The Modern Equine Vet - December 2019 by The Modern Equine Vet

The Modern

Equine Vet www.modernequinevet.com

Vol 9 Issue 12 2019

3 Common Rehab Modalities Ask the Nutritionist? Feeding After Soft Tissue Injury During Stall Rest or Turnout Importance of Diet for Gastric Ulcers Videos: Addressing Antiparasitic ResistanceÂ Should You Perform Laryngoplasty? Ultrasound Might Help

CHECK OUT: ASK THE NUTRITIONIST? YOUR NUTRITION QUESTIONS ANSWERED

TABLE OF CONTENTS

COVER STORY

4 The Evidence Behind 3

Common Rehab Modalities Cover photo: Shutterstock/Osetrik

ASK THE NUTRITIONIST?

Special Nutritional Considerations for a Horse Recovering from a Soft-Tissue Injury While on Stall Rest or Turnout....................................... 3 COLIC

Don’t Forget Diet When Treating Gastric Ulcers........................................... 8 NEWS

FDA Addressing Antiparasitic Resistance in Horses and Livestock................................................................12 Transcutaneous Ultrasonography Might Be Useful For Laryngoplasty Determination..................................................................15 ADVERTISERS Purina Sponsored Content.........................................3 Merck Animal Health..................................................5 Avalon Medical.............................................................7 American Regent Animal Health/Adequan...........9

Heska............................................................................11 American Regent Animal Health/BetaVet...........13 Stokes Pharmacy........................................................15

The Modern

Equine Vet SALES: Matthew Todd • Lillie Collett EDITOR: Marie Rosenthal ART DIRECTOR: Jennifer Barlow CONTRIBUTING WRITERS: Paul Basillo • Adam Marcus COPY EDITOR: Patty Wall Published by PO Box 935 • Morrisville, PA 19067 Marie Rosenthal and Jennifer Barlow, Publishers PERCYBO media  publishing

Issue 12/2019 | 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.

SPECIAL ADVERTISING SECTION

Ask the

Nutritionist

MARY BETH GORDON, PH.D., DIRECTOR OF EQUINE RESEARCH AND NEW PRODUCT DEVELOPMENT, PURINA ANIMAL NUTRITION

Ask the Nutritionist is a new monthly column featuring questions answered by PhD equine nutritionists and sponsored by Purina Animal Nutrition.

Have a nutrition question you want to see featured? Email the Editor. For clinics looking for specific nutritional advice, visit purinamills.com/ask-an-expert.

Are there any special nutritional considerations for a horse recovering from a soft-tissue injury while on stall rest or turnout? Nutrition is important during the recovery period because it helps support a horse’s inherent healing powers. Energy management is key for horses on stall rest. Injured horses should be kept quiet during the recovery period to prevent further aggravation of the injury. Make caloric adjustments for horses who are suddenly not exercising or working and are confined to a stall. Reducing the amount of concentrate feed an injured horse receives, while still providing enough feed to meet nutrient requirements, is a good first step. Horse owners tend to cut out concentrate rations completely or scale back to just a “handful” of feed, but this strategy can lead to nutrient deficiencies, which can slow healing. Feeding a ration balancer, like Purina® Enrich Plus®, can help provide the protein, vitamins and minerals a horse requires for base metabolism and healing. A small meal of 0.5-1 pounds per day, fed twice per day (depending on body weight of the horse), will suffice while managing calories and energy input. Horses on stall rest also need adequate forage to meet fiber requirements. Aim to provide 1.5-2.0% of body weight in good quality grass hay to help keep injured horses nutritionally satisfied and prevent boredom while confined in a stall. We highly recommend hay nets, hay bags or other forage feeding systems to slow down intake and prolong mealtimes. And pay attention to the type of hay fed—calories and nutrition matter here, too. Some types of hay like alfalfa or a rich grass may provide more calories than the horse needs while on stall rest. A moderate to good quality grass hay can be fed in larger amounts while controlling energy inputs. Horses on stall rest are at an increased risk for gastric ulcers. Feeding Purina® Outlast® Gastric Support Supplement can help support proper pH in the stomach for horses during their layup.

Forage requirements are typically met for horses on pasture. However, monitor closely so that horses do not become overweight on lush pasture or underweight on poor pasture. Horses on poor quality pasture may require supplemental hay, and a grazing muzzle can be used to curb consumption of lush pasture. A ration balancer can help balance the pasture’s nutrients to facilitate healing.

