because your horse is currently sound, doesn’t mean you shouldn’t be pursuing additional exercises outside of the saddle to help preserve soundness and prevent lameness.  From basic hill work to raised trot poles and the EquiCore system, many of the modalities below will help you to build the strongest horse possible.  The stronger your riding partner, the lower the risk of injury while on the trail or in the arena. 

Stretching

Please oh please don’t extend your horse’s leg out in front of them without providing ample support to the knee!  In doing so, the knee becomes hyperextended, and you could injure the small collection of carpal bones that comprise the horse’s knee.  Instead, hold the limb behind the knee and ask for forward stretch from the knee, not the hoof or the fetlock.  There are no muscles below the knee so why try to stretch what isn’t there?  This is one of the most common mistakes I see when clients are trying to stretch their horse’s limb, when in reality, this stretch is really geared toward stretching the muscles of the shoulder and upper limb.  

Beginning Carrot Stretch

Personally, I am a huge fan of carrot stretches.  These are so helpful for helping to alleviate muscle tension in the horse’s neck while also bringing flexibility through the bones, muscles, and ligaments of the neck.  There is also the added bonus of abdominal strengthening once your horse builds up flexibility and starts really getting deep into their stretches.  I stand with my back towards the horse’s shoulder and ask the horse to stretch around the front of my body back towards the levels of the stifle, hock and hoof, aiming to hold a stretch at each zone for a minimum of five seconds.  Some horses will try to cheat and move their haunches away to avoid stretching through the neck and thorax.  Standing with the horse against a wall can help eliminate this form of cheating.  Personally, I use carrot stretches five days a week, asking my mare to stretch both directions multiple times, multiple zones.  After a few weeks of consistent stretching, you’ll be amazed at the increased range of motion. 

Advanced Carrot Stretch

Sure Foot Pads®

Once your horse becomes proficient at the carrot stretches, Sue Foot pads are a fantastic way to increase the intensity of the exercise.  The pads come in varying densities.  The harder the pad, the higher the stability, the softer the pad, the higher the dynamic instability.  This is the same concept as performing yoga or pushups on a Bosu ball.  By increasing the instability of the surface the horse is standing on, we increase the workload of the tiny, stabilizing muscles of the limb while also applying small amounts of stress to the ligaments supporting the joints of the lower limb.  Both processes work to increase the strength of the soft tissue structures supporting the limb which then decreases the risk of injury in a performance setting.  I will also use the soft, squishy Sure Foot pads in my patients suffering from chronic foot pain like laminitis.  By providing them a soft surface to stand on during farrier appointments and follow up exams, I improve the quality of their experience while also increasing their overall comfort.  I do not recommend these pads for use in horses recovering from acute soft tissue injuries as the dynamic instability of the exercise can potentially worsen the injury. 

www.surefootequine.com

Raised Trot Poles and Hill work

Assuming your horse is sound, raised trot poles and riding up hills will help to engage the muscles of the back and haunches.  Keep in mind that you’re not using trot poles to increase the length of the stride, but instead, you’re aiming to increase the height of the step taken over the pole.  As such, increasing the distance between your poles will be counter productive as it will result in a hollowing of the horse’s back and excessive extension of the lumbosacral joint.  Aim for a slower trot with a higher step over the pole. 

As for riding hills, many horses want to traverse hills with their head held high and their back in extension (hollowed out).  (We are after all asking them to carry us on their backs while climbing hundreds if not thousands of feet in altitude.  Why would they want to work harder than necessary?)  A horse will build better musculature climbing hills if asked to climb at a slightly slower pace with their head in a very slight frame (versus giraffe pose).  Same can be said for descending hills and mountains. 

http://www.equicoreconcepts.com

The Equi-Core System

If you have spent any time in my truck, you have heard me reference the Equi-Core system at least once a day.  Seriously, I should earn a commission with the number of sales my recommendations have resulted in! This system consists of one to two, wide, flat resistance bands that go around the horse’s haunches and under their belly.  You can use one band at a time to isolate an area of work, or both bands simultaneously.  The benefit of this system (above all other training systems out there) is that it never contacts the horse’s mouth.  The mere presence of a loose band around the haunches can instantly increase the level of engagement of the horse’s pelvic muscles. 

By engaging the pelvic muscles, we tilt the pelvis towards the forelimbs which brings the hind limbs further under the horse’s belly, elongates the muscles of the back and engages the abdominal muscles, all without having to be a Grand Prix dressage rider!  The bands can be used at certain portions of a training ride or throughout the entire ride.  They can be used on a trail ride or during a beginner’s riding lesson to build topline musculature in the horse, without the rider having to do a thing.  You’ll want to introduce the bands slowly, one at a time, so your horse doesn’t feel trapped by them, and you’ll want to slowly increase the amount of time your horse spends in them so he doesn’t get sore.  After several weeks working in the Equi-Core system, you should see an increase in topline and gluteal musculature. 

Orthobiologics… say what?!?!?

If you’ve ever had to deal with lameness issues in your horse, you’ve probably heard us use a buffet of acronyms like IRAP and PRP as we discuss the multitude of intraarticular (ie. in the joint) treatment options available in equine sports medicine today.  Both IRAP (interleukin-1 receptor antagonist protein) and PRP (platelet rich plasma) are considered orthobiologics as these products are harvested from the horse’s own physiologic resources.  Other orthobiologics like stem calls are obtained from bone marrow and adipose tissue (fat).  Regardless of their origin, these products have been well researched in both equine and human athletes and are now being utilized much more regularly in field ambulatory settings.  In this blog, we will review the different types of orthobiologics currently being used in equine medicine and how they compare to the traditional intraarticular steroid therapy. 

