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The Modern

Equine Vet www.modernequinevet.com

Vol 3 Issue 2 2014

Consider cervical cerclage

to prevent ascending placentitis

Cutting-edge therapy for sarcoid tumors Stem-cell & IRAP for stifle injury Technician Update: Case presentation

Table of Contents

Cover story:

4 Consider cervical

cerclage to prevent ascending placentitis Cover photo by Shutterstock/ hosphotos

Dermatology

Cutting-edge therapy for sarcoid tumors ...................................................................... 8 Regenerative Therapy

Stem-cell & IRAP appears successful for stifle injury................................................10 technician update

Heather Hopkinson: Colic case presentation...............................................................17 News

Saving grace for Gracie............................................................................3 Reaching the next level....................................................................... 12 Dad's genes build placentas............................................................... 14 AAEP convention news ........................................................................ 14 Cornell opens specialty hospital ...................................................... 15 Purina introduces new feed............................................................... 15 IDEXX offers expanded respiratory panel...................................... 15 The Modern

Equine Vet Sales: Robin Geller • newbucks99@yahoo.com Editor: Marie Rosenthal • mrosenthal@percybo.com Art Director: Jennifer Barlow • jbarlow@percybo.com Published by

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news notes

Saving grace for Gracie That the horse, known as Gracie, is even alive is a something of a miracle, given the medical challenges of her condition, said Sarah Graham, DVM, a clinical assistant professor in the University of Florida College of Veterinary Medicine’s department of large animal clinical sciences and lead surgeon on the case.

But the willingness of a local rehabilitation center to provide the horse with regular physical therapy to aid in her healing adds a special saving grace to her story.

“Grace was unable to bear weight on her right front leg. She was in a lot of pain and distress,” said Andrew Smith, DVM, a large animal surgery resident, who received the case that night.

Radiographs of the shoulder all were normal, but a subsequent bone scan revealed a rare fracture in an area of the humerus known as the lesser tubercle.

“There is no report in the literature of this type of fracture being fixed,” Graham said. “The fracture itself is rare, and no one has ever tried to repair it.”

The prospect of surgery was daunting, in part because veterinarians knew the fracture’s location was deep and on the inside of the shoulder. Surgical access to that area is difficult, Graham said. Routine fracture repair involves the use of bone screws and plates and would have been ideal, but that was not possible in Gracie’s case due to the location of the fracture, she said.

“The piece of bone that was fractured is an insertion point for a number of muscles that stabilize the shoulder,” Graham said, adding that muscles would pull constantly on the bone, therefore, healing of the fracture on its own would be impossible.

But the surgeons had noticed Gracie’s calm temperament and her willingness to let them help her.

They felt she had a good instinct for taking care of herself. Those characteristics, plus her owner’s attachment to her, were encouraging, Graham said.

Rather than repair the fracture, the veterinarians took a different approach. They removed the piece of bone entirely. Graham and Smith performed the procedure, which took several hours. Overall, things went smoothly, as did the horse’s first weeks of aftercare.

Gracie returned home to Jacksonville with her owner and began the long process of recuperation, which included months of stall rest and limited exercise. But when Gracie returned to UF several months later for follow up, her care team noted that she was showing signs of severe lameness.

Gracie had developed a lot of scarring and restricted motion around the shoulder joint. Gracie needed more physical therapy to therapy to maximize her recovery, but her owner was unable to provide the kind of extensive care needed.

Graham contacted Peter Kazakevicius, DM, head veterinarian at the Sanctuary Equine Sports Therapy and Rehabilitation Center in Ocala. He and Brenda McDuffee, the center’s general manager, were excited to get involved in the case and to contribute their expertise in rehabilitation.

“We started in July with therapy in a water treadmill to make her more buoyant and offset some of her weight,” McDuffee said. In addition to hydrotherapy, Gracie received laser, vibration and magnetic pulse therapies to loosen up her muscles and offset body soreness.

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Cover story

Consider

cervical cerclage

to prevent ascending pla

Cervical Cerclage placement

Photos used with permission of the AAEP

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Cervical Cerclage suture in place

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Cervical cerclage can be an effective procedure to prevent ascending placentitis in some mares with cervical incompetence, according to Stefania Bucca, DVM, an equine reproduction specialist at the Qatar Racing & Equestrian Club in Qatar.

“Cervical competence means the ability to form a tight seal in diestrus and during gestation and to relax appropriately at estrus and at parturition,” Bucca explained

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at the 59th Annual Convention of the American Association of Equine Practitioners in Nashville.

“A dysfunctional cervix is associated with infertility in the mare, as well as several pathological conditions including endometritis, early pregnancy loss, abortion and ascending placentitis.”

Horses are not the only females who suffer cervical insufficiency, and equine medicine has learned by looking at the way the problem

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is handled in women, according to Bucca. Specific treatment strategies commonly applied in human obstetrics include medical treatment with progesterone, cervical cerclage and placement of a cervical pessary. Treatment strategies for mares with cervical incompetence are not as clearly defined as for women, she explained.

