Recognizing Abuse and Neglect in Equine Patients

According to the American Horse Council statistics from 2005, approximately 9.2 million horses live in the United States. During the past decade, equine welfare has come to the forefront as one of the most important issues facing the equine industry.

What Is Equine Welfare?

Defining what constitutes acceptable welfare practice continues to be an evolving process that has yet to be conclusively agreed on among investigators.¹⁷ Previous to the past decade, the emphasis focused on food animal confinement systems, with the improvements in welfare correlating positively with increased production. The modern concept of welfare attempts to merge scientific knowledge with the emotional state or “experience,” which has led to a greater emphasis on quality- of-life assessments.¹⁸ Evaluating the health and welfare of horses can be a complex undertaking when one considers the number of contradictory ideas and opinions relating to husbandry and training practices.

As first responders, veterinarians are in the best position to not only recognize health issues that may be due to or affected by these practices but also educate clients who may be unaware of the harm they cause. To protect the welfare of horses, veterinarians must be equipped to recognize features that define abuse and neglect in patients. Unfortunately, social, moral, ethical, religious, and philosophical views affect how individuals, including veterinarians, approach the welfare of animals and ultimately react. Opinions vary widely as to exactly what constitutes “neglect” and “abuse,” and the sheer complexity of defining and quantifying the less tangible elements that affect a horse's welfare, such as pain, depression, and anxiety, is immense when attempting to construct a “one-size-fits-all” paradigm. As a result, developing universally agreed-on guidelines that accurately identify welfare cases in a way that protects all horses is not straightforward. In acting as the “voice” for the horse, clinicians are placed in a precarious and challenging position by these issues. The veterinarian is obligated to put the best interests of horses front and center but, to do so, must reconcile in his or her own mind what parameters will be used to identify cases of neglect or abuse. Unfortunately, few veterinary school curricula include courses dedicated solely to issues of animal welfare and behavior, which can be particularly challenging for new graduates who will be expected to recognize differing degrees of abuse or neglect and respond appropriately.

Spotting Cruelty or Neglect

Millions of horses and donkeys around the world live in the poorest, most underdeveloped countries, where their primary use is work related—transporting goods or working in factories, on farms, or as the sole source of transportation for their owners. Veterinary care and education in animal husbandry practices are often lacking or nonexistent, and sources of quality forage in many areas further affect general health and survival. Signs of abuse and neglect are usually obvious to even the untrained eye, as evidenced by open wounds, chronic sores, overt lameness, and a skeletal appearance. In a study by Pritchard and colleagues,²¹ which examined nearly 5000 working donkeys, horses, and mules residing in Afghanistan, Egypt, India, Jordan, and Pakistan, 70% had a body condition score of 2 or less (scale of 1 to 5), and nearly 90% of the 2071 horses examined had obvious lameness or gait abnormalities, associated with limb and/or hoof deformities.

In contrast, horses residing in modern, industrialized nations such as the United States are, for the most part, considered companion animals. Depending on the circumstance, individuals with little or no knowledge of horses can recognize cases of abuse or neglect, yet signs often may be vague or equivocal, enough to escape detection by experienced horsemen and equine veterinarians. At first glance, such horses may appear well fed, well groomed, properly housed, and cared for with no obvious signs; however, closer inspection may uncover evidence of behavioral (e.g., stereotypic behaviors) or physical mistreatment, such as healed pastern scars from a previous “soring.” Even on commercially successful or well-managed farms that provide high-quality feeds, pasture, grooming, and regular veterinary care, owners or trainers may employ psy­chologically damaging or physically painful or abusive proce­dures and training techniques aimed at enhancing the horse's performance. Veterinarians should be cognizant of subtle signs of inhumane treatment in these environments that may escalate over time to negatively affect the horse's health and quality of life.

