The definition used for a ‘geriatric’ donkey is one that is aged 20 years or over (Evans and Crane, 2018). Many donkeys living as companions, rather than feral or working individuals, will live far beyond this age and have a long, fulfilling life. Arthritis is common in geriatric donkeys. Veterinary surgeons and Registered Veterinary Nurses (RVNs) working in equine practice should be aware of the individualised care required by arthritic geriatric donkeys, in order to ensure a good quality of life for them in their later years.
Arthritis in the geriatric donkey
Degenerative joint disease is a common form of arthritis found in donkeys, and is not an unusual finding in donkeys with a normal lifespan of 30–40 years old (Barrio et al, 2019). In non-working donkeys, it frequently affects the upper limb joints, primarily the shoulders and the hips (Evans and Crane, 2018). One of the first indications of degenerative joint disease can be seen in a change in the donkey's behaviour during routine farriery. The donkey may be more difficult to handle and may resent having limbs held (Barrio et al, 2019). If this is reported, a full musculoskeletal examination should be carried out by a veterinary surgeon.
Lameness evaluation
A lameness evaluation in a donkey has similarities to those of horses and ponies (Thiemann and Poore, 2019). A full general clinical evaluation should be undertaken initially, with an assessment of conformation. Gait analysis is an essential component of the lameness evaluation in donkeys. However, it can be challenging as a result of behavioural constraints (Thiemann and Poore, 2019). Despite reports to the contrary, donkeys are neither stubborn nor stupid, but their natural propensity is to freeze when threatened or frightened (Burden and Thiemann, 2015). It is this freezing behaviour that can make lameness examinations more challenging in donkeys compared to horses. A systematic approach and an experienced handler are essential (Thiemann and Poore, 2019). This is where an RVN, who is experienced in donkey handling, could be brought in to make the process more efficient and less stressful for the donkey. Van Dierendonck et al (2020) found that locomotion in donkeys could only be objectively assessed by using positive reinforcement. Burden and Thiemann (2015) suggested that positive reinforcement can be provided in the form of a tasty, high-sugar treat such as a ginger biscuit, or in the form of a bonded companion.
Gait analysis in a straight line can give important information and allow recording of baseline lameness values (Thiemann and Poore, 2019). Lameness evaluations on a circle are often not possible in donkeys, as they are typically not used to this modality of training. Evaluation on a circle can be performed in hand and will often exacerbate the lameness seen on a straight line (Thiemann and Poore, 2019). Proximal and distal flexion tests can be performed and may provide information regarding joint motion. Diagnostic analgesia and radiography can be performed as in other equids. Appropriate sedation protocols may improve the quality of radiographs in painful or anxious donkeys. Keeping a bonded companion close by can reduce stress and make the process more efficient (Thiemann and Poore, 2019).
Treatment of arthritis
Once a diagnosis has been made, it is important to speak to the owner to find out how the donkey is adapting to life with arthritis. Medical treatment of the condition is similar to that of the horse and pony and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used. However, donkeys generally metabolise drugs faster than horses, so the frequency of dosing is often increased to twice daily (Evans and Crane, 2018). Corticosteroids are often used as intra-articular medication in horses with arthritis. However, reports of this treatment being used for arthritis in donkeys is scarce. Zanotto and Frisbie (2021) found that a high percentage of veterinary practitioners considered corticosteroids as somewhat likely, or very likely to contribute to laminitis when used in an intra-articular application. Donkeys are prone to developing laminitis; therefore, it could be concluded that the use of corticosteroids should generally be avoided as a treatment method in donkeys. Other treatments commonly used to manage arthritis in horses include biological therapies such as interleukin receptor antagonist protein, platelet rich plasma and stem cell therapy (Zanotto and Frisbie, 2021). However, the financial outlay required for these therapies would render them unaffordable to the average donkey owner.
Care of the arthritic donkey in veterinary practice
Vets and RVNs caring for geriatric donkeys with arthritis at their practices can help to increase their comfort in several ways. Providing comfort in the form of a deep, clean bed and rubber mats is important to allow proper recumbency. This will help to minimise movement and maximise the healing process (The Brooke, 2013). It is often best to use shavings for bedding as donkeys will readily eat straw, and this can be counter-productive to the management of some clinical conditions. When picking feet out, it is best to keep the donkey's feet low to the ground and underneath the donkey to avoid discomfort (The Donkey Sanctuary, 2018). Warmth can be provided with the use of rugs or heat lamps. It is important to source a well-fitting rug for a donkey (Figure 1). Rugs made for small ponies often do not fit donkeys, who tend to be narrower in the shoulders, and using these can lead to slipping and chaffing. There are now several manufacturers that make rugs specifically for donkeys, making them readily available and easy to obtain. To measure a donkey for a rug, measure from the centre of the chest along the donkey's side to the end of its rump (not to the centre of the tail). If the rug is the correct size for the donkey, it should fit snugly but not restrict or prevent movement (The Donkey Sanctuary, 2016). Feed and water buckets can be raised off the floor to make eating and drinking easier. This can be especially useful if the donkey has arthritis in the cervical vertebrae (Evans and Crane, 2018).
