ModernEquineVetFeb1513

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How to examine the foot Is lameness the cause of that saddle slip?

February 2013 | Vol 2 No 2

Who's at fault

when mares don't conceive?

Table of Contents

Cover story:

4 He said, she said

Who's at fault when mares don't conceive?

Cover photo by Michael C. Gray /shutterstock

Orthopedics

From AAEP meeting: Examining the foot........................................ 8 Good physical exam can help pinpoint lameness

Is lameness the cause of that saddle slip?.....................................12 This fundamental cause is often overlooked

Regenerative Medicine

Which stem cells best for tendon injuries?....................................11 A look at different types of stem cells to see which might perform better for tendon injuries

Practice Management

Breaking bad news................................................................................................................14 Excellent communication skills are essential in veterinary medicine

Reproduction

Some conditions enhance survival of female embryos...........................................17 Horses among mammals that can adjust the ratio of male-to-female young

To contact us, email Marie RoSenthal LEGAL DISCLAIMER: The content in this digital issue is for general informational purposes only. PercyBo Publishing Media 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 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.

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Reproduction

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Who's at fault when a mare doesn't conceive? h

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Used with permission

Collecting sperm with a phantom mare.

Photo by Bob Langrish, equestrian photographer • www.boblangrish.com

When a mare fails to come into foal, mare owners

tend to blame the stallion, and stallion owners tend to blame the mare. The fact is that any time there is human intervention, problems may exist, and addressing issues related to timing and management in advance can help make breeding easier on everyone.

“With today’s technology, we are solving fertility issues quickly,” said Laura Young, manager at Southwind Farms in New Jersey, “but at the same time we are creating new problems.”

Most stallion owners collect semen on a certain schedule, such as Monday, Wednesday and Friday, to assure adequate sperm counts in that collection. Once collected, extended semen lives about 48 to 72 hours.

The mare’s egg, in turn, lives about eight hours after ovulation. She must be inseminated before she ovulates to maximize the chances of conception, so collection and shipping times might not always coincide with that mare’s cycle.

“There are many human issues — and it has nothing to do with incompetence or someone doing something wrong — but your hands are tied by the stallion’s schedule, and the shipping or airline schedules,” said Amanda C. Ragon, DVM, DACT, an equine reproductive specialist at Equine Fertility Specialties in Michigan. “And sometimes, the mare doesn’t go through her cycle as you thought she would. Often, the timing cannot be coordinated ideally.”

The problem is living animals do not always work on human schedules, agreed Bridgette Jablonsky, VMD, farm manager at Hanover Shoe Farms in Pennsylvania.

“Everyone wants breeding to work like an assembly line, but it’s nature,” she said. “You can do everything right and breed to a fertile stallion, and your mare just does not get into foal.”

But Adam Bowden, owner and general manager of Diamond Creek Farm in Kentucky, said technology has also given information where once there was none. Science allows breeders to get up close and personal with semen, allowing them to check both motility and morphology. When Bowden checked 50 semen samples from 10 stallions shipped to his Diamond Creek Farm for about five months, he found that two of the 10 stallions consistently produced some less progressively motile sperm.

“The industry standard of 500 million progressively motile sperm is much higher than the doses we received, due to the fact that less than 30% of the 500 million were normal (morphologically speaking),” he said, “and was low enough to decrease the normal conception rate of the other eight stallions.”

Bowden acknowledged his was not a scientific study and it was a small sampling, but he found enough subpar samples to cause concern.

“If the mare had no reproductive issues and the quality and motility of the semen were poor, it was more likely a semen issue rather than the mare,” he said.

But stallion managers say issues may also lie with mare management. Admitting “all stallions are not perfect,” David Heffering, manager of Tara Hills Stud in Ontario, said that most farms do an excellent job in stallion management and shipping semen. While he knows his stallions’ thresholds to get a mare into foal, once the semen is shipped, mare management is out of his hands, and that is important.

ModernEquineVet.com | February 2013

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Photos copyright © Dr. Shelby Haden

“[Mares] need the proper ovulation drugs at the right time,” said Heffering. “We want everyone’s mares to get into foal or we are not going to make a dollar. But even with the best management on both ends, it’s not going to work every time.”

Each farm and stallion are different, but the artificial insemination process is generally the same everywhere. Mare owners notify a stallion’s manager right before they think she will ovulate. A stallion's semen is collected off an artificial vagina, and the ejaculate is assessed for motility, morphology and sperm count. The semen is then divided among the mares that booked to that stallion that day, placed into an extender and sent to the mares’ owners.

Sperm can be shipped overnight, sent by courier or picked up. Rarely does the mare come to the stallion’s farm for insemination.

Dr. Shelby Hayden examines the inner catheter for semen following insemination during the transrectally guided deep-horn insemination procedure. She is assisted by technician Katrina LaCaze.