“What we tend to do in mare reproductive practice is to treat those mares who have a history

The Challenge of Diagnosis

By Marie Rosenthal, MS

centitis

Removal of a cervical cerclage suture

of abortion due to placentitis and that group of mares that present a disruption of the caudal reproductive tract that may increase the risk of ascending placentitis,” she said.

Typically mares with cervical incompetence receive an antimicrobial, a nonsteroidal antiinflammatory drug (NSAID) and altrenogest (Regu-Mate, Merck Animal Health), a synthetic progestagen. The duration of the regimen depends on the circumstances. Despite the medical treatment, some pregnancies still fail.

Anatomical or functional cervical incompetence plays a pivotal role in the pathogenesis of placentitis, but its diagnosis can be challenging, especially during the early days of presentation, according to Stefania Bucca, DVM, an equine reproduction specialist at the Qatar Racing & Equestrian Club in Qatar.

However, researchers such as Bucca have defined parameters and measurements that can help veterinarians make this determination.

Yellon and colleagues referred to the cervix as the “gatekeeper for pregnancy” because it forms a functional barrier that prevents the uterus (and the fetus) from exposure to physical challenges, as well as, chemical and biological invaders that can cause chronic endometritis, ascending placentitis and fetal loss.

Therefore, much of the work has been done by assessing the equine cervix, which can be easily accomplished by a transrectal examination with ultrasonography. Here, the vertical cervical diameters and evaluation of cervical echotexture can identify premature cervical ripening (remodeling) and relaxation that can lead to ascending placentitis.

In the study, the researchers found that premature cervical remodeling and shortening of the cervical canal may be indicating abortion/premature delivery due to loss of mechanical support and threat of infection. Premature cervical ripening causes uteroplacental instability and results in detachment, hemorrhage and inflammation radiating from the cervical pole. Avillous detached areas may prolapse into the inner cervical os under the mechanical forces of fetal extremities and pressure from the fetal fluid.

These large detached areas create a funneling effect that can be seen on the ultrasound, Bucca explained at the 59th Annual Convention of the American Association of Equine Practitioners.

In a study done by Bucca and colleagues, the researchers found that the vertical cervical diameter and the echotexture or appearance on ultrasonography can identify this state of relaxation of the cervix that should not occur before the last two months of gestation.

The equine cervix is particularly easy to evaluate with standard reproductive equipment, usually linear ultrasonography, as it presents particular features that include: • a hyperechoic serosa that will delineate the borders of the cervix, • a central lumunal striation that corresponds to the ridges of the cervical mucosa, a continuation to the endometrial folds • a more echodense layer, corresponding to the muscularis.

“Cross-sectional views of the cervix by ultrasound can be extremely informative, too, but they are not easy to obtain, as negotiating a 90 ° rotation within the pelvis when fetal parts are engaged maybe quite challenging,” she said.

The diameter of the cervix can also be telling. “When the measurements of the three cervical diameters are plotted against gestation of three months to term, we can see a great uniformity of measurements up to nine months gestation, whereby, the cervix appears to be very consistent in size to about 2 cm. And then after 9 months [in a normal pregnancy], we see a gradual increase of the three diameters. The study also proposed a cervical grading system, based on cervical echotexture, which correlates with the changes occurring to the cervix during the process of remodeling that leads up to relaxation."

The cervical grading system proposed by the study identifies four different grades, as follows:.

• Cervical Grades 1 and 2, quite similar to each other, where the cervix is very compact and tight and uniformly echogenic, but with a different amount of central linear striation • Grade 3 shows an increase in the mucosal layer and a hypo-echoic layer between mucosal and muscularis.

• Grade 4 shows profound cervical remodeling and indicates cervical relaxation. A variable degree of cervical softening can be appreciated on transrectal palpation of a Grade-4 cervix. Grade 4 is generally identified during the last two months of gestation in association with a gradual palpable shortening and softening.

“When we plot the grading against gestation from three months, we see a great preponderance of Grade 2 up to nine months gestation where we see a transition to grade 4, which is solely represented during the last two months of gestation, in normal pregnancies,” she said.

Veterinarians should focus on the uterine cervix to identify those problem mares who are at risk for ascending placentitis and possible preterm delivery, according to Bucca. With this identification, MeV preventive measures can be taken that might save the pregnancy.

