The Equine Veterinary Practitioner September 2021

The

Equine Veterinary Practitioner

The Official Publication of the New Zealand Equine Veterinary Association

SEPTEMBER 2021 Vol. 46 No. 3

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CONTENTS

SEPTEMBER 2021 PAGE NO.

NZEVA President Report Brendon Bell NZEVA AGM 2021 Minutes Your NZEVA Executive Editorial Blog Joe Mayhew Update on Racehorse Welfare Bill Bishop & Peter Gillespie Analgesia for the Equine Trauma Patient – Part 1 Gayle Hallowell Gene Doping - 101 How to Determine Joint Involvement in Limb Wounds Brendon Bell Medication Musings Emma Gordon Colleague Profile Brendon Bell Free Book: Donkey Dentistry Murmurs in Performance Horses Katharyn Mitchell The Horse Podcasts Penetrating Wounds to the Hoof and Frog Grace Reed NZEVA Conference 2021 - Montage EVP Educational Fund Grants The Olympic Hoof Explained Peter Glimberg & Fran Jurga NZERF Bulletin & Videos Two Cases of Epilepsy – Follow-Up Rose Stocker BCET Webinars CPD Conferences, Seminars & Workshops AAEP Infectious Disease Guidelines Book Review: ECG Interpretation in Equine Practice Angela Hawker Uroperitoneum and C. difficile infection in a 3-day-old colt Anna Forbes NZERF Scholarships & Grants Useful Links VetLogic Puzzle What Would You Do? Rabecca McKenzie & Greg Quinn Massey Equine Home Page Update on Hepatotoxins Megan C Romano Surveillance Reports – MPI EVE Podcasts STOP PRESS: EHV-1 Myeloencephalopathy US Racing Indicators

3 4 5-6 7-8 8 9-12 13-14 15-16 17-18 19 20 21-26 27 29-31 33 34 35 36 37 37 38-39 39 40 41-44 46 47 48 & 59 49 50-51 52 53-55 56 57 58

EquiManagement

58

Obituary: Frazer J Allan Obituary: W.R Twink Allen Obituary: Alexander de Lahunta Interactive Equine eBooks - University of Georgia Poetry and Song Feature: You are a Flower BB Don McLaren Fellowship Fund OUR ADVERTISERS

60-61 62-65 66 68 69 70 70

Eq Vet Pract 2021 September; 46 (3) iii

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THE EQUINE VETERINARY PRACTITIONER

The Official Publication of the New Zealand Equine Veterinary Association EQUINE VETERINARY PRACTITIONER EDITORIAL GROUP Joe Mayhew (Editor)

2 Owen Road, Gisborne 4010 evp.editor@gmail.com

Erica Gee (Convenor)

e.k.gee@massey.ac.nz

Mobile: 027 437 3651 Home: 06 927 7263

Lucy Russell (Secretary) Lotte Cantley (Chair NZEVA Edu Comm)

Gareth Fitch

Emma Gordon

Angela Hawker

Barbara Hunter

Rabecca McKenzie

Katie McKinlay

Luca Panizzi

Tim Pearce

Trish Pearce

Lucy Holdaway (NZEVA Executive Rep.)

HOW TO SUBMIT PAPERS FOR PUBLICATION Papers for publication in The Equine Veterinary Practitioner (EVP) should be sent to the Editor in electronic form. Authors are requested to follow the usual EVP format for the front page of a paper including name(s) and address and email for contact author. The Editor must be made aware of any copyright matters and any appropriate acknowledgments.

HOW TO ADVERTISE Please direct all advertising inquiries to Tony Leggett (NZ Farm Life Media) on 027 4746 093 or tony.leggett@nzfarmlife.co.nz.

A full media kit for the publication is available on request.

DISCLAIMER The “Equine Veterinary Practitioner” is published by the NZ Equine Veterinary Association (NZEVA) a branch of the NZ Veterinary Association Incorporated (NZVA). The views expressed in the articles and letters do not necessarily represent those of the editorial committee of the NZEVA, the NZEVA executive or the NZVA, and neither NZEVA nor the editor endorses any products or services advertised. NZEVA is not the source of the information reproduced in this publication and has not independently verified the veracity of the information. It does not accept legal responsibility for the truth or accuracy of the information contained herein. Neither NZEVA nor the editor accepts any responsibility whatsoever for the contents of this publication or for any consequences that may result from the use of any information contained herein or advice given herein. The provision is intended to exclude the NZEVA, the NZVA, the editor and the staff from all liability whatsoever, including liability for negligence in the publication or reproduction of the materials set out herein.

COVER PICTURE: Geriatrics and EVP Editorial Group members (combined age considerably over 100): you are never too old to get out and have fun!

From left to right, Erica Gee on Munro (aged 19), Tim Pearce on Leo (aged 19), and Trish Peace on Mary (aged 19), enjoying a sunny autumn day at the Rangitikei Hunt Jubilee. All three mounts have previously had competitive careers, and now in their less-daring years still enjoy spending a day with their mates, supported by appropriate feeding, exercise and veterinary medicine.

Photo kindly provided by PJ Renshaw at Petapix Photography. PJ is a well-known photographer seen at many equestrian events in the lower North Island.

The EVP Editorial Group would like to invite NZEVA members contribute to the photographic art we display on the front covers, so please feel free to send any potential photos to evp.editor@gmail.com. These may be of an artistic, clinical, industry, social or humorous theme as long as they relate to Equidae.

We may even spring for a prize for best contribution each year! So get your cameras out, scrutinise your hard disks and contribute.

Eq Vet Pract 2021 September; 46 (3) v

ONLINE

Professional skills for veterinary teams Promote team and workplace effectiveness, and develop your own workplace wellness plan ALL VETERINARY VETERINARY PROFESSIONALS PROFESSIONALS ALL This course outlines theoretical and practical strategies for improving veterinary professional competencies which are essential for practice success, and team and individual wellness. The course starts with an introduction to the concept Relationship Centred Care, as a theoretical foundation for building good quality work relationships with colleagues, staff, clients, patients and with self. The following topics outline practical strategies to improve each of these relationships.

On completion of this course, participants will: » » »

» »

Improve practice wellness, productivity and promote positive relationships with clients, veterinary staff and individuals Learn how to monitor and measure team effectiveness with the goal of improving and maintaining team wellness Easily identify when a workplace conflict requires attention and learn conflict resolution techniques which address the conflict respectfully and effectively Improve self-awareness, team wellness, effectiveness and ultimately resilience and practice productivity Reduce the likelihood of excessive stress, burnout, compassion fatigue and job dissatisfaction

DATES Available from January 2021

FORMAT This course offers recorded lectures, comprehensive notes and resources.

TUTOR Michael Meehan BVSc BSc(hons) PhD

TOPICS Relationship centred care • Improving team resilience and self awareness • Veterinary team effectiveness • Communication skills that build relationships with clients • Conflict management to sustain workplace wellness • Promoting individual wellbeing and resilience

PRICE Member: Free as part of your subscription Non-member: $400 Prices are in NZD and include 15% GST.

CPD RECORDING CPD hours will reflect the time individuals devote to implementing the strategies.

Register at nzva.org.nz/professionals/edhub/business For more educational resources and courses visit www.nzva.org.nz/professionals/edhub

NZ EQUINE VETERINARY ASSOCIATION EXECUTIVE COMMITTEE Brendon Bell (President)

nzevapresident@gmail.com

027 484 6378

Katie Kindleysides (Secretary)

nzevasecretary@gmail.com

021 926 3074

Roisin McQuillan (Treasurer)

Lucy Holdaway

Melissa Sim

Andrea Ritmeester (Past President)

Grace Reed

Pip Hendron

Alex Fowler

YOUR NZEVA CONTACT PEOPLE Continuing Education

Charlotte Cantley charlotte.cantley@vets.org.nz

Dentistry

Katie Kindleysides katiekindleysides@gmail.com Glenn Beeman mountainviewequinenz@gmail.com

Endoscopy

Ivan Bridge ivan@vetassociates.co.nz

EVP Journal

Erica Gee e.k.gee@massey.ac.nz

Farriers

Open

Grooms Scheme

Ivan Bridge ivan@vetassociates.co.nz

Insurance

Brendon Bell brendonb@vetsouth.co.nz

Medication

Andrew Grierson andrew@aucklandvets.co.nz

Website

Open

Young Members

Pip Hendron pip.hendron@swvets.co.nz

LIAISON WITH NZ Equine Health Association

Ivan Bridge ivan@vetassociates.co.nz

NZ Equine Research Foundation

Tim Pierce timpearce@srvs.co.nz

Racing Authorities

Andrew Grierson andrew@aucklandvetcentre.com

Sport Horse

Celia Grant vet@helpmyhorse.co.nz

Eq Vet Pract 2021 September; 46 (3) vii

2 Eq Vet Pract 2021, September; 46 (3)

NZEVA PRESIDENT REPORT - SEPTEMBER 2021 Brendon Bell, NZEVA President nzevapresident@gmail.com

This is my first EVA President Report, and I can already see there are big boots to fill here. I am still learning the ropes and am grateful to have immediate past president Andrea Ritmeester to help me. It’s been a quiet start for me compared to the turmoil of 2020/21, which has been appreciated.

We also have an EVA Executive Committee with some old and some new faces. Secretary is Katie Kindleysides now in Canterbury and treasurer remains Roisin McQuillan of Matamata. The rest of the executive is Lucy Holdaway in Cambridge, Alex Fowler in Auckland, Melissa Sim in Pukekohe, Grace Reed here in Invercargill and Pip Hendron in Masterton: see page 5 for mini profiles of your EVA Executive members It was great to be at the recent conference in Christchurch in June - one of the few and maybe the only current, faceto-face, national veterinary conferences in the world. We hit a small speed bump with the Wellington NZVA staff being recalled due to the CoViD-19 scare, but apart from this the conference went extremely smoothly. Keynote speakers Ben Sykes and Katharyn Mitchell provided some easy to understand and stimulating discussions. Thanks must go to

the tireless efforts of Alanna Zantingh and her committee for the great organisation.

As an organisation we face a new way of doing business and a new financial structure. This comes by way of the NZVA’s newly introduced all-inclusive membership model. There are merits to this new model and although many of us still have some misgivings we are looking to embrace change: the only constant.

At the time of writing the Entry Level Equine Dental Course is about to start in Christchurch. The increasing number of older pleasure horses many of us are treating coupled with recent changes to Animal Welfare legislation has seen an increase in equine dental work for many of us. This course will be a great grounding for practitioners looking to get involved in this burgeoning field.

The days are already getting longer, so soon enough it will be spring and breeding time. Enjoy the quiet while it lasts.

Kind regards, Brendon Bell nzevapresident@gmail.com

Khajeh A et al. Effectiveness of nuchal ligament autograft in the healing of an experimental superficial digital flexor tendon defect in equid. Vet Res Forum. 2021; 12(1): 53-61. DOI 10.30466/vrf.2019.97919.2330 A 3x1.5 cm segment of the funicular part of the nuchal ligament [NL] was excised and implanted into a full thickness defect created in the left fore superficial digital flexor (SDF) tendon in eight healthy donkeys. No weight-bearing lameness or clinical changes observed in the necks were detected following harvesting and implantation. Mild to moderate adhesions were detected in the dorsal surface of the SDF tendon. There was no significant difference in the echogenicity and fibre alignment on days 90 and 120 after surgery.

Treatment significantly amplified the collagen diameter and enhanced collagen fibril diameter and density compared to the right SDF tendon. The transplanted tissue was mostly in the remodelling or maturation phase by day 120 postoperatively. It appears that the nuchal ligament is biocompatible and almost biodegradable and is effective in tendon healing without metaplasia or tissue rejection.

Hedia M et al. Hemodynamic changes in cytokines, chemokines, acute phase proteins and prostaglandins in mares with subclinical endometritis. Theriogenol. 2021; 171: 38-43. DOI 10.1016/j.theriogenology.2021.05.011 Forty-nine mixed-breed mares of known reproductive history were allocated into healthy (control), chronic endometritis (ChE), and subacute suppurative endometritis (SSE) Groups [n = 12, 26 and 11 mares, respectively]. Serum concentrations of IL-6, IL-8 and IL-10 and plasma PGF-2α concentrations were increased (P < 0.01) in mares with SSE compared to healthy mares. Serum concentrations of IL-6 (P < 0.05) and IL-10 (P < 0.05) were elevated in the ChE group compared to the healthy group whereas SAA (P < 0.01) and PGE-2 (P < 0.05) were higher in healthy mares compared to ChE and SSE mares. However, serum concentrations of IL-1β and TNF-α were not significantly different among groups. Serum IL-6/IL-10 and IL-6/TNF-α concentrations, as well as plasma PGE-2/PGF-2α ratio, may yield novel diagnostic markers for chronic subclinical endometritis.

Eq Vet Pract 2021 September; 46 (3) 3

MINUTES NZEVA ANNUAL GENERAL MEETING 5 PM, THURSDAY 24TH JUNE 2021

1. Welcome 2. Present Andrea Ritmeester, Brendon Bell, Alex Leander, Roisin McQuillan, Alanna Zantingh, Leigh De Clifford, Katie Kindleysides, Joe Mayhew, Tarryn Walker, Caitlyn Sloan, Hannah Burrows, Michelle Badke, Kevin Miers, Babiche Heil, Ian Heyns, Bill Bishop, Paul Fraser, Brian O’Shea, Amarins Sijsling, Caroline Thompson, Grace Reed, Alan Julian, Mike Hills, Jordana De La Varis, Chelsea McKenzie, Alex Fowler, Andrew Bailey, Angela Hawker, Rabecca McKenzie, Lucy Russell, Julie Bell, Jason Lowe, Jess Slattery, Greg Quinn, Celia Grant, Nicola McDonald, Michael Hurley, Michael Fitzgerald, Dave Kruger, Warren Mitchell, Charlotte Cantley, Michelle Logan, Chris Riley, Sally Newall, Orla Roan, Frederic Pauwels, Gary Winchcombe, Patricia Pearce, Elizabeth Thompson, Amy Ardern Apologies: Neil Houston, Ivan Bridge, Bill Ewen, Barry Drayton, Tim Pearce, Murray Brightwell, Sam Taylor, Andrew Grierson, Petra Hazlitt, Jenny Sonis, Dave Keenan 3. Obituaries Past members Dr Jim Mortimer, Whangarei, Dr Pat Brooks, Oamaru, and Prof Twink Allen, Newmarket, UK, were remembered with a moment of silence.

4. Visitors We welcomed Dr Grant MacCulloch, President NZVA, Kevin Anderson, Financial officer NZVA, and Dr Holly Lewis, President Equine Vets Australia 5. Confirmation of Minutes of the 2020 Annual General Meeting Motion by Andrea Ritmeester to accept the minutes, seconded by Alanna Zantingh 6. President report Motion by Andrea Ritmeester to accept the President report, seconded by Joe Mayhew 7. Financial report i. Adoption of annual accounts for year ended 31 December 2020 Roisin McQuillan presented the 2020 financial report Motion by Roisin McQuillan to accept the financial report, seconded by Celia Grant ii. NZVA letter regarding financial autonomy Kevin Anderson Chief Financial Officer NZVA attended the meeting on Zoom to discuss the above letter and answer questions from the meeting. NZEVA money will be held in a specified fund within NZVA accounts but will still be under NZEVA jurisdiction and can only be used for NZEVA activities. Operating expenses for equine branch, as applied for and specified in the yearly budget, will be covered by NZVA funds.

4 Eq Vet Pract 2021, September; 46 (3)

Q Trish Pearce: “What is the reason for this change, is there a gain in efficiency?”

KA: Motivation to reduce the number of accounts, by centralising the money it can be invested for better returns. Will allow for better cash flow within NZVA. Any interest would be credited back to NZEVA. Q Fred Pauwels: “Will money always be available for NZEVA use or locked in the investment fund?”

KA: NZEVA money may be temporarily unavailable if invested, but if requested then NZVA money would be used in the meantime.

Q Paul Fraser: “If anyone would like to donate to NZEVA will it go into the equine specified account?”

KA: Yes, or another fund can be created, like the McLaren and Jonathan Hope Funds as example.

Q Roisin: “So if the expense has not been mentioned in the budget, will we have to eat into the NZEVA reserve funds?

KA: If NZEVA wants to spend on something not in the budget NZVA will have to approve it.

Motion by Andrea Ritmeester to sign the NZVA letter, seconded by Chris Riley.

Vote passed unanimously.

8. Sub Committee reports Motion by Andrea Ritmeester to accept subcommittee reports, seconded Liz Thompson 9. Constitutional changes Election of 4 new members of Executive Committee Alex Leander, Leigh DeClifford, Alanna Zantingh and Mike Fitzgerald retired from the committee, and we welcomed Alex Fowler (Vet Associates, Karaka), Grace Reed (Vet South, Invercargill), Pip Hendron (South Wairarapa Vets) and Melissa Sim (Franklin Vets) as new committee members.

10. General business i. NZTR horse mortality review.

NZTR doing a lot of work around welfare, social licence and traceability. Owner and breeder responsibilities, network of registered/accredited TB re-training facilities.

Setting up a panel to investigate all equine racetrack fatalities. ii. Catastrophic injury project.

Raceday vets to retrieve injured and contralateral lower limbs from fatally injured horses, to be shipped to Massey University for analysis. Kits for transport of limbs are in equine ambulances. iii. Matters arising 11. Venue for 2022 Annual General Meeting June 22-24, Claudlands, Hamilton

YOUR NZEVA EXECUTIVE

The recent NZEVA AGM saw a changing of the flag for some members of the Executive Committee. Most notable is our new president Brendan Bell who will also feature in this issues Colleague Interview on page 19. As the committee structure has moved away from being regionally based, we thought it would be a good idea to introduce everyone.

Our New President Brendon Bell being congratulated by our beflowered Past President Andrea Ritmeester – with smiles.

Brendan Bell has practiced as an equine vet in England, the USA and Auckland before settling in Invercargill where he has been for the last 25 years. Brendan has been on the VPIS Board for 20 years and has enjoyed the challenges this has presented. Since his small practice became part of a larger group practice in 2015, he no longer must run things all on his own. In addition, his family has grown up and left home leaving him a little more time to do something else; bring on the EVA presidency! Brendan’s approach to the president’s role will be continuing the good work that’s been done before him and hopefully being able keep our profession going in the right direction.

Andrea Ritmeester graduated from Massey in 1991. She took a job in mixed large animal practice for two years at Veterinary Associates Equine and Farm before moving to USA to complete a 3-year Residency programme in Large Animal Surgery at Purdue University, Indiana. She stayed on as Instructor at Purdue University for another year while finishing a Master of Science degree. Andrea returned to NZ in 1997 to resume work at Veterinary Associates as Practice

Surgeon. She passed the ACVS Diplomat examinations in 1998 to become the only board-qualified large animal surgeon in private practice in NZ at that time and was granted Specialist status in Equine Surgery by the VCNZ in 2000.

Andrea continued to work at Veterinary Associates until early 2010, when a lifestyle change saw her move to the Waikato with husband Mark and daughter Jessica. She joined the Matamata Veterinary Services Equine team in March 2010 and is currently performing all types of surgery with a special interest in arthroscopy and abdominal surgery. Andrea is the immediate past president of the NZEVA. Roisin Mc Quillan graduated from Dublin 2004 and spent a couple of years enjoying mixed practice in county Cork. Her interest in horses got the better of her and she ventured to the Southern Hemisphere, initially scanning mares in Australia before moving to New Zealand where a month’s visit turned into 13 years! Roisin currently works at Matamata Veterinary Services as one of the ambulatory vets which provides her with a great variety of cases. Outside of work Roisin enjoys trail running, getting outdoors with her dogs and socialising. For the past three years she has been the NZEVA Treasurer which has involved compiling budgets, dealing with invoices, and getting to know and work with some great people! Roisin is staying on the committee for one more year to ensure a smooth hand over of the treasury role.

Katie Kindleysides is originally from the north of England. She graduated from the University of Liverpool in 2008 and started her career in Yorkshire before moving to South Auckland in 2011 to a primarily equine ambulatory role. In 2020 she headed to the broodmare paddock and with her Kiwi husband they welcomed a wee boy into their lives. A change of jobs for the husband saw the family move to Canterbury in April this Eq Vet Pract 2021 September; 46 (3) 5

year where they enjoy switching beach views for snowy mountain tops and are excited about making a few visits to the ski fields this year. Although out of practice currently, Katie remains involved in equine dentistry via her commitments to the dental sub-committee. Katie is the new secretary on the EVA committee.

Melissa Sim is originally from Singapore but has also lived in Thailand for four years and the USA for nine years. She did her bachelors in equine science at UC Davis and then got her DVM at Purdue University in 2016. This was followed by an internship at the Equine Clinic at Oakencroft, NY, before moving to New Zealand in 2017 where she works at Franklin Vets. Sports medicine and ophthalmology are her absolute favourite parts of equine practice. She has obtained her veterinary acupuncture certification (CuraCore) and is currently working towards her sport horse medicine and rehabilitation certification (IVMI) thanks to the NZERF Jonathan Hope Scholarship. Outside of work Melissa enjoys circus, hiking, and spending time with her mare.

Grace Reed has Dunedin as her hometown. She graduated from Massey University in 2018 and started work at VetSouth Invercargill in January 2018.

She has worked predominantly in equine practice since graduation and enjoys a varied caseload in both first opinion and referral practice.

Reproduction, internal medicine and dentistry are areas of particular interest. Outside of work Grace enjoys travelling, pottering around her lifestyle block and is also a Group Fitness Instructor.

Pip Hendron is originally from Dublin and graduated from the Royal Veterinary College in 2011. Following an internship in Ireland she went on to do a stint as a resident vet for Darley in Newmarket,

6 Eq Vet Pract 2021, September; 46 (3)

UK. Overseas then beckoned and Pip headed down under and worked several southern hemisphere breeding seasons in Australia and New Zealand. She returned to Ireland to a predominantly thoroughbred practice on the Curragh in Kildare doing a mixture of racetrack, breeding and internal medicine hospital work. Having married a Kiwi, she returned to New Zealand and they have lived in the beautiful Wairarapa for the last few years. Pip likes tricky lameness work ups along with all aspects of mare reproduction medicine. Outside of work she enjoys trail running in the mountains with her spaniel and most other outdoor pursuits that can be done with a 1-yearold in tow.

Lucy Holdaway calls Waiheke Island home. Unfortunately, there is only a small population of equids over there now, so living the dream on Waiheke is not an option and she simply has to enjoy the fruits (i.e. grapes) of Waiheke in the weekends. She graduated from Massey in 2011 and went on to work in a mixed practice in Tokoroa. In 2018 she moved up the road to Cambridge Equine where she now does sole equine practice. Her clinical focus is dentistry, but she also dabbles in anaesthesia, hospital care and general ambulatory work. When not at work, Lucy is found in the garden, at the beach, on the lake skiing or at some vineyard expanding her cellar.

Alex Fowler grew up in Christchurch and discovered a love for working with animals while spending summers on his uncle’s sheep and beef farm in the McKenzie country, leading him to Massey University to pursue a BVSc. Following graduation in 2015, he took on a rotational equine internship at Pioneer Equine Hospital in the Central Valley of Northern California, then moved east to undertake a residency in equine surgery at North Carolina State University. Alex passed his ACVS boards in 2020 and has since been working as a surgeon at Veterinary Associates Equine in Karaka, Auckland. In his spare time, he enjoys escaping to the South Island for skiing and relaxing with family and friends at Lake Tekapo.

EDITORIAL BLOG FOR SEPTEMBER 2021

It was very evident at our NZEVA Conference at Wigram Museum that we had suffered a deficiency of opportunities to mingle and link with colleagues due to that dastard SARSCoV-2 and its disease CoViD-19. All sessions, the exhibition hall, the Dinner - even the AGM! - were very well attended and the presentations all were top-class; a credit to NZEVA and NZVA organisers as well.

As your EVP Editorial Group receives more submitted items, we may try to have themes for each issue and this time you can update on some current thoughts on handling distal limb injuries, particularly where synovial penetration is suspected [see pages 9, 15, 29 & 49].

Holy mackerel! I was dumfoundered by an editorial opinion in the British Medical Journal quoting several systematic reviews that determined that ~20% of trial results published in renowned journals cannot be trusted; the trials either did not happen as reported or the results were fabricated.

Professor Ben Mol, Monash University, concluded that ~20% of trials are false, with very few of these papers being retracted.

John Carlisle analysed 526 trials reported in the journal Anaesthesia that 14% had false data, and 8% he categorised as fatally flawed, classified as - I love this - zombie trials.

It appears there are not only ‘bad-apples’ but ‘bad-barrels’.

When epidemiologist John Ioannidis further analysed the trial data he found clustering of proportion of false trials by country of origin of the authors. There were 7/7 (100%) zombie trials/ total papers from Egypt, 3/4 from Iran, 7/13 from India, 22/48 from China, 2/5 from Turkey, 5/20 from South Korea, and 2/11 from Japan – FOR ONE YEAR! ‘It may be time to move from assuming that research has been honestly conducted and reported, to assuming that health research is fraudulent until proven otherwise’.

Richard Smith, ex-Editor, BMJ. Following publication of an article Consolidation in the Veterinary Profession [Baralon & Frayssinet, 2020], Jonathan Pycock drew conclusions reported in Veterinary Practice that firstly corporate groups will often pay a premium to purchase practices where they anticipate that a rapid and sustainable profit can be obtained, and that independently owned veterinary practices can compete with corporate groups on most levels in terms of services offered. Jonathan then

worked with the Equine Veterinary Group [EVG] to survey its members this year on the effects of corporate ownership on equine practice. Their take-home messages were that this is a topic which divides the profession, but those who have been through a change to corporate ownership seem to have viewed it as a positive change. However, there is a perceived reduction in satisfaction for one third of clients, and increased treatment costs reported by almost half of respondents. Work/ life balance tended to improve. There was an even split between increased and decreased job satisfaction. Salary was more likely better under corporate ownership.

Colleagues who are or plan to develop an effective Internship Program will be interested to follow the approach that our colleagues in BEVA are taking in their Approved Internship Standards Scheme. Also, it is accepted that these junior positions can sometimes be poorly structured, and used more as cheap labour, rather than acting as a positive and inspirational introduction to a career as an equine vet. Thus, BEVA has been working on developing a toolkit for new and recent graduates [for BEVA members], alongside a helpful video repository on advice for new graduates on What I wish I’d known. Finally, a provisional document on List of Skills for Approved Internships is being developed for Internships in Hospital, Reproduction, and Ambulatory practice.

We are all aware of zoonotic diseases, especially emerging viral endemics and pandemics, but such pathogens can and do jump species to become more or less pathogenic in a new host species. A recent example has been seen in Central Kentucky this year when there was an increase in cases of severe watery to haemorrhagic diarrhoea in neonatal foals from which the expected cause, equine rotavirus group A (ERVA) virus, could not be detected. A novel equine rotavirus group B (ERVB) was found in faeces from the affected foals in the absence of any other known pathogens. The viral sequences all had >96% identity with group B rotaviruses previously found in ruminants. This and other findings suggest that the foal ERVB originating from ruminants was the likely cause of the outbreaks of neonatal foal diarrhoea in the 2021 foaling season. Why is this? Maybe we have been ignorant of ERVB as a cause of foal diarrhoea, or maybe with pressure from intensification in ruminant and equine industries there has been an opportunity for a mutant rotavirus strain to jump ship and find a new host.

