I thought we’d start off 2023 talking about a product for osteoarthritis in horses, pentosan polysulfate sodium (we’ll just call it pentosan from now on). A new, FDA-approved formulation has just been released in the United States, although it’s been available in Australia and a few other places since the 1990s.

NOTE: You might have been giving your horse a pentosan product already. There have been compounded formulations of pentosan available for some time in the United States. Compounded drugs are not the same as FDA-approved drugs, although the horse drug market is flooded with compounded products. Compounded medications are the subject of another article, but suffice it to say that if you’ve been giving pentosan to your horse, depending on where you live, it’s production may be more or less regulated, that is, you may be more or less sure that you’re getting pentosan in your pentosan. If you want to try the new, FDA-approved product on your horse, you’ll have to get it from your veterinarian.

WHAT IS PENTOSAN?

Pentosan is an ester (a chemical term) that’s made up of a chain of sugars (known as polysaccharides). In this case, the sugars are called pentoses, that is, they contain five carbon atoms. None of this is particularly important to horse owners (or veterinarians, for that matter), unless you love chemistry, but at least you now know why it’s called pentosan (from pentoses).

In its chemical action, pentosan is similar to a class of drugs known as low molecular weight heparins. In people, heparins are used to prevent blood clots, and to treat stroke and heart attacks. In horses, heparin was once tried for treatment of laminitis, but it didn’t pan out. This is mostly relevant to you because heparin inhibits blood clotting, and bleeding is a side effect of pentosan (more on that in a bit).

HOW DOES PENTOSAN WORK?

Well, begging questions such as, “If” and “How Well” (more on that in a bit), frankly, it’s still a bit of a mystery of pentosan might work for osteoarthritis. Oh sure, there are lots of entirely optimistic proposed mechanism, such as increasing production of hyaluronic acid (which is thought of as a sort of joint lubricant) and increasing production of cartilage components (known as glycosaminoglycans), and maybe it helps prevent enzyme destruction of cartilage, and perhaps it affects the production of cytokines (which are just substances secreted by some cells that have effects on other cells).

Heck, maybe it even sops up free radicals, those dreaded compounds that are said to damage about anything they come in contact with (in the simplistic way of looking at the compounds that seems to be pushed by Dr. Google). But the fact is, nobody really knows how pentosan works for the treatment of osteoarthritis, if in fact it does much at all. To me, this is annoying, because I like to have some idea of how something really works before I give it to a horse. Call me cranky.

WHAT IS PENTOSAN USED FOR?

There is a pentosan pill available for humans. In humans, pentosan may be prescribed to relieve the bladder pain that’s caused by a condition known as interstitial cystitis. There, it apparently works by preventing bladder wall irritation. For what it’s worth, interstitial cystitis is apparently not a big problem in horses, although it apparently does occur. I’ve never seen a case.

Of course, the big news in animals – especially insofar as advertising and sponsorship goes – is that it’s yet another option for the treatment of osteoarthritis. Interestingly, in humans, pentosan is NOT approved for the treatment of osteoarthritis, in spite of some early evidence which concluded it was helpful (CLICK HERE) which, to me anyway, is curious, because if you want to make a lot of money for a successful treatment for arthritis, there’s no better place to start than the human market. That fact is a bit of a red flag for me when it comes to pentosan for osteoarthritis in horses (and dogs, too).

NOTE: Apparently, there are now clinical trials being conducted on pentosan in humans. It will be very interesting to see the results of these trials.

WHAT’S THE CLINICAL EVIDENCE?

While it’s been tried in humans – to no avail, apparently, insofar as getting drug approval, and in spite of a couple of studies that showed “promise” – pentosan has been occasionally tested on horses (and dogs, too). For example, it’s been reported in an influential book on equine arthritis that a group of racing Thoroughbreds who had chronic osteoarthritis were given pentosan in the muscle once a week for four weeks and that signs of joint disease were “improved” but not eliminated.

In another study, nine horses that got pentosan in an experimental arthritis model had improvement in the quality of their joint cartilage (but we don’t know if they got any better – CLICK HERE to see the study). Finally, in another study, a product containing pentosan and a couple of other things didn’t do much of anything when administered to horses (CLICK HERE).

Since, sadly, there’s not really much robust clinical evidence for the effectiveness of pentosan (after, oh, nearly 30 years), perhaps it might be instructive to ask veterinarians who have been using the stuff what they think. Or, maybe not. I’ve asked a couple of friends who practice(d) in Australia and one thinks it’s wonderful, while the other things it’s akin to pouring water on their back. But rather than just rely on two conflicting opinions, in 2014, a survey of 76 Australian veterinarians was published (CLICK HERE) Here’s a summary of results

1. Pentosan was most commonly used as prophylactic therapy prior to competition (80.3%). NOTE: That’s right along the lines of the rationale typically used for a bunch of horse products intended to help joints. That is, “We don’t know if it will do anything, but it might help.”
2. Pentosan was considered by 48.2% of respondents to have high efficacy. NOTE: That also means that 51.8% of respondents thought that the product didn’t do much, which is right along the opinions of the two people that I asked.
3. The most common dose regimen for prevention and treatment of OA was 3 mg/kg, intramuscularly, once weekly for four weeks followed by monthly injections. NOTE: That’s a combination of the manufacturer’s recommendation plus some unknown dosing schedule, which, again, is just like what’s used for many other products. First, the products are dosed according to the label, and then, they’re given on some other schedule that’s often dictated by how much the medication costs. Otherwise stated, you don’t really know what you’re doing, but at least you’re doing something, if you can afford it.
4. Most respondents (78%) combined PPS with other drugs for treatment of OA. NOTE: That’s not much of a ringing endorsement for the effectiveness of the product.
5. For treating OA, 83% of respondents considered a combination product was more efficacious than pentosan alone. NOTE: This was a curious finding, especially since the research that I previously cited showed exactly the opposite (CLICK HERE).
6. The most common reason not to use this combination was cost. NOTE: That makes a good deal of sense, actually. It’s fine to spend money on your horse but if it doesn’t seem to do much, why bother?

SO, WHAT ABOUT THE EVIDENCE THAT GOT THE DRUG APPROVED?

In spite of the previous (underwhelming) evidence, the fact of the matter is that pentosan did get approved by the US Food and Drug Administration, so the evidence had to show something. This is where you have to dig into the evidence a little bit. I did, and here’s what I see, based on the drug summary, which you can see if you CLICK HERE.

The manufacturer of the new product did a field study, that is, they were using horses at barns, stables, etc. They ended up with 109 horses that got a shot of pentosan in the muscle once a week for four weeks, and 113 horses that got an injection of saline once a week for the same period (that’s according to the recommended dosing regimen).

All of the evaluated horses were lame, and they were graded by the lameness scale developed by the American Association of Equine Practitioners:

• 0: Lameness not perceptible under any circumstances.
• 1: Lameness is difficult to observe and is not consistently apparent, regardless of circumstances (e.g., under saddle, circling, inclines, hard surface, etc.).
• 2: Lameness is difficult to observe at a walk or when trotting in a straight line but consistently apparent under certain circumstances (e.g., weight-carrying, circling, inclines, hard surface, etc.).
• 3: Lameness is consistently observable at a trot under all circumstances.
• 4: Lameness is obvious at a walk.
• 5: Lameness produces minimal weight bearing in motion and/or at rest or a complete inability to move.

So, what were they measuring? The metric for improvement was a change of one level on the AAEP scale. For example, perhaps a horse was lame at the walk initially (grade 4) but after the medication, he was only lame all the time at the trot (grade 3). I guess that’s something, but it’s not much, in my opinion. In fact, I rarely hear clients congratulate me, saying, “Great doc, after treatment, now he’s less bad!” Plus, add that to the fact that the measurement was subjective (“Is he a bit better?”) and the relatively small number of horses (relative to the large trials often conducted in human medicine, that is), and there’s some reason to wonder how meaningful the metric really is.

But how about the results? Well, according to the study, 57% of the horses that received pentosan improved. Of course, 36% of the horses that got saline also improved. That’s a difference that is statistically significant, that is, it’s somewhat less likely (although not impossible) that the results occurred purely by chance.

But there are larger questions that can’t really be answered by this study. In fact, you’re probably the best person to answer them. Specifically:

1. Is the relatively modest possibility of mild improvement worth the cost?
2. Do the results, even if true, really mean anything (that is, are they clinically relevant – I don’t think that they’re likely to be, but I’m pretty conservative)?
3. Are the possible side effects worth the risk (more on that, below)?

WHAT ABOUT SIDE EFFECTS?

I’m glad you asked. If you want to give your horse pentosan, there are some side effects you should be aware of. In fact, the study documented several of them, including:

• Increase in measures of blood clotting (which you’d probably expect in a heparin-like product)
• Lethargy
• Behavior changes
• Colic
• Stiffness

The effect on blood clotting is real. As a result, I’d probably avoid giving it immediately before your horse is going to do something potentially traumatic (like run, jump, or spin). I’d probably also avoid giving it to a horse that might need surgery. Oh, and, just in case you have blood clotting problems yourself, and since pentosan is an anti-coagulant, if you take an anti-coagulant, you should take care not to inject yourself, or maybe even have someone else do it.

WHAT’S THE BOTTOM LINE?

Frankly, I’m not very impressed. To be fair, I’m pretty conservative, so I’m rarely an early adopter. That said, first of all, this really isn’t a new drug – it just finally got approved in the US after being available for nearly 30 years in other countries. Experimental reports – including the one that got the drug improved – aren’t particularly robust, that is, you shouldn’t expect to see a great improvement, if you see improvement at all. In addition, pentosan is also NOT a pain-relieving medication. The idea that the product might prevent arthritis is mostly just naïve optimism, although, as with other products, and as per the Australian survey, it’s probably the number one reason that people will use pentosan.

You’ll probably see lots of advertising coming up in the next few months – perhaps you’ll even see sponsorships show up at horse shows. Hopefully, I’ve given you plenty of information with which you can start to make up your own mind.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

Colic is the most common medical problem affecting horses – in fact, something along the lines of 50% of the medical problems of the horse are described as “colic” (the “whys” of that would probably make a good article, in fact). Colic has been recognized in horses for a long, long time, but it’s only fairly recently that have veterinarians have been able to accurately diagnose and effectively treat colic cases.

For example, Chinese observers of a few centuries back recognized the signs of colic, and saw that affected horses couldn’t defecate. They even wrote about the problem in an early 17th Century text. However, since the Chinese didn’t understand the horse’s anatomy, they didn’t really know what was going on inside the horse. So, they concluded that to effectively treat colic, a person should insert his arm into the horse’s rectum and attempt to remove feces from one of several “points” at which a blockage might occur.

CURIOUS NOTE: These observations seem like a perfectly reasonable suggestion to me, given the state of knowledge at the time. I mean, if you feel around inside a horse’s abdomen, you do encounter different things in different areas of the abdomen. However, the idea that you could remove feces from “points” inside the horse’s abdomen to help cure colic gave rise to the modern myth that these points were “acupuncture points” to be used in the treatment of colic. Actually reading the text that came with the pictures in the book might have helped dispel that myth.

Medical myths often get started with reasonable observations. However, whether those observations reflect anything that’s actually going on with the horse is a different question entirely. In fact, nonsensical information has a remarkable ability to stick around, even after there’s good proof that the information is nonsensical. Many myths about colic persist today. Let’s see if we can take on some of the more common ones, just for fun. You never know – it might give someone some peace of mind.

–Horses do not seem to colic because the weather changes. It’s hot one day, it’s cool the next. Or the rain moves in. Your horse colics. What could be a more reasonable association? But the weather changes all of the time, and horses colic all of the time (being the most common medical condition of the horse). However, one seems not to have anything to do with the other – at least, not consistently, according to the studies. But since they both occur often, it’s easy to make a spurious association. Most studies have even shown that weather changes don’t cause colic. If you’d like to see a few of the studies, including one outlier that does show an association, CLICK HERE, CLICK HERE, CLICK HERE, and CLICK HERE.

That said, I’m not sure what you would do with information that weather changes cause colic if it were true. The colic-weather thing kind of reminds me of the old joke about the silly person who, upon finding out that most automobile accidents occur within 25 miles of your home, moved. The association between weather and colic isn’t confirmed, but it’s not something that you could do anything about, even if it were true. I don’t really worry much about things like that.

