TOPICS LISTED ALPHABETICALLY

1. ARTHRITIS

2. CHOKE

3. CUSHING'S DISEASE (PPID)

4. GASTRIC ULCERS

5. JOINT INJECTIONS

6. LAMINITIS

7. METABOLIC SYNDROME

MORE TO COME IN THE NEXT FEW WEEKS

ARTHRITIS

Osteoarthritis - the facts

Osteoarthritis is a common cause of lameness in horses. It is a progressive degenerative condition and there is no cure, however it can often be managed. Osteoarthritis (also known as 'arthritis' and 'degenerative joint disease') is a degenerative condition of joints resulting in cartilage erosion and inflammation. Articular cartilage has very limited ability to repair so the condition is irreversible. Any joint injury or insult can result in osteoarthritis. Most cases are due to wear and tear. Horses are large animals and put huge forces on their joints. Injuries to ligaments or bone (chip fractures) and inflammation resulting from infection are also causes.

How do I recognise osteoarthritis?

Symptoms of osteoarthritis include:

• Lameness this may be the only sign in many cases.
• Joint swelling.
• Pain on flexion of the joint.
• Increased lameness after flexion.

What should I do if my horse has these symptoms?

You should make an appointment to have your horse's problem investigated by your vet. Lameness examinations are often best performed at an equine hospital to allow a full examination and investigation with appropriate equipment. Lameness investigation is extremely challenging and can be very time consuming.

What will my vet do?

Your vet will perform a comprehensive lameness examination. Following the examination, nerve blocks are then used to localise the lameness or confirm that a swelling is significant. This can be very time consuming as each block takes at least 30 minutes to fully assess before progressing to the next block.

Once lameness is localised, radiographs are taken to determine the severity and assist with determining a cause. Further imaging may be required, such as ultrasonography, scintigraphy or magnetic resonance imaging (MRI). Ultrasound is used to assess soft tissues and scintigraphy may be needed to assess bone if radiographs are not productive. MRI is available at some specialist clinics and gives very detailed images of soft tissue and bone.

Treatment for your horse will depend on the severity of the symptoms and may include:

• Rest and anti-inflammatories such as phenylbutazone.
• Anti-arthritic drugs, eg pentosan, hyaluronate.
• Feed supplements containing glucosamine and/or chondroitin sulphate.
• Intra-articular medications, these include corticosteroids, hyaluronate.
• Arthroscopic surgery - removal of chip fractures, trimming of cartilage and synovium, and flushing out of enzymes are all beneficial to the joint.

I have heard that intra-articular cortisone therapy damages the cartilage - is this true?

This statement is based on experiments where cortisone was used at extremely high dose rates in normal joints. More recent studies have shown that lower doses in arthritic joints actually prolongs the life of the cartilage. Used carefully, cortisone can increase the functional life of a joint significantly. There are risks, as with any treatment, so consult your vet about all the pros and cons before agreeing to intra-articular therapy.

What can I do to prevent my horse developing osteoarthritis?

It probably isn't possible to prevent osteoarthritis, especially in horses undergoing heavy athletic work. Measures you can take to help prevent your horse from developing the disease, especially at an early age, include:

• Keeping your horse well shod - well balanced feed will reduce the stress on lower limb joints.
• Avoiding work on hard ground - this will reduce concussion to lower limb joints.
• Use cold therapy (icing) after hard work - will help control inflammation.
• Regular use of anti-arthritic preparations - this may be helpful, but their cost effectiveness is questionable.

CHOKE

Choke - oesophageal obstruction

Every owner will at some time have to deal with an emergency involving their horse, so it is essential to know how to deal with such emergencies before they arise. When you think your horse is unwell or in pain make sure you call your vet immediately. If your horse chokes it should be treated as an emergency - you should learn to recognise it and deal with it appropriately.

What is choke?

Choke is also known as oesophageal obstruction as it is associated with an obstruction in the oesophagus NOT the trachea as in humans. Obstructions are usually found at the end of the oesophagus just before the entrance to the stomach.

What causes choke?

Poor dental health  Elderly horses and horses with congenital disorders such as malocclusion, loose/missing teeth, sharp edges/hooks, etc will have difficulty chewing their food properly and are particularly at risk.

Dry food  This doesnt pass through the oesophagus as freely as feed that has been dampened with water before feeding, it is always advisable to dampen your horses feed before feeding, this also helps to prevent blockages in the intestines which can cause colic. This is very important of sugar beet, make sure it is properly soaked before feeding.

Bolting feed  If your horse eats its food too quickly without chewing it properly, this can cause a blockage, eg large pieces of carrot could get stuck.

