#isat mirror photo

[tisezra]

13 - Emptiness

I feel like my art's improved so much with realizing I have textures at my disposal

edit: why didnt i , add arms ?i know it's originally a triangle but

[starryemeralds]

self-reflection🪞

[chipper-smol]

Never gonna be normal about vampire Siffrin. I need to know and the mirror key event. Does Siffrin show up in the mirror? The answers know I'd imagine since it's still a mirror even if it takes pictures.

. .

I FORGOT ABOUT THE MIRROR

[lostfan10000]

Siffarooni! Some more photos I took today of my Siffrin cosplay. I don't have a collared white cloak so Sif gets a big scarf for his big hat!

[insertdisc5]

i was looking thru my old isat files like hm. is there anything thats not in the artbook. and yes. the answer is "the draft for the mirror photo, before i realized making it oval would be cuter and way better composition-wise"

[mari-lair]

Just wanted to start by saying I absolutely adore your au! Exploring the issues siffrin has even without the time loop from an outside perspective is really interesting :D

Sorry if this has been asked before but, is it okay to draw what I think things from isat will look like in this au? (Specifically asking for the mirror photos but ig this can be applied elsewhere).

Thank you! I'm happy you like the au!

And yeeeees, you can draw scenes inspired by it! :D please tag me if you do so I can see it

[faislittlewhiteraven]

Been having some ISaT tech level and timeline (as in 'when backstory things happened') thoughts and want to ramble a bit:

Tech

ISaT's setting is based on your classic sword and sorcery fantasy JRPG so its easy to assume that tech wise everything is 'fantasy medieval' and call it a day but consider:

Body Craft is at bare minimum is magic sex changing surgery (earliest known equivent in our world dating to 1930) that any old person can learn to do safely on themselves in only a few months, and more likely has many many broader applications like regular old surgery, the 'combat healing' Mira and Sif use, etc.

Cameras and photos are rare enough that Odile comments on it (namely she's happy the group get a photo in the House due to them being 'so rare') yet are also common enough that everyone in the party knows about them and doesn't question the existence of a camera beyond being surprised that the mirror was one. (In our world cameras date back to the 19th century, with the earliest manufacturing of them being in 1839). 

Printing presses and ways to make plenty of paper to feed those presses given absolutely everyone in this game can read, expects everyone else to know how to, and both mass produced book series and newspapers are a thing. (Note: Printing presses have existed since waaaay back but it's the mass paper manufacturing that makes newspapers and The Cursing of Chateu Castle possible that really has my eyebrows raised here, especially since neither Siffrin or Odile find either odd in any way, indicating such things are common everywhere, and while newspapers have been around since 1604 in our world, mass produced fantasy books didn't really take off until the start of the 20th century).

Food production and storage: despite being in the middle of a national disaster that almost certainly cut off trade networks and access to most suppliers for literal months now, Bonnie, a small child, is able to easily get their hands on fresh Pineapple, curry ingredients (for samosa), potatoes, plantains etc with no issues or anyone commenting on this being unusual or lucky. Oh and the only character who even brings up the concept of potential starvation is the Fishing One, and only in a sort of 'we're not at risk now but sooner or later...' kinda way due to noticing that the fish they fish up for fun are disappearing and likely being frozen. So yeah, that heavily implies Vaugarde has very good food storage tech/Craft (possibly better than ours), and likely also good food production and harvesting tech/skills also.

The Island's incredible knowledge of the stars: while the oldest known orrery in our world is dated from around 205 to 87 BC (ancient Greek, earth centric model), the fact Sif -who would've learnt this as a child/teen- is so very certain that stars are big balls of fire made up of gas is interesting as that's something our world couldn't prove the theory of until around the 1900s (note: it'd been theorized a LONG time but Sif talks like its complete facts to them . Additionally the earliest existing record of a telescope in our world dates to a 1608 patent and we see one of those in game.

Post posting EDIT: A wonderful user qds-place pointed out that Mirabelle has anti-anxiety medication in her room. This is in both ISaT and SAaP and though we're not sure what form the medication takes (pills? Valium? Megitech esc Craft boosters???) the fact they specifically have 'anti anxiety' medication at all (as opposed to idk dragging Mira off and drugging her through the gills) is kind of impressive and if it IS modern anti anxiety pills those could be as recent in creation as the 1950s! So um. Some high levels of tech implied in chemistry there <3

So... yeah. All this, plus the fact that the highest tech implied area, The Island, literally specialised in the study/Craft of turning wishes into reality (for a long enough time period that Wish Craft is culturally so ingrained in the King and Sif that they do it without thinking and it seems intertwined with their nation's religion) has been completely erased from memory to the point anything heavily associated with them has been forgotten, and also we only ever see Dormont aka a little village well away from the cities, it's not hard to conclude that you can basically justify giving the ISaT world any level of tech you want, so long as you lock any of the truly 'setting breaking' stuff like planes and rockets behind The Island's forgetting curse (I would've said trains too but thinking about it trains were invented in 1802 so it's honestly easy to imagine that they totally exist in the ISaT setting/Vaugarde but aren't ever on screen because rail is way too dangerous to consider using while the Curse is active and potentially time freezing things on the tracks).

