The Modern
Equine Vet www.modernequinevet.com
Tying up:
Vol 2 Issue 5 2013
Should you order genetic test? Managing neonatal colic Determining risk of navicular disease
TABLE OF CONTENTS
COVER STORY:
4 Genetic testing for horse that is tying up? Cover photo by photographer Bob Langrish http://www.boblangrish.com
ORTHOPEDICS
Determining risk of navicular disease............................................ 7 Presence of distal border fragments might be key
COLIC
Managing the neonate with colic.................................................... 8 Good outcome depends on many factors
NEWS
Standing MRI eliminates need for anesthesia.......................10 Looking for a few good broodmares..........................................10 EIA confirmed in Nebraska............................................................11 Patent issued for beneficial animal "candy"...........................13 Adequan limited................................................................................13 Penn works to improve stem cell's cartilage formation.....17 TECHNICIAN UPDATE
Good medical records decrease risk................................................................................15 Deborah Reeder talks about this important technician responsibility
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COVER STORY
Photos courtesy of Dr. Stephanie Valberg
Who’s at risk?
Tie me up,
ties me down Should vets order genetic tests for tying up? It depends. Exertional rhabdomyolysis
can have many causes and some of these are related to an underlying genetic susceptibility to muscle damage with exercise. There are two genetic tests available for forms of exertional rhabdomyolysis, type 1 polysaccharide storage myopathy (PSSM1) and malignant hyperthermia (MH). PSSM1 is characterized by chronic bouts of stiffness, muscle
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pain, cramping, and cell damage during exercise. A dominant genetic mutation in the glycogen synthase (GYS1) gene is responsible for PSSM1. MH can lie hidden in horses and periodically give rise to severe episodes of muscle damage with exercise or with general anesthesia. Horses with signs of MH have a severe metabolic imbalance and high body temperature, and this can be fatal.
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PSSM1 is known to affect more than 20 different breeds but to date the GYS1 genetic mutation has not been found in purebred light breeds, such as Standardbred, Thoroughbred and Arabians. If these light breeds have exertional rhabdomyolysis, the likelihood that it is due to the GYS1 mutation is very low. That doesn’t mean the horse isn’t tying up, it just means the cause is not due to the GYS1 mutation, according to Stephanie Valberg, DVM, PhD, DACVIM, ACVSMR, professor at the University of Minnesota and director of its equine center, and one of the patent owners of the PSSM1 genetic test. In general, less than 10% of Paints, Appaloosas and Morgans will test positive for the genetic mutation. About 10% of quarter horses will test positive, but there are variations within the Quarter horse breed. Knowing which performance types are most affected can help veterinarians decide when to perform genetic testing. For example, about 28% of halter horses will test positive. “If you have a halter horse with exertional rhabdomyolysis then testing for the PSSM1 genetic mutation is a good place to start when searching for the cause,” Valberg said. “On the other side of the spectrum, less than 2% of racing Quarter horses have the gene for PSSM1, so it may not be the place to start.” If the genetic test is performed, owners should be told that further diagnostics will be needed if it is negative to find the cause of this horse’s exertional rhabdomyolysis. The prevalence of PSSM1 is very high in certain Draft breeds. More than 30% of Belgians and 50% of Percherons have the PSSM1 genetic mutation, but this mutation is rare in Shires and Clydesdales, she said. “This is important to take into account because no matter what disease you are looking at you have a
What does a positive genetic test mean?
“There are many things that impact whether a horses with the GYS1 mutation have clinical disease or not: turn out, pasture, diet and exercise regime,” said Valberg. In addition, a horse has about 30,000 genes, and the unique composition of these genes in an individual influence whether or not one genetic mutation will result in mild or severe clinical signs. Valberg likes to use a poker analogy when discussing this with clients. Having the GYS1 gene mutation is like being dealt the Ace of Clubs. If the hand doesn’t have any aces or clubs, an ace of clubs has less impact than if the hand has two aces. If the hand has the King, Queen, Jack and 10 of clubs, the ace of clubs becomes very significant. When recommending a genetic test, veterinarians must explain the odds of a positive test and the implications of both a positive and a negative test, Valberg said. If the odds are low due to the breed, clients need to be prepared for the next steps, such as a muscle biopsy, if the genetic test is negative. “For example, less than 20% of Warmblood horses with exertional rhabdomyolysis have the GYS1 mu-
tation, the genetic test is a pain-free place to start exploring the cause of tying up but the odds are it will be negative and a muscle biopsy might be needed,” Valberg said. Owners, especially breeders, also need to be prepared if a test is positive. A positive test can occur in some horses that have not had clinical signs of exertional rhabdomyolysis. This can be a nasty surprise for breeders. In cases where the test is positive but horses are symptom-free, horses may have had lots of exercise throughout their life, been on the right diet, large sparse pastures or they may have luckily had the right combination of other genes to prevent the disease from being expressed. Owners should consider what they will do with a positive test result before they test.
