Equine Vet www.modernequinevet.com
Learn how to read the horse Emerging coronavirus outbreaks in adults
'Test tube' baby born at New Bolton Horses set to benefit from stem cell advance Technician Update: Preemie in the ICU Horse Care for Life
Vol 4 Issue 4 2014
Table of Contents
4 Assessing lameness? Learn how to read the horse
Cover photo by Shutterstock/ Anastasija Popova
Outbreaks associated with equine coronavirus............................................................ 3 Reproductive medicine
'Test tube' baby born at New Bolton................................................................................. 8 neurology
Horses set to benefit from stem cell advance..............................................................10 Technician Update
A preemie in the ICU..............................................................................................................13 Practice Management
Horse Care for Life...................................................................16 News
UC Davis surgeons return horse to winning ways......15 Purina introduces SuperSport Supplement.................15 USDA offers disaster assistance.........................................17 The Modern
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Outbreaks associated with equine ECoV emerging in adults By Marie Rosenthal, MS A collaboration between academics and clinicians has revealed much about equine coronavirus (ECoV) in adult horses. “I received a call from Dr. Robert Ball, who told me ‘I have this neurologic horse and he has fever and he is going down on me, and I have two additional horses with fever at the same barn. What do you think it is?’” said Nicola Pusterla, DVM, PhD, DACVIM, of the department of medicine and epidemiology at the University of California Davis, College Veterinary Medicine. “I told him: ‘That’s humbling that you called me, but this sounds like EHV-1[equine herpesvirus-1]. You are welcome to send me some samples, and we will analyze them,” Pusterla said during a presentation at
Eighty horses developed clinical signs from all the facilities. “Almost all the horses were adults with a median age of 15 years, but they ranged in age from 6 months to 32 years,” he said. The three most common clinical signs were complete or partial anorexia, lethargy and a rectal temperature that ranged from 102° F to 106° F. “In several cases, we had changes in fecal character, eight cases experienced colic and four horses developed acute onset of encephalopathy. Horses with enContinued on page 7
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The three most common clinical signs were complete or partial anorexia, lethargy and a rectal temperature that ranged from 102° F to 106° F. the AAEP 59th Annual Convention in Nashville. “We ran the samples, and they turned out to be negative for EHV-1, and that is when we started to screen for additional equine pathogens.” The horse tested positive for ECoV, an emerging equine disease. Pusterla presented the results of a multicenter study of 270 adult horses involved in eight outbreaks of ECoV, which occurred in separate boarding facilities in California, Texas, Wisconsin, New Jersey, Idaho and Massachusetts between November 2011 and April 2012. Once ECoV was detected in the feces of index cases, veterinarians observed herd mates for the development of clinical signs. During the outbreaks, clinicians collected fecal samples from sick and healthy horses, which were tested for ECoV by polymerase chain reaction (PCR). Hematologic results were available for some horses. Necropsies were performed in some that died or had to be euthanized.
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Learn how to read the horse Horses adapt to pain in many ways. Understanding the individual's response can help determine the cause of the gait abnormality.
Photo courtesy of Dr. Sue Dyson
You know the old joke:
“How do you get to Carnegie Hall? Practice, practice, practice.” Well, diagnosing equine lameness is sort of the same idea. The identification of lameness is a combination of art, skill and science that can be enhanced with — you guessed it — practice, according to Sue Dyson, MA, Vet MB, PhD, DEO, FRCVS, head of the Equine Orthopedics Center at the Animal Health Trust in the UK. Dyson was the Frank J. Milne State of the Art Lecturer at the AAEP Annual Convention in Nashville, Tenn. The theme of the lecture was “Equine lameness: clinical judgment meets advanced diagnostic imaging.” She spent a good part of her lection talking about the art and skill of identifying equine lameness. Accurate lameness diagnosis requires: • recognizing which limb (or limbs) is lame, • identifying any palpable abnormalities, • determining the source of pain, • recommending the appropriate diagnostic imaging to identify the cause of pain, and • accurately interpreting those images. But before one applies the high-
tech science, diagnosing lameness starts with the art, the lameness examination, which necessitates careful observation, pattern recognition, a logical deductive reasoning and a questioning mind, she said. Diagnosing lameness is more than just assessing head nod and hip hike. “I think we need to be looking at the whole horse under a variety of different circumstances,” Dyson said. She suggested watching the horse perform on various surfaces, soft and firm."I use the word firm deliberately rather than hard because I believe horses will trot in a more natural way on a firm, gravel surface compared with a concrete surface," she said, "particularly, big moving dressage horses feel apprehensive moving on concrete, and they will naturally shorten their stride. This is a reflection of their apprehension rather than a reflection of any underlying lameness." In addition, the veterinarian should assess the horse at a walk, canter and trot and while transitioning from one to another. “I want to observe the horse performing during transitions,” she said. “From walk to trot, trot to canter, from canter to trot and from trot to walk, and I am looking for a number of different aspects. If the