–Horses don’t twist their intestines when they roll. Have you ever seen a horse lie down and roll, happily scratching his back and rubbing his sides in the dirt? Have you ever seen that same horse develop a twisted intestine afterwards?

Didn’t think so.

Horses that are uncomfortable from the pain of colic will often lie down and roll. They are trying to find a way to get comfortable, just like when you lie down on the couch after, say, a bad meal. Horses with colic pain will often change positions and roll around. They’re just trying to get comfortable: trying to get away from the pain.

This is another curious observational fallacy. The pain that occurs from a twisted intestine is extreme. One of the ways that horses show extreme pain (from (volvulus, strangulation, entrapment, and such) is by rolling around. But it’s the twist that comes first, not the other way around. In human medicine, it’s thought that intestines twist around scar tissue, or maybe from the weight of feed – to my knowledge, no one knows if there’s anything like that in horses. If you’re really interested in this problem in humans, CLICK HERE to read a great article from MEDSCAPE.

If a horse is beating himself up from rolling around frantically in pain, there’s certainly ample reason to keep him from doing so. However, if your horse rolls, the gut isn’t in danger of twisting. In the worst cases, it probably has already.

–Walk your horse, no matter what. I think that the idea that horses need to be walked when they have a colic probably comes from the concern over twisting a gut. “If they can’t lie down, they can’t twist their gut,” is how the thinking must go, I guess.

However, walking is not directly therapeutic for a colic. If a horse is relatively comfortable lying down, there’s no real reason to get him up just so that he can walk. Imagine you, on the couch, feeling bad after that spicy food you ordered against your better judgment. How would you feel if someone came up to you and said, “OK, let’s go, we’re going for a walk.” That’s justifiable homicide, in my book.

That said, there may be some slight benefit to walking a horse with colic. It may help distract the horse with a mild case colic, and help him forget about his pain. It also gives the owner something to do until the veterinarian arrives!

QUICK ASIDE: In some cases, I will suggest that clients lunge their horse with colic. In my experience, if a horse has a colic related to the accumulation of gas in his intestines, sometime jostling things around seems to help. But one can go too far with this sort of thing – I have seen horses that were literally walked (or lunged) to death.

–Banamine® (flunixin meglumine) is a potent pain reliever for your horse with colic. When it was first released a few decades ago, flunixin was heavily advertised as the drug to treat colic (with some beautiful illustrations and even a rather spectacular belt buckle given away as a promotion). Based on those advertisements, it seems that horse owners (and some veterinarians, apparently) learned that the drug is a “must” for treating horses with colic. In fact, some people even say that it is so potent that it works within minutes of its administration, (which, given what we know about how the drug works, isn’t even possible).

The scientific evidence doesn’t back up the idea that flunixin is a very potent drug, and it certainly doesn’t seem to be a “must” for treating a horse with colic. In fact, experimental studies on the drug have shown that it’s not very effective at all at treating the pain of colic (CLICK HERE). Flunixin is a useful drug in certain circumstances, but it’s not a miracle drug for anything. I don’t suspect these facts will dampen its use, however.

NOTE: There’s no reason at all to give any drug for any condition, without a proper diagnosis. If you have flunixin in a medicine chest or tack box, I personally don’t think you should give it to your horse with colic without consulting with your veterinarian first. That said, it often is.

–You have to oil ’em. For – well, forever – when a horse has had a colic, people have given him light mineral oil. By syringe. By nasogastric tube. In bran. Somehow. And … it’s probably not very effective.

The idea seems to be that some horses colic because the manure gets “stuck” in the intestines (sometimes, it sort of does). The rationale seems to have been that the only thing that’s keeping a horse with colic from defecating is that the tube needs some lube. But that’s not how things work. Research pretty conclusively suggests that horses that have manure plugging up the tube need fluids, not oil. When you think about it, that makes some sense. Put a ball of horse manure in light mineral oil and it…. just sits there. Put it in some water and if falls apart. Your horse’s hydration is far more important in cases of colic than is the slipperiness of his intestinal tract. Your veterinarian can help you here, with both oral and intravenous fluids. It doesn’t hurt to oil ’em… it’s just probably not as important as everyone used to think.

–Add “alternative” treatments to help your horse with colic. Some people may add things such as acupuncture or massage to their efforts to help a horse with colic. Others may add any number of supplements that are said to help prevent colic, or do such things as “aiding” in digestion. Keeping horses is expensive enough – save your money.

In general, there’s no evidence at all to indicate that any “alternative” things are helpful, either in the prevention or treatment of colic.* In the case of acupuncture, there’s good evidence that it doesn’t help at all (CLICK HERE). If your horse has a colic, focus on getting quick and proper diagnosis and treatment. Don’t look for any “alternatives” to that!**

When it comes to colic, the two most important things to keep in mind that 1) It’s the most common medical condition of the horse, and 2) most cases of colic will resolve on their own. Sometimes medical treatments really do help – and sometimes horse horse will need surgery, but most horses do get better (of course, there are many individual exceptions). Adding treatments that lack evidence of effectiveness only adds to your costs, not to mention adding to your anxiety. Of course, if you’re worried – and in some cases, you certainly should be – you should always consult with your veterinarian. Keeping a level head is always the best way to go!

* One could argue about the usefulness of giving horses psyllium to treat or prevent colic caused by sand accumulation. I don’t really think of that as an “alternative” treatment, but I thought I should mention it. I really don’t think it does much – the best way to prevent sand accumulation is to try to keep your horse from eating sand.

** You may have noted that some supplement companies are now offering to pay for part of your horse’s colic surgery if he has a colic while on the supplement. This is really cagey marketing. The fact is that most horses that colic don’t need surgery. So, if you could somehow get everyone with a horse to buy your supplement regularly, and then absorb some of the cost of the occasional surgery, you’d be money way ahead – and even farther ahead, depending on your markup. If you’re really worried about paying for colic surgery, just buy insurance. It will be way cheaper in the long run.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

It’s kind of cool, being a veterinarian. Most people have a general appreciation for what you do. I mean, taking care of animals (in my case horses) really is a pretty great thing, and most people seem to appreciate you for it. However, most people don’t know much about veterinary medicine – and particularly horse medicine. So, upon meeting me, and in starting up a conversation, they often want to jump in with a question of what-would-seem-to-be mutual interest.

So, when learning that I’m a veterinarian who takes care of horses, there’s one question that seems to crop up all of the time as an icebreaker. People always ask, “Why do you have to put a horse to sleep if it breaks its leg?”

Still, even if they haven’t been around horses, people are aware of them as, say, arguably the most important animal in human history. They’ve seen them; in old Westerns, on TV, in old pictures, and in various urban settings where horses happily take blanket-covered couples on evening tours. People care about horses! Thus, the question comes from a combination of unfamiliarity, a bit of compassion, and a bit of curiosity as to why fractures – which are generally handled rather routinely in most other species, seem to be such a big problem in horses.

Putting horses to sleep seems to also have been a pretty well-accepted solution to the majority of horse health problems. People apparently think that working on horses can be a pretty hopeless endeavor, especially when it comes to their legs. Such despair seems to be pretty ingrained. You know, in the movies, the horse gives his all to save the hero, breaks his leg in the process, and gets shot for his efforts. Racehorses break their legs, and sometimes have to get put to sleep (for various and sundry reasons that we’ll get into). Heck, the cartoonist Gary Larson even got his two cents in.

Yet, the fact is, that you don’t always have to put a horse to sleep when he breaks his leg, although, sometimes, you may not have any choice. Still, the answer to the question is complicated. And, unfortunately, in my experience, the nuances of this discussion cause the people who asked it to almost immediately regret having done so, but since you’re here, and have made it this far, here we go.

1. What kind of break are we taking about? In a way, to say that a horse broke his leg is sort of like saying that a person has cancer. For people, cancer can be everything from a little spot on the end of the nose that the dermatologist shaves off in a quick office visit, to the chilly realization that your affairs had better be in order. Some “breaks” really aren’t that big a deal. For example, I’ve seen a couple of horses that cracked the big bone above the knee, in the forearm (the radius). The horses were very lame. The leg was, in fact, broken. Looked just horrible on X-rays. And, after a couple of months in the stall, the leg healed. The bones didn’t displace. The horses were fine. Uncommon fracture, to be sure, but not dead as a result, either. Other breaks, however, are an enormous problem. That’s because of the forces generated on the horse’s legs when they are running. A horse is pretty much built to the limit of its tolerance – with its muscular body, and relatively skinny legs, it really can’t be much bigger than it is. As such, when a horse is running, turning, jumping, pivoting, or otherwise exercising, it’s putting stresses on its limbs that are right up to the maximum of what they can take. When those stresses exceed what the horses limb can take – BOOM! – an explosion goes off in the horse’s leg.  As such, the bone not only fractures into a bunch of pieces, but blood vessels can tear, tendons can rupture, and ligaments can shear off the bone. Under such circumstances, there’s not really anything left to fix. The limb of a person who had sustained such an injury would usually be amputated – that’s something that’s rarely done in horses. But even under such catastrophic circumstances, people sometimes try to fix fractures; thus, the story of Barbaro, the 2006 Kentucky Derby winner who, despite the best efforts of the best surgeons, was unable to recover from his fractured leg.

1. Where’s the break? A crack in the middle of a long bone can sometimes heal with rest. But a crack that’s into a joint will ultimately destroy the joint. If that joint is a joint that doesn’t move a lot, a fracture may not be a big deal. So, for example, a horse with a broken pastern can sometimes be saved by screwing the broken bones together and fusing the joint – turning two bones into one, as it were. Horses can move pretty normally – even perform – with a fused pastern. But it’s a lot harder for horses to get around if their fetlock joint has been destroyed. The higher up the leg you go, the harder it gets. Once you start dealing with fractures of the upper leg, repairs are pretty much impossible. For one reason, that’s because they’re so hard to get to. If you wanted to try to fix a horse’s femur (in the hind leg), or its humerus (in the front leg), you’d have to dissect through so much tissue trying to get to the fracture that you we’re trying to fix that you’d essentially be destroying the leg anyway. And the forces placed on the implants in such areas are almost unimaginable – the muscles of the horse’s legs can pull apart the repaired tissues, bending metal screws and plates as if they were pieces of licorice.

1. How bad is the fracture? The worse the fracture, the harder it is to deal with. Some fractures are described as a “bag of glass.” In such fractures, there are so many pieces of bone that they can’t be put back together. Others, such as the ones in the radius that I described, are pretty simple – just a crack that has to heal. Even the best surgeon can’t fix the worst fractures – there’s not really anything left to fix.
2. What’s the horse used for? Sometimes, you might be able to fix a fracture, but you’d end up with a pasture ornament. So, for example, if you had a horse that fractured its fetlock, while it might be possible to fuse the fetlock, and save the life of the horse, you’d also have a horse that you couldn’t really ride (I’m sure there may be an exception somewhere), but it would certainly be a horse that would always walk around with a limp. In the case of a valuable breeding stallion, the cost might be worth it. But the fact is that if, say, a 5-year-old barrel horse is rendered unusable as a result of a fracture, many people may not feel that the cost of keeping the horse for the next 20 years is worth the price of the repair.
3. How much is fixing the break going to cost? Fixing a horse’s broken leg isn’t cheap. Even under the best of circumstances, a successful fracture repair is going to cost many, many thousands of dollars (those screws and plates that you see in the X-rays aren’t cheap!). As such, the decision of whether to try to repair a horse’s fracture often comes down to a single question: “Do you want this horse, or do you want a horse?” If you’re being asked to spend $20,000 to fix your horse’s broken leg, and you’ll end up with a lame horse, well, to be simply factual, you can buy a really nice replacement horse – a horse that won’t be lame – for the same money. Plus, there’s no guarantee of the outcome, even under the best of circumstances.

The fact is that limb fractures in horses can have terrible outcomes. But there can also be some wonderful success stories, ending with sound horses, or even lame horses that live happy and long lives as pets and companions. The decision as to whether to try to fix a horse’s broken leg is usually complicated – but you sure don’t always have to put them to sleep!

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

Vaccination is certainly one of the most important interventions in health (human, animal, fish, etc.) that has ever been invented. But not all vaccines for horses are equally effective. Before the time comes for spring shots, I thought I’d give you some information about individual vaccines, and how well they are likely to work.*  And by “work,” I mean, how likely they are to actually prevent the disease that they are supposed to prevent.