UNEQUIVOCAL CRUELTY OR NEGLECT. All practicing vet­erinarians will likely be confronted with some form of cruelty or neglect during their careers. Aside from being exposed to these issues in their own practices, veterinarians may be invited to render second opinions or act as agents for humane organiza­tions or local authorities investigating cases of welfare. In the latter case, a veterinarian may act as both caregiver and advocate for the horses in question. The decision regarding when to intervene with clients may be complicated by several obstacles, including the relationship with the owner or trainer, the veterinarian's employment status, and personal convictions. Depending on the magnitude of the abuse or neglect, sharing concerns with and providing a plan to owners must be carefully thought out to prevent embarrassment or alienation. After showing empathy for the horse and owner, most clients are willing to be compliant and eager to share the responsibility of improving the situation. To provide the best plan of action, it is imperative that practitioners show flexibility and under­standing regarding the owner's particular situation. In cases where a veterinarian is merely an employee without ownership in the practice, a practice manager or owner may attempt to pressure a colleague against proceeding with a welfare claim for more practical reasons such as the loss of an influential client or one who may contribute significantly to the financial interests of the practice. In certain cases, state or local laws and ordinances may apply, and it is the veterinarian's responsibil­ity to be aware of such statutes, to not only protect his or her own interests but also remain in compliance. The American Veterinary Medical Association Model Veterinary Practice Act²² guarantees immunity from liability in welfare cases, and most state and local laws ensure the protection of veterinarians who report cases of neglect or cruelty in good faith. In either case, evidence including accurate medical records, diagnostic tests, and photographic documentation is necessary to support a case of abuse and protect the veterinarian against liability claims.

Beyond an intensive physical examination and body condition assessment, additional diagnostic tests may be warranted and serve to support claims of subclinical, clinical, chronic, or terminal diseases such as gastric ulceration, pituitary pars intermedia dysfunction (PPID), laminitis, and neoplasia, respectively. The minimum database includes a complete blood count, chemistry profile, and fecal analysis. Several body condition scoring systems have been developed to determine body condition in horses and donkeys.²³ All are comparatively

■ BOX 2.2

Body Condition Scoring^a,b

1— POOR. Extremely emaciated. Spinous processes, ribs, tailhead, Hipjoints, and lower pelvic bones project promi­nently; bone in withers, shoulders, and neck are easily noticed. No fatty tissue can be felt.

2— VERY THIN. Emaciated. Slight fat covers base of spinous processes; transverse processes of lumbar vertebrae feel rounded. Spinous processes, ribs, tailhead, Nupjoints, and lower pelvic bones are prominent. Withers, shoulders, and neck structure faintly discernable.

3— THIN. Fat buildup about halfway on spinous processes. Transverse processes cannot be felt. Slight fat covers ribs. Spinous processes and ribs easily discernable; tailhead prominent but individual vertebrae cannot be identified visually. Hip joints appear rounded but easily discernable; lower pelvic bones not distinguishable. Withers, shoulders, and neck accentuated.

4— MODERATELY THIN. Slight ridge along back. Faint outline of ribs discernable. Tailhead prominence depends on con­formation, but fat can be felt around it. Hip joints not discern­able. Withers, shoulders, and neck not obviously thin.

5— MODERATE. Back is flat; ribs easily felt but not visually distinguishable. Fat around tailhead feels a bit spongy. Withers round over spinous processes; shoulders and neck blend smoothly into body.

6— MODERATELY FLESHY May have slight crease down back. Fat over ribs spongy; fat around tailhead soft. Small fat deposits behind shoulders and along sides of neck and withers.

7— FLESHY. Might have slight crease down back. Individual ribs can be felt, but noticeable filling between ribs with fat. Fat around tailhead soft; fat deposited along withers, behind shoulders, and along neck.

8— FAT. Crease down back. Difficult to feel ribs. Fat around tailhead very soft; area along withers filled with fat. Area behind shoulder filled with fat; noticeable thickening of neck. Fat deposited along inner thighs.

9— EXTREMELY FAT. Obvious crease down back. Patchy fat appears over ribs. Bulging fat around tailhead, along withers, behind shoulders, and along neck. Fat along inner thighs may rub together Flank filled with fat.

^aBody condition scoring: Body condition influences everything in your horse's life, from reproductive efficiency, to performance, to good health. By using Body Condition Scoring you can find out what kind of shape your horse is in and work to improve the score. Scoring focuses on critical areas of the body, based on palpable fat and visual appearance.

^bIdeal scores: Most horses, including performance horses and growing horses, should be in a body score of 5 to 6. For optimum reproductive efficiency, broodmares should be a 5 to 7 and not allowed to lose condition such that they are below a 5 during breeding season. Horses over a condition score of 7 may be at greater risk for developing metabolic disorders such as insulin resistance.

