Hello, and welcome to this webinar for the webinar vet where we're going to discuss horses that present with problematic behaviour and have the conversation about are they in pain or are they just being a pain. And this is really what the topic of equine behavioural medicine is all about, understanding those links. So when a problematic behaviour occurs, how do we know if it's due to pain or if it's a behaviour problem?
This is probably the most common question that I get asked as a specialist in equine behavioural medicine. And I'm going to challenge you today and say you are asking the wrong question. So if that's the wrong question, then what's the right question?
Well, first of all, I think we need to take a step back and we need to ask us what is behaviour? Because everyone knows what behaviour is until we ask them and then they kind of go, oh well, you know, and they get a bit more confused. So let's think about this.
Behaviour is the motor output of sensory input that is modulated by other factors including current mood or emotional state. So let's work through some scenarios and think about how this works in practise. OK, I work as a racecourse veterinary surgeon at Musselburgh, and this was a horse that I attended that pulled up with an SDFT injury.
So the behaviour of the horse, i.e. The motor output that had changed, was lameness.
That told me that there was lame, that there was pain originating from the limb, i.e. The sensory input from the limb, that's altering the weight distribution, and on clinical exam, it's very clear that this horse has a significant tendon injury, although he did go on.
To do absolutely fine. We all recognise. The collective behaviours associated with colic.
And we are all trained to understand that that tells us that there is sensory input from the horse's abdomen, indicating that there is a source of pain within the horse's abdomen. And so we can investigate further to localise and treat that pain. This is a very specific form of booking called proking.
So unlike the kind of head going up and the, you know, kicking out, which can be a rider's leg or a couple of different reasons, but generally when you get this kind of N-shaped book rather than a U-shaped book, it's a bit more of a reflex response and it is associated with some discomfort. Now it doesn't have to be impingement of the dorsal spinal processes, but it tends to be some discomfort associated with the musculoskeletal system. Usually back up Elvis.
But what about this one? This is a harder one for people to get their heads around. So here we have a horse that the motor output, the behaviour is ears back and a threat to bite, there's lots of tension around the muscles of facial expression, particularly around the eye.
So what's the sensory input, and that's the question that we have to ask. We can see what the motor output is, i.e.
The behaviour. So what is the sensory input? And this is where of course it gets a little bit more tricky.
So, first of all, I look at the level of arousal, the energy levels that are involved with this. If it's a low to medium level of arousal, that tells me that there's a very limited stress response, and that could be a habit or a reinforced unwanted behaviour. So that's, they're the really simple ones.
They're the ones that we just retrain the response that we want, because we've accidentally trained the unwanted behaviour in this case. If we have a slightly higher level of arousal, that tells us that it activates the standardised physiological stress response, so there's the two pathways there, the HPA and the SAM pathways. .
And if you try and measure stress kind of physiologically, all it does is tell you that you have a high level of arousal. So what we really need to think about is what is the emotional states that are associated with this. So in this context where we have an aggressive type response, and to be honest with almost all of the contexts that we're really looking at with problematic behaviours, we're really looking at pain, fear, or frustration.
Repulsion is much less common in horses than it would be in dogs, or I guess people, and that is where the horse doesn't want someone else near them just because they don't like them that much. But as social animals, as prey animals, horses have very strong social bonds. So there may be a little bit of this, but between the horses, but I've never been convinced I've seen it between a horse and a human.
If they don't like the human, there's a reason they don't like them. . So we're really looking at pain, which of course is potential tissue damage, fear, is there an escape or avoidance type response or even a a fight type response to, to make the threat go away from them, or frustration.
Have we got thwarted motivation, and the horse can't achieve something that is important to them. So then we start to dig down a little bit deeper to work out what's going on. So we've talked a little bit about what behaviour is, it's the motor output of sensory input.
So what is pain? I'm sure many of us are familiar now with the International Association for the Study of Pain Definition, which is that pain is an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage. So we have all of these different factors that are contributing to pain.
But I just want to think through this a little bit more so they now, as well as the definition, I, I also have, some other factors that they think we should consider. The first one is that pain is always a personal experience. It's influenced to varying degrees by biological, psychological and social factors, and we're gonna come back to this a lot in the treatment.
But a really good example of this is, imagine you jump up and you stub your toe. We all know how much it hurts when you stub your toe. Now imagine that you've just got a message come through on your phone, you've just won the Euromillions, you've won €50 million and you jump up and you stub your toe.
Probably hurts a little bit less. Now imagine that you've just got a message on your phone, and you're due to go away on annual leave, you're going away on holiday somewhere next week, but someone else has said that they've can't work next week and someone else is also can't do it for whatever reason. So not only are you're gonna have to work, but you're gonna have to do all the on-call, and you're gonna have to cancel your holiday, and your partner's gonna kill you, and it's all going to be a disaster.
And you jump up and stub your toe. How much does it hurt then? So we need to remember that pain isn't just related to nose deception, it's also massively influenced by how you feel.
And pain and nociception are different phenomenon. Pain cannot be inferred from activity in the sensory neurons. So again, you know, this is a wound that I dealt with a long time ago.
Clearly this horse needs analgesics. Clearly this is a horse that's going to be painful. But we can't flip that the other way around and say because we can't see much evidence of pain, the horse isn't in pain, and we'll we'll talk through this a bit more.
Throughout their life experience, individuals learn the concept of pain, and it alters how they feel about pain. It also alters their behavioural response, either the motor output to feeling pain. And a person's report of pain should be respected.
