Can We talk About Helmets?

A proper ASTM approved helmet!

And here I am in an old fashioned helmet, riding Sir Tally, 1980

The use of riding helmets has always been a controversial subject, but with the recent injury of Dressage legend Courtney King Dye, it seems there is a renewed interest of the topic. It is surprisingly how many riders adopt the attitude that "Well, I rode as a kid without a helmet, and nothing bad happened, and 20, 30 years later, nothing bad has happened yet, and besides, it is my body, I can do as I damn well please". Well you know, lots of us grew up with mothers who smoke and drank when they were pregnant with us, a whole lot of us did not wear seat belts ( we would routinely drive the whole way from Pittsburgh to Florida and back, stretched out in the far back of the station wagon, never buckled in!) and yes, alot of us did ride without helmets. But what about those who did end up being born prematurely, those who did suffer serious injuries or death in car accidents, and those who did suffer injuries or death from falls from horses? Just because you or I did not happen to have anything bad happen, well, that just means either we are lucky or our time just hasn't come yet.

Growing up in rural Pennsylvania, with a pasture full of my grandfathers horses, I have pictures of me as a toddler, sitting on a horse, no helmet on. Fugly would have a field day with that image! At least my parents never wandered from my side! I really don't even remember when I started riding daily with a helmet...when I think of all the crazy stunts I did as a teenager, with no helmet on, I am convinced I must have had a guardian angel looking after me. My scrap book is full of pictures of me jumping my beloved Sir Tally, over 4' fences, with no helmet on! I know I had one to show in, but that was the only time I wore it. At some point though in my teens, for some reason that I don't remember, I started to wear one every time I rode...but even then, it was the helmet without a chinstrap...you know, the one that has a warning label in the catalogs that "this helmet is not to be used for riding in?" Um, hello, then why in the world are you selling a helmet for a hundred dollars that you issue a warning label not to ride in? But for years, that is what I wore, as did many of my friends and competetors. A helmet with a harness was absolutely hideous. It was hot and sweaty and lets face it, in the professional photos that you shell out good money for, well, you look awful! That is what I used to think anyhow.

What changed my mind? My daughters always rode in an approved helmet. Period. Nothing to discuss. But I was still riding in my old fashioned helmet. Then I watched the video "Every Time, Every Ride" at a regional pony club meeting, and literally, my first stop on the way home was at a tack store to purchase an ASTM approved helmet. I have never ridden without one since. Yes, the video made that much of an impact on me. That was in 2001.

I never understood the argument that riding one discipline versus another was so much safer that helmets were not the normal standard of attire...western riding or saddle seat for example. I about had a melt down watching a video of a friend's teenage daughter, riding a very high strung Saddlebred, wearing a top hat! I mean, a fall from a horse, whether the horse is wearing a western saddle, a dressage saddle or even if bareback, is still a fall, and it can have devastating results. Lets face it..all horses spook. There really is no such thing as a bombproof horse, no matter how much we like to think that we own such a creature. Things happen. They spook. And if they don't spook, they can trip, they can fall. It happens in a blink of an eye. It happens regardless of our riding experience, or the saddle we are riding in. I know personally of two local riders who suffered permanent brain injuries, when their horses tripped at the WALK. Because neither were wearing a helmet, their lives, as are their families lives, forever changed.

And speaking of experience level, advanced riders are just as likely to fall as a beginner. It is a fallacy that the more experienced rider just doesn't fall. I think that Courtney King Dye's fall is proof that this just isn't true. In fact, since more experienced riders may be more likely to be riding a green horse, jumping higher or riding a rank horse, this really can't be a legitimate argument.

Eventers seem to always be one step ahead of the industry when it comes to protection. ASTI approved helmets, along with safety vests have always been considered normal attire, even when schooling. Even so, riding in a top hat at the upper level dressage tests has been acceptable, but the appearance of Allison Springer at the Kentucky Rolex this past spring, riding her dressage test in a helmet, brought about much accolades in the eventing forums. It seems more and more eventers are opting for helmets instead of top hats. And the racing industry reports that jockeys now suffer fewer head injuries than pleasure riders since requiring approved helmets.