DISCLAIMER:  By no means should you read this article and then go our and ignore the advice of your veterinarian.  He or she may be aware of some individual circumstances that might make certain vaccines more or less useful in your area.  But with the information below, if nothing else, you can have a good discussion.

FIRST THING:  Vaccination is the process whereby a horse can be made somewhat resistant to a particular disease.

SECOND THING:  Vaccines are not an iron-clad guarantee that your horse won’t ever get sick with that disease.

Vaccines have enabled veterinarians to control and prevent many awful diseases, especially in the pet and livestock industries.  However, while I know your horse is important to you, economically speaking horses are not as important as livestock or pets.  That’s perhaps one reason why there hasn’t been a strong reason (read: return on investment) to spend a lot of time on developing and testing vaccines. So, in many respects, the equine vaccine field has lagged behind other that of other species.

It’s actually pretty hard to determine how well – or even if – many equine vaccines work. That’s because, when compared to most every other species, there’s not much published data put out before vaccines are released, and not much data gets accumulated after the vaccines are out there. Otherwise stated, nobody really keeps track once the vaccines are released. That means that the sort of information you’d need to make a fully informed decision (effectiveness, rate of reactions, etc.) for your horse just isn’t available. In fact, such aftermarket oversight isn’t even required.

The rationale behind vaccination is pretty simple — you vaccinate your horse, you prevent a disease, right? To be perfectly honest, that’s not always the case (and not necessarily through any fault of the vaccine).

Many vaccines simply claim to be an aid in the management of the disease, which can be quite a shock when your vaccinated horse still gets sick.  The fact of the matter is that no vaccine is perfect. Using vaccinations to prevent disease should be just one part of an overall strategy to control disease in horses, a strategy that might also include such things as:

• Isolation of sick animals
• Keeping shared environments clean
• Quarantine of new animals brought onto a premise

There’s a lot more that can be said, of course, about the type of evidence that’s (not) available and such, but let’s get to the bottom line: which vaccines appear likely to be effective, based on the evidence we have.

EQUINE INFLUENZA (FLU)

In experiments, flu vaccines tend do pretty well at preventing disease caused when horses are challenged with a particular strain of virus. However, most horses don’t live in laboratories, at least not the ones I take care of  Unfortunately, field data – that is, how well the vaccines prevent the flu in barns, stables, and pastures – is extremely limited, and field trials have not shown the vaccine to be particularly effective at preventing the spread of influenza. In fact, if you consider that horses are pretty widely vaccinated against the flu (except in Australia, where, with the exception of one outbreak a number of years back, the disease doesn’t occur), and that flu is still a very common problem, you might be drawn to conclude that the vaccine hasn’t been very effective.In general, vaccinated horses will still get infected with flu virus, and even though they may show milder clinical signs of disease, they will still shed virus and so be a source of infection for other susceptible horses.

PLEASE NOTE:  If you show your horse, there are many competitions and show organizations that have requirements for flu vaccines – make sure you’re aware of them. This fact is independent of vaccine effectiveness.

EQUINE HERPES VIRUS (EHV, Rhinopneumonitis, Infectious Abortion, etc.)

There are three scenarios where your horse may be affected by a herpes virus.

1.  Pregnancy.  EHV (you don’t want me to have to spell it each time, do you?) causes mares to abort their fetuses. And, happily, there is some evidence that EHV 1-4 vaccines (the numbers indicate a vaccine strain) do reduce the likelihood of abortion. However, the vaccines may not work very well if horses exposed to a high dose of the virus, and the rationale behind the five, seven, and nine month vaccine schedule is not at all clear. You’ll probably do it if you have pregnant mares, because you’d feel terrible if your mare aborted from the virus, and you didn’t vaccinate.

2.  Respiratory Disease. EHV-4 can cause respiratory disease that is pretty much indistinguishable from the flu. There’s some evidence that vaccination can reduce the severity and duration of respiratory disease after an experimental challenge, but it probably doesn’t do anything to stop the spread of the disease, and particularly since many horses are exposed to the virus when they are very young.

In fact, latent (inactive) EHV-1 infection is quite common in horse populations worldwide. It has been estimated that inactive infections exist in something like 90% of the horses in some areas. Otherwise stated, EHV-1 vaccines probably don’t do much good because horses are already infected in the same way that people with cold sores are carriers of the herpesvirus. Vaccination doesn’t help when you’ve already got the disease.

3.  Neurological Disease.  No EHV-1 vaccine has been shown to prevent the neurologic form of the disease that periodically captures equine health headlines, and no vaccine claims that it can prevent the neurologic form of the disease. Period.

WEST NILE VIRUS

There is good evidence that vaccination against West Nile Virus is effective against preventing clinical disease and death in horses. You should follow the manufacturer’s recommendations, but in some areas, those areas where there are lots of mosquitoes, more frequent boosting may be recommended in order to maximize the protective immunity. Ask your veterinarian for his or her recommendations if you’re in an area where West Nile Virus is a particular problem.

POTOMAC HORSE FEVER (PHF)

PHF is more of a regional disease, mostly seen in the eastern United States. When the disease first came out, a vaccine was rapidly made available, and the early experimental data, which was based on challenge with a selected strain of the disease, was very good.

Unfortunately, there’s not much data pertaining to use of the vaccine in the field, and what is there suggests that the vaccine doesn’t work very well.  That’s probably because there are many strains of the disease (as I recall, it’s at least nine), but only a couple of strains are in the vaccine. Bottom line is that the PHF vaccine is not likely to provide much protection against disease.

ENCEPHALITIS (Eastern, Western, Venezuelan)

Viral encephalitis is an uncommon, but regularly seen problem that mostly occurs in the eastern United States (VEE doesn’t occur in the US, but it’s occasionally crosses the southern border with Mexico). If your horse gets encephalitis, he simply isn’t going to get better, so vaccination is your best strategy to prevent the disease. Ask your veterinarian for the best vaccination schedule in your area. The vaccine is very effective.

STRANGLES

Frankly, there’s very little evidence to suggest that strangles vaccines work. In fact, most of the world doesn’t vaccinate against strangles. In addition, strangles vaccinations have among the higher incidences of vaccine reactions. If you’re using the intranasal vaccine, it’s also possible for your horse to get sick from the vaccine strain of the bacterium. There are some newer vaccines that sound promising, but they’re not here yet.

I don’t recommend that my own clients use the strangles vaccine. And as I said at the start of this article, the vaccine is certainly not a substitute for hygiene, quarantine, and control measures.  CLICK HERE for the 2018 position paper on strangles from the American College of Veterinary Internal Medicine (which does not advocate vaccination).

TETANUS

It works. Vaccinated horses survive tetanus infections, and non-immune horses die. We’re not sure how long the vaccines last, but evidence from other species suggests that it’s measured in years. Your horse is going to get plenty of opportunities to be vaccinated against tetanus if you, like most people, use a combination products (e.g., “Four-Way”) and there’s no evidence that it will hurt him if he gets vaccinated against tetanus every year.

EQUINE VIRAL ARTERITIS (EVA)

EVA is another annoying viral disease, and vaccines are used in distinct regions of the world. These regions generally not include the US; they’re not allowed to be used in the UK. That said, it does seem that the vaccine is effective at preventing the carrier state in vaccinated colts. However, safety concerns about the vaccine exist, the safety of vaccinating pregnant mares is up in the air, and there are some worries about vaccine-caused disease.  It’s also pretty much impossible to tell if a horse has been vaccinated, or if it’s been exposed to disease:  this can be a concern if you’re planning on shipping a stallion internationally.

RABIES

In some parts of the United States, those with high rabies activity, it’s advisable to vaccinate your horse. Plus, in some states, it’s the law. The available vaccines are effective, and in areas where there is rabies in the wild population, it’s important. Plus, you can get rabies from a horse. Why take that chance?

HOMEOPATHIC NOSODES

You may not have heard of these things, and they aren’t common, but they’re out there. Nosodes (which are not, in fact, homeopathic), are prepared from high dilutions of infectious agents, material such as vomitus, discharges, or fecal matter, or infected tissues. Curiously, the founder of homeopathy, Samuel Hahnemann, decried the use of such preparations and was even a supporter of smallpox vaccination.  There is no evidence at all to suggest that homeopathic nosodes have any effectiveness. To the contrary, there is one case reported in the human literature where a patient followed her homeopath’s advice and took a homeopathic immunization against malaria before traveling to an endemic area. The patient promptly got malaria. Nosodes have also failed to protect puppies against parvovirus.

I think that it is of note that the British Faculty of Homoeopathy acknowledges the effectiveness of vaccines and recommends their use in humans.  Seriously, just don’t bother with them.

Heck, don’t bother with homeopathy, either – CLICK HERE to see why.

A QUICK NOTE ABOUT TITERS – In some circles, people are trying to decide whether or not to vaccinate their horses based on a measure of immunity in the blood. Those measures are called titers. It sounds like a good idea, but there’s actually no information in horses to suggest that a certain titer equals disease prevention. Seems like a good idea, but, in reality, nobody really knows what a particular titer means for a horse.

Oh, one more thing — don’t fall for all of the negative stuff that some people say about vaccines. They aren’t 100% effective at preventing disease, but they don’t cause widespread harm, either. There are a lot of dopey things said about vaccines – CLICK HERE to read about some of them.

So there. The bottom line is that some vaccines are likely to help your horse(s) – others, not so much – and that nobody really keeps track. That’s why it’s important to work with your veterinarian to establish the ideal schedule for your horse – he or she should have a good idea of particular problems in your neck of the woods.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

Regardless, I’ve got some secret inside information to share with you. The single most important nutritional factor for the normal growth and health of the horse – including the hoof – is a good diet. Otherwise stated, if you’re feeding your horse a good diet, it’s likely that he’s getting all of the nutritional stuff that he needs to grow as good a quality of hoof as is possible. A “good” diet is one that provides and adequate amount of protein, carbohydrates, vitamins, and minerals, and such. Happily – for both you and the horse – in nearly all situations the horse is set up (physiologically speaking) to obtain all of those things from his normal diet.

You can get a pretty good idea when everything’s OK without too much effort, too. Here’s how. If your horse is at a good body weight (can’t see the ribs, but can feel them easily), and he’s feeling good, then it’s pretty unlikely that anything else is wrong. It’s not like horses are delicately balanced on the edge of some nutritional cliff, waiting for the lack of a nanogram of aluminum to push them over the edge. If they look good, and they feel good, it’s usually because things are, well, good.

Of course, there are all sorts of nutritional problems that can affect the horse’s hoof. Here are just a few:

1. Selenium toxicity
2. Carbohydrate overload (your horse breaks into the feed room and eats 25 pounds of grain, or he eats lush spring grass for hours on end)
3. Insulin dysregulation (more commonly known as insulin resistance or metabolic syndrome)
4. Obesity (one of the biggest nutritional problems for horses)

These are certainly things that you should be aware of and do your best to prevent. However, there’s very little evidence to suggest that giving nutritional supplements to horses will prevent any of these things, and giving supplements to horses on good diets doesn’t do anything to benefit their hooves.

There are occasions where a particular supplement may be helpful. So, for example, if you live in an area where the ground is deficient in the mineral selenium – part of the Northwest, Northeast, the Atlantic coastal area, Florida, and regions surrounding the Great Lakes – supplementation with some selenium may be of benefit. Even here, you have to be a little careful, because too much selenium is arguably worse than not enough (and too much selenium causes hoof problems, too).

When it comes to, oh, just about anything in horse medicine, people tend to follow the “bigger hammer” theory. This goes for nutrients for their horses, as well. According to this line of thinking, if you’re trying to build a healthy horse, more is usually better. Want a healthy hoof? Feed them more of the stuff that’s in hooves! But that’s not how the horse’s body works. If you give nutrients in excess, the body tends to do one of three things. It gets rid of them, it metabolizes them, or it stores them (which is why horses that get too much to eat for too long get fat – they just store the extra calories).

When it comes to nutrition and your horse’s hooves, you don’t need a bigger hammer, you need the right hammer for the right job. In the case of your horse, a horse that’s being fed well will usually look good and feel good, and his hooves will be in good shape, too. That’s as good as it gets. There’s really no support at all for the idea that additional vitamins, protein, amino acids, or trace minerals will benefit the hooves of otherwise healthy horses.

