Sedations Considerations for Hoofcare - The Humble Hoof

0:00Welcome to the Humblehuff Podcast. My name is Alicia Harlov. This is a podcast for both horse owners and hoof care professionals offering discussions into various philosophies on the health of the hoof and soundness of your horn. Please check us out on Facebook or at the Humblehuff.com. As horse owners and as equine professionals, we have all come into contact with a horse that we were maybe a little bit nervous to be around or work on, either due to behavior issues or safety when it comes to their handling. The idea of sedation becomes a little bit taboo because there seems to be two camps where one group says that everything is a training issue and another group says that sedation is super valuable in certain circumstances. I wanted to dive more into the use of sedation for things like hoof care. So I reached out to Dr. Jeff Hall, a veterinarian who works with Zoetis Equine Technical Services team, as well as being the current president of the California Mid-Cost Veterinary Medical

1:01Association and is on the advisory board for the Equine Disease Communication Center. One of his special focuses is on equine pain and sedation. So I wanted to pick his brain a bit about what sedation looks like for horses, what it does for them, different options for it, and in what instances it can be used. When we just start, you can tell us a little bit about your journey into veterinary medicine. Sure. Okay, great. Yeah, so I graduated from North Carolina State College of Veterinary Medicine in 2001. So it's been 26 years now that I've been a veterinarian. My journey to that point was I grew up in the Midwest, I grew up on a farm with every animal that you could possibly think of. My dad was in the medical field and so it made a lot of sense to just connect the medical field with the experienced loving animals and taking care of animals and that's what drove me to want to be a veterinarian. And then during school I a lot of my training and my interests were in equine medicine and surgery. And so I did an

2:05internship at the end of school in equine medicine and surgery and then met my lovely wife who was in the class behind me. She's a small animal veterinarian and then she had family at Oregon. So we moved from all the way from the West East coast to the West coast and started our journeys in practice. So I practiced ten years there in the equine medicine and surgical practice and did a little bit of everything. General care, surgery, preventive medicine, all experiences with equine. And then in 2012 I joined Zoletus, which is a global animal health company that manufactures medicines and vaccines and diagnostics for every pet you can think of in livestock. And so I joined their equine technical service team, which for those of you might not be familiar with that. Each of the animal divisions of these large animal health companies have groups of veterinarians that basically support that division. And so I work on a small

3:07team of equine specialist veterinarians that support what we call equine specialist in the field are those of the individuals that work very closely with your equine veterinarian. And their practices and support them. I support that. We do a variety of different things from teaching, labs, research, practice, a little bit of everything. And I've been doing that now for 14 years and I live in Central Coast, California and I travel all over the West working with veterinarians. Yeah, that's awesome. And a few weeks ago, I talked to Dr. Helbig and it was really cool to hear more of like the nitty gritty in terms of vaccines and medications and things that, you know, I'm a healthcare provider. So I don't really think as much about those things in my day to day work, but learning more about them can really affect our work. So I think it's important to kind of dig into this, some of that information. So I really appreciate you being willing to chat with me today. Yeah, happy to be here. And you know, it's, it is the humble of podcasts that were obviously

4:09primarily focused on healthcare. And something that I've had to use in my healthcare practice and that I know many of my friends have recommended to talk to their veterinarian about is using sedation for some very work, especially if there's a horse that's painful or honestly, some horses that are not quite safe or they feel like they're not safe to work on. So in the context of failure work, when does sedation transition from just like a convenience like, oh, this horse is a little bit difficult to a necessity for safety? Yeah, I know it's a great question. You know, I think, I think most of us to work around horses, whether you're a failure or whether you're veterinarian or horse owner handler, I mean, we know generally when our horses are very anxious, when they're potentially going to tap into their fight or flight response, which is pretty strong for horses. It's built into

5:09their genetics. And that's how they survived in the wild for so many thousands of years. And so, you know, that's when it becomes a necessity is the safety issue is so that when we as professionals are working around them, both as veterinarians and as failures, and there are times when it just is absolutely needed to be able to reduce the horse's anxiety, to reduce their stress, to relax them so that we can evaluate them, proper care can be taken care of their hooves. And it's just, it's a safe environment all the way around for everybody that's involved with that particular horse or that particular day. And I think pain comes into that too, right? Sometimes the horses are very safe to work around. And you know, we don't worry about them, you know, injuring us or something in that manner, but they're they're very uncomfortable or painful due to some condition that's