Managing PSSM1
The product of GSY1, glycogen synthase, is involved in the production of glycogen, which provides energy to the muscles during exertion. In normal horses, there is a set point for how much glycogen is made and stored. The mutation in GSY1 in PSSM1 horses disrupts that set point and they keep synthesizing glycogen even when enough glycogen is stored. The enzyme activity is greatly enhanced by insulin, so a high-grain diet will further enhance glycogen synthesis. “For there not to be any confusion about whether a muscle is going to synthesize or use glycogen, there is reciprocal activation and inactivation of glycogen synthase and phosphorylase, which tells the muscle when to break down glycogen,” explained Valberg. In horses with PSSM1, the muscle signal to make glycogen is usually greater than the signal to break down glycogen, so the body has difficulty metabolizing glycogen to supply energy for aerobic exercise. The muscle cannot supply energy
Taking a biopsy sample for testing. Source: Dr. Valberg
Photos courtesy of Dr. Stephanie Valberg
50% chance in Percherons that it will come back positive,” she said. “Clinical judgment is needed to interpret the positive result. Veterinarians need to ensure that the clinical signs in a Percheron horse are consistent with the consequences of the GYS1 mutation.” In contrast, MH is only known to exist in Quarter horses and paints and has a very low prevalence. Less than 3% of quarter horses are affected, so a positive genetic test is highly significant in horses with exertional rhabdomyolysis. Some Quarter horses have both MH and PSSM1 that makes their clinical signs worse and harder to manage.
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COVER STORY for muscle contraction, and the horse experiences the clinical signs that stop its activity. “Most horses develop tying up at around 15 minutes of exercise and that is a time when they are reliant on glycogen metabolism for energy and before they have circulating free fatty acids as an energy source,” she said.
A healthy diet
If a horse has the GSY1 mutation, veterinarians can offer practical advice to improve the horse’s function by helping it to start activating glycogen breakdown and find another energy source. Changing the diet and keeping the horse active are the keys to helping the horse. “Get rid of insulin stimulation of the glycogen synthase enzyme by modulating dietary starch and sugar. That is the whole basis for wanting to ensure that the hay is low in nonstructural carbohydrates, that the grass is limited if it is lush and high in nonstructural carbohydrates, and that we eliminate the grain that these horses are being fed because it will decrease stimulation of this enzyme,” she said. Make sure there is enough oxidative capacity to use other substrates and that means exercising these horses. “We can’t let them stand still. We can’t let them go without exercise because we want to increase the mitochondria in their muscle and increase their capacity to use an alternative energy source and that energy source can come in the form of fat. By bypassing their inability to metabolize glycogen early in exercise, clinical signs can be reduced. Watch the calories when switch-
ing the diet, she warned. “Owners sometimes read on the internet, ‘feed them a pound of fat a day.’ I don’t think that is the place to start,” she said. Instead, determine what the daily caloric intake of that horse should be and make sure that the nonstructural carbohydrates are low and that the right balance of energy is supplied as fats for that individual. A veterinary nutritionist can be very helpful in recommending an appropriate diet. If the horse is already overweight or obese, consider a management technique of horse owners in the late 1800s; take their feed away before exercising so they have a negative energy balance. “If the owner of an overweight horse rides in the morning, I usually recommend throw it their flake of hay at night, don’t give them their morning feed and then ride the horse. And if you do that, it will have a much higher amount of circulating free fatty acids concentration and you get the same benefit as feeding them fat. But you also get the added benefit of taking off weight,” she said. If the horse is in good body condition and receives about 45 minutes of exercise a day, feed it a hay that is about 12% nonstructural carbohydrate. Staying below 12% will prevent the release of insulin. Supplement with oil. The cheapest method is to moisten hay cubes and put oil on top. If that is too messy, rice bran is a great choice. Make sure that fat supplies about 15% of the energy in the total diet and carbohydrate provides less than 15% of the total energy. If the horse is exercising intensively and needs more feed to maintain weight, high-fat, lowstarch concentrates can be used.