Reprinted with permission: © 2014 Purina Animal Nutrition, LLC.

similar for horses but vary enough in the scoring number and description that all clinicians in a practice should agree to use the same numeric system to avoid any ambiguity that may occur with an already subjective assessment. Box 2.2 illustrates an example of a nine-point scoring system for horses. Because donkeys accumulate fat preferentially over localized areas, scoring systems developed for horses should not be used to assess body condition in donkeys and mules.²⁴ The Donkey Sanctuary (www.thedonkeysanctuary.org.uk) has developed a body condition score chart specifically for donkeys.

IMPACT OF HUSBANDRY ON WELL-BEING AND BEHAV­IOR. Regional (rural Western states vs. Eastern cities), cultural (Amish), political (animal rights activists), and religious dif­ferences strongly affect how societies and individuals view the treatment of horses and other animals. Husbandry practices vary widely and are also affected by location, property size, financial commitment, and an individual’s personal background and exposure. Irregularities can affect the health and behavior of horses, leading to boredom, stall vices, training problems, and stereotypic behaviors. Problems usually result from misguided information or anthropomorphism, as most owners love their horses and do not set out to cause them harm. Paradoxically, veterinarians are often confronted with overzeal- ous or ignorant owners who “over-care” for their horses and unnecessarily keep them covered in heavy blankets and hoods, ill-fitting tail sets, and tight leg bandages or with well-meaning owners who simply overfeed and oversupplement their horses. These benign-appearing practices may seem harmless but should be monitored by the veterinarian because they can affect the horse’s behavior, health, and well-being and can lead to systemic disease such as laminitis secondary to obesity, localized disease (bacterial/fungal skin infections, blanket sores), and physical discomfort (overheating, pruritus).

The natural environment from which horses have evolved is one of vast, uninterrupted space, nearly continuous grazing or food-seeking behavior, and close affiliation and bonding with herdmates. As prey, they have learned to be acutely sensitive to changes in their environment and to respond quickly, usually with avoidance or flight. What owners may assume to be disobedience or spookiness is merely a form of self-preservation. Stereotypic behaviors such as wood chewing, cribbing, weaving, pawing, stall walking, and self-mutilation are seen most often when horses are kept in confinement, though once manifested, many horses will continue the behavior to some degree even when turned out in a paddock or pasture. Facial abrasions (weaving), open wounds (self-mutilation), worn teeth (cribbing), orthopedic injury (repetitive turning), and bleeding hooves

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(weaving)²⁵ can occur secondarily as a result of these stereotypies. Several causes for these behaviors have been cited, including a diet low in fiber or nutrients²⁶ and solitary confinement and stress.²⁷ Impediments (muzzles, cribbing straps, head ties) imposed to prevent these behaviors can be painful or injurious and lead to greater frustration and anxiety, further affecting the horse’s welfare and mental well-being.^26,27 Many owners and trainers believe that other horses can “learn” these ste­reotypic behaviors from stablemates, so they will often sequester horses with these behaviors, further compounding their anxiety and stress. Often the horse is brought directly to the veterinarian from a stall or paddock for examination, so unless previously disclosed by the owner or witnessed by the clinician, the veterinarian may be unaware that the horse possesses an undesirable behavior. In fact, under certain circumstances (e.g., prepurchase inspection), such information may be intentionally withheld from the clinician in the fear that it will be passed on to potential buyers and affect the value or sale of the horse.

Modern feeding practices such as time grazing, forage and concentrate selection, quantities fed, and feeding intervals are not in line with the horse’s natural behavioral and gastrointestinal requirements. Ideally, horses kept in confinement should have access to pasture or turnout for extended periods and be allowed to socially interact with other horses, as this has been shown to reduce stress^26-28 and behavioral problems,^26-31 improve musculoskeletal health,^30,32 reduce the occurrence of gastric ulceration²⁹ and certain types of colic,³¹, and improve quality of life.¹⁸

Patients suffering from chronic diseases such as recurrent airway obstruction (“heaves”), advanced PPID, or uncontrolled laminitis should be closely monitored, and every effort should be made to maintain a continuing dialogue with the horse’s owner/trainer regarding effects of treatment and quality-of-life issues and to discuss euthanasia when appropriate. Further, clients should be made aware of the costs involved in maintain­ing chronically ill horses and the likelihood that such costs may be necessary for an extended period or possibly for the life of the patient. The subject of euthanasia is never an easy one but is necessary to discuss under certain circumstances.

