2012 Equine Extravaganza

Chiropractic and Mesotherapy: What’s

New!

Dr. Katie Crossan

Certified by the American Veterinary Chiropractic Association

Kirkton Veterinary Clinic

Equine Services

What is Chiropractic?

►Chiropractic is a technique that restores motion to joints in order to maximize nerve function

►The back and neck contain multiple joints- if any of these are not moving through their full range of motion secondary issues will arise

Chiropractic- How Does it Work?

►The brain and spinal cord are the body’s “command centres” and are responsible for the behaviour of every organ in the body.

►The bones, ligaments, and soft tissues that surround these command centres can negatively impact their function if they are not working properly.

So… What’s New?

►“old style” chiropractic- theory that bones are out of place and need to be “moved”

►NEW RESEARCH: manipulating the release of chemical neurotransmitters by stimulating receptors in the body can help to “reset” dysfunctioning pathways.

► Electron microscope image of neurons

► Messages pass from neuron to neuron through the chemicals released between them

► Manipulating the release of different chemicals can change the message sent

►Resending a message again and again builds “plasticity”, which means the message is sent quickly and the resulting action occurs smoothly.

►Recognizing how the brain controls the body allows us to manipulate the “messages” to improve function.

EVERY CELL IN YOUR BODY IS UNDER NERVOUS

CONTROL

This may be an explanation as to why chiropractic seems to have an effect on

internal organs as well as the musculoskeletal system

How Do You Adjust a Horse?

►You adjust only one “joint” or segment at a time with very specific movements

►Chiropractic moves the affected joint in the direction it naturally should move- this is important as random motion could cause injury

► Newer techniques may use known pathways of the nervous system to “reset” muscles and nerves.

► Consequently, more recent chiropractic techniques may not resemble the quick thrust you have seen in the past, and may consist of multiple small motions.

Why Do Horses Respond so Well to These Therapies?

►Light horses have mostly fast twitch muscle fibers (Type II a and b)

►This helps them react very quickly to stimuli- ie skin twitches when a fly lands

►The brain receives information regarding motion much more quickly than it receives pain impulses.

The Vicious Circle

►Pain will cause the body to stop moving

►While this can be beneficial (ie broken bones!) it can also lead to problems as previously discussed

►The decreased motion in turn results in more inflammation (painful!)

When To Use Chiropractic

►Barrel racing►Roping► Jumping►Dressage►Driving►Cutting or working cattle►Racehorses►Older horses►After an accident as part of a rehabilitation program

Specific Problems

► Shortened stride

► Poor Performance

► Inability to pick up canter leads

► Sore back to the touch

Other Benefits

►Great way to pick up on subtle lamenesses more quickly

►Assess problems with harness or saddle fit

►Enjoyable for most horses

How Often…

►Animals hold their adjustments far better than people

►An individual schedule will be decided on depending on your horse’s workload and severity of findings

Mesotherapy

►Involves injection

of small amounts of

medication into

the mesoderm using

tiny needles mounted

on a device

Mesotherapy- How It Works

►Used since 1950’s

►Originally thought to work only on muscle spasm, and to work through temporarily blocking a nerve reflex loop traveling from the skin to the spinal cord.

Mesotherapy- Multiple Modes of Action

► Pharmacological effect of medication given

►Blocking the reflex arc

► Stimulating “giant fibers” and changing the impulses sent from underlying tissue

►Very effective at breaking the cycle of muscle spasm

►Also provides long lasting (up to 6 months) pain relief from neck and back pain resulting from ligament strain, arthritis, etc.

Other Techniques to Treat Back and Neck Pain

►Shockwave therapy

►Ultrasound guided injection of the cervical facets/ bursa of the nuchal ligament

►Anti-inflammatories

►EXERCISE!!! It is crucial to maintain muscle mass in horses with sore backs, so every effort must be made to make them comfortable enough to work.

Questions?

EQUINE JOINT HEALTHCarly Telfer, DVM

WHAT IS A JOINT?

� A joint is the location where

two bones make contact. They

are constructed to allow

movement and provide

mechanical support.

� Synovial joints are the most

common moveable joints in

mammals.

