Caring for the

Geriatric Horse

Jordan Cook, DVMMoore Equine Veterinary Centre

Client Appreciation Seminar 2016

What is Geriatric?

• Generally any horse over 18 years of age

– Every horse ages differently, some in their mid-teens, others not until their mid or late 20s

• What are our goals?

– Provide a safe and comfortable environment

– Maintain body condition score• Dental care

• Proper nutrition

• Parasite control

– Eliminate or minimize pain

“Special Needs”

• Preventative health care

• Dental care

• Nutrition

• Musculoskeletal

Problems

• Internal Problems

• Environmental Factors

• Winter Care

The Aging Horse

What do we see?• Weight loss (ribby)

• Muscle loss (top line, hay belly)

• Poor hair coat/graying out

• Moving slower/stiffness

• Trouble getting up/down

• Drinking more water

• Eating slower +/- dropping feed

• More frequent health issues– Colic, skin/other infections, bad

breath, runny manure

Preventative Health Care

• Physical exam

– Monitor heart, lungs, body condition, etc

• Vaccinations

• Deworming

– Use Fecal Egg Counts to target deworming

• Dentistry

• Routine bloodwork

• Regular farrier care

Address problems EARLY!

Dental Care

• Regular dental exams and floating are essential to an older horses health– 1 – 2 times per year

• More significant problems as a result of malocclusions and poor mouth balance– Often require more corrective dentistry

– Start to “run out of tooth” and have poor occlusal surface

– Sharp points, hooks, waves, diastemas, cupping out/severe wear, incisor abnormalities

– Loose or absent teeth

• Often need to make diet adjustments– Can’t chew feed effectively

– Caloric intake will change over time, often rapidly

Dentistry

• As horses age they “run out of tooth”

• Sometimes they will lose teeth on their own

• Other times we have to remove lose teeth to make them more comfortable

http://www.1animalcare.com/Dental_Horse5.htm

Equine Odontoclastic Tooth Resorption and

Hypercementosis (EOTRH)

• Exaggeration of the normal tooth eruption process

– Excess breakdown and lysis of the tooth infection, osteomyelitis

,pain Affected tooth needs to be removed

– The tooth builds up excessive cementum to try and stabilize

Inability to properly chew

ChokeInability to properly digest

Weight loss despite a

good appetiteChronic colic

Soft manure or diarrhea

• Inability to chew

• Poor esophagealfunction

• Poor salivary gland function

Choke

http://equineink.com/2012/01/29/what-to-do-

when-your-horse-chokes/

Nutrition

• Henneke body condition score system

• 1 = extremely emaciated

• 9 = obese

• Ideal = 5-5.5/9

• GET A WEIGHT TAPE!! Regularly body

condition score and weight tape your horse

Body Condition Score

• Inability to chew long stem fibre

• Reduced digestibility

– Poor hind gut function– break down of fibre

– production of b vitamins

– absorption of protein

• Underlying diseases =

caloric demand

– Heaves (RAO/COPD)

– Cushings

– Liver / Kidney disease

– Cancer / Tumors

Things to Consider

http://www.equisearch.com/horses_care/nutrition/feeds/eqdigestio3120/

• Easily chewed

• Easily digested

– Roughage/fibre

– Protein (12 – 16%)

– Fat and energy levels

• Balanced vitamins

and minerals

• Address medical

conditions

Goals of a diet

http://www.balancedequine.com.au/nutrition/nutrition.html

Musculoskeletal Issues

http://www.equineskeletons.com/?paged=3

• Lameness? Stiffness?

– What are your expections?

– What is the horses job?

– ACUTE vs CHRONIC lameness

• Why is this important?

= PAIN• Will reduce appetite

• Promote weight loss

• Increase stress

http://towcester-vets.co.uk/equine/

• Arthritis

– Not just “hocks”

– Neck (cervical) and spinal arthritis too!!

• Soft tissue

– Degenerative suspensory ligament desmitis

• Regular turn out with appropriate workload

• Joint Supplements– Glucosamine/MSM, Adequan, Polyglycan, Legend

• Long term anti-inflammatories– Previcox

• Shockwave Therapy

• Alternative Therapy– Acupuncture/Chiropractic

• Joint Injections

• Appropriate farrier work

• Provide soft deep bedding

What can you do?

