Thursday, August 8, 2013

Does my vet know?

by Maksida Vogt, Natalija Aleksandrova

In these times as we are becoming increasingly educated on different aspects of the health of our horses, and animals in general, quite a few situations arise which cause us to think deeper about the knowledge and treatment options that veterinarians apply to our animals. This article is not meant to be an affront to the knowledgeable and responsible up-to-date veterinarians. The sad fact however is that we routinely encounter a pattern that an international majority of veterinarians display. The pattern is a lack of knowledge about horses biologically correct keeping, about illnesses connected to biologically wrong keeping, about the natural normal behavior of these animals inside of and outside of their biological niche, as well as treatment of simple infections and abscesses related to their biological niche requirements being disregarded.

This problem is not connected to any particular country. In fact, we watch it happening in many places, as our organization receives feedback from horse owners of different countries, and our professionals encounter it on an ongoing basis everywhere as well. It seems this is a general problem. With this article we would like to encourage horse owners to never be afraid of questioning the proposed work of veterinarians and the health of their horses.

The scientific thesis by Dr. Cook, which conclusively proves the harm of the bit in the horse’s sensitive mouth, has already been in print and available for YEARS, it is however yet to be included in veterinary school syllabus, and is largely unknown by vet professionals. The bit is a foreign body laying on the mucosal tissue and the nerve endings of the jawbone. In the mouth of a horse the presence of this foreign body, alone, triggers the chewing reflex, and the horse starts producing saliva. Influencing this foreign body in different ways via the rider’s hand causes neurological discomfort and pain. We have an amount of photographs documenting the damages caused by bits, starting from bruising up to and including severe tissue trauma of tongue, soft palate and damaged mandibula, problems with teeth. These documented proofs were published in scientific magazines and to date remain unopposed, yet veterinarians still do not use this knowledge in their practice and do not educate horse owners regarding this problem. This leaves room for speculation on the quality of their knowledge and also on possible reasons that might influence their lack of action.

Especially regarding hooves – most veterinarians lack up-to-date knowledge on diagnosis and correct treatment options. Here we would like to present several cases of incompetency in the diagnosis and treatment of different hoof problems, which we collected from horse owners and our practice.

Case 1. A wrong treatment of hoof problems by a team of veterinarians and a farrier

A mare 19 years of age, was rescued and arrived with a so called „orthopedic“ shoe on one of her front hooves. The treatment was for ‘hollow foot’ (‘white line disease’ with the wall separation), a problem which she had had for years. The mare was a competition show jumper with this foot — an unbelievable fact, which gives us another serious reason to question the existence of equestrian „sport“ and people who are in it and who support it. The owners/rescuers were told that this problem was ‘nothing special’, but in reality the hoof could not keep even a shoe on anymore. The mare needed to be transported to a clinic at Telgte. At this clinic a farrier pushed a nail into the hole in the hoof wall to see how deep it went, a softer object would have sufficed. Then he performed a hoof wall resection, removing a large section of the dorsal part of the wall.

The mare was sent home with a bandaged hoof and with a plastic pad underneath serving as „protection“. It was advised that the mare was to be kept confined in a box rest situation. The mare spent one year in the box. Her bandage was renewed every few days. Everything was done exactly as prescribed by the veterinarian team. The owners followed their advice in the belief that the team knew what they were doing and that they were in fact helping this mare. The owners made considerable efforts to give the mare more space in which to live in her Solitary confinement by offering her the space of two boxes and a small paddock. After the year, when nothing had improved and the hoof wall still remained separated, the owners decided to reject further advice from this team of vets and farrier and to search for another solution. They decided to let this horse out of the box so that she could move freely together with the herd. Their decision proved to be a sound one as they observed over time that this free movement situation alone contributed to the improvement of her hooves and better growth of the hoof wall.

Case 1. Analysis

Despite the wide spread believes, bacteria and fungi do not create any threat to the white line of a healthy hoof, since in the healthy situation the rate of horn production always exceeds the rate of its decompression. Bacteria and fungi are always present in any hoof, they are necessary to the hoof. When a healthy balance exists, fungai and bacteria are an integral part of the natural self-trimming mechanism of the hoof. (more: “Hoof thrush” >>).