ABOUT THE AUTHOR Dr. Mary Beth Gordon is the Director of Equine Research and New Product Development at Purina Animal Nutrition. She and her research team have completed over 200 research protocols at the Purina Animal Nutrition Center, leading to the creation of 11 new products and 15+ reformulated products in the equine market since 2005. SPONSORED BY PURINA ANIMAL NUTRITION

ModernEquineVet.com | Issue 12/2019

REHABILITATION

The Evidence Behind

Common Rehab Modalities

Shutterstock/Kelly vanDellen

B y

P a u l

B a s i l i o

Many of the same rehabilitation modalities used for injured human athletes can be used in horses, but objective, peer-reviewed information and dosing parameters can be difficult to come by. “Knowing which modality to use, when to apply it, and what to expect can be confusing,” said Katherine L. Ellis, DVM, here at the 65th Annual AAEP Convention in Denver. “You’re often left with more questions about which machine to use, the appropriate settings and whether you can potentially cause harm. As a resident, I have the same questions, so I turned to the peer-reviewed human and veterinary literature to get some answers.”

Issue 12/2019 | ModernEquineVet.com

The Science of Unique

Fenbendazole Mode of Action: Unique mode of action is what makes Panacur® (fenbendazole) so effective against the most dangerous parasites of the horse

Deep Penetration

Helps Control Parasites

Protects Cells & Organs

Effective against all stages of encysted small strongyles1

Effective against ivermectin resistant ascarids2

More attracted to the cells of the parasite than of the animal being treated3

See the Difference Scan code to watch our video and learn how Panacur® works differently than other dewormers at panacur-mode-of-action.com

2 Giralda Farms Farms • Madison, NJ 07940NJ • merck-animal-health-usa.com • 800-521-5767 2 Giralda • Madison, 07940 • merck-animal-health-usa.com • 800-521-5767 Copyright © 2019©2018 IntervetIntervet, Inc., d/b/aInc, Merck Animal Health, a subsidiary & Co.,of Inc. Copyright d/b/a/Merck Animal Health,ofaMerck subsidiary Merck & Co. Inc. All rights reserved. 18-Merck-MOA PP AD • US/EQD/0119/0001

Consult your veterinarian for assistance in the diagnosis, treatment and control of parasitism. Do not use in horses intended for human consumption. When using Panacur® (fenbendazole) Paste 10% concomitantly with trichlorfon, refer to the manufacturer’s label for use and cautions for trichlorfon. PANACUR (fenbendazole) POWERPAC equine dewormer product label. Reinemeyer CR, Vaala, WE. Larvicidal efficacy of fenbendazole against a macrocyclic lactone-resistant isolate of Parascaris equorum in foals. Proceedings of the 55th Annual Meeting of the American Association of Veterinary Parasitologists. 2010, Atlanta, GA, p49. 3 Lacey E. Mode of Action of Benzimidazoles. Parasitology Today, vol. 6, no. 4, 1990. 1 2

REHABILITATION

Lasers

While Class 1 and Class 2 lasers are useful for scanning groceries and entertaining cats, Class 3 and Class 4 lasers can offer therapeutic benefits. Class 3 lasers are often referred to as low-level or cold lasers—they operate at less than 500 milliwatts (mW). These lasers are safe to use on skin, but can cause eye injuries if used improperly. Class 4—or high intensity—lasers have a power output greater than 500 mW, and can generate enough heat to burn a horse’s skin. “In humans, both low- and high-intensity laser therapy has been shown to reduce musculoskeletal pain, increase range of motion and reduce neuropathic pain,” said Dr. Ellis, a veterinarian at the Gail Holmes Equine Orthopaedic Research Center at Colorado State. “It’s also shown to accelerate tissue healing by improving fibroblast function, enhancing local microcirculation and oxygen supply, aiding in the removal of waste products, increasing neovascularization and promoting angiogenesis.” The therapy can markedly reduce inflammation by decreasing production of prostaglandins, TNFalpha, IL-1 beta, plasminogen activator and cyclooxygenase. Evidence has also shown that low-level laser therapy (LLLT) can improve muscle strength and function in humans. A study in elderly women showed that LLLT resulted in an increased number of knee flexion extension repetition vs. sham treatment.

Objective, peer-reviewed information about some rehab modalities is difficult to find. High-intensity laser therapy (HILT) is more effective than LLLT for certain conditions, as the more powerful laser is able to reach and stimulate deeper structures. Evidence in horses is less extensive, but still promising, according to Dr. Ellis. A recent study of 150 sport horses with tendinopathy/desmopathy of the superficial digital flexor tendon, deep digital flexor tendon, and suspensory ligament showed that 2 weeks of HILT significantly improved ultrasound and lameness scores. Another paper showed that weekly laser therapy alleviated back pain in 10 of 14 study horses. Preparation is key. Clipping and cleaning the limb prior to laser therapy results in significantly greater energy penetration. “In horses with gray, brown, chestnut and black hair, more than 99% of the laser energy is blocked if the limb is unclipped,” Dr. Ellis said. “While better penetration occurs in all horses after clipping, energy penetration is greatest in non-pigment-

ed skin, and greater in medium-colored vs. dark-colored skin.”

