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June 1, 2007

Managing The Patient On Stall Rest

In order to best care for a confined horse, you need to know how a change in his exercise pattern can affect him.

The show season is going smoothly when suddenly your horse comes up lame. After a thorough exam, the veterinarian recommends the treatment: stall rest.

Finding out that your partner is out of commission for a few weeks or even months can be difficult, but the road to recovery doesn’t have to be.

Some of the things requiring stall rest include fractures and post-operative repair, soft tissue injuries (tendons, ligaments and muscle damage), and post-operative recuperation (such as following a colic surgery). While all horses react differently to confinement in a stall, most are able to adapt to stall rest even if they are initially unhappy with it.

“People have great empathy for horses when they’re confined because we think of ourselves being constricted to bed and how bored we would be,” said Shauna Spurlock, DVM, an equine internal specialist who, along with her husband, surgeon Gary Spurlock, DVM, owns Spurlock Equine Associates in Lovettsville, Va. “But I think often we underestimate how well horses accept routine. Once they know what the new routine is, most horses adjust to it very well and with minimal problems.”

“A horse is a special kind of athlete because, unlike humans, it doesn’t detrain quickly,” explained John Pagan, Ph.D., an equine nutritionist and the president of Kentucky Equine Research, Inc.

But that doesn’t mean that two to six months of confinement in a stall won’t have some effect on a horse’s body.

When in consistent work, a horse’s skeleton absorbs and produces bone in response to a signal/stimulus received during exercise. But when completely immobile, the skeleton de-mineralizes and begins to waste away.

“The skeleton doesn’t need a lot of stimulus,” emphasized Pagan. “So hand walking or turn-out in a small paddock is best.”

In most instances, taking a horse out of its stall to move it to another stall in the same barn or taking it right out the barn door to graze isn’t detrimental to the healing process, so long as the handler can retain control of the horse. But hand walking as “purposeful exercise” (like doing laps around the indoor arena) can be detrimental to the recovery process.

“I think it’s important that a person distinguishes [with their veterinarian] between hand walking as part of the rehabilitation and hand walking just outside the stall for grass,” clarified Gary.

So what if hand walking as purposeful exercise or restricted turnout is not an option?

“If a horse can’t hand walk, then upon rehabilitation the rider must be aware that while the horse may be capable of long work, his skeleton may not,” said Pagan, who, for this reason, recommends giving a horse as much exercise daily as the underlying problem can reasonably tolerate.

Brendan W. Furlong, who has served the U.S. Equestrian Team in various capacities for more than 15 years while maintaining his own practice, B.W. Furlong & Associates, in Oldwick, N.J., agreed. “Because horses are athletes by nature, when they are on complete stall rest they experience a wastage of muscle, a loss of bone density and an improper functioning of the hoof, so restricted exercise is preferable,” he said.

In cases where limited exercise is an option, walking under tack (and maybe with draw reins) can be a useful exercise because the rider, assuming he’s competent, should have more control than on the ground and can encourage the horse to use certain muscle groups. Hot walkers are also an option because they allow a person to set the machine at a controlled speed for a controlled length of time.

Horses that are able to spend some time outside during the recuperation process, even if it is strictly limited, are at a lower risk for developing respiratory disease. Chronic exposure to dust and barn mold (especially if a horse is bedded on dusty straw or shavings, or if he’s kept in the barn while it is mucked out) can contract inflammatory airway disease, also known as “heaves,” or recurrent airway obstruction. Nasal discharge, chronic cough and respiratory difficulty, marked by a prolonged labored expiratory phase of respiration, are the typical symptoms of a horse with RAO.

“When I treat a horse for respiratory disease, I often make recommendations about increasing ventilation and reducing the amount of dust in the environment, like soaking hay or using chopped hay silage. If the disease goes untreated, a horse can have long-term effects like reduction in the intake of airflow because of bronchoconstriction [similar to asthma] and a reduced lung capacity,” warned John Nolan, DVM, founder of Piedmont Equine Practice, Inc., in Marshall, Va.