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There are several extenders available, but all include milk, glucose and an antibiotic. Veterinarians say the extenders help the stallion, because they extend the life and volume of the semen and provide energy. Stallion owners test each stallion’s sperm in several extenders to see which is best for that horse.

“Some semen looks terrible when it’s first collected,” Jablonsky said. “You add extender, and in five minutes it looks better, and in 10 minutes, it looks super.”

The sperm-to-extender ratio varies among stallions, but the industry standard says that 500 million “progressively motile sperm” be in each dose, regardless of the amount of extender.

“That old adage that it just takes one sperm to cause conception isn’t actually true,” said Ragon. “Every sperm cell has a sack of enzymes around the head, which are released as the sperm bump up against the

February 2013 | ModernEquineVet.com

egg and help one sperm penetrate the egg.”

Once extended, the semen is either inseminated or packaged for shipment to another facility.

“Once it leaves your farm its destiny is out of your hands,” said Young. “Anything can happen if the semen is being shipped overnight — weather, flight delays, customs, courier issues — and any of these can affect the semen.”

There are several techniques for inseminating the mare, but generally she is cleaned with a mild soap.

(Avoid using betadine antiseptics, suggested Jablonsky, because they are spermicidal.) Her tail is moved aside. The semen syringe is attached to a pipette and semen is deposited into her uterus. Jablonsky said if the mare is ready to breed, the cervix will be loose and open — like the end of a garden hose, but softer.

One step that some mare owners skip, Ragon added, is asking the veterinarian to return the next day to make sure the mare has ovulated. If she doesn’t ovulate within a certain time, more semen needs to be ordered to try again.

Although mare owners might pay a deposit or a booking fee, stallion owners don’t get fully paid until the mare delivers a live foal. If the mare needs more semen, however, owners pay for it to be collected and shipped. The finger-pointing starts as soon as she doesn’t conceive.

Bowden said that rather than blaming each other after the fact, better communication between farms before breeding might prevent subfertile mares from being bred to subfertile stallions.

“I don’t think there is enough information being passed between these two groups,” he said. “If a mare or a stallion has fertility issues, neither farm seems to know that. And if both parties knew that information, solutions could be devised, which would increase the chances that the mare gets into foal.

“Instead the mare owner complains that it’s the stallion’s fault, and the stallion owner complains that it’s the mare’s fault.”

Ragon agreed. Rather than just asking if the stallion is fertile or checking sperm viability, she suggested that mare owners ask about the stallion’s first cycle conception rate.

“Sometimes it is easier for the veterinarians to talk with each other because we can talk about things on a medical basis, instead of a business basis,” she said.

“There’s a lot to it. You just can’t order some semen, put it in the mare and expect to get a pregnancy, but unfortunately, that’s what some people think they can do.” MeV This article was first published in Hoof Beats, a USTA publication, in Dec. 2009. It is used with permission. http://www.ustrotting.com

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Orthopedics

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February 2013 | ModernEquineVet.com

How to examine

the

foot

Anastasija Popova /ShutterStock

Sometimes veterinarians will

able position?” she asked.

The limbs should be symmetric. Because symmetry is pleasing to the eye, asymmetry is easy to see. Laterality, high/low syndrome, mismatched feet and mild club feet may occur because of uneven weight bearing caused by asymmetric movement, asymmetric tendon tension or pain.

block the foot to diagnose lameness and the horse is still lame, so they will disregard the foot as the cause of the problem. At the recent 58th Annual Convention of the American Association of Equine Practitioners, Debra R. Taylor, DVM, MS, DACVIM, told veterinarians: don’t be too quick to make that call.

“If you look a little closer you might wonder what this horse is trying to tell you,” said Taylor, associate professor at Auburn University College of Veterinary Medicine.

Pain in the foot is a common cause of lameness in all horses.

The hoof is dynamic and always responding to various loads and stressors. Abnormal biomechanics of the foot may contribute to pain and lameness in other areas of the limb. Many signs, some subtle, some not so subtle, can indicate that the foot is contributing to the horse’s lameness, and Taylor reviewed some of them at the meeting.

During the examination, observe the horse walking on hard and soft ground. Taylor discussed one patient that corrected his high coronary band angle and his hoof pastern access when walked on soft ground. He did this several times.

“Does he have to do this because the soft ground doesn’t properly support the toe or does he choose to do this because it is a more comfort-

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Good physical exam might help you pinpoint location and cause of horse’s lameness — even if it’s not the foot

A low coronary band angle (<20°) is often associated with a high palmar/plantar angle, and a high angle (>30°-45°) is often associated with a low or negative palmar/plantar angle. This affects the forces exerted by the deep flexor tendon on the navicular.