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Making the grade By Marie Rosenthal, MS Sue Dyson questions the usefulness of the Lameness Scale developed by the American Association of Equine Practitioners. There are two reasons, she said. The scale does not go far enough to allow the veterinarian to measure subtle improvements or worsening after intervention, and many veterinarians don’t use it correctly. “This is not an ordinal scale, although it is commonly misused as one. Each Grade has a specific definition. So, why don’t I like this? Let’s take Grade-3 lameness. This is lameness that is consistently observable at a trot under all circumstances,” said Dyson, MA, Vet MB, PhD, DEO, FRCVS, of the Animal Health Trust. She showed a video of a horse with “Grade-3 lameness” but after blocking the horse, it improved about 50%. However, it would still be considered a Grade 3 under the AAEP scale. With this scale, she could not indicate the improvement seen on blocking, she explained. “How do I grade this improvement?” She asked. Dyson has developed a scale of 0 to 8 with 0 being sound; 2 being mild; 4 being moderate; 6 being severely and 8 being non weight bearing. “With the intervening grades of 1,3,5 and 7, I grade the horse at the walk and the trot. I grade it in circles, both on soft and hard surfaces, and I grade it ridden,” she said. Under each circumstance, she gives the horse a grade, which she embellishes with a verbal description of the horse, such as “the horse is looking outside the circle” or “The head is over bent.” In addition, she records the description and grade, so she can compare this baseline to later results. With this scale and description, she can more accurately determine if the horse sees any improvement after local analgesia. So for the horse that showed Grade-3 lameness on the AAEP scale, she scored him a 4 out of 8. After blocking the foot, it improved to 2 out of 8, which gave her a clearer idea of what was going on. “I believe we need a sufficient number of grades to cover a wide range of gait abnormalities. Often, there is more than one source of pain causing lameness and we need to be able to grade the imporvement after diagnostic analgesia.” MeV
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Talking to the rider can provide important information, but remember that not all riders recognize the problem, and a good rider can work past or mask the lameness, while a bad rider can make it worse. Photo courtesy of Dr. Sue Dyson
horse does not step smoothly upward, but jumps that may reflect a lack of hindlimb push due to pain, or it may reflect some degree of weakness, which may be associated with ataxia.” It is also important to see the horse lunged in circles, which is preferable to being led in hand in circles because it is easier to assess the horse’s balance and to evaluate it in both trot and canter. In many cases, it is also helpful to observe the horse being ridden. “We are often asked to evaluate a problem that the rider is experiencing when the rider is riding the horse. Therefore, it behooves us to examine the horse ridden,” Dyson said. Talking to the rider can provide important information, but remember that not all riders recognize the problem, and a good rider can work past or mask the lameness, while a bad rider can make it worse, she said. Looking at the horse’s attitude to work and its shape when working can offer a lot of clues about
the lameness and the degree of pain the horse is in. Sometimes the lameness only becomes apparent during certain movements, therefore, it is important to assess the horse performing all of its normal work program. “Horses adapt in many ways to pain depending on the severity of the pain, the source of the pain, the individual’s response to pain and the type of pathological abnormality that is causing the gait or lameness abnormality,” she said. Each observation will provide important information about what is causing the horse’s lameness and each should receive a lameness grade (See Making the grade). Sometimes there is more than one reason (or limb) causing the lameness. If there is only a 70% improvement after diagnostic analgesia this frequently indicates that there is an additional source of pain, she said, so keep that in mind when performing a lameness examination. MeV
Infectious Disease Equine ECoV continued from page 3
Photo courtesy of Bob Langrish/boblangrish.com
ECoV transmission is via the fecal-oral route, and the index case frequently brings it to the farm from an event. Virus can be shed for several weeks.
Clinical Signs Associated with ECoV
100 90 80 70 Percentage
cephalopathy presented with abnormal behavior, such as head pressing, were severely depressed, and showed nystagmus, ataxia, proprioceptive deficits, recumbency and seizure. “The majority of sick horses experienced a self-limited disease. These horses improved with supportive therapy, which consisted mainly in the administration of anti-inflammatory drugs and intravenous fluids for horses with colic and severe diarrhea Most horses improved within one to four days,” he added. With the exception of one outbreak, all clinical signs among all the horses resolved within one to three weeks. The last outbreak he investigated was an exception. Two American miniature horses returned from a show and were separated from the rest of the herd. They were reintroduced to the herd two weeks later, and several resident horses developed fever, anorexia and depression.
