Tuesdays with Tony

You may have noticed (or not, if you’re oblivious to the racehorse world like me) that some major bad players were recently indicted by the FBI. That’s right, the Federales were involved. I am above these things you humans call laws, except when it comes to Rabies shots, but I understand some pretty big laws were broken. More importantly, horses were hurt, and potentially even died because of what happened. I will let you humans sort out the law side of things, but I wanted to chat about science, ethics, and supplements.

What do you want for your horse?

The trainers involved in this indictment obviously don’t want the best for their horses, but what do you want for your horse? I’m okay with saying we pushed hard for the championship. If I wasn’t a cat who’s only motivation is finding the ideal sleeping spot, I’d probably want to push hard for the championship too! You all know horses. You know they understand the game, and many of them like to do what you humans ask of them. Some of them don’t, but that’s a whole different blog topic. However, at the end of the day, it’s up to the humans to understand where the line is between pushing and breaking, and what’s more important: the win, or the horse. I’m not a young kitten, I do understand that the line is in different places for different people. Think about where the line is for you, and your horse. 

What’s in it?

One of the products involved in the FBI raids has an ingredient list that reads as: an innovative formulation consisting of amino acids derived from Ovine Placental Extract. SGF 1000 RMR is manufactured and purified through a patented low temperature process that involves homogenization, fractionation and ultra-filtration of the ovine placental extract suspended in a sterile liquid.

As stated earlier, I’m no kitten, but I am a wise cat. I’ve done my time on the front counter listening to my Docs. That is a bunch of big, sciency sounding words that don’t mean a thing. And nowhere do they have the unabridged version of what’s supposed to happen when they put it in a cold blender, then run it through an expensive strainer. Tony’s Take Home: Be very wary of a company that won’t give you a good answer to 1. The science behind their process, 2. What’s actually in the stuff they’re selling you for what I’m sure is a decent amount of money. This applies to every single thing you humans buy for your horses. From grain, to hay, to probiotics, to saddles, tack, bits, and ANYTHING called a supplement.

There is one particularly overpriced, but very pretty, supplement on the market that is 90% flax seed (!) plus some vitamins and minerals. You can give your horse a pound of flax seed daily, and a pound of a good ration balancer and have the EXACT same thing for about 1/10th the price. Anyway, you and/or my Docs should have a very clear understanding of what’s in any product you are putting in or on your horse. 

What does it do?

In the case of this supplement, it did a lot, and there were statements made like “it doesn’t test,” and “there’s no test for it.” Those seem like red flags to me. Many of these drugs are illegal because, not only do they cause profound performance enhancement, but they also have pretty awful side effects. Mother Nature has done what can be done with the available materials. Racehorses already perform at the edge of what their engineering is capable of. Giving them performance enhancers will only cause the engineering to fail.

That’s exactly what’s suspected in one horse, X Y Jet. One of the nasty side effects is the potential for a heart attack. Well guess who died of a heart attack? That’s right, X Y Jet. Imagine if your tiny human was on that horse when that happened rounding the third barrel and heading for home. I promise you, it’s not a good outcome. Things that promise to vastly improve Mother Nature come with a very, very high price. 

On the other side of the spectrum (and way more common) is the drug that promises to make your barrel horse run faster, your jumper jump higher, and your western pleasure horse to lope slower. Guess what? It very likely doesn’t do ANY of those things! The only thing this type of product, supplement, boot, saddle pad, widget, or thingy is good at is separating your money from your person. Horses are pretty good at that all on their own. You don’t need snake oil to help you. 

Know what makes your horse run faster, jump higher, or lope slower? Good training, hard work, and natural ability. If things aren’t going the way you want, here’s some simple rules:

1. Have my Docs talk with you, watch your horse perform, and do a lameness evaluation
2. Check your tack
3. Check yourself.

I’m not a big fan of rules, but they are important occasionally. So follow the rules, avoid the FBI, and have a happy, healthy horse at the end of the day. 

Until next week,

~Tony

P.S. Looking for more knowledge in the world of horses? Head on over to our podcast page for an abundance of useful knowledge. To get there, just click here. 

Very few things around here are uttered with the same hateful tone as the word sarcoid. My Docs do NOT like this tumor. They feel the same way about sarcoids, as I do about cold, rainy days. I’m lucky. The sun will come out tomorrow. The sarcoid may not go away tomorrow, or the next day, or the year after. Let me share a little Tony wisdom with you about this pesky, not quite cancer, but definitely a tumor, growth that horses get, and veterinarians hate. 

