Section: Treatment In-depth
There are many potential treatments for all of the causes of poor performance. Some of the most common include:
Inflammatory airway disease(IAD) is best treated with a combination of environmental management, anti-inflammatory medication (corticosteroids), and judicious use of bronchodilator drugs. This often means taking the horse off hay, and replacing hay with special hypoallergenic hay, hay or alfalfa cubes, or a complete pelleted ration. Alternatively, you can soak the hay, but it doesn't always stave off the breathing in of fungal spores by the horses. Today, the most effective method to treat the airways of horses with IAD is to give aerosols, just like the puffers used by asthmatics.
Left recurrent laryngeal neuropathy is treated with surgery. However, unless the noise is truly bothersome (or prohibited, such as in hunters), it is important to determine if the LRLN is actually affecting performance. Your veterinarian can size up the problem to determine if surgery will be effective or not. The most commonly performed surgical procedure is called a tieback, in which the left side of the larynx is fixed in the semi-open position. In addition there are procedures that remove the vocal folds, and this is why horses after tie-back make a hoarse, ineffective, whinny sound.
Exercise induced pulmonary hemorrhage is commonly treated with Lasix®, which is a diuretic. Studies have shown that Lasix may improve performance due to its effect to cause the horse to urinate, and thus shed 15 to 30 lbs of body weight immediately. Otherwise, there is no known reason to think that Lasix will improve performance, and there is only minimal evidence that Lasix affects the course of EIPH. Some horses appear to respond to rest, as well.
Atrial fibrillation is treated with a drug called quinidine. Because quinidine is actually quite a toxic substance, it is necessary for this treatment to be administered under constant veterinary supervision. Most horses with benign atrial fibrillation will respond favorably to quinidine administration.
Equine protozoal myeloencephalopathy must be treated with anti-protozoal drugs. The most commonly used combination is pyrimethamine (Daraprim®) and sulfa drugs. Other anti-protozoal drugs are currently still in the experimental stages. Treatment for EPM ordinarily must be continued for a minimum of 6 to 8 weeks, but some horses have required treatment for 3 to 6 months. Full resolution may not be achieved.
Cervical vertebral malformation. There is no real cure for CVM. Surgery to stabilize the vertebral column has been attempted, but full return to athletic function should not necessarily be expected in any case.
Gastric ulceration should be treated with a combination of management changes (more roughage, less concentrate in the diet, more turnout), and drugs that decrease acid production in the stomach. Some of the most commonly used drugs include cimetidine (Tagamet®), ranitidine (Zantac®) and omeprazole (Gastrogard®).
Degenerative joint disease can be treated with a combination of training changes (usually, decreasing the concussive workload), anti-inflammatories such as phenylbutazone and corticosteroids (corticosteroids should be reserved for low motion joints such as the lower hock joints), and physical therapy (warm water soaks before work, cold water after, massage, range of motion exercises). Cartilage protectants, such as glycosaminoglycans (psGAGs), hyaluronic acid (HA), and chondroitin sulfate can be very helpful to restore the damaged joint surface and probably provide pain relief if they are anything like humans that attest to its effects.
Navicular disease is initially treated with shoeing changes, which may include egg bar shoes and degree pads. Judicious use of phenylbutazone and drugs that are thought to increase blood supply to the area may also be recommended. In chronic cases that do not respond to conservative treatment, a neurectomy (cutting the nerves that supply sensation to the heel) may be recommended. Isoxpurine, a vasodilator, also seems to reduce pain in some horses.
Recurrent exertional rhabdomyolysis is often an emergency in the initial stages. The horse should usually be transported home, and not be asked to walk. Depending on the severity of the signs, the horse may require intravenous fluids, anti-inflammatory medication and sedation. Preventative treatment of tying up is controversial. Most veterinarians will advocate steady work without prolonged stall rest, low carbohydrate diets, supplementation with minerals and vitamins, and adequate salt in the diet. Other therapies that have been promoted include vitamin E and selenium supplements to the diet, dimethylglycine (DMG), methylsulfonylmethane (MSM), acepromazine prior to work, thyoid supplements, and dantrolene. None of the above treatments is dependable in warding off RER. The most important thing you can do is to reduce carbohydrate intake and go easy on the horse.
Follow-up
Follow-up care depends on what your veterinarian diagnoses as the cause of poor performance. Regardless of the cause of poor performance, it is important to schedule re-evaluations as recommended by your veterinarian. A good example is to remeasure muscle enzymes in horses that have previously tied up.
It is also important to follow treatment recommendations. Do not expect overnight success. Often, specific treatments may take weeks to months to see real improvement. For example, treatment of IAD can take several weeks to months before the horse has returned to full form, and in many cases, the recognition and proper treatment can result in new lifetime marks and top performances in these horses.
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