Page 1

The Modern

Equine Vet www.modernequinevet.com

Modern Marvels:

Saving Lives With Vaccines Predicting Return-to-Work after SDFT Can a Rider's Weight Induce Lameness? AAEP Updates Biosecurity Guidelines Sepsis-Induced Laminitis: Treatment Update Technician Update: Managing Beyond the Everyday Emergencies

Vol 8 Issue 4 2018


TABLE OF CONTENTS

COVER STORY

Modern Marvels ... 10 Equine Vaccines Save Lives Cover photo: Chelle129/Shutterstock.com

LAMINITIS

Boy, You Gotta Carry That Weight, Carry That Weight a Long Time............................................................... 4 Sepsis-Induced Laminitis: Treatment and Prevention Update....................................................... 6 TECHNICIAN UPDATE

Managing Beyond the Everyday Emergencies...............................18 NEWS

Ultrasound Findings May Help Predict Return-to-Work ............................................... 3 AAEP Updates Biosecurity Guidelines..................................................................................17 ADVERTISERS Shanks Veterinary Equipment.................................. 3 Equinosis........................................................................ 7 Boehringer Ingelheim................................................ 9 Merck Animal Health................................................11

Avalon Medical...........................................................13 Standlee Premium Western Forage.......................15 AAEVT............................................................................19

The Modern

Equine Vet SALES: Matthew Todd • ModernEquineVet@gmail.com Lillie Collett • ModernEquineVetSales@gmail.com EDITOR: Marie Rosenthal • mrosenthal@percybo.com ART DIRECTOR: Jennifer Barlow • jbarlow@percybo.com CONTRIBUTING WRITERS: Paul Basillo • Carol Jean Ellis Jason Mazda COPY EDITOR: Patty Wall Published by PO Box 935 • Morrisville, PA 19067 Marie Rosenthal and Jennifer Barlow, Publishers PERCYBO media  publishing

2

Issue 4/2018 | ModernEquineVet.com

LEGAL DISCLAIMER: The content in this digital issue is for general informational purposes only. PercyBo Publishing Media LLC makes no representations or warranties of any kind about the completeness, accuracy, timeliness, reliability or suitability of any of the information, including content or advertisements, contained in any of its digital content and expressly disclaims liability of any errors or omissions that may be presented within its content. PercyBo Publishing Media LLC reserves the right to alter or correct any content without any obligations. Furthermore, PercyBo disclaims any and all liability for any direct, indirect, or other damages arising from the use or misuse of the information presented in its digital content. The views expressed in its digital content are those of sources and authors and do not necessarily reflect the opinion or policy of PercyBo. The content is for veterinary professionals. ALL RIGHTS RESERVED. Reproduction in whole or in part without permission is prohibited.


NEWS NOTES

Ultrasound Findings May Help Predict Return-to-Work Specific features from the first ultrasonographic examination following a superficial digital flexor tendon (SDFT) injury might help predict the likelihood of a successful return to racing in Thoroughbreds.

cross-sectional area (CSA) affected and longitudinal fiber pattern (LFP) of the maximal injury zone (MIZ). The horses were split into two groups based on the presence or absence of a core lesion. The right forelimb was most commonly affected, and the midmetacarpal region was the most common site of the MIZ. Most of the horses (76%, n=357) had a core lesion. Lesion location, CSA and echogenicity influenced the likelihood of a successful return to racing in the core lesion group, whereas LFP and echogenicity did so for those horses without a core lesion. Horses in either group with reduced echogenicity of the MIZ were less likely to have a successful return to racing. Although 49% of horses (n = 175) raced again, only 31% (n = 112) were deemed to have a successful return to racing. MeV

Courtesy of Dr. Rafa Alzola Domingo

Lifting Large Animals Since 1957

The top image shows SDFT tendonitis with a core lesion; the cross-sectional area of the lesion affects to <25% of the total surface of the tendon. This horse will have a 35% chance to return to racing. The bottom shows SDFT tendonitis without a core lesion; the lesion longitudinal fiber pattern affects to â&#x2030;Ľ50-75% of the tendon. This horse will have a 49% chance of returning.

Rafa Alzola Domingo, BVMS, MSc GPCert (EqP), Cert AVP (EP, ESST, ESO, VDI), MRCVS, of the Oakham Veterinary Clinic, and his colleagues in the United Kingdom and Hong Kong performed a retrospective study to characterize the abnormalities of SDFT injuries in Thoroughbred racehorses and to see if these findings could be used to predict whether the horses would return to racing. They evaluated the images of 460 horses obtained during the initial examination within one week of injury for location, type and extent of injury, echogenicity,

For more information: Alzola R, Easter C, Riggs CM, et al. Ultrasonographic-based predictive factors influencing successful return to racing after superficial digital flexor tendon injuries in flat racehorses: A retrospective cohort study in 469 Thoroughbred racehorses in Hong Kong. Equine Vet J. 2018 Feb (Epub ahead of print). http://onlinelibrary.wiley.com/doi/10.1111/evj.12795/full

www.shanksvet.com â&#x20AC;˘ info@shanksvet.com ModernEquineVet.com | Issue 4/2018

3


LAMINITIS

Boy, You Gotta Carry That Weight,

Carry That Weight a Long Time High rider-to-horse body-

weight ratios can induce temporary lameness and discomfort, affecting the horse’s performance, according to a new pilot study presented at the National Equine Forum. In other words, if the rider is excessively heavy for the horse in question, it can affect the animal’s performance, explained Sue Dyson, MA, Vet MB, PhD, DEO, FRCVS, head of Clinical Orthopedics at the Animal Health Trust Center for Equine Studies in Newmarket, U.K. There is growing debate about relative rider-horse sizes, with riding school horses epitomizing the variety of rider weights that a single horse may have to bear. Numerous inter-related aspects are involved with the horse-and-rider combination including the age of the horse, its fitness and muscle development, the length of its back and the presence or absence of lameness. The rider’s skill, fitness, balance and coordination are important factors, as is the fit of the saddle to both the horse and rider. The type, speed and duration of work and the terrain over which the horse is ridden must also be considered. The researchers wanted to know the effects of rider weight on equine welfare and performance. The study set out to assess gait and behavioral responses in six horses ridden by four riders of similar ability but different sizes. The riders were all weighed in their riding kit and were categorized 4

Issue 4/2018 | ModernEquineVet.com

Scores that may reflect pain were higher in the horses ridden by the heavier riders. as being light, moderate, heavy and very heavy. Their body mass index (BMI) was also calculated. Lameness was assessed subjectively by an orthopedic veterinary specialist and objectively using inertial measurement units, which were mounted on the poll, withers and pelvis. Discomfort during ridden exercise was also assessed by applying an ethogram for ridden horses, which is a description of a variety of behaviors that Dr. Dyson’s group showed may indicate musculoskeletal pain. Each rider rode each horse in its usual tack and performed a set pattern of exercises comprising mainly trot and canter. Gait, horse behavior, forces under the saddle, the response to palpation of the back, alterations in back dimensions in response to exercise, heart and respiratory rates, salivary cortisol levels and blink rate were assessed for each combination. “While all the horses finished the study moving as well as when they started, the results showed a substantial temporary effect of rider weight as a proportion of horse weight. The results do not mean that heavy riders should not ride but suggest that if they do, they should ride a horse of appropriate

