Thursday, February 17, 2011

Pain Management, Part I

Someone in the comments asked about managing pain in older horses or horses with long term issues. That is a really tough question to answer simply because each individual horse owner has a different philosophy in regards to this subject.

I will say for myself and my own horse, if the need ever arose I would not be opposed to daily bute or daily equioxx/previcox. Of course long term daily use of NSAIDS can potentially have side effects down the road, but for me personally I am all about quality of life and not quantity of life. If some daily pain relief provides a reasonable quality of life I'm all for it. Of course not every horse owner subscribes to this theory. Some would rather euthanize a horse than use daily pain meds. I don't think this is wrong either, it just isn't my personal choice.

I think the best thing anyone can do for pain and health management of a horse is to give them as natural a lifestyle as possible. In reality nothing we do with horses is natural. We feed them grain, we feed them hay, they are trimmed and/or shod by the farrier, they are fenced into pastures instead of roaming thousands and thousands of acres, we vaccinate them, we provide them with barns and run-in sheds and we blanket them. Let's face it, horses in their natural state have none of these things.

That said I do strongly believe that maximizing turnout with compatible groups is the number one thing that can be done for pain management. It is amazing how pulling the shoes and letting the horses enjoy group living increases their soundness and mental health. However I think this can be tough to accomplish, especially depending on where you live. In my opinion (I keep putting that disclaimer out there!) a 40 stall boarding barn on 20 or 30 acres isn't going to be able to accomplish this.

The groups need to be small compared to the acreage they are turnout out on. Having good grazing most of the year is critical to success in our experience. This means the horses don't feel like they have to share each other's space to forage. They can graze as close or as far away from each other as they desire. And I will say again the groups need to be compatible. Too often the choice of turnout groups at a boarding barn consist of the mare group and the gelding group. Well, not all mares are going to like each other and be compatible as companions and the same for all geldings.

Using our farm as an example not all horses will enjoy being part of the Big Boys. When they are so moved the big boys like to be rowdy. At times they run hard and they play hard. We have another group that the members pretty much want to eat and nap, period. Their big daily activity consists of a couple of trips to the water trough. The other groups are somewhere in between.

I would say the number one concern that we hear most often is worry over pulling the shoes. We are not opposed to leaving a horse shod if that is the owners desire, and I do not subscribe to the philosophy that barefoot is always best. However we have successfully transitioned every single retiree out of shoes and over time their soundness improves. It goes without saying the we need a truly gifted farrier to accomplish this.

The majority of the retirees here had a vet and farrier saying the horse could not be comfortable without shoes under any circumstances. A lot of the owners really had to take a leap of faith and trust our judgement when we did the barefoot transition. When you are used to listening to one trusted team of advisors saying "must have shoes/special shoes" and then we're saying "trust us and let us try a different route" that is a huge decision on the owner's part. This is something we never EVER take lightly. Someone is trusting us to take care of a living, breathing animal and we do not take this lightly. I am not going to ask someone to allow us to transition their horse out of shoes unless I am confident that the outcome will be good.

Just to be clear I am NOT saying that these same horses could go back into regular work and stay barefoot. I AM saying that living the life of a retired horse where they self direct their exercise on comfortable turf footing without shoes has never, not once, had a negative effect on one of the retirees here. It has always improved soundness over time. We often use boots with pads for a period of time (varying lengths of time according to the individual) in order to assure a pain free transition out of shoes but often this is not even necessary.

I think what often happens is we start tweaking the shoeing jobs. Changing this angle or that angle, using a wedge, or bar shoes or trailers. And it works for awhile. Then another tweak is needed and that works for awhile. But eventually it often stops working at some point, and then no matter what you do with the shoeing package you still have a lame horse. Many of the retirees here have chronic or permanent soft tissue damage. It is my personal opinion that the state of the horse's feet is often to blame for this. Jason and I have a running joke that if vets continue to treat the soft tissue injuries while "tweaking" the shoeing package we will never hurt for business. I know that sounds like a harsh statement but it is simply a truth that we see played out over and over.

An interesting observation is that some of the easiest transitions out of shoes are the ones that you would think would be the hardest. Without fail horses with navicular, pedal osteitis, and ringbone often don't even need the boots for a period of time after pulling the shoes. The right trim combined with the right lifestyle and the right nutrition is really a magical thing.

Someone asked me once what I would do if I had a horse showing chronic lameness, especially when all rehab options kept failing. I would pull the shoes, make sure the horse had a good, BALANCED trim, feed him a balanced diet, and turn him out for a minimum of a year. Don't even look at soundness for a year. Even if the horse looks sound at month 9 leave it alone. The horse needs to look SOUND for at least 3-4 months running around in the pasture before you even think of putting it back to work. Too often the horse is put back to work as soon as it looks sound and it doesn't last. I think a lot of these scenarios could be avoided if the horse was not put back to work until it had looked sound for at least a few months.

With most of the retirees here the hope is not for complete soundness but improved soundness, or maintaining where they were upon arrival. Simply due to the nature or extent of their issues leading to retirement there does come a point when it is time to step off the soundness roller coaster and save your sanity, and not all damage can be undone no matter how you trim, feed or otherwise care for the horse. Anyone who has experienced this realizes that you finally hit the point when when you've done all you can realistically do short of a body transplant. I've already covered that topic in another post.