6:09happening there that may make it very difficult to be able to work on their feet. And so a lot of the sedatives that we have also have very effective pain medication components of them. So we, you know, horse owners see the horse is getting sleepy and relaxed. But we as veterinarians know that those sedatives work directly on the receptors that control pain. And so by reducing the pain, the hope is, is that horse that may have, you know, arthritis or may have a sore foot that they don't want to stand on. And we're working on the other foot that it just can help. And it can just make it make the procedure possible. Without sedation, we probably couldn't do that. Yeah. And I know that honestly, in the healthcare world, it can be a little bit controversial, which I know sounds a little odd, but I think that, you know, it might revolve around a little bit of the fact that maybe the failures or healthcare providers aren't quite sure what is going on when horse is sedated or if it's just that they feel that, you know, all horses should, you

7:13know, if it's a training issue, it should just be a training resolution instead of using sedation if it's not a pain issue. So I would love to know more about like what's actually happening when a horse is being sedated. And how does that differ from a stronger option, like putting a horse under general anesthesia? Yeah. Yeah. So when we administer sedatives to horses, there's, there's obviously multiple different types of sedatives and different groups of sedatives. And so the main group of sedatives that we use are what's called alpha two agonists. And so that's just a medical term for the type of receptor that the sedative works on in the horse's nervous system. And so you or your listeners may be familiar with, you know, common brand terms like rompin, which is silo zine, or thermosodane, which is the tomodine, or maybe ace promazine, those are common ones that are used for horses. And

8:16when they're administered to the horse, immediately, most of time from a veterinary perspective, we're giving it to them IV drivenously, you can give sedatives to horses intramuscularly or even orally. But basically, the drugs are all in the same general classes. And as soon as they get into the horse, they're starting to work on those receptors within the nervous system. And they're doing a variety of primary things, first and foremost, they're reducing their stress levels, they're bringing their heart rate down, they're bringing a respiratory rate down, they're reducing their sensitivity to stimulus in the environment. So things that are around them that move fast or make noises, they're less sensitive to those things. We're still very aware that even under sedation, they can react and kick and run away. So we always have to know that anytime about working around horses. And then there's the pain relief

9:16kind of things that we talked about. And so what's different between kind of what we do from a general anesthesia standpoint and what we're doing with sedation that we're administering to horses is a lot of times it's the doses that we're using. If we're going to put a horse under a free anesthesia and we're pre-mitting them for that procedure, we're using likely more or higher doses that we would use the sedatives. When we're doing sedation for just like failure care or maybe a diagnostic, like we're taking some x-rays or something like that, often we're adjusting our doses or maybe the way that we're administering them and using a less of a dose. So we just don't have as much impact on the central nervous system and on those receptors that we would have when we're using those higher doses. And so the nice thing about your veterinarian's understanding is that they can adjust that based on their experience and knowledge of the drug that they're using. And it's very individual to the individual horse right to each horses a little bit different.

10:19The breeds are affected differently based on the sedatives that we use. And so your veterinarian is very experienced and kind of making those decisions. And as you said at the beginning, I mean, it's a very delicate balance that we play when we're doing sedation for for failure care for horses because we're thinking about the safety of the failure and horse owner and veterinarian. And we're also wanting to make sure that the sedation is the proper amount. So it doesn't make it too difficult for the failure or too much. And then they have it actually makes it maybe more unsafe for them to be able to try to lift a horse that's wobbling or from side to side. And so that is very important to work as a team together to decide okay, you know, is this something that we can handle more from a training perspective and maybe some other types of restraint and we don't need the sedative. Or this is very clearly the best choice for this horse is deciding a sedative

11:19to work as a team. Yeah, and I know that you mentioned a few different options for sedation. And one that I am probably most familiar with seeing owners, administer is dorm gel. And you know, you mentioned that a lot of the three that you said are often done IV or you know, there's something you can do intramuscular or orly. Can you talk a little bit about dorm gel and when that might be used as opposed to one that you would do IV? Does it make it less of an effect? Yeah, it's a great, great question. Yeah, we dorm gel is is a really great option that horse owners now have as a sedative choice for their own horses. And so since 2010, this is the only FDA approved prescription oral sedative that is available. And so it has the same drug that dormocid and the injectable form of what we use. So it has detomating in it, but

12:20just in the gel form. And the very nice thing in the way that the reason this was designed was this is a oral sedative that horse owner can give a failure could give a veterinarian can give administered underneath the tongue in the horse. So it's very easy to administer to most horses that are difficult about their mouths. Then and it and it takes a little bit more time to work than when you think about or you've seen an IV injection or an intramuscular injections, typically IV injections, the horses will start getting sedated within two to three minutes. Intramuscular may take 5 10 15 minutes to take effect. And the oral takes 40 minutes to take effect. So it takes a little bit more planning to work, but it it's very safe and very easy to administer. And it's less of a depth of sedation than what we typically see or want when we do

