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Do Sedatives Affect Lameness Exam Outcomes?

Lameness exams on high-energy horses can be difficult to complete, especially if they involve joint or nerve blocks. Occasionally overly exuberant horses must be sedated for the exam to be performed to keep both horse, handler and vet safe. Concerns have been raised that sedating the horse may mask a horse's pain response, and potentially compromise the results of the joint or nerve block and the exam.

A group of Brazilian veterinarians tested the effects of xylazine and xylazine used in conjunction with butorphanol on induced hind-end lameness. Drs. Antônio Alcemar Beck Júnior, Flávio Desessards De La Côrte, Karin Erica Brass, Stéfano Leite Dau, Gabriele Biavaschi Silva and Marina de Aguiar Camillo compared the results of the sedated horses to the results of a control group of horses that did not receive sedation.

The researchers used 16 horses and placed metal clamps around their hoof wall with small screws. The screws were tightened to induce lameness until the horses became a Grade 3 or 4 (out of 5) on the AAEP lameness scale. This was done immediately before the administration of sedation.

Each horse received all three treatments: no sedation, xylazine alone or a combination of xylazine and butorphanol. The scientists concluded that xylazine used alone or in conjunction with butorphanol (at the recommended doses) can be used as chemical restraint without masking lameness intensity. They note that additional research must be done to determine how detomidine and romifidine might interact with butorphanol during hindlimb lameness evaluations.

Horse-Handling Skills Helps Keep Equine Vets Safe

Being a large-animal veterinarian is fraught with danger—vets are often placed in precarious positions where they can be kicked, bitten or worse by the patients they're trying to help. It's estimated that about 80 percent of equine vets have suffered injuries from a difficult horse and 37 percent of those injured have had ongoing pain or a disability from the injury.

It's difficult enough to entice vet students to consider large animal practices; the risk of injury is just another strike against the profession. Gemma Pearson, Melanie Connor, John Keen, Richard Reardon, and Natalie Waran, all students at the University of Edinburgh's Royal (Dick) School of Veterinary Studies, are working to create a program to teach vet students horse-handling methods that are based on equine learning theory. It's hoped that this program will reduce the number of vets who don't consider large-animal work or who leave the profession early.

The research team tested the effects of a single lecture that focused on practical learning theory tips for equine vets on pre-final-year vet students. The 45-minute lecture focused on how horses learned; videos were shown that demonstrated how to apply that theory to equine patients.

Examples shown included overshadowing, where the horse is asked to do a task it knows (like stepping backward) to draw attention away from the action the vet is performing, like administering a shot. Using negative reinforcement to get a horse to enter stocks by lightly tapping him with a whip, and stopping as soon as he took a step forward was also included in the lecture .

Students watched videos of “difficult” horses both before and after the lecture; they were also asked questions. After the lecture, the students were more likely to suggest learning theory-based solutions on how to hand the horse. The vet students also indicated that they had greater confidence in their horse-handling skills after the lecture.

The study group concluded that just one lecture had the potential to positively alter students' perception of how to handle “difficult” horses; it may also influence how they deal with difficult horses, thus creating a safer work environment.

The researchers went on to note that horse owners play a key role in keeping vets safe; by teaching their horses to stand still unless asked to move, and to respond to leadrope cues to go forward or backward, they can help veterinarians remain safe on the job.

When Digging For A Diagnosis Becomes Harmful

Equine and pediatric medicine has many parallels, notes Dr. David Ramey in an article for Horse Network, including a propensity for overdiagnosis.

Ramey draws multiple similarities between the two, including that both horses and children are reliant upon adults to make medical decisions for them. Additionally, neither small children nor horses can talk, so diagnoses must be made on observation and testing.

Ramey says that a horse may have an issue where a diagnosis is warranted, but determining an exact diagnosis can be difficult—and in some cases harmful–to the horse. An ultrasound can be a helpful tool to use if a horse is colicking and a diagnosis on whether surgery is needed is imperative. However, sometimes a precise diagnosis isn't needed. If a horse is older and sore, using every diagnostic tool to determine where it is unsound may not change the treatment or the outcome—it simply adds to the owner's expense. In Ramey's words, “'Overdiagnosis' describes a situation when an abnormality is found, but detection of that abnormality doesn't actually benefit the patient.”

Though vets have multiple diagnostic tools at their disposal, their use doesn't always behoove the horse or the owner. Using every tool available to find a diagnosis might physically harm the horse: It's imperative that the owner and vet agree that the benefit outweighs the possible risk of the test or procedure.

Psychologically, naming the issue may change the perception of what a horse can do. Some owners then become focuses on “fixing” the problem, adding in supplements and other treatments that the horse may not need. Finally, the financial strain on owners who choose to offer treatments to horses that may not garner long-term improvement can be immense.

Ramey offers some thoughts on why veterinarians may seek to over diagnose the equines in their care:

Industry influence
Defensiveness
Incentives

Owners may attempt to seek out concrete diagnoses for their own peace of mind; uncertainty is not well tolerated by most people.

The benefit—to both horse and owner–of performing a test or procedure should be discussed before an owner agrees to pay for it. Many equine conditions improve on their own, so immediately throwing every test and procedure at the horse may result in the same diagnosis as waiting and not doing additional tests.

Shortage Of Veterinarians Apparent During Pandemic

Vet care is one of the only industries to see a significant increase in business during the pandemic. As people were stuck at home and spending more time with their animals, they became more aware of abnormalities and minor symptoms—some of which would require medical intervention. This increase in necessary care has made many animal clinics across the country in need of employees.

Veterinarians and veterinary clinics were considered essential business during the pandemic, but were prevented from doing elective procedures. Now that elective surgeries and preventative care have been added back into the roster of services, vet's schedules are becoming more packed.

Additionally, more households than ever have pets and many have more than one pet, compounding the need for skilled vet clinic staff. More people are also willing to do preventative care for their pets than ever before, as well. Pets, like people, are living longer, with more care needed as they age.

Veterinary jobs are expected to grow by 15,600 between 2018 and 2028, according to a report by the U.S. Bureau of Labor Statistics. Additionally, the American Veterinary Medical Association expects nearly 20 percent of veterinarians to retire in the next 10 years, intensifying the need for more vets.