Synovial joints

� Synovial joints consist of a

synovial cavity, an articular

capsule and an articular

cartilage.

� They can also include

accessory ligaments, fat pads,

menisci, tendons, and bursae

Joint Diseases

� ARTHRITIS

� OSTEOARTHRITIS (DJD)

� SYNOVITIS

� OSTEOCHONDROSIS

� SOFT TISSUE INJURIES

� TRAUMA

� FRACTURES

� WOUNDS

Diagnosis

� HISTORY/ PRE PURCHASE EXAMINATION

� LAMENESS EXAMINATION

� RADIOGRAPHS

� ULTRASOUND

� BONE SCAN (NUCLEAR SCINTIGRAPHY)

� MRI

� ARTHROSCOPY

WHAT CAN YOU DO?

� Controlled growth

� Consistent regular exercise

� Good quality diet

� Good body condition

� Preventative Therapies

� Treatment

Non-Steroidal Anti-Inflammatory Drugs

(NSAIDs)

� PHENYLBUTAZONE (bute)

� FLUNIXIN (banamine)

� ASPIRIN

� MELOXICAM

� FIROCOXIB (equioxx)

� NAPROXEN

� CARPROFEN

NSAIDs

� IN GENERAL – INHIBIT ONE PART OF INFLAMMATORY CHAIN

� WANT TO USE RECOMMENDED DOSES AND NOT USE POLYPHARMACY

� TRY TO DECREASE DURATION OF USE

� GASTROPROTECTANTS FOR LONGER TERM USE OR SENSITIVE HORSES

� COX 1 AND COX 2

� COX 1 INHIBITORS ARE MORE LIKELY TO PRODUCE MUCOSAL DAMAGE AND ULCERATION IN THE GASTROINTESTINAL TRACT THAN COX 2 INHIBITORS.

INTRA-ARTICULAR CORTICOSTEROIDS

� METHYL-PREDNISOLONE ACETATE (depo-medrol)

� TRIAMCINOLONE

� BETAMETHASONE

THE GOOD, THE BAD AND THE UGLY!!!

SODIUM HYALURONATE

� INTRA-ARTICULAR

� INTRAVENOUS

� ORAL

Hyaluronic acid

� Integral component of both synovial fluid and articular cartilage. It is synthesized within the synovial membrane and chondrocytes.

� Important in elasticity of joint and lubrication of joint.

� Tons of beneficial effects after IA administration of HA have been reported in a number of equine studies.

� Anti-inflammatory

� Increased production of HA within the synovium

� Helps clear infected joints

� Potentially reduces cartilage degradation

SODIUM HYALURONATE IA

� SIGNIFIGANT STUDIES ON INCREASED JOINT HEATLH

� IA injections with steroid only versus HA and steroid together

resulted in HA/steroid having a better and longer lasting

improvement.

� Significant difference in studies compared to placebo!

IVHA (Hyonate/ Legend)

� Horses treated once a week for 3 weeks were found to have

lower lameness scores and significantly better synovial

membranes as well as significantly lower inflammatory

mediators within their joints compared to placebo treated

horses.

� Mechanism is uncertain

POLYSULFATED

GLYCOSAMINOGLYCANS

Thought to be chondroprotective (PROTECTS CARTILAGE FROM DAMAGE)

Repeated IA injections show significant improvement in synovial fluid protein concentration and improved viscosity.

Improves clinical signs of arthritis.

Can markedly decrease development of OA but no benefits for cartilage lesions already present in one study.

Potential complications of IA use is a greater potential for infection compared to other products.

Intramuscular use: positive side effects for IA difficult to show with IM use. Minimal objective data. May be useful at higher concentrations? Only therapy every 4 days seems to show anti-inflammatory levels with the joint.

IRAP

� INTERLEUKIN-1 RECEPTOR ANTAGONIST PROTEIN

� An anti-inflammatory protein that counteracts the destructive effects of inflammatory proteins such as Interleukin-1 (IL-1) within the inflamed joint.

� Harvest from the horses own blood and incubated with glass beads that enhance the production of anti-inflammatory proteins including IRAP. The serum is then filtered and frozen until use.