In the United States Pony Club, head injury rates were lowered by 29% with mandatory helmet use.

Need more facts?

-Approximately 80% of injuries occur while riding. This means, 20% of injuries occur on the ground. My daughter Jen suffered a concussion and mild memory loss when the horse she was mounting, inexplicably bolted, leaving her on the ground, unconscious for 10 minutes, until she came to. Her trainer thought she was in the barn, late for a lesson, and I, seeing her leave the barn, thought she had joined her lesson group. Had she not been wearing a helmet, she may not be walking or talking today.

-Most injuries occur during pleasure or trail riding. I know the reason why. It is because this seems to be the group that is least likely to wear a helmet. For whatever reason, maybe because they think they aren't doing anything dangerous, they feel they don't need one. Well guess what? Just standing next to a horse can be considered dangerous! I know way too many riders that fit this way of thinking.

More facts?

-Most common reason for riders being admitted to the hospital is for head injuries.

-A fall from 2 feet can cause PERMANENT brain damage. Think about where you are on a horse...6 feet? 8 feet above ground? How high are you off the ground while jumping a four foot oxer?

-A human skull can be shattered by an impact of 4-6 mph. How fast are you going at that canter? Gallop? About 40 mph!

-A rider who has suffered from one head unjury has a 40% chance of suffering a second head injury. Two years ago, after eventer Darren Chiacchia was severely injured in a fall at Red Hills, there was an uproar when he returned to riding within just a few weeks of being released from the hospital. Yes, he was wearing an approved helmet...I don't think he would be here today had he not been. Many argued that it was not safe for him to be riding so soon after a brain injury. Months later, interviews show that he was clearly not 100%. Had he suffered another fall so soon after his return, he probably would not have survived, or at the least, he would most likely have suffered permanent brain damage. Children, teen and young adults are most vulnerable to sudden death from secondary impacts.

-There are things far worse than death. Those who do survive may do so with epilepsy, memory impairment, paralysis and more.

And how about this fact? Head injuries are the number one horse related cause of death, accounting for 60% of deaths.

SIXTY PERCENT! And this number is so preventable! It is a proven fact that helmets work! Modern helmets greatly reduce the risk of head injuries by cushioning the landing of a fall with a layer of crushable foam. The foam slows the stopping time of a rider's head as it hits a surface. A bare head will just come to an abrupt halt when it meets a hard surface, which causes the rider's brain to crash into the inside of the skull. The secondary impact of the brain into the skull is when the majority of brain injuries occur. This is why the old fashioned helmets that I used to prefer are useless. They don't have the lining that today's ASTM helmets do. Also, I can vouch that upon landing, helmets without a harness can and will, go flying upon impact..so buckle up that harness while mounted!

When my daughter went away to college, I gave her the book "How Not to Die" by Dr. Garavaglia. It provides tips on how to live longer, safer and healthier. Obvious tips like eating healthy, staying out of high crime areas, and not smoking. For me, whatever I can do to prolong my life, I am all for it! As I told two pony clubbers I was examining recently, "Always, always wear your pony club pin! You would hate to have points taken off at a rally for something you could have prevented"! Well, wear your helmet...wouldn't you hate to have your family preparing your funeral, or feeding you jello because you can't feed yourself, when it could have been prevented so easily? Save death for another day, for a reason that you cannot avoid...like old age!

The itchies, habronemas and allergies (or, Welcome to Florida!)

Tucker's face looking beautiful and clear, June 1, 2010

Another shot of his face

The habronema is just a bare spot..hopefully, it stays that way!

Tucker ready to battle the elements in his nightly turnout.

The habronema at its worst. Notice the granulation tissue.

Typical summer face

Sheath and midline

Tail rubbing

Part One, Habronemas!