In general, to get the right amount of fat this often means at least 4 lbs a day of some of these concentrates. Some owners who think the diet isn’t working are feeding a high-fat, low-starch concentrate, but they don’t feed enough to get an adequate amount of fat. Make sure the horse is getting about 1015% of the calories a day in the form of fat, Valberg suggested. The diet is only effective if the horse receives an appropriate amount of daily exercise, but the exercise does not have to be too long or too strenuous to be effective, according to Valberg. “The thing that is important for owners to know is that it doesn’t take much exercise. In our trials, those horses could not do more than 20 minutes of exercise, but we could with 20 minutes of exercise a day and very little in the way of turn out dramatically improve their lifestyle and improved their rhabdomyolysis and the pain they experienced. “So, even if they can’t ride, getting the horse out is important. Even exercising on a lunge line for 10 minutes a day makes a huge difference for these horses.” Turnout is an excellent activity. Try to put the horse out with other horses that will encourage activity and make sure they have to forage for food. Use a grazing muzzle if the grass is lush, she suggested. “When you adjust the diet and give them some exercise, the muscles feel better and their performance is better,” she said, warning that veterinarians should watch out for previous undetected lameness when the horse becomes active again. It often goes unnoticed because everyone is focused on the tying up. MeV
For more information: Dr. Valberg is one of the owners of the patent for the PSSM genetic test and receives sales income from its use. Her financial interest has been reviewed and managed by the University of Minnesota in accordance with its conflict of interest policies. 6
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ORTHOPEDICS
Risk of
navicular disease Presence of distal border fragments might be key B
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The presence of distal border
fragments of the navicular bone might indicate that a horse is at risk for navicular disease. Therefore, during the purchase examinations and when selecting breeding stallions, veterinarians should look for horses with more favorable navicular border shapes (straight or convex), which may reduce the prevalence of distal border fragments and likely the risk for developing navicular disease, suggested Sarah Claerhoudt, DVM, PhD, of Ghent University in Belgium. Researchers have determined that the shape of the proximal articular border is hereditary and the distribution of biomechanical forces exerted on the navicular bone depend on that shape. There is also a shape-grade association, in which concave and undulating shapes are associated with the highest risk for developing navicular disease. The fragments may arise from a fracture at the insertion of the distal sesamoid (impar) ligament (avulsion fracture), mineralization in the ligament or from a separate ossification center. Claerhoudt and her colleagues reviewed radiographs from 325 Belgian Warmbloods and found that concave and undulating shapes were associated with the highest risk
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of having distal border fragments. “These fragments were significantly more prevalent in bones with a concave or undulating shape,” she said. “We hypothesized that distal border fragments result from unfavorable loading of the navicular region. “In our study, all of the navicular bones with fragments had a corresponding defect in the bone, which may strengthen our hypothesis that distal border fragments arise from a fracture due to abnormal strain at the attachment of the impar ligament, [which holds the navicular bone in the hoof capsule],” she said. The clinical significance of these distal border fragments remains unclear. However, today, if Belgian veterinarians find a distal border fragment, they typically will recommend against selecting that breeding stallion, and therefore, this defect has an important financial consequence.
Finding fragments Distal border fragments are seldom prominent, so they can be difficult to see on a radiograph. To evaluate the foot for distal border fragments, Claerhoudt takes three standard radiographic projections (lateromedial, dorso55°- and dorso65°proximal-palmarodistal oblique projections). Two dorsopalmar views are taken from different
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angles with the horizontal, which results in a better study of the distal border. If a distal border fragment is not obvious, additional oblique projections should be made. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may help overcome radiography’s limitations. MRI is used for diagnosing the exact location of the fragment and the presence of navicular bone edema, representing an inflammation or degenerative bone change, while CT is good for detailed imaging of normal bone and bony disorders. “CT and MRI are complementary, but since the introduction of the standing MRI, MRI is the technique of choice for evaluating distal foot pain,” Claerhoudt said. Although the clinical significance of these fragments remains unclear, the hereditary of shape, the shapegrade and shape-fragment associations described, one may assume a possible relationship between these fragments and navicular disease, she added. MeV
A radiograph of a navicular bone with a distal border fragment at the medial and lateral aspect. Source: Dr. Claerhoudt
For more information: Claerhoudt S, Pile F, Vanderperren K, et al. Association between navicular bone fragmentation and shape in Belgian warmblood horses. Vet Comp Orthop Traumatol. 2011;24(2):132-6. doi: 10.3415/VCOT-10-03-0037. Epub 2011 Jan 11. http://www.ncbi.nlm.nih.gov/pubmed/21225084 ModernEquineVet.com | Issue 5/2013
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COLIC
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Managing the
neonate with colic Good outcome depends on many factors, but most neonates fair well Most cases of neonatal colic can
be managed medically with good outcomes, according to Michelle Harris, VMD, DACVIM, a lecturer 8
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in emergency and critical care at New Bolton Center, University of Pennsylvania. “The vast majority of neonates
presenting to a referral hospital for colic signs can be managed medically. The need for surgical intervention is less common than it is for
adult horses,” Harris said recently at the 58th Annual Convention of the American Association of Equine Practitioners. Harris discussed a study lead by Melissa MacKinnon, DVM, DACVS, while she was a surgical resident at New Bolton Center. MacKinnon now practices at Milton Equine Hospital in Campvellville, Ontario, Canada. In this retrospective study, the researchers reviewed the medical records of 137 neonates younger than 30 days of age with signs of colic that were treated at the George Widner Hospital for Large Animals between January 2000 and August 2010. Most were Thoroughbreds (72) with
Harris said. Nineteen had surgical lesions, and 11 underwent surgery. The researchers found that the overall short-term survival was good to excellent. Neonates that were less likely to survive to discharge were diagnosed with severe NEC or SISO. Overall short-term survival was 75% and was not significantly different between surgically and medically managed cases, according to Harris. Four neonates with severe NEC that underwent surgery were euthanized under general anesthesia due to grave prognosis. “All of the foals that were treated surgically and were allowed to
considered carefully,” she said. In the neonates diagnosed with transient medical colic, four were euthanized due to concurrent diseases.
