Equine Vet www.modernequinevet.com
Vol 8 Issue 2 2018
Therapy for Foals Still in Its Infancy New Surgical Technique for Laryngeal Neuropathy New Guidelines for EGGD Management Technician Update: Managing Uterine Torsion News from the AAEP Meeting
TABLE OF CONTENTS
Therapy for Foals
6 Still in Its Infancy Cover photo: Scandphoto / Shutterstock.com
Check Around Back........................................................................................................................10 TECHNICIAN UPDATE
Managing Uterine Torsion in a Late-Stage Mare............................................................14 NEWS
New Surgical Technique for Recurrent Laryngeal Neuropathy Appears Successful....................................... 3 New Stem Cell Harvesting Site Means Less Pain and Stress...................................................................................12 New Guidelines: EGGD Complex Disease..........................................13 THE BUSINESS OF EQUINE MEDICINE
Equine Veterinarians in Good Shape....................................................................................17 ADVERTISERS Shanks Veterinary Equipment.................................. 3 Datamar......................................................................... 4 Merck Animal Health.................................................. 7
Standlee Premium Western Forage......................... 9 AAEVT............................................................................15
Equine Vet SALES: Matthew Todd • ModernEquineVet@gmail.com Lillie Collett • ModernEquineVetSales@gmail.com EDITOR: Marie Rosenthal • firstname.lastname@example.org ART DIRECTOR: Jennifer Barlow • email@example.com CONTRIBUTING WRITERS: Paul Basillo • Carol Jean Ellis Jason Mazda COPY EDITOR: Patty Wall Published by PO Box 935 • Morrisville, PA 19067 Marie Rosenthal and Jennifer Barlow, Publishers PERCYBO media publishing
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New Surgical Technique for Recurrent Laryngeal Neuropathy Appears Successful A novel technique for the treatment of recurrent laryngeal neuropathy (RLN) could offer a better physiological outcome than prosthetic laryngoplasty.
Seventeen horses underwent the procedure, all without complications from the surgical technique. Twelve horses received postoperative stimulation of the first cervical nerve, 11 of which showed a positive response (defined as a clear twitching and submaximal to maximal abduction of the left arytenoid). Fourteen horses had both pre- and postoperative exercising endoscopy performed; nine saw an improved RLN grade after surgery, four were unchanged and one had deteriorated. Abnormal respiratory noise resolved in 14 of the 17 horses. The success rates of RLN were comparative to prosthetic laryngoplasty, according to the researchers. MeV
Courtesy of The Equine Veterinary Journal
Lifting Large Animals Since 1957
Novel nerve transplantation procedure for RLN
Surgeons from France, Germany, the United States and the United Kingdom investigated a novel surgical technique to treat RLN. Horses of various breeds with grade â‰Ľ2/4 RLN at rest underwent the nerve transplantation procedure, which involved the first or second cervical nerve being tunneled through the left cricoarytenoideus dorsalis muscle to reinnervate it. Successful reinnervation was confirmed within 12 months of the surgery by stimulating the first cervical nerve under ultrasound guidance in addition to resting and exercising endoscopy being performed on most horses once back to work.
For more information: Rossignol F, Brandenberger O, Perkins JD, et al. Modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy (RLN) in horses. Equine Vet J. 2018 Jan. 5 (Epub ahead of print). http://onlinelibrary.wiley.com/doi/10.1111/evj.12788/full
www.shanksvet.com â€˘ firstname.lastname@example.org ModernEquineVet.com | Issue 2/2018
DON’T SKIP THE EQUINE CHIP: A review of new equine microchip regulations B Y
A M Y
V A N
G E L S ,
D V M
SPONSORED BY DATAMARS
icrochip implantation in horses has gained considerable traction in recent years. As myths regarding microchips have been disproved, attitudes regarding microchipping among horse owners have improved dramatically. Horse owners now have a heightened awareness regarding the safety, reliability and ease of implantation of microchips. Margaux Buchanan, DVM, from South Shore Equine Clinic and Diagnostic Center in Plympton, Mass., has noticed a shift in attitudes about microchips among her clients. “My clients frequently ask for microchips, and they respond positively when I recommend them. Just last week, we implanted five chips at one barn, and our practice implanted about 100 last year, especially during annual spring vaccines.” Dr. Buchanan believes this change may have occurred in part because clients have more confidence that the chip won’t break or migrate and have fewer reservations about the size of the implanter needle. “I use a local block before implanting microchips. Clients are pleased with how well horses tolerate the procedure.” Sporting organizations, governmental groups and breed registries are also taking note of the advantages that microchips offer for positive identification. Many are changing their policies to require microchipping. The US Equestrian Federation (USEF), the US Hunter Jumper Association (USHJA), and the Jockey Club all have new regulations about microchipping. The Fédération Equestre Internationale (FEI) and the British Show Jumping Association are international sporting groups that require microchips. Breed regis-
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tries, such as Rheinland Pfalz-Saar International and the Oldenburg Horse Breeders’ Society, also have microchip requirements. Dr. Buchanan has seen an increase in awareness among her clients about these new regulations. “I see a lot of horses that compete. Their owners are aware of the new rules and are asking for microchips.” Because the American Association of Equine Practitioners (AAEP) classifies microchipping as a veterinary procedure, implantation must be performed by—or under the supervision of— a veterinarian. This article reviews the new regulations to help veterinarians stay abreast of the new rules.