Pulsed Electromagnetic Field (PEMF)

PEMF is created when an electrical current is driven through a coiled wire, generating a magnetic field. The magnetic field creates small currents in the tissue without creating heat. “The magnetic field that's applied creates an electrical signal in the tissue that is similar to the one that occurs during bone deformation with weight bearing,” she explained. “This stimulates osteogenesis.” There is also some evidence that PEMF stimulates nitric oxide production, which can help reduce pain and inflammation, but most of the evidence in humans deals with bone healing. It is an FDA-approved treatment in humans with long-bone fracture nonunions, as well as an adjunct treatment following lumbar/ cervical spine fusion. Despite the plethora of PEMF devices available for horses, there have been few studies performed that evaluate the modality. One study from 1987 found a small but significantly positive effect for incorporation of cancellous bone grafts in ponies. In 1985, another study showed that PEMF may actually delay tendon healing, but more research is needed to evaluate that relationship. “At our facility, we apply PEMF to horses with regions of osseous changes, particularly with bony re-

For more information: Hinchcliff KW, Kaneps AJ, Goer RJ. Equine Sports Medicine and Surgery. 2nd ed. St. Louis, MO:Elsevier Saunders. 2014:3061-3064. Ross MW, Dyson SJ. Diagnosis and Management of Lameness in the Horse. 2nd ed. St. Louis, MO: Elsevier Saunders. 2011:903-905. Ryan T, Smith RKW. An investigation into the depth of penetration of low-level laser therapy through the equine tendon in vivo. Irish Vet J. 2007;60:295-299. https://irishvetjournal.biomedcentral.com/articles/10.1186/2046-0481-60-5-295 Nankervis KJ, Lefrancois K. A comparison of protection-retraction of the distal limb during treadmill and water treadmill walking horses. J Equine Vet Sci. 2018;70:57-62. https://www.sciencedirect.com/science/article/abs/pii/S0737080618304556 6

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sorption or avulsion fractures that can be found in horses with proximal suspensory ligament disease,” Dr. Ellis said.

Whole body vibration (WBV)

WBV is most often indicated for improving muscle and core strength. The transmission of mechanical oscillations initiates a rapidly and repeating eccentric and concentric muscular action through activation of alpha-motor neurons. This can lead to physiological changes by stimulating skin receptors, muscle spindle cells and joint mechanoreceptors. It can also stimulate osteogenesis. “There is modest evidence that supports vibration therapy for reducing pain perception in patients with osteoarthritis,” Dr. Ellis said. “There’s also an emerging profile

for application of vibration therapy as an exercise modality in humans. It appears to have a rapid, energysparing warm-up effect, and it’s been shown to demonstrate an increase in jump height and muscle power.” Timing for the exercise application is important. One study showed an increase in body power 10 minutes after WBV therapy, but a decrease at 1 minute post-therapy. “Exercising immediately after full body vibration therapy may be detrimental,” she explained. Whole body vibration therapy appears to be beneficial for increasing muscle strength, postural stability and power, but no direct comparison studies on the vibration direction, frequency, duration, or magnitude have been conducted. Extrapolating human studies to the horse is difficult due to the vast

number of commercial WBV platforms that are available. However, the limited equine studies do seem to agree that there are no adverse effects based on the acute hematologic and clinical responses of horses undergoing alternating horizontal and vertical vibration therapy. One study that evaluated the effects of WBV therapy on bone density showed that horses confined to stalls for 60 days and who underwent 45 minutes of WBV 5 days weekly were able to maintain the same bone mineral content when compared with horses that had light exercise during that time. “In our facility, we typically use vibration therapy to help improve core muscle strength and postural stability,” Dr. Ellis said. “The horses will typically stand on the vibration plate 1 to 2 times daily.” MeV

Make the comeback stronger than the setback. Heal All Types of Wounds 30-50% Faster RediHeal offers better, faster, more scar-free healing in a wide variety of soft tissue applications - without steroids or antibiotics. If you’re looking for an alternative to other wound care therapies, look no further. Use it for: • Trauma & surgical wounds • Abscesses • Any chronic or challenging wound Request your FREE sample today! Call 888-289-1890 or visit www.avalonmed.com

COLIC

Don’t Forget Diet

WHEN TREATING GASTRIC ULCERS

Image courtesy of Dr. Nanna Luthersson

B y

A d a m

For horses with gastric ulcers, a diet high in fiber and low in starch can prolong the benefits of drug therapy to treat the condition, new research shows. “Diet is an important factor in both treatment and prevention of gastric ulcers in horses. This study highlights the importance of improving nutrition and management when horses are

Getting ready to insert the endoscopy during study of equine diet and gastric ulcers.