The true cause of white line problems actually lies in incorrect hoof form and/or in shoeing and/or in improper horse keeping conditions, which restrict horse’s movement, cause hoof dehydration and horn damage via exposure to ammonia. The incorrect hoof form and/or shoeing and the lack of natural movement lead to reduced blood circulation as well as mechanical damage of the corium, which is the tissue that produces white line horn. These causes also lead to damage of the white line itself. Through the damage and poorer quality and quantity of the horn produced, the speed in which the horn is decomposed begins to exceed the speed at which horn is produced, and the white line is thus destroyed far up into the hoof capsule. The space now existing where the white line has been destroyed allows foreign bodies and infection to enter the interior of the hoof. Also the normal populations of bacteria and fungi, explode ‘out of control’ and they move deeper inside the space, ‘eating up’ the horn. If the hoof continues experiencing reduced blood circulation, and damaging mechanical forces continue affecting it, the laminar corium and the laminar horn get eventually affected, and the ‘hollow foot’ effect appears — the wall starts separating from the sole and the coffin bone.

In this situation, shoeing or so called ‘orthopedic’ shoeing can only mask the problem for some time as it remains the obstacle to healing, while the damage will continue progressing, often unnoticed by horse owners and professionals. Because, through restricting the hoof mechanism*, shoeing blocks the blood circulation in the hoof and creates damaging mechanical forces.

*(hoof mechanism >>)

The wall resection also doesn’t address the true cause, as its purpose is only to remove a part of a hoof ‘affected by bacteria and infection’. Quite contrary, the resection can create a situation where infection now severely affects the inner tissues and structure, as the hoof is cut open. Bandaging material and the placement of an artificial wall can create more damaging pressure on the corium tissues.

And the worst advice that can be prescribed in a situation such as this — when a hoof problem is caused by a lack of blood circulation, amongst the other — is putting a horse on the stable rest. It is a basic natural fact — healing can only happen through increased metabolism, i.e. through increased blood circulation. As “fresh” blood supplies a damaged area with nutrients — ‘building blocks’ needed to renew damaged tissue. The more intensive the circulation, the faster healing can happen. To put a horse on the stable rest means to reduce the circulation in her hooves, as the normal circulation in the hooves is only possible through the constant movement that the horse’s body and hooves are created for. Thus, restricting the circulation, we restrict the healing process.

Additionally, separating a horse from a herd, delays the healing process through resulting mental suffering and psychological imbalance. The horse is a herd animal and its brain has different capabilities than the brain of a solitary animal. The horse’s cerebral cortex is built to function normally giving normal correct orders to subordinated brain centers only when the horse lives in a herd.

First, what any veterinary practitioner should recommend in a case of white line problems is physiologically correct hoof care in proper keeping conditions providing unrestricted movement, which would promote the hoof mechanism and, through it, all the healthy hoof functions which are designed to promote healing.

Case 2. Wrong diagnosing and treatment of hoof problems by a veterinarian

A veterinarian was called to a mare who had been found lame in her right front leg the previous night upon returning from her paddock. The mare’s hooves were quite overgrown, and she was scheduled for a trimming session in a few days time. The mare had had her shoes taken off less than 2 months before and was sensitive on hard ground. The vet checked her lame foot and told the owner that the lameness was caused by laminitis in her right front because she had eaten too much grass. The vet took an x-ray of the one hoof, and from this evidence his next verdict was: 'O.k., no coffin bone rotation visible. It is not laminitis.' Though he still believed that the problem making the mare lame was in the hoof. The mare received painkillers and anti-inflammatory drugs and was put on a box rest. Two days later the mare walked normally, and was taken by her owner to the paddock and her herd, as she was becoming quite crazy staying inside alone.

Two days later there was still no visible lameness so the mare was trimmed. Day after trimming she was lame in her right front again. The vet came and concluded 'Laminitis'. He prescribed full rest, pain-killers and antibiotics. The mare stood all the time without putting weight on her right front foot. Loading her left front foot was not a problem. When walking she seemingly didn't have a problem in weight-bearing on her left front foot, but was limping on her right front foot. The owner couldn't agree that it was laminitis causing the lameness, and decided not to give all the prescribed medicine before she could feel sure of the diagnosis. Hoof care professionals in this stable also didn't agree it was due to laminitis, they believed it was rather more likely to be an abscess.