What is it??

Putting on my overly dramatic professorial voice here: sarcoids are a neoplasm of fibroblast cells occurring at the level of the skin in anything equine, to include horses, donkeys, zebras, and all the crazy horse, donkey, zebra crosses that also exist. Now back to regular sarcastic Tony. This means it’s a tumor caused by the cells that give tissue toughness. Blast is science’s way of saying cell, and fibro is what these cells make. They make that tough fiber that keeps skin from tearing, tendons from ripping apart, lungs able to expand without breaking. You get the idea. Neoplasm technically means cancer, but the only good news about sarcoids is they don’t metastasize. That means little bits don’t break off to go form new tumors elsewhere on the body. If you see a horse with multiple sarcoids, each one of those is its own separate little hell creation, not a spawn. 

Why? Oh, Why does my horse have Sarcoids?

It’s a reasonable question for so many of the things horses do, and get. It’s a reasonable question here too, but, as usual, the answer is complicated. There’s a cow wart virus called Bovine Papilloma Virus (BPV) that’s associated with many (but not all) sarcoids. That seems reasonable. I can see how horse skin could be like, eww get this cow wart virus out of here, and make something that looks like the warty, knobby, crusty thing sarcoids tend to look like. However, there’s some of these tumors that don’t have BPV associated with them. Being honest here, it’s a big old “they don’t know”. Here’s another big however: flies are implicated in the spread of BPV to uninfected horses! Need more reasons to have good fly control?? (I’ve written a few great blogs on this along with Dr. Erika Machtinger, known as The Other Erika around here, and there’s a podcast about it over at Straight From the Horse Doctor’s Mouth) One way doctors and scientists have determined flies are involved is the general location for sarcoids in the same areas flies like to hang out on horses. Scientists have also isolated way more BPV-carrying flies around horses with sarcoids than they have around non-sarcoidy horses. In other words, manage your flies. There is also (well, likely, anyway) a genetic predisposition to get more, and worse sarcoids, but this is so far beyond clear that my best answer is wait for more work on this topic. 

The many faces of Sarcoids

This is where the fun starts. Sarcoids can have many, many different appearances, and the approach my Docs take will depend on what that appearance is. Sometimes they can’t even be sure it’s a sarcoid, based on appearance, so they do a biopsy. That biopsy has to go to one of a few equine skin specialists because sarcoids love to look like other things, even when being evaluated under a microscope! 

So what are the sarcoid appearance options? Well there’s occult, verrucose, nodular, fibroblastic, mixed (my personal favorite), and malignant. Very often my Docs will take a wait-and-see approach to the occult and verrucose variety. These sarcoids are known to stay exactly as they are for years and years. They are also known to react poorly to negative stimuli, much like cats. Occult and verrucose also like to play together. They will even combine in one lesion. These guys can usually be described as flat for the most part. Don’t worry, I’ve included pictures for you. 

Nodular are, not surprisingly, nobby, and have intact skin covering them. Fibroblastic are nobby, but with gnarly, warty, not intact skin covering them. Mixed are, well, mixes of the types. And finally, malignant. These guys are super aggressive, spreading, ugly, and very, very invasive. They like to grow on the sides of the face, the groin, and the elbows. 

Pictures

These pictures were rather shamelessly borrowed from one of  Dr. Knottenbelt’s excellent lectures on this topic at the recent American Association of Equine Practitioner’s meeting. 

Die Sarcoid! Die!

Let’s talk about treatments. An important “rule” when it comes to treatments must be discussed here. When there are a whole lot of “treatments” available for a condition, it means science doesn’t have a good handle on the best treatment. It also means a whole lot of those “treatments” don’t do a darn thing, so you best check with one of my Docs before dropping a bunch of money on Dr. Google’s latest trend in sarcoid treatment, only to find out it’s nothing more than repackaged toothpaste. That’s a real example by the way. 

For my Docs, treatments are generally two pronged in some way. Prong one involves removing as much of the tumor as possible. These include surgically removing it, freezing it, heating it, lasering it off, and sometimes even radiation. You know typical evil villain type stuff. Prong two involves getting after the remaining cells with chemicals. This is chemotherapy. There are topical and injectable versions. Choices here are based on location, type of sarcoid, and your horse’s willingness to let you do what needs done. There are also some really great, but very expensive options such as radiation therapy, brachytherapy, and photodynamic light therapy. These are only available at a few specialty hospitals around the world, but offer great ways to kill sarcoid cells in some very sensitive areas like around the eye. 