ModernEquineVet.com | Issue 2/2014

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Cover story

diagnosed at 7 months because Bucca recommended that she had premature lactation. veterinarians consider cervical “Treatment with altrenogest cerclage, which is commonly was the first line of attack that applied to mares with anawe commonly used to try to tomical disruption by musobtain a reduction in vertical cular overstretching of the cervical diameters and revercervix that is not amenable to sal of grading back to Grade 2. surgical repair. “It’s a basic salObviously, in these cases that was vage procedure,” she said. not achieved, and we went ahead At the AAEP meeting, Bucca with the cervical cerclage,” she said explained the results of this techThe first mare was a 17-yearnique used six times in four mares Schematic of the placement of a cervical cerclage old Thoroughbred with a two-year (two mares had the procedure done suture. history of abortion and ascending during two pregnancies.) Three of Used with permission of the AAEP placentitis despite monthly adthe four mares, had a known cerministrations of altrenogest and vical incompetence problem. The antimicrobials of one-week duration, throughout gesgestational age of diagnosis and treatment varied, but tation. She received cervical cerclage for two pregnanranged between 5 to 8 months gestation. cies.

Five cases had sonographic evidence of premature The next mare was a 19-year-old Thoroughbred cervical ripening. The sixth mare was much younger with a three-year history of pregnancy loss due to asand a mare that had an anatomical disruption of the canal that had not been previously diagnosed. She was cending placentitis despite medical treatment.

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The next mare presented for sors, according to Bucca. intermittent vaginal bleeding at All of the mares that received cervical cerclage delivered live about 7 months gestation. The foals that survived at least the one cause of the bleeding was identiyear of follow-up. No abnormalified (some vestibular varicosities) ties of the mare’s reproductive and corrected, but during the ulsystem were noted following the trasonography, the veterinarian cerclage sutures. Of note, one found evidence of premature cermare who successfully carried vical ripening. She was already on after cerclage was bred again the an altrenogest regimen because of following year, but cerclage was her medical history. not performed and she did not The final mare was a 9-year-old carry that foal to term.

Arabian who showed signs of early Ascending placentitis involving cervical pole and Veterinarians should consider mammary development and lactabody of the placenta, showing thickening of the applying a cervical cerclage suture tion. She had a history of stillbirth allantochorion, loss of chorial villi and presence of exudate in mares that previously suffered and dystocia and had been bred ascending placentitis and fetal naturally late in the season and not loss, whenever signs of premature relaxation are adbeen checked for pregnancy. Ultrasonography showed vancing, despite the administration of progestagens. signs of premature cervical ripening and ascending The time when a cervical cerclage suture is required placentitis. may vary between 4 and 8 months gestation. MeV

Performing the cerclage

Bucca says that she performs the application of the purse-string suture over the vaginal os of the cervix with the mare sedated (detomidine HCL 0.02 mg/kg and butorphanol tartrate 0.04 mg/kg) and restrained in stocks. The rectum is emptied and the perineal area is cleaned. Make sure the tetanus prophylaxis is current.

She uses modified Finochietto retractors and a good source of light to visualize the mare’s cervix.

Using long-handled Knowles forceps, she grasps the cervix and applies a purse-string suture using a single-stranded No. 2 nylon suture to the outer mucosal layer. The suture is made up of three partial-thickness bites, about 1.5 to 2 cm long, which are applied to the circumference of the os, the length depending on the relaxation and size of the relaxed oz. Start dorsally at a 2 o’clock position and end at the 11 o’clock position. Make sure to avoid penetrating the cervical lumen. Bucca normally ties the knot between 11 and 1 o’clock positions.

“It is important to try to place the knot in the dorsal position for easy removal,” she explained.

The mares receive medical treatment (antimicrobials, NSAIDS and altrenogest) prior to and for 5-7 days postprocedure.

Follow-up includes ultrasonography immediately following the procedure, again in a few days, and then about every 2-3 weeks.

Suture is removed on due date or in the presence of impending parturition and the procedure is carried out in the mare restrained in stocks under sedation, using Finochietto retractors and long-handled scis-

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dermatology

Researchers Test Cutting-Edge Therapy for

Stubborn Skin Tumors A new treatment may help horses with recalcitrant tumors Even though sarcoid tumors are almost always benign, they can be aggressive.

“Sarcoids are locally invasive skin tumors that we deal with often in equine medicine,” said J. Michael Cissell, DVM, MS, clinical assistant professor, large animal clinical sciences, at the Virginia-Maryland Regional College of Veterinary Medicine.

Typical patients are younger horses, but the tumors have occurred in horses of any age. Common locations for the tumors include the legs, face and ears. Often they occur after a prior trauma and

Paco, a Thoroughbred-Percheron mix, who stands 16.3 hands at the withers. Every two weeks this elegant, easygoing horse comes to the clinic to be treated for sarcoids.

“Paco is the first sarcoid patient we have treated using the H-FIRE system,” Cissell said.

The researchers are still trying to determine the actual effect H-FIRE has on the tumors that helps improve the condition. “We’re still assessing the actual effect of H-FIRE on these tumors but it may be that it helps to decrease the periphery of the lesion making removal more successful,” Cissell said.

Virginia-Maryland Regional College of Veterinary Medicine is accepting more patients with sarcoid tumors into its study.

