Hello beautiful people!
Eric Lamaze and Chacco Kid won the Equinimity WEF Challenge Cup AGAIN this week! Marilyn Little, Beezie Madden, Tiffany Foster, and Shane Sweetnam rounded out the top 5. The Grand Prix this weekend is going to be fabulous!
As promised, I have a lot of great takeaways to share with you from this weeks topic at Lunch & Learn at WEF: Constructing a Wellness Program for the Aging Performance Horse. This subject was of great interest to me for so many reasons.
I have an aging performance horse myself. One that I have invested years of blood, sweat, tears, and money into to bring him to his current status of “can do no wrong” “Mr. Perfect” (almost always) status. Of course I want to protect that as much as I possibly can! We also have other aging performance horses under our care and management that we value greatly. It is really fantastic to have horses in your program that can stay with you for a long time and stay well doing it and doing it well. If there is anything I can do to help that to happen, I am alllll in friends.
Marian G. Little DVM gave the presentation, sponsored by Adequan. I took my seat at the front table again this week. Dr. Little joined me for a few minutes prior to the start of her presentation. I chose a great seat! It was nice to get introduced and learn a little about her before it began. She is a fabulous speaker (something I admire).
The following is a combination of a direct summary of the presentation as well as my own personal thoughts:
There is a growing need for the care of aging horses. They are lasting longer, hooray! Across three different study years, the population of horses over 20 years of age increased from 5.6% to 11.4% with that last number being taken from 2015. So really, even that is already dated information. Behind joint problems, senior horse care was the top concern in a survey of 11K horse owners. In creating a management plan for our horses, we are helping to expand not only their lifespan, but also their “healthspan”. If you can keep a horse over a long period of time you get the opportunity to have a really special relationship with them. We also need experienced safe mounts to stay in the game for up and coming riders.
As our horses age, it is ideal to keep them performing at their original level of wellness even if it has to be at a lower level of job. Currently more than half of horses >15 years are still involved in physical activity. 25% of those are competing. Soundness management of these partners is essential. Who wouldn’t want to extend and maximize their horses’ longevity and quality of life!
In order to achieve and maintain wellness involves knowing what to expect as the horse ages. Are things that come up with your horse the normal signs of aging or could they indicate something more? Horses don’t exhibit random emotion. If they don’t seem right, they probably have something going on. It can be managed if we pay attention to the early indicators. This is a challenge, no doubt. So, we need to be proactive! I often refer to our horses as having a “team” and that is truly what it is all about. Dr. Little also emphasized the team approach to care. It takes a combination of owners, riders, trainers, and multiple specialists from farriers, veterinarians, dentists, chiropractors, and nutritionists to experts in analyzing your footing, saddle fit – the list just keeps on going! It literally takes a village you guys!
She talked about structuring a wellness program in our older athletes stressing the importance of bi-annual physical exams that equal in thoroughness to a pre purchase exam, ideally. Evaluation of their mobility and quality of gates, giving them a body condition score, evaluating nutrition, deworming – getting a fecal egg count, noting the condition of the hair coat, as well as endocrine, and ophthalmic exams. She presented the idea of developing a program within your barn in a tiered structure “silver, gold, platinum” as far as depth of this bi-annual exam.
In our barn, we put the health and wellness of the horses first and complete biannual wellness checks in addition to utilizing all of the above mentioned variety of team members. I do like the idea of making it a package with specific parameters put in place for the exam itself, including geriatric screens, as necessary based on each horses individual circumstance.
She talked about how there are many in the industry that are unaware that aging leads to fewer resiliencies involving environmental stressors. They need longer warm ups and cool downs, they are more effected by the elements (temperature extremes), a need for appropriate diets to address impaired fiber and nutrient absorption, and increased risk of impactions. Really cold water is undesirable to the horse. A horses status in the herd (if they are in one) can change and keeping them with consistent mates can be considered of importance as they age – Our dearest Sara will appreciate this – Guilder and Gandalf immediately came to my mind when I heard this. Guilder is another one of the perfect gems in our barn. He is Sara’s golden boy – they show in the adult amateur hunters. He has spent his entire life with his brother, Gandalf. Gandalf had to retire from work at an early age due to chronic back issues, but Sara did not want to separate them and Gandalf’s job since retiring has been as Guilders security blanket. You’ve done right by them, Sara!