There’s no way around it, sarcoids suck. Control your flies, and ask my Docs about lumps and bumps early is my very best cat advice.

Until next week,

~Tony

PS – If you would like to learn more about this topic, the humans just did a great podcast on this topic. Click here to learn more.

Show season is in full swing and my docs have been super busy getting your horses ready to perform their very best. Now that you and your horse have been competing for a few weeks, it might be time to have them looked at again. When your horse is competing, they are under a significant amount of stress; their normal routine is altered, they are being ridden multiple times a day, and they’re pouring their hearts into their work for you. Competitions can take a toll on your horse. Thank goodness there aren’t cat shows, that seems like way too much work for this cat.

Now that you’ve been competing for a few weeks, maybe you’ve started to notice your horse is just a tad late with his lead change, or he isn’t quite jumping the same as he was at the start of season, or that push off the last barrel just isn’t quite as strong. You’ve heard competitors talking about joint injections and how they have improved their horse’s performance and you’re thinking, maybe it’s time for my horse to get his joints injected.  Joint injections are not without their risks, so luckily for you, I am here to talk about the pros, the cons and everything in between on joint injections.

The Exam

You think your horse needs some joints injections, so you schedule an appointment with one of my docs. Before my docs go all willy-nilly injecting joints, they will require a lameness examination. You’re probably thinking, but my horse isn’t lame, he’s just not as good as he usually is.  And you’re probably right, your horse probably isn’t lame, but a full lameness examination will allow for my docs to determine if your horse even needs injections and if they do, which joints should be injected.  They put their expert hands on your horse and feel their muscles, their joints, and their tendons and ligaments to determine where the source of pain might be. They watch your horse move at the walk and trot on different terrains and in different directions.  They may even perform some joint flexions. Based on their examination they can then determine if your horse needs joint injections or if further diagnostics are necessary.

Diagnostics

After a thorough lameness examination is performed, diagnostics such as radiographs and/or ultrasound may be recommended. If my docs recommend radiographs, they may be looking for hoof abnormalities such as toe length, coffin bone angles, or navicular changes. They will also assess the radiographs for evidence of arthritis which can lead to inflammation and decreased performance.  Ultrasound can be used to assess tendons and ligaments for inflammation, small tears, or other areas of concern. My docs can also use ultrasound to assess joints capsules for inflammation, infection, and arthritis.  While radiographs and ultrasound may not be necessary to treat your horse, they are extremely useful to locate precise areas of concern.

The Injections

Now that a lameness examination and diagnostic imaging have been completed, my docs can determine if your horse needs injections and what joints need to be injected.  They will also determine what will be best to inject your horse’s joints with.  There are several different options for joint injections including steroids, hyaluronic acid, and platelet rich plasma (PRP).  Steroids help to decrease inflammation in joints. Hyaluronic acid can be used to help lubricate the joint. Platelet rich plasma brings a large number of growth factors to the joint which helps to stimulate production of repair tissue. Depending on your horse’s lameness exam, my docs will decide which medication or combination of medications to inject into your horse’s joint(s). My docs choose which product, and how much, very, very carefully. Steroids cost less in dollars, but can cost way more in side effects. For instance, steroids injected into joints can cause laminitis, even if the joint is really far from the feet. This side effect is particularly worrisome if your horse’s weight tends towards the pudgy like mine. Steroids also don’t heal the joint at all. They do reduce inflammation, but they also bring calcium to the soft tissues around the joint. Calcium in your very soft, flexible joint capsule is, shall we say, less than ideal, and it hurts. This side effect often happens after repeated steroid injections, and can be a cause for retirement. Platelet rich plasma and hyaluronic acid don’t carry these concerns, but every time a needle is placed in a joint there is a very small amount of damage done. That damage needs to be less than that being caused by the inflammation present.