M a r c u s

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diagnosed and treated for gastric ulcers,” said Nanna Luthersson, DVM, an equine veterinarian at the Horse Doctor clinic in Denmark, who led the study. In a 2009 study, Dr. Luthersson had found that a high-starch diet was a major risk factor for the development of equine squamous

gastric disease. “But it’s one thing to find a risk factor in an epidemiological study. We couldn’t be sure that reducing starch in the diet would reduce the recurrence or improve the score by itself before this study had been performed,” she told Modern Equine Vet. For the new study, Dr. Luthersson and her colleagues from the United Kingdom and Spain assessed the effects of a low-starch, high-fiber diet

There’s nothing else like it. Over the past 30 years, Adequan® i.m. (polysulfated glycosaminoglycan) has been recommended millions of times1 to treat degenerative disease, and with good reason. From day one, it’s been 2, 3 the only FDA-Approved equine PSGAG joint precription available, and the only one proven to. Restore synovial joint lubrication Repair joint cartilage Reverse the disease cycle Reduce inflammation When you start with it early and stay with it as needed, horses may enjoy greater mobility 2, 4, 5 over a lifetime. Discover if Adequan is the right choice. Talk to your American Regent Animal Health sales representative or call (800) 458-0163 to order. BRIEF SUMMARY: Prior to use please consult the product insert, a summary of which follows: CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: Adequan® i.m. is recommended for the intramuscular treatment of non-infectious degenerative and/or traumatic joint dysfunction and associated lameness of the carpal and hock joints in horses. CONTRAINDICATIONS: There are no known contraindications to the use of intramuscular Polysulfated Glycosaminoglycan. WARNINGS: Do not use in horses intended for human consumption. Not for use in humans. Keep this and all medications out of the reach of children. PRECAUTIONS: The safe use of Adequan® i.m. in horses used for breeding purposes, during pregnancy, or in lactating mares has not been evaluated. For customer care, or to obtain product information, visit www.adequan.com. To report an adverse event please contact American Regent, Inc. at (800) 734-9236 or email pv@americanregent.com. Please see Full Prescribing Information at www.adequan.com.

1 Data on file. 2 Adequan® i.m. Package Insert, Rev 1/19. 3 Burba DJ, Collier MA, DeBault LE, Hanson-Painton O, Thompson HC, Holder CL: In vivo kinetic study on uptake and distribution of intramuscular tritium-labeled polysulfated glycosaminoglycan in equine body fluid compartments and articular cartilage in an osteochondral defect model. J Equine Vet Sci 1993; 13: 696-703. 4 Kim DY, Taylor HW, Moore RM, Paulsen DB, Cho DY. Articular chondrocyte apoptosis in equine osteoarthritis. The Veterinary Journal 2003; 166: 52-57. 5 McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren PR. Joint Disease in the Horse.St. Louis, MO: Elsevier, 2016; 33-48. Adequan and the Horse Head design are registered trademarks of American Regent, Inc. © 2019, American Regent, Inc. PP-AI-US-0222 2/2019

Images courtesy of Dr. Nanna Luthersson

COLIC

Endoscopy procedure during study of diet and gastric ulcers and results showing gastric ulcerations (immediate right).

in 58 horses and ponies with gastric ulcers that were confirmed by endoscopy. Of these, 24 had low-grade ulcers and 34 had more advanced lesions. All of the animals underwent 4 weeks of treatment with the proton-pump inhibitor omeprazole. Half continued on their regular diet, while the rest ate the modified diet, which was provided for the duration of the 10-week study. The horses were scoped at the end of the drug-treatment phase and again at the 10-week point of the trial. “We needed 4 weeks for treatment with omeprazole [the recommended duration of therapy] and were expecting that

