'Care of the Geriatric Horse,' presented by Dr. Jen Gold, DACVIM-LAIM internal medicine specialist. This presentation is a great resource for all horse owners!
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The Geriatric Horse
1. Care of the Geriatric Horse Jenifer R Gold, DVM, DACVIM Mountain Horse Medical Center April 2011
2. Definition of a Geriatric Horse General Care Nutrition BCS Gastrointestinal tract Dentistry Pasture Diseases Euthanasia Outline
3. A horse > 20 years of age Recent study indicates anywhere from 7.5-20% of equine population in the US is geriatric1-2 Definition-What is a Geriatric Horse? 1Baseline reference UDSA:APHIS 1998 2Harper F.Large Anim Vet 1992
4. Horses do not age at the same rate as humans. Geriatric Horses
5. Provide a safe and comfortable environment Adequate feeding protocols Provide good nutrition Attention to ambient temperatures Grooming care Parasite Control Dental Care General Care
6. One of the most important parts of geriatric care is maintenance of body condition. Older horses tend to lose weight to due Parasites Poor dentition Competition with pasture mates Disease Nutrition
7. The Henneke System is an objective evaluation of a horse's body condition Developed in 1983 by Don R. Henneke, Ph.D. Based on both visual appraisal and palpable fat cover of the six major points of the horse that are most responsive to changes in body fat. Neck withers (where the neck ends and the back begins) the shoulder area ribs loins the tailhead area What is Body Condition Score (BCS)?
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9. Poor — Animal is extremely emaciated. Spinousprocesses,ribs, tailhead, tuber coxae, and tuber ischii project prominently Bone structure of withers, shoulders, and neck is noticeable No fatty tissue can be felt. BCS- 1
10. Moderate Back is level. Ribs cannot be visually distinguished but can be felt easily. Fat around tailhead is somewhat spongy. Withers appear rounded over spinousprocesses shoulders and neck blend smoothly into the body. BSC-5
11. Extremely fat Obvious crease is seen down the back. Patchy fat appears over ribs. Bulging fat is seen around tailhead Bulging fat along withers, behind shoulders, and along neck. Fatalong inner thighs may cause thighs to rub together. Flank is filled with fat. BSC-9
12. Horses too thin or too fat are prone to develop secondary diseases Of particular concern Hepatic Lipidosis Why is BSC important?
13. If an animal is too fat or too thin They go off feed for a short time for any reason Mobilize fat Blood becomes lipidemic/lipemic Fat accumulates in the liver Hepatic Lipidosis
16. A well balanced diet is important for the geriatric horse because… Digestion of fiber decreases Ability to manufacture and absorb vitamins decrease B vitamins Vitamin C Decrease in kidney function Calcium stones may build up Decrease in liver function Jaundice, weight loss, lethargy, loss of appetite, intolerance for fat and protein in diet. Nutrition
17. Confinement? No-Turnout with a friend! Weight loss reasons: Poor dentition Reduction in digestion - parasites, microbial constituents, B Vitamins Nutrition
18. Selection of Feed Highly palatable Easy to chew & swallow Clean & dust free Highly digestible pellets or extruded feeds Contain enough high quality fiber to aid digestion. High quality hay – no alfalfa. Chopped hay, hay cubes or pellets Soaked feeds or mashes…Enough so they are easily palatable, doesn’t have to be a soup Nutrition
19. Geriatric horses should be fed a senior feed Senior feeds offer the horse increased protein, minerals, and vitamins. Specially formulated for our older horses Small feedings three to four times a day is ideal. ¼ to ½ cup of corn or vegetable oil may be added daily as an extra source of calories. Nutrition
20. Older horses are prone to weight loss, especially in the colder months, and require more calories to maintain their body condition. Soaked alfalfa cubes or pellets are also a good feed to offer older horses. Dengie hay is a good choice for older horses too because it is less dusty, minimizing any flare-ups of heaves, a disease that will be discussed later. Nutrition
23. Differences in rates of passage Equine rush through foregut time delay in cecum rush through rectum Ruminant Slow recycling flow of digesta
24. Water Essential for all body functions Temperature regulation Feed digestion Amount of water intake Level of exercise Ambient temperature Quality of feeds in ration Proportion of diet that is forage Minimum 1 gallon/100 lbs BW/day