Joint injections are considered an invasive procedure.  My docs take special care when performing joint injections which includes sedating your horse as well as sterile preparation of the injection site.  Prior to injecting, my docs will have their technician place a twitch on your horse’s upper lip. They tell me that the placement of the twitch actually helps to release endorphins and helps relax your horse. Maybe so, but I sure don’t want to find out if that is true. I’ll keep my lips to myself thank you very much. While your horse’s joints are being prepared for injection, my docs will pull up the medication for the joint in a sterile fashion. They also may add in a small amount of antibiotic to help reduce the risk of joint infections.  Often times they will administer a dose of bute to help decrease the inflammation that is a result of the injection.  Finally, they will leave you with specific instructions for your horse going forward, including stall rest the day of injection, usually turn out the day following injection, and then light work for a few days. They will also instruct you to monitor your horse for any pain, swelling, redness, or lameness in that limb that was injected.  They will tell you to call us immediately if you notice any of those signs.

The goal after joint injections is to decrease the inflammation in the joints to help your horse return to peak performance.  However, joint injections cannot and should not be performed any time your horse has a decrease in performance.  Instead, joint injections should be accompanied by physical therapy and a strict exercise program to boost your horse’s fitness level and keep your horse sound longer.

Physical Therapy

My clinic is a one-stop-shop for all your horse’s needs.  If my docs recommend physical therapy, I can offer that as well. We have the functional electrical stimulation (FES) which we use to help retrain your horse’s muscles to work in the correct way. It helps to relieve muscle spasms, treats muscle atrophy, and overall strength of your horse’s muscles.  We also have two very new offerings coming your way in Spring 2020: Springhill Equine is excited to offer acupuncture and spinal manipulation (chiropractic) treatments for your horse! Get excited, I know I am! I think I could use some acupuncture. You know, sleeping all day results in some very sore muscles for this old cat.

If you think your horse might have some performance issues, give me a call at the clinic and I will get you scheduled for a lameness workup. My docs can answer your questions and help you make the best choices for your horse, both for today and down the road.

Until next week,

~Tony

P.S. If you want to learn more about joint injections, my docs did a podcast on this topic a while back. They go very in-depth, which I don’t really have the energy for, but if you want to advance a few knowledge levels on joints, that’s the podcast for you. Click here, and scroll down the list until you get to the one called Joint Injections. You can listen to it right from your phone or computer.

Let’s talk sleep and narcolepsy in horses. I’ve been accused of this, but to be 100% clear, I don’t suffer from narcolepsy. As a top line predator, I require up to 18 hours of sleep daily to keep my highly tuned body ready for the chase. Horses sleep much differently. I suppose you could call me a subject matter expert on sleep, so I feel uniquely qualified to talk on the topic this week.

They just stand around and sleep, right?

Horses sleep standing up. This statement is often made with all the confidence in the world, and yet it falls under the “colics should be walked” category. Only rated “sorta true” by science. Horses can nap while standing up. You know, that sleep you get when you’re on the couch with the TV on, and a whole lot of stuff going on around you? Yeah, your eyes are closed, and yeah you were “asleep”, but you would never call it really good cat-in-the-sunny-spot level of sleep. That’s what horses do when they sleep standing up. It’s more of a less-than-restful nap which lets you run from those panthers when they sneak up on you.

Slight side note: The mechanism that lets horses sleep standing is called the reciprocal apparatus. The front and hind legs each have a version. When the reciprocal apparatus is locked into place, the horse only needs a very tiny amount of muscle input to remain standing. This allows everything to relax. It’s kind of like when I sleep with my head on the keyboard, and my body against the monitor. I don’t have to use a lot of muscle strength this way, but I also can’t enter REM sleep this way.

REM is key

Pretty much everybody who sleeps has to enter REM state at some point. REM stands for Rapid Eye Movement, and it is characterized by not just eye movement, but also changes to brain activity. The more scientists learn about sleep, the more they learn about why REM sleep is important.

During REM sleep, our brain processes things we’ve learned during times of wakefulness. It files and categorizes them into the proper memory, emotional, and movement categories. This is why it’s really important to sleep well after you learn something new. Look at me; I’m full of knowledge, and I sleep all the time.

Anyway, the learning stuff has been known for years. Recently, scientists have also learned that REM sleep is when the brain does housekeeping. Dusting, vacuuming, and all the other brain-cleaning activities happen only right around and during REM sleep. You humans will usually enter this state 5-7 times per night if you’re sleeping well.

Horses MUST enter this state every three days to keep functioning at their best. Why is every three days important? Your horse has to lie down to enter REM sleep. This doesn’t happen during that sleep-standing-up phase.

No REM = Unhappy Horse

When your horse doesn’t experience REM sleep, the first thing you’ll notice will likely be the same as what you notice on people (or even yourself): they’re cranky, and generally unhappy with the world. The next thing, and this is the one my Docs get called about, is your horse falls asleep while standing up.

