Posts Tagged ‘alternative’
By Hannah Mueller, DVM, Cedarbrook Veterinary Care
Heaves is a respiratory illness similar to human asthma, with flare – ups that make it hard for the horse to breath. The original veterinary term for the condition was COPD, or Chronic Obstructive Pulmonary Disease. It’s now called RAO, or Recurrent Airway Obstruction. The name was changed because the condition is thought to be recurrent, with repeated episodes, rather than chronic or always present.
Causes and Diagnosis
Heaves is thought to be caused by chronic exposure to dust, molds, or other air pollutants and allergens. It can be triggered by respiratory tract infections or increased exposure to the above causes.
Diagnosis is often based on the clinical signs of respiratory disease without evidence of infection, fever, or acting sick. In chronic cases, the abdominal muscles become overdeveloped from breathing efforts, causing a “heave line”.
Hint – Heaves can lead to clinical signs such as exercise intolerance (easily winded), expiratory dyspnea (difficulty exhaling), chronic coughing or wheezing, nasal discharge, and weight loss.
A definitive diagnosis can be made by cytology (looking at the cells present) and culture (checking for bacterial growth) of a transtracheal wash (TTW) or bronchoalveolar lavage (BAL), both of which are used to obtain fluid samples from the horse’s lungs. When testing is not possible, response to treatment can also help determine a diagnosis.
Treatment with Western Medicine
Environmental management is the first line of defense against heaves, no matter what approach you are taking. Eliminating allergens, especially dust and molds, can be done by:
• switching to pelleted hay
• soaking your horse’s hay before feeding
• feeding pelleted grain
• soaking the horse’s grain before feeding
• keeping the horse outside 24/7 if possible
• if he must be stalled, using pelleted shavings in a well ventilated stall
• riding in dust free environments
Steroids are medications that reduce airway inflammation. They are often needed to control the clinical signs of heaves and to keep the horse comfortable. They are used for maintenance therapy at as low a dose as possible, often once a day or just seasonally or during flare – ups.
Because steroids can have harmful long term side effects, the route of administration is important. Inhaled steroids treat the condition locally and are used at lower doses, which help minimize negative side effects. Flovent (the human inhaler, fluticasone) is the steroid of choice, but others such as Beconase (beclomethasone) or dexamethasone via nebulizer can also be used. Inhaled steroids require the use of a special mask, such as the Aeromask, which is often quite expensive; a second option is the Equine – Haler, which is bit less expensive. However, the Aeromask rates higher in drug disposition in the lungs, making it a better choice long term.
If inhaled steroids are not an option, oral or injectable steroids such as dexamethasone or vetalog can be used.
Bronchodilators dilate or open the airways. Inhaled bronchodilators are used as “rescue” therapy on an “as needed” basis.
Hint – Bronchodilators should be given 15 to 30 minutes prior to inhaled steroids. This helps open the airways so the steroid reaches further into the lungs.
A long acting inhaled bronchodilator such as Salmeterol can be used, but in some cases a shorter acting but less expensive option such as Albuterol is more reasonable.
The oral bronchodilator Ventipulmin (clenbuterol) is less effective, but can be used if inhaled bronchodilators are not an option.
Diagnosing and treating allergies can help decrease the need for steroids and bronchodilators. Allergy testing can be done with a blood test or by intradermal testing. The latter is more accurate, but also more difficult to do. The blood allergy test is controversial among veterinarians because of the high number of positives to antigens, but I have found it to be a helpful guide.
Once allergens are identified, they should be eliminated or minimized. In cases where exposure is unavoidable, allergy shots may be helpful. Antihistamines such as tri-hist granules or hydroxyzine may also help in these cases early on, but tend to be less useful as the condition progresses.
Hint – In some cases, secondary bacterial bronchitis can occur; a course of antibiotics may be helpful.
Going Beyond Western Therapies
Acupuncture can be helpful for heaves, although some research shows that one treatment is not enough to make a difference. Treatments should be initially repeated at short intervals (such as every three days) and the interval slowly lengthened as clinical signs resolve. In Chinese medicine, heaves can be a Deficiency of the Lung and/or a Deficiency of the Kidney, or less commonly an excess of Wind and Phlegm.
Hint – If you are interested in learning more about acupressure for horses, a good place to start is Nancy Zidonis’ book Equine Acupressure: A Working Manual.
Acupressure can be performed between acupuncture treatments. Interested clients can learn from their veterinary acupuncturist how to treat their own horses daily with acupressure. Depending on the case, the acupressure points involved may include Bladder – 13, Lung – 9, Stomach – 36 and Spleen – 3.
Supportive herbs and supplements can help significantly decrease dependence on steroids and bronchodilators. There are now many products available that can be helpful for treating heaves; it is often necessary to try a few combinations before deciding on the best fit for a particular horse.
