Lethargy and loss of stamina in the competitive horse can originate from a variety of clinical problems. Upper airway conditions are common and are a potential source, however, even then, there are contributing factors. Dorsal displacement of the soft palate and laryngeal hemiplasia are specific problems found intermittently in the horse, which can be troublesome to manage outside of surgery. In this case, we have an upper airway disturbance in a Quarter Horse gelding, which resolved as the underlying condition was managed without surgical or medical interference.
Loss of stamina and performance in the competitive equine athlete can be troublesome and costly for many horse owners. There are many potential causes for this loss of energy, but the bottom line is that there is a lack of proper cellular energy production. The question is what is creating the energy drain and how deeply the problem is intertwined into the horse?
Upper airway conditions, including dorsal displacement of the soft palate in the horse, can be common at times, often seeming to wax and wane, being better at times and worse at others. Any upper airway condition in the horse can create stamina or performance problems, as the condition can limit the amount of airflow and thus oxygen exchange. The conditions are readily diagnosed with upper airway endoscopy, but may require scoping while under stress or work to force the problem and make it visible. Treatments generally rely on surgical correction, which is most often successful, but comes with risks and complications. In other cases, medications are used to reduce inflammation and manage the problem, but are rarely beneficial for the long-term.
The Quarter Horse Gelding with a Noise and Loss of Stamina
A 4-year-old Quarter Horse gelding was presented for evaluation. He had been in training for the past 6 months, originally with great stamina and energy, but has become depleted over the past 60 days. His energy levels have dropped, which is noted in his lack of ability to maintain exercise intensity. The owner has also noted a decrease in his body condition, loss of muscle tone, and has also noted a ‘noise’ while he is being worked which seems to be coming from his head. The noise was categorized as being a ‘choking’ type of sound, which when it happens, he slows down his stride and seems to swallow, then returns back to a higher level of work. His appetite is good and he is fed an orchard grass forage and fortified grain blend. He is turned out on a small paddock alone for a few hours each day, then kept in a box stall for the remainder. The gelding was purchased at auction as a 2-year-old for a lower cost than anticipated given his pedigree.
On examination, the gelding was somewhat anxious, having a difficult time standing still for an examination, but soon settled down. His body condition was good, deemed a 6/9, with good muscle tone, however, the owner has noted he has lost topline and overall conditioning. The heart and lung sounds were normal with no evident noise upon use of rebreathing bag. There was no nasal discharge and both heart and respiratory rates were normal. His gum color (mucous membranes) were pink with a normal refill time, however, he had copious amounts of saliva that were quite sticky and slimy. The gelding’s feces were normal, being green-brown in color and formed. There did appear to be some excess moisture present in the fecal balls.
A quick lameness evaluation with limb flexion and hoof testers were normal. There was no evident lameness. A neurological examination did not indicate any deficits outside of a positive tail pull in both directions, indicative of a weak back or dorsal spinal musculature. This could be related to a neurological problem, but given there were no other deficits, it was suspected to be more muscular in origin.
The Quarter Horse gelding was lunged in both directions, pushing him harder and harder to a level which he would tolerate. There were no lameness noted and no upper respiratory sounds on examination. He did tend to back off his gait after a short period of time in an attempt to slow down due to perceived tiredness.
An upper respiratory endoscopy examination was performed under light sedation with a noted accumulation of the sticky saliva in the back of the throat or pharyngeal region. There were no evident laryngeal problems or dorsal displacement of the soft palate noted, however, under light restriction of the nares, the soft palate would displace readily but was relieved upon swallowing.
Blood was drawn post-exercise and submitted for muscle enzymes, which indicated a mild elevation in the creatine-kinase and LDH enzymes, both would indicate muscle strain or damage. An HYPP test was submitted and returned negative by the owner prior to the examination.
The alternative medicine diagnosis of Qi deficiency with dampness accumulation and Jing deficiency was made and recommendations were as follows:
- Switch to alfalfa forage for increased nutrient provision and energy
- Elimination of all grains
- Increased turnout and intermingling with other horses
- Herbal supplementation with Astragalus membranaceus and Cordyceps sinensis (Cur-OST EQ Revive)
The Quarter Horse gelding was put onto the new regimen, allowed for 10 days off of work and time on pasture, then reintroduced into work. His energy was markedly improved per the owner and no breathing noises were noted. He resumed his training with no future problems and was maintained on the herbal blend as directed for the next 90 days, after which he was to be monitored for a return of the original condition.
Discussion of Therapy in the Quarter Horse
Qi is perceived as being energy which is present in the body and what is allows or permits for active physical work and functioning of organ system. Qi is produced through proper food consumption and a properly working digestive tract. It is also gained from the air taken into the body, as oxygen helps to fuel energy production. This Qi or energy essentially stems to the ability of cells within the body to produce ATP or energy.