The crossties, while being groomed or girthed up, is the most common place this happens, but it can happen anywhere, even while being ridden. These horses hit that wall of sleepiness, and, boom, down they go. In humans, there is a medical syndrome called narcolepsy. This is a true medical condition, and involves the brain inappropriately triggering sleep. Except for a few cases of miniature horses with a genetic defect, this isn’t what horses are doing. They are actually sleep-deprived.

How to make your horse go to sleep

The first thing my Docs rule out is pain. Back, neck, or hip pain can make it hard for them to get up from laying down, especially in older horses. These horses don’t feel comfortable laying down. Remember, vicious panthers like myself could be lurking, and horses want to feel like they can run away at a moment’s notice. If they are worried about this, they won’t lay down in the first place until it is absolutely necessary.

A trial of a pain reliever like bute, or Banamine (after speaking with a veterinarian to get the right dosing) can help rule pain in or out as a cause. This one is generally pretty easy. After three or four days, you’ve got your happy horse back who doesn’t go crashing down on cross ties. You may even notice that this behavior has come on slowly, and you didn’t realize how much of a behavior change you were experiencing.

The next thing my Docs look at is social structure. Horses like to know they can sleep safely. Many of these horses have had a sudden change to their friends. Maybe a new horse moved into the barn, maybe you moved stalls around, maybe you moved pastures. In one case, the horse had recently been imported from Europe. We’re pretty sure he thought he had been kidnapped by aliens.

For these horses, you have to be committed to a whole lot of trial and error. If possible, go back to the set up that allowed your horse to sleep. If not, evaluate your horse’s personality. If they are a dominant type, ask yourself if the change has brought another dominant horse into position to challenge your horse. If your horse is submissive, the issue is more commonly that their dominant protector has moved. Submissive horses usually (but not always, because horses don’t like rules anymore than cats do) do best with a dominant horse close by to watch over them.

After pain and social structure, it becomes a game of trying to find what works. This can be a long, tedious, patience-testing project. Of course, that’s horses in a nutshell.

Sleep is a subject that is near and dear to my heart. I do a whole lot of it. If your horse seems to be getting cranky, or falling asleep while standing around, call my Docs. Let’s get them back to dreamland!

Until next week,

~Tony

More and more often I get the question, could my horse’s performance issue, behavior problem, weight loss, or other problem be caused by ulcers? Boy, this is a loaded question for a clinic cat to answer! But I will do my best to guide you to the answer you are looking for and how we can figure out if your horse’s problem is indeed due to ulcers.

Definition of Stomach Ulcers

First, let’s define “stomach ulcers”. Ulcers describe inflammation and a disruption of mucosa of the upper gastrointestinal tract. Contrary to popular belief, ulcers typically occur in the lower esophagus, stomach, and upper small intestine, NOT in the hind gut. Yes, I know you know that ulcers occur in the stomach, but listen to this cat when I tell you, there is little to no research indicating that horses get hind gut ulcers, so let’s just stop that conversation here. I am a man of much wisdom, but my wisdom is always backed by research. Ok, I will get off my soap box now and get down to the nitty gritty of today’s blog, gastric ulcers.

The horse’s stomach is made up of glandular and non-glandular or squamous portions which are separated by a distinct line called the Margo Plicatus.  Say that again: Margo Plicatus. Isn’t that just a fun thing to say? Margo Plicatus! Anyway, gastric ulcers can occur anywhere in the stomach, but most commonly occur along the Margo Plicatus on the non-glandular portion of the stomach. They can occur on the glandular portion of the stomach leading into the pylorus and duodenum or upper small intestine as well.

Signs/Symptoms

The fun thing about gastric ulcers is, they can present any way they want. Sometimes they can cause a horse to lose weight, sometimes they can cause a horse to have poor performance, other times they can cause a horse to develop odd behaviors, and sometimes, we may never even suspect a horse has ulcers, but they do.  It’s like finding a needle in a haystack, which is always super fun. Who doesn’t love rolling around in the hay? There have been reports of horses who get grumpy when their girth is being tightened. Some colic signs have been associated with gastric ulcers as well. However, it is very rare that severe colic signs are associated with gastric ulcers.

