OSTEOARTHRITIS IN HORSES

Hayley Parker MA VetMB CertAVP MRCVS, Clinical Director and Equine Vet, Kingston Equine Vets

With the summer months now upon us, the days are longer and the weather is kinder whilst the ground is getting harder. This paired with many competitions, rallies and camps to attend means our horses and ponies are generally doing more work which is more testing for their joints. Arthritis simply means joint inflammation. In horses, several types of arthritis can occur, with causes ranging from infection to age and years of athletic use. Osteoarthritis or degenerative joint disease refers to the type of arthritis involving chronic, progressive, painful degeneration of the cartilage lining the ends of long bones inside joints.

Osteoarthritis is often diagnosed due to joint pain and lameness (which is sometimes very mild).

A lameness investigation involving trotting up, limb flexion, ‘blocking’ joints and x-rays can be involved when localising the joints affected.

Changes that are seen on x-rays of joints with osteoarthritis include: osteophytes (bone spurs at the joint margins); joints appearing narrower if the cartilage is damaged; and, thickening or absorption of the bone beneath the cartilage (sub-chondral bone).

Non-steroidal anti-inflammatory drugs such as Bute or Danilon have been the mainstay of treating joint disease for many decades. This is, however, not acceptable in horses that are competing. If the horse is not competing, it is safe to give oral medication daily as there are not the same requirements for the horse to be clean of performance-enhancing medication. If multiple joints are affected, it is not appropriate to medicate each joint individually (we rarely treat more than 3 joints at a time as there is a maximal horse dose for the joint medications and an increased risk of having other side effects). Oral medication treats ‘the whole horse’ and therefore all of the painful joints.

Other drugs such as Cartrophen/Osteopen

(pentosan polysulphate) which is given as an injection into the muscle can help keep the horse sound by slowing the degenerative changes within the joint and by having anti-inflammatory effects.

Bisphosphonates are drugs that prevent or slow down bone damage. Tildren is a bisphosphonate which is given intravenously via a cannula whilst Osphos is a bisphosphonate which is given by intramuscular injection.

In addition, joint supplements containing oral glucosamine, chondroitin sulphate, MSM and hyaluronic acid can help slow and alleviate the signs of osteoarthritis. Some supplements also include Boswellia which is a natural herbal anti-inflammatory that is also FEI-permitted. Devil’s claw supplement has been used as a natural anti-inflammatory but is not FEI-legal in competition horses.

Osteoarthritis is routinely treated using corticosteroid joint injections with the addition of hyaluronic acid. Corticosteroids are very strong anti-inflammatories that reduce the inflammation which causes the pain and lameness associated with osteoarthritis. Hyaluronic acid encourages the production of proteins normally present within joint fluid and so acts as a joint lubricant. kingstonequinevets.co.uk

Polyacrylamide gel (Arthramid) injected into the joint can provide lubrication and cushioning whilst re-establishing healthy joint lubrication using hydrogel with the effects often lasting longer than routine joint medication.

Arti-Cell Forte is a stem cell-based veterinary medicine which can be injected directly into a joint aiming to repair cartilage and alleviate signs of osteoarthritis.

IRAP is a biological treatment which harnesses the regenerative and anti-inflammatory properties of the horse’s own blood cells to encourage damaged musculoskeletal tissues to heal.

PRP (platelet-rich plasma) is also harvested from the horse’s own blood cells and is used most commonly to treat tendon and ligament lesions but is being increasingly used to treat joint inflammation and osteoarthritis having been shown to improve lameness scores in fetlock osteoarthritis.

Stem cell therapy is a treatment whereby stem cells are collected from the horse’s own bone marrow and then the stem cells are injected into joints, which can reduce pain and increase limb function in horses with osteoarthritis.

Osteoarthritis cannot be cured but in most cases, the symptoms can be suppressed to enable the horse to become sound and to continue in work or have a comfortable retirement. Horses that have been successfully treated for arthritis may continue a full athletic career but it may be necessary to repeat the joint injections in the future at variable intervals.

Corrective shoeing to ensure good foot balance is critical in the management of horses with lower limb joint pain.

It is especially important in horses that are known to have osteoarthritis but are still in work to have regular consistent exercise to aid the muscular and soft tissue support of the joints. Regular physiotherapy and chiropractic treatment can also help maintain a normal range of movement and help treat any secondary muscular tightness.

Hot Tips

Passport, boarding pass…hydration spray? Check, check and check.

When on holiday my skincare routine becomes a little more relaxed with easy-to-apply products to keep my skin calm and happy. If you are going somewhere warm it’s best to leave the exciting progressive ingredients of retinol and exfoliating acids at home as they increase sensitivity in the sun. Instead, your focus should turn to calming, hydrating and dealing with any pesky breakouts that may pop up because of the change of scenery for your skin.

