The presentation of horses and ponies in thin or emaciated states is highly emotive. However, extreme loss of body condition may arise as a result of malnutrition, whether through neglect, ignorance or circumstance, focal (e.g., dental disease, dysphagia) or systemic disease (e.g., lymphosarcoma, granulomatous enteritis, parasitism), as a consequence of old age or in feral animals, as a result of lack of available feed.
Before treatment options and prognoses can be made, each case must be individually considered. For emaciated animals, establishing a realistic prognosis for recovery should be the priority. This should be based on :
- The duration and rate of body condition loss and / or recumbency.
- The extent and treatment prognosis of any underlying disease.
- Financial, practical and time constraints
Chronic starvation and the shift to catabolic metabolism can result in:
- Decreased metabolic rate
- Decreased body condition;
- Decreased immune status; increased parasite load and systemic disease
- Gastric ulceration
- Cold intolerance
Once a decision for rehabilitation has been taken, early care should include moving the horse to a secure, sheltered and deeply bedded area to promote comfort. These severely debilitated horses may spend significant proportions of the day laying down – a mechanism which promotes energy conservation but may cause pressure sores. Topical dressings should be used as appropriate.
A full clinical evaluation should be undertaken by a veterinarian to identify any concurrent disease, develop a nutrition plan, and to provide a baseline against which progress can be monitored. Our initial exam includes a full physical exam, initial body condition scoring, lameness assessment, dental exam and fecal worm egg count (see below). We will also guide you in nutritional management of your rescue horse including a full diet plan tailored to your individual animal. Nutritional management is extremely important, especially in the early stages. Over-exuberrant feeding can lead to the fatal re-feeding syndrome (see below). Depending on the case, we will also recommend blood samples be collected to permit full hematological analysis, characterization of blood electrolyte concentrations, accurate assessment of hydration status, kidney and liver function, and gut absorptive capacity.
Parasites burdens may be large and complex. Counterintuitively, the early use of broad-spectrum dewormers should be avoided. Aggressive treatment may result in colic, extensive mucosal damage and even death (Cheever 2004). Treatment should be used guardedly and only initiated when appetite has been regained and animals begin to show modest weight gain. Fecal worm egg counts should be performed to determine the parasite egg shedding status of the horse when first brought into care. We will also guide you as to what dewormers can be safely used and when to use them.
KEY POINTS :
• Ensure physical and thermal comfort.
• Rehydrate if necessary.
• Identify and address concurrent disease.
• Delay deworming therapy until appetite is restored and initial fecal egg count is performed.
• Beware of Refeeding Syndrome!
People and animals in extreme states of emaciation are at high risk of succumbing to the fatal, “refeeding syndrome”. This is a major factor contributing to the high mortality rates during rehabilitation of severely malnourished animals. This syndrome was first described for the human survivors of prison camps during the WWII.
In chronic starvation, the body’s dependency on glucose as an energy source has been minimized due to lack of food. People and animals in this state become very sensitized to the effects of insulin. With the abrupt reintroduction of “high glycemic” diets, such as the carbohydrate laden, grain-based feeds for horses, a profound and potentially fatal increase in blood insulin occurs (Tresley & Sheean 2008). This massive spike in insulin abruptly shifts the horse’s metabolism from one of fat and protein breakdown, back to using carbohydrates for energy. As the body struggles to regulate the unaccustomed increase in blood glucose, water and sodium are retained. This large volume expansion causes widespread tissue edema, which further exacerbates respiratory and cardiac distress. Death from refeeding syndrome usually occurs within 1-9 days (Witham & Stull 1998).
On the first day, priority must be given to restoring hydration status (Kronfeld 1993). Where animals will drink willingly, frequent (every 20–30 minutes), small (2–3 liters) drinks should be offered until the animal no longer drinks greedily, from which point water may be offered freely.
Lucerne hay has been used to good effect as an initial feed. Compared to other hay, lucerne has increased concentrations of digestible energy, protein and minerals which decreases the quantities which must be eaten to achieve target nutrient intakes. Where lucerne is not available, rhodes grass or low sugar meadow hay could be used in conjunction with the slow introduction of a low energy, ration balancer meal to bolster protein, vitamin and mineral intake. Horses that remain stable during the initial regime can gradually be introduced a balanced horse pellet, fed in small meals (3-4 x day). Some authors suggest that once horses are consuming consistent intakes of forages and have established good patterns of manure production, the diet can be supplemented with protein in the form of linseed meal or soyabean meal (soyabean meal has a higher % of lysine – an essential amino acid). However, we only recommend increasing protein intake in horses in which kidney and liver function has been tested and returned normal.
Initially (~3 days), lucerne or good quality grass hay should be offered as small meals, evenly spread throughout the day (in 6 meals, every 4 hours) in quantities not exceeding 75% of estimated daily requirements
Over the following week, forage intake can be gradually increased to 125% of estimated daily requirements
Don’t rush rehabilitation. Start low – go slow!
An initial veterinary examination should also consist of a thorough oral examination. If dental abnormalities exist, they may need to be tackled in stages once the horse has stabilised to prevent more stress on an already compromised animal. However, this does not mean delaying an oral exam. Dental abnormalities could prevent the horse from ingesting sufficient amounts of food and will only halt any progress in their rehabilitation.
Horses which have been neglected are likely long overdue to have their feet trimmed. It’s important to note that these animals may be suffering from underlying arthritis and/or laminitis resulting from improper care. Employ a knowledgeable, patient farrier who understands that rehabbing a rescue horse’s feet will likely need to be done in stages. Aggressive and over-enthusiastic trimming at the initial visit may result in a cripple horse who will struggle to walk, further compounding other issues.
Any new horse should be confined away from the resident herd for a period of 21 days. During this time they should have their temperature monitored and be closely observed for signs of disease. A rescue horse is likely immunocompromised and could be harbouring any number of infectious diseases which may spread to the rest of your herd. They should not be allowed nose-to-nose contact with any other horse on the property during their time in quarantine. Manure should also be picked up from their paddocks daily and composted to prevent the introduction of parasites onto your pasture. Handle these horses last and do not share rugs/brushes or tack between them and your resident herd. If you notice any signs of disease (eg. cough, nasal discharge, neurologic signs), contact your vet immediately.
Successful rehabilitation is a long term commitment. It has been reported that a period of between 6 and 12 months was required for the chronically starved horse in very poor condition and with no other confounding medical conditions, to reach an acceptable weight.
Please contact us on 0427 072 095 if you would like to discuss any questions or concerns with your horse.
Cheever, H., 2004. Equine care in the animal shelter. In: Miller, L., Zawistowski, S. (Eds.), Shelter Medicine for Veterinarians and Staff. Wiley Blackwell, Oxford, pp. 203–208.
Kronfeld, D.S., 1993. Starvation and nutrition of horses: recognition and treatment. Proceedings of the First Conference on Equine Rescue. Santa Barbara, California, USA, 1993. Journal of Equine Veterinary Science 13 (5), 298–303.
Tresley, J., Sheean, P.M., 2008. Refeeding syndrome: recognition is the key to prevention and management. Journal of the American Dietetic Associa- tion 108 (12), 2105–2108.
Witham, C.L., Stull, C.L., 1998. Metabolic responses of chronically starved horses to refeeding with three, isoenergetic diets. Journal of the American Veterinary Medicine Association 212, 691–696.