Causes

Gastric acid has an extremely low pH. The glandular portion of the stomach is made to handle the low pH. However, the non-glandular portion of the stomach really does not appreciate constant insult from low pH gastric acid. When a horse is being exercised, pressure within the stomach increases, the stomach collapses and the gastric acid moves around. This causes inflammation of the non-glandular portion of the stomach. Frequent insult to the non-glandular stomach leads in increased inflammation which leads to erosion of the mucosa.

Causes of ulcers in the glandular portion of the stomach are not as well known. However, there is some relation to the chronic use of NSAIDs such as bute and banamine and ulcers in the glandular portion of the horse’s stomach. That being said, there have been many horses who come through my clinic that are on daily NSAIDs and do not have these kinds of ulcers.

Diagnosis

Diagnosing gastric ulcers can only be done by gastric endoscopy. When performing a scope on your horse, my docs take this long tube with a camera on the end of it, they put it up your horse’s nose and then expect them to just swallow it.  You won’t get this cat to swallow any cameras; I certainly don’t need anyone knowing what my insides look like. Anywho, so this little camera thing goes down your horse’s esophagus and into the stomach. Then my docs “drive” it around looking at all the different parts of your horse’s stomach. They concentrate mainly on the Margo Plicatus, because as you already learned, that’s where most gastric ulcers occur.

They will then point the camera towards your horse’s pylorus and duodenum where they will look for evidence of ulcers, such as keratinization (yellow phglemy-looking stuff).  Oh, I forgot to mention, in order to scope your horse correctly, your horse must be fasted for at least 12 hours. Once your horse’s stomach has been fully inspected, my docs will slowly bring the scope out of the stomach and into the esophagus. They inspect the esophagus for signs of ulcers or any other abnormalities.

While scoping is the only definitive way to diagnose gastric ulcers, a presumptive diagnosis can be made with treatment with medications and resolution of clinical signs.  If you want to know for sure though, come in and see me, and get your horse scoped. It’s the only way to go.

Treatment

The goal of treatment for gastric ulcers is to bring the gastric acid to the maintenance level between a pH of 4 and 5. There is only one approved medication for the treatment of gastric ulcers, omeprazole. Omeprazole comes in several different formulations including oral paste and injectable. You all know the oral paste by the trade names GastroGard and UlcerGard. GastroGard is only available through your veterinarian. It is the only oral paste I recommend as it is highly regulated, and its contents are thoroughly monitored in order to ensure the appropriate dose of medication is in each tube.

The injectable omeprazole is a little less common but just as effective as the oral paste and it is given just once a week. It is extremely convenient for those horses who are difficult to dose orally on a daily basis. Next time you see one of my docs, ask them about the injectable omeprazole.  Other effective treatments for ulcers include Ranitidine and sucralfate. However, their effectiveness is not as well known or studied and therefore cannot be considered the gold standard, first line treatment or preventative for gastric ulcers.

So, by now you might be thinking your horse may have gastric ulcers, and you may be right.  So call my people and they will get you on the schedule for a gastric endoscopy! My docs can determine if your horse is at risk for or currently has gastric ulcers.  Treatment isn’t always cheap, but there are many other tricks my docs can talk to you about to help reduce the risk of your horse developing ulcers. Finding out for sure that they don’t have ulcers can save you a lot of money in the long run, too, and who doesn’t want to save money?

Until next week,

~Tony

P.S. If you want to take a deep dive into ulcers, go over to the podcast page and listen to Season 1, Episode 13, Stomach Ulcers. My humans do a good job of explaining the nuts and bolts of ulcers and treatments. It’s a great free resource!

I’m not even going to pretend I didn’t straight up steal this week’s blog from Dr. Lacher. I was listening in on a recent podcast she did on airway issues. I found it pretty fascinating, so I’m going to summarize it here for you. If you like podcasts, and you should, because they’re a pretty great thing, check out Straight From the Horse Doctor’s Mouth. If you have no idea what a podcast is, you should follow these steps: 1) join us here at the Clinic in 2020, and 2) ask anyone of my minions to show you how to get to podcasts on those phones you humans worship. Anyway, on to airways.

Anatomy of an Airway

Let’s start with the fact that horses are amazing athletes. Fun fact of the day: horses increase their oxygen consumption 40 times when running flat out. Compare that to humans who can only increase oxygen consumption by about 7 times. There’s no value for cats, since science hasn’t figured out how to motivate us cats to exercise during a study. Anyway, using that much air takes a whole lot of really cool anatomy goings on to make it work. Let’s talk about that anatomy.

