When looking at medicine from a CAVM standpoint, the first question to ask is what is health? Health is defined as freedom from disease. According to this definition many domesticated horses are not truly healthy. In conventional medicine “normal,” chronic conditions are accepted as healthy, as long as the animal is considered free from devastating illness. In other words, many signs of chronic disease, when not life-threatening, are accepted as normal health.
True health in CAVM terms is freedom from any signs of disease. It includes the ability to acquire common, self-limiting infectious diseases, such as the flu, and have adequate immunity such that the illnesses are short-lived and require little medication to recover. A healthy individual should mount a strong reaction to an infectious disease, often running a high fever (up to 105°F or more) for a short period of time, followed by a quick recovery.

Signs of chronic disease
A horse, by nature, is a prey animal. It lives in areas with scrub-type vegetation, and moves twenty hours a day eating, with about four hours spent resting and sleeping. Humans expect horses to adapt to our ways of living, eating and exercise, and, for the most part, horses do this very well. However, the levels of stress brought on by the unnatural living conditions create and exacerbate chronic disease and cause weakening of the immune system. Recognition of the nature of horses helps the practitioner understand how best to treat them in a holistic manner.
Signs of disease manifest as mental or physical symptoms that range from mild to severe. Any deviation from health can be considered a sign of disease, but may only indicate a poor quality feed or a parasite overload. The following signs of disease are an introduction to observing horse health in a different light.

Mental signs that chronic disease may be present include excessive fears, nervousness and inability to adapt to change. Horses with repetitive behaviors such as weaving, stall-walking, self-mutilation or cribbing appear addicted to these behaviors and are probably not coping with the stresses of confinement very well. If a horse is having a hard time adapting to the stress of confinement, the immune system is probably compromised and the animal’s health may deteriorate.

Typically horses that are either consistently underweight or overweight have a problem with chronic disease. Underweight horses may have trouble digesting or utilizing food, or they may have low-grade liver disease or cancer. Horses chronically overweight, especially those with fat deposits and “cresty” necks, may have metabolic problems but may simply be overfed and under exercised .

The respiratory system is commonly affected in the chronically ill horse. Allergies usually manifest as COPD and allergic coughs (although allergies with itchy skin are commonly seen in the warm climates). Allergies are a sign of immune system imbalance and over reactivity. Many high-speed horses (racing, eventing, steeplechasing) bleed from the lungs, indicating a sign of weakness in the respiratory tract. Foals with upper respiratory “snots” of several months’ duration may be considered normal by conventionally-trained practitioners. However, from a CAVM perspective, protracted infections or slow recovery are an indicator of chronic disease.
Skin is the largest organ in the body, with the internal health and nutritional state reflected in the skin and hooves. The dry, dull, bleached coats on which clients spend a fortune on shampoos and supplements, can be best treated from the inside using a complete CAVM approach. One of the primary signs of a healthy horse is a deep rich color to the hair. Truly healthy horses have a glow to their coat and they do not bleach out in the sun.

Allergies, especially itching eruptions, are signs of chronic immune system problems (Dodds, 1993), and though skin allergies are difficult to cure with any form of medicine, the CAVM approach is often successful. Some seemingly simple conditions like dermatophilis (“rain rot,” etc.) are signs of subtle disease.

All horses on a given property may be exposed to a causative agent such as dermatophilis or a virus, yet only a subset of the horses succumb to the infection. And, some horses will become significantly ill from a contagious agent, while the horse in the next stall is only mildly affected. As horses are cured from chronic disease, skin conditions including warts, sarcoids, oily or sticky sweat, discharges from the sheath, poor wound healing and excessive scar-tissue production tend to resolve.

Feet are an adaptation of the skin structures, and the old adage, “no foot, no horse,” is as true today as when it originated. Poor nutrition, chronic disease and weather conditions play important roles in the health of the foot, as does the quality of the farrier work. Cracked, brittle or dry feet as well as soft or crumbly feet can be signs of chronic disease. Thrush, white line disease, abscesses and seedy toe need to be addressed from a CAVM standpoint and be considered as subtle signs of disease.

Gastro-intestinal disorders are an important disease entity. Horses with chronic digestive tract problems including dry feces, soft feces, ulcers, sensitivity to change in diet or weather, odiferous stools, failure to digest completely, cravings for dirt, salt or wood, fussy eaters and various mouth problems probably suffer from chronic disease. Colic is the number one killer of horses and in many cases colic, especially repeated bouts can be considered as chronic disease. However, since most facilities where colic is common have identifiable management problems a complete examination of the facility is part of the exam. Horses’ natural grazing and exercise habits are usually ignored in show barns and small acreage horse keeping. Lack of correct roughage is one of the primary causes of colic, since the equine gut is designed for long stem roughage and not concentrates. The stress of confinement contributes to colic, as can the overuse of antibiotics and dewormers.

The reproductive system is affected by nutrition, management, heredity and chronic disease. Horses are selected for desirable performance and are not selected for reproductive health as they are in the wild. Mares have many problems, both physical and behavioral, associated with their heat cycles. Infertility of the male and female, including lack of libido, sterility, ovulation problems and chronic uterine infections of all types, can often be corrected with CAVM modalities.

Equine musculoskeletal problems, which usually manifest as poor performance or lameness, are a common reason for horse owners to seek veterinary services. Lameness is yet another sign that can be an indication of disease in the horse. Muscle stiffness and tying up, as well as weak tendons and ligaments, may have a nutritional or chronic disease origin. Arthritic changes in the joints, including navicular syndrome, can result from an ill-fitting saddle, shoeing, nutrition or chronic disease. From a Chinese perspective, constant swelling or stocking up of the legs indicates poor digestion