Long-term survival
The veterinarians were able to provide 12-month follow up for 69% of the neonates; 93% of those survived to 12 months of age. “None of these horses died or were euthanized as a result of their colic as a neonate. Colic after discharge was uncommon,” she said. “If the neonate survived to maturity, the neonate had a good chance of being used as intended at an expected age. If they failed to be used
Concurrent Diseases 87 neonates with concurrent disease • Sepsis • Neonatal encephalopathy • Neonatal nephropathy • Failure of passive transfer • Umbilical remnant infection
Clinical Features Associated with survival • Plasma lactate • Total plasma protein • Oral mucous membrane color • Intestinal borborgmi • Primary colic diagnosis • Concurrent disease
Foals with colic. Thanks to Dr. Michelle Abraham for permission to use them.
Standardbred (28) being the second largest group represented. Seventysix were colts and 61 were fillies. They obtained information about signalment, history, physical exam, laboratory results, ancillary diagnostic tests, details of treatment and primary diagnosis. The primary diagnosis was enterocolitis, followed by necrotizing enterocolitis (NEC), meconiumassociated colic, and small intestinal strangulating obstruction (SISO). “The majority or 89% of neonates were managed medically,”
recover from general anesthesia survived to discharge,” she said. Concurrent diseases in neonates with colic are common. In this study, 87 neonates had a comorbidity, which included sepsis, neonatal encephalopathy, neonatal nephropathy, failure of passive transfer and umbilical remnant infection. “It is important to keep in mind the potential presence of a concurrent disease, when assessing and managing a neonate with potential colic. The impact of the severity of the concurrent disease should be
as intended or at the expected age, the reason was unrelated to colic,” she added. Don’t discourage owners from consenting to an exploratory celiotomy if it is indicated, Harris said. “Early treatment, close monitoring and prompt surgical intervention if necessary are recommended.” MacKinnon worked with Jon Palmer, VMD, DACVIM, a neonatologist, and Louise Southwood, BVSc, PhD, DACVS, DACVECC, an emergency clinician, at New Bolton Center. MeV ModernEquineVet.com | Issue 5/2013
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NEWS NOTES
Standing MRI eliminates need for general anesthesia
Photo courtesy of Hallmarq Veterinary Imaging
Hallmarq Veterinary Imaging continues to increase the number of clinics throughout North America using their standing equine MRI machine. Because the standing MRI eliminates the need for general anesthesia, equine clinics can now obtain scans of the foot and lower limbs with virtually no risk to the horse. “The standing MRI machine allows us the abil-
ity to clearly determine what type of injury the horse has without the use of general anesthesia. It’s more convenient for me and my staff, and it is much safer for the horse,” said Wesley Sutter, DVM, MS, DACVS, Lexington Equine Surgery & Sports Medicine. Sutter, a specialist in equine orthopedic surgery and sports medicine, says his clinic plans to install and offer the standing equine MRI machine to provide clients a better option for MRI. “We are an orthopedic surgery and lameness referral clinic that sits about one mile from the Kentucky Horse Park here in Lexington, so as you can imagine, we specialize in premier equine athletes,” Sutter said. “Conducting an MRI will be a routine procedure at our clinic, so being able to do that in the least invasive way and still get the information we need is not only important to our business, but to the client experience as well.” The Hallmarq standing equine MRI machine allows veterinarians to get clear, high-resolution scans of the soft tissue in the horse’s foot or leg to allow for a more precise diagnosis. The system is unique, as the horse is simply walked in for the scan, making it less labor-intensive for staff. MeV http://www.hallmarq.net/equine
Looking for a few good brood mares The University of California, Davis William R. Pritchard Veterinary Medical Teaching Hospital is asking for donations of young, healthy mares for its teaching herd. The horses will serve as embryo recipients for hospital clients with mares participating in the embryo transfer program. UC Davis will give the donated horses a quality home during their time in the program. If a mare successfully receives an embryo, she will be sold to the client whose mare provided the embryo. That client will care for the recipient mare until the foal is born and is weaned. The client can sell the mare back to the program afterward. To be accepted into the recipient herd, mares must: • Be at least 15 hands and (ideally) 1,100 lbs • Be between 3 and 10 years of age • Be (preferably) Warmbloods, Standardbreds, Drafts, Quarter Horses or Thoroughbreds • Be "broodmare sound" (sound in a pasture situation, not necessarily sound enough to ride or perform) • Be halter broken • Be free of any history of reproductive problems or subfertility • Can be a maiden or foaled mare “These mares will play a critical role as we expand our student teaching and resident training programs, and fulfill our teaching and service visions,” explained Bruce Christensen, DVM, MS, DACT, chief of the equine reproduction service at VMTH. To discuss a donation, please contact Christensen or through the VMTH Large Animal Clinic at (530) 752-0290. M eV