BIOTIN

Essentially every hoof supplement known to man (and horse) has biotin in it. Curiously, a biotin deficiency has never been identified in horses. In fact, given that the intestinal bacteria make all of the biotin that any horse could ever possibly want, the idea that hoof problems are a result of a lack of biotin is a pretty big stretch.

There has only been a little bit of scientific investigation done on biotin supplementation for hooves; most of it is pretty old. Some studies from the 1990s did conclude that there was some benefit of giving biotin supplements to horses with poor quality hooves. The hooves of other species – like pigs – have benefited from additional biotin, but no matter what you think of your horse’s eating habits, pigs and horses are different, so it’s hard to make a direct extrapolation.

All that said, biotin is pretty harmless – it’s a water-soluble vitamin that, in excess, just makes for expensive horse urine. Beneficial effects have only been shown with higher doses: along the lines of 15–20 mg/day for a 500 kg horse. You also have to be patient, because it takes several months of supplementation before any effect might be seen; the biotin would get incorporated into the growing hoof, and the hoof slowly grows down from the hairline. And, of course, don’t be TOO optimistic, because biotin is certainly not a hoof panacea. Not all hoof problems respond to biotin supplementation.

ZINC AND COPPER

While they are often included in hoof supplements, neither zinc nor copper supplementation have been shown to promote hoof health in the few investigations that have looked at such things.

There’s no question that they are both needed in the horse’s diet (copper, for example, has been shown to be important for orthopedic health in growing horses), but it’s far more likely that horses will get exposed to too much copper or zinc than it is that they will get too little. Fortunately, horses seem to tolerate zinc and copper pretty well, so you probably won’t hurt them with the stuff unless you really give it some effort. But don’t expect it to do much under any circumstances.

AMINO ACIDS

Many hoof supplements contain amino acids. Amino acids are the “building blocks” that make protein, and hooves have a lot of protein in them. According to the bigger hammer theory, since hooves contain protein (keratin), feeding them more stuff to help them make protein will make their hooves bigger/better/stronger. As a result, hoof supplements may have amino acids such as cysteine, methionine, lysine, proline, and tyrosine: amino acids all. But again, more isn’t necessarily better. For example, additional methionine – the sulfur-containing amino acid often included in hoof supplements due to its existence in hoof tissue – hasn’t been shown to benefit horses. In fact, poor hoof quality has been related to higher methionine levels in the horn of the sole.

Perhaps even more troubling, proteins and amino acids can also stimulate insulin production in some circumstances, which is exactly what you DON’T want if you’re worried about things like laminitis (which, in general, is something to at least be aware of, if not consumed with worry). The bottom line is that feeding a bunch of amino acids to your horse isn’t likely to help his hooves.

BOTTOM LINE?

The bottom line is that for most horses fed a good, healthy diet, feeding them some nutritional supplement is not likely to help them very much. Of course, good hoof quality is not only about nutrition – you also have to make sure that your horse gets good hoof care, and that he’s not perpetually standing around in mud puddles or on hard, rocky, dry surfaces, and such. Good hoof care does require a bit of attention on other fronts besides nutrition. If you pay attention to the important stuff, you can usually just walk right on by all of the buckets and bags in the hoof supplement aisle.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com, and is reprinted here with permission.

OK, here’s the full question –

“A couple friends and I were talking about all the horses we’ve trained and ridden throughout the years and comparing their characteristics and personality traits, etc. We were wondering if horses can develop mental illness similar to what humans exhibit. For example, one of my horses, many years ago, acted like he had a nervous breakdown. And my one friend described her mare as ‘acting autistic.’ We both had raised these horses from birth and they had never been mistreated, and had normal-acting sires and dams. Do horses experience mental illness? Have there been any studies? Or do you think all behavior problems stem from training?”

I guess that we’d first have to define terms. Otherwise stated, what does the term “mental illness” mean? In looking it up, I find this definition, in the online medical dictionary: “Any of various conditions characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma.”

As such, that seems to me to be a pretty broad definition. But the key phrase seems to be “impairment of an individual’s normal …. functioning….” As such, in order to determine if a horse had mental illness, you’d have to know what’s normal for that individual. And there’s the rub.

One would presumably equate mental illness in a horse with abnormal behavior. And, the subject of horse behavior is one that has received a whole lot of study. There’s a lot that goes into horse behavior, but a lot of it comes down to two things: how horses normally behave, and how they were raised. So, for example, in the wild, horses are prey animals, so they normally react quickly, and without thought, when confronted with things that seem threatening; while we may understand that a traffic cone or a flapping tree limb isn’t going to eat us, to a horse, it’s something strange, and something to be afraid of. You never know when that tree limb is being pushed around by a pack of wolves, I guess. And while it’d be pretty weird for a person to run off blindly if, say, they saw a piece of paper blowing across the street, that’s just the way that horses are.

The way that horses are raised definitely affects behavior. So, for example, it’s been shown that stalled weanlings spend significantly more time engaged in behaviors that are considered undesirable, such as licking or chewing the stall/shed wall, kicking at the stall/shed wall, pawing, and bouts of bucking and/or rearing. And, of course, they may react quite aggressively to an unpleasant stimulus, remembering, for example, that something was unpleasant for them (like a horse trailer). While some people may not be able to understand why the horse wouldn’t want to climb in the trailer, and may think that it’s irrational, I personally have no idea why a horse would ever consider climbing into a dark, moving box.

Certain diseases definitely cause behavior changes, as suggested in the definition of mental illness. Diseases like encephalitis or rabies can cause depression or aggression. I remember one horse that I treated that had a brain abscess – he would seem normal, then start running around blindly, and become very aggressive. (He had to, ultimately, be put to sleep.) So I guess from that standpoint, you could say – at least on some level – that the horse was mentally ill.

From a physiology standpoint, horse brains are somewhat similar to human brains in both form and function; for example, most of the same chemical neurotransmitters work in both horses and humans. So there’s not any reason why horses couldn’t have mental illness.

But I think that the biggest problem with answering your questions is that there’s no objective way to tell if a horse might have mental illness. There aren’t any cognitive tests that might help differentiate between a horse with a behavioral problem and one that is certifiable. Even some of the questions that are typically asked people wouldn’t help much if you were screening a horse.

OWNER: “Doc, I’m concerned that my horse might be depressed.”

PSYCHOLOGIST, TO CLIENT: “Hmmm. Let’s see. Let me ask him a few questions.”

PSYCHOLOGIST, TO HORSE: “Do you feel like eating all the time? Do you feel fearful, but you can’t figure out why? Do you find it hard to focus?”

From my point of view, if the horse answered, “Yes” to any of those questions, it would mean that he was a… well, a horse.

So, bottom line is that I think it’s possible, but I think that it would be really hard to tell. Some of your friends probably act crazy from time to time, too, but you accept them for who they are, or move on. I think that’s probably a good idea for most horses, too!

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

I will readily admit that I have not studied the religions and philosophies of India. Nevertheless, I find myself drawn to a quote that is attributed to Sai Baba, an Indian guru and yogi who lived in western India, and who died in 1918 (he’s buried in the town of Shirdi). Sai Baba is considered as a saint by many Hindus and Muslims (you can CLICK HERE to read about him, and if you ever think that this is just a horse blog, well, now you’ve been thoroughly disabused of that notion). I think that the quote has much to say in its own right, but this isn’t an Indian philosophy blog (CLICK HERE to see a list of Indian philosophy blogs).

Anyway, here’s what he said: “Before you speak, ask yourself: Is it kind, is it necessary, is it true, does it improve upon the silence?”

I’ve been thinking about this quote a lot, especially as pertains to treating horses. What strikes me about it is how it succinctly sums up what I think should be the approach to the veterinary care of horses. Of course, an interest in taking care of horses is something that everyone who reads my articles probably has in common, and while there may be some disagreements in the particulars of how we may take care of them, for me, at least, I think that Sai Baba’s words offer some pretty good direction, no matter what treatment is selected. See what you think.

1. Is it kind? If your horse is like, say, every other horse that I’ve ever seen – or person, for that matter – he’d probably prefer NOT to be bothered with some sort of medical attention. Horses would much rather be running around in a field, or munching on some hay, than they would be standing with some bandage on their leg, or having someone grinding away at their teeth. They don’t think kindly of that sort of attention. Of course, it’s also not kind to allow a horse to suffer, and that’s why, say, cutting into a horse’s abdomen for a colic surgery is kinder than letting him die of colic.

To me, “kind” implies that you should choose the treatment with the least amount of discomfort, side effects, fuss, and bother.

Of course, it’s “kind” that’s one of the appeals of the “natural” health movement – “natural” gets used as a synonym for “kind” or “good.” And, while the association “natural” with positive attributes is a bit silly (see, for example, rattlesnakes, or Hurricane Katrina), to be honest, I completely agree with the idea that a treatment should be as kind as possible. For example, I always preferable to use a treatment that is less invasive to one that is more invasive. Or, to take another example, I like the idea that, when treating a wound, you should never put anything on a wound that you wouldn’t put in your own eye. (CLICK HERE to read about things to put on wounds).

Still, kindness only goes so far. Kindness isn’t the ONLY thing that one needs to consider, when it comes to treating. In fact, if you use something to treat a horse that isn’t effective, that isn’t kind at all. We owe it to horses to treat them with things that are likely to be effective, and we shouldn’t bother them by giving them treatments that aren’t (and you shouldn’t have to pay for them).

2. Is it necessary? I really can’t think of any reason to give a treatment if a treatment isn’t needed. I figure that if a medication, product, or service isn’t needed by your horse, why bother? If it doesn’t do anything, why should you pay for it?

Now there’s no question that things get done to horses all the time that are both kind and not necessary for the horse’s health. Blanketing comes to mind. Daily brushing. Tail extensions. Deworming again and again without seeing if your horse actually has parasites (CLICK HERE to see recommendations on internal parasite control). Trimming a horse’s feet on a preset schedule, rather than as needed. Stuff that seems, on the surface, like excellent care, but isn’t really needed. It could be a long list.

And, of course, there a lot of things that people do to horses that aren’t necessary for the horse, but make the people feel better – brushing might fit in there, and surely checkered leg bandages – and, mostly, I’m OK with those things. I mean, why have a horse if you don’t get to feel good too? But things start to change if someone’s trying to sell you something. That’s where the “true” comes in.

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3. Is it true? If I said that people should be told the truth about the treatments that someone wants to give to their horses, would you disagree with me? I hope not. Still, truth is a funny thing. In terms of medical treatments, it’s supposed to mean something like, “In accordance with fact or reality.” But when it comes to medical treatments, people mostly use the word “truth” to mean something like, “It worked for me (and that’s the truth).”

Sadly – frustratingly – medicine isn’t that simple. The history of medicine is littered with treatments that people swore “worked.” They were being truthful in their thoughts, even though, in the light of hindsight, it was clear that the treatment did no good – or even did harm. For example, George Washington was most likely bled to death by his doctors. At the time, bleeding was considered a standard medical treatment – it “worked” – for something like 2,000 years. So, I think that “true” has to mean something more than, “In my experience,” or, “In my opinion.”

For example, I have absolutely no doubt that almost every time when someone tells me (or writes to me angrily) that this or that “worked” for a horse, that that person is telling me a truth – their truth. But if someone else’s experience has been different – if, say, the exact same product or service hasn’t done anything at all – when that person says that it hasn’t done anything, he or she is telling the truth, too. So it seems to me that, in the context of treatment, there’s a deeper meaning of truth, and, given that this whole discussion started with a comment from Eastern philosophy, that’s probably not surprising. The deeper meaning goes beyond, “It worked for my horse.” I think that we owe it to everyone – and especially the horse – to find out if what we think is so (the truth, in some sense) is actually in accordance with fact or reality.

Now that said, one of the things that really makes me steam is the fact that there’s so much stuff out there in the horse world that’s just not true. Here are just a few examples:

• Acupuncture isn’t some historical tradition of treating animals in China
• Stem cells haven’t yet been shown to do anything useful for horses
• Ribs – any bone – don’t get “out of place” unless there has been serious trauma. And, when they do get knocked out of place, you can easily show that they are out of place.
• Supplements haven’t been shown to do anything to improve animal health, except in certain cases where there’s a deficiency of something. In fact, in human medicine, they’ve been shown to be mostly useless, and they can sometimes cause harm.