Next she talked about having a plan for monitoring, recording, and reporting all of the important findings.
The sections to consider in these keeping of records are preventative health (vaccines, coggins, teeth), body weight and condition scores, tracking of subtle changes, any lab data results, any changes in exercise regimen, farrier records, diet & water consumption, and overall performance. For our aging friends, consider well horse geriatric screens: CBC/Chemistry, Plasma ACTH, Serum Amyloid A, and Fecal egg count.
If they are overweight or have a history of EMS or PPID they suggest fasting or resting insulin and an oral sugar test. Horses with unexplained weight or muscle loss should be ruled out for early PPID and get a TRH test.
Equine metabolic syndrome (EMS), is an endocrinopathy affecting horses and ponies. It is of primary concern due to its link to obesity, insulin resistance, and subsequent laminitis.
Thyrotropin-releasing hormone (TRH) stimulation test, which is particularly useful when horses with early PPID have normal resting ACTH concentrations. TRH causes the pituitary gland to release more hormones and ACTH concentrations increase to a higher level in horses with PPID.
There are some great programs out there for managing your stable and keeping detailed records. I personally use Nicker Notes and I really love it. I can’t remember what happened 2 days ago let alone days or months ago. That is why having this kind of platform for record keeping is so important to me. Nicker Notes is built to provide a team-centric approach to horse care. You can share key horse info like allergies, handling, tack, and turnout preferences. Stay apprised of training activities and treatments. Coordinate upcoming procedures with an eye to future events. It keeps a detailed journal of all of your horse’s activities, including pictures and attachments. Filtering & analytics provides insight into your horse’s activities over time, so you can fine tune their program to best meet your management, training, and competitive goals. The only downside I have come across with this program is when I have customers that do not use Facebook, as it is linked to your Facebook login credentials. The team members you want to have access to all of this information must have a FB account to login. Nicker Notes is a cloud service so you can use it from any web browser. Your horse’s data is private and only accessible to the people you invite to their team. It supports iOS devices. I keep track of all of the veterinary and therapies and I can pull it up on my phone at any time. Particularily helpful when you are standing there with the vet and both wondering just when was it that the horse had it’s hock’s injected last.
If you don’t have or want to use an online platform, you can always create your own record keeping in an Excel spreadsheet.
Back to the subject at hand: The common issues in aging horses are multi factorial weight loss, colic & GI disorders, opthamalic issues, skin problems (secondary to PPID), endocrine disorders, chronic respiratory disease, exercise intolerance, and poor thermoregulation.
PPID (formerly known as Equine Cushing’s Disease) Pituitary Pars Intermedia Dysfunction is one of the most common diseases of the endocrine system that can affect horses. PPID causes the horse’s pituitary gland, which utilizes hormones to control body functions, to work overtime.
The big one – it is estimated that 60% of lameness problems are related to Degenerative Joint Disease (DJD) and/or osteoarthritis (OA), greater of course in aged performance horses.
DJD is a progressive deterioration of the articular cartilage accompanied by changes in bone and soft tissue of the joint. Traumatic arthritis develops after single or repetitive episodes of trauma and may include: Synovitis, Capsulitis, sprain, intra articular fractures, meniscal tears, Osteoarthritis (end stage DJD – presence of degradative changes in articular cartilage),
What is synovitis?
Synovitis is an inflammation of the delicate synovial membranes that surround, protect and nourish the joints that are particularly subject to stress in the horse’s legs. Repeated concussive trauma (wear and tear) is the type of injury most likely to cause the synovial membrane to become inflamed.
What is capsulitis?
Inflammation of the joint capsule (capsulitis) can be very painful in horses. Monitor your horse’s response to treatment by paying attention to their degree of lameness, swelling, heat, range of motion of the joint in question as treatment and time progresses.
The risk factors for DJD have two fundamental mechanisms. They are the adverse effects of abnormal loading on normal cartilage and of normal loading on abnormal cartilage.
In the equine athlete, synovitis and capsulitis occur in response to repetitive trauma. This trauma initiates the breakdown of articular cartilage, which leads to DJD/OA. It is not IF joint disease will occur, but WHEN, and it can happen to any horse at any time. Some factors that can play a role in that WHEN are genetics, conformation, age/development abnormalities, poor hoof balance, use, muscle atrophy, inadequate warm ups/cool downs, and fatigue.
