Typically, I would not choose acupuncture for a sick horse as my first line of defense.  We have excellent drugs, like antibiotics and anti-inflammatories that have been known to save lives. During a course lecture for “Evidence Based Acupuncture” I am attending, research papers talking about the use of electro-acupuncture in respiratory disease were discussed.  Various studies noted that stimulation of certain points caused increased clearance of mucus in the trachea (windpipe), reduction in inflammatory cells, and increase in circulating infection-fighting cells (neutrophils).  When I was called in recently to use acupuncture as an adjunctive therapy on an ill patient, I was pleased to be able to put this information to use!

My patient was on antibiotics for a lung infection (pneumonia), and one of the required medications tasted particularly bad.  The poor thing didn’t want to eat (as many horses on this medication don’t).  Of course he had to stay on this excellent drug to help him get better, so we were in a catch 22-position. While he did not have a fever, he was quite dull and almost looked sleepy upon pulling him from his stall.  We worked the points noted in the papers, as well as a couple for appetite stimulation.  Afterwards, our boy was pretty relaxed, partly due to feeling poorly, in addition to the sedative effects of acupuncture.  However, later that day, he began to feel better and started eating again.  His attitude improved and he is on his way to a recovery.  I obviously can’t and won’t take credit for healing the pneumonia; antibiotics were of course the right therapy to use! I think this is a perfect example of marrying Western and Eastern medicine to achieve a positive outcome for our patient.

As the owner of several geriatric horses, I know first hand how endearing owning an “oldie” can really be.  A swayed back, a droopy lip, a greyed face, a missing eye are charming qualities that become all the more sweet when you have shared many years together.   I recently attended a webinar given by Dr. Sarah Ralston, nutritionist, who spoke about nutrition for the older horse.  Twenty years ago, no feed company offered a diet for older horses, believing that no one cared about feeding and maintaining the elder equine. Purina was one of the first to offer a “Senior” diet, with the guidance of Dr. Ralston.  Now, senior diets are amongst the top sellers at any feed outlet, and geriatric medicine is a big part of equine veterinary practice in North America.

Talking about the elderly equine got me thinking about how we care for our old companions, and what else could be done for them.  There is no doubt that our older friends have more problems than their younger counterparts.   Early intervention of issues with proper nutrition, dentistry, good husbandry and pain reduction are the keys in my mind to ensuring that as long as they are happy to be munching on hay, they can.   With old horses, little changes can go a long way.  I always find it satisfying to float a set of teeth on an older patient and later hear that they have gained 100 lbs before going into winter!

I am always up for a challenge, especially when approached with the challenge by a fellow colleague.  Dr. Caldwell, from our Niagara practice, approached me about using acupuncture as a non-invasive method for helping an older patient.  This old fellow was 33 years old and had some issues with mobility, keeping weight, as well as some neurological issues.  Upon meeting this bright-eyed gelding, and his kind, dedicated, owners, I was inspired.  We began using acupuncture with the goals of improving mobility, energy and reducing his neurological signs.  My goal was not to make my patient into a young foal again, but to improve his quality of life and make his remaining years as happy as possible.

In an older patient, I use fewer needles, and minimal electro-acupuncture so as not to overwhelm the system.  Our patient had some aches and pains in his hind end and neck, so we worked on those points, also choosing some energy boosting and appetite boosting points.  Being an easy-going guy, he really enjoyed his treatment.   After the first treatment, he was more energetic and more mobile. After another 3 treatments with good responses, we plan on reducing the treatment regime with the idea that “tune-ups” may become less frequent.  We achieved some good improvement from the first few treatments, and I am excited to see how things come along in the next few months.

Acupuncture, as with all aspects of geriatric medicine, is a balance of working on main problems, and helping as much as we can.  Given the level of change in attitudes and therapies for older horses in the past 20 years, it will be interesting to see what happens next.  Do you have any ideas?

At our practice, we regularly get together as veterinarians to share educational information.  Sometimes we have a wet-lab, where we can tryout new xray views or learn landmarks for unusual diagnostics etc (Don’t be concerned; no horses are harmed, just palpated!!)  Other times we discuss recent conference information and how we can apply the information to our patients.  At a recent vet meeting at MPES, we discussed applications and cases in which acupuncture has been useful.  Upon reflection, I have been very happy with my results with acupuncture for secondary back and neck discomfort this year.  As I learn more about acupuncture and improve my practice of acupuncture, I am interested and impressed by the results.

Many horses I see will experience some discomfort from arthritis or inflammation within the joints.  Secondarily, they experience compensatory back discomfort.  I liken this to having a sore knee or hip.  While avoiding moving the sore joint, we hold the back in tension, leading to a sore back at the end of a long day.  There is soreness within the back or neck, but no primary arthritis or issue.  Is this back pain the primary or root problem?  Of course not, but it sure hurts!

As all veterinarians do, I deal with primary problems first, perhaps treating a sore hock or fetlock.  For the most part, this should alleviate the discomfort and make our equine friend more happy and comfortable in his job.  However, I try not to ignore the secondary soreness areas, as they have been inflamed for almost as long as the primary issue (as long as the horse has been compensating!) so the pain from those areas can be profound.  When evaluating these secondary spots, I have to decide if they will alleviate themselves within a week or two or if they require some help.  If they need help, what kind of help do they need?  People do often ask, “Will this problem resolve with a joint injection?” From a mathematical perspective, a + b =c.  Unfortunately, as anyone with a sore back knows, the answer is “it depends, but I hope so!”  It depends on the horse’s lifestyle (job, turnout, nutrition), conformation, ability to withstand pain (!), workload etc.

At the vet meeting, I discussed the work I did in a barn where several horses had sore backs and one a sore neck.  On lameness evaluation, one had stifle inflammation, one had hock arthritis, and another sore feet with abnormal changes in the coffin joints.  The back and neck pain I palpated was pretty noticeable, and two of the horses were no longer enjoying being brushed anymore. Once inflammation and pain conduction gets started, the cycle can be hard to break, so sometimes we need to inject these sore areas with steroids, or perform mesotherapy, even though the “primary” pain is gone.  I am a big advocate of treating secondary issues when they need to be treated, so our athletes/companions can be as pain-free in their jobs as possible. I treated the affected joints/regions in all 3 horses (stifles, hocks and coffin joints) and added in electro-acupuncture of the secondary areas while the horse was sedated.  If the single acupuncture treatment and joint injections did not deal with the secondary discomfort adequately, we would come back and re-evaluate to see if other therapies would be needed. I have a good idea of how much improvement we should see after 1 treatment of acupuncture, so if there is still a terribly inflamed back a week later, I know that the secondary inflammation is really profound enough to warrant more treatments (of acupuncture, mesotherapy, injections etc).

Happily, all 3 of these horses were able to show the following week and almost immediately went back to enjoying their brushing, and on recheck, looked great!  Admittedly this is not a scientific study, but based on previous experiences where joints where injected and acupuncture was not performed, using acupuncture at the time of injection seemed to reduce secondary inflammation and allow the horse to continue on with his athletic life sooner than if we hadn’t elected to use acupuncture.