Having looked at many horses with funny ways of moving and having stumbled through several long running races with subsequent delayed onset muscle soreness or DOMS and Eq Vet Pract 2021 September; 46 (3) 7

other accompanying musculotendinous injuries, I am rather of the opinion that we underdiagnose muscle damage as a cause of lameness in exercising horses, compared to the rather high incidence of muscle injury in human athletes.

These injuries are not too well documented, so I enjoyed the short article from Canad Vet J on Muscle tears as a primary cause of lameness in horses along with the brief review of literature. Well, if indeed horses suffer DOMS etc. another meta-analysis from Brazil seems to indicate that in human sports many physical interventions are statistically proven as effective therapy for DOMS, as well as crocodile blood as reported from Thailand. Now after reading the above sceptical reports on zombie trials, would I dare suggest that these papers might be a tad over-rated?

Finally, it is enough to make any editor cringe on considering the experimental design of the study reported in BMC Vet Res, 2021; 17(1): 256 [Leech therapy (Hirudo medicinalis) attenuates testicular damages induced by testicular ischemia/ reperfusion in an animal model]. It is nice to know that when one suffers such a vascular event, the lowly leech can be one’s saviour. Ho-hum.

Kia kaha, nä Joe evp.editor@gmail.com

Put this link https://www.worldcat.org/ where you keep reference material because WorldCat can help you find reference material in any library, world-wide, and find the nearest location that may assist in getting borrowing rights or full access.

The Illustrated Horse Doctor Ninth Edition. 1876 Edward Mayhew

UPDATE ON RACEHORSE WELFARE NEVER, EVER, EVER GIVE UP! In 2012 the then South Island based executive of the NZEVA envisioned establishing a fleet of purpose-built equine ambulances for use throughout New Zealand to protect the wellbeing of horses competing at race meetings and equestrian events, to assist injured horses, and to promote animal welfare standards.

When the NZEVA executive moved on to Central Districts work on the project was continued in the south. We met with representatives from New Zealand Thoroughbred Racing, Harness Racing New Zealand, and the Racing Integrity Unit. They supported the idea and joined us as founding trustees of the of the NZ Horse Ambulance Trust in 2016 [see Gillespie, EVP 2020; 44(4): 44 for full account of progress].

Funds of more than $1,500,000 were raised, primarily from the racing industry, community trusts and the equine and veterinary community at large. There are now eight mobile units in operation, which are based in Auckland, Waikato, Manawatu, Canterbury, and Otago/Southland. An ambulance is now on track at every TB race meeting in NZ, most TB trials, and at all principal HRNZ race meetings. A further two ambulances will complete the fleet ensuring presence at all TB and SB meetings, benefitting also many other equestrian sporting functions such as eventing and show jumping.

The horse ambulances, designed and custom-built here in NZ, are a world class asset and have helped highlight the importance of equine welfare in our community. NZEVA should rightly feel

8 Eq Vet Pract 2021, September; 46 (3)

https://clipground.com/pics/getsecond

proud of its role in the establishment of the NZ Horse Ambulance Trust. This proactive initiative has stimulated an awareness of the importance of equine welfare. It has resulted in growing appreciation by the public at large that concrete steps are being taken to ensure that the welfare of horse is paramount.

Most significantly, the success of the Equine Ambulance program has recently been further acknowledged by TB Racing NZ and Harness Racing NZ by both organisations recently announcing funding initiatives for the new racing season. TB Racing NZ has announced that a 1% levy on stakes won will be used to fund welfare activities. Harness racing NZ has resolved to allot 1% of its total funds received for welfare expenditure. Some of this additional funding will ensure that ongoing operational, maintenance and replacement costs for the equine ambulance units will largely be met. Other welfare initiatives budgeted for include increased expenditure on equine research, traceability, rehoming and re-education of horses retiring from racing.

This, after almost 10 years of work, is a really gratifying result for both the veterinary profession and the NZHAT. Veterinarians attending racing and equestrian events now have a facility available to them to carry out their job in a safe and professional manner, in what are often extremely difficult circumstances.

Bill Bishop Peter Gillespie 23 August 2021

COMMISSIONED REVIEW ARTICLE* ANALGESIA FOR THE EQUINE TRAUMA PATIENT – PART 1: WHAT IS THE EVIDENCE FOR WHAT WE DO, AND CAN WE DO BETTER? Gayle Hallowell University of Nottingham, UK. Gayle.D.Hallowell@nottingham.ac.uk

OVERVIEW The aims of this article are to discuss the evidence and controversies regarding use of analgesia in our equine trauma patients. I will discuss some of the challenges regarding provision and knowledge relating to analgesia in these cases and limitations compared with human and small animal patients. The article will try and apply these principles to some of the author’s cases, to be presented in Part 2 in the next issue of EVP.

INTRODUCTION Analgesia is an important aspect of management of the equine patient that presents with trauma. However, in equine practice, we may not always embrace all the drugs available to us in our armoury due to lack of efficacy data or concerns of side effects, which may not be of serious enough consequence or have low likely prevalence to not justify use of those drugs.

The horse, as a prey species, is more challenging to evaluate for pain as it is designed evolutionarily to mask pain to prevent it being a target for predators. There has been a lot of work on pain assessment for the horse with acute abdominal pain, which have resulted in the development of some excellent pain scores at CSU Comfort Scales. However, unlike in humans and small animals, we do not have a pain scale that can be applied to multiple situations (Barr et al. 2013; Murrell et al.

2008). This is especially relevant to the equine trauma patient, where cases are often individual with a multitude of injuries affecting one or more body systems. The types of cases seen in equine practice are wide-ranging and would include wounds, often of unknown cause, flipping over backwards, kicks received by other horses, rotational falls over fences, falls on the road, head trauma, ophthalmic trauma and very occasionally road traffic accidents.

It has been widely accepted that a multimodal approach to analgesia is likely to result in improved efficacy and reduce the likelihood that acute pain (defined as any painful response that has been present for <14-21 days depending on the source

Image: Horse & Hound

that you use) will become chronic via the mechanism of ‘windup’. Although it is often described that use of multimodal analgesia allows us to lower the doses of combined drugs, (thus reducing potential side effects), this is something that I believe is rarely done and is usually not necessary.

In equine analgesia research, historically there has been a lot of focus considering types of drugs for different types of pain – somatic or skeletal and visceral i.e. aimed at the equine patient with abdominal pain. And the models used for these studies, although good, do not always reflect the type of complex pain encountered in clinical patients, particularly when we are considering the equine trauma patient. This separation has not been emphasised in other species as much and becomes less relevant in trauma patients where both visceral and somatic pain may be present.

ANALGESIC APPROACH My approach to the equine trauma patient always involves assessment of the level of pain based on clinical appearance, but also some assumption of the likely level of pain based on findings in other species and believe it is important to always ‘give them the benefit of the doubt’. I absolutely do not advocate ‘letting them have some degree of pain to reduce them using a painful part’. The only time I may be more cautious with provision of analgesia is if there is any doubt regarding assessment of a potentially infected synovial structure that could result in inappropriate treatment in the short term, where surgery is an option. I try to obtain videos of animals after initial triage and prior to sedation and administration of analgesia. Analgesia can then be provided in a stepwise manner and appearance of the horse compared every 4-8 hours with initial appearance at admission or first examination. The next step is to then consider classes of analgesic drug available and whether they are appropriate in that case. Classes will include sodium channel blockers (either locally or systemically), non-steroidal anti-inflammatory drugs (NSAIDs), opioids, NMDA receptor antagonists (ketamine, tiletamine, amantadine), alpha-2 agonists and

* These commissioned articles are made possible by a generous grant made to EVP by Jonathan Hope.

Eq Vet Pract 2021 September; 46 (3) 9

then the less main-stream compounds such as paracetamol, gabapentin and tramadol. In addition, it is worth considering any ancillary management strategies that might improve comfort including anti-spasmodic (N-butyl scopolamine) and anti-inflammatory drugs including glucocorticosteroids, limb stabilisation, removal from bright or UV light, use of cold and/or heat, acupuncture and laser therapy. I then consider most appropriate routes of drug administration and whether multiple routes would be beneficial and potentially reduce any untoward side effects. These would include, but not be limited to topical, parenteral (oral, subcutaneous, intramuscular, intravenous), regional (perineural analgesia, intra-synovial), epidural or spinal analgesia.

EVIDENCE FOR USE OF ANALGESIC DRUGS IN THE EQUINE TRAUMA PATIENT There is little to no evidence available for the use of analgesic agents in equine trauma patients compared with humans and to some extent small animals. The aims of this article are to discuss some of the controversies in provision and type of provision of analgesia and consideration of some other routes of administration more commonly and routinely used in other species.

NSAIDS These drugs are the mainstay of analgesia in equine practice, which contrasts with human patients and to some extent small animal patients. This difference likely relates to concerns of renal dysfunction seen because of administration to hypovolaemic patients, which is deemed rare in adult equine patients and may not be seen with the types of trauma encountered in equine practice. However, right dorsal colitis is a condition seen relatively frequently in the horse and can result in mild to moderate signs, which include diarrhoea, signs of abdominal pain, weight loss and hypoalbumnaemia.

These signs are attributed to the inhibition of protective prostaglandins that stimulate mucus production and maintain blood flow to the colon (Robert 1979).

It is well established that PGE2 lowers the threshold at which nociceptors fire, thus potentiating the triggers for pain (Vane 1971). With inflammation, primarily PGE2 (and some other prostaglandins) are generated in peripheral nerves resulting in hyperalgesia (Ferreira 1972) and produced centrally as NSAID’s have been shown to reduce hyperalgesia at this location (Samad et al. 2001). NSAID’s are also thought to act centrally via endogenous opioid peptide mediators and inhibition of serotonin and other excitation amino acids (Cashman 2012)).

Over the last two decades, there has been a lot of focus on the cyclo-oxygenase selectivity of NSAIDs. It was initially proposed that COX-1 activity was constitutive (MengleGaw and Schwarz 2002), whereas COX-2 activity primarily associated with inflammation. Further work has elucidated that COX-2 also has normal housekeeping roles. Other factors to consider are that COX-2 selectivity is species specific (Knych 2017), with meloxicam and oral firocoxib being the 10 Eq Vet Pract 2021, September; 46 (3)

most COX-2 selective in the horse (Knych 2017). However, safety concerns in human patients regarding cardiovascular signs [see The cardiovascular safety of non-steroidal antiinflammatory drugs.] should make us prudent in using them until more widespread data is available. In addition, the effects of firocoxib are reportedly similar to low dose phenylbutazone in a laminitis model, which supports clinicians’ observations that this drug is not as potent an analgesic as some other NSAID’s available to us and that are licensed in the horse.

OPIOIDS Opioids, and more specifically pure mu-agonists are the mainstay of analgesia in human (Barr et al. 2013; Simon et al. 2005) and small animal trauma patients. Recently the UK military have switched from morphine auto-injectors to fentanyl lollipops for human personnel suffering moderate to severe pain that are not in respiratory distress and do not have haemorrhagic shock (Butler et al. 2014). This switch is to minimise respiratory depression as well as other adverse effects seen with morphine (Butler et al. 2014).

There is over 80 years of data available on the use of opioids in the horse (Bennett et al. 2002). Many clinicians are comfortable using low dose butorphanol (0.01mg/kg) as part of sedative and premedication protocols and at higher doses for analgesia (0.1mg/kg). More recently buprenorphine has gained a license for use in equine patients in a variety of countries. These agonist-antagonist or partial mu-agonist drugs would generally not be used in moderately to severely painful small animal or human patients. The use of pure mu-agonists is either very popular or unpopular with equine clinicians. There is a good body evidence available on the use of morphine and pethidine (which is licensed in the UK for management of spasmodic colic), but also data on fentanyl, oxymorphone, hydromorphone, remifentanil, and methadone. Reported side effects, which include excitation (which is extremely rare in the painful animal), box-walking and reduced gastro-intestinal motility that can result in pelvic flexure impactions. I believe use of mu-agonists in equine trauma patients should be further utilised, both systemically, but also epidurally and intra-synovially, where opioid receptors are not only present, but also up-regulated in disease.

PARACETAMOL The mechanism of action of paracetamol is not completely understood but is thought to involve inhibition of cyclooxygenase receptors centrally and its active metabolites act upon cannabinoid receptors. There have been some studies human patients undergoing routine surgery and in emergency and trauma situations that have demonstrated that paracetamol was equally as efficacious as morphine or combined morphine and paracetamol was better than morphine alone (Khan et al. 2007; Craig et al. 2012; Serinken et al. 2012). Although this drug has been associated with liver dysfunction in people and dogs, this has not been reported or identified in horses (Hallowell, Unpublished data). Anecdotal evidence suggests that this drug is efficacious alone and in combination with conventional NSAID’s and other drugs in

a multi-modal analgesia protocol in horses. Further work is needed to evaluate this drug in horses for acute and chronic pain, as it may offer an excellent and financially favourable analgesic in the horse, particularly where opioids are contraindicated.

GABAPENTINOIDS Gabapentin and pregabalin are structurally related but are not the same drug. In humans, pregabalin is more potent, is absorbed faster and has greater oral bioavailability.

Although these drugs are primarily known for their use in the management of neuropathic pain, gabapentin has been used for acute surgical pain with some success (Chang et al. 2014) and may be an option for the management of pain associated with certain types of trauma in the horse.

human trauma medicine, especially for injuries to the chest (Simon et al. 2005) are not commonly performed in horses, despite described techniques (Natalini 2010). And use of local anaesthetics, alpha-2 agonists and hyperbaric opioids, is not described for the management of thoracic pain in the horse.

If ‘high’ epidurals are used, for conditions such as severe pain associated with forelimb and hindlimb laminitis, it is ESSENTIAL that local anaesthetics and alpha-2 agonists are NOT used as these would block neural supply to the thorax which would result in respiratory paralysis.

KETAMINE This drug is widely used in human trauma patients and is recommended for the management of battlefield casualties that have moderate to severe pain concurrently associated with haemorrhagic shock or respiratory distress or at risk of developing these signs. It is also used alongside opioids to provide additional analgesia (Butler et al. 2014). Recent studies have suggested that this drug does not increase intracranial or intraocular pressures (Butler et al. 2014) and therefore traumatic brain injury and ophthalmic trauma should not preclude its use. Ketamine and other drugs in this class also have the advantage of inducing bronchodilation which may be of benefit in patients with thoracic trauma and has minimal cardiorespiratory depression (Zhou et al.). Ketamine ‘stun’ and ketamine in CRI’s with other drugs have become widely used in the management of acute equine pain, but perhaps could be utilised more in this group of patients. The author has used ‘stun doses’ alongside other agents in equine trauma patients following falls when competing cross country and when stuck in ditches.

Amantadine, an oral NMDA receptor antagonist, has a much longer half-life meaning dosing regimens of once to twice per day are appropriate in humans and dogs. There has been very minimal work undertaken evaluating the PK-PD in horses as an analgesic agent, although it was investigated as an anti-viral agent in the 1990’s (Rees et al. 1997), but doses of 20mg/kg three times daily may be appropriate. Oral bioavailability was average and variable, as is often the case with oral drugs used in the horse.

ROUTES OF ADMINISTRATION OF ANALGESIC AGENTS In equine practice and for the management of acute pain, the use of a variety of parenteral analgesic agents including continuous rate infusions and intravenous regional anaesthesia are relatively widespread. Epidural anaesthesia as a single dose or more frequently via epidural catheter infusions (Figure 1) is widely used for desensitisation of the anus, rectum, perineum, vulva, vagina, urethra, and bladder.

However, subarachnoid analgesia, used relatively widely in

Figure 1. Placement of an epidural catheter for repeated instillation of medications for a case of severe laminitis.

The advantages of subarachnoid over epidural administration include direct administration of drug into the intrathecal space where the opioid receptors are present rather than relying on drug penetration of the dura. Drug administration into the epidural space can also result in slow uptake into the intrathecal space due to deposition into the fat of the dura mater and systemic absorption. However, even more care is required to prevent trauma and contamination in this area (Natalini 2010). Interestingly in human medicine, lower volumes are used for intra-thecal versus epidural administration, but this is not reflected in the equine literature.

Another route of administration explored in the battlefield trauma setting has been intranasal administration of drugs when gaining intravenous access has proved challenging.

This could be considered in certain circumstances such as with horses stuck in wells. Drugs evaluated in other species including humans and dogs include fentanyl, diamorphine and ketamine (Shrestha et al. 2016).

SUMMARY In summary, there are more analgesic drugs and potentially routes of administration that could be explored in the equine trauma patient that may beyond what we currently do.

Clinical Case Examples of the use of multimodal analgesia in trauma patients will be presented in the second part of this paper by Prof Gayle Hallowell in the next issue of EVP.

Eq Vet Pract 2021 September; 46 (3) 11

REFERENCES

Barr J, Fraser GL, Puntillo K et al. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 41(1); 263-306.

Murrell JC, Psatha EP, Scott M et al. (2008). Application of a modified form of the Glasgow pain scale in a veterinary teaching centre in the Netherlands. Vet Rec; 162: 403-408.

Natalini CC. (2010). Spinal anesthetics and analgesics in the horse. Vet Clin N Am Equine Pract; 26: 551-564.

Bennett RC and Steffey EP (2002). Use of opioids for pain and anesthetic management in horses. Vet Clin North Am: Equine Pract; 18: 47–60.

Rees WA, Harkins JD, Woods WE et al. (1997). Amantadine and equine influenza: pharmacology, pharmacokinetics and neurological effects in the horse. Eq vet J. 29(2); 104-110.

Butler F, Kotwal S, Buckenmaier C et al. (2014). A TripleOption Analgesia Plan for Tactical Combat Casualty Care: TCCC Guidelines Change 13-04. J Spec Operat Med; 14(1): 13-25.

Robert A. (1979). Cytoprotection by porstaglandins.

Gastroenterol; 77(4 Pt1): 761-767.

Cashman JN. (2012). The mechanisms of action of NSAIDs in analgesia. Drugs; 52(5):13–23.

Samad TA, Moore KA, Sapirsterin A et al. (2001). Interleukin1beta-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature; 410(6827): 471–5.

Chang CY, Chaitanya K, Challa et al. (2014). Gabapentin in Acute Postoperative Pain Management. BioMed Res Internat; Article ID 631756, 7 pp. https://doi.org/10.1155/2014/631756.

Serinken M, Eken C, Turkcuer I et al. (2012). Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial. Emerg Med J; 29(11): 1-4.

Craig M, Jeavons R, Propert J, Benger J (2012). Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emerg Med J; 29(1): 37-39.

Shrestha R, Pant S, Shrestha A et al. (2016) Intranasal ketamine for the treatment of patients with acute pain in the emergency department. World J Emerg Med; 7(1): 19-24.

Ferreira SH. (1972) Prostaglandins, aspirin-like drugs and hyperalgesia. Nat New Biol; 240(102):200–3.

Simon BJ, Cushman J, Barraco R. et al. (2005) Pain Management Guidelines for Blunt Thoracic Trauma. J Trauma; 59:1256–1267.

Khan ZU, Iqbal J, Saleh H et al. (2007). Intravenous paracetamol is as effective as morphine in knee arthroscopic day surgery procedures. Pak J Med Sci; 23(6); 851-853.

Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for the aspirin-like drugs. Nat New Biol 1971; 231(25): 232–5.

Knych HK. (2017). Non-steroidal anti-inflammatory drug use in horses. Vet Clin North Am Eq Pract; 33: 1-15.

Zhou Y-L, Liu W-J, Wang C-Y, et al. Cardiovascular effects of repeated subanaesthetic ketamine infusion in depression. J Psychopharm. 2021;35(2):159-167.

Mengle-Gaw LJ, Schwartz B.D. (2002). Cyclooxygenase-2 inhibitors: promise or peril? Mediators Inflamm; 11(5): 275–86.

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12 Eq Vet Pract 2021, September; 46 (3)

29/07/20 2:48 PM

GENE DOPING - 101 A synopsis edited from: Tozaki T and Hamilton NA (2021).

Control of gene doping in human and horse sports.

Gene Ther 10.1038/s41434-021-00267-5

INTRODUCTION Gene doping is prohibited in human and equine competition alike. The World Anti-Doping Agency (WADA), Fédération Equestre Internationale (FEI) and International Federation of Horseracing Authorities (IFHA) are the internationally recognised industry bodies that oversee governance of the Olympics, equestrian events and horseracing internationally.

These organisations have introduced regulations to prohibit gene doping. The WADA (https://www.wada-ama.org/) and IFHA (https://www.ifhaonline.org/) have also published definitions of gene doping (FIGURE 1) while the FEI (https:// inside.fei.org/) is yet to do so.

In humans, gene editing is most likely to be performed on adults, and as such will not affect the germline. This contrasts with the situation in horses which could be gene edited as adults or prenatally, as zygotes or embryos. In fact, editing horses as early as possible in development is appealing to reduce mosaicism and increase the efficiency of the edit. The editing of racehorse embryos to create genetically modified animals would be a direct contravention of Stud Book and horseracing rules. With the recent publication of a method to gene edit horse embryos, this is a particular concern for Horseracing Authorities. Further, in human sports, the recipient of gene doping can consent to the doping treatment, while clearly horses cannot, adding a further dimension to the ethical problem of gene doping in animals.

WHAT IS GENE DOPING? WADA defines gene doping as the use of nucleic acids with the potential to enhance sport performance and can be broadly grouped into gene transfer, gene silencing and gene editing.

Gene transfer involves the introduction of exogenous transgenes into living cells that normally is aimed at treating genetic disorders by facilitating expression of the transgene in the targeted cells. Erythropoietin gene therapy has been explored to treat renal failure, and insulin-like growth factor 1 to treat various causes of skeletal muscle loss. However, these two genes are very likely to be targeted for gene doping since the administration of their recombinant proteins is already prohibited by both equine and human anti-doping agencies.

Gene silencing technology suppresses translation by hybridising the mRNA with artificially synthesised antisense oligonucleotides. Gene doping by gene suppression or silencing would target genes with products that can negatively affect performance, such as myostatin (MSTN), which contains a variant in Thoroughbred racehorses that is associated with racing performance.

Gene editing is a technique used to perform substitutions, insertions, deletions, inversions, or translocations. The three best known gene-editing systems are zinc-finger nucleases, transcription activator-like effector nucleases, and clustered regularly interspaced short palindromic repeats (CRISPR) with CRISPR being the fastest and cheapest to use leading to easy and reliable editing of targeted genes.

CONCLUSION Gene doping presents a progressing threat to the integrity of all forms of competitive sport. Although there is no evidence indicating that gene doping is being used currently in horses, the technology to apply many forms of gene doping already exists. Tests to detect inserted transgenes have been developed, but the detection of gene editing is still very difficult. While the most effective measure for anti-doping control is the introduction of doping tests, the broad range of possible targets means that a successful anti-gene doping programme will combine different types of detection testing, education, and surveillance, to send the message that gene doping will not be tolerated.

REGULATORY CONSIDERATIONS Gene doping regulations published online for the International Federation of Horseracing Authorities, IFHA International Agreement on Breeding, Racing and Wagering (IABRW) are continually updated and are summarised in TABLE 1. The most up to date versions are found at IFHA International Agreement.

FURTHER READING Tozaki T and Hamilton NA (2021). Control of gene doping in human and horse sports. Gene Ther 10.1038

Eq Vet Pract 2021 September; 46 (3) 13

TABLE 1: Summary of recommendations from The International Agreement on Breeding, Racing and Wagering published by the International Federation of Horseracing Authorities.

ARTICLE 6 B (RACING) - PROHIBITION OF GENETIC THERAPY, GENE EDITING AND GENOME EDITING 1. Prohibition on use or administration of Genetic Therapy a. Definition of Genetic Therapy Genetic Therapy is defined as including any therapy, method or process which involves the use or administration of: i. oligomers or polymers of nucleic acid ii. nucleic acid analogues iii. genetically modified cells iv. gene editing agents which are capable, at any time, of directly or indirectly causing an action or effect on, and/or manipulating, gene expression in any mammalian body, including but not limited to gene editing agents with the capacity to alter genome sequences and/or the transcriptional, post-transcriptional or epigenetic regulation of gene expression.

For the avoidance of doubt, the use or administration of autologous conditioned serum or ‘platelet-rich plasma’ treatments which do not involve the transfer of whole cells / DNA are not defined as a Genetic Therapy for the purpose of the IABRW. b. Except as provided by this Article, the use or administration of a Genetic Therapy on or to a horse is prohibited at all times. c. Exempted Genetic Therapy Genetic Therapy may be used or administered to a specific horse with the express prior approval of a Racing Authority if that Genetic Therapy is used to treat an injury or disorder formally diagnosed by a veterinarian, and:

i. is not capable of modifying a horse heritable genome ii. does not pose a threat to the welfare of horses iii. does not pose a threat to the integrity of racing, either by having the potential to enhance or harm the performance of a horse in a race d. Control and recording The owner or trainer has the responsibility to inform and obtain the approval of the relevant Racing Authority of any intended Genetic Therapy to a horse prior to such treatment, irrespective of whether it is to be administered before, in or out of training. The owner or trainer must maintain full and accurate records of all such therapies – which must be kept for a minimum of five years and be readily available for inspection by regulatory officials when requested.

2. Prohibition on Gene Editing and Genome Editing a. Definition of Gene Editing Gene Editing is defined as any process or treatment in respect of a horse which involves the insertion, deletion and/or replacement of DNA at a specific site in the genome of the horse. b. Definition of Genome Editing Genome Editing is defined as any process or treatment in respect of a horse which involves the insertion, deletion and/or replacement of DNA in the genome of the horse. c. The use on, or administration or application to, any horse of Gene Editing or Genome Editing is prohibited at all times.

Last update: JANUARY 2020

Gates S et al. A Case Series of Five Horses with Superficial Digital Flexor Tendon [SDFT] Lesions in the Carpal Canal. J Eq Vet Sci. 2021; 103: 103656. DOI 10.1016/j.jevs.2021.103656 The five horses were 11-28 years old and presented with an acute, unilateral forelimb lameness which worsened following proximal limb flexion and was accompanied by a mild swelling of the palmar carpal region in most cases. Ulnar nerve block abolished the lameness. Ultrasound evaluation revealed an increased cross-sectional area (CSA) of the SDFT tendon and a loss of tendon fibre architecture within the palmar aspect of the affected tendon, most readily identifiable upon longitudinal images. Three out of the five horses returned to their previous level of performance, and two were euthanized. A back-at-the-knee conformation was associated with a poorer prognosis in these cases. An intratendinous fibroma was identified histopathologically in one horse following euthanasia.