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EIA confirmed and contained in Nebraska Nebraska Department of Agriculture (NDA) officials worked quickly to contain an outbreak of equine infectious anemia (EIA) in one horse herd located in Northwestern Nebraska. EIA is a bloodborne disease and is typically transmitted by biting insects (such as horseflies and deerflies), but also can be transmitted from horse to horse through infected needles. There are no treatment options for infected horses, according to State Veterinarian Dr. Dennis Hughes. Symptoms include fever, depression, weight loss, swelling and anemia. Horse owners are encouraged to take biosecurity precautions to reduce the risk of infection in their herds, including: • Implement control measures, including husbandry practices that reduce biting insects, such as horseflies and deerflies; • Follow the rule of one horse-one needle; and • Additions to herds should have a negative Cog-
gins test before being allowed to intermingle with other equids. For more information about protecting horses, direct clients to www.nda.nebraska.gov. Hughes reminded those who are importing horses into Nebraska for show/exhibition or other reasons to follow Nebraska’s horse import regulations, which includes the requirement of a negative Coggins test. Producers with questions about import regulations should contact NDA at (402) 471-2351. MeV
One-fifth of a teaspoon of blood from a horse with acute EIA contains enough virus to
infect 1 million horses.
Equine Infectious Anemia Equine infectious anemia (EIA) is a potentially fatal viral disease of equids. No vaccine or treatment exists for the disease. It can be difficult to differentiate from other fever-producing diseases, including anthrax, influenza, and equine encephalitis.
Degrees of Infectiousness
Acute — When horses are exposed to EIAV, they may develop severe, acute signs of disease and die within 2 to 3 weeks. This type is the most damaging and the most difficult to diagnose because the signs appear rapidly, and often only a fever is noted. One-fifth of a teaspoon of blood from a horse with acute EIA contains enough virus to infect 1 million horses. The clinical signs of the acute form of EIA are nonspecific. In mild cases, the initial fever may be short lived (often less than 24 hours). As a result,
horse owners and veterinarians may not recognize this initial sign as EIAV. These infected horses often recover and continue to move freely among the herd. The first indication that a horse was exposed to, and infected with, EIAV may well be a positive result on a routine Coggins test. Chronic — If the horse survives this first acute bout, it may develop a recurring clinical disease with these signs: • Fever—An infected horse’s temperature may rise suddenly to about 105° F or, rarely, as high as 108° F. Then it may drop back to normal for an indeterminate period until the onset of another episode. • Petechial hemorrhages • Depression • Weight loss • Dependent edema • Anemia.
The horse with chronic EIA is the classic “swamper” who has lost condition, is lethargic and anorexic, has a low hematocrit, and demonstrates a persistent decrease in the number of blood platelets, especially coincident with fever induced by EIAV. Inapparent — Most horses are latent carriers without overt clinical signs. They survive as reservoirs of the infection for extended periods. Carriers have dramatically lower concentrations of EIAV in their blood than horses with active clinical signs of the disease. Only 1 horsefly out of 6 million is likely to pick up and transmit EIAV from this horse. All horses infected with EIAV are thought to be lifelong carriers. The inapparent form may become chronic or acute due to severe stress, hard work, or the presence of other diseases. MeV Source: USDA ModernEquineVet.com | Issue 5/2013
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INFECTION CONTROL
Prevent MRSA Methicillin-resistant Staphylo-
coccus aureus (MRSA) infections in horses are difficult to treat because few antibiotics are effective against these resistant bacteria. But veterinarians can reduce the spread of resistant bacteria by improving hygiene in the equine hospital, according to Karin Bergström, of the Swedish National Veterinary Institute, who defended her dissertation on the topic this month. “An infection-control program requires continuous work with audits, training and monitoring. Hospital leaders need to give their support by allocating resources and by their active engagement. The introduction of infection-prevention and -control measures is a self-evident responsibility of horse hospitals, as MRSA involves both patient safety and the working environment,” said Bergström, who is the assistant state veterinarian. In the summer of 2008, MRSA was found at an equine hospital in Sweden. Bergström studied the outbreak and the biosecurity measures 12
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that were implemented for her dissertation. Most of the horses were suffering from superficial wounds that healed without the use of antibiotics, which she felt was a key observation. The bacteria in the outbreak belonged to a type of MRSA called CC398 associated with food-producing animals, but it has also been found in horses in Europe. However, this was the first time this type of bacteria had caused equine infections in Sweden. Of a total of nine horses that could be monitored after the infection, all but one showed negative samples within two to seven months, and the nasal passages proved to be the most reliable sampling site for obtaining MRSA. Collaboration among the hospital where the infection had spread, experts in human infection control and public authorities contributed to the development of a program for infection control. But the cost to the hospital was steep — almost $200,000.