60 50 40 30 20 10 0
ECoV is spread through the fecal-oral route. Clinical signs develop shortly after exposure (incubation time of about 48 to 72 hours), and horses remain infectious up to 14 days. Most adult horses with ECoV experience self-limiting signs of partial anorexia, depression and fever, but some suffer more severe signs. In fewer than 20% of cases, there are gastrointestinal signs, such as changes in fecal character and colic, and about 5% experience an acute onset encephalopathy. “Between 20% and 57% of all horses involved in an outbreak will eventually develop any of the clinical signs mentioned above, and the fatality rate is about 11%,” he said. Fatalities were associated with complications relating to the disruption of the mucosal barrier, leading to endotoxemia, septicemia and metabolic derangement in the form or hyperammonemia. There was little in the literature about equine coronavirus, he said, and the cases he found were among much younger horses. Veterinarians treating three recent outbreaks at a Japanese racetracks among adult draft horses had experiences similar to those in the outbreaks Pusterla and his colleagues studied: depression, fever, anorexia and gastrointestinal signs. In the Japanese cases, the signs were self-limiting, and they all survived with supportive treatment. MeV For more information: Pusterla N, Mapes S, Wademan C, et al. Emerging outbreaks associated with equine coronavirus in adult horses. Proceedings 59th Annual Convention (AAEP), Dec. 7-11, 2013, Nashville, Tenn. The study was supported in part by a grant from Boehringer Ingelheim Vetmedica. MeV
The above chart shows the clinical signs associated with ECoV as demonstrated in the study by Pusterla et al.
For more information: Pusterla N, Mapes S, Wademan C, et al. Emerging outbreaks associated with equine coronavirus in adult horses. Proceedings 59th Annual Convention (AAEP), Dec. 7-11, 2013, Nashville, Tenn. The study was supported in part by a grant from Boehringer Ingelheim Vetmedica. ModernEquineVet.com | Issue 4/2014
Test tube baby born at New Bolton B y
My Special Girl's pregnancy
was truly special, because it was made possible by the advanced reproductive technique intracytoplasmic sperm injection, known as ICSI, which involves injecting a single sperm into a mature egg. The embryo was transferred to My Special Girl in April 2013 at New Bolton Center's Hofmann Center for Reproduction. The colt was born on the 355th day of gestation, 15 days past the average of 340 days. With the world watching, My
A s h l e y
Special Girl gave birth to a colt at 9:22 pm on Saturday, March 29, 2014, at Penn Vet’s New Bolton Center. My Special Girl’s water broke at 9 pm. It was a tight fit, but the presentation, position and posture were all normal. Still, New Bolton Center clinicians assisted with the delivery. The birth canal was lubricated and the colt was delivered with moderate traction. Stage-2 labor lasted 22 minutes. “It was good that we were here,” said Regina Turner, VMD, PhD,
Foal Facts • Foals are born after a gestation period of about 11 months. However, there is a greater variation in normal gestational length in the mare than in any other species, with normal births occurring after a gestation as short as 10 1/2 months or as long as 13 months.
For more details on this story, click here. • Birth takes place quickly, consistent with the status of a horse as a prey animal, and more often at night than during the day. • Foals are born with an ability to quickly escape from predators; normally a foal will stand up and nurse within the first hour after it is born and can trot and canter by the next day. • A newborn foal weighs about 100 pounds. • A newborn foal's legs are almost as long (90%) as those of an adult horse. 8
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B e r k e
DACT, associate professor of large animal reproduction. “It was a strain for the mare because it was a tight fit and the colt's shoulders were hung up briefly in the birth canal. We were able to assist the delivery with some lubrication and traction. We are all so happy that the mare and foal are bonding so well. It looks like My Special Girl is going to be a great mom.” The foal at birth was not as responsive as the staff would have liked. "He had a lower heart rate than normal, and had other indications that he was slow to start, so we did give him a dose of epinephrine to stimulate his heart rate and to support his circulation at birth,” said Jonathan E. Palmer, VMD, chief of neonatal intensive care service and director of perinatal/ neonatal programs at New Bolton Center. “We attached an ECG to monitor his heart rate and rhythm because of his slow start. Within minutes he responded. We routinely in high-risk pregnancies take a blood sample from the umbilical cord at birth. We found mild abnormalities that showed the foal had some stress in utero and this may have led to a slow start. He was some-
My Special Girl's foal is truly special, because the mare was impregnated using the advanced reproductive technique intracytoplasmic sperm injection, known as ICSI.
