Terrible or Tolerant? Training to Handle Veterinary Procedures

One of the most frustrating scenarios for horse owners and their veterinarians is the horse that is difficult to treat. We all have known such a horse, one which might start out fighting the annual Coggins blood sample and vaccinations. Or the one that dangerously refuses placement of the rectal thermometer. Or the one that successfully avoids the eye ointment or oral deworming. All too often, one thing leads to another, and you can't even get in the stall safely with the vet on the property. You have tried everything from the twitch to the blindfold. The more restraint, the more the horse fights. You start weighing the risks and benefits of "messin' with him" for routine preventive care. When you really do have to treat the animal, it becomes an explosive wreck. When he has a problem serious enough to require a trip to the hospital, signs are plastered on the stall door, "Caution: horse has an attitude!" Great, now everyone hates the horse that hates the vet. What can you do?

My usual first recommendation is to stop fighting with such a horse, and instead turn the effort toward teaching the horse to enjoy veterinary procedures. Yes, a realistic goal. Even the most difficult horse can learn to comply willingly with veterinary procedures for a reward.

Behavior modification to overcome procedure shyness costs almost nothing if you can do it yourself, except some time with your horse. Most people who have been battling with a non-compliant horse typically are amazed at how little time it does take to turn a horse around. What it will require is patient, calm, and consistent application of some straightforward behavior modification principles and techniques.

Most people find behavior modification a lot of fun. Some even feel a little silly at first. But the results are almost always immediately positive. If you are successful, there are many benefits. The horse will be a joy to treat, and so will have a better life and greater general trust in you. And all the people involved will have learned some powerful tools that are widely applicable to all sorts of human-animal interactions.

The general principles of learning that can be applied to teach a horse to comply willingly with injections, nasogastric tubing, genital manipulation, or any other mildly annoying procedure are the same learning principles that animal behaviorists and psychologists have studied for decades. The background research, terminology, and details are described in most introductory animal behavior or psychology textbooks. The same principles work with a circus elephant, our pet dogs, our kids, us as adults, and our horses for other types of training.

In addition to the general principles, for any species there are some specific techniques that take advantage of that animal's innate behavioral characteristics, size, or strength. These general principles of learning and equine-specific techniques can be effectively applied by just about anyone competent to care for a horse. Actually, much of the magic of a good horse owner or of many of the horse training experts is consistent application of the laws of learning. The specific techniques might vary, but in the end much of what successful horse owners or animal trainers do all comes down to the same simple principles.

What Causes The Aversion?

Before we begin, there are a couple of important points to consider. First of all, horses--like any other animal--are born naive to the domestic world around them. Newborn foals might have an innate fear of humans in general. That usually is overcome readily with repeated exposure that has a neutral or positive experience for the foal. When it comes specifically to needles, tubes, or veterinarians, a foal's first response typically is neutral or even curious. Depending on the experience, positive or negative, the foal will either become more leery or more compliant.

So, it's useful to appreciate that for a procedure-shy horse, the resistance most likely is based on negative experience. In other words, the horse learned to dislike veterinary procedures. Its experience so far in life has summed up to negative when it comes to certain procedures.

This is not all bad news. First, if a reaction or association has been learned, then it can be unlearned or re-learned. The animal's response easily can be reversed from negative to positive. His recent experience relative to the procedure just has to sum up to a positive.

Second, it's likely that your horse is fairly smart. Although there is no scientific data to back up the contention, many clinical animal behaviorists agree that procedure-resistant individuals often appear to be among the most intelligent in terms of associative learning ability. These often are the animals that take very few repetitions to learn or re-learn just about anything we normally expect horses to learn.

In my experience, horses which have started to "know the minute the vet drives in," or which appear to be able to see the tube of dewormer behind your back, have exactly the learning ability that will enable them to overcome procedure shyness quickly with organized behavior modification.

It also is important to realize that appropriately conducted veterinary examinations and treatments should not be painful. Injections, jugular stick, insertion of a rectal thermometer, or other ordinary veterinary examination might be mildly aversive or slightly uncomfortable for a moment, but not painful enough to evoke escape or serious resistance from an otherwise well-handled horse.

So, when a horse starts to be seriously non-compliant, it is time to step back and evaluate the whole picture, looking for what has become aversive to the horse. Improvements very often can be made in the method of restraint or the manner in which the procedure is done to reduce the aversiveness.

One simple example we see frequently comes from our work in reproduction. It is common practice to wash a stallion's penis with warm, clear water before breeding or semen collection. Most stallions tolerate this procedure, and actually come to associate it as a positive step leading up to breeding. For horses which resist the procedure, a common problem is rough handling of the penis during washing or drying that leaves the surface of the penis abraded. Another common problem is for a handler of the horse to be worried and anxious that the procedure will hurt the horse. Their anxiety seems to elicit concern from the horse.

I certainly have worked with people with genuine extreme concern, particularly for young horses, that had to be addressed before progress could be made with the horse's compliance. One very nice young boy I know who was holding his pony for eye treatments would let out a shrill yelp each time the veterinarian was just about to squeeze the ointment along the eyelid. Of course, this affected everyone negatively.