14 Eq Vet Pract 2021, September; 46 (3)

HOW TO: DETERMINE JOINT INVOLVEMENT IN LIMB WOUNDS# Brendon Bell brendonb@vetsouth.co.nz

The most common cause of limb synovial infections in adult horses is from wounds that penetrate or breach synovial structures, most often joints. The early and aggressive treatment of any wound that also involves a joint minimises the deleterious consequences of joint infection. It thus follows that if presented with a wound over or close to a joint, the earlier any joint involvement is recognised and treated, the more successful the outcome likely will be. In the early stages of a wound involving a joint, the joint may be contaminated and not yet actively infected, so that if joint involvement is recognised early the area can be decontaminated, greatly reducing the chances of bacterial colonisation and subsequent infection.

When presented with a wound on a limb an appreciation of the precise location and extent of synovial structures in relation to the wound is necessary.

The excellent reference by Moyer et al, (2011) has colour coded diagrams showing the extent of joint limits in relation to other limb structures. Downloading a copy to your phone allows horse-side reference to help gauge possible joint involvement.

When first presented with the horse and its wound, taking a full history is important. Often owners have no idea how the wound occurred but there are occasions when they witnessed the injury. Factors like impaling on objects such as nails or spikes will help to determine the possible depth of wounds and whether a joint has been breached.

Initially, perform a quick clinical examination to determine if the horse has any systemic involvement such as pyrexia. Next, assess the degree of lameness - horses with established joint infections are normally moderately to severely lame. Inspect the wound carefully for evidence of a clear/yellow sticky discharge coming out and running down the limb? This may be joint fluid, but there often will be a serous inflammatory discharge from the wound surfaces. The differentiation between inflammatory discharge and synovial fluid can be difficult but synovial fluid tends to be stickier and more globular compared to the waterier inflammatory discharge. If you gently flex or extend the joints near the wound this may pump out

#

Image Dr. Suzanne Mund

joint fluid and you may see synovial fluid – sometimes bubbly – egress from the wound.

For a close inspection the horse will probably require sedation.

Clip and clean the wound edges well before investigating the wound. Lavage out the wound with an isotonic fluid like lactated ringers to remove as much foreign material as possible. Retract the wound edges. Any sight or glimpse of white shiny articular cartilage indicates a joint breach. Next, investigate using a blunt ended instrument such as haemostat or small curette, or using a gloved finger, to determine the depth and direction of the wound. If injuries have occurred when the limb was flexed then the skin wound can be in a different position to the joint, so try to find the direction of the wound path that may require the limb being flexed and extended again. Check to feel any smooth hard surface of joint cartilage. Look and feel for any foreign bodies like pieces of wood which might be in the joint.

At this stage radiography can be useful to show any damage to joint and bone structures and to outline radio opaque material like metal or wood near the joint. It may also show up air within the joint indicating joint breach, but be aware of any overlying subcuticular emphysema. If there is a penetrating tract detected, radiographing the wound with a probe in place can demonstrate its proximity to the joint. This is especially helpful with puncture wounds to the foot (Figure 1).

If you are suspicious of a joint breach, then it may be possible to perform synoviocentesis of any local joint. This is easier in certain joints that have two or three easily accessible sites for synoviocentesis. Care should be taken in doing this if the area around the joint is inflamed and swollen. Apart from swelling making the joint harder to find, if you inject a needle through an inflamed area, local material and bacteria can be iatrogenically introduced into the joint. If this procedure is to be undertaken, then pre-preparing the necessary equipment saves valuable time when you are gloved up (Figure 2). Consider trying to obtain a joint fluid sample for cytologic examination and protein content, and for possible culture. You should also prepare several syringes of isotonic fluid to use as lavage. Regional anaesthesia can facilitate these procedures.

Based on presentation given by the author at NZEVA Conference, Christchurch, June 2021, and re-edited here with permission of NZVA and of the author.

Eq Vet Pract 2021 September; 46 (3) 15

With joint involvement still strongly suspected or confirmed there then are several options for further joint infection treatment, either on site or as a referral. With ongoing treatment, aggressive systemic broad-spectrum antimicrobial therapy, joint lavages every 48 h, IV regional limb antimicrobial perfusion, sterile bandaging to protect from further contamination, and further direct or arthroscopic wound and joint debridement need all to be considered to resolve joint infection.

Moyer W, Schumacher J & Schumacher J [2011]. Equine Joint Injection and Regional Anesthesia. Academic Veterinary Solutions, LLC, Chadds Ford, PA, USA. https://equinevetinfo.com/ products/eji-book and Joint Injections

Figure 1: Lateral foot radiograph taken with sterile catheter inserted through a tract from a distal limb wound showing proximity of the wound to the coffin joint.

Figure 3: Insertion of needle with IV tubing attached into coffin joint away from the cleaned wound suspected of entering the coffin joint.

Figure 2: Layout of sterile equipment to be prepared ahead of further probing or flushing of a wound suspected of entering a synovial structure.

After surgically preparing the site for joint penetration, insert the needle. The use of an extension set is advantageous as there is less movement on the needle when connected to an extension set compared to repeatedly connecting a syringe (Figure 3). Once the joint is entered, attempt joint fluid recovery. Then connect the already primed extension set and pressurise the joint. If the sterile solution is seen leaking from the joint, breach is confirmed (Figure 4). In the event of a joint breach then as you are already connected to the ingress needle, go ahead and lavage the joint with 100-200 ml of sterile ringers as a primary decontamination treatment. Depending on joint size at this time you could also run a bag of sterile fluid through under pressure. Instilling gentamycin or ceftiofur into the joint at the end of lavage should be considered.

16 Eq Vet Pract 2021, September; 46 (3)

Figure 4: Flushing of the coffin joint with saline exiting the wound to indicate traumatic penetration of the coffin joint.

MEDICINE CORNER MEDICATION MUSINGS Emma Gordon E.Gordon1@massey.ac.nz

Readers must be aware of their obligations in using drugs on the ACVM product-use cascade that are not registered for use in horses.

For this edition of Medicine Corner, we bring to you a brief discussion of some medications that are lesser used in equine practice in New Zealand.

diclofenac is most useful for very mild or controlled anterior uveitis but tends to be insufficient in controlling more severe inflammation. The 0.1% solution is available from most human pharmacies.

Typical application is 0.2 ml to the eye every 12-24 hours.

as it changes corneal permeability to medications [Dennis Brooks, pers comm].

Reference Gilger BC [Ed]. Equine Ophthalmology, 3rd ed. Hoboken, NJ, Wiley Blackwell.

2016.

Reference Davis JL. Medications for the Treatment of Ocular Diseases in the Horse. Proc 2013 NAVC.

Figure 3: Tranexamic acid.

Tranexamic Acid - AFT®: an alternative to formalin! Tranexamic acid (Fig. 3) is an antifibrinolytic agent most used in haemorrhagic conditions such as in periparturient mares to help prevent clot breakdown and assist in clot stabilisation. Tranexamic has been shown to have approximately eight times the antifibrinolytic activity of aminocaproic acid.

Figure 1: Ophthalmic diclofenac Na solution 0.1%.

Voltaren® Ophthalmic solution (Diclofenac sodium 0.1%). While diclofenac sodium (Voltaren®) is widely available and commonly used in humans for topical application on various conditions such as muscle aches, an ophthalmic diclofenac is also available. As a topical NSAID, diclofenac ophthalmic (Fig.1) can be used as an anti-inflammatory agent such as in treatment for anterior uveitis.

It is much less potent than topical corticosteroids but has less concern for side effects such as mineral keratopathy with long term usage. Similar to corticosteroids, topical NSAIDs inhibit corneal epithelialisation, therefore are contraindicated in the presence of a corneal ulcer or infection. Topical

Figure 2: Ophthalmic 5% NaCl solution.

Muro 128® (5% ophthalmic hypertonic saline). Muro 128® (Fig 2.) is a hyperosmotic ophthalmic solution of use in treating corneal oedema. It is available from human pharmacies though often requires a special order.

While it is exorbitantly expensive considering it is composed of common salt, this product is very effective at reducing corneal oedema by way of osmotic draw. It can be used q6-24h and should be administered separately, with no other medications applied within 15-30 minutes either side of Muro 128

While literature in horses is sparse, safety and expected efficacy makes tranexamic acid a superior product to intravenous formalin which should no longer be considered acceptable to use.

Anti-fibrinolytic agents are routinely used overseas, with one study reporting that 92% of post parturient mares with uterine artery rupture received epsilon amino caproic acid. Epsilon amino caproic acid appears to be unavailable in New Zealand however tranexamic acid has the same mechanism of action and is easily obtained. Safety of use in horses has been established. Dose rates of 5-25 mg/kg IV, IM, or SC, repeated up to

Eq Vet Pract 2021 September; 46 (3) 17

q12h is recommended by one Australian manufacturer (Ilium Vasolamin S 100).

One study (Fletcher et al. 2013) suggests that some recommended doses may be up to 10 x higher than necessary, however an ideal in vivo dose has yet to be determined. This author typically uses 10 mg/kg iv q 12h, diluted in 1 L saline as a precaution against some anecdotal reports of potential reactions when administered rapidly as a bolus.

Due to short mechanism of action, CRI administration is also a consideration.

References Arnold CE, Payne M, Thompson J et al.

Periparturient hemorrhage in mares: 73 cases (1998-2005). J Am Vet Med Assoc 2008; 232: 1345–51.

Fletcher DJ, Brainard BM, Epstein K et al. (2013). Therapeutic Plasma Concentrations of Epsilon Aminocaproic Acid and Tranexamic Acid in Horses DJ. J Vet intern Med. 27: 1589-1595.

Taylor EL, Sellon DC, Wardrop KJ et al. (2000). Effects of intravenous administration of formaldehyde on platelet and coagulation variables in healthy horses. Am J Vet Res, 61(10): 1191-6.

Figure 4: Paracetamol is the most used analgesic in (human) medicine [Image from Panadol.co.nz].

Paracetamol (acetaminophen).

Paracetamol, commonly used in human medicine for analgesia and fever control, appears not to cause similar negative effects as COX inhibitors on the gastrointestinal or renal systems in humans. It is thought to be a weak prostaglandin inhibitor, but its mechanism of action is not completely understood. There also appears to be a centrally mediated mechanism of action involving inhibition of prostaglandin E2,

18 Eq Vet Pract 2021, September; 46 (3)

substance-P and 5-HT-3 receptors.

Additionally, in humans, paracetamol is commonly combined with traditional NSAIDs in order to provide greater analgesia/anti-inflammatory effects.

Research in horses is still occurring to determine optimal dosing rate and interval, however most practitioners dose at 20 mg/kg PO q 12h with an expected oral bioavailability of 91%. One study investigating this dosing regimen for 14 days showed no adverse effects other than mild periportal inflammation in the liver which could not be definitively attributed to the drug. Effectiveness of analgesia is also still undergoing research in horses, however a 2016 study using an equine pain model determined lameness to be reduced for 5h and heart rate for 11h following a single administration of 20 mg/kg (Forman et al. 2016).

On the basis of such information this medication may hold promise and offers an alternate oral analgesic option that may be of use in chronic musculoskeletal pain such as laminitis, which is affordable and easy for the owner to administer. Caution should be used if using in combination with NSAIDs however anecdotally this is done quite frequently in practice.

Readers may be aware of a metanalysis published in the Medical Journal of Australia by Christina Abdel Shaheed and colleagues (2021) that casts some doubt on the evidence for the effectiveness of paracetamol as an analgesic in some common human conditions. “… there is strong evidence that paracetamol is not effective for reducing acute low back pain.”

References

Equine Drugs App, Kevin Corley.

Accessed April 2021.

Mercer MA, McKenzie HC, Davis JL et al.

(2020). Pharmacokinetics and safety of repeated oral dosing of acetaminophen in adult horses. Eq Vet J. 51(1): 120-125.

Foreman J, Foreman C and Bergstrom B. (2016) Acetaminophen/paracetamol efficacy in a reversible model of equine foot pain. Proc AAEP Ann Conv: 295- 296.

Trazodone. More commonly used in canine medicine, trazodone is a serotonin receptor antagonist and reuptake inhibitor that has been shown to have a mild anxiolytic and sedative effect in horses and can be utilised in facilitating stall rest. Trazodone appears to have dose dependent mild sedative effects from 30 minutes and lasting about 8-12h. Reported side effects have included sedation, ataxia, mild sweating, excitement, muscle fasciculations and transient cardiac dysrhythmias.

Horses have been reported to develop tolerance. Recommended dose for oral administration to facilitate stall rest is 4-10 mg/kg q 12-24h, with sedation/ anxiolytic effects typically noted within 1-2h of administration. Anecdotally, doses as low as 2.5 mg/kg have been effective. Starting at the low end of the dose range, assessing the clinical effect, and adjusting the dose accordingly is recommended. Trazodone is a banned substance by the FEI. References

Equine Drug App, Kevin Corley, Accessed April 2021.

Davis JL et al (2018). Pharmacokinetics, pharmacodynamics and clinical use of trazodone and its active metabolite m-chlorophenylpiperazine in the horse.

J Vet Pharmacol Ther. 41(3): 393-401.

Moss AL et al (2021). Investigation of the effects of orally administered trazodone on intraocular pressure, pupil diameter, physical examination variable, and sedation level in healthy equids. Am J Vet Res. 82(2): 138-143.

COLLEAGUE PROFILE BRENDON BELL YOUR NEW NZEVA PRESIDENT FOR 2021 Brendon Bell nzevapresident@gmail.com

To help get to know our new NZEVA President for 2021, here is an intimate profile of this sweet wee lad pictured above What is your practice area, and how many years have you been doing this?

Equine practice with an interest in surgery since 1987.

Where did you obtain your veterinary degree, and did you take on any post-graduate studies?

Graduated from Massey in 1985. After 3 years in England I undertook an equine surgical residency at the University of Illinois USA 1989-1992.

Why did you choose this area of practice?

Equine practice seems challenging - and it certainly is.

Outline the data and knowledge sources that are most useful to staying current in your areas of practice.

Being geographically isolated is somewhat challenging but I try to get to meetings and conferences where possible. Talking things over with colleagues is a great source of knowledge as they have frequently encountered the same problems you have.

What do you like most about your work?

Doing work for appreciative people.

What is the most challenging part of your job?

Compliance for sure is affecting us all and seems to be weighing us down an awful lot.

What advice would you give to someone thinking of following your line of practice?

Get some mixed practice experience first as I think it makes for a better practitioner.

Should our BVSc [Massey] programme include substantial species or discipline specialization, or should that be mainly left to post-graduate training periods?

Things tend to happen so it can be hard to envisage where you might end up while at vet school and while newly graduated, so I think it’s good to keep your options open and not get too specialised too soon.

What pisses you off the most about your daily grind?

Attending meetings.

What are your passions outside of work?

The outdoors - hunting and fishing, and playing around on our lifestyle block.

Brendon Bell. NZEVA President 2021

A FEW PERSONAL QUESTIONS: Concert you travel back in time for Live Aid, 1985.

Last memorable meal Walnut Tree Restaurant England, 1988.

First ever concert Dire Straits, Christchurch 1986.

Favourite ever album/band Simple Minds, Greatest Hits.

What was the last lie you told I dont mind doing after hours.

Most interesting surgery you have done Placing screws in a horse’s leg under standing sedation.

Best self- defence tip If they tell you it never kicks, watch out, it will!!

Best life lesson/life motto Don’t ask someone to do something you wouldn’t do yourself.

Eq Vet Pract 2021 September; 46 (3) 19

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THE CLINICAL COMPANION OF DONKEY DENTISTRY Register with the Donkey Sanctuary HERE for your free PDF copy of: Lilly, G. & Evans, L. (Eds.).

The Clinical Companion of Donkey Dentistry.

Sidmouth, Devon. EX10 0NU. UK The Donkey Sanctuary.

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Available via: https://www. thedonkeysanctuary.org.uk/ what-we-do/for-professionals/ resources/clinical-companiondentistry

20 Eq Vet Pract 2021, September; 46 (3)

COMMISSIONED REVIEW ARTICLE*

MURMURS AND ARRHYTHMIAS IN PERFORMANCE HORSES: WHEN DO WE WORRY ABOUT THESE? PART 1: MURMURS Katharyn J Mitchell University of Zurich, Switzerland katharynm@hotmail.com

PART 2 of this paper discussing the practical approach to arrhythmias in performance horses will appear in the next issue of EVP.

INTRODUCTION The cardiovascular system is central to the delivery of oxygen and nutrients to the peripheral tissues so any cardiac abnormality that affects cardiac output could result in decreased athletic capacity, seen clinically as exercise intolerance or poor performance [1, 2]. The equine cardiovascular system, however, is one of tremendous reserve capacity; therefore, it can take quite considerable dysfunction to result in a measurable effect on performance. In addition, it should be considered that there are cardiac conditions that do not affect overall performance per se, but could result in a sudden and dramatic adverse event during exercise (e.g. weakness, collapse, or sudden cardiac death) [3].

One of the difficulties practitioners face is trying to determine the relevance of any abnormal findings. There can be a variety of abnormalities detected on physical examination, but deciding if a single problem alone, or more commonly, if a combination of problems are acting together to either a) reduce the exercise capacity of an individual animal or b) increase the risk of an adverse event, can be challenging.

The breed of horse and the type of exercise (e.g. high-speed racehorse, endurance, eventer or show jumper) will also influence how any clinical signs are manifested. In addition, it is important to note if the performance of the horse has suddenly changed in recent times, or if this problem is longer standing, or if in fact, the horse has always performed below the owner/trainer’s expectations. In many cases of incidentally detected heart disease, the horse has been performing normally to the owner/trainer expectation.

Cardiac murmurs and arrhythmias are common findings on physical examination of horses [4-6]. Trying to decide if the detected cardiac abnormalities are clinically relevant

Image: VeterianKey

requires experience, interpretation of other clinical findings and the addition of further diagnostic investigations, including echocardiography, ECG analysis (resting and at exercise), non-invasive blood pressure measurements and in some cases stress testing under exercising conditions. Any reported change in murmur intensity, development of a new murmur or detection of an arrhythmia should be evaluated particularly closely.

RECOGNISING AND DESCRIBING MURMURS ON CLINICAL EXAMINATION The first step when evaluating any horse is to perform a thorough clinical examination, including careful auscultation of the heart from both sides of the thorax and assessment of the entire cardiovascular system [7]. The normal heart sounds should be identified, as seen in Figure 1.

Figure 1. The normal heart sounds are visualised, and the timing of systole and diastole explained. The closing of the atrioventricular valves (S1) and semilunar valves (S2) are the most heard heart sounds signalling the start and end of systole, while S4 (atrial contribution to ventricular filling in late diastole) and S3 (early diastolic filling) are less commonly auscultated.

The two loudest heart sounds, S1 (closing of the atrioventricular valves) and S2 (closing of the semi-lunar valves) should be appreciated in all healthy horses. S4 is appreciated in many but not all horses and can become more prominent in older horses (because of a more active atrial contribution to ventricular filling in late diastole). S3 is usually quite subtle and dull and more commonly heard in younger horse (due to a more active early ventricular filling phase); it can become very prominent in the rare cases of heart failure.

* These Commissioned Articles are made possible by a generous grant to EVP from Jonathan Hope.

Eq Vet Pract 2021 September; 46 (3) 21

Murmurs are sounds that occur between the normal heart sounds, either caused by the physiological flow of blood or from turbulence created by pathological abnormalities.

Murmurs should be described using the criteria defined in Table 1.

Some cardiac murmurs remain similar over a long period, while others can change in intensity and character over time (some murmurs increase in grade, while others become quieter). These changes can reflect alterations in intracardiac gradients (pressure equalisation as compensatory mechanisms fail) or different vibration mechanics (e.g. as seen with aortic regurgitation when nodular degeneration on the aortic cusp becomes stiffer and more fibrotic vibrating less or a sudden honking vibratory murmur in a horse with long standing MR, indicating chordal rupture). A sudden change in murmur quality is an indication for re-evaluation with echocardiography.

It is important to clearly describe the findings of your auscultation in the medical record and when discussing the case with colleagues, to ensure an accurate information is recorded. The use of a high-quality analogue stethoscope is invaluable for clear auscultation, while the auscultation conditions (e.g. quiet barn, no external noise, horse standing still) are extremely important for a thorough cardiovascular evaluation. The use of a digital amplifier on an analogue stethoscope, or the use of a fully digital stethoscope can provide additional information about the timing and duration of the murmur and allow recording of the murmur to be included for teaching purposes and as part of the medical record.

rubs are caused by motion of the heart against the pericardium and are often highly variable in intensity, location and duration.

Valvular regurgitation, causing backflow of blood across the valve, is a common finding, particularly in athletic and older horses [4-6]. The difficulty for practitioners is determining the hemodynamic effects of any regurgitation. Some valvular regurgitations are known to increase with athletic training and it is important to recognise these ‘typical’ regurgitations from those with pathological consequences. It is also fundamental to recognise that the regurgitation per se is not the biggest issue, but rather the cardiac remodelling that occurs in the ‘receiving chamber’, the cardiac chamber that receives the regurgitant blood. The degree of cardiac remodelling cannot be easily determined based on physical examination alone, therefore, echocardiography,ECG analysis and non-invasive blood pressure measurement are important parts of the diagnostic evaluation.

Descriptions of common murmurs and their possible hemodynamic and clinical consequences are summarised in Table 2.

PHYSIOLOGICAL FLOW MURMURS In some horses, particularly younger horses with lower body condition or a thin chest wall, flow of blood in the great vessels can be appreciated. These murmurs are often referred to as ‘ejection murmurs’, corresponding with the ejection of blood into the great vessels in early systole. It is important to recognise these physiological murmurs are short in duration (early systolic), quiet (grade 2 or less) and audible only cranially on the left, over the area of the great vessels (Figure 2) [7].

Occasionally, physiological diastolic filling murmurs are detected, particularly in young horses. Some of these are described as an early-mid diastolic ‘squeak’ or ‘rub’ and are considered normal.

PATHOLOGICAL MURMURS Caused by the turbulent flow of blood and vibration of the surrounding cardiac tissues, these pathological murmurs are most commonly the result of valvular regurgitation, although occasionally are caused by abnormal communications between chambers and/or vessels [1, 4, 7]. Valvular stenosis is exceedingly rare in horses, compared with other species, and is usually only seen in combination with a complex congenital malformation. Rarely in horses, additional sounds on auscultation superimposing the ‘normal’ heart sounds can be caused by pericardial disease; these pericardial friction 22 Eq Vet Pract 2021, September; 46 (3)

Figure 2. Coronal view of the location of the heart valves. The great vessels can be seen located cranially on the left thorax (the location where any physiological ‘flow’ murmurs will be heard), while the mitral valve is quite caudal on the left. The tricuspid valve is appreciated on the right. The most common location of a ventricular septal defect (VSD) is identified with the black arrow.

Illustration by Matthias Haab, University of Zurich, modified by the author.

CONSEQUENCES OF MURMURS In most cases, the common causes of cardiac murmurs, valvular regurgitations, are well tolerated and most horses with cardiac disease have completely normal exercise tolerance, performance and life expectancy [1, 2, 17]. It should be noted that diastolic murmurs compatible with aortic regurgitation (especially in horses with increased pulse pressure or a ‘hyperkinetic’ pulse) are generally more worrisome due to the potential consequences (LV dilation, malignant ventricular arrhythmias, sudden cardiac death) when compared with systolic murmurs of mitral and tricuspid regurgitation (causing primarily atrial dilation, atrial fibrillation). The combination of a murmur and development of a pathological arrhythmia like atrial fibrillation certainly might be very relevant when it

comes to any reported performance limitation and should be considered when monitoring for disease progression.

Far less commonly, a rapidly progressing, severe valvular regurgitation can become hemodynamically relevant, resulting in reduced exercise capacity, poor performance and decrease life expectancy [5, 18, 19].

Most (but not all) congenital defects resulting in cardiac murmurs are identified earlier in a horse’s life, and depending on the severity of the defect and degree of resulting hypoxia,

some horses can perform and have a normal life expectancy, while others will develop severe clinical signs and present with exercise intolerance or signs of congestive heart failure [10].

As practitioners, the key is for us to recognise cardiac abnormalities on a thorough clinical examination, investigate those meeting the criteria for additional diagnostic evaluation and then closely monitor the horse for any change in performance. From a safety perspective, early recognition and close monitoring of horses with aortic regurgitation is considered particularly important.

Table 1. Criteria for describing and reporting on cardiac murmurs Criterion

Comments

Timing

Within the cardiac cycle • systolic, diastolic or continuous • early, mid or late • Holosystolic/holodiastolic (whole duration of systole/diastole but S1/S2 still audible • Pansystolic/pandiastolic (whole duration of systole/diastole, S1/S2 or both no longer audible • Diastolic murmurs tend to vary in duration depending on heart rate (longer at lower heart rates, shorter at higher heart rates), while systolic murmurs are similar duration regardless of heart rate

Point of maximal intensity (PMI)

Where is the murmur loudest?

• Left or right thorax • Base (near shoulder level) or apex (olecranon level) • Cranial (under the shoulder) or caudal (olecranon level) • Over which valve (mitral, aortic, pulmonary or tricuspid)

Grade

Intensity or loudness of the murmur (note that this can but may not necessarily relate to the severity of the problem) 1. Very quiet and localised, often labile or variable 2. Quiet, localised but clear when over the PMI 3. Obvious, less loud than S1/S2 4. Obvious, louder than S1/S2, radiating in some cases to the other side of the thorax 5. Loud, radiating, palpable thrill on the chest wall 6. Audible with the stethoscope off the chest wall

Character and shape

Descriptive terms, typically including

• • • • • • • • • •

Soft Blowing Harsh Whooping Musical Dive-bomber Vibrant Buzzing Squeak Honk

Shape • Band-plateau (even throughout the murmur) • Crescendo (increasing in intensity) • Decrescendo (decreasing in intensity) Effect of exercise

It is important to auscultate the heart before and after exercise

• •

Some flow murmurs and mitral regurgitation murmurs can increase in intensity after exercise Most diastolic murmurs decrease in duration and intensity at higher heart rates, as seen after exercise

Eq Vet Pract 2021 September; 46 (3) 23

Table 2. Summary of common murmurs in horses and their hemodynamic consequences Problem

Murmur

Consequence

Comments

Clinical signs

Mitral regurgitation (MR)

Systolic, loudest over the mitral valve on the left side (often radiating caudo-dorsally).

Receiving chamber: left atrium (LA)

MR is a common finding in athletic and older animals.

Left atrial enlargement can predispose to atrial arrhythmias (particularly atrial fibrillation, AF).

Compensation – normal to increased LA contractile function (louder S4)

If AF develops, reduced athletic capacity and poor performance is common.[8]

Can be early, mid or late systolic, or holo- or pan-systolic.

Typically described as crescendo or bandshaped

Tricuspid regurgitation (TR)

Systolic, loudest over the tricuspid valve on the right side.

Can be early, mid or late systolic, or holo- or pan-systolic.

Typically described as crescendo or bandshaped

Both pressure and volume can increase within the LA, depending on the mechanism and duration of regurgitation.

Receiving chamber: right atrium (RA) Right atrial enlargement can predispose to atrial arrhythmias (particularly AF).

Both pressure and volume can increase within the RA, depending on the mechanism and duration of regurgitation.

