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Rehabbing a Starved, Neglected, or Abused Horse

Liz is a licensed veterinary medical technologist. She acquired a B.S. in veterinary medical technology from Lincoln Memorial University.

The Significance of Equine Abuse, Cruelty, and Neglect

It is difficult to comprehend the depth of the surrounding situation that produces such a depressed, devastated creature as an abused horse. Few people understand the true definitions of words such as neglect, abuse, or cruelty, and even fewer know how to identify these scenarios and appropriately intervene.

Neglect is defined as the failure to provide proper food, water, and shelter, and may also include the failure to provide proper veterinary care for a horse that is ill or has been injured.

Abuse and cruelty include the intentional act, omission, or neglect that allows any unjustifiable or unnecessary physical pain or suffering to be caused; this includes, but is not limited to, acts such as:

  • beating
  • harassing
  • starving
  • intentionally scaring a horse

In many abuse/neglect cases, the responsible person may deny ownership of a horse in order to avoid responsibility and criminal charges. However, an owner is defined as any person who cares for, possesses, controls, or otherwise assumes custody and responsibility for the care of a horse.

When experiencing abuse and neglect cases in the veterinary world, it is hard to imagine what would drive a person to cause such significant misery to an animal as majestic as a horse. An estimated 100,000 horses per year in the U.S. are categorized as unwanted. General ignorance or lack of husbandry skills accounts for more than 50% of neglect cases. In ideal situations, these cases can be resolved with proper education, and the animal may be later returned to the original owner and live out a healthy life.

However, economic hardships can precipitate neglect, especially in cases where the horses are kept solely as companion animals. Illness, injury, or substance abuse may cause owners to make compromises on their horses’ quality of care over a long period of time.

The apathy and laziness of an owner will almost guarantee improper care. In worst-case scenarios, individuals involved with domestic violence may use the abuse of an animal as a strategy to “punish” a child or spouse.

The Role of the Veterinary Team and Other Appropriate Agencies

When presented with an equine abuse case, the role of the veterinary team is to provide an evaluation, diagnosis, prognosis, and any treatment or supportive care that the animal requires. This is best administered under the direction of an equine veterinarian. In cases where education can resolve the issue, the veterinarian or veterinary technician must be ready to take the role of lead educator.

The reporting of cases of neglect to the authorities must be reserved for offenders who intentionally ignore educational interventions, or fail to initiate therapy altogether. Reporting obvious neglect to the authorities will often on its own serve to prevent any further neglect or abuse, and may be mandatory under some government authorities.

For the veterinary professional, “good faith” reporting may be necessary where reporting is not compulsory. A strong connection between domestic violence and animal cruelty has been found; if conditions suspicious or obvious of human abuse become apparent during the management of an equine abuse case, it is mandatory for the veterinary professional to report such findings to the appropriate agency. Veterinary professionals are frequently called forth to testify as expert witnesses in the prosecution of animal abuse or neglect court cases and should be prepared to do as such.

Different agencies have different roles in handling neglect cases. Investigations are usually performed by humane or animal protection agencies. Animal control officers, sheriffs and deputies, local and state police, and governmental veterinarians may also investigate and serve to enforce existing laws and regulations surrounding animal abuse and neglect. Law enforcement agencies are also concerned about public health and safety, and so social services may assist with neglect cases if human violence, health, or safety is suspected to be at risk.

The veterinary team plays a primary role in the rehabilitation of neglected horses.

The veterinary team plays a primary role in the rehabilitation of neglected horses.

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Initial Assessment of Neglected and Abused Horses

When first assessing the abused or neglected equine patient, safety is the number one concern for the veterinary team. If the cause for abuse or neglect is unknown, and especially if the suspected perpetrator is unstable or at large, one must proceed with caution. Never trespass on private property to help a horse, as this may result in criminal charges, jeopardize your credibility, and/or damage any existing legal measures against the owner.

