Wednesday, November 1, 2017

Harnessing the Power of DMSO

Is DMSO a miracle drug or dangerous toxin? Here's everything you need to know about using the power of DMSO safely and effectively.

If you spend much time around horses, sooner or later you'll encounter dimethyl sulfoxide (DMSO). After all, this pungent, syrupy liquid is used to treat a variety of equine health problems ranging from orthopedic inflammation to neurological injury.

Yet DMSO's route to acceptance in equine veterinary care has been far more circuitous than that of most therapeutic substances. For starters, it was developed not in a pharmaceutical laboratory but from the industrial wastes of paper manufacturing. Initially, it was considered a potential miracle drug: "My first experiences with DMSO were in the 1960s," says Barney Fleming, DVM, of Custer, South Dakota. "At that time it was considered something magic and everyone wanted to stick their finger in it." But within a few years, the use of DMSO ceased entirely, in the wake of safety concerns. In the decades since, especially after it was approved for use in horses in 1970, DMSO has gradually gained renewed acceptance.

"DMSO is not just another medicine; we're looking at a whole new therapeutic principle," says Stanley W. Jacob, MD, of the Oregon Health and Science University medical school, who was the first in the United States to investigate the medical potential of DMSO. "A medicine treats a particular disease. A therapeutic principle is a new method for treating diseases in general."

In other words, DMSO doesn't just have specific effects on the body; its actions can also help other treatments work better. "DMSO is an economical therapy, and many people who have used it over the years swear by it and feel that it is a great help for many medical conditions," says Fleming.

However, DMSO is a powerful agent that must be used with care. "DMSO is a relatively safe product when properly applied, but it can be harmful if misused," says David McCarroll, DVM, DACVIM, of Interstate Equine Services in Goldsby, Oklahoma. "The best thing to do is use it under the direction of your veterinarian."

Solvent to solutions
DMSO's remarkable versatility as a therapeutic agent comes from its molecular structure, which allows it to interact with water in unusual ways. "DMSO is literally water's alter ego," said Jacob in a lecture to the American College for Advancement in Medicine in 1980. Because DMSO and water molecules are similar in shape, size and polarity, they share three important properties:


  • DMSO and water blend together extremely well, at all concentrations. "The DMSO-water bond is 1.3 times stronger than the water-water bond," said Jacob, in his 1980 lecture.
  • Water has two and DMSO has six hydrogen atoms that act like magnets to dissolve and "hold onto" large quantities of complex organic molecules without binding with them or changing their structures.
  • In the body, DMSO can pass through cell membranes as readily as water does without damaging the tissues, and it can replace water molecules within many bodily fluids. And, because DMSO so readily dissolves other molecules, it can also carry them through the cell membranes with it. "DMSO alters cell membrane permeability," says Jacob. "It moves through membranes and substitutes for water so that it pulls substances through cells that ordinarily would not move through them. This is its basic mechanism of action."


An indication of this action lies in that distinct taste DMSO causes in your mouth after it touches your skin: "When applied topically or by IV, DMSO goes into the blood quickly and is excreted through the lungs, giving the breath a garlic or burnt-almond smell," says McCarroll. "People need to be aware of this when they use it, so they won't be surprised."

These properties, along with a few others, account for the ways DMSO is currently used in veterinary medicine.

Anti-inflammatory action
In horses, DMSO is applied as a topical gel or administered in liquid form intravenously or through a nasogastric tube. It is classified as a nonsteroidal anti-inflammatory drug (NSAID) because it has antioxidant properties that can interrupt the inflammatory process. DMSO binds readily with hydroxide (OH) and other "free radicals," which are oxygen compounds that can damage or destroy healthy cells. Free radicals are often a byproduct of inflammation, and as they build up, they can stimulate more swelling and inflammation, which produces even more free radicals. Studies have shown that DMSO is a powerful free radical scavenger, and can slow or halt the destructive cascade of inflammatory damage to healthy tissue.

