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“I think people don't necessarily understand what they're using and why,” Dr. Emmanuelle Van Erck Westergren tells WoSJ about the use of medication when treating horses. “While some vets seem to encourage consumption of medication, I think that each time you are going to use any substance, you should have an open and honest discussion: Why are we doing this, for how long and what are the secondary effects?”

In this article, Van Erck Westergren – the president of the Belgian Equine Practitioner Society (BEPS) and founder of the Equine Sports Medicine Practice – shares her views about the most common misconceptions when it comes to medication, the importance of understanding what our horses are trying to tell us and why a more targeted approach to treating horses is needed. 

“It's very important to be aware of all the possible secondary effects, because you might be doing something counterproductive without realising it,” Van Erck Westergren points out. “You can create a secondary problem without being aware of it being linked to the use of medication. As an example, if you use cortisone – which is a great and a very potent anti-inflammatory drug and required for some horses – you are going to depress the immune system. That's the way cortisone works, but in a period where your horse is in intense training and travels, you are actually creating a window of risk for infections by using this drug. If a horse gets an infection and a cough after using cortisone, I don't think many people are going to link the two. However, these are facts have been published scientifically.” 

Antibiotics should be reserved for horses that have a bacterial infection which actually requires an antibiotic, meaning an infection that is out of control. “Using antibiotics when your horse has a small cough or a little bit of fever after shipping – in a “preventative” way – can be problematic,” Van Erck Westergren explains. “The more you're going to treat with antibiotics, the more resistances are created. In the worst case, you're going to end up with a horse that cannot be treated because the bacteria in its body are so resistant that you've got no options left. Overmedication, especially with antibiotics, is a really bad idea. It isn’t problematic only for horses; it's a global health issue for everyone, including humans and other animals. The use of antibiotics must be limited to the necessary conditions that require them.” 

When it comes to anti-inflammatory medication, which is necessary to control pain, it is important to keep in mind that the horse should always feel comfortable. “Anti-inflammatory medication might be required if a horse is injured,” Van Erck Westergren says. “However, pain is a signal from the body to show that there is a problem. If you mask that by using anti-inflammatory medication too often or in too high doses, you are more likely to work a horse on an injured tissue. This can lead to more dramatic consequences; a horse can sustain more serious injuries if the original warning signs are ignored. If you have an older horse with known diagnosed underlying issues, anti-inflammatory substances can be needed for the well-being of the horse. However, using them blindly and systematically, you will cause secondary problems that you might not be aware of immediately.” 

The use of antibiotics must be limited to the necessary conditions that require them

“Any anti-inflammatory that you use has secondary effects,” she continues. “As an example, anti-inflammatory substances can cause issues in the digestive tract. Horses can develop gastric ulcers, which are going to be painful in another way. Gastric disease, as any cause of internal pain, translate into changes in behaviour, which can be more difficult for riders to pick up than lameness.” 

“If your horse needs constant intra-articular treatment, you should have an honest discussion about what exactly is going on and if the horse should be working at all,” Van Erck Westergren points out about another issue when it comes to medication and treating horses. “Maybe that individual would benefit from an off period with other types of rehabilitation treatments instead. It's not that treating joints is harmful as such, but if you are doing it systematically and continuously, you might need to review other issues, such as the shoeing or the tack – or even your own riding.”

“Combining anti-inflammatory substances with omeprazole is counterproductive for several reasons,” Van Erck Westergren points out about another common misconception that can have fatal consequences. “When used in combination with phenylbutazone, omeprazole can create ulcers in the colon. This can cause colic on the long-term. You might not link the colic with the fact that you've used these medications because there is a certain delay in between the use and the onset of the colic symptoms. Horses' digestive systems need the acids of the stomach to deal with phenylbutazone, and feeding omeprazole – which lowers the acidity – at the same time is the worst thing you can do.” 

If your horse feels a little bit uncomfortable when you put leg on or is girthy, don’t take a shortcut by using omeprazole without doing a thorough check-up

“The other problem with omeprazole is the rebound effect it has,” Van Erck Westergren continues. “Omeprazole stops the production of acid in the stomach, but once you stop using it, the rebound effect causes the stomach to compensate and over-produce acid. This can create glandular disease in the second part of the stomach, which can be even more painful than the gastric ulcers that you were treating in the first place. Therefore, overusing omeprazole is not a good idea either. If your horse feels a little bit uncomfortable when you put leg on or is girthy, don’t take a shortcut by using omeprazole without doing a thorough check-up. You might be doing your horse a disservice because if he's got ulcers in the second, glandular part of the stomach, you are going to worsen his condition.” 