6 weeks post-treatment would be a reasonable timeframe for ulcers to reappear,” Dr. Luthersson said. “Of course, 8 weeks or even 12 weeks would have been better, but with a very limited budget for this study, which had to cover the cost of feed and compliance of the horse owners, our time was limited.” For horses and ponies with moderate-to-severe lesions, the addition of the modified diet prolonged the benefits of drug treatment for at least 8 weeks after cessation of therapy, the researchers reported. Such benefit was not evident for animals with less-advanced ulcers. Howev-

er, Dr. Luthersson said, “I am quite sure that diet has an effect, but for the low-grade lesions it probably takes longer before you see the improvement.” Unlike for horses with serious ulcers, the modified diet was associated with improvements in behavior reported by trainers and owners. “Diet is known to have an effect on behavior and the same for gastric ulcers” Dr. Luthersson said. However, she added, the study was small and behavior “is a difficult parameter to measure, since it is based on owner/rider assessment and therefore not easy to evaluate.” MeV

For more information: Luthersson N, Bolger C, Fores P, et al. Effect of changing diet on gastric ulceration in exercising horses and ponies after cessation of omeprazole treatment. J Equine Vet Sci. 2019 Dec;83:102742. doi: 10.1016/j.jevs.2019.05.007. Epub 2019 May 14. https://www.sciencedirect.com/science/article/abs/pii/S0737080619300620?via%3Dihub 10

Issue 12/2019 | ModernEquineVet.com

Intraoral

•

DIGI

• T

E DENT

•

U IN

In tra ora

Equ

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NEW

•

Dental DR

R ST

THE

LD WOR ’S FI

RADIOGR

Picture this… Denti Pod™ is the world’s first intraoral equine dental digital radiography detector. The elusive advantages of dental diagnostics are now readily available to you.

Denti Pod Intraoral Digital Radiography Detector 100mm x 150mm Imaging Area

You cannot practice a veterinary level of equine dentistry without dental radiology. Period. The average equine or mixed animal practice that is doing equine dentistry could, and should, easily incorporate dental radiology. If not, then I guarantee they are missing things. It is really quick, it is really easy, it is good for the bottom line, it is good for patient care, and it sets the general practitioner apart… doing better dentistry on fewer horses, while increasing practice revenue. In my opinion, dental equipment, including radiology, is the single greatest return on equipment investment in the clinical equine practice. Dentistry is a huge profit center. The initial purchase of the equipment is minor compared to what you generate long term. Jon M. GIECHE, D.V.M., FAVD EQ, Diplomate AVDC EQ (One of only eight AVD-EQ Fellows in North America!)

Introducing Denti Pod, the latest advancement in equine dental care.

As part of the revolutionary new Cuattro Hub™ portable multi-modality wireless diagnostic system, Denti Pod brings intraoral Dental DR anywhere you need it. Switch between acquisition of Dental DR, Wireless Ultrasound and Large Animal DR, all on one device, at the press of a button. Call today to schedule a demo.

www.heska.com 800.464.3752

© 2019 Heska Corporation. All rights reserved. HESKA is a registered trademark and Cuattro Hub and Denti Pod are trademarks of Heska Corporation in the United States and in other countries. Specifications are subject to change without notice. Pricing dependent on final configuration. US19AD0501

Imaging the Possibilities

NEWS NOTES

FDA Addressing Antiparasitic Resistance in Horses and Livestock

Image courtesy of the FDA

The FDA is working with stakeholders to address antiparasitic resistance in horses, cattle, sheep, goats, swine and poultry. Although resistance can't be stopped, it can be slowed, the agency said. The FDA has produced 2 videos on antiparasitic resistance; surveyed the U.S. veterinary community about antiparasitic drug use and antiparasitic resistance in grazing animals; and asked animal drug companies to add information about antiparasitic resistance to the labels of all approved antiparasitic drugs for horses and livestock. Effective antiparasitic drugs are vital to the animal health industry in the United States, the agency said in a recent report. However, parasites are becoming increasingly resistant to drugs that were generally effective in the past. Heavy parasite infections can cause diarrhea, weight loss, anemia and death in animals. Science shows that antiparasitic resistance can’t be stopped, the agency said, but it can be slowed down. The FDA’s strategy to address antiparasitic resistance and promote the sustainable use of antiparasitic drugs should ensure that antiparasitic drugs remain effective for as long as possible, the agency said. Within the last 2 years, the FDA has: 1) Produced 2 videos about antiparasitic resistance for animal producers and owners. • Antiparasitic Resistance in Cattle, Small Ruminants, and Horses in the United States, which discusses how to detect antiparasitic resistance and what to do about it. • Using Refugia to Manage Parasites in Cattle, Sheep, Goats and Horses and Reduce Resistance to Deworm-