DMSO gel is sometimes applied topically to reduce swelling and inflammation associated with strained muscles and soft tissue injuries. Because the chemical is hygroscopic---meaning it attracts and binds to water molecules---it draws excess fluids out of tissues. "It makes a great sweat for swollen legs because it reduces edema," says Fleming, who frequently uses DMSO in his work with endurance horses. Liquid DMSO injections may also be used to treat bowed tendons and other injuries of dense tissues that are difficult to reach with other drugs.

In addition, DMSO is also often administered orally or intravenously in the early stages of laminitis to arrest inflammation in the soft tissues of the hooves. "The toxic effects that are taking place in the feet of the horse can be relieved considerably by administering a 10 percent solution of DMSO, adding it to the IV fluids," says Fleming. "It enhances the elimination of the toxins and reduces the damaging changes taking place in the foot."

Finally, DMSO is sometimes prescribed to treat brain or spinal inflammation associated with trauma, oxygen deprivation or diseases such as West Nile encephalitis or equine protozoal myeloencephalitis (EPM). "DMSO does two things; it reduces inflammation, and since it is hydrophilic it also draws moisture from the tissues, reducing edema and swelling in the meninges or spinal cord, or any other tissues," says Marlin C. Baker, DVM, of Alpha Equine Breeding Center in Granbury, Texas.

What more can DMSO do
DMSO also has wide-ranging applications that go beyond the control of inflammation:

Enhancement of drug action. When DMSO penetrates the skin and other membranes, it can readily carry many types of complex molecules with it---and that capability is often harnessed to help carry other drugs deeper into the targeted tissues. "For treating sore muscles, we just add DMSO to dexamethasone or prednisolone or any other drug we want to get inside the tissues as an anti-inflammatory," says Fleming. "When you rub those drugs over the skin they only work topically, but if you add DMSO to them, they go into the tissues and work better."

DMSO can also carry other drugs into tissues that are otherwise difficult to penetrate. For example, some skin infections, such as ringworm, rainrot or scratches can be hard to treat because the infective organisms can be deep under the skin or crusty scurf. DMSO can help other antifungal or antibacterial drugs reach their targets more effectively.

Not all drugs work well with DMSO, depending on their molecular weight, shape and electrochemistry. And DMSO will not carry bacteria or viruses across cell membranes because they are too large.

Pain relief. Research shows that DMSO slows or blocks conduction of impulses along nerve cells, which in effect reduces pain from musculoskeletal injuries, postoperative incisions and other sources. Relief is only temporary---lasting up to a few hours---because as the DMSO dissipates, normal function returns. However, DMSO is also often used in conjunction with other analgesic drugs to produce more long-lasting pain relief. "We also use it as an adjunctive therapy in intestinal surgeries and for analgesia postoperatively," says McCarroll. "Many surgeons use DMSO in postoperative colic cases to improve microcirculation around the bowel. This promotes better healing and also gives some pain relief."

Diuretic action. Because DMSO draws fluids from tissues, it may be administered intravenously in cases where it is necessary to increase the horse's urinary elimination, such as to flush toxins from the system faster. "We use it for cantharidin poisoning [blister beetle toxicity]," says Baker. "In this situation it is given intravenously, to lessen the effect of that toxin on the kidneys and GI tract."

Some veterinarians also routinely administer low levels of intravenous DMSO to horses who are tying up, experiencing massive cramping of the large muscles after exercise. "By giving it intravenously, with fluids, it also helps the horse urinate more," Baker says, which in turn both helps the horse flush out and excrete the waste products from the breakdown of muscle cells and increases blood circulation into the area.

DMSO may be used to draw fluids out of the lungs in cases of acute pulmonary edema. "It is beneficial in respiratory disease because it reduces inflammation and draws some of the fluid/edema out of the lungs," says Baker. "Along with DMSO, we use Banamine or some kind of corticosteroid (to also reduce swelling and inflammation) and sometimes it's hard to tell which one is doing the most good, but they seem to work well together to gain a better response."

Inhibition of microbial growth. DMSO is a bacteriostatic agent, which means it inhibits the reproduction of bacteria but doesn't necessarily kill them outright. Some veterinarians add it in low concentrations to flushes used to rinse out draining abscesses or other infected wounds. Baker uses DMSO when he flushes out guttural pouches: "It's not irritating when it's diluted enough, and it does help liquefy a lot of the heavy, purulent material that is often found in the guttural pouch."