The early signs of DJD are diminished performance or decreased willingness to work, subtle alterations in gate, heat, pain, swelling, stiffness, and lameness. Later indicators are chronic joint enlargement, decreased range of motion, and palpable bony abnormalities.
How you treat this widely depends on severity, use, familiarity, and economics. Treatment can be medical or surgical, or a combination. Surgery is of course not ideal. The goal is to do what it takes to reduce pain and lameness by quickly returning the joint to normal and also reducing severity of OA by minimizing progression of joint deterioration.
The goal is rapid resolution of synovitis and capsulitis, which is where the initial cartilage matrix breakdown begins.
Different options for DJD include traditional measures like Polysulfated, Glycosominoglycan (Adequan), corticosteroids, Hyaluranic acid, and NSAIDS.
Corticosteroids are injected directly into joints and are reasonably safe and effective agents for reducing the inflammation that can be caused by injury. The most common corticosteroids used in horse joints are triamcinolone (most commonly sold as Vetlog®) and methylprednisolone acetate (most commonly sold as Depo-Medrol®)
Surgical intervention would mean arthroscopy to target cartilage defects. Arthroscopic surgery, developed in the horse in the 1970s, is the keyhole technique by which surgery is performed on equine joints for traumatic injury, fractures within joints, soft tissue injury, and abnormal joint development in young horses, such as osteochondritis dissecans (OCD).
Regenerative therapies would include Interlueken Receptor Antagonist Protein (IRAP), Platelet Rich Plasma (PRP), stem cells, or combinations of the above.
Alternative therapies would include acupuncture, chiropractic, and massage.
Nutraceuticals, more commonly known as oral joint supplements, which are not proven. Here is a great article from Thehorse.com regarding nutraceuticals.
And rest! Probably the most important yet, under-utilized therapy.
The key characteristics in a therapeutic agent for DJD relieves the symptoms of lameness and produces disease modifying effects addressing cartilage wear and tear. This is where the Adequan comes into play! Adequan is Polysulfated Glycosaminoglycan (PSGAG) and what it does is this:
Inhibits cartilage matrix degenerations, stimulates production of cartilage matrix components, improves synovial lubrication, decreases inflammation, and improves lameness.
When considering corticosteroids to manage DJD we need to consider that the therapeutic index is not the same for all preparations. Anecdotal reports suggest narrower therapeutic index with Vetlog as compared to Depo Medrol and Betavet/Celestone Soluspan. It has been suggested that the total body dose not exceed: Vetlog 18 mg, Depo-Medrol 200mg, and Betavet/Celestone Soluspan 30 mg. These numbers are based on anecdotal reports but with the main goal to eliminate corticosteroid induced laminitis. Except when high doses are administered, it appears that glucocorticoids might only increase the risk of developing laminitis when other causative factors are present or when laminar tissues are “primed” to undergo changes leading to cell endocrinopathies. Doses that are safe for one horse may not be the same for another.
I hope that this has been informative! It certainly was for me. It is really important to manage our horses by keeping them in steady work, giving them adequate turnout, recognizing subtle changes, discussing the difference in medication with professionals when medical therapies become necessary for soundness, and realizing there is no one size fits all solution for soundness.
My questions for Dr. Little pertained directly to Adequan. There is always a lot of controversy and varying opinions and direction given depending on who you ask when it comes to giving horses Adequan. I wanted to know if in fact the 1 dose every 4 days for 7 treatments was the way to go or if monthly or weekly administration was a good thing to do. It was so nice to finally be asking a literal expert on the product instead of relying on the varying opinions of others. So, the verdict is: Adequan studies support the series when promising the results that are intended to be delivered. Giving Adequan monthly or even weekly is not supported by the study. I can’t tell you how many times I’ve asked that question. I’m just glad I have the answer now. As far as how often the series needs to be administered, it is dependent on the individual horse. When you see the signs you give the series again. That could be 3 months, 6 months, a year…Again, no one size fits all. I also found it really interesting that there is nothing to support prophylactic use. If you give adequan and there is no unhealthy joint and therefore no imbalance, you just won’t see any change. I’d love to see a study on prophylactic use personally! It is difficult to imagine waiting to see an issue as opposed to providing preventative care. What do you all think? As always, I’d love to hear from you with comments.
Have a great Friday and stay fabulous!