A horse with sarcoids, which is not part of this study. www.boblangrish.com

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may appear in the same place as an old wound.

Researchers have begun using a new, experimental treatment called high-frequency irreversible electroporation or H-FIRE to treat this and other tumors. The treatment uses a long needle that delivers a short burst of electricity into specific places in the tumor.

Currently, the researchers and veterinarians studying this treatment have found that H-FIRE appears effective at controlling the tumor's growth, at least for one subject, 8-year-old,

In all, seven horses have served as clinical trial patients for H-FIRE for various types of tumors. Paco is a veteran having had the treatment a dozen times for lesions along his right jaw.

Although sarcoids just invade skin and don’t affect other organs of the body, they often recur, and can appear in areas other than the initial site. “Management of sarcoids can be difficult even though there are several treatment protocols available,” Cissell said. "All of the currently used treatments have their limitations.”

Improper surgery or an incomplete surgical effort can make matters worse; it is essential to get

Courtesy of Virginia-Maryland Regional College

Paco waits patiently while Drs. John Robertson and J. Michael Cissell use H-FIRE to treat his sarcoids.

good margins when removing the tumors.

The bioengineering team that developed H-FIRE and the veterinary team that is using it in the equine clinical trials plan to start trying it on melanomas and squamous cell carcinomas, both malignant tumors, that can develop in horses and people.

To do this and to refine the treatment on horses with sarcoids, they need a larger generator. The generator delivers the electric pulses and must be custom made. Funding for that currently isn’t available, according to Rafael Davalos, PhD, who leads the research team from the Virginia Tech-Wake Forest University School of Biomedical Engineering and Science.

“One of the challenges is the generator isn’t as powerful as we’d like for a horse,” said Davalos. “With a larger one, we wouldn’t have to do as many treatments. A custom-built pulse generator would cost $50,000 to $60,000.”

Paco has undergone all of the treatments currently available to fight sarcoids. His tumor first appeared about the size of a silver dol-

lar on his right jaw line when he was about 4 years old. It didn’t become a problem until about two years later when he scraped it on a tree while he and his owner, Fred Powell, were on a trail ride. “Every time we’d treat the sarcoid with traditional methods, it came back as big as a fist in a week,” Powell said.

The tumor has continued to recur although sometimes in a spot adjacent to the last one treated.

The needle that carries the pulsating 800-850-volt electric charge to the tumor stays in each spot 3 minutes and then is reinserted about 1 cm away. It does not burn the horse because it is not a continuous charge and it is only focused on the tumor cells. The electric pulse is one burst of energy per second with each burst lasting about 100 microseconds.

Paulo Garcia, a member of the bioengineering research team who was monitoring Paco’s vital signs throughout a recent treatment, said that the actual charge feels like a mosquito bite. A local anesthetic is given before the treatment. Cissell and Davalos said being able to perform this treatment with just local

anesthesia so the horse can remain standing would be one advantage of H-FIRE. They think that this treatment method may be applicable for other types of tumors and diseases in which it’s better for the patient to be awake to measure the effectiveness of a procedure.

H-FIRE is not yet available for commercial use and much more research is needed before it is.

Until then, owners and referring veterinarians should not be concerned about referring these patients for surgery, because the surgical procedure for sarcoids is largely successful. Most surgeons also use ancillary therapy postoperatively, which helps tremendously.

The researchers at VirginiaMaryland Regional College of Veterinary Medicine are accepting more horses into the clinical trial if you are treating a refractory case.

The patients for the trial are those horses for whom traditional treatments have been ineffective. The veterinarians and the biomedical engineering team hope to test the new treatment on 15 more horses in the next year.

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Stem-cell & IRAP therapy appears successful for stifle injury repair in performance horses

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Photo courtesy of Vet-Stem

during this period, but follow-up information was only available for 42.

Success was measured as a horse that returned to full work and remained working for more than one year follow-up. A treatment failure was a horse that required analgesics or ongoing treatment for intra-articular medications to return to work for more than one year or if they did not return to work for more than one year.

Rich found that treating stifle injuries with stem cells and IRAP improved athletic outcomes, performance longevity and shortened the recovery times for most of the horses: • 64.3% (27 horses) returned to work at their prier or higher level of performance; • 28.5% (12 horses) returned to work at a lower level of performance; • 7.2% (3 horses) did not return to work.

None of the horses displayed any obvious recurrent lameness during the follow-up period. Age, breed and discipline appeared to have little or no effect on the outcome.

Rich also found evidence in this study to support the continued use of these treatment methods for successful treatment of bone, cartilage, and ligament injuries/lesions of the equine stifle.

The research was presented recently at the North American Veterinary Regenerative Medicine Association Conference in Atlanta.

