OK, thank you very much. So tonight, I'm gonna go over kind of injury rates amongst the equine veterinarian population, where they come from, how it occurs, and obviously, most importantly, how we can stop these occurring, what we can do differently. I am going to make an assumption that there's some basic understanding of learning theory.

As I say, I've done a few of the webinars and I think people are getting to grips with it a little bit more now. But I'll mention it at the end if there's anything you're not comfortable with, then obviously just ask a question and and we can discuss it later. So what do we know about occupational injuries to equine veterinarians?

Well, we know that you're more likely to be injured as an equine veterinarian than you are working in the fire service or the prison service or the construction industry, and that the average vet is going to sustain 7 to 8 work-related injuries that are severe enough to impede them from working. And these are always injuries that are caused by the horse, not because you're too tired driving home after a night on call. So I want to just discuss a little bit of what I looked at in my MSC through research, and really the aim of this was to investigate the prevalence of unwanted behaviours, how vets deal with these behaviours, and then how they understand how well horses, learn and how that kind of interacts with it.

So to do this, we sent a web-based survey out and thankfully, Beaver were happy enough for us to include a link to it in their e magazine. And then we also sent it out to referring practises of the University of Edinburgh, so mainly practises around Scotland and the north of England. We got 220 completed responses, and they were what you'd expect, you know, 2/3 were female.

The majority of them were purely equine vets, but we also had a mixture of people in mixed practise. And to look at this, what we really wanted to do was to look at people who were looking at horses quite frequently to get an idea for prevalence. And as you can see, there was nearly 70% of vets which were treating more than 50 horses each month.

We did have more people from Scotland because of the who we send it out to, but generally we felt it was representative of the UK in in general. In terms of those we excluded, as I said, we only really wanted to look at horses which were seeing a significant number of horses on at least a monthly basis, ideally at least 20 horses in a month. So any that were from outside the UK or was seeing less than that, we took out, which left 168 responses in the final analysis.

So first of all, and this is just, you know, very similar to the Beaver study and other studies that have been done in other parts of the world, but we asked them how many injuries they'd sustained in the last 5 years. And as you can see, 81% of vets had sustained at least 1 injury. And you can see, you know, 15% had one or two injuries, 16% of 3 injuries, not, you know, not many of those 9% which said that they had 10 injuries.

It does worry me a little bit. This person here, so there's one person which said that in the last 5 years they had sustained more than 30 injuries, and I do question whether they should actually still be in equine or not. What was also concerning because obviously, we allowed them to decide whether, you know, what they perceived was an injury or not.

So you could say, well, it was just minor bruising, it wasn't significant. But of these injuries, 35% required at least one visit to hospital, 26% required at least one visit to their doctors, nearly 30% required days off work. And what really concerned me was just over 50% have some continued discomfort or loss of function.

So I think we're in no doubt that equine vets get injured very frequently by horses that they're caring for. So the next thing we asked them was how frequently they perceived that they put themselves in a potentially dangerous situation when working with a horse. And they could choose, as you can see on the bottom of this grass every day, a few times each week, a few times each month, a few times each year, or very infrequently.

And then on the right-hand side, you see we have a cumulative percentage. And, I'm explaining this now because we'll look at this in a few. But almost 30% said every day, and this is why it was important, of course, that these were vets that were seeing at least 20 horses a month, and most of them were seeing a lot more.

Weekly, the cumulative percentage is 67%, and by the time you get up to monthly, you're looking at 92% of bets. And that's not surprising considering how many get injured. So as well as asking about dangerous scenarios, I said, how frequently do you perceive that you are dealing with horses that are difficult?

And again, 95% of vets said they were dealing with difficult horses on at least a monthly basis. And we broke this down a little bit further. So the most common reason for unwanted behaviours, the difficult horses was horses.

Those which would push you out of the way. Then it was those that won't stand still and then needle shy horses and as you can see we've got over 90% for all of those scenarios. Now what I found interesting was if you looked at how many years' experience vet's had and how frequently they were seeing difficult horses, and particularly needle shy horses was one that I felt showed this really nicely.

The smallest number of respondents were those which had less than 2 years' experience, and yet those were the ones which had the highest, variation overall, and also the highest mean percentage of needle shy horses that they were seeing, whereas over time, vets with more experience were seeing less and less needle shy horses. So for me, this poses a question as are vets getting better over time in their technique? Or is it that the ones that are struggling with these difficult horses are leaving the profession, or are they leaving it to the new graduates?

And I, I must admit the last one I, I don't think happens. I think the partners tend to take responsibility for the more challenging horses. Other unwanted behaviours that we saw, the one really to pick out on here is kicking out with a hind foot at nearly 70% on a monthly basis.

Again, striking with the front foot, 50% and rearing 49%. So again, it's no wonder that equine vets are becoming injured when we're dealing with all these difficult behaviours. I asked them about any other behaviours that they saw, and headbutting or striking with the head was the most popular one.

Crushing, which I guess also fits in with the horse that's bargy. You see, there's a few others there which were less common. Twisting sideways to come down on top of you.