Now, obviously, we're talking about horses, we're not talking about people. They can't verbally report it to us. And these are some pictures that I took at Brownham horse trials a couple of years ago.
And I know, I was, I know, in at least 2 of these horses, I was confident that this horse was absolutely fine. And, and then it became stressed, for example, when the clouds started clapping. So, We need to pick up on the fact that horses are often telling us when they're unhappy, but it takes a little bit more digging deeper to work out why they're unhappy.
Whether pain is a component, or whether actually there are other forms of stressor that are involved as well. And pain should serve an adaptive role, but it can have adverse effects on function and social and psychological well-being, particularly if it's more chronic in nature. So this is where we talk about this difference between adaptive versus maladaptive pain.
At high school, we all learned about the kind of reflex arcs and the fact that, you know, if you touch something very hot, then your arm would withdraw even before your brain became aware of it. But your brain was then very aware of it. I'm sure you'll have seen small children touch something hot when they've been told not to do, and then they're crying and they're screaming.
There's not that much damage to their their hand. You know, there's a small burn, but it's not, it's not that bad. But they have a strong emotional experience to it, and that is really adaptive.
Because you can tell them as long as you want, you know, not to touch something hot, but they almost have to do sometimes, to learn that experience for themselves. And so it protects them from. Damaging themselves in the future.
And also, you know, if you have to burn your hand, it's a bit sore, you're a little bit more careful with it, which allows it to heal properly. On the other hand, so yeah, so we've already said this in terms of adaptive pain. But on the other hand, and this was a horse that I, sorry, I put this in for another presentation just to talk a bit more about, how horses are not always great at learning from adaptive pain, but this was a horse that obviously had a significant degloving injury, and then went on to do absolutely fine.
And this horse did then avoid fences more carefully in the future. But let's talk about maladaptive pain. So initially we talked about this as chronic pain.
This is pain that lasts for a long time, and we would traditionally they would talk about chronic pain as being more than 3 months. But now we talk about it as being maladaptive because there's not a distinctive time period that tells us whether this becomes a, a problematic pain response or not. It can be less than 3 months.
What we do know it is it is poorly responsive to analgesics, so this is really important to consider when you're trying to do an analgesic trial with these cases, and it's not self-limiting. So even if the site of the original injury heals, we still have wind up in the spinal cord and in the brain, which means that this horse still experiences pain even though there is no longer any tissue damage. And that's where we can get hyperalgesia and allodynia.
And that can be localised to the source of pain, but it can also be a more generalised response. Common causes in people would be things like back pain and migraines, so things where you don't have an obvious physical source, and that's very easy to measure, like a, something like a wound would be. And it has a really strong emotional component.
So it has a massive impact on your life, and this is where it becomes more of a problem. And then finally, verbal description is only one of several behaviours to express pain. Notice how we talk about behaviours now when we're talking about pain.
Inability to communicate does not negate the possibility that a human or a non-human animal experiences pain. We all understand this really nicely now. But what I want us to start thinking about is the fact that we talked about behaviour, and most of the examples of behaviour that I gave you were actually horses in pain.
And now we're talking about pain and we're talking about behaviour. So there's a massive crossover between the two, we need to stop trying to separate them out. Again, we've already talked about this concept that, you know, how you feel has an impact on your perception of pain, i.e.
The stubbing your toe example. But that also works from the perspective of pain. So if you're painful, then you have a more negative outlook on life generally.
You're more likely to see things in a negative context, and to be unhappy about things than you are if you are not experiencing pain. I'm sure we all know if we are painful for whatever reason, we can be more grumpy with people, we can get frustrated more easily, and we may get sad more easily. So how do we work these cases up then?
We've said that, you know, we're not going to say is it pain or behaviour. And instead, what I would suggest is I try and say, what evidence do we have for cognitive pathology, i.e.
The horse's behavioural responses, what evidence do we have for emotional pathology in the horse, and what evidence do we have for physical pathology. And then we treat all areas where pathology is identified at the same time. There's no point in just treating one area and seeing if it'll get better and leaving the others.
Because we're unlikely to have success in that case. So let's go back to this little mare that we mentioned previously then. So, first of all, we mentioned this, you know, we've got this aggressive response from this mayor.
So if I'm going to investigate this case, I'm often going to look at the kind of ABC, the antecedent, what happens before the problematic behaviour? What does the behaviour look like? The client is often going to tell you they just went mental, they just exploded.
They were just really mayish. And that's not helpful in any way, shape or form. What I want to know is there was a threat to bite, there was a high level of arousal, you know, the ears were pinned back, we had lots of tension on the muscles of facial expression.
And then what's the consequence? So if we think about this case, this was a case that I had seen originally for difficulty to catch, and we'd overcome that problem. And this male wasn't a massive fan of being in the stable.
So the owner was taking her into the stable and then doing some clicker training with her in there, which was fine. She wanted some more feedback on this, so she's wanted, I said, send me a quick video of you doing this and I can give you some feedback. So she had gone into the stable and she was trying to set her iPhone up and see if it was facing the right way or not, making sure it was recording, making sure the stable was in view.
Now from Mrs. Horse's point of view, what normally happens is when they go in the stable, she starts clicker training immediately. And in this scenario, she went in the stable and she was faffing around a little bit, getting her phone set up.
So this caused frustration in this horse. This wasn't the outcome that this horse was expecting. And therefore, this horse then demonstrated this aggressive behavioural response due to frustration.