Rich’s findings demonstrated good to excellent (more than 64%

Stem Cell Therapy in Development Vet-Stem is evaluating the use of stem cells for treatment in: • Laminitis • Uveitis • Heaves

Photo courtesy of Vet STem

Good to excellent results were demonstrated in horses with lameness caused by stifle injuries/lesions treated with adipose-derived stem cells (ADSC, Vet-Stem) and interleukein-1 receptor antagonist protein therapy (IRAP).

Stifle injuries causing ongoing lameness are relatively common in performance horses and have prematurely ended many an equine athlete’s career. Stifle problems can be refractory to treatment and have long recovery times, explained Ross Rich, DVM, PA-C, of Cave Creek Equine Surgical and Diagnostic Imaging Center in Arizona.

In a retrospective study from 2005 to 2011, 42 horses that were no longer able to perform their athletic discipline due to lameness resulting from stifle injuries were treated with ADSC and IRAP, with or without arthroscopy-assisted treatment. Arthroscopy was performed in horses when more diagnostic information was needed or the injuries were severe and required débridement. Thirty-seven horses (88.1%) had bilateral stifle problems.

All lameness was diagnosed with a lameness examination, diagnostic anesthesia, radiographs, ultrasonography, nuclear scintigraphy and/or MRI, and were classified by severity, location, number and types of lesions, and chronicity, according to Rich.

Using ultrasonographic and/ or arthroscopic guidance, the abnormal stifles were injected with ADSC-IRAP. All horses also received 6 months of standard rehabilitation treatment.

In all, 64 horses were treated

of the patients) long-term return to full work, in horses with lameness caused by stifle injuries, treated with arthroscopy, stem cell therapy by Vet-Stem, and IRAP.

History

In the last decade, 10,000 animals, mostly horses, dogs and cats, have been treated with the regenerative stem cell therapy provided by Vet-Stem Inc. Robert Harman, DVM, founded VetStem in 2002 seeking to discover a successful treatment for horses with potentially fatal injuries to tendons and ligaments. In 2003, Vet-Stem signed a worldwide exclusive license for ADSC technology for veterinary application, and the first horse was treated. MeV

For more information: Rich R, Carpenter E. Outcome of 42 horses with stifle injuries treated with adipose-derived regenerative cells and IRAP. Presented at the Fourth Annual NAVRMA Conference. Atlanta. Nov. 10-13, 2013.

ModernEquineVet.com | Issue 2/2014

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Practice management

How does an equine practice

reach the next level?

A veterinarian would not try to remedy a medical problem without proper diagnosis and a treatment plan. Why would he or she try that approach for a growing a veterinary practice? Taking action without first developing a plan can do more harm than good, according to press materials provided by PeopleFirst, a Zoetis program.

Planning was an important step for Carolina Equine Hospital, with a new location in Browns Summit, N.C. The practice was growing, and its staff members needed to make sure they had a clear vision for the practice over the next five years.

Developing a plan

“It can be very stressful when you just show up to work, you pay your bills and you have no idea where your business is going,” said Dr. Andrea Boyer. “Without having an overall plan, you’re going to end up struggling. You’re not going to have that team of support in the office. You’re not going to have the growth that you need to sustain a practice.”

For veterinarians, advancing

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a practice means not only providing exceptional animal health care services but also focusing on good management, marketing and financial planning.

“Most of us as veterinarians are so busy practicing veterinary medicine that we don’t take time to plan a treatment program for ourselves and our business,” Dr. Rebecca Stinson said. “Without a treatment plan for your business, your business is going to have a hard time measuring response to treatment. Not having the ability to measure response, you won’t know when you need to make adjustments in your plan.”

To help develop a strategic plan, they sought guidance from PeopleFirst Strategic Planning Services from Zoetis.

“Our PeopleFirst consultant, Dr. Bob McManus, was a veterinarian who had been in mixedanimal practice,” Stinson said.

“He had a real concept of what the industry was doing nationwide and really understood our needs.”

The strategic planning process helps define business objectives and identifies an overall stra-

tegic direction. Once a plan is developed, the consultant helps the practice understand when to activate each stage specific to the clinic or business. After completing this, owners should walk away with a strategic intent statement, business objectives, core strategies, and action and monitoring plans.

With their consultant, the staff at Carolina Equine was able to set out some basic objectives.

The process involved breaking everything down into steps for short-term and long-term goals and determining who would be responsible for each objective.

Dr. Rebecca Stinson leads a patient into the barn at Carolina Equine Hospital.

Photo courtesy of PeopleFirst , a Zoetis program

“We came out of that meeting very motivated,” Boyer said. “We felt good about our company, and we felt good about our plan.

We’re each able to work toward the whole picture.”

With their written plan, they will strive as a practice to accomplish the goals they set by 2017.

The team has follow-up sessions with their consultant to review strategic statements, provide feedback and discuss how to use these tools to better engage the staff. They also will measure their

The consultant helped break down the 5-year plan into short- and long-range goals for growth.

progress and review benchmarks they have set for the practice — such as in-hospital patients, haulin visits, dollars per transaction and the net profit per client visit.