Maintaining a logbook is useful, and should record all communication, visits, dates and times, and both positive and negative objective observations. If possible, photograph the conditions of the facility in which the patient was found, including barns, flooring, bedding, food and water sources, enclosure conditions, sanitation, and any other conditions that may affect the horse’s health. The history in the weeks or months prior of the neglected patient should be gathered from the owner; however, owners may falsify information in order to avoid persecution. Contacting the feed supplier, farrier, or local veterinarian may be more useful when forming an accurate timeline of events. When multiple horses are involved, each horse should have its own written record and photographs for accurate identification. These records should include gender, breed, age coat color, any special markings or brands, and any other unique characteristics. Any signs of illness and all injuries, along with their locations and severities, should be documented.

The horse’s body condition should be assessed upon initial exam and at every weekly interval during rehabilitation. Body condition is often scored using the Henneke method under field conditions. This method utilizes visual appraisal and palpable fat areas, with scores ranging from one to nine. A score of one is considered “very poor” with no fat observable, and a score of nine is considered “extremely fat” with bulging fatty deposits. A score of five or six is most desirable in horses. While heart girth tapes may be used to estimate a horse’s weight, scales offer the most accurate weight measurements. While on-site, the amount and condition of feed available to the horse should be documented, including plants on pasture. The presence and physical condition of any other animals on the premises should also be recorded.

When assessing the health of horses in neglect cases, each horse should be evaluated by a veterinarian with consideration to any necessary diagnostic tests. A physical exam should be performed promptly, as the conditions of starved horses may deteriorate very quickly. The symptoms of a starved horse include:

  • behavioral changes
  • depressed reactivity to external stimuli
  • immune compromise with a decrease in circulating lymphocyte count
  • compromised phagocytic response
  • excessive weight loss

All aforementioned symptoms will become noticeable within one to two weeks of nutritional deprivation. Parasite control programs should be evaluated. If there is not one, then one should be started. The dental condition should be examined, as the ability to chew food effectively is vital to weight gain during the rehabilitation process. The condition of the hooves should also be examined, and overgrown hooves should be photographed with a ruler to demonstrate hoof length.

If the animal dies during rehabilitation, a necropsy should be performed, with special attention paid to atrophy of fat deposits in adipose, subcutaneous, and abdominal depots. Muscle atrophy and wasting begin to occur after prolonged starvation. Any parasites should be identified and recorded. Tissue samples from the liver, kidneys, thymus, pancreas, intestines, and lymph nodes should be submitted for histology. Cancers such as lymphoma and adenoma can often be identified by necropsy.

Never Trespass to Save Horses

Never Trespass to Save Horses

Starving Horses, Refeeding Syndrome, and Feeding Regimens

Starved horses are depressed, with bones so prominent that the skeleton appears too large for the horse, and the tail is always low and motionless. The head hangs low, and the ears hardly respond to any sounds around them. The eyes are dull, and the horse has no interest in interacting with any horses around it.

During starvation, horses initially lose any carbohydrate and fat stores to supply their energy requirements. This is normal for any healthy horse; carbohydrates and fat are used first for energy and brain function, they are replaced with nutrients absorbed from food. This cycle is constant, even during sleep. In a starved animal, however, once the stores of carbohydrates and fat are gone, the body must turn to the breakdown of protein to obtain energy. While protein is present in every tissue in the body, there are no actual stores of it, as there are with carbohydrates and fat. Therefore, a starved horse must use the protein not only from its muscles but also from vital organs. A starved body cannot select from which tissues to metabolize protein. Over time, this situation becomes dangerous.

The causes of emaciation in horses may be multi-faceted. The most common cause is a lack of quantity and quality of feed with insufficient calorie intake. If the feed is provided in sufficient quantities, it may be deficient in nutritional content and balance. Deficiencies in certain vitamins and minerals, and also the excessive use of supplements, may contribute to emaciation over a long period. Primary feed sources at pasture naturally decline during the fall and winter months, and emaciation may result when owners fail to provide supplemental food sources in compensation for this seasonal decline.