Coronary band

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The coronary band provides a lot of information, she said, so examine it closely. A normal coronary band angle should be about 20° to 25° away from the ground and straight or slightly arched. The hair should lie flat along the hoof wall with the hair shafts directed distally.

“Farriers often talk about ‘angry hair’ and I used to wonder what that meant,” she said about her early days as an equine veterinarian. “When excessive hoof wall pressure is present, the hair of the coronary band will often stand out horizontally. It is important to watch for this as an indication of an overworked and distorted hoof wall,” she said.

Chronic overloading can affect the shape of the coronary band.

“Even a small dip of the coronary band at the dorsal hoof wall is indication for taking a radiograph because there will often be bone remodeling that can be a source of hoof pain,” she said.

If the coronary band of the hind foot is normal and someone were to project a pointer from the coronary band, the ray would strike the knee or below. If it is abnormal, it would strike well above the carpus.

Take the time to look at the direction of the coronary band angle to determine if the horse might have a

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A healthy digital cushion.

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negative plantar angle.

“Many horses with negative plantar angles are presented for hindlimb lameness. While these horse’s seldom block sound to the hoof, correcting the negative plantar angle often diminishes the lame-

excessive ground-reaction force in that region, and the circulation is altered or uneven.

Hoof tubules should be straight, and the sole should meet the tight white line at the hoof wall. A foot under stress will be flared or dished.

Look for bruising. Bruising, which can be hard to see, might be easier to see on a photograph, she said.

Frog Walk the horse on hard and soft ground because lameness caused by pain in the distal portion of the limb tends to worsen when the horse is trotted on hard ground.

Photo courtesy of Dr. Taylor

ness. This observation warrants further study,” she said.

Hoof wall

A normal hoof wall should be smooth, without flares or cracks, which would signal chronic, excessive overloading. The surface should have a light sheen. Growth rings should not be prominent. If the growth rings are narrower in any particular region, this could be a sign the hoof has undergone 10

February 2013 | ModernEquineVet.com

The frog’s morphology changes in relation to the hoof demands and the terrain. The frog width should be 50% to 60% of its length. The frog of a healthy foot has sufficient depth at its dorsal aspect to reach the bearing surface.

“We want the frog to reach the bearing surface. It is stimulated by the ground. If it does not interact with the ground, it is not contributing to weight bearing,” Taylor explained.

The central sulcus of the frog should be wide enough that the veterinarian can lay his or her finger in it. If it is narrow and contracted, it will harbor thrush-causing organisms and can become a primary source of pain.

Collateral grooves can be used to predict sole depth, P3 suspension, palmar angle and heel development. The veterinarian can predict distal phalanx orientation by assessing the depth and slope of the collateral grooves.

Sole depth decreases as collateral groove depth decreases. The slope of the collateral grooves in the front half of the foot parallels the palmar/planter angle. This information might help decide what types of hoof care and protection the horse may need when radiographs are not readily available.

Palpation

Palpation should start with assessment of the temperature of the

hoof wall, coronary band and heel bulbs by using the palm or the back of the hand.

• Elevated temperatures can signal inflammation, infection or the prodromal stages of laminitis.

• Decreased temperature can signal poor perfusion and a host of problems, such as chronic laminitis.

When palpating the digit, the normal coronary band should be full or spongy with no evidence of a shelf or ledge where a finger can be placed behind the proximal aspect of the hoof capsule. A ledge or shelf would indicate the distal phalanx is located deeper than normal within the hoof capsule. If this occurs, there are usually other abnormalities present, such as thin or flat soles and/or coronary band distortion.

When palpating the heel, the volume of the heel is important because it represents the volume of the digital cushion. The digital cushion should be 2 inches thick and three or four fingers wide. It should feel firm like a tennis ball or a well-done steak. When the digital cushion is pushed, there should not be a lot of give, and the frog should flex slightly.

Collateral cartilages should be thick and slightly bendable with moderate pressure, Taylor noted.

Although hoof testers might help rule in or out the presence of pain associated with the hoof wall, sole, dermal tissues and digital cushion, false-negative and false-positive indicators are common, according to Taylor. However, they can help assess the integrity of the structures of the hoof capsule.

Many foot problems produce similar clinical signs, so careful examination of the feet can help the clinician diagnose the location and cause of a horse’s lameness, according to Taylor.

MeV

Regenerative medicine

Which stem cells for

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Tendon injuries can affect athletic horses at all lev-

els. Researchers from the University of Connecticut are studying the use of stem cells in treating equine tendon injuries.

“My work focused on determining appropriate conditions for expansion of umbilical cord blood (UCB)-derived stem cells,” said Sarah A. Reed, PhD, assistant professor, department of animal science, at the University of Connecticut. “Often, stem cells are cultured to expand the population prior to injection. The culture parameters are extremely important, as they can greatly influence gene transcription, protein production and cell identity. My work describes the effect of different culture media and basement substrata on gene expression in UCB and adipose-derived mesenchymal stem cells.”