USEF and USHJA To better trace a horse’s competition history and to positively identify horses, the USEF requires that USHJA-registered horses must be microchipped. The rule consists of two phases. As of Dec. 1, 2017, horses that do not have a microchip cannot receive points and/or prize money for any Hunter, Hunter Breeding, Jumper, and Hunter/Jumping Seat Equitation classes not restricted by breed. After Nov. 30, 2018, horses without a microchip will not be able to compete in any Hunter, Hunter Breeding, Jumper and Hunter/ Jumping Seat Equitation classes not restricted by breed USEFlicensed competitions. It is important to note that the USEF states that microchips must have 15-digits and comply with ISO standard 11784 and 11785. The microchip should be implanted in the nuchal ligament on the leftARTICLE SPONSORED BY DATAMARS
side of the neck, halfway between the poll and the withers. Michelle Bray, the Managing Director of Customer Care and Horse Services at the USEF, states, “In addition, the USEF strongly encourages that the microchip be registered by the International Committee for Animal Recording (ICAR) so that it does not have duplicate number or a shared code. At this time, we are considering a rule change to include specific microchip criteria to exclude any chance of duplication.” Until such a rule is in place, veterinarians should avoid using microchips that begin with the numbers 900-, 911-, or 999-. Microchips that start with 900- are very difficult to trace to a specific provider, those that begin with 911are not recognized by ICAR, and microchips that start with 999- are test chips—not intended for use as positive identification. Utilizing microchips from a reputable company, such as Datamars™, can ensure that an appropriate chip is used.
MICROCHIPPING PROTOCOL Ensure the identity of the horse. Scan for an existing chip with a universal scanner. Shave and disinfect the implantation site. Utilizing a local block can help alleviate patient discomfort. Consider mild sedation for especially fractious horses. Scan the chip prior to insertion. Verify that it does not start with 900, 911, or 999, and check that it matches paperwork.
ernmental groups are beginning to rely on microchipping for positive identification and to trace disease outbreaks. The state of Louisiana mandates that horses are positively identified with a microchip as part of its Coggins testing policy. Since 2009, the European Union has required a microchip for all horses older than 6 months of age. The United States government requires that horses be positively identified for interstate transportation but does not yet have a microchip requirement. Because microchips are less painful than branding or tattooing, they are an obvious recommendation for horses that do not have another form of identification. Even though more and more organizations now require microchipping for positive identification, it is not just these horses that are receiving microchips. Dr. Buchanan says that she recommends them for all horses, even those that never leave their owner’s backyard. Microchips can help reunite owners with their horse in the event that it is stolen or lost, especially after a natural disaster. Because of their traceability, they can also help deter theft. Similarly, they can help prevent fraud and improve confidence during a transfer of ownership. Because of these reasons and the new regulations discussed, microchips are being used much more frequently across all categories of horses.