size and fitness, with a saddle that is correctly fitted for both horse and rider,” Dr. Dyson said. The riding tests for the heavy and very heavy riders were all abandoned, predominantly because of temporary horse lameness. This was likely to have been induced by bodyweight rather than BMI, given that the heavy and moderate riders had similar BMIs, both being classified as overweight, yet only one of the moderate rider’s tests had to be abandoned. The pain scores were significantly higher in the horses when ridden by the heavy and very heavy riders. “I had expected this, based on previous clinical observations over the years. I have seen many horses ridden sequentially by people of very different weights and seen an immediate change in the way the horses moved. I have previous evidence of horses in full work with no underlying clinical problem showing transient lameness when ridden by a heavy rider. Horses with lowgrade lameness when ridden by a lightweight rider may show much more obvious lameness when ridden by a heavier rider,” she said. The lameness, which was temporary, was a direct effect of the weight of the rider, according to Dr. Dyson. It had resolved within 45 minutes and all horses moved at the end of the study as well or better than they did at the start when ridden by the light or moderate


riders. However, if a rider of similar weight to the test rider rides the horse regularly, then lameness may become a permanent feature. The study also raised the issue of rider height and saddle fit. The owner of one of the test horses had a similar bodyweight: horse bodyweight ratio to the heavy rider and was of similar weight, but significantly different in height (157.0 and 185.5 cm, respectively). This large difference in height has major potential implications for saddle fit for the rider and consequently the rider’s position and weight distribution. The taller rider sat on the back of the cantle, overloading the back of the saddle and making it more difficult to ride in balance, with the heel being in front of a vertical line between the shoulder and hip. (Read our article on saddle fit here.) “We know—based on a previous study—that more than 50% of 506 horses in normal work had illfitting saddles; approximately 34% of horses I investigate on a weekly basis have ill-fitting saddles, so we need to know if a heavy rider accentuates any ill effects of a poorly fitting saddle. It is also very unlikely that a single saddle on one horse could have fitted all four riders.

Photos courtesy of Dr. Sue Dyson

Saddle Fit Another Factor

Researchers place the sensors on the horse (left). A horse written by a rider of moderate weight (right).

This mimics what happens in the real world, e.g., a show pony being ridden in by an adult rider. “Pads or numnahs may possibly provide a short-term fix for a saddle that does not fit properly. However, they should not be regarded as longterm solutions. A well-fitting saddle is essential,” she said. These pilot results were not surprising but are very significant in adding vital evidence to inform an appropriate rider: horse weightratio matters, according to Roly Owers, chief of the Executive World of Horse Welfare, which helped fund the study. “It is common sense that rider weight impacts equine welfare. However, many might not fully understand or recognize this. What is desperately needed is basic

guidance to help riders identify a horse or pony that is right for them and this research is a vital step in that direction,” Mr. Owers said. “We must remember that this is a pilot study: further work is required to determine if horse fitness, adaptation to heavier weights and more ideal saddle fit will increase the weight an individual horse can carry. This should help us further in our quest to develop guidelines for optimum rider:horse bodyweight ratios,” Dr. Dyson said. Ultimately the study should help with the development of guidelines to help all riders assess if they are the right weight for the horse or pony they intend to ride to enhance both equine welfare and rider comfort and enjoyment. MeV

For more information: The study was supported by World Horse Welfare, the Saddle Research Trust, Frank Dyson, British Equestrian Federation, British Horse Society, Pony Club, Polocross, The Showing Council, The Showing Register, The Society of Master Saddlers, Riding for the Disabled, British Eventing, British Dressage, the British Horse Foundation, the Worshipful Company of Saddlers and Endurance GB. Dyson S, Ellis A, Guire R, et al. The influence of rider-to-horse bodyweight ratios on equine gait and behaviour: a pilot study. Presented at the National Equine Forum, March 8. Clayton H, Dyson S, Harris P, et al. Horses, saddles and riders: Applying the science. Equine Vet Educ. 2015;27:447-452. doi:1111/ eve.12407. https://onlinelibrary.wiley.com/doi/abs/10.1111/eve.12407 Dyson S, Berger J, Ellis A, et al. Development of an ethogram for a pain-scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. J Vet Behav: Clin Appl Res. 2018;23:47-57. https://www.sciencedirect.com/science/article/pii/S1558787817301727

ModernEquineVet.com | Issue 4/2018

5


LAMINITIS

SEPSIS-INDUCED

LAMINITIS: Prevention and Treatment Update While the exact mechanism of sepsis-induced laminitis is unclear, there are ways to better manage this condition, and maybe even prevent it. B 6

Issue 4/2018 | ModernEquineVet.com

y

P

a

u

l

Sepsis-induced laminitis is complicated to manage. The horse’s intestinal epithelium undergoes a rapid breakdown that results in the release of endotoxins, which causes a profound inflammatory response with a unique lesion. “In the sepsis-induced form of laminitis, there tends to be a classic tearing away of the basement membrane and a lot of inflammatory changes,” said Andrew van Eps, BVSc, PhD, MACVSc, DACVIM, associate professor of Equine Musculoskeletal Research at the University of Pennsylvania School of Veterinary Medicine. “In endocrinopathic laminitis, for example, it tends to be a slow stretch with a different type of lesion.” In naturally and experimentally induced septic laminitis, the onset typically involves damage to the gut mucosa. “A horse walks around with enough endotoxin it its gastrointestinal tract to kill itself and all of its equine friends 1,000 times over,” Dr. van Eps said at the 63rd AAEP Annual Convention in San Antonio. “WhenB

a

s

i

l

i

o

Photos courtesy of Dr. Andrew van Eps

Several studies have confirmed the protective effect of continuous digital cryotherapy.


HOW LAMENESS IS MEASURED The gold standard of field-based measurement of lameness used in over 60 veterinary schools & 28 countries.

Wireless sensors track movement accurately to less than 1 millimeter. Algorithms, based on decades of equine research, compute lameness metrics the human eye can’t see.

• • • •

Real Time Fast & Easy Field-Based In the Clinic or in the Field

LEARN MORE

equinosis.com

ADVANCED LAMENESS EVALUATION LECTURE SPONSORED BY EQUINOSIS® RECORDED EVENT

LAMENESS

Biomechanics of Lunging & Ridden Evaluations Lunging and ridden evaluations induce asymmetries that are measurable and must be considered when evaluating lameness. Whether you are measuring lameness objectively or not, the biomechanics are the same says equine lameness expert and pioneer in objective lameness measurement, says Dr. Kevin Keegan. Dr. Keegan imparts learnings from 25 years of research Kevin G. Keegan, DVM, MS, DACVS and analysis as a

Professor of Equine Surgery at the University of Missouri. Also the co-inventor of the Equinosis® Q with Lameness Locator® and author of objective lameness assessment chapters in Adams & Stashak’s Lameness in Horses, Dr. Keegan shares the biomechanical principles of these movements over ground and the impact of rider activity on measurable asymmetry. Learn from Dr. Keegan’s unique background and ground-breaking work in a free recorded lecture. This lecture is only available to licensed veterinarians. Registration and verification of credentials are required. A

D

V

E

R

T

I

S

M

E

N

T

Advanced Lameness Lecture

Lunging & Ridden Evaluation This lecture is only available to licensed veterinarians. Registration and verification of credentials are required.

REGISTER


LAMINITIS

ever the containment ability of the gastrointestinal barrier is taken away, you see endotoxins as well as other bacterial products absorbed into the bloodstream to cause systemic inflammation.”