Decompensation – increasing LA pressures, pulmonary congestion, pulmonary hypertension (PH), pulmonary oedema (particularly in cases of acute and/or severe MR).

In severe cases, left ventricular (LV) enlargement can develop.

TR is a common finding in athletic animals and can worsen with training; this is usually harmless and often considered “normal”.

TR can also develop secondary to PH, leading to more severe consequences.

Measurement of the TR velocity (by echocardiography) can provide useful information as to the trans-valvular pressure gradients (between the right ventricle (RV) and RA).

With acute MR or in cases of chronic MR with severe LA enlargement and decompensation, exercise intolerance, respiratory signs (tachypnoea, dyspnoea, frothy nasal discharge) and congestive (usually biventricular) heart failure can develop. In more chronic cases, the signs of right-sided heart failure can predominate.

If AF develops, reduced athletic capacity and poor performance is common.

If severe RA enlargement and decompensation, exercise intolerance and congestive heart failure can develop (jugular vein distension/pulsation, ventral and limb oedema, ascites).

Compensation – normal to increased RA contractile function (louder S4) Decompensation – increasing RA pressures, signs of right sided congestive heart failure.

In severe cases, RV enlargement can develop.

Aortic regurgitation (AR)

Diastolic, left sided, over the aortic valve, typically decrescendo, holo- or pan-diastolic, varying in intensity and character depending on valvular pathology.

Receiving chamber: left ventricle (LV) Left ventricular enlargement, ventricular myocardial hypertrophy and decreased myocardial oxygen delivery can predispose to (potentially malignant, life-threatening) ventricular arrhythmias.

Both pressure and volume can increase within the LV, depending on the mechanism and duration of regurgitation

AR is a common finding, particularly in older animals however AR in a young horse is rare and should be immediately investigated.

Ventricular arrhythmias pose the biggest concern over safety and as a cause of poor performance in horses with AR.

Compensation – normal to increased LV function

LV enlargement and compensatory LV hyperkinesis is associated with increased pulse pressure (difference between SAP and DAP) that can easily be felt as a “hyperkinetic pulse” during physical examination; this is a prognostic indicator, indicates potential risk for ventricular arrhythmias and can be used to monitor for disease progression.

[9]

Decompensation – decreased LV function leads to increased LV volume and pressures, often development of MR secondary to stretching of the mitral valve annulus results in volume overload of the LA in addition.

If the LV decompensates, then exercise intolerance, respiratory signs and congestive heart failure can develop.

Some horses with AR and secondary MR with LA enlargement can develop AF. If AF develops, reduced athletic capacity and poor performance is common.

Pulmonary regurgitation (PR)

Diastolic, left sided, cranial (over the pulmonary valve), typically quiet and difficult to hear. Louder if PH is present.

Receiving chamber: right ventricle (RV) Right ventricular enlargement can predispose to (potentially malignant, life threatening) ventricular arrhythmias.

Both pressure and volume can increase within the RV, depending on the mechanism and duration of regurgitation

24 Eq Vet Pract 2021, September; 46 (3)

PR is a common echocardiographic finding but is rarely associated with clinical disease unless PH is present.

Measurement of the PR velocity (by echocardiography) can provide useful information as to the trans-valvular pressure gradients (between the pulmonary artery and RV).

Clinically relevant PR is found in cases of PH. Clinical signs of PH include exercise intolerance, respiratory signs (tachypnoea, dyspnoea) and delayed recovery after exercise.

Problem

Murmur

Consequence

Comments

Clinical signs

Ventricular septal defect (VSD)

Holo- or pan-systolic, right sided but often radiating to the left side, harsh/coarse, typically band shaped.

Receiving chamber:

There are several things than influence the clinical relevance of a VSD [10, 11].

The clinical signs of a VSD will depend on the degree of cardiac remodelling present.

In the rare cases of subpulmonic VSD location, the murmur can be loudest very cranial on the left, over the pulmonary valve.

The grade of murmur does not correlate with the severity of defect.

Although the shunt flow through a VSD is typically LàR, the shunt flow is predominantly systolic, therefore the blood quickly enters the pulmonary circulation and the lungs, so that RV size and function are not as affected. From the lungs, the shunt flow blood returns to the left heart, leading to enlargement of the LA and LV over time.

1. Size of the defect (relative to the size of the heart) 2. Location of the defect (paramembranous/muscular/ subpulmonic) 3. Pressure gradient (derived from shunt flow velocity) between the LV and RV (and pulmonary circulation) 4. Abnormalities of aortic root alignment (e.g. dextro-positioned/ overriding aorta) 5. Involvement of the aortic cusps and tricuspid valve in the defect 6. Presence of concurrent congenital anomalies

Horses with small, restrictive VSD’s can have normal performance and normal life expectancy.

Horses with clinically relevant VSDs can have reduced athletic capacity and poor performance, respiratory signs, weakness and are predisposed to arrhythmias that can cause reduced performance or have safety implications.

Complex congenital malformation

Typically, these have a VSD included in the malformation, therefore the predominant murmur is usually a holo- or pan-systolic, right sided, coarse/harsh, band shaped murmur that radiates often to the left heart. Depending on the malformation, other murmurs (e.g. from pulmonary stenosis) may also be present.

Depending on the malformation, both the right and left heart can be affected, severity is associated with the degree and direction of blood flow shunting across the defects.

These defects can be difficult to diagnose and fully understand the abnormal communications and anatomical defects. A careful, thorough echocardiographic examination is recommended including evaluation of intra-cardiac pressure gradients and direction of shunt flow across any defects (e.g., following a bubble study).

The clinical relevance of the malformation is largely dependent on the combination and severity of the defects. Most of these defects will result in exercise intolerance and many will be life threatening. Frequent clinical signs include respiratory signs (tachypnoea, dyspnoea) and congestive heart failure (tachycardia, jugular distension/ pulses, ventral and limb oedema and ascites).

Aortic-cardiac (ACF)/aorticpulmonary fistulas (APF)

ACF – diastolic-systolic (or continuous) right sided murmur, frequently associated with arrhythmia and colic-like signs

Receiving chamber (ACF): These typically affect the aortic root, interventricular septum (IVS), RV +/- pericardium. They can cause right sided or bilateral cardiac enlargement depending on the direction and severity of shunting across the defect

These defects can be difficult to diagnose and fully understand the abnormal communications and anatomical defects. A careful, thorough echocardiographic examination is recommended including evaluation of intra-cardiac pressure gradients and direction of shunt flow across any defects.

Although uncommon, these defects can cause severe clinical signs, potentially during exercise.

Exercise intolerance, weakness, collapse or sudden cardiac death have been reported, typically as a result of malignant ventricular arrhythmia or massive extracardiac haemorrhage [12].

APF – diastolic-systolic (or continuous) cranial left sided murmur (these are often difficult to auscultate)

Receiving chamber (APF): These typically affect the aorta and pulmonary artery at the level of the ligamentum arteriosum. They can cause right sided or bilateral cardiac enlargement depending on the severity of shunting across the defect

REFERENCES [PARTS 1 & 2] 1. Durando, M.M. Cardiovascular Causes of Poor Performance and Exercise Intolerance and Assessment of Safety in the Equine Athlete. Vet Clin North Am Equine 2019;35:175-190.

2. Martin, B.B., Jr., Reef, V.B., Parente, E.J. et al. Causes of poor performance of horses during training, racing, or showing: 348 cases (1992-1996). J Am Vet Med Assoc 2000;216:554-558.

3. de Solis, C.N., Althaus, F., Basieux, N. et al. Sudden death in sport and riding horses during and immediately after exercise: A case series. Equine Vet J 2018;50:644-648 4. Marr, C.M. Equine Acquired Valvular Disease. Vet Clin North Am Equine 2019;35:119-137.

The clinical presentation of an ACF is a new onset right sided murmur, with colic, tachycardia and arrhythmia, while APF are frequently associated with tachycardia and colic-like signs.

5. Leroux, A.A., Detilleux, J., Sandersen, C.F., et al. Prevalence and Risk Factors for Cardiac Diseases in a Hospital-Based Population of 3,434 Horses (1994-2011). J Vet Inten Med 2013;27:1563-1570 6. Patteson, M.W. and Cripps, P.J. A survey of cardiac auscultatory findings in horses. Equine Vet J 1993;25:409415.

7. Keen, J.A. Examination of Horses with Cardiac Disease.

Vet Clin North Am Equine 2019;35:23-42.

8. Buhl, R., Carstensen, H., Hesselkilde, E.Z., et al. Effect of induced chronic atrial fibrillation on exercise performance in Standardbred trotters. J Vet Intern Med 2018; 32:14101419.

Eq Vet Pract 2021 September; 46 (3) 25

9. Boegli, J., Schwarzwald, CC., Mitchell KJ. Diagnostic Value of Non-invasive Pulse Pressure Measurements in Warmblood horses with Aortic Regurgitation. J Vet Intern Med 2019;33:1446-1455.

10. Scansen, B.A. Equine Congenital Heart Disease. Vet Clin North Am Equine 2019;35:103-117.

11. Reef, V.B. Evaluation of ventricular septal defects in horses using two-dimensional and Doppler echocardiography.

Equine Vet J 1995;27:86-95.

12. Decloedt, A. Pericardial Disease, Myocardial Disease, and Great Vessel Abnormalities in Horses. Vet Clin North Am Equine 2019;35:139-157.

13. Mitchell, K.J. ECG interpretation in Equine Practice. CABI International, Oxford, UK. First edition. 2020 14. Schwarzwald, C.C. Equine Echocardiography. Vet Clin North Am Equine 2019;35:43-64.

15. Mitchell, K.J. Equine Electrocardiography. Vet Clin North Am Equine 2019;35:65-83.

16. Reef, V.B., Bonagura, J., Buhl, R., et al. Recommendations for management of equine athletes with cardiovascular abnormalities. J Vet Intern Med 2014;28:749-761.

17. Trachsel, D.S., Schwarzwald, C.C., Bitschnau, C., et al. Atrial natriuretic peptide and cardiac troponin I concentrations in healthy Warmblood horses and in Warmblood horses with mitral regurgitation at rest and after exercise. J Vet Cardiol 2013;15:105-121.

18. Reef, V.B., Bain, F.T. and Spencer, P.A. Severe mitral regurgitation in horses: clinical, echocardiographic and pathological findings. Equine Vet J 1998;30:18-27.

19. Reef, V.B. and Spencer, P. Echocardiographic evaluation of equine aortic insufficiency. Am J Vet Res 1987;48:904-909.

New Zealand Equine Veterinary Association

BRIAN GOULDEN AWARD

The Brian Goulden Perpetual Trophy will be awarded annually and presented at the Annual Dinner of the NZEVA conference.

This annual prestigious prize is awarded to members or past members of the NZEVA who have shown leadership, enterprise, contribution to knowledge or education, and have made significant contributions to the equine veterinary profession in New Zealand.

Please send your nomination including name, address and qualifications, together with any supporting information for the nominee, whom the nominator considers merits the award. This can include curriculum vitae, letters of support and documentation of achievements etc.

Send all details AT ANT TIME to nzevasecretary@gmail.com.

Brendon Bell NZEVA President

nzevapresident@gmail.com

YOUR CHANCE TO WIN $150.00!

All you must do is write a clinical report that is published in the EVP, and your contribution may be eligible for one of several prizes of $150.00 that the EVP has available each year.

The EVP Editorial Group wish to promote the sharing of your interesting cases and practice tips with the wider equine veterinary community, so please contribute.

Every case, technique, test and interpretation are different, no matter how experienced we are or how routine the case is, so there is always something for us to learn from each other.

26 Eq Vet Pract 2021, September; 46 (3)

Take photos, dig out your diaries, get keyboard tapping and share your views with colleagues. You could be $150.00 richer for it!

Please send your clinical reports to the EVP Editor for consideration.

Joe is happy chat with you about any articles or ideas you might have.

Please contact Joe at

evp.editor@gmail.com or on 027 437 3651.

THE HORSE PODCASTS Click on The HORSE – Podcast website HERE and listen to many 20-60 minute audio talks from The Horse. You may need to LOGIN/SIGNUP. You can go to a selection of these topics directly by Ctrl+Clicking on the following: • Older Horses.

Amanda Adams • Racetrack Surfaces.

Mick Peterson • Bits, Bridles, and Equine Welfare.

Hilary M. Clayton • Mare Reproductive Cycles and Anxiety.

Jenny Beard Biehunko • Calming Horses: Education and Options.

Camie Heleski • The Best Forage for Insulin Resistant Horses.

Stephen Duren • African Horse Sickness.

Peter Timoney

• Vitamin E: Carrie Finno • What Does Vitamin Deficiency in Horses Look Like?

• Why Do Horses Need Vitamin • Vitamin E and Selenium: What’s the Relationship?

• Which is Better: Skin or Blood Test for Equine Allergies?

Susan White & Ann Rashmir • Mowing Horse Pastures to Keep Them Healthy.

Krishona Martinson • Old Gray Horses and Melanomas.

Bryan Waldridge • Basic Anatomy of the Equine Neck and Back.

Kevin Haussler

SISTER ORGANISATION PUBLICATIONS AVAILABLE The latest Equine Health Update from the SAEVA is available HERE to view.

And all copies of Australian Equine Veterinarian are available on SciQuest HERE to browse.

Eq Vet Pract 2021 September; 46 (3) 27

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CLINICAL UPDATE PENETRATING WOUNDS TO THE HOOF AND FROG

https://vetsouth.co.nz/clinic/invercargill

Grace Reed grace.reed@vetsouth.co.nz

Penetrating wounds to the hoof and the frog are not an uncommon emergency call out for the equine practitioner. This article gives some guidance for approaching these cases in the field, appropriate criteria for referral and potential sequelae of these wounds if, for whatever reasons, immediate treatment cannot be instigated.

A solar puncture will usually present as a sudden onset of severe lameness with an increased digital pulse, local warmth and a marked reaction to hoof testers applied to the affected area. Due to the similarity in presentation with our good friend, the foot abscess, the importance of cleaning the foot and performing a thorough visual examination cannot be stressed enough.

More chronic penetrating injuries can present with marked swelling of the distal limb and secondary abscessation or draining tracts bursting out from remote locations in the foot, coronet, or heel.

as the elastic tissue in this area can often make it difficult to locate and to follow the tract once the object is removed. It is obviously imperative that the object does not move any further into the foot, so that the horse should not be moved until the object has been stabilised. Further movement can be prevented by placing a block of wood or similar material on the foot around the nail or object, preventing the horse from weight bearing on the site the foot has been penetrated.

Penetrating injuries to the foot can be classified into three types (Redding, 2010; and Figure 1):

Type I penetrations enter the sole and may contact P3.

Type II penetrations enter through the frog and the heel and may involve any of the following structures:

• Distal Interphalangeal Joint • Navicular Bursa • Deep Digital Flexor Tendon (DDFT) • Distal Sesamoidean Impar Ligament (DSIL) • Digital Flexor Tendon Sheath • Digital Cushion Type III penetrations enter in the region of the coronary band and can involve P3, collateral cartilages of P3 or the coffin joint [see What would you do? on page DFG].

Septic osteitis, chondritis or arthritis are all of concern. Infection of any of the above structures carries a guarded to poor prognosis due to the extensive damage caused by the massive inflammatory reaction that occurs within the joint or synovial structure. Infections within the bone can also be notoriously hard to treat once established.

It should also be stressed to clients that solar punctures should always be treated as emergencies.

Wound assessment and correct identification of all structures involved allows for appropriate treatment to be instigated immediately.

If the object that has caused the penetrating wound is still present, clients should be advised to leave it in place if possible until imaging has been performed that can allow for more accurate assessment of the compromised structures. This is particularly useful if the object has penetrated through the frog,

Figure 1: Distal Limb Anatomy. From MSD Veterinary Manual

Eq Vet Pract 2021 September; 46 (3) 29

GENERAL APPROACH TO THESE CASES. Following a completion of history-taking and a clinical examination, the area of solar penetration should hopefully be able to be identified and one should have an idea of what structures have the potential to be involved [see How to determine joint involvement in leg wounds on page JKL]. Following this assessment and depending on location of the injury, it is prudent to discuss with the owner the possibility of referral to a surgical facility, particularly for Type II injuries. Management in the field often does not allow for further decontamination, usually requiring arthroscopic or tenoscopic lavage. These procedures also allow for visualisation of affected structures and appropriate decontamination and debridement of the DDFT and other soft tissue structures.

Prompt referral, if this is an option, will likely improve the prognosis for the patient, particularly if return to athletic function is desired. Depending on the nature of the injury, the client should be informed as to the effect of this decision upon the horse’s prognosis.

Management in the field is targeted to assessment of affected structures, decontamination of these structures and appropriate antimicrobial therapy.

If the offending object is still in place, a complete set of radiographs is taken of the foot prior to its removal. If the offending object is no longer present, gently inserting a sterile probe allows assessment of the depth and direction of the tract [Figure 2]. The area should be thoroughly prepared and flushed prior to such exploration to avoid introducing further contamination. Depending on the chronicity of the injury, it pays to remember what can be probed may not be the full extent of the damage. The tract may have partially or fully sealed or a secondary tract may be present because of sepsis. Follow up radiographs may be necessary for sequestrum assessment ten days to two weeks post injury.

Contrast fistulography or arthrography can be useful to establish communication with the penetrating injury if this cannot be confirmed via radiographs and probing. If contrast material

30 Eq Vet Pract 2021, September; 46 (3)

is not available or is not practical, then sampling of individual synovial structures can confirm contamination or contamination/infection via cytology.

Joint fluid culture can also be attempted but is often unrewarding. Pressure testing of adjacent synovial cavities with sterile saline can also be performed to indicate communication and can be followed by standing synovial flushing [see page JKL]. An excellent resource for synoviocentesis is Equine Joint Injection and Regional Anaesthesia (Moyer et al., 2011), in which nerve blocks are also detailed. The palmar/plantar digital nerve block and abaxial sesamoid block are very useful for examination and treatment of these wounds.

Ultrasound examination is obviously limited by the window of vision around the hoof capsule but can be useful to assess the nature of the fluid in the flexor tendon sheath, coffin joint and the soft tissue structures to the level of the coronary band. Radiolucent foreign bodies can also be detected.

Thorough cleansing and debridement of the tract in the foot should be performed as aseptically as possible.

Paring away the hoof surrounding the

tract in a systematic manner allows for assessment and debridement of damaged and necrotic tissue. For wounds with significant necrotic tissue that are difficult to debride due to location, sterile maggot therapy can be considered. The author has had good results with a deep coronary band injury with such biologic debridement in one case.

Systemic antibiotic therapy supported by intravenous regional limb perfusions (IVRLP) with antibiotics are a necessary component of treatment. First line antibiotics include procaine penicillin (22,000-44,000IU/kg IM SID or BID) and gentamicin (6.6mg/kg IV SID) in combination, or oxytetracycline (5mg/kg IV BID) as first line defence is recommended (Anon., 2018).

Other antibiotics may be considered dependent on culture and sensitivity results in refractory infections. The anaerobic environment that is created in deep puncture wounds creates ideal conditions for the growth of C. tetani so tetanus prophylaxis should be used, and another reason to use penicillin.

Potential complications and sequelae of managing these wounds in the field

Figure 2: Sterile probe gently inserted into penetrating tract following thorough cleaning of the foot.

can also be life-threatening. Without the ability to appropriately decontaminate and debride on farm, immediate surgical referral should always be considered for wounds involving synovial structures for clients that have the means to do so.

Management on farm using standing needle lavage, IVRLP and systemic antibiotics is a possibility, but may also present a poorer prognosis, particularly for return to full athletic performance.

Incomplete or poor treatment of these wounds can lead to further necrosis and breakdown of vital structures within the foot, and to adhesions causing permanent lameness, both generally entailing euthanasia.

The use of IVRLP with antibiotics is a mainstay of treatment for these wounds and can be easily repeated q24-48 hours in the field (Kelmer, 2021).

CASE EXAMPLE A 7-year-old thoroughbred mare with foal at foot was presented to the clinic with an approximate 4-week history of marked, non-weight bearing lameness in the left hindlimb. The mare had lost body condition and was assessed as BCS 2/9 at the initial consultation. There was marked muscle wastage over the left hindquarters.

Initial assessment showed a 4/5 lameness of the left hindlimb while on phenylbutazone at 4.4mg/kg PO BID. There was marked oedema of the distal limb and the digital pulse was not palpable. The mare stood with the fetlock in permanent flexion and the plantar pastern appeared particularly thickened.

Evidence of a penetrating tract was visible in the lateral sulcus of the frog approximately halfway between tip and heel. Probing of this area appeared to track caudally towards the heel, likely due to secondary abscessation.

Initial radiographic examination showed mild to moderate subluxation of P3, caudal migration of the navicular bone, severe bony change of the navicular bone with complete loss of corticomedullary distinction and fracture of the lateral wing. It was unclear whether this was a primary fracture or pathological

fracture due to the presence of widespread osteomyelitis. Subluxation of P3 was indicative of partial rupture/ compromise of the DDFT and caudal migration of the navicular bone indicated that the impar ligament had been compromised. Facilities did not allow for ultrasound examination.

The mare was placed in a temporary wedge with a short heel extension.

Results of routine blood work were mostly within normal limits, but with fibrinogen at 4.9g/L (reference range 1.45.0 g/L), total protein 98g/L (reference range 57-80g/L) and total globulins 70g/L (reference range 27-50g/L), all indicative of chronic inflammation. SAA was <1mg/L (reference range 0-8mg/L).

An IVRLP was performed and then repeated at 48-hour intervals using 0.5g ceftiofur. The mare was also started on trimethoprim/sulphadiazine 30mg/ kg PO BID and NSAID therapy was switched to meloxicam at 0.6mg/kg PO SID. Trimethoprim/sulphadiazine was selected again due to owner and case circumstances. Penicillin and gentamicin would have typically been the author’s preference in these cases. The mare had received a tetanus toxoid four weeks prior to foaling.

Surgical referral and stabilisation of the joint was discussed at length, along with DDFT shortening (Kelmer, 2006). It was elected to attempt to manage the mare up until weaning of the foal if her clinical comfort allowed for this. The owner elected for on-farm management.

At the follow up radiographic examination for permanent shoe placement five days later, subluxation of P3 had markedly worsened. The mare’s clinical comfort had improved dramatically and swelling of the limb had rapidly subsided. The marked improvement in clinical comfort may well have been due to further or complete rupture of the DDFT and subsequent release of tension on the region.

The mare was managed for a period with a long heel extension and a tapering dose of meloxicam. She remained surprisingly comfortable over this time, despite progressive bony change to the coffin joint. Following the weaning of the foal at four months of age, the mare

was euthanised. Long term survival for chronic septic arthritis and synovitis is poor (Murray, 2012). The best outcome for chronic cases is ankylosis of the affected joint, usually resulting only in pasture soundness in most instances.

This case was a pertinent reminder as to the importance of correct diagnosis and management of penetrating foot wounds within the acute phase due to the potentially catastrophic consequences.

Thorough owner education regarding the potential severity of these cases and reminding owners that all foot issues are not always abscess≈es, is of upmost importance.

REFERENCES Anon. New Zealand Veterinary Association. Judicious Use of Antimicrobials - Equine. 2018.

Accessed August 2021.

Kelmer G. Antimicrobial Intravenous Regional Limb Perfusion: From Theory to Practice. Part 1 – Procedure. Eq Vet Pract. March 2021; 46(1): 25-30.

Kelmer G. Antimicrobial Intravenous Regional Limb Perfusion: From Theory to Practice. Part 2 – Pharmacology. Eq Vet Pract. June 2021; 46(2): 33 – 36.

Kelmer G., Kramer J. Deep Digital Flexor Tendon Shortening as a treatment for Distal Interphalangeal Joint Hyperextension in a 2-year-old Mare. Vet Comp Orthop Traumatol.

2006; 19:250-4.

Moyer W, Schumacher J & Schumacher J [2011]. Equine Joint Injection and Regional Anesthesia.

Academic Veterinary Solutions, LLC, Chadds Ford, PA, USA. https:// equinevetinfo.com/products/eji-book and www.vetebooks.com and Joint Injections Murray SJ. How to Manage Penetrating Injuries of Synovial Structures in the Field. AAEP Proceedings. 2012; 58: 221-227.

Redding WR. An In-Depth Look at Puncture Wounds to the Foot. AAEP Proceedings. 2010; 56: 512-521.

Eq Vet Pract 2021 September; 46 (3) 31

RE GIS TER NO W!

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www.nzva.org.nz/2021conf-november 32 Eq Vet Pract 2021, September; 46 (3)

Eq Vet Pract 2021 September; 46 (3) 33

EVP EDUCATIONAL FUND Dear Colleagues.

Did you know that you are eligible to apply for EVP funds to assist you in obtaining equine veterinary experience, training, travel, CPD etc? This is an annual sum of money is set aside each year by the NZEVA EVP Editorial Group to establish a Continuing Education (CE) fund.

These funds can be for use within Aotearoa.

Possible uses of funds include attending the NZVA/ NZEVA conference or short courses, spending time at specialist equine clinics and learning new skills from other (non-clinical) sources e.g., veterinary pathology laboratory.

Liquid supplement containing Glucosamine, Chondroitin & Biotin suspended in Omega Oil for bone & joint health, mobility & hoof condition in horses.

The two main purposes of this fund are:

• facilitating continuing education and/or specialist training for all paid up NZVA members and EVP Editorial Group members • disseminating information resulting from such funding that is of benefit to New Zealand equine practitioners through publication in the Equine Veterinary Practitioner journal Applicants seeking assistance from the CE fund must adhere to the following guidelines: 1. Present a complete budget for the proposed CE project and identify all sources of funds being sought and the planned use of any funds awarded from this fund.

2. Demonstrate that funds awarded under this scheme were used for the stated purpose.

3. Normally present a verbal report to the NZEVA EVP Editorial Group at a convenient EVP meeting held after completion of the CE project, or at the next NZEVA Annual Conference.

4. Within 60 days of the applicant completing, and/ or returning to NZ from, the CE project, submit to the Editor of the EVP a concise report of the project, identifying key new practical items of interest and value to NZ equine practitioners.

5. Applications can be made in writing to and will be assessed by two members of the EVP Editorial Group [currently JM and BH], who are NOT eligible for funding.

6. The application must include a signed statement: “I have read and understand my obligations to the EVP Editorial Committee.”

7. Approved applications can access up to 75% of awarded funds prior to undertaking the proposed travel. The remaining 25% will be paid upon receipt of an acceptable written report.

8. Except in exceptional cases, the amount awarded to any individual applicant will not exceed 50% of the available funds.

34 Eq Vet Pract 2021, September; 46 (3)

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THE OLYMPIC HOOF EXPLAINED SWEDISH FARRIER OUTLINES BAREFOOT MANAGEMENT OF GOLD MEDAL SWEDISH EQUESTRIAN TEAM Peter Glimberg Farrier, Grevlunda Training Center, Sweden

Following on from viewing Sweden’s top-class performances at Tokyo, Fran Jurga from Hoofcare Publishing interviewed notable Swedish Farrier Peter Glimberg on the use of barefoot farriery for elite horses.