Nutritional malabsorption is often associated with diarrhea from poor quality feed, parasites, and poor dental conditions. Parasites and dental conditions may serve as primary or secondary contributors to a horse’s emaciated condition. In mares, pregnancy and lactation will increase their dietary needs, making their nutrition a priority during rehabilitation in order to avoid poor body condition and be able to maintain productivity for the foal. Certain pathological diseases associated with cancers, diabetes, infections, or conditions of the liver, kidneys, heart, or pancreas may elicit progression toward emaciation.

The nutritional rehabilitation of starved horses is a delicate science within itself. In human starvation cases, a condition called refeeding syndrome occurs when an emaciated patient is given concentrated calories in excessive amounts in the form of glucose, either enterally or parenterally. Refeeding syndrome can cause cardiac, hepatic, and respiratory failure, seizures, coma, and death within a week. These patients will have normal electrolyte ranges at the initial start of refeeding but will develop severe hypophosphatemia, hypomagnesemia, and hypokalemia due to the effects of insulin on the meager stores of electrolytes present in the body.

Emaciated horses with a BCS of one to three may also experience refeeding syndrome when given too many concentrated calories at one time. Studies from starved horses have demonstrated normal serum phosphorus levels during initial treatment, but then being to decline through a 10-day trial. At the initial start of refeeding, serum magnesium levels were low, and showed an increase during the trial in horses that were fed a diet high in magnesium content (alfalfa). Therefore, the general recommendation is to gradually increase the amount of high-quality forage over time, and preferably offer forage that is low in bulk and high in magnesium content. Grains, such as oats and corn, are not recommended, as they are high in soluble carbohydrates and may produce an elevated post-prandial insulin response. Alfalfa hay is preferred due to its high phosphorus and magnesium contents, low carbohydrates, and low bulk. These are the qualities of feeds that are supportive of successfully rehabilitated starved horses.

Successful feeding regimens are based upon the digestible energy (D.E.) requirement of the horse at its recommended normal body weight. The daily D.E. requirement of a horse differs with the changing body weights and production levels (as with growth, pregnancy, and lactation) and with the kind of feed being given. As a general rule, small amounts of high-quality feeds should be given at four-hour intervals to allow the horse’s insulin response to return to normal. In general, and with a proper feeding regimen, a severely starved horse will gain about 10 pounds during the first week and regain a normal body condition by six months, albeit no other medical conditions interfere with progress. When refeeding a starved horse, consider this general guide:

  1. For the first three days, feed 50% of the D.E. requirement divided across six feedings, with four-hour intervals between each feeding. If no complications arise, the horse may be advanced further through the regimen.
  2. 75% of the D.E. requirement may be given on days four and five, again over six feedings with four-hour intervals between each feeding.
  3. On days 6 through 10, 100% of the D.E. requirement may be given in three feedings with eight hours.
  4. After day 10, continue to feed two or three times a day, increasing the quantity offered if the horse consumes all feed that is given. It is not recommended to feed any grain at all until the animal’s body condition score is a three or above, which is usually about two months after initially refeeding an emaciated horse.

A previously starved horse will begin to show signs of increased energy after about two weeks of refeeding. A difference in their eyes, ears, and head movements will be noticed first. The eyes will become brighter and more expressive, and the ears will be more responsive to sounds around them. The head and tail will be held higher. The horse will move around more, and be more willing to interact with horses around them. This very thought is rewarding, however, rehabilitating a starved horse can be difficult, as many complications can occur.