Implant the microchip into the nuchal ligament, halfway The Jockey Club has also passed new microbetween the poll and the chipping requirements. All Thoroughbred withers, on the horse’s left side. foals of 2017 and later now need to be microchipped. The microchips must be inserted priAfter insertion, scan the or to or at the same time as registration, when injection site with a universal a DNA sample and photographs are taken and reader to confirm the placement the horse’s official markings are recorded. At and number of the chip. least one photograph of the scanned microchip number also needs to be submitted to the Jockey Club. The Jockey Club states that the microchip provides “an additional layer of confidence” in posiABOUT THE AUTHOR: tively identifying the Thoroughbred. Similar to the USEF, the Jockey Amy Van Gels, DVM, is a veterinarian and freeClub requires an ISO 11784/11785-compliant microchip to be imlance medical writer. She draws on her experiplanted in the nuchal ligament on the left side of the neck, halfway ence in clinical practice to write educational between the poll and the withers. information for pet owners, training documents for sales teams, and technical papers Governmental Regulations for veterinarians. For more information, please Microchip regulations do not just apply to sporting horses. Govvisit www.AVGmedicalwriting.com.
The Jockey Club of America
FOR MORE INFORMATION: Animal Disease Traceability Home. USDA APHIS Website. https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/SA_Traceability. Updated December 21, 2017. Accessed December 29, 2017. Lenz T. Chip your horse. American Association of Equine Practitioners (AAEP) Web site. https://aaep.org/horsehealth/chip-your-horse. Accessed December 29, 2017. Lindegaard C, Vaabengaard D, Christophersen MT, et al. Evaluation of pain and inflammation associated with hot iron branding and microchip transponder injection in horses. AJVR. 2009; 70(7): 840-847. Microchip FAQs. US Equestrian Federation (USEF) Web site. https://www.usef.org/forms-pubs/rkAyv3QcA9M/microchip-faqs. Accessed December 31, 2017. Microchipping 101. United States Hunter Jumper Association (USHJA) Web site. https://www.ushja.org/programs/rules/microchipping.aspx. Accessed December 29, 2017. Microchipping of Animals. American Veterinary Medical Association (AVMA) Website. https://www.avma.org/KB/Resources/Reference/Pages/Microchipping-of-Animals-Backgrounder.aspx. Accessed January 2, 2018. Microchips. Fédération Equestre Internationale (FEI) Web site. http://inside.fei.org/fei/your-role/veterinarians/passports/microchips. Accessed January 2, 2018. Stein FJ, Geller SC, Carter JC. Evaluation of microchip migration in horses, donkeys, and mules. JAVMA. 2003; 223(9): 1316-1319. Thoroughbred Microchipping Frequently Asked Questions. The Jockey Club Web site. https://www.registry.jockeyclub.com/registry.cfm?page=dotRegistryHelpDeskMicroFAQ#. Accessed December 29, 2017. ARTICLE SPONSORED BY DATAMARS
ModernEquineVet.com | Issue 2/2018
Therapy STILL IN for Foals ITS INFANCY Scandphoto / Shutterstock.com
Research needed for antimicrobial treatment of young foals
Sick neonates and foals are more likely to have a bacterial infection, but the pharmacokinetics of the antimicrobials are different in younger horses than adults. Which to use, when to use it, how much to use—all need to be considered carefully, said experts at the American Association of Equine Practitioners (AAEP) Annual Convention 2017 in San Antonio, Texas. Antimicrobial prescribing for foals would benefit from more reB
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search to determine best practices for various situations, according to Steeve Giguère, DVM, PhD, DACVIM, a professor at the University of Georgia College of Veterinary Medicine in Athens. Prescribing for Rhodococcus equi, a gram-positive organism that is a common cause of pneumonia among foals, is a case in point. Most animals with clinical signs of disease require therapy, but small pulmonary lesions re-
cover without antibiotics. The treatment of choice is the combination a macrolide and rifampin, but studies have documented macrolide- and rifampinresistance after widespread use to combat R. equi. Bacterial sepsis is another common problem in neonates and is a leading cause of mortality, making the antibiotic choice critical. But choice of drug becomes more challenging because of the foal’s metabo-
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Best antimicrobial prescribing practices vary from foal to foal and clinical situation to clinical situation. lism. The foal’s rapid growth changes their body weight and composition, metabolic activity, as well as liver and renal function. These are all factors that affect absorption, metabolism and clearance of antimicrobial agents. This is the same problem facing pediatricians. Children are not little adults when it comes to medications, and neither are foals. For instance, many oral betalactam antimicrobial agents that are poorly absorbed and cause digestive disturbances in adult horses can be administered orally to neonatal and young foals for treatment of systemic bacterial infections caused by susceptible microorganisms. The bioavailability of oral amoxicillin, for instance, is up to 50% in the week-old foal, but only 5% in adult horses. Veterinarians see a similar experience with oral cefadroxil, which decreases from 99% bioavailability in a 14-day old foal to about 15% by 5 months of age, according to Dr. Gigueres. But they don’t see this with every antimicrobial agent, he explained. Cefpodoxime has a similar bioavailability in the very young foal, the older foal and the adult horse.