26. Aged horses may lose some of their teeth Have sharp edges on their teeth or a "wave mouth” Leads to an impaired ability to chew hay, grain, or hay cubes. Frequent teeth floating by a veterinarian will ensure good oral health Correct any defects that may impact a horse's ability to chew MUST NOT BE OVERFLOATED! Dentition
28. Fecal egg counts are important False negative tests can occur especially with encysted stronglyes. Important to work out de-worming program with your veterinarian specific to your horse/ranch De-worming Help maintain good body condition Keeps geriatric horses Parasite Control
29. Experts consider them the #1 nematode problem in horses today. They can account for up to 90% or more of a horse’s worm burden (and 75% of them may be encysted) Encysted small strongyles: Are undetectable in routine fecal examinations Usually don’t visibly affect the horse until he becomes ill Can survive the effects of most common de-wormers Small Stronglyes
30. It has a 3-stage life cycle Unlike many parasites it can do something in its larval stage that creates a huge danger to horses Under certain (common) conditions, stronglyescan bury themselves in the wall of the large colon and “encyst” When they do, hard to kill and even harder to detect Can remain in this state for up to three years. Encysted stronglyes
31. No way of knowing how heavy an encysted small strongyle load a horse is carrying Fecal analysis cannot measure worms in the encysted state. Horses may not show outward sighs of a parasite problem until it is too late. Encysted Strongyles
32. Encysted small strongyles can cause severe clinical signs and even death. When thousands to millions of the fourth stage larvae (L4) emerge simultaneously from the intestine wall. Encysted Strongyles
33. Listlessness, weakness Anorexia Recurring colic Diarrhea Weight loss Peripheral edema (swelling) Death In less severe cases, horses may exhibit decreased performance, poor food utilization, and a dull hair coat. Clinical Signs
34. Fenbendazole is the only de-wormer that treats the encysted strongyles. Other de-wormers ieIvermectin, Moxidectin and pyrantel get the other stages. Moxidectin does get the L3 stage but that’s not encysted. Treatment
35. If your horse is on a daily de-wormer It’s still important to have your veterinarian perform a fecal egg count twice a year during spring and fall. That way you’ll know if your horse needs a supplemental treatment to reduce a specific parasite population. Horses on daily dewormer still need additional treatments to target encysted small strongyles, bots and tapeworms. Daily De-wormer
36. When a new horse arrives on your property Quarantine the newcomer and Monitor the horse for signs of contagious respiratory diseases and fecal parasites. Obtain a fecal sample and treat the newcomer for parasites before turning the horse out on your pastures. For long-term additions to your herd, treat the horse with a larvicidal dose of Fenbendazole Followed by ivermectin or moxidectin with or without a tapeworm treatment. New Horses
37. An effective parasite management program includes more than just de-wormers. Rotate pastures if possible. Ideally it is best to rest pastures when the weather is hot and dry. Cross-graze pastures with cattle or other ruminants. Beyond Deworming…
38. Remove manure from pastures and paddocks. Harrow pastures only during hot, dry periods and keep horses off for several weeks. Consult your extension agent regarding proper composting techniques. Avoid overstocking your pastures. Beyond Deworming
39. Older horses often lose their place in the herd hierarchy May be bullied by younger horses in the pasture. Allow them time in the pasture alone or with another older horse. This will eliminate stress on the horse and allow them proper grazing time. Adequate pasture time is vital to minimize orthopedic issues and stiffness. Pasture Environment
40. Additional considerations Placing older horses in a pasture with a flat surface Monitor weather conditions Often have significant osteoarthritis May have stiffness and weakness in the hind-end Predisposing them to fall in slippery conditions such as severe rain, snow, or ice. Pasture Environment
