A Quarterly Newsletter from Your Equine Health Care Provider | Spring 2013
A Better Understanding of Equine Herpes Virus By: Chris Newton, DVM
IN THIS ISSUE EQUINE HEALTH A Better Understanding of Equine Herpes Virus
Rood & Riddle Equine Hospital and Veterinary Orthopedic Education
Worthy Yearling Given a Shot at Life
NEWS LeBlanc Reproduction Center to be dedicated at Rood & Riddle Rood & Riddle, Again, Takes its Hat Off to Kentucky’s Horse Industry Around The Practice
Clients frequently ask me about the neurologic herpes outbreaks which occur from time to time at horse shows. There has been a tremendous amount of misinformation circulating about the disease, and the “outbreaks”, so I hope to quickly clarify the disease and how we can best deal with it as an active sport horse community. Equine herpes virus has 4 different types of viruses associated with it. The most common are EHV-1 and EHV-4. These 2 viruses commonly (over 90% of the population) infect horses in the first few months of life. This infection occurs in spite of vaccinating mares prior to foaling, so the foals have strong immunity from mom. They generally cause respiratory disease with fever, nasal/ocular discharge, mild cough, vasculitis, depression. EHV-1 can also cause abortion in pregnant mares, and cause Equine Myeloencephalopathy, which is the neurologic form of the disease. This form has a fever followed by weakness to paralysis, often worst in the hind end, and potential death. The EHV-1 virus has been shown to have 2 mutations which make it more likely to cause the neurologic form of the disease. However, the neurologic form does occur less frequently from the nonmutated form of the EHV-1 virus. Once a horse is infected with the virus as a baby they may have recrudescent periods, often associated with stress, where the virus leaves its latent form in the body and enters the blood and then the respiratory tract. If a high enough level of virus is shed, then transmission will occur to others. This transmission is generally from nasal secretions in the air or on carrier objects. The virus does not live long out of the body, and is easily killed with a 10% bleach in water solution. The general incubation period from infection to clinical signs is 3-8 days, with 14 days being the outer limit. If a horse is to develop neurologic herpes they will generally show signs 8-12 days after infection. It is possible to test for EHV-1 in the blood and nasal secretions. A PCR test will identify DNA of the virus, and can also identify the mutated forms of the virus which are more likely to cause the neurologic form which we all fear most. However, the test has a poor positive predictive value. This is because most horses are carrying the virus in its latent state, and some become intermittently viremic but never show illness or affect those around them. Therefore, a positive test is only useful in horses showing clinical signs of the disease, and it would likely result in the elimination of healthy horses if used as a screening tool.
“If a horse is to develop neurologic herpes they will generally show signs 8-12 days after infection.”
We therefore have to look at protecting our equine athletes, as it appears that eliminating the potential of exposure with a screening test is not currently possible. There are 3 types of vaccines currently available to prevent Equine Herpes. Unfortunately these vaccines make no claim to prevent the neurologic form, only the respiratory and abortive forms. The types of vaccines are killed single component, killed multiple component, and modified live. The four brands recommended to best provide immunity are Pneumabort, Prodigy, Calvenza, and Rhinomune. Initial vaccination should involve a series of 3 shots 3-4 weeks apart. Non pregnant show horses should receive boosters every 6 months, and if they are entering an outbreak type situation they should be boostered 7-10 days prior if it’s been longer than 60 days since the last booster. These vaccines have not been shown to prevent the disease consistently, but studies have shown they diminish the amount of virus shed in the nasal tract and one study showed a diminished incidence of the neurologic form of the disease when exposed after vaccination. The jury is still out, and the vaccine is not perfect at this time but it provides one component of prevention. It is becoming clear now why everyone is confused about the disease. We can’t reliably screen for it, we can’t reliably vaccinate against it, and our best tool for early identification is a fever. How many of you take your horses temperature daily at competitions? Based on my experience, that reply is rather poor. However, practicing good biosecurity habits is likely the best way of preventing infection. Unfortunately the chain of biosecurity is only as strong as its weakest link, and that is the owner of the horses who do not take temperatures daily. We all have to show each other respect by monitoring temperatures, having horses with fevers evaluated by a veterinarian, and keeping those horses away from others. Vaccinating will help diminish spread, but not necessarily disease. Keeping our horses happy and healthy takes an entire community. Hopefully this article will improve the understanding of Equine Herpes, and the feared neurologic form. This disease is endemic in the national herd, and in spite of significant research and effort we continue to have intermittent cases at racetracks, horse shows, and areas of commingling. We can help by vaccinating appropriately, but biosecurity monitoring and practice can also help significantly. This is not easy, and with the irregularity of the disease we easily return to old habits.