Tendon injuries in horses tend to worsen over time, as damage to the tendon creates lesions. Currently, horse owners treat tendon injuries by resting the horse and then carefully exercising it to control the growth of scar tissue in the tendon, which requires substantial recovery time, as well as, carries a high risk for reinjury, according to Reed.

“Stem cells have great promise as a therapeutic aid, but we have little data regarding proper dose, timing and expansion protocols to promote optimal repair.

Much research is needed to allow researchers and veterinarians to make informed decisions about the best implementation practices. Veterinarians should seriously consider their options,” she said.

Stem cell injections are already common in veterinary medicine, and scientists are curious about how to make stem cell treatments more effective. In this re-

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view, the researchers looked at the use of three types of stem cells: bone marrow-derived mesenchymal stem cells (BMSCs), adipose-derived stem cells and UCBderived stem cells because these cell types have the potential to strengthen a tendon after injury.

Implants of BMSCs can increase collagen production and organized collagen fibers in the tendon. Adipose-derived stem cells can express certain proteins important in healing.

UCB stem cells may have the most potential for healing horse injuries because these cells may be better able to grow into new types of cells and repair tendon damage. So far there have been no studies of UCB use in actual horse tendon injuries. But in vitro studies show that UCB could be capable of tendon regeneration, according to Reed.

“We predict that UCB stem cells would perform better in the tendon because they are more naïve and do not differentiate as completely in culture as adipose-derived stem cells. There have been no published experiments using UCB to treat tendon injuries at this time,” Reed said.

UCB stem cells are actively being banked by several companies, she added. BMSCs are readily available from each individual horse and can be isolated fairly easily. However, most veterinarians do not have the culture facilities to expand the true MSC population. There are hospitals that offer this service.

More studies are needed about the best implantation techniques and the role of stem cells in different parts of the tendon. With this knowledge, horse owners, veterinarians and animal scientists can help keep equine athletes healthy.

MeV

S Umbilical cord blood derived stem cells grown on gelatin. The staining is phalloidin (green – stains the actin filaments of the cells) and Hoescht 33342 (blue – stains the nuclei).

Photo by Dr. Reed.

For more information: Reed SA, Leahy ER. Growth and development symposium: Stem cell therapy in equine tendon injury. J Anim Sci 2013 Jan;91(1):59-65. doi: 10.2527/jas.2012-5736. Epub 2012 Oct 16. http://www.ncbi.nlm.nih.gov/pubmed/23100589

ModernEquineVet.com | February 2013

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Is

lameness the cause of that slipping saddle?

This fundamental cause is often overlooked

Photo courtesy of Dr. Dyson

A number of factors can

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February 2013 | ModernEquineVet.com

cause saddle slip, not just a poorly fitted saddle. Often, lameness is the cause, according to Sue Dyson, VetMB, PhD, head of clinical orthopedics at the Center for Equine Studies, Animal Health Trust (AHT) in the United Kingdom.

For many years, Dyson has noticed saddle slip on horses with hindlimb lameness. Often, however, lameness is not recognized as the fundamental cause of the saddle slip, she told The Modern Equine Vet. “I was prompted to initiate the study because I had seen a horse with saddle slip in which the saddle slipped a lot, but the rider sat squarely, and I could not see lameness. But when I blocked the tarsometatarsal joint, the saddle slip resolved. I became intrigued and wanted to know more about the incidence of this and thought that it was an excellent project for my intern, Dr. Line Greve,” Dyson explained.

Together Dyson and Greve con-

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ducted a prospective study of 128 horses referred to AHT for lameness or poor performance, or were undergoing a prepurchase examination. Some were overtly lame, and some were not moving properly but lameness had not necessarily been recognized, according to Dyson. The horses were ridden by two riders during the assessment.

Saddle slip was defined as the saddle consistently slipping to one side when observed from the ground (this may have been only on one rein but was a consistent feature). With grade-1 saddle slip, the riders continued without readjusting the saddle. In many cases, the riders were not aware of the saddle slip. However, they generally became aware if they intermittently had to stop and readjust the position of the saddle (grade-2 saddle slip).

Saddle fit was assessed in all horses. “In two horses, one with forelimb lameness and one with hindlimb lameness, we identified an ill-fitting saddle. Saddle slip

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Orthopedics

in which the forces on the stirrups change. In some, it was worse during canter, presumably because the three-beat asymmetric gait produces different forces than the two-beat trot, according to Dyson.

She plans to study the biomechanics of this.