Best practices can vary from case to case, according to J. Scott Weese, DVM, DVSc, DACVIM, a professor at University of Guelph’s Ontario Veterinary College. If a possibly septic neonatal foal is prescribed ampicillin and amikacin, but three days later the culture result indicates resistance to these drugs, the first instinct may be to change drugs. However, Dr. Weese suggested observing the patient’s response as well. “We sometimes get lost,” Dr. Weese said. “We get this ‘See bug, must kill’ response. Culture results are a good guide, but we must treat the patient. If the patient is not doing well 3 days later, then we can discuss other drugs. However, if the patient is doing swimmingly three days later, the resistant organism is likely a contaminant or was not relevant clinically. We still need to consider whether the improvement is due to other factors, such as fluid support. However, we often over treat because of culture results. The patient is really the key.”
Antimicrobial therapy considerations extend to pregnant mares, according to Mark Papich, DVM,
MS, DACVCP, a professor at North Carolina State University’s College of Veterinary Medicine. “We are coming up with a list of risks for drugs used in pregnancy; there is still a lot we don’t know,”he said. For both neonates, foals and pregnant mares, more research would improve treatment. In the meantime, Dr. Giguère has developed a guideline that offers solid advice (See For more information). “Treatment protocols for equine neonates must include antimicrobials with a high level of activity against enteric gram-negative bacteria while providing adequate coverage against gram-positive microorganisms,” Dr. Giguère said. “Bactericidal agents are preferred because neonatal foals have a naïve immune system and their defense mechanisms against bacterial pathogens might be compromised. The combination of an aminoglycoside (amikacin or gentamicin) with either penicillin, ampicillin, or ceftiofur is often initiated until culture results are available. Such combination provides adequate coverage against approximately 90% of bacterial isolates recovered from blood cultures.” MeV
For more information: Giguère S, Alfonzo T. Antimicrobial drug use in horses. In: Giguère S, Prescott JF, Dowling PM, eds. Antimicrobial Therapy in Veterinary Medicine. 5th ed. Ames, IA: Wiley-Blackwell;2013:457-472. http://onlinelibrary.wiley.com/book/10.1002/9781118675014 8
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Proud sponsor of:
Check Around Back While the effect of hoof imbalance in the forelimbs is well documented, a look at the hind limbs can be just as important. B
Photos courtesy of Dr. Tracy Turner
Medial to lateral imbalance, high medially
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Tracy Turner, DVM, DACVS, ACVSMR, has some earth-shattering news. As it turns out, the back end of the horse is kind of different than the front end. “I have spent the majority of my career talking about front feet, but then I started looking at the back,” he said at the 63rd AAEP Annual Convention in San Antonio, Texas. “I started to notice that rear hoof imbalances have largely been ignored. When was the last time anyone even brought it up?” Biomechanically, the hind limbs are attached directly to the axial skeleton via the pelvis, while the forelimbs are attached via muscle. Horses can adjust the forelimbs much easier than the hind limbs. As a result, an imbalance in the forelimbs will typically cause foot pain, while a rear hoof imbalance is more likely to cause problems higher up in the leg. The rear hooves are of comparable significance in the overall treatment and prevention of lameness. A broken hoof-pastern axis is the most common hind limb imbalance. The hind hoof is typically 5° more upright than the forefoot, but the dorsal hoof wall and pastern should be in the same alignment.