The owner was not aware that the mare was doing this behind her back. The owner then turned round. The mare pricked her ears and looked sweet as, and they started doing the clicker training session.
So I know that the consequence of this from the mare's perspective was that this aggressive response made her owner hurry up and turn around and start clicker training her. Now, we know that the owner was going to turn around and do that anyway, but from the horse's perspective, that's the next thing that happened. So we just accidentally reinforced this behavioural response.
So we then had a conversation about using a lower value food reward for the clicker training and also training more calmness around food so that she could have these delays without getting frustrated. So always think about the ABC of a a a problematic behaviour, and that will help you to understand what's going on with it. How do we investigate these cases?
We'll talk through this a little bit more, and particularly with regard to, we're going to work through some case examples, but they are quite complicated ones. I often think they're a little bit like unpeeling an onion whereby you take off the first layer and then you find something else, and then you've got to deal with that and then you find something else. I do think it's sensible to rule out obvious pain.
We can never rule out pain, but, look for obvious sources of pain first of all. And then look at the other aspects of the horse's life, treat those as are needed, have a behaviour modification plan, but then we need to keep coming back. And you just keep circling around and going deeper and deeper and deeper in these cases.
In terms of taking a history, I would say it often takes me an hour to take a history from my cases. I'm trying to build up a picture of everything that is contributing to throughout the horse's entire life that's impacting on how they feel at this moment in time, because how they feel is motivating the problematic behaviours that we're seeing now. You know, if I get a history and this horse has been seen for multiple veterinary problems, lots of orthopaedic problems, maybe colic on and off, maybe it's got some itchy skin, you know, and it's constantly seen for different things.
A physical pathology is really highly likely in terms of the evidence, even before I've I've discussed the case with the owner. Whereas it's less likely if you have a young horse that appears very physically fit. .
If it's a generalised response, you know, if we've got our most the other way, if it's very context specific response, if you've got horses absolutely fine, but is fearful of being clipped, then the chances are that that horse is just has a fear response to the clippers, and we need to desensitise that. If you've got a horse that they say is tricky to clip, but actually this horse also is difficult to tack up, and it can be aggressive in the stable, and it doesn't really want to go forward when it's being ridden. All of a sudden I'm starting to think, is this horse got some hyperesthesia or allodynia due to some chronic maladaptive pain, and, and actually the owner may have presented it for clipping, but it may be a more generalised response.
. And then, you know, if a new behaviour develops. If the horse has been absolutely fine, particularly for a long period of time with the owner, and then something changes, that suggests that there's some physical pathology. And then we'll go through this, but there's a couple of myths that I want to bust, on this subject.
So first of all, there's no response to an analgesic trial, so it must be behavioural. There's no way of ruling out pain. You know, we'll often have people say, you should take them to the vet to rule out pain first of all.
And this is, sorry, this is kind of the non-veterinary behaviourists that may say this. Well, first of all, you can't do a clinical exam and rule out pain. And secondly, you can't do an analgesic trial that rules out pain.
Obviously, if you put the horse on mute for 2 weeks and the horse improves, then that suggests that pain is a contributing factor. But if the horse doesn't improve, it hasn't given you any meaningful information. And I think the challenge with that is in particularly the owners, even if you tell them this, they then believe that pain isn't a contributing factor.
So we need to be really careful in how we go about these things. And then I will still get cases referred to me where people say it's unpredictable, some days they're fine, other days they are, you know, performing the problematic behaviour regardless of what that may be. Therefore, it can't be pain.
And I would actually flip that the other way and say if it is an a, you know, an unwanted behaviour response that's a habit that's been learnt. Then we tend to be able to see the antecedent, what the behaviour is and the consequence of that. So you can predict when it's gonna happen and you can see how that behavior's been reinforced.
If the horse is trotting round, and looks absolutely fine, and then all of a sudden it, it spooks or it rears or bucks or you know, and there isn't, a pheasant hasn't just flown out of the hedge in front of it or something like that. Then why would that happen? If we can't see an external sensory stimulus that has motivated that behaviour, we have to ask the question, is there an internal sensory stimulus?
Now, if the horse is trotting round and he's clearly stressed, maybe the rider is putting too much pressure from the horse's perception on with the hand or the leg or. You know, you can see the horse is just on the verge of coping and then they boil over. That's different, but if the horse looks pretty happy, and then something happens, that tends to suggest that there's a, a physical cause.
When you do your clinical examination, just step back and look at the horse. This is the same warm blood mare. In the left hand picture here, she was doing low level of evening and was doing lots of galloping up hills, lots of pole work.
You can see her abdominals are a bit tighter, but look how weak she looks. She's really flat over her pelvis, she's got no top line, really weak round her shoulder and her forearm. And then look at the difference once we got on top of the pain.
Her gluteals and her biceps femoris, and all of her hind quarter musculature looks much stronger, she's way stronger over the top line. Her man's slightly in the way there, but she's got much more top line here and again through this shoulder and this forearm, she's so much stronger. So if a horse looks weak.
Then you just have to ask yourself the question, why do they look weak, and because you cannot recruit your motor muscle units if you're uncomfortable. We mentioned analgesic trials. I think these are really, really hard, .
I think just putting the horse on one medication for 2 weeks. I know some horses respond to that and that's fine, but most of them don't. And certainly if you've got chronic pain, they're unlikely to respond to it.