Dyson also noted that horses with a rounder back in the caudal saddle region were more prone to saddle slip than less rounded horses.

recognizing lameness should examine a horse carefully if the owners complain of frequent saddle slip. But first, make sure the saddle fits properly, and the rider is sitting squarely on the saddle. When assessing lameness, remember that the saddle normally slips toward the side of the lamer limb, but not always. “It can be confusing because occasionally, it slips the other way,” Dyson said.

Dyson indicated that the AHT

“Interestingly, the presence or absence of saddle slip was not related to the severity of lameness, but we need more numbers to see if horses with different types of pain causing lameness are more at risk for saddle slip,” she said.

Veterinarians experienced in

riders were probably better at feeling saddle slip than the typical horse owner, and veterinarians and technicians should train owners about how to “feel” saddle slip.

Have someone stand behind them and watch the movement of the saddle, she suggested.

MeV

Photo courtesy of Dr. Dyson

was not eliminated by resolution of the lameness; saddle slip was eliminated when we used a correctly fitting saddle,” she said.

The saddle consistently slipped to one side in 38 of 71 horses that had hindlimb lameness, compared with 1 of 26 horses with forelimb lameness. There was no saddle slip in 20 horses with back pain and/or sacroiliac joint pain or in 11 sound horses.

Saddle slip improved in 97% of horses after the lameness was addressed.

“I was surprised by the proportion of horses with hindlimb lameness that we documented with saddle slip,” Dyson said. “I was not surprised at all that 97% improved after elimination of the lameness.

“The fact that saddle slip occurred with at least two riders and was abolished when the lameness was resolved proved a causal relationship between hindlimb lameness and saddle slip,” she added.

Hindlimb lameness probably alters back movement, she explained. “In most affected horses with saddle slip the saddle slipped toward the side of the lame or lamest limb, but in a small proportion the saddle slipped toward the less lame hindlimb. Therefore, horses must be adapting their gaits in the face of lameness differently.

“It gets quite complex,” she said. Saddle slip worsened when the horse was ridden in a circle vs a straight line, reflecting the way in which horses change their gaits on a circle compared with straight lines. It worsened in rising trot than sitting trot because of the way

Above: Saddle slip as a result of lameness.

Left: Saddle slip worsens when the horse is ridden in a circle vs a straight line.

For more information: Greve L, Dyson S. An investigation of the relationship between hindlimb lameness and saddle slip. Equine Vet J 2012 Dec 18. doi: 10.1111/ evj.12029. http://www.ncbi.nlm.nih.gov/pubmed/23360352

ModernEquineVet.com | February 2013

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Practice Management

Breaking

Bad News Excellent communication skills are essential in veterinary medicine When emotions are high

during an emergency, the veterinarian and technician must remain calm and focus on the patient’s needs, while recognizing the best ways to communicate with clients.

“By their very nature, emergencies are unexpected, and people are thrown off balance. So, emotions are high,” said Amy L. Grice, VMD, a partner at Rhinebeck Equine in New York. “Clients have no idea what to expect.

Is their horse going to live? Is their horse going to die? Will they lose the use of the horse? Will it be lame for a long time? How much is it going to cost?”

Clients often have no way to assess the clinical and technical skills of their horse’s doctor, so they tend to judge the entire veterinary team by the way everyone communicates, Grice said at the 58th Annual Convention of the American Association of Equine Practitioners held in December in Anaheim, Calif.

“People may not remember what you say, but they will always remember the way you made them feel,” she added.

Veterinarians and their staffs

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need similar skills to those followed by pediatricians and their staffs who also deal with caregivers. Equine veterinarians do the same. They aren’t just treating

People may not remember what you say, but they will remember the way you made them feel. a horse — they are explaining and getting buy-in from owners, trainers and others involved in the horse’s life.

Human medicine researchers have found that assigning a patient navigator or facilitator helps both the patient and family. In one study, researchers randomly assigned pediatric patients into two groups: families with a patient navigator and families without. The patient navigator answered any questions the family

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had, explained laboratory results and provided other information the family wanted.

The researchers found that families with a patient navigator rated the care better than families who did not have a navigator. This could be a good role for a veterinary technician, especially in a large equine hospital.

“The simple act of listening and answering their questions had a marked effect on the overall satisfaction of the family,” Grice said.

Several studies in veterinary medicine have found the same effect, according to Grice. “Essentially, communication drives satisfaction,” she said.

Watch what you do

The human body communicates, sometimes more loudly than voices. Nonverbal communication or body language comprises about 60% of the communication that people receive.

“Your tone of voice, your facial expressions, your gestures, how you hold your head and hands, how you hold your body and body contact. The way that you look and listen and move and re-

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5% Intuitors

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Thinkers

Sensors

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Feelers

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Psychologist Carl Jung suggested people fall into these communication styles. act tells the other person whether you are actually listening and care,” Grice explained. “If your nonverbal signals do not match the words you are saying, they can generate tension, mistrust and confusion.”

Nonverbal communication can reinforce or contradict the message.