41. Geriatric horses are more sensitive to extreme weather conditions than younger horses Older horses often have hirsutism (an overlong haircoat) Not able to thermoregulatecorrectly They may also have areas of patchy sweating Important to clip them Use blankets in colder weather Provide a cool environment during hot months. Daily brushing is advisableto help with circulation Temperature and Grooming
42. Pituitary Pars Intermedia Dysfunction (PPID) Heaves Laminitis Uveitis Common Diseases of Geriatric Horses
43. Otherwise known as Cushings disease Usually seen in horses > 15 years of age Malfunction/micro/macroadenoma of the intermediate lobe of the pituitary PPID
44. Cushings versus PPID Equine Intermediate lobe Dopamine-dependant No negative feed back Dog Adrenal or Anterior Pituitary Cortisol-dependant Negative feedback
47. Depend upon the stage of the disease Classic symptom is Hirsuitism Excessively long curly hair coat Early signs Late shedding out Excessive hair on legs and face Clinical Signs
48. Laminitis Lethargy Excessive drinking and urination (PU/PD) Excessive sweating Excessive muscle loss Repeated infections Sinusitis (primary) Sole abscesses Tooth root abscesses Infertility Bulging supraorbital fat pads Other Clinical Signs
49. No test 100% sensitive/specific Hirsuitism-No other disease causes this process ACTH Hormone Concentrations: Veterinarian draws a blood sample (except in fall-End of August-end of October) Can still have false negatives/positives Consider PPID if ACTH > 50 pg/ml any other time of year Consider PPID if ACTH > 100 pg/mL in autumn Diagnosis
50. Dexamethasone Suppression Test- Veterinarian comes out end of day, takes blood sample, administers (40 μg/kg) which is typically 20 mg of dexamethasone. Comes out next day around noon. If cortisol values are not decreases ie < 1 ng/dl cortisol =PPID Diagnosis
51. Oral Domperidone Challenge Test:1 Your veterinarian comes out Administers one tube (25 mL gel; 2.75 grams) domperidone (Equi-Tox®) orally Collect EDTA blood samples at 0, 2, and 4h If single sample method is used, collect a blood sample 2h (Fall) or 4h (rest of year) after the owner administers the domperidone Measure ACTH concentrations; + if > 100 pg/mL Diagnosis 1Miller et al. Vet Pathol2008
52. Why? Determines Management/Prognosis: Leave one flake grass hay in stall after 10 PM Collect blood sample in the morning (no stress) Insulin concentration > 20 μIU/mL (mU/L) indicates hyperinsulinemia (presumed insulin resistance) Check glucose for evidence of hyperglycemia Within reference range in majority of case Insulin Resistance (IR)
53. Drug Therapy-Pergolide (Compounded): Type: Dopamine agonist Action: Inhibition of PI cells Dose: 1 mg total dose/day (up to 5 mg) Response: Improved “energy” / activity, muscle mass, haircoat Side-effects: Transient anorexia / depression "Pergolide cloud or veil" Take off Pergolide for 2 days, then re-start at lower dose, working back up to 1 mg total daily dose **If no response to one type of compounded Pergolide, then switch to another. Pergolide
54. Increase in “energy” and activity-IT WORKS! Improvement in physical appearance Lower incidence of associated problems Laminitis Sole abscesses Sinusitis PUPD Proper shedding of the winter hair coat the following season Back to ”old self”! What to expect with Pergolide
55. Cyproheptadine: Synergistic activity with Pergolide; use if no response to Pergolide alone Type: Serotonin antagonist Action: Reduces excitation of PI cells Dose: 0.25 mg/kg SID for 2 weeks Increase to BID for 2 months 125 mg for 500-kg horse Response: Improvements in hirsutism, laminitis, lethargy, ACTH levels, and DST results Side-effects: Drowsiness and ataxia Adjunct Therapy
56. Drug Therapy with Pergolide Lab Monitoring Proper Nutrition IR or non-IR? Hoof Care Routine Dentistry Custom Wellness Programs Body Clipping Activity Laminitic, or non-laminitic IT WORKS!!! Treatment-Whole Horse Management
58. Old Disease “Heaves are produced upon the diaphragm by too much food in the stomach and bowels and is cured by lessening the quantity of food to occupy the same space. After the horse is turned out to grass a few days, the heaves will usually disappear, from the fact that the bowels are generally relaxed by exercise and pure air”… 1903 D. Magner2 2B Rush ACVIM 2006
59. Review of RAO NO LONGER CALLED COPD Not similar to the human form of COPD Similar to human asthma Seen mostly in horses > 7 years of age Most common exacerbation is winter and spring No gender or breed predilection, though females seem to be more prone.