Peter Glimberg has been farrier for Peder Fredricson (Gold Team Medalist and Silver Medalist for Show Jumping at Tokyo) at the Grevlunda training center for three years and usually travels as the Swedish national team farrier, but this was not allowed at this Olympics. Below is a synopsis of Peter Glimberg’s personal comments to Fran Jurga that can be read in full at https://hoofcare.blogspot.com.

‘The hoofcare program for these top horses centers on the balance between the positive and the negative effects of both shod and unshod hooves. I believe that the unshod hoof interacts better with the modern fiber-sand arena surfaces, where these horses train and compete.

The negative side of nailing a shoe to a hoof is that you automatically lift the hoof from the ground and therefore take away support from the underside of the frog and sole.

Since modern arena materials are very firm, with a nailed-on steel or aluminium shoe, we also take away the hoof’s ability to flex medio/laterally. This is a problem because I think we therefore put excessive stress on the hoof, especially on the coffin joint, since the fiber-sand surfaces don’t allow one side to sink while turning.

Foot of a Swedish showjumper with a coating of epoxy resin to help reduce wear. Image © Peter Glimberg/ Hoofcare and Lameness.

Obviously, If the hoof wears down more than it grows, the horse will get sore. It is as simple as that. And then you will have to protect the hoof. At Grevlunda, they do use hoof boots while hacking out, but only then, not when training on fibresand surfaces.

Peter Glimberg devised a thin aluminum shoe, so that grass studs could be used. However, he later found that thin steel shoes were more successful. (Image © Peter Glimberg/ Hoofcare and Lameness)

Quite often, I build up some extra hoof wall on these horses with a thin layer of epoxy material such as Vettec Superfast, so that the horses never get sore because of excessive wear.

Sometimes they compete with the adhesive and sometimes they don’t. We use it when the horses need extra protection.

The reason for putting this on is mainly for protection at areas surrounding the main arena. We have also tried really thin aluminium shoes for jumping at grass shows, just to be able to put studs in. These really thin hunter-fit type shoes allow the frog to function.

However, I think we use far too thick standard shoes on show jumpers. I believe that horses can benefit from thinner shoes, just by getting closer to the ground and therefore getting better support from the surface.

I believe that this program is something horsemen can benefit from if they have horses performing at the absolute top level.

Otherwise, they are better off keeping their horses shod.

I’m very proud of the Swedish riders in Tokyo and very proud to be a tiny bit part of it.’

My advice: “Keep it as close as you can to barefoot. The simplicity of a barefoot hoof interacting with a soft surface, that is what I believe in. But it is much, much easier said than done.”

Readers can subscribe to the Hoof Blog at https:// hoofcare.blogspot.com/ and perhaps of greater interest is subscription to Fran Jurga’s HoofSearch: The index of peer-reviewed equine foot research

Eq Vet Pract 2021 September; 46 (3) 35

News From NEW ZEALAND EQUINE RESEARCH FOUNDATION – NZERF The NZERF Spring 2020 Bulletin is now available: also via NZERF website at https://www.nzerf.co.nz/ Due to Covid-19 NZERF did not run their usual Rodmor Trust Lecture Series in 2020.

Partly in response to this, NZERF are developing brief educational videos on equine topics of interest.

Secretary NZREF, PO Box 52, Palmerston North allan.fenwick@xtra.co.nz The first of these videos, presented by Paul Fraser, are on Strangles [available HERE] and on Laminitis [available HERE]

WE’RE HERE TO HELP CONTACT US TODAY (07) 888 8193

• 24/7 Emergency Referral Hospital • Full Reproductive Service • Performance and Sports Medicine • Sales and Yearling Consultancy and Radiology

ADVANCING VETERINARY SCIENCE IN THE HEART OF THE WAIKATO Our dedicated team of highly experienced Equine Veterinarians provide the latest diagnostics, treatment and best care available for your horse.

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36 Eq Vet Pract 2021, September; 46 (3)

362 Hinuera Road West Matamata (07) 888 8193 matamatavets.co.nz

CASE REPORT FOLLOW-UP TWO CASES OF EPILEPSY EVP June 2021; 46 (2): 39-41 Rose Stocker rose@cvsgore.co.nz

CASE 1, 8YO STB GELDING A video of seizures of Case 1 can be viewed HERE The seizures commonly began with asymmetrical head positioning, ataxia, and walking in a small circle usually progressing to very rapid spinning in the same direction, like a very rapid, uncoordinated ‘spinning on the haunches’. At this point the gelding often fell onto the ground, with tonicclonic movement, sometimes accompanied by a grimace.

Another common sign was a stance where he leans back on the hindlimbs to various degrees, with the forelimbs extended, and various degrees of lordosis.

Widespread muscle twitching, especially of the facial muscles, ataxia and hypersensitivity to external stimuli were almost always observed, and the ensuing post-ictal period was frequently characterised by obtunded mentation, some paddock-running and apparent exhaustion. The gelding usually appeared to be normal by 30 minutes after the seizure, and often sooner.

Such asymmetric facial, head, neck and limb posturing is characteristic of a focal onset to the seizure, strongly indicating an acquired, intracranial event acting as a seizure focus.

CASE-2, 12YO TBX MARE Unfortunately, due to further seizures and for welfare reasons, this mare was euthanized May 2021 and 10 H&E slides of the brain were studied. Nothing significant that might be related to the epilepsy was found.

This is common for chronic epilepsy in adult patients. It only takes a small, functional or morphological lesion, to act as the seizure focus, so in a country where neuroinflammatory diseases such as caused by viruses and protozoa are rare, it can be unusual to find a focus, unless there are specific focal ictal or interictal signs that allow for an exquisitely focussed gross and histologic investigation.

The take home message is that although in the mind of an owner there is a huge problem with their animal’s brain, don’t offer hope of finding a gross or histologic diagnosis in such cases of epilepsy.

FREE WEBINARS & BULLETINS The Beaufort Cottage Educational Trust is a small charity that aims to support educational projects and events for all those involved in the care of horses and disseminate knowledge of the best veterinary and management practices and thereby enhance horse welfare.

The BCET makes available many educational resources on a wide selection of topics and these include the recent Gerald Leigh Memorial Lectures 2021 that were added in July 2021:

Angular limb deformities in foals and yearlings by Matt Coleridge, and What is OCD and how do we diagnose it? By Rhiannon Morgan. Both available HERE. Other useful presentations can be viewed at: • Gastrointestinal Disease in Foals • Herpes Virus • Foal Injuries and Diseases • Radiography at the Sales • Juvenile Orthopaedic Disease • Proximal Suspensory Desmitis • Suspensory Branch Injury

• Third Phalangeal Cysts • Imaging the Neck and Back • Fractured Ribs • Pelvic Ultrasonography • Wobbler Surgery • Recurrent Laryngeal Neuropathy • URT Function in the Young TB For Sale

Eq Vet Pract 2021 September; 46 (3) 37

Image credit: ACVECC

EQUINE CONFERENCES, SEMINARS & WORKSHOPS FROM SEPTEMBER 2021

Image credit: TheHorse

CHECK WEBSITES FOR COVID-UPDATES

• • • •

To access CLICK on hyperlink or insert name and location of event into your search engine.

Listed events are delivered in English For additional events see http://www.ivis.org/home.asp Aware of an upcoming equine event? Please inform the editor evp.editor@gmail.com Note that many organisers now have reduced registration fees for access to recorded conference presentations, that are available for an extended period after the actual conference, and good value in our opinion. Some of them even keep track of what you have watched, so you can easily and painlessly claim for CPD!

2021 SEPTEMBER September 4-7 September 11-15 September 27-October 1 OCTOBER October 7-9 October 20 NOVEMBER November 4-7 November 14-20 November 20 November 28-December 2 DECEMBER December 4-8 2022 JANUARY January 19-21 FEBRUARY February-November MARCH March (tba) MAY May 22-27 JUNE June 20-22 June 23 June 23-25

38 Eq Vet Pract 2021, September; 46 (3)

BEVA Annual Congress, Birmingham 2021. UK & ONLINE International Veterinary Emergency & Critical Care Symposium. Nashville, TN, USA International Equine Infectious Diseases Conference. Normandy, France ACVS Surgery Summit 2021. Chicago, USA AO-VET Complex Equine Fractures. WEBINAR, USA AO-VET Equine Fracture Management. ON-SITE; Berlin, Germany SAEVA & VetPD Safari Event. Dinokeng Game Reserve, South Africa European College of Equine Internal Medicine ONLINE. UK AO-VET Equine Arthrodesis and Fracture Fixation ON-SITE. Davos, CH AAEP Annual Convention. Nashville, TN. United States. LIVE & ONLINE

AAEP 23rd Annual Resort Symposium. Hawaii Principles of Veterinary Epidemiology. ONLINE. Massey University VetPD Course - Advanced mare reproduction. Equibreed, Te Awamutu (tbc) AVA Annual Conference. Broadbeach, AUS NZEVA Conference. Claudlands, Hamilton VetPD Workshop - Foot lameness and podiatry. Hamilton (tbc) ACVIM Medicine Forum. Austin, TX. USA

JULY July-February 2023 July 7-9 SEPTEMBER Sept 7-11 Sept 14-17 OCTOBER Oct 19-22 NOVEMBER Nov 18-22

Applied Veterinary Epidemiology. ONLINE. Massey University ECVS - Annual Scientific Meeting. Porto, Portugal IVECCS Emergency & Critical Care Symposium. San Antonio, TX. USA European Veterinary Diagnostic Imaging (EVDI). Edinburgh, UK European College of Equine Internal Medicine. Lyon, France AAEP Annual Convention. San Antonio, TX. USA

AAEP INFECTIOUS DISEASE GUIDELINES AAEP guidelines are created to provide instruction about horse health topics for the practitioner and the equine industry. Below is access to downloadable PDF guidelines for those diseases pertinent to Aotearoa NZ. A full listing is available HERE

• Botulism (Clostridium botulinum)

• Rhodococcus equi

• Clostridial diarrhea/enteritis

• Rotavirus

• Equine Coronavirus (ECOV)

• Salmonellosis

• Equine Herpesvirus (EHV-1 and EHV-4)

• Strangles (Streptoccocus equi)

• Equine Parvovirus-hepatitis Virus (EqPV-H)

Ibrahim M et al. Evaluation of mare endometrial cytology using the novel cytotape technique. Anim Repro Sci. 2021; 230: 106770. DOI 10.1016/j.anireprosci.2021.106770 The cytobrush is considered the method of choice to obtain endometrial samples. It was hypothesized that samples collected using a novel cytotape would provide sample smears of greater quality and less blood contamination than the cytobrush. Endometrial samples were collected with a cytotape and a cytobrush from ten mares without endometritis. Endometritis was then induced with AI and samples were again collected six hours later. Accuracy parameters were calculated using endometrial biopsy as the gold standard. Cytotape samples had less red blood cell contamination compared to cytobrush samples (P < 0.05). The number and percentage of PMNs, frequency of positive cytology diagnosis, number of colony-forming units and frequency of positive cultures did not differ between collection methods. Thus, the cytotape is a rapid, easy, and practical technique that can provide endometrial samples with similar diagnostic value to the cytobrush, but with less blood contamination.

Armengou L et al. Basisphenoid bone fracture in two juvenile horses with different clinical presentation. Vet Rec – Case Rpt. 2021. e141. DOI 10.1002/vrc2.141 This paper describes two foals with basisphenoid bone fractures, with clinical presentations varying from mild to severe neurological compromise. Take home messages were: • The absence of neurological signs does not exclude a fracture of this bone, as lethargy and retropharyngeal swelling may be the only clinical signs.

• Superimposition of complex neurocranial structures limits the use of plain radiography • Endoscopy of the guttural pouches can be also helpful, but it does not provide enough evidence for a diagnosis.

• Computed tomography is the optimal imaging technique for a rapid and straightforward diagnosis.

Eq Vet Pract 2021 September; 46 (3) 39

BOOK REVIEW

ECG Interpretation In Equine Practice Katharyn Mitchell

Mitchell, K. (2020). ECG Interpretation in Equine Practice: Cabi. https://www.cabi.org/cabebooks/ebook/20203269764 This extremely useful little book written by our very own Massey graduate, medicine specialist and cardiology superstar is a must-have reference for any equine vet.

Published by CABI, this compact book is the perfect size to fit into a glove compartment or door pocket without cluttering up the car. It is packed full of the essentials needed to do a thorough job of recording, reading and interpreting ECGs correctly. The book starts with the basics of the cardiac cycle and the generation of the tracing, and then gives practical advice about how to get the best quality result, whether the examination is a basic short check at rest or a detailed longer-term or exercising ECG. The logical and stepwise instructions for reading the tracings and clear explanations of exactly what to look for provide a solid foundation for calmly approaching even the most haywire hearts. There are examples of good and bad quality recordings, artefacts, and the way the three leads give different information about each area.

40 Eq Vet Pract 2021, September; 46 (3)

A particular highlight for me was the idiot-proof decision tree algorithms provided to help decide what kind of arrythmia you’re dealing with.

Once you’ve familiarized yourself with the approach, there are several case examples with test questions so you can see if you learned as much as you think you did in the first half of the book. This clever feature really suited my inner geek, and I did have to flip back to the earlier text to check my logic, which served brilliantly as spaced repetition to make that learning stick.

Now that I have the book, I wouldn’t want to be without it, and I can’t wait to start using our new Televet machine and take my cardiac diagnostic capability to a new level.

Spoiler alert: This book makes no mention of the use of limb leads or heart scores because this is no longer 1985.

Angela Hawker July 2021

BVSc-V [MASSEY] STUDENT CASE REPORT UROPERITONEUM AND CLOSTRIDIUM DIFFICILE INFECTION IN A THREE-DAY OLD COLT Anna Forbes annaforbes@hotmail.co.nz

INTRODUCTION Uroperitoneum is well documented in neonatal foals and numerous aetiologies have been described. Bladder rupture is the most reported cause of uroperitoneum in the equine neonate, with the majority of these cases resulting from trauma due to increased intra-abdominal pressure during parturition (Castagnetti et al. 2010; Hardy 1998; Love 2011).

Various other causes have been recorded, including urachal and urethral defects, urinary tract infections, and sepsis (Butters 2008; Mendoza et al. 2010). While most of these cases report trauma as the cause of urinary tract rupture, congenital defects have also been reported (Chaney 2007; Hardy 1998).

This report describes an interesting and relatively uncommon case of uroperitoneum caused by a congenital bladder defect, which was diagnosed and surgically repaired in a 3-dayold colt. The colt was subsequently confirmed to have a concurrent Clostridium difficile infection.

CLINICAL FINDINGS A three-day-old thoroughbred colt was presented to Massey University Veterinary Equine Clinic with an acute onset of lethargy, distended abdomen, and haemorrhagic diarrhoea.

The stud farm was experiencing a neonatal outbreak of Clostridium perfringens at the time, so veterinary treatment was promptly sought with concern for C. perfringens infection.

Parturition had been uneventful three days prior, and the foal had appeared healthy at birth and throughout the first two days of life. He had received an enema of warm soapy water the day before due to a meconium impaction and had reportedly experienced haemorrhagic diarrhoea since.

The colt was able to stand and nurse on admission, with normal hydration. He had a heart rate of 110 bpm and a respiration rate of 40 brpm. Rectal temperature was 38.8⁰C. Auscultation of his abdomen revealed typical borborygmi present in all four quadrants. The abdomen was noted to be moderately distended.

Haematologic results revealed mild leucocytopenia (4.3x109/L), with a mild left shift neutropenia (segmented neutrophils 3.1x109/L, band neutrophils 0.5x109/L), and mild lymphocytopenia (0.6 x109/L). Blood biochemical results [Table 1] showed hyponatraemia, hyperkalaemia, hypochloraemia,

markedly increased creatinine, and signs of metabolic acidosis: hyperlactataemia (4.48 mM/L), hypocapnia (22.5 mM/L), low pH (7.33), and low bicarbonate (22.8 mM/L).

Abdominal ultrasonography revealed a large volume of hypoechogenic fluid (Figure 1), as well as a collapsed urinary bladder (Figure 2).

Table 1. Serum biochemical values obtained on this case [Epoc analysis system].

Time point

Potassium (mM/L)

Sodium (mM/L)

Chloride (mM/L)

Creatinine (µM/L)

Admission

6.3

121

91

710

Initial stabilisation

4.4

127

92

371

Immediately post-surgery

4.3

129

94

314

1.9 - 4.1

128 - 142

100 - 111

35 - 195

Reference ranges

Uroperitoneum resulting from a ruptured bladder was diagnosed, and the decision was made to stabilise the colt and then proceed to surgery. An over-the-wire catheter was placed in the left jugular vein and he was administered 2L of 0.9% NaCl (Sodium Chloride 0.9%, Baxter) IV, with 30mL 50% glucose solution (Glucose 50%, Baxter) added per 1L bag.

The colt was also given 5mg/kg ceftiofur (Calefur, Dechra) IV 30 minutes prior to the start of surgery.

SURGERY The colt was anaesthetised and positioned in dorsal recumbency and a urinary catheter was placed through the urethra and secured in the bladder. A fusiform shaped incision was made around the external umbilicus and this was removed via sharp dissection. A 10cm long ventral midline abdominal incision was made. The free fluid in the abdominal cavity was diluted with warm 0.9% sodium chloride and then suctioned out. Stay sutures were placed in the urachus to allow retroflexion of the bladder and exposure of the dorsal surface. A 4cm long rent was noted on the dorsal surface of the bladder [Figure 3]. The defect had smooth edges with no evidence of haemorrhage, indicating that this was likely of congenital origin rather than traumatic. This defect was repaired with a double layer of 3-0 monocryl suture using a Cushing pattern. The umbilical and urachal remnants were removed via sharp dissection and the site was closed with 0

Eq Vet Pract 2021 September; 46 (3) 41

500mL carboxymethylcellulose (Belly Jelly, Sigma-Aldrich) into the abdomen. The linea alba was closed with 2-0 PDS in a simple continuous pattern, the subcutaneous tissue closed with 2-0 Monocryl™ (Ethicon) in the same pattern, and the skin with 2-0 ethylon in a simple interrupted pattern. The site was bandaged with a primapore dressing and the colt was recovered from the two hour-long uncomplicated anaesthesia.

Figure 1. The colon surrounded by hypoechogenic free fluid (star).

Post-surgery, the colt was given ceftiofur at 5mg/kg IV QI D for four days, and flunixin meglumine (Flunixin, Norbrook) at 0.5mg/kg IV BID for six days, then once daily as needed following discharge. One-hour post-surgery he was administered a 2L bolus of 0.9% NaCl IV, followed by additional 1L boluses approximately four hourly for five days.

The foal started urinating an hour after surgery and was then ambulatory and nursing from the mare with progressive normalisation of blood biochemical parameters [Table 1].

One day post-surgery the colt developed watery yellow diarrhoea which was treated with continued fluid support and Bio-Sponge® (Platinum Performance). A faecal sample was PCR positive for Clostridium difficile and negative for Clostridium perfringens, following which metronidazole antibiotic was administered.

Figure 2. The empty urinary bladder with surrounding free fluid and umbilical arteries visible on either side (arrows).

Figure 3. Defect in the dorsal bladder wall (arrow) at time of surgery.

monocryl suture in a double layer with Lembert and Cushing patterns. The bladder was then fully distended with sterile saline via the urethral catheter to confirm secure surgical closure. The abdomen was lavaged with 5L of 0.9% NaCl which was then suctioned out followed by placement of

42 Eq Vet Pract 2021, September; 46 (3)

Other than the diarrhoea and some resulting mild dehydration, the colt recovered well from the surgery and had no further issues while in hospital. He was discharged six days postsurgery with continuing marbofloxacin and metronidazole. The diarrhoea resolved following discharge and the colt recovered fully.

DISCUSSION The presentation and management of uroperitoneum in this case was typical of similar reported cases (Butters 2008; Castagnetti et al. 2010; Hardy 1998). Uroperitoneum is a commonly documented occurrence in neonatal foals, with traumatic bladder rupture during parturition being the most common aetiology (Castagnetti et al. 2010; Landro 2011; Mendoza et al. 2010). Bladder rupture should therefore always be a prominent differential when neonatal foals present with indicative clinical signs. Foals typically appear healthy at birth, but deteriorate over the first 24-72 hours of life, with a distended abdomen, lethargy, and stranguria or anuria becoming apparent. Recumbency, tachycardia, tachypnoea, reduced peripheral circulation, and diarrhoea have also been reported (Butters 2008; Mendoza et al. 2010; Pelt 1994). The colt in this case presented with acute onset of lethargy, abdominal distension, and haemorrhagic diarrhoea, although the diarrhoea was likely due to concurrent infection with C. difficile. He was still able to stand and nurse at the time of admission, indicating that electrolyte imbalances were not yet advanced enough to cause a more severe clinical manifestation.

Biochemical parameters associated most with uroperitoneum are hyperkalaemia, high creatinine, hyponatraemia, and hypochloraemia, all of which were present in this case (Butters 2008; Dunkel et al. 2005; Mendoza et al. 2010).

These abnormalities are seen due to the high concentrations of potassium and creatinine, and low concentrations of sodium and chloride in urine, which rapidly equilibrate with blood across the peritoneum (Love 2011).

Diagnostically, abdominal ultrasonography was equally conclusive in this case. Large areas of hypoechogenic fluid within the abdominal cavity and a collapsed urinary bladder strongly indicated uroperitoneum caused by a defect in the urinary bladder (McAuliffe 2004). Due to most bladder defects in neonates regarded as being caused by traumatic rupture, trauma during parturition was the top differential for the bladder rent. Intraoperatively, there was very little evidence of recent trauma to the bladder, which might be more indicative of a congenital developmental defect in closure of the bladder wall. Regardless of the precise aetiology, the treatment and surgical plan would have been the same, so this was not a clinical issue.

The bladder defect in this case made anaesthesia a necessary risk, but uroperitoneum causes a multitude of biochemical changes including hyperkalaemia, hyponatraemia, hypochloraemia, azotaemia, and metabolic acidosis, that have the potential to react poorly with anaesthetic drugs (Hardy 1998; Love 2011; Butters 2008; Love 2011). Hyperkalaemia is perhaps the most important of these changes, as it has the potential to cause severe bradycardia and ventricular fibrillation, while hyponatraemia and acidaemia may worsen these cardiovascular effects (Love 2011). These serum abnormalities carry a significant risk on their own but combined with anaesthetic drugs that depress the cardiovascular system, may quickly become life threatening.

Thus stabilisation prior to surgery is essential, the goal being to bring these biochemical parameters quickly but safely to as close to normal ranges as possible before surgery. This foal was given 0.9% NaCl IV with added glucose to lower potassium and creatinine concentrations, while increasing sodium and chloride [Table 1]. Administration of glucose stimulates insulin release, which promotes the insulinmediated movement of glucose intracellularly. Potassium is also affected by this mechanism and is similarly transported intracellularly, thus reducing blood potassium concentration (Shingarev and Allon 2010). The concurrent administration of insulin along with glucose has been shown to be effective in more severe cases, although was likely not called for in this case as no clinical effects of the hyperkalaemia were apparent. Calcium gluconate can also be administered to minimise the cardiac effects of hyperkalaemia by restoring the transmembrane electrical gradient of the cardiac myocytes (Shingarev and Allon 2010).

Dunkel et al. (2005) reviewed 32 cases of uroperitoneum in foals and found that most patients presenting with uroperitoneum had a leucocytosis and mature neutrophilia.

In this case however, haematology on admission revealed a mild neutropenia with a mild left shift. These leukocyte changes were indicative of a more severe degree of acute inflammation than a bladder rupture would have accounted for alone. The subsequent confirmation of C. difficile infection

by faecal PCR likely explained this discrepancy (East et al.

1998; Uzal et al. 2012).

Clostridium difficile is an endospore-forming, anaerobic, grampositive bacillus, widely reported as a cause of diarrhoea in neonatal foals (Arroyo et al. 2004; Båverud 2004; Uzal et al. 2012). A range of clinical signs and severities have been documented, from mild softening of faeces and abdominal discomfort, to watery, haemorrhagic diarrhoea, extreme lethargy, dehydration, and death (Arroyo et al. 2004; East et al. 1998; Uzal et al. 2012). A link between severity of disease in foals and failure of maternal antibody transfer has been suggested, with adequate serum immunoglobulin G (IgG) concentrations (>8g/L) associated with milder clinical signs and improved recovery rates (Arroyo et al. 2004). Had the foal not also had the bladder defect and resulting uroperitoneum, it is probable that the C. difficile infection would have resulted in veterinary attention regardless when clinical signs progressed.

It is likely that the colt’s early admission to hospital and subsequent supportive care minimised the effects that the clostridial infection may have otherwise had.

C. difficile is not only highly infectious to other horses, it also poses a significant zoonotic risk to humans (Båverud 2004; Diab et al. 2013; Kelly and LaMont 2008). In humans, C. difficile infections have been shown to cause colitis resulting in a range of clinical signs from mild diarrhoea to severe abdominal pain, haemorrhagic diarrhoea, and death (Kelly and LaMont 2008). Infection can occur via direct contact with an infected patient, or via fomites (Båverud 2004). To reduce risk of infection in both humans and other horses, it is therefore imperative that strict infection control measures as used herein are adhered to.

The farm involved in this case was already aware of a C. perfringens outbreak in their foals, so had some control measures in place to reduce infection with both organisms between foals. It is essential that these control measures are strictly adhered to for the duration of the clostridial outbreak. It is also important that any handlers are aware of the zoonotic risk that this disease presents and are educated on how to reduce the risk of infection.

ACKNOWLEDGEMENTS Massey Equine Veterinary Clinicians involved with this case referred by EquiVets/SRVS were Emma Gordon, Ellison Aldrich and Ella Chappaz, and Stuart Gordon helped with editing.

REFERENCES Arroyo LG, Weese JS, Staempfli HR. Experimental Clostridium difficile enterocolitis in foals. Journal of Veterinary Internal Medicine 18, 734-8, 2004 Båverud V, Gustafsson A, Franklin A, Aspan A, Gunnarsson A. Clostridium difficile: prevalence in horses and environment, and antimicrobial susceptibility. Equine Veterinary Journal 35, 465-71, 2003 Båverud V. Clostridium difficile diarrhea: infection control in

Eq Vet Pract 2021 September; 46 (3) 43

horses. Veterinary Clinics: Equine Practice 20, 615-30, 2004 Båverud V, Gunnarsson A, Karlsson M, Franklin A. Antimicrobial susceptibility of equine and environmental isolates of Clostridium difficile. Microbial Drug Resistance 10, 57-63, 2004 Butters A. Medical and surgical management of uroperitoneum in a foal. The Canadian veterinary journal = La revue veterinaire canadienne 49, 401-3, 2008 Castagnetti C, Mariella J, Pirrone A, Romagnoli N, Pasquali F, Spadari A, Parmeggiani F. Urethral and bladder rupture in a neonatal colt with uroperitoneum. Equine Veterinary Education 22, 132-8, doi:10.1111/j.2042-3292.2010.00040.x, 2010 Chaney KP. Congenital Anomalies of the Equine Urinary Tract.