To effectively use nonverbal communication to reinforce the message, Grice suggested that veterinarians and their staffs recognize and manage their own emotions, as well as, send the right messages to their clients and interpret clients' messages accurately.

“Sometimes, we have to act as advocates for the horse because the

client won’t hear the message that we are trying to give. Sometimes you have to stand up tall, square your shoulders and really speak firmly. Be the advocate for the horse to get your message across.”

Are you listening?

One study that looked at medical doctor-patient interactions found that doctors typically interrupt their patients after an average of 23 seconds. Without interruption, the patients take an average of 60 seconds to explain the problem.

Grice suggested taking a few more seconds to listen to clients. When taking the patient history ask openended questions. “Tell me...What?

How? Describe for me” are good ways to start the discussion. And avoid using why because it sounds judgmental.

A good technique is called reflective listening, which involves repeating back to the client what you heard to make sure you understood. This not only assures the client that you understand him or her, but gives the client a chance to correct or add information.

Veterinarians and staff can help clients deal with negative emotions by expressing and naming those emotions. “Say things such as, ‘I can see how much you care for your horse. This must be hard for you,’” she suggested.

ModernEquineVet.com | February 2013

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Ways to Communicate Effectively

1. Be a compassionate listener.

8. Ask open-ended questions.

2. Confidently state your observations.

9. Listen reflexively and listen with empathy.

3. Don’t label; don’t judge.

10. R ecognize communication styles and if you can adapt, do so.

4. State your expectations and limitations. 11. Use bridging techniques and pacing.

5. Express yourself directly and honestly.

6. Evaluate how other people are feeling.

7. Be aware of nonverbal communication.

Use empathy, but remember empathy is non judgmental. “You did the best you could to help him.

No one could have known that he would try to jump that ravine.”

Another physician study found that those with the best communication skills had fewer malpractice claims than those who were judgmental, lacked empathy and did not spend time communicating. Physician communicators told patients what to expect from the visit or procedure. They used humor. They asked the patient’s opinion. They checked their understanding. They encouraged them to talk and they spent longer in routine visits, 18.3 vs 15 minutes.

“Think about that time: spending 3.3 minutes prevented malpractice claims. Three minutes is not a long time,” Grice said.

Communication can be enhanced by recognizing a person’s preferred communication style and tailoring the message to fit that style. Carl Jung described several communication styles, including intuitors, thinkers, feel16

February 2013 | ModernEquineVet.com

ers, sensors and adaptors.

Intuitive communicators are creative, unique and innovative.

Under stress they can be reactive or detached. Make an emotional connection by appeal to their emotional side. Speak slowly and calmly.

Thinkers are logical, sequential and thorough. Under stress, they become cautious and make decisions more slowly. Be clear and complete. Give them time to process the information. It might be a good idea to set the process in motion as early as possible, especially if they will have to make a difficult decision.

Feelers are compassionate, traditional and like consensus.

Under stress, they are volatile and can be difficult. They can become unhinged. Be sensitive to their feelings and not reactive.

Be soft spoken and caring. Make eye contact. Slowly and calmly repeat your message.

Sensors are driven, focused and bottom-line oriented. Under pressure, they are impatient.

These folks want to know if their

horse is going to die before the veterinarian has even examined it. “They have difficulty with deliberate, methodical exams, so educate them or ask the technician to educate them, giving them information along the way,” Grice advised.

Adaptive communicators represent only about 5% of the population. They can easily handle any communication style.

“When you are delivering bad news, bridging statements can help clients prepare. A general statement ‘I am very worried’ gives a little bridge so the brain can process that something very serious is going to happen and then you tell the client what it is you need to say,” she said.

“The use of bridging statements, as well as slowing the pace of your communication, can help the client stay calm and make critical decisions.”

Better communication can improve client satisfaction and loyalty, as well as, help you help patients through a difficult time.

MeV

Reproduction

Some conditions enhance survival of

female embryos Many mammals can adjust

the ratio of male-to-female young, depending on surrounding conditions at the time of conception, but precisely how this is accomplished is unknown.

A recent study published in the journal Theriogenology, has provided important information about the survival of female embryos, which may be enhanced under conditions that would oth-

erwise tend to favor the birth of males.

Because of the process involved in the formation of sperm cells, there should be an equal chance that a mammalian egg will be fertilized by "male" sperm, carrying a Y chromosome, as by a "female" sperm, carrying an X chromosome. The symmetry of the system ensures that roughly the same number of males and

Equine embryo

Lipizzan mare with her foal

Photo: Spanish Riding School - Federal Stud Piber

ModernEquineVet.com | February 2013

17

male

30

female 20

10

12

10

0

8

females are born, which is clearly helpful for the species' long-term survival. Surprisingly, though, many mammals do not produce equal numbers of male and female offspring.