Treatment

While the exact mechanism of sepsis-induced laminitis is still unclear, there are ways to prevent and treat this problem, according to Dr. van Eps. Because the disease predisposes the horse to laminitis, treating the underlying sepsis or endotoxemia is crucial. Dr. van Eps recommended circulatory support including fluids, vasopressors, and specific neutralization of circulating endotoxins with hyperimmune plasma or serum and polymyxin B to specifically bind to toxins. This is not only useful in horses with colitis, but also in those with pneumonias that have a component of endotoxemia. “Anti-inflammatories—particularly NSAIDs—are probably not going to stop laminitis from developing, but they are important for controlling systemic inflammation,” he said. “You can get a little more of an effect from pentoxifylline.” Dr. van Eps is not convinced of the benefits of DMSO in these horses, but he has been interested in the use of corticosteroids, which may not be every practitioner’s first choice. “We're all a little bit reluctant to give corticosteroids to sick horses because of the obvious effects on potentially hampering the immune response,” he explained. “There's also the association between corticosteroids and the development of laminitis, but that's more [related to] insulin dysregulation. Clinically, I've been impressed, and I use corticosteroids early in colitis cases that have a lot of systemic inflammation. I've found it to be beneficial, but not 8

Issue 4/2018 | ModernEquineVet.com

Circulatory support, including fluids, vasopressors and medications for neutralizing the circulating endotoxins, are recommended. NSAIDS and icing also help. detrimental, for a one-off dose or even one or two doses.” Evidence for low molecular weight heparin is scant in the literature, and Dr. van Eps believes the jury is still out on antithrombotics.

Hoof chilling

Several studies have confirmed the protective effect of continuous digital hypothermia, or cryotherapy. In clinical cases of colitis, it has been shown that cooling the feet results in a 10-fold less likelihood of developing laminitis. Since most of the horses with colitis survive if they do not develop laminitis, this is key to getting the horse healthy and back to previous function. Cooling the feet works by dramatically inhibiting transcription of inflammatory mediators if it is started prior to the onset of clinical lameness. In addition, it has an inhibitory effect on lamellar-matrix metalloproteinase expression,

which is consistent with experimental studies of brain trauma and cardiac arrest in humans. While there are several methods for cooling a foot, none of them are particularly great. Ice packs and wraps tend to perform poorly, as the area next to the skin warms up quickly and the effect is lost. Placing ice from a freezer next to the skin (without a water interface) can also result in coldinduced injury and frostbite. “Ice and water in a 5-liter bag strapped to the limb achieve temperatures similar to what we get experimentally, but it has its drawbacks in terms of taping and re-taping.” Dr. van Eps related an experiment where he waited for the horses to show mild signs of lameness. The horses were blocked, and one foot was kept cool and one foot was not. Four of the eight horses in the trial had severe laminitis with marked separation in the non-cooled foot, but not in the cooled foot. “We didn’t think [the cooling] would work well, but we found that even with total separation in the non-cooled foot, they had almost normal histology in the cooled foot,” he said. “We were impressed at the action of the cooling, even after the development of lameness.” The decision to end the cryotherapy can be a difficult one, but clinical and laboratory parameters can be used to help with the timing. Dr. van Eps recommended using the white blood cell count and potentially levels of serum amyloid A to gauge when the systemic inflammatory processes are starting to resolve. “Serum amyloid A reflects ongoing inflammation, particularly gastrointestinal inflammation, and it has a fairly short half-life,” he said. “When that starts to come back down, I usually give them a bit longer and then stop.” MeV


UPDATED GUIDELINES FOR PPID NEW PPID DIAGNOSTIC RECOMMENDATIONS ARE NOW AVAILABLE FROM THE EQUINE ENDOCRINOLOGY GROUP.1 Pituitary pars intermedia dysfunction, or PPID, also called “equine Cushing’s disease,” can sometimes be difficult to diagnose. To help veterinarians identify and test for this disease, the Equine Endocrinology Group (EEG) updated its recommendations to include updated reference ranges for ACTH while also adding additional early and advanced signs of the disease.

“If a horse is borderline for PPID after a resting ACTH test, veterinarians can then utilize the TRH stimulation procedure, giving a more precise diagnosis,” says Steve Grubbs, DVM, PhD, DACVIM, equine technical manager for Boehringer Ingelheim. “Information from the history, clinical signs and testing results should all be utilized when making the diagnosis of PPID. Each aspect is extremely important for the proper diagnosis.”

There are two types of procedures available for PPID testing. TRH stimulation procedure (measuring ACTH at T0 and T10) is used for horses with early signs of PPID or suspected horses with a normal resting ACTH. Resting ACTH is recommended for the suspected PPID horse with moderate or advanced clinical signs. If resting ACTH is normal or equivocal in horses with advanced signs, the follow-up procedure is the TRH stimulation.

The new EEG guidelines also updated the clinical presentation of the early and advanced signs of PPID. Additions to early signs include abnormal sweating (increased or decreased), infertility, desmitis and tendonitis. Additions to the advanced signs include dull attitude/altered mentation, exercise intolerance, excessive mammary gland secretions and suspensory ligament laxity.

Seasonal variations in ACTH have been previously documented in the horse. Testing in the fall months has been shown to increase the sensitivity of resting ACTH in horses with signs of early PPID. TRH stimulation testing in the fall is not recommended as sufficient data to establish accurate cutoff values is being further evaluated. It’s important for veterinarians to use seasonally adjusted resting ACTH reference ranges specific for the time of year they’re testing for PPID.

For horses showing signs of PPID, Boehringer Ingelheim offers complimentary testing for up to three horses per veterinarian. This testing is part of a study to identify epidemiological information for horses with PPID at initial diagnosis. This offer continues through June 13, 2018. For more information about complimentary testing and the complete 2017 EEG diagnostic guidelines for PPID, please visit www.test4PPID.com.

Recommendations for the Diagnosis and Treatment of Pituitary Pars Intermedia Dysfunction, Equine Endocrinology Group. Available at https://sites.tufts.edu/equineendogroup/files/2017/11/2017-EEG-Recommendations-PPID.pdf. Accessed February 14, 2018.

1

™Unbridle Your Potential is a trademark of Boehringer Ingelheim Vetmedica, Inc. ©2018 Boehringer Ingelheim Vetmedica, Inc. All rights reserved. EQU-0598-PRAS0518

UNBRIDLE YOUR POTENTIALTM

A

D

V

E

R

T

I

S

M

E

N

T


VACCINES

Modern Marvels

Equine Vaccines Save Lives B

y

Photos courtesy of Dr. Beth Davis

Administration of an intramuscular vaccine.

An abscess develops after a vaccine is given incorrectly.

10

Issue 3/2018 | ModernEquineVet.com

C

a

r

o

l

j

e

a

n

E

l

l

i

s

Vaccines are among the most remarkable achievements in modern veterinary history. That is because they work. Although no vaccine can guarantee 100% protection, a good immunization program assures the best outcome. “The high level of patient benefits coupled with low risk for adverse events justify vaccine use in most cases,” explained Beth Davis, DVM, PhD, DACVIM, department head and professor of Equine Internal Medicine at Kansas State University. Selecting which vaccines to administer can be somewhat daunting for clients. By applying American Association of Equine Practitioners (AAEP) guidelines and adhering to manufacturers’ labeled recommendations, clinicians can help their clients establish safe and effective vaccination protocols. Not all horses are at risk for all infectious diseases, which is why each vaccination program needs to be individualized under the guidance of a licensed veterinarian. Unfortunately, without proper immunization, disease development can sometimes be deadly. • Unprotected, up to 50% of horses with Western equine encephalitis (WEE) die. • Unprotected, 80% or more of horses with Eastern equine encephalitis (EEE) die.