So then you start to say, well, we need to have a multimodal approach to these cases. And you really need to think about where you have a suspicion that discomfort may be arising, you know, do we think it's something like osteoarthritis and a kind of inflammatory type response? Do we think we've got a neuropathic pain component, bearing in mind that you always get a neuropathic pain component if you have a, a chronic response because you get, altered sensory input into that area.
And don't forget fundamentally. All pain occurs in the brain. Nociception can happen anywhere in the body, but it is the perception of pain that's important.
So I also think we need to be treating the emotional component of pain in these cases, even if we think it is a overwhelmingly a physical pathology case. And I won't go through all of the other areas, but just starting to really think about what it is that you're, what you're trying to achieve with these cases, and, and where you've got a suspicion of pain. In small animal behavioural medicine, they will often have a dog on a multimodal analgesic regime for 3 months, 4 months.
So again, that can be quite hard to persuade owners to do it for long enough, but doing it for two weeks, again, if you get a response, it's fine, but you're often not going to in these sorts of cases. And then further investigation, so I just want to give a bit of a plug for overnight video analysis. And this is something that I think you need a bit of experience to do, you need to be seeing these cases regularly to build up that experience.
But it really is worth its worth in gold, in a lot of these cases. So this was developed by Sue McDonnell at the new Bolton Centre. And I was very lucky to go over and spend a bit of time with Sue and see how she does this.
And I particularly found this paper on the left interesting, whereby they video recorded 20 hospitalised horses, that had had orthopaedic surgery. And what they found was that these horses were showing. Discomfort behaviours which stopped as soon as someone walked down the yard and may or may not have interacted with the horse, and then resumed as soon as they left, and I've seen this, I've got evidence for so many cases now which.
You know, showing lots of signs of discomfort, and as soon as people come onto the yard, even if they don't come anywhere near their box, they just stop and prick their ears, stand at the front of the box looking absolutely fine, often picking away at their hair net, and then as soon as people leave, they go back to looking uncomfortable again. So just use a quick case example to talk through this. This was a 7 year old Irish draught cross mare.
She'd been tried and found to be very suitable for purchase and had a 5-stage pre-purchase exam, no problems. But then a couple of days after the owner got her, she leapt in the air when the owner tried to lift her hind foot. Got to the stage where the owner couldn't handle her feet, then couldn't touch her anywhere at all, and this manifested as kicking and biting.
So she'd had extensive medical investigation from a really excellent equine hospital. But they hadn't found anything that they could treat that then resolved the problematic behaviours that we're seeing with this case. And, and she then, the more she was having workups, the more aversive she got to veterinary care.
And so it then became difficult to work her up properly. So by the time I saw her, she had bitten several people and caused some damage from that. They were currently clipping lead rope on over the stable door and leading her with some form of protection such as a stick or some stones in a can that they could rattle at her.
To and from the field, and any attempt to touch her or enter a stable was met with extreme aggression. And they've been using a lot of positive punishment with her. So we know that she had never been hit, there's never any physical harm, and again, people often say the horse must have been abused.
That's really not the case. We know for this case that it was all about just shouting at her or shaking something at her to try and make her go away when the owners feel threatened, and that's perfectly understandable, but it was problematic for her. So first of all, we set up the overnight video analysis.
You see, she has a, a quick scratch there, of herself on her left chest. But then you can also see she's now scratching herself on her hind legs on her hay feeder. Now the important point here is that this mare had never been observed to be itchy when people walked past her stable.
No one had ever observed her itching. She also, when she was out in the field, she was in the paddock right in front of the stables at the front of the yard. So there's people walking past all the time, no one had ever seen her itch in the paddock.
But when I watched an overnight video analysis, she spent quite a significant percentage of her time doing this, throughout the night. So this told me that this was important to this mare. This was bothering her.
So. I thought she's not the, the best case for a Decttamax injection, but I thought I can probably put a deltamethrin collar on her hind pastterns. I thought oh I'll just click a trainer to stand still and I'll allow her to to put these dog flea collars on.
Because I was obviously suspicious of Corioptis, some, some leg mites with her. Unfortunately, I was not successful with this case. I could stand in her stable door and do some clicker training.
She would tolerate that. She would allow me to stand just inside the stable and lift her hand up towards her neck. But when I actually made contact with her skin, I got an extreme aggressive response.
And it was very clear that. If I couldn't even touch her neck, there was no way that I was going to be able to get anywhere near her hind limbs, and it was geographically a long way away from where I was, so I was only down in that area for kind of a few days. So, we started her on oral prednisolone, .
If you can't, you know, get on top of what you believe is the underlying cause, can you alter how they feel about it? And that's what we needed to do with her. And then we had this lovely interaction between I was kind of overseeing her treatment as the veterinary behaviourist.
We also started her on some Floxin as well. Then we had a non-veterinary behaviourist helping out, and then we were obviously always liaising with the treating vets to keep on top of what we're doing with her. We had a baby modification plan which put her back in control of some of her human interact human interactions.
And once she felt a little bit more in control, she then felt braver, to allow people to touch her again. And this is the same mare. Several months later, you can see this is the lovely non-horse of humour that husband that supported his wife through all of these problematic behaviours that they've had.
And you can see that she is now very happy to be touched everywhere, groomed everywhere. And she now interacts like a normal horse again. OK, so we've talked about investigating these cases.
How do we treat these cases, and we're gonna do this through a series of case examples, which will include a little bit more on the investigation aspects as well. So again, we just need to remember that stress and disease are not mutually exclusive, one is going to drive the other. And it's very chicken and egg, it's very hard to determine what came first, but if I'm honest, it probably doesn't matter because I think successful treatment requires addressing both elements.