The discrepancy could be explained theoretically by differential fertilization efficiencies of male and female sperm (Y chromosomes are smaller than X chromosomes, so perhaps male sperm can swim faster?) or by different rates of survival of male and female fetuses in the uterus.

Indeed, it does seem as though male embryos are better able to survive under conditions of high energy intake. But how does this work?

Jana Beckelmann, DrMedVet, DECAR, at the Vienna University of Veterinary Medicine (Vetmeduni Vienna), presented provocative evidence that a particular protein, insulin-like growth factor 1 (IGF-1), might somehow be involved. When examining about 30 equine embryos, Beckelmann noticed that during early pregnancy (between eight and 12 days after fertilization) the level of messenger RNA (mRNA) encoding IGF-1 was approximately twice as high in female embryos as in male embryos.

The difference could relate to the fact that female embryos have two X chromosomes, which might produce more of the fac-

Relative gene expression (ß-actin)

Agarose gel staining from RT-PCR with Xist specific primers of equine female (f) and male (m) primary cell cultures and RNA of different embryos as well as one negative control (nc).

Day of pregnancy Relative gene expression of IGF-1 (related to β-actin) in male and female (n = 28) equine embryos on days 8, 10 and 12 of pregnancy (effect of sex: p = 0.01)

tor required for expression of the IGF-1 gene (which is not encoded on the X chromosome) than the single X chromosome in males is able to generate. Beckelmann was also able to confirm that the IGF-1 protein was present in the embryos, confirming that mRNA is actually translated to protein.

IGF-1 is known to have important functions in growth and to inhibit apoptosis. As IGF-1 treatment of cattle embryos produced in vivo improves their survival, it is likely that the factor has positive effects on the development of the early embryo in the horse. So why should female embryos contain more of the factor than males?

Losses in early pregnancy are unusually high in the horse and it is believed that female embryos are especially prone to spontaneous abortion. Male embryos are known to be better able to survive under high glucose concentrations, so well-nourished mares preferentially give birth to male foals.

“We think the higher IGF-1 concentrations in female embryos might represent a mechanism to ensure survival of the embryos under conditions that would otherwise strongly favor males.” If this is so, the ratio of the sexes in horses is the result of a subtle interplay between environmental and internal factors, including IGF-1, Beckelmann noted. MeV

For more information: Beckelmann J, Budik S, Helmreich M, et al. Sex-dependent insulin like growth factor-1 expression in preattachment equine embryos.

Theriogenology 2013; 79(1): 193 DOI:10.1016/j.theriogenology.2012.10.004.

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February 2013 | ModernEquineVet.com

BEHAVIOR

Horses donâ&#x20AC;&#x2122;t have stage fright â&#x20AC;&#x201D;

but their riders do

Blazej Lyjak/ShutterStock

Most people are familiar with stage fright and its manifestations, such as rapid pulse, dry mouth, shaky voice, blushing and sweaty palms. But is the condition restricted to people? Does stress increase in horses when they perform in front of an audience?

It is well-known that horses show signs of stress when ridden but relatively little attention has been paid to the effects on their riders. This is surprising, as equestrian sports rely on close cooperation between the animals and their riders. How does the horse-rider team cope with the stress involved in competing in an equestrian event?

Researchers in Vienna found that horses react identically regardless of whether spectators are present, but riders suffer more stress when performing in front of an audience than when practicing for the event.

The horses and their riders thus perceive the challenges of competition ModernEquineVet.com ModernEquineVet.com || February February 2013 2013

19 19

Photo: Vetmeduni Vienna/J. Aurich Photo: Vetmeduni Vienna/J. Aurich

Taking a saliva sample

Show program at the Ecole nationale d`équitation in Saumur, France.

in equestrian events differently, according to the study, which was published online in the Veterinary Journal.

Mareike von Lewinski, Dr

Med Vet, and colleagues at the University of Veterinary Medicine, Vienna (Vetmeduni Vienna) and at the Ecole Nationale d’Equitation in Saumur, France, looked at six riders and their horses and measured the changes in various stress-related parameters, such as salivary cortisol concentrations, heart rate and heart rate variability. Measurements were taken during practice before the event without an audience and after completion before 1,000 spectators. The results were compared to assess how the riders and their mounts responded to the presence of an audience.

In line with previous experiments, the researchers could observe signs of stress — higher cortisol concentrations in the saliva and more irregular heartbeats — in both horses and their riders during the study. However, the presence of spectators resulted in more pronounced changes in cardiac activity among the riders than the horses.

The researchers found that cortisol concentration increased in both horses and riders (P<0.001) but did not differ between performance and rehearsal. The heart rate in horses and riders increased during the rehearsal and the public performance (P < 0.001 ) but the increase in heart rate was more pronounced (P<0.01) in riders than in their horses during the public performance (from 91±10 to 150±15 beats/min) compared with the rehearsal (from 94±10 to 118±12 beats/min).