The horse hospital presents challenges that are not seen in human hospitals, and further studies are needed to find better ways to control equine infections, she said. For example, the development of surface materials that are suited to horses, but are easy to disinfect facilitated infection control in these hospitals. Environmental sampling showed that MRSA was prevalent in places accessible only to people, which means that hand hygiene is key to stopping the spread of this bacteria. MRSA was found on furnishings that are difficult to clean. Therefore, mangers and water cups were replaced by buckets that could be disinfected. Observations at three horse hospitals showed that biosecurity routines regarding work clothing and the like were exemplary, but workers were less likely to comply with routines for hand hygiene and disposable glove use. Reasons for lack of compliance were practical difficulties, insufficient knowledge and high workloads. MeV
CDC/ Janice Haney Carr/ Jeff Hageman, M.H.S.
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NEWSNOTES
Supplies of Adequan Limited Due to renovations at a New York factory, Luitpold Pharmaceuticals Inc. announced that supplies of polysulfated glycosaminoglycan (PSGA, Adequan) will be limited over the coming months. "Our factor in New York has undergone a significant renovation to meet enhanced quality standards and address observations of the FDA. This has resulted in depletion of our existing inventories," the company said in a press release. Although the company has tried to manage supplies as well as possible, it expects to be out of the product for a short time and to resume shipments of the 5 mL size in early July followed by the 50 mL size in August. Since approved for equine use by the FDA in
1984, Ad-
equan is the only PSGAG labeled to treat non-infectious degenerative and/or traumatic joint dysfunction and associated lameness of the carpal and hock joints in horses. There is no generic product labeled for use anywhere in the word, the company said. For the most recent updates on expected release dates, visit www.adequan.com. MeV
Patent issued for beneficial animal 'candy' A U.S. patent has been granted to a Kansas State University-developed "candy" that stimulates the growth, health and reproductive functions of cattle, bulls and other livestock. Jim Drouillard, PhD, MS, professor of animal sciences and industry, discovered a specific combination of molasses, oilseeds and oilseed extracts that when heated and evaporated, formed a substance that improves absorption of specific omega-3 fatty acids. "It's a free-choice type of supplement in a block form — sort of like a big, 250-lb piece of candy for livestock," Drouillard said. "It's put in the pasture and the animals consume it whenever they want. The product's physical characteristics restrict the animals to consuming less than a pound each day, making it a convenient and cost effective way to deliver essential nutrients." The substance contains desirable fats that elevate levels of specific omega-3 fatty acids in the bloodstream. The increases in omega-3 fatty acids can stimulate growth, improve immunity and enhance reproduction function and overall fertility in livestock that
consume the supplement. New Generation Feeds, a South Dakota company, has retained exclusive rights to the patented technology for use in its SmartLic brand of livestock supplements. The process is used in making the company's HorsLic supplement for equines and FlaxLic supplement for beef and dairy cattle. MeV ModernEquineVet.com | Issue 5/2013
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AAEVT Membership
AAEVT* membership is open to US and international equine veterinary technicians, assistants, practice managers, and support staff employed in the veterinary industry. It is also open to students of AVMA/CVMA accredited programs
AAEVT Membership • • • • • • • •
Bi-Annual Newsletter Weekly “HoofBeats” email NEwsblast Full access to www.aaevt.org, including the Career Center and the Library Up-to-date information on the AAEVT Discounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT Convention NTRA, Working Advantage and Platinum Performance Benefits The opportunity to participate in the AAEVT Online Certification Program or to become a member of the AEVNT Academy-Specialty in Equine Veterinary Nursing • Scholarship opportunities. • AAEVT’s Equine Manual for Veterinary Technicians (Blackwell Publishing 20% discount on purchase price) • Subscription to THE HORSE Magazine, compliments of Intervet Schering/Plough Opportunity to attend Purina’s Annual Equine Veterinary Technician Conference All Expenses paid!