what slow standing on his own and somewhat slow nursing on his own, but we fully expect that he will come around. But because of his slow start we will be monitoring him carefully. We will be watching his behavior closely and we will be taking more blood samples to make sure he continues to make a smooth transition.” The colt, whose show name is New Bolton Pioneer and barn name is Boone, will spend its first six months at the Hofmann, until he is weaned. But he will remain in the New Bolton Center family, because he will be adopted by Rose Nolen-Walston, DVM, assistant professor of medicine, who lives on a nearby farm. Lisa Fergusson of Cochranville, once on Canada’s Olympic Eventing team, will be Boone's trainer when he is ready to
begin his athletic career. This is the first successful pregnancy by Penn Vet using the advanced reproductive technique intracytoplasmic sperm injection (ICSI), which involves injecting a single sperm into a mature egg. Penn Medicine’s Matthew VerMilyea, PhD, director of the IVF and andrology laboratories at Penn Medicine, is performing ICSI for the Hofmann Center. ICSI is a common procedure in human medicine that revolutionized the treatment of male infertility. VerMilyea is using a microscope with laser technology, used for people but rarely used in the ICSI procedure in horses. ICSI has great potential for use of frozen sperm from deceased stallions to carry on a legacy. In addition, the procedure can be used for mares who cannot get pregnant or
Photo courtesy of New Bolton
Photo courtesy of New Bolton
carry their offspring themselves in the conventional manner, as all the donor mare needs to do is produce an egg. My Special Girl, an 11-year-old Thoroughbred, was donated to New Bolton Center’s herd of horses used for teaching veterinary students. The egg for the foal came from a Thoroughbred-Cleveland Bay cross mare. The sperm was from frozen semen from a long-deceased Thoroughbred-Quarter Horse cross stallion that was part of the Hofmann Center’s teaching program. MeV
An ultrasound of the foal's eye and lense on March 7.
This article first appeared on the New Bolton Website where the are lots of pictures, videos and news about Boone. ModernEquineVet.com | Issue 4/2014
Stem cells (iPSCs) generated from equine skin cells.
Horses set to gain
health benefits stem cell advance from
Horses suffering from neu-
Photo courtesy of Dr. Xavier Donadeu
rological conditions similar to those that affect people could be eventually helped by a break through in stem cell research. University of Edinburgh (UK) researchers have created working nerve cells from equine stem cells. Horses suffer from about 90 genetic neurological conditions that have similarities to human conditions. The advance may pave the way for cell therapies that target motor neuron diseases. The research could also benefit horses affected by equine grass sickness, a neurological condition that affects around 600 horses a year in the United Kingdom. Little is known about the EGS, which causes nerve damage throughout the body. It is untreatable and animals with the most severe form usually die or have to be put down. “Stem cells hold huge therapeutic potential both for people and animals. Our research is an important step toward realizing that potential for horses and provides an opportunity to validate stemcell based therapies before clinical studies in humans,” said Xavier Donadeu, DVM, MS, PhD, who led the study at The Roslin Institute, University of Edinburgh in Scotland. The researchers took equine keratinocytes from a 5-monthold foal and turned them into stem cells using a cell reprogramming technique that was originally developed for human cells. The reprogrammed cells are pluripotent, which means they can be induced to become virtually
any type of cell in the body. The team then used the pluripotent stem cells to create nerve cells in the laboratory and tested whether they were functional by showing that they could transmit nerve signals in a petri dish. Horse pluripotent stem cells have been produced in the laboratory before but this is the first time that scientists have created specialized working cells from them. The new cells provide a powerful tool for scientists to study horse diseases in the laboratory, and it is hoped that in the longer term they will also have a clinical application, Donadeu explained. Veterinarians around the world
are using stem cell therapies to treat horses, but they use adult stem cells derived from bone marrow or adipose tissue, which are harder to maintain and are more restricted in the types of cells that they can become. The approach is mostly used to treat tendon, ligament and joint problems. “Pluripotent stem cells offer greater potential as they can uniquely generate all cell types in the body and could be more widely used for tissue regeneration, including neuroregeneration,” the researchers wrote in the study article published in Stem Cells and MeV Development.
Neuronal networks produced from those stem cells. Photo courtesy of Xavier Donadeu
For more information: Sharma R, Livesey MR, Wyllie DJA, et al. Generation of functional neurons from feeder-free, keratinocyte-derived equine induced pluripotent stem cells. Stem Cells and Development. 2014; 140218101906009 DOI:10.1089/scd.2013.0565 http://www.ncbi.nlm.nih.gov/pubmed/24548115 ModernEquineVet.com | Issue 4/2014
AAEVT* membership is open to US and international equine veterinary technicians, assistants, practice managers, and support staff employed in the veterinary industry. It is also open to students of AVMA/CVMA accredited programs
AAEVT Membership • • • • • • • •
Bi-Annual Newsletter Weekly “HoofBeats” email NEwsblast Full access to www.aaevt.org, including the Career Center and the Library Up-to-date information on the AAEVT Discounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT Convention NTRA, Working Advantage and Platinum Performance Benefits The opportunity to participate in the AAEVT Online Certification Program or to become a member of the AEVNT Academy-Specialty in Equine Veterinary Nursing • Scholarship opportunities. • AAEVT’s Equine Manual for Veterinary Technicians (Blackwell Publishing 20% discount on purchase price) • Subscription to THE HORSE Magazine, compliments of Intervet Schering/Plough Opportunity to attend Purina’s Annual Equine Veterinary Technician Conference All Expenses paid!