General Procedures

For gaining compliance with any procedure or manipulation, it is useful to consider that the job requires sending three basic messages to the horse:

1) The procedure doesn't really hurt (that much).

2) Ordinary resistance or reasonable reaction will not stop the procedure.

3) Tolerance of the manipulation can lead to a reward.

For this to work, you need to ensure that the procedure is in fact as painless as possible, at least at first. For restraint, I like to use the minimum necessary for everyone's safety. It's good if you can avoid restraint that itself invokes discomfort or fear. For many procedures and horses, I like to work in a large, quiet enclosure with good, quiet footing and plenty of head room. This allows for some safe wiggle room without a crash and goes a long way toward keeping everyone calm. I like to use a simple halter and cotton lead shank. If the horse has been charging, rearing, or striking, I like to use whatever safety gear gives me the confidence to remain calm--safety shoes, helmet, and sometimes a safety vest.

Consideration should be given to making the most aversive part of the procedure, say the needle stick or the nasogastric tubing, as painless as possible. This is particularly important during the re-training. (It also goes a long way in preventing procedure shyness in naive horses.) When re-training needle-shy horses, for example, I try to use a very tiny needle--22 or 26 gauge--for the re-training. Once they get through the procedure and get a reward, the larger needle usually is tolerated.

The behavior modification procedure itself is simple. All you need is the horse, the usual equipment for the procedure, and a reward. For most things I use a palatable food reward, in which case I do it before mealtime, and often in lieu of the meal. First, for whatever procedure the horse has been resisting, you just make a list of the preliminary procedures, identifying several distinct individual steps that lead up to the actual procedure. Then each step is repeated and rewarded individually several times.

In the case of jugular stick, your list might include: 1) approaching the stall with the syringe in hand; 2) entering the stall; 3) opening the wrapper of the syringe; 4) uncapping the needle; 5) holding off the vein; and 6) touching the vein, or whatever the preliminary steps used by your veterinarian.

If the horse is one which has started to anticipate even the very early steps, be sure to include those in your list of increments. Each one of these steps should be performed several times independently of the others. They don't necessarily have to be in the logical order. At that point, each element has to become a positive for the horse. For most situations, I like to use a small food treat paired with a simple verbal response, such as "Good," spoken with a consistent tone. By association with the food reward, "Good" will become a conditioned reinforcer that will carry positive value alone. The conditioned verbal reinforcement is very handy for times when you cannot deliver the primary reinforcer--the food treat. Unlike a pat on the shoulder, the verbal reinforcer is hands free and is usually always available. Once it is well established, it can and should be used intermittently as the only reward for the procedure.

The goal is to repeat and reward each preliminary step until the horse indicates behaviorally that he perceives that element as positive. How do you know that the step has become a positive event for the horse? When he begins to approach you or reach for his treat, you know that he now associates that step with a positive outcome. You can move on to another step. Once all of the preliminary steps have switched from negative to positive, you can start putting them together in the logical sequence.

Remember the procedure-shy horse is likely to be smart enough to distinguish the particular sequence that leads to the needle stick. He will likely need a reward for the actual linked sequence, in-cluding the actual procedure itself.

You should reasonably expect that the horse might have some setbacks. It is important to calmly expect them, and try not to become frustrated or punish the horse. I like to think of animals in this situation as little calculators adding up the positive and negative experiences associated with various events, then behav-ing according to the sum total. Strong voice tones, over-restraint, or explosive wrecks can represent inadvertent punishment, sending the message that this really is a nasty procedure and that the person doing it is to be avoided and feared. When there is some relapse, just back up to a step that the horse still views as positive, and go again.

A common observation is that this all works well until you get to the point of the aversive part of the procedure. Then the horse starts to pull back or resist, so he never gets the reward for the entire procedure. Much of the skill--perhaps art--of doing this type of behavior modification is being able to ride out some minor resistance safely, and so get to the point of completing the procedure and the reward at the end.

In an open area, the horse can move around a bit and you can calmly stay with the horse and the procedure to get the job done and get to the reward. If it is successful, the horse can continue to learn that the procedure was not all that bad this time (smaller needle, gentler approach). It also will teach the horse that simple movement doesn't avoid the procedure.

One repeatable phenomenon that can get you sidetracked involves your reactions to minor resistance of the horse. If you flinch or jump back each time the horse flinches, some horses appear to read your reaction as confirmation that this is a scary procedure. Others seem to learn a game of directing your behavior. They flinch, you jump; they flinch, you jump. Beyond avoiding the veterinary procedure, they have a fun new game of "make my handler jump!"

For horses which have proceeded eagerly through compliance with all the preliminary steps, then resist the actual procedure, it is effective to offer the treat as a distractor during the procedure. In the case of injections, this can work very well. Many horses seem not even to notice the actual stick when they are rooting around for a few grains of sweet feed in the bottom of a deep bucket. In the case of a jugular stick, the bucket can be used to draw the horse's neck out for good exposure of the vein. Once you are successful with the distractor bucket, it is good to continue with the step until the horse accepts treatment without the distractor. In other words, the horse will need to learn to wait for the procedure to be completed before the reward is given.