To find out how deep the truth of what someone is telling you runs, ask them for the basis of their, “truth.” If they just come up with stories about how their horse was helped, or how this or that should be used because it is the “latest” treatment, I’d raise an eyebrow. You don’t want your horse to just be the subject of some treatment experiment that you pay for and of which no one is keeping track. That’s also not necessary or kind: to anybody. The sad thing about the horse world is that there are lots of people trying to sell you something but precious few who actually work to provide good evidence that their wares actually do anything.

4. Does it improve upon the silence? With treatments, “silence” means, “Doing nothing.” Otherwise stated, is the product or service that is given to the horse better than just doing nothing?One of the beautiful things about treating horses is that they try to heal whatever injury they have. All biological systems have mechanisms to try to repair themselves. The goal of a medical treatment is to try to do better than the horse’s body would have done on its own. If all you do is run around in circles providing treatments while the horse’s body takes care of the problem – and pay for the privilege of doing so – you really haven’t accomplished much.

It’s a simple fact that some of the treatments being given to horses today haven’t been shown to do more than the horse would do on its own. They keep getting given for a variety of reasons (hope, money, good intentions, etc). Of course, if improvement is noted while the treatment is being given, then the treatment usually gets the credit, at least for a while, at least until the next newest treatment craze comes along.

I think most people promoting this or that treatment or therapy really do want to help horses. I’m a skeptic, not a cynic. But I think you should keep Sri Baba’s words in mind when you consider doing something to or for your horse. If you can’t answer all four questions with a resounding, “Yes,” then maybe you should think twice.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

NOTE: This story is also a good illustration of why you should be careful before you jump into the latest new treatment boat. Today’s treatment that nobody uses anymore is often yesterday’s “cutting edge” therapy. The list is long, and every year – sometimes every few weeks – there’s another one for horse owners to buy.

But this story starts with the horse’s navicular bone. People have recognized that the horse’s navicular bone can give some horses all sorts of problems for centuries.* And it was, and has pretty much always been, a very bad disease, because once the horse’s navicular bone is shot, you can’t fix it. (I wrote a book on navicular disease – you can see it if you CLICK HERE. It’s needs to be updated just a little – another project – but it’s still pretty good, even if I do say so myself).

It’s a truism that when horse’s have problems, veterinarians (and many other folks) want to make horses better. So, in the 20th century, people started to really look closely at navicular bones, to try to figure out what caused the problem, and to see if it could be prevented, or treated. They dissected navicular bones, they X-rayed navicular bones, and they advanced theories about what caused navicular bones to go bad.

They kept very busy.

One of the first things that they noticed was that, when you took X-rays of the navicular bone, the bones of some horses looked like they had holes in them. Some of the horses had more holes than others. And so it was determined that holes (also given descriptive names like “lollipops” or “channels”) were bad, and that a lack of holes was good. And, importantly, it was easy.

VOICEOVER: … and, yea, verily, so it was that holes in the navicular bone became diagnostic for “problems,” (not only now, but in the future, too).

It was also determined that if you shot a bit of anesthetic over the nerves that run down the back of the horse’s pastern (the palmar digital nerves), you could make many horses that were limping go sound. Horses limp because something hurts – make the spot that hurts numb and, voilà, the horse goes sound. Branches of the nerves on the back of the pastern run right on down to the navicular bone. So, in the 1980’s, if you had a limping horse, and he stopped limping once you shot some anesthetic over his nerves, and he had some holes in his X-rays, he was probably diagnosed as being “navicular.”

VOICEOVER: … and yea, verily, so it was that a simple nerve block became “diagnostic” for navicular disease.

It was very clean and easy. But alas, it was not to last.

Somewhere towards the end of the 1970s, a British veterinarian by the name of Dr. Chris Colles came up with a theory. He asserted that disease of the navicular bone was caused by a lack of blood to the navicular bone – he said that little clots in the arteries that go to the bone caused the bone to die, and deteriorate (the process is called ischemic necrosis). Thus, in his view, the possible cure for disease of the navicular bone was to get the blood flowing.

Thus armed with a plausible theory – and even a study or two – Dr. Colles (who, as far as I remember, was a great guy) got people going on treating “navicular” horses with rat poison. Not rat poison like you’d buy at the home improvement store, but warfarin, a drug that gets in the way of the blood’s clotting process (the same drug has been used for decades used to treat humans who have had a stroke, although newer drugs are taking its place). Amazingly, many horses that became sound with an anesthetic block, and had some holes in their X-rays, got better after getting warfarin.

And all was good. I mean, how easy could it be? Block a couple of nerves, shoot a couple of X-rays, give a medicine, the horse gets better… AMAZING!

VOICEOVER: … and, yea, verily, navicular disease became a problem with blood circulation that was treated with blood thinners.

Well, sort of good. The problem with giving a poison to a horse is that, well, it poisons them. Warfarin kills rats because it makes them bleed to death internally. So horses that got warfarin had to be closely monitored to make sure that their blood still clotted, which was important, but something of a pain. And that became a bit of a problem.

THREE TRUISMS ABOUT MEDICAL TREATMENTS:

1) Treatments that are a pain are less likely to be administered than treatments that aren’t a pain.

2) Otherwise stated, when it comes to treatments, the easier it is to do something, the better.

3) Nobody likes treatments that have really nasty side effects.

So, in the early 1980’s, thinking that the blood supply was the key to navicular disease, and being acutely aware that administering warfarin was a pain in the backside, other British investigators proposed the use of isoxsuprine for the treatment of navicular disease. And they concluded that the drug was very effective, and that it made horses that they had diagnosed with navicular disease (whether they had it or not) go sound, and stay sound. Isoxsuprine was pretty cheap, and very safe, and could be given in pill format. It wasn’t a pain. And, even better, there was one small study that supported it’s use!

And all was good (again).

VOICEOVER: … and yea, verily, isoxsuprine became the treatment of choice for navicular disease.

And then things got messy.

In the mid-1980’s, a study was done where a pile of X-rays was thrown on a table (almost literally). Some of the horses had been diagnosed with navicular disease, and others were normal. Veterinarians were asked to look at the X-rays, and decide which ones belonged to the lame horses, and which ones belonged to the sound horses. And they couldn’t. Then additional studies came along, showing that there was tremendous variation in the appearance of navicular bones of normal horses. Normal horses had all sorts of holes, channels, whatever.

Then, even more studies came along – including one I did in 1994 – that showed that you couldn’t predict if a horse would become lame based on the appearance of his navicular bone X-rays. And later studies involving CT scanning showed that navicular bone X-rays don’t provide a particularly good picture of the navicular bone anyway. All of a sudden, we, as a veterinary profession, went from being very confident in saying that a horse had – or was going to get – navicular disease, based on his X-rays, to realizing that we probably didn’t know very much after all (or, at least some of us went to that spot).

But then it got worse.

People started looking at what we were doing when we put anesthetic over the nerves that ran down the back of the pastern. Turns out, veterinarians weren’t just making the navicular bone numb, they were blocking most of the foot. And there a whole bunch of things inside the horse’s foot that can get injured. Turns out that many of those horses that had holes in the navicular bone on X-rays, that also went sound after a nerve block, did not also have navicular disease.

And, believe it or not, it got even worse. Folks that were looking for the cause of navicular disease kept looking, they did dissections of navicular bones, and they found out that there was no evidence that navicular disease was caused by a lack of blood supply to the navicular bone. Diseased navicular bones didn’t look like bones that lose their blood supply. In fact, diseased navicular bone look at lot like joints that have osteoarthritis. So, the underlying rationale for prescribing things like warfarin, or isoxsuprine, turned out to be wrong all along.

And, believe it or not, it still got worse.

People then started looking at isoxsuprine. It turns out that when you give a horse isoxsuprine pills, only 2.2 percent of it is actually available to the horse, and most of that gets taken out of the system right away by the horse’s liver. Studies in horses showed that there weren’t any effects on the horse’s cardiovascular system following oral administration. Another study showed that it didn’t have any pain-relieving effects, either. All of which indicated – to people that were paying attention anyway – that the rationale for the use of isoxsuprine for the treatment of navicular syndrome (or laminitis, another popular condition for which isoxsuprine has been advocated) – is, to be very, very kind, questionable.

So, whereas previously, navicular disease was something that was pretty easy to diagnose and treat, all of a sudden, pretty much everything that veterinarian’s thought they knew turned out to be wrong. After about fifty years, we’ve at least figured THAT out.

Unfortunately, people tend to have long memories. So, even today, horses get quickly diagnosed with navicular disease, based on a simple series of steps, and they get treated with a drug that’s almost certain not to work. There are new drugs, too – and there’s good reason to believe that they don’t do much, either. But the kicker is: the horses still get better. Of course – and you know this, having read this far – the reason that some of these horses get better is they didn’t have the problem in the first place. They got better in spite of their treatment, not because of it. The problem still persists in the prepurchase arena, too, where good sound horses can get condemned for having “pre-navicular” or “navicular changes” when, in fact, there’s no evidence that these horses have – or will have – any problem at all.

So, look, if your horse gets diagnosed with navicular disease, or if your horse gets rejected on a prepurchase exam, don’t necessarily despair. Make sure that it’s a diagnosis that’s arrived at carefully. Make sure that your horse gets plenty of time off to allow other things in his foot to heal; a good number of problems related to the foot will heal with time (and may be assisted by good shoeing). And forget about the isoxsuprine, because it almost certainly can’t work.

And try to forget all that other stuff, too. Except….

Now there are new treatments for navicular disease (CLICK HERE to read about them). They’re being doled out like candy. They’re the latest. We’ll see how that goes, I guess. If history is any example, memories will likely persist, at least until the next new opportunity to make one comes along.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

Being a horse doctor is wonderful. Just about every day I get up, knowing that I’m going to be outside, working with what I think is one of the most wonderful creatures on the planet. So strong, so patient, so willing to trust, so willing to do the most amazing things for people, asking nothing more than a little attention and a good bit of food.

Being a horse doctor is terrible. Not a day goes by that I don’t worry. I worry about if a horse is getting better. I worry about making a difficult diagnosis that a client may not want to hear. I worry that I won’t get called. I worry that I will get called when I have something that I really want to do. I rarely get a full night’s sleep. Sometimes it’s because I get a call to go out to see a sick or injured horse. Sometimes it’s because I’m worrying. My phone rings all the time — when I’m in the shower, or at the gym, at a restaurant, or even in the bathroom. I’ve coached young boys playing games while consoling concerned horse owners. I’ve spoken to concerned horse owners while on vacation, walking through the streets of foreign countries. I carry a terrible responsibility — to help horses, to help people.

Being a horse doctor is wonderful. Just about every day, I wake up knowing that I’m going to go out and help somebody, and help a horse. I like that. It feels like I’m doing something good for the world. I really love horses.

Being a horse doctor is terrible. I have to deal with the worst sides of human nature. I have a long list of people who have asked me to be there for them – to take care of their horse, to give them needed supplies, to help their mare bring a new foal into the world – and then have simply refused to pay me for the work that I’ve done, or for the products that I’ve given them. Afterwards, I’m the one who is bad-mouthed. I’ve seen horses given needless medications, and countless needless products and supplements, all in an effort to live up to people’s expectations for them. And I’ve been called ugly names for not wanting to participate in the charade.

Being a horse doctor is wonderful. Just about every day, I get to see friends who I have known for years. Friends who have shared triumphs and tragedies, and with whom I have shared my own. I have become part of their lives. Friends who trust me, not just to do the right thing by their horse, but to do the right thing. Friends with whom I have shared joy and laughter, triumph and heartbreak, both in the horse world, and beyond.

Being a horse doctor is terrible. In addition to my own concerns, I become part of every client’s worry about his or her horse. I share hurt and despair when bad things happen, and especially at the end. Each client has his or her personal pain. I carry a little bit of each and every one. I have seen awful accidents happen to horses, bad memories that I won’t be able to forget, and that I don’t want to describe. I wonder if, in some way, these are not like the emotional scars that soldiers take away from battle. Not as extreme, not as emotionally devastating, but just as real.

Being a horse doctor is wonderful. Veterinary medicine is an art, and a science. I know lots of artistic tricks that help me convince a 1,200-pound animal that I’m not going to hurt him, even when I might, just a little bit. I’m paid to be a veterinary Hercule Poirot, noticing countless details, and trying to assemble them into a diagnostic package that makes sense. Some cases are actually pretty simple, and I can take care of them quickly — with an injection, perhaps some fluids, or maybe just tincture of time. Others are more complicated, more difficult, and more frustrating, requiring time, patience, and a variety of approaches to find the right answer, if a “right” answer can be found at all. I get to help sick horses find health. I get to help worried owners relax and not worry. At the end, I can help provide comfort and understanding, and give my client’s emotions a soft shoulder on which to rest.