“At some point we just quit observing that,” he said. “We work so hard to get the front end done, but the back end is not that much fun to deal with. You slap shoes on there and call it a day. I think we’re having trouble with that now.” Some factors that can affect this alignment include age-related suspensory ligament weakness, frontfoot pain that can cause the horse to place the hind feet further under the body, and long toes and under-run heels in the front feet that lead to a similar postural change. “Pain in the front end has a huge effect on how the horse is going to stand on its hind legs,” he said. “What do horses do to relieve pain in the front end? They shift the weight to the back. Even horses with long toes and under-run heels just try to get some relief by moving things around a little bit.” Often with this posture, the overloading of the rear heels can retard heel growth. While a diagnosis of hoof pain in the rear feet is rare, Dr. Turner said the pain has a different presentation. He noted that a veterinarian can miss more problems by not looking than by not knowing. A stringhalt gait is one of the
Low heel foot radiograph
Low heel foot
Low heel with bull nose
Negative sole angle
most common gaits that indicates pain in this area, and a broken back hoof axis with a negative angle to the sole of P3 is one of the most common rear hoof imbalances that Dr. Turner encounters. “In my experience, tenosynovitis of the digital flexor tendon is the most serious of all these problems,” he said. While the horse still may be mobile, this tenosynovitis can lead to marked swelling of the sheath, pain and disruption of the blood supply to the tendon, Dr. Turner explained. The most common lameness associated with a broken axis is tarsitis, or inflammation of the hock. Dr. Turner said that as the frequency of
hock injection has increased in private practice, it may be masking a more serious problem. “People [sometimes] forget to look at the predisposing problems,” he said. “You start to look at these hocks, and you find these horses with telltale signs [on radiography] that show they’ve had a lot of hock injections. I like to call it the ‘corticosteroid mark.’”
Rebalancing the Horse
Raising the heels of the hind feet is done fairly frequently, but it can exaggerate a heel-first landing in the gait. This can further damage the hoof capsule, which is not helpful. “In the front end, the horse might
feel better with the raised heels,” Dr. Turner said. “In the hind end, the riders tend to complain about the altered gait.” In cases where a horse has a broken-back hoof-pastern axis, one treatment method is to remove the shoes and allow the horse to go barefoot for four to eight weeks. “You’re still going to trim the heels back until you get to a solid hoof wall structure,” Dr. Turner said. “Remove the toe and round the edges so they don’t break off, and then let the horse walk around. I don’t know why the hind end is so much easier, but if a horse walks around on a firm surface for four to eight weeks then it just fixes itself.” ModernEquineVet.com | Issue 2/2018
Prolapsed frog 1
Prolapsed frog 2
A second method that takes less time is to use direct pressure on the frog. After trimming the heel to get the hoof back into proportion, cut out a wedge pad so that pressure is applied to the frog. The hoof should then be wrapped. Make sure the horse is bearing full weight on it. “You want to put a little extra moisture on that foot and make the
horse stand on it, because the water will soften it up,” Dr. Turner said. “Then make the horse stand around for 24 to 48 hours on a firm surface. After that, come back and shoe the horse again, but don’t shoe it the same as it was shod before.” The third method is to trim the heel from the widest part cranially and trim the hoof cranial to the wid-
est part in a different plane to maximize unrollment. Afterward, shoe the horse in two planes. “Some people call it a rock and roll shoe, but I don’t care what you call it,” he said. “I call it a shoe in two planes. We’re taking a length of toe off of the hoof and making it turn to come underneath. It allows more wall to grow length.” MeV
New Stem Cell Harvesting Site Means Less Pain and Stress
Fluoresced equine endometrium stem cells (green) were identified using a stem cell marker. Credit: Elisabeth Rink/ Vetmeduni Vienna
European researchers have harvested stem cells from the endometrium of the equine uterus, causing reduced pain and stress for the animals. Researchers from the Centre for Artificial Insemination and embryo Transfer at Vetmeduni Vienna accessed the uterus nonsurgically using small instruments inserted through the cervix, harvesting mesenchymal stem cells from the endometrium, instead of from adipose tissue or bone marrow. “While the human endometrium is known to harbor stem cells, these had previously not been identified in equine endometrium,” said Elisabeth Rink, MagMedVet, from the center, who worked with Vetmeduni’s Christine Aurich, MD, PhD, and an international team to isolate, culture and characterized mesenchymal stem cells from the equine endometrium.
