HORSE HEALTH
ISSUE NO. 4 | Winter 2024
Spotlight
FEATURED
How to Be YOUR VETERINARIAN'S FAVORITE CLIENT
Mutual respect and support put the “treat” in veterinary treatments and services. By Dr. Cara Wright, MS, IVCA, Merck Animal Health Everywhere you look these days, there’s talk about the shortage of veterinarians for both small and large animals. Perhaps you’ve even heard your own veterinarian talk about having trouble hiring someone or worrying about selling their practice when they retire because not enough graduates are choosing equine medicine—only about 5% of veterinary school graduates enter equine practice, according to a study from the American Association of Equine Practitioners (AAEP). In addition to lower numbers of equine veterinarians, several factors are adding to burnout that causes professionals to leave the industry, such as on-call demands and salaries that are only slowly catching up to small animal medicine. The industry is stepping up to support equine veterinarians. •
2
The Merck Animal Health Veterinary Wellbeing Study III, which Merck Animal Health administers as part of its unconditional commitment to the veterinary industry, identified three concrete steps veterinarians can take to reduce their own burnout: establish a healthy balance of work and personal life, establish a healthy mechanism of stress relief, and hire a financial planner.
IN PRACTICE | Spring 2020 HORSE HEALTH SPOTLIGHT | Winter 2024 2 PARTNERS
•
MentorVet is an evidence-based mentorship program for early-career veterinarians, and Merck Animal Health is a founding sponsor.
•
Decade One, which is supported by the AAEP and Merck Animal Health, focuses on business education and small group peer support.
But without support from clients and horse owners, some veterinarians—especially early-career veterinarians—will struggle. So, what can you do to support equine veterinarians so they can keep supporting horses? The following tips will help get you “favorite client” status, plus help your veterinarian thrive on a day-to-day basis.
Respect the business. •
Pay your bills promptly. The costs to run a veterinary practice are high. Did you know that every medication your veterinarian carries is already paid for by the time it gets to your horse? Delayed payment affects the practice’s cash flow, which can affect the ability to pay employees, upgrade equipment, and attend important continuing education meetings.
Respect time. •
•
Appreciate the logistics required to schedule clients throughout the practice radius, and respect the appointment options presented to you. Your veterinarian can be much more efficient and see more patients in a day if appointments are scheduled based on geography.
education meeting, both of which are integral for longevity in the profession. Your veterinarian trusts them to take care of you and your horse, so please give them a chance. •
Trust your veterinarian’s recommendations. Vets stay up to date on trends in medicine and diseases through special programs such as the Merck Animal Health Equine Respiratory Biosurveillance Program, which studies the prevalence and epidemiology of relevant viral and bacterial respiratory pathogens. Google can be helpful with generalized information, but your veterinarian is well-versed in the most current treatments and your horse’s specific needs and situation.
•
Value and respect the clinic staff. Veterinarians cannot do their jobs without their staff. One of the most effective ways for veterinarians to increase efficiency in daily practice is allowing technicians to handle some cases. For example, technicians are licensed and qualified to pull blood, change bandages, take radiographs, and administer certain medications. Support the technicians sent to your farm for cases that don’t require a doctor’s immediate attention.
Offer to trailer in. This enables your veterinarian to care for more horses in a day, as well as makes it easier to work your horse in if an emergency call affects the schedule.
Respect people. •
Support and encourage veterinarians who are new to the profession. According to the AAEP, nearly 50% of their membership leaves the profession after five years. Be patient with new veterinarians, keeping in mind that every veterinarian was new once. Enabling these doctors to learn and thrive is vital to the profession’s survival.
•
Welcome practitioners who may be filling in while your veterinarian is on vacation or attending a continuing
Winter 2024 | HORSE HEALTH SPOTLIGHT
3
•
Have your horses clean and ready when the vet arrives. Time waiting for you to catch horses from the pasture is time your veterinarian could be using to see patients. Most veterinarians will strive to be timely for your scheduled appointment and will call if they are delayed by an emergency, so aim to return the favor.
Communicate. •
Consider time and format. Every veterinarian has a preference for emails versus phone calls versus texting. Regardless, be considerate of business hours, and respect that there may be a delay in response to nonurgent questions.
•
Use the emergency line for emergencies. If you aren’t sure whether your horse is experiencing an emergency, absolutely call the veterinarian. Answering questions and learning about a potential case early on helps your veterinarian create better outcomes for your horse. And a conversation helps avoid an unwarranted emergency call if your veterinarian determines your horse’s situation can be handled later in the day or the next morning.
•
Be forthcoming about second opinions. Veterinarians’ feelings won’t be hurt if you’re up front about wanting or already seeking more information. Your veterinarian can help you find the best resource for follow-up and next steps. Also, if your veterinarian recommends referral, strongly consider that option. Veterinarians know their limits and want their patients to be served by specialists when the need arises.