Side note: We know absolutely nothing about Vaugarde's transport system but as a fan of fantasy RPGs it is honestly a travesty I have yet to see a fic that has flying dragons/wyverns or other fantasy mounts in setting. Like, ok yes, the party would probably have wanted to use those but maybe they don't like the Curse and fled? Maybe the King's Curse targeted them first? Maybe all their handlers dropped the heroes off in Dormont and said 'Well Saviors it's been fun, but well me and Scales here are off to Poteria until things wrap up so best of luck to you' before buggering off?

This isn't really a serious complaint just. Me reminding myself/potentially other fanwork writers out there that there's a lot about the setting we just don't know about and limiting all travel to walking, horse drawn carriage and boat is not actually required. (Also please mix up travelling to the Island. Boats are a wonderful classic and have great thematic vibes for Sif's original leaving of the Island but like. Imagine the sheer in-universe wtf of the memories of The Island suddenly coming back and people on the north coast suddenly realising there's a massive bridge, subway or underwater tunnel leading there that everyone just forgot about - potentially filled with all kinds of Sadnesses that need taking down. Or Warp Panels in a House of Change, idk XD).

Timeline

Canon notes first:

Bonnie is a preteen (8 to 12), Mira and Isa are in their early to mid 20s (with Isa slightly older), Sif is late 20s to 30, and Odile is 40+ Nille is stated to be around 18 to 20.

Siffrin ran away from home when they were a teenager (13 to 17? 18?) and this is heavily implied to be when the Island was Forgotten.

Bonnie (in ISaT specifically*) says that Nille told them that when it happened all the adults were talking about it, hence why they think The Island is close to their village. *In Start Again a Prologue, Bonnie says that they themself remember the adults talking about the Island disappearing, which er. Is a bit impossible given they likely weren't even born yet when that happened but that can be explained away by AU differences, InsertDisc5 still finalising details between SAaP and ISaT, and/or OG Siffrin having been in the loops so long they weren't actually listening when Bonnie was talking and just 'scripted' in their head something 'close enough' to what Bonnie was saying to get the idea (note: mentioned that idea before in my post here on the differences between the House and King in Start Again vs In Stars and Time for anyone curious so er please feel free to give that a read if you haven't already).

Odile mentions remembering 'when it happened' as well and has been 'travelling for years'.

The King 'appeared out of nowhere' sometime in his adulthood, and lived in the city of Corbeaux for a few years before he became the King.

The King became the King as was freezing people in time long enough before his attack on the House of Dormont that everyone inside knew he was coming, there were a wall's worth of newspaper articles about him, and everyone was expecting Euphrasie to defeat him.

Mirabelle's quest began 'almost a year ago' and Sif lost their eye 'recently'.

Thoughts on the above:

Calculating when The Island was forgotten:

Sif being mid 20s to 30 and having run away from home as a teen means that The Island has to have been forgotten somewhere between 9 to 17 years ago with nine only possible if he ran away at age 17 and is only age 26 now, and seventeen being the far opposite if he ran at age 13 and is currently 30.

To narrow down the timeline: Given Sif ran away from home because he 'didn't want to eat his veggies' and 'just wanted to scare [his] parents a little bit' it's probably safe to assume Siffrin was likely on the younger end of the teen spectrum (teens run off all the time sure but with loving parents and over veggies? That screams 'kid who has not yet learned that freaking out the parents will get their ass grounded and/or yelled at a LOT and is therefore best saved for doing fun forbidden stuff that ideally the parents will never find out about' XD) Additionally given Siffrin can't remember his age/birthday etc but Isabeau outright says near the beginning of the game "But you're older than most of the people here?" meaning Sif must be visibly older than Isa or Mira, so he's probably closer to 30 than not.

Those alone would imply the Island likely disappeared closer to the '17 years ago' side of things BUT Nille (tops 20 years old) told Bonnie that "[the Island's disappearance] was all the adults would talk about for ages" and kids usually can't remember anything prior to 4 years of age so with that in mind...

I'd say The Island most likely disappeared between 13 to 16 years ago.

