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Sunday, March 25, 2012

Convention - Treatment Seminar

In my notes I have "Treatment 101 for endurance rides and riders".  Actually.....since vets don't treat rides or riders, maybe the title should be "treatment 101 for endurance HORSES".

The vet who presented this (Dr. Jay Mero) was fabulous.  Straight shooting, no nonsense, with a sense of humor.  She's fairly local to me and running a mobile clinic similar to what I *might* want to do, so I'm planning on shadowing her as an externship in my 4th year (I asked and she does take 4th years). 

Anyways, back to the seminar.  As always any mistakes or errors are mine and if you attended the seminar and remember the information differently, please let me know!  

In AERC, there have been increase in fatalities, even while the number of rider starts is the lowest in the last 10 years.  Fatality numbers adjusted according to number of ride starts shows an increase of fatalities over the last 5 years.  

It was emphasized during the seminar that our perception of horse treatment at rides HAS to change.  Although I did not see the case studies (although I did get permission to attend the vet CE portion of the conference next year!), I get the feeling that major factors in the fatalities was either the lack of treatment, waiting on treatment too long, or improper treatment since an endurance horse coming out of a ride is very different than a horse presenting for the same problem out of pasture.  

The key point in the beginning of the seminar is "know what to expect and know what to ask".  Horses that present for treatment at rides often present fast and violently.  It is STRESSFUL.  Take some time now to think about what you want to ask, and educate yourself on your options, as well as thinking about the finacials (more on this later.  I mentioned this after Minx's euthanasia and I believe that deciding the finacials ahead of time is VERY important).  A point emphasized over and over and OVER was don't think it won't happen to you.  A huge problem is the perception that by riding slow, or sticking to distances that you've always done, or because you are super careful not to override your horse that you won't be faced with a treatment situation.  This is simply not true.  

Preventing a treatment situation:

A couple of specific factors were mentioned as proper preparation at home, before the ride.  Includeding basic dressage, hours in the saddle, LSD, control.  It was here that Mero commented that she firmly believes it takes 3 years to build a 100 mile horse.  Besides the training that occurs at home, choice of ride is really important.  I agree with this and while my first thought was a rating system, it would be overly complicated.  Additionally, trails change, sometimes the morning of the ride due to a variety of factors so there's no guarantee that ride you signed up for is the ride you ride.  The best way to find an appropriate ride is to find someone in the area that has ridden the ride and talk to them in detail about it.  I know that I keep a document where I put all the details of the rides that I attend - where to park, where the water is, the structure of the vet checks etc.  Details may change from year to year, but at least I have some information and not relying on my memory.  I do share these docs by request so if you are doing a ride and you want to email me, I'd be more than happy to share.  

At ridecamp, allow adequate rest period  for trailering.  This could range from a couple of hours for a shorter trip, to a couple of days for cross-country trips.  Keep stress to a minimum - no spinning horses on high ties, separation anxiety from a buddy leaving etc.  Any of these factors decrease the likelihood of making it through the ride without incident.  

During the actual ride do what it takes for control.  Power is nothing without control (something "endurance prospect" ads do not take in consideration).  This is was the single factor that I remembered being mentioned during this seminar.  Control control control.  Not having a horse that is fighting you is KEY.  

After the ride do NOT let your guard go down.  Allow time for adequate rest and recovery before trailering home.  Again, for a cross country trip, this may be a couple of days.  After the ride, up to 3 weeks for a 100 miler, was the period of time I was most interested in and planned on doing some preliminary research to identify what welfare issues endurance horses are at risk for in the time AFTER a ride - a period that is currently not tracked.  Unfortunately, I was notified on Friday that this research will not be funded this summer, which is disappointing.  

A note about completions.  Fit to continue is incompatible with something metabolic going on - your horse doesn't have to be "sick" in order to be pulled.

Catching an issue early

Mero encourages everyone to use a HR monitor and says it is the MOST important parameter.  An increased heart rate in a horse that is a consistent performer is a key sign.  This is harder to use in a new or inexperienced horse.  

If you DO catch an issue early, your "treatment" plan could be really easy - slow down, allow more time at a hold, assess hydration and potential need to elyte.  You may still be able to finish if you listen correctly and ride CAREFULLY.  Rest and cooling can prevent treatment!!!!!!

Another key parameter to determine whether you might have an issue is anything over 10 minutes for heart rate recovery.  This means something.  An inverted CRI is also key.  She did mention that something like a 15/16 isn't really that big of a deal.  It's more of the 60/72 CRI that is a cause for concern.  

Absent or VERY reduced gut sounds mean something.  A "B" doesn't mean as much - gut sounds are subjective .  

Monitor gut sounds and heart rate during the hold.  