•
Track your horse’s annual care and prescriptions. Your vet will always have this information available, but keeping track of your own paperwork and prescription refills will save their office staff time and the headache of last-minute urgent orders. Treat Coggins and health certificate requests the same way; the further in advance your veterinarian knows you need these, the better (and less expensive!) it is for everyone involved.
Be prepared for an emergency. •
4
Learn how to take a basic temperature and heart rate. Create a first aid kit and know basic wound care steps. Call your vet before giving any medication that you have on hand (ex. Banamine), and do not put anything in a horse’s eye without discussing with your veterinarian first.
HORSE HEALTH SPOTLIGHT | Winter 2024
•
Be prepared to trailer your horse to a referral center. With the shortage of vets, being proactive and transporting your own horse to a clinic may be the timeliest way to get needed emergency care.
•
Understand your budget and insurance options before urgent care is needed.
Being an equine veterinarian isn’t an easy job, but it is a rewarding one. This is especially true when clients like you build a relationship based on respect and trust. By working together, your veterinarian can focus less on job stresses and more on giving all equine patients the best care. Because let’s face it, horses are really the favorite—for you and for veterinarians.
About the author Before joining Merck Animal Health in 2022, Dr. Cara Wright was in equine private practice since her graduation from the Virginia-Maryland Regional College of Veterinary Medicine in 2009. She has focused most of her career on the needs of the equine athlete, integrating modalities such as chiropractic, laser, and rehabilitation to keep horses working and feeling their best. She has served as an adjunct professor for the University of Florida’s Practice-Based Equine Clerkship and teaches sessions on veterinary pathology and physiology for other veterinarians and human chiropractors. In addition to Dr. Wright’s passion for equine health, she enjoys international travel and training for and competing in triathlons.
UNCONDITIONAL
Serving Animals WITH THE 3 T’s By Dr. Duane E. Chappell, Merck Animal Health
Often, it can be easier and more efficient to financially back a charity, or other cause-related issue or group, we deem worthy of our support. Though this act of giving is often necessary to finance important causes, perhaps an investment of ourselves is also needed, and maybe even more valuable. With this in mind, I have the opportunity of using the volunteer service time I graciously receive as a Merck Animal Health employee to give the three T’s: my time, talents and treasures. My background as a mixed animal veterinarian led to my first short mission trip many years ago. I served on the Navajo Reservation in Arizona with Christian Veterinary Mission (CVM). Fast forward to March 2023, I was privileged to lead the eighth annual CVM short-term mission team to the hills and valleys of the Appalachia Mountains in southeastern Kentucky to serve the needs of animals in coal mine country. Our team partnered with a local ministry organization named Meridzo Ministry. This organization has leveraged community interaction to help meet the physical and spiritual needs in a five-county area. A snapshot of the local economy reveals peak unemployment rate of 50% has occurred in years past with the downturn of the coal mining industry. Though some economic recovery has developed, veterinary care continues to not be locally available. Our team traveled from 10 states and consisted of veterinarians, veterinary technicians, veterinary and undergraduate students and resource members with no specific training. Everyone shared a heart to serve and a love for animals. The initial point of service was in the local elementary school, sharing about our profession in ways to inspire the next generation of veterinarians or veterinary technicians. During the following three days at two clinic locations, we cared for nearly 200 horses, dogs and cats by providing routine procedures like vaccinations, deworming, spay/ neuter surgeries, Coggin’s sample collection, dental exams and floating teeth. Through a gracious donation by Merck Animal Health, vaccinations were available to address the basic health needs of these animals.
Animals provide the relational bridge to connect the hearts of those who give and those who receive. It’s a two-way street! Animals open the doors to sharing with one another. This includes time of prayer and physically caring for the basic health needs of their companion animals. That time brings unimaginable amounts of joy for all involved. Even the critters! Closing with a quote by Theodore Roosevelt that has been a mantra I’ve practiced both professionally and personally: “People do not care how much you know, until they know how much you care.” I hope we can all use our time, talent and treasures to show others how much we care and reach beyond our personal comfort to serve others.
Dr. Chappell and the mission team visit a local elementary school to talk to students about caring for animals.
About the author Dr. Duane Chappell has spent his career improving the health of horses through his work in the field, in the classroom and on research projects. Dr. Chappell practiced at mixed animal clinics in the Midwest. He owned and managed solo and group practices and was the resident veterinarian at a Quarter Horse breeding farm. Transitioning from many years in the field, Dr. Chappell joined Morehead State University in Kentucky as an assistant professor for a few years prior to joining Merck Animal Health in 2014. He received his Doctor of Veterinary Medicine from Purdue University. Outside of work, Dr. Chappell enjoys hiking, landscaping, wood working and sporting events. He is married with three children and six grandchildren.