60. Review of RAO 12% of mature horses have some degree of environmental-induced lower airway disease 50% of horses that present for evaluation of respiratory disease have heaves Heritable component 10% incidence in horses with healthy parents 44% incidence in horses with 2 affected parents Intermediate incidence in horses with one parent affected
61. Etiology of Heaves/RAO Hypersensitivity reaction Primary allergens thought to be Aspergillus fumigatus, Thermoactinomyces vulgaris, Faenia rectivirgula
62. Pathophysiology of Heaves Delayed hypersensitivity reaction Natural defense mechanisms are hyper-reactive Inflammation occurs in excess Massive infiltration of neutrophils Proliferation of mucosal cells Leads to thickening in the airway walls and obstruction of normal air flow during breathing
63. Bronchoconstriction Mucosa is thickened by inflammation Increase in mucous secretion Acetylcholine causes constriction of smooth muscle Thus…BRONCHOCONSTRICTION
64. Inflammation & Bronchoconstriction Leads to… Pulmonary hypertensions is consistent finding Due to hypoxic vasoconstriction and alveolar hyperinflation Horses with end stage heaves have increasedright heart size
65. Usually based on clinical history and signs Heave line, increased respiratory effort at rest. Bronchoalveolar lavage Presence of neutrophils Can be as high as 50-70% neutrophils Horses with >20% neutrophils will likely have impaired lung function Diagnosis
67. Treatment Environmental management is key Wet hay Pelleted feed Pasture versus stall-unless summer pasture associated disease Improve ventilation of barn
68. Anti-inflammatories Corticosteroids are drugs of choice Can be administered intravenously, per os, or inhaled Inhaled steroids allows high dose of steroids with much less systemic side effects.
69. Corticosterids Horses treated with systemic steroids usually breathing more comfortably In 24-72 hours depending upon the severity of disease
70. Inhaled Corticosteroids Beclomethasone is less expensive Greater systemic effects than fluticasone Fluticasone expensive Less systemic effects, better efficacy Potency of Aerosolized Corticosteroids- fluticasone>beclomethasone>flunisolide Need to be used with bronchodilators Bronchodilator given several minutes Prior to corticosteroid
73. Albuterol Albuterol good for rescue therapy Can be used every 15 minutes for up to 2 hours to sequentially dilate small airways Also improves pulmonary distribution of aersolized medications Speeds mucociliary clearance Salmeterol-long acting bronchodilator Good for 6-8 hours
74. Clenbuterol Provides long acting β2 stimulated bronchodilation for horses with moderate to severe heaves Also a mucokinetic agent which increases mucociliary clearance Can cause cardiac problems with long term use Terbutaline not effacious
75. B2 Agonists Important to continue to administer corticosteroids This prevents down regulation of β2 receptors which comes with regular use or overuse In humans with asthma that use bronchodilators alone-deterioration of asthma control Down regulation of β2 receptors documented in horses after 12 days of clenbuterol Corticosteroid administration accelerates recovery from down regulation in horses tx with clenbuterol
76. Mild to Moderate RAO Ideal management is with environmental management Aerosolized corticosteroids Pre-exercise bronchodilation
77. Horses with moderate to severe RAO May need daily low dose long term aerosolized corticosteroid therapy Have to judge depending upon the horses response to tx. Cannot treat horses with systemic steroids long term due to side effects. Thus….. Environmental management and inhaled corticosteriods are the key!!!!
