WHOLE-HORSE APPROACH: Advances in veterinary diagnostics and treatments are helping sport horses to live healthier and more comfortable lives. Veterinarian Mark Donaldson (center) uses endoscopy to check a horse for gastric ulcers. Photo by Jennifer Bryant

Advice from a US Equestrian Team veterinarian

 Reprinted from the June 2016 Issue of USDF Connection

By Jennifer O. Bryant

We dressage enthusiasts like to call our sport “classical,” as if it were a relic of an ancient time. In fact the sport, and its equine athletes, have evolved tremendously. Along with changes in sport-horse breeding have come advances in veterinary care and research breakthroughs, which have had profound effects on the way we care for our horses. US Equestrian Team veterinarian Richard D. Mitchell, DVM, MRCVS, Diplomate ACVSMR, has seen many changes in his 25 years of traveling with Olympic and World Equestrian Games teams. (Learn more about him in “Heads Up: Behind the Scenes,” May).

At the 2015 Adequan/USDF Annual Convention in Las Vegas, Mitchell brought audiences up to speed on the latest thinking with his session on “Maintenance Care of the Competitive Sport Horse.” Here are highlights of his presentation.


“Horses evolved to eat for 20 out of 24 hours a day,” Mitchell said. Many modern horses don’t get that opportunity; and restricted access to forage, diets high in concentrates, and the stresses of travel and competition contribute to the proliferation of equine gastric-ulcer syndrome, or EGUS, he said.

 If possible, give multiple small meals throughout the day instead of feeding just twice a day, Mitchell advised. When a horse eats he produces saliva, which contains bicarbonate, an acid reducer. Bicarbonate—the same active ingredient as in Alka-Seltzer—helps to counteract the acids that the horse’s stomach constantly produces, regardless of whether food is present. Th e ulcer-prone horse may also benefit from more alkaline feedstuff s, such as alfalfa or other legume hays, which help to control acid levels, he said.

Any horse in heavy work needs a lot of fuel, but diff rent breeds have different needs, Mitchell said. “Warmbloods and Quarter Horses have different requirements as compared to young Thoroughbreds. Th ere is often the need for adequate calories without excessive carbohydrates” because the heavier breeds may be predisposed to muscular disorders such as polysaccharide storage myopathy (PSSM) and to metabolic disorders, he said. The modern sport horse tends to do well on a feed that’s moderate in protein (around 12 percent) and with higher amounts of fat (9-12 percent) and fiber (around 18 percent), combined with good-quality hay and pasture.

Vaccines and Maintenance Care

If you compete in dressage, you probably are aware that the US Equestrian Federation (USEF) has instituted a new vaccination requirement for horses at USEF-licensed shows. Per USEF GR 845, horses must be vaccinated for equine influenza and equine herpes virus, aka rhinopneumonitis (“fl u/rhino”) within six months of the competition. Mitchell’s own recommendation for the competition horse is to administer fl u/rhino booster vaccines every four months. And “all horses need a tetanus shot,” he said.

Many dressage riders worry about the state of their horses’ joints. According to Mitchell, “Slow, progressive conditioning is the best way to prevent joint disease” and is especially important in the younger horse. Vary training sessions’ intensity and focus. Getting a horse out for exercise more than once a day—an additional session could consist of walking in hand or under saddle, or putting the horse on a treadmill or on an automatic walker—is beneficial to soundness, he has found.

For those horses that require more help in keeping their joints feeling oiled, owners often turn to one of several well-known injectable products. Many veterinarians, Mitchell included, like Adequan. Unfortunately for the horse owner, Adequan is not inexpensive. To try to “stretch” the product, many owners give one dose of Adequan per month. According to Mitchell, this method is ineffective.

“Once a month is silly,” he said. He recommends starting a horse on Adequan using the manufacturer’s recommended loading dose of seven doses, giving one dose every four days; and giving a weekly dose thereafter for maintenance. If that’s out of your budget, then you’re better off giving the full seven-dose series periodically rather than resorting to the once-a-month schedule, he said.

Mitchell will supplement a competition dressage horse’s joint-maintenance regimen with Legend (intravenous hyaluronic acid), he said.

 There is less evidence that oral joint-health nutraceuticals are effective, although one additive, avocado-soy unsaponifiables, has been shown to have an anti-inflammatory effect, Mitchell said.

Nutrition, as Mitchell pointed out, is the first line of defense against equine ulcers. But the stresses of training and competition may mean that the dressage horse needs more help. Prophylactic levels of omeprazole products such as GastroGard and UlcerGard, given daily during stressful times of training and travel, may be useful, he said.

Don’t forget your horse’s teeth; have them checked twice a year, Mitchell recommended. “Some performance issues may be related to dental problems, which can mimic back issues.”

Finally, good foot care is critical. “Foot lameness is probably the number-one problem we see.”

Advances in Diagnostics and Treatment

As diagnostic methods become more sophisticated and accurate, veterinarians are better able to pinpoint the cause of lameness. The down side to this, if you will, is that veterinarians are becoming able to identify lamenesses that in the past we were blissfully unaware of.

Thankfully, treatment methods also have advanced. Today’s sport horses can benefit from shock-wave therapy, stem-cell therapy, administration of platelet-rich plasma (PRP) or interleukin-1 receptor antagonist protein (IRAP), and other cutting-edge methods. Mitchell said he’s been using “more and more” of a newer PRP/IRAP product, Pro- Stride, that’s unique in that it’s “horse-side” (the equipment is portable, so the horse does not have to travel to a clinic) and ready for use in 30 minutes, unlike traditional PRP and IRAP therapies, which either aren’t portable or require a more lengthy incubation time.

PRP and other regenerative techniques, Mitchell said, “reduce convalescent time only slightly, but they can improve the quality of healing.”

Another newer product Mitchell mentioned is BetaVet (betamethasone), a corticosteroid injected intra-articularly (into the joint) for the treatment of equine osteoarthritis. Other arthritis treatments called bisphosphonates (brand names: Osphos and Tildren) are used to help retard bone loss. Mitchell said he has had some success using bisphosphonates along with shock-wave therapy in cases of degenerative arthritis that no longer respond to injectable therapies. Lyme-disease testing remains part of Mitchell’s maintenance regimen for the horses under his care. He recommended twice-yearly testing.

Treatments for equine ulcers also continue to develop. Veterinarians now know that “a horse can have hindgut ulcers and not stomach ulcers. Horses with hindgut ulcers typically—but not always—also have chronic diarrhea.”

 For treating ulcers, misoprostol, a synthetic prostaglandin, “in smaller doses stimulates the enzymes that make gut mucous,” which protects against acids. A product called Arthrotec is a combination of misoprostol and diclofenac, a nonsteroidal anti-infl ammatory drug (NSAID), and currently it’s used in human medicine to treat arthritis pain in patients prone to NSAID-induced ulcers. The digestive-health product Succeed “has some benefit.” Probiotics may play a role, as may “changing the horse’s diet to something really basic: hay and crimped oats.”

Beyond Competition

Although Mitchell is a veterinarian who has spent much of his career treating top competition horses, he said his philosophy doesn’t revolve around the winning of ribbons and medals.

“I don’t believe in just trying to get the horse to the ring,” he said. “I believe in trying to help the welfare of the horse.”

Jennifer Bryant is the editor of USDF Connection.  

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