AAEVT Objectives • • • •
Provide opportunities for CE, training, communication, and networking Educate the equine veterinary community and the public about our profession Inform Members of issues affecting our profession Assist in providing the best medical care to improve the health and welfare of the horse
AAEVT Online Equine Certification Program
• A three course, 10 module, equine-only online program offered through ACT • Geared toward Credentialed Veterinary Technicians, Assistants, Support staff, & Students • Areas of study include: equine medical terminology, anatomy and physiology, parasitology, laboratory, diagnostics, equine basics (breeds, wellness, husbandry,) diagnostic procedures, emergency medicine, restraint, pharmacology, surgical assistance and anesthesia, equine office procedures • A certificate of completion is awarded to those who: Successfully complete required courses Complete the list of required skills (per a supervising DVM who is an AAEP member) Attend an AAEVT regional CE symposium and participate in the we labs • Those individuals who successfully complete the programs will be recognized as AAEVT Certified Equine Veterinary Technicians / AAEVT Certified Equine Veterinary Assistants depending on their current designation. The certificate is recognized by the AAEVT and the AAEP but does not grant the credentialed status by the AVMA • For more information go to www.aaevt.4act.com or call 800-357-3182
AAEVT Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.
For more information visit www.aaevt.org
*American Association of Equine Veterinary Technicians and Assistants
Case Study: A preemie in ICU By Andrea Whittle A Thoroughbred foal presented to the Rood and Riddle Equine Hospital with her mare. The mare had been treated for a placentitis for 5 weeks prior to foaling with gentamicin-betamethasone, altrenogest, pentoxyfylline, sulfadiazine-trimethoprim and flunixin megumine per the referring veterinarian. The last recorded breeding date was March 27, 2010 giving this foal a gestational age of 329 days. The mare foaled the night before admission. She presented as a premature placental separation, and the premature filly was slow to take her first breath, no resuscitation drugs were needed after some stimulation. Upon examination, the placenta was incomplete with a shredded tip of a horn. The filly was maintained at the farm overnight but was still unable to stand although a suckle reflex was present when she was admitted at 5:30 am on Feb. 20, 2011. The foal had received 30 oz of colostrum; a combination of the maresâ€™ and frozen colostrum.
blood cell (WBC) count was 11,800 cells/mL with the following differential: 81% segs, 9% bands, 7% lymphocytes and 3% monocytes. The immunoglobulin G (IgG) at admission was 992 mg/dL and blood glucose registered at 124 mg/dL when measured at stall side. An ABG pulled at admission found pO2 66, sO2 92.8 and CO2 54. The foal was receiving supplemental oxygen at this time at a rate of 6 L/min. A fecal sample was submitted to the laboratory to test for Clostridium difficile and C. perfringens, no antitoxins were identified to either bacterium, the foal also had a negative blood culture. Kpen and amikacin were chosen for broad-spectrum antimicrobial coverage and were given for the duration of the fillyâ€™s stay. We gave 500 mL of Lactated Ringers Solution with a 10% DMSO solution and 0.5 cc thiamine was administered as a bolus once the IVC was secured and flushed. The LRS/DMSO/thiamine fluids were continued for four additional treatments on a BID schedule.
Upon presentation to the clinic, the filly was small but a good body weight. She weighed 94 lb on day 5 of hospitalization. The filly had a silky coat, there were no other obvious signs of prematurity. The filly was alert to stimulation, unable to stand with assistance and was active on the mattress. The initial vitals were a temperature of 97.1o F, heart rate of 108 bpm and respiratory rate of 24 bpm. Urine was seen during the work up and dark tar-like feces were present on the tail and perineum. The mucous membranes were moist and pink with a CRT of <2 seconds; all joints and the umbilical structures palpated within normal limits (WNL). Peripheral pulses were palpable and an arterial blood gas (ABG) was obtained. Entropions were present bilaterally, the right eye was held closed. Auscultation of the abdomen revealed hypomotile borborygmi. Auscultation of the thorax revealed moist sounds primarily cranioventral on the left. A double lumen over the wire (OTW) catheter, an Arrow 7 French, was placed in the LJV with 5 mg diazepam for sedation. An indwelling flexiflow nasogastric feeding tube was placed alongside an oxygen canula. The initial blood work showed several abnormal values; creatinine 10.2 mg/dL, lactate 6.2 mg/dL, potassium 6.5 mmol/L, fibrinogen 300 mg/dL. The white
Photo courtesy of Rood and Riddle
Physical exam findings on admission
A foal in the ICU at Rood and Riddle Equine Hospital.