Click here to watch videos

 12

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ers, which explains the concept of refugia and how it helps reduce antiparasitic resistance. 2) Released the results of a survey of the U.S. veterinary community about antiparasitic drug use and antiparasitic resistance in grazing animals to collect information about: • The current level of awareness of and concern about antiparasitic resistance in grazing animals among veterinarians and parasitologists; • Which strategies they commonly use to detect, monitor, and/or manage parasites and antiparasitic resistance; and • Their opinions about the best ways to ensure the safe and effective use of antiparasitic drugs. The FDA hopes the survey results will facilitate dialogue among animal drug companies, researchers, regulators, educators and animal owners regarding ways to minimize the development of antiparasitic resistance. In July 2018, the FDA presented part of the survey results at the annual meeting of the American Association of Veterinary Parasitologists. 3) The agency requested labeling changes specifically for anthelmintics, which are used to treat certain internal parasites, such as roundworms. Resistance to anthelmintics is particularly concerning in grazing species, but it is also a problem in swine and poultry. The new labeling information emphasizes these points: • Any use of a dewormer can result in the development of antiparasitic resistance. • Proper dosing is critical to the safe and effective use of a dewormer. • End-users should work with their veterinarian to monitor herds and flocks to determine the extent of antiparasitic resistance on a particular farm. • Dewormers should be used as only 1 part of an overall internal parasite control program. The FDA made this request in December 2018 to all drug companies with approved dewormers (both overthe-counter and prescription) for livestock and horses. More than one-third of the companies have added the new labeling statements to their products. MeV

The only dual ingredient injectable corticosteroid approved by the FDA for use in horses

The link between RAPID ONSET and LONG-ACTING RELIEF of pain & inflammation1 BetaVet ® (betamethasone sodium phosphate & betamethasone acetate injectable suspension) is indicated for the control of pain and inflammation associated with osteoarthritis in horses. Learn more at www.betavetequine.com or call 1-800-458-0163. Please see Brief Summary of Full Prescribing Information on the following page.

INDICATION: BetaVet ® is indicated for the control of pain and inflammation associated with osteoarthritis in horses.

IMPORTANT SAFETY INFORMATION For Intra-Articular (I.A.) Use in Horses.

CONTRAINDICATIONS: BetaVet ® is contraindicated in horses with hypersensitivity to betamethasone. Intra-articular injection of corticosteroids for local effect is contraindicated in the presence of septic arthritis. WARNINGS: Do not use in horses intended for human consumption. Clinical and experimental data have demonstrated that corticosteroids administered orally or parenterally to animals may induce the first stage of parturition when administered during the last trimester of pregnancy and may precipitate premature parturition followed by dystocia, fetal death, retained placenta, and metritis. Additionally, corticosteroids administered to dogs, rabbits and rodents during pregnancy have resulted in cleft palate in offspring and in other congenital anomalies including deformed forelegs, phocomelia and anasarca. Therefore, before use of corticosteroids in pregnant animals, the possible benefits to the pregnant animal should be weighed against potential hazards to its developing embryo or fetus. Human Warnings: Not for use in humans. For use in animals only. Keep this and all medications out of the reach of children. Consult a physician in the case of accidental human exposure. PRECAUTIONS: Corticosteroids, including BetaVet ®, administered intra-articularly are systemically absorbed. Do not use in horses with acute infections. Acute moderate to severe exacerbation of pain, further loss of joint motion, fever, or malaise within several days following intra-articular injection may indicate a septic process. Because of the anti-inflammatory action of corticosteroids, signs of infection in the treated joint may be masked. Due to the potential for exacerbation of clinical signs of laminitis,

glucocorticoids should be used with caution in horses with a history of laminitis, or horses otherwise at a higher risk for laminitis. Use with caution in horses with chronic nephritis, equine pituitary pars intermedia dysfunction (PPID), and congestive heart failure. Concurrent use of other anti-inflammatory drugs, such as NSAIDs or other corticosteroids, should be approached with caution. Due to the potential for systemic exposure, concomitant use of NSAIDs and corticosteroids may increase the risk of gastrointestinal, renal, and other toxicity. Consider appropriate wash out times prior to administering additional NSAIDs or corticosteroids. ADVERSE REACTIONS: Adverse reactions reported during a field study of 239 horses of various breeds which had been administered either BetaVet ® (n=119) or a saline control (n=120) at five percent (5%) and above were: acute joint effusion and/or local injection site swelling (within 2 days of injection), 15% BetaVet ® and 13% saline control; increased lameness (within the first 5 days), 6.7% BetaVet ® and 8.3% saline control; loose stool, 5.9% BetaVet ® and 8.3% saline control; increased heat in joint, 2.5% BetaVet ® and 5% saline control; and depression, 5.9% BetaVet ® and 1.6% saline control. DOSAGE AND ADMINISTRATION: Shake well immediately before use. Use immediately after opening, then discard any remaining contents. RX ONLY References: 1. Trotter GW. Intra-articular corticosteroids. In: McIlwraith CW, Trotter GW, eds. Joint Disease in the Horse. Philadelphia: W.B. Saunders; 1996; 237–256.