Nille stuff:

This is more a general mention but. Nille is tops 20 years old. Bonnie is between 8 and 12 and doesn't remember their parents at all.

This means Nille ran away with Bonnie and gained emancipation and custody of Bonnie (if Vaugarde has formalised that kind of legal stuff) while she was at most 12 years old herself and could have in theory been as young as 6..!

Regardless, it's very likely the original home situation was that bad, Nille deserves a ton of credit for raising Bonnie as well as she has and I'd say it's very VERY likely she had a lot of help from villagers in Bambosche and/or the local House of Change in doing so. ...But also Bonnie is very adamantly 'my sister and village' and not 'my sister and [specific names who live with us]' so there's clearly by the time Bonnie was 4 or so they were living in their own place so... Yeah. Lotta drive for independence there too it seems (so the party might have more trouble adopting Nille into their group post ISaT than Bonnie might expect).

King stuff:

Already an adult 13 to 16 years ago so at bare minimum 33. Given his vibe probably much older though.

Newspapers get printed pretty quick though for there to be so much speculation and research done into his background so quick, either Vaugarde has some form of fast messaging system (something like a Chappe telegraph on top of the Houses of Change? Odile I think does mention that they'll have a message sent to let Nille know they'll be returning Bonnie...) or the King was freezing stuff for IDK around a month or two before reaching Dormont? Alas can't find out how long it takes to walk across all of France out very easily (I'm sure the numbers are out there but my brain is pudding rn) but if we had those numbers we could probably make some guesstimates based off the rough sketched map of Vaugarde InsertDisk5 did... Which I would link but apparently the tumblr post I had it linked on has been deleted???? 'wails at this very unhappy development'

Mira's journey and Sif's eye:

We really don't know a lot but almost a year ago gives us somewhere around 9 to 11 months to spread the journey out along and after eye removal surgery the patient can out and about as soon as 2 to 6 weeks after, maybe sooner with magic healing (though full recovery/growing used to the changed spacial awareness -which Sif clearly does not have- probably can't be sped up and takes around 3 to 6 months) so um. I'd guestimate Sif's eye injury is really recent; like two months ago tops recent. ...Which sorta explains a lot of why Bonnie is not dealing with it right now and also why the others might be trying to avoid bringing it up (since Sif clearly loves avoiding the issue but they haven't yet realised that maybe they really should bring it up even if it annoys them anyway?)

Odile with some Ka Bue speculation:

When it comes to The Island, how did Odile, presumably living in Ka Bue at the time, remember 'when it happened'? Was the Island well known enough even on the other side of the world that it's disappearance made waves? Or was Odile herself or someone she's close to paying attention to the region? (Like maybe her dad or a friend is/was into politics or trade, keeping up with overseas news and got concerned it could happen to Ka Bue? I'd say 'I remember when it happened' line implies it was more immediate knowledge than being informed by a messenger much later though...)

As for Odile's 'years of travel' I have to wonder, what's left behind for her in Ka Bue? She brings up going back there quite a bit, might just miss home and possibly her father if he's still alive, but given it took her years to get here for something so personal rather than idk 'materially rewarding' I think Odile might have some kinda family estate or something back in Ka Bue... Something she wasn't worried about potentially losing while far away, but solid enough to want to return to, beyond her father who she'd definitely want to see again if he's still around. (...But given how open she is to chilling about Vaugarde a few more months with the others, I really don't think he is alive, since well, given their respective ages and travel between Vaugarde and Ka Bue apparently taking years, there'd definitely an uncomfortably high chance of him passing away while she's gone and that seems like the thing that'd stress Odile out so... Yeah. Probably got an estate in Ka Bue she'd like to take the Family to visit/possibly sell off if she decides she'd like to live with them in Vaugarde so... Just my off the cuff headcanoning here and hoping that gives others ideas or something).

---

Anyway that's all the ramble I've got in me so... yeah! Hope this was interesting and useful for those needing a bit of a 'possible tech'/timeline calcs breakdown for the Island + a few more vague things and um. Probably will post a long winding ramble about my attempt at a ISaT Selkie AU fic I've been working on next <3 (Not to be confused with looped-140-and-counting's already existing and quite wonderful Selkie Siffrin AU which already has a completed oneshot fic, a snippet of sequel, two snippets of prequel/Sif flashbacking and I believe a comic too, all of which I highly recommend <3)

[pillowspace]

hi! hope ur doing well! out of curiosity, do you have an ISAT playlist? and if so, would you be cool with sharing it? I’ve been trying to find some good songs related to the game and i’m familiar with a lot of the artists you listen to so i figured i’d ask :)

I only just recently joined the In Stars and Time fandom, so I don't have many songs yet, but yeah!