“AO today fosters one of the most extensive networks of surgeons, operating room personnel, and scientists - Currently more than 10,000 individuals in over 100 countries.”
Rood & Riddle Equine Hospital and Veterinary Orthopedic Education By: Larry Bramlage DVM DACVS & Alan Ruggles DVM DACVS
The AO Foundation (AO is an abbreviation for the German word meaning study group for techniques in fracture repair) is a medically guided nonprofit organization led by an international group of surgeons specializing in the treatment of trauma and disorders of the musculoskeletal system. Founded in 1958 by 13 visionary physician surgeons, AO today fosters one of the most extensive networks of surgeons, operating room personnel, and scientists currently more than 10,000 individuals in over 100 countries.
AO has four clinical divisions: Trauma (concerned with injuries to the limbs), Cranial Maxillofacial (facial reconstruction after injury or tumor removal), Spine (spinal trauma, intervertebral disc disease and congenital disorders) and Veterinary (orthopedic disorders of both small and large animal species). Each clinical division is populated with international experts in the field of musculoskeletal trauma. Its mission is to foster and (A) (B) expand the network of health care Pre and post-operative radiographs of a 4 yr old TB Colt injured professionals in education, research, while breezing with multi-piece spirally front cannon bone fracture development and clinical investigation repaired with single plate and multiple screws. This horse is still convalescing from his injury. to achieve more effective patient care worldwide for both humans and animal patients. It is active in basic research of orthopedic disorders such as bone healing and infection, instrumental in the development of new orthopedic devices through its industrial partner Depuy-Synthes and provides a significant humanitarian effort in the developing world and disaster relief. AOVET is the clinical division of the AO Foundation for veterinarians; its mission is to advance the practice of veterinary surgery to improve patient outcomes by promoting clinical and experimental research, education and development. A major activity of AO and its clinical divisions, AOVET among them, is to educate both surgeons in training and practicing surgeons in state of the art surgical techniques and the use of new orthopedic innovations. This is accomplished by courses in operative techniques, publication of research projects and e learning on the web. AOVET has offered annual courses in these techniques for veterinarians in Columbus Ohio since 1970. In fact the Columbus course was the first AO course in the United States and was for the first few years. Physicians from around the country would come to the veterinary course in Columbus to learn AO techniques for fracture repair. In addition, it is very likely that every Equine Surgical Resident in North (C) (D) America in the past 30 years has taken both the Intraoperative and pre and post- operative radiogrpsh30 Principles and Advanced Equine Course given in day TB F with fracture of the distal radius repaired using two Locking Compression Plates (LCP) and screw. The Columbus. The surgeons at RREH have had a LCP is a recent innovation of AO which allows improved long involvement with AOVET. fracture fixation in areas where only a small amount of bone is available for purchase. This filly survived but did
not enter racing training and is now a broodmare Dr. Bramlage has been a co-chair of the annual course since 1978 and he and Dr. Ruggles have co-chaired the course since 1994. In addition to the Columbus courses other continuing education programs developed by RREH Surgeons include courses on arthrodesis techniques, use of advanced plating systems and foal fracture repair. Because of their involvement in AOVET Drs. Bramlage and Ruggles are frequently invited faculty to international courses on fracture repair techniques. Dr. Ruggles is currently in in his third year as Chair of the North American region and for AOVET which oversees all AOVET activities both small animal and equine within North America. He is also Trustee for the AO Foundation and member of the AOVET International Specialty Board.
Examples of fracture repairs using techniques and implants develop through AO.
Intraoperative (see images A & B for pre and post-perative radiographs)
Intraoperative (see images C & D for pre and post-perative radiographs)
Pre and post-operative radiographs of a 6 weeks old TB F with multi-piece fracture of the short pastern bone repair with 2 plates and 7 screws. The picture below is 18 months later prior to being shipped to Florida for race training
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Worthy Yearling Given a Chance at Life A yearling paint filly named Worthy is being given a shot at a normal life thanks to The Gentle Barn, a California animal sanctuary, and Rood & Riddle Equine Hospital. Worthy was born with what is known as a windswept angular limb deformity in her front legs. Her particular deformity was a very extreme case.