Veterinary Clinics of North America: Equine Practice 23, 6916, doi:https://doi.org/10.1016/j.cveq.2007.09.004, 2007 Diab SS, Songer G, Uzal FA. Clostridium difficile infection in horses: a review. Veterinary Microbiology 167, 42-9, 2013 Dunkel B, Palmer JE, Olson KN, Boston RC, Wilkins PA. Uroperitoneum in 32 Foals: Influence of Intravenous Fluid Therapy, Infection, and Sepsis. Journal of Veterinary Internal Medicine 19, 889-93, doi:10.1111/j.1939-1676.2005. tb02783.x, 2005 East LM, Savage CJ, Traub-Dargatz JL, Dickinson CE, Ellis RP. Enterocolitis associated with Clostridium perfringens infection in neonatal foals: 54 cases (1988-1997). Journal of the American Veterinary Medical Association 212, 1751-6, 1998 Hardy J. Uroabdomen in foals. Equine Veterinary Education 10, 21-5, doi:10.1111/j.2042-3292.1998.tb00842.x, 1998

Kelly CP, LaMont JT. Clostridium difficile—more difficult than ever. New England Journal of Medicine 359, 1932-40, 2008 Landro K. Uroperitoneum in foals. Hungarian Veterinary Archive, 2011 Love E. Anaesthesia in foals with uroperitoneum. Equine Veterinary Education 23, 508-11, 2011 McAuliffe SB. Abdominal Ultrasonography of the Foal. Clinical Techniques in Equine Practice 3, 308-16, doi:https://doi. org/10.1053/j.ctep.2005.02.008, 2004 Mendoza F, Lopez M, Diez E, Perez-Ecija A, Estepa J. Uroperitoneum secondary to rupture of the urachus associated with Clostridium spp. infection in a foal: a case report. Veterinarni Medicina 55, 399-404, 2010 Pelt RJV. Correction of rupture of the urinary bladder in a foal. Equine Veterinary Education 6, 80-2, doi:10.1111/j.2042-3292.1994.tb01095.x, 1994 Shingarev R, Allon M. A physiologic-based approach to the treatment of acute hyperkalemia. American journal of kidney diseases : the official journal of the National Kidney Foundation 56, 578-84, doi:10.1053/j.ajkd.2010.03.014, 2010 Silva ROS, Moreira FM, Rezende JV, Pires PS, Maranhão RdPA, Palhares MS, Lobato FCF. First confirmed case of Clostridium difficile-associated diarrhea in foals in Brazil.

Ciência Rural 42, 498-500, 2012 Uzal FA, Diab SS, Blanchard P, Moore J, Anthenill L, Shahriar F, Garcia J, Songer J. Clostridium perfringens type C and Clostridium difficile co-infection in foals. Veterinary Microbiology 156, 395-402, 2012

Hyman SS, Wilkins PA, Palmer JE, Schaer TP, Piero FD. Clostridium perfringens urachitis and uroperitoneum in 2 neonatal foals. Journal of Veterinary Internal Medicine 16, 489-93, 2002

Sun TC et al. Ketofol: A ketamine-propofol admixture for induction of anaesthesia in two foals. Vet Rec Case Rpt, 2021; e136. DOI 10.1002/vrc2.136 Two foals undergoing surgery for angular limb deformities were anaesthetised using ketamine:propofol admixture (ketofol). Ketamine was used at 2 and 1 mg/kg, and propofol at 2 and 1.5 mg/kg in cases 1 and 2, respectively.

Induction of general anaesthesia was smooth and occurred within 30 s after ketofol administration. No apnoea, nystagmus and paddling were noted. In case 1, anaesthesia was maintained with additional boluses of propofol (0.4 mg/kg) and flow-by oxygen delivered via face mask, and in case 2 with isoflurane delivered in oxygen. The anaesthetic time was 20 and 55 min in cases 1 and 2, respectively. Before recovery, xylazine (0.2 mg/kg) was administered IV in case 2. Both foals stood at the first attempt approximately 10 min later with mild ataxia.

NOTE: Lots of uncontrolled variables here. So, as recommended in human emergency medicine, structured clinical trials comparing ketofol, each drug separately, and other combinations such as ketamine/benzodiazepine are required before this combination can be promoted. See https://www.aliem.com/ketofol-game-changer-procedural-sedation/

44 Eq Vet Pract 2021, September; 46 (3)

STUDENT SPONSORSHIP FOR NZEVA CONFERENCE

Final Year Massey BVSc Equine Track Students sponsored by Equine Practices to attend the‘How-To’ Day at NZEVA 2021 Conference, accompanied by practice representatives. Shown left to right at NZEVA Conference at the Wigram Airforce Museum venue are:

1. Andrew Bailey, Rangiora Veterinary Services; 2. Steph Matthews; sponsored by Rangiora Veterinary Services; 3. Lucy Bell; sponsored by Waikato Equine Veterinary Centre; 4. Kerry Dyson; sponsored by Matamata Veterinary Services; 5. Alannah Zantingh, Cambridge Equine Hospital; 6. Andrea Ritmeester, Matamata Veterinary Services; 7. Alex Leander, Waikato Equine Veterinary Centre; 8. Rachel Hocking; sponsored by Cambridge Equine Hospital; 9. Edward Searle; sponsored by Veterinary Associates Equine and Farm Karaka; 10. Alex Fowler, Veterinary Associates Equine and Farm Karaka;

We provide emergency service 24 hours a day, 7 days a week.

We are a team of highly qualified equine veterinarians, including a registered Specialist in Equine Surgery with extensive experience.

We provide the highest quality of first opinion, emergency, and referral services for all horses and ponies, from the paddock pet to the elite athlete.

P 07 827 7097 E cambridgeeh@xtra.co.nz 71 Racecourse Rd, Cambridge NZ www.horsehospital.co.nz

Our routine hours of operation are from 8am to 5pm Monday to Friday, with our reception also open on Saturday from 8am to 11am.

Eq Vet Pract 2021 September; 46 (3) 45

NEW ZEALAND EQUINE RESEARCH FOUNDATION

VETERINARY SCHOLARSHIPS AND GRANTS http://www.nzerf.co.nz/

TRAVEL AWARDS For any travel relating to research and development in the NZ horse industry. http://www.nzerf.co.nz/travel_awards APPLICATIONS RECEIVED ANY TIME VETERINARIAN – FARRIER SCHOLARSHIPS $3,000 for a veterinarian and a farrier to attend a suitable course or symposium and/or spend time with colleagues in the USA http://www.nzerf.co.nz/travel_awards CLOSES 30TH NOVEMBER ANNUALLY VALACHI DOWNS YOUNG ACHIEVER AWARD $15,000 available annually to assist an individual under the age of 35 in their career in the equine industry http://www.nzerf.co.nz/valachi downs young achiever CLOSES 10TH JANUARY ANNUALLY JONATHAN HOPE EQUINE VETERINARIAN SCHOLARSHIP $10,000 available annually to help a “young at heart” New Zealand-based veterinarian to travel and gain practical skills that will be valuable in supporting his or her work within the NZ horse industry. http://www.nzerf.co.nz/hope_scholarship CLOSES 10TH JANUARY ANNUALLY EQUINE RESEARCH GRANTS Applications from interested people for funding or projects in the field of equine research. http://www.nzerf.co.nz/research_grants CLOSES 30TH APRIL ANNUALLY PROF CHG IRVINE MEMORIAL SCHOLARSHIP Research Grant may be used as part of a larger research project or as a standalone award. http://www.nzerf.co.nz/memorial_scholarship CLOSES 30TH APRIL ANNUALLY APPLICANTS SHOULD APPLY IN WRITING/EMAIL TO: The Secretary, NZ Equine Research Foundation, P O Box 52, Palmerston North Email allan.fenwick@xtra.co.nz

See the latest NZERF bulletin here

USEFUL LINKS

We thought you might appreciate having a listing of useful URL links to allied contact groups in your E-EVP - so here is a start.

Please contact us to add or change any address.

AAEP - American Association of Equine Practitioners ANZCVS - Australian & NZ College of Veterinary Scientists

Massey Equine Veterinary Clinic

NZERF - NZ Equine Research Foundation

ARVS - Association of Racecourse Veterinary Surgeons

NZEVA - New Zealand Equine Veterinary Association

BAEDT - British Association of Equine Dental Technicians

NZVA - NZ Veterinary Association

BHS - The British Horse Society

BEVA - British Equine Veterinary Association https://equinesurveillance.org/ iccview/

https://www.nzva.org.nz/events/ event_list.asp SPCA – Society for the Prevention of Cruelty to Animals-NZ Thoroughbred RACEHORSE OWNERS Federation

NZTR - NZ Thoroughbred Racing ESNZ - Equestrian Sports NZ

EVA - Equine Veterinarians Australia

EVJ - Equine Veterinary Journal

RCVS - Royal College of Veterinary Surgeons SAEVA - South African Equine Veterinary Association SIVE - Societa Italiana Veterinari per Equini

EVJ - Equine Veterinary Journal The Donkey Sanctuary Harness Racing NZ

https://www.vetpd.com/

HBLB - Racehorse Health

Eq Vet Pract 2021 September; 46 (3) 47

VETLOGIC PUZZLE - EVP SEPTEMBER 2021

4. The Kinsky stallion is not the shortest horse.

5. Grace Reed either imports the shortest stallion or bought the Spiti horse..

Can you work out on the fillable grids the HORSE BREED and HEIGHT each OWNER imports?

OWNER

HEIGHT (cm)

3. Pip Hendron’s stallion is 160 cm tall.

150 160 170 Spiti Kinsky Moyle Curly

HORSE BREED

See page 59 for answers

HEIGHT (CM)

Melissa Sim Grace Reed Pip Hendron Alex Fowler

Wismann ES et al. Long-term athletic performance in sport horses after desmotomy of the accessory ligament of the deep digital flexor tendon. Eq Vet J. June 2021; DOI 10.1111/evj.13472 Records from multiple practices of 74 horses undergoing desmotomy of the accessory ligament of the deep digital flexor tendon (AL-DDFT) to treat flexural deformity of the distal interphalangeal joint and 194 age-matched siblings as controls were reviewed. Although not significantly different (P = 0.2), the proportion of treated horses entering competition (28%, 95% CI 16%-38%) had a risk difference compared with the proportion of control horses entering competition (38%, 95% CI 26%-44%). Career longevity was significantly (P < 0.001). better for control horses (16 competitions over a median of 570 days) than for horses operated in one limb (10 competitions over a median of 219 days), and 6.1 competitions over a median of 446 days for horses operated in two limbs. Age at the time of surgery and whether the condition was unilateral or bilateral did not affect chance of competing. There were many incomplete data points, however it appears from this study that desmotomy of the AL-DDFT is associated with decreased longterm athletic performance in sport horses compared with matched horses.

48 Eq Vet Pract 2021, September; 46 (3)

Curly

Moyle

Spiti

Alex Fowler

Pip Hendron

HORSE BREED

140

HORSE BREED

2. The Spiti horse is 20 cm shorter than the Curly horse.

Curly Horse:Wikipedia

Grace Reed

1. Regarding the shortest and tallest horses, one is imported by Alex Fowler and the other is the Curley horse.

Melissa Sim

OWNER

Kinsky

Four new members of your NZEVA Executive decide to import exotic breed stallions into Aotearoa..

WHAT WOULD YOU DO? 3YR OLD THOROUGHBRED FILLY Rabecca McKenzie rabeccam@energyvets.co.nz

BACKGROUND Filly was normally boxed in a concrete brick and thick meshnetted stall. Injury occurred overnight and horse was travelled to the track and worked, despite lameness. Trainer mentioned she ‘worked out of it’. The primary phone call was from the trainer who wanted to administer antibiotics himself.

GENERAL PLAN AT REFERRAL HOSPITAL GREG QUINN

In keeping with principals for antimicrobial stewardship I asked some questions, including location of the wound and level of lameness. After not being satisfied to prescribe ‘over the counter’ a call was booked within the hour.

On arrival the wound was obvious [Figure 1]. The horse had a normal physical examination. She was 4/5 lame at the walk.

Figure 2: Showing debris in joint including hair (arrows).

Figure 1: Wound at first presentation

WHAT WOULD YOU DO? The wound was clipped and aseptically prepared. A sterile probe was placed which hit bone and on retraction of the probe there was a flush of serosanguineous fluid. A 20-gauge 25mm needle was placed, and a small amount of bloody synovial fluid was aspirated, after which 180mg of gentamicin was injected. Sterile swabs were then placed over the wound and two-layer bandage placed for transport. Photographs of the wound were sent immediately to the referring surgeon and transport arranged for the filly. Systemic medications were started with gentamicin (6.6mg/kg IV minus the 180mg in the joint), ceftiofur (5mg/kg IV), flunixin meglumine (1.1.mg/kg IV) and a 1500units TAT SC.

After initial assessment of vital parameters and comfort, the filly would be sedated for further evaluation. Following bandage removal, an initial survey set of four standard radiographic films would be the first task undertaken. The wound would then be prepped for ultrasound with protection of the wound from additional contamination prior to clipping. The adjacent soft tissue and bony structures would be assessed. It would be unusual for a horse that is 4/5 lame, not to have damaged something deeper and more vital. After placement of an abaxial nerve block, the respective synovial structures would be evaluated for their integrity. The ultrasound examination would help determine which structure to assess by following the trajectory of the wound penetration, if possible. With this location shown in Figure 1, there could be involvement of underlying bone and collateral ligament, distal interphalangeal (coffin) joint, or proximal interphalangeal (pastern) joint.

Ideally, if there is insufficient fluid identified on ultrasound for synoviocentesis, the respective joints would be dissented with sterile isotonic fluids from the opposite side of the limb (palmar/plantar pastern) or abaxial to the midline (coffin) joint away from the wound. A small volume of antibiotic (gentamicin or amikacin), would be injected after sterile fluid distension.

Any egress of fluid would indicate a breach of the synovial environment and the recommendation then would then be an arthroscopically guided surgical flush, with particular attention being paid to removing all fibrin and foreign material such as grit and hair [Figure 2]. If samples of joint fluid could be obtained, these should be cytologically evaluated and fluid sent for culture using a blood culture broth bottle.

Eq Vet Pract 2021 September; 46 (3) 49

MASSEY EQUINE HOMEPAGE SPRING The season’s first foals have hit the ground, and practices are gearing up for this busy time of year. Of course, the rain and cool weather adds to the challenges of on-farm calls.

The fifth-year students have returned from their spring calving and are working hard on their rosters to finish the year out. In addition to running the clinic, this is a busy time for teaching in the BVSc programme. We share with you the challenges of maintaining a full complement of staff, which will surely be felt more keenly as the season progresses. Nevertheless, we will be working hard to support our referring veterinarians and profession. A new equine student facility has been added to the Equine Veterinary Clinic which will increase the comfort of students on equine rosters. In addition to our regular twoweek long rosters, we run additional experiences for equine students called Special Topics. Our third and final one for the year will be completed next week.

PEOPLE Heartfelt congratulations from all members of the Equine Group at Massey are extended to Emeritus Professor Joe Mayhew. Joe was the 2021 recipient of the ACVIM Robert W. Kirk Award for Professional Excellence in recognition of outstanding achievements and dedicated service to the veterinary profession. This was followed by the award of the 2021 NZVA President Award presented by the President Dr Grant McCulloch at the NZEVA Gala dinner at our conference in June. Having heard the attestation as to his excellence and service to a profession for both presentations, I can say that we are truly fortunate to have Joe as a member of our profession in New Zealand.

Ben Sykes recently returned to the clinic from a visit with his family in Australia. Because of the closure of the AustraliaNew Zealand CoViD-19 travel bubble he had to do this via a two week spell in MIQ . Ben has been appointed as the acting Equine Group Leader while a candidate is sought to fill this position following Erica Gee’s move into her new role.

Ben was also recently recognised as a Fellow of the Higher Education Academy.

We welcome Amy Lovett to the Equine Group as Senior Lecturer in Equine Medicine. She received her BVSc from the University of Melbourne in 2013. After a short stint in mixed animal practice she accepted and completed an equine internship at a private equine referral hospital near Sydney.

Her love for equine internal medicine developed during this time, ultimately leading to her completion of an equine medicine residency program at Oklahoma State University.

Following her residency, she spent six months in a fellowship in equine internal medicine at the Hagyard Equine Medical 50 Eq Vet Pract 2021, September; 46 (3)

Amy Lovett

Institute, Kentucky (USA). She is currently a diploma candidate of the American College of Veterinary Internal Medicine, soon to be board certified following the publication of her residency research project investigating coagulation profiles in horses with obesity and insulin dysregulation. Unfortunately she is currently stranded in Australia due to the travel restrictions associated with CoViD. Kate Averay, our short term Resident in Equine Surgery that we introduced in our last newsletter has completed her programme. Kate has returned to Australia to start a position with the Victorian Equine Group in Bendigo. Her enthusiastic and bubbly personality will be missed. Emma Gordon recently moved from her role in equine medicine to take up a new position as Senior Lecturer in Veterinary Simulation-based Education. In this role she seeks to enhance the experience of veterinary students in developing their veterinary skills. We are happy to acknowledge the welcome support of the Don Maclaren Fellowship Fund support to purchase of equine simulation models as part of this innovative approach to teaching.

OUTREACH Ben Sykes, Chris Riley and Joe Mayhew on behalf of Massey were among the many presenters that contributed to this years Equine Branch program at the NZVA meeting in Christchurch. CoViD drama aside, it was great to see colleagues in person again and to participate in the great CPD opportunities on offer. Chris Riley and Alex Fowler of Veterinary Associates Equine recently worked with the NZEHA to develop further training modules for the China

Horse Industry Association [CHIA]. Special recognition goes out to Ivan Bridge and Trish Pearce who worked to broker a MOI with CHIA in partnership with MPI and with the New Zealand Embassy in China. Such partnerships are important to maintain international trade opportunities for our equine industry.

RECENT PUBLICATIONS Bardin AL, Tang L, Panizzi L, Rogers CW, G. Colborne GR. Development of an anybody musculoskeletal model of the Thoroughbred forelimb. Journal of Equine Veterinary Science 2021; 103. DOI 10.1016/j.jevs.2021.103666

Guinnefollau L, Bolwell CF, Gee, EK, Norman EJ, Rogers CW. Horses’ physiological and behavioural responses during undergraduate veterinary practical teaching classes.

Applied Animal Behaviour Science 2021; 241:105371. DOI: 10.1016/j.applanim.2021.105371

Cuille O, Bodaan C, Brown S, Riley CB, Munday JS. Mack JS. Acute suprarenal occlusion in an American Miniature Horse. Equine Veterinary Education 2021; 33(9): E338-E344. DOI 10.1111/eve.13406 Sykes BW. A free ride: Is long-term omeprazole therapy safe and effective? Equine Veterinary Education 2021 DOI10.1111/ eve.13458

Warm Regards from the Massey Equine Team

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Eq Vet Pract 2021 September; 46 (3) 51

UPDATE ON HEPATOTOXINS1 There have been numerous papers recently on the role of viruses, especially equine parvovirus-hepatitis (EqPV-H) and equine hepacivirus, nonprimate hepacivirus [NPHV] causing liver damage, liver failure and hepatoencephalopathy. The presence, incidence, and clinical importance of such hepatotropic viruses in Aotearoa is not known. Probably of more importance in causing liver damage in NZ horses are the primary hepatotoxins. The recent paper below reproduced with permission of the author (Romano, 2021) gives us an update on the important equine hepatotoxins found in Kentucky, all of which are found in NZ. Liver disease in horses can occur due to many causes, including infectious agents, neoplasia, and toxicants. Clinical signs are often nonspecific, and can include inappetence, depression, colic, weight loss, weakness, icterus (jaundice), yawning, head-pressing, abnormal behavior, and coagulation abnormalities. Toxic agents can vary tremendously depending on an animal’s environment and geographic location. This article describes some of the hepatotoxicants (liver toxins) that affect horses in central Kentucky.

Pyrrolizidine alkaloids (PAs) PAs are found in a variety of plant species and can cause chronic liver disease and eventual liver failure with prolonged ingestion. Due to the liver’s immense reserve and regenerative capacity, horses can appear normal until greater than 80% of the liver is affected.

Severe clinical signs can then develop rapidly, giving the appearance of acute disease. PAproducing plants found in Kentucky include ragwort, butterweed, groundsel, and rattlebox (Senecio, Packera, and Crotalaria spp.). Most PA-producing plants are unpalatable when fresh, although horses may eat them when other forage is lacking. The plants become palatable when dried and can pose a greater threat in hay.

Poisoning can be prevented by providing highquality forage and checking hay for weeds.

Cocklebur (Xanthium strumarium) Cocklebur and related plant seedlings (2-leaf stage) contain large quantities of the toxin carboxyatractyloside. Seedlings emerge in early spring when other forage is limited and are readily consumed by horses. High concentrations of the toxin are present in the seeds, and horses have been poisoned by cocklebur seed contamination of hay or grain.

1

Of further note is that ingestion of foliage of the Ngaio tree [Myoporum laetum] causes acute liver damage in NZ horses (Parton & Bruere, 2002), and high environmental levels of iron in groundwater (Gummery, Johnston, Sutton, & Raftery, 2019) and ferrous fumarate given to foals as a nutritive supplement (Divers et al., 1983; Mullaney & Brown, 1988) have been known to cause liver disease in horses.

Finally, it is notable that Facial Eczema, the very common mycotoxicity seen in ruminants and camelids in NZ that is caused by sporodesmin from the saprophytic pasture fungus Pithomyces (leptosphaerulina) chartarum is not known to occur in horses.

Cocklebur poisoning can be prevented by providing high-quality forage and inspecting hay and grain for cocklebur seeds.

Aflatoxin A mycotoxin produced by species of Aspergillus molds under certain conditions. Aflatoxin can contaminate corn, oats, or any other highenergy feedstuff. Mold can contaminate crops growing in fields, particularly if the plants have been stressed by drought, frost, insects, or other harmful elements. Warm and damp storage conditions and pests also facilitate mold growth.

Aflatoxin can be present in toxic concentrations with or without visible mold. To avoid the risk of mold and mycotoxins, feed should be purchased from reputable sources; stored in a cool, dry location; and adequately protected from rodents and other pests.

Blue-green algae (cyanobacteria) Under the right environmental conditions, these microscopic organisms normally present in ponds, lakes, streams, oceans, and other natural water sources can undergo rapid growth (harmful algal blooms, HABs). Certain species produce toxins, including hepatotoxins (e.g. microcystins and nodularins). Horses can die rapidly after ingestion, and animals are often found dead in or near water sources. Excess nitrogen and phosphorus from animal waste or fertilizer runoff can facilitate HABs. Horses should be provided with fresh, clean water, and ponds or other natural water sources should be fenced off to prevent blue-green algae poisoning.

Amanitin Toxin found in certain species of mushrooms, including Amanita, Galerina, and Lepiota spp.

Mushrooms can appear suddenly in pastures

Constant yawning as commonly seen with hepatoencephalopathy

and occasionally in stalls. Horses are less likely to ingest mushrooms than other animal species, but the best way to prevent poisoning is to monitor pastures and remove mushrooms.

Certain medications (e.g., phenylbutazone, flunixin, acetaminophen, salicylates, antifungals, and many others) can cause liver damage, especially if administered in high doses, for prolonged periods of time, or to animals with pre-existing condi-tions. Accurate dosing and careful consideration of medication risks versus benefits can help minimize chances of adverse effects. Many other substances can cause liver damage and may be more common in different geographic areas. Consultation with a clinical veterinary toxicologist should be considered when toxicosis is suspected.

References Divers, T. J., Warner, A., Vaala, W. E., Whitlock, R. H., Acland, H. A., Mansmann, R. A., & Palmer, J. E. (1983). Toxic hepatic failure in newborn foals. J Am Vet Med Assoc, 183(12), 1407-1413.

Gummery, L., Johnston, P. E. J., Sutton, D. G. M., & Raftery, A. G. (2019). Two cases of hepatopathy and hyperferraemia managed with deferoxamine and phlebotomy. Equine Veterinary Education, 31(11), 575-581. 10.1111/ eve.12913 Mullaney, T. P., & Brown, C. M. (1988). Iron toxicity in neonatal foals. Equine Vet J, 20(2), 119-124.

Parton, K., & Bruere, A. N. (2002). Plant poisoning of livestock in New Zealand. New Zealand Veterinary Journal, 50(sup3), 22-27.

10.1080/00480169.2002.36262

Romano, M. C. Common Equine Hepatotoxins in Central Kentucky. Equine Disease Quarterly July 2021; 30 (3): 4-5

Paper reproduced here with kind permission of the author, Megan C Romano, University of Kentucky, Veterinary Diagnostic Laboratory, Lexington. KY. USA. megan.romano@uky.edu

52 Eq Vet Pract 2021, September; 46 (3)

SURVEILLANCE REPORTS BIOSECURITY NEW ZEALAND

Biosecurity New Zealand’s Incursion Investigation team investigates suspected cases of emerging or exotic diseases in New Zealand. They are interested in hearing about any equine health issues that seem out of the ordinary, including but not limited to: • Parasites or unexplained disease in one or more horses associated with recent international travel • An unusual or unexplained outbreak in a group of horses, particularly involving: – acute respiratory disease – neurological signs – abortion/reproductive signs – unexplained mortalities If you suspect you’ve seen an exotic or emerging disease, please phone Biosecurity New Zealand on 0800 80 99 66 as soon as reasonably practical.

Digested from Surveillance, June 2021; 48 (2) available on SciQuest HERE

SUSPECTED EQUINE EXOTIC DISEASES

Accessed and edited from Surveillance June 2021; 48 (2): 15-22

EQUINE PIROPLASMOSIS EXCLUDED An AHL scientist contacted the duty Incursion Investigator to report a positive Babesia caballi cELISA test result in a 3-year-old Thoroughbred gelding being prepared for export.

The horse had been born in New Zealand. To meet Australian import requirements, horses must return negative results for both B. caballi and Theileria equi in both the cELISA and IFAT tests. The cELISA result (50 percent) was close to the cut-off point (40 percent) and the same sample was negative on IFAT for B. caballi at an Australian laboratory. The weak positive cELISA test was considered to be a false positive result attributable to a non-specific cross-reaction. Repeat blood samples were collected from the gelding 4 weeks later for follow-up testing and submitted to the OIE Collaborating Centre for Surveillance and Control of Animal Protozoan Diseases at Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan. This sample also returned a low positive B. caballi cELISA result (42 percent) and was negative on the IFAT. The gelding was bled again 6 weeks later and serum and EDTA samples were submitted to the reference laboratory. The gelding was confirmed negative to B. caballi and T. equi by IFAT, cELISA and nested PCR test.

Equine piroplasmosis was excluded and the investigation was closed.

GLANDERS EXCLUDED A veterinary pathologist called the exotic pest and disease hotline after a private veterinarian from Taupo submitted

a uterine swab from a 17-year-old Warmblood mare for bacteriological culture. The mare had presented with a copious mucopurulent vaginal discharge. The horse had not been recently imported. A Gram-negative species of rodshaped bacteria was isolated, with basic identification tests (sugars) suggesting that it was Burkholderia mallei. This is a zoonotic agent and the cause of glanders in horses, a disease not present in New Zealand. Normally a subculture would be sent for MALDI-TOF identification, but in consultation with the S&II team it was decided to definitively exclude glanders by molecular testing at the AHL (Wallaceville). There, 16S rRNA sequencing showed the highest correlation (100 percent) with Klebsiella aerogenes, an endemic bacterium. Burkholderia mallei was excluded and the investigation stood down.

