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Managing Inflammation in the Horse; When to Cut Back

You want your horse sound and healthy, right?  Not an easy request in many cases due to ongoing inflammation in the horse, which is very complex and multi-faceted.  This process can impact their joints, back, neck, feet, behavior, and digestive tract.  It can reach even further over time, when unregulated, and impact the proper function of the immune response.  The thing is that as much as you or I want to manage or control this process of inflammation in the horse for a better outcome, you need to keep in mind that there are many factors involved.  Given this, as you begin to manage all of the contributing factors to inflammation in your horse, when this is possible, the need for ongoing supplementation often can be reduced or in some cases, even eliminated.  If you don’t realize this, it is possible to swing that pendulum from ‘bad’ to ‘good’ and then right back again.

Inflammation and Recovery in the Horse

Inflammation and Recovery in the Horse

Inflammation.  This is a cellular process that is deeply involved in every aspect of your horse’s health, soundness, and performance.  Whether if you acknowledge it or not, it is real.  The process of inflammation is needed in acute cases, such as an infection or injury, but in the long term or chronic situations, it becomes detrimental to your horse’s health.  It is this chronic inflammation that is in our sites when it comes to therapy.  However, don’t be misled into thinking that an acute tendon injury, as an example, exhibits ‘good’ or acute inflammation.  This injury could be a result of long standing, uncontrolled chronic inflammation.  Or, this injury may exhibit normal inflammation initially in the course of therapy, but if you cross over that 30-day mark and still have a lame or sore horse, then you have encountered chronic inflammation.  An entirely new beast to deal with over time.

Our goal, with any horse, whether if that animal has a tendon strain, joint pain, a sore back, allergies, foot ailments, or metabolic concerns is to balance that inflammatory process.  It is there and playing a major role in the progression of that condition…so it needs to be addressed.  You will only find out what role it plays when that inflammation has been properly managed and balanced.  You don’t want to eliminate inflammation, like putting out a fire with a bucket of cold water, but more so your goal is to balance it.  Reduce it too much and you can create health problems.

Using a tendon injury as an example, many owners understand that inflammation plays a major role, but they believe that confining the horse to a stall, or giving a NSAID medication is controlling the process adequately.  My general response to this is to ask a question, and that question revolves around how that horse is doing clinically and how long have they, as the owner, been recovering that horse?  Is there progress being made, are they holding ground, or is the condition getting worse?

Contributors to Inflammation in the Horse

If your goal is to manage inflammation in your horse to improve his condition or health, then you have to look at all contributors, which include:

  • Diet
  • Housing/Environment
  • Medications
  • Foot Balance and Travel
  • Stress (emotional/physical)
  • Exercise

These are my top six contributors to the inflammatory process and in many horse cases, some are intertwined with one another.  If you are trying to recover a horse with a tendon injury, as an example, you can’t just give an NSAID medication and stall confine, hoping for the best.  That stall confinement will in most cases add to the inflammatory process through the creation of stress, which then coincidentally explains why so many of these horses have gut issues and are on ulcer medications.  The other factor, specifically with a tendon injury, is that in the process of prolonged stall confinement, that inflammatory response can get out of control, thus resulting in excess scar tissue deposition which restricts the end result for the horse.  In the hope of stifling inflammation, in most cases, you have just made it worse and thus, many tendon cases fail to recover completely or take months on end to recover.

All 6 of these factors need to be addressed and managed if at all possible for optimal results.    The more contributors that you can address and rectify, the better the outcome.  A tendon injury shouldn’t take 4-6 months to recover.  This holds true for many other issues as well, whether if that is involving health complaints or lameness conditions.

If you have a health or lameness condition that seems to not go away or returns quickly, then the process of inflammation has not been completely addressed and balanced.  This means that likely a factor is still contributing and desires attention.  Now, with that being said, some of those factors cannot be addressed in certain cases of horse health or lameness.  As an example, a horse may be boarded and turnout is not possible, exercise can only be provided just a few times per week, there is a strict feed regimen for all horses, or there are herd dynamics present that cannot be altered.  I totally understand those situations, but on the same side of the coin, like it or not, despite not being able to alter them, you still need to realize that they are a player in the game.

In my experience, most factors can be addressed and balanced, but even here in our facility, we have dynamics that cannot be made optimal or in some cases, the horse has a learned behavior or insecurity that is fighting his recovery.  Keep in mind that you cannot supplement your way out of avoidable factors.  There is no supplement to counteract a poor diet, poor hoof health or balance, ongoing stress, or a poor fitting saddle.

Inflammation in the Horse and the Role of Supplementation

Proper supplementation to me is like a bridge to get me where I want to go, a little faster.  When I say ‘proper supplementation’, I am not referring to feed supplements, vitamin/mineral mixes, or typical joint supplements.  I am referring to specific herbs that have a proven track record in research or clinical experience, to target the inflammatory process and work similar to a medication, but better.  Many herbs have the ability to impact the inflammatory response, some are better than others, but many also have other capabilities that are utilized, including impact on the immune response or even digestive health.  The keys to proper herb usage include:

  • Proper potency
  • Proper dosing
  • Proper frequency
  • Proper combination with other active herbs

We could take a horse with a tendon injury, as an example, and address all 6 factors above and in most cases, he would do fine and recover uneventfully in 4-6 weeks, maybe longer.  However, if we address all 6 factors and implement some specific herbs to assist in balancing that inflammatory process, likely that horse will respond much quicker, often in around 2 weeks.  Tendon injuries in my experience, often respond the most quickly out of all injuries in the horse.