Foreign objects  If your horse ingests a foreign object such as a piece of wood, this may become lodged in the oesophagus causing a blockage; this is particularly true of crib-biters.

How will I know if my horse has choke?

Signs of choke include:

• Distress the horse may panic at the initial inability to swallow.
• Difficulty swallowing.
• Not interested in food.
• Coughing.
• Head and neck extended in a downwards position.
• Nasal discharge containing saliva and/or food material.
• Saliva drooling from the mouth.
• Increased heart rate caused by distress.

Can my horse be treated for choke?

If you find your horse choking you should call your vet immediately and remove any food and water to prevent worsening the obstruction. Your vet will probably sedate your horse to help him relax this also relaxes the muscles of the oesophagus which will hopefully release the blockage.

For more persistent blockages your vet will probably use a stomach tube to confirm the extent of the blockage. Your vet will then flush the blockage through by pouring warm water into the tube to soften the blockage and flush it through into the stomach.

This picture shows the placement of a stomach tube that goes in via the nostril, down the oesophagus and into the stomach.

Other methods include the use of an endoscope to retrieve foreign objects or to disrupt other obstructions.

If none of these methods are successful, as a last resort, your vet may need to perform an oesophagostomy this is where an incision is made in the oesophagus to enable manual removal of the obstruction in question.

How can I prevent my horse from choking?

If you follow a few easy steps, you can ensure your horse isn't affected by an oesophageal obstruction:

• Ensure your horse received regular dental care.
• Always provide your horse with plenty of water.
• Dampen each feed with water so they are not dry.
• Make sure sugar beet pulp is soaked according to manufacturer's recommendations.
• Discourage your horse from bolting its feed - feed little and often.
• Cut apples, carrots and other treats into small pieces.

CUSHING'S DISEASE (PPID) PLEASE FOLLOW THE LINK BELOW TO SEE THE EQUINE ENDOCRINOLOGY GROUP'S LATEST INFORMATION ON EQUINE CUSHING'S DISEASE

Cushing's Disease: Equine Endocrinology Group Recommendations

GASTRIC ULCERATION

Gastric ulcers

Equine gastric ulceration syndrome (EGUS) is a common condition seen in many types of horses, but is often missed as the cause of a variety problems, including reduced body condition, changes in appetite, and behavioural and exercise-related issues. EGUS has many causes and can be complicated in nature, so if you think you horse may be suffering from gastric ulcers, call your vet immediately.

What is EGUS?

EGUS describes the development of ulcers on the inner wall of the stomach caused by exposure to excessive amounts of acids produced by the stomach. As a general rule the horses stomach acids are neutralised by a constant supply of saliva while the horse eats/grazes, preventing the development of ulcers, however under certain conditions, the horse may not produce enough saliva to neutralise these stomach acids which can lead to EGUS.

The severity of gastric ulceration ranges from minimal inflammation of the stomach lining to severe ulceration and bleeding of the stomach lining. In extreme cases the stomach can perforate which can lead to sudden death.

A grading system has been implemented to help classify the severity of EGUS:

• Grade 0 = intact stomach lining; no appearance of reddening.
• Grade 1 = intact stomach lining; areas of reddening.
• Grade 2 = small single or multiple ulcers on stomach lining.
• Grade 3 = large single or multiple ulcers on stomach lining.
• Grade 4 = extensive/deep ulcers on stomach lining.

There are two types of gastric ulcer:

• Squamous ulceration ulcers occur in the upper section (often near the junction between the squamous and glandular tissues) of the stomach as a result of overexposure to acid secretions.
• Glandular ulceration ulcers occur in the lower section of the stomach where the protective mucus layer overlying the tissue is undermined, eg due to side-effects of certain medications, chronic stress and potentially bacterial infections.

What causes EGUS?

EGUS can affect any type of horse, from pony to performance horse. There are a number of risk factors which can lead to the formation of gastric ulcers including, diet, intensive exercise, physical stress/illness, psychological stress and medication, although EGUS can affect horses even in the absence of these factors. Foals are particularly at risk due to the delicacy of the stomach lining at this young age; they also produce high amounts of gastric acid from the first few days of life making them at higher risk of developing EGUS.