Traditionally in the human world. They would either treat it from a medicine perspective or from a surgical perspective, it's all about the biology. But this is not gonna be 100% effective.
Now, if you've got a horse with a foot abscess, yep, you can just treat that biologically. You can, pare out the abscess, release the pus, very satisfying. Put the horse on some analgesics, poultice the foot.
You know, within a week, that horse is gonna be absolutely sound and you're gonna return it to full function. But if you're dealing with something like osteoarthritis. Then You're probably not going to get on top of that, even when we're dealing with things like skin conditions.
And we're unlikely to have a horse that never suffers from that again in their life. So this is where in humans they move to this biopsychosocial approach to pain, because pain is not just a physical sensation, but a complex experience influenced by biological, psychological and social factors. And the focus is on how the person feels.
So again, you think about that stub in the toe example. So obviously we're still gonna think about the biological factors. I'm not gonna tell you guys how to do that because you, you know that already.
But from a person's point of view, they also think about the psychological factors. So their thoughts and feelings and behaviours related to pain. You know, what are your beliefs around pain?
As a child, if you fell over and grazed your knee, did you just have someone say, oh well, never mind, come on, get on with it, it doesn't hurt. Or did you have a parent that went, oh my God, are you OK? Do we need to get to the hospital?
Do we need to do this, you know, cause that. Alters how you feel and how you believe pain to be, and we actually see similar things with owners. If owners become awfully anxious about a horse that has a minor.
Injury or ailment, then actually that has an impact on how the horse behaves. So, understanding these things, . Understanding the coping mechanisms that people use, and now they do a lot of things like cognitive behavioural therapy for complex pain in people, because you can alter the way you think about pain and it can help you to cope with it.
I had a really nice example of this where some of the chronic pain specialists were saying to people at this point in time. You know, your pain is like a massive beach ball that's in front of you, or a gym ball, sorry, that's in front of you, that you, you can't see in front of, you can't focus on your life because of how much of an impact it's having. And we're not gonna get rid of that ball, but we're gonna shrink it and shrink it and shrink it until it's maybe tennis ball size, and it's still gonna be there, but it's small enough that you're gonna be able to see past it.
You're, you're gonna be able to have a good life. And then the social factors. So, if you have two people with the same amount of damage, let's say they have pain in their knee.
If one of these people. Has a great social life. They've got lots of friends and family around them.
They love their job. It gives them a sense of purpose. They're really engaged in life.
They're going to experience pain very differently to someone that is lonely, that hates their job, that doesn't see any purpose and doesn't get any, thing meaningful out of their job. And he's generally unhappy about life. So it's about looking at all these other aspects of a person's or a horse's life in order to support them going forward.
So we're thinking about the interconnectedness of these factors, we're not just looking and then the holistic approach, we're not just looking at the biological aspects. We're looking at all aspects of the horse's life. And we need to understand that pain is a very individualised experience, therefore we need to treat it appropriate to that individual.
And trying to have a multidisciplinary approach. I think particularly as we all specialise more, it's very easy for orthopaedics to just look at the lameness and medicine to just look at the ulcers and actually you need to take a step back and discuss it as a team and also think about the behavioural medicine aspects of this case and really think about what's going to work for this case overall. So as we've said, it's all about the focus on how the person feels.
And you might then say, well, how do we apply this to horses? Because we know that horses. You know, can't talk to us.
But Welfare is how a horse feels. People often say welfare is the physical and mental state of the horse, but if you look at David Broome's papers on quality of life and welfare, or particularly, David Mellor's the five domains model, it's all about the impact that the 1st 4 domains have on the mental state of the animal, which is how they feel. So we then start to think about this from a kind of biopsychosocial aspect.
And I will work through the five domains model and say, well, how do each of these aspects influence how the horse feels? And remember, the fourth domain behavioural interactions is interactions with other horses and other animals, interactions with people and how they interact with their environment. And I'll say, well, where can we reduce the negatives, but also where can we increase the positives in these cases.
So let's talk through some case studies. So this was one where. The physical health of the horse was having a negative impact on their mental state.
So it's a 9-year-old Irish sports horse Geling. Owner had had him for 6 months. Previously worked in a riding school and for, trekking, so he was in quite a bit of work.
He was now in much lighter work. Owner's really happy with this horse's ridden work. And the only problems related to the farrier.
So he'd been OK the first time, but then he had gradually deteriorated over time. So we're gonna watch a video, and we'll, I'll talk you through it. So, we go to lift this horse's left foreleg up.
He immediately shifts his weight and offers me the leg before I have offered it. And then giving him the verbal cue and clicking. Notice that weight shift, and he lifts his leg up.
You can see him thinking he's then happy for me to do stuff with his foot, all his attention is on what I have to do to get the food. You know, if this horse could do a backwards somersault for food, he would do. Notice how I got a tail swish and I had to physically ask for him to lift the left hind up.
And then the right hand asks once, ask twice, ask the 3rd time, and he does lift it up, but I get a tail switch. So for me, that's really important information. For a horse that is that food motivated to not want to lift a leg up for knowing he's going to get food for it, tells me that he is more motivated by not lifting the leg up than he is by food.
And that is a very important consideration for this sort of case. So of course, I trotted him up and he was lame right behind. Now, interestingly, he was much more lame on the yard than he was when we took him into the hospital, and I think anyone that works in a hospital environment, just be aware of that.