The Science of Convenient Protazil® (1.56% diclazuril) is the only FDA-approved alfalfa-based top dress antiprotozoal pellet for the treatment of EPM. • Equine Protozoal Myeloencephalitis (EPM) is a serious neurological disease that can strike anytime, anywhere. Make treatment easy with Protazil® • Safe and accurate dosing with a calibrated scoop • Easier to use than paste, less stress for you and your horse • Rapid absorption — no loading dose required1 Now that’s convenient.

Ask your veterinarian for Protazil®. Visit us at Protazil.com to learn more about Merck Animal Health and the equine products and programs that help keep horses healthy. Use of Protazil® (1.56% dicazuril) is contraindicated in horses with known hypersensitivity to diclazuril. Safe use in horses used for breeding purposes, during pregnancy, or in lactating mares has not been evaluated. The safety of Protazil® (1.56% dicazuril) with concomitant therapies in horses has not been evaluated. See related page in this issue for details. For use in horses only. Do not use in horses intended for human consumption. Not for human use. Keep out of reach of children.

The Science of Healthier Animals 2 Giralda Farms • Madison, NJ 07940 • merck-animal-health-usa.com • 800-521-5767 Copyright © 2018 Intervet Inc., d/b/a/ Merck Animal Health, a subsidiary of Merck & Co., Inc. All rights reserved. 3894 EQ-FP AD Protazil®

1

Hunyadi L, Papich MG, Pusterla N. Pharmacokinetics of a low-dose and DA-labeled dose of diclazuril administered orally as a pelleted top dressing in adult horses. J of Vet Pharmacology and Therapeutics (accepted) 2014, doi: 10.111/jvp.12176. The correlation between pharmacokinetic data and clinical effectiveness is unknown


VACCINES ANTIPROTOZOAL PELLETS

(1.56% diclazuril)

FOR ORAL USE IN HORSES ONLY For the treatment of equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona in horses. CAUTION Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. NADA #141-268 Approved by FDA DESCRIPTION Diclazuril, (±)-2,6-dichloro-α-(4-chlorophenyl)-4-(4,5 dihydro-3,5-dioxo-1,2,4-triazin-2(3H)-yl) benzeneacetonitrile, has a molecular formula of C17 H 9 CI 3 N4O2, a molecular weight of 407.64, and a molecular structure as follows:

Diclazuril is an anticoccidial (antiprotozoal) compound with activity against several genera of the phylum Apicomplexa. PROTAZIL® (diclazuril) is supplied as oral pellets containing 1.56% diclazuril to be mixed as a top-dress in feed. Inert ingredients include dehydrated alfalfa meal, wheat middlings, cane molasses and propionic acid (preservative). INDICATIONS PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets are indicated for the treatment of equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona in horses. DOSAGE AND ADMINISTRATION Dosage: PROTAZIL® (1.56% diclazuril) is administered as a top dress in the horse’s daily grain ration at a rate of 1 mg diclazuril per kg (0.45 mg diclazuril/lb) of body weight for 28 days. The quantity of PROTAZIL® necessary to deliver this dose is 64 mg pellets per kg (29 mg pellets/ lb) of body weight. Administration: To achieve this dose, weigh the horse (or use a weigh tape)). Scoop up PROTAZIL® to the level (cup mark) corresponding to the dose for the horse’s body weight using the following chart: Weight Range of Horse (lb) 275 - 524 525 - 774 775 - 1024 1025 - 1274