This post has gotten long and we haven't even delved into subjects like joint injections, supplements and other medications. I covered a lot about soft tissue injuries but of course there are other issues such as arthritis that need to be managed. I'll end this post for now and carry on with this topic in another post in the future. Feel free to ask about anything specific in the comments section. Of course you do need to keep in mind that opinions are often worth about what you paid for them!


Chance, Tony, Homer and Ivan
Baby and Thomas
Noble, Snappy, Spike, Lucky, Silky, Lightening and O'Reilly
Murphy and Ogie
Clay, Fuzzy and Chili
Cuffie going after an itchy spot and Maisie
Winston, Faune, Gus, Chimano, Romeo and Asterik
Wiz and Chili
Johnny and Stormy
Gus and Asterik; they were watching me ride Sky in the arena and I am pretty sure they were doing this Facebook smileys
to her. When I dismounted and started walking towards the gate they ran away. They definitely didn't want IN the arena!!


Calm, Forward, Straight said...

If your horse is only sound when he is shod, then he is lame...

Great post! Looking forward to part II :)

Kaitlyn Elizabeth said...

I was curious how you let the other horses deal with a loss. Do you allow them to see what is happening and/or visit with the horse that has passed? I know this probably isn't good for a blog post, but I am curious how you deal with it... On another blog I follow they feel it is really helpful to allow the others to sniff/touch/see the events that transpire around another herdmates passing.

Melissa-ParadigmFarms said...

Kaitlyn over the years we've watched the horses experience loss in many ways. Twice the horses died in the field of old age and natural causes and the rest of the time the decision has been made to euthanize.

When you are talking about small groups, especially 3 or fewer, I think a loss is noticed more, especially if it was just 2 horses and now 1 is left behind. A lot of people don't like to hear this but in groups of horses they get over it quickly, whether they know what happened or not. There is sometimes a day of discontent and then it is back to business as usual. We've watched this happen many times over the years.

Horses are prey animals and they are hardwired not to linger on these types of things. I find this to be ESPECIALLY true if they are living as part of a group like they are meant to do. I talk about it in more specific detail in this blog post:

Gillian F said...

Pain management is something I always worried (and worry about) with Faune. I spent thousands of dollars each month specific to his management for showing. It's funny how that all turned out now that he spends so much time outside. Remember how terrified I was to pull his shoes??? Meanwhile, his big time farrier hadn't been doing right by him as it turns out.

Obviously he's a big guy and has some chronic issues, which will worsen as he ages further. The thing is, I know how well you know my horse now. So I know you know what he needs and when it's time to do more. I appreciate that immensely since I am not there. Thank you again for all you do for my boy. And thank you for the intuitive way in which you care for him.

Anonymous said...

Good post! I think one other element is having a trimmer who knows what they're doing in transitioning a horse to barefoot - there are a lot of bad barefoot trimmers out there and also some very good ones.

I agree with your response to Kaitlyn - when we've lost horses at our barn, even though our herds are pretty small, the other horses go on about their business - it makes sense that they would have to do this to survive in the wild.

Melissa-ParadigmFarms said...

Kate, I really don't care if it is a trimmer only or a farrier. It just needs to be someone who can really read the foot and someone who has some tools available outside of the more typical tool box (in other words not a farrier where the only tool is shoes or shod and not a trimmer whose only tool is barefoot). Finding this person is not easy!!

SmartAlex said...

I had my horse on joint supplements for his stifles for several years. If I discontinued them for more than a week or two, I could tell the difference.

Last year I decided to leave his hind shoes off past his winter off and all through his working summer. I was able to take him off the joint supplements, and haven't noticed more than an occasional stiffness.

I think that allowing his natural hoof to determine his stride and torque alliviated a lot of the stress that was bothering his stifles. Less is more!

Jill said...

The very first thing I did when I got off the lameness roller coaster was pull shoes. Heck, I'm not riding anymore so what's the use? My mare hasn't looked any the worse for wear - and I'm very lucky to have a GREAT farrier.

How awesome it must be to be able to provide a great, loving last home for those noble steeds who have meant so much to their owners. To look at the pictures and see such contented horses, it makes me just want to come visit and love on some of the oldies. :)

kickshaw said...

The value of turnout...WAY under-estimated!!!

smazourek said...

I want to hug you for this post. So much wisdom there!

Vivian, Apollo's Mom said...

I was so upset when my vet told me to pull Apollo's shoes, about a month or two before we sent him up to you. It was very traumatic for me because I felt that this was the END. He was not getting better, he would not BE better, and he was unsafe from now on to be ridden... It broke my heart. He was not a horse to go barefoot while he was in work- too big and too heavy- and he had terrible feet in the Florida wetness. I can't tell you how happy I was when I looked at his feet last November! They look beautiful now and they just used to crumble down here and were stuck together with epoxy and my farrier's concoction of melted ground up tires! Not to mention the contracted heels and the thrush! If he were in pain, I would use some bute but he does not seem to be in any. Once again, thank you so much for taking care of my best friend!