13:22intravenous injections or eye injections. So dorm gel is designed just specifically for husbandry uses. So things like chewing or hoof trimming, if you're going to clean the sheets or maybe body clipping or trimming hair or maybe if you're going to do a vantage change or something like that, then you know, we the dorm gel is very, very nice to use for that because we don't need the pain relief or the heavier sedation that we use when we do IV or I am, but the gel provides just an easy way to administer that to to the horses. It's important to remember that it is a prescription medication. So you have to have your veterinarian prescribe the gel specifically to you and specifically to your horse. And so that requires just your veterinarian seeing your horse, doing an exam, all the things that you would want any ways to make sure they're healthy. And this is the appropriate

14:22choice for what we're trying to do. And then they can dispense that to the horse owner and then the horse owner can have it there to be able to administer prior to, you know, for example, the failure coming out for a trimming that day. Yeah, and you know, I know sometimes the dorm gel like for owners that I've worked with, it's prescribed and that, you know, does free up the vet in those cases where they don't necessarily need to be there for the appointment. But when you're when the vet's not there and they're not there to tell you what, you know, obviously you go by the dosage, what how sedated the horse should be, I guess, what should a sedated horse look like? And you know, how do you know if they're at the proper level of sedation for a failure or whatever husbandry tasks you're doing? Yes, well, the there is a specific chart that is provided with the dormose of the gel that looks at your horse's weight and recommends the proper dosage for them. So for example, each tube has three mills of gel in it. And so that can

15:25treat up to a horse that weighs 1,320 pounds. And for like an average, like 1,000 pound horse, that would be about two and a half mills of the gel. And so my recommendation in general is if you've never used it before with your horse, obviously talk to your veterinarian discuss everything with them, talk to your failure to, and I think it's good to just kind of do a trial run with them to give them the standard dose and watch them at 40 minutes or an hour into the dose and kind of see how it affects them. And so then you kind of have an idea of for that individual horse, this is the dose. And it may be that you work with your failure and your veterinarian to adjust the dose for the next time, maybe you do a little bit less than that, if it's if it's not what you want. And what you're looking for for them is that at that, you know, 40 or 45 minute mark, they should be relaxed. You likely see their head will be kind of dropped down. There'll be a little less

16:27sensitive to the environment that's around them. They, you know, will be a little slower to move. And then usually what I'll do is I'll have them in a safe environment inside a barn or in a flat area. And I'll start working a little bit with their front feet and just lift their feet up, work around them a little bit, just kind of see how they're responding to the sedative to determine, okay, you know, this is perfect. This is exactly what we need. Or maybe they're a little bit heavy on that particular dose or it's a little bit too much to deal to work around the feet. And the good thing about that is you just have to wait a little bit of time. I know, you know, time is money. But if if they're a little too heavy, then you just maybe there's other horses that you're working on there at that farm aren't using sedatives or dorm gel and you go trim those horses. You come back in 20 or 30 minutes or an hour or so and you look at that horse again. And so what will happen over, you know, a couple hours is that that sedative will just slowly wear off

17:31and then they'll wake up more and more and they'll be able already to be worked around. Yeah, my horse is one of those ones that seems like he's more sensitive to dorm gel. And he gets really like you mentioned kind of like heavy or plants his feet. And so how long does it usually take or how long does it take to fully wear off, I guess? Yeah, so the fully wear off again, that's going to depend on the horse and it actually can be three or four hours before they're back to completely awake and normal. And so it can be quite a while with the gel. It's actually longer than you would expect than like a, you know, when we give something that is IV, they metabolize that drug very, very quickly and sedation sometimes depending on what we use can wear off within 20 or 30 minutes or maybe 45 minutes or less. And the gel, because of the way it works and it's slowly absorbed and metabolized, it actually can take a little bit longer for them to to for it to wear off. The important thing in the thing that when you're using this for

18:32the first time, waiting that 40 to 45 minutes before you do anything with the horse is very, very important. Because if you, you know, get impatient or 25 or 30 minutes in, you've given them the gel and then you're like, okay, I'm going to start working on them, start doing things, then you can actually, though, you'll stimulate them and the gel will not have the effect that we're trying to do. So important to wait that full time and then kind of see how they are. And if, you know, for example, for your horse or horses that it's just the standard dose is a little heavy, then you know that after your first use, and it's very simple to work with your veterinarian and say, okay, I gave two and a half ccs to my horse this time. And this is the effect that I saw. It was too much for what we wanted for that particular horse for trimming their feet or whatever procedure you're doing. What would you as a veterinarian recommend we go from down to to try for the next time? And that'll be able to work with you with that. Yeah, awesome. And so I know we mentioned before

