Equine Preventative Medicine Checklist

Along with spring comes vaccinations and preventative care appointments for our equine friends. We all understand the importance of preventative medicine, but it’s easy to miss things, so we’ve prepared a list of what you should be doing with your horse to make sure they’re healthy and prepared for summer riding season.

Vaccinations

We will start with the easiest – vaccinations. Vaccine protocol for the spring varies depending on your geography and your individual horse’s exposure potential and travel schedule. Always consult with your veterinarian if you are going to travel somewhere new with your horse. Here on the Front Range, we typically recommend a 5 way (eastern and western equine encephalitis, tetanus, rhinopneumonitis, and influenza) and a West Nile booster as the basic starting place for spring vaccinations. For a more in depth discussion of the vaccinations we recommended in Colorado and why, see the blog titled Why are the Vaccines we give in Spring So Important Here in Colorado?

Deworming

Deworming used to be easy – give your horse a deworming paste at set intervals and you’re done. But research has shown that deworming is certainly not as straightforward as we once thought it was. There are several options and differing approaches to deworming, and whether you opt to use a classical “rotational” deworming, or a more targeted “Fecal Egg count” approach, spring is a time to think about how to protect your horse from internal parasites. There are pros and cons to different deworming approaches, and we have complete articles on both of these regimes listed below.

Rotational Deworming – What’s the Right Choice?

The Scoop on Fecal Egg Counts

Dentistry

teeth

Although there is nothing tying teeth floating to vaccination, deworming or seasonality, most people (veterinarians included) like the convenience of combining all of the preventative medicine into a single visit. Spring is a critical time to have your horses’ teeth checked comprehensively. Tooth and other mouth issues can have a dramatic impact on your horses’ comfort, performance, and even lameness issues. Dental issues and questions like “Does my horse need a float?” are immense subjects and are covered in detail in previous issues of the blog.

Why is Regular Dentistry so Critical to your Horses’ Health?

How Do I know My Horse Needs a Float?

Why Do I Need to Float my Horses’ Teeth?

Physical Examination

A good general physical exam is a good idea for all horses this time of year so that we (both owner and veterinarian) are assured that there is no need for an alteration to the diet or that some insidious disease process is slowly creeping in unnoticed. It’s also very helpful to have a baseline of your horses’ health so when changes happen they can be noticed, and dealt with, quickly. Summer is riding and show season, and a physical examination will ensure your horse is at the top of their game, making your time together enjoyable for you both. An important aspect of the physical exam that often gets ignored is a very brief (just a few minutes) lameness exam. Whether you have noticed that your horse is tripping a bit more, or he just hasn’t been evaluated, a check of his legs could be invaluable in finding a mild issue before it is a major one. If this is something you are interested in, be sure to let the office know when you schedule your appointment that you would like the veterinarian to spend a bit of time with a lameness evaluation, so that a scheduling issue doesn’t arise.

Spring Preventative Medicine Checklist

Below is a quick reference for when your vet arrives for spring tune ups for the horses. I have had clients use this little outline as a basis for questions they have for the vet when he or she arrives. We all fall victim to “I forgot to ask while you were here” questions! Happy trails and enjoy the beautiful Colorado spring!!

Quick Checklist for Spring:

  • vaccines – 5-way and West Nile Booster
  • deworming or FEC – which is better for your horse?
  • Dental – Does your horse need a teeth float?
  • General Physical including weight evaluation, diet discussion, old age changes (ie cushings), and lameness evaluation

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!

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. 

Wet Weather Hoof Troubles: Thrush and Abscess

While we are always grateful for precipitation here in Colorado, wet and muddy conditions contribute to the development of two common horse hoof conditions: abscesses and thrush.

Abscesses

A hoof abscess commonly presents as an acute onset severe lameness without obvious signs of injury. Abscesses occur when bacteria is trapped within the foot. Wet conditions can soften the foot, allowing easier access of bacteria. A deep bruise, hot nail, or other foreign body can also lead to abscess formation. Horses with poor hoof quality or white line disease can be more susceptible to abscesses.

Exam findings that help your vet localize the lameness to the foot include an increased digital pulse, localized warmth of the foot, and sensitivity to hoof testers. Radiographs may be recommended to rule out other more serious problems or foreign bodies. In some cases, radiographs may show a tell-tale pocket of gas (infection).

Most abscess resolve in about 7-10 days. The key to improved comfort is drainage of the abscess, resulting in relief of pressure. Care during this time includes application of a poultice to allow drainage while also keeping the foot clean. The most common methods used are a medicated poultice pad (Animalintex) or packing the foot with magnapaste. Both methods help draw out infection and are much easier (and more quickly successful) than soaking your horse’s foot in a bucket of warm water and Epsom salt. A drainage tract is needed for healing, but this tract can potentially allow more bacteria back into the foot, so a proper foot wrap over a poultice pad or magnapaste is essential for cleanliness. Elastikon and duct tape are invaluable for a good foot bandage!