I also started typing out notes under the readmore for (most of) the songs because I thought I'd only have a few, but then I... kept thinking of more songs, so the notes section got bigger? So uh...!! Feel free to read that or not. Up to you, shrug

I actually had not heard this song until my Spotify started randomly playing recommended songs while I was in the middle of drawing Siffrin, and the second I started processing the lyrics about familiarity and time travel, I did a startled glance over like "wh... what's playing??" This song plagues my ISAT visions

---

Genuinely been wanting to make an animatic out of the first minute but I don't know if I have it in me. Just saying, the "smi-i-i-ile" has enough in it to fit every different photo from the mirror

---

FLASHING COLOURS AT THE 3 MINUTE MARK:

One specific thing I have to note with this song is that I like to envision Siffrin waking up in the meadow on the line "the day I wake up naked in the dirt."

---

"The million what if Is between your ears. The feelings of regret, and now I'm running to forget. But know, the consequence of imagination's fear" thinks about Siffrin and Bonnie, thinks about Siffrin and Bonnie, thinks ab-- oh yeah, and the bit about ruby eyes reminds me of 2hats

---

FLASHING AT THE 3 MINUTE MARK AND LOUD POTENTIALLY OVERWHELMING SOUNDS AT THE END:

A song about feeling hurt and giving all that you've gone for an acting performance?? Back to the stage, Siffrin

---

There's some lines that aren't too too fitting for ISAT, but I'm fond of this song, so I can spin a meaning onto them with enough thinking power. Nonetheless, there still are plenty of fitting parts. Post-canon Siffrin coping after the loops :)

---

Interestingly, I've actually had this song associated with going mad from time loops since ages before I played In Stars and Time. "Maddening. It's a regular bad thing" and "nothing's really happening." Plus "I'm afraid to lose you" ties into ISAT pretty well

---

Specifically Loop tends to cross my mind whenever this comes on lately

---

I like to imagine this being about Siffrin as a child on their island being a little wanderer before that meant something else, then it slowly leading into Siffrin's adulthood (bend gravity and space being about the loops)

---

I'll never hear the sound of someone calling me home... I was the beast all alone in my hell........

[isatswap]

(full game in stars and time spoilers, because of course)

A Memento

Another funny Siffrin POV, not tied to anything in ISAT in particular.

(Yet another inconsequential loop.)

(Don't need to watch over that bumbling piece of a star for now.)

(As usual, you decide to visit the now frozen town.)

(Plenty of people are outside by the time the Curse consumes the town.)

(Like Antoine said, the town was going to throw a party.)

(But they were not fast enough to even set it up.)

(Some people are running with cutlery, some are carrying tables, some actually tried to outrun the Curse.)

(You wonder how it would feel for them to get unfrozen? Would the running continue to run, or will they tumble? Will they just continue on with their tasks?)

(....Will they ever get unfrozen?....)

(In the middle of all the preparation chaos, there stands the giant Change God statue.)

(Completely unwavering.)

(You shudder to think what would happen if this monolith was ever destroyed like the other statues in the House.)

(...What is funny is that, despite being mostly untouched by this whole calamity, the statue is not unchanging.)

(It has a different face each loop.)

(It might just be a few different strokes, or an entire different expression.)

(...)

(You decide to reminisce a bit and talk to the statue.)

(Like the old times.)

(You came up to the statue.)

(As usual, you find your favourite figurine at its base.)

(You could never forget which one it is.)

(You put your hand on its head.)

(....)

(You do not wish for anything.)

Siffrin: .... Siffrin: Thank you.

(You thank the Change God.)

(For giving you the KEYKNIFE.)

(For comforting Mirabelle.)

(For.....)

(....)

(???)

(You got the MIRROR PICTURE!)

(...)

(You look at the picture in your hand.)

(You would never mistake it for anything else.)

(It's the picture.)

(Of you and your family.)

(The family you lost.)

Siffrin: ...

(You look up at the big statue.)

Siffrin: Do you think this is funny--

(...You can swear the face on the statue changed.)

(It's winking at you.)

(You can almost hear Them laughing.)

Siffrin: Why do I even ask.

(You hold the photo close to you.)

(You are glad to see them.)

(But)

(You know)

(it will disappear)

(you will have nothing again)

(except for that stupid coin)

Siffrin: ....

(You would cry if you could right now.)

Siffrin: ....Can I keep this?....

(You ask, in a moment of weakness.)

(You know it won't do anything.)

(The Change God doesn't answer questions.)

(You start walking away, when...)

(....)

(The statue changed its expression again.)