EQUINE VIRAL ARTERITIS, EQUINE INFECTIOUS ANAEMIA AND EQUINE PIROPLASMOSIS EXCLUDED A commercial veterinary pathologist called the exotic pest and disease hotline to report regenerative anaemia, thrombocytopaenia and hypoalbuminaemia in an aged (~25 years) Thoroughbred gelding that had been losing weight over several weeks. Haematological examination also showed signs of an inflammatory response, with neutrophilia and monocytosis evident. Although the horse was New Zealandbred and had not travelled overseas, because of potential contact with imported animals, exotic disease exclusion testing was carried out. Serum was submitted to the AHL (Wallaceville) and tested for equine infectious anaemia (EIA), equine viral arteritis (EVA) and equine piroplasms. Testing was negative by AGID and VNT for EIA and EVA respectively, and negative by ELISA for Babesia caballi and Theileria equi.

Exotic disease was excluded, and the investigation closed.

Eq Vet Pract 2021 September; 46 (3) 53

EQUINE HERPESVIRUS MYELOENCEPHALOPATHY EXCLUDED A veterinarian in Waikato called the exotic pest and disease hotline to report a possible case of equine herpesvirus myeloencephalopathy (EHM) in a Thoroughbred broodmare.

The mare was more than 10 years old, although her exact age was not known. She was 6 months in foal, with another foal at foot. The mare had been found down in the morning, unable to rise, with dry nasal discharge and leaking urine (presumed upper nervous system compromise). The mare was one of a herd of broodmares on a large farm. The farm had a history of ryegrass staggers, caused by growth of the fungus Neotyphodium lolii and ingestion of the toxin lolitrem.

However, this mare’s clinical signs were not consistent with typical ryegrass staggers. Nasal swabs and cerebrospinal fluid (CSF) were submitted to a commercial laboratory for molecular testing for equine herpesviruses 1 and 4 (EHV-1 and EHV-4).

When the horse was euthanased owing to its deteriorating state and the risk of welfare issues, further samples were taken and sent to the AHL (Wallaceville). These included nasal swabs, cerebrospinal fluid, whole blood and serum. A postmortem was performed and all organs sampled, except the central nervous system (CNS) owing to the considerable logistical issues involved. Histopathology performed by the commercial laboratory indicated a possible ongoing intestinal inflammatory condition, which was considered a possible factor in the mare’s recumbency. All molecular tests were negative at both laboratories for EHV-1 and EHV-4. A VNT carried out by AHL showed the mare had antibodies to EHV, although this was not unexpected since these viruses normally occur within the equine population, causing minimal illness.

New Zealand’s biggest outbreak of EHM occurred in January 2014, when it was confirmed here for the first time (Bingham 2014; McFadden et al. 2016), although it is presumed that the disease can manifest under the right circumstances within any exposed equine population. Although not exotic, EHM is a rapidly transmissible and frequently fatal disease. In this case the cause of the mare’s recumbency was not identified, but EHM was excluded, and this provided management guidance for the farm manager and the veterinarian

References Bingham P (2014). Quarterly report of investigations of suspected exotic diseases. Surveillance 41(3), 52–58.

McFadden AM et al. (2016). The first reported outbreak of equine herpesvirus myeloencephalopathy in New Zealand.

N Z Vet J, 64(2), 125-134.

54 Eq Vet Pract 2021, September; 46 (3)

EQUINE CLINICAL DIAGNOSTIC LABORATORY CASES

Accessed and edited from Surveillance June 2021; 48 (2): 23-33.

IDEXX LABORATORIES A 6-year old Thoroughbred mare in Waikato presented with recumbency and red-brown urine. Serum biochemistry showed marked increases in muscle enzymes, with creatine kinase > 25,000 IU/L (reference range 63–469) and aspartate aminotransferase 8,000 IU/L (reference range 0–700). The mare went into respiratory distress and had to be euthanased. Necropsy revealed subcutaneous oedema, skeletal and cardiac muscle pallor, subendocardial, subpleural and diaphragmatic haemorrhages, and haemorrhagic adrenal necrosis. Histopathology revealed skeletal muscle myonecrosis, which together with the severity of the disease and the grazing history was consistent with hypoglycin A toxicity (atypical myopathy). Other differentials excluded included other toxicities (selenium, mallow and monensin), polysaccharide storage disease and exertional rhabdomyolysis. Hypoglycin A is found in the seeds of the box elder (Acer negundo) and the sycamore maple (Acer pseudoplatinus). After ingestion the toxin is metabolised to methylene cyclopropyl within the mitochondria, where it inhibits acyl-coA dehydrogenases, thus disrupting fatty-acid metabolism and transport that type 1 muscle fibres depend upon for energy production (Rendle, 2016). A 13-year-old mare in Nelson presented with an acute cough and respiratory effort (heaves) suspicious for small airway disease. A wholeblood (EDTA) sample submitted revealed low whole-blood selenium (360 nmol/L; reference range 1,600–3,200), confirming selenium deficiency.

A 20-year-old Warmblood mare in Waikato presented with inappetence and increased periods of recumbency for 3 days. Serum biochemistry revealed hypoalbuminaemia, with albumin at 24 g/L (reference range 29–41) and serum amyloid 360 mg/L (reference range 0–8). Haematology showed a mild left-shift neutrophilia (band neutrophils 0.5 x109L; reference 0). A faecal sample showed 900 strongyle eggs per gram, confirming equine strongylosis.

GRIBBLES VETERINARY PATHOLOGY A yearling Thoroughbred horse on a Canterbury stud farm developed a lump under the jaw but was otherwise well. There was concern about the possibility of the highly infectious condition of strangles (Streptococcus equi ssp. equi infection) but a PCR test on a sample of fresh tissue from the lesion was negative. Bacterial culture of the tissue yielded a heavy growth of an Actinobacillus species, which was identified as presumptive Actinobacillus equuli on further testing (including the use of MALDI-TOF). The horse is the most common host of this organism, which can cause various diseases including diarrhoea, pneumonia, septic arthritis, and other conditions, as well as the type of localised actinobacillosis lesion seen in this case.

A 3-month-old male foal in Rangitikei was presented for veterinary examination with a history of diarrhoea for 2.5 days.

The foal had initially responded well to supportive treatment after the first day, but relapsed. It had been treated with anthelmintic 2 weeks prior to the diarrhoea. Haematological testing revealed elevated fibrinogen at 8 g/L (reference range 2–4) and mild monocytosis of 0.7 x 109/L (reference range < 0.3), consistent with a systemic inflammatory response.

Bacterial culture of a faecal sample yielded a heavy growth of Campylobacter jejuni, with no Salmonella or Yersinia isolated, and an ELISA test for Cryptosporidium was negative.

Campylobacter jejuni can be recovered from both healthy and diarrhoeic foals and horses, so positive culture results alone do not definitively indicate that campylobacteriosis is the cause of any diarrhoea. There are only a few reports of Campylobacter sp. infection causing diarrhoea in foals (Blunden 2006) and these animals were reported to have clinical signs including fever, colic, diarrhoea and, in one case, sudden death. Enteritis caused by Campylobacter infection is rare in mature horses and affected animals are usually immunosuppressed, debilitated or affected by concurrent intestinal disease such as endoparasitism. In the absence of other findings and with the described clinical signs and history, it was considered likely that C. jejuni was significantly contributing to the clinical signs in this case.

A 2-month-old Thoroughbred foal in Auckland had bilateral effusions in the medial femorotibial joints. Bacterial culture of the joint fluid yielded no growth and there was no evidence of inflammation on cytological examination of the fluid.

Radiographically, there was subchondral bone lysis of the medial trochlear ridges. Histopathological examination of the affected area showed cartilage necrosis and a subchondral cleft surrounded by fibrosis, with irregular endochondral ossification of subchondral bone, consistent with osteochondrosis dissecans. The medial femoral condyle is a predilection site for this condition, which is considered multifactorial. Genetics, nutrition, and trauma are all considered to be potential contributing factors.

SVS LABORATORIES A 3-year-old colt from Waikato presented for being off colour. On physical examination it had tachypnoea and on ultrasound it had a 1.5-cm-diameter abscess in the cranial lung. A complete blood count showed a leucocytosis. A transtracheal wash (TTW) was performed and samples submitted for cytology and culture. Cytology was consistent with suppurative inflammation with background cocci and bacilli. On culture Serratia marcescens was isolated. The organism was resistant to penicillin and had an intermediate

sensitivity to enrofloxacin. Serratia marcescens is a coliform bacterium that can be cultured from the upper and lower respiratory tracts of a very low percentage of normal horses (Bond et al. 2017). Cytology revealed a mixture of cocci and rods, and while it is rare to isolate Serratia from a TTW, cytology suggests it may have contributed to infection in this case.

A uterine swab from an adult Waikato mare was submitted for culture. A highly resistant strain of Escherichia coli was cultured. The organism was resistant to ceftiofur, gentamicin, penicillin, tetracycline, and trimethoprim sulphate. It had an intermediate resistance to enrofloxacin.

A 5-month-old filly from Waikato presented with respiratory disease. TTW fluid was submitted for culture. A heavy growth of Streptococcus equi ssp. zooepidemicus and a heavy growth of Escherichia coli were isolated. No Rhodococcus equi was isolated or detected by PCR, nor was Streptococcus equi ssp. equi detected by PCR assay. In this case, the E. coli was resistant to most tested antibiotics including enrofloxacin, ceftiofur, gentamicin, penicillin, tetracycline, trimethoprim sulphate, azithromycin, ciprofloxacin, marbofloxacin, ticarcillin and tobramycin. The isolate was sensitive to chloramphenicol.

An adult horse from Matamata-Piako had a non-healing corneal ulcer. Samples were submitted for cytology and culture. The cytology smear had neutrophils and occasional macrophages on a background of protein and cellular debris.

Large mats of hyphal fungi were present throughout. Fungal culture yielded Trichosporon sp. This fungus is common in soil, fresh and sea water, and plant detritus.

References Blunden AS, Smith KC, Neal HN, Dugdale DJ (2006). Enteritis associated with infection by Campylobacter jejuni in two Thoroughbred foals. Eq Vet Edu. 2006; 18 (1): 8-10.

Bond SL et al. (2017). Upper and lower respiratory tract microbiota in horses: bacterial communities associated with health and mild asthma (inflammatory airway disease) and effects of dexamethasone. BMC Microbiology 17(1), 184.

McKenzie RK et al. (2016). Detection of hypoglycin A in the seeds of sycamore (Acer pseudoplatanus) and box elder (A. negundo) in New Zealand; the toxin associated with cases of equine atypical myopathy. N Z Vet J, 64(3), 182-187.

Rendle D (2016). Equine hypoglycin toxicity. Vet Times, April 25 2016

SISTER ORGANISATION PUBLICATIONS AVAILABLE The latest Equine Health Update from the SAEVA is available HERE to view.

And all copies of Australian Equine Veterinarian are available on SciQuest HERE to browse.

Eq Vet Pract 2021 September; 46 (3) 55

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56 Eq Vet Pract 2021, September; 46 (3)

STOP PRESS There is currently no vaccine available which claims to protect against the clinical signs of EHM; hence early identification of disease and prompt implementation of stringent biosecurity strategies are essential to prevent transmission and reduce morbidity and mortality within a population.

Mare showing dysmetria and somnolence during first outbreak of EHM in NZ in 2014. [McFadden et al. (2016).

EQUINE HERPESVIRUS MYELOENCEPHALOPATHY A case of suspected equine herpesvirus-related Equine Herpesvirus Myeloencephalopathy [EHM] has been identified at a property in the North Island. As we look ahead towards a busy breeding, racing and performance season this serves as a timely reminder to equine veterinarians and the wider equine community to remain vigilant. Recent and continuing outbreaks of EHM in North America and Europe have illustrated the potentially devastating implications of this condition.

These outbreaks can be associated with high mortality rates, widespread geographical transmission and significant economic damage to the respective equine industries. While only one confirmed outbreak of EHM has been documented in New Zealand (McFadden et al, 2014) this remains an ever-present threat given the difficulty of identifying carriers of latent disease (Bueno et al. 2019) and importation of horses into NZ from countries with a higher disease prevalence.

Equine Herpesvirus is a ubiquitous and highly contagious pathogen affecting equine populations worldwide. EHV-1 infection results in multiple syndromes, most commonly respiratory disease but occasionally abortion, neonatal death and neurological syndromes. Different strains vary in their abortogenic and neuropathogenic potential, with the G2254/D752 Pol variant predominantly associated with EHM outbreaks.

Clinical effects are attributable to the effects of damage to the microvasculature of the uterus, the CNS and other organs. Although vaccination with a whole inactivated vaccine during pregnancy helps to reduce rates of transmission and abortion within a group, abortion storms in naïve populations can be devastating.

Recently updated International Codes of Practice from the Horserace Betting Levy Board (https://codes.hblb. org.uk/index.php/page/76) and ECEIM Guidelines for dealing with returning horses from EHV-1 outbreaks (https://www.eceim.info/news/outbreak-of-ehv-1-invalencia-update-16th-march-2021) provide invaluable guidance if faced with a potential outbreak situation in a breeding and performance operation respectively.

FURTHER READING Bueno, I. M. C., Pearce, P., & Dunowska, M. (2019). Frequency of latent equine herpesvirus type-1 infection among a sample of horses in the central North Island of New Zealand. NZ Vet J DOI: 10.1080/00480169.2019.1653238 Ivens, P. et al. (2019). Equine herpesviruses: a roundtable discussion. UK-Vet Equine, 3(Sup4), 1-12.

10.12968/ukve.2019.3.S2.1 Khusro, A., Aarti, C., Rivas-Caceres, R. R., & Barbabosa -Pliego, A. (2020). Equine Herpesvirus-I Infection in Horses: Recent Updates on its Pathogenicity, Vaccination, and Preventive Management Strategies.

J Eq Vet Sci, 87, 102923. https://doi.org/10.1016/j. jevs.2020.102923 Maxwell, L. K. et al. (2017). Efficacy of the early administration of valacyclovir hydrochloride for the treatment of neuropathogenic equine herpesvirus type-1 infection in horses. Am J Vet Res, 78(10), 1126-1139.

10.2460/ajvr.78.10.1126 McFadden, A. M. et al. (2016). The first reported outbreak of equine herpesvirus myeloencephalopathy in New Zealand. N Z Vet J, 64(2), 125-134.

10.1080/00480169.2015.1096853 http://www.sciquest. org.nz/node/111147] Oladunni, F. S., Horohov, D. W., & Chambers, T. M. (2019). EHV-1: A Constant Threat to the Horse Industry.

Front Microbiol, 10 10.3389/fmicb.2019.02668 Soboll Hussey, G. et al. (2019). Histopathologic Findings Following Experimental Equine Herpesvirus 1 Infection of Horses. Front Vet Sci, 6, 59. 10.3389/fvets.2019.00059

This Stop Press was prepared by colleagues handling the current case, who are doing a sterling job of enacting current recommended biosecurity control measures.

Eq Vet Pract 2021 September; 46 (3) 57

US THOROUGHBRED RACING ECONOMIC INDICATORS JAN - JULY 2021 VERSES 2019 SARS-CoV-2 caused US TB racing prize money and number of race days to slump in 2020, but wagering has bounced back for first half of 2021 when compared to figures from 2019, pre-CoViD-19..

Indicator

YTD 2021

Wagering on U.S. Races*

YTD 2019

% Change

$7,379,543,305

$6,152,548,050

+19.94

$625,643,005

$414,389,542

+50.98

2,326

1,699

+36.90

U.S. Races

19,323

14,186

+36.21

U.S. Starts

141,830

113,058

+25.45

7.34

7.97

-7.90

$3,172,633

$3,621,276

-12.39

$268,978

$243,902

+10.28

U.S. Purses U.S. Race Days

Average Field Size Average Wagering Per Race Day Average Purses Per Race Day

Summer 2020

LATEST ISSUE OFCorporate EQUIMANAGEMENT NOW AVAILABLE FREE HERE: Ownership of Equine Practice

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• What To DoSAFE! About an Aging Immune System?

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58 Eq Vet Pract 2021, September; 46 (3)

ELECTRONIC COPIES OF E-EVP You can enjoy your E-EVP Current Issue and E-EVP Archive at your NZVA login pages.

1. Go to http://www.nzva.org.nz/ and sign in 2. Click on: > FOR VETERINARY PROFESSIONALS > Branches > New Zealand Equine Veterinary Association [on left] > NZEVA Documents [on left] 3. There you have Current and Archive for E-EVP 4. Or you can View the E-EVP catalogue on SciQuest and download individual pages/articles

VETLOGIC PUZZLE - ANSWER

Curly Horse:Wikipedia

See page 48 for puzzle

OWNER

HORSE BREED

HEIGHT (CM)

Melissa Sim

Curly

170

Grace Reed

Spiti

150

Pip Hendron

Kinsky

160

Alex Fowler

Moyle

140

Acutt EV et al. Deep digital flexor tendon lesions in the pastern are associated with the presence of distal tendinopathy. Eq Vet J. June 2021; DOI 10.1111/evj.13470 This was a retrospective descriptive case series involving 88 limbs with deep digital flexor tendon (DDFT) lesions in sport horses. Thirty-four MRI scans of 33 horses and 64 ultrasonographic examinations of 58 horses were analysed.

Distal DDFT lesions were found in 75% (95% CI: 66.0-84.0) of total cases of pastern DDF tendinopathy and in 97% (95% CI: 91.6-100.0) of cases with core lesions of the DDFT in the pastern. Core lesions in the pastern were significantly more likely (OR = 20.7, 95% CI: 2.2-191.0; P = 0.008) to be associated with injury in the foot than other types of pastern lesion. As with most retrospective studies, incomplete data retrieval is a problem. But it can be said that when DDFT lesions are found in the pastern, particularly core lesions, further imaging of the tendon within the foot should be considered to help direct more thorough treatment and to help in giving a prognosis for the horse.

Knych HK et al. Pharmacokinetics of transdermal flunixin meglumine and effects on biomarkers of inflammation in horses. J Vet Pharm Therap. June 2021; DOI 10.1111/jvp.12993 Six horses were administered a single transdermal dose of 500 mg of a bovine transdermal flunixin meglumine product.

Serum concentrations of flunixin and 5-OH flunixin were above the limit of quantitation at 96 h post-administration in both serum and urine. The mean (range) for C-max, T-max and the terminal half-life were 515.6 (369.7-714.0) ng/ml, 8.67 (8.0 12.0) h, and 22.4 (18.3-42.5) h, respectively. Based on effects on eicosanoid synthesis, flunixin meglumine inhibited COX-1, COX-2 and 15-lipooxygenase activities, with anti-inflammatory effects lasting for 24-72 h.

Eq Vet Pract 2021 September; 46 (3) 59

OBITUARY FRAZER JAMES ALLAN (1966-2021)

he decided to leave Massey to work at The Pet Practice in Hamilton. He wrote up his PhD and submitted whilst working as a medicine clinician at the practice, on time and to plan.

After three years at The Pet Practice, he returned to academia to become director of the Massey University Veterinary Teaching Hospital, the beginning of his administrative career.

We were not sure how Rebecca and Frazer’s children might cope with the frequent moves and Frazer’s changes of plan but I am sure they knew what was best for their family at the time.

We first became familiar with Frazer when he entered 4th year of the Massey BVSc course. Here was an enthusiastic and organized student with clear goals, who not only wanted to learn and achieve but also to enjoy student life and all that the University had to offer. His Territorial Army training created the organized approach to clinical problems and making diagnoses, that he developed. He was clever and I was pleased that on graduation he chose small animal medicine as a discipline when many of his contemporaries went to large animal practice.

Frazer had some time in small animal practice in Hamilton before he returned to Massey to undertake residency training in internal medicine with both of us as supervisors. What a great time that was! As expected he applied himself to the program, worked hard, was fun to work with, accepted the challenges, solved the medical puzzles with application and study and even survived the ‘set ups‘ that we thought would test him. The research study component of his program validated the use of BIPS for the diagnosis of gastrointestinal diseases in dogs and cats, his first taste of clinical research which led to his Master of Veterinary Medicine degree. In addition, he became a member of the Australian and New Zealand College of Veterinary Scientists in canine medicine.

The expectation was that he would complete his specialist diploma examinations, but his decision was to undertake a PhD program with Keith Thompson, after many earnest discussions about this decision, and its wisdom. Complete the PhD he did, on aspects of lipoprotein metabolism related to diet in pigs but having completed the bench research

60 Eq Vet Pract 2021, September; 46 (3)

It was with great skill that Frazer ran the Massey University Veterinary Hospital and Clinics. He made the hospital a financial success and established a structure that was nurturing for both academic and support staff. Frazer undertook a Diploma in Business Administration (with distinction) and with that management training he was able to apply business principles to the academic environment.

He retained the goodwill of veterinarians and clients as well as creating a productive workplace for staff. His managerial and administrative experience and abilities became clear, and his non-confrontational style of management was accepted by all staff. Importantly, all staff were confident that what he said was true, without hidden agendas. He was respected by colleagues for his leadership and management skills.

When Grant Guilford left Massey for University of Auckland Frazer became Head of School for the Institute of Veterinary and Biological Sciences(IVABS), a role in which he showed continued leadership and managerial skills. He was a passionate leader, while retaining a friendly, cheerful countenance with a broad smile that everyone remembers.

He was a team player and wanted all sectors of IVABS to advance, to be productive and to work together. He looked after students, attended all their functions, listened to their concerns, and acted when required to do so. He supervised the curriculum review and the reaccreditation process for the AVMA visitation that was completed successfully. Overall, Frazer was an inspiring academic leader for IVABS. Whilst Frazer’s academic career was advancing, he did not forget that he was part of the wider community. He supported his children with time on the management board of the Massey Childcare Center, on the Parent Teachers Association of Tiritea school, as a coach of schoolboy cricket and as treasurer of the United Cricket Club. For the veterinary profession he served on the NZVA Board for some time and played a key role behind the scenes for the organization of the WSAVA congress held in Auckland in 2014. His work with NZVA and the profession was acknowledged in 2017 with the NZVA President Award, which recognizes those

who accomplish extraordinary achievements on behalf of the profession and provide meritorious service to the profession in the broadest sense; a prestigious achievement.

Frazer moved to Victoria University of Wellington in 2015 becoming its Deputy Vice-Chancellor (Engagement). He was an enthusiastic advocate for the close engagement of universities with their communities. He championed the University’s civic-university ideal - strengthening relationships with central and local government, the private sector, community groups, alumni and friends. He saw engagement as a pan-university activity and led the development of the University’s first engagement strategy which ensured that leaders right across the university played their part in building enduring relationships. He led the University’s engagement group which had representation from different sectors of the University and melded their individual professional talents into the University mission.

For those of us who knew Frazer as a veterinarian, it was not without amusement to hear that he enthusiastically extolled the virtues of the latest avant-garde exhibition at the Adam Art Gallery and revelled in the latest publishing success at the Ockham Book Awards. One of Frazer’s key achievements while at Wellington was overseeing the creation of the Miramar Creative Centre in partnership with Miramar Creative Ltd. The Centre has gone from strength-to-strength and is a fine example of Frazer’s ability to build enduring partnerships.

In 2018 Frazer moved from Wellington, being appointed Head of School and Dean of Veterinary Science at University of Sydney. He had a vision for the future of veterinary science and was about to put that vision in place. The seeds are sown, but alas, those plans will not now be progressed by Frazer.

Frazer was greatly respected by his contemporaries and was an exceptional and inspirational leader and beloved manager by those who worked with him. His colleagues remember him as being genuinely kind, particularly when a fellow staff member required support, having a true sense of egalitarianism, and always showing respect to those around him. Staff in all workplaces have fond memories of the

lively and purposeful encounters with him. He was friendly, cheerful, a team player and led with professionalism. He was a determinedly positive individual, committed to those around him and to making the world a better place.

Frazer and I (BRJ) spoke reasonably often especially after his move to Sydney to talk not only about veterinary matters and his vision for change and progress, but also about sport. He was a keen supporter of New Zealand cricket through all its ups and mostly downs. The winning of the test match series (and the mace) a few days before he died must have given him immense joy. He always kept us up to date with what his children Sophie, Fergus and Phoebe were doing. He was incredibly proud of his children and would often share stories of their lives and their successes.

His other activity outside work was mountain biking. He was a keen rider in the hills around Palmy and in Wellington; a competitive cyclist, often leaving others in his wake. Several of his colleagues benefitted greatly from his 6am, enthusiastic road cycling challenges, especially the weaker, shorter ones who could benefit from drafting behind Frazer’s bulk! He was chairman of the Wellington Trails Trust and advocated for the development of more mountain biking tracks around Wellington. Some accidents and the perils of cycling in Sydney led to his interest in rowing in a veterans crew at the Leichardt Rowing Club. Rowing was his new sport.

Frazer’s life has been one of great success, cut short and with future plans unfulfilled, but it is clear that he made a major contribution to veterinary medicine and the veterinary profession in New Zealand. We must thank him for his vision, his enterprise and his success on our behalf.

Our sympathies go to Rebecca, Sophie, Fergus and Phoebe who shared most of Frazer’s life and its ups and downs, and to his wife Leith and stepson Felix, whose future plans with Frazer have been unexpectedly and suddenly curtailed.

Farewell Frazer you have been a good friend and colleague.

Boyd Jones and Grant Guilford August 2021

Haralambus R et al. Detection of synovial sepsis in horses using enzymes as biomarker. Eq Vet J. June 2021; DOI 10.1111/evj.13459 Sixty-seven synovial fluid samples were assigned to: healthy control (n = 10); aseptic (n = 27); and septic synovitis (n = 30) Groups.

The enzyme activity assays for lysozyme (LYS), myeloperoxidase (MPO) and elastase (ELT) were compared with standard synovial fluid parameters and broad-range bacterial 16S rDNA PCR. LYS and MPO activities were significantly different between septic synovial samples and both aseptic and control samples (P < 0.001). LYS achieved a 100% sensitivity and 100% specificity in differentiating between septic and aseptic (cut-off value 751.4) or control (cut-off: 484.6) samples (P < .001). MPO reached 93.33% sensitivity, 100% specificity for distinguishing septic from control (cut-off value: 0.1254) synovial samples and 93.33% sensitivity, 81.48% specificity for discriminating between septic and aseptic (cut-off value: 0.1305) synovial samples (P < 0.001). ELT activity could not be measured in any synovial sample. Both the LYS and the MPO measurements were highly correlated with bacterial rDNA PCR (LYS r = 0.79, MPO r = 0.69), synovial leukocyte count (LYS r = 0.752, MPO r = 0.571), % neutrophils (LYS r = 0.751, MPO r = 0.663) and each other (r = 0.744, all P < 0.001). It was concluded that increased MPO and LYS activities allow reliable, rapid diagnosis of synovial sepsis with high sensitivity and specificity.

