Ask the vet: Tendon & Ligament Injuries and Rehabilitation.

Has your horse experienced a tendon or ligament injury? Pose your questions on the topic of tendon and ligament injuries and rehabilitation for our AAEP expert, Dr. Rebecca Linke.

1	Question: Our 13-year-old Holsteiner tore his left hind oblique sesamoidian ligament. This was diagnosed in early June following a year long quest to determine the cause of a transitory lameness (and injections to many joints including neck, SI joints, stifles, hocks and coffins). Treatment consisted of two sessions of shockwave therapy that were 2 weeks apart and hand-walking for 6 weeks. Tack-walking was then for an additional 4 weeks and a slow build-up of work. He is now up to a full 45 minutes of flat work including trotting and cantering. How long should it be before we can get back to jumping? He was being used as an equitation horse doing 3'6" to 4' medals. Following an injury like this, can he ever be expected to go back to the same level of competition? Answer:  This is a question we hear a lot: "will my horse ever return to the work he was doing prior to his injury?" Unfortunately, there is no way to predict which injuries will recur and which will not. It sounds like you and your veterinarian have done the right thing for your horse so far, combining rest, gradual return to work, and shockwave therapy. Continue to work with your veterinarian to determine when is the best time to reintroduce jumping, starting with ground rails and low cavaletti and working up to a goal determined by your veterinarian. The more gradual the return to jumping, the better for your horse. I haven't been able to find a percentage of these injuries that recur, but unfortunately Ross and Dyson (Lameness in the Horse, 2003) report that "the incidence of recurrence of oblique distal sesamoidean ligament injury is high". Because of this, you and your veterinarian may decide that it is best for your horse not to try to return to his previous level of athleticism, or perhaps even find another job that is less physically demanding.
2	Question: I live in South Africa and this morning my veterinarian recommended your site in regards to which boots to use on a horse that had a deep superficial flexor tendon injury on his near fore just over a year ago. He was rested for almost 9 months and given PRP treatments three times. I was told the AAEP recommends a certain type of boot for work after this kind of injury. His tendon is cool to the touch and unless one is an expert one would not see that there had been such a drastic injury. I intend to have him scanned again as the thought is to put him back into racing, or is this a very bad idea? Your comments would be much appreciated.  Answer:  I am a member of AAEP but I am not an employee. However, AAEP does not endorse products of any kind. I have merely volunteered to answer questions on this topic because I feel that I have had some experience with these types of injuries during my veterinary career.  It sounds like you have done everything you could for your horse in the hopes of getting him back to the racetrack. I would absolutely agree with having an ultrasound performed on him before he is cleared for this kind of work. One thing you haven't mentioned in your question is whether your horse is a Thoroughbred or a Standardbred, as this may affect whether he is able to return to racing and how successful he may be there. The majority of my experience is with Standardbreds, and in my experience, they have moderate success in returning to racing, even with as severe an injury as you have described. My other question is whether the injury involves the deep digital flexor tendon as well as the superficial digital flexor tendon; you described it as a "deep superficial flexor tendon injury," which I must interpret as being deep within the superficial digital flexor tendon, although that tendon is not usually very thick. Without seeing the original ultrasounds and also the current scans, I'm afraid I can't tell you what his prognosis is for returning to racing. Equine Sports Medicine and Surgery (Hinchcliff, et all, 2004) recommends Dalmar support boots for use after tendon injuries. These boots are designed for use in the exercising horse, but I don't know if they are compatible with horses that are racing, as that is one of the highest levels of performance. If you choose to try these boots on your horse, I recommend that you investigate how he works in the boots extensively before asking him to race in them.
3	Question: My 17-year-old Quarter horse mare bowed the tendon low in her right hind leg in May of this year. Our vet completed a sonogram which revealed an already healing lesion. She has been confined to a small turnout area and separated from the other two horses for the last 5 months. There is some swelling at the fetlock joint, but the leg has never been hot. We applied liniment and polo wraps for 4 weeks. She is showing improvement, especially in the last 3 weeks with being turned out in a small area to graze alone. My vet has suggested re-evaluating in December and proceed from there. Any other suggestions, supplements, treatments we may have missed? Answer:  Tendon injuries can be frustrating because they take a long time to heal, may or may not resolve ultrasonographically, and may carry the risk of reinjury for a significant time after the original injury. There are a few therapies that are used to try to increase healing and decrease the length of time needed to return to work, but there is really no safe way to rush a tendon injury. Your veterinarian can discuss with you whether your mare is a good candidate for treatments such as stem cell therapy and extracorporeal shock wave therapy. Supplements are available that claim to support tendon and ligament health, and certainly some supplements, such as antioxidants, support the general health of the animal, but supplements are not a substitute for proper veterinary care. Some of these injuries respond best to conservative therapy, such as time off and then slow return to work, with or without nonsteroidal anti-inflammatories, and your veterinarian will be best able to determine the best course for your mare.
4	Question: My horse has continued with bouts of reoccurring lameness. I would find swollen hind fetlocks and would commence to ice, bute, wrapping and rest. She would be fine and I would start her back on light work, but after several times of the lameness coming back, I contacted my veterinarian to do a work-up. An ultrasound showed slight tearing with no noticeable difference right to left in the SDFT as far as swelling. She was sent to the paddock for the next two (2) months, to begin hand walking in one month. He administered ace to keep her calm and DMSO on the joint capsule. When I read up on this type of injury, it seems that it can easily reoccur once it has been weakened. We do nothing more than walk, trot, canter in the ring and the mare has five (5) acres of turnout. Would stem cell or some other type of therapy give me a better chance for recovery? Answer:  This is also a good question, but more information is needed to be able to answer. First of all, how old is your horse, and how long have the bouts of lameness been going on? How long would the bouts of lameness last? Certainly tendons and ligaments that have been injured or have shown fiber disruption are often prone to reinjury but unfortunately, it is impossible to predict which ones are more likely to reinjure. Certain factors, such as the severity of the original injury and the intensity of the work program that your mare returns to may have an effect on whether or not she may reinjure her tendon. Your veterinarian would be best able to assess this injury both by how lame your mare is and also how much disruption there is in her tendon, and help you decide whether this is a case that would benefit from stem cell therapy or not. Often if there is a small amount of tearing or fiber disruption there may not be a "hole" into which to inject something like stem cells or PRP, and the injury can successfully be managed conservatively, as you're doing.
5	Question: I have a 4-year-old mare that sustained a puncture injury to the back of her pastern. It went TO the tendon but not through the tendon. Subsequently, an infection popped an abscess at the top of the tendon sheath, which allowed us to drench the length of the wound and the sheath with antibiotic fluid. We did this for several days in a row until the wound did not open through. She was on stall rest and daily bandage changes with several courses of antibiotic treatments. She apparently had infection off and on for at least 3 or 4 months. During this time she was also on higher doses of bute that tapered off along with Ulcergard since she lost a lot of weight.  She has been ultrasounded 3 times and one of my vets believes she will make a full recovery. The other vet is hoping for pasture sound and pain free. The ultrasound does not show any significant ligament damage but the last one showed a couple of areas that were still healing deep within her leg. Treatment was to leave her on pasture rest for 6 months and then start light riding.  My concern is the fetlock is much larger on the injured side and also the pastern angel is steeper. I'm not sure if there is something else I should be doing. The vet thinks the larger fetlock is due to scar tissue and doesn't seem to be worried about it. But it does come and go in size and is not painful when palpated. The entire area seems mostly pain free. She does still slightly favor the leg when trotting or slight loping. She won't lope for a long distance but still does buck on occasion. This horse was being ridden at the time of injury in February 2013. Is there anything else I should try or be doing?  When she was injured in February of 2013, she spent 5 months in a stall with daily dressing changes. It took this long for the initial wound to close. This was up and down period with varying degrees of pain for her with swelling. She was on multiple antibiotics off and on during this time to treat both aerobic and anaerobic bacteria. She was on bute the entire 5 months. Since July she has been pastured. She has responded well to all treatments.The two vets we use are partners in the same practice and both have seen her. Answer:  That sounds like a very serious injury and one that may be difficult to recover fully from. My main concerns with this injury are the extensive and lengthy infection and the change in pastern angle. The swelling in the fetlock may be due to either scar tissue or edema caused by decreased circulation, which may be a result of the original injury. It sounds like you and your veterinarians have taken the best possible care of this mare, but it may be difficult to be sure that the infection is completely cleared up, even after all your hard work. I am concerned that the swelling is still changing, rather than just staying one constant size, but the fact that it doesn't seem to bother your mare when you palpate it is a good sign. My concern with the change in pastern angle is that if the fetlock is dropping, it may indicate damage to the suspensory apparatus. With regards to further treatment, it sounds like you and your veterinarians are doing just about everything this mare could need for a successful outcome. Shockwave therapy may help at this point, but without seeing the patient and the ultrasound images, it's difficult to say what her prognosis may be. Conservative treatment sounds like the right way to go. Your veterinarians are absolutely right in advising you to give her six more months turned out before thinking about putting her back in work, and I'm sure they're going to want to reassess her soundness level at that point before they clear her for even light work. I agree, pasture sound is a good goal to work towards, and it is difficult for any of us to say how sound she will be or how long it will take to get there.