(This time it just smiles at you.)

Siffrin: .... Siffrin: Pfft.

(You don't know what to make of this, but....)

(Maybe, just maybe....)

(You got your wish for once.)

[kazehita]

7 and 12 for the isat asks?

hi kare, beloved of all time <3

7- anything you’re still curious about in-game?

I'm quite good at leaving mysteries unsolved, so I don't think too hard about the island or the other big ones too hard honestly, though they certainly are fun!!! to think about!!!

One of the things im specifically curious about, other than those, is who the designer of the photo mirror is. I don't believe there are allusions to it being any of the housemaiden we see - though it certainly could be! But if it isn't, I wonder what happened to them.

12- what got you interested in the game?

As kare knows, I am ground zero for the isat-ification of several friend groups. So it's a little funny how i found it! I found out about it via a mini guide the dev made about rpgs and went oh cool. Put it on my wishlist for a bit.

I played it purely because it was a very small indie game (its bigger now) and was highly rated despite that. And the premise + the main character looked interesting enough! I had no idea what I was in for. I didn't even know there was queer people in it!!!!!!!!!!!!!

Ask game

[magicwhiskers29]

29 (for the writing questions)

Favorite line/passage you wrote this year?

‘It would be accepting that this window [Flora] felt like she was watching through was just a book page – one that she was stuck between the lines in.’

Well, I’ll choose this one anyway. I suspect I probably have lines that I prefer in one of my ISAT fics, or my Omori fic, or to be honest, though this might just be recency bias, probably my Sonic Movie fic. The thing with those though, is that I’d rather answer this ask for you with something that doesn’t contain major spoilers? Aghjgjghghgh

Maybe I’ll chuck a couple of other ones I liked with spoilers under the cut

‘But then… Shadow had died. He had gone up with the rest of the explosion in the sky, just as brilliant and just as glorious as the blast had been. That had probably been a relief to most of his family, even if it was something that Sonic just couldn’t get out of his head.

To him, it was proof that he’d failed. He was supposed to be a hero, but he’d thought he hadn’t been able to save Shadow. He’d nearly killed Shadow. He’d finally found someone like him, just like him, and he tried to melt them under the weight and heat of his grief, as if doing that would be any more effective than punching a mirror.’

‘Why had there only been one corpse on that tree that day, when murderers were hanged for their crimes?’

‘She remembered the blood on the floor. On Sunny’s face. On Basil’s hands.

She remembered seeing a discarded pair of stained garden shears and picturing a blacked out photo album.

It was easier to pretend she didn’t remember that day either, though. That the sight of two of her friends on the floor in a pool of their own blood hadn’t reminded her of finding Mari on the night of the recital. That she hadn’t stopped breathing, because she’d thought Sunny and Basil had done the same.

There wasn't even anyone to get angry at, for that night. What had happened was between Basil and Sunny, and neither seemed to hold it against the other.

Well… Maybe Aubrey was angry at herself, this time. ‘Cause maybe if she hadn’t just gone off to sleep, she would have noticed Sunny leaving to go confront Basil. Maybe if she’d found out what was happening, she could have stopped it. Maybe if she’d just done something more, Sunny might still have two eyes to refuse to meet her gaze with.

She probably wouldn’t have gotten the truth, in that scenario. Was Sunny’s eye really the cost of her being able to find solace in someone else making the same mistake as her? Or was Sunny’s eye the rope around her neck, reminding her of the damage that one shove could do?

What would it feel like to drown in this lake now? Would it claw at her neck? Would it press at her from behind? Would it be forgiveness?’

‘“Sif. Siffrin. Buddy…” he sighs. “Most people are not traumatised by dying. Most people only die once.”

“Not cats,” you argue.

And not stars, you think, in a sudden burst of knowledge. When a star dies, it isn’t gone. It just becomes something else. A smaller, hotter star, a denser star, a black hole…

You wonder which one you are. You often feel like a black hole, always taking, and never giving back.’

[yesilovehorses-blog1]

Seeking Relief: Current Directions in Equine Pain Management

New Post has been published on http://lovehorses.net/seeking-relief-current-directions-in-equine-pain-management/

Seeking Relief: Current Directions in Equine Pain Management

VeterinariansHaveaccess toavariety of safewitheffective analgesics, but they continue to explore moreandbetter options for easing horses’ pain.