Physiotherapy
Rest and extended lying periods may lead to joint stiffness, muscle cramp, or congestion and oedematous swelling of the limbs. A combination of stretches, joint mobilisations and massage techniques can be used as part of a management regime for the older horse (Sharkey and Herbots, 2009) and this concept can also be applied to older donkeys. A treatment programme would involve close liaison between the attending physiotherapist and veterinary surgeon. However, aspects of the programme can be taught to the owner to allow care to continue at home (Sharkey and Herbots, 2009). A range of physiotherapy techniques can be used, including manual therapy, mobilisations, manipulations and stretches (Sharkey and Herbots, 2009). Passive motion can be encouraged by gently flexing and extending joints (Figure 2). Dynamic motion can be encouraged by using carrot stretches (Figure 3). Care must be taken with stiff, arthritic joints and movement should never be forced. Stable bandages can be applied overnight to help to control lower limb oedema (Southwood, 2008). Stable bandages can also provide warmth and comfort to arthritic joints, but should be checked daily for any bandage complications such as rubs and sores (Linnenkohl and Knottenbelt, 2012). Stable bandages should be removed and reapplied daily, and washed when required.
Quality of life assessment
It is important that vets and RVNs in equine practice can support the owners of geriatric donkeys to help them to maintain the best quality of life for their equine companion. An arthritic donkey will need to be carefully assessed for joint pain. A recent project looking at equine end-of-life care found that veterinarians serve an important role in supporting owners when making the decision to euthanise their donkey at an appropriate time (Barrio et al, 2019). The Donkey Sanctuary have produced an easy-to-use quality of life guide that owners can complete on a regular basis, and this can help them to track changes over time (Barrio et al, 2019). Veterinary surgeons and RVNs should discuss the answers to quesitons regarding end-of-life care at length with owners. Management adjustments and environmental changes can be made, and medication can be given to increase the comfort and quality of life for the geriatric arthritic donkey (Evans and Crane, 2018). The donkey should be regularly assessed to ensure the treatment plan is still relevant and effective. Over time, the quality of life of the donkey may deteriorate. If treatment options become limited by severity of disease or financial considerations, then euthanasia is likely to be the best outcome for the donkey's welfare (Evans and Crane, 2018). Euthanasia should not be considered a failure, but as the last good thing that can be done for the donkey (Evans and Crane, 2018). It is important that the vet and RVN support the client through the process of euthanasia. This can involve helping the client to manage the donkey's companion, help find a new companion, and offering details of bereavement services.
Conclusions
Geriatric arthritic donkeys require special care and monitoring throughout their old age. This process begins with early recognition of behavioural changes by the owner and a thorough investigation by the veterinary surgeon. The specifics of donkey behaviour should be kept in mind during these examinations, and everything possible should be done to make it a positive experience for all involved. The use of positive reinforcement in the form of tasty treats and close proximity to a bonded companion should be encouraged (Burden and Thiemann, 2015). Once a diagnosis has been made, care should be taken when selecting treatments and drug doses should be tailored, with the specifics of donkey drug metabolism being kept in mind. Techniques to keep the donkey comfortable should be instigated, including providing shelter, a deep bed, maintaining warmth and carrying out regular physiotherapy to increase mobility and reduce pain. Veterinary surgeons and RVNs should involve the owner as much as possible during the management process, and regular quality or life assessments should be carried out to monitor progress. If the severity of disease or financial considerations start to limit the options for treatment, then euthanasia may be the best outcome for the donkey's welfare (Evans and Crane, 2018). This should be carried out with care and respect, and the owner should be fully supported through the entire process.
KEY POINTS
- The definition used for a ‘geriatric’ donkey is one that is over 20 years old.
- Arthritis is common in geriatric donkeys and frequently affects the upper limb joints, primarily the shoulders and the hips, as well as the lower limb joints.
- Non-steroidal anti-inflammatory drugs are commonly used, although donkeys generally metabolise drugs faster than horses, so the frequency of dosing is often increased to twice daily.
- Veterinary surgeons and Registered Veterinary Nurses caring for geriatric donkeys with arthritis at the practice can help to increase their comfort in several ways. The owners of arthritic donkeys should be fully involved with any treatment plans and fully supported through any management changes.