6	Question: I own a 10-year-old Quarab gelding that presents swelling at the top of the rear pastern, but shows no lameness. The swelling has shown no improvement after two weeks of home treatment. My veterinarian does not own a portable radiograph or clinic radiograph machine for horses. I need to haul him. Should I go direct to the University vet school, or a veterinarian at almost half the distance that has imaging equipment, but is not an "equine hospital"? Or should I give it more time and continue with the home treatment? He was not "in work" when the injury occurred and his job is mostly a pasture ornament with very little trail work. Answer:  I'll do my best to answer this question with the limited information given. First of all, is the swelling hard or soft? This will help you and your veterinarian to decide whether it would be better to take xrays first, or to ultrasound it first, although the information that the horse is sound makes me lean towards ultrasound as the first choice for diagnostics, since it is rare for a horse with a bony abnormality to be sound, although it is possible. This is why it is difficult if not impossible to answer these questions without seeing the patient. Is the swelling hot or warm, and is it painful on palpation? Was there any trauma observed that caused the injury, like a kick from another horse, a bad step or trip, or playing rough with pasture buddies? This will help you to decide how recent and how severe the injury is. Frequently, we wait at least three to five days after injury to perform an ultrasonographic exam, as this allows time for the surrounding soft tissue swelling to go down, which lets us get a better view of the structures we're trying to assess. What is the "home treatment" that the horse is getting? There are many options for this, including stall rest and/or handwalking, treatment with nonsteroidal anti-inflammatories such as bute or banamine, cold therapy, and poulticing or other types of wraps and pressure bandages. Has the horse shown any improvement at all after the home treatment? How far of a drive is it to the nearest university vet school, and how far is it to the local clinic? Does the local clinic concentrate on horses even though they are not an equine hospital, as you reported, and are you comfortable with the level of care that your horse would get there? Finally, you must decide what your goals are for this horse and how rapidly you want to achieve them, and to this end how much money and time you are willing to spend. If the horse is sound and comfortable, and you are satisfied to keep him at home and take the "wait and see" approach, if advised by your veterinarian that that is an acceptable option, than certainly do that. If you would rather try to get an answer as to what is causing the swelling and how best to resolve it, then you may want to consider shipping the horse to a facility that can help you get these answers. There are many options for dealing with swellings such as these, and the most important thing to consider first is the health and safety of the horse - above all, we want to make sure that we're not dealing with an injury that may get worse if it is not treated properly. Your veterinarian can discuss with you what is the best option for you and your horse.
7	Question: I have a 13-year-old, 14.2 hand pony on rehabilitation following a tear in her left hind annular ligament (fetlock area) during August. She was only ever lame at a trot. She has recovered very well and has been on walk road exercise for one month and some trot work for two weeks. We are just starting to introduce a little canter work. She is still on box stall rest to avoid injury in the field but I am hoping to get her out during the day anytime soon. Are there any specific exercises that would benefit her return to jumping and anything to avoid? Answer:  With any type of soft tissue injury, slow and steady return to work is the key. As you've probably discussed with your veterinarian, your pony should not be turned out in a big field where she can re-injure herself until she's almost back to full work. You can talk to your veterinarian about possibly turning her out in a small paddock or round pen, especially if she's quiet and doesn't usually run or play much, to get a little more exercise in a somewhat controlled setting. You probably started the trot work on the straightaways and gradually added turns, and tried to keep her on a firmer surface and out of any deep footing or sand, which would put more strain on her tendons, ligaments, and other soft tissue. I often advise owners to add either one minute of trot work per day, or five minutes per week, so you gradually work up to thirty minutes of trot work per session, and begin canter work when you have reached thirty minutes of trot work. Avoid sharp turns, especially at higher speeds. It's a tedious process, but necessary to allow the structures to heal while reducing the risk of re-injury.
8	Question: Are there any supplements that can help with rehabilitation? We have tried homeopathy and different types of physiotherapy, which have worked, but maybe there could be supplements, (except C and collagen, and devil's claw) that could help during the first weeks? Answer:  There are many supplements available that are intended to support tendon and ligament health. As you noted, antioxidants like vitamin C and vitamin E are important, as well as collagen and other building blocks such as MSM. Amino acids, L-carnitine, and creatine may help support muscle function, which may take some of the strain off of other soft tissue structures. Hyaluronin, polyglycan, glucosamine, and chondroitin may help support joint health. There are also Chinese herbal supplements available to support certain tissues within the body, including tendons and ligaments. As with any dietary supplement, these are not a substitute for a good feeding program, and they should not be used as a substitute for veterinary care, but rather used in conjunction with regular visits from your veterinarian they can help support a program that addresses your horse's needs. Consult your veterinarian and remember that supplements are not proven to treat any conditions, but may be part of a protocol that ultimately benefits your horse.
9	Question: With a suspensory injury, does the lesion ever fill in or look normal on ultrasound after rehabilitation? What are the chances of re-injury? Answer:  Both of these are excellent questions, and unfortunately both vary depending on the individual case. It is possible for a suspensory lesion to fill in, given enough time, but sometimes they persist on ultrasound even a year or more after the original injury. Certain therapies, such as the injection of PRP, can cause a lesion to fill in ultrasonographically, although the ligament may still not be as strong as it was prior to the injury. Sometimes the lesion may fill in with slightly different tissue fibers, which causes it to remain visible on ultrasound. In certain cases, the ligament may contain muscle fibers interspersed throughout the structure, which may make interpretation of the ultrasound difficult, both before and after injury and rest and rehab time. This is more commonly found in hind suspensory ligaments. The potential for re-injury depends on many factors, such as severity of the injury, therapies used during rehabilitation, length of time before return to full athletic function, and intensity of training.
10	Question: I have a 14-year-old Quarter horse gelding that I use for English flat and western pleasure along with horsemanship lessons and show him. He came up lame on his right front beginning last January. Radiographs showed he had bone chips in front of his fetlock joint, which we thought needed to be removed. After diagnostics, the veterinarian did not feel the bone fragments were the problem. The MRI showed soft tissue damage including the ligament that attaches to the coffin joint was enlarged three times it's usual size and there was swelling of the navicular bursa. To date, he has had radiographs, ultrasound and a MRI. The fetlock joint was injected and the navicular bursa and coffin joint were also injected with no results. We have tried stall rest, and bar shoes neither of which have worked. Any suggestions? Answer:  As you have found, this can be a very frustrating problem, and yours is complicated by the fact that there were bone chips found on x-ray. It is not uncommon to find bone chips in the fetlock joint that are occurring coincidentally and are not actually the problem, which is sometimes disappointing because the owner and the veterinarian both want to be able to remove the chips and solve the problem, but the chips are not the cause of the lameness, so the search must continue. There are many small but important structures in the foot that can often be the cause of the problem, and I'm glad that you and your veterinarian pursued so many imaging modalities to get a good idea of what the actual cause of the lameness is. You're probably talking about either the impar ligament of the navicular bone, the medial collateral ligament of the coffin bone, or the collateral ligament of the coffin bone - in any case, as you have found, these structures are difficult to image without MRI and just as difficult to treat, since they are, to some extent, enclosed within the hoof capsule. They are also, unfortunately, slow to heal in most cases. Stall rest, bar shoes, and NSAID (bute, etc.) treatment are all good therapies for this type of injury. Your veterinarian may also want to suggest extracorporeal shock wave therapy, and possibly therapeutic shoeing to raise the horse's heels. In severe cases where further degeneration is less of a concern, a last ditch treatment may be to cut the palmar digital nerves ("nerving"), but this should only be done when all other treatment methods have been exhausted because of the potential for complications.
11	Question: My 18-year-old horse tore 60% of his deep flexor tendon. We are five months into recovery. Will he ever be able to jump again or do these injuries have a tendency to tear again? Answer:  This is an excellent question and one I often get from my clients. Unfortunately, each case is individual and there is no way to predict which injuries will recur and which will not. It is widely accepted that stall rest, "active rest", and a slow return to work are all very important in cases like this. The larger the lesion, the worse the prognosis is and the more likely the horse will re-injure the tendon when he resumes work. Front limb injuries have a better prognosis than hind limb injuries, but adding extracorporeal shock wave therapy during the rehabilitation period may improve the prognosis in hind limb injuries. Traditional support bandages like polo wraps don't actually help support the tendons during exercise, but there are new support boots on the market that may in fact help support the tendons during and after the rehab period, which could help prevent re-injury. These cases can sometimes be "heartbreakers", because it is possible to give the horse all the time he needs, bring him back to work very gradually, and still experience a re-injury, despite taking all possible precautions.
