Horses are not much different from you or I, regarding their health and soundness. They are just as predisposed to harm when it comes to an improper diet and stress, which can dramatically impact health one way or the other, as it does in people. When you have a medical or soundness condition, the ultimate question is how you look at things, which then determines your approach in providing care. Do you favor pharmaceuticals, including pain medications, steroids, and antibiotics? Or do you truly see the problem on a much bigger level? I think ultimately, which approach is taken is dictated by a true level of understanding, but also motivated by short term desires.
The horse’s body is a living, breathing machine. All organ systems communicate with one another through cellular signaling. Just like a car, it requires the right set of circumstances to function properly, but is easily hindered or thrown out of balance by certain factors. In many cases, those set of factors have been out of balance for so long, that it is not just one body part that is impacted, but many.
When it comes to remedying a health or lameness condition in the horse, you really have two approaches; conventional and non-conventional medicine. In some cases, you might combine the two, while in others, it is one or the other.
Conventional Medicine in Horse Health and Soundness
Conventional medicine, to keep terms simple, is the approach taken regarding the diagnosis, treatment, and prevention of disease that is utilized in a high majority of veterinary and human healthcare practices. This approach utilizes diagnostic laboratory testing to determine a disease when present, then often relies heavily on pharmaceutical or surgical means of intervention to remedy that disease. In many cases, the the term ‘cure’ is used, which is often a misnomer, but can stand true in certain situations.
In reality, with conventional medicine, health and disease are seen as being due to certain deficiencies of pharmaceutical medications. Now, we don’t believe that a horse is deficient in an antibiotic or pain medication, as an example, but really on a basic level we do feel that with daily usage their condition is managed.
Conventional medicine sees the disease as just the disease. It is about reducing health down to a specific disease that the horse may have, such as allergies, Lyme disease, cancer, or even a foot abscess. We see that disease or specific problem, and believe that if we could remedy that one problem, all will be well in the world. This is simply not true, but many do accept it to be.
A horse may have a skin infection, as an example, and be diagnosed with skin cultures, then treated with an antibiotic which resolves the issue. All good, right? In some cases, yes, this may be true, but in others the problem will come back later that year, or potentially even manifest next year as full skin allergies with hives and persistent itching. What then? More antibiotics and maybe corticosteroids this time?
Non-Conventional Medicine in Horse Health and Soundness
Non-conventional medicine takes a different approach to disease management. Medications and other pharmaceuticals may be required and used, which gets into complementary or integrative medicine. The basis here is that with non-conventional medicine, we essentially realize three things:
- Pharmaceuticals may be helpful, but may not be the answer for any one patient
- The body can heal and recover naturally with the proper support
- The body can become more resistant to disease and injury through diet and herbal approaches
The second point is the basis for non-conventional medicine when it comes to horse health care and soundness. In this world of non-conventional medicine, we look beyond the pharmaceuticals in most cases, and see the disease as being a part of a bigger problem. The disease is just one reflection of the state of imbalance in the body, which is creating un-health in that patient.
Conventional medicine is fixated on disease, while non-conventional medicine is more fixated on overall health restoration and preventative medicine. If you keep the body healthy and strong, it is less subject to injury or disease.
Both conventional and non-conventional medicine look at the cell and cell pathways, but in the conventional approach one chooses to use pharmaceuticals while the other does not. Pharmaceuticals can be effective in some cases, but are often restricted to acute care cases. They are very specific in their actions, thus can create negative outcomes and side effects for the patient, due to their specificity.
In non-conventional medicine, we tend to see the same pathways but on a broader level and use other non-traditional modalities to benefit the patient. In my practice, we tend to focus on herbs and proper diet to benefit that patient. In others, they may use acupuncture, chiropractic, or homeopathy. The tie in with all of the therapies is that they are attempting to restore balance in that horse’s body, which if achieved and maintained, will result in a higher state of health.
Why Choose One Approach Over the Other?
The answer to this is dependent on the situation and your ultimate goals for your horse. In the acute care case, such as a strained tendon, infection, or even critical colic, the conventional approach fits in nicely and can really benefit the patient. However, in the chronic health care or lameness situation, this same approach doesn’t often fit the bill.
Let’s face it, the high majority of health and lameness conditions in the horse are chronic in nature. At one point, they were acute, but due to lack of specificity in the approach taken, the problem continued over time, resulting in a chronic crisis. Remember that a chronic health condition is not one that has been present for years, but by definition is any problem that is present beyond a 30 day mark.
Taking into consideration that most health and lameness conditions in the horse are chronic, we must ask why? There are several reasons.
First, in many acute cases, aside from direct trauma, there is already a state of health imbalance in that patient which is creating the acute crisis. This crisis may be a foot abscess, colic, infection, or even an allergy situation. Conventional approach provides medications to quiet the acute symptoms, which is good, but this does little for the underlying imbalance. Thus the problem continues and becomes chronic in nature.
Second, in many cases, the conventional approaches taken actually further upset the health imbalance, propelling the patient into a chronic health state. Examples of this include long term use of NSAIDs, corticosteroids, and antibiotics. NSAIDs can further weaken an already damaged intestinal or stomach lining, creating more ulcers, organ damage, and negatively impact digestive health. Corticosteroids can further weaken an immune response, impede tissue healing, create organ damage, and impact normal adrenal gland function. Antibiotics can aid in clearing an infection, but when used long term they can negatively impact the normal bacterial flora of the digestive tract, skin, ears, and even urogenital system.