AAEVT Objectives • • • •
Provide opportunities for CE, training, communication, and networking Educate the equine veterinary community and the public about our profession Inform Members of issues affecting our profession Assist in providing the best medical care to improve the health and welfare of the horse
AAEVT Online Equine Certification Program
• A three course, 10 module, equine-only online program offered through ACT • Geared toward Credentialed Veterinary Technicians, Assistants, Support staff, & Students • Areas of study include: equine medical terminology, anatomy and physiology, parasitology, laboratory, diagnostics, equine basics (breeds, wellness, husbandry,) diagnostic procedures, emergency medicine, restraint, pharmacology, surgical assistance and anesthesia, equine office procedures • A certificate of completion is awarded to those who: Successfully complete required courses Complete the list of required skills (per a supervising DVM who is an AAEP member) Attend an AAEVT regional CE symposium and participate in the we labs • Those individuals who successfully complete the programs will be recognized as AAEVT Certified Equine Veterinary Technicians / AAEVT Certified Equine Veterinary Assistants depending on their current designation. The certificate is recognized by the AAEVT and the AAEP but does not grant the credentialed status by the AVMA • For more information go to www.aaevt.4act.com or call 800-357-3182
AAEVT Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.
For more information visit www.aaevt.org
*American Association of Equine Veterinary Technicians and Assistants
TECHNICIAN UPDATE
Medical records reduce risk in equine hospitals By Deborah Reeder, RVT, VTS-EVN AAEVT Executive Director Accurate medical records, completed in a timely fashion are a legal necessity and the only protection against successful malpractice litigation. There is little doubt that equine practitioners face some unique challenges in their practices when compared with companion animal veterinarians. For instance, the critical issue of obtaining the consent to treatment from the owner becomes blurred when the equine clinician regularly accepts instructions from a trainer or stable manager. It is important for the proper management of the equine practice to make sure that the actual owner of the horse is both identified and provides specific instructions that the trainer is authorized to act on the owner’s behalf. Too often the equine practice is compromised when the owner refuses to pay for services because the instructions to provide service were never actually authorized by the owner. During the initial engagement the veterinarian should ensure that authorization can be provided by the trainer or other designated party. This is particularly true when a syndicate owns the horse.
Talk to me!
Communication is the key in the success of any service business. Veterinary medicine is no exception, and the clients’ interactions with the practice can be the most important factor in the success of a practice. On a daily basis there may be communications with the backyard owner of a single horse, multiple owners of million dollar racing Thoroughbreds, buyers, sellers, agents, referring veterinarians, barn managers, trainers, riders, insurance companies, an export agent, a show office, the USDA or a farrier. All of these communications need to be documented. Timely, complete and correct messages delivered to the appropriate person, with prompt follow-up, will go a long way toward reassuring clients that their requests are being well handled. Confidentiality when dealing with client information is an absolute necessity, which, if not strictly adhered to, can result in the loss of a client or practice reputation at the minimum or a lawsuit attacking profession ethics. Consistent and timely com-
munication among staff is a challenge, which must be met if the practice is to run smoothly. Medical Records are the practice communication between staff and to the client. Creating and maintaining correct, accurate and timely medical records is the single most important responsibility of the equine technician in a practice.
Who owns what
The challenges associated with obtaining and recording this information must be met. Ethically the information within veterinary medical records is considered privileged and confidential. It must not be released except by court order or consent of the owner of the patient. This is especially true when horses change owners or are presented for a pre-purchase examination, as the absolute confidentiality of information must be maintained and prior medical history cannot be included in the medical record or communicated to a second owner or potential buyer without the express written permission of the original owner.
Creating and maintaining correct, accurate and timely medical records is the single most important responsibility of the equine technician in practice. It is important to note that the physical images (radiographs, ultrasound images or bone scan images for instance) are the property of the practice, which created them. The information contained in these images is the property of the client who paid for them to be made. Release of this information requires a signed release from that client. Absolute adherence to this law is essential. The time that patient records, including imaging, must be maintained by a practice, regardless of the status of the patient, varies from state to state; however a minimum of 10 years provides a good rule of thumb. Medical Records should contain the minimum standards of information collected and documented. A complete and thorough description of the horse, it’s age and weight, it’s use, identifiable ModernEquineVet.com | Issue 5/2013
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TECHNICIAN UPDATE markings or tattoos, breeding history if relevant, and any medical history, including medications, feed and supplements. Complete client information should be documented, and information collected that assures the practice has done due diligence in assuring ownership/ agency authorization of the horse. The physical examination should be recorded and should include notations on normal findings as well as any abnormalities. In addition, the following should always be included in any medical record for any visit or examination and noted as to day, time and person performing the procedure: • Presenting complaint(s) • Diagnostic recommendations • Treatment provided • Prognosis, if indicated • Written and oral client communication •A uthorizations to treat as well as declining of any recommended procedures •N otation of any Educational materials given to clients
All communication with clients must be noted in the medical record, whether they are made in person, by telephone, email, fax, text or a voicemail message. Note the time and day the message was delivered, as well as the initials of the person involved in the communication. The saying that often comes up in a court case is “If it is not in the medical record ... it did not happen.” The records should be consistent in the information collected and format and they should be legible. If they cannot be easily read or deciphered, they will be thrown out in any court or state board case. Do not include any editorial comments and make sure that any corrections done are noted that they are a correction and why. Equine practitioners must do better, and the more information collected, the better. Have your practice perform a records audit at least twice a year and discuss ways to reduce your risk through better management of your medical records. MeV
Call for
case study papers: The AAEVT is looking for veterinary technicians to submit case study papers to be presented at its annual AAEVT conference held in conjunction with AAEP Annual Convention. Technicians who are already planning on attending AAEP in Nashville, TN (December 7-11, 2013) are invited to submit an interesting case in which they participated for a panel discussion during the scientific sessions.