BRIEF SUMMARY OF PRESCRIBING INFORMATION (Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension) 6 mg betamethasone per mL For Intra-Articular (I.A.) Use in Horses CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. INDICATION: BetaVet® is indicated for the control of pain and inflammation associated with osteoarthritis in horses. DOSAGE AND ADMINISTRATION: Shake well immediately before use. CONTRAINDICATIONS: BetaVet® is contraindicated in horses with hypersensitivity to betamethasone. Intra-articular injection of corticosteroids for local effect is contraindicated in the presence of septic arthritis. WARNINGS: Do not use in horses intended for human consumption. Clinical and experimental data have demonstrated that corticosteroids administered orally or parenterally to animals may induce the first stage of parturition when administered during the last trimester of pregnancy and may precipitate premature parturition followed by dystocia, fetal death, retained placenta, and metritis. Additionally, corticosteroids administered to dogs, rabbits and rodents during pregnancy have resulted in cleft palate in offspring. Corticosteroids administered to dogs during pregnancy have also resulted in other congenital anomalies including deformed forelegs, phocomelia and anasarca. Therefore, before use of corticosteroids in pregnant animals, the possible benefits to the pregnant animal should be weighed against potential hazards to its developing embryo or fetus. Human Warnings: Not for use in humans. For use in animals only. Keep this and all medications out of the reach of children. Consult a physician in the case of accidental human exposure. PRECAUTIONS: Corticosteroids, including BetaVet®, administered intra-articularly are systemically absorbed. Do not use in horses with acute infections. Acute moderate to severe exacerbation of pain, further loss of joint motion, fever, or malaise within several days following intra-articular injection may indicate a septic process. Because of the anti-inflammatory action of corticosteroids, signs of infection in the treated joint may be masked. Appropriate examination of joint fluid is necessary to exclude a septic process. If a bacterial infection is present, appropriate antibacterial therapy should be instituted immediately. Additional doses of corticosteroids should not be administered until joint sepsis has been definitively ruled out. Due to the potential for exacerbation of clinical signs of laminitis, glucocorticoids should be used with caution in horses with a history of laminitis, or horses otherwise at a higher risk for laminitis. Use with caution in horses with chronic nephritis, equine pituitary pars intermedia dysfunction (PPID), and congestive heart failure. Concurrent use of other anti-inflammatory drugs, such as NSAIDs or other corticosteroids, should be approached with caution. Due to the potential for systemic exposure, concomitant use of NSAIDs and corticosteroids may increase the risk of gastrointestinal, renal, and other toxicity. Consider appropriate wash out times prior to administering additional NSAIDs or corticosteroids. ADVERSE REACTIONS: Adverse reactions reported during a field study of 239 horses of various breeds which had been administered either BetaVet® (n=119) or a saline control (n=120) were: acute joint effusion and/or local injection site swelling (within 2 days of injection), 15% BetaVet® and 13% saline control; increased lameness (within the first 5 days), 6.7% BetaVet® and 8.3% saline control; loose stool, 5.9% BetaVet® and 8.3% saline control; increased heat in joint, 2.5% BetaVet® and 5% saline control; depression, 5.9% BetaVet® and 1.6% saline control; agitation/anxiety, 4.2% BetaVet® and 2.5% saline control; delayed swelling of treated joint (5 or more days after injection), 2.5% BetaVet® and 3.3% saline control; inappetance, 3.4% BetaVet® and 2.5% saline control; dry stool, 1.7% BetaVet® and 0% saline control; excessive sweating, 0.8% BetaVet® and 0% saline control; acute non-weight bearing lameness, 0.8% BetaVet®and 0% saline control; and laminitis, 0.8% BetaVet® and 0% saline control.