“These are benchmarks we can measure time and time again,” Stinson said. “It was great to sit down and see that when we all think about it and talk together, we recognized that we all want to go in the same direction together.”

For more information, go to www.peoplefirst.com.

MeV ModernEquineVet.com | Issue 2/2014

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News NOtes

Dad’s genes build placentas, explaining grandsire effect Placentas support the fetus and mother, but those organs grow according to blueprints from the father, according to new research at Cornell University. The study, published in the Proceedings of the National Academy of Sciences, shows that the fetal genes donated by the father dominate in building the fetal side of the placenta.

Genes normally work in pairs: one from each parent, but about 1% of mammalian genes choose sides, a phenomenon called genomic imprinting. Imprinted genes use molecules that bind to DNA (epigenetic tags) to quiet one half and let the other lead. In the study, the researchers discovered 78 new imprinted genes using horse-donkey hybrids.

“This is the first study to offer an unbiased profile of novel imprinted genes in a mammal other than mice,” said lead author Xu Wang, a postdoctoral associate in the laboratory of Andrew Clark, professor of molecular biology and genetics.

Most of the imprinted candidates were paternally expressed, and this expression bias was lost when the

transcriptomes of fetal tissues were examined. At the same time, paternally imprinted genes heavily regulate placental development in these animals.

“Mouse experiments showed that if all DNA comes from the mother, the embryo grows quite well, but not the placenta, suggesting some degree of sexbased division of labor between programming the placenta and the embryo,” said Wang.

Their approach can identify imprinted genes that may be linked to racehorse traits and which could help breeders. “This discovery explains what breeders call the maternal grandsire effect,” said Doug Antczak, equine geneticist at Cornell’s College of Veterinary Medicine. “Some genes, like so-called speed genes in great racehorses, skip a generation and only express in grandchildren if their carrier was a certain sex. For example, most foals of history’s best racehorse, Secretariat, raced poorly. So did his sons’ offspring. But many of his daughters’ foals were outstanding racehorses.”

MeV

For more information: Wang X, Miller DC, Harman R, et al. Paternally expressed genes predominate in the placenta. PNAS 2013 110 (26) 10705-10710. http://www.pnas.org/content/110/26/10705.full.pdf+html?sid=6073b330-8790-4cd5-aa92-346cf1c0a073

AAEP Convention brings nearly 6,600 to Music City for equine education The 59th Annual Convention of the American Association of Equine Practitioners, held Dec. 7 – 11 in Nashville, Tenn., attracted 6,592 veterinary professionals, guests and exhibitors, making it the fourth largest convention in the AAEP’s history.

Highlights from the 2013 convention include:

Installation of new officers and board members. Jeff Blea, DVM, Sierra Madre, Calif., was installed as the 60th president. Other members of the 2014 Executive Committee are Kent Carter, DVM, College Station, Texas, president elect; Kathy Anderson, DVM, Elkton, Md., vice president; Jim Morehead, DVM, Lexington, Ky., treasurer; and Ann E. Dwyer, DVM, Scottsville, N.Y., immediate past president.

New members of the board of directors are Mark Baus, DVM, Bridgewater, Conn., and Stuart E. Brown II, DVM, Lexington, Ky.

Annual awards presented.

In addition to four days of education covering topics ranging from pain management to sport horse medicine, the Convention featured famed horse trainer Buck Brannaman as the keynote speaker.

Renowned lameness expert Dr. Sue Dyson delivered the prestigious Frank J. Milne State-of-the-Art Lecture.

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The association honored several veterinarians during the Dec. 10 President’s Luncheon.

Distinguished Life Member: Benjamin Franklin Jr., DVM Distinguished Service Award: Harry W. Werner, VMD Distinguished Educator Award - Academic: Frank Nickels, DVM Distinguished Educator Award – Mentor: Barrie D. Grant, DVM President’s Award: Edward W. Kanara, DVM

news notes

Cornell University’s College of Veterinary Medicine has signed a lease-buy agreement with Racebrook Capital Advisors LLC for the former Ruffian Equine Medical Center to establish Cornell Ruffian Equine Specialists, a referral and emergency hospital.

The hospital, located near the Belmont Racetrack in New York, is expected to open April 1, and will provide elective specialty services to horses referred by their attending veterinarians. Full emergency and critical care services will be offered by Spring 2015. The Ruffian specialists will partner with referring veterinarians to meet the needs of NY racing and the surrounding sport horse communities.

Cornell University veterinarians and technicians will staff the 22,000 sq-ft state of the art facility, which will offer advanced orthopedic and soft tissue surgery and re-

generative therapies, internal medicine and a diagnostic modalities including advanced imaging such as MRI, CT, nuclear scintigraphy, high-speed treadmill endoscopy, arthroscopy and laboratory services.