Winter 2024 | HORSE HEALTH SPOTLIGHT
5
ASK A VET
We haven’t seen a rabies case in our area in years. Can I reduce the number of rabies vaccines my horse receives? By Dr. Bryant Craig, Merck Animal Health
When people ask me about the need for rabies vaccination, I’m transported back to when I was 8 or 9 years old. I had an Icelandic pony named Dolly who lived at my grandfather’s house in Oklahoma (a state that saw three cases of rabies in 2022, according to the Equine Disease Communication Center). One day, Dolly wasn’t acting herself, so we called the veterinarian and he came to check her. The next day, Dolly passed away. The vet was suspicious, so he came back and tested her body for rabies. She’d been positive. We’d all handled Dolly the day before, which meant we’d been exposed to rabies. Since it’s zoonotic—spread between animals and people—everyone had to get immune globulin shots to try to prevent infection. Luckily, the shots worked and none of us became ill. 100% fatal. Always preventable.
6
HORSE HEALTH SPOTLIGHT | Winter 2024
I share Dolly’s story because while rabies is rare, it’s always terminal. There are no treatment options available to animals showing signs of rabies. That’s why the American Association of Equine Practitioners (AAEP) recommends that every horse everywhere be vaccinated every year. The rabies vaccine is basically 100% effective, plus it’s an economical piece of a horse’s annual health plan. Once-a-year vaccines are recommended based on the amount of time they’re proven to be effective. PRESTIGE® EquiRab® has a 14-month duration of immunity in one dose. It’s 97.7% reaction free in field safety trials, making it a critical component of an annual vaccination program. It pairs well with PRESTIGE® 5 + WNV, which covers the remaining AAEP-recommendedannual vaccines and protects against key at-risk diseases.
Rabies Quick Facts
Rabies cases still occur
See more at-a-glance details about how rabies is transmitted, diagnosed and, most importantly, prevented.
This brings me back to vaccination. Even if rabies hasn’t been in the news in your area, cases are happening. The Equine Disease Communication Center (EDCC)—which Merck Animal Health supports as a founding sponsor through our Unconditional commitment to the horse—reports that the total number of equine rabies cases ranges from 25 to 82 a year. The EDCC reported a confirmed rabies case in Marion County, Florida, as recently as August of this year and three cases in Oklahoma in 2022, as mentioned earlier.
GET RABIES FACTS
Spread by common wildlife Remember that unlike some equine diseases, horses don’t need to be around other horses to contract rabies. Even if your horse is the only horse on a 4,000-acre farm, he’s still at risk, because any mammal can contract and spread rabies. The most commonly infected animals include: •
Bats (We suspect my pony Dolly was bitten by a rabid bat.)
•
Raccoons
•
Foxes
•
Skunks
All these cases were preventable with vaccination. While rabies isn’t common, the finality of the disease, the ease of transmission and the risk to humans make an annual vaccination for horses imperative.
Most horses live in an exposed environment and can easily come into contact with wildlife that might be infected with rabies. Even stalled horses are at risk because wildlife is drawn to feed rooms and barns.
Spread between animals and people When horses are at risk of rabies, so are people. Like in my story with Dolly, when your horse is acting sick, you’re likely going to handle it before knowing what’s wrong. If the cause of illness turns out to be rabies, you’ve already exposed yourself and possibly your family members and friends. The signs of rabies infection can be nonspecific and confusing. We veterinarians often say it can “look like anything else.” However, at some point during the course of the disease, most rabid horses exhibit: •
Sensitivity to touch
•
Fever
•
Paralysis or impaired balance
About the author Prior to joining Merck Animal Health, Dr. Bryant Craig owned and operated a private equine veterinary practice for six years in central Oklahoma before joining a top Quarter Horse ranch as resident veterinarian in 2005. In addition to the ranch’s reproductive services, he also oversaw the health, fitness and nutrition program for the ranch’s sales horse operation. Dr. Craig received his Doctor of Veterinary Medicine from Oklahoma State University. He joined the Merck Animal Health Equine Veterinary Professional Services team in 2013. Outside of his equine interests, Dr. Craig enjoys skiing and fishing with his sons.
Unfortunately, there’s no way to definitively diagnose a living animal with rabies.
Winter 2024 | HORSE HEALTH SPOTLIGHT
7
DISEASE 101
Equine Protozoal Myeloencephalitis (EPM) QUICK FACTS A horse’s risk of developing equine protozoal myeloencephalitis (EPM) is six times higher in the fall.1 Opossums, which carry the EPM-causing parasite Sarcocystis neurona, are more active in the fall. Autumn is also a time when months of strenuous activity and transport can take a toll, increasing horses’ stress and, thus, their risk of EPM. Check out these quick facts to help protect your horse from EPM this season— and throughout the year.
