Tower Equine

Veterinary Surgeons


Handle with Care - November 2013

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Commissioned by Horse & Hound and printed in edition 14 November 2013:

Anxious or unruly horses are not just a safety risk - clinical examination is more difficult and less accurate. Roger Lee MRCVS explains why horses should be properly prepared for the vet:

Working with horses can be a risky job, event when you're not actually riding them. Grooms, farriers, dentists and physiotherapists can - and do - get injured by the horses they help to look after. For vets, who are often dealing with a horse who is scared or in pain, the risks can be even higher.

Two problem areas vets often highlight are inexperienced handlers and poorly trained or ill-behaved horses.

Competent handling certainly helps. There is clear evidence from MRI studies on human brains that anxiety about a procedure increases the amount of pain felt. This means that keeping a horse calm and relaxed when he is presented to the vet will make him much less likely to respond badly.

Bedside manner

The examination setting should be clean, dry and well lit, but above all familiar to the horse. Separating him from close companions or putting him in a strange stable will inevitably increase his anxiety levels.

The handler's behaviour also significantly affects how the horse reacts to the vet. Adult horses have an acute awareness of the subtle changes in human body language and are able to discriminate different tones of voice. Soothing words are of little use if the speaker's tone and body language are signalling fear or stress.

With a difficult horse, the success of an examination often depends on the confidence and experience of the vet. Vets need to take time to let a nervous horse assess them. Sight and smell are important triggers for horses, so wearing dull, unthreatening clothing is best - fortunately, not a problem for most vets. Similarly, snapping on white latex gloves or smelling strongly of surgical spirit is not patient friendly!

Vets are not simply looking out for themselves. As a professional in charge, they also have a duty of care to the handler and need to take reasonable steps to protect them too. The layman's view is that horses bite at one end and kick at the other, but this ignores the fact that the front legs can be effective weapons too.

Although horses have an extra ligament to their hip joint, which reportedly limits their ability to strike forward with a hindleg, they can still easily reach girth level. This means that, when dealing with a difficult horse, the only safe area is close up to his shoulder.

In addition, both vet and handler should be on the same side of the horse. Then, if he spins around, one person will not find themselves facing the hindlegs.

A chifney, or even a regular bit, is essential for an adult horse or youngster who is misbehaving, since no large horse can be adequately controlled with a headcollar alone. Taking a horse out of his stable can also reduce his assertivenenss and give everybody more room.

Early learning

Many difficulties can be avoided with correct early handling.

Habituation, the process of becoming used to something through repeated exposure, is key to young horse management. Picking up feet, walking and trotting inhand and tying up are all procedure that have to be learnt, as do good manners.

All horses will push the boundaries, and they have to learn who is in charge. Any handler response needs to be proportional, however, and it is important to distinguish between the horse who is badly behaved and one who is genuinely scared.

Some generally well-behaved horses will still react badly to specific procedures such as clipping or injecting. One method to overcome this is to practice a training method known as overshadowing.

Overshadowing is the technique of exposing a horse to two stimuli of different strengths, so the stronger one "overshadows" the weaker. The idea relies for its effect on the horse being able to concentrate on two things simultaneously. For a horse with a fear of injections, for example, the trainer puts a hand on the jugular vein to raise it. When the horse tenses or objects, he is asked to take a step forward or backwards. In having to concentrate on this stronger stimulus he will eventually ignore the hand on his neck and relax, at which point the hand is them removed as a reward.

Things can then be taken a step further - pushing the end of a pen firmly on to the jugular to mimic the needle and again asking the horse to step backwards. Quite quickly the horse will become sufficiently desensitised to allow an injection to be given.

Training the horse so he can be examined safely should be part of his normal education and needs to start early in life. It makes for a less stressful experience for all concerned.

A risky business

Concern about injury rates among vets has prompted the British Equine Veterinary Association to commission a survey, the results of which will be published next year.

But a smaller study in 2012 showed that, within a group of 22 vets and 15 support staff working with horses at the Royal (Dick) School of Veterinary Studies, there were eight significant injuries over a 12 month period.

A third of those surveyed reported they felt themselves to be in a potentially dangerous situation on most working days.

At the sharp end

Vets often have to resort to sedation when dealing with difficult horses. Some of these will also be needle-shy, however, and this is when injuries to vet or handler can occur.

Sedatives work best injected directly into the jugular vein, but a needle-shy horse anticipates this as soon as the vet approaches the neck.

The overshadowing technique takes a little time, so in theses situations a neck twitch - grasping a fold of loose neck skin in front of the horse's shoulder - works for all but the most resistant horses.

Twitching is reported to cause release of endorphins (natural painkillers). Although a recent study didn't show an endorphin rise, it did indicate a calming effect, including a reduction in heart rate. A nose twitch is best avoided, however, because needle-shy horses often react badly to them and may rear. Shielding the eye may help, as can using a very fine needle and moving it slowly through the skin while tugging firmly on the neck fold. Slow, deliberate movements are preferable to a quick jabbing action.

How does behaviour affect examination outcome?

A horse's fight or flight response is the result of the triggering of the sympathetic nervous system and the release of a wave of nerve transmitters, including adrenalin. These transmitters have a wide range of effects on the body:

- Heart rate: this is important indicator of pain or illness can increase as much as twofold, affecting the vet's assessment of the seriousness of the condition.

- Blood: blood pressure may be raised, while red and white blood cell counts may change and make test results less accurate.

- Muscle tone: increased muscle tone makes palpation less reliable.

- Soundness: adrenalin can have a blocking effect on pain signals, with the result that an excited horse no longer shows a subtle lameness. Research has also shown that a slow, straight trot is the best for "seeing" lame strides, but this is often impossible when the horse is misbehaving.

Roger Lee MA VetMB CertEM MRCVS