12	Question: My horse currently has swelling on the outside of her carpal joint and advanced arthritis in the radiocarpal joint. The swelling was diagnosed as 'Carpal Tunnel Syndrome,' and following a scan, the Superficial ligament was thought to be the problem. The swelling frequently comes and goes and my horse is only walked out a couple of times a week - any schooling results in noticeable lameness. On light work, the veterinarian confirms she is sound (she was rested for 7 months and is on monthly injections of Carprofen). My question is what are your experiences of Carpal Tunnel in horses and is this frequently seen in horses with arthritic changes in the joint? Answer:  You're probably referring to an accumulation of fluid within your mare's carpal canal, which is a structure that surrounds the superficial and deep digital flexor tendons at the area of the horse's carpus, or knee. There are many potential causes of this swelling, but unfortunately without viewing your mare's radiographs and ultrasound images, it's impossible to say exactly what is the cause here. In her case, it sounds like she has two potential issues: her arthritic changes, and the 'problem' with her superficial digital flexor tendon. Either one of these issues may cause lameness on their own, as well as causing fluid to build up within the carpal canal, which could potentially contribute to her lameness. Your veterinarian will be best able to determine which is the most likely cause of the accumulation of fluid, and how best to address it. Arthritic changes are usually changes on the articular surfaces of bones, which would be treated differently from tendon damage, since in general mild arthritis is treated with mild to moderate amounts of exercise, while horses with tendon or ligament damage are frequently rested. Carprofen is one non-steroidal anti-inflammatory drug used to treat pain and inflammation caused by arthritis and/or tendon and ligament damage. Another commonly used anti-inflammatory is phenylbutazone, or "bute". Your veterinarian may also recommend injecting the carpal canal with hyaluronic acid and/or corticosteroids, which can often alleviate joint effusion and the inflammation that causes it.

Ask the vet: Infectious disease

The summer may be drawing to a close, but the threat of Infectious Disease still lingers. Make sure your horse(s) is still safe. Pose your infectious disease questions to this month's AAEP expert, Dr. Phoebe Smith.

1	Question: Can a horse that has had Potomac Horse Fever (PHF) make a complete recovery? Can they return to their prior job as if nothing has happened or will their performance ability be diminished? Answer:  Yes, a horse can recover completely from Potomac Horse Fever (PHF) and return to normal performance. Not all horses do recover to this degree. The severity of clinical signs is quite wide with PHF, and the development and severity of laminitis is often the limiting factor in future athletic endeavors.
2	Question: I have a 19-year-old gelding and a recently acquired 11-year-old mare. I've had the mare for about three months. Three times since I've owned her, I have noticed that she has episodes of short rapid 'puffy' breaths, no nasal drainage and no sweating. Just over the past couple weeks, I have now noticed that my gelding (I have had him since he was a foal) has had the same 'episodes' on about 3 or 4 occasions! The rapid breathing goes away in about 3-4 hours. They receive very little sweet feed (about 2 cups) morning and night and are locked in for the night at 8 pm. I let them out again to graze around 2 pm daily. I've had horses over the years in this same pasture and have never had any problems but am wondering if it is some kind of a new weed growing (we have a 5-way grass mixture) or if I need to be concerned about illness. Answer:  The episodes of rapid breathing sound very curious. Unfortunately, without seeing/touching/listening to your horses, I cannot offer much useful information. I'd recommend your veterinarian examine both horses as a starting point. Lab work and an assessment of your pastures may also be useful.
3	Question: I have a beautiful Palomino Quarter horse gelding that I want to show. When I got him last year, they told me not to vaccinate him because he foundered two days after his last routine vaccines. That was back in 2008. He was in the same barn so it was not a problem. Now I own him and the barn that I want to go to, won't let me board him without a flu/rhino vaccine. His previous veterinarian said no...don't vaccinate him as it's not worth the risk. Do you have any suggestions for me? Is there a vaccine that pinpoints herpes? Is there a more mild, for lack of a better word, type of vaccine that I could give? I don't want to risk my horse's life, but just thinking there must be someway to protect horses that have adverse reactions. Answer:  This is a very difficult, if not impossible, question to answer. My best advice is to request the specific vaccine type (manufacturer, vaccine trade name) from your horse's previous veterinarian. The previous owner may need to authorize your acquisition of this information. Then discuss with your current veterinarian the options available for vaccination with different products. Each manufacturer uses a different adjuvent (a substance that is added to the vaccine to increase the body's immune response to the vaccine). There are multiple vaccines available targeting herpes virus, both in combination with flu and alone. Ultimately, you and your regular veterinarian are best suited to determine the best preventive care program and living environment for your horse. I apologize that I cannot answer your question more specifically.
4	Question: My 13-year-old pony mare recently showed part of the symptoms of strangles. She had a moderately high temperature and swollen lymph nodes on both sides of the jaw as well as between the lower jaw. I called my veterinarian, but as he was very busy and my pony didn't show any nasal discharge, he told me to wait. The next day, the temperature had gone back to normal and in three (3) days the swelling had decreased without any medication and disappeared in about a week. The mare never lost her appetite yet the lymph nodes were obviously painful when palpated. The other horse, a 15-year-old gelding, never showed any symptoms. My two horses never go out of their pasture and never mix with other horses. Do you think it was benign strangles or could it be something else? Thank you in advance for your answer. Answer:  Strangles can cause less severe disease in adult horses than in younger horses, such as the clinical signs you describe. Strangles can also lie dormant in "silent carriers" and cause disease in unprotected and incompletely protected horses. So it is possible that your pony mare indeed had strangles. Additionally, horses can be exposed to the strangles bacteria through contaminated clothing and equipment (called fomites) and develop illness, so direct contact with a sick horse is not required for the development of disease. However, it seems more likely that your mare had another disease causing her short-lived fever and lymph node swelling. We really can't be sure on this one.
5	Question: It's the end of summer and in the 90's with unusual humidity for California. To my frustration, my gelding has presented a fever of 104+/- and a snotty nose. My veterinarian suspects a virus. This horse has been on "bed" rest for the last month due to lameness. How the heck did he contact a virus with no other horses on the property or within nose contact? Answer:  Fever and nasal discharge may indeed be caused by viral infection, or by bacterial infection. Equine herpes virus lies dormant in clinically healthy horses until periods of stress, when it becomes re-activated, causing clinical disease. Another possibility in this case is that transmission occurred between a contaminated item, or even person, and your horse. In the early stages of viral infection, there may be no outward signs and thus transmission can occur by fomite (person or item) quite readily. Additionally, it can be difficult to distinguish viral from bacterial infections in the first few days of clinical disease. Viral infections typically resolve within a few days, while bacterial infections are often more prolonged.

Ask the vet: Summer Eczema/ Summer Itch.

Is your horse feeling itchy? Maybe it's the season . . . Join us in AugustAAEP expert, Dr. Frank Reilly, answers your questions concerning your horse's summer itches.

1	Question: I have a Clydesdale mare with sweet itch. This spring and summer I was able to keep the itching at bay for the most part with heavy, twice a day, Permethrin spray. In the summer, she goes out at night because she stays in during the day to avoid the Texas heat. However, these past two weeks, she has come in with evidence of scratching her face and neck a lot, which seems like a reaction to something else besides culicoides. It is hot and dry in Texas in August and not favorable for culicoides breeding. Is it another insect allergy or could she be allergic to something else? I suspect she also has other allergies. What types of food allergies can horses have? Is it effective to give a corticosteroid shot in the spring at the first sign of itching, as well as periodic shots instead of daily steroid? I'm aware of the side effects but I'm wondering if the benefit of giving the lowest possible dose to control the itching cascade would outweigh the risks. I read your recommendations about baths, sprays and herbal supplements. What is the best herbal anti-inflammatory combination? Answer:  Culicoides bite at night, so when you are having problems at night, it is likely them.Yes, many folks have to do night turnout due to heat. Also, there are over 20 species of culicoides, that said, your horse can be allergic to many different species and one of them might have moved in recently or had a population explosion and is overwhelming the skin.  You need to apply strong spray on a paper towel and wipe the face, ears and neck. Also, make sure your spray is high in piperonyl as this allows pythrerins/permethrin to work better. I would add omega 3's to her diet to help the skin. Also, search or Google "equine summer eczema herbals" for natural oral formulas  to help her skin as there are many choices.