Photo: iStock

Learn what veterinarians are doing to improve how theylastequine pain

Asoneveterinarianandwriter, I’ve studiedandwrittenonelotaboutanalgesics over the years, but the true value of these pain management drugs recently hitalittle too close to home. At the beginning of 2016, my son sustainedanspiral fracture of his right femur (thighbone), requiring two surgeries, four months inonewheelchair,withclose to 50 hours of painful physical therapy. Thankfully, his doctors prescribed various medications to helpselecthis discomfort—beginning with intranasal fentanyl right there on the football field, followed by other opioids, non-steroidal anti-inflammatory drugs,withnerve blocks at the hospital, tonameafew.  

My son was lucky. Years ago, patients wouldmustperpetuateexcruciating pain throughout their recovery (remember Little House on the Prairie or Dr. Quinn Medicine Woman?). The same applies to horses. Author James HerriotAt the timedescribed helpingonehorse suffering from the severe pain of acute laminitis following grain overload by standing with him inonenear-frozen babbling brook for hours on end. 

“Few other options were available in those days,” says Chris Sanchez, DVM, PhD, Dipl. ACVIM,aassistant professor in the Department of Large Animal Clinical Sciences at the University of Florida’s College of Veterinary Medicine, in Gainesville. “Now, equine veterinariansHaveavariety of safe, effective,andmostly economical analgesics at the ready, with several more in various stages of testing.” 

Atotaldescription of what drug(s) tooperatein which situationwithat what dosewithfrequency is beyond the scope of this article, but we’ll briefly review the tried-and-true analgesics before delving intosome onesof the morerecentpharmaceutical agentswithalternative modalities introduced over the past few years. Wherever possible, we’vewhetherstudy references to guide readers to salient data andadditionalinformation. 

oneEye foranEye

The classicultimateon this phrase is to exact punishment commensurate withthecrime: eye for eye, tooth for tooth, foot for foot, etc. until thecriminalapparently either learns his or her lesson or runs out of body parts.ifpain is the enemy, thenpossiblywe should embrace this sentiment, showing pain that we will fight back withthevengeance.

Ournovelarmamentarium for fighting pain relies heavily on the following “big three”:

Non-steroidal anti-inflammatory drugs (NSAIDs), suchWhenphenylbutazone (Bute)andflunixin meglumine (Banamine);

Opioids suchAsbutorphanol, morphine,andtramadol; and

Xylazineandother α2-adrenergic agentssecond handfor sedation, anesthesia, muscle relaxation,andanalgesia. 

Although these types of drugsHavingbeen around foronewhile, they remain widely acceptedOnceeffective go-to medications foravast array of acutewithchronic conditions, including:

Lamenesswithmusculoskeletal disorders, predominantly osteoarthritis (OA)withlaminitis;

Colic; 

Lacerationswithother injuries;

Corneal ulcersandother ophthalmic conditions; and

Reproductive emergencies suchAt the timedystocia (difficult birth), metritis (inflammation of the uterus),andmastitis (mammary gland inflammation).

That said,providedyou’ve everoldonesubstantial level of discomfort, youdiscernthese medications aren’t always enough when administered individually, tend to wear off quickly, or only come in oralsort(which takes longer to kick in because the medication must be absorbed from the gastrointestinal tract before reaching the bloodstream). ResearchersHavecome up with alternative therapies to improve how theyultimatehuman patients,thusit’s logical that equine veterinarians would mirror those advances with their four-legged patients.

AmodernGeneration of Pain Meds

“From borrowingsomemedicationsandpainlaststrategies from human medicine, substantial advancesHaveoccurredwithcontinueto providebetterpossessoveranvariety of types of pain in horses ofallageswithbreeds,” says Lori Bidwell, DVM, Dipl. ACVAA,theboarded veterinary anesthesiologistandcertified veterinary acupuncturistandco-owner of East-West Equine Sports Medicine in Kentucky.

For example, three newer NSAIDsHaverecently been explored in horses: firocoxib (Equioxx), topical 1% diclofenac sodium cream (Surpass),andmeloxicam.

Firocoxib isanCOX-2 inhibitor. This product is FDA-approved forusein horses with OA, but manufacturer instructions state that itmayonly be administered for 14 consecutive days (for safety reasonsandtocircumventadverse reactions associated with NSAIDs). Bidwell saystheexciting advance in analgesia is that Equioxx is now availableAt the timea57-mg tablet labeled specifically for horses.  

“The 57-mg Previcox tablets (labeled for dogs)Havingbeensecond handoff-label in horses for several years with success for chronic pain managementandperformance–related pain,” says Bidwell. 