Prudent precautions
Because DMSO carries molecules through the skin and into the body, it's important to make sure the skin is clean and free of any other chemicals that could be inadvertently carried into the bloodstream. Fly sprays, for example, are safe when used as directed on the skin, but they contain chemicals that could become toxic if they are absorbed into the body.

"[DMSO] should not be used in conjunction with any organophosphate or cholinesterase-inhibitor insecticides," says McCarroll. "If a person applies one of these types of fly repellents and uses DMSO, this can have an additive effect and cause toxicity. The insecticide or parasiticide would have been fine used alone, but when combined with DMSO it will potentiate or increase the effects of that drug and make it toxic to the animal."

Many liniments also contain ingredients that are toxic if taken internally. "You don't want to use [DMSO] with certain types of products, such as those that contain mercury salt," says McCarroll. "This would take the mercury into the horse and can cause a fatal mercury toxicity. Iodine is not as toxic to the horse, but could also cause a problem. Certain other drugs like alcohol, insulin, corticosteroids and atropine may be made more powerful if used concurrently with DMSO."

This ability of DMSO to ease absorption of other topical products is also an issue if a horse is to be drug-tested for competition. "There is a relatively new nonsteroidal anti-inflammatory drug called Surpass that is designed to be used topically," says McCarroll. "When used according to directions it will not cause a positive drug test. But if you combine it with DMSO the drug level will be too high within the body and will cause a positive test."

Because DMSO is a powerful diuretic as well as a vasodilator, it can be harmful when given to dehydrated horses and those in shock. "It can increase loss of fluid via the kidneys and further dehydrate the animal," says McCarroll. "It also dilates the peripheral blood vessels and can thus lower the animal's blood pressure. If the animal is in shock, this would make the condition worse."Repeated or overzealous topical use of DMSO can dry out the skin, leading to scurf and scaling, redness or rash. DMSO produces heat when applied with other solutions, such as water or saline, alcohol or acetone, which can have therapeutic benefits---but too high a concentration can actually burn the skin. "In these instances it will produce a significant amount of heat and can actually cause thermal injury if a person is not careful with it," says McCarroll.

Veterinarians often recommend mixing DMSO with Furacin ointment, which buffers it to reduce burning of the skin. Some horses may be more sensitive to this effect than others. "You also don't want to use it on any individual that has had a bad reaction to DMSO in the past," says McCarroll.

Intravenous administration of DMSO also carries the risk of side effects. If the concentration is too high or the solution is administered too quickly, muscle tremors, diarrhea, colic, seizures and/or other adverse reactions may occur. Large intravenous doses may also destroy red blood cells and inhibit clotting.




Thursday, October 26, 2017

JUMPERS 21 | Training Tips from 3 Olympians

Under the watchful eye of Beezie Madden, Gracie Marlowe and Valdelamadre Centalyon clear a wide liverpool on the second day of the training session. Amy K. Dragoo

Anne Kursinski, Beezie Madden and Laura Kraut share wisdom with young riders at the George H. Morris Horsemastership Training Session.

Anne Kursinski spoke about developing connection and feeling with your horse by establishing a solid position and riding lots of transitions to test responsiveness. Beezie Madden built on Anne’s lessons, focusing on control and adjustability by getting your horse in front of your leg and riding transitions over ground poles. Laura Kraut taught how to ride a successful jumper course by thinking about the time allowed early, creating energy to get over the jumps and never giving up.

The three Olympians shared their knowledge with auditors and 12 young riders, who tackled training on the flat, gymnasticizing and competing their horses in a Nations Cup-style event, at the 2017 USEF George H. Morris Horsemastership Training Session, held in January in Wellington, Florida.

The clinic, presented by the U.S. Hunter Jumper Association and sponsored by Adequan, Ariat, Practical Horseman and Equestrian Sport Productions, is designed to develop the next generation of U.S. Equestrian Team talent through intensive mounted and unmounted instruction. Athletes earned invitations to the 2017 Training Session through one of three avenues: success in specific U.S. Equestrian Federation competitions, performance at the U.S. Hunter Jumper Association Emerging Athletes Program National Training Session or by selection from a competitive pool of wild-card applicants.