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The researchers collected uterine tissue samples from six mares, then separated suspected stem cells from endometrial epithelial cells and expanded these in cell culture, analyzing them using immunohistochemistry, genetic analysis and flow cytometry, to identify the stem cells through specific cell markers, according to Dr. Rink. They compared the endometrial cells with the bone marrow cells collected by traditional surgical techniques. Cells obtained from the uterus clearly expressed the same markers as bone marrow stem cells and differentiated into fat, bone, cartilage and muscle cell lines. MeV
For more information: Rink EB, Amilon KR, Esteves CL, et al. Isolation and characterization of equine edometrial mesenchymal stromal cells. Stem Cell Res Ther. 2017;8:166. https://stemcellres.biomedcentral.com/ articles/10.1186/s13287-017-0616-0
Equine Glandular Gastric Disease Is a Complex Syndrome
Courtesy of the UK-Vet Equine
Equine glandular gastric disease is cine specialists, based on a review a complex syndrome that is distinct of published and unpublished evifrom gastric ulceration. dence to provide veterinary pracEGGD is an inflammatory gastitioners with up-to-date guidance tritis, predominantly at the gastric on risk factors, diagnosis, treatoutflow, which has different causes ment, dietary management and and risk factors from gastric ulcers. prevention of EGGD. As such, medication effective in “Clinical guidelines are comtreating gastric ulceration may be monly used in human health care Moderate multifocal hemorrhagic and fibrinosupless effective for EGGD. and have been shown to improve purative lesions New evidence-based guidelines clinical outcomes by condensing on the management of EGGD have data from large numbers of reunderlined its distinct differences search publications and promoting from gastric ulcers and provided rapid adoption into clinical pracinformation for distinguishing betice. These new guidelines represent tween the two, as well as for prevena step forward in the management tion and treatment of EGGD. of this complex condition by comThe clinical signs of EGGD are bining a consensus of expert opindiverse and nonspecific and may be ion with the best available current mild or recurrent. They may include clinical research and evidence,” Hemorrhagic EGGD lesions changes in temperament, changes in said Josh Slater, PhD BVM&S, rideability, unexplained weight loss, professor of Equine Clinical Studreduced appetite or cutaneous sensiies at the Royal Veterinary College. tivity manifesting as biting the flanks or resentment of girthing, groomTreatment ing, leg aids or rugging. The guidelines offer logical suggesRecommendations for reducing tions for treating this condition, the prevalence of disease include explained Mark Bowen, BVetMed providing rest days from work, MMedSci (MedEd), PhD, CertVA, maximizing turn-out, minimizing DACVIM, PFHEA, FRCVS, proMarked multifocal depressed hemorrhagic and management changes and other pofessor of veterinary internal medifibrinosuppurative lesions tential stress factors and minimizing cine at the University of Nottingchanges in equine companions and human caretakers. ham who is based at Oakham Veterinary Hospital. Despite the high prevalence of EGGD, the evidence “Our findings challenge long-standing dogma on for the various treatments being used is limited, the EGGD, a condition about which there is currently guideline panel said. Treatment is complicated by the very little advice available to vets and horse owndiversity of the lesions. “Although EGGD is unlikely ers. It is becoming increasingly clear that the distincto be caused solely by acid injury, acid suppression is tion between disease of the squamous and glandular considered important for mucosal repair,” the panel mucosa is important clinically and the group felt that wrote. The guidelines offer detailed suggestions for updated guidance may help to improve management treatment. of EGGD in practice," said David Rendle, BVSc, “Our understanding of this condition is in its inMVM, CertEM (IntMed), DECEIM, MRCVS, an infancy but we hope that the summary document, which ternal medicine specialist at Rainbow Equine Hospital also highlights the gaps in our knowledge, will provide in North Yorkshire, United Kingdom, who chaired the a useful framework for vets to follow and will be a group. stimulus for future research,” Dr. Bowen said. MeV The new guidelines were developed by equine medi-
For more information: Rendle D, Bowen M, Brazil T, et al. Recommendations for the management of equine glandular gastric disease UK-Vet Equine 2018;2(1)3-11. https://www.magonlinelibrary.com/doi/full/10.12968/ukve.2018.2.S1.3
ModernEquineVet.com | Issue 2/2018
Managing Uterine Torsion
Photo courtesy of Sally Schwartz
By Sally Schwartz CVT A late-term pregnant recipient mare was presented to our hospital for further evaluation. The referring veterinarian was called out to the farm to evaluate her for colic. She had been mildly colicky for the past 36 hours. Upon rectal palpation she was discovered to have a uterine torsion. She was sent to us for confirmation of that diagnosis. Upon arrival, the mare was noted to be quiet, alert and in good body condition. Her exact age was unknown. She had successfully carried several other foals. On physical exam, her heart rate was 60 beats per minute, respiration rate was 12 breaths per minute, temperature was 100.3Â° F. Her mucous membranes were pink and slightly dry. The capillary refill time was less than 2 seconds. Gut sounds were present in all four quadrants. Digital pulses were prominent but not elevated. The mare had moderate udder development and distension in her lower abdomen consistent with late term pregnancy. Her calculated due date was her date of admission. Rectal palpation confirmed a counter
clockwise uterine torsion. The foal was palpated to be in normal anterior presentation within the uterus. A closed cervix was noted on vaginal exam. Transabdominal ultrasound showed a viable foal with a normal heart rate for its gestational age. After a lengthy conversation with the owners, the veterinarian decided to take the mare to surgery to correct the torsion. Presurgical blood work was fairly normal with the exception of creatinine and liver and muscle enzymes: creatinine was 2.5 mg/dL (RR 0.91.7 gm/dL); lactate dehydrogenase (LDH) was 2,797 U/L (RR 0-1839U/L) and aspartate aminotransferase (AST) was 529 U/L (RR 0-228 U/L). A short-term 14 gauge catheter was placed into her right jugular vein. Her abdomen was clipped and rough prepped with betadine scrub and alcohol. Her eyes were lubed with artificial tears and her mouth was washed. She was given the following for pre-op medications: IV potassium penicillin, gentamicin and IV flunixin meglumine. The mare was walked over to the surgery induction stall and sedated with butorphanol and xylazine. She was placed behind the squeeze door and received diazepam and ketamine for induction. She was intu-
The colt todayâ€” almost 15 hands.