PP-BV-US-0027_FullPg_Ad.indd 2

CLINICAL PHARMACOLOGY: Betamethasone is a potent glucocorticoid steroid with anti-inflammatory and immunosuppressive properties. Depending upon their physico-chemical properties, drugs administered intra-articularly may enter the general circulation because the synovial joint cavity is in direct equilibrium with the surrounding blood supply. After the intra-articular administration of 9 mg BetaVet® in horses, there were quantifiable concentrations of betamethasone (above 1.0 ng/mL) in the plasma. EFFECTIVENESS: A negative control, randomized, masked field study provided data to evaluate the effectiveness of BetaVet® administered at 1.5 mL (9 mg betamethasone) once intra-articularly for the control of pain and inflammation associated with osteoarthritis in horses. Clinical success was defined as improvement in one lameness grade according to the AAEP lameness scoring system on Day 5 following treatment. The success rate for horses in the BetaVet® group was statistically significantly different (p=0.0061) than that in the saline group, with success rates of 75.73% and 52.52%, respectively (back-transformed from the logistic regression). ANIMAL SAFETY: A 3-week target animal safety (TAS) study was conducted to evaluate the safety of BetaVet® in mature, healthy horses. Treatment groups included a control (isotonic saline at a volume equivalent to the 4x group); 1X (0.0225 mg betamethasone per pound bodyweight; BetaVet®); 2X (0.045 mg betamethasone per pound bodyweight; BetaVet®) and 4X (0.09 mg betamethasone per pound bodyweight; BetaVet®). Treatments were administered by intra-articular injection into the left middle carpal joint once every 5-days for 3 treatments. Injection site reactions were the most common observations in all treatment groups. Injection site reactions were observed within 1 hour of dosing and included swelling at the injection site, lameness/stiffness of the left front limb, and flexing the left front knee at rest. The injection site reactions ranged from slight swelling (in many horses on multiple days in all treatment groups) to excessive fluid with swelling, pain, and lameness (4x group only). Injection site reactions were observed most commonly on treatment days, and generally decreased in number and severity over subsequent days. The incidence of injection site reactions increased after the second and third injection (number of abnormalities noted on day 10 > day 5 > day 0). In the BetaVet® treated groups the number and severity of the injection site reactions were dose dependent. The 4X BetaVet® group had the highest overall incidence of and severity of injection site reactions, which included heat, swelling, pain, bleeding, and holding the limb up at rest. The control group and 4X group (which received similar injection volumes) had a similar incidence of injection site reactions; however, the severity of reactions was greater in the 4X group. Absolute neutrophils were statistically significantly higher in the BetaVet® treated groups as compared to the control group. Trends toward a decrease in lymphocytes and eosinophils, and an increase in monocytes were identified in the BetaVet® treated groups after the initial dose of BetaVet®. Individual animal values for white blood cells generally remained within the reference range. BetaVet® treated horses also had a trend toward increased blood glucose after the initial dose. Some individual animals showed mild increases in blood glucose above the reference range. SHAKE WELL BEFORE USING NADA 141-418, Approved by FDA For customer care or to obtain product information visit www.betavetequine.com or call 1-800-458-0163. To report an adverse event please contact American Regent Animal Health at (800) 734-9236 or email pv@americanregent.com.

A Division of American Regent, Inc. 5 Ramsey Rd. | Shirley, NY 11967

5/17/2019 9:15:15 AM

NEWS NOTES

Transcutaneous Ultrasonography Might Be Useful in Laryngoplasty Determination Assessment of the cricoarytenoideus dorsalis (CAD) using transcutaneous ultrasonography may be a useful technique in determining whether to perform nerve graft or laryngoplasty. This study aimed to evaluate the use of transcutaneous ultrasound of the left cricoarytenoideus dorsalis muscle (LCAD) and right cricoarytenoideus dorsalis muscle (RCAD) to diagnose recurrent laryngeal neuropathy (RLN). A total of 164 Thoroughbreds underwent resting endoscopy without sedation and were graded using the 4-grade Havermeyer system. Horses with resting grades 1 and 2 with no history of abnormal respiratory noise acted as controls, whereas horses with resting grades 3 and 4 with a history of abnormal respiratory noise at exercise

were deemed to be clinically affected by RLN. Following endoscopy, the horses were sedated and transcutaneous ultrasonography of the larynx performed. The axial plane thickness, cross-sectional area and echogenicity of the LCAD and RCAD were measured, and the LCAD:RCAD ratios in thickness and area compared between controls and affected horses. Thickness and area of the LCAD showed a negative correlation with resting laryngeal grade. In contrast, the thickness of the RCAD showed a positive correlation with resting laryngeal grade. Increasing RCAD thickness was found in horses with resting grades 3.II and 4, while increasing RCAD cross-sectional area was found in horses with grade 3.II. LCAD was more hyperechogenic than RCAD in resting grades 3 and 4. MeV

For more information: Satoh M, Higuchi T, Inoue S, et al. External transcutaneous ultrasound technique in the equine cricoarytenoideus dorsalis muscle: Assessment of muscle size and echogenicity with resting endoscopy. Equine Vet J. 2019 Nov. 17 (Epub ahead of print). https://beva.onlinelibrary.wiley.com/doi/abs/10.1111/evj.13209

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