The three coaches’ tips and advice, though, can improve the horsemanship skills of riders of all levels.

Anne Kursinski: Connection and Feeling


Anne Kursinski shows Michael Williamson how to sit deeper in the saddle to create a more effective seat and better connection when riding Casco Junior. Amy K. Dragoo

On Day 1 of the Horsemastership Training Session, Anne focused on working on the flat. Anne, a five-time Olympian with two team silver medals, was voted the 1991 Female Equestrian Athlete of the Year by the U.S. Olympic Committee. During that year, she claimed individual and team gold medals at the Pan American Games in Caracas, Venezuela. In 1988 and 1992, she was named the AHSA (precursor to U.S. Equestrian Federation) Horsewoman of the Year and in 1995, she was named AHSA Equestrian of the Year.

1. Rider position, attention to detail and flatwork are key.

Anne is a stickler on rider position and sweating the small stuff while working on the flat. “Self-awareness and position are being supple and elastic but not frozen,” she says. “If you are crooked, your horse will jump crooked. You can really solve most of your jumping problems on the flat.”

Anne instructed the riders to perform numerous transitions without stirrups to help develop a deeper connection, test their balance and be more aware of their position. Emma on Baricello, Caroline Dance on Bizette B and Gracie on Valdelamadre Centalyon perform a halt on a straight line. Amy K. Dragoo

2. Connect your body to connect the dots.

Your legs, seat and back are not separate from your body. Talk to your horse with your aids. Hold him with your seat and back. Remember to keep your arms elastic with short reins. “If you can’t feel your own body, you can’t really feel your horse’s body,” Anne says. “I had a trainer who used to say my hands are in my seat and my hands are in my back, like my legs are in my seat and my legs are in my back.” Ride with your entire body. “My whole body rides the whole horse. McLain [Ward’s] whole body rides the horse. Beezie’s whole body rides the horse. You don’t see them pulling the horse’s head to the side with just their hands.”

3. Be patient and aware.

Be clear, consistent and patient. Never lose your temper. Don’t be overly critical of your horse or yourself. “To be a great rider, you have to be aware of everything—no stone left unturned.”

4. Test your connection—a lot.

Lengthen and shorten the trot and go from posting trot to sitting trot and back again. Do countless transitions. Then balance in two-point position to test if your horse has accepted your seat, legs and reins with lightness. If he has, he will maintain the same balance and rhythm for several steps. Pilot your horse into small circles to test his responsiveness to your aids. You have to put in the time and then test or ask as if you are going to get the right answers.

Another exercise you can use to test his responsiveness is to ride a shoulder-in. When going to the left, keep your hands even and move both of them and your torso slightly to the left. “Take a little and give a little,” Anne advises. “Push with the seat and receive with the hands. Keep the inside leg active.” Lateral work is mental and requires the horse to be respectful of the rider.

5. Sit the saddle.

When you have trouble getting your horse to move forward into the trot without him breaking stride or backing up, drop your stirrups to sit deeper in the saddle. Concentrate on the rhythm by keeping your body back and your hands together. Anne’s oft-repeated mantra is, “Sit the saddle.”

6. Knot the reins for sympathetic contact and connection.

Try tying a knot in your reins “just for fun.” Hold the reins in front of the knot, closest to your horse’s mouth. The knot requires you to have longer arms and use more give and take with the reins. Make a circle and then leg-yield out to encourage your horse to step into the outside rein. You’ll know the exercise has merit when your horse is softer and more responsive. “Connection is key,” Anne says.

Anne knots Madison Goetzmann’s reins to help her lengthen her arm and establish a more supple connection to Prestigious. Anne knotted each rider’s reins and then guided the students through circle and leg-yield exercises to create softer and more responsive horses. Amy K. Dragoo

7. Give when your horse responds.

When your horse reacts positively, give with your hands. “I feel his mouth,” Anne says. “When he stretches down, I give. When he’s flexing, I’m giving and rewarding. As he accepts the contact, I give. I sit the trot to see if he accepts. As he gets it, I keep my seat and my contact. I follow his neck as it goes down. If he roots a little, I resist a little. No sawing. I have a very light hand. When he fusses with his mouth, I close my legs and tickle him with my spurs and make him think about his hind legs.”

