Treatment and prevention

The perils of over- and undertreatment

Not every horse recovers equally well from laminitis. Therapies, medication, dietary changes, modifications in housing, exercise and hoof care are not always successful. Effective treatment of the underlying problems is not always possible either. In many cases though, it would help to have another critical look at whether all conditions for a reasonable chance of recovery are being met. However, some horse owners will first look at the possibilities of other, new therapies or try to intensify the current treatment. This approach involves a risk of both over- and undertreatment. Both can be harmful to the horse.

In the first case, we bombard the horse with diagnostic methods, drugs, herbs, needles, magnets or over-engineered therapeutic horseshoes. In case of undertreatment, on the other hand, the horse does not receive the care it needs. Over- and undertreatment often go together. For example, by opting for the promising, radical therapy X (overtreatment), we discontinued therapy Y, which did not deliver the quick results we hoped for (undertreatment). The damaging side effects of a new, revolutionary drug can be more significant even than the relief it offers. Or the results of unproven diagnostic methods, which were used to prove the veterinarian wrong, might give the owner hope, but can cause the horse to keep on limping unnecessarily long. The same applies to complementary therapies for which there is not more than some anecdotal evidence.

Placebo effect

Another risk of over- or undertreatment arises where the personal and professional interests of a therapist stand in the way. On the internet you will find many websites of people who claim to have had the most incredible successes in treating laminitic horses. Any lack of success would endanger their reputation. They will try to prevent this happening at any cost and continue treatment until they (or the horse) drop. The credibility of the therapy and the associated positive expectations contribute to the well-known placebo effect that the owner of the horse is subject to.

Pygmalion effect

Then there is the ego-boosting admiration for the therapist and his status. Not every therapist can disengage from this and admit that his therapy did not produce the long-awaited (and expensively-paid) positive results. If the perception of the horse owner is blurred by this admiration this is called the Pygmalion effect.

Akrasia

Veterinarians and hoof care practitioners can continue for too long with an unsuccessful treatment in an attempt to prevent the horse owner from seeking help from someone else. This can be a noble goal if they are convinced that the horse will be worse off with that other caregiver. Acting against one’s better judgment in this way is called akrasia. Unfortunately, the horse will ultimately be the victim of this. Let’s have a look at an example. A hoof care practitioner who does not manage to change a client’s behaviour, while this is essential for the recovery of the horse, will never be able to perform miracles with trimming alone. If, in that case, giving up means that the horse will end up with an unexperienced, shoe-happy farrier, there is a fair chance that the hoof care practitioner chooses to proceed working in this far from ideal situation to at least prevent worse. Understandable, but a clear case of undertreatment. The author of this text has unfortunately been guilty on a few occasions too.

Let’s be honest – there are also many horses that were given up on by both the veterinarian and the farrier, who were then cured, because their owners chose not to listen indiscriminately and instead seek a good and proven alternative. Indeed, a large part of the readers of ‘Laminitis – understanding, cure, prevention’ consists of such horse owners. However, we cannot just say when we cross the line to over- and undertreatment. It can differ on a case-by-case basis. The bottom line is that a sensible horse owner strives to provide the best possible care and will thereby keep both eyes open for the perils of over- and undertreatment.

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