Avoiding Colic And Weight Gain

A healthy horse requires a diet comprised of varying quantities of energy, protein, minerals, vitamins and water on a daily basis to maintain a healthy, functioning state, but when a horse’s exercise program changes, so must the components of his diet. When standing in stalls for long periods of time and not exercising, horses don’t use many calories, therefore making an adjustment in diet is necessary. While extra hay may help combat boredom, it’s not always the best solution.

“Exercise is one of the key components of intestinal function, and if you increase a horse’s hay because it provides them with mindless occupation, they eat more than they need to, and that, combined with decreased exercise, will lead to food accumulation in the large colon,” said Gary, who added that horses with a history of impaction should be bedded on shavings instead of straw to prevent them from eating the straw out of boredom.

Not all horses react to confinement in the same manner, so the best way to determine what dietary changes are best for your horse is to speak with your veterinarian, make all changes slowly and monitor the horse’s reactions.

Shauna explained, “An injured horse doesn’t have the opportunity to make a slow transition to stall rest, so I recommend transitioning their diet slowly and allowing them time to acclimate. It’s important not to overwhelm the intestinal tract over the first few days of confinement.”

To prevent overwhelming the intestinal tract, the caretaker needs to be aware of any changes in the amount of food digested, the quantity of water ingested and the consistency and volume of manure production. The consistency of the manure and the volume shouldn’t change drastically.

Small, mucousy or dry fecal balls are signs that the intestinal tract isn’t functioning the way it should, and additional changes to the horse’s diet, like cutting back more on hay or feed, may be a solution. But if reducing the hay and grain consumption doesn’t change the consistency of the manure, or if the horse is exhibiting unusual behavior, a veterinarian should be called.

“It makes me cringe when I see barns where the people who clean the stalls miss health clues like how much manure the horse made the night before. If we can catch impaction at the early stages, it prevents bigger problems,” said Shauna adamantly.

Avoiding highly caloric forage, like alfalfa, is another rule of thumb for confined horses since it’s been proven that it increases a horse’s chance for gas colic and is high in calories.

Similar to people, in order to maintain their weight, horses only need to consume as many calories as they burn. Since confined horses aren’t burning as many calories as they were prior to their injury, their need for calories decreases.
 
“When a horse is on stall rest, their caloric requirements go down, so you need to adjust their diet to rid them of the excess calories,” said Pagan. “Ideally, you want a balance between caloric intake and caloric expenditure.”

The best way to reduce the caloric intake is to cut back on grain, but when you cut back on grain or cut it out completely, you also take away the majority of a horse’s micronutrient fortification.

“Feeding a pound of supplemental concentrates of vitamins and minerals, or grain balancer pellets, is a good way to make sure a horse gets vitamins without additional calories,” said Pagan, who added that any time a horse’s grain is reduced for more than one week he needs additional supplements.

So what is so important about micronutrient fortification?

Bone tissue is alive and is therefore in a constant state of mineral (calcium and phosphorus) deposition and resorption. In a continuing process of growth and remodeling, the bone acts as a mineral mine from which minerals are constantly being resorbed and laid down, and a horse requires a consistent source of these minerals to maintain its body reserves.

Depletion of micronutrient fortification and colic are not the only two roadblocks your horse may face on the road to recovery. Sometimes when a horse’s feed is reduced he will gulp what little feed he receives, leading to obstructions in the esophagus. Risks for esophageal obstruction, or “choke,” are higher with pelleted feeds because they are drier, but  soaking the pellets or putting rocks or chunks of a salt block in with the feed help slow down the eating process.

Depending on a horse’s individual personality, abrupt changes in management can also result in increased stress and the development of equine gastric syndrome, more commonly known as gastric ulcers. Oftentimes the presence of pain combined with a change in location daily habits lead to stress, one of the key triggers for ulcers. Giving low-dose medications designed for treatment and prevention, like Omeprazole, can help guard a horse against EGS.