mLs of Pellets 20 30 40 50

Weight Range of Horse (lb) 1275 - 1524 1525 - 1774 1775 - 2074 -

mLs of Pellets 60 70 80 -

One 2-lb bucket of PROTAZIL® will treat one 1100-lb horse for 28 days. One 10-lb bucket of PROTAZIL® will treat five 1100-lb horses for 28 days. CONTRAINDICATIONS Use of PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets is contraindicated in horses with known hypersensitivity to diclazuril. WARNINGS For use in horses only. Do not use in horses intended for human consumption. Not for human use. Keep out of reach of children. PRECAUTIONS The safe use of PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets in horses used for breeding purposes, during pregnancy, or in lactating mares has not been evaluated. The safety of PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets with concomitant therapies in horses has not been evaluated. ADVERSE REACTIONS There were no adverse effects noted in the field study which could be ascribed to diclazuril. To report suspected adverse reactions, to obtain a MSDS, or for technical assistance call 1-800-224-5318. CLINICAL PHARMACOLOGY The effectiveness of diclazuril in inhibiting merozoite production of Sarcocystis neurona and S. 1 falcatula in bovine turbinate cell cultures was studied by Lindsay and Dubey (2000). Diclazuril inhibited merozoite production by more than 80% in cultures of S. neurona or S. falcatula treated with 0.1 ng/mL diclazuril and greater than 95% inhibition of merozoite production (IC 95 ) was observed when infected cultures were treated with 1.0 ng/mL diclazuril. The clinical relevance of the in vitro cell culture data has not been determined. PHARMACOKINETICS IN THE HORSE The oral bioavailability of diclazuril from the PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets at a 5 mg/kg dose rate is approximately 5%. Related diclazuril concentrations in the cerebrospinal fluid (CSF) range between 1% and 5% of the concentrations observed in the plasma. Nevertheless, based upon equine pilot study data, CSF concentrations are expected to 2 substantially exceed the in vitro IC 95 estimates for merozoite production (Dirikolu et al., 1999) . Due to its long terminal elimination half-life in horses (approximately 43-65 hours), diclazuril accumulation occurs with once-daily dosing. Corresponding steady state blood levels are achieved by approximately Day 10 of administration. EFFECTIVENESS Two hundred and fourteen mares, stallions, and geldings of various breeds, ranging in age from 9.6 months to 30 years, were enrolled in a multi-center field study. All horses were confirmed EPM-positive based on the results of clinical examinations and laboratory testing, including CSF Western Blot analyses. Horses were administered PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets at doses of 1, 5, or 10 mg diclazuril/kg body weight as a top-dress on their daily grain ration for 28 days. The horses were then evaluated for clinical changes via a modified Mayhew neurological scale on Day 48 as follows: 0. Normal, neurological deficits not detected. 1. Neurological deficits may be detectable at normal gaits; signs exacerbated with manipulative procedures (e.g., backing, turning in tight circles, walking with head elevation, truncal swaying, etc.). 2. Neurological deficit obvious at normal gaits or posture; signs exacerbated with manipulative procedures. 3. Neurological deficit very prominent at normal gaits: horses give the impression they may fall (but do not) and buckle or fall with manipulative procedures. 4. Neurological deficit is profound at normal gait: horse frequently stumbles or trips and may fall at normal gaits or when manipulative procedures were utilized. 5. Horse is recumbent, unable to rise. Each horse’s response to treatment was compared to its pre-treatment values. Successful response to treatment was defined as clinical improvement of at least one grade by Day 48 ± conversion of CSF to Western Blot-negative status for S. neurona or achievement of Western Blot-negative CSF status without improvement of 1 ataxia grade. Forty-two horses were initially evaluated for effectiveness and 214 horses were evaluated for safety. Clinical condition was evaluated by the clinical investigator’s subjective scoring and then corroborated by evaluation of the neurological examination videotapes by a masked panel of three equine veterinarians. Although 42 horses were evaluated for clinical effectiveness, corroboration of clinical effectiveness via videotape evaluation was not possible for one horse due to missing neurologic examination videotapes. Therefore, this horse was not included in the success rate calculation. Based on the numbers of horses that seroconverted to negative Western Blot status, and the numbers of horses classified as successes by the clinical investigators, 28 of 42 horses (67%) at 1 mg/kg were considered successes. With regard to independent expert masked videotape assessments, 10 of 24 horses (42%) at 1 mg/kg were considered successes. There was no clinical difference in effectiveness among the 1, 5, and 10 mg/kg treatment group results. Adverse events were reported for two of the 214 horses evaluated for safety. In the first case, a horse was enrolled showing severe neurologic signs. Within 24 hours of dosing, the horse was recumbent, biting, and exhibiting signs of dementia. The horse died, and no cause of death was determined. In the second case, the horse began walking stiffly approximately 13 days after the start of dosing. The referring veterinarian reported that the horse had been fed grass clippings and possibly had laminitis. ANIMAL SAFETY PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets were administered to 30 horses (15 males and 15 females, ranging from 5 to 9 months of age) in a target animal safety study. Five groups of 6 horses each (3 males and 3 females) received 0, 5 (5X), 15 (15X), 25 (25X) or 50 (50X) mg diclazuril/kg (2.27mg/lb) body weight/day for 42 consecutive days as a top-dress on the grain ration of the horse. The variables measured during the study included: clinical and physical observations, body weights, food and water consumption, hematology, serum chemistry, urinalysis, fecal analysis, necropsy, organ weights, gross and histopathologic examinations. The safety of diclazuril top-dress administered to horses at 1 mg/kg once daily cannot be determined based solely on this study because of the lack of an adequate control group (control horses tested positive for the test drug in plasma and CSF). However, possible findings associated with the drug were limited to elevations in BUN, creatinine, and SDH and less than anticipated weight gain. Definitive test article-related effects were decreased grain/top-dress consumption in horses in the 50 mg/kg group. In a second target animal safety study, PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets were administered to 24 horses (12 males and 12 females, ranging from 2 to 8 years of age). Three groups of 4 horses/sex/group received 0, 1, or 5 mg diclazuril/kg body weight/day for 42 days as a top-dress on the grain ration of the horse. The variables measured during the study included physical examinations, body weights, food and water consumption, hematology, and serum chemistry. There were no test article-related findings seen during the study. STORAGE INFORMATION Store between 15°C to 30°C (59°F to 86°F). HOW SUPPLIED PROTAZIL® (1.56 % diclazuril) Antiprotozoal Pellets are supplied in 2-lb (0.9 kg) and 10-lb (4.5 kg) buckets. REFERENCES 1. Lindsay, D. S., and Dubey, J. P. 2000. Determination of the activity of diclazuril against Sarcocystis neurona and Sarcocystis falcatula in cell cultures. J. Parasitology, 86(1):164–166. 2. Dirikolu, L., Lehner, F., Nattrass, C., Bentz, B. G., Woods, W. E., Carter, W. E., Karpiesiuk, W. G., Jacobs, J., Boyles, J., Harkins, J. D., Granstrom, D. E. and Tobin, T. 1999. Diclazuril in the horse: Its identification and detection and preliminary pharmacokinetics. J. Vet. Pharmacol. Therap. 22:374–379. May 2010 Intervet Inc. 56 Livingston Ave, Roseland, New Jersey 07068 © 2010 Intervet Inc. All rights reserved. 08-10 211.x.3.1.0

•Rabies may be rare, but without protection, death always occurs. • Unprotected, equine herpesvirus (EHV)-1 and equine viral arteritis (EVA) are responsible for major outbreaks of abortion, along with birth of nonviable foals and death in young foals. The list goes on, reflecting the dangers of failing to protect overall herd health.

Keeping Clients (and Yourself) Current

Clinicians already know why spring starts the vaccination cycle. Likewise, they are aware that all vaccines must be selected based on individual risk. Sometimes clients need a gentle reminder that—to protect their stable—vaccinations need to be administered on a regular, timely basis. “Risk of exposure to pathogens and overall health status of the individual are key,” Dr. Davis emphasized. Accordingly, the AAEP core and risk-based vaccine guidelines provide the equine community with the opportunity to protect horses against at-risk diseases. This is the backbone—the strategic armamentarium—that clinicians can share with owners. Also good news to share, Dr. Davis noted, is that multivalent vaccine products are designed to ease administration and efficiency, providing broad-based protection against a variety of pathogens. “In some instances, using a multivalent vaccine is a highly practical approach to induce immune activation to a wide range of pathogens.” Establishing optimal vaccination pro-

tocols is essential, Dr. Davis continued. “It’s imperative that horse owners work with their veterinarian to establish protocols based on information gathered about the entire stable.” Accurate information on overall health, athletic use and environment is critical when making vaccine recommendations. Horses that have immune impairment because of age (ie, being young or old), receive immunosuppressive medications (eg, corticosteroid therapy) and endure long-distance transport should be carefully evaluated before vaccine administration. “Our aim is to establish the optimal health status of each horse so we can determine ideal timing for vaccination,” Dr. Davis added. “A multipronged approach of optimal biosecurity combined with herd immunity based on optimal protocols can help maintain health in a majority of horses.” When the setting is optimal, there’s expectation that an optimal response can be induced to provide immune protection for the labeled, expected period. “Booster vaccines administered at proper intervals are designed to generate an effective amnestic [memory] response that maintains immunity for an extended period,” Dr. Davis explained. “But naturally, this will vary, depending on the vaccine type, pathogen exposure and baseline host immunity.”

Gathering all the Facts

Specifically, Dr. Davis said, core vaccines are designed to protect horses from diseases that are endemic to a region, diseases with potential public health signifi-

CRITERIA FOR EVALUATION Because there is no standard vaccination program for all horses, each individual situation requires evaluation based on: • Risk for disease • Age • Breed • Use (eg, performance, pleasure) • Sex • Anticipated exposure 12

Issue 3/2018 | ModernEquineVet.com

• Environmental factors • Geographic factors • Consequences of not vaccinating against disease (eg, morbidity/mortality) • Cost of immunization versus potential cost of disease


cance (required by law), those that are highly virulent and/or those that pose severe or life-threatening risk. “Core vaccines have strong evidence supporting demonstrated efficacy and safety, thereby justifying their use.” All horses should receive core vaccinations. In contrast, performing risk-benefit analysis of each individual horse is strongly urged before including the risk-based vaccines in vaccination programs. “These vaccines are designed for specific pathogens of concern after the true risk of exposure has been established by the veterinarian,” Dr. Davis emphasized. The real risks associated with using risk-based vaccines may not be readily identifiable by clients, Dr. Davis noted. “Equine clinicians are optimally trained and

In general, multivalent vaccine are safe and effective, providing protection for multiple diseases. have extensive experience in the appropriate use of these vaccines and the vaccination protocols to be followed. It is very important that owners rely on their veterinarian to establish the ideal risk-based vac-

cine protocol for each horse in the equine establishment.” In general, multivalent vaccines are safe and effective, providing protection for up to 8 diseases per product. “Strong evidence has shown that multivalent vaccines provide a protective level of immunity from pathogen challenge in healthy horses,” Dr. Davis said. “However, if there is a need to induce high-level immunity against a specific pathogen, such as high-pathogen exposure in a high-risk individual, then a monovalent vaccine approach may provide superior antibody production.” Evidence also supports that the highest level of immunity may not be achieved for all the variant pathogens targeted by a given combination vaccine. “One investigation specifically dem-

Heal wounds 30-50% faster, with little to no scarring and reduced infection potential. RediHeal offers better, faster, scar-free healing in a wide variety of soft tissue applications especially abscesses, lacerations, and chronic or challenging wounds. Have a wound you’ve been dealing with for a while? Request a free sample, and try the best in advanced wound care today! Rusty - one former non-healing wound where RediHeal worked in just a matter of days!