8. Isolate the shoulder to move the haunches. Isolate the haunches to gain shoulder control.

Work on turns on the forehand to isolate your horse’s haunches and control the shoulders. If your horse backs up to avoid the exercise, move his hind legs forward by deepening your seat as soon as you feel him back. It’s important to feel in order to gain responsiveness. Try using haunches-in to bend the horse “like a banana” and make him use his hind end. “To be a great and effective rider, you have to be able to do many things. The sign of a great rider is a happy horse.”

Beezie Madden: Control and Adjustability


Day 2 featured Beezie, who built on Anne’s lessons while working on gymnasticizing the horses. Beezie is a three-time Olympic athlete, an individual Olympic bronze medalist and a member of two gold-medal U.S. teams. In 2006, she won both team and individual silver medals at the World Equestrian Games and in 2014, she returned to the WEG to claim both a team and an individual bronze medal.

1. Control the pace and line while freeing the neck.

Get ready for action by putting your horse in front of your leg and on the outside rein while making sure he doesn’t drop his shoulder to the inside. “If the shoulder [balance] is on the outside, it frees up his neck,” Beezie says. “That’s one of the reasons to have the horse on the outside rein. The other is that the outside rein controls the pace and the line.” No matter what you are doing, feel as if you can jump a fence with enough impulsion so that the horse has spring in his step. Remember: The goal is to make every jump in the middle of your horse’s arc over the jump.

2. Use ground poles for practicing a variety of exercises.

Beezie sets up ground poles in a number of ways to help riders gain the skills to improve their horses before graduating to bigger jumps. Set the poles 45 feet apart and fluctuate the number of strides and different gaits between poles. Work on pace, balance, rhythm and riding with feeling. “They have to stay in your hands so you can control the balance and the stride,” she says. The changes in stride and transitions test and improve your horse’s adjustability.

Madison and Prestigious lead the way through a pole exercise, which Beezie designed in order to improve the horses’ adjustability. Amy K. Dragoo

3. Halt.

Stop your horse in a variety of places to test responsiveness. “I like stopping straight in the corners because horses anticipate turns in a short arena,” she advises.

After completing a jump or a line of jumps, halt your horse instead of turning to slow down. Make sure you halt straight. Use your back by stretching up for strength, not your hands. Your seat needs to stay in the saddle for a downward transition. If your horse backs up instead of halting, leg him up and allow him to walk forward a step or two before halting again. When he fusses, keep your hand above the withers. Try to make the halt smooth and keep your horse on the bit with your shoulders behind your hips.

4. Use leg to create roundness.

You want your horse’s hind legs reaching under your seat and not behind you while he stays up in the bit, creating roundness. You need this activity in the hind end to jump big jumps and your leg is the impetus for getting that roundness. When your horse lengthens his body, the way to shorten it is by thinking of using your leg to your hand. Make a fist and close your fingers on the reins.

Next, pilot your horse in small circles while pushing the haunches out into a bigger circle. For example, as you turn your horse to the right, look to the right, open the right rein and push with the right leg to give the feeling that the leg is bending the horse instead of an indirect rein. To make your horse more supple, be sure and use your inside leg when coming around a turn and not just your outside leg.

Beezie offers advice to Coco Fath after her jumping round with Bart C. Amy K. Dragoo

5. Use your body to slow down.

Make sure your shoulders are behind your hips while slowing your horse. “Your seat needs to stay in the saddle for a downward transition,” Beezie says.

Try riding over a series of ground poles and halt mid-pole with the horse straddling it. The exercise, meant to teach connection, the delicate control between the hand and the leg, and patience, is not easily mastered. “Use your back for strength,” she says, by stretching up. “Do not use your hands. You have to get more independent with your balance. Soft with the hands, soft with the hands, soft with the hands.” If your horse resists, he may not be confused; sometimes it’s an avoidance of the connection. “You’ve got to be strong when they’re resisting and soft when they’re giving,” she says.

