The Horse

MAR 2019

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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A13 The Horse | AAEP Wrap-Up March 2019 YOUR GUIDE TO THE 2018 AAEP CONVENTION and other potential problems; 2. Nerve blocks can be difficult in these cases because the horses are not obvi- ously lame, he said; 3. If a lameness isn't visible when a horse jogs in hand, evaluate him on the track; 4. Nuclear scintigraphy (bone scan) can help pinpoint areas of stress remodeling or bone fatigue before radiographs can; 5. Conduct upper airway endoscopy both at rest and during exercise; 6. Always evaluate the trachea for mucus or blood following exercise; 7. A neurologic exam can help rule out issues such as equine protozoal myelo- encephalitis (EPM), neck arthritis, and spinal cord compression; 8. Conduct bloodwork. Elevated liver enzymes, such as γ-glutamyltransferase, could indicate issues that can decrease performance, and elevated muscle enzymes, such as creatine kinase and aspartate transaminase, suggest exer- tional rhabdomyolysis (tying-up); 9. Check for gastric ulcers, which 90- 100% of racehorses have, he said; and 10. Check for uncommon cardiac issues, such as atrial fibrillation. Some of the most common diagnoses he makes during these exams include: ■ Musculoskeletal disease (specifically, bone stress remodeling and proximal suspensory desmitis); ■ Upper respiratory tract issues (recur- rent laryngeal neuropathy, or "roaring"; dorsal displacement of the soft palate; and aryepiglottic fold deviation), all of which block airflow into the trachea; ■ Neurologic problems (EPM and cervi- cal facet OA); and ■ Liver disease (caused by oxidative stress, mycotoxins, viral infection, and/ or diets high in cereal grains). But, he said, "the No. 1 cause of poor performance is a horse's lack of abil- ity and unrealistic trainer and owner expectations." Even so, if there is a disease process or injury behind a horse's subpar perfor- mance, an accurate diagnosis can help the vet get him back on track. Middle-of-the-Road Laryngeal Grades: No Impact on Racing Sales veterinarians know minor abnor- malities of the arytenoid cartilages and larynx in a Thoroughbred can have little impact on his racing prospects, while severe ones can end a career. Effects of throat aberrations falling between these extremes were less clear, so Brian Ander- son, BVSc, MVSc, MS, MANZCVSc, Dipl. ACVS, of Ballarat Veterinary Practice, in Victoria, Australia, and colleagues in New Zealand recently took a closer look. Recurrent laryngeal neuropathy is the paralysis of one or both arytenoids (carti- lages that form either side of the tracheal entrance, abducting—or opening—during breathing), resulting in respiratory noise and decreased performance. Vets use a flexible endoscope to peer into the airway and grade laryngeal func- tion using a four-point grading scale in North America. In New Zealand they ap- ply a five-point scale; the researchers used this scale to grade and evaluate horses in the study. Horses that score Grades 4 and 5 (meaning the cartilage cannot be fully abducted) "fail" inspection, Anderson said, while horses with Grades 1, 2, and 3 "pass." The team evaluated the impact of Grade 3 abnormalities (in which the Vets: Rehabilitate the Entire Horse Practitioners gathered at a Table Topic to discuss the variety of thera- pies and equipment they can use to rehab horses coming back from injury. Melissa King, DVM, PhD, Dipl. ACVSMR, an assistant professor of Equine Sports Medicine and Rehabilitation at Colorado State Universi- ty's College of Veterinary Medicine & Biomedical Sciences, in Ft. Collins, and Carrie Schlachter, VMD, Dipl. ACVSMR, medical director at Circle Oak Equine Sports Medicine and Rehabilitation, in Petaluma, California, moderated the talk and answered questions about particular injuries. Stifle Injuries Therapies King and Schlachter said they might use on horses recovering from stifle injuries such as meniscal tears include: ■ Resistance band systems to encourage proper alignment and move- ment during a controlled exercise program; ■ Underwater treadmill for range of motion and resistance while work- ing on a straight line; ■ Hand-walking over ground poles to initiate range of motion; ■ Caudal (toward the rear) and lateral (side-to-side) tail pulls to work on pelvic and stifle stability; and/or ■ Shock wave therapy. Hind Suspensory Strains For horses with injured hind suspensory ligaments that aren't markedly lame but have limitations, King advised keeping them in work, but backing down to just walking and trotting. "Footing is important," she said. "Stay out of deep footing." She said she might also perform shock wave or laser therapy. Back Pain King first tries to pinpoint the cause, then does body work (e.g., chiropractic adjustments, acupuncture, kinesiotape, core work, baited stretches, massage) plus shock wave therapy. Schlachter said she finds functional electronic stimulation (electro- therapy that stimulates the motor nerves responsible for muscle func- tion) effective for lumbar and sacral pain because, in her experience, many of these chronically painful horses have very tight muscles. The discussion then turned toward incorporating exercise into a back pain rehabilitation program. Schlachter advised keeping riders off horses with moderate to severe back pain for 21 to 45 days. "Turn them out where they'll have their head down" often, she said. Then, depending on where the pain is, she'll incorporate other exer- cise programs, such as long-lining over ground poles. "Anything to get them to look down and arch up," she said. Schlachter said she'll also perform core exercises with a bellyband if the surcingle used to anchor the band attachment doesn't cause pain. Once the horse can be ridden, she recommended practicing transi- tion work and pole work and riding in a square pattern, not a circle. King favors working long and low, encouraging the horse to relax and stretch over his topline and swing his back, limiting trot work initially. Then, practice serpentines, figure-eights over poles, and backing through patterns, asking for full range of motion over the back. Take-Home Message "Rehabilitate the entire horse, not just the in- jured region," said King. "Horses often develop maladaptive compensatory mechanisms due to the primary source of pain that if left unaddressed will continue to cause additional lameness issues and poor performance." And each rehab case is unique, said Schlachter. "What worked for your neighbor may not work for you," she said.—Alexandra Beckstett

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