� We often recommend IRAP if a joint is non-responsive to corticosteroid injections or if frequent injections are required. Additionally recommend IRAP when there is a well defined synovitis/ capsulitis within a joint.

� In general the process produces 5-6 doses of the serum. We usually us 2-3 consecutive doses within the joint 8-14 days apart.

LONDON EQUINE

HOSPITAL

Tiludronate

� Inhibits osteoclasts

� Research shows improvement for navicular

disease, hock arthritis, back/neck arthritis…

� WANT TO USE BASED ON BONE LYSIS to

reduce resorption of bone.

SURGERY

DIAGNOSIS

TREATMENT

SUPPLEMENTS

� Glucosamine

� MSM

� Chondroitin

� HA

� GAGs

ETC, ETC, ETC

EXERCISE

� Consistent regular exercise

� Appropriate for individual horse

Thank you!

� Please contact us with any questions!

The Top 10 Reasons

To Call Your Vet�

At least, according to us!!

Presented by

Dr. Jennifer Hodge

Why would YOU call?

• Colic

• Open wound

• Eye injury

• Lameness

• Choke

• Foaling

• Fever

• Sickness

• Routine health care

• Export papers

#1 COLIC�• EMERGENCY!

• Some colics may be simple and can be resolved easily - others can be deadly, especially if untreated

• BEFORE YOU GIVE YOUR HORSE ANYTHING - call us! Even a phone call with your vet can help you decide the best course of action

• If colic signs do not improve after a half hour of handwalking (or worsen) it is better to have your horse examined and treated ASAP than to wait

COLIC�

– Take away all feed (water is ok)

– Handwalk if your horse is trying to roll

– If the horse will stand in the stall, make sure it is clean so you can monitor for new manure

– Do not administer any medication without consulting the vet

– If you administer medication, make sure you take the heart rate and temperature first and record time of administration

–Rolling, pawing

–Sweating

–Lifting upper lip

–Kicking at belly

–Off feed,

distress

What to do while you

wait�

Signs:

#2 OPEN WOUNDS�• Lacerations that go all the way

through the skin (full thickness)

should be sutured

• The newer a wound is when it is

sutured, the better the chance is that

it will heal well

• If you think that a wound can be

sutured, DON’T WAIT!

• Especially wounds on lower limbs -

these like to grow proud flesh if they

are not closed and can be a

nightmare to heal

OPEN WOUNDS�• What to do while you wait??

• If the wound can be rinsed clean (cold

hose, clean water) safely, do so

• If the vet is on their way, avoid applying

any topical medications (Blue/silver

spray, furacin, etc) as they can

complicate suturing

• If the wound is on a limb and/or

bleeding, apply a clean bandage if

possible. Applying pressure with a

clean towel will work for wounds that

can’t be bandaged

#3 EYE INJURIES�

• Eyes are ALWAYS an

emergency!!

• If you suspect your horse

has had an eye injury don’t

wait to call

• Treating eyes quickly can

mean the diffence between

keeping and losing vision,

as well as the eyeball!

EYE INJURIES�

– Squinting, tearing

– Ocular discharge (yellow

or greenish)

– Eyelid lacerations

– Visible scratches or

spots on the surface of

the eyeball (cornea)

• If you think your horse has

had an eye injury>

•Call the vet!

•Move the horse to a safe, dark

location

•Do not apply any eye ointments

without consulting your vet - some

can actually make they eye

worse!

•If you think the eye is very

painful, putting a well-fitting fly

mask on can help protect the eye

until the vet arrives

Signs to look for:

#4 LAMENESS�

Different people will call the vet for

lamenesses of differing severities..

– SEVERE LAMENESS IS AN

EMERGENCY!

– Mild lameness may not provoke an

emergency call> but even mild

lameness that persists for an extended

period of time should be diagnosed

– If the lameness seems to involve

BOTH FRONT FEET - call your vet

right away, as you may be seeing the

first signs of laminitis - TIME TO

TREATMENT IS CRITICAL

SEVERE LAMENESS�• What to do while waiting for the vet>

– If possible, move the horse to a safe location where they will not be bothered by other horses, inclement weather, etc. Soft bedding is usually ideal.

