The horse, the veterinarian, and the firetruck. Three totally different beings, but yet linked together in many cases in various ways. I listened this morning to the sounds of sirens screaming down the interstate behind our house and it reminded me of veterinary practice. More times than not, despite the best intentions by the horse owner or veterinarian, the most optimal care is not provided, and gaps in therapy are often left unfilled. We each play a role in the care of that horse, but for the most optimal outcome, time needs to be devoted and parties need to work together. In addition, one is best served to act from a preventative health standpoint, rather than a reactive one. For many, despite the best of efforts, things tend to be more reactive, an emergency of sorts, chasing a tail round and round. This opens the concept of the firetruck and the part the veterinarian plays in equine health.
Your horse’s health is best maintained when preventative actions are taken. Items including annual examinations, vaccinations, deworming, and dental care all fall into this bracket. Although these items are important, they do not always equate to a healthy horse. I encourage my clients to perform these yearly services and form a tight relationship with your veterinarian, as they can help to prevent some really obvious problems. However, with that said, despite these efforts, many horses continue to suffer the ill-effects of chronic health conditions. These may include:
- Overweight/metabolic or insulin resistance
- Chronic immune related ailments from allergies and uveitis to high worm burdens
- Chronic lameness due to joint, tendon, or poor hoof health
- Digestive upset including colic and diarrhea
- Poor body condition
- Emotional problems including anxiety and even depression
What I have observed in my years of equine practice, is that for many horse owners, the veterinarian is used for preventative health on one level, but all too often, is also used as a firetruck on the other, tending to one emergency situation after another. The ultimate question is whether if those emergencies, which are often related to chronic health instability, can be better managed? Considering the high cost of veterinary care, especially in an emergency situation, is it time to step back and re-evaluate your horse’s situation? Think honestly on this concept of money, and if the money spent on your horse is really benefiting them or maybe hindering them?
Horse Health and Information
Your horse, just like your body, did not come with a user’s manual. However, in today’s world of the internet, practically any piece of information you could desire is readily available at your finger tips. There is often so much information available that it can be overwhelming, and creates anxiety in the horse owner. When this happens, instead of taking a step back to fully evaluate and understand the information presented, we just tend to want to rely on another to make the decisions for us and tell us what to do. Very common in both equine medicine and human medicine, not to mention other situations in our lives.
The reality is that when we rely completely on another to tell us what to do, instead of understanding what is going on, our outcome is often reduced greatly and the cycle continues one year or season after another. This reliance can be upon your veterinarian, your barn manager, your trainer, your farrier, or even a friend or group of friends on social media forums. It is in our nature to just follow what another does or tells us to do.
Despite my years of clinical and research experience, I honestly get stumped sometimes. I recall years ago, having cases in my care that were not responding to traditional therapies. Whether if that was a wound that was failing to heal or a septic colic case in my facility that was fading quickly. As a veterinarian, I found myself applying what others told me to do, whether if that was from a classroom during college, from an internship program, or a continuing education seminar. Much of what I did was almost robotic, applying this and that, then hoping things worked out. There was thought involved, but in many instances it was like following a recipe of sorts.
About 18 years into my equine practice career it finally hit me that we, as veterinarians, were often just following the input and advice of others. Some cases responded, but others did not. Plain and simple. I was not one that could just walk away from a case due to failure to respond. I had to know why, what was different, and more importantly, did I miss something? Could I have taken a different approach? Bottom line is that you, as horse owners are not much different that us, as veterinarians. More time spent following the words of another than often thinking for ourselves.
Why is that?