These were just single responses at the bottom, try and roll on the ground, aiming at you with any part of their body, which I've definitely see horses do, and I've also seen them deliberately try and step on your foot. So knowing that we're seeing all these difficult scenarios, difficult horses, unwanted behaviours on a frequent basis, I was then interested to see how vets actually deal with this. So, for this, they could say that, for each method was either very useful, fairly useful, unhelpful, or very unhelpful.

And you can see sedation, unsurprisingly, was the most popular one with 99% of vets in sedation was at least fairly or very useful. And we can all imagine how if you're doing a head CT, you know, a good level of sedation is absolutely imperative. But at the same time, if you're doing a lameness evaluation, sedation might not be an option.

And remember that over 90% of horses were actually reported to be needle shy. So whilst sedation is a great tool, we also have some challenges there as well. The second most popular method was a nose switch with 74%, thinking it was either there or fairly useful.

Then a neck twitch, then a chimney. After that, the responses, which were less than 50%. Again, you'll notice bridle holding up a foreleg, lunch line, you know, there are three other options which are looking at physical restraint of the horse.

Food distraction, only 40% using these remote injection using an extension set less popular. I also asked them about methods which were based on learning theory, so the use of positive reinforcement, reinforcing the behaviour we want, usually with food. And only 20% of vets felt this was at least fairly useful.

So this obviously, this was a few years ago, now it's perhaps changing now, but they didn't see that this was something that was useful to our profession. Negative reinforcement, we have to take this one with a pinch of salt because when we actually tested them, they didn't understand what negative reinforcement was very well. But as you can see, very few of them actually thought this was a good idea.

And again, the same with overshadowing some which I've talked about in previous lectures. I think mainly as you can see, 60 or 17% of them didn't actually know what this was. They had free text.

Is there anything else that you find useful? And again, you'll notice on this list that the majority of them involve some form of physical restriction, some form of physical restraint. One vet recommended, ear twitch by hand, hold on to the tongue, put them in socks with the tail over the back, put a rug on backwards to stop them striking with the front legs, or put them in a closed down space such as a horse box.

So lots and lots of restraint going on there. Another one actually said, I have thrown a fallabella to the floor before like I would do a sheep. Well to treat for microchipping owner less impress.

And I would say that really sums it up that we're moving into an era whereby the owners want to see their horses having a more positive veterinary experience, as well as the fact that we don't want vets to get hurt, the owners don't like seeing their horses becoming stressed. So so far we know that there's high rates of injuries caused by horses. There's a high prevalence of difficult horses.

There's a reliance on physical or chemical restraint, and another part of my MSC had looked at, asking vets how well they understood learning theory and testing them on it. And for the majority of those cases, they, they did really poorly on this. I think that might be better if we repeated it again now.

But in terms of retraining horses, there was little knowledge there. And one of the themes that come out was that I never saw it coming. It came out of nowhere.

This horse looked absolutely fine, and then it exploded, it kicked out, it reared, it badged and knocked someone over. So how can we predict when we're working with horses, which ones are going to react adversely to a procedure? Well, I think to answer that question, we first need to say how do we measure a horse's emotional state?

And when we look at emotional state, we break that down into different segments. So we can look at valence, which is what we call the effective state, whether basically whether a horse is happy or sad, whether it's a positive or negative experience. And When we're looking at this, one of the most basic ways of deciding if a horse is is happy or sad when you present them with a stimulus is do they approach it or do they move away from it.

So if you put a feed bucket down, we all know that's a very positive experience for horses. It's a pleasant stimulus, so they're motivated to move towards it. They want more.

Whenever horses have something that they find pleasant, it releases in dopamine release, and it also influences things like serotonin and oxytocin. So it's having a calming influence on the horse. Whereas if the horse sees something horrifically scary, like, for instance, a plastic bag, they're more likely to, Activate the avoidance or escape systems.

So now we start talking about fear, we start talking about stress, we start talking about the fear centre in the brain, the amygdala being activated, and all, you know, cortisol, adrenaline, all the hormones that go along with that response. So we should always be thinking when we're working with a horse, which system do we want to promote? Do we want to approach this relaxation, this, happy system, or the more avoidance escape system?

Surveillance is one aspect. The second aspect is arousal, and basically arousal just means the level of alertness of a horse. So then we can start to put the two things together.

So in a perfect world, we would have horses which were in a positive effective state, i.e., happy with low arousal, i.e.

They're calm. That is what we would like to work with as vets. Of course, it's perfectly normal for horses to have a positive effective state with high arousal.

If a stallion sees the mare in season or if a horse is going across country, you know, you don't want it to be too calm. There has to be a little bit of adrenaline flow in there, but they're still in that happy place. However, what we see more of when we're working as vets are these horses which are in a negative effective state, they're wanting to escape, but they also have high arousal levels, and they have this fight or flight response.

And we don't see too much of it in the veterinary world, but I've probably mentioned it before that you can also get horses which have a negative effective state which with very low arousal. And this would be the equine equivalent of depression. We often talked about conditions suppression or learned helplessness, whereby even if the horse is undergoing painful stimulus, they just become switched off to it.

I think it's also important that we remember that horses are primed for fear. They have the largest amygdala relative to their body size of any domestic species, and we also know that aggressive horses have lowered serotonin levels compared to controls. Fear is easily learned.

