equine therapeutics

factors affecting treatment choices (5)

• Accurate diagnosis

• Timing in progression of lameness

• Client budget

• Prognosis (expected success of outcome)

  • Future use

  • Survivability

• Patient signalment

  • Age, Sex, Life stage

Treatment categories

1. Prevention

2. Conservative management/supportive care

3. Medical Management

4. Surgical management

5. Rehabilitation

6. Alternative therapies

Prevention: vaccines

• For viral disease; expose immune system to viral antigen in safe manner

  • Inactivated or greatly reduced infection capability

• Allow body few weeks to mount primary response via antibiotics

• Administering a booster will increase immune response a second time, resulting in much longer immunity

• Most vaccines administered once, booster 3-4 weeks later, annual administration after

Prevention: good husbandry (3)

1. Environmental management

• Provide protection from environmental extremes

• Provide good footing

  • Indoor = slip resistant/appropriate bedding

  • Outdoor = dry pasture with few rocks

  • Safe training surfaces

2. Nutritional management

• Discussed more in GI section

• Horses are: herbivores, hindgut fermenters, grazers

3. Lameness specific

a) Routine hoof management

• Farrier ever 4-6 weeks

• Keep foot balanced to prevent absecces, bruises, cracks, thrush, laminitis

b) Appropriate job assignment

• Racing thoroughbreds not suited to pull heavy loads 

• Draft horses not well suited for jumping

Conservative management/supportive care (4)

• Fluid therapy: stabilizes and maintains hydration

• Probiotics: especially if getting antibiotics

• Temperature regulation: prevents animal from expending extra energy

• Lameness specific: Rest and confinement/reduced exercise–stall rest, paddock rest, field rest, hand walking (all allow for reintroduction to full function)

Types of shoes (7)

• Regular

• Rim: big groove down middle for extra traction

• Scotch bottom: draft breeds

• Bar: closed heel, more likely to come off (extra shoe coming off back)

• Wedge: corrective shoes

• Racing plates: aluminum, lightweight

• Glue on: for horses that can't have shoes nailed on

*see images

Therapeutic shoeing (supportive care) (5)

• Rollover shoes: beveled volar surface facilitates normal breakover (between when heel leaves ground and when toe leaves the ground)

• Suspensory shoe: extra support around toe to prevent over stretching of suspensory ligament

• Toe extensions: force heel down and stretch contracted tendons

• Bar shoe: extra support at heel to prevent shifting (straight bar, egg bar, heart bar)

• Wedge shoe: take pressure off navicular bone if diagnosed with navicular disease

*see images

Medical management: general

• Antimicrobials: Systematic = whole body, Local = near infection point

• Pain management: corticosteroids (steroid) or NSAIDS = flunixin, meglumine, phenylbutazone (nonsteroids)

Lameness Medical management: 1,2,3

1. Bandaging

• For wounds:

  • Absorb exudate

  • Reduce swelling

  • Prevent contamination

  • Keep tissue bed viable

  • Prevent over proliferation of scar tissue (proud flesh: when it dries out)

• Important to maintain proper tension, have cushion layer, prevent increased pressure over prominences

2. Splinting

• Uses: stabilizing minor fractures, stabilize soft tissue disruptions (tendon, ligaments)

• Important to stabilize above and below joint, be rigid/secure, use over padding

3. Soaking

• Treatment for foot abscess, usually epsom salt solution (hypertonic to draw out liquid)

• Used with opening abscess and bandaging foot with salve to promote drainage

Lameness Medical management: 4+5

4. 5 types

5. 5 types

4. Joint supplements

• Typically not FDA regulated

  • Glucosamine: major cartilage component

  • Chondrotin: major cartilage component (used with Glucosamine)

  • Hyaluronic acid: major synovial fluid component

  • Dimethyl sulfoxide DMSO: anti-inflammatory, leaves bad taste when absorbed via skin, byproduct of pulp industry

  • Hydrolyzed collagen: component of connective tissue, broken down into more digestible form

5. Non antibiotic injectables

• IRAP: taken from blood drawn from same horse, inhibits further degradation of cartilage

• Platelet rich plasma PRP: platelets taken from blood, helps improve new collagen formation (especially for tendon/ligament injuries)

• Hyaluronic acid: improves function of synovial fluid, alleviating pain associated with osteoarthritis

• PSGAG/Adequan: improves function of synovial fluid

• Corticosteroids: reduce inflammation and therefore pain

Surgical management

• type 1: 5 types

• type 2: 3 types

→ Soft tissue surgery

• GI

• Respiratory

• Reproductive

• Neurologic

• Wound closure

→ Orthopedic surgery

• Fracture repair

  • Internal fixation: screws and/or plates attached directly to bone internally (permanent)

  • External fixation: support attached from outside body (temporary)

• Joint fusion (arthrodesis)

  • Intentional fusion of a joint (normally joints that don't move a lot in general)

  • Treatment for articular fractures, osteoarthritis, or other instability

  • Remove cartilage and immobilize joint until bones fuse together

• Fragment removal

  • Typically arthroscopic (with small camera, light, graspers)

  • Can be done standing, depending on severity of lesion

Rehabilitation

• Controlled reintroduction to function

• Similar to conservative treatment, but after surgical treatment

• Lameness specific methods: low impact exercise, alternative therapies

Alternative therapy: acupuncture

fine needles at acupoints (high density nerves, vessels, arteries)

• Stimulation of acupoints releases endorphins, serotonin, other neurotransmitters

• Often accompanied by weak electrical signal stimulation

• Needles left in places for 5-30 mins

• Considered safe, can be done without meds (good for drug tested horses)

Alternative therapy: ultrasound

low frequency ultrasound waves to promote tissue/bone healing

• Combination of acoustic and mechanical effects with heat increase circulation and oxygenation of tissue

• Painless, no sedation

Alternative therapy: laser

high powered lasers to promote healing and tissue repair (red lasors)

• Used for wound management, pain management, tendon/ligament injuries, etc

• Seems effective particularly on ligament and tendon injuries

Alternative therapy: shock wave

• high amplitude acoustic waves at specific point within tissue to treat disease

  • Break up bladder stones

  • Stimulate fracture healing

  • Generally improve musculoskeletal healing in slow healing tissues

*Not well understood, but evidence of new blood vessels in healing area

*Analgesia (pain reduction) seems to only last a few days

Alternative therapy: spinal manipulative therapy

manual adjustments to spinal vertebrae to ensure correct motion and articulation

• Goal: improve comfort, manage pain, improve performance

• Typically used with standard lameness exams

• Chiropractic adjustments technically only done in humans, CVMPP or CVSMT done by vets in horses