Florida, with all its miserable, hot, humid seasons of spring/summer/fall (which kind of just flow into one another, with no real discernable fall or spring), and mild winters (usually..thank goodness this past winter it was COLD!), mean that all kinds of funky, icky things like to grow, mutate and generally make the lives of humans and animals miserable. I have always said that Florida is not fit for anything living. I work for a Veterinary Dermatologist, and the large amount of animals we see with allergies and skin issues, and the 2-3 week waiting period for new patients, just proves this. And it seems that everyone I know, suffers allergies once they move to Florida.

I have spent the last 4 years dealing with allergies in horses, and combined with my job, feel that I have learned a thing or two.

Tucker arrived in November of 2003 but his skin issues did not begin until the spring of 2006, when he scraped the bridge of his nose. It didn't appear to be anything abnormal, it certainly wasn't deep, but its inability to heal was our first clue that something was amiss. Using all kinds of medications, both OTC and vet prescribed, nothing worked. Either right from the get-go, there was simply no healing noted, or it would start to heal, and then once a scab developed, Tucker would rub it open and we would be back to square one. Four months passed, and finally a combination of Preparation H and Lidocaine solved the problem and healing finally was achieved, although to this day, there is a slight indentation from where the sore was.

The following spring of 2007, Tucker became itchy. Very itchy! Let me tell you, a 1400 pound draft cross that is itchy is not a good thing for fencing. Lets just say, hot wire became my best friend that year! Tucker was suffering hair loss and was just plain miserable. Medicated shampoos, and anti-fungals were of no help. Eventually, I allergy tested him.

Now one thing I have learned working at the Vet Derm Center is, if you are going to spend the money for allergy testing, which costs hundreds of dollars, if your animal is not on steroids, then do the more reliable intra-dermal skin testing, where a patch of hair is shaved and the animal is injected with possible allergens. It is much more reliable than blood testing. Also, you cannot test for food allergies, only food elimination trials will reveal true food allergies.

I ended up blood testing Tucker, and he tested positive for 26 of 72 allergens. Unfortunately for him, one of the positives was grass. Boy, does this suck for a horse or what? Because I blood allergy tested him, I am not positive that he is truely allergic to all of those 26 items, but I can definitely say he is allergic to culicoides, mosquitoes, no-see-ums and grass!

Changes were made, including the use of a fly sheet and fly boots, but fly boots do not always stay on Tucker. He often came in from the pasture with tiny, crusty sores on his ankles and pasterns, which usually healed in just a few days.

In the fall of 2007 however, one sore would not heal. It became the size of a peach, was oozing and bloody and smelled. Nothing we tried would heal it. My vet speculated it was a habronema, but a biopsy indicated it was an auto-immune issue. Shortly there after, the weather got cooler and it started to shrink and heal and we weren't too concerned about it.

It was well on its way to healing, until the spring of 2008. The first warm day and suddenly the sore, which had shrunk to the size of a nickle, was oozing and bleeding and growing at an alarming rate. It was soon the size of an apple and the smell was horrendous at times. A second biopsy was performed and the culture was sent to the lab we utilize at work. This time, the results showed a habronema.
What is a habronema? If you are eating, you may wish to stop doing so for a few moments.

An open sore attracts flies. Even being diligent with SWAT and fly boots doesn't guarantee 100% protection. Flies land on the sores as well as in the moisture of the genitals or eyes, and lay their larvae. When the larvae emerge, they can migrate into the tissue and this causes a granulomatous reaction.

It can be just bad luck but it can also be attributed to an increased fly population, poor manure management or moist patches of long grass. The condition is seasonal, with remission in cooler weather. Affected horses are often repeatedly infected in succeeding years, which may indicate genetic factors having an influence.

There are 2 kinds: Ophthalmic and Cutaneous. Tucker suffered the Cutaneous. His was a classical case, with the parasite causing a rapidly enlarged superficial and granulating skin ulcer. Irritation results in rubbing, chewing and biting and can cause scarring. Wounds infested with the parasite may fail to heal and can expand with the production of unhealthy tissue.