Fingers are a great way to apply multi-tasking products and I am a fan of this method even at home.

Save case space with multi-toned bronzers and cream blushes that can be used to add a hint of colour and finesse to your newly golden face. Lighten up your face base too and opt for a tinted moisturiser or BB cream (Beauty Balm) to give you a dewy wash of evening colour, rather than a fuller coverage foundation.

If you prefer a brush to apply make-up products there are many mini versions on the market to help you apply powder formulations. However, when it comes to our holiday mascara – that crucial grease, sweat and ocean-defying waterproof formula that you covet –only the full-sized real McCoy brush will cut it. When using water-proof mascara and with heavier sun creams regularly being applied to our faces, our eyes can get a bit puffy. So support them with a proper gentle eye make-up remover and an appropriate eye product to hydrate and soothe the eye area. Keep lips nourished from the drying salt water and wash over them with a pop of colourful lip balm or gloss.

Having an eyelash lift and tint before a holiday or break is also a real joy. Your eyes are opened up, lashes are darker and appear longer for 8-10 weeks. It really helps to give you that ‘I just woke up like this daarling’ look but without any faff – perfect when the mercury and humidity are hitting the heights.

Be mindful that most perfumes and aftershaves contain alcohol which will react and damage your skin in strong sunlight so keep them for the evening only. During the day use a plant-based aroma scent or spray to make sure you smell incredible on holiday without the risk of stinging or post-holiday pigmentation.

Sun protection products have come a long way since the gloopy white stuff from our childhoods and, the seemingly acceptable at the time, baby oil for fast tanning fans. Tanning happens when the melanocytes in our skin create the pigment melanin to protect the skin from the damage the sun is causing. So tan sensibly. Use SPF protection to get a healthy colour and that post-holiday glow while aiming to minimise damage, ageing and potential cancer risks too. There are so many formulas on the market for different areas of your body and also your hair. Buy the best you can afford and apply plenty frequently.

Enjoy the summer and all its adventures… thesanctuarysherborne.co.uk margaretbalfour.co.uk

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We currently have both permanent and respite vacancies. Call us today to book a viewing and meet our amazing team. Call us on 01935 316800 or visit healthcarehomes.co.uk

Mental Health In The Face Of Change

Abbie Hole

Summer is a period of transition for many. Perhaps you’re about to embark on a new journey or are seeking change as a way of self-improvement. The only constant in life is change so it’s important to learn to respond and adapt to it in a mentally healthy way.

Challenges of change

Change can be difficult for many reasons. For example:

• Breaking from routine can trigger worry/uncertainty.

• Change can be overwhelming especially if one change leads to other changes.

• Sometimes the benefits of change can be unclear.

When we perceive change as a threat it can lead to distress because we experience the demands posed by our environment to be too taxing, and we feel we are being forced to go beyond our limits or capacity to cope.

In the short-term change can be difficult, especially if you have a pre-existing mental health condition, such as anxiety, but in the long-term change can be rewarding.

Change as a positive

Although it can be challenging, there are many positive aspects of change. For example:

• You grow and learn new things every time something changes.

• When we meet change with a positive attitude, we learn to let go of our set ways and become flexible.

• Depending on what the change is, it may also reinforce your values.

• When you turn from your usual path, there could be further opportunities waiting for you.

• Change brings new beginnings and excitement to life.

When we experience change as a challenge, for example, as an interesting opportunity to learn or do something new, it can be beneficial because the new environmental demands seem within our abilities and limits.

Growth Mindset

There are strategies to help you develop a growth mindset to change. A growth mindset is a belief that you can improve your abilities and talents with effort and persistence, not just talent or luck.

Cognitive Behaviour Therapy (CBT) is a process which works to help people discover, challenge or reframe unhelpful thoughts. The way we think, feel and behave are all linked and continuously affect one another. Types of unhelpful thoughts, which may arise in response to change, may include expecting the worst outcome from any situation.

Reframing unhelpful thoughts

Try to keep the categories of negative thoughts in mind and, if you find yourself having an unhelpful thought as you go about your day, consider whether it fits one of them.

Examine the situation, take a step back and try asking yourself,

• How likely is the outcome you’re worried about?

• Is there good evidence for it?

• Are there other explanations or possible outcomes?

• Is there good evidence for alternative ways of looking at the situation?

Support For Anxiety Amidst Change

Check out the NHS website ‘Every Mind Matters’, nhs.uk/every-mind-matters for further advice on reframing unhelpful thoughts and coping with anxiety.

