by Kevin Haussler, DVM, DC, PhD
Veterinary medicine has made significant advancements and can effectively diagnose and manage many disease processes in animals; however, there are still certain conditions that continue to be difficult to manage. These challenges can arise due to the complexity of the disease itself, limitations in diagnostic tools, or the lack of an effective treatment.
- Atypical presentations: Clinical signs can sometimes be very unusual, making it challenging for veterinarians to recognize and diagnose the underlying disease process.
- Subclinical disease: All disease processes must reach a certain threshold or severity to produce clinical signs before they can be recognized and diagnosed.
- Diagnostic uncertainty: Despite extensive lameness workups, running lots of diagnostic tests, and consulting with several different specialists, the cause of the clinical complaint cannot always be identified.
- Chronic conditions: Chronic diseases, such as osteoarthritis, can be particularly challenging to manage due to the long-term nature and potential for relapses.
- Genetic and hereditary disorders: Inherited diseases can be difficult to manage, as they may require long-term care and specialized treatment to maintain the animal’s quality of life.
- Limited research: Some diseases may not have received extensive research attention, leading to a lack of understanding about their underlying causes or effective treatment options.
In cases where diseases are particularly challenging to diagnose and manage, veterinarians may collaborate with other healthcare providers, seek the advice of specialists, use advanced diagnostic techniques (CT scans, muscle biopsies), or explore experimental treatment options.
While the veterinary treatment of most disease processes is quite effective, there are some clinical conditions that are often difficult or challenging to manage, such as:
- Chronic pain
- Head tossing
- Resistance to bit pressure
- Intermittent, mild lameness
- Bucking or rearing
- Refusal in training
All too often, proposed methods for addressing these challenging conditions may include overmedication (repeated corticosteroid injections), telling the owner it’s all in their head (hysterical owner), or that the horse is a bad or difficult horse (need to buy a new horse). Does this sound familiar?
No single individual has the answers to the many issues that affect horses. While veterinarians are highly trained and skilled at recognizing disease processes, they may not have clear answers for managing subclinical disease or functional deficits unless they have pursued additional education or have developed insights from personal experience.
From a healthcare perspective, addressing mental and physical wellness, optimizing performance, and preventing injuries due to chronic, repetitive use are issues just as critical to address in horses.
This is where consultation and collaboration with paraprofessionals and other specialists can help.
A horse’s healthcare team might include:
- Nutritionists to provide balanced rations for optimal nutrient absorption and energy production needed for growth and fitness.
- Qualified equine dentists who can conduct full oral examinations, ensure proper dental occlusion, and provide routine maintenance.
- Farriers to regularly maintain hoof health and manage hoof imbalances through corrective trimming and proper shoeing.
- Tack and saddle fitters to assess the individual horse and rider needs and provide proper fitting equipment.
- Physical therapists to do functional assessments, recommend therapeutic exercises, and address rider imbalances that negatively affect the horse-rider interaction.
- Trainers to improve the horse’s flexibility, strength, coordination, and endurance.
- Biomechanists to provide objective measures of lameness, saddle pressures, or rein tension.
- Behaviorists to improve learning skills, assess chronic pain behaviors, and provide effective coping strategies for stressful or fearful situations.
- Chiropractors to address axial skeleton pain, stiffness, and muscle hypertonicity.
- Acupuncturists to manage musculoskeletal pain and neurologic deficits.
- Osteopaths to apply structural and functional techniques to affect skeletal, neuromuscular, and visceral disorders.
- Bodyworkers and massage therapists to address muscle and myofascial pain, release tension, and improve joint range of motion and posture.
While some practitioners may be qualified to provide a combination of the above, unfortunately, the level of education and training continues to vary greatly. The challenge is to find the right qualified people with the right skills at the right time to help the horse.
The question then arises: Who is most qualified to oversee the combined efforts of all these healthcare providers – who leads the team?
I would argue that the horse’s regular veterinarian is most qualified to serve in this role. The team leader should be able to assess the horse’s overall medical status, discuss indications for care with the owner and each healthcare provider, consider when best to start and stop the different therapies, and, when indicated, pursue additional or advanced diagnostic procedures or medical care.
The development of a successful healthcare team requires ongoing open and honest communication, a mutual exchange of knowledge, with recognition of everyone’s strengths and limitations. The primary focus needs to always be on the horse and the owner. Unfortunately, egos and the propensity to protect one’s turf often gets in the way of maintaining effective teams, which ultimately harms the horse and can alienate the owner.
A collaborative approach can greatly enhance the quality of care and outcomes for these magnificent animals. By combining their individual expertise, members of the healthcare team can provide holistic solutions that promote optimal musculoskeletal health and improve the overall performance and comfort of horses.