Being a horse doctor is terrible. I am constantly told that I am wrong. Everyone’s an expert, it seems. I’m accused of not being open-minded, that I only like drugs and surgery, that I can’t do this or that (even when I can), and that I don’t care about the “whole” horse. I’m told that I’m wrong by “dentists,” and farriers, and “chiropractors,” and any number of “therapists.” And when it turns out that I was right after all, no one remembers. I often feel crushed by the stupidity of some of the things that people are told, and by the lies and weasel words that are used to get people to spend seemingly limitless dollars on needless products and services. I hate seeing people waste time and money on needless things, time and money that they should be using to enjoy their horse.

Being a horse doctor is wonderful. Experience has brought a good deal of wisdom, and tempered some of the arrogance that first came with being a “doctor.” I understand more about the limits of what I can and cannot do. I understand the limits of my profession. I accept myself for who I am – I accept others for who they are. I have made many deep connections: it’s the most important thing in my professional life. I help horses, and I help the people who own and take care of them.

Being a horse doctor is terrible. I have made countless decisions that affect the lives of other people, and their horses. Happily, almost all of them have turned out well. But not all. Sometimes it��s not possible. Sometimes bad things happen, no matter how much you know, how well you work, how perfectly you do your job. I remember the battles that I’ve lost, and the people that I’ve lost them with. Soon, there will be another battle to fight, and I will fight it as hard as I can, replacing some of the old memories with new ones. Again and again.

Being a horse doctor is wonderful. I live comfortably, but not extravagantly. I can go out to a nice restaurant every once in a while. As a veterinarian, I still get a little respect. There seems to always be something to do. My days aren’t boring, and in between my work, I get to play some: on the golf course, in magic sessions – isn’t horse medicine just another kind of magic? – with friends, with family.

Being a horse doctor is terrible. Paperwork is a constant part of my life. There are insurance forms. Health certificates. Lab forms. Over and over again. I sign lots of papers every month, and I’m not always sure what my signature really means. It takes lots of time, and some people don’t think that’s worth anything at all. I know, because that’s what they tell me. My time isn’t worth anything to them. It’s terrible, being told you’re worthless.

Being a horse doctor is wonderful. I wouldn’t have chosen any other profession. No matter how terrible it can be sometimes.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

In my view, sometimes it’s OK to not know exactly what a horse’s problem is. In addition, sometimes it’s OK to try a treatment without knowing the mechanism of action. Honestly, it happens more often than we’d like to admit.

However, in my view, when that happens, you shouldn’t lie about it or make stuff up.

A few years back, I treated a horse. He got better. He hasn’t had a problem since. Happily, this is not the first time this has happened, of course, or I probably wouldn’t have been doing this for three-plus decades. But I wanted to tell you about this horse in light of all of the back-and-forth that goes on when it comes to talking about treatments, and how, if, or why they might work.

The horse I treated was a 3-year-old Quarter Horse gelding used for barrel racing. His owner was (and is) a long-time client with lots of experience around horses — caring, showing, riding, loving… you know. The horse had been in training for a few months, and she told me that he didn’t feel “right” behind. She said that he felt like he was “stepping under himself.” She wanted to to take a look and see if something was wrong. Having worked for my client for a couple of decades, and knowing her to be a good horseperson and a very caring owner, I was pretty sure that she was feeling something.  It’s great to have relationships like that with your clients. When they have confidence in you and you have confidence in them, a lot of good things can happen for everyone involved.

I examined the horse. I watched him trot. I watched him in hand, under saddle, and on the lunge line. I did flexion tests. I used hoof testers. And…. I didn’t see anything wrong. However, when I felt the muscles on one of the hindquarters (I don’t remember which one), I was pretty sure that I identified an area of soreness. I kept going side-to-side, seeing if the response that I was getting on one side was the same as on the other side. It wasn’t. There was a difference.

The first time I ever saw a horse that reacted like this was in my twenties. At that time, I was working with one of the founders of the American Association of Equine Practitioners, interning as a senior veterinary student. He pushed on a horse’s muscles in that same area and told me that the horse has a problem with in his whirlbone.

The whirlbone thing was news to me. Go through any text on equine anatomy and you won’t find a whirlbone (for those who love anatomy, and as I found out, it’s an old term that was used to describe the greater trochanter of the femur). However, in spite of the fact that the problem was apparently in an as-yet unidentified bone, I could see what he was seeing and I could feel what he was feeling.  So at least there was that.

Next, was the treatment. He injected the muscle in the horse’s hindquarters in a pattern – a series of lines, really – with a few milliliters of a product made up primarily of iodine and peanut oil at a number of spots along the lines.  At least, that’s what I recall was in the stuff. It was black as tar, and thick, because of the oil. The horse went home. I have no idea what happened to the horse after that.

Having just seen a horse get a diagnosis that I’d never heard of and receive a treatment for that condition that I’d also never heard of – and frankly, kind of shuddered at – made me think of several possibilities.

1. This guy is nuts, or
2. They sure don’t teach some important things in veterinary school (they don’t, but that’s another story, and, honestly, it’s hard to be too hard on vet school because there’s so much to teach and so little time in which to teach it), or
3. I’d missed too many lectures while trying to work on my putting.

Regardless, when confronted with the 3-year-old in the present day, I remembered back to my internship days. In my nearly 40 years of practice, I’d also seen a couple of other horses that had similar presentations to that horse I’d seen during my internship, I’d treated them with the oil and iodine, and they improved. So, I figured, having failed to come up with a better diagnosis, “Here’s another one.” I treated it just like the other ones, too. He got better. He hasn’t had a problem since (he’s six now).

Only…

I don’t know what I really treated. And I don’t know why the treatment worked – or even if it did.

Many people get uncomfortable when a doctor says that he or she doesn’t really know what the problem is. In the wonderful old “All Creatures Great and Small” series of books, Siegfried, the veterinarian who employed James Herriot (nee James Alfred Wight) advised, (paraphrasing), “No matter what the condition is, give it a name.  I don’t care if you call it McCluskey’s Disease. It has to have a name.”

Apparently acolytes of such an approach, many people will identify what they’ve found with a name. Call it a subluxation. A “tight band.” A “reactive point.” Call it something.  And make sure you have some sort of certification representing your expertise in coming up with such a name.

I don’t do that. When confronted with this horse, here’s what I told my client. I said (paraphrasing), “You know, I’m not sure what’s wrong with your horse. I don’t really see anything. However, I certainly respect what you’re feeling. I did find this area on your horse’s hindquarters where he reacts differently than the other side. I’ve seen a few other horses like that, too. I’m not sure what the problem is, but I have seen something like this before.”

Having been a client for nearly 30 years at that point, she was OK with that “diagnosis.”

“What should we do?” she asked.

I could have said, “Well, we’re going to use an internal blister on your horse.  This will bring circulation into the area and help heal up the injured tissue. He’ll be right in no time.”

I didn’t say that, however, because the idea of “blistering” is pretty archaic and has been shown to be not related to any medical fact. It was used for a couple of hundred years – still is in some circles.

I could have said, “Well, with soreness in this area, we’ve found a reactive acupuncture point. We’re going to inject into and around the acupuncture point, based on historical Chinese medical theory, in order to balance the chi/stimulate the acupuncture point in order to treat the leg.”

I didn’t say that, however, because modern acupuncture is not based on historical Chinese medical theory, acupuncture points have not been shown to exist as discrete entities, talk of things like “balance” and “chi” don’t reflect anything that’s measurable or demonstrable, and also because there’s no good, consistent evidence that acupuncture has any relevant clinical effect on any condition of the horse.

I  could have said, “We’ll be injecting trigger points today in order to relax the muscle spasm that’s causing the problem that you’re feeling.”

However, while people who look into such things say that a trigger point is an area of tightly contracted muscle, or some sort of small muscle spasm, unfortunately, that’s all still theory, even after a few decades, and such science as there is is controversial, or even a little nutty sometimes.

What I did say was, “I’ve seen a couple of horses like this.  I’ve injected them with this horrible sounding combination of peanut oil and iodine. I have no idea why it does anything – my best guess would be that it makes them a little sore, alters the way that they move the leg, and they get over the problem as they exercise. But I don’t know.”

If I wanted to be honest – and I did – that was the best that I could come up with.

My client asked for a day to think about it, but, after a day, she said, “Sure, let’s give it a try.” We did. I injected the horse, we kept him working, he got better, and he hasn’t had a problem since. If I ever see another one like that, I’ll probably do the same thing, assuming that I can get the medication.

I’m OK with uncertainty. What I’m not OK with is making stuff up in order to make a diagnosis or a therapy sound more convincing. I’m not OK with lying to people about what the history of Chinese veterinary medicine was about. I don’t mind if people want to stick needles in their horses in hopes of finding some therapeutic effect, but I’m totally against telling them that this is based on some ancient “wisdom” or worse, that it provides and effective and drug-free alternative to giving a horse horrible and nasty chemicals (or something like that). I don’t mind if people want to try to do something to horses with their hands, but I’m not OK with people telling horse owners that they are “equine chiropractors” when there’s no such degree, or that they are any kind of chiropractor when they haven’t gone to chiropractic school. I’m not OK with making up mechanisms of action that aren’t based in reality: circulation increases, bones out of place, mysterious energy channels, magnetic nonsense, and many, many more examples.

Anyway, a few years back, I treated a horse with a problem, with a medication. I didn’t know exactly what the problem was, and I didn’t know exactly what the medication did. I was honest about those things, I told that to my client, and we agreed to try something based on some experiences I had. Happily, the horse got better (even though one could plausibly argue that I don’t know that the “better” was because of the treatment). I was honest about my uncertainty and it worked out. In this day of curious names and dubious rationales, do you think my approach will ever catch on?

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

One question that seems to come up fairly often during the course of my practice is, “Which hoof dressing do you recommend?”  I wish I had a good answer to that. It’s a hard question to answer anyway. A Google search of “Horse hoof dressing” shows 21 pictures of products on the first page, and a total of 10 pages of options, so it appears that it’d be kind of hard to try all of them over the mere course of a human lifetime.

But if it’s a given that many horses don’t have good quality hooves – you know, brittle, shelly, cracking, thin walls, and such – and that there are almost as many hoof dressing products as there are stars and that horse owners understandably want to make sure that their horses’ hooves are in the best shape possible, I thought it might be fun to try to sort through the surprisingly sparse literature pertaining to hoof dressings and see if we could come up with a least a couple of reasonable conclusions.

BEFORE WE GET STARTED:  I won’t be recommending any specific product.  If you have a favorite, I’d suggest you keep using it, at least use it until another product becomes your favorite product.

Let’s start with a basic question.

WHAT IS HOOF?

Before you can do anything to something, you have to understand what the something is, right? There have been a good number of microscopic studies of the horse’s hoof. They’re very interesting and all – here’s a fairly recent one if you’re really interested in such things.

Hoof is basically the same sort of tissue (a protein called keratin) as are the outer layers of your skin, and particularly your fingernail or toenail. It’s quite different from human nails, however, in that the tissue of the horse’s hoof is arranged in both layers and tubes – human nails are more of a plate. The unique structure of the horse’s hoof allows the horse to support his tremendous weight, which, of course, is not part of the function of your nails. The tubular structures of the horse are thought to have the main mechanical role in allowing the horse to trot, canter, piaffe, gallop, and walk (and rack and any other gait you want to add, as well). Oh, hooves give the horse something to stand on, too.

That’s all well and good, but the biggest thing that you have to understand about hoof tissue – insofar as hoof dressings go – is that it’s dead. Now I don’t know what sort of luck you’ve ever had resurrecting dead things, but mine has been pretty dismal. Still, that’s a pretty important fact to keep in mind when it comes to evaluating the claims made for various hoof dressings. You can’t make dead come back to life. But you still may be able to do something.  Emphasis on the “may.”

WHAT’S IN A HOOF DRESSING?