Most things horses learn, they would learn within 3 to 5 repetitions, whereas anything learned through fear is learned in a single repetition. It's also never forgotten. So once anything's, normally if something's learned, over time, that memory can become extinguished.

You know, if that response is not reinforced, so a good example would be if you teach a rat to press a lever and food comes out. If the food stops coming out, eventually they stop pressing the lever. That doesn't become a response anymore.

However, anything they learn through fear is subject to what we call spontaneous recovery. So no matter how far down you bury this with retraining, you can never guarantee that it is not going to occur again. And this is why I think it's really important to avoid fearing horses, and I'll explain a little bit more about this later on.

But the more dangerous horses we see are the ones which have really practised these hyperreactive responses. And it's always associated with how fast and how far the horse can escape the fearful stimulus, whether that's just throwing their head or whether it actually involves movement of their feet. I think it's also important that we consider how emotional state influences learning.

So there are 3 phases to learning. The first one is where you acquire a new behaviour, then you monitor, does continuing to under to participate in this action, result in the outcome that I'm expecting, and then over time it becomes a habit whereby you don't have to think about it anymore. So when it comes to stress, we know that the acquisition of new behaviours is slower in stressed horses.

And one thing that I see quite a lot of when I go out to see behaviour cases is the owners, or sometimes the vets will say, I will show you what he does. And actually, I don't want to see what the horse does when I go out. If I've got a nice calm, relaxed horse, if the vet goes to inject it or if the owner turns the clippers on and the horse turns itself inside out.

You're then having to counteract that and you're starting on the back foot. So it's fine to look at video examples, but I would say if you're going out to a horse that you know is needle shy, don't have a go first and see how it goes. Start with some behaviour modification from the start, and if the horse never gets wound up, they will be so much faster to learn the new behaviours.

We also know that once hosts have learned these behaviours, they are much less likely to change them when they're stressed. So when you are fearful, when you're stressed, you go back to the behaviours which have worked for you in the past. So even if a horse starts to improve and becomes less needle shy, you just do a little bit too much with them and they can revert back to these other behaviours.

And obviously there's a degree of spontaneous recovery involved with this as well. So how do we measure the stress response in horses? Well, generally we talk about from a scientific point of view, we talk about having a behavioural response and then a physiological measure which can either be looking at the neuroendocrine response or the autonomic nervous system response.

But realistically as a vet in practise, you are looking at a behavioural response. You want to be thinking, what can I actually look at in the moment, which is gonna tell me how stressed this horse is, how fearful this horse is, and give me feedback so that I don't get hurt. And I think this is something that we still have work to do, in terms of the equine world.

So I think in the dog world, I don't know if there's any mixed practitioners here tonight, but we have the canine ladder ladder to aggression. And people are very good at noticing that a dog might, injure someone when it's growling, when it's snapping, when it's biting. But what a lot of people miss is the dog yawning, it blinking.

Licking its nose or its mouth, turning its head away, all these more subtle postural indicators that this dog is not coping with this situation. And this is what we need to see in horses. I think people are very good at seeing horses that are rearing, kicking, barging out, but they miss a lot of the subtle signs that horses are warning you that if you don't.

Do something differently, they're gonna go up to the level whereby they're kicking or rearing or reacting much more aggressively. So what are these sounds? Well, I think the horse's head is often one of the best places to look.

The muzzle can be quite tense. You see these pursed lips? And, and I would say tension is the number one thing you'll you'll see.

I keep coming back to this throughout the talk. You can see tension, you can feel muscular tension if you've got your hand on the horse, and you'll feel it changing. The nostrils can be flared, sometimes they can actually contract them a little bit.

The eyes, we often talk about being able to see the white of a horse's eye. Well, this is due to a combination of factors. One of them is that the horse's eye becomes more wide.

The horse's eye may become very fixed and looking at stimulus, or it may be flicking around, looking for escape, looking at lots of different things that are going on in the room. But often it's actually focused backwards and slightly downwards, and you'll see in both the horses in these pictures, the eye is rotated a little bit backwards and downwards, even though the people are either in front or to the side of them. And we see the same thing with the ears.

This is this really classic ear posture of the horse being anxious. They go out to the side and rotate it slightly backwards and down. And then head higher, where is the horse's head?

You know, normally the horse's head is roughly level with the wither. And what I would often say happens is when someone, let's give the example of giving a vaccine, the person first goes in and the horse's head is what is classed as a normal level, and then they go to listen to the horse's heart, and the horse's head lifts a couple of inches, and then they draw the vaccine up and the horse's head lifts a couple more inches, and then they get hold of a neck twitch and the horse's head is quite high like these two in the pictures. And then when they go to inject the horse.

They can't work out why this horse has suddenly reacted so adversely, and why it has either struck out or barged past them. But actually, this horse was giving them lots of signs that it wasn't able to cope very well with this scenario. The other thing to do is look at the muscles on the horse's neck.

So in a calm, relaxed horse, the muscles on the top line are the ones that are the most prominent, whereas the horse becomes more anxious, the ones on the underside of the neck, the brachocephallic, become more bulging, and they become really firm. So this flattens the jugular vein. It makes it harder to get an injection into the into the jugular.