In reality, what needs to be done is not to choose one over the other, but to apply them together, integrate them, for the best interest of the horse. This would imply that if medications or pharmaceuticals are needed, you utilize them but with purpose and caution in the interest of the patient. If these medications could be producing harm, are counterproductive, or are producing minimal results for the horse, then they are discontinued. Additionally, using non-conventional medicine, you don’t forget about the patient, their health, and the sequence of events that have unfolded in creating that health condition or lameness.
Case Examples in Non-Conventional Equine Medicine
Equine Lameness: In our facility, we work with many horses regarding chronic lameness conditions. A high percentage are off-track Thoroughbreds, with ongoing tendon complaints. In evaluating these horses, many things become evident. First, the ongoing tendon injury is a result of other factors, but yet has been treated or managed in the past as an isolated event. Second, the imbalance of health in those patients is quite dramatic, and is really the main problem at hand.
In these Thoroughbreds, there is often a history of being ‘off’ in one forelimb, thought to be isolated to the tendon, but indeed, the foot is comprised, poorly growing, and not supportive of the body as a whole. This foot weakness is likely contributing to the tendon injury and both are created as a result of an ongoing digestive disturbance in that horse.
These horses have had conventional therapies applied with minimal or no results. Steroid injections, NSAIDs, antibiotics, topical therapies, special shoes, and other isolated approaches, often over and over again. If we step back and look at the whole horse, the picture becomes clearer. In reality, what we have in most cases is severe digestive upset which contributes to poor nutrient absorption, poor tissue health and growth, inflammation and degeneration. This is not due to an improper diet, but ongoing factors which include stress on a physical and emotional level. Then the problems are often made worse due to ongoing medications.
What choice to you have in a situation such as this? Conventional approaches have not yielded results and the horses have remained constantly or intermittently lame. The only approach that is feasible and realistic, is to use non-conventional medicine. Here, we pull shoes, barefoot trim, utilize a whole food diet, and supplement with specific foods and herbs to promote health, balance, healing, and modulate the inflammatory and stress patterns in that horse.
This approach takes time and persistence, along with a certain level of understanding, but it will produce the most satisfactory results regarding bringing that horse back to soundness and to a higher level of overall health.
Equine Allergies: Allergies are common in the horse and tend to become worse with each ongoing year, despite conventional approaches of steroids, bronchodilators, and anti-histamines. These horses usually start off as being sensitive to bug bites or flies, but over time, become worse and result in skin granuloma formation, hives, or otherwise. Through all of the years that the horse is enduring these allergies, conventional approaches are taken over and over, despite little impact on the allergy.
Corticosteroids are used, which can provide relief for the patient but do little for the course of the disease. In some cases, the horses can become clinically worse due to organ compromise and are at risk of laminitis. Antihistamines offer little benefit additionally. It seems that over time, instead of abandoning these approaches, we just increases the doses or frequencies, hoping that something helps.
Again, if you just step back, the condition becomes self-evident. The allergy is a result of immune dysfunction, which is often tied back to gastrointestinal health. Manage those two factors and the patient often quickly become manageable. Medications become a thing of the past for most, while for others their continuation is required, but often at lower doses. Better management can be acquired as a result of diet manipulation and utilization of specific herbs that can target the digestive tract, immune health, and inflammation.
The Ultimate Question
When it comes to non-conventional medical therapies, the argument is often raised that they are not evidence based. Now, while this is true for some therapies, if is not universally true when it comes to food and herbs. There is plenty of research to prove the benefits of whole-foods and even more to substantiate the use of specific herbs for promoting health. In most cases, this research is done in rodent models, then in humans. Some has been done in horses specifically, but not all. Does this mean you abandon them because there are no equine studies? Absolutely not! Metabolic syndrome in people is very similar to metabolic syndrome on horses. A tendon injury is almost identical to that in a horse, although different body weights and pressures exist. Leaky gut in humans is identical to that in horses, as are allergic conditions. They are all the same cellular pathways. We shouldn’t abandon these potent therapy options, but embrace them and utilize them to do what research has proven….they support and promote overall health in the body. That is our goal!
If you are facing any medical or lameness condition in your horse, especially if it is chronic in nature, you need to ask yourself what your bottom line goal is? In most, you would respond that you want your horse healthy and sound. You want them to be able to compete without coughing, run without bleeding, or jump without tendon pain. This is a good goal, but the question is how do you want to get there, especially if the condition is ongoing and repetitive?
I am not against medications and many choose this route, but be aware of whether if they are truly helping, hurting, or potentially of no benefit. Even if providing immediate relief, be conscious of the long term effects. You could help that horse through a season, but what are the long term ramifications to the horse? Could he be worse next year and if so, how are you going to manage then?
Medications do serve a purpose and can be used to break pain cycles, as an example, or replace deficient hormones in the body. The goal regarding the use of many medications, such as NSAIDs, is to provide the framework for healing within the body while using them. As you hopefully provide the framework for healing through proper diet, supplementation, and environment, the need for these medications may reduce.
Can your horse heal and recover? I believe that every horse has the power to heal, but the extent of recovery is dependent on the stage of the condition. The sooner you intervene, the better the outcome will be in the end. There are many options to assist you in this path and we are here to help.
Author: Tom Schell, D.V.M., CVCH, CHN