A lot, depending on the dressing. But, fundamentally, not all that much. Hoof dressings generally contain one of three things, with a bunch of other stuff tossed in to appeal to… someone. That said, you can be pretty sure that any hoof dressing will contain one of three things:

1. Petroleum oil derivatives – These might include neatsfoot and/or cod liver oil, pine tar (think: “sticky”), petroleum compounds, and/or turpentine. Vaseline® is petroleum based. I once had a client that painted his top show hunter’s horses hooves with used motor oil (I’m not recommending this, however, as far as I could tell, the horses did fine).
2. Lanolin-based products – Lanolin is a wax secreted by wool-bearing animals. Some wags call it “sheep grease.”  Lanolin products aren’t oily – they’re more like hand lotion. Lanolin-based products have things in them such as lanolin (hence, the name), lactates, stearates, alcohols, and glycerin.
3. Drying agent – Hoof dressings with drying agents in them are made with ingredients such as acetone, which is a primary ingredient in nail polish remover. In my experience, most people don’t use drying agents routinely on their horses’ hooves, probably because most people don’t think that trying to dry out a horse’s hoof is a good idea (and it’s probably not).

WHAT IS A HOOF DRESSING SUPPOSED TO DO?

Well, let’s see …  all you have to do is read the labels!  Critically, of course.

“…. retards split hooves and quarter cracks. Helps create healthy feet with regular use. Shines up hooves.”

A QUESTION:  Have you ever called your veterinarian because of concerns about the shininess of your horse’s hooves?  I think it would be sort of like going to the mechanic because your car is dirty.

“…. helps prevent brittle, cracked hoof walls. This effective, long-term hoof conditioner that allows hooves to breathe.”

AN OBSERVATION:  Breathing through the skin (cutaneous respiration) occurs in a surprising number of organisms, including some insects, amphibians, fish, sea snakes, mudskippers, and turtles. Hooves, as previously noted, are dead. They don’t breathe.

“Maintains optimum hoof condition and aids re-structuring & growth of the hoof. Application by hand stimulates keratin producing cells.”

YOU CAN’T USE A BRUSH?  Keratin-producing cells are in the horse’s coronary band, not the hoof. Just sayin’.

“With daily use, XXX promotes growth of the outer aspect of the hoof, giving new hoof growth extra time to form without being exposed to harsh elements.”

NOW WAIT A SECOND: Hoof growth occurs at a fairly steady rate from the horse’s coronary band, “elements” notwithstanding. And what about the “inner” aspect?

“,,,provides intense hydration for the hooves. The butyrospermum and fatty acids in its formula have very potent nourishing qualities. This action is further boosted by helianthus annuus seed oil, which provides emollient, nourishing, and renewing properties and and provides hooves with the ingredients they need to allow them to renew fully.”

THAT DEAD THING:  Renewing and renourishing probably work best when the target tissue isn’t already dead. If you didn’t know (I didn’t), butyrospermum is a vegetable oil sold as shea butter and helianthus annuus seed oil is plain old sunflower seed oil, most commonly used to fry foods. Why can’t we just say that?

“…the first hoof formula to include hyaluronic acid (HA) and MSM.”

OH DEAR: Adding extra stuff to something that you put on dead tissue still doesn’t fix the underlying dead problem.

I could go on.  But I think you see the point. Lots of stuff on hoof dressing labels sounds good. But the key question is, “Do they do any good?”

HOW IS A HOOF DRESSING SUPPOSED TO DO WHAT IT IS SUPPOSED TO DO?

Hoof tissue is affected by the moisture content of the ground on which it walks (… trots, or canters). That’s even been demonstrated in good scientific studies, but maybe not as much as you think. It’s mostly the shape of the hoof that’s affected by the ground. In wild Australian horses, the hardness of the ground and the distance horses have to travel have an effect on the shape of the foot. Harder ground and longer travel distances are associated with short hoof walls and minimal hoof wall flaring. Softer ground and moderate travel distances are associated with long flared walls, similar to that of typical untrimmed feet of domestic horses.  Hoof shape is also affected by exercise. It’s also affected by genetics.

TAKEAWAY NUMBER ONE – Hoof dressings are not going to change the shape of your horse’s feet.

As important as the ground is, the curious thing is that the ground itself doesn’t seem to have much to do with the amount of moisture in the hoof wall. Whether horses live in wet or dry environments, their hooves seem to have about the same amount of moisture.

TAKEAWAY NUMBER TWO:  You’re not going to do much to change the amount of moisture in your horse’s hooves.

“But what about if you soak it in water?” you say (having been told to do this by many authority figures, but not necessarily how to get your horse to cooperate).

Hoof acts very much like your skin when you soak either one in the water. When left in a bathtub for a while – presumably with you in it – your skin gets all wrinkly from absorbing water into the outer layers. When it dries, all of the water evaporates.  Scientific American did a great, quick article about what happens with water and your skin:  it’s a pretty directly comparable to what goes on in hoof.

ANY BOTTOM LINES?

Well, yes, actually.

About the only thing that a hoof dressing can realistically do is affect the rate of moisture loss from the dead hoof tissue.  And, in one study, done in the 1990’s, and presented to the American Association of Equine Practitioners, petroleum-based hoof dressings ointments slowed evaporation more than lanolin-based dressings. So, you can look for that, but how important it is, is really anyone’s guess.

Under any circumstances, since hoof is dead, putting stuff like MSM, or vitamins, or hyaluronic acid into hoof ointments really doesn’t make a lot of sense. It might make someone some extra money, but it doesn’t make a lot of sense.

Even so, if you think that your horse’s feet have some sort of a problem that makes you want to run out and invest in a particular hoof dressing, you might want to consider looking elsewhere, for things such as a problem with diet, an inappropriate shoeing schedule, genetics (which you can’t fix), excessive toe length, or exercise frequency and intensity. Otherwise stated, if you think your horse has the kind of foot that has a problem that a hoof dressing can fix, it’s likely that something else is going on.

Lastly, if you think you’ve found a hoof dressing that solves all of your horse’s hoof problems, stick with it. I would never try to convince you otherwise. I haven’t found a cure-all yet. But it’s only been 37 years since I started practicing and I still haven’t gotten to most of the available products.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

I will be the first to admit that I am really glad that I am practicing on horses in modern times, as opposed to just about any other times.  For example, sedatives, the drugs that make horses sleepy, are wonderful, because they make horses so much easier to work on.

Still, sometimes modern sedatives aren’t quite enough, or sometimes you don’t want to sedate a horse that you’re working on (maybe it’s at a horse show, for example). In those times, older methods of restraint may work just great.  One of the more curious of those methods is the nose twitch (or just twitch).

SCHOLARLY ASIDE:  I was curious why it’s called a twitch, so I started looking around. Not as easy to find the origin of the word as you might think. Google was useless. My copy of the Oxford English Dictionary (yes, my innate curiosity can make me a bit nerdy at times) helped some, showing the first reference of the word in horses to come in 1623. But it was my 1933 copy of the Oxford Universal dictionary that had this obscure definition:  “4.  To pinch or pull at as with pincers or the like; to nip; to hurt or pain as by doing this.”  So, there you go (although how much pain it causes a horse is an interesting discussion, as you’ll see below).

BY THE WAY:  If you haven’t seen a twitch being applied, here’s a link to a quick video clip on the procedure:

NOTE:  The video clip above shows just one kind of twitch. I’ve seen twitches made with metal chain, bicycle chain, baling twine, and all kinds of rope. I’ve seen handles made from baseball bats, old axes, hickory sticks, and broom handles. There are metal “humane” twitches, which can be used by one person, some of which clip to the halter, and others of which secure themselves. And they all essentially do the same thing: they pinch the horse’s muzzle (although I’ve also seen them put on a horse’s ear, which I wouldn’t advise unless you just want your horse to be headshy).

Now you look at this video, and you think, “OK, what’s going on here?  You just tighten a loop of rope around a horse’s nose, and he’ll just stand there?”

And, most of the time, the answer is, “Yes, he’ll just stand there.”  And there are several theories why.

Probably the most common explanation is that the causes a bit of dull pain. The idea is that this bit of pain will cause the horse to concentrate on the pain while an unpleasant task is being performed. That’s exactly what William Youatt, and English veterinary surgeon wrote in his book, The Horse, in 1831, Youatt said, “The horse suffers great pain from the pressure – sufficiently great to render him comparatively inattentive to that which is produced by the operation; at the same time, he is afraid to struggle, for every motion increases the agony caused by the twitch, or the assistant has the power to increase it by giving an additional turn to the stick.”  If you like old veterinary books like I do – and this one’s a classic – you can even see the book online if you CLICK HERE. (The passage is on page 321.)

There’s actually a well-known phenomenon called a diffuse noxious stimulus, whereby the perception of pain in one area can be diminished by pain in another area. So, for example, your headache might not feel so bad if someone kicks you hard in the shin. I’m not really persuaded by that explanation, however. I’ve been around plenty of horses who have been in pain, and they usually don’t just stand there. Take a horse with colic (please). When a horse is in pain from a colic, he shows it. He rolls around, or paws, or gets up and down. When a horse is in pain from a lameness, he limps. Pain usually doesn’t make a horse just stand in one place, insensitive to his surroundings, it makes them want to get away from the pain. I think there may be a more persuasive explanation.

In the 1980s, it was asserted that the twitch does its weirdness because it’s applied at an acupuncture point, and because of some sort of acupuncture-like effect. You can see a link to an abstract of the article, which was published in a fairly prestigious journal, if you CLICK HERE.

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As you might guess, I’m not at all persuaded by this explanation, and for a variety of reasons, including that there’s never been any such thing as an acupuncture point demonstrated, in any species.

(CLICK HERE if you want to read about why I wouldn’t bother with acupuncture.)

Some folks assert that the twitch works by triggering the release of endorphins from the horse’s brain. Endorphins are sort of like the body’s very own morphine, and they’ve been credited with all sorts of effects, including calming (which is something that narcotics generally do to people, and which is one reason why they are popular in drug abuse circles). I’m not at all persuaded by that explanation either, because there are all sorts of things that cause endorphin levels to rise in the horse, such as putting them in a horse trailer and driving them around. Horses that are being hauled in a trailer do have high endorphin levels, but there certainly don’t stand there as if in a daze.

None of the above three reasons makes much sense to me.  Here’s what I think.

I think a twitch works because of a phenomenon known as tonic immobility. Tonic immobility is a basic defense strategy in many species (including many mammals, and including humans). Tonic immobility is an adaptive response demonstrated when one individual – usually prey – does not think that it can possibly escape from, or win, a fight. Predators tend to react to the movement of their prey, but if the prey doesn’t move (instead of struggling or fighting), it can increase the probability that it will ultimately escape. If the prey doesn’t struggle, the predator cam become distracted, and even temporarily release the prey, sometimes giving the prey enough time to run away.

Tonic immobility is characterized by pronounced physical immobility, trembling, muscular rigidity, sensations of cold and numbness or insensitivity to intense or painful stimulation. It’s caused by things such as fear and physical restriction, but the most important aspect may be the perceived incapacity to escape.  That’s what I think is happening when a horse gets twitched.

If you haven’t used a twitch on a horse, don’t just run out and try it, or think of it as some sort of a fun parlor trick.  You’d like to learn about twitches with an experienced person helping you out. Putting a twitch on a horse is something that does carry the potential for some adverse consequences.  For example, I’ve seen poorly-applied twitches come off in the middle of procedures (to explosive effect), and wooden handled twitches whirling around in the air after having been let go of by an inexperienced handler. Trust me, the things hurt when they hit you. It’s a useful tool, but not one to be used unless you have some experience.

Anyway, that’s what I think about twitches.  What about you?

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

So, I was walking up to this barn, and I see a client strolling down the aisle, shaking her head, obviously concerned about something.  “What’s the matter?” I asked.

“I had my horse talk to the psychic,” she said.

This is the sort of instance where you can easily blow a doctor/client relationship by saying something like, “Oh, geez, what an utter and complete waste of time and money!”

Being somewhat wizened to client psychology at this point, instead, I wondered, “What did she say?”

“Well,” my client offered, “my horse hates the color red.”

Perplexed, for among other reasons, because I know that horses are mostly colorblind, I asked, (somewhat reluctantly, because I knew that some answer would be forthcoming), “Why is this a problem?”

Turns out that the horse had red leg bandages, in which his legs could be wrapped at night.  Worse:  he had a matching red blanket.  The poor beast was covered in red.  Fortunately, there was a solution.

“I’m going to have to go out and buy blue leg wraps and a blue blanket this afternoon,” she said. “It’s the only way he’ll be happy.”