After a few days of the full rest, the owner took the mare outside for a short time. The mare was happy to move freely and trotted, though still lame. A day later the owner couldn't bear to see her horse suffering from separation anxiety from her herd and so she let her lame mare out into the paddock for night. The next day the abscess burst out in the area of the coronet. In a few days the lameness disappeared fully. The owner called the vet to inform it was the abscess. But the vet didn't agree the physical evidence. He still insisted it was laminitis in the right front. Later the owner got a bill from the vet, it stated on the bill 'Signs of the rotation of the coffin bone in the right front hoof visible on the x-ray. Diagnosis: laminitis.' (We remember that the owner was said 'no coffin bone rotation' in the beginning, don't we?)

Case 2. Analysis

Laminitis usually affects both of the front hooves or all four hooves in horses. The acute form of laminitis is characterized by pain a horse shows in all affected hooves. Laminitis can happen without pathological changes inside hoof capsule such as coffin bone rotation. In severe cases, the bone rotation can appear, but not before 48 hours after the signs of pain appeared.

The x-ray made the day after the signs of acute laminitis had appeared cannot be used as a confirmation of this diagnosis: it is too early for the changes to become visible. The changes visible on such x-rays can be the result of previous problems. X-rays may never show any changes, since the acute laminitis can happen without them.

Next, what might make us suspicious about the diagnosis 'laminitis' in this case is that it was diagnosed only in one hoof. It is extremely rare that a horse develops laminitis in only one hoof. So far the only conditions recorded under which such type of laminitis could occur: being a sequelae of excessive weight placed on a limb due to an injury to the opposite limb, when the horse is not allowed to move after being injured ('static laminitis', Rooney, J.).

Another statement, which contradicts the diagnosis 'laminitis in one hoof', is 'the mare got it because of eating too much grass'. All four hooves are ONE metabolic organ of the horse's body. The carbohydrate overload, which causes an effect in the body similar to intoxication, cannot affect only 1/4 of one metabolic organ in our case.

Now we look into the hoof shape of both of the mare's front hooves.

(Click to enlarge.)

We notice the same considerable degree of dorsal wall flaring in both front hooves, the flaring suggests to us a seriously compromised laminar connection similar for BOTH hooves. Having the same degree of damage of the lamina of both front feet, it is very unlikely laminitis could be triggered only in one hoof.

Knowing only these few facts could make us search for another explanation of the lameness in one hoof.

The horse was unshod not so long before the described events. De-shoeing can restore the hoof mechanism in the hooves to some considerable extent. With any restored hoof mechanism, the blood circulation is consequently also improved inside the hooves. With better blood supply, it becomes possible for the body to start repairing the damage, including cleaning the hooves from necrotic tissue, that was caused to the inner hoof tissues by the period of long time shoeing. Abscessing is a method the body uses to remove fragments of dead tissue, which are too big to be removed within the blood stream.

In this case lameness returned in all its strength directly after trimming. Removing the overgrown horn via trimming improved the hoof mechanism even more. Improved hoof mechanism means improved blood supply and thus improved healing capacity. The abscess, previously suspended in its function due to lack of blood supply was supplied new strength for resolving its work after the blood supply of the affected area was improved. Abscesses are supplied from the blood with all the tools they need as their work materials such as white blood cells. The better the blood supply, the more intensive a healing abscessing process can be.

This is why abscessing is not rare after de-shoeing and can appear right after just a planned trim.

Now we look again into hoof photos.

(Click to enlarge.)

If we look closer, we can notice 'seedy toe' in the right front hoof — the 'hole' in the toe. The constant pressure of the coffin bone tip into the sole due to an incorrect hoof shape (too high heels), combined with the pressure from the shoe clip lead to damage of blood vessels in this area and later to bone tissue destruction. Dead tissue from the bone and the corium was accumulating for a long time in this area. The damage in the horn created an entrance for infections from the outside. This creates the perfect situation for an occurrence of abscesses.

And if we look at this photo:

We can see the place, where the abscess eventually broke out at the coronet. It happened directly over the damaged spot in the toe. This is very typical behavior of abscesses — to find the shortest trajectory for exit through a more elastic horn, such as the laminar horn. Abscesses tend to come out at junctions of softer and harder horn.

(More on hoof abscesses >>)

Case 3. Unacceptable quality of x-ray shots made by a veterinary specialist and further mistakes in diagnosing hoof problems using the x-rays

A vet was called to an 18 year old gelding to make x-rays of his front hooves. The gelding had been shod for many years and de-shod a month previous to the visit. The x-rays of the front hooves were required by a hoof care professional for judging hoof conditions after de-shoeing. At the time of making the x-rays, the hooves looked like this:

These are the x-rays that were made for this case:

From the note the vet sent to the owner along with the shots, we learn amongst other things that '...the spacing between the hoof wall and the coffin bone seems to be bigger in the horse's right front hoof than in his left hoof, and this may indicate resorption (a loss) of the bone.'