It is possible to misdiagnose habromenas, as happened with Tucker. Initially we thought it could be cancer, and at one point I was afraid it was pythiosis. Seasonal appearance is really the best clue. Smears and biopsies are not always conclusive and as we learned, 2 different labs came back with different results.

Once we had a diagnosis for Tucker, we began treatment of a mixture of Ivermectin, DMSO and Fura Ointment. Within a week, the sore had healed and shrunk by 90%! Unfortunately however, we hit a wall after the first week, with no more improvement, but no regression either. Then, our farm was flooded with Tropical Storm Fay in August of 2008. Weeks of flooding was the worst possible thing to have to subject Tucker's leg too. The sore began to grow again. It was impossible to keep dry and we just had to deal with Mother Nature. Thankfully, fall came, we dried out, the weather got cooler, and once again we were in a healing pattern.

Again, winter provided a lull in the growth. Once again, it shrunk and healed. But come the spring of 2009, the first warm day and once again, literally overnight, the habronema was growing and now it was bloody and oozing. Again, we spent another summer fighting the habronema: daily regiments of medicating and protecting the leg.

Last winter was probably the best thing to happen to Tucker. With day after day of record lows and multiple freezes, the habronema had disappeared to its smallest size yet. We have now survived 2 months of warm and hot weather with no oozing, bloody mess. It is still there, there is a bald spot about the size of a quarter. But I am diligent about managing his allergies and the habronema. Beginning in March, he started wearing a fly sheet. His leg with the habronema always wears a fly boot. Tucker seems to understand that the left front leg needs to stay covered, and that is the only leg wrap that he does not try to lose! We try to keep a fly mask on, but Tucker and I have different opinions about these and rare is the morning that he comes in with it still on. So instead, I just wipe his face and ears with the EquiDerm mixture before going out. I have learned that all it takes is just one itchy moment for him to rub the leg open, and one small bite on any part of his body can quickly escalate into a big itchy sore by morning. By keeping to these measures, I am hoping that this will be the first summer we do not have an issue.

Part Two, the Itchies!

In addition to the habronema, Tucker is extremely itchy! I read an interesting thread on COTH (Chronicle of the Horse) bulletin board regarding Onchocerciasis or neck threadworms. I will spare you all the details, if you want to read more, I highly suggest going to COTH (http://www.chronofhorse.com/) and searching or you can go to http://www.brunswickvet.com/

A lot of itching, and the lumps and crusty sores which develop along the midline, which Tucker has, as well as tail rubbing (which Imp was doing) has been proven to be related to neck threadworms. I already grossed you out with the habronemas, so really, go read about these nasty things on the 2 sites I mentioned. A good cure for this is a double dosing of Ivermectin, 2 weeks apart. I did this to all my horses. Interestingly, the lumps disappeared from the midline, and Imp stopped rubbing her tail. I now do a DD of Ivermectin several times a year!

Another cause of rubbing, especially the face, can be ulcers. Jockey Calvin Borel told me about this cure. A tube of UlcerGuard will cure this. I told Calvin that how could Tucker be stressed out enough to have ulcers, he has it pretty easy, but as I thought about it, his skin issues could be pretty stressful enough. And sure enough, a treatment with UlcerGuard did clear up his face. Another handy trick Calvin taught me is to use castille soap and rub the bar good over the legs at bath time. The soap will remove any contact allergens. You can also use this all over the body for that matter.

I have tried alot of different products for Tucker. Toad Juice and Calm Coat are great to use on open, crusty and oozing sores. I add Calm Coat to my fly spray as well. He gets bathed weekly with MicroTek Medicated shampoo. My favorite medication, and he gets coated with this every night during the summer, as both a prevention and a treatment, is a mixture of EquiDerm and Desitin. The first raw spot I see, he gets a good coating of it.

We have about 4 more months of hot, humid, miserable weather. Keeping up with an allergic horse requires a lot of diligence. One slip up, whether its not medicating a sore, or not putting on the fly sheet or leg wraps, can mean we have lost the battle for another season. It really does not take much for him to regress that quickly.