2	Question: My 15-year-old Morab palomino has developed a terrible hypersensitivity to both vaccines and now the bugs (and even some weeds) of spring and summer and has had terrible outbreaks of hives! At present, he is on a daily dose of 5 Hydroxizine tabs AM/PM after initial loading doses to get the reaction down. Recently, he has become lethargic and, while his coat is incredibly golden (having been covered all summer), his gums are pale and his mane and tail are slowly falling out. He is on an Omega supplement and, while I know it helps, I cannot seem to get him over this slump. Blood was drawn and he is only mildly anemic. The veterinarian thinks he may have developed a selenium toxicity because of the mane and tail hair loss symptom, which started about 3 weeks ago. I have tried to come up with a number for the selenium content in his feed and it may be around 3.5 mg - feed and supplements considered - and we are in Northern Illinois. While this seems high to me, I have read that 5 mg is the high end for this area. He is so uncomfortable, and now with the suggestion of a possible selenium toxicity - I don't know what to do and how to treat him. I have eliminated all possible sources of selenium except the omega supplement as of this week - that sel. value is .8 - and it helps with the itchiness. This is a terrible summer for bugs! Answer:  You are describing several allergy events in your Morab. Allergic reactions to insects, usually culicoides, resulting in equine summer eczema (itching, skin crusts, rubbing, hair loss...) AND food allergy to weeds resulting in hives. Horses that are hyper-reactive to these (one or both), often are more reactive to vaccines. At vaccine time, split up into 3 sessions 1 week apart (so less antigen load) and 2 hours prior to administering the vaccines, give banamine and pyrilamine in the vein. By having these medications on board, prior to vaccination, really helps. Also, avoid giving vaccines in the neck. Instead, use that big gluteal on the hind end. Next, the insects. You need to treat this condition using a strong fly spray 2x a day (culicoides eat at dusk to dawn but regular flies attack damaged skin in morning) at dusk and morning. He also should be bathed 3x a week to remove urine attraction (culicoides are 30x more attracted to horse urine than cattle urine). Oral herbs can also be given daily to lessen reactions. Your omega supplement is helpful due to omega 3's, which help skin quality, but it's not going to be able to stand alone. Your horse needs a barrier system (spray) and also consider night stalling with 2 fans to blow away culicoides since they are weak fliers. Your mane and tail hair loss is very common in equine summer eczema. Selenium toxicity is rare and Illinois, from studies with corn, show that area is actually low in selenium. Yes, 5mg is the top level. I would run a selenium blood level test (do not use sst tubes with gel as these create false low numbers due to selenium trapped in gel) and submit the spun down serum on ice packs to New Boltons Toxicology Lab(610-444-5800). The lab can tell you blood levels for peace of mind, but I bet they are fine. Your Omega supplement is fine and not a large selenium source. Remember, on your feed label, for example, if its 2ppm selenium, that means 2 mg selenium for every 2.2 pounds of feed. If feeding 1 pound of feed, then its about only 1mg selenium. Your hydroxyzine is a antihistamine but also has side effects of being a tranquilizer and can make your horse drowsy. Your anemia requires your vet to go over your feeding program and double check your deworming program to ensure parasites are not leading to anemia.
3	Question: I have a mare with anhydrous, which I am treating with a product from Platinum with success, but I am still dealing with a dry coat and itching. I use a coat conditioning supplement in her feed but still have to deal with this issue. Any suggestions? Answer:  The Refresh product from Platinum is electrolytes, vitamins and amino acids, so the addition of omega-3's are ok to add for added coat condition. Including a 1/4 cup of ground flax seed, once a day, for a 1000-pound horse is helpful. Poor coats also can be from parasites. Go over your deworming schedule  with your veterinarian to ensure you are not leaning too heavy on fecal tests, which miss tapeworms, bots and encysted strongyles. Also, the addition of a ration balancer with about 30% protein helps skin, which is mostly protein.
4	Question: My 6-year-old Morab mare has evidenced allergic dermatitis the two summers that I have owned her. She was given initial dexamethazone injections and then daily prednisone tablets. I also shampoo her with EquiShield shampoo, spray with Genesis spray and fly spray and give Wellactin omega-3 oil. She is better, but not cured. We are considering having CSU vets do immunotherapy after fly season and after she is off steroids. Is there any reason to be optimistic that immunotherapy will cure her? Answer:  For certain conditons, immunotherapy can work (i.e. stems cells into injured tissue), but for allergy issues, it is difficult to say allergy shots are effective most of the time (and there is the expense). For example, culicoide (#1 cause of allergic skin itching in horses) gnats come in over 20 species. Your horse will be tested for 1-2 of those, but could have problems with 5 out of 20 for example. Often, horses are ok until the population of the allergic gnat overwhelms the immune system. You have many good points in your program: 1. Baths--horse urine is 30x more attractive to these gnats than cattle urine. Bathe your horse three times a week, as once a week will not work. Any shampoo works well, even dawn dish soap. 2. Omega-3--wellactin and fish oil are great, but add flax to the mix (highest omega-3 product in world as well as economical). Take 1/4 cup flax seed, grind in coffee grinder (K-mart has them for about $15) and feed once a day. Flax seed must be ground to be effective. 3. Genesis spray (topical steroid spray) + dexamethasone shots + prednisone tablets all are used to control inflammatory reaction AFTER the bite. This tells you that the barrier system being used is failing. Your spray is not strong enough and its not being used enough. All fly sprays degrade in sunlight and gnats start biting at dusk, so you need to spray twice at day and dusk and morning (morning spray can help stop other pests from attacking damaged skin). 4. Consider flysheets (wash once a week to avoid urine attraction) and night stalling with two fans blowing as culicoides are tiny and weak fliers. Fans and sheets are barriers on top of a better fly spray and more applying of it. 5. Try some of these added management ideas and keep me posted.
5	Question: Through the years, I have had several horses, as well as noted clients horses, that loose mane hair on the underside of the mane. This causes a thinning of the mane. The area is slightly flaky but does not appear red or inflamed. The flakiness is not more than the normal appearing thicker mane. No history of rubbing this area of the neck, and the condition does not appear to bother the horse at all. Any ideas what causes this or if there is a way to encourage mane hair growth in this area once it happens? Answer:  Often, when I am not sure of what is causing a skin problem specifically, I will treat the most common skin conditions and get good results; what exactly was the problem goes undiagnosed, but the horse improves. 1. Insect hypersensitivity mild case----2x day spraying of a strong fly spray + omega-3 oil via 1/4 cup flax seed then ground in a coffee grinder (K-mart for $15) +  bathing area 3x a week with any shampoo. I have luck with dawn dish soap + oral herbals that keep inflammation down. 2. Parasites--I will do Equimax paste dewormer three weeks in a row (i.e. Monday, Monday, Monday). Many horses skin problems are due to deworming schedules too dependent on fecals. Tapeworms, bots, encysted stronglyes can be missed on fecals and a lot not dewormed for 6+ months. By using this program also helps get many ectoparasites. I will have the owner then go every 60 days with dewormers during the season of hair loss. 3. Sunshine increase--many of these horses get mild bacterial/fungal hair problems that sunlight helps control. 4. Nutrition---I will add more protein to the diet. There are many ration balancers with higher protein and zinc to help immune system of skin. Three baking cups is equal to one pound given to a 1000-pound horse. Skin is mostly protein. 5. I figure if I can get the top 3 or 4 causes of skin problems, then I will get most cases- shotgunning some may say, but the above items are easy and economical to try.
6	Question: My horse gets itchy on his sheath. He then scratches it with his teeth, which causes swelling. If I put swat on him every other day it prevents this from happening. Are any of the anti-itch supplements useful? I was concerned because of the ingredients like calf thymus. Other ingredients of some of these supplements included diatamacious earth  as I don't want to give this to my horse. Answer:  Your horse has a insect hypersensitivity reaction to most likely culicoides gnat, the #1 cause of itching in horses. There are many thing that can help: 1. Strong fly spray sprayed on the sheath twice a day in dusk (when they come out to bite) and in morning when other flies attack damaged skin. You can spray sheath safely but do not spray directly on the penis. Blast the spray right up the groin, belly area as the spray will cover a larger area than ointment swat and gets way under between the legs better. 2. Bathe your horse three times a week as urine of horses is 30x more attractive these insects than cattle urine. Be sure to scrub the sheath area with medicated shampoo and rinse well. You may use a medicated shampoo for three weeks then after that any shampoo, even dawn dish soap. If you find yourself in a pinch after a ride, at least hose off the sheath area with water and bath next day. 3. Consider night stalling with two fans blowing in the stall as this keep the insects away. 4. Fly sheets are of little help in this area. 5. Consider daily herbal anti-inflammatory therapy. 6. Add omega 3's to the diet including 1/4 cup of ground flax seed (#1 for omega 3 content of any product) or use chia seed (no need to grind) or a daily dose of 30cc orally of wheat germ oil. Purchase 100% Wheat germ oil and not the blend, which is 1/2 corn oil. Some horses may need an iv/im shot of antihistamines/steroids as a one time therapy for quick relief, but keep dose low. If your horse has Cushing's or insulin resistance (IR), your veterinarian will likely use only antihistamines. 7. If area looks infected from wounds, call your veterinarian for antibiotics--if your horse is not dropping out his penis fully and the area is getting sprayed with urine, your veterinarian will sedate the horse and check to see what the problem is. Get your horse's sheath cleaned with clean water every few months if he is one of those horses that accumulate a lot of debris.
7	Question: I have three horses stabled in a barn with a horse that was recently diagnosed with "herpes". His symptoms are lesions on both of his ears and his chest. Their reason for how he contracted the disease was from a fly bite that bit a cow and then bit him. I have two mares and a stallion in this barn and I am worried because this horse has not been isolated and is stalled right next to one of the mares that was scheduled for the breeding shed in the spring. Is this herpes and will my horses be effected? Answer:  What you are describing is a sarcoid, which will cause small benign tumors on the skin. Some will be nodular, some will be rough like sandpape and some will be in pinhead-like bumps. This problem appears from the latest research to be most likely from a form of papilloma virus very similar to that of cow papilloma. A papilloma virus is a different class than the herpes virus, therefore; your breeding should go on and do well. The one drawback of the sarcoid is its ability to topically spread on the skin to other places on that horse, but also when these areas become raw and bloody, spread to other horses. Sarcoids are the most common skin tumor of horses, but are benign, meaning they do not move internally or lead to loss of life. Many horse operations have sarcoid horses in a herd with no resulting transfer to other horses. There are many different treatments for sarcoids and your farm veterinarian can direct you to the ones they have found to be the best for the type this horse has on its chest and ears.