At once nodding sympathetically, and pinching my forearm as hard as I could so as to maintain my composure, I offered her some obviously needed support. I held up pretty well until she said, “Doctor Ramey, I never knew horses were so materialistic.”

“Neither did I,” I said, moving quickly towards a quiet spot where I could lie down and hold my sides.

Actually, the whole idea of blanketing horses is mostly pretty silly. Horses originated in some of the coldest parts of the world: the Central Asian steppes. If they hadn’t figured how to stay warm, they would have frozen out long before we started riding them. See — they’ve got a nice coat of dense hair to provide insulation, in addition to their body mass.

The body mass of a horse actually makes it fairly hard for them to get rid of heat. In fact, getting rid of body heat is the main problem for most large-bodied animals. Horses have less body surface relative to their size than do smaller animals. So, for example, if you’re an elephant (not making any weight comments, I’m talking about the animal), you’ve got a very big body with relatively little surface area exposed from which you can radiate heat. On the other hand, if you’re a canary, well, cold weather is a big problem.

(Does anyone sell canary blankets?)

GRAPHIC EXAMPLE:  When I worked at Iowa State University, after I graduated from veterinary school, a horse died in the barns at about 10 p.m. It was 22 degrees below zero outside. All horses that died in the clinic had to have a post-mortem exam. Unfortunately, the pathology lab was closed, so to keep the horse in a state where a good post-mortem exam could be performed, we moved him from inside the barn to outside. About 12 hours later, we did the exam, and the horse was still quite warm inside. What I’m saying is that if dead horses can stay warm in 22 below weather, live horses can SURE do it.

Horses also generate a lot of heat, mostly through digestive activity.  So if, for example, you’re feeding hay to your horse in the winter…

WAIT – You are feeding hay to your horse in the winter, right?  I mean, if not, your horse will have a lot worse problems than getting cold.

… then he’s going to be generating a lot of heat on his own. Hay, or any feed, adds fuel to your horse’s internal fire, as it were.

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Now, if you live in Finland, and it’s January, and you’ve body clipped your horse, and you insist on keeping your horses outside all of the time, by all means go ahead and blanket him. But the idea that horses might ever get cold in the warmer climes – say Southern California – is fairly hard to understand, at least from a horse physiology standpoint.

It’s not that blanketing is necessarily benign, either. One of the things bad things that blankets do is compress the horse’s hair coat. With a blanket on, they can’t fluff up their hair and help insulate themselves. In addition, if it gets wet under the blanket – as it can in a winter storm, or, when a horse is sweating under the blanket – the blanket keeps the water from evaporating, making the horse even colder. (As you probably know, cold and wet is a pretty miserable thing to be.)

So, mostly, there’s not really any reason to blanket your horse.

However, blanketing certainly does do a couple of things. It may help keep some dirt off of your horse, which can be helpful if you’re at a show. Maybe it’ll save you some grooming time. If you’ve decided that the perfect time to body clip your horse is just before the latest blast of arctic air comes your way, putting a blanket on him probably won’t hurt. Blankets certainly adorn horses in a delightful color of your choice, which not only allows you to express your latent interior design talents, but it allows you do so without much embarrassment for your horse, since horses are mostly colorblind. However, blanketing does NOT do anything to limit the growth of the coat – coat growth is controlled mostly by day length (as the days get shorter, the coat gets longer, and vice versa).

I’ve seen catalogs that try to sell you on the fact that not only does your horse need blanketing, he needs a different blanket for just about every conceivable temperature range. I haven’t seen the slightly chilly, light westerly breeze, 60% humidity model being marketed yet, but I’m sure it’s coming. What I’m saying is that if you are bound and determined to blanket your horse, at least don’t see how many of the darn things you can own. They take up a lot of storage space, too.

All this said, my experience has been that no matter the facts, a lot of people are going to blanket their horses anyway because, well, just because.  And, mostly, that’s fine – it certainly doesn’t hurt them, unless they get their legs wrapped up in it (it happens).  And I won’t criticize you at all, because I know you’re doing it because you love your horse.

When it comes to blanketing your horses, it’s mostly for you, not for them. And that’s OK. Just don’t forget to take his blanket off when the forecasted high temperature is 75 degrees F the next day.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.

I get that some horses cost more to buy than others. In fact, I wrote about it – CLICK HERE to read “On the Value of Horses.”

Over my career, I’ve been fortunate enough to see and to take care of some pretty great horses. I have a picture that I took of Secretariat in my family room, taken when I worked at Claiborne Farms for a couple of days as a senior veterinary student. I’m still taking care of Richard Spooner’s great horse, Robinson (and his best friend Nanny II, the goat). Cristallo, the number one jumping horse in the world in 2012, retired last year. And I’ve also taken care of too-many-horses-to-mention that you have never heard of, but that meant the world to their owners.

Still, my experience is that if one is lucky enough to own or care for a very valuable horse (value, based on how much it would cost to buy the horse), it tends to make people go a bit crazy. That’s OK in a sense – it’s important to take care of things that are valuable. But some people who have or keep valuable horses seem to think that also means that they have do all sorts of special things for these horses. And I think that’s too bad, because it sets those people up to be taken advantage of. So, based on my experiences, as well as a whole bunch of acquired knowledge and information, I’m here to let you in on the differences between the needs of high-level performance horses and all of the other horses.

What performance horses need in the same amounts as most other horses

1. Just about anything you can think of. Horses are horses, even if people are willing to pay more for one horse than another. What they do usually doesn’t change what they need. For example, requirements for vitamins and minerals don’t go up in performance horses (or with any form of exercise). I suppose that heavily working horses may need to drink more than your average backyard pleasure horse – particularly if they sweat a lot – but since exactly no one should ever withhold water from their horses, this is rarely a problem. Healthy performance horses need good foot care, occasional vaccination against some important diseases, the occasional dewormer (check the feces first), and their teeth should get looked at from time to time – and really, that’s about it.In a way, you can think of performance horses like performance automotive vehicles. Lamborghinis, Ferraris, and the like, all run on gas, have engine coolants, and lubricating oil. Sure, performance cars have bigger engines, but all cars run on the same stuff.But owners of high performance vehicles – like owners of performance horses – don’t just stop at what the car needs. Fancy car owners like to make sure that the cars are waxed, and that they have GPS systems, and leather interiors, and tinted windows and maybe some fuzzy dice hanging from the rear-view mirror. Maybe some engine cleaner additive, or special oil additive, too. However, all of that stuff means as much to the car as most of the “necessary” stuff that people spend money on does to performance horses. And none of it means anything if the cars don’t get what they really need.

What performance horses may need more of than other horses

1. Calories. This may seem a bit obvious, but if a horse works really hard, he’s going to need more calories than a horse that doesn’t work really hard. Exercise takes calories; more calories means more food. How do you know if a performance horse needs more food? Simple – he’ll be skinny. Ideal body condition for a horse means that you can feel his ribs, but you can’t see them. If your performance horse’s sides look like a washboard, he needs more food.By the way, not all performance horses need extra calories. Some show horses that are deemed performance horses really don’t work that hard at all. Many of these horses are fat – you couldn’t feel their ribs if you got a running start. Like I said, they may need more calories – some folks really overdo it. Fat individuals tend not to perform well – ever see a hefty competitive high jumper in a track and field competition?
2. Petting and brushing – It just kills me to see folks that don’t give their performance horses time and attention. To me, the biggest part of the enjoyment of horses is just hanging out with them. It makes me sad to see folks so caught up in the performance part of horse owning that they forget to give their horses some attention (NOTE: there are plenty of exceptions). It may be convenient to have boots polished, saddles oiled, and a horse that’s ready to mount on arrival, and handed off on dismount, but that’s really missing out on most of the fun that owning a horse can be. A bit more horse bonding might be good for both performance horse and rider.

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What performance horses probably need less of than other horses

1. Riding– Horses have amazing memories. You can train them to be ridden, turn them out in a field for a year, and then come back and jump right on. They won’t have forgotten a thing. People, on the other hand, seem to benefit from endless repetition. Thus, many horses get jumped/spun/run/slid/piaffed/etc. incessantly in the course of their training. It might be good for the rider; it’s probably bad for the horse. All of this riding stresses their limbs in the same way: over and over. Limbs which are repetitively stressed and not given the time to recover respond in the same way that paper clips do if you keep bending it back and forth; they break.In my opinion, performance horses would hold up a lot better if people would keep their riding and training sessions shorter, and train the horses less often, especially when it comes to movements that stress their legs. For example, in racing horses, injuries largely result from an inability of the biological repair process to keep up with the rate of damage accumulation. The amount of damage accumulation is directly related to the amount of high speed exercise (the number of times that the horse has worked and raced). I think a lot of performance horses are like that. People used to ask me the secret to keeping Robinson sound. They would ask me how many injections I did, what secret formulas I used, that sort of thing. I had to confess that it wasn’t me. I shared his secret, though: “He doesn’t get ridden that much, and then it’s mostly on trails.” Robinson’s 31 now, and, as far as I know, he doesn’t have an arthritic joint in his body.

1. Injections– I don’t think that there is any other athletic species that gets stuff injected into them as often as do performance horses. And it’s not just injections; dentistry, surgery, deworming, supplements, etc. are way overdone, too. There’s sure no evidence that all of this stuff is good for the horse (CLICK HERE to read about the waste of time and money that is often described as “maintenance” of normal joints). Plus, there is certainly the potential for harm; many of the drugs that get injected into horse joints have the potential to hurt the joint in the long run.In general, a lot of the things that are done to horses in the name of performance share a few things: 1) They aren’t proven to be of benefit, 2) They cost the owner a good bit of money, and 3) They increase someone’s bottom line. I saw the records from a performance horse the other day that, in one month’s time, had had his coffin joints, his fetlocks, his hocks, his stifles, and his sacroiliac joints injected, all with no diagnosis of any problem. I’ve seen entire barns get their “hocks done.” Can you imagine lining up a team of high school basketball players to get all of their knees injected? In the horse world, this sort of thing happens.

1. “Specialists” – This gets back to the story that I told at the onset. Horses are horses, and veterinarians are trained to take care of them. Sure, there are veterinarians who specialize in things like surgery, but that’s different. There’s generally no need for self-proclaimed “specialists” (even if they do come with some sort of obscure “certification”). In fact, in my experience, one big problem with specialists is that they have to try to do things to justify their designation. So, for example, if you enlist the help of a “specialist” who is known for treating horse joints (or backs, or jaws, or whatever), chances are that your horse is going to need his joints treated. Just sayin’ – if the only tool that you have is a hammer, pretty soon everything starts to look like a nail (CLICK HEREto read my article about that).
2. Fretting over – There’s a ranch that I’ve worked at for a long time that boards, and also takes layups and retirees. The horses live in pretty good sized corrals, and they get to see and hang out with their neighbors. Periodically, a really nice performance horse will get to rest there for a few months, and the owners are genuinely amazed at what happens to their horse(s).”He’s like a different horse,” they’ll say.And I’ll say, “That’s because everyone’s not making him nuts.”To myself, of course.

Performance horses are horses. They love getting fed, they tolerate getting brushed, and most seem to really like human interaction. But I think that it’s very important that they get to be horses. Sure, performance horses are valuable, but so is the 26-year-old school horse who safely carries a 4-year-old. At the end of the day, there’s really not much difference, and even though one may cost more than another, it’s hard to say which one is more valuable. And they pretty much all need the same things, plus a good, healthy dose of TLC.

Dr. David Ramey is a 1983 graduate of the Colorado State University School of Veterinary Medicine. Following graduation, Dr. Ramey completed an internship in Equine Medicine and Surgery at Iowa State University. He entered private equine practice in Southern California in 1984, and set up his own ambulatory clinical practice, Ramey Equine, in 1987. Dr. Ramey’s practice specializes in the care and treatment of sport and pleasure horses.  He cares for a diverse group of horses, from top level hunters and jumpers, to pleasure horses and miniature horses.

In addition to being a full-time practitioner, Dr. Ramey is also an internationally recognized researcher, author, lecturer, and blogger. He has written 13 books, 5 book chapters, and has had over 70 papers published in professional journals. He has lectured on various topics in universities, expos, and conventions around the United States, as well as Canada, Australia, and the UK. He has presented at the annual American Association of Equine Practitioners (AAEP) convention 10 times.

Dr. Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey’s website, doctorramey.com and is reprinted here with permission.