When there is a depletion of Qi or lack of ability to produce that energy, then problems develop clinically in the horse. This Qi deficiency can result in loss of stamina or overall clinical energy, resulting in fatigue, but can also result in conditions such as diarrhea, airway or respiratory problems, poor tissue healing, and immune related conditions. A Qi or energy deficiency will also directly impact body condition, as energy is needed to extract nutrients and build tissue, including muscle.
Qi deficiency can be related to an improper diet, poor air circulation, or an inherent deficiency within the cells to produce energy. It can also be related to a combination of all three contributors in many horses. As energy becomes low or deficient, the digestive tract is often involved which can result in diarrhea, loose or moist stools, and a condition referred to as ‘dampness’. Dampness is a traditional Chinese medical term that implies accumulation of fluid or toxins within the body. This can be noted as edema or swelling, diarrhea, mucous or phlegm production, and many other problems. It can often be noted in the saliva, as being a sticky, slimy secretion. This dampness signifies and improperly functioning digestive tract in the horse, which can be related to a Qi deficiency, but also an improper diet.
In my experience, most cases of dorsal displacement of the soft palate in the horse are tied closely with dampness and digestive impairment. This is noted on endoscopy as the epiglottis is heavy and thick in appearance, often coating with sticky saliva. The theory is that the epiglottis, being heavy and damp like a wet sponge, simply drops down and displaces out of the normal position. The noise that is produced is due to the abnormal positioning and vibration of air as it passes around tissue. It is generally resolved by the horse through repeated swallowing attempts, which puts the tissues back into normal position, albeit temporarily.
Jing is a termed used to describe an inherent type of energy, like a battery of sorts, which is present in the horse and any living body. This Jing energy is passed to the off spring by the parents but is also acquired through production of Qi in the body, replenishing the post-natal Jing. The interesting thing about pre-natal Jing, or that which the off spring is born with, is that it cannot be replaced. This is like an internal battery and when that energy is utilized, the body slowly becomes depleted. It can be supplemented through Qi production in the body, which is ideal as the body should use the Qi which is generated and not the Jing. However, in cases of depletion where the body does not produce enough Qi, the horse will utilize Jing, which can be detrimental.
Now, going further, the quality of the Jing which is passed to the off spring is dependent upon the parents, being the mare and sire. If health is compromised in either the mare or sire, or if they are of increasing age, their own personal Jing may be compromised and thus, the quality passed off to the off spring will also be inferior, leading to problems. This is commonly seen in foals with health issues either immediately after birth or acquired early in life. Many of these foals are born to mares which have their own health issues, being turned into a broodmare due to laminitis as an example, or retired into a broodmare position because of poor performance. It is also common in foals born to older stallions which are heavily collected.
Think of Jing and/or Qi deficiency resulting in a poor-doer type of situation in a young horse. This opens them to all sorts of performance and health problems.
In this specific case, the Quarter Horse gelding was born to a mare who was retired from barrel racing due to laminitis and was turned into a broodmare. Her laminitic condition was not well managed and she actively experienced pain during her pregnancy. The foal was born uneventfully based on records which could be retrieved, but did seem to have several ‘accidents’ as a weanling, with many cuts, scrapes and minor injuries.
From our perspective, this gelding was likely born with a Jing deficiency, or an inherent internal weakness. He was sent to auction as a 2-year-old for unknown reasons, but I suspect he wasn’t proving himself worth keeping by the original owner. After purchase, he was put into a training facility, kept in a stall which was not well ventilated, trained a few days per week with minimal turnout and socialization with other horses. This situation will easily inflict stress upon such a young horse, which will further deplete the body on many levels. Combined with a high grain diet and improper forage provision, and the situation becomes compounded.
The primary goal with therapy is to improve the quality of the nutritional plane. This is done by utilizing alfalfa hay, not just for nutrient provision, but other phytochemicals which are present in the forage which benefit cellular and mitchondrial function, resulting in increased energy production. Alfalfa is beneficial for digestion as well, due to inherent fiber and other phytochemicals. There is also a mild diuretic property to alfalfa, which will benefit the dampness and remove fluids.
Grains are removed as they are heating to the body. This can be beneficial in some circumstances, but in this case, they were believed to be contributing to the dampness because digestion was not strong enough to process them. In addition, grains can easily modify and negatively impact the digestive microbiome which can create more problems and inflammation. Going further, grains, due to their inherent heat, can contribute to anxiety and stress, especially in a stalled horse.
Herbs are used in this case to help fortify and support digestive energy (Qi) and Jing. Astragalus membranaceus is well known for impacting Qi or energy production, benefitting digestion and immune support. Cordyceps sinensis is known for support of energy production, Jing stabilization, and kidney support. These two herbs are used in combination in high quantities in the Cur-OST EQ Revive formulation.
As digestive Qi is improved, digestion improves and dampness is resolved. This can then benefit upper airway conditions including dorsal displacement of the soft palate. As noted in this case, a simple approach was able to improve this Quarter Horse with no surgery and no medications. Through this approach, the gelding can be rebuilt internally, which supports overall health. This then directly impacts his performance and future outlook on many levels.
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Author: Tom Schell, D.V.M, CVCH, CHN