8	Question: I have a mare that cannot stop rubbing. In the past, she has almost rubbed her entire tail off and most of the hair on her hindquarters. I have covered most things so she can't rub her tail off. She chews on her legs a lot. I keep fly spray on the best I can and have a barn fan in the shed where she spends nights. I know she is miserable, but is there anything else I can do? My other horses are not as bothered. Answer:  Yes, your horse has an insect hypersensitivity allergy, so other horses are fine but she is likel unhappy. Please go to my other responses to see program---your fans at night are great but make sure at least two of them are blowing so there is a great deal of turbulence as culicoides are tiny and have a hard time traveling through these conditions. You also need to spray twice with a strong fly spray(doing right on tail but also entire body and up groin also), a good deworming program, include omega 3's within her current diet, if bathing, she will need to be bathed three times a week to remove attraction, possible herbal anti-inflammatories added. Unfortunately, no one thing will stop it and will require a gang tackling to get results. I like using a medicated shampoo for 30 days then go to any shampoo, even dawn dish soap, works well.
9	Question: I purchased a Tennessee Walking horse (light bay) this May. He had just a little dandruff in his mane, but it cleared up. Now he has lost two long chunks of his mane from scratching. In among the roots of the hairs are small red areas and some light scabbing. He also has flaking at the top area of his mane. I am currently giving him a top-dressing bug-off additive and it seems to be working for most of his body, but he has rubbed his chest area and now has small raw areas. I have tried horse products for itchiness, but many of them had sulfur and he welted from them. Head and Shoulders for itchy scalps seems to be working for the mane and tail issues if I use it every day. I am putting an ointment on his chest to help it heal and to keep small insects away. I use Ultrashield on his body and legs where there doesn't seem to be a problem. Also, he has managed to scratch both sides of his sheath with his hooves, so that there are raw spots there as well. I am using the ointment there as well. He goes out at 4am and comes in at 10:30am as the Florida heat is terrible right now and he likes the stall fans, which probably help keep the bugs at bay. I am at my wits end trying to make him comfortable. Answer:  Have your veterinarian look over chunks of hair area as this might be a combination of rain rot (hair out in paint brushs like chunks with bacterial pus under) and insect hypersensitivity.Your doctor may need to put your horse on antibiotics for a small time.Your shampooing is a great idea since the culicoides are very attracted to urine, but you must bath 3x a week at a minimum. Currently, in an outbreak, you are using a medicated shampoo, which is perfect, as you need to avoid secondary bacterial infections from bites or from horse self mutilating skin from rubbing on posts, kicking himself with back feet into his own sheath. Next, your spray is good, but it is not being used correctly if he is kicking his sheath. You can spray these right onto the sheath (not on penis) on both sides. Give him a blast of fly spray twice a day at dusk and in the morning over the entire body including mane. Your spot on will not protect the entire body as it is NOT in the same class of medications as spot on dog products. The horse spot on is only pyrethrins or derivatives of that. Also, add omega 3's to the diet and ensure you are deworming correctly at least every 60 days with these type horses--do not rely on fecal tests--see my last response for dosing omegas and dewormers. Remember culicoides eat at nite, so nite turnout requires daily dusk fly spray over the entire body. However, many horse owners in Florida are doing as you are with nite turnout due to hot daytime and providing a stall he can walk into with fans to blow insects away at nite or a shed with fans in the corners to further avoid culicoides since fly sheets in hot weather are difficult.
10	Question: I have a middle-aged pony that in the summer, particularly July and August, starts to itch. Itching is mainly on her face, neck and chest. Her once beautiful mane becomes very brittle and breaks off as does her forelock and tail. Her tail also begins to look like a honey comb with all the dead skin build up. I have tried the usual shampoos, conditioners sprays, ointment, fly sheets, feed additives, etc. I have not done blood workups on her. Is this something I should try and what tests should be run? Answer:  What your pony has is a specific allergy to a specific insect or group of insects that move into your area during this time, OR are there but reproduce rapidly at that time so the numbers are overwhelming. Remember, there are over 20 species of culicoides and the populations change and your horse might not be allergic to one type of culicoides but is to another that moves into that area. I would suggest several items to "combo- tackle" the problem--1 or 2 things will fail: 1. Make sure you are deworming every 60 days with ivermectin products from May to Sept (i.e., May, July, Sept) as you will need the immune system at peak performance (wormy horses have poor coats and poor protective barriers).  2. Add omega-3 products shown to help skin in small animals---flax seed (you may have to grind up to 1/4 cup of seeds a day, every day as flax is highest in omegas), or chia seed at 1/8th of a cup a day (no grinding) or wheat germ oil at 30cc a day (NOT wheat germ oil blend which is 1/2 corn oil--get 100% wheat germ oil). 3. Sprays---2x day at dusk and in morning--use with pyrethrins, permethrin,  piperonyl stabilizer. No fly spray lasts over 12 hrs as sunlight breaks them down. Be sure to pay attention and spray on mane and spray a clean paper towel with two pumps and wipe her face. It is very important to know that often spray is weak or not applied at right times or not done twice a day. Why should you spray during the day? Damaged skin attracts other flies. 4.Oral herbals with anti-inflammatory ability can help. 5.Yes, shampoos can help but must be done 3x a week for effect since the urine of horses is very attractive to culicoides (30x more then cattle urine). Also, blankets that get dirt/urine on them can be a problem as they need to be cleaned once a week or put a new one on. 6. Stall at night with fans as culicoides are tiny and poor fliers and eat at dusk to dawn.
11	Question: I recently purchased a 13-year-old Tennessee Walking horse that was on 24-hour turnout. Now he has a stall and is turned out 7-10 hours per day. He has managed to scratch out part of his long mane (on trees, walls,etc.) When I look between the hair roots of his missing mane area is it red and slightly scabby. Also, along the opposite side of his neck where his mane originates, there are faintly bumpy areas where there are dead skin flakes (gray in color) that are rising from his skin's surface. I am using a very very fine toothed comb to remove these flakes and separate them from his coat. There is no loss of hair, just these flakes rising from his skin's surface. I am at a loss as what to do for him. His tail, at the base, has also flaked before, but I have gotten this under control using Micro-Tek spray, however, it doesn't seem to be working for his mane area....HELP!!!!! Answer:  The most common allergic condition of the horse is insect hypersensitivity and the #1 cause of that is allergic reaction to the bite of culicoides---this can produce an itch that has your horse self-mutilating its skin via vigorous rubbing on fences, poles, trees like you are seeing. There are several steps to take to help your horse: 1. Apply a strong fly spray 2x a day---culicoides bite from dusk to dawn so apply once at dusk, but also in morning---damaged skin is attractive to other bugs during the day. 2. Bathe 3x week--the urine of the horse is very attractive to culicoides--when they roll, they place urinary components into the mane. The baths also soothe damaged skin by preventing secondary infections. 3. Add omega 3 to diet via flax seed (ground), chia seed or wheat germ oil--shown to help soothe skin. 4.Go over your deworming program with your veterinarian----ensure onchocerca is not an issue--ivermectins also can be of help in lice, mite problems (given multiple times over weeks). 5. Nite time stalling with fans would help avoid culicoides due to weak fliers and eat at nite. Remove any old standing water that breed culicoides (tires with water in them, stagnant water). Please remember that these insects can fly up to one mile, therefore; if your neighbors have standing water, it will be tough to stop. 6.Fly sheets may also benefit--- another barrier on top of fly spray, to protect--are ones that cover the mane. 7.Your veterinarian also can do a skin scraping of the area.
12	Question: The use of cortocosteroids (oral prednisolone or injectable Vetalog) are invariably recommended by my veterinarian to treat sweet itch in my 20-year-old mare with worsening symptoms each season. Which horses will develop laminitis in response to steroid therapy? Is the horse more at risk of doing so each subsequent year? How can the risk be reduced? Answer:  At times, in severe outbreaks of summer eczema, steroids may be needed for one to two treatments to decrease inflammation and stop itching that is so bad the horse mutilates itself by rubbing on fence posts or crawling on the ground, rubbing its belly over rocks. Steroids for this small amount of time avoid problems with possible triggering of insulin resistance surging or laminitis episodes in horses with Isulin Resistance (IR) and Cushing's. Long term, daily steroids are not an option in horses with IR, Cushing's, past laminitis and studies have shown even in normal horses, IR can be seen in long-term steroid use over 21 days. The goal is to avoid the active case by management---fans blow culicoides away easily as they begin biting at dusk to dawn. That said, stalling at nite with fans helps. The 2x day application of strong fly sprays is mandatory to avoid the bites. The addition of omega-3 supplements such as flax seed (ground), chia seed or wheat germ oil has been shown to help skin conditions and skin health. Baths given 3x a week has been shown to be very helpful in reducing bites as the horse's urine is very attractive to these insects. Barriers of fly sheets can help, but they must be cleaned regularly of horse urine picked up when they roll. The use of daily antihistamines has been used, but like steroids, this is only treating the horse after its bitten, which is not the goal.

