Common geriatric equine diseases (Proceedings)
Older horses are at risk for developing a number of diseases. This lecture will focus on common diseases of older horses including dental disease/weight loss (and other complications of poor dentition), recurrent airway obstruction, lameness and common neoplasms of older horses.
Weight Loss/Dental Disease
Dental Disease:Most geriatric horses have some degree have some dental disease, and some can have severe dental abnormalities.
Periodontal disease=presence of disease and loss of tissue that surround the tooth, which includes the alveolus (bony socket), cement, and gingival. Oral examination reveals gingival hyperemia, edema, and ulceration, deepening of periodontal pockets, and packing feed material. The tooth may be loose.
Diastema=abnormal detectable space between the teeth, that accumulates feed. This results in pain and quidding. Treatment includes daily lavage, removal of sharp enamel points, tooth reduction, and feeding soft feeds or grass.
Malocclusions: can be severe in geriatric horses. Treatment includes reduction of hooks, ramps and steps. Use of power equipment is helpful. Care should be given to prevent thermal injuries. Care must be taken if using molar cutters in older horses.
Smooth mouth: absence of enamel on the occlusal surface of the cheek teeth. As the enamel wears out the dentin and cement are exposed resulting in rapid wear of the teeth.
Dental caries/tooth root abscess
Consequences of Dental Disease: Weight Loss, Choke, Large Colon Impactions
Weight Loss: Most common cause is likely related to poor dentition; chronic intestinal parasitism can be more of a problem in older horses, in addition to other more serious systemic diseases resulting in weight loss.
Recommended Feeding for Older Horses:
There are rations made specifically for geriatric horses that are easier to digest and masticate. Most designed to be "complete feeds", and may be used as a sole ration. They include a combination of roughage, energy concentrates, protein supplementation, and mineral and vitamin supplements. The roughage is usually consists of dehydrated alfalfa meal and/or beat pulp. The energy concentrates include cereal grains (corn, oats, and barley) and fat. The cereal grains in complete feed often undergo heat treatments (extrusion, pelleting) which results in gelatinization and starch molecules (which will increase their availability for digestion and absorption. Hay (if can be tolerated) can be feed to prevent boredom. To note, complete feeds have a significant amount of cereal grains in horses with insulin resistance.
Other options: chopped hay (alfalfa or mixture of high quality grass hay/alfalfa mixture). Chopping hay minimizes the amount of mastication needed. It may increase dust/fine particles (may need to wet the hay). Generally, consumption of 1.5-2% (dry matter) of body weight of forage (grass, hay) is adequate to meet a horse's digestible energy requirements. Ensiled or chopped hay will have a higher moisture content, and it is important to take this into account. It probably necessary to add a vitamin-mineral supplement. Vegetable oil can be added to the diet (1-2 cups/day) if necessary to maintain weight.
Esophageal obstruction: Dental disease resulting in poor mastication can result in esophageal obstruction.
Clinical signs include coughing, retching, bilateral green (food) nasal discharge.
Diagnosis: not difficult; failure to pass NG tube; additional- endoscopy, radiographs (if complicated), blood work (chronic cases), assessment of lungs (aspiration pneumonia)
Treatment: early cases: withhold feed and water, sedation, anti-inflammatory drugs, oxytocin (0.11-0.22 iu/kg iv- caution in mares), broad spectrum antibiotics; more aggressive treatment necessary if not resolved in 4-6 hours: heavy sedation, careful esophageal lavage; in some cases general anesthesia.
Sequella: Recurrence of choke: concerns- stricture #1; further work-up (endoscopy, contrast radiographs); options- could be addressed surgically; life-long gruel diet in some cases
Large Colon Impaction: poor dentition most likely risk factor
Clinical signs: variable- mild-moderate signs of colic, depression, decreased appetite decreased fecal production
Diagnosis: rectal palpation
Treatment: feed restriction, analgesics, administration of oral fluids and laxatives; intravenous fluids if necessary; laxatives include- mineral oil, diocytl sodium succinate 6-12 g/500kg; magnesium sulfate (0.1 mg/kg given in 2-4 L of water)
Recurrent Airway Obstruction
Recurrent airway obstruction (RAO, heaves) is the most common respiratory disorder in geriatric horses. RAO is characterized by bronchospasm, excessive mucous production, and pathologic changes of the bronchiolar walls that result in terminal airway obstruction. Geriatric horses often have more severe clinical signs due to RAO than younger horses. RAO is usually a drug-responsive disorder in middle-aged horses, but as the horse ages, horses are more likely to have permanent pulmonary remodeling and fibrosis.
Clinical signs: flared nostrils, chronic cough, and nasal discharge. Respiratory impairment may range from exercise intolerance to dyspnea at rest. An increase in expiratory effort can be noted. In severe cases tachypnea, weight loss, and a heave line may be present. Auscultation can range from normal to abnormal (expiratory wheezes and in some cases crackles. Horses should be afebrile.
Diagnosis: In most geriatric horses with advanced disease, the diagnosis is based on clinical signs and history. Performing other diagnostic tests (such as a CBC, thoracic ultrasound) can be important to rule out other diseases including bacterial pneumonia or less common diseases (such as neoplasia or interstitial pneumonia). In horses with subtle disease, bronchoalveolar lavage (BAL) can be helpful to examine cytological samples from the lower airways.
Treatment: The primary goal is prevention of exposure of allergens combined with intermittent medical treatment of the inflammation and bronchocontriction.
Environmental Management: Reduce dust, increase ventilation, change feed (no round bales, wet hay, or avoid hay)
Systemic corticosteroids: indicated with severe/moderate RAO- "Rescue Drugs". Associated with laminitis, immunosuppression and adrenal suppression.
Dexamethasone: drug of choice. 0.02-0.05 mg/kg iv (up to 0.1 mg/kg)- improves clinical signs by day 3 maximal response at day 7. Adrenal suppression 3 days after discontinuation. Usually use for 10-14 days, decreasing dose, alternate day therapy, and orally
Oral prednisone: has been shown not be effective with horses with RAO, and is likely poorly absorbed; Oral prednisolone also has a very short duration.
Use of NSAID and anti-histamines- are not effective
Aerosolized corticosteroids: effective for mild-moderate disease. To note- that in horses there still is adrenal suppression associated with the use of aerosolized steroids (which is not true in humans). There are 3 aerosolized corticosteroid products in metered-dose inhalers, listed in order of potency: fluticasone propionate> beclomethasone dipropionate> fluisolide
Delivered to horses via: Equine AeroMask® (Trudell Medical International , London, Ontario) or Equine Haler® (Equine Healthcare APS, Hillerod Denmark)
Fluticasone: dose 2000 ug SID to BID/adult horse; Glaxo Wellcome Flovent® 220 ug/puff
Beclomethasone dipropionate: improvement in clinical signs within 24 hours; Doses range from 500-1500 ug SID to BID/adult horse; 3M Pharmaceuticals/QVAR® 40-80 ug/puff
Most common are the B2 adrenergic agonist. Down regulation occurs resulting tolerance within 72 hours of use. Combining these drugs with corticosteroids will reduce the tolerance.
Oral Bronchodilators: Clenbuterol (Ventipulmin® ) oral B2; long acting, recommend intermittent dose scheduling to prevent side effects (tachycardia sweating). Terbutaline and albuterol have poor oral bioavailability
Short acting: Albuterol Sulfate: 360-900 ug – "Rescue Drug" improves clinical signs in 5 minutes; can give a dose every 15 minutes for 2 hours; short lived (1 hour); Torpex® (no longer available); Schering Corporation/Proventil 90 ug/puff