19:36about training and how, you know, some people think like, oh, every, every appointment should be a training opportunity, which I agree with, I think that every time we interact with a horse, we're training it, essentially. But in terms of, you know, safety for the horse is sedated, does that also impact their ability to learn during that time? Like, can it be a good experience that then they, you know, take to their next appointment if they're sedated for trimming or suing? Yeah, I think, you know, there aren't really any good controlled studies because it's very difficult, obviously, to measure a horse's ability to learn, right? Like we can when we do studies on humans and we can ask them questions and those kind of things. And so it's just different in the veterinarian world. But we know that, you know, horses under sedation, many times if it's done properly, it can gain some trust from them, especially in abused horses and horses that are very, very difficult to work around. And

20:37then the sedation just kind of takes the edge off and then they learn to trust you and working around you. And so I think they do learn and they can learn negative things too during that period of time. So if, you know, if you're giving the sedative and then you're working with them aggressively, or you're doing things that are painful to them, they're going to still feel those and remember those things. It's not like the sedation will wipe that out. And so it might be more difficult the next time if you're not cheerful and paying attention to what you're doing. And so I mean, it's very important to know is that, you know, sedatives will never replace, you know, good training or proper handling, right? We'd never want to use it as a crutch or an easy way to get from A to B, because in the long run, it won't pay off. And so you've got to kind of look at all the options together. And I think us as experienced horse owners know that if you take the time and

21:39you work with your horses and you understand what's causing their anxiety and do positive reinforcement, many times with just time and training, we can get horses to where we want them and we don't need to use our sedatives. Sometimes we have to, but you know, we can do that. And you know, sedatives are, we're very lucky in the equine veterinary world that we have very, very safe sedatives that we administer to horses. But they aren't without their risks, right? There are potential side effects and problems that can happen with any sedative. And so if we don't have to use those and we can get through that with training or handling exercises, then you know, that's our goal too. Yeah, and I do have some questions about that. But before, you know, I asked some of those, just kind of talking about more of that practical use of the sedative. So when a horse is coming out of sedation, what, you know, how, what's the best practice for after a

22:41horse is sedated? Like, do they have to, I know that typically we like pull hay and, you know, does it very based on the type of sedative or what, what's kind of the timeline for after that? When we're finished with horses that we're doing the procedure that we're doing and they're still under the effects of sedation, it's very important to kind of look at the environment that they're in and think about the safety aspects as they wake up, right? Because if we just let them go or just kind of turn them loose on their own, they probably would naturally try to walk around or move around to areas and because they're under sedation, they may not have the normal coordination or the normal awareness to avoid some hazards. And so when horses are waking up from sedation, I always have them in a very safe environment that you can think of. So that's in a stall, that's in a just in a protected area or protected small paddock, level grounding, you know, nothing that they could potentially step into or get into that could potentially hurt them and then allowing them

23:45enough time to wake up. As you mentioned, we always pull away their food. The reason we do that is horses that are under sedation as they're waking up, they will try to eat, but they aren't awake enough to swallow properly and then they can choke and that can be an emergency. So we always pull their food away, you know, for at least a couple hours until we make sure that they're bright alert and awake and you don't see any any, you know, evidence of the sedation taking effect and then I'll usually put them away from other horses or at least not back into a paddock with a number of other horses where they normally have to kind of defend themselves or find where they are in the group of hierarchy because when they're sedated, they just don't have the same responses that they can have since best to kind of leave them in a safe area by themselves until they're completely awake. Yeah, and you know, talking about risks and kind of going back to what you'd mentioned before, I work with a lot of metabolic

24:48horses that have had a history of laminitis or founder or horses that are dealing with, you know, EMS or equine metabolic syndrome or PPI-D and when I was talking with Dr. Helbig a few weeks ago, we talked about, you know, the research around the regenerative medicine devices and horses with metabolic issues. So do, you know, these conditions affect the use of sedatives that we know about? Yes, absolutely. Metabolic issues do affect how sedation works in horses and so your veterinarian understands that and that's why it's so important to have, you know, regular exams done by your veterinarian on a yearly basis, especially if you're thinking about using sedation so that you can identify these issues and be aware of these issues because what typically happens in horses that have metabolic issues like a metabolic syndrome or