A nebulizing regime began at 9 am, 4 hours after admission, with acetylcysteine and sterile H20. Albuterol and ceftiofur were added on 2/21. This was after a follow-up ultrasound scan of the thorax showed areas of consolidation on the left side primarily at intercostal space 5. An ABG was repeated after this scan: pO2 56.7, SO2 89.7 and CO2 55.1. The foal was nebulized 4 times a day until being slowly weaned off on day 7 to TID then day 9 to BID. The supplemental oxygen was maintained at 6 L/min until day 4 when the rate was weaned down. It was ModernEquineVet.com | Issue 4/2014
technician update discontinued completely on day 9. A follow-up ultrasound on day 6 showed significant improvements with mild comet tails seen cranioventral. On this day transtracheal aspirate was performed through the endoscope, culture revealed Escherichia coli that was sensitive to amikacin. Small feedings of the mare's milk were started at 7 am on the day of admission; 2 oz Q2 via the indwelling NGT. These feedings were stopped at 5 pm, 12 hours post admission. The foal was noted to become slightly distended and lethargic; the stomach was seen to be distended on ultrasound. A Harris flush tube replaced the feeding tube and no significant amount of reflux was obtained. Metronidazole was added to the list of treatments. Lidocaine was spiked into the CRI fluids after a loading dose in 150 mL NaCl. No further colic episodes were noted and the lidocaine was discontinued early on day 2. An indwelling NGT was replaced on day 4 and feedings were reintroduced gradually; the filly was allowed to nurse on day 7 for the first time (2 minutes Q4 on an empty udder) when she was deemed strong enough. CRI fluids were started at admission; a 10% dextrose solution in LRS was initially hung and then changed to a 10% dextrose solution in 0.9% NaCl due to the hyperkalemia. On day 2, the foal was switched to TPN with Normasol M CRI, blood glucose levels were monitored Q4. The blood glucose was averaging 200 mg/ dL on day two and reached 260 mg/dL on day 3. An insulin CRI (15 units in 150 mL NaCl @ 2 mL/hr) was started to allow the foal's caloric requirements to be met through TPN. The insulin was discontinued after being decreased to 1 mL/hr on day 4. CRI fluids were switched from Normasol M to D5W on day 3 with KCl supplementation (between 20-60 mEq/L) due to hypokalemia (2.5 mmol/L). Oral KCl granules were added to bring blood levels to 3.4 mmol/L on day 5 and 4.1 mmol/L on day 6. At 3 am on day 2, the filly became difficult to stimulate to wake up when handled, by 6 am seizure activity was seen; predominantly stargazing and stretching behaviors with horizontal nystagmus. Diazepam was given (5 mg IV) twice before 7 am. Seizure activity continued through the diazepam and phenobarbital (260 mg in 150 mL NaCl over 20 minutes) was given once at 8 am and again (390 mg) at 1 pm. The filly was placed on a Q15 minute respiration check due to a depressed respiratory rate, averaging 16-24 b pm. The final dose of phenobarbital controlled most of the seizure activity with a third diazepam dose being given at 8 am on day 3. The foal remained recumbent on the mattress in a deep slumber for duration of day 3, she was handled with minimal stimulation just having her hips flipped Q4hrs. 14
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The respiratory rate remained depressed throughout day 3, at 7 pm a doxapram CRI was started (400 mg in 250 mL NaCl @ 21 mL/hr); with continues Q15 minute respiratory checks. The doxapram drip was stopped in the evening on day 4 as the foal became more responsive. Day 4 showed a positive turn around with no continued seizure activity, the foal was more appropriately responsive to stimulation and was able to be stood and turned every 2 hours by 2 technicians. Between treatment times the foal was falling in a deep sleep; caffeine was added to the treatment regime as needed when the respiration rate dipped for any extended period. On day 3 the urinary output became sporadic; she had previously been producing a moderate amount Q2. No urination was noted for 4 hours in the morning with a small amount of overflow urine seen at 11 am. A urinary catheter (Mila, 12 French) was placed and 1.5L’s of urine relieved from the bladder. Phenazopyridine (200 mg PO BID) was started and continued through day 9. The urinary catheter was removed on day 5 and the filly continued to urinate appropriately. The right eye was noted to be almost closed at admission. Staining the cornea revealed an ulcer that progressed quickly. Bilateral entropions were handled non-surgically, being rolled out by hand Q2 hrs with artificial tears being applied between medications. A corneal scrape, completed with diazepam (5 mg) and butorphanol (1 mg), on day 5 revealed a Micrococcus sp and Q4 treatments were tailored to suit the sensitivity.