Thrush

Thrush is another common hoof condition linked to wet conditions. You may notice a strong odor when picking your horse’s feet, and wet dark material along the sides and center of the frog. The odor is due to infection with anaerobic bacteria (bacteria that thrive in areas with little to no oxygen). Severe infection can cause sensitivity when using the hoof pick or pressing on infected areas, and sometimes lameness.

Poor hoof conformation and infrequent farrier care can contribute to the development of thrush. Treatment options for thrush include topical drying/antibacterial products (Thrushbuster, dilute betadine, copper sulfate, etc) and farrier work to remove exfoliating frog that may trap additional moisture. A dry environment is also critical.

Observing an acute onset severe lameness in your horse warrants at least a conversation with your vet and most likely an exam. Good management, including a clean dry environment, regular farrier care, and checking/picking out your horse’s feet daily can help minimize his risk of developing a hoof abscess or thrush.

What is Cellulitis?

Last night when you fed your horse you didn’t notice any issues as you performed your quick “once over” before rushing back out the barn door. But this morning they have a severely swollen leg, and they are hobbling around.

What happened? 

The list of possibilities isn’t terribly long, but there are serious things on it: fractures, hoof abscesses, laminitis, joint infections, and cellulitis.  Of course, fracture is the one that no one wants to hear and has significant ramifications.  Laminitis and abscesses typically don’t have the significant swelling described in the “case” above.  Joint infections would likely have been associated with trauma or a recent joint injection, and the swelling would likely be associated with a particular joint, not the entire leg.  That leaves this horse with a likely case of cellulitis. 

If you haven’t ever seen a case, they can be impressively swollen, and this can happen relatively quickly (overnight)! See below for an example.

What is cellulitis

Cellulitis is an infection of the deeper layers of the skin and the subcutaneous spaces.  The pressure and inflammation make it extremely uncomfortable for the horse.  They are usually very painful to the touch (maybe not everywhere they are swollen, but some portion of the swelling), and there is a lot of heat. Severe cases can have serum oozing from the skin. The horse may have a mild to moderate fever as well.

What causes cellulitis?

The infection can initiate from an obvious recent wound, bed sore, “scratches”, or other minor scrapes. It could also be a result of a more significant laceration from days before that seemed to be healing in the right direction.  Another common route that these can begin is secondary to a hoof abscess.  The infection begins in the hoof and then in the right set of circumstances, manages to take hold and cause further infection higher up the leg.

How is cellulitis treated?

If you notice the swelling before it is as extreme as the picture above, getting medical attention could prevent it from becoming such an advanced case.  Medical attention usually consists of antibiotics and anti-inflammatories systemically.  On occasion, a “regional limb perfusion (RLP)” may be justified.  An RLP is a way for the veterinarian to get very high concentrations of antibiotics to the area of concern using a tourniquet and antibiotics directly infused into the affected limb.  Hydrotherapy (cold hosing) is also often indicated. 

Managing cases of cellulitis early is paramount to preventing long term ramifications such as lymph damage (lymphangitis), or laminitis.  Lymphangitis is an inflammatory process in the normal lymph drainage of the limb, and can leave the limb permanently swollen.  If there is enough swelling in the leg during the cellulitic process, it could cause enough vascular alterations to damage the laminae of the foot, causing laminitis. 

If you find your horse with a sudden non-weight bearing lameness (or barely weight bearing), we would always tell you that it is justification for a phone call to your veterinarian, and most likely a visit.

Street Nails – Call your vet immediately

No matter how safe their environment may be, horses will always manage to find trouble. Unfortunately, a not-so-uncommon equine emergency is a sharp object that has penetrated through the bottom of the hoof, also known as a street nail. Any penetrating injury to the bottom of your horse’s foot is an emergency, and timely assessment is essential for the best outcome.

The number one rule for the horse owner is NEVER REMOVE THE NAIL before talking with your veterinarian! The exact location of the nail is crucial for determining the best treatment for your horse. ALWAYS call your vet first! Sometimes a photo can help your vet offer the best advice before evaluation.

Nail prior to removal

In general, foreign objects to the back third of the foot present the highest risk because of the position of important structures and the consequences of infection.

Nail Prior to Removal

Your vet will take radiographs of your horse’s foot prior to removal of the nail to determine its exact location. If the nail has been removed or fallen out, special dye can be injected along its tract that will show up on the radiographs, but it is more informative to leave the nail in place if possible! If the nail falls out prior to evaluation, save it and mark the depth of its tract if possible.

Dye injected along nail tract

The next step is beginning treatment, depending on the location of the nail. If the nail is well embedded, temporary numbing of the horse’s foot enables non-painful removal. The nail tract will then be flushed to remove dirt and debris. A bandage, sometimes including a drawing poultice, is applied to ensure the tract remains clean during healing. Sometimes a hoof abscess can develop during healing. Depending on the nail location, a technique called a regional limb perfusion may also be used.