In related news, the NY State Gaming Commission appointed Scott E. Palmer, VMD, as the state’s Equine Medical Director. Palmer, a renowned veterinarian from New Jersey with more than Dr. Scott E. Palmer three decades of experience in providing medical care for horses, will oversee the health and safety of horses at all New York State Thoroughbred and Standardbred racetracks. Palmer will be responsible for all aspects of equine health, safety, and welfare at New York racetracks. MeV

IDEXX introduces equine respiratory Real PCR Panel with 5 new pathogens IDEXX Reference Laboratories has added five new pathogens to its Comprehensive Equine Respiratory RealPCR Panel : equine rhinitis A and B viruses, equine herpesvirus (HSV) types 2 and 5 and equine adenovirus.

These are in addition to the tests in the original panel, which included HSV-1 and -4, Streptococcus equi subsp. equi and equine influenza virus.

Veterinarians can also add a test for equine arteritis virus.

Equine respiratory disease is one of the most prevalent issues equine veterinarians face, and the panel provides a convenient, economical way to quickly and accurately test for nine of the most common respiratory pathogens. Identifying the causative pathogen is critical for determining treatments and implementing biosecurity protocols, and a quick diagnosis can prevent a serious problem, particularly in commercial barns that have resident horses transported regularly to and from horseshows or races.

"With one sample, up to nine respiratory disease pathogens can be detected or ruled out, quickly, accurately and economically, and practitioners can give clients more comprehensive diagnostic IDEXX Reference Laboratories offers new pathogens to its comprehensive diagnostic panel information.," said Christian Leutenegger, head of Molecular Diagnostics at IDEXX. When the original equine respiratory panel launched in 2008, real-time PCR results indicated that, in many cases, more than one pathogen was detected. As the new Comprehensive Equine Respiratory RealPCR Panel went through clinical validation, multiple pathogens were again detected in equine respiratory cases. In addition, the equine rhinitis A and B viruses were detected in 4-20% of the samples tested. With the additional tests, this new panel should allow clinicians better capability to assess and differentiate the likely cause of the disease. The Comprehensive Equine Respiratory RealPCR Panel is available by calling IDEXX Reference Laboratories at 800-621-8378.

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Purina introduces new feed Purina Animal Nutrition recently introduced IMPACT Horse Feed, a line of premium feeds at a non-so-premium price.

Designed to meet the nutritional requirements for horses of all types and lifestyles, the product line offers textured, pelleted and complete feeds.

Photo by Shutterstock/AG-PHOTO

Cornell to open specialty-ER hospital near Belmont Park

Extensive research in feed intake, digestive physiology, breeding and foal growth, and development and exercise physiology allow nutritionists to formulate, develop, and test the performance of IMPACT before marketing.

The new feed offer several benefits: • High-quality protein for muscle maintenance • Added fat for sustainable energy and healthy hair coat • Nutritional balance, removing the need for supplements • Formulated with ingredients that support overall horse health “Purina is dedicated to creating unsurpassed nutrition for every type of horse, and IMPACT horse feeds are a reflection of that dedication,” said Katie Young, PhD, manager equine nutritional services, Purina Animal Nutrition.

“Our feeds are made with the finest ingredients and backed by research, so owners can trust that they’re feeding their horses high-quality nutrition.” MeV For more information, visit purinamills. com/horse-feed/impact or speak with your local Purina® dealer.

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AAEVT Membership

AAEVT* membership is open to US and international equine veterinary technicians, assistants, practice managers, and support staff employed in the veterinary industry. It is also open to students of AVMA/CVMA accredited programs

AAEVT Membership • • • • • • • •

Bi-Annual Newsletter Weekly “HoofBeats” email NEwsblast Full access to www.aaevt.org, including the Career Center and the Library Up-to-date information on the AAEVT Discounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT Convention NTRA, Working Advantage and Platinum Performance Benefits The opportunity to participate in the AAEVT Online Certification Program or to become a member of the AEVNT Academy-Specialty in Equine Veterinary Nursing • Scholarship opportunities.

• AAEVT’s Equine Manual for Veterinary Technicians (Blackwell Publishing 20% discount on purchase price) • Subscription to THE HORSE Magazine, compliments of Intervet Schering/Plough Opportunity to attend Purina’s Annual Equine Veterinary Technician Conference All Expenses paid!