Truth be told, time is often the reason, as is the desire to learn and advance. Our schedules, as horse owners, farriers, and veterinarians are often so tightly crammed with ‘stuff’, that there is little time to truly seek answers or solutions. I’ve been there and I was there in the first 18 years of my career. Owners seeking farm calls, haul-in appointments, or calling with emergencies at all hours of the day and night. Many times, there was barely enough time to have a decent lunch, let alone sit down and read over medical journals. I, like many other veterinarians, relied on our yearly continuing education conventions to bring me up to speed on pertinent research and recommendations on how to manage that wound, that tendon injury, or that colic. Essentially, we became regurgitators of information, applying what we could remember from those conferences to our patients. Then, cross our fingers that things worked out. If things didn’t work out, the cases were often referred to the university or otherwise, as they were perceived as knowing more, had access to more technology, or simply had the time to dig deeper into the case. Not always true, by the way.
For me, as a veterinarian, after 18 years of equine practice, I was not happy with just applying the words of another as I saw those philosophies were not helping many horses. Those patients kept coming back or having relapses. While this was good from a revenue perspective in the veterinary world, it is not sound science and to me, it indicates that we are missing a piece to the puzzle. I thought our job, as veterinarians, as doctors, was to solve those cases and keep them from coming back again. Maybe I was wrong?
Time, Money, and the Desire to Provide Solutions
I sat down with my neighbor recently, who has a couple of Quarter Horses that are starting to develop problems. One is more advanced in health deterioration than the other, with the more advanced case having spinal issues, EPM, and generalized arthritis for likely over a decade. We talked about our goals and what could be possible, if the diet was altered and proper supplements initiated. These two horses had suffered the ill-effects of an improper diet for years and now the question was can they be reversed or at least improved? My neighbor seemed hesitant, willing to do what needs to be done, but hesitant nonetheless. She asked if I thought they could be helped, to which I responded with no hesitation, ‘ABSOLUTELY!’. However, she seemed to feel different and that difference may impact the final outcome.
Most horse owners that I encounter in this phase of my career are dealing with chronic health conditions in their horse. In many cases, these problems have been going on for years, building up over time and finally boiling over. These could be metabolic challenges, laminitis, chronic foot ailments and lameness, joint deterioration, body condition concerns, or allergies. The problems have been present, but again building over the years. A high percentage of these horses are tended to annually by their veterinarian with the mentioned preventative healthcare procedures mentioned above, but the chronic health complaints are often not fully addressed. The veterinarian may recommend this or that diet, a dry lot, no pasture access, a specialized shoe, corticosteroids, or an injection of this and that medication. These are all standards of care and again, regurgitation of information passed on from one vet to another, often used and ‘prescribed’ with little thought.
I mean that statement as no offense to my colleagues, as really, this is truly how we are and how we are trained. If you see a high worm burden in a particular horse, deworm them, recheck and deworm again if needed. In order to prevent an influenza or herpes outbreak, vaccinate. Encounter a lame horse, inject the joint or send them for an MRI. That is the mentality, but little thought is put into exactly WHY that horse has a high worm burden, why the dewormer fails to completely fix the problem, or why some horses are more prone to influenza or herpes. Even more, the whole concept of vaccinating fails to take into consideration WHY some horses still succumb to those infectious diseases despite the performance of vaccines. We don’t put thought into that joint injection and really connect as to why that horse more often than not reverts back to lameness in a short period.
I was not trained in college to think that way or rationalize the differences between one horse and another. We, as veterinarians, may have a general idea in our head as to ‘why’, but it is rarely acted upon to be honest. The reason being is that time is needed to research the ‘why’s’ and then action needs to be taken to alter those outcomes. This goes beyond the ‘standard of care’ for most veterinarians, and often leads them into a zone of healthcare that they are very uncomfortable in as they are often on their own.
Thirteen years ago, I made a decision as a veterinarian. What was being presented to me, regarding treatment options, was not working, at least MOST of the time. Sure, some patients improved in their condition, but for most, they just improved a little and never returned back to the prior state of health. Some horse just simply failed to respond period. I realized that we, as a whole, did not understand truly what we were treating. Thus, I stepped back from private, general equine practice, in order to research and better understand what it was that we were treating. As we gain a better understanding of the condition, our treatments become more effective and more options are available to us.