It also makes it harder to get hold of a skin twitch. And I would say if you can get hold of a good amount of skin with your hands, then I wouldn't be putting a needle into that neck, because that is a horse that is ready to react, and he's most likely going to react adversely. Also look at the body.

And again, you know, you can see the muscles become more prominent because they become tight and tense. But sometimes you can't actually see the horse. You know, you might have a hind leg lifted up to pare out an abscess or to take a shoe off, but you will be able to feel the tension in that leg, you know, is the leg loosely draped over you, or is the horse, you know, you, you can feel that tension really easily.

Can the horse stand still? It's a good indication if they can't, that they're already activating that system whereby they're wanting to run away. The steps tend to be quite fast and jerky.

If we look at the top picture, you'll see this horse, the forelimbs are quite rigidly extended, and this is why the horses often look taller than they actually are. And then the hind limbs, people will often say, well, if a horse is resting a hind limb, it's relaxed. But actually, it can also be an example of the horse crouching.

So when a horse rests a hind limb. It really drops the hip on that side, and the rest of the body looks relaxed, you know, the head is down, the lip might be drooping, whereas when a horse you can see really easily in this top picture, even though it's on the toe of the left hind, both hind limbs are crouching here. So that's a really good example of a horse that's preparing themselves for flight.

Something else that's talked about quite a lot is licking and chewing in horses, and people used to talk about it as submission, whereas we now know that this occurs when you get a change from sympathetic stimulation to parasympathetic stimulation. So this tells you that the horse has just found something a little bit stressful. And sometimes you may find that you listen to the horse's heart and it looks OK, it's head's not too high, it's maybe a little bit of tension, but not too much.

And then as you step away, the horse starts licking and chewing. So that was probably a mild freeze response from that horse. They were probably monitoring the situation, they were unconfident about it.

And the fact that they then lick and chew tells you that, you know, they were unconfident. So you need to be a little bit more careful with these horses. You might want to do something a little bit different.

And then that brings me on to what might we do different. A concept that's used a lot in the small animal world now is of choice. And horses will always choose fly over fight.

So you've got to think to yourself, if this horse is a little bit anxious, do they have room to move away? If you've got the horse, you know, and the horse keeps moving away and you move with it until it's in the corner of the stable, the only option that horse has left is either to run and push you out of the way, or to rear or to kick or to to do something more aggressive. Can you complete the procedure another day?

And it may be that you can't. It may be that you, you know, the horse has a severe wound, you, you know, you obviously have to sedate it get dressing on and deal with the wound. But for a lot of things, certainly when we get horses in the hospital now, that are coming in for nucleus intigraphy, if we know that these horses are extremely difficult, we ask if the owners are happy to bring them a day or two beforehand, and we will just do 5, 10 minutes, 2 or 3 times a day for, you know, 1 day, sometimes 2 days before we go to put a catheter in and start handling their legs, do a learner workup whatever it is we want to do, and that can make a massive difference to these horses.

In the same context, if you have a horse that's difficult when the owner rings up and books it in for its vaccine, can you give them something, and if you go onto the YouTube, don't break your vet campaign. Which was done through Beaver. There are some exercises that the owners can do, just teaching a horse to stand still, that can make the world of difference.

Do a little bit of clicker training with them so that when you come in, you can do a little bit of clicker training and the horse already understands what it is, and you start looking at 2030 seconds to inject this needletra horse with it calm, rather than having to do the full retraining from the start yourself. I would also say sometimes when people start learning a bit about behaviour modification, they then want to use it with every single case that they see. And you have to ask yourself, well, is that the best thing for the horse and for the owner and indeed for your safety?

So again, sometimes we may have a horse come in for sintigraphy and they say, look, we can't get anywhere near this horse's neck to get a catheter in, or to give it any injections, you know, it's just a nightmare. We can't even get in stable with it. So we will do some behaviour modification.

But when we have to put that catheter in that morning, if we think that that horse is still likely to react, rather than using more and more behaviour modification in a more forceful way, what we might do is we might say, well, we'll give it a domici and gel. And a lot of these horses, people have said that even with the domiciding gel, they weren't able to get a catheter in before, whereas because we've done some of the behaviour modification, then with the domo gel. We can get it done with everyone staying nice and calm and relaxed.

Now, I would say this is very uncommon. I'd say that we get maybe 1 or 2 cases a year, which are that bad that we think this is the right choice. But don't be afraid to, to use things like this as an option if you need it to.

So Albert Einstein said that the definition of insanity is doing the same thing over and over and expecting to get a different result. So we'll go back to the dog example for a minute, seeing as I've got the Kendall Shepherd ladder to regression up here. But if you're a dog and you see another dog coming towards you and you're not comfortable with it, so you start off with these appeasement behaviours, you start licking your nose, you're blinking, yawning, you turn your head away, you try and walk away a little bit.

Eventually you start to stiffen up and say and say like I can't deal with this. The dog still is trying to bounce all over you, so you growl and then you either snap or bite. Well, there's lots of different steps here to go through, and dogs will try and horses will try to go through all these different steps.