You know, horses are prey animals, they're always going to hide pain, and, and particularly in a different context. So, and I also flexed him on the yard as well, and that had a really positive response to flexion. So we took some radiographs of his hooks, and these were really not very exciting.
So orthopaedics then said, look, this horse is really happy in his ridden work. Are you sure you want us to work up a horse that is this happy? You know, this could be opening a tin of worms, trying to block a lameness that's not that lame, and actually everyone's happy with it.
And I'm like, yes. The fact that this horse does not want to lift his leg up for food when he's very food motivated. And there's no real pressure on him.
We're not going to get on top of the farrier problems until we do this. Now, ironically, he then, we blocked his right hind and he switched to the left really convincingly and actually looked much more lame left hand at this point. So of course we medicate these hacks, and then we also made sure this horse also got analgesia, so just some butt in his feed an hour before the farrier came, and we didn't have any further problems with him.
This is one that's all about the behavioural interactions between horses and people. And this is a horse called Gavin, as you can see, he's a very handsome horse. But he, you can even see from this picture, you know, he's often quite hyper vigilant, he's often quite alert.
And a lot of what we did with him was about training him not to practise being stressed. So This was a horse that from time to time would nap, so this was the kind of antecedent. The rider would then put their leg on and then he would rear.
And then the rider would remove the pressure from the leg and from the hand, because obviously they don't want to pull the horse over backwards or get a more extreme response. But what it doesn't tell us is what motivated that behaviour of napping in the first place. So you almost need to move it back and go if the behaviours napping, what's the antecedent to that?
Now, on one occasion, a whip was used to stop him napping. And it resulted in him rushing forwards. So I think in this scenario, the consequence was that he felt that this rushing forwards avoided an aversive stimulus, but this was now starting to become a ritualised behaviour when stressed.
So this was him a little while later, where she'd gone to a different venue for a training, a training scenario, and as you can see. This horse is now getting to the stage where he's starting to bolt. It was her husband that was taking this video, and he.
Stopped at this point, and then the next time around the horse actually she had to put him into the fence to stop him, and he broke the fence at this point. Now, I watched the the full video of this. He's ridden horse pain ethogram score was less than 8, which Sue Dyson would say suggests that, pain is, is not a component.
Also got him into the hospital, had him, you know, a full orthopaedic evaluation on different surfaces with a, a diplomat and couldn't see any lameness, couldn't see any back pain, we were not really concerned about him. So, we really talked about training calmness as a habit with him, and we talked about this pan of boiling water whereby his level of arousal is often a little bit high. And when he, you know, if his level of arousal at home is 40 degrees, as soon as you go somewhere else, it's up to 70.
But then when you go to a more challenging venue or there's other things going on, the pan boils over, we get to that 100 degrees C. So what we really need to do with him. Was to work on everything being quieter and calmer so that even though he would go up a few degrees in a more challenging environment he'd still stay well away from that 100 degrees.
And it was also clear that a lot of his motivation was fear and frustration from confusion from the ridden, so we needed to retrain that. So first of all, we start on the ground because this is a horse that has bolted with someone, and this horse, you could put as much pressure on his mouth as you wanted, and he didn't step back. He would tuck his nose in into a dress edge frame, but that's not what we want.
We need him to learn to step back from pressure. So you'll see we're just doing some retraining with him here. So rider puts the pressure on and releases the pressure as soon as his feet start to move backwards.
And she also, I think, was giving him a treat for this as well, so he starts to form a positive association with stepping back from light vein pressure. We then did the same with her on board. OK, go again.
Light pressure, remember. So she puts pressure on, he ignores it at first cos he's distracted, but then he takes a step back and notice how her reins come forward. That's the most important thing, that they get a release of rein pressure for stepping back.
Horses use the same muscles for stopping as they do for stepping back. So the more you train the step back response, the more you're gonna train the stop response. We're new forming, we're now forming new neuronal pathways, new habits for this horse.
You can also see again, we give him that treat. And don't forget about the equitation aspects of this. So if you've got a rider that has been bolted with, their inclination is going to be to push their seat into the saddle and use their body weight to pull back on the reins, because they're used to having to use a lot of pressure and actually pushing down on the saddle is going to push the horse forward and using a lot of pressure on their mouth is really uncomfortable for them.
So instead I got her to really think about lightening her seat and asking really lightly on his mouth for him to stop, and then that went really well. But don't forget that a lot of these problems started because this horse was napping. So we then got to the stage where we said, well, we now need to retrain him to go forwards off of leg pressure because he was a naturally forward horse.
She often wasn't using any leg much leg pressure. So it was only when that he stopped, you went to use the leg pressure and then it all went wrong. So we're gonna retrain this using whip taps.
So you can see we've got no pressure on his mouth. Use very light whip taps just next to the leg. And as soon as that hind leg steps forward, we stop tapping and just give him a quick rub.
But it's the timing that you stop tapping that tells him that's the right response. So this is still Gavin at basic attempt level. I know what this is now.
It took him a little bit of time, but he confidently stepped forward from those really light whip taps, and that's the sort of level of whip taps that you should only ever need, really. And then we move it on. We classically condition it to a seat cue.
So you'll see the rider gives a seat cue, and if he doesn't walk forward off a seat cu, she then squeezes with her leg, and if he doesn't walk forward off of that, we then use the whip taps. But you can see as soon as she lifts and squeezes with her seat, he immediately lifts his back and confidently walks forward. So we've now got a a really nice response with that, and she took him back, she got him back to working at medium level dressage, including at the venue where he bolted with her just by thinking about retraining these basic responses, but also thinking about his level of arousal like that pan of boiling water analogy, and really getting him to be nice and quiet and calm, in different areas.