This foal was hospitalized for 10 days. On day 7, she could stand unassisted and was gradually introduced back to the mare full time. Radiographs of the left tarsus and carpus were WNL on day 9. At discharge, the foal was bright with extended periods of “playtime” and was comfortably handling the mare's milk. Three days after discharge a follow-up exam was carried out at the farm. The foal was bright and alert although still on stall rest. Upon ultrasound exam, the pneumonia was improved bilaterally when compared with previous images, her WBC count was 10,100 cells/mL. The corneal ulcer was smaller with an improvement in comfort. This Thoroughbred is now in training as a 3-yearold with her original owners. MeV
About the Author:
Andrea Whittle is an Internal Medicine Technician at Rood and Riddle Equine Hospital. She presented this case at the AAEVT Meeting held in Nashville, Tennessee.
UC Davis surgeons return racehorse to winning ways Caddy (Spook DeVille), an 11-year-old Quarter Horse gelding, was at the top of his game in 2012. He captured several racing titles, including the Western Classic Grand Champion barrel race title, and set a new Western Classic arena record for the fastest time. In 2013, he escaped from his box stall during the night, and when his owner found him in the morning, he had extensive injuries to his chest, head and legs. An inspection of the property revealed a large amount of blood in the arena and on a tractor drag. Caddy must have fallen on the drag during the night. Caddy is back to winning after being treated by UC Davis surgeons for very severe injuries after escaping his stall. Photo courtesy of UC Davis.
dressings and bandages. Three drainage tubes were placed in his chest wall, axilla and foreleg to help remove fluid from the injured areas. Caddy remained hospitalized at the VMTH for 12 days to properly manage the healing of his injuries. After release, he recovered at a layup facility, and later at home, with stall rest, medications, and regular dressing changes, before later moving on to therapeutic laser and ultrasound treatments and working out on an underwater treadmill. Caddy’s three- and five-month re-check examinations at the VMTH showed that the lacerations had healed remarkably well, and he was gradually returning to normal activity. Six months after the accident, Caddy returned to competition, and much to his owner’s surprise, ran faster than ever, breaking new records and continuing his winning ways. MeV
Purina Introduces SuperSport Supplement for Faster Muscle Recovery
His owner brought Caddy to the Equine Surgical Emergency & Critical Care Service at the University of California Davis Veterinary Medical Teaching Hospital’s Large Animal Clinic, where he was immediately evaluated and treated for multiple lacerations on his face, chest and legs. Because the injuries to his chest were extensive, the initial concern was that he may develop respiratory difficulty. The veterinarians performed a thoracic ultrasound to determine if he had a pneumothorax, which is caused by air leaking into the space between the lungs and the chest wall. Luckily for Caddy, there was no internal damage, but the level of his lacerations would take a great deal of care and time to heal. Examination of the lacerations on his face revealed a frontal facial bone fracture and exposed right frontal sinuses. A deep vertical laceration on his chest measured about six inches, opening a massive gaping wound and a severe axillary wound. Multiple smaller lacerations covered his front legs. Jorge Nieto, BS, MVZ, PhD, associate professor of surgical and radiological sciences, and Sarah Gray, BVSc, staff veterinarian, cleaned, debrided and closed all of Caddy’s wounds with multiple sutures,
Purina Animal Nutrition introduced SuperSport amino acid supplement, a scientifically formulated amino acid formula proven to support equine performance and overall fitness. In a controlled, 56-day study, horses received either SuperSport supplement or an identical level of protein from alfalfa pellets. Horses on SuperSport supplement saw significant improvements in key measures that are critically important to top equine athletes, including: • Faster muscle recovery • Increased exercise capacity • Supported muscle development • Maintained optimal performance Researched and developed by equine nutritionists, SuperSport supplement features an optimal amino acid profile, high-quality protein and added antioxidants to support muscle protection and repair. And it is grain-free, making it suitable for horses with sensitivities. “At Purina, we know riders need their horses to consistently perform at their best and bounce back quickly after exercise, so they can be ready for what’s next,” said Kelly Vineyard, PhD, equine nutritionist, Purina. “With SuperSport supplement, top competitors of all ages and disciplines now have a scientifically proven supplement to help their horses recover faster, increase stamina and fitness for training and competition, and develop a more athletic body type to support their performance.” For more visit supersportready.com. MeV ModernEquineVet.com | Issue 4/2014
Horse Care for Life
B y W e n d y V a a l a , V M D , D AC V I M Merck Animal Health S enior Equine Technic al S er vices veterinarian
New program helps direct clients to the veterinarian for answers Even though clients browse the Internet, at least occasionally, for equine health care information, I think all veterinarians would agree that “Dr. Internet” is not always providing them with accurate information. Recognizing this and the overall need to build a stronger veterinarian-client partnership to ensure standards of care, Merck Animal Health and Purina Animal Nutrition, partnered to develop a program that is backed by science and champions the veterinarian as the best source for equine health care and nutrition. The result: Horse Care for Life, the interactive health care program tailored to the horse’s age and use. The program is about growing the veterinarian’s posi16
Issue 4/2014 | ModernEquineVet.com
tion as primary health care provider for the horse. We want horse owners to stop thinking, “How do I get my vaccine online?” and to start thinking, “I need to get my veterinarian back on my farm.”