6. Don’t zone out while riding.

Make a habit of ensuring that you and your horse are attentive whether walking, cooling out or when you are hanging out and talking to friends while mounted. When riding, if your horse zones out and ignores your request for more energy, first use your calf to remind him to pay attention. If that doesn’t work, turn it up a notch and keep increasing the volume with the spur or the stick until he listens. “Ask and take your leg away,” Beezie says. “When you ask, there has to be a reaction.” Remember, if you want a reaction forward, you have to take the brakes off and not pull on the reins. He should hold the reaction for a stride or two.

Taylor St. Jacques exhibits a strong position as Devine tackles the low course built to help the students focus on fundamentals before moving to the bigger jumps. Amy K. Dragoo

7. Keep weight in your heels.

When your horse hops or bucks to avoid the halt, put weight in your heels. “You have to weight your heels without stiffing him by gripping with the legs,” she says. “There is a fine line. Sometimes you’ve got to push them through something, but you also don’t want to get them so frustrated they can’t concentrate.” Don’t increase your horse’s anxiety by constantly gripping with your legs instead of taking pressure off by weighting your heels.

Laura Kraut: Make the Most of a Course


On Day 3, the 12 riders were divided into teams of four and a Nations Cup-style competition pitted the three teams against each other. Laura gave the riders feedback specific to each competitor after their rides on the Conrad Homfeld-designed course. She cautions that some of the advice is geared to a situation unique to that course and to tailor these tips to your individual circumstances. Laura represented the United States at the 2008 Olympic Games and came home with a gold medal. She was a member of the 2006 silver-medal World Equestrian Games team at Aachen. She is highly ranked on the All-Time Money list in career earnings with more than 100 grand prix wins.

After finishing her jumping course with Baricello, Emma Marlowe receives feedback from Laura Kraut. Amy K. Dragoo

1. Make judicious use of your time early in the course.

“Something I think about when I’m in a grand prix Nations Cup is if there’s an opportunity in the beginning of the course to go quick before you get to the meat of the course, so you can get rid of the time faults early,” Laura advises.

2. Create energy.

“You have got to put leg on. Help him out. Give him that reach,” Laura says. “When you pull a rail, the first thing that should go through your mind is, ‘I just had a bad rail. I need to kick into gear and get going.’” Don’t slow down. You’ve got to get a reaction. Get over it fast. Make up time. Often the rider’s choices allow the chance for the horse to clear the jump.

Help your horse over the jumps by using your body or applying your legs to give him confidence. If there is a water jump, you need to build momentum and keep that momentum to clear it. If you need to increase energy, do so.

When you approach a water jump, get behind him and sink down in the stirrups. “Never, never, never approach the water with your shoulders out in front.”

Halie Robinson adds leg and a soft following release, which gives Air Force the confidence to jump boldly across a wide oxer on the final day. Amy K. Dragoo
3. Jump the fence like you mean it.

If your horse is running out of energy, don’t lose your focus. “Know that you’re running out of horse. Use this to fight for the jump and lift him over.”

4. Shake off setbacks.

If you have a problem in the warm-up arena, shake it off and move on. “Know that if you have problems in the warm-up area, that is not necessarily translating to the ring,” she suggests. Similarly, when you have a rail down, move on. “When you have a fence down, that’s happened. That’s passed.”

TJ O’Mara plans his next fence aboard Queen Jane after Laura advised riders to make better decisions during courses to avoid frustrating time faults. Amy K. Dragoo
5. Never look back.

If you pull a rail, never, ever look back to check. Never.

6. Never give up.

If your horse refuses a jump, offer a quick reprimand and then confidently go forward again. “It’s about learning, and one of the things you learn is to never give up. You can be tough and make something happen,” Laura says. “When something goes wrong, particularly when [the horses] are afraid and they stop, don’t give up. Re-approach it and give him confidence and give yourself confidence.”

This article originally appeared in the April 2017 issue of Practical Horseman.