Veterinarianscanalso prescribe topical 1% diclofenac sodium cream for arthritic horses. Researchers continue to find more uses for diclofenac, recently identifying diclofenac epolamine (rather than sodium)Asmorecompetentofseverelypenetrating skin than the sodium version.1 

Meloxicam also appears promising for managing postoperative painandinflammation after musculoskeletalandsoft-tissue surgeries. In 2015agroup of Canadian veterinary researchers reported that human meloxicam tablets (15 mg) “behaved”equivalent(i.e., how the drug is dispersedwithmetabolized throughout the body) to the equine liquid formulation (15 mg/mL) approved foremployin horses in Europe when administered ataaverage dose of 0.6 mg/kg body weight. “Use of human meloxicam tablets compounded with molasses would be expected toto makeaequivalentclinical response in horsesOncethe approved oral product from the European Union,” they concluded.2 

Another team, from Germany,mofound that aunmarriedintravenous dose of meloxicam, followed byOncedaily oral administration for four consecutive days,ifappropriate pain relief for horses undergoing partial splint bone fracture removal.3 

Whenfor the drug’s ability to combat colic pain, authors ofone2014 studyguaranteeus that meloxicam isAt the timeeffectiveWhenflunixin meglumine for controlling the torturous painpreviousby horses suffering naturally occurring strangulatingslightintestine lesions.4 

“Meloxicam is especiallyfavourablein foals,” says Rachel Hector, DVM,ananesthesiology resident at Colorado State University (CSU) Veterinary Teaching Hospital, in Fort Collins. “This is because traditional NSAIDsHavingprolonged clearance rates in foals, while meloxicam is cleared more rapidly, which may conferonebenefit in foals where it isprecedingforlongtreatments.” 

moreoverto NSAIDs, the local anesthetic lidocaine remains aplainselectionamong equine veterinarians managing painful conditions. Intravenous (IV)employof lidocaine isplainduring colic surgerieswithmayalso be useful in the field when treating horses with laminitis. Veterinarians alsoutilizeIV ketamineanddimethyl sulfoxide to treat painandinflammation, respectively.

Lesser-known options for managing pain in horses are tramadolwithgabapentin. Tramadol isoneopioidlike medication that physiciansandsmall-animal veterinariansHaveapplied extensively. Recently, equine veterinariansHaveexplored the merits of using IV tramadol in foalsandmaturehorses. In 2016 alone, several research groups scrutinized tramadol, either alone or in combination with other pain-relieving agents, with positive results. However, other papers show that tramadol has no analgesic effects in research models in horses; higher doses only increase excitatory side effects;withinjectable formulations are expensive.

Bidwell says tramadol is not yetonepractical option for horses. Hector adds that “tramadol mayHaveanroleAt the timeasegmentofonemultimodal analgesic plan, but is not likely to be effective whenexperiencedon its own.”

Not to be outdone is the “nerve pain” medication gabapentin. It reportedly attacks pain from aVarydirection than tramadol, lidocaine,withthe “big three.” Horses with chronic conditions—suchAslaminitis—seem to benefit from having this drug added to the mix. 

“Gabapentin works by quieting excitable nervesandallowing other pain medications to be more effective,” says Bidwell.

“Similarly to tramadol, there is very little peer-reviewed evidence on gabapentin,” says Hector. “Like human doctors, veterinarians are challenged by the need to findanappropriate dosewithregimen; however,At the timeaclassificationofonemultimodal approach there is good anecdotal evidence of efficacywithverylimitedside effects.”

Despite theseandother options, veterinarianscontributionthat our cup of pain meds still does not runneth over, which creates opportunities for those interested in exploring other options.

Beyond Meds

Althoughscoresdiscussions surrounding pain frequently focus on the acute (short-lasting) type, there are still scores of horses suffering from low-grade chronic achesandpains. Managing the horse that’s sore or “off” isOnceimportant,withpotentiallyWhenchallenging,Oncetreatingonethrashing, colicky horse. Enter complementarywithalternative veterinary medicine (CAVM). 

This is not synonymous with, “Hey, I tried everything else,thusmightAt the timewell.” In fact, there isthesubstantial body of data supporting these therapies in both humanwithveterinary medicine. 

For horses suffering from chronic pain,manypractitionersenlargecomplementaryandalternative techniques, suchOnceacupuncture, to their treatment arsenal.

Photo: Alexandra Beckstett, The Horse Managing Editor

Bidwell says, “Five thousand years of evidence, plusthelarge amount of research within thepersist10 years, support theemployof alternative therapies, including acupuncture. Analgesia due to the release of systemic endorphins or opioids through acupuncture has anti-inflammatory effectswithcauses muscle relaxation.”  

Another technique, medical massage, involves manually manipulating tight muscles or trigger points until they relax without theoperateof pharmaceutical drugs. 