Once compliance is gained, it is good to continue with the same gentle, non-threatening, and as painless as possible approach. Intermittent reinforcement with as little as a one-in-10 ratio of primary reinforcement will maintain compliance. In the worst cases of procedure shyness, the re-trained horse sometimes is described as "short-fused" or "leery" of new handlers for a long time, maybe for the rest of its life.

Frequently Asked Questions

How long will it take? For most horses, it will take less than a couple of hours of interaction with the horse over a few sessions. This procedure seems to work well when it is undertaken as an exercise outside the context of actual treatment. Like everything, when you're not in a hurry, it never seems to take much time. When there is urgency for complete success, it sometimes seems to take longer. It is not easy to predict how much time it will take for any given horse and handler pair. Some of the toughest horses and most inexperienced handlers have achieved rapid success. There are a lot of factors at play, including the basic temperament of all involved.

It is also hard to say how best to pace the training. At the extremes, I have seen success in one 15-minute session. Sometimes multiple sessions are required per step, meaning weeks of diligent work.

There are guidelines. During any session, it's probably good to end before the horse loses interest and before he has earned his full ration of treats. When there is plenty of time, my usual goal is to get through at least two or three preliminary steps per session. Of course, the longer you spend reinforcing compliance with each element, the more positive experience the horse is acquiring. So if there is no need to rush, just relax and enjoy. It rarely takes many sessions, and all that matters is that each session has some progress. The session should end on a positive note. It is useful to begin a new session by repeating the last successful step in compliance a few times before starting a new one.

Following are some of the questions that are asked frequently when we are dealing with the general principles of learning when applied to horses.

Does the food reward create a "mouthy," nippy horse?

Sometimes it can. If that seems to be happening, you can switch to giving the reward from a special container used only for that purpose. Most horses will distinguish the source, and will not nudge for treats unless the container is present. That way you can put up with the eagerness for treats during the re-training, then eliminate the treat container and the associated mouthiness once you have achieved compliance. You also can teach the horse to wait for the offer.

What about relapse?

I have known horses which have relapsed, then using the same training procedures, compliance has been regained. While it is sad to watch a horse gain and lose trust in people over and over, most can keep at it indefinitely, getting wiser with every round.

Is it true that horses which have gone through a bout of critical care with lots of injections and other poking and prodding--perhaps at an early age--are doomed to hate veterinary procedures?

No, just as the laws of learning would predict, it all depends on the quality of the experience. Actually, some people whose horses have had a round of intensive care comment that the horse's experience taught the horse to comply with just about any procedure. We know from working with hundreds of horses in research settings, where there is variable opportunity for organized positive experience with veterinary procedures, that the more experience, the better the willing compliance.

Is it ever too late to turn a horse around on veterinary procedures?

Depending on the resources available, I generally would say no. That is, not for a horse which is otherwise normally interactive with people and other horses, and is just resisting specific procedures.

When treating a horse, is it better to hurry up or to take your time with the ouchy part?

Almost always it is better to proceed very calmly and smoothly, but without hesitating or being jerky with the uncomfortable part. This is the one reason why I sometimes recommend getting help from a professional for the initial re-training of a severe case. Enlist the aid of someone who is especially talented and confident with the uncomfortable part of the procedure. Skill and confidence helps with the smooth, committed approach that horses seem to like.

Should I use a twitch?

A twitch applies pressure to the sensitive nerve endings in the nose. This inflicts pain, which initially distracts the horse from either noticing or responding to an unpleasant procedure. It usually particularly inhibits movement and kicking. That's why it is often used to restrain mares for breeding. The pain causes a release of natural analgesic chemicals in the brain--known as endogenous opiates or endorphins--which then likely mask both the pain at the nose and any discomfort elsewhere. You will see that after a few minutes, the horse might get a droopy lip and drowsy, glazed-looking eyes. This drowsiness corresponds to high levels of endorphins in the blood. After about 10-15 minutes on the twitch, most horses become agitated. Some seem to explode or "blow the twitch." This behavior corresponds to lowering blood levels of endorphins, perhaps because the brain has temporarily depleted its supply.

Some horses seem to grow in their dislike of the twitch, while others don't. This might be related to how the twitch is applied and whether or not the twitch was removed during the relaxed drowsy (positive) state or whether they reached the obviously unpleasant point of "blowing the twitch."

So for mildly painful, brief procedures, a twitch will give some added security. For most ordinary examinations and treatments, I recommend teaching the horse to comply as we have described, rather than twitching. If a twitch is used, it is useful to accustom the horse to the twitch in practice sessions. These sessions will allow the operators to more effectively learn how to apply the twitch smoothly to the individual horse, as well as to learn the horse's typical behavioral response and the duration of twitch tolerance. Practice sessions will allow a calm and unhurried approach, which will maximize the possibility that it becomes a tolerable emergency procedure.