But if every time you go through all these steps and the outcome is the same, you have to get to snapping or biting, why would you bother to go through them all? And I would say the most dangerous horses that I have come across are the ones that have been forced into veterinary compliance with a lot of physical restraint, sometimes punishment, on multiple occasions. And these are the horses whereby when you go to enter the horse's stable, their first response may be to rear, to strike out, or to come at you with their teeth, or to swing the hindquarters round and kick out at you.

I've dealt with quite a few semi- feral horses, and particularly when I was younger, I got myself in some situations where the horse suddenly spun round. I was right beside it. I could see it had massive levels of tension, but rather than kicking out or biting or striking, they just try and get out of the way.

And the only horses I've ever dealt with, which I'd say are truly aggressive, are the ones which have had a long history of being forced into compliance. So sometimes we need to think, well, we need to give the horse some choice over what's happening to it, because I would much rather if the horse is anxious that it takes a few steps away from me and I realise that I'm doing too much too soon, then it starts to be offer more aggressive responses. And I think it's also important to remember that arousal levels in horses are not static.

You have to keep monitoring them. So just because the horse is fine at one point, it might not be in a few minutes' time. And this brings me nicely on to the concept of trigger stacking in horses, because this is something that I don't think we talk about very much.

So if we have a horse come into the hospital, or you go out to, to deal with it on a yard, what are the type of things which might increase the level of stress or the level of arousal in a horse? And this is just, these graphs are just an arbitrary stress level, as an example. So taking it away from other horses is always going to initiate a stress response, and that might be a fairly mild stress response.

It might only be a level of, say, 20. Taking it into a new area, such as a new exam room where it's got to walk over a drain. Again, maybe fairly mild, maybe a 30.

A bit of poor handling, you know, sticking a cold stethoscope up into its tickly armpit without, preparing it, maybe a 15. Hearing another horse, Winnie or another horse walk past, my PhD work has shown me that it is one of the most stimulating things that actually happens in terms of increasing arousal. So You're 40, and your IV injection, you've got a nice technique, so maybe only a 20.

So you could say, well, all these things are happening to this horse, but actually this horse can cope absolutely fine with all these things. It never gets near that threshold whereby it is going to react adversely by rearing, kicking, striking out. But actually, life doesn't happen like that.

So imagine you, you know, you normally have to walk through a graveyard on your way home. If you've just been for a nice relaxing day at the spa with your friends and you walk through, you're probably going to be nice and relaxed. If you hear a noise, you probably think, oh, it's a rabbit scurrying across through the gravestones.

However, if you've just been to see a scary movie with your friends, You have primed your fight or flight response. So then when you walk through that graveyard, you are much more likely to jump, to be hypervigilant, and to be more scared if a rabbit runs around and you hear a strange noise. So this is what's a more likely scenario that happens in horses.

You know, the horse is firstly isolated from its common specifics, so it's stress level goes up to a 20. But rather than coming back down to a baseline, as it starts to degrade, something else happens and it goes up a bit higher. Again, it starts to degrade over time, but then something else happens and it goes up higher.

And when you actually come to do the IV injection with the horse, that's when you've pushed it over its threshold. So that's when this is the horse that again then reacts adversely and injures someone. Now studies done in rats have shown that it takes 72 hours for cortisol and adrenaline to return back to a true baseline after a stressful event.

We think it's similar levels in dogs. There's been no work done on this in horses yet, but my experience is that it would be a similar thing. You know, I've even had horses that have had a few stressful things happen to them the day before, and they seem to start the next day at a higher, higher level of stress.

They're more reactive. And this is just an example of one of the cases that I'm looking at in my PhD work. So the blue line on the bottom is looking at heart rate variability parameters.

So basically, the higher it is, the more stressed the horses. The yellow and grey lines are actually looking at surface high temperature. So we're looking at changes in vascular perfusion.

And you can see this is a horse that came into the hospital. It's stress levels were actually moderately high because it had just been transported. The first thing we do is put them on a way bridge.

And every single horse had a stress response to the way bridge, even the ones that went on and stood and, you know, allowed us to be, to have their weight taken. So sometimes I think, well, if we've got a horse coming in for nerve blocks, we don't actually need, need the weight to work on that. Why don't we put them on the way bridge at the end?

Anyway, with this horse, started doing the limbs investigation, brought it into the exam room and you can see as it's being clipped and the limbs being prepped, becomes a little bit more stressed, and then it has a stress response, to the first nerve block. Then the levels start to drop again, but by the time we go in for the 2nd nerve block, it's stress responses are already starting to become larger, and then we get a second, a bigger response to the second nerve block, and then these levels never really return to baseline before the horse is then taken in and given X-rays. Another case, and this shows how we can actually do things slightly differently.

So this, oh, excuse me, let me go back. This was a case that came into the hospital. It was a 3 year old warm blood that had only been castrated, I think, 3 months before.

So we're still quite, you know, I hadn't had a lot of handling, hadn't had much done with it. And you can see this is just heart rate that was easier to look at on this graph. So when he first comes in, it goes into the, the day box and he's really anx in there, so his heart rate's sitting really between 60 and 70.