Steps 2 Wellbeing is a free, NHS service which provides guided self-help sessions based on the principles of CBT. Find out more about their services at steps2wellbeing.co.uk.

Find mental health support in Dorset for adults and young people through your local mental health charity, Dorset Mind at dorsetmind.uk

Please Stay In Touch

Emma Rhys Thomas, Instructor, Art of Confidence quantockpilates.com

Remember I am a posture nut – I want to teach the world to stand, to move well, to present and feel more confident, for the betterment of physical and mental health. I want people to actively listen to and respond to their own bodies. One way to achieve this rather ambitious aim is to examine what I consider to be the greatest of all sensory inputs – touch.

Why does it feel so good to be hugged? Caveat – appropriately! A sprained ankle, a headache or muscular pain, feels instantly better if we use our hands to hold the affected area. Consider how our descriptive language is often related to touch – we ‘embrace’ new ideas, we ‘reach out’ to others and our ‘gut reactions’ tell us how to feel.

Touch is so much more than the end of your fingertips or a burnt lip from your Americano. Touch is pressure, temperature, vibration, stretch and pain. From inside the womb, pressure teaches us proprioception; the ‘edges’ of self and environment. Language is learned from felt vibrations transmitted through the mother’s body. Warmth, stretch and pain can all be felt as our sensory systems develop. It might be argued that anything you ‘feel’ physically or mentally, internally or externally, can be traced directly to touch, involving the cutaneous (skin), muscularskeletal and fascial systems. Touch drives my passion to train the body in movement, encouraging everyone to take up their space.

We are all being encouraged to participate more in our very being. What I mean is, whilst the body is quite capable of functioning freely without conscious intervention, where it may have acted and reacted without reflection, we are learning to become more mindful. We are able to bring into controlled focus normally autonomous functions such as breathing. We are more aware of what we see and hear – we pay attention. The sense of touch, in all its guises, is about grabbing the brain’s attention to the wisdom of the body and hopefully getting an intelligent translation that the brain feeds back as an appropriate response. These conversations are happening millions of times a day, without us knowing, and they are super-fast. However, just like learned breathing techniques, we can develop the skills to actively listen to the body’s touch sensations inside and out, to teach us how to move better or deal with stress. We can tune in.

From a movement perspective, activities such as Pilates, yoga, tai chi, and dance are all great ways to reach that end goal. I can add my own movement technique, INSKN; informing the body and the brain, through touch sensations. Whilst most of the body’s sensory input occurs at a subconscious level, this particular piece of apparatus and its use helps bring heightened awareness to the conscious mind through resistance and proprioception. All these movement modalities are associated with touch, through sensory receptors located in the skin, fascia, muscles, joints and internal organs. Those receptors respond to weight load; pressure, force and resistance. They respond to stretch; positively, as in yawning, or expanding the body’s framework or negatively as in ‘if you go any further you are likely to rupture something!’ Pain is felt to protect the body from further injury or to help in rehabilitation.

Vibrations are felt through rhythms, aiding the release of serotonin, the feel-good hormone. The body needs a corset-like tension to enable movement in day-to-day life and to keep all the internal organs in the right place.

Proprioception is learned through feedback from our sense of touch. External tactile responses of the skin contact with the ground and consequent reactions from long chains of internal muscle contractions and millions of sensory nerves of the fascial system, allow the body to ‘know’ where it is in space. Proprioception is practised in those aforementioned movement modalities above and is vital to wellbeing. We would be constantly banging into things without it. We would not be able to give or receive that appropriate hug, with the appropriate meaningful amount of squeeze. We would not be able to judge our own, and others’, sense of space, and the majorettes would be in a terrible mess! Importantly, knowing how we stand and how we present ourselves depends on it.

The message I want to teach is to listen to your own body and bring more attention to feelings of touch. We can tune in for better physical and mental wellbeing when we move with this in mind. Done well, we improve on every level. We understand more how movements should be executed. We bring conscious thought to our space, shape and the effort and force we need. We are poorer without the sense of staying connected.

There are other techniques to address touch deprivation and make us feel better, these include; acupuncture, massage, weighted blankets and those best of human companions, our pets (except perhaps the goldfish!). My dog has been part of the inspiration to develop my INSKN technique. Her sense of proprioception must be innate – she does not look at her feet all the time, her back legs follow where her front legs have been and she ‘knows’ where she is in time and space. Dogs always stretch and they get a good feeling when they roll – something we empathically understand when observed. That’s another interesting thing about touch, even when we are not participating, we know it ‘feels’ good!

Moving better, aside, and to argue my case for our greatest sense of all, touch teaches us how to love, how to be loved and bond with others. In very simplistic terms, this is all we crave as human beings – to be loved and to belong. So please do stay in touch!