If you are in the gray area for treatment, i.e. "pulled but not in crisis", take the horse to the treatment vet ASAP.  Do not wait.  Have them checked out.  It just takes a few minutes and won't cost anything.  We MUST get over the head-in-the-sand, it was fine last time so it will be fine this time, I don't want other people to think I'm a bad endurance rider, I'm embarrassed, attitudes.  It's hurting our horses.  

The number one reason for a crash is herd runners up front where they don't belong, BUT sometimes subtle stuff is all you get before your horse crashes - a slightly higher HR on the trail etc.  

Pre-plan if you ride some one else's horse.  "Can I act as owner for terms of treatment?".  Have it written down.  Give a copy to the ride manager.  Only the owner can agree to treatment!  

Some notes about treatment.  You are entering into a legal client-vet-patient relationship.  This means that it's like if you are seeing a vet at home - you have the right to know what's going on, to have things explained to you, and to leave with paperwork/stuff written down.  Be prepared to make decisions both emotionally and financially.  Base line treatment is $400-800, but can vary greatly.  Some vets at rides give a "break", some vets charge according to if they were in a clinic.  According to Mero, "fair" to the horse if you are going to compete in endurance is being willing to spend the money for initial fluids (you should budget around $800).  Many many many horses (86%?) that need IV fluids fully recover and comeback to compete.  Your odds are good!!!!!  Fluids don't have to be "spiked" with anything - although some vets have a preference for something a little "extra" like potassium.  Volume is key when giving fluids.  

Pain meds need to be used VERY carefully.  Dehydration dramatically affects dosing.  This seminar was before Garlinghouse's but knowing that endurance horses - even those without issues - are dehydrated, you can't assume that your horse is fine for bute, banamine etc after a ride.  Mero stated that the endurance horse needs to drink about 5 gallons an hour, which will not happen - thus an endurance horse at a ride is a dehydrated horse.  Dehydration can make a 1/2 dose act as a full dose.  A full dose given to a dehydrated horse is BAD.  However, if they aren't dehydrated a subclinical dose doesn't work.  Bottom line: DON'T USE BUTE/BANAMINE AT A RIDE.  Go see the vet.  

Specific Disease notes:

A horse that has recurrent the ups is a management issue.  Get an experienced vet to help you.  She mentioned that tye ups can present in all sorts of ways, and can happen anywhere in the ride.  Some tye ups are one sided - only one side of the horse is affected.  

Thumps - diet at home needs to be evaluated.  

80% of the mortalities are resulting from colic.  Don't underestimate a mild colic.  

Notes on non-metabolic conditions:
-Severe lameness may be a good candidate to trailer to a referral hospital.  There were some really wild stories about fetlock dislocations etc. that the horse was still walking on etc.  
-when talking about fractures, CORRALS came up over and over and over.  Single wire hot wire is not sufficient because it's a flight animal and the horse will easily bust through.  However, there is no perfect system - each has it's pros and cons.  

Other notes:
-if you are needing to cool a hot horse, use ice water.  Don't worry about cramping.  At the point where you are having to cool a horse like this, cramping is the least of your issues.  
-don't feed dry feed to minimize your risk of choke.  

The running theme throughout the entire seminar is that an experienced endurance vet is needed to treat!

The lack of treatment is a vet AND rider issue
-Culture has to change
-We wait to too long to treat
-Sub-clinical level of fluids DO help (classically in vet school you are told if you can't/don't need to give "x" amount of fluid to not bother).  It's OK to ASK THE VET not to wait on fluids.
-The blame the rider mentality needs to stop.  Instead, why don't you do over there and see if you can help the rider - get them a cup of coffee, watch their horse while they use the bathroom.  Just listen.  Provide a shoulder to cry on.  Heat up some dinner for them.  Don't stand around with your friends condemning them because their horse is in treatment or judge them because of what you "guess" happened out on the trail.  
-Fluids will not hurt.

Some questions I asked after the presentation:
-Is the use of Surpass OK after a ride or is it similar to other NSAIDs and should be avoided? A: surpass is fine.  
-Are you testing CBC/chem panels at the rides when you decide to "spike" the fluids? A: no, the amount of potassium etc. going into the fluids isn't enough to screw up the biochemistry if they don't end up needing it.  
-Is the treatment of a horse at a ride different than how you would treat one out of the pasture? A: yes - there are special considerations with a horse at a ride such as dehydration.  
*I asked this question because when Farley tyed up at home, we didn't treat with fluids, and we administered pain medication right away.  When we ran the blood panel, she was NOT dehydrated, and our choices were appropriate.  This could be why some endurance horses run into trouble if they are being treated by vets that are not familiar with some of the unique factor at an endurance ride.  Dehydration/elytes are always decreased in every horse at an endurance ride.  

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