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AAEV T M E M b E r s h i p Membership in the AAEVT is open to all veterinary technicians, assistants, support staff and those employed in the veterinary health care industry worldwide. Student membership is open to those currently enrolled in an AVMA/CVMA accredited veterinary technology program.
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Provide opportunities for CE, training, communication, and networking Educate the equine veterinary community and the public about our profession Inform Members of issues affecting our profession Assist in providing the best medical care to improve the health and welfare of the horse
AAEVT Online Equine Certification Program
• A three course, 10 module, equine-only online program offered through ACT • Geared toward Credentialed Veterinary Technicians, Assistants, Support staff, & Students • Areas of study include: equine medical terminology, anatomy and physiology, parasitology, laboratory, diagnostics, equine basics (breeds, wellness, husbandry,) diagnostic procedures, emergency medicine, restraint, pharmacology, surgical assistance and anesthesia, equine office procedures • A certificate of completion is awarded to those who: Successfully complete required courses Complete the list of required skills (per a supervising DVM who is an AAEP member) Attend an AAEVT regional CE symposium and participate in the we labs • Those individuals who successfully complete the programs will be recognized as AAEVT Certified Equine Veterinary Technicians / AAEVT Certified Equine Veterinary Assistants depending on their current designation. The certificate is recognized by the AAEVT and the AAEP but does not grant the credentialed status by the AVMA • For more information go to www.aaevt.4act.com or call 800-357-3182
AAEVT Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.
Fo r m o re i n f o r m a t ion v ist w w w.a ae vt.or g
*American Association of Equine Veterinary Technicians and Assistants
Photo courtesy of Sally Schwartz
The colt at home with its twin embryo, born 12 days sooner.
bated with a 26 mm endotracheal tube and hoisted onto the surgical bed. She was in dorsal recumbency. Once comfortably positioned on the bed she was hooked up to the anesthetic machine and monitoring equipment. IV fluids were bolused throughout surgery. Blood pressure was monitored through an arterial line placed in her transverse facial artery. ECG and pulse ox were also hooked up. She ran smoothly on isoflurane. Ventilation rate was 8 breaths per minute. She was maintained between 2.5 and 3% ISO. Heart rate ran a bit high at 42–46 bpm. Mean arterial pressures were steady between 80–95 mmHg. A ventral midline incision was made. Upon entry, a 360° uterine torsion was clearly present. The surgeon was able to manipulate it by bringing the left horn ventrally and across the incision. This was followed by manipulation of the right horn ventrally and across the incision from left to right followed by the left uterine horn being taken across the dorsal body wall to return to the left side. At this point the uterus was no longer torsed. Both broad ligaments, ovaries and uterine horns were in proper position. The surgeon briefly explored the rest of her abdomen and everything else appeared to be normal. The body wall was closed with number 3 Vicryl. The subcutaneous layer was closed with 2-0 Biosyn. Skin staples were placed. The incision was sprayed with aluminum bandage and covered with a long Biogard pad and Ioban. Overall surgery was time was less than 60 minutes. Anesthetic recovery was uneventful. The mare was recovered with head and tail ropes and stood on her first attempt. The surgeon noted the torsion corrected was much easier than he anticipated. The mare was moved to our CCU for post opera16
Issue 2