AAEVT Objectives • • • •

Provide opportunities for CE, training, communication, and networking Educate the equine veterinary community and the public about our profession Inform Members of issues affecting our profession Assist in providing the best medical care to improve the health and welfare of the horse

AAEVT Online Equine Certification Program

• A three course, 10 module, equine-only online program offered through ACT • Geared toward Credentialed Veterinary Technicians, Assistants, Support staff, & Students • Areas of study include: equine medical terminology, anatomy and physiology, parasitology, laboratory, diagnostics, equine basics (breeds, wellness, husbandry,) diagnostic procedures, emergency medicine, restraint, pharmacology, surgical assistance and anesthesia, equine office procedures • A certificate of completion is awarded to those who: Successfully complete required courses Complete the list of required skills (per a supervising DVM who is an AAEP member) Attend an AAEVT regional CE symposium and participate in the we labs • Those individuals who successfully complete the programs will be recognized as AAEVT Certified Equine Veterinary Technicians / AAEVT Certified Equine Veterinary Assistants depending on their current designation. The certificate is recognized by the AAEVT and the AAEP but does not grant the credentialed status by the AVMA • For more information go to www.aaevt.4act.com or call 800-357-3182

AAEVT Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.

For more information visit www.aaevt.org

*American Association of Equine Veterinary Technicians and Assistants

technician update

Colic management requiring blood transfusion

By Heather R. Hopkinson, RVT, VTS-EVN On June 17, 2013 at 10:25 pm, an 18-year-old Quarter horse mare was admitted to the North Carolina State’s Veterinary Teaching Hospital (NCSU-VTH).

The mare, who weighed 461 kg, presented with a one-day history of colic. Management by the referring veterinarian included 500 mg of flunixin meglumine (Banamine injectable, Merck Animal Health) and an unknown dose of both butorphanol and N. butylscopolammonium bromide (Buscopan injectable solution, Boehringer Ingelheim Vetmedica).

Upon arrival, the mare received a physical examination, which showed that there were some abnormalities. She had a heart rate of 76 beats/min with normal sinus rhythm. Mucous membranes were icteric and dry with a capillary refill time of 3 seconds. She also had decreased gut sounds in all four quadrants. Her initial blood work also showed some abnormalities.

Packed Cell Volume (PCV) was 13%, creatine kinase was mildly elevated at 824 units/L, total bilirubin was markedly elevated at 10.1 mg/dL, and marked hemolysis was shown on the serum biochemistry.

At this time a nasogastric tube was place yet yielded no net reflux so 4 L of water with electrolytes was given through the nasogastric tube. A 14-gauge 5.25 inch over the needle intravenous catheter was placed in the mare’s right jugular vein and secured in place with suture (2-0 Ethilon on a straight needle). The abdominal ultrasonography revealed no significant findings and rectal palpation revealed dry, mucous covered feces.

It was noted when the mare was placed in her stall that her urine was extremely red and dark.

Due to the blood work and clinical signs, reasons of intravascular hemolysis had to be ruled out, including oxidative damage, such as red maple toxicity, infectious causes, such as piroplasmosis, as well as, immune mediated or iatrogenic causes.

Initial medical management included conservative intravenous fluid therapy (lactated Ringers solution) supplemented with calcium gluconate, antioxidant therapy (ascorbic acid and acetylcysteine), flunixin, and analgesics. The mare was closely monitored for laminitis, colic and ischemic organ damage.

On June 19, the mare showed clinical signs of colic

but was managed with flunixin and butorphanol. She still had hematuria and a decreased PCV. Methemoglobin measurements came back as normal and a Coomb’s test was run, which also came back negative. The mare’s PCV continued to decrease, and she continued to be tachycardic.

On June 20, the PCV had dropped to 12% and the mare had a heart rate of 70 beats/min. She needed a blood transfusion.

A mare that had already been cross-matched was brought up from our donor herd.

A 10-gauge 5.25 inch over the needle IV catheter was placed in the donor mare’s left jugular vein and secured in place with suture (2-0 Ethilon on a straight needle). She was given 500 mg of flunixin IV before collecting 8 L of blood. The donor mare was placed in a stall and given 10 L of lactated Ringers solution IV through a gravity system. She stayed overnight for constant observation.

The patient received the full 8 L of blood at a rate of 1 L/hr. Mild blood transfusion reaction was noted evident by urticaria, which resolved with methylprednisolone administration. The mare was closely observed for any other reactions yet continued to be bright and responsive. She gradually continued to improve after the blood transfusion. A PCV was performed on June 21, which showed that her hematocrit had gone up to 16%.

Her PCV continued to increase thereafter.

After showing continual improvement, the mare was gradually tapered off flunixin, which was eventually discontinued on June. The IV fluids and ascorbic acid was also discontinued.

The mare was discharged on June 27 after a 10-day stay in the hospital. Discharge instructions did not include any medications. She was to gradually transitioned back to her normal diet. It was recommended that the mare not have any forced exercise for 6 to 8 weeks but could receive limited pasture turnout as long as she remained quiet. The mare’s final diagnosis was anemia due to intravascular hemolysis (suspected Red Maple toxicity).

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About the Author

Heather, RVT, VTS-EVN, has work at the North Carolina State University Large Animal Hospital for eight years and has experience in neonatal and intensive critical care of equine patients. She currently holds the office of President-Elect for the Academy of Equine Veterinary Nursing Technicians.

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