The horses appeared to be unaffected by the presence of spectators: their reaction to the course was essentially independent of

whether an audience was present or not. In other words, the horses and their riders responded differently to the challenges posed by performing for spectators, with the horses not suffering from the increased levels of stress shown by their riders.

The results implied that the riders do not communicate their heightened anxiety to the animals. The lack of transfer of emotions between rider and horse was unexpected, according to the researchers.

A horse's reaction to the course was independent of whether an audience was present or not.

“We started with the assumption that rider stress would affect the horse but this does not seem to be the case. Nevertheless, we should bear in mind that we were working with experienced horses and highly skilled riders: our findings cannot be generalized to inexperienced riders, who might be less able to prevent their horses from being stressed by the situation,” said Christine Aurich, DVM, PhD, DECAR, head of the group at Vetmeduni Vienna. MeV

For more information: von Lewinski M, Blau S, Erber R, et al. Cortisol release, heart rate and heart rate variability in the horse and its rider: Different responses to training and performance. Vet J 2013 Feb 1. pii: S1090-0233(13)00003-8. doi: 10.1016/j.tvjl.2012.12.025. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/23380228 20

February 2013 | ModernEquineVet.com

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finish line

Marketplace fairness not the only issue when it comes to purchasing medications for horses If you are a consumer who buys a lot of items online, the fact that you often do not have to pay sales tax on these items is great news. I mean, who doesn’t want to save a few bucks?

But this might not be such a great deal if you’re a veterinarian trying to compete with an online pharmacy.

Marketplace fairness, however, is not the only issue when it comes to purchasing medications for horses and pets. The American Veterinary Medical Association (AVMA) said there is a lot more at stake than just money – there are quality-control and safety issues.

“While it is evident that losing customers who turn to online companies for their pets’ medications results in a negative impact on the business of veterinary medicine, it is important to understand that our first concern involves the lack of quality control for our patients’ prescriptions and our inability to ensure that they are receiving not only the right products, but safe products," said Mark Lutschaunig, VMD, MBA, director of the governmental relations division, AVMA. “It is essential that this legislation is passed so that veterinarians are not at an unfair disadvantage when

it comes to providing the products and medications that our nation’s pets need and deserve,” he added in a release.

Power in numbers

The AVMA and more than 200 business and trade associations from across the country are trying to level the playing field. They formed the Marketplace Fairness Coalition to support the passage of federal legislation, which would empower states to update their sales and use tax laws.

Businesses of every size, sector and channel of product distribution, including both brick-andmortar and online sellers, have joined the group to advocate for modernizing the current sales and use tax framework so that all businesses will play by the same rules.

Congress is finally listening. Led by a group of bipartisan legislators, companion Senate and House bills were recently introduced. It is hoped that the Marketplace Fairness Act will level the playing field for all sellers and support a marketplace that is vibrant, viable and equitable for everyone.

The Marketplace Fairness Act should

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• give all sellers the chance to compete in a free market without government preferences, • relieve consumers of having to self-report sales and use taxes they already owe, • exempt truly small businesses and • give states a road map for simplification that will provide them with flexibility to respond to today’s evolving marketplace.

This is a good first start for veterinarians everywhere, but another area where legislators really should look would have a real impact for equine veterinarians – the feed store. Many products can be purchased without a prescription at the feed store, even though the customer is not a licensed veterinarian.

doctor’s prescription.

Isn’t it time for the FDA, USDA and everyone else regulating animal medications to take a look at these rules? They've started taking a closer look at compounding pharmacies. This seems like a natural next step.

Although many end-users might think that the only reason why they go to the doctor or call the veterinarian is to get drugs, what they really get is years of education and experience – and that is the real reason why we should be getting prescriptions.

The Marketplace Fairness Act should Give all sellers the chance to compete in a free market without government preferences Relieve consumers of having to self-report sales and use taxes they already owe Exempt truly small businesses Give states a road map for simplification that will provide them with flexibility to respond to today’s evolving marketplace.

By Dr. Robert M. Miller

I understand why the rules allowing farmers to do this were put in place, but those rules were enacted in another era when veterinary medicine was less sophisticated, and when it was farmers and ranchers who bought them.

There are so many reasons why this might not be a good idea today: • Many drugs have interactions with other products.

• Animals just like people can have adverse reactions that might need medical management.

• Resistance to all kinds of products can develop from overuse and misuse.

• There are also survivalist websites that champion the use of feed stores to stockpile veterinary medications for themselves and their families to avoid a

Marie Rosenthal, MS Editor The Modern Equine Vet

Dr. Miller’s books and videos are available for sale at www.robertmmiller.com ModernEquineVet.com | February 2013

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