Common herbs in respiratory formulas include cleaver, elecampane root, eyebright, garlic, ginger, licorice, marshmallow, plantain, and thyme. A combination of Hilton Herbs’ Freeway and Equilite’s Garlic+C is a good first line of defense. The following supplements may also offer support:
• APF (Advanced Protection Formula) for immune support
• NCD (Natural Cellular Defense) for detoxifying
• VivoZeoComplete2 for both immune support and detox
• Mushroom extracts, such as reishi and cordyceps sinsensis. These, in combination with transfer factors, have shown promising results in helping to treat pulmonary function in humans with asthma, and may also be helpful for horses with heaves.
• Antioxidants for additional nutritional support
• Bioflavonoids are pigments found in fruits and vegetables known for their antioxidant activity
• Ester C (calcium ascorbate) is a potent pH neutral form of the antioxidant vitamin C
• Ground flaxseed is high in omega – 3 fatty acids and helps with allergies
Homeopathics can also be used, although there is limited data showing their efficacy in treating heaves.
Preventing Heaves Prevention is the foundation of a holistic approach; with heaves, prevention or early treatment is key. Simply providing a healthy living environment with good quality hay, plenty of turn – out and dust free arena footing can help minimize dust and mold exposure. Horses that are continually locked in stalls, with or without small paddocks, and ridden in dusty arenas while being fed poor quality hay are at the highest risk of developing heaves.
Hint – Respiratory infections can trigger heaves; overall general health helps decrease the frequency or severity of these infections.
What’s the Prognosis?
With dedicated management and treatment, the prognosis for complete resolution is good. The outcome is dependent on the level of care, though, so without commitment heaves can easily become harder and harder to control, ending the horse’s athletic potential and lowering his quality of life. Prevention is important, but if heaves does occur, the earlier a diagnosis and treatment plan is established, the better the prognosis is for the horse.
Dr. Hannah Mueller is a 2004 graduate from Oregon State University College of Veterinary Medicine. She has loved, cared for, ridden and trained horses most of her life — they are her passion. She started her own mobile veterinary practice in Monroe, Washington in December of 2004 and offers full service equine veterinary care including acupuncture, chiropractic, advanced dentistry, sports medicine and more. Find out more at www.cedarbrookvet.com
by Hannah Mueller, DVM, Cedarbrook Veterinary Care
Most of us associate the word “sedative” with chemicals. Here are some alternative relaxation tips and techniques to try when your horse gets over-excited or stressed.
Most of us feel our hearts pound with excitement when we see a herd of horses run across a field. Even if we spend every day with horses, it never gets old! But sometimes this endearing quality can cause your equine to injure himself, or you. For example, the herd is running and playing in one field, while the horse with the bowed tendon in the paddock next door is leaping in place because she wants to join in. Meanwhile, you’re madly trying to put a halter on to calm her down so she doesn’t reinjure herself. Some horses have trouble controlling their excitement level and flight response, and this can be a serious matter.
Take a holistic look at your horse’s environment. If your horse is so amped up every time you take her into the arena to ride that you have to lunge her for half an hour before it’s safe to get in the saddle – and she’s kept in a 12’x12’stall with a 12’x24’ paddock the rest of the time — then it’s not your horse’s fault. It’s yours!
Horses are meant to have turnout, to be in herds, to play and to graze. They need this for their emotional health. Yet so many horses are kept inappropriately, then worked too hard to compensate for their excess emotional energy. This leads to injuries and lameness, and masks the underlying problem.
This must be the first thing you address if you are having behavioral issues with your horse! With that said, there are times where horses have medical problems requiring quiet stall rest; needless to say, those cases are often the most difficult to manage.
Emotional Roller Coaster
Much of this unwanted behavior can be prevented or minimized with proper training and handling. The key is to prevent the “switch from getting flipped”, beyond which horses stop using their rational thought processes and simply react through emotion. Through the work I’ve done with Equine Facilitated Learning (EFL), I have found the same is true of people. When we reach a high level of anxiety or excitement, our brains shut down and we often can’t remember the details of what happened or what was said. The key is to lower the level of excitement to a point where the brain still functions rationally.
Another pearl of wisdom from EFL is that horses can sense our emotional state. They react to it either by mirroring it or becoming agitated. For example, your horse is on stall rest and you’re afraid to take him out for his 15 minutes of “controlled” hand walking because you think he’s going to try to run you over and get away. You pretend you’re not afraid even though your heart is racing – and sure enough, he’s already dancing before you even get the halter on.
A better approach would be to stand in front of the stall and acknowledge that you’re nervous about taking the horse out. Tell him you’re worried about it, then take a deep breath to let the fear go. Wait until your heart rate has dropped, then walk confidently into the stall to catch him for the walk. Your own emotions should be taken into consideration any time a horse is acting out through over-excitement or anxiety.
Touch for Relaxation
You may also want to try a few bodywork techniques to relax your horse. Use caution and only do what your horse seems to like and respond to. When horses are agitated they can act out unexpectedly, and doing bodywork can put you in a vulnerable position.