Ask the vet: Nutrition

Join AAEP's "Ask the Vet" forum during July to pose your questions on the topic of equine nutrition to our AAEP expert, Dr. Lydia Gray from SmartPak Equine.

1	Question: In the hot summer months when my horses are sweating a lot, which electrolyte supplement would you recommend feeding? There are so many on the market and so many articles about which ones to feed and which ones to avoid. Answer:  I agree, there are a lot of choices out there when it comes to electrolytes! And since replacing the vital nutrients lost in sweat as well as encouraging horses to drink and rehydrate themselves are both critical to your horses’ health, so let’s see if we can help you sort things out.  Some things to consider when choosing an electrolyte are palatability (i.e. tastiness), the presence of extra or unnecessary ingredients (like sugar), and how closely the supplement mimics the minerals horses lose in their sweat. The ideal equine electrolyte, therefore would be one that horses eat readily, that contains little or no added sugar, and that is formulated to replace what is actually lost from the horse due to sweating. Numerous studies in this area have shown that the major ions found in horse sweat are chloride (Cl), sodium (Na), and potassium (K), in that order, with a little bit of calcium (Ca), so look for a supplement with primarily these macrominerals. Here is a link to a fact sheet with more detail about sweating in horses and electrolyte supplementation to replenish losses: http://www.thehorse.com/free-reports/30000/electrolytes.
2	Question: I would like to know, when feeding crimped oats, what vitamin/mineral supplement would be a good choice. My horse is a pleasure AQHA gelding, not worked but 2 to 3 times a week. Answer:  If your horse was getting a full serving of a fortified grain I would tell you that a vitamin/mineral supplement isn't necessary, but since your horse is getting just crimped oats for extra calories, you’re smart for looking into a vitamin/mineral supplement to complement his diet. I’m going to assume that he is also getting an appropriate amount of quality hay.  When looking for a multivitamin, remember that not every horse’s nutrient needs are equal. Your horse’s workload will influence his vitamin and mineral requirements, so look for one that differentiates between different workloads. Also consider looking for a multivitamin designed for his life stage. For example, senior horses may benefit from additional vitamins that also serve as antioxidants such as vitamins E and C. If your horse is older, look for a multivitamin formulated with the senior in mind. Lastly, palatability is important as the supplement won’t do him any good if he doesn't eat it. Try and find a pelleted option, as most horses prefer them to powdered supplements.
3	Question: I have three older horses(15, 20, and 25) that are fed hay twice daily, and get pasture turnout two hours in the afternoon/evening. The pasture is now dry and getting sparse. Their weight remains good as I have always fed 1/2 grass hay and 1/2 oat hay. This year my local feed store has run out of oat hay several times and they recommended feeding wheat hay. I tried it and the horses loved it! Are there any problems associated with feeding non-bearded wheat hay? Any benefits over oat hay? Answer:  That’s great that your horses all like the wheat hay, as some don’t care for it. Where I’m located, neither oat nor wheat hay are very common forages for horses; we’re more familiar with oat and wheat straw for bedding. If the wheat hay is beardless, it’s been tested for nitrates, which can be high in both these crops, and you’re feeding a ration balancer to provide protein, vitamins and minerals (especially calcium) then gradually introducing your horses to this new forage should not be an issue.  If you’re concerned about this significant switch in hay types, consider adding a digestive supplement with ingredients like yeast, probiotics, prebiotics and enzymes to assist in the transition, much as you would when introducing horses to pasture in the spring. Remember that changes in hay can increase a horse’s risk for colic by ten times (while changes in grain can increase the risk five times).
4	Question: I have a 26-year-old Tennessee Walking horse that has recently started losing some weight around his flanks. He is free of parasites (this was checked last month) and an equine dentist pronounced his teeth in good condition. Good pasture is available to him 24/7 and he is also fed about 4lbs of grass hay daily at this time though he prefers to graze in his pasture. He receives no grain. I started him on Purina Senior about 10 days ago to supplement his nutrition needs and am feeding him twice per day (3.5 lbs per feeding). I have been told by my local animal feed store that I could put more weight on him by using Purina Strategy or Purina Ultimum. He is not worked and only on a maintenance feeding plan. He is otherwise alert and seems happy with his other Tennessee Walking horse companion. Could you please advise me on a feeding plan? Answer:  Congratulations for getting this far with your guy! Now it may be time to think of him as a senior horse with senior needs. I’m really glad to hear that you've had his mouth inspected and all seems to be fine there. You still need to make sure that he can bite off, chew and swallow pasture grass though and hasn't begun quidding. If you suspect that may be the case, he might not be able to masticate long stem hay either in which case it’s time to transition to chopped hay, hay cubes or hay pellets. Next, AAEP has just published Parasite Control Guidelines that I would encourage you to read, with one of the first things you’ll learn being that no horse is truly “free” of parasites. He may be a low shedder, or the parasites may not be laying eggs right now, but I’ll guarantee you that your horse has worms so please don’t neglect giving him dewormer at least once or twice a year! The older horse begins to become less efficient in many organ systems, including the immune system, so an appropriate parasite control program (and vaccination program) becomes even more important as he ages. Another organ system that doesn't work as well as cells and tissues get older is the digestive system. Since he’s now less able to extract nutrition from the same food he’s always eaten, starting him on Purina Equine Senior was a great idea! This commercial “hay and grain in a bag” is specifically made for the older horse, with higher protein levels to keep their topline and other muscles from wasting and easier-to-digest ingredients than traditional concentrate. Since it is like both hay and grain combined--with feeding rates as high as 12, 15, or even 18 pounds per day--don’t be afraid to add a third meal or to give him more each time. Of course, if you switch to a true concentrate like Strategy or Ultium, you would feed much less. So there’s a trade-off between feeding large amounts of a highly digestible feed made for senior horses or smaller amounts of a higher calorie feed made for hardworking or hard-keeping horse. You may want to (gradually) try both approaches and see which does a better job of keeping weight on your individual animal. There are lots of other ways to put weight on horses and keep it there, and unfortunately you have to do a little bit of experimenting with your own horse to see what works best for him. Some horses really blossom when the diet is supplemented with additional protein or amino acid, others respond to extra fat, while still others gobble down beet pulp, a high fiber feedstuff, which is fermented by the beneficial bacteria in the hindgut into fatty acids or energy. I recommend trying one thing at a time and seeing how your guy does, while at the same time identifying and removing sources of stress or unnecessary calorie loss, such as stomping flies in the summer, shivering in the winter, or illnesses and injuries. I’m also a big proponent of keeping horses in consistent light work as long as possible, soundness permitting, as even walking promotes muscle development. And of course, stay in touch with your veterinarian, who may want to bump up the annual visit to twice yearly, since problems with immunity, digestion, teeth, hooves and other parts happen much faster once horses enter their golden years. Good luck and enjoy your horses for a long time to come!
5	Question: I have a 10-year-old Warmblood/Thoroughbred that I got last fall. At that time, he was on a high fat high fiber diet. His weight has decreased so we have switched him to a Purina feed, which is suppose to give him all the calories he needs. He has been dewormed recently and does not spill his feed when he eats. I believe his teeth are good. He is currently on grass and always has hay. He shares pasture with two others and is use to being in a herd. I was thinking about checking for ulcers? Any ideas? Answer:  If I were your veterinarian trying to help you figure out why your horse lost weight and how he might gain it back, I would want to know a couple more things. For example, what was his body condition score (BCS) last fall when you acquired him and what is it now? Each BCS is about 50 pounds (slightly more for a larger horse like a Warmblood or Draft) so if he was a 5 and is now a 4, he lost 50-75 pounds. If he is a 3 now, he may have lost more like 100-150 pounds. Next, where do you live and where did the horse come from? If in a northern climate, do you think he either did not acclimate to the move or just in general has a hard time keeping warm in cold weather and burns a lot of calories to do so? I had an OTTB that would consistently lose weight in the SUMMER because he didn’t tolerate the heat or bugs well and just stood around stomping instead of eating. That said, make sure you understand your new horse’s personality and metabolism when it comes to seasonal weather changes. What do you do with this horse? If he came from a pasture ornament situation into full training and is now expected to compete in dressage, eventing or as a hunter/jumper, then his caloric intake needs to increase accordingly.  You mention that he is used to being in a herd and now lives with two other horses. How did the establishment of pecking order go? Do you know where he is in herd hierarchy? Sometimes horses get pushed off their hay pile prematurely and spend the bulk of their eating time getting moved around, which uses up calories instead of taking them in. The Warmblood I have now wears a grazing muzzle at all times because he can inhale all eight piles of hay in “his” seven-horse paddock faster than you can say “easy keeper.” Since you also describe the grain that he eats (Purina TriMAX, available in Canada), I’m assuming you bring your horses into stalls for meals or in some way separate them so they can eat their fair share in peace? Speaking of “fair share,” Purina recommends feeding a range of 0.5 to 0.75kg grain per 100kg body weight. If we assume your horse weighs 500kg (1100lb) then he should be getting 2.5 to 3.75kg each day (5.5 to 8.25lb), aiming for the lower end of the range to meet his minimum vitamin, mineral, and protein needs and the higher end of the range to provide extra calories for heavy work or weight gain. Remember the rule of thumb: no more than 0.5% of a horse’s body weight per grain meal, which for a 500kg (1100lb) horse is 2.5kg (5.5lb). To use this grain as it is intended then, you should be giving your horse 1.875kg (a little over 4lb) in the morning and in the evening. Since that’s a lot of grain and feeding large amounts of grain has been linked to gastric ulcers, you may want to provide calories via another route, such as beet pulp, alfalfa cubes, a fat supplement or other option. Each horse responds differently to these various methods of increasing the energy in the diet so I recommend trying one at a time, for about a month, before moving on to the next. The clinical signs of ulcers, their diagnosis, treatment and prevention have been covered in great detail elsewhere http://blog.smartpakequine.com/2013/06/foregut-or-hindgut-thats-the-question-part-1/, so I’ll let you research those facts on your own! Finally, if you have not had a qualified person actually examine his mouth and inspect his teeth since you purchased him (and performance horses usually get looked at twice a year) then it’s time. Also, I strongly urge you to read AAEP’s guidelines on parasite control, to make sure your program is as up-to-date as possible. If careful consideration of what changed in his life since you purchased him and attention to the details of his diet don’t improve things, then it may be time to have your vet out again to examine him and try to get to the bottom of his weight woes.