Diet - the stomach continually produces acids to cope with the continuous trickle of feed horses consume, in turn these acids are neutralised by the saliva produced while eating and trapped within food. Feed in the horse's stomach forms distinct layers - very acidic fluid and small food particles sit at the bottom in the glandular layer, higher up in the squamous layer the fluid is almost neutral with large food particles, particularly roughage. When a horse experiences prolonged periods of fasting/starvation, excessive amounts of acids build up causing ulceration. High grain/low roughage diets are also thought to contribute to EGUS as grain requires less chewing which in turn stimulates less saliva. A predominantly grain diet also upsets the normal layering within the stomach. Ulcers can develop within a 24-48 hour period if a horse is unable to eat.

Intense exercise - during exercise blood flow to the stomach is reduced and the pressure in the abdomen is increased which in turn pushes the accumulated acids up into the sensitive portion of the stomach which can cause squamous ulceration.

Physical stress/illness - eg shock, infection, parasites, traumatic injury, transportation, stable confinement these may cause ulcers due to restricted blood flow to the stomach and increased acid production.

Psychological stress - stressful situations may affect a horse's feed intake which leads to reduced saliva production and consequently excess amounts of acids in the stomach; increased acid production also occurs during stress.

Medication - some long-term medications or drug overdosage, particularly of anti-inflammatory drugs, eg phenylbutazone/equipalazone (bute), can cause restricted blood supply to the stomach which can lead to glandular ulceration.

How will I know if my horse has EGUS?

Many horses will show no signs of suffering from EGUS, however they may show non-specific signs, including poor appetite, slowed eating activity, rough hair coat, weight loss, poor performance, poor condition, colic, changes in behaviour, pain on girth tightening, teeth grinding, difficulty swallowing and excessive salivation. Foals on the other hand will show more obvious signs, most commonly diarrhoea, but also excess salivation, teeth grinding, colic and excessive periods of recumbency.

If you think your horse might be suffering from EGUS, call your vet immediately. Your vet will be able to investigate further with the use of an endoscope to look inside your horse's stomach. The procedure is relatively simple and painless, and your vet will be able to give you an accurate diagnosis.

Can my horse be treated for EGUS?

Yes, EGUS can be treated simply and effectively.

Initially your vet will ensure your horse's diet is suitable and discuss any improvements necessary. Other factors to consider are to avoid stress, such as prolonged stabling or long journeys. Your vet may also prescribe some acid inhibitor drugs to help your horse's recovery. This usually comes in an oral paste that is given over a 28-day period.

Ulcers can take between 2-4 weeks to heal completely, although severe cases can take longer.

How can I prevent my horse from developing EGUS?

 

As with most equine conditions, prevention is the name of the game. Feed your horse as naturally as possible allowing daily turnout, ad lib hay and hard feed fed little and often - avoid high grain/low roughage diets.

Avoid stressful situations and regulate your horses exercise - do not over-exercise an unfit horse. Other strategies to reduce stress, such as the use of stable and box mirrors can be useful. If your horse is on long-term medication that could be the cause, you will need to review this treatment with your vet.

JOINT INJECTIONS: MAINTENANCE

There really si no such thing as "maintenance joint inections." Joints are injected when clinical examination suggests that it is warranted. for an excellent discussion, see Dr. Rick Mitchell discussing maintenance joint injections

LAMINITIS

Laminitis - the facts

Laminitis is a common but often poorly understood disease. It is usual for owners to believe it only occurs in spring in small ponies. This is not always the case and it is important you understand the consequences of an episode of laminitis.

What is laminitis?

Laminitis (also known as 'founder') is a very painful condition of the foot. It results from the disruption of normal bonds between the laminae within the hoof which usually hold the pedal (coffin, P3) bone in place. In severe cases, due to the weight of the horse pushing down or the pull of the flexor tendons, the pedal bone in the foot can sink and/or rotate downwards and may eventually come through the sole and be exposed. Laminitis has 3 stages... 1. The first stage is the developmental (or prodromal) stage in which there are no visible signs, but the damage is already occurring within the hoof.

2. This is followed by the acute stage in which the clinical signs become apparent. 3. The disease can then either resolve with appropriate treatment or can progress to the chronic stage.

There are 3 types of laminitis... Endocrinopathic: associated with changes in metabolism, especially those affecting the hormone insulin, eg equine metabolic syndrome, pituitary pars intermedia dysfunction (PPID, equine Cushing’s disease), or excessive carbohydrate consumption. Septic: associated with diseases associated with severe bacterial infection and/or endotoxemia, eg some types of colic, pleuropneumonia, retained placenta. Supporting limb: associated with weight overload due to severe lameness in the other limb, eg fracture, joint sepsis.

How do I recognise laminitis?