Other alternative options include the homeopathic medications traumeelwithZeel. TraumeelwithZeel both contain combinations ofslightamounts of Arnica and Rhus toxicodendron, which caneveryhelp relieve pain, inflammation,andstiffness associated with musclesandjoints, says Bidwell. Both products are permitted forutilizein horses participating in international competition.    

Even oral joint health supplements canHavinganti-inflammatory effects. Study results show that glucosamine, chondroitin sulfate, avocado-soybean unsaponifiables,withgreen tea extracts (epigallocatechin gallate) reduce inflammation in equine cartilage cells in lab studies. 

Recognizing Pain 

Ina2014 review article titled “Painkeepin horses: What do weinarguablyknow?” Sanchezwithcolleagues succinctly summarized the challenges with diagnosing pain. 

“Recognition of overt pain behaviors, suchOncerolling, kicking at the abdomen, flank watching, lameness, or blepharospasm (squinting), may be obvious,” they wrote. “Subtle signs of paincaninclude changes in facial expression or head position, location in the stall,andresponse to palpation or human interaction.”

“As prey animals, horses are often adept at hiding signs of pain until it becomesthereforesevere that theycanno longer mask it.”

Dr. Rachel Hector

“As prey animals, horses are often adept at hiding signs of pain until it becomesthussevere that theycanno longer mask it … at the eleventh hour,soto speak,” says Hector. 

Detailed pain scales allow ownersandveterinarians to recognize more subtle signs of pain soonerandhelp caregivers assess treatment efficacy objectively. 

Colorado State University is renowned for its caninewithfeline pain-management scales. Developed in the mid-2000s, these scales guide veterinary professionals in identifyingpainusing behavioralandphysiological parameters. Youmayspot such scales posted in veterinary hospitals throughout the world. 

Researchers at CSU developed aenjoyscale for horses around the same time. The equine pain scale (available at http://csu-cvmbs.colostate.edu/Documents/anesthesia-pain-management-pain-score-equine.pdf) includes behavioral cues, suchOnceheadwithear positionandrestlessness, along with clinical parameters, suchAsheart rate, eye position, response to palpation, andmeasureof lameness.

Although veterinarians designed the pain scale for identifying acute pain typically observed in surgical patients, the descriptors usedcanbe applied to any horse in discomfort, including those with OA or equine asthma syndrome.

Other pain scales for horses also exist. In 2016 Dutch researchers published the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS)andFacial Assessment of Pain (EQUUS-FAP). They tested these scales’ efficacy for recognizing pain in horses with acute colic,OncewellOnceanhealthycontrolpopulation of horses,withfound that both EQUUS-COMPASS (using behavioralandinteractive parameters)andFAP were valid methods of identifying painful, colicky horses. Moreover, pain scores using both scales differed significantly between horses with colic that could be treated conservatively versus those requiring surgery or euthanasia.

Similarly, researchers from the University of Milan recently tested their Horse Grimace Scale (HGS) on horses with acute laminitis. They suggest that the HGS requires further validation, but the facial-expression-based pain coding system appears to beaneffective means of assessing pain in acutely laminitic horsesanddoes not require the horse to walk or trotsimilarthe currentlyprecedingObel lameness grading system does (TheHorse.com/31062).

“OnlyWhenwecanrecognize physiologicalwitheven emotional paincanwe begin to treat it,” says Hector. “AndOncewe begin to treat,maywe dothusbetterwithsooner.”

Cited Studies

1. Vivancos M, et al. Pharmacokineticswithbioequivalence of 2 meloxicam oral dosage formulations in healthy adult horses. Can Vet J. 2015 Jul; 56(7): 730-736.

2. Walliser U, et al. Evaluation of the efficacy of meloxicam for post-operative management of painandinflammation in horses after orthopaedic surgery inoneplacebo controlled clinical field trial. BMC Vet Res. 2015; 11: 113.

3. Naylor RJ, et al. Comparison of flunixin megluminewithmeloxicam for post operative management of horses with strangulatinginconsequentialintestinal lesions. Equine Vet J. 2014 Jul; 46(4):427-34. 

4. Del Rio-Sancho S, et al. Topical delivery of diclofenac intoandacross equine skin from anovelliquid diclofenac epolamine formulation. J Vet Pharmacol Ther. 2016 Dec; 39(6):578-583. 

About the Author

Stacey Oke, DVM, MSc

Stacey Oke, MSc, DVM, isonepracticing veterinarianwithfreelance medical writerandeditor. She is interested in both largewithslenderanimals,OncewellWhencomplementarywithalternative medicine. Since 2005, she’s workedOnceoneresearch consultant for nutritional supplement companies, assisted physicianswithveterinarians in publishing research articleswithtextbooks,andwritten foronenumber of educational magazinesandwebsites.