“People want to have a quick fix,” she says. “It might seem like a good idea to just do a treatment and see how your horse responds to it without first doing a proper check-up. However, because all medications have secondary effects, you can actually worsen a condition or an underlying issue by doing so. If you have an underlying lameness and the source is a recurring problem that has been identified and diagnosed, you should discuss the best options to maintain it comfortably with your vet. However, there are more and more alternative treatments like physiotherapy, chiropractic, massage and acupuncture. These alternative treatments can be just as good, if not better, than medication because you're not creating secondary issues.”

For sport horses with intense training and busy competition schedules, adequate rest is essential. “Systematic medication should not be the first option,” Van Erck Westergren points out. “First of all, before reaching to any medication, you should let the horse rest the time it's required to rest. Secondly, take an objective look at the management around your horse, from his diet and environment to his shoeing and tack. All these details are going to make your horse more comfortable.” 

Before reaching to any medication, you should let the horse rest the time it's required to rest

“Active rest allows horses to move freely without having a saddle on their back; in the paddock or on the lunge. They can go out for a hack, as long as they do something that is different to their usual workload so that they are not overusing the same muscles and articulations over and over again. Even while resting, you should be maintaining some movement because we're talking about horses, and movement is important for these animals. On a rest day, horses should move in a way that does not overstrain them but helps the recovery of the muscles.”

“It's a question of responsibility towards the horse,” Van Erck Westergren answers when asked where the line should be drawn between treating and not. “Sport horses can have really long careers if they're well managed. Every horse has their own individual strengths and weaknesses, but having a good, honest discussion with your vet is important. We can use technology as an aid, but it doesn't replace the trainer’s eye, the rider’s feeling or the vet’s experience. And if you're repeatedly treating the same things over and over again without any results, maybe it's a good idea to have a different pair of eyes look at the horse or take a different approach. Some horses, like some people, require more attention than others and it would be malpractice and irresponsible to deny a treatment that is needed. However, each time a horse gets a treatment, we have to question why it's getting it. The current equine anti-doping regulations are a safeguard against overuse of medication and sometimes those limits force people to realise that a horse actually might need a break more than anything else.” 

Each time a horse gets a treatment, we have to question why it's getting it

“There is a direct link between the intensity and the repeatability of work and injury,” Van Erck Westergren says about the number of international competitions in jumping – the highest in all of the equestrian disciplines. “I think it is the responsibility of the organisers to limit the number of times a single horse can compete over a given period of time. To ensure that horses are left with enough time to recover in between competitions and that they are not overused, maybe there should be a limit on the number of competitions a single horse can enter annually.”   

“I don't think that we have excuses to overlook what is being published,” Van Erck Westergren concludes about the need of continual education. “There are loads of science published on a monthly basis. It's important to stay tuned to what's coming out, especially as a vet. Science evolves, medicine for humans evolves, but it's the same for horses. As an example, doing joint injections with cortisone was what we did 30 years ago. Now we've got orthobiologics, which are much more respectful of the tissue and have less consequences.” 

We have to get better at listening to the horses and learning their language

“We have to go back to basics and learn how to read horses,” Van Erck Westergren points out. “If we don't see anything on a horse trotting back and forth, then we need to look at them under the saddle. You can get valuable information by looking at horses being ridden because you see the horse in the way that it's supposed to be working and competing. You can also see the interaction with the rider, which should not be undermined. Sometimes, the problem does not lay with the horse but in the rider. We have to get better at listening to the horses and learning their language. There are scales of pain that have been published and I think it's very important for people to learn how to read those changes in facial expressions or behaviors that express pain. We're not very good at it, because horses can have up to 80 different changes in their face that indicate that they're in pain.” 

“We don't have any excuses of being incapable of looking at a horse in a very objective way,” Van Erck Westergren concludes. “We've got tools that can help us do it and we should use the technology that is out there. We should choose to treat with a more targeted approach rather than just treating the whole horse without finding the actual problem. In the long run, overuse of medication can have significant consequences and it is a very archaic way of doing things.” 

*Dr Emmanuelle Van Erck Westergren is the president of the Belgian Equine Practitioner Society (BEPS).  She graduated from the Ecole Nationale Vétérinaire de Maison Alfort (France) and did a PhD on respiratory functional tests in horses at the University of Liege (Belgium). She is a diplomate of the European College of Equine Internal Medicine (ECEIM) and the European College of Veterinary Sports Medicine and Rehabilitation (ECVSMR). Emmanuelle founded her specialized referral practice, the Equine Sports Medicine Practice based in Belgium and consults internationally.

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