• Cushing’s Disease

• Insulin Resistance / Equine Metabolic Syndrome

• Colic

– Impactions

– GI tract tumours

• Renal Disease

• Hepatic Disease

• Heaves (RAO/COPD)

Internal Medical Issues

http://www.talkaboutlaminitis.co.uk/ppid-symptoms-and-diagnosis/

• Cushing’s = PPID Pars Pituitary Intermedia Dysfunction

• Involves enlargement of a part of the Pituitary Gland

– Tells the adrenal glands whether or not to produce Cortisol (=“stress” hormone)

• Slowly progressive

• Older horses (18 yrs +)• 15 – 30% of the population

Equine Cushing’s Disease

• Pituitary gland is regulated by dopaminergic neurons in the hypothalamus (located “upstream”)

• When these neurons are lost

production of dopamine

pititary gland can’t turn off

• production of many hormones

– Cortisol

– ACTH

• Similar to Parkinson’sin humans

What is it?

• Hirsutism

– Shaggy hair coat that doesn’t shed

What does it look like?

• Laminitis

– Due to increased cortisol levels and insulin

resistance

Clinical Signs

http://www.yourhorse.co.uk

• Polyuria/Polydipsia

– Increased water intake, increased urination

• Hyperhidrosis

– Excessive sweating

• Muscle Atrophy

– Difficult to maintain muscle mass

• Abnormal fat distribution

– Large pot belly, cresty neck, shoulder and rump fat deposits

• Poor functioning immune system

– Increased cortisol levels leads to

immunosuppression

– Increased sensitivity to parasites,

common viruses, infections (ex.

Cellulitis, scratches), etc

– Opportunistic infections

• Dexamethasone Suppression Test

– Not for laminitic horses

• Endogenous ACTH

Diagnosis

• Management is key

– Preventative health extremely

important

– Dentistry, deworming,

vaccinations, weight

management

– Drug Therapy

• Pergolide

Treatment

• Dental problems = poor mastication of feed

• Improper nutrition

• Poor water intake

• Reduced activity

• Can lead to bacterial imbalances, impactions, etc

• Can benefit from probiotic

– Saccharomyces

– Hind gut buffer (ex. Equisure)

• Monitor water intake

– Flavour water, offer electrolyte spiked water

Colic

• Hypersensitivity (allergic) reaction in the airways

– Inflammation/thicking of the airways

– Increased mucus secretion

– Bronchoconstriction

• Increased respiratory rate/effort +/- cough

Heaves (Recurrent Airway

Obstruction – RAO)

Diagnosis

– Bronchoalveolar Lavage (BAL – Lung Wash)• Infuse sterile fluid into the lungs and then aspirate

back to collect a sample of cells– Increased neutrophils and other inflammatory cells

– Occasionally have mild secondary oppourtunstic infection

• Chronic bronchconstriction and inflammation in the lungs can lead to scarring, respiratory distress, weight loss, and heart failure

– This can happen very rapidly if left untreated

Treatment– Systemic antiinflammatories / steroids (Dex, Pred)

• Often can’t use long term due to side effects

– Bronchdialators (Ventipulmin)

– Expectorants (Sputolysin, Quiex Forte)

– Inhaled antiinflammatories

• MANAGMENT is critical!!– Reduced allergens

– Wet hay, soaked feed

– Improve ventilation

– Increase turn out

– Allergy testing

• Changes in herd status/hierarchy

– Ensure they are eating what they are supposed to!

• Loss of a herd mate

• Increased sensitivity to stress

• Any change in routine

Environmental Factors

• To Blanket, or not to Blanket?

• Difficulty maintaining body temperature

– Decreased body weight

– Decreased hay intake

– Decreased movement

– Decreased access to shelter

• Herd mates

• Shelter distance to food/water source?

Winter Care

• More likely to go down and not be able to get up

• Stay calm

• Spread non-slip materials

– Shavings, salt

• Offer water

• Often they get tired, let them rest

• Call your vet

– Might have serious injury

http://www.boston.com/news/local/breaking_news/2011/03/and

over_firefig.html

On to greener pastures...

• When is it time?

• There is no easy answer, very personal decision

– Monitor “good days” vs “bad days”

• Write it down, use a calander

– Sometimes the decision is made for you

• Colic, catastrophic injury

• Quality of life is the goal of you and your vet

• Don’t be afraid to talk about it and ask questions

Euthanasia

We are fortunate in having the ability to end

pain and suffering

Questions??

• Major advances in geriatric care

• Horses are living well into their 30’s

• Age is not a disease!