6	Question: I rescued three starved horses, two 12-year-old Percheron geldings and a 23-year-old Quarter horse mare. My veterinarian told me to put them on some high fat/high fiber and I was also told senior would be the best as its HF-HF, and easily digestible. What would you recommend? Answer:  I’m impressed that you rescued three horses at one time! You’ve certainly got your hands full! Fortunately for you, and for them, my background is in horse rescue and I swore by the research that Dr. Carolyn Stull and her team did at the University of California-Davis. She found that starved horses were not unlike starved people (think POWs) in being susceptible to refeeding syndrome, which can be fatal.  This syndrome happens when a person or animal goes without food for a long time, begins to breakdown their own body for nutrition, then is “rescued” and given food high in energy/calories, which then leads to electrolyte disturbances and even death. She found that small, frequent meals of alfalfa hay were the best way to bring starved horses back to health, as oat hay was too high in fiber and too low in other nutrients but grain was too concentrated a source of calories. Here is the research if you would like to share it with your veterinarian so you can develop a safe feeding plan: http://www.vetmed.ucdavis.edu/vetext/local-assets/pdfs/pdfs_animal_welfare/eq-isoenergetic-javma212-5-691.pdf My advice is don’t be in a hurry to fatten them up or to put their preventive care programs in order (vaccines, parasites, teeth, hooves). All of these procedures create stress and some, like immunizing, rely on the horse’s body to mount an appropriate response. If they’re truly a body condition score of 1, immunizations will likely slow down their recovery while conferring no protection. So give them time to eat and heal from the inside out; there will be plenty of time later to start providing good veterinary medical care!
7	Question: I own a 13-year-old Morab mare that is out on pasture. I have not been riding much lately. She has her deworming, vaccinations, feet and teeth up to date. Should I give her any free choice mineral, and if so, what would you recommend? The horses do have access to a cobalt salt lick. Answer:  There are a couple of key pieces of information missing from your question in order for me to give you the best advice, such as what part of the country you live in, how much and what quality of pasture she has access to, and if she is a an easy keeper or at an ideal weight (she could be a hard keeper but guessing from her breeds that is less likely). Depending on the answers to these questions, your horse “may” be getting a complete and balanced diet just from the pasture, but most horses don’t, as—you got it—minerals can sometimes be lacking or in the wrong ratio in some areas.  I’m not a big fan of licks for horses, whether they’re white salt licks, red trace mineral licks or blue cobalt licks. These blocks were made for the rougher tongues of cattle and while some horses don’t mind licking them, others scrape them with their teeth or don’t bother with them at all. So loose minerals as you suggest would be a better choice, but rather than asking her to select what she needs or doesn't need (horses don’t have a craving for anything but sodium) why not top-dress salt or minerals onto something she likes, like a handful of oats, hay pellets or beet pulp? By separating the horses just once a day to supply their individual minerals, you’ll be ensuring that each horse gets his or her daily serving of essential nutrients.
8	Question: For a few years, my 18-year-old Appaloosa gelding has been given Equinyl Combo once a day. He has had no serious joint issues, but we want to maintain joint health. A veterinarian recently recommended Cosequin ASU instead. What is your opinion on the efficacy of each? One concern is that Equinyl is partially continued release, and Cosequin is not. Answer:  Kudos to you for staying on top of your horse’s joint health! Fortunately, more and more research is being published about the effect of oral supplements on the health of equine joints. ASU or Avocado Soybean Unsaponifiables is one example. In 2007, researchers at Colorado State University gave six grams of ASU (about three times as much as is in Cosequin ASU) to half of the horses in their study and a placebo to the other half. While there was no difference in pain or lameness between the two groups, the horses that received ASU showed a significant reduction in severity of articular cartilage erosion and synovial hemorrhage and a significant increase in glycosaminoglycan synthesis. That is, ASU had a disease-modifying effect, which is probably what your veterinarian is basing his recommendation on. When it comes to choosing supplements there are many factors to consider, with research being one of them. You also have to take into account levels of key ingredients, cost, palatability and probably the biggest factor: how does my horse feel and move while on this product? For reasons I cannot explain, some horses seem to do better on a certain brand or with certain ingredients while other horses respond to a different brand or different ingredients. Since you and your vet know your horse best, I’ll step back and let you guys choose the product that is in his best interest!
9	Question: What are your thoughts on feeding naked oats? The nutrition value in protein and amino acids, fat, easily digested starch and in bonus avenanthramides is certainly the number one grain. What do you think? Answer:  I’ll admit, I had to look up “avenanthramides” to learn that they are a type of oat phytoalexin that exist predominantly in the groats of oat seeds and have antioxidant and anti-inflammatory properties. Now I finally know why oatmeal baths and shampoos can be so soothing to skin after a sunburn or poison ivy outbreak! And just so everyone is on the same page, hull-less or “naked oats” are high-fat (12-15%) varieties of oats that have been produced which are higher in energy than traditional oats. In addition, hull-less oats typically contain more protein, including higher amounts of the limiting amino acids lysine and methionine. However, they also contain more phosphorous, so owners need to make sure the rest of the diet has appropriate levels of calcium to ensure the ratio between these two macrominerals is correct. So there are some pros to “naked oats” and some cons, and as long as you understand which type of oats you’re buying (with the higher price tag for hull-less oats this shouldn't be too hard) I say avenanthramides away!
10	Question: My horse appears to overproduce oil on his head. Could this have anything to do with his diet? His hair falls out in patches as though it is not being hosed down properly, but slowly grows back. Then the cycle begins again. This only happens when he is in full work.  Answer:  While there are some nutritional deficiencies and excesses that manifest as skin and hair conditions, I’m not sure this is the case in your situation. I recommend having your veterinarian out to examine your horse and perhaps take some skin and hair samples to get to the bottom of the problem. At the same time, you’ll want to share your horse’s complete history with your vet as well as what you’re feeding your horse, including when and how much. Hopefully, between the physical examination, biopsies or cultures, and evaluation of your horsekeeping and feeding, a diagnosis can be reached and appropriate treatment started so you can get back to enjoying riding!
11	Question: I have three Quarter horses and a Tennessee Walking horse. Their diet consists of a high quality forage (hay and pasture) with a mix of pelleted feed (low carb/no corn) and timothy pellets, supplemented with Gro strong vitamin and minerals, freshly ground flax seed, and biotin. They look great with a body condition score of 5 to 6. I have searched for a grass hay based feed that does not contain wheat middling or beet pulp. The commercial feed manufacturers do not consider wheat middling a grain since they sell 'grain free' feeds with wheat middling as the primary ingredient. What is the nutritional benefit of the wheat middling to the horse, or is a cheap filler? Answer:  Sounds like you’re doing a great job feeding your horses! To answer your wheat middlings question, I turned to AAFCO (Association of Animal Feed Control Officials), who defines it as a grain by-product that “consists of fine particles of wheat bran, wheat shorts, wheat germ, wheat flour, and some of the offal from the ‘tail of the mill.’ This product must be obtained in the usual process of commercial milling and must contain not more than 9.5% crude fiber.” My other go-to source for equine nutrition, The Sixth Edition of Nutrient Requirements of Horses, says the inclusion of wheat GRAIN in horses diets is somewhat uncommon. However, wheat by-product feeds are often used in horse feeds, wheat middlings (midds) being one of the most common. Because most of the flour has been removed, wheat midds are higher in fiber and protein, but lower in energy than wheat grain. Wheat midds may contain more than one percent phosphorous so calcium supplementation is usually necessary when wheat midds constitute a significant portion of the diet. Due to their fine texture, wheat midds are not easily fed alone; however, they are commonly used in pelleted feeds. Let me see if I can translate some of this nutrient-speak. First of all, don’t be alarmed by the use of the word “by-product.” I know the term scares some people off, but it doesn’t necessarily mean an ingredient is bad, all it means is that some ingredients, such as wheat midds, are not the main reason for processing wheat, which is primarily used to make flour for people. Because wheat midds are a by-product, their quality and nutrient composition can vary, but in general; this ingredient is high in protein, energy, starch, phosphorous, and potassium, with some trace minerals and vitamins to boot. So it does have nutritional value to the horse, and for this reason, as well as the fact that it’s fine texture helps bind pellets, you’ll see it in many commercial horse feeds.

