There have been significant changes in the sport of endurance riding in recent years. From the rigs that we drive to the shoes on our horses' feet, we have made important improvements in every aspect of the sport. The way we treat lameness or metabolic problems in our horses is no exception.
We are all aware of how the caliber of veterinary treatment at rides has improved drastically. As the level of available care has changed, so have our attitudes and expectations regarding the treatment of horses that have gotten into trouble. As the public becomes more aware of our sport and some of the risks associated with it we must remain beyond reproach in terms of the care that we offer to endurance horses.
As treatment veterinarians it is our responsibility to provide the best care possible for our patients in often less than ideal situations. Part of what we love about endurance is the variety of environments we have to enjoy with our horses. From a treatment perspective sometimes it is not quite so pleasant. We sometimes find ourselves treating horses in the most primitive circumstances while at other rides we have well-equipped hospitals to work in.
Empirical treatment
On one end of the spectrum most of us have been faced with treating horses by the side of the trail under an "IV tree." We do the best we can in that environment with the equipment and supplies we have on hand. Many horses have certainly been saved in these situations. When the patient is stable enough they can often be transported to a more fully equipped treatment area or referral center where they can receive more complete care. In the field the therapies are "empirical," based on our best well-educated guess of what is happening on a physiologic level in a metabolically unstable horse. With good clinical judgment and sound empirical therapy most horses will benefit greatly with this type of treatment.
One example of the potential inadequacy of empirical therapy struck a personal note a few years ago when a friend's horse became ill after a ride. After a limited distance ride in heat and humidity, the mare appeared to be tired but otherwise felt fine. Or so she seemed. After trailering a short distance home that night and appearing normal, she was found the next morning in serious trouble. She would stand normally for a few minutes and then simply collapse on the ground for a few seconds. Her muscles and gait were normal and she had clear urine. The only clinical abnormality found was that she was skipping heartbeats for a long time right before she would collapse.
Because it was a Sunday and we had no access to a laboratory, she was treated empirically on the farm with fluid and electrolytes given intravenously while we got the rig ready to haul her to a nearby university hospital. At the referral center her EKG looked perfectly normal with a regular rate and rhythm. Her muscles still felt fine and she gave us a clear urine sample.
As the clinician was trying to decide how to tell us we must be mistaken about the heart problem, the mare flat-lined and collapsed on the concrete floor. She soon pulled herself together and stood up long enough to walk to a padded stall. Blood and urine samples were rushed to the lab and it seemed like an eternity passed before the results came back. Although she was not dehydrated and most of her electrolytes were normal, she had almost no sodium in her bloodstream. Her muscle enzymes were off the scale and she had severe kidney damage. Her clinically normal urine was full of myoglobin.
The mare's electrolyte abnormality had caused a potential fatal cardiac arrhythmia and she had tied up, causing her kidney damage. All of this was going on without any initial outward signs. After ten days of intensive care the mare trotted out of the hospital and came home. A happy ending.
The lesson learned is that what the outside of the horse tells even the most experienced clinicians in the field or in the hospital is not necessarily representing what is actually happening on the inside of the horse. Empirical therapy in the field can be dangerously inadequate in spite of our best efforts.
Field treatment options
In recent years we have seen important changes in our options for treatment of horses in the field. Portable blood chemistry and electrolyte analyzers almost instantly identify clinical pathologies that can be addressed. We are seeing the development of full-service mobile hospitals that provide high level intensive care at the ride site. Fully equipped with laboratory and diagnostic equipment, accurate diagnoses can be made and appropriate therapy can be started without delay. Referrals are generally needed for surgery only.
As this higher level of care becomes more available, it also becomes the level of care that is expected. The old days under the IV tree may soon be seen as less than optimal care. In the veterinary profession we have an ethical and even legal obligation to practice at the accepted standard of care. The bar is being raised.
Of course, these advances in field diagnostic and therapeutic options come with a cost. Laboratory and diagnostic imaging equipment, medications, supplies and the mobile units themselves can add up to the cost of a house. While efforts are made to keep treatment costs at a reasonable level, intensive care can be an expensive endeavor.
Vet/owner communication
If you find yourself in the unfortunate circumstance that your horse needs to visit the treatment vet keep a few basic things in mind. First, make sure that you and the doctor communicate clearly. Discuss cost estimates up front and be aware of changes as the case progresses. Try to understand what the problems are and what the prognosis is. As the horse's condition either improves or deteriorates the overall cost will reflect those changes. Talk about payment options and make arrangements to follow through on your financial commitment. If your horse is insured be sure to communicate with your insurance company as soon as possible.
As ride times get faster and competition intensifies treatment veterinarians will face tougher challenges. As a result, treatment veterinarians continue to intensify our diagnostic and treatment capabilities to ensure the highest standard of care is available for our equine athletes that deserve only the best.
Riders need to remember, however, that this level of care comes at a cost and so should be financially prepared for the medical emergencies that can and do come up at rides.