Case 3. Analysis

The first and the very important problem, which the increased space between the bone and the wall indicates, is chronic laminitic changes inside the hoof capsule: damaged and weakened laminar corium, rotation with separation and sinking of the coffin bone. Even so that laminitis usually is presented in both front hooves, the degree of change can be different in each hoof due to differences in the shape of each hoof.

For the interpretation of bone loss alone to cause a visibly larger distance between the bone and the wall, it would have to be really dramatic bone re-modeling, which we don’t see in the bones on these x-rays. If the statement was to be correct then the kind of bone re-modeling the vet was talking about usually creates a specific shape in the dorsal surface of the coffin bone, making the extensor process look bigger, more pronounced than normal because, due to specifics of the hoof anatomy and physiology, it is not affected by the damaging pressure, which causes the bone loss in the dorsal surface of the coffin bone. We don’t see this specific shape in either bone on these x-rays.

The diagnosis states that only one bone is affected and that supposes a different degree of the remodeling to be shown in each bone, we don’t see such difference on these x-rays.

First what we actually notice about these x-rays is that their quality is unacceptable. They are unacceptable because no hoof soles are visible on them and the lowest part of the x-rays is overexposed. Thus we cannot judge by these x-rays such important things as thickness of the soles and position of the coffin bone in relation to the ground. Hoof x-rays should always be made with a visible ground level on the shot. There’s also no clearly marked junction between the wall and the coronet on the x-rays, this prevents one from correctly judging the degree at which the bones have sunk down.

There’s no significant difference in size of spacing between the wall and the bone between the two hooves visible on the x-rays. What we do notice, actually, is a difference in the coffin bone positions inside the hoof capsules due to the difference in the hoof shapes (we can see this difference on the photos) — one hoof is more upright (has higher heels) and the other is flatter. And we can see the degree of the bone rotation in each hoof.

When a not ground parallel coffin bone in an x-ray is visible, this is a certain sign of overload of the lamellae suspension and therefore in the most of all cases the reason for the laminitis (Glenn Ramsey, PhD candidate, New Zealand's University of Auckland, "The effect of hoof angle variations on dorsal lamellar load in the equine hoof," Equine Veterinary Journal, September 2011).

Obtaining similar x-ray results, a veterinary professional has to inform the owner of the danger of further progress of the pathological changes in such hooves and on a possibility of the horse developing acute laminitis if it doesn't receive correct hoof care, which would help to bring the coffin bone to a physiologically correct position inside the hoof capsules, and, through this, to relieve the laminar corium thus preventing further damage to it.

* * *
We do encourage the horse owners to ask all the questions they might have on this article and also on any treatment of their horses by veterinarians. We recommend following steps:

— Do not be afraid to question anyone for the sake of your horse.
— If you have an expert, then this expert must be able to explain every detail you ask for and also all the coherence regarding present problem in the horse's body. Bear in mind that conventional veterinary care is not holistic care and your vet might not know about holistic care.
— Refuse the treatment suggested by a vet who recommends that you shut your horse in the box. Horses need free movement to be able to heal.
— Refuse the treatment suggested by a vet who recommends chemical painkillers, corticosteroids or antibiotics for your horse without warning on their harmful side effects and without looking into alternative therapy possibilities (herbal, homeopathic, etc.). Besides causing metabolical chaos in the horse's body that makes the healing process difficult, chemical drugs are well known for their severe side effects in the horse’s body. Just a few of the side-effects: non-steroidal anti-inflammatory pain killers are known as a cause of stomach and gut ulcers; antibiotics are known to suppress immunity; corticosteroids are listed as a common cause of laminitis in horses.
— Refuse the treatment by a vet who does not consider any psychological side of the horse behavior (horse is a herd animal, separation from the herd causes enormous stress and makes the healing difficult).
— Refuse treatment that only makes your horse “functioning” in order that you can use it again quickly.
— Search for the horse experts who will work at the body’s pace with the real healing processes the body has, no horse deserves less than this.

The cases presentation and analyse by Natalija Aleksandrova
English editing courtesy Tamlyn Labuschagne Ennor