Different scenario. This was a maladaptive stress response. It was a 14-year-old Arab ridden by an owner in her 70s.
They were out hacking with a friend when they were attacked by dogs, and the horses bolted. Both riders fell off, and the dogs continued to chase the horses. I don't think they chased them for 30 minutes, but it took them over half an hour to find the horses, and there was a lot of, a lot of damage there, and the horses were very distressed.
So this horse was then put on box rest for the physical wounds to heal, and he became aggressive on box rest, which he hadn't been previously. They thought once he's back out with his friends, he'll return to being a normal horse, but he didn't. He remained hyperreactive and spooky.
He was really badgy and would knock his owner out of the way. Again, this is an older lady, so this was really problematic, and he remained aggressive. The referring vet had done some clicker training with him and said he's great when we're doing the clicker training, but they were only doing that for 10 minutes a day, and the rest of the time it was still a problem.
So they were now discussing euthanasia with him. Now, we had this conversation that, you know, stress is turned on neurologically. It's designed for the zebra to get away from that lion, but it is turned off endocrinologically.
It takes a couple of hours to return to baseline. But this horse had an extreme stress response of being attacked by these dogs, and there were some, some bite wounds, I believe, to his hind legs as well. And then he'd been put on box rest.
So his stress response had got stuck in this state of wind up where it couldn't return back to normal by itself. So we had to return this, stress response back to normal using medications. So we started him on fluoxetine and within 2 weeks, he was easier to handle.
His bed was no longer messed up. After 6 weeks he was almost back to his former self, and then he was gradually weaned off without any relapse. And I would now probably keep them on it a little bit longer, but this was one of the early cases that we use floxetine on.
So sometimes we need to identify. Where we actually have pathology in the brain, where we have a post-traumatic type stress response and treat that directly. And, and just a very quick one, but in terms of emotional states, we know that floxetine doesn't have any impact on the level of arousal, i.e.
The arrow is not going up or down, but it is promoting calmness, content, relaxation and positive emotions with a higher level of arousal. On the other hand, we know that Aceromazine, reduces the level of arousal, but what it also does is it has a negative impact on mood. And that's why there's now a, a position statement from the European Society for Veterinary Clinical Pathologists to say that ACEpromazine is contraindicated where anxiety is a component in animals now.
And a, a, a sham option that we would use much more frequently would be trazodone. Notice how the arrow is pointing in the opposite direction. So yes, it lowers arousal, which is something that we often want.
We want the horse to be calmer, quieter, but rather than having a negative impact on mood, it should have a positive impact on mood. And I would suggest now, the more that I use these meds that not giving a psychopharmaceutical to a horse that is stressed is similar to not providing analgesia to a horse that's in pain. Obviously that's where the stressor can't be resolved.
OK, one last case to flip through. So this was a show jumper, and the problem here was this was the show jumper that was kicking the walls. And this had become an abnormal repetitive behavioural response.
He was doing a lot of damage to the walls, but there was also concern he was going to fracture his pedal button. He went to Spain, show jumping, and he was unable to jump after the first few days as he was kicking his shoes off almost daily. And the firery was putting them back on, but he'd now become footsore.
So they tried him in a lot, they've done a great job at home. They tried different things. They tried to put him in a stable, that was next to other horses with barriers, and he was much so just bars so he could sniffle the horses, and he was much worse in that than when he was kind of more by himself.
But what was really clear to me was that, yes, he was worse when there was, bars between him and the next horse, but he was also triggered by all the horses walking past him. And lots of people think, oh this is a horse that doesn't want to be near other horses, but actually I thought this horse needs contact with other horses. He's frustrated.
You know, this is a frustration response that's now becoming ritualised to other contacts. So we talked about what the setup of their yard was and what might be possible in that yard, and he was moved to one of the pens that's normally used by the brood mares. So this is the horse of grey in the picture.
And you can see he can interact with other horses, but also there is that tape between them so they can easily interact over the tape, but he can't get in with them. There's no damage of, of injury. And at the same time, you know, if he lays down and relaxes, then.
He can still see that he's surrounded by other horses, so he stopped kicking the walls. But a side effect of this was that he also started jumping better, and the rider said how he, you know, had gone from a horse that took a long time to warm up because mentally he wasn't focused on the rider to one that was focused on the rider much, much more quickly. And this was him exactly a year later on the same cho Min tour in Spain.
And as you can see, he is not kicking the walls of his box. He does now get a double stable where he goes, and he was much more calm and relaxed, and he's now really settled away from shows because he's not stressed at home. Sometimes people think, you know, if you give them an environment at home where they're surrounded by other horses, they'll be worse when they can't have that from a biosecurity perspective away from home.
But it's actually often the other way around. If we're not constantly driving a stress response at home, they can cope with smaller stressors away from home. And so, so I'll just go.
Back, OK, so anyway, I'll move on. So he has then gone on, and he's now jumping Grand Prix and, and doing really well. And then, sorry, this is my last case scenario because this is the biopsychosocial case.
So this was a mare that had a bilateral ovarectomy, and 5 days after this, she started kicking at her abdomen, mainly on the right hand side. But this would stop with the weight of a rug over it. So you've got that gateway control theory of pain.