25:49Cushing's disease, those can alter their metabolism rate and it can actually slow their metabolism rate down and so you can imagine, you know, these sedatives that we give to horses are metabolized and the rate at which they are metabolized determines the length of their sedation, right? And so if their metabolism is slower then that can actually extend the time of the sedatives or it may even be a little bit deeper of sedation and if they have some underlying maybe liver issues or kidney issues or something like that which can happen with horses with metabolic issues then that can also affect how the drugs are cleared from their system and can lead to different effects of the amount of blood pressure changes and sedation effects as far as the length of time. So yes, so it's I don't want to scare horse owners or barriers away from sedation in those horses because there are many horses that are sedated on a daily basis that

26:53have these metabolic issues and we do it very safely, very regularly. And so it's it's not something to be afraid of it's just something that we as veterinarians understand and it's important to work with your veterinarian in those situations so that we can adjust the doses if we need to or maybe we need to do a little bit of more blood work ahead of time before the sedation just to check and make sure liver and kidney values are okay or make sure they're on the proper medications for helping control their metabolism and helping control their insulin, the sugar values and all of those things. But if there are those risks of limonitis or currently going through limonitis issues or those kind of things were were aware of that we're doing sedatives. Yeah and we're you know talking about not scaring owners so hopefully this question won't scare owners but you know I've had owners nervous about sedating horses too frequently and is that a risk especially you know when you're thinking about these special cases is that something that we should

27:53avoid doing? You know it's a great question. Again I don't I don't think horse owners should be generally afraid of sedation when they're working with their horses and veterinarians. You know sedations themselves right if if you're you know if we're giving horses sedatives on a very very regular basis or very short period times let's let's maybe say multiple times a day or multiple days in a row. Then you know those the sedatives have effects on their GI tract it slows down their motility it may increase their risks of colic and those kind of things if they're used frequently in a short period of time. But generally if if owners are thinking well I have to sedate my horse once a month for the ferry or every six or eight weeks for the ferry or is that a problem? In general no that is not a worry or concern. Again it's important to have your veterinarian do a full exam make sure they understand the health and blood work if needed to see if there are certain risks with sedation that we need to do less often

28:58but generally in those frequencies we don't worry too much about having to give sedatives. And the what often happens too is if you're doing this and they're having positive experiences with each of the sedations that you're doing the ferry or start doing great job working on their feet then you're just kind of positive really enforcing the situation and so what we often see with horses is that we either have to use less sedation over time or maybe we just eventually get to a point where we don't need any sedation at all and they're able to trust us and they see that everything goes well and that's kind of we know we've reached the best we can for the horse. Yeah and you know listening to all this I'm sure there are owners that are going to be thinking about horses and their care that could benefit from it is there a way that they should approach their vet about asking about you know it's a prescription medication so is there a way that they should specifically talk to their veterinarian about using sedation or or what information they should

30:02share with their veterinarian to to get that um yeah it's it's not complicated it's just just next time you see your veterinarian or contact your veterinarian just explain to them that you're interested in using sedation and explain to them why or what your goals are for your individual horse and why you want to use the sedation and then they're going to be able to very comfortably walk you through and answer your questions and say okay based on this situation this is what I think is going to be very appropriate for you. In many of the situations that we've talked about dorm gel is going to be likely a very good option and they can as long as they've seen your horse and done a physical exam typically that's within last year or more than they can write your prescription or dispense the dorm gel from the clinic to you so that you can have that and use it. Yeah I mean this has been such a great conversation I feel like I know so much more

31:04than when we started so thank you so much and I guess you know obviously I'm still learning about it is there anything that we didn't talk about that you any advice that you have for owners or hoof care providers or or any kind of equine professional around the use of sedatives? Yeah well thank you Alicia this has been fantastic I always love to teach and love an opportunity to kind of share our knowledge and understanding and hopefully it was helpful and yeah for both horse owners and veterinarians the Zoetis website has some really great information on it both for horse owners and veterinarians so I always steer individuals to those websites it's zoetis equine.com so all one word zoetis equine.com and you can go on there and there's a learn tab and you can select learn tab and even for failures there's failure resources that I'll talk about the different resources that we have and there's dorm gel videos on there and there's information

32:07brochures and lots of great resources so I'm always a little cautious for telling horse owners about doctor google and be careful about the AI and chat gpt's of the world because you'll ask them questions and it'll sound absolutely correct and the information is is is wrong and can be dangerous and so be careful of your sources and I think if you're using your sources like zoetis websites then all of that information is very accurate and I think it's a great just a great source to go to if you want to learn more awesome well thank you so much for sharing your time today and um being willing to share your knowledge too yeah happy to help thank you for having me yeah of course yeah i was a pleasure talking to you you too you too bye bye i always say that i'm slightly more hoof obsessed than the average person and chances are if you're listening to a hoof care podcast you are too so we should probably be friends feel free to find me on facebook

33:10or email me at the humblehuff at gmail.com