Learning various massage techniques can help your horse relax and feel good, as well as strengthen your mutual bond (check out Horse Lover’s Guide to Massage: What Your Horse Wants You to Know by Megan Ayrault). Facial massage is a good place to start because it can be soothing and it keeps you in a safe place by the horse’s head. Try gentle pressure and massage over the temporal (forehead) region, or gently rub around the eyes.
You may also want to try incorporating a few acupressure points into the relaxation massage. Some effective calming points are HT-7 (at the back of the front leg just above the accessory carpal bone), GV-24 (at the start of the mane under the forelock), and GV-20 (at the highest point of the poll behind the occipital crest). To learn more, check out Equine Acupressure, A Working Manual by Nancy Zidonis.
What Comes Naturally
If you’ve worked on any training issues and have addressed your own emotional state, yet your horse is still upset, then you’re probably simply dealing with his natural, normal response. Rarely are horses truly “crazy” even though you may think yours is! Understanding this is important, because your horse isn’t trying to be “bad”. He’s reacting the way all horses do — some just react more than others! Reprimanding him for being “bad” won’t solve the problem and often leads to insecurity, which makes the problem worse. However, establishing and enforcing appropriate personal space boundaries (e.g. not letting your horse run you over) is essential. This is why some horses are good for beginners, and some are not. Making sure you and your horse are a good fit is essential.
The next step in dealing with the problem is to try a safe and natural remedy to help mellow your horse. There are a number of natural calmers on the market made up of herbs, flower essences or nutritional supplements. Common sedating herbs include:
• Passion Flower
• Lemon Balm
• Gotu Kola
The herbal formula I have the best results with is called Tranquility Blend, and contains organic valerian, skullcap, oat flower, passion flower, vegetable glycerin and distilled water. I like this formula because it is a liquid tincture that’s easy to administer to patients prior to medical procedures like dental floats or surgeries.
A number of other dry herb formulas can be easily added to a horse’s daily ration (Chava Naturals’ Harmonious Horse or Hilton Herbs’ Temperamend, etc.). These formulas are safe and work well for most horses depending on the level of calming needed. Herbal formulas tend to calm and take the edge off, but are not as strong as chemical sedatives, although valerian root is the one herb that can cause visible sedation when given as an overdose.
Other Calming Remedies
Flower essences work on an energetic level. If they are given in the right combination, they are very effective; if not, they seem to do nothing. Working with someone experienced in flower essences and trying out a few different formulas can help determine the best combination for your horse. The most widely recognized formula (and one of the most effective) is Rescue Remedy. Dynamite has a similar product called Relax that I like to use as well. Rescue Remedy or Relax are must-haves for your first aid kit. I also like to use essential oils like lavender for additional calming support. Other natural calmers on the market contain the amino acid L-Tryptophan (Calm & Cool), magnesium (Quiessence), and B vitamins (SmartCalm). These products are safe and work well for many horses. Be sure to check show regulations if you are planning on using a natural calmer at an event.
When Pharmaceuticals are Needed
When the natural approach doesn’t work, it may be time to consider chemical sedation. However, these medications must not be abused and should only be utilized as a last resort or in serious medical situations (e.g. a horse with a serious injury on life-or-death stall rest), not for clipping or training purposes. The main chemical sedatives we use are Reserpine, Acepromazine, Xylazine and Dormosedan.
• Reserpine is a long acting sedative that is herbal in origin (the drug is isolated from the root of Rauwolfia serpentina and Vomitoria plants). It can be used for long-term lay-ups. It does have a number of potential side effects. It can cause diarrhea, colic, depression, ulcers and sweating. Because it is long acting, the side effects can also be long lasting and serious. It is important to start with a small trial dose first to help determine your horse’s level of sensitivity, before using a full dose.
• Xylazine and Dormosedan (most commonly used for dental floats and minor surgical procedures) are a2 (alpha2) adrenergic agonists. These drugs are short acting (one to two hrs) and should be used only under direct veterinary supervision.
• Acepromazine is a phenothiazine sedative and is fairly safe. It causes mild sedation for a few hours, so is often used for situations like safely getting through the fourth of July. It is not good for long-term use.
Each horse responds differently to alternative sedation and relaxation options. Experiment with the safe and natural options so you know what works with your horse. In more extreme situations, be sure to talk to your veterinarian about the appropriate use of chemical sedatives. In many cases, chemical sedatives can be avoided by taking a holistic approach.
Be sure to check show regulations if you are planning on using a natural calmer at an event.
Dr. Hannah Mueller is a 2004 graduate from Oregon State University College of Veterinary Medicine. She has loved, cared for, ridden and trained horses most of her life — they are her passion. She started her own mobile veterinary practice in Monroe, Washington in December of 2004 and offers full service equine veterinary care including acupuncture, chiropractic, advanced dentistry, sports medicine and more. Find out more at www.cedarbrookvet.com.