..“She is so sweet and so alive and we believe she deserves a chance. When you look her in the eyes and see her incredible spirit, there is no doubt that we are doing the right thing by giving her this chance.” said Ellie Laks, Founder and Director of The Gentle Barn
Worthy after surgery.
Her two front legs should have been corrected when she was a newborn, when the procedure would have been much simpler. Now older, the required surgery was much more complex.
Worthy and her mother, Indie, were rescued from difficult circumstances in South Carolina. The Gentle Barn in Santa Clarita, which arranged the life-saving surgery, said
Worthy would have been unable to live with the deformity, as her legs would eventually collapse under her growing weight. The choice was either to put her down or try to save her with difficult corrective surgery. Veterinarians in South Carolina recommended that the yearling be put down as her deformity was very extreme and she was too old for the standard correctional procedure. Ellie Laks, Founder and Director of the Gentle Barn, responded: “She is so sweet and so alive and we believe she deserves a chance. When you look her in the eyes and see her incredible spirit, there is no doubt that we are doing the right thing by giving her this chance.” Last Tuesday, with her mother patiently waiting in a stall, Worthy finally got her surgery and her chance. The pair will remain at the hospital for three weeks as Worthy begins her recovery, after which the pair will return to a nearby pasture for another three weeks. “She just came out of surgery and she walked back to her stall and her awaiting mommy,” the charity reported to its followers on Facebook. “In two weeks Worthy will get her cast off and Dr. Ruggles will let us know how it looks. We jumped the first hurdle, but we are not out of the woods yet. Please keep those good thoughts coming!”
Worthy as a foal.
Worthy was reported to be relaxing and doing well. “The leg is completely straight and so far, so good!” It is hoped that Worthy will make a full recovery and can then travel to the Gentle Barn in California to become part of its therapeutic program.
The Gentle Barn Foundation is home to 135 animals rescued from abuse. The charity plays host to abused children, kids recovering from substance abuse, kids on probation, foster kids, and children and adults with mental, emotional, and physical challenges. Through the interaction with animals, they learn forgiveness, courage, strength, leadership skills, trust, empathy, and kindness. The healing that takes place when the children get together with the animals is miraculous, the charity says. It was not all smooth sailing for Worthy and Indie. The pair had to be boarded in Kentucky for two months after their arrival from South Carolina to regain condition and strength in preparation for the complex operation after years of neglect and abuse. They were frightened of people, which also needed to be worked through to help them trust their caregivers.
“The healing that takes place when the children get together with the animals is miraculous..” the charity says.
LeBlanc Reproduction Center to be Dedicated at Rood & Riddle Rood & Riddle announces plans to dedicate the LeBlanc Reproduction Center at a June 22nd event celebrating the life of renowned equine reproduction specialist Michelle LeBlanc, DVM, Dipl. ACT who passed away at her home in Florida on April 13 after a battle with cancer. LeBlanc, 58, was a cherished member of the Rood & Riddle Equine Hospital Reproduction team and had been in and out of remission the last two years. She had continued in her work giving many presentations and taking calls from her clients and other veterinarians throughout the world.
“She was a great friend to many and will leave a long lasting impact on equine reproduction,”
LeBlanc was awarded the Lifetime Achievement Award from the World Equine Veterinary Association in 2011 and was named 2000 Theriogenologist of the Year by the American College of Theriogenologists. Last summer, the Theriogenology Foundation, in partnership with Rood & Riddle, held a symposium honoring LeBlanc at the conclusion of the annual theriogenology conference in Baltimore, Md. Veterinarians and researchers around the country and world gathered at the event to show their support of LeBlanc. "She was a great friend to many and will leave a long lasting impact on equine reproduction," said veterinarian Chris Sanchez, DVM, PhD, Dipl. ACVIM, associate professor at the UF's college of veterinary medicine. Sanchez worked closely with LeBlanc and has remained a close friend. "In my practice lifetime, Michelle had the greatest impact on equine reproduction of any person I've worked with," said veterinarian Tom Riddle, DVM, co-founder of Rood & Riddle. "She was an outstanding professor, teacher, practitioner, and researcher. "She was also an amazing person throughout her illness...she never thought about herself; she was always concerned with other people," Riddle added. Last month, Rood & Riddle re-named its reproduction center after LeBlanc. "Fortunately, she was still well enough to know what we had done," said Riddle. "We're honored to now have the LeBlanc Reproduction Center at Rood and Riddle."