WELFARE AND TRAINING PRACTICES. Not every horse has the talent or mentality to excel at the discipline the owner has chosen, but many owners are unable to make this determination or refuse to accept such reality and will search for “shortcuts” designed to force the horse to succeed. Countless methods, training devices, and frightening contraptions have been developed over centuries to teach certain disciplines. Tying a horse’s head in a fixed position for extended periods³⁴ and the use of severe bits, electric shock prods, and topical blisters are examples seen in modern training barns. In addition, surgical cosmetic alterations, systemic drugs or topical irritants, silicone injections, and alcohol tail blocks may be used in some breeds to enhance certain physical “breed” characteristics or change the horses’ conformation to fit a show ring ideal. Physical and in some cases psychological effects resulting from such abusive practices can confound physical examination findings and delay diagnosis and timely intervention. This may be of particular concern for someone hired as an official horse show veterinarian who is inexperienced or unfamiliar with training practices related to a particular breed or discipline and is presented with an affected horse on emergency. For example, the ideal Western pleasure horse should carry the head and neck in a low, fixed, relaxed position while performing required gaits in the show ring. To maintain this unnatural head position³⁵ for the duration of the class, trainers suspend or “hang” the horse’s head high above the withers for hours before the entered class. As a result, the neck muscles of these horses become fatigued and sore to the point that they will refuse to lift their heads above a horizontal plane, appearing compliant and well disciplined during the class. Clever pharmaceutical intervention is also used by some to affect the horse’s vision, particularly in an indoor show ring. Ophthalmic atropine is used occasionally in English show horses to alter the gait, the head and neck carriage, and how they “look” through the bridle. The resulting mydriasis can last for days to weeks.³⁶ Depending on the present­ing complaint, it is clear from only two isolated examples how secondary signs from undisclosed intervention may lead to confusion on initial physical examination.

Owners frequently seek the advice of veterinarians for problems related to training and behavior, and clinicians should recognize the responsibility of such recommendations and not make them unless confident in their abilities. Aside from previously discussed stereotypies, most problems manifest as fear²⁵ (avoidance) or aggression expressed as ear pinning, rearing, bucking, bolting, biting, and kicking. Fear and aggressive responses are unpredictable and of particular concern for the veterinarian or staff that may be inadvertently exposed to injury when the owner or handler is inexperienced or afraid of the horse. Conversely, accidental injury of the horse or owner as a result of a confrontation may lead to liability claims against the veterinarian. These actions by the horse can be a result of pain associated with disease or abuse, evasion of a painful impulse such as a misdirected snap of a shank chain, or a learned behavior. The owner’s attempt at behavior modification often involves doing nothing, applying positive reinforcement for the behavior, or wielding some form of punishment, which tends to make the problems worse and the horse even more anxious and unpredictable. A veterinarian should gain a feel for the experience and competency of clients and become adept at determining when such behaviors result from poor manage­ment by owners or if a physical problem or injury exists and may be causing the response. If the practitioner is uncomfortable giving advice, suitable professionals should be recommended to the owner for help in determining the underlying motivation for the behavior.^25,26 If not remedied, the horse or owner may be exposed to serious injury and the horse may be exposed to escalated physical abuse by a frustrated or fearful owner or passed on to an innocent party that is unaware of the possible dangers.

Musculoskeletal disease and lameness are common client complaints in equine practice. Numerous elements can con­tribute to lameness, including misadventure, overexertion, inappropriate footing, poor conditioning, abusive or inappropri­ate training techniques, lunging, poor riding skills, poor hoof care, and improper shoeing. These elements should always be evaluated when attempting to determine the cause of an injury or change in temperament. Poorly fitting tack, unbalanced or heavy-handed riders, and inappropriate use of training aids (spurs or whips) can result in avoidance or physical damage to the horse. To make a complete assessment, it is often advantageous to observe the horse under tack to determine what factors may be causing or contributing to musculoskeletal or behavior issues. Unsuccessfully managed lameness can result in chronic pain, spread to other areas such as the back,³⁰ and limit the horse's value and potential welfare. Practitioners should stress the importance of rest and rehabilitation after injury and carefully monitor the client's use and potential abuse of antiinflammatory drugs, over-the-counter medications, and supplements.