Ask the vet:Colic

If you own horses long enough, chances are you will be faced with the threat of colic. Get the answers first by posing your questions concering the topic of colic to our month's AAEP expert, Dr. Christina Hewes.

1	Question: I have a 17-year-old Thoroughbred with a history of gas colic - usually about 3 episodes a year - and is a mild cribber. He is turned out on pasture 24/7. A couple of months ago, our barn switched feed and since then, he has increased his cribbing and has become more gassy. With his history, my veterinarian believes the cribbing is a sign of gastric distress brought on by the feed and recommended that I find a different feed (he said that the new feed might have too much sugar as the feed bag says that the pellets contain molasses). What do I need to look for in a feed? He is already getting pre- and probiotics. Answer:  I agree with your veterinarian that this new food seems to be upsetting his gastrointestinal tract. I would look at the previous feed that did not cause problems and switch back to the original feed or find one very similar to it by looking at the ingredients, not the percentage of protein, fat, or fiber. I do not know which ingredient upsets your horse's system in the new feed. It could be the molasses or it could be something else. The only way to know is by comparing the old and new feeds.
2	Question: My 22-year-old mare coliced and after the episode, the veterinarian recommended I put my horse on an ulcer medication. Why would my veterinarian make this recommendation? I have owned my horse for 12 years and she is a very easy keeper as this colic episode was her first that needed the attention of a veterinarian. In the past, she has had two mild gas colics. Answer:  This is a tricky question since I did not see your horse. A large percentage of horses have been found to have ulcers in their stomach. Ulcers can only be accurately diagnosed by placing an endoscope (medical camera) into the stomach to visualize the inside lining. Many vets have found that treating for gastric ulcers can resolve colic in some horses, whether or not the horses have ulcers. It may help to lower the gastric acid levels, which the ulcer medication does, to reduce some intestinal discomfort. Although your horse seems to be at a low risk for ulcers, ulcers or intestinal irritation still could be present. If the medication helped your horse, there may have been something irritating the intestines that reducing stomach acid helped.
3	Question: My horse went into colic mulitple times over the winter. Finally, the last veterinarian that came out to treat my horse, determined that the horse needed to take Sand Clear every day. The product says to only take a week a month but the veterinarian insists it must be taken every day due to the shale on the property. Is it safe to feed Sand Clear everyday? Answer:  There are different opinions on the use of psyllium, which is the active ingredient in Sand Clear. I prefer to give it one week of every month. Horses can develop the ability to digest psyllium in the colon, especially if they are receiving it everyday. This would prevent the psyllium from moving the sand through the colon. By feeding it intermittently, the horse is less likely to develop the ability to digest it so it can still help move the sand/silt through the intestine. Another thing to consider is using probiotics to help keep the intestinal bacteria working appropriately. This can improve the colonic motility and help move sand out. One study found significantly more sand was passed through the intestinal tract when probiotics and psyllium were given together.
4	Question: Does coastal hay cause colic? Answer:  Coastal Bermuda grass hay has been associated with feed impactions in the ileum, which is a portion of the small intestine. Some of these impactions resolve with nasogastric tubing with water, mineral oil, and electrolytes, while a small number require surgery. With that being said, many horses eat coastal hay regularly without a problem. Having good quality hay is very important so if you need to feed coastal hay due to your situation, many horses will tolerate it without colic.
5	Question: I have an 8-year-old Thoroughbred mare that developed spasmodic colic after getting cast in the stable two years ago. Since then, she has had a number of spasmodic episodes with the last one for a period of 36 hours. She lost a lot of weight and is currently on haylage and a high fiber, slow release mix. She is getting little turnout or grazing, but is being worked and hacked out 3 to 5 times a week. Is there anything else I should do to maintain her and stop the incidents of colic? Answer:  Chronic colicers are always tricky to manage. In some of the scientific studies they have found that horses that live on pasture have the lowest rate of colic. If you could find a situation where your mare is turned out for most of the day, it may help her. The movement in the pasture seems to improve the ability of the intestinal tract to move gas and feed material. If a pasture is not an option, getting her out every day for some activity is important. It can be just hand walking if you do not have time to ride. You may also want to note if there are certain types of feed or weather patterns that correspond to her colic. If she colic's when it rains, you want to ensure that she is getting some extra exercise on those days. If she colic's when fed a certain type of hay, try to find one that seems better.
6	Question: The stable where I board my horse has very sandy pastures. The horses are in a dry lot for all months except a few in the summer when the grass is tall enough. Is it a good idea to give my gelding a 7-day dose of a sand-clearing supplement like Arenus Assure Plus (a pelleted psyllium based feed additive with synbiotics and controlled release digestive aids. This patent pending pelleted combination of psyllium and digestive aids removes all of the sand and silt from the large colon)? On the other days of the month, I give him just the regular Arenus Assure (a granular daily feed additive with psyllium and synbiotics that improves the environment of the colon and improves normal digestive processes). I feel these are good preventative steps - as I have already lost a horse to sand colic. Do you feel this is a safe plan? Answer:  Sand colic is a difficult type of colic since horses tend to ingest sand when eating from the ground. The only way to prevent sand colic is to prevent sand intake. Feeding inside a barn or on a mat can reduce sand intake. Since this may be difficult in your situation, a one week course of psyllium is a good idea. I tend to have horses fed psyllium for one week a month and then have no psyllium for the following three weeks. This seems to prevent horses from obtaining the ability to digest psyllium, which is possible if fed psyllium constantly. For the products you are looking at, they both have psyllium in them so I would want to ensure that the Plus version has more psyllium than the other version. I might also try to find a supplement without psyllium that can be fed daily and add the psyllium for one week per month. Also, I do not think there is a  feed supplement that can remove all psyllium from the colon despite the label claims. If a product worked that well, then we would recommend it to all horses. At this time, intermittent psyllium seems to be the best way to prevent a large buildup of sand in the colon.
7	Question: Why is it so important to not let a horse with colic roll?  Answer:  This is a very common question. It is important to not let a horse with colic roll since they can injure themselves when they are rolling. The rolling rarely causes the intestine to move into an incorrect position but is a sign of the pain caused by the abnormal position of the intestines. If the horse is trying to roll, I recommend walking them to distract them from the pain and possibly relieve the cramping from the colic. Walking can also help the gastro-intestinal tract expel gas, which may relieve the colic pain. If the horse is sitting or lying quietly, the horse can be left alone until the veterinarian arrives to examine him. If the horse is uncontrollable and trying to roll, everyone needs to stay out of the way so they are not hurt by the painful horse.
8	Question: What diagnostics should be performed on an 8-year-old, otherwise healthy, gelding that frequently (every 1-3 months) suffers from low grade gas colic? His manure consistency and volume remains unchanged, his feed remains the same as does his stress level. He lives in an acre field (dry lot under trees) with a 21-year-old companion. They both have access to ample fresh water and frequent small feedings of quality grass hay. The hay is fed in slow nets tied inside clean plastic livestock tanks. Aside from 1/4 cup flax, mineral supplements, and regular psyllium doses mixed in grass hay pellets, and a carrot or two, he's not ingesting anything other than hay (the bark on the trees remains untouched, the fencing is plastic/Centaur, the field is covered with fine pine chips). He has had a tendency to colic since my daughter purchased him as a yearling, but now that he's living at our home and not a boarding facility. We notice his discomfort more often (appetite diminished, lying down and getting up, flehmen response). He often walks and passes gas as his way out of the discomfort, but we need some help for the poor guy! Answer:  This is a complicated question since it sounds like you have made a good environment for him. It sounds like your gelding is either producing too much gas or has a motility disorder in his intestinal tract, which could be secondary to inflammation. I would start with a fecal exam to look for parasites, even if he is regularly dewormed. I would then consider adding a probiotic to his diet since he is producing excess gas on a regular basis, which may help normalize the bacteria in his colon. If he is on any medications, I would ensure that he needs them and consider side effects, which could upset his gastro-intestinal system. Another thing I like to do is ensure he is getting enough activity with daily exercise form riding, lunging, or hand walking. Although he is in a pasture and should be walking around often, he may not be active enough. Another diagnostic is a gastroscopy to look for gastric ulcers even though he is in a low stress environment. A final option is to try a different type of hay to see if it produces less gas in colon. If you change his hay, it should be done gradually by adding small amounts of the new hay to his old hay. The amount of new hay should slowly increase and old hay decrease over a 1-2 week period to transition him to the new hay.