Once a horse loses more than 50% of its normal body weight, the prognosis for recovery becomes very poor. Horses that have been recumbent for long periods of time also experience a poor prognosis, as they often fail to positively respond to refeeding therapy. Horses that experience an onset of respiratory distress or neurological compromise by the fourth to sixth days of refeeding are usually elected to euthanasia if they do not die on their own, as these symptoms are characteristic of refeeding syndrome with hypophosphatemia and hypomagnesia. If the immune system is significantly compromised, salmonellosis and other enteral bacterial infections may occur, resulting in significant diarrhea and electrolyte losses. Diarrhea may also result from consuming large bulks of grains. Initially, a horse may lack an appetite, but this is usually transient. Repeated attempts at offering small portions of fresh forage usually establish consumption.

Sample Rehab Feeding and Medication Chart

An example of a feeding and medication chart used during multi-horse rehab situations.

Horse Name or IDMorning Feeding +/- MedicationsMid-day Feeding +/- MedicationsEvening Feeding +/- MedicationsTurnout and Other Special Instructions
















Diseases and Secondary Health Problems

Many other problems can result from abuse and neglect, whether they are a direct result of the abuse or a secondary result of neglect and starvation. Dental problems can contribute to weight loss, although it is unusual to find a horse that is underweight solely due to dental issues. Dental problems typically contribute to a poor body condition in combination with an inadequate calorie intake. Horses are hypsodonts, meaning that their teeth grow continuously throughout their lives. Over time, chewing creates sharp enamel points on the upper buccal and lower lingual edges of the premolars and molars. These points can become so sharp that they create cuts on the gums and the insides of the cheeks, making it very painful for the horse to chew. Horses with severe enamel points may suddenly drop feed from their mouths while eating (called quidding) and toss their heads around, and pace in an attempt to escape the pain. Floating is required to correct this problem and should be performed by a veterinarian.

In addition to enamel points, missing teeth, fractured teeth, or malocclusions may also impair a horse’s ability to properly chew food. Because chewing is the important first step in digestion, food that has not been properly chewed will pass through the body whole, resulting in improper digestion and inefficient nutrient absorption. The body must then turn to its own stores to meet energy demands. Correcting any dental problems can increase the efficiency of chewing and therefore, the absorption of nutrients from food. During rehabilitation, a horse’s teeth should be examined and floated to correct any enamel points and malocclusions.

Another common problem of neglected horses is overgrown hooves. Horses’ hooves grow continuously, and when left untrimmed, they can grow and curl backward, impairing the way the horse walks and even injuring or crippling the animal. In one rescue case in Maryland in 2015, an emaciated stallion was found to have hooves that were three feet overgrown. The horse was hardly able to walk, as he would nearly entangle himself in his own hooves with each step. Transport of horses with such overgrowths is nearly impossible, as they can often hardly walk or be loaded onto trailers. Therefore, horses whose hooves are so grotesquely overgrown must have them trimmed immediately. Horses in these cases must be allowed to rest afterward, as such drastic changes to the feet can cause pain as the hooves reattach and legs readjust to the changed weight distribution.

Horses recovering from overgrowths must have their hooves trimmed and adjusted every one to two weeks, which is far more often than the typical once every 8 to 10 weeks in a normal horse. Unfortunately, many horses who suffer from overgrown hooves over long periods of time often suffer from coffin bones that have detached from the hoof wall and rotated downward; no amount of trimming or special shoes can correct this condition. These horses will forever have an unsound gait and will never be able to carry a rider. Some horses will develop severe laminitis due to coffin bone rotation and collapse, either causing the hoof to detach from the coronary band or causing the coffin bone to erupt from the sole of the hoof. This condition is extremely painful and cannot be reversed, so these cases often result in euthanasia.

During periods of neglect, infections and infestations are allowed to wreak havoc on a horse. The body must expend extra energy to ward off bacterial and parasitic infections, resulting in weight loss and an unthrifty hair coat. Horses that are sick as a result of infections may refuse to eat just as a human would, even if sufficient feed is available. Chronic infections as a result of neglect may include pneumonia, pyometra in mares, peritonitis, internal abscesses, and especially pyoderma. Skin diseases, dermatophytosis, and rain rot are typical of horses that have nutritional deficiencies or have been left out in the weather for extended amounts of time without being groomed. Many neglect cases will display crusting, scaling, and alopecia, with lesions distributed across the chest, back, rump, and limbs. Treatment of these conditions varies on the causative agent of the lesions.