Day 1

Day 9

To learn more about our advanced wound care options, call or visit our website or speak with your equine veterinarian.

www.avalonmed.com 888-289-1890


VACCINES

onstrated that immunoglobulin [IgG] levels against West Nile virus were not as high after administration of a multivalent vaccine that contained WNV, as compared with a monovalent WNV product administered independently,” Dr. Davis said. However, she added, although in this investigation a lower level of antibody was produced after multivalent vaccine administration, the investigated multivalent vaccines were protective against subsequent pathogen challenge.

Tailoring Vaccination Protocols

When tailoring vaccination protocols, Dr. Davis said, considering all factors is imperative, but particularly age, lifestyle and location. As noted, young and aged horses may be more susceptible to specific diseases. Horses that attend shows or other competitions need protection against diseases that spread horseto-horse, while geographic location covers not only the region where the horse lives but also where the horse may be shipped on occasion. Armed with information on health status, veterinarians can review all potential scenarios of herd exposure to specific diseases. Vaccination strategies can then be tailored to individual horse populations on that farm. Killed (inactivated) vaccines are generally produced from inactivated organisms, which are unable to replicate but are in a relatively native conformation. In general, these vaccines require a primary and booster series (three doses in a foal’s first year of life, two doses in adults) to achieve sufficient immunity for host protection. MLV vaccines are attenuated pathogens that are unlikely to replicate and therefore unlikely to revert to virulence and lead to disease. “Having the whole pathogen in a native conformation provides appropriate protein expression, giv14

Issue 4/2018 | ModernEquineVet.com

ing the host a substantial advantage in terms of the type of immunity that is induced. In addition to antibody production, cell-mediated immunity is more likely to be induced, leading to a strong cytotoxic response with a more robust cytokine,” Dr. Davis explained. Because protection of all vaccines gradually declines over time, booster vaccinations are essential to maintain immunity. Some diseasecausing organisms, such as tetanus and rabies, require annual booster shots, while other organisms require more frequent booster intervals to maintain adequate protection. Regardless of whether the vaccine is MLV or inactivated, each horse needs to undergo an initial priming series; typically, one or two doses of the vaccine is needed to induce protective immunity, she noted. Once the priming series for a pathogen has been completed, booster vaccine doses are administered at USDA-licensed intervals (as indicated on the label) in order to ensure optimal protective immunity. Of note, MLV vaccines require a priming dose similar to that for inactivated vaccines, but the level and duration of immunity are typically longer lasting. When discussing recommendations for adult horses with healthy immune function, in addition to receiving all core vaccines (tetanus, rabies, EEE/WEE, WNV), determining whether the horse has previously been vaccinated for specific at-risk pathogens is, therefore, key. In addition, Dr. Davis said, some risk-based vaccines (a few required by law) are commonly administered to performance horses and horses exposed to a transient or young equine population, most notably for equine influenza virus (EIV) and EHV-1 and EHV-4. In some areas, risk-based protection against Streptococcus equi subsp equi respiratory disease (ie, strangles) is very important, she added.

Vaccination against leptospirosis also needs to be considered. For broodmares, staying upto-date on all appropriate adult vaccinations is important. Vaccinations for botulism, rotavirus (a deadly type of diarrhea in foals) and equine viral arteritis also are common in breeding populations, as is protection against EHV-1 (abortion, rhinopneumonitis). In addition, Dr. Davis said, “it’s routine practice—and in accordance with AAEP guidelines—to booster-vaccinate mares (mares need to be properly vaccinated prior to breeding to mount an appropriate amnestic response at this point) approximately 4–6 weeks before the expected foaling date to enhance the quality of colostrum at time of foaling,” adding that if a mare has not been booster-vaccinated, immunoglobulin concentrations transferred via suckling in the first 12 to 24 hours of birth are likely to be diminished. Foals delivered to mares that have not been immunized against the primary (core) diseases should begin their vaccination series at about 3 to 4 months of age, depending on risk of disease. “In warmer climates, the vaccine protocol for a foal delivered in the early part of the year should begin around 3 months of age to ensure immune activation is initiated,” Dr. Davis explained. The second dose should then be administered about 4 to 6 weeks after the initial priming dose, followed by a third dose at about 10 to 12 months of age. Thereafter, vaccination should follow manufacturer guidelines. “In contrast,” Dr. Davis continued, “the vaccination protocol should start at about 4 to 6 months for foals delivered to mares with up-to-date immunizations. Again, determination of initiation needs to be based on risk for disease. Early vaccination in the face of high


HAY LOOK!

WHICH BALE WOULD YOU CHOOSE FOR YOUR HORSE?

STANDARD EASTERN BALE 40 LBS CONVENTIONAL LOCAL HAY

VS

COMPRESSED BALE 50 LBS STANDLEE PREMIUM WESTERN FORAGE®

Standlee grows and manufactures the highest quality forage products available, which equine veterinarians and nutritionists strongly recommend feeding your horse. Choose the best for your horse by feeding Standlee Premium Western Forage®.

DISCOVER THE DIFFERENCE FOR YOUR HORSE OR FIND A STANDLEE DEALER AT

STANDLEEFORAGE.COM

Proud sponsor of: EA1


VACCINES

6 1 2 3 4

5

6

16

TIPS FOR CLIENTS

Some at-risk diseases, such as West Nile Virus (WNV), Western and Eastern equine encephalitis (WEE and EEE), are transmitted during mosquito season, requiring springtime vaccination. Other diseases, such as tetanus and rabies, can be given any season, as the risk is year-round. Because the seasonal (mosquito-targeted) vaccines need to be given in the spring (March–May), most clinicians opt to give all recommended vaccines at that time. AAEP guidelines for core and risk-based vaccines have been carefully designed to address the issues that come into play for equine practitioners who are making recommendations regarding vaccination protocols. The 4 core vaccines are EEE/WEE, WNV, tetanus and rabies. Of the 10 risk-based vaccines, the most commonly used are equine influenza virus (EIV) and equine herpesvirus (EHV-1, EHV-4). In some areas, the vaccine for strangles (distemper) is also very important. Other vaccines cover botulism, Potomac horse fever, rotoviral diarrhea in foals, equine viral arteritis, anthrax and snakebite. The most recent addition is a leptospirosis vaccine. Basically, two types of vaccines are used in equine medicine: killed (also called inactivated) and modified-live virus (MLV). MLV vaccines have a modified live microbe, while the disease-causing microbes in inactivated vaccines have been killed. Most equine vaccines are inactivated. Additional vaccines include live canarypox vector vaccine, available for WNV and EIV, and an inactivated flavivirus chimera vaccine for WNV. When might a priming series be necessary for a horse that is already on an established vaccination protocol? If for example a horse is moved to a new (geographic) location where Potomac horse fever is prevalent but the horse was not previously vaccinated against this disease, then the initial priming series of doses followed by booster vaccination about 4 to 6 weeks later is necessary to ensure initial protection. Mild reactions (low-grade fever, local muscle soreness) can occur. Although uncommon, an injection can lead to bacterial infection and, in rare cases, vaccines have caused severe allergic reactions. It’s a stark reminder of why it is important for you to work with your veterinarian in creating a safe and effective vaccination strategy, Dr. Davis said. Despite rigorous testing, adverse events can happen. Similar to humans, immune activation induces minor local inflammation, resulting in tenderness for 1 to 3 days. Significant signs such as urticarial rash, marked fever or severe swelling may indicate a serious adverse event, hypersensitivity or allergic reaction. If unexpected changes such as fever and/or marked swelling develop, call your veterinarian to determine the specific cause of local or systemic responses.