Performed on the sedated horse, a regional limb perfusion involves the placement of a tourniquet on the limb above the hoof, allowing for antibiotic injection into a vein below the tourniquet. The tourniquet is left in place for up to 30 minutes to allow a higher concentration of antibiotic in the limb below the tourniquet.

If the location of the nail is in a critical location, such as through the center of the frog or potentially involving the tendon sheath or navicular bursa, prompt surgical flushing at a referral hospital is the best treatment to minimize the risk of fatal or career-ending infection.

Timely treatment of any penetrating wound to the foot is imperative for the best outcome!

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.

My Horse’s Sheath is Swollen!

Most of us who care for geldings have encountered this situation before – you walk in to greet your horse and notice his sheath is larger than usual, although he seems to be behaving normally. Is this an emergency? The answer- not usually.

What is the Sheath?

First things first. For those who might not know, the sheath is the ‘tube’ or ‘pocket’ of skin that protects the penis of a male horse when it isn’t in use for urination or breeding. Because the sheath is located along the underside of the horse, gravity allows extra fluid to settle here, similar to when your horse gets “stocked up” in his legs, usually after a decrease in activity.

What is Edema?

Edema is an abnormal accumulation of fluid within the body.  Usually it is found just underneath the skin, in a gravity-dependent location, such as the lower legs, sheath, or lower abdomen. It originates from a source of inflammation within the body. This inflammation can be as simple as a reaction to a bug bite or even a topical grooming product. Edema is typically described as “pitting” when the swollen area can be indented with your fingertips and feels spongy.

What should you do?

Before you panic, check your horse’s temperature to ensure it is normal (<101.5). Check along his midline to see if there is additional swelling across his entire belly, or just locally around the sheath. In the absence of a fever, it’s reasonable to try some turn out/exercise to reduce the swelling. Just as we see with lower limb swelling, sheath swelling generally improves with exercise. Some overweight horses tend to accumulate extra fat in this area as well, contributing to a swollen appearance.

When should you call the vet?

An examination with your veterinarian may be indicated if your horse has a fever, and/or if the swelling persists, is hot or painful, or is increasing in size. A sheath cleaning with your veterinarian allows a thorough examination of this area, even though a “dirty sheath” is unlikely to be responsible for swelling. As always, knowing what is normal for your horse is vital to recognizing what is abnormal.

Different Styles of Equine Chiropractic Adjustment

Any of you who have watched Dr. Hartman adjust a horse will immediately notice that her approach might not conform to one’s initial expectation.  We all have a general idea that a chiropractic adjustment involves a high velocity, low amplitude (HVLA) thrust, but that isn’t the only option available to chiropractic practitioners. What’s best for your horse may be something entirely different.

Is your horse ready for chiropractic adjustment?

Before initiating any chiropractic manipulations, Dr. Hartman begins every appointment with a focus on the musculature and mind of the horse.  It is important for the horse to be mentally present and physically relaxed during the session so that any restrictions within the musculature can be addressed.  If we keep in mind that it is the muscles that control the vertebrae of the spine, it immediately becomes evident that these too are a part of the overall chiropractic equation.  Without addressing acute and chronic issues with the musculature, the efficacy and duration of therapeutic effects resulting from the chiropractic adjustment may be less than optimal.  In severe situations, Dr. Hartman may choose to forgo chiropractic treatment for the day in favor of addressing the muscular pain and restrictions so as not to cause further damage with a HVLA thrust.

What chiropractic method is appropriate for your horse?

Once the musculature supporting the spine is in a malleable state, the timing is now appropriate for chiropractic manipulation.  In some situations, a traditional HVLA thrust is appropriate to address any restrictions in the spine.  However, over the past few years, Dr. Hartman has worked with her mentor, Dr. Kyla Awes, to incorporate a new technique of adjusting into her system.  Keeping in mind that a vertebral motion unit can move in multiple planes, Dr. Hartman can often create a fulcrum with her hand around which she can manipulate the horse’s body.  As a result, she can restore motion of the vertebral motion unit in multiple planes with one adjustment.  Think of it like the “two birds with one stone” analogy.

Additionally, some horses perceive the HVLA thrust as an aggressive act, especially those that are highly reactive or sore in their musculature.  By integrating this new approach into her practice, Dr. Hartman has been able to accommodate the needs of various types of horses from the heavy-boned draft horses to the sensitive Arabians.

 

Every horse is a unique individual and as such, will benefit from different styles and approaches of chiropractic care.  During an appointment, Dr. Hartman will work to identify the primary source of back pain in your horse (ie. Hind limb lameness, poor saddle fit, overriding dorsal spinous processes, nutritional deficiencies, etc).  In addition, she will also work with you to develop short and long term plans to keep your horse sound and comfortable.  Please don’t hesitate to get in touch with Dr. Hartman to discuss how chiropractic work can help your horse.