These herbs, when chosen properly based on the patient, can not only impact the inflammatory process but also support cellular health, which equates to increased healing capabilities and reduced recovery time.  These herbs can supply vital protein, vitamins, minerals, and co-factors such as nitrates that enhance recovery and impact blood circulation.  It’s a double whammy type of benefit to the horse and why so many recover so quickly.

Inflammation and Supplements; Too Much of a Good Thing

Initially, in almost any horse case, whether if that is a tendon, joint, allergies or even laminitis, I will often use 2-3 different supplements to get things under control and better managed.  Not uncommon at all and the reason for this is that more often than not, that horse is not only inflamed, but in a state of deficiency on many levels.  Many also have secondary complications including gastric or hindgut ulcers.

In addition to the supplements, our patients are put onto a very clean and restricted diet, eliminating most of the other supplements and commercial feeds that were being utilized.  This change in diet does two things.  It helps to provide a cleaner base of provision for the horse and the change also eliminates many contributors found in the prior diet that were making the inflammatory process worse.

Along with the dietary changes, the horse’s feet are assessed, trimmed and balanced in all cases.  Shoes are removed, at least for the short-term, and the foot is allowed to ‘breathe’ and regain shape and balance. The main goal here is to establish a normal foot, or close to it for the horse.  Many have been kept in shoes which were constricting and causing pain, which then adds to stress and inflammation.  Others have poor hoof health, which has been masked by shoes, and continues to create distress for that horse.  Bottom line is that the feet are either directly or indirectly involved in almost 75% of all cases.

The horse’s recovery is further enhanced by allowing them to be a horse, which means access to a paddock or full turnout.  Even with a tendon injury, they get turnout to a degree.  This ability allows them to release stress, burn off energy and just be a horse.  In most cases, they are allowed to co-mingle with other horses, which reinforces their herd tendency and further reduces internal stress associated with human captivity.  This turnout also includes exercise, which may be forced in terms of a regimen of ground work, progressing into saddle work.  Exercise is very beneficial to health and recovery, and is implemented in every patient as long as their recovery has progressed to that point.

Considering that these factors are addressed, and taking into consideration that we may have 2-3 supplement being used in that horse for the first month, in most cases by week 4, the horse has made some significant strides in recovery.

The interesting thing is that often by week 6-8, if the regimen has not been changed, some horses that have been noted to be improving start to backslide a bit.  Maybe their lameness is starting to peak it’s head out again, or there is a subtle soreness or stiffness.  In some, it may be a shift towards a negative attitude.  The point is that with that horse, we were doing well, but now not so much.  Why?

Inflammation is an ongoing and necessary cellular process.  Think of inflammation on a scale of 0-10, assuming a normal value of maybe a 5.  In the early stages of that horse’s recovery, the inflammatory levels were likely very high, maybe an 8 or even a 10.  As we controlled the contributors, that inflammatory process begins to drop, which is good.  Add in specific herbs and the process drops even further.  In some cases, it is possible to drop that inflammatory level below the normal ‘5’ and with that, health begins to be negatively impacted.  I call this phenomenon, “excessive inflammation downregulation” or E.I.D.  This is not due to herbs being ‘bad’, but really more that we have done a nice job and now need to back off.

How do you back off?

Well, if you have controlled all of the contributors to the best of your ability, the next thing that I do is start to reduce the supplements.  In many, as an example, we may be using a herb blend to assist with generalized inflammation, but also one to address stress and maybe ‘gut’ health.  Even though those herbs may be used for stress balancing or gut health, many of them still impact the inflammatory response.  So, their use becomes additive in essence.  In these cases, I will generally start to pull back on the gut formula, as an example, and give the horse a week to tell me how they are doing.  If he responds and is back to doing well, then we hold steady.  If not, I reassess and take a different approach, maybe this time removing the stress formula as well.

This overall process is not too uncommon in our facility, especially if the horse is here for 6 or more weeks.  In the end, in most cases, we continue to modify the contributing factors and keep that horse doing well maybe by using 1 or 2 herbal supplements.  Some require no supplements if their condition is relatively minor, and considering that all factors are controlled.  If a joint is severely damaged or a tendon is scarred down, then obviously inflammation will remain high and thus, herbal supplementation is needed in the long-term.

In the End, It’s Up to You as the Horse Owner

I have outlined our general approach to any horse that presents to our facility.  My overall goal and purpose is to better manage their inflammatory process, and through this, recovery is enhanced.  Each horse is different, due to personality, attitude, and even extent of injury.  Their feet are also different in which some can be helped or remedied more quickly than others.  No one or no horse is perfect.  You do what you can and no judgments passed. When I don’t succeed at improving a horse, more often than not, it is not something I am doing but more so that more time is needed, which means patience.

The one observation that I will make over 23 years of working with horses, is that there are contributors to the process of inflammation in every horse.  I’ve encountered many cases where supplement usage and dosage remains very high, even after 6-12 months of time, sometime even longer.  Is that detrimental to the horse?  Likely not, but more so to me, as a veterinarian, it indicates that there is a contributor that still needs to be managed.  In many cases, it is either diet or foot balance.  Both of which easily ignored, but both could have a tremendous impact on recovery for that animal one way or the other.

The root foundation of any recovery in the horse is proper diet, foot care, and environment.  This is where we should all start and then add in as needed.  Through this foundation, inflammation in the horse can often quickly regain balance and be controlled into the future.  When we do this and monitor the horse for a response and alter our course if possible, then recoveries are often very quick, not so expensive, or laborious.

Struggling or have questions regarding your horse’s situation?  Schedule a consult today!

We are here to help!

 

Author:  Tom Schell, D.V.M., CVCH, CHN

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