Issue 4/2018 | ModernEquineVet.com

levels of maternal immunity will impair maximal immune activation through the process of maternal antibody interference.” Again, subsequent vaccine doses are administered about 4 to 6 weeks following the initial dose, with a third dose at 10 to 12 months of age.

Important to Know

If owners prefer to administer vaccines themselves, it is imperative that they work with their veterinarian. In addition to previous statements, owners need to fully understand the principles of safe vaccine handling. “If handling is hindered in any way, such as a break in the ‘cold chain,’ this will likely lead to inactivation of the vaccine,” Dr. Davis emphasized. “Likewise, if a vaccine is purchased from a vendor that failed to maintain stringent vaccine-handling protocols, the unknowing horse owner may purchase a failed product.” The person administering the vaccine must maintain a clean environment, prepare the skin surface appropriately and effectively inject the vaccine. If proper cleanliness and vaccine administration principles are not followed, potentially life-threatening complications can occur secondary to serious bacterial infection.

Final Thoughts

The importance of veterinary vaccines is well recognized, as vaccines were designed to control infectious diseases in companion animals, horses and food animals. In some instances, such as proper administration of rabies vaccine to horses (and other species), the impact on reducing the incidence of disease in people is substantial. An example of the importance of vaccine development in horses is well represented by how quickly the WNV vaccine was developed and licensed, Dr. Davis said. WNV was identified in the United States in August 1999. The veterinary vaccine industry worked nonstop, collabo-


rating with the USDA Center of Veterinary Biologicals, by engineering an effective vaccine to prevent WNV in horses. Within 2 years, a WNV vaccine was conditionally licensed by the USDA, and today that vaccine is one of four the AAEP core vaccines. Although major progress has been achieved in vaccine development, significant challenges still exist. Thus, animal and human infectious disease experts need to work closely on: • Developing more adaptive pre-

diction controls • Reinforcing the regulatory process to ensure adequate evaluation of biologicals • Keeping vaccine costs low “It’s inevitable that new diseases will continue to emerge in both human and equine medicine,” Dr. Davis noted. And in response, she predicted, veterinary vaccines will continue to be a major player in saving both human and equine lives. One individual at a time. MeV

For more information: American Association of Equine Practitioners. Vaccination Guidelines. Internet data updated when material undergoes review. https://aaep.org/guidelines/vaccination-guidelines Cortese V, Hankins KG, Holland R, Syvrud K. Serologic responses of West Nile virus seronegative mature horses to West Nile vaccines. J Equine Vet Sci. 2013;33:1101. Nash D, Mostashari F, Fine A, et al. The outbreak of West Nile virus infection in the New York City area in 1999. N Engl J Med. 2001;344:1807-1814.

DOWNLOAD A QUICK REFERENCE Visit the AAEP website regularly, as the organization continuously reviews and updates the recommended equine vaccination protocols.

AAEP Updates Biosecurity Guidelines By Marie Rosenthal, MS Although the large outbreaks, such as the 2016 equine herpes outbreak at the New Orleans Fairgrounds, might garner all the headlines, every facility that houses horses, especially if they are involved in breeding, boarding or competition, should be practicing good biosecurity measures. Equine veterinarians should be the ones helping their clients develop a biosecurity plan for the facility by doing risk assessments, developing plans and providing advice during an outbreak. “Veterinarians have knowledge of the biology of specific infectious pathogens and health care preventive measures veterinarians,” said Nicola Pusterla, DrMedVeT, MedVet, professor of medicine and epidemiology at the UC Davis College of Veterinary Medicine. Identify the horses on the property, disease risks and venue risks before developing a biosecurity plan. The American Association of Equine Practitioners (AAEP) has updated its biosecurity guidelines to minimize the occurrence and mitigate the spread of potential disease outbreaks. Dr. Pusterla said the document is very comprehensive. The downloadable PDF file incorporates comprehensive information and step-by-step protocols in three distinct areas:

1. identification of key personnel, important contacts and reference materials; 2. routine biosecurity protocol; and 3. outbreak response. “The outbreak of an infectious disease can inflict significant economic hardship due to loss of horses, loss of use and shutdown of industry activity,” the AAEP said. The AAEP is assembling a companion worksheet that will serve as a practical resource for practitioners to use with their clients in planning for an outbreak, which will also be available online. Dr. Pusterla added that biosecurity is not a oneand-done activity, but veterinarians should review the biosecurity plan regulatory. He said that regularly reviewing a facility’s biosecurity protocols is like checking the smoke detectors to make sure they still work. It just makes common sense. MeV

AAEP BIOSECURITY GUIDELINES AVAILABLE AT aaep.org/guidelines/ infectious-disease-control and select “AAEP Biosecurity Guidelines.”

LEARN MORE ModernEquineVet.com | Issue 4/2018

17


TECHNICIAN UPDATE

Managing Beyond the Everyday Emergencies

All photos courtesy of Dr. Brett Robinson

By Nicole LaGrange, RVT In December 2017, the “Lilac” wildfire quickly swept across north San Diego County in Southern California. Our practice is nearby and helped to manage the horses through this wildfire. Although we deal with emergency situations almost daily, a wildfire like this is an “all-hands-on-deck” moment. We often don’t slow down to consider how we handle these emergencies, either during or after. Here’s what we did at the San Dieguito Equine Group. I hope that this account helps you plan for the worst and set up your own emergency protocols. Early in the morning on Dec. 7, 2017, every staff member had their eyes on the weather. The winds were up and blowing hot, dry and fast from east to west, which put us all instantly on alert for fires. The Lilac fire started sometime late morning and was almost instantly bearing down on San Luis Rey Downs, a large racehorse training center. We quickly started to do what we do in the case of an emergency like this.

First Hour

We rescheduled the day’s appointments and decided who within our practice were in the projected route of the fire and needed to go home and evacuate their homes and personal horses. Three staff, including one administrator, one veterinary technician and one veterinarian, lived just downwind of the fire. Our team instantly became smaller.

Second Hour

One of our veterinarians has worked at San Luis Rey Downs almost every day for more than 30 years. Our staff is familiar with many of the horses, as well as their owners and trainers who train and work at the Downs. When San Luis Ray Downs caught fire, that veterinarian was already onsite. We dispatched another veterinarian and registered veterinary technician who were familiar with the Downs to assist with the horses at the scene. Because several of the barns had caught fire, most of the horses had been set loose from their stalls. It was a chaotic situation with many frightened horses running loose. Our team provided sedation to frightened horses, triaged wounds and assisted with getting

Smoke covers the track at San Luis Ray Downs.