79. Suspension of the axial skeleton of the animal within the hoof Dissipate concussive forces during locomotion. There are about 600 pairs of interleaved laminae The epidermal laminae attached to the hoof wall and the dermal laminae attached to the coffin bone. Digital Laminae
80. Compromise of this interaction between laminae The mechanism of which remains unclear Currently the subject of much research. Laminitis literally means inflammation of the laminae Controversial whether this is the primary mechanism of disease Evidence of inflammation occurs very early in some instances Laminitis
81. The first is classical inflammation, which includes infiltration of potentially destructive white blood cells. The second is ischemia-reperfusion injury. Researchers have observed both decreased and increased blood flow to the laminae. Ischemia-reperfusion injury reconciles both observations Third is metabolic derangements Lead to impaired cell function Proteolyticenzyme activation has been proposed to be the primary mechanism for development of laminitis. Three Mechanisms Proposed
82. Diseases Associated with Laminitis Due to a plethora of diseases Acute condition Grain overload Strangulating gastrointestinal lesions Retained placenta Chronic Condition PPID Metabolic Syndrome Tendon injuries
83. Lameness Depression Anorexia Reluctance to move or lift its feet to be cleaned Increased pulsations in digital arteries “pounding” Clinical Signs
85. Supportive care Deeply bedded stall Pain medication Icing feet-if in the early stages Icing helps if you start 48 hours before clinical signs start DMSO, acepromazine…. Packing hooves/soft rides or other means Multiple therapies really means we don’t understand the disease well… Treatment
86. Treat primary or underlying disease Farrier work is key especially with chronicity If severe rotation, sinking or both If exceptionally bad; salvage procedure cutting deep digital flexor tendons Euthanasia may be recommended in severe cases Treatment
87. Horses with PPID have higher rate of foot abscessation Must be treated aggressively Important to not mistake laminitis with foot abscesses and visa versa Abscesses
88. Equine Recurrent Uveitis one of the most common ocular diseases of the horse Most common cause of blindness Thought to be an immune mediated disease Characterized by periods of inflammation Inactive periods where inflammation may be difficult to discern Uveitis
89. Photophobia Swelling and reddening of the conjunctiva Excessive tear production Discharge from eye Corneal edema Constriction of pupil Squinting of eye Clinical Signs
92. Based on underlying clinical disease Topical and systemic anti-inflammatory medications Antimicrobial medications to decrease intraocular inflammation and further damage to eye Antifungals may be added depending upon where you and the horse live. Treatment
93. Surgical intervention Vitrectomy-removal of vitrous Seems to work better than Europe than here… Suprachorodialcyclosporinimplantion Works well but eye has be be quiescent Chronic Treatments
94. Tough decision Sometimes the decision is made for you… Quality of life Suffering? We are blessed with the ability to relieve pain and suffering…. Saying Goodbye
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96. A horse should not have to endure continuous or unmanageable pain from a condition that is chronic and incurable.
97. A horse should not have to endure a medical or surgical condition that has a hopeless chance of survival.
98. A horse should not have to remain alive if it has an unmanageable medical condition that renders it a hazard to itself or its handlers.Considerations for Euthanasia 1AAEP Guidelines for Euthanasia 2011
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100. A horse should not have to endure a lifetime of continuous individual box stall confinement for prevention or relief of unmanageable pain or suffering.Considerations for Euthanasia 1AAEP Guidelines for Euthanasia 2011
105. Esophagus Esophagus Can’t vomit, strong cardiac sphincter muscle in stomach prevents Digestive upset = Colic Choke Obstruction within esophagus Fast eaters
106. Stomach Stomach - small, frequent, meals; initiates digestion, like non-ruminant 10% of tract Limited digestion Gastric ulcers
107. Small Intestine - 30% of tract Digestion of Starch 65-75% Protein, AA’s 60-70% Fat 90% Ca absorption 95-99% Phosphorous 20-25% Fast rate of passage No gall bladder Small Intestine
108. Large Colon Large Colon Absorbs H20 VFA’s AA Phosphorus, 50% NaCl Small Colon Absorption of H20 Fecal ball formation
Notas do Editor
B vitamins and Vit C are generally produced by the microbes in the hind gut. In aged horses they have shown a decreased ability to manufacture these vitamins.
85% of horses diagnosed with PPID are greater than 15, has been seen in horses as young as 7. All breeds can get this disease more common in Morgans and ponies
