Q: I had my Dutch Warmblood mare for more than 23 years, and I know that was a gift. Last spring—the year she turned 27—she couldn’t get up for the first time. I took her to the local university veterinary clinic for a full examination. They checked everything and could find no medical reason for the problem. My mare didn’t lie down for the three days she was there, so they couldn’t see what happened when she tried to get up.

Several weeks later, in July, she was down again. We barely managed to get her up. She had obviously hurt herself, and I knew I would have to euthanatize her the next time it happened. She went down five days later. Evidently, her back legs just gave way while she was eating her hay in the morning. 

When I got to the stable she was on her chest with her back legs stretched out to the side. She couldn’t or wouldn’t pull them up to her body. She was so frustrated that she couldn’t get up—or was in such pain—that she was stamping her front feet. Then she lay down and was quiet while I stroked her head. The veterinarian came, and everything else went peacefully.

My mare had had a tendon injury in her right front leg diagnosed the December before. In spring we were very slowly beginning work at a trot after weeks of hand-walking and then riding at a walk. I don’t know if that had an influence. She was also being treated for that injury at the university clinic, so they knew about it.

I know that this is not uncommon in old horses. And I am sure the veterinarians would have told me if there was anything else that could have been done. We tried nutraceuticals and put rubber mats in her stall so her feet wouldn’t slip. I would like to have a medical explanation for why this happens. Can you help? Kathleen O’Day; Rotkreuz, Switzerland

A: You are right: This is a common and sad ending for many older horses. It sounds like you and your veterinarian did a great job of maximizing the quality of life for your mare, while assuring that she did not suffer in the end.

I suspect that no one could explain why this happened because there are so many possible reasons for this chain of events. It is generally very expensive to figure out exactly why a horse has gone down and can’t get up, and the process required to get the necessary answers can put the horse through some discomfort.

What’s more, even if a cause is found, chances are good that we won’t be able to treat it effectively. In many horses, the inability to rise is the result of pain and weakness in multiple areas of the body that culminate in a final crisis.

Common reasons for older horses having trouble getting up and down include the following:

  • Arthritis. It is easy to understand how pain and decreased range of motion in aging joints can make getting up and down hard. Arthritis and general degeneration in the neck can also cause problems because the horse needs to move his neck well, both for getting up and down.
  • Neurologic problems. Severe ossification and other significant changes in the spinal and neck vertebrae can begin to crowd the spinal cord, sometimes causing the horse to lose proprioception, which is the awareness of the position of his body. Typically, loss of proprioception affects the hind end more than the front. This causes a decrease in coordination, which can be profound. In addition, the coordination necessary to rise can be dependent on the position of the neck, and the complex movements required become more challenging if neural communication is interrupted by vertebral impingement or other problems during the attempt.
  • Chronic pain and muscle wasting. Aches and pains, particularly those affecting the back and pelvis, cause the horse to move less and in ways that compensate, sometimes leading to loss of muscle mass from disuse.

A wide variety of other medical issues can also contribute to general weakness and wasting in old horses, but it sounds like you and your veterinarian were very diligent. I assume your mare had good dental care, along with blood work to look for signs of infection or cancer, as well as problems like kidney or liver disease and equine Cushing’s syndrome.

You and your veterinarian did all the right things for your mare. You identified the problems you could, gave her supportive care with good nutrition and joint supplements, and provided a safe environment with good footing and protection from the elements. Keeping our old horses happy and well is rewarding—I know you will cherish the memories of your mare’s happy golden years.

Melinda Freckleton, DVM
Firestar Veterinary Services, LLC
Catlett, Virginia