Eq Vet Pract 2021 September; 46 (3) 61

OBITUARY PROFESSOR W.R. (TWINK) ALLEN FRCVS, DSC, CBE (1940-2021)

in 1969 with a single author paper in the pre-eminent scientific journal Nature: a unique achievement. He was also a lifelong member of the Society for the Study for Reproduction and Fertility. Twink remained active in research to the end, flushing mares to recover early embryos only weeks before his untimely death.

Professor W.R. (Twink) Allen died on 6th June 2021, after a short illness. We send our deepest condolences to his personal and professional partner Dr Sandra Wilsher, family and friends.

Twink was internationally renowned for his numerous and excellent pioneering contributions to equine reproduction, although he also made significant contributions to the understanding of reproduction in old and new world camelids, African wildlife (particularly the elephant) and even hedgehogs!

The list of Twink’s qualifications and honours speaks for itself but among his highest honours were his appointment as a Commander of the British Empire (CBE), a Higher Doctorate (DSc h.c. multi) from Cambridge University, and Fellowship in the Royal College of Veterinary Surgeons (FRCVS). He received many other degrees and honours: BVSc (Syd), PhD (Cantab), ScD (Cantab), DESM, Dip ECAR, FRAgSE and FSB. Twink also took great pleasure in his role as an Emeritus Professor at Robinson College, University of Cambridge.

Working with Twink was intellectually stimulating, and his enthusiasm for science shone through. His work ethic was immense, and he never shied away from undertaking difficult projects, followed by the timely publication of the data in beautifully written, scientific papers. Twink was not only active in fundamental research and the training of PhD students, but he was also a driving force in the development and translation of many advances to practical equine reproduction procedures.

Beginning his career in Cambridge and Newmarket in the late 1960s, Twink was the right person, in the right place, at the right time to make major scientific advances in equine reproductive biology, many of them firsts, and to apply those discoveries and new technologies to improve the fertility of the horse. In all, Twink was an author of over 300 scientific papers and numerous book chapters, beginning remarkably

62 Eq Vet Pract 2021, September; 46 (3)

Twink loved horses and was fascinated by all aspects of equine reproduction, but his area of expertise was early pregnancy in the mare; whether it be searching for the maternal recognition of pregnancy signal, the origin of the equine capsule, molecular mechanisms underlying implantation and the endometrial cup reaction or the causes of pregnancy loss.

Regardless of the problem, he was continually searching for ways to improve the fertility of the horse and particularly the Thoroughbred. Nevertheless, he was equally passionate about research and education and he formed long-standing, fruitful collaborations with Prof Doug Antczak at Cornell University, USA, Prof Bob Moor FRS and Dr Francesca Stewart at the Babraham Institute, Dr Peter Rossdale at Rossdale and Partners, and Prof Marian Tischner at Krakow University, Poland; all became lifelong friends. These collaborations led to multiple honours, including his election to the Polish Academy of Sciences, the award of Honorary Doctorates from the Universities of Krakow, Gent and Helsinki, as well as the prestigious Marshall Medal from the Society for Reproduction and Fertility, election to the Equine Research Hall of Fame at the Gluck Equine Research Center (Lexington, Kentucky) and a Lifetime Achievement Award from the International Symposia of Equine Reproduction.

Born in Auckland, New Zealand, Twink graduated in veterinary science from Sydney University (1965). Twink then entered general practice New Zealand, where he suffered a devastating car crash, spending almost 18 months in hospital and emerging with one leg substantially shorter than the other, which curtailed his career in clinical practice. Serendipity led to him embarking on a PhD Research Fellowship with Professor Roger Short FRS at the Department of Veterinary Medicine at Cambridge University (1966-1970), producing a thesis entitled Pregnant Mare Serum Gonadotrophin. He was then employed as a post-doctoral Fellow at the nearby Animal Research Station in Cambridge (1970-1972), which was a world-renowned large animal reproduction research institute, supervised first by Mr L.E.A. (Tim) Rowson FRS and then Prof Thadeus R.R. Mann FRS. In a far-sighted move to improve the efficiency of Thoroughbred breeding, Mr Peter Burrell CBE, then Director of the National Stud in Newmarket

and Colonel Nat Frieze, Chairman of the Thoroughbred Breeders’ Association established the Equine Fertility Unit (EFU) in 1972 and appointed Twink as its Director. The EFU was initially based in a portacabin at the Animal Research Station, but moved to a purpose built facility at Mertoun Paddocks, Newmarket in 1989, where it remained until its closure in 2007. During this period, Twink supervised many PhD students and post-doctoral researchers, most of whom went on to successful careers within the field of reproduction.

All maintained links with Twink as part of the ‘EFU Family’.

Twink was appointed as the Jim Joel Professor of Equine Reproduction at the University of Cambridge in 1995 and ‘retired’ from Cambridge in 2007. Not remotely interested in retiring and taking it easy Twink then established the Paul Mellon Laboratory of Equine Reproduction at his home in Newmarket (2008-2015). However, the opportunity to set up the Equine Reproduction Laboratory at the Sharjah Equine Hospital, U.A.E. arose in 2015 where he established a small herd of research mares and was performing clinical work with his personal and professional partner Dr Sandra Wilsher until two weeks before his untimely death.

The enormous scope of Twink’s work is astounding and matched by the importance of his findings. Thus, no obituary would be complete without detailing some of the key milestones in his academic career. In the 1970s, Twink developed the first robust laboratory assay for equine chorionic gonadotrophin (eCG). This proved invaluable during his collaboration with Dr Bob Moor FRS which solved a decades old puzzle, namely that the chorionic girdle portion of the equine fetal membranes is the progenitor tissue of the unique equine endometrial cups, which are embedded in the endometrium of the pregnant mare. These cups are therefore the source of the equine-unique protein hormone eCG. This is present in large quantities in the blood of early pregnant mares and other equids (days 40-120 of gestation). It is eCG that is responsible for the development of secondary or accessory corpora lutea in mares’ ovaries, which secrete progesterone and thus maintain the pregnant state until the diffuse epitheliochorial placenta is sufficiently well established to assume the role of progesterone production.

Twink’s fascination with the endometrial cups composed of fetal cells embedded within the mare’s endometrium, and the associated cellular immune response around the base of the cups, led to his pioneering work with Prof Doug Antczak that illuminated unique aspects of the fetal-maternal immunological relationship. The intensity of the immune response also defined the pattern of eCG levels in horses, donkeys and their reciprocal interspecies hybrids, that presaged the discovery of genomic imprinting. Furthermore, the extra-species donkeyin-horse model of early pregnancy loss could be explained by a failure of the donkey chorionic girdle to invade the horse endometrium and thus led to failure of the endometrial cup formation and initiation of placentation.

In the early 1970s, with Prof Tim Rowson, Twink drove the development and practical application of both surgical and non-surgical methods of embryo recovery and transfer in the mare, which is now common in equine reproductive veterinary

practice internationally. A typical adventure involved Twink, with Drs Francesca Stewart and Alan Trounson, transporting six horse embryos in the oviducts of two rabbits by car along the Berlin corridor to Krakow in Poland in 1974 for transfer to recipient mares. This in turn led to the birth of three live foals in 1975, all in close and enjoyable collaboration with Professors Wadslaw Bielanski and Marian Tischner of the Institute of Animal Physiology in Krakow. Twink also pioneered the application of embryo transfer to hasten genetic progress in horse breeds that permit its use. Then there was the production by between-breed embryo transfer of ‘deprived’ Thoroughbred-in-Pony and ‘luxurious’ Ponyin-Thoroughbred pregnancies to study the influences of maternal and placental size on the development of the foal.

Twink also used embryo transfer to break new ground in the preservation of endangered species. In collaboration with the late Dr Phil Summers of the Zoological Society of London, they undertook heroic and spectacularly successful extraspecies embryo transfers among member species of the genus Equus, including zebra and the endangered Przewalski horse. An extension of the embryo transfer technique involved the successful bisection and reconstruction of horse embryos to create a number of pairs of genetically identical twin foals, all in collaboration with Drs Steen Willadsen, Robert Pashen and Lulu Skidmore. Twink then lead two important spin-offs from these technically difficult experiments, being further study of the unique equine capsule with Dr Julio Oriol, and in 1989, the establishment of the Camel Reproduction Centre (CRC) in Dubai, under the governorship of Twink, along with Professors Roger Short and Brian Heap FRS, with Lulu as its Scientific Director. The pioneering research of the CRC has covered many topics including camelid ovarian follicular dynamics, pregnancy and placentation, endocrinology throughout the cycle, and pregnancy, maternal recognition of pregnancy, embryology and semen collection and analysis. There has been particular emphasis on embryo transfer, management of recipients and bisection, cooling and deep freezing of camel embryos as well as semen collection and analysis and artificial insemination.

Twink was an early exponent of using reproductive hormones to advance and assist the onset of reproductive cyclicity in the Thoroughbred mare. Thus, with Mike Cooper and Ray Newcombe, he developed the practical application of prostaglandin-F analogues (Equimate™ and Estrumate™) to manipulate the oestrous cycle of the mare. This was followed by the successful trialling and application of allyl trenbolone (Regumate™) and Gonadotrophin-releasing hormone (GnRH) analogues (Deslorelin™) to hasten reproductive cyclicity in the mare, all with the collaborative assistance of the stud farm veterinary practitioners in Newmarket, notably Peter Rossdale, Bob Crowhurst, Donald Simpson, Richard Greenwood and David Ellis.

Further examples of Twink’s ability to think outside the box was the determination, in collaboration with equine surgeon Huw Neal, that blockage of the oviducts in mares can be a cause of infertility, which can be simply overcome by the laparoscopic application of PGE2 gel to the external surface of the oviduct.

Eq Vet Pract 2021 September; 46 (3) 63

And last, but certainly not least, in collaboration with Dr Eric Palmer, Twink initiated the early development and practical application of the technique of transrectal ultrasonography to Thoroughbred horse breeding. And all agree that this has proven to be invaluable for the accurate visual assessment of follicular growth, ovulation and corpus luteum development, and for the early accurate diagnosis of singleton and twin pregnancy and early pregnancy failure. This work was also carried out in collaboration with the Newmarket veterinary practitioners and the technique of ultrasound scanning has since revolutionised horse breeding throughout the world.

Of course, this rather dry information does little to describe the colourful personality that Twink was. No one who met Twink could ever forget him! He travelled extensively, visiting many countries and virtually all continents where he made many, long lasting friendships. He had an unrivalled energy and joie de vivre. He held very strong views about many subjects and loved nothing better than a robust discussion, usually around the kitchen table with a well-made - i.e. strong - gin and tonic, which continued through animated dinners, hosted with his wife Diana. He was a well-known figure around Newmarket and took great delight in following the careers of his three children and many grandchildren, including cheering on his son-in-law Frankie Dettori. However, the number and range of Twink’s friends throughout the world was truly astounding and once a friendship was made, it was loyal, steadfast and generous. Twink delighted in encouraging young scientists and if they worked hard, he gave them every opportunity and indeed the confidence to spread their wings and fly. He also revelled in asking probing questions at scientific meetings but had an equal talent for communicating with horse owners and breeders. He was in his element when asking the local Newmarket veterinary practices, and the stud farm owners and managers what their equine reproduction problems were, doing the necessary scientific research and then hosting social evenings to report his results.

Many events were initiated by Twink, indeed he loved ‘a project’ and approached them all with immense determination and energy. With the support of John Hughes, Doug Mitchell, Bill Pickett and Peter Rossdale, Twink organised and ran the First International Symposium of Equine Reproduction in Cambridge in July 1974. The aim of the symposium was to provide a forum for biologists and veterinarians to exchange and argue their views, to review the present state 64 Eq Vet Pract 2021, September; 46 (3)

of knowledge, to produce guidelines for future research, and to foster international friendship and collaboration. The first proceedings entitled Equine Reproduction was edited by I.W. Rowlands, W.R. Allen and P.D. Rossdale and published as a supplement of the Journal of Reproduction and Fertility.

These symposia continue to be held every four years, with the abstracts published for posterity. In recognition of his immense contributions to equine reproduction, Twink was Honorary Chair of ISER-VI in Caxambu, Brazil (1994) and delivered the John Hughes Memorial Lecture entitled Sex, Science and Satisfaction: a Heady Brew at ISER-X (2010) in Lexington, Kentucky. It was fitting that Twink received the Lifetime Achievement Award at ISER-XII (2018) in Cambridge, UK. Arising from his desire to encourage participation in ISER, Twink was instrumental in setting up the International Equine Reproduction Trust which raises funds to support young researchers’ travel costs to attend ISER, regardless of their financial circumstances. A completely different but equally notable project, demonstrating Twink’s commitment to his local community, was the establishment of a fund and appointment of a sculptor to erect the Newmarket Stallion, a bronze statue of a rearing stallion and handler on the roundabout adjacent to the July Racecourse. This is an eye-catching and fitting welcome to the ‘Headquarters’ of the Thoroughbred flat racing and breeding industry in the United Kingdom.

Privately, in his younger days Twink loved to ride and gained his Thurlow Hunt ‘buttons’ awarded for a substantial contribution to the hunt. He frequently attended the Rowley Mile and July racecourses in Newmarket, chatting to friends and trainers with obvious great enjoyment. His taste in music was diverse and he was equally at home listening to opera at the Metropolitan in New York, or to his beloved Robinson College choir in Cambridge, or to musicals; and he was also a country and western devotee! Most will remember Twink’s exploits on the dance floor at scientific conferences, where he could jive to virtually any type of music, not stopping until he had danced with all ladies present.

Twink enjoyed returning to New Zealand - which he called ‘God’s Country’ - on a regular basis, visiting his family as well as his favourite childhood beach, Piha. More recently, Coopers Beach in Northland became a favourite haunt. There, Twink would soak up some sunshine, swim, catch a snapper and ‘slurp some gin’ with old friends. Always the educator and generous in spirit, Twink would make time to catch up with his Kiwi colleagues and give a seminar or two for the local vets and breeders. His visits were treasured, and every word, story or snippet was held in the highest esteem by everyone he met.

A unique character, Twink had a profound influence on many lives, and as the grandfather of equine reproduction, Twink’s death marks the end of an era and he will be sorely missed by his family and many friends. Many more of us, far and wide, will echo thanks to Twink for all the amazing and happy experiences, and the spirit of Twink will survive in all his students, friends and colleagues. As a proud New Zealander, the last verse from one of his favourite songs Pokarekare Ana is poignant:

My love will never be dried by the sun, it will be forever moistened by my tears.

On behalf of everyone who had the honour of knowing and working with you Twink, rest in peace my dear friend.

A small family funeral was held in Dubai, UAE on 15th June 2021.

If you would like to be informed of a future memorial event, please email Mrs Jan Wade: janwade@btopenworld.com Donations towards the W.R. (Twink) Allen Young Researcher Fellowship can be made to the International Equine Reproduction Trust. £-Sterling: Sort code: 20 60 38; Account number: 10513504

$-US: Sort code: 20 60 38; Account number: 48697766

€-Euros: Sort code: 20 60 38; Account number : 88875966 Lee Morris July 2021

Tura G et al. Fibroblast-associated protein-alpha expression and BPV nucleic acid distribution in equine sarcoids. Vet Pathol. June 2021; DOI 10.1177/03009858211022696 The presence of bovine papillomavirus [BPV], the cause of equine sarcoids, was confirmed in all 74 sarcoid tissues examined by either or both PCR and in situ hybridization with signal distribution appearing as either diffuse (61/70, 87%) or subepithelial (9/70, 13%); the latter being more frequent in the verrucous subtype. No significant association was found between clinical subtypes and specific histological features or hybridization pattern. Moreover, hybridization signal for BPV was not detected in the epidermis overlying sarcoids nor in the tissue surrounding the neoplasms. Fibroblast-associated protein-alpha labelling was observed in neoplastic fibroblasts of all sarcoids, suggesting this as a potential candidate for the immunohistochemical diagnosis of sarcoids.

Fussell D et al. Bullous amyloidosis in a horse: first description in veterinary medicine. Vet Dermatol. 2021; 32(4): 374. DOI 10.1111/vde.12982 Human bullous amyloidosis is a rare characterised by haemorrhagic vesicles and bullae on the skin and mucosae due to amyloid deposition. A 17-year-old thoroughbred mare presented for weight loss and severe oral cavity ulcers. Postmortem findings included haemorrhagic vesicles and bullae on the mucosa of the oral cavity, lips, oesophagus and stomach, and much less the muzzle, face and mucocutaneous areas of the perineum. Congo-red staining confirmed the presence of amyloid deposits in dermis and submucosa, in association with vesicle and bulla formation, consistent with bullous amyloidosis. TEM confirmed amyloid fibril deposition in the dermis and along the basement membrane zone. Clefts occurred in the superficial dermis and submucosa, which explained haemorrhage and scarring. The presence of a polyclonal gammopathy supported the presence of serum amyloid A and secondary amyloidosis. Bullous amyloidosis is a novel disease of the horse and a newly recognised differential for bullous disease, for which the haemorrhagic nature of bullae, scarring and deep secondary ulcers are considered clinical clues to the condition.

Hardeman AM et al. Movement asymmetries in horses presented for prepurchase or lameness examination.

Eq Vet J. June 2021; DOI 10.1111/evj.13453 Horses undergoing PPE were assigned by six clinicians having ≥8 years’ experience each as having minor vet concerns (n = 84) or major lameness concerns (n = 14) based on findings during the dynamic-orthopaedic part of the PPE. Lame horses were only included if lameness improved after diagnostic analgesia using optical motion capture. Two lameness patterns differentiated both forelimb and hindlimb lameness from PPE horses with minor vet concerns: RUD Poll + MinDiff Withers - RUD Pelvis; and RUD Pelvis + RUD Poll - MinDiff Withers. Thus, correcting for vertical range of motion enabled differentiation of PPE horses with minor vet concerns from PPE horses with major lameness concerns. Combinations of kinematic parameters discriminate between PPE horses with minor vet concerns and subtly lame horses, though overlap exists.

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OBITUARY ALEXANDER (SANDY) DE LAHUNTA (1932 - 2021)

so stimulated my intelect that I have continued to this day trying to emulate his imposing, logical and detailed approach to veterinary neurology and to comparative neuropathology.

Through Sandy’s greathearted approach to learning I gained sufficient intellectual assurance to rub shoulders with specialist clinicians and pathologists while still studying at Cornell. I am certain that I could not have achieved this academic assurance without the mentorship from such a great academician and teacher.

Three specific aspects of academic training I received from Sandy that I remember most vividly are efficiency, accuracy and toil. These attributes were passed on by Sandy, usually at an early hour, over a double-headed microscope, when this particular ingenuous, though inquisitive, graduate student would pester his mentor with thoughtful posers regarding neurologic clinico-pathologic correleates. Training in this component of neuroscience is what has stood me in good stead through my career, and I believe is what has been of great joy to so, so many of Sandy’s students and colleagues.

Image: https://vets.nysvms.org

It is with utmost sadness that I share with readers the news that Dr Alexander (Sandy) de Lahunta, Professor Emeritus, Cornell University, NY, passed away in New Hampshire, USA, yesterday. Although many readers of EVP will not have known Sandy de Lahunta very well, probably all would be familiar with his gigantic contribution to veterinary neurology, world-wide, perhaps mostly through five editions of Veterinary Neuroanatomy and Clinical Neurology.

My relationship with Sandy de Lahunta began when I was fortunate enough to undertake graduate studies in veterinary neurology at Cornell University in 1974 under his mentorship.

Because Sandy’s working days ran from 3:00 am till 4:30 pm, I needed to commit to early starts to attempt to follow his jetpropelled working habits and most importantly to benefit from his remarkable mentorship in guiding me through the – then new to me – complex though exciting disciplines of neurology and neuropathology.

It should be noted that at the stage of me taking up postgraduate studies I was a very naive and reserved student from the other side of the world. Dr de Lahunta was never phased by this incognizance and proceeded to feed my enquiring mind with exciting questions and scenarios that 66 Eq Vet Pract 2021, September; 46 (3)

There is ample evidence of Sandy de Lahunta making a lifelong contribution to education, training and research in veterinary neuroscience by referring to the 5th edition (2020) of the seminal text on Veterinary Neuroanatomy and Clinical Neurology, and to both an early [J Am Vet Med Assoc, 1967; 150(9): 994-1011] and a recent [J Comp Pathol, 2020; 178: 1-8] publication on novel veterinary neurologic disorders, demonstrating a remarkable publication record spanning more than five decades. Alone, and in collaboration with Cornell colleagues, he has published five leading text books and is the author of close to 300 peer reviewed publications in professional and scientific journals. He also is renowned as an exceptional educator. Within the Cornell Veterinary College he was four times the recipient of the Norden Distinguished Teacher Award. In 1991, he was recognized by the American Veterinary Student Association as the Best Teacher in basic sciences. In 2000, he received the Robert W. Kirk Distinguished Service Award of the American College of Veterinary Internal Medicine, and has been granted honorary membership by the American College of Veterinary Pathologists (2002) and the Royal College of Veterinary Surgeons (2005). Finally, this year Sandy was the inaugural recipient of the ACVIM Specialty of Neurology Lifetime Achievement Award.

Through tears of sadness and respect, I offer my spiritual thoughts to one of veterinary medicines giants.

I.G Joe Mayhew 18 August 2021

AU Wong D et al. Evaluation of a continuous glucose monitoring system in neonatal foals. J Vet Int Med. ; 35 (4): 1995-2001. DOI 10.1111/jvim.16186 A commercial human continuous glucose monitoring systems [CGMS; DEXCOM] was placed on 4 healthy and 4 ill neonatal foals, and these glucose measurements were compared to simultaneous measurements of blood glucose concentration using a point-of-care [POC] AlphaTRAK® glucometer and to using standard laboratory chemistry enzymatic laboratory [CHEM] method resulting in 200 matched glucose measurements (78-212 mg/dL; 4.3-11.8 mmol/L). The Pearson correlation coefficient (r) was significantly correlated among all devices: GCMS and CHEM (r = 0.81); CGMS and POC glucometer (r = 0.77); and POC glucometer and CHEM (r = 0.92). This indicates that CGMS measurements are an acceptable method to provide meaningful, immediate, and continuous glucose concentration measurements in neonatal foals.

Isgren CM. Improving clinical outcomes via responsible antimicrobial use in horses. Eq Vet Edu. June 2021; DOI 10.1111/eve.13502 Extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA) and Salmonella spp. are pathogens of significant concern but there are also other opportunistic pathogens such as Pseudomonas spp., alpha-haemolytic Streptococcus spp., Enterococcus spp. and Acinetobacter spp. which, due to their high intrinsic resistance, have limited treatment options in adult horses. It is essential that highest priority, critically important antimicrobials such as ceftiofur, enrofloxacin, rifampicin and polymyxin B are used prudently, with use based on culture and susceptibility testing. A few points in this paper are highlighted: • The use of polymyxin B at a low, anti-endotoxic dose for treatment of systemic inflammatory response syndrome (SIRS) is a potential driver for resistance to colistin (polymyxin E), an antimicrobial used as a last resort in the treatment of multidrug resistant (MDR) Enterobacteriaceae infections in humans.

• Serum procalcitonin levels are used in humans to distinguish non-infectious inflammatory conditions from inflammation caused by bacteria and other infectious agents and are also used to guide cessation of antimicrobial treatment. This and other markers may prove to be helpful in guiding antimicrobial treatment decisions in the future.

• Optimising sampling techniques, such as sampling from a venous drainage site from localised sepsis and carotid sampling for cases of suspected endocarditis, as well as good communication with the microbiology laboratory, are essential for generating accurate cultures and sensitivity results that underpin appropriate antimicrobial use.

• There is clearly a need for national and international harmonisation of laboratory methods in order to improve the reliability and consistency of results reported by different laboratories.

BRIAN GOULDEN AWARD

New Zealand Equine Veterinary Association

The Brian Goulden Perpetual Trophy will be awarded annually and presented at the Annual Dinner of the NZEVA conference.

This annual prestigious prize is awarded to members or past members of the NZEVA who have shown leadership, enterprise, contribution to knowledge or education, and have made significant contributions to the equine veterinary profession in New Zealand.

Please send your nomination including name, address and qualifications, together with any supporting information for the nominee, whom the nominator considers merits the award. This can include curriculum vitae, letters of support and documentation of achievements etc.

Send all details AT ANT TIME to nzevasecretary@gmail.com.

Brendon Bell NZEVA President

nzevapresident@gmail.com

Eq Vet Pract 2021 September; 46 (3) 67

Take your understanding to the next level with

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Diagnostic Imaging

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68 Eq Vet Pract 2021, September; 46 (3)

POETRY AND SONG FEATURE YOU ARE A FLOWER dailypost.co.uk

Greg Brown https://youtu.be/tppp_WUNu4k Greg Brown is a little-known American singer and songwriter born in 1949; an old bugger who has been around the traps, and it shows. He writes wonderful songs, and his music is equally good. He has a growly, deep, baritone voice with great enunciation and clarity which highlight the splendid lyrics - he cuts right to your heartstrings. I think he is a wonderful artist.

His guitar accompaniments are simple with very little added instrumentation; soft drums, occasional mouth harp and piano, all of which quietly add to the songs without cluttering or overpowering the lyrics.

You Are A Flower is simply a wonderful song.

It pays tribute to all those beautiful women out there who nurture us and our families.

You definitely need a quiet space to experience this song, perhaps a Little Biddy Reefton gin or two will render you suitably melancholic before you relax in front of the fire and embrace these great lyrics. After listening, further embracing may be in order.

Slainte.

BB

http://www.gregbrown.org

You Are A Flower Greg Brown

Your smile makes me smile I can always see your face You help me make it through every day You're with me every place You left so much here with us Your love is all around Your children's children will smile that same smile And say "oh look what I have found" You are a flower Shining for a while You are a flower What a life, what a woman, what a smile And I will laugh and I will sing And I will go on through To let this love just come on out That's what I learned from you Your heart went out to everything A field of stones, a field of flowers And when we form that magic ring We feel your hand in ours You are a flower Shining for a while You are a flower What a life, what a woman, what a smile

Eq Vet Pract 2021 September; 46 (3) 69

Veterinary research and education funding available The Don McLaren Fellowship Fund Through the generosity of the McLaren family and in memory of Don McLaren and the huge contribution he made to our profession through his drug company, Bomac, a fund is available to further veterinary research and education. A significant proportion of this money is allocated to the equine sector. A total of $10,000 is available for equine research and education each year, and applications are now invited for 2020.

Priority will be given to veterinary practice-based projects, especially involving young veterinarians.

Consideration will also be given to broader-based equine research work or suitable education-related applications.

Applications close 31 October 2020 and the successful applicant(s) will be notified by 1 December.

Please apply in writing to: Leanne Fecser New Zealand Veterinary Association, PO Box 11212, Wellington nzva@vets.org.nz Applications must include: (a) Details of the proposal (b) Curriculum vitae

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We at Equine Veterinary Practitioner are extremely grateful to our supporting advertisers and trust that you, our readers, will support them in return.

THANK YOU!

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