Now at this point here, hopefully you can see my mouse, we've also got the orange markers at the top to show when we have an event. So at the first orange marker. This was when a student went in to do a clinical evaluation of this course.

Now, in my PhD, I'm obviously not meant to interfere with anything that happens, but at the same time, if there's any worry about student safety, then it goes without saying I would have to do. And I actually seriously considered advising that the student did not do a clinical exam because this was a 17-2 horse that was flying around the box. It was obviously very stressed.

But actually, she was a very, very good student. And she came in and she started scratching him on the wither. And you can see from the heart rate being 60 when she first started, this heart rate actually dropped down to about 48 while she was doing her clinical examination because she did it really softly, really quietly.

She read the horse's body language, she stroked him, she gave him, you know, a scratch, and he responded really well to that. And then when she stopped, his heart rate actually started to go back up again. In the meantime, the big cross is where we were exercising him.

This was a horse that came in for dynamic endoscopy. So ignore that one. And then you'll see when we took the horse into the exam room.

So this is the, the, the next blue dot, his heart rate was 60. And at this point, they're ready to bring the trolley up with the endoscope that's attached to it, and this is a large trolley. It's big and rattles everywhere.

And I said, I would probably sedate this young horse before you scope him or before you bring the trolley into the room. And they said, Well, we'd really like to be able to do it without sedating him. We know we might not be able to in this horse, but we'll see how he goes.

Well, just wheeling the trolley into the room, his heart rate went from 60 to 125. So with a little bit of forethought, knowing that this horse was actually very young, very reactive, that trolley could have been in the right spot in the room before the horse came into the room, and then we could have walked him up to the trolley, which was then stationary rather than trying to rattle it past him. And then his heart rate dropped a little bit, but as soon as they went to try and scope him, it obviously increased again and he, it was not going to be possible to scope him.

So they had to sedate him anyway. So it's often worth thinking about this from the theory of bank accounts. So every time you do something nice with the horse like that student was, that could be giving the horse food.

We know that obviously that promotes parasympathetic dominance. It helps relax them. Any handling they enjoy, usually scratching, and it's an individual thing.

Some horses just like being stroked quite calmly, others like a really vigorous scratch. You've just got to read what they're like. But anything you do which takes a withdrawal is anything that induces fear or induces pain.

So I try and put lots of deposits in. I try and give horses really good handling so that if I have to make a small withdrawal, the horse is actually still in the black, if you like. I've still got plenty of room before they're going to react.

And I think we have to take a little bit of responsibility for this, because if a healthy horse came in for a vaccine and we sent it home with a tendon injury, we would consider we had done a bad job, you know, something had gone wrong. But if a horse comes in with no behavioural problems, is it acceptable to send them back to the owner with problems such as the horse doesn't want its legs picked up anymore because of nerve blocking, or they can no longer give it oral medication because it was having oral antibiotics, which were done poorly, and then the horse became more aversive to it. So how can we create a better environment?

Well, it goes without saying that happier horses are easier horses, and as we've discussed in previous webinars, this then comes back to the ethology, understanding how horses have evolved to live, and also cognition, understanding learning theory, and how we can work with them to make life easier. So set yourself up for success. You know, you really want to prevent arousal levels from escalating, like I said about rather than wheeling that trolley in, if it'd have been there anyway, it would have been much easier.

And if we do this, we prevent horses becoming aversive to veterinary care, and then we don't need the behaviour modification to resolve the problems because they just don't occur. So the environment should always be kept nice and quiet. Everyone needs to be really calm.

And I think sometimes you need to remind people of this, particularly students or nurses, you know, they've got the horse in, they might have had a fantastic night out at the weekend. There might be some gossip. They can become quite excited talking about this.

But actually, horses tune in to your arousal levels. So if they're becoming excited and animated in their conversation, even though they're happy, the horses can become their arousal levels can increase a little bit. We know that horses need social companionship.

So, you know, if you can try and have horses in an area where they can still see other horses, there may be things that you can do in the horse's stable rather than taking it out away from, you know, into an examination room. It may be that you can't. When we have horses come into the hospital, we try and think about which stable we want to put them in.

If we've got, and I'm sure you all know this scenario whereby someone's asked you to castrate a cult, and you say, yeah, that's fine. And they say, Oh, it's a 3 year old, you go, OK, we have to do on a GA, but that's fine. And then they bring it in and they say, by the way, it lived out on the hill and we only put a head collar on it for the first time 3 weeks ago.

These are not the horses that you put in the end box where they can't see any of the horses. You know, put them where they can see lots of other horses and ideally calmer older horses. It really helps them.

If you're in a smaller practise, and you haven't got, you know, lots of other horses in, this was one practise that I went down to in Essex, and they actually had this mannequin horse that they used for bandaging tutorials with owners. And just putting this horse outside the horse's stable door really, really helped. Mirrors can sometimes help as well, and as we've already said, using older calmer horses.

Often when you come into a house, you know, the owner's holding it or the nurse is holding it, you're in a rush, you're already late for your next call, your wife or your husband has phoned you saying that there's a problem, you need to sort this out. We sometimes can be a bit quick to just go in and just try and get the job done, and just taking a few seconds to just walk in a little bit slower, give the horse a little bit of a stroke or a scratch while you chat to the owner, literally 30 seconds to 1 minute. And then start working with the horse can make all the difference to them.