“We’re honored to now have the LeBlanc Reproduction Center at Rood and Riddle.” www.roodandriddle.com
Rood & Riddle, Again, Takes Its Hat Off to Kentucky’s Horse Industry
“the Grand Prix serves as a charity fundraiser for the Kentucky Equine Humane Center and the Kentucky Horse Park Foundation, raising more than $550,000 for charitable organizations in Kentucky since 2003.”
Rood & Riddle Equine Hospital will, again, be organizing the Hats Off to Kentucky’s Horse Industry Day to be held Saturday, July 27th. The industry that provides Kentucky with thousands of direct and indirect jobs will, for the 10th year open its arms and doors to the public at the Kentucky Horse Park by providing a free afternoon of family fun and educational activities for people of all ages. Equine industry leaders are proud to host this event to celebrate the horse and its vital role in Kentucky’s past, present and future. Thousands of Kentuckians attend this annual event, enjoying the beautiful Kentucky Horse Park attractions and the many special Hats Off Day activities. This year’s Hats Off Day – presented by Official Partners Spy Coast Farm and Rood & Riddle Equine Hospital along with Free Admission Sponsor Central Bank kicks off at 4:00 PM at the magnificent Rolex Outdoor Stadium at the Kentucky Park Horse Park. Activities include free pony rides, educational booths, and interactive equine stations. The day’s events continue at 7:00 PM with an exciting demonstration of combined driving by driving star Sterling Graburn and a premier show jumping competition, the $50,000 Rood & Riddle Kentucky Grand Prix. In addition to promoting awareness of the horse industry and its impact on Kentucky, the Grand Prix serves as a charity fundraiser for the Kentucky Equine Humane Center and the Kentucky Horse Park Foundation, raising more than $550,000 for charitable organizations in Kentucky since 2003.
First Annual Equine Book Fair
“Plan to attend the first ever equine exclusive book fair!”
We are pleased and excited to announce the First Annual Hats Off Day Equine Book Fair, which will be held from 5:00 PM to 7:00 PM adjacent to the Rolex Stadium. Some of the authors who have already committed to participate include Elizabeth Letts, The Eighty Dollar Champion, Ed Bowen, author of eighteen books, including Legacies of the Turf, Leslie Guttman, Equine ER, and Maryjean Wall, How Kentucky Became Southern. Plan to attend the first ever equine exclusive book fair!
Around the Practice... Congratulations to Dr. Rolf Embertson winning the 2013 Distinguished Alumni Award from Michigan State’s College of Veterinary Medicine. Winners of this award are nominated by fellow alumni of the college and chosen by the board of the College of Veterinary Medicine. Dr. Embertson is a long-time surgeon and partner at Rood & Riddle Equine Hospital and is the Director of Medical Services.
Rood & Riddle welcomes the intern class of 2013-2014. Our incoming hospital interns for this year are Drs Katy Dern (Colorado State University), Hope Douglas (University of Pennsylvania), Scott Fleming (Texas A&M), Christine Fosnacht (Kansas State), Janelle Moerlein (Michigan State), Courtney Pope (University of Pennsylvania), Lindsey Rings (Mid-Atlantic Equine Clinic), and Carly Turner (University of Georgia. Ambulatory interns include Drs Morgan Agnew (University of Pennsylvania), Julia Gloviczki (Iowa State University), Jessica Harmon (St. Georges University), Lilly Haywood (University of Pennsylvania) and Angela Infante (Michigan State University). Dr. Alan Ruggles was reelected for a 4th term as the chair of AO Vet North America. As referenced in the earlier article, AO fosters one of the most extensive networks of currently more than 10,000 surgeons, operating room personnel, and scientists in over 100 countries. It has four clinical divisions: Trauma (concerned with injuries to the limbs), Cranial Maxillofacial (facial reconstruction after injury or tumor removal), Spine (spinal trauma, intervertebral disc disease and congenital disorders) and Veterinary (orthopedic disorders of both small and large animal species). Dr. Ruggles was chosen from a pool of thousands of human, equine and small animal surgeons. Dr. Ruggles is a surgeon and partner at Rood & Riddle.
Recently 5 former Rood & Riddle Interns passed their board exams and have become Diplomates of the American College of Veterinary Surgeons. We wish sincere congratulations to Eric Carlson, Niklas Drumm, Albert Sole, Stavros Yiannikouris, and Lacy Kamm. This is truly a testament to their hard work and quality of character.
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Rood & Riddle is a worldwide leader in equine veterinary healthcare, offering complete services in surgery, internal medicine, podiatry, imaging, ambulatory, reproduction, sports medicine, and stem cell therapy.
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