The categories for submission are: • Anesthesia/Surgery • Diagnostic Imaging • Critical Care Case studies will be evaluated and two cases per category will be selected to present during our scientific session in a panel discussion and appear in our annual AAEVT proceedings
Guidelines: Submit a 1-2 page, originally written case study in which you participated in the care of an equine patient. Include the following information: • History, PE findings, lab values, diagnostics, treatment and outcome. • Any appropriate references
Information for submission: • Please submit your case study in a word document, via e-mail to Jessie Loberg on or before July 1st, 2013. • Authors will be notified by August 1, 2013 of the decision to include your case study in the 2013 Annual AAEVT scientific sessions.
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Issue 5/2013 | ModernEquineVet.com
NEWSNOTES
Bioengineers are interested in finding innovative ways to grow new cartilage from a human patient’s own stem cells, and, thanks to a new study from the University of Pennsylvania, such a treatment is a step closer to reality. Jason Burdick and his colleagues at the University of Pennsylvania have been studying mesenchymal stem cells, a kind of adult stem cell found in bone marrow that is capable of turning into bone, fat or cartilage cells. His group has been particularly interested in deducing the microenvironmental signals that tell these cells which way to differentiate. The group recently investigated conditions that can preferentially coax these stem cells into becoming either fat-like or bone-like cells while encapsulated in hydrogels, polymer networks that simulate some of the environmental conditions in which stem cells naturally grow. The first step in growing new cartilage is initiating chondrogenesis, or convincing the mesenchymal stem cells to differentiate into chondrocytes, which in turn generate the spongy matrix of collagen and sugars that cushions joints. One challenge in prompting this differentiation is that, despite the low density of adult chondrocytes in tissues, the actual formation of cartilage begins with cells in close proximity. “In typical hydrogels used in cartilage tissue engineering,” Burdick said, “we’re spacing cells apart, so they’re losing that initial signal and interaction. That’s when we started thinking about cadherins, which are molecules that these cells use to interact with each other, particularly at the point they first become chondrocytes.” To simulate that environment, the researchers used a peptide sequence that mimics these cadherin interactions, which they bound to the hydrogels used to encapsulate the mesenchymal stem cells, which “tricks” them into making cartilage. To test the efficacy of their cadherin-mimicking peptide, the researchers encapsulated mesenchymal stem cells in several other kinds of gels: a regular hydrogel with no peptide; one with a non-functional, scrambled version of the peptide; and one with the peptide as well as an antibody that blocked cadherin interactions. After a week, cells within gels containing the cad-
Photo: Megan Farrell
Penn works to improve stem cell’s cartilage formation
Fluorescently labeled mesenchymal stem cells in a hyaluronic acid hydrogel.
herin peptide exhibited more genetic markers of chondrogenesis than any of the controls. A second experiment involved growing gels for four weeks, long enough for them to start developing cartilage matrix. This allowed the researchers to conduct functional tests, such as subjecting them to mechanical loads. They found the peptide-containing gels performed more like natural cartilage than the other gels. The researchers also sectioned the gels and stained them for type-II collagen and chondroitin sulfate, molecules that are part of the cartilage matrix. Once again, the peptide-containing gels produced more of these markers of matrix formation than the controls. “All together,” Burdick said, “these experiments provide a thorough demonstration that this cadherin signal can improve the chondrogenesis response when presented from a synthetic hydrogel.” MeV
For more information: L. Bian M, et al. Hydrogels that mimic developmentally relevant matrix and N-cadherin interactions enhance MSC chondrogenesis. Proceedings of the National Academy of Sciences, 2013; DOI: 10.1073/pnas.1214100110. http://www.pnas.org/content/110/25/10117.long ModernEquineVet.com | Issue 5/2013
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