Health care by Life Stage
Horse Care for Life will help keep your clients engaged and proactive in monitoring their horse’s health while keeping you front and center as the primary source of health care information for horses in every life stage, including: • Broodmares, foals and stallions • Young horses • Adult horses (performance and pleasure) • Senior horses
Your clients can use Horse Care for Life for expert infor-
mation through a member-only website to help stay on top of vaccinations, deworming, nutritional needs and risk factors specific to their horses. Horse Care for Life works to educate your clients while boosting your practice, which ultimately creates a higher level of partnership between you and your clients. The unique life-stage approach of the information and veterinarian-client interface will help you set your practice apart, encourage greater veterinary involvement and preventative care, and help facilitate referrals for new business. At the end of the day, this means better health for the horse and better business for you.
How it Works
After receiving their exclusive invitation to the site from you, horse owners create a profile for
USDA Announces Sign-Up Date for Farmer and Rancher Disaster Assistance Programs Ths month, farmers and ranchers can sign-up for disaster assistance programs, reestablished and strengthened by the 2014 Farm Bill. Quick implementation of the programs has been a top priority for USDA. "These programs will provide long-awaited disaster relief for many livestock producers who have endured significant financial hardship from weather-related disasters while the programs were expired and awaiting congressional action," said Agriculture Secretary Tom Vilsack. "President Obama and I prioritized the implementation of these disaster assistance programs now that the Farm Bill has restored and strengthened them." The Livestock Indemnity Program (LIP) and the Livestock Forage Disaster Program (LFP) will provide payments to eligible producers for livestock deaths and grazing losses that have occurred since the expiration of the livestock disaster assistance programs in 2011, and including calendar years 2012, 2013, and 2014. Enrollment also began for producers with losses covered by the Emergency Assistance for Livestock, Honeybees, and Farm-Raised Fish Program (ELAP).
Horse Care for Life should increase client engagement, provide detailed demographics data for planning and marketing, and offer other tools to help grow your practice.
each horse. The program generates health reminders based on the horse’s profile that include general information and recommendations to support best practices and guidelines from the AAEP. Horse owners are encouraged to talk to their veterinarians for more information. Your clients will also have access to veterinarian and nutritionist-written educational content based on the life stage of their horse, as well as valuable recordkeeping tools to track vaccina-
tions, deworming, nutrition, dental care, and much more. Armed with the right information, horse owners reach out to their veterinarians more frequently to prevent problems or stop them from becoming worse. Additionally, you will have access to clients’ detailed demographic data, such as clients’ health care interests/concerns, horses’ ages and breeds, and much more, for your planning and marketing purposes. MeV
For more information:
• LIP provides compensation to eligible livestock producers that have suffered livestock death losses in excess of normal mortality due to adverse weather. Eligible livestock includes horses, beef cattle, dairy cattle, bison, poultry, sheep, swine, and other livestock as determined by the Secretary. • L FP provides compensation to eligible livestock producers that have suffered grazing losses due to drought or fire on publicly managed land. An eligible livestock producer must own, cash lease, or be a contract grower of eligible livestock during the 60 calendar days before the beginning date of the qualifying drought or fire in a county that is rated by the U.S. Drought Monitor as D2, D3, or D4. • ELAP provides emergency assistance to eligible producers of livestock, honeybees and farm-raised fish that have losses due to disease, adverse weather, or other conditions, such as blizzards and wildfires, as determined by the Secretary of Agriculture. To expedite applications, all producers who experienced losses are encouraged to collect records documenting these losses in preparation for the enrollment in these disaster assistance programs. Information on the types of records necessary can be provided by local FSA county offices. Producers also are encouraged to contact their county office to schedule an appointment.
To learn more about Horse Care for Life, contact your Merck Animal Health sales representative, call 800-521-5767, or visit HorseCareforLife.com. ModernEquineVet.com | Issue 4/2014
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