Picture from Anatomy of the Horse by Budras, et al

Things start at the nose. Those nostrils can open very, very wide to help scoop tons of air into that big old nose. From there, air heads back to the pharynx and larynx. The larynx is the voice box, and the pharynx is the area kinda behind your mouth but in front of your voice box. In humans, and cats, it’s not a very large area. In horses, it’s downright cavernous. Air continues down the trachea, also called the windpipe for obvious reasons, and then down into the lungs. In the lungs, air is funnelled into progressively smaller and smaller airways until it gets into the alveoli. Alveoli look like little grape bundles. This is where oxygen goes from the air to the blood through walls that are often only two cells thick! That’s like 1/1000th the thickness of one of my hairs, and I’m not talking whiskers. That’s incredibly thin! 

Potential Problem Areas

I swear horses were designed to have problem areas everywhere. Turns out the airway is no exception. I’m glad you humans find them pretty, or horses would really be in trouble. Let’s go through the airway trouble spots one by one.

1. Those nostrils. Sure, they can open wide, but sometimes they don’t do that the right way. If the nostrils don’t open and stay open, all that air rushing in and out hits a wall and slows down. This reduces the amount of air that can get to the lungs, thus reducing how fast and/or how long a horse can perform. Things like FLAIR strips can help this.
2. That big old nose itself. It’s not usually a problem area, but if there’s any swelling, or growths like nasal polyps, air flow can be pretty quickly restricted. 
3. The soft palate. If you fold your tongue backwards and feel the top of the very back of your mouth, that’s the soft palate. In horses, it’s really long and usually sits below the bottom edge of the voice box. It’s the reason horses can’t breathe through the mouth. It can also decide it doesn’t want to be where it’s supposed to be. It pops up above that bottom edge to flap in the breezes blowing by. As you can imagine, this doesn’t help airflow at all! There is a pretty effective surgery for this called a Tie Forward. 
4. The pharynx. This guy has to withstand massive pressures as air goes screaming by on its way in and out. It’s mostly soft stuff like mucosa and muscle with only some little tiny bones on the bottom called the hyoid apparatus. This means those muscles have to work like crazy to hold the pharynx open during breathing. Sometimes they just can’t even. We call that pharyngeal collapse. It’s tough to manage since there’s no surgery, medication, supplement (little cat joke there, supplements are never the answer), bit, or other gadget that can manage this. 
5. The larynx. Oh, the larynx. This is where Roarers happen. On either side of the larynx are the vocal folds. These flaps move in and out to create the vibrations that cause the much-loved whinny. I use mine to demand, I mean request, food from my humans. Either way, the left one is powered by a nerve that does some really strange meanderings to get where it’s going. The nerve starts at the base of the skull, runs down to the heart, does a u-turn and comes back up the left side of the larynx. Given the long journey, it has a lot of opportunities for bad things to happen. When the nerve quits working, that flap stops opening properly. That creates turbulence when your horse is breathing, and that sounds like roaring. There’s a surgery for this one too. It’s called a Tie Back. Those surgeons are so original with their names. 
6. The trachea. This one doesn’t cause too many problems for most horses. Minis are known for getting a collapsing issue. 
7. The lungs. Oh, the lungs. That teenie, tiny little membrane that allows horses absorb oxygen really efficiently so they can run fast, also does a really bad job at keeping the blood on the correct side of the wall. This is where “bleeding” comes from. If a horse runs enough times, and hard enough, bleeding will happen. It takes management and good training to keep this to a minimum. Sure, there’s Lasix, but did you know even a subtle lameness can massively increase the chances your horse will bleed? Talk to my Docs about making sure you’ve got a good plan to minimize the chances of bleeding. Medications are likely going to be part of it, but there’s a whole lot more to it. 

Moral of the story: horses can really mess up their airways in a lot of different ways. If your horse isn’t performing like they should, don’t just head to Dr. Google. Talk with one of my Docs about what’s going on. They will help you come up with a cause, and a treatment plan. Dr. Google can’t do that!

Now then, about that podcast. I’m sure you want more information about airways, so I’m going to show you where you can listen to the podcast without having to download anything fancy on your phone. All you have to do is click this link: Straight from the Horse Doctor’s Mouth. That will take you to the podcast page on our website. Then, you just scroll through the episodes. When you see one you want to listen to, just click Play. Make sure you turn your volume up.

Until next week,

~Tony