18

Issue 4/2018 | ModernEquineVet.com


AAEV T M E M b E r s h i p Membership in the AAEVT is open to all veterinary technicians, assistants, support staff and those employed in the veterinary health care industry worldwide. Student membership is open to those currently enrolled in an AVMA/CVMA accredited veterinary technology program.

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) 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.

Fo r m o re i n f o r m a t ion v ist w w w.a ae vt.or g

*American Association of Equine Veterinary Technicians and Assistants


TECHNICIAN UPDATE

Third and Fourth Hours

The track at night under the light of the Lilac wild fires.

horses onto trailers as quickly as possible. Many of the horses had just arrived to the track that morning and were untrained yearlings. Meanwhile back at the clinic, I took stock of what lay ahead of us. Because it was Thursday and deliveries would not be made on the weekend, I knew I only had hours to order supplies. If I needed anything, it had to be ordered soon, so it could be delivered the next day. I considered the types of injuries we would be treating: lacerations, punctures, smoke inhalation, burns and tie-up’s from the horses running loose for hours. I checked our inventory—and if needed—ordered: 1 and 5 L bags of fluids, IV Sets, short term catheters, IV bag pumps, DMSO solution, Banamine, Getamacin, Butorphanol, examination gloves, suture, silver cream, 1 and 5 L bags of fluids, combi rolls, Vetwrap, Elasticon, brown gauze, soft gauze, Telfa pads, ophthalmic flush/wash, and ophthalmic Neo-poly Bac ointment. Equipment that was available on every truck included a digital x-ray system, ultrasound machine, ophthalmoscope and dental headlamps. I received calls from our local distribution and drug representatives reaching out to us and asking what supplies they could send. I had to answer A LOT of phone calls. Make sure their contacts and numbers are saved to your cell phone and not just stored in a computer. Make sure you have a cell phone charger with you and you keep your phone charged. You might lose internet service and/or electricity.

Our practice owner approved any overtime that the employees were willing to work that night, to assure that if anyone were hurt, it would be covered under our insurance. Each employee was then contacted to find out if they were willing to work at the Del Mar Evacuation Center. By 4 pm, we had 10 employees at our office ready to help. We divided them up into pairs or groups of three to work out of each truck. A veterinarian, technician and assistant teamed up in each vehicle. Always thinking of the team, our office manager did a quick stop—purchasing food and water for everyone for the evening on the way to the evacuation site. By this time in the day it was starting to get dark and all roads leading into the fire, including the Downs, were closed. Most horses were arriving to Del Mar Racetrack since it is the largest evacuation site that could house all evacuees (not just racehorses). The Del Mar racetrack, which has a lot of experience organizing evacuations for large animals, was up and running by the time we arrived at 6 pm. The horses brought in specifically from San Luis Rey Downs were being directed by evacuation officials to a separate stabling area, knowing that keeping them separate from the other evacuated horses would make it easier to unite the horses with their trainers and owners. This proved to be a critical organization detail. We went directly to the separate stabling area and started checking on each horse, many of their grooms and trainers were there since they were not being allowed back to San Luis Rey Downs. Having the horses’ caretakers present was very helpful because we could see the most critical horses first. The stabling area had lights, but they were overhead, which made looking over each horse particularly challenging because all of their legs were in the dark. High quality, bright headlamps, like the ones used for dentistry were absolutely crucial. More than 75% of the large lacerations, bumps, lumps, etc. that we saw that night were on the stifle and medial gaskin. Many of these would have been missed if we were simply glancing over a stall door to see if a horse looked “OK” because the lights were overhead and the horse’s legs were in the shadows. It was critical to walk into each stall of every horse with a headlamp on and really look them over closely. Several horses had very deep punctures or burns that only appeared as abrasions until you got a headlamp shining on them so you could see the full extent of the injury.

The Del Mar Race track was up and running by the time we arrived.

20

Issue 4/2018 | ModernEquineVet.com


We had three to four staff members working together on each horse: one person holding the horse, one veterinarian evaluating the horse, and a technician assisting and managing supplies. When able, we had another person writing down a brief description of each horse, any known information about the horse (owner, trainer, etc.), as well as what was given for medications with a date, time and contact information for us as treating veterinarians. We then left this paper taped to the door of that horse’s stall. We repeated this procedure over and over for hours late into the night until we attended to every horse. Several of our staff worked with other solo practitioners, or other veterinarians who had run out of supplies caring for horses that night. Just as we thought things had calmed down, things got a bit more complicated. There were still missing horses. As the evacuation of San Luis Rey Downs was nearly complete, efforts by owners, grooms and trainers turned to organizing and finding their horses. Trainers and grooms were combing the grounds looking at each horse and then moving the ones that they were responsible for to their stabling area. Most of the horses that were moved to different stalls never got their treatment sheets moved with them. Fortunately, there was great verbal communication among the veterinarians that were working on-site that night. Information was shared among them regarding what horses had already been treated with medication and had diagnostic imaging (if necessary). Going forward, it would be very helpful to make sure that important medical treatment information stayed with the horses as they moved to new stalls. I came up with an idea for future use. Soft gel luggage tags could easily be attached to the halters of the horses, with our contact information and quick treatment notes written on the backside. I’ve seen other options for identifying the horses, but none for conveying treatment information. In the future, I can envision some kind of chip or flash drive being used to gain treatment information. However, it seems that a uniform identification system will need to become more widely used. Perhaps ID microchips could be useful here? Overall, the experience left a real impression on me about what it means to be part of a horse community, and working as a team. That night I saw horse trainers from famous barns hauling in backyard ponies in their giant high-end rigs. I saw people completely filthy from soot and ash that had waited on the side of the road for hours to pick up horses from behind fire lines and bring them to safety at the evacuation center. Veterinarians and technicians from many different practices were sharing supplies. Some were performing

The wildfires were devastating for everyone involved.

radiographs using equipment that wasn’t theirs. Techs were assisting veterinarians they had never met. A veterinarian and some technicians rode in the back seat of a truck sitting on top of an X-ray system case, hurrying to a horse that was down in a trailer. The stories could go on and on, but most importantly we were all working together. This sense of community is what makes our jobs so special. I hope that this article will help people to be a little more prepared if they have to assist in a natural disaster. I would encourage you to think ahead for how to deal with the emergency situations you might face in your local areas. Sometimes it’s not just being on the scene immediately that makes the difference. It’s slowing down, thinking through the whole scenario and planning ahead that makes the outcome all the better. MeV

About the author

Nicole LaGrange, RVT, has worked for San Dieguito Equine Group in San Diego, Calif., since 2008. She primarily works in the ambulatory section of the practice, and is passionate about imaging. She also performs standing MRIs. She is currently the president of the AAEVT. Ms. LeGrange has always had a love for horses and has been riding from an early age. She learned how to ride in the United States Pony Club, and she now competes with her off the track Throughbred "River" in Eventing. ModernEquineVet.com | Issue 4/2018

21


The Modern

Equine Vet

Reach your veterinarians wherever they are, whenever they want. FOR ADVERTISING RATES AND INFORMATION, EMAIL Matthew Todd

The Modern Equine Vet April 2018  

Our mission is to enhance your ability to practice equine medicine by providing the latest info you need.

The Modern Equine Vet April 2018  

Our mission is to enhance your ability to practice equine medicine by providing the latest info you need.