The most urgent situation is always the one at hand, or in sight, right there and then. We have to attend to emergency situations, whether if that is an acute lameness, injury, wound, health ailment or even colic situation. They are dire, in most situations, and must be dealt with accordingly, however, once through that crisis situation, we need to step back and really look at the big picture, hopefully isolating or honing in on the cause of why things happened or developed. This often entails looking past the obvious problems at hand, whether if that be a lameness or even a health situation, looking deeper and hopefully arriving at insight and wisdom. Can we do this? As easy at is sounds, it is not generally well accepted to look beyond the obvious problem at hand. Certainly a challenge for many horse owners, people themselves or even veterinarians.
Many issues that develop with our horses are acute in nature and the cause is obvious, simple and straight forward. Examples of this would include an injury, laceration, twist of a foot and tendon compromise, or even an improperly placed shoe nail. These are all 'acute' in nature, with obvious cause, but in reality, most issues that we are contending with are chronic in nature, more long term despite some appearing as acute. The list is long here, as examples, but include many types of infections, ongoing joint degeneration, tendon compromise, allergies, eye problems, metabolic issues, colic concerns and most hoof ailments. It may appear that the horse just 'came up' foundered or had an acute case of laminitis or even just colicked, but in reality, that pot had been brewing for a while, usually for months to years. You just happened to see it reach a boiling point.
A high percentage of health and lameness problems in horses and pets are man made, to be honest. In most cases, we, as man, play a role in their development either through improper provided diet, too high of a stress load, too high of work load, improper dynamics, improper foot care, or maybe even allowing those horses to become lazy and overweight. The medical consequences may be internal to them, on a cellular level, but we, again as man, helped them to get there. Looking at the feral horse or wild mustang, most are completely different from our everyday domesticated equid. The wild version is leaner, fitter, more energetic and constantly moving. They have feet made of iron, withstanding surfaces of all types with rarely a lameness. They are fitter, healthier and infection is not a major problem as it is in our domesticated version. There is a big difference, and from a vet's perspective, when I'd have an owner that adopted a wild mustang, we rarely had health or lameness issues, but more so they were just harder to manage physically due to fear. Seeing this, there are things we can do to somewhat return our domesticated versions back to their roots, but it doesn't always work because genetics now play a major role. They are just not as tough as they once were, and with this, we have health and lameness weak spots that develop. We can't change that, but we can work around it, seeing the players in the game.
Our focus, no matter the problem at hand, has always been the inflammatory process, which is fundamental to most conditions. Whether if we are talking joints, tendons, hoof issues or metabolic concerns, inflammation is a main player as it creates the path of degeneration and cellular changes. The more I dive into research, the more I explore, the more I see. I know, as a veterinarian and researcher, that inflammation is a major player, one of the main players, but I am now focusing efforts on where that inflammation is arising from. What is contributing to its development? It is like having a rash of house fires, one per night, seeing the fire (inflammation) and using water to extinguish it, but missing the cause, which is an unattended child with a box of matches.
In many cases, I get emails from owners with statements of what is, focusing on the problem at hand. Maybe they are emailing about a foundered QH, or a horse with uveitis, joint or tendon issue, or even a horse with respiratory allergies, EIPH, EPM or even just poor performance. They state the obvious problem at hand, which is correct, but also note that all prior therapies just are not working and the frustration this creates, not to mention expense. If I mention to most the concept of digging deeper, making connections between diet, stress and even gut health on that problem, more often than not, I get strange replies or no reply at all. We instinctually just see the problem at hand, which is a problem or more so a situation, but it is usually a manifestation of a bigger situation, one that we cannot 'see' physically. In order to see the bigger problem, it takes time to digest information, fit pieces together and make sense of it all. In the end, most do see the bigger picture, but then fixing it poses another dilema as usually the problem has been present for months or years. Not an easy fix, but certainly not an impossible one either.
The more I consult with patients and dive into research, two things become very obvious to me when it comes to roots to most health and lameness concerns. Those two things are gastrointestinal health and immune function. In reality, the concept of inflammation is tied back to these two entities in most cases. Inflammatory proteins are produced in most cases by immune cells, and in many cases, that is due to changes within the gastrointestinal tract. Not always the case, but more prominent than what we think.