IRAP (Interleukin-1 Receptor Antagonist Protein)

IRAP is a protein harvested from the horse’s blood.  It is incubated and processed over an eight-hour period and then reinjected back into the joint at a later date.  It works by permanently binding to the interleukin-1 (IL-1) receptor which in turn, inhibits the inflammatory pathway within the joint environment.  With IRAP permanently bound to the IL-1 receptor, the IL-1 cytokine cannot initiate inflammation in the joint which in turn makes the horse more comfortable and gives the lining of the joint (aka. synovium) the chance to heal.  The more opportunity the synovium has to heal in the absence of inflammation, the lower the risk of subsequent development or perpetuation of arthritis. 

The benefit with IRAP is that it specifically targets the inflammatory pathway within the joint.  It is an extremely specific approach to increasing a horse’s comfort from arthritis, but, it only lasts as long as that deactivated receptor remains intact within the synovium.  Once the body naturally metabolizes and overturns the deactivated IL-1 receptor, a new, active IL-1 receptor becomes present in the joint.  As a result, horses benefiting from IRAP therapy often require more frequent injections to remain comfortable.  Additionally, the initial series of intraarticular IRAP requires two to three injections into the joint, two the three weeks apart.  IRAP is labor intensive compared to other autologous products or steroids, but it is extremely effective in decreasing pain and discomfort associated with arthritis and synovitis in equine joints. 

PRP (Platelet Rich Plasma)

PRP is defined as plasma with a higher concentration of platelets compared to whole blood.  There are a multitude of factors that can impact the quality of the PRP harvested from a patient, the biggest one being the presence of systemic NSIADs.  As a result, we will always ask you to pull your horse off Equioxx/Previcoxx, bute, aspirin or banamine prior to collecting PRP.  Once collected from the patient, the blood that will be used in procuring PRP is spun in a centrifuge and the resulting isolated plasma is collected and injected back into the joint or soft tissue structure at the same appointment as the initial blood draw.  The therapeutic effect of PRP is due to the presence of a wide variety of growth factors and anti-inflammatory cytokines that decrease inflammation and oxidative stress in the synovium.  When used in joints with moderate to severe damage to the cartilage, PRP is thought to help repair the tissue comprising the cartilage to a small extent.  Repeat injections can be performed at 3–4-week intervals but the need for multiple injections is not as necessary as in IRAP.  Whereas IRAP targets a specific inflammatory pathway, PRP provides a generalized collection of positive, beneficial effects on the joint environment with the intent of reducing inflammation and preserving the synovium.  When used in soft tissue injuries, the presence of numerous growth factors in PRP helps to stimulate the development of a stronger matrix for healing as well as the recruitment of proteins for the regeneration of individual cell lines.  In doing so, the goal is to encourage a stronger repair than the scar tissue the body normally uses to fill the lesion in the absence of external influence. 

Prostride

Prostride is essentially a combination of the physiologic effects of IRAP and PRP.  There are a few additional components found within the preparation of Prostride that result in a higher likelihood of joint flares after injection.  As such, this is not a product commonly used in our practice, but it is widely researched and utilized in the equine veterinary community. 

Stem Cells

Stem cells can be harvested from both the fat and bone marrow of a horse.  They are most commonly utilized as part of the therapeutic rehabilitation of soft tissue injuries.  One of the biggest issues currently faced in horses with tendon and ligament injuries is the inability to control or direct the cell-type that the body uses to repair a soft tissue lesion.  As a result, without intervention, horses commonly lay down scar tissue instead of type I collagen, which is the main component of healthy soft tissue structures.  As a result, the repaired structure is usually weaker than the original and prone to a higher rate of reinjury.  The purpose of using stem cells is to specifically direct the body to develop and utilize type I collagen when repairing damage to tendons and ligaments.  The stem cell research as it pertains to equine medicine is still in its early stages of development but every year more is known about the biochemical and physiologic factors that influence soft tissue repair. 

If you have any questions about orthobiologics, as always please reach out to us and we’ll be happy to discuss the options for your horse.

The Truth About NSAIDs

NSAIDs (Non-Steroidal Anti-inflammatory Drugs) are commonly used in the equine industry to control pain and discomfort associated with musculoskeletal disease and abdominal discomfort (among many other applications).  While veterinarians will commonly dispense NSAIDs like bute and banamine to clients for use in their horses, there are a few key points we’d like to remind clients of before administering those medications: 

  • If there is any question on whether your horse is colicking, please call our emergency line first to discuss the clinical presentation and status of your horse, prior to administering banamine. 
    • Signs of colic (abdominal pain) include:
      • Rolling
      • Pawing
      • Off feed/anorexia
      • Demonstrating the flehmen response (lifting the upper lip)
      • Kicking at their belly
      • Lethargy
  • NSAIDs should not be used concurrently alongside other NSAIDs.  This includes Equioxx and Previcox, as those are both NSAIDs and should not be used in addition to bute or banamine in a 24 hour period. 
  • Do not use bute or banamine for several consecutive days without consulting with your primary veterinarian first.  Excessive use, or overdosing, of NSAIDs can cause significant damage to the horse’s GI tract and other organs. 
  • Check your horse’s temperature prior to administering an NSAID as these medications will mask a fever, which could confound a clinical examination and prevent an accurate diagnosis.
  • If the condition for which the NSAID was prescribed is not improving, please contact your primary veterinarian to discuss the progress of the case before subjecting your horse to prolonged NSAID exposure. 

NSAIDs are a powerful tool in the veterinary toolbox that require judicious use and a detailed knowledge of their effects, both positive and negative, on the horse’s physiology.  If you have any questions pertaining to NSAID use in your horse, please feel free to reach out to one of our veterinarians to discuss your concerns in further detail.