– Do not remove any foreign objects that may be causing the lameness (ie. Nail in the foot, penetrating sticks, etc)

– If there is an obvious injury to a lower limb, and a bandage can be applied safely it may be helpful in providing support and stability

– Before administering medication, consult with your veterinarian

#5 CHOKE�• Can be mistaken for other

things (ie colic)

• Generally seen after feeding

• Older horses more prone -esophageal motility not as good

• Signs of choke:

– Excessive salivation

– Coughing (cough up feed material - seen in/around nostrils

– Agitation, retching

CHOKE�• What to do??

– If a choke does not resolve on it’s own in 10-15 minutes, it will likely

need veterinary attention

– Remove all feed material (water is ok)

– Sometimes taking the horse out for a brief walk will help relieve their

distress and distract them (won’t fix a serious choke)

– If the choke is mild (and recent) a few syringes of water given orally

may help with swallowing

– If signs persist after 15 minutes THIS IS AN EMERGENCY!

– Untreated choke can lead to esophageal rupture, aspiration

pneumonia and other bad things!! Not to mention the horse feels

miserable :(

– Even mild chokes can have some aspiration - if you have any doubt it

is best to treat with antibiotics

#6 FOALING�• Generally, foaling is a quick and

easy event

• It is an EMERGENCY if the process stalls anywhere along the way!!

• From the time the mare’s water breaks, foaling should progress quickly - the foal should be born in 30-45 minutes

• If you are nervous, or inexperienced with foaling - call your vet as soon as the water breaks (this gives a few minutes to get on our way to your farm!!)

FOALING�

• Emergencies DURING foaling..

– Malpositioning of the foal

– Fetal-maternal disproportion

– Congenital deformities

– Umbilical cord abnormalities

– ‘Red-bag’ - premature

placental separation

– Failure of amniotic sac to

rupture (suffocation)

• Emergencies BEFORE foaling>

– Premature udder development

– Vaginal discharge

– Leaking colostrum

• If any of these are noted, it is best

to contact your vet ASAP - things

like abortion and immunodeficient

foals can hopefully be avoided with

early treatment

** ALL MARES AND FOALS SHOULD BE EXAMINED BY A VET

WITHIN 24 HOURS TO CHECK FOR CONGENITAL BIRTH

DEFECTS AND ENSURE PASSIVE TRANSFER OF ANTIBODIES

#7 FEVER�And

#8 SICKNESS• Fever generally

indicates an underlying illness

• It is often accompanied by other clinical signs such as dullness and being off-feed

• Febrile horses are often reported to “not be themselves”

• Febrile = Temp over 38.5º Celsius or 102.5° Fahrenheit

• Sickness - coughing,

nasal discharge, etc

• Can be mild, but may lead

to more serious illness (ie

pneumonia) if left

untreated

• Often viral causes (EHV,

influenza) but can be

complicated by secondary

bacterial infections

FEVER�and SICKNESS• Your vet can do bloodwork on the

most affected horse(s) to determine the best treatment course

• In addition to calling the vet>

– Avoid bringing new horses into/out of the barn

– Monitor rectal temperatures daily

– Wash hands between sick and healthy horses

#9 ROUTINE HEALTH

CARE�

– Rabies

– Tetanus

– EEE/WEE

– WNV

– EHV/Influenza

– Strangles

• Dentistry (annual

check-up)

• Deworming/Fecal

sampling (3-4 times

per year, depending

on environment)

Vaccinations:

COGGINS and EXPORTS�

• A Coggins test determines if a horse is affected with Equine Infectious Anemia (EIA)

• Not a common disease in this part of the world, but very serious

• Negative test required for some horse shows/events as well as for racing and importing/exporting horses

• Takes 5-10 days to get original paperwork back from the lab!!

• Export papers are a statement

verifying that a horse is healthy

and fit for travel

• They also list the most current

negative Coggins result

• Required to cross the border

between Canada and the US

• ‘Temporary’ papers are good

for 30 days to leave the country,

any longer requires a

“permanent’ set

• Must be signed by a CFIA vet to

be valid*Take home message: Paperwork takes time - plan ahead! :)

And finally�

Any Questions???

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