And then make things as positive as possible. So using food, using licks, they can really, really help to have horses which rather than not wanting to walk into an examination room, are actually really keen to go in because they know every time they go in there, something nice happens to them, even if they also get a nerve block as well, which goes back to the bank account theory. And then think about how you can do things, as quietly and as calmly and as, they'd often talk about in small animal medicine as lemur, so least invasive, minimally aversive.

And that's a really good way to think, well, how can I make this procedure as nice as possible for horses? So this is actually my own horse that I used as a demo, and we're taking pictures, so I apologise for the flash photography. But this is often how people take a horse's temperature.

They come round, they lift the tail up and they shove the thermometer in. And look at where I was stood when that thermometer was going in. If that horse did kick out, I'm definitely going to be kicked.

Whereas actually if I've got a horse that I know kicks, I can stand at the horse's back, I can run my hand along, and if you just scratch the horse just on the area of hairless skin, the tail magically lives up in the air, and from there I can actually insert the thermometer and take the horse's temperature through feel. And continue just to scratch the horse a little bit on the side, and the horse becomes much more relaxed about it. And they can actually start to enjoy having their bums scratched a little bit and look at where I'm stood if the horse did kick out.

So it's little things like this that can just make a massive difference to horses. So we'll just finish with a scenario. So you have a horse with a hind limb lameness.

Given the type of horse it is, you think it's probably got bone stabbing, so you want to start with a TMT giant lock. But this horse is aversive to clippers. So, look what happens every time the nurse puts the clippers on.

Leg lifts up. Leg lifts are a bit higher and a bit faster. And that time it definitely lifts up higher and faster before the nurse even manages to get the clippers on properly.

So someone puts a twitch on physical restraint, and they get the leg clipped. The nurse then starts to scrub the limb. Each time the horse heals the wet swab, it lifts the leg up.

Obviously they want that to remain sterile, so they throw the swab away. Each time that leg comes up higher and faster until it makes a small kick out. So this is a really good example of where negative reinforcement is working against you, whereby every time anything goes near that horse's leg, it has a bit of a fear response and the way to make that adversive stimulus go away is to lift the leg up.

And eventually it kicks the nurse and the horse is reprimanded for it. And then you walk in to block that horse. So I'm sure you can understand that at this point, you've got a horse that is very highly aroused.

So how can we turn that scenario around? Well, first of all, when we take the horse into the exam room, why not have someone just giving it a little bit of food, just a or a molasses lick it, just something that it can really enjoy. And then In terms of the clipping, just start higher up the leg and use the battery side if it's a horse that's a bit anxious.

So you'll see I start higher up. Let go. So I'm now using negative reinforcement to reinforce the behaviour that I want rather than the one that I don't.

And because I'm doing it with the battery side, you can press on a little bit harder, so it's not as ticklish for the horse, so we're making it less aversive. And now we're training the horse that whenever anything funny happens to the leg, it keeps its leg on the ground and the funny, the aversive thing will go away again. And the same thing for the swabs, you know, you can put the swabs on, you can start to move them around, and as soon as the horse relaxes a little bit, take the swabs away.

So we're starting to promote relaxation. Now, I would say in summary that lots of people are good at seeing the fight or flight response to horses, but they often miss these freeze responses or the bits where the horses are fidgeting around. So always keep monitoring the horse's body language and always think, how can I make it less aversive for the horse, how can I make it as nice as possible, and it will make a world of difference to your veterinary practise.

So as I said many times, there are no bad horses, just badly trained ones. There are two other webinars which go into behaviour modification in a bit more detail. One of them is on pain behaviour or both, through the webinar that which you can watch.

There's some great, If you go on to YouTube, if you look at the Beaver don't break your vet campaign, there's some great things for owners or for vets to look at and there's some in practise articles that you may find useful as well. So thank you very much for your attention. Does anyone have any questions about what we've discussed tonight?

Thanks very much, Gemma, really enjoyable talk, as always. So I guess you probably get asked, this, quite often. So, I mean, you, you covered a lot of things actually that as vets that we, we can certainly do to improve things within the the clinics.

So wheeling the trolley is a really good example. Why not have the trolley in there in the first place, etc. Do you think there should be more of an onus on owners regarding how their horses behave?

You know, just, there, there's more and more people that are getting horses that have less experience, with animals, or, you know, that they're treated as a pet. Do you think there's a bit of a problem there as well? Or, or is this genuinely that, you know, the horses really don't like the interventions that we, I think, I think there's a huge onus on owners, and, you know, the number one behaviour that we saw was horses which are badgy.

The second one was horses that don't stand still. And they are basic things that any owner can teach their horse, which, and there is a link on the Don't Break your vet campaign to basic exercises. One is to get the horse to stand still, and another one is to lead off of leader up pressure.

So that, you know, if the horse goes to step forward and feels the pressure on the lead rope, they step back and stand still again, or if you're leading them, they lead well. And there's a strong association between adrenaline levels and movement of the horse's feet. So teaching them to stand still as a habit is really useful.