Let's take some examples and dig deeper....
Equine metabolic syndrome and related issues are rampant in today's horse society. These horses are overweight, no offense implied, just making observations. They also have generally lower exercise levels, being stagnant most days. We say they have insulin resistance, then they have laminitis and maybe even poor thyroid function or even develop PPID in the years to come. We then use pain medications, special shoes, fancy diets, restricted diets and other medications to keep chasing problems that develop, supplementing what we perceive is deficient. How do these horses respond? A high percentage of them do very poorly, to be honest, having repeat flare ups month after month or year after year. We may see a medication reducing insulin values, but yet that patient is still 'sick', not doing well with various problems.
Equine respiratory problems, including COPD and IAD are also rampant in various disciplines, really dependent often on breed. These horses have a hard time moving air, breathing and thus performing. Some also have ongoing concurrent bleeding or EIPH concerns. Many of them are also overweight or easy keepers, some having other health or lameness problems additionally. We put them on medications to shut down the immune response, 'open airways' and even some to reduce fluids (diuretics), but again, we are often chasing our tail as they seldomly improve. They might get through that competition, but their health status is rarely enhanced, but really more so swept under the carpet.
Immune related issues, such as infections are also a major concern in the horse industry. This can range from recurrent influenza or herpes, to potentially more serious conditions such as EPM, Lyme and even Anaplasmosis. In many cases, the infections are mild and the horse recovers quickly and back to work. However, in other situations, things are not as simple. We use medications, antibiotics, anti-protozoals, often with little or only short lived impact on the patient. If the infection was the main problem at hand, shouldn't we expect a full recovery with medication usage?
Hoof related problems are also a major concern, ranging from recurrent abscesses to thrush, white line disease and laminitis. Again, here we supplement to boost growth and use specialized shoes to combat those changes, all with good intentions, but rarely is this a permanent fix. In most, the problems are still there, just covered up with silicon, patches or metal with wedges.
These are all just examples of pretty common problems that I encounter daily. They are also huge expenditures for most owners, on a montly basis, not to mention a source of frustration. Now, I am not one to imply or say that any of these issues are easy to resolve, but I will say that if we dig deeper, find the roots or contributors, then address them properly, that problems will be easier to manage and more responsive.
The common denominator with all of these conditions, and many that were not mentioned, is inflammation. The process of inflammation is what is impacting cellular function, impacting immune function and opening the door for those problems. However, in most of these cases, that inflammatory issue stems back to gut health. Even then, it is not that simple, as gut health is impacted by everything from a poor diet to stress. Not an easy fix in most cases, but many are readily responsive, IF we address all players in the game. This is where we have to have owner participation, a certain level of understanding and willingness to make change. The changes that we need to make often are so simple and basic, that we easily dismiss them as having potential to really make an impact. This gets back to one of my first rules and that is to keep things simple.
As I have told many a horse owner over the years, if a regimen is not working for you, which includes diet, supplementation and medications...then we need to make a change. Start with a clean slate, not adding to our current regimen but more changing that regimen entirely. In many cases, a contributor is present in that current regimen, and unless we eliminate it, we will continue to chase our tails.
We need a shift in our level of consciousness when it comes to health and lameness. If a solution is not working, then we must dig deeper if we truly want to improve the outcome. In order to do this, we must have a level of understanding as to cause and what our therapy approach is trying to do. If we do not have this, then the outcome will be diminished. We have to become educated, ourselves, on a certain level. The more dependent we are on another to 'fix' things, the more frustration we will encounter and likely, the longer the problem will persist.
Step back and look at the wild mustang in comparison, then ask yourself, "what am I doing or not doing here that is creating problems in my horse?" The answers are easy to see, but application of those answers is not always easy, given the difference in circumstances. Not impossible, just challenging sometimes.
If you are seeking, we are here to help.
All my best,
Tom Schell, D.V.M, CVCH
Nouvelle Research, Inc.