Now, 6 weeks down the line, this was still occurring. And there'd been no response to analgesics, including gabapentin. Ultrasonography of the surgical site per rectum and transcutaneously was unremarkable, and the surgical sites had healed really well, but there was some constant sweat patches over them and in her inguinal regions bilaterally.
So this is what the mare was doing at this point in time. She's off. So remember when she's got a rug over, she's not reacting, so we've got that gate control theory of pain where we're stimulating the mecano receptors, so it's not stimulating the pain fibres.
But without the rug, she's clearly unhappy. Literally took the rug off 30 seconds ago. And of course at this point in time, the owner was really not very happy, you know, with what was going on, even though we all warn owners about the potential complications associated with the procedures, they still believe that if the horse is going in for an elective procedure, then it's all going to be nice and simple.
So she was now back at the equine hospital, and this is an example of complex regional pain syndrome. This is chronic pain that's disproportionate to the severity of the injury. You get hyperalgesia allodynia, you get local autonomic dysregulation, hence the sweat patches.
Now we know that it is exacerbated by stress, and in people, if someone is suffering from stress and anxiety, they're much more likely to develop this when. They have a minor surgical procedure, it's never a major one, it's always something that's quite neat and tidy than someone that isn't suffering from anxiety and stress. So again it comes back to that link between your perception of of pain and the brain.
And people describe it as a constant burning sensation. Now we need to be careful not to be too anthropomorphic with horses, but I'm sure we can all understand looking at those videos, how this horse may be perceiving something similar. So how did we treat her?
Well, again, we think about this by a psychosocial aspect. So biological, the referring practise had already put her on steroids. Nothing should die without steroids.
I wanted to think about her social life. We made sure that she was turned out in a paddock where she could interact with other horses over the fence. We also spent some time grooming her with her rug on, so it's kind of, you know, a, a rug without a neck.
And making sure that if you, you know, you could spend some time grooming her where she's starting to twitch that upper lip and lean into people. We know that activates the parasympathetic nervous system. So again, this is the opposite of stress.
And we made sure she had ad lib forage, which she did anyway, but again, you don't want these horses to be hungry. This can be a massive component of their stress response. And we also did a little bit of light lunging work with her.
So I'm sure there'll be plenty of people watching this webinar that. If they are stressed, they want to go for a run or a swim or a bike ride. You know, it's a physical outlet for your stress response, so we tried to give her one.
And then I put her on amitriptyline, which is a drug that treats the emotional components of stress, as well as some of the physical components of a maladaptive pain response and the wind up that you get in the brain and spinal cord. And then we had a behaviour modification plan. So this is classical counter conditioning.
Now I've put all of the, you know, I've put the kind of plan on. I'm aware the text is quite small. It's not about the exact plan.
What's important is that I didn't say just gradually get her used to having the rug taken off. What we wanted to do. Was to get it, no, you know what happens at the minute is as soon as people start doing the straps.
That predicts in her brain that she's going to experience pain, and so all of her focus goes on to where she's going to experience pain, and then it becomes a self-fulfilling prophecy. So we want to just undo the chest straps and do some clicker training, we did some target training with her. So that she enjoyed that, and then the chest straps were done back up.
So after a couple of sessions, undoing the straps on the rug predicted a positive experience, either the clicker training and doing the straps back up meant the fun stops. And then we started to just fold the rug forwards and backwards and move it around a little bit, so it was, you know, initially still covering that surgical site, but eventually we got to the stage where we could take the rug off completely. And this was the same mayor.
Afterwards you can see we've got her back out in the field without a rug on and back in rhythm work, and she was off all of the medication. At this point in time. So it's really thinking about all aspects of the horse's life and thinking about the, the brain as well in terms of how that interacts with stress and pain, not just thinking about the, the, the local biological response.
So have we forgotten anything else in this? Well, we haven't discussed too much about the human factors, and we haven't got time to do now, but this is huge. I was quite lucky to be involved in a major research grant along with Doctor Tamsin Furtado of the University of Liverpool, where we were understanding horse owners' experience of problematic behaviours.
And there are 3 aspects which really matter. For getting, for having a successful outcome, and it all, you know, I always knew that potential solutions was important to owners. We had to help them solve what was going wrong with their horse, and I probably also had a good idea that the more they can understand why it is happening, the more likely they are to stick with the programme and to get success.
But what became really apparent was just how strong the emotional capacity of the owner is and. A lot of these owners have really gone through so much, to get to the point that they're at now, that they're often really struggling. So being able to point them in the right direction, and one of the reasons I've, I've put this up is because we have a website that's gonna be launched imminently, maybe by the time this webinar is out.
Which is a collaboration between the Horse Trust, the University of Edinburgh, and the University of Liverpool, and it's going to be a resource for owners to go to when they have problematic behaviour, and it's going to show some basic how to deal with simple behaviours, but also help talk them through where they can, you know, signpost them to help for more complex problems. And there's lots of examples of horse owners telling their stories about what they've been through on this, so I hope that will be a useful resource for you. In terms of working up these cases and equine behavioural medicine, I have really just told you that the tip of the iceberg today.
We do have now equine behavioural medicine and equitation Science are actually a newer AVP. So for those of you that are looking to go and do a certificate, then you can do these as your C modules, and there's there's hundreds of hours' worth of, of learning material in those. But thank you very much for your attention on this.
Equine behavioural medicine is all about understanding those links between the cognitive, emotional, and physical health of the horse to get the best outcome possible. Thank you very much, and we'll stop there.