The Recovery Process

As part of the recovery process, some horse owners (with the approval of their veterinarian and farrier) decide to remove their horse’s shoes in cases where doing so won’t exacerbate the initial injury.

“People often ask me if they should leave their horse’s shoes on or take them off, and I think that if the horse has normal feet and they are going to be in their stall for a few weeks then it’s safe to pull off the back shoes,” said Nolan. “Shoes are a necessary evil, but horses can benefit from taking them off because it gives the hoof a chance to spread out.”

However, if a horse has poor hoof quality, removing his shoes is not always a beneficial alternative. “It can be false economics if the horse has a bad hoof—what you end up doing is robbing Peter to pay Paul. In other cases, like hoof-related injuries, shoes can be therapeutic in the healing process,” he added.

As your horse’s period of confinement draws to a close, the focus needs to shift from treating the injury to safely bringing your patient back into work. Even though horses don’t detrain quickly, their bodies do undergo adaptations, and the return to exercise can exacerbate those physical changes. While convalescence depends on the nature of the injury, the same precautions must be taken when resuming normal activities, like turnout and exercise.

“In most instances, the first time you turn a horse out in a paddock after it’s been confined for a few weeks or months, it’s going to run across the paddock and do something stupid,” said Shauna. “The most dangerous time is usually the first few minutes.”

In order to avoid re-injury during the first period of turnout, certain sedatives like reserpine or acepromazine can be administered, but the owner should be aware of potential side effects and competitive withdrawal times. Or, putting a horse out in a round pen or on a hot walker are other alternatives to sedation that still preserve the safety of your recuperating horse.

As a horse resumes its normal work pattern, his grain should also be increased accordingly. “Know ahead of time what body condition you are shooting for and balance the caloric intake to your desired body condition,” recommended Pagan.

But that’s a lot easier said than done. First determine your horse’s ideal weight. If you can’t weigh your horse easily, then think about what you want his ideal neck and topline to look like and how much feed is needed to get him to that point and then maintain him.

A general rule of thumb, said Shauna, is: “Any time your horse is laid up, reconditioning becomes important. If he is out of work for longer than 30 days, you’re dealing with an individual that needs to be reconditioned, so the more he works, the more food he needs. Therefore, it’s likely that you’ll need to increase the feed as the exercise level increases. As long as things are done slowly and deliberately, the consequences should be minimal.”

Ways To Combat Boredom

Your horse has been doing fine with the confinement, but suddenly the patient who’s been standing quietly in his stall munching hay thinks he’s well enough to join his buddies out in the paddock and starts kicking at the wall to let you know just how he feels.

In order to avoid re-injury to the affected area or a new injury, his latest state of mind demands attention, so what can you do?

If you have a horse that you know won’t escape, one possibility is keeping his door open and attaching an escape guard so that he can at least see what’s going on in the barn—just don’t forget to close his door when no one’s in the barn to keep a watchful eye on him!

Rubber balls, tetherballs, hanging ropes, plastic milk jugs, rolling plastic barrels mounted to the wall or various types of flavored lick toys are other ways to provide your horse with entertainment. And if you want to get really creative, putting old tires in his stall to keep him from stall walking solves not only his problem, but yours as well, for you no longer have to make that dreaded trip to the dump!

“You need to be careful of strangulation when you hang anything in a stall, so it’s important that you watch carefully and see how the horse reacts to it,” said veterinarian Gary Spurlock, who’s seen horses do some very strange things.

But what if, despite your valiant efforts at decorating your horse’s stall so that it looks like your neighbor’s front lawn at Christmas, he’s still kicking, pacing and walking right over the top of the tires without a second thought? Maybe what your horse is really trying to tell you is that he is craving personal attention. Periods of stall rest are a great time to get his coat looking the way you’ve wanted, and, if he doesn’t get too upset about it, to work on manners.

 
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