Symptoms of acute laminitis include:

• Reluctance to move and lameness (often in more than one limb): particularly seen when the horse is turning in circles or walking on hard surfaces.
• Abnormal gait: 'heel before toe'.
• Characteristic stance: weight is shifted off the painful toe region and onto the heels resulting in a leaning back stance.
• Hot feet with a 'thumping' pulse in the fetlock/pastern.
• Pain just in front of the point of the frog when pressure is applied.
• A depression at the coronary band.

Symptoms of chronic laminitis include:

• Rings in the hoof wall which are wider at the heel than at the toe.
• Bruising of the soles.
• Widening white line ('seedy toe'), possibly with abscesses.
• Dropped soles or flat feet.
• 'Aladdin slipper' hoof due to faster growth at the heels than at the toe.

What should I do if my horse has these symptoms?

If your horse has signs of acute laminitis, call your vet immediately - laminitis is a medical emergency. Your horse has a much better chance of recovery if treatment is started early. Before the vet arrives you can make your horse more comfortable by:

• Removing it from the field, if outside.
• Stabling it on deep bedding (shavings, paper or sand).
• Removing concentrates but do not remove hay or water.
• Encouraging it to lie down to take pressure off the feet.

But I thought only fat ponies got laminitis?

Any horse can be affected by laminitis, but some horses are more prone to the condition than others. Factors which make a horse more at risk of developing laminitis are:

• Breed: ponies and heavy breeds, such as draft horses, are more susceptible.
• Obesity.
• Diet containing high carbohydrate content, eg grain.
• Abrupt changes in diet or overeating, especially consumption of excessive amounts of fresh grass or grain ('grain overload'), particularly in spring.
• Severe colic.
• Recent heavy exercise on hard surfaces.
• Severe infection or illness causing high temperatures, eg pneumonia or retained placenta after foaling.
• Excessive weight bearing on one leg because of injury to another leg.

What will my vet do?

Your vet will need to confirm that your horse has laminitis, and this may involve:

• Asking about the recent health, diet and exercise of your horse.
• Examining your horse's feet and applying hoof testers to the foot just in front of the point of the frog.
• Taking x-rays (radiographs) of your horse's feet to look at the position of the pedal bone.

Treatment for your horse will depend on the severity of the symptoms and may include:

• Treatment of the primary condition, eg pneumonia, retained placenta, etc.
• Fluids if your horse is dehydrated.
• Drugs to reduce pain (anti-inflammatories), to fight infection (antibiotics), and to improve blood flow to the feet (vasodilators).
• If your horse has overeaten, liquid paraffin may be administered by stomach tube to speed up the passage of feed through the gut. Activated charcoal can be given to absorb toxins if poisons have been ingested.
• Dietary change, eg removal of concentrates from diet, feeding only soaked hay with a vitamin and mineral balancer.
• Follow up x-rays to check on progress.
• Therapeutic farriery, eg corrective trimming, frog supports and therapeutic shoes or pads. Your vet will liaise with your farrier on the best option for your horse. Frog or frog and sole supports can be applied by your vet if the farrier is not readily available.
• It is important to follow your vet's instructions carefully and keep him/her informed on the progress of your horse.

Unfortunately, extensive, irreversible damage to the feet can occur in very severe cases, for example when treatment has not been started promptly. In these instances, the horse may never be free of pain and the only option might be euthanasia.

Will I be able to ride my horse again?

Most horses that have been treated for laminitis can be ridden again. However, this depends on how severe the symptoms are and how well your horse responds to treatment. You should not attempt to ride your horse until your vet has said that this is safe. Also, once a horse has had laminitis it is much more prone to further episodes and so it is essential to watch it closely for signs of laminitis and to stop riding and seek veterinary attention if any signs reoccur.

What can I do to prevent my horse suffering from laminitis again?

To prevent relapses of laminitis, it is important to make permanent changes to the daily management of your horse. Although you may need your vet's advice for some of these changes, there are easy steps you can take yourself such as:

• Using electric fencing to divide pasture and restrict access to grass, especially during spring.
• Turning your horse out onto sand if no other turnout is available.
• Preventing access to frosted paddocks.
• Restricting exercise on hard surfaces.
• Riding your horse daily.

Your vet can advise you on other important preventative measures which include:

• A diet that provides adequate nutrition without excess carbohydrate.
• Weight loss if your horse is overweight: use a weigh tape for accuracy.
• Routine foot care, including regular hoof trimming.
• Improving parasite control and vaccination protection to keep your horse in good health
• Nutritional supplements to promote healthy hooves.

METABOLIC SYNDROME (EMS) Follow the link below for the latest on Equine Metabolic Syndrome from the Equine Endocrinology Group

Equine Metatolic Syndrome (EMS)