What Is EPM? EPM is an infectious, progressive neurological disease that affects horses following environmental exposure to opossum feces infected with causative parasites. EPM can cause devastating and lasting neurological damage and any horse is susceptible. •
Caused by infection with the parasite Sarcocystis neurona (S. neurona); less frequently with Neospora hughesi (N. hughesi)1
•
Up to 90% of the U.S. horse population has been exposed to S. neurona, depending on geographic location1
•
Not all horses infected with S. neurona or N. hughesi will develop disease
EPM Risk Factors1 •
Exposure to wildlife; presence of opossums
•
Stress associated with illness, transport, strenuous exercise
•
Young horses (1–5 years)
•
Horses used for western performance, racing and other strenuous activities
•
Immune-compromised horses of any age
•
Immunosuppression associated with concurrent conditions
•
Commonly seen in late summer and fall, but can occur any time
IMPORTANT SAFETY INFORMATION Use of PROTAZIL® is contraindicated in horses with known hypersensitivity to diclazuril. The safety of Protazil in horses used for breeding purposes, during pregnancy, or in lactating mares, and use with concomitant therapies in horses has not been evaluated. Do not use in horses intended for human consumption. Not for human use. For complete safety information, refer to the product label. 1 Reed SM, et al. Equine Protozoal Myeloencephalitis: An Updated Consensus Statement with a Focus on Parasite Biology, Diagnosis, Treatment and Prevention. J Vet Intern Med 2016;30:491–502. 2
T. Mullaney, et al. Evidence to support horses as natural intermediate hosts for Sarcocystis neurona. Veterinary Parasitology; 133 (2005) 27-36.
8
HORSE HEALTH SPOTLIGHT | Winter 2024
Lifecycle of Sarcocystis neurona1
Watch for These Signs
1.
The S. neurona organism is ingested by the definitive host, the opossum, by scavenging on intermediate hosts (cats, raccoons, skunks, armadillos, sea otters) that carry sarcocyst in skeletal muscle
2.
The infective stage of the organism (the sporocysts) is passed in the opossum’s feces
3.
The horse (dead-end host*) acquires the infective sporocysts while grazing or eating contaminated feed or drinking water
4.
nce ingested by the horse, the sporocysts migrate from the intestinal O tract into the bloodstream and cross the blood/brain barrier
5.
The resulting inflammatory response to sporocyst presence injures the horse’s central nervous system
(The definitive or intermediate hosts for N. hughesi have not yet been identified.)1 *Evidence exists supporting horses as intermediate as well as dead-end hosts.2 Intermediate Hosts: • Skunks • Raccoons • Armadillos • Cats
• Passerine Birds • Sea Otters • Horses
• • • • • • • • • • •
Contact your veterinarian immediately if your horse exhibits neurological signs. Horses that are diagnosed early and treated aggressively have the best chance for recovery.
1. Sexual reproduction in digestive tract (intestinal epithelium) Definitive Host: Opossum
Sarcocyst in skeletal muscle
Diagnosis Diagnosing EPM is difficult because it can mimic other neurologic diseases.
2. Infective sporocyst in feces
•
Complete neurologic and physical exam to rule out other diseases
•
Blood and cerebrospinal fluid (CSF) analysis to detect antiprotozoal antibodies
5. 4.
Lesions in spinal cord and brain
Gait abnormalities Ataxia (incoordination) Stumbling Muscle atrophy Weakness Lethargy Inability to chew or swallow Head tilt, ear droop Behavior change Blindness Seizures
3. Dead-End and Intermediate Host: Horse ingests contaminated feedstuffs
Evidence cysts can live in skeletal musculature of horse (without perpetuating life cycle).2
Treatment and Recovery • An FDA-approved EPM treatment such as PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets will be prescribed to control infection • Additional supportive treatment may be recommended based on the severity of neurologic deficits and associated complications • 60–70% of horses show clinical improvement with early treatment1
Opossums can be scary for horses. Not because of spooking, but because of equine protozoal myeloencephalitis (EPM). Opossums, which carry the EPM-causing parasite Sarcocystis neurona, are more active in the fall, which increases horses’ risk of contracting the disease. Autumn is also a time when months of strenuous activity and transport can take a toll, increasing horses’ stress and, thus, their risk of EPM. Click Here to quick facts to help protect your horse from EPM this season—and throughout the year.
Winter 2024 | HORSE HEALTH SPOTLIGHT
9
Copyright © 2024 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. US-XX-123