A physical exam performed early on in case management can greatly improve the prognosis of these cases. These exams may also illuminate parasitic infestations. Blood or fecal testing can determine if and where the infestation is occurring, as parasites may play a major role in a horse’s poor body condition score. With this being said, the mere presence of parasite eggs on fecal examination does not necessarily mean that parasites are contributing to a horse’s poor condition; almost all horses have some parasitic infection at nearly all stages of their life, but as long as the parasite load is managed, the horse should not have any complications. As a satisfactory general deworming, I recommend using Ivermectin Paste at least once every six months to manage the most common parasitic infections. As with other types of infections resulting from neglect, the treatment, and management of parasitic infections depends upon the parasite and factors of the individual case itself. Most veterinarians will perform a fecal egg count once every six months to a year to determine what type of parasite the horse(s) are harboring and what deworming method would be most beneficial in that case.

There are hundreds of chronic diseases that can cause a horse to become emaciated if one neglects to manage them. This includes various cancers, Cushing’s disease, gastric ulcers, enterolithiasis, bone fragility syndrome, mandibular fractures, neurologic conditions, mineral deficiencies or toxicities, and various organ dysfunctions and failures. These are only to name a few. These diseases each have their own mechanisms by which they cause increased metabolic demands.

Some diseases cause the horse to lose its appetite, and it loses its body condition as a result of refusing to take in calories. In others, an extreme metabolic demand is placed upon the body by the disease process and the horse is unable to keep up with such demands, thus creating a negative balance between energy intake and expenditures and resulting in weight loss. Each condition involves its own diagnosis, tests, treatments, and management considerations; for these reasons, underweight horses must be thoroughly examined early on in the rehabilitation process. It cannot be stressed enough that early diagnosis and correct treatment is key to the survival and success of abuse and neglect cases.

The Importance of Training Rehabbed Horses

One aspect of horse rehabilitation that many people do not initially consider is training. Many horses brought in to be rehabilitated have health conditions that require physical therapy in order to fully overcome. Some may have developed fear and aggression towards humans as a result of previous abuse, and others may have been without human interaction for so long that they require retraining. Still others may have behavioral issues that caused them to be abused or neglected in the first place. Either way, many horses require training or retraining in order to obtain the physical and psychological well-being to facilitate the re-homing process, which is the desired end goal of the training rehabilitation process.

Rehabilitation trainers often use either positive or negative reinforcement training strategies before horses are released to their new homes. In a recent study, most horses benefited most quickly and effectively from positive reinforcement techniques. This education should be passed on to fosters and new owners of re-homed horses. Not only does this increase the chances of a horse being re-homed, but it also makes the handling of the animal safer and more enjoyable for the horse, the rehabilitation staff, and the future owners.

Training is an extremely important part of the rehabilitation process, as it makes rescued horses "more adoptable" to the public.

Training is an extremely important part of the rehabilitation process, as it makes rescued horses "more adoptable" to the public.

The Rewarding Results

In successful rehabilitation cases, it is extremely rewarding to watch horses go from depressing, scarred, emaciated beings to the healthy, gleaming, majestic beings they were meant to be. Successful rehabilitation cases are always made possible by people who care for the animal’s well-being, diligent veterinary care, and proper nutritional support. This takes a team of many people, thousands of dollars in management, and months of time, but the end result makes it worth it; a beautiful living being with another shot at life and happiness.

Sources/Additional Reading

This article is accurate and true to the best of the author’s knowledge. It is not meant to substitute for diagnosis, prognosis, treatment, prescription, or formal and individualized advice from a veterinary medical professional. Animals exhibiting signs and symptoms of distress should be seen by a veterinarian immediately.

© 2018 Liz Hardin

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