Now, on Monday, the horse that you saw in the video, you know, my own horse, she's a big 17 hand warm blood mare. She naturally has very high arousal levels. She is not a calm horse in any way, shape, or form.

But she's had some back pain, so we needed to X-ray her back. So we had all of the equipment, on the, the beams and such like. And obviously you have your generator quite close to the horse, you have large plates quite close to the horse's back, and we did that completely without sedation because I've trained that horse to stand still until she is told otherwise.

And I did give her a molassess lick while that was going on as well. But I would say she would be one of the more challenging horses for a lot of people to deal with. And if things were done badly, she would escalate extremely quickly.

But just because I've always taught her to stand still and to yield to pressure, we could X-ray her back without any problems whatsoever. At the same time, I do think we have to take some responsibility, but I do see a lot of horses which are actually They may be not the best to lead or you know, they don't have the greatest thing, but they don't have any real aversions and particularly course is becoming head shy. You know, horses that have never been head shy and then they have interventions with the vet.

Maybe the vet's trying to get a twitch on them a lot, and then the owner starts having problems afterwards. So it's, it's a double-edged sword. Yeah, the owners need to do an awful lot more, but we also need to do what we can to not make things worse.

Yeah. So do you think that we, we should be, you know, I think, you know, with the work that you're doing, you know, I think people are becoming more aware of, you know, horse kind of body language, etc. So do you think it should be getting to the stage that I was saying, well, actually, no, I, I'm not gonna do this procedure today because, you know, your horse is is too stressed or, or whatever, I mean.

Yeah, absolutely that's you know. Yeah. Yeah, and, and I think like I said, the scenarios when you have to do things, but there are lots when you don't.

And I know some places now that have had very needle shy horses and they've said look, I'm gonna come back with a nurse. Can you work on this over the next couple of days? You know, because what you're trying to do, I think there used to be a an attitude of, you can't let the horse win.

If you don't do it today, they'll know they've got away from it. Whereas actually, all you end up doing is giving that horse a really negative experience. I think most owners are happy if you say, look, I don't think it's safe for me to do this.

But also, as you said, a lot of people have horses as pets or even I would go as far as child substitutes in some cases, and to say, look, your horse is going to find this really stressful. How about we spend a couple of days or you do a little bit with this. I'll, I'm just going to put my hand on the horse's neck or raise the vein or whatever today with a little bit of food, and then we'll come back and we'll do the injection of the day.

My experience is that most owners are actually quite happy to pay for a second visit or, you know, to put a little bit of time and effort in because they don't like seeing their horses stressed. Yeah, yeah. OK, and so you think that, you know, horses that we are just, you know, you know it's not your horse, you're just kind of automatically sedating before that that's actually causing potentially a greater problem because they're the ones that then don't show this kind of build up of behaviour before they lash out.

They're much more likely to just kind of explode, do you think, or? So, so I guess a double edged sword again, I am a strong proponent of sedation. And, you know, I'd much rather a horse that finds something aversive be sedated.

And obviously, you've got analgesia on board as well. You know, if you're stitching up a wound or or doing something, I think sedation's a great thing. I probably, I'm against sedation for more routine things like clipping or ferrying work, because in my experience, what I see is a lot of horses that then become very needle shy.

Because they were already fearful of the clippers, and then they now start to associate the, the needle with with something happening to them afterwards. So I, I think sedation is a good thing. As you say, one of the challenges sedation sometimes is that you can't read the horse's body language quite as well.

They give you much fewer warning signs before they suddenly react. But I still tend to find if I take things quite slowly. Most horses, you start to get an idea, you know, you just get a twitch of the ear or, you know, the houses that have been really dangerous and I've said even, you know, with oral and intramuscular sedation, it still tries to kill you when you try and put a catheter in.

We've maybe done some work with them. Whereby we can raise the vein, we can scrub, we can clip, you know, but we just feel that actually putting the catheter in might be a step too far. So we'll give them a domo gel.

And I just do everything really slowly. And if I go to raise the vein and the horse lifts its head up, I'll just keep my hand there and wait for that sedation to kick in again before I then try and put the local in or, you know, do, or put the catheter in, whatever it is I'm doing. And I tend to find even with sedated horses, you don't get anywhere near as many warning signs as with the most sedated, but you do still get some.

So I'm not sure if I answered your question there if I. I know, yeah, yeah, yeah, you did. So I think we can all, kind of take heed that, taking things, I know with, you know, that kind of practise, you, you're busy going from call to call, but sometimes maybe taking 30 seconds longer to do something actually will pay dividends by by actually having a calmer horse.

So ultimately may actually save you time. Yeah, I, I find the slower I go with the difficult horses, the less time it takes in overall. Yeah.

Brilliant. Well, thanks again. That's the end of the questions.

So, yeah, thank you very much, Gemma, as always, really, really informative, as you can see on your screens, and there's Gemma's email address, and if anybody's got, any further questions, so I'd just like to thank Gemma one more time for a really, really fascinating talk. And also thanks to Bailey's for sponsoring the equine webinars, and we'll, hopefully, see you at the next webinar. Thank you very much, everyone.

Good night.