As mentioned before, most veterinarian’s days are spent putting out fires, rather than truly seeking the causes of those fires. This is both our fault and the fault of the horse owner, as they are intertwined. Given this situation, the time and money factor, the drive to take time out of the day to fully research and understand a problem, a health condition, is just not there. This is true for the veterinarian and the owner. Thus, I, as a veterinarian, could not do both, practice and research. I chose to dedicate what time I did have to research, to understanding, and to knowledge. As this is gained, then it can be passed onto others to assist them in their journey.
The Horse Owner’s Responsibility
I am reminded of a conversation I had a few years ago with a physician that was in family care. I had inquired whether if he advised his clients on proper eating habits, the benefits of proper supplementation, and exercise regarding the management of type II diabetes. Although this physician knew all about those factors and their importance, he simply said to me, ‘Tom, why even bother when most will not even get up and take a walk.’
This is a level of frustration that most cannot understand, but I can relate to fully. The information is available to us, usually from research, that could potentially change the course of many illness and lameness conditions in the horse, but most owners will provide resistance. The reason for resistance is usually linked back to either money, time or effort involved, and skepticism.
As in the case of my neighbor, for her whole horse owning career, she was led by marketing in magazines as to what the best supplement was or which grain to give her horse. She was also misled by prior boarding facilities that she used as to what type of hay to feed and even how often she should get a joint injected or deworm her horses. The information I provided her with during our talk was not new to her, as it did ring a bell with what maybe she had heard in the news, or maybe it just registered with her gut instinct. Despite, she put up resistance as this new information went against the popular supplement advertisements or the fancy wording on the bag of grain she was feeding. It also went against what her veterinarian had been telling her for years and years, about joint injections and the need for frequent vaccinations. How could I be right and all of that be wrong?
The reality is that I don’t want you to believe everything I tell you. Neither should you believe what your trainer tells you, your veterinarian, or a fancy bag of feed or advertisement in a magazine. As a horse owner, you should never take something as absolute truth and blindly follow those directions, especially when it comes to chronic healthcare issues. This is where we get into trouble and for most, the reason this happens is because we lack time and simply want to be told what to do or how to treat our horse. I’m not implying that we should ignore all of those sources of information, but more so, you should take that information, digest it, research it, then apply it if deemed proper, and see how it works for you and your horse. If it doesn’t set well with you, don’t do it, plain and simple. If it rings true, makes sense and helps you to see the light and rationalize why things are the way they are, the go for it and put in your best efforts.
The bottom line, at least to me, is that you, as the horse owner, are an intricate part of your horse’s health and recovery. In the case of an infection, I could prescribe an antibiotic, but I am dependent on you to follow directions for the best outcome. In the case of chronic health conditions, of which represent likely over 80% of all conditions in the horse, you need to understand that your veterinarian may be limited in time and knowledge, which is no fault of their own. Given these limitations, you can choose to either be content in their recommendations or be discontent and seek more. You can either accept those recommendations and potentially deal with the recurring problem in your horse year after year, or you can take matters into your own hands and seek further answers. Either way, you play a vital role in your horse’s health and soundness.
I think about all of the horse’s and the owners that we have played a role with in helping, with each making huge strides in recovery. Then I think about all of the others, the horses and the owners, that had similar situations, but were resistant to input and suggestions, which were based on sound experience. The outcomes were dictated by the level to which the owner was willing to commit.
I read this past weekend in a book, that evolving in our lives and in healthcare is like climbing a ladder. In order to advance to the next rung, climbing higher and achieving more, we have to let go of the rung we are clinging to. This means that often we need to step outside of our comfort zone, forget everything we have been taught, that others dictate to us, and begin to accept that there might just be something more out there. This only comes with a desire for further understanding.
Then, I am reminded of the definition of insanity, which is plainly, “doing the same thing over and over again, but expecting a different outcome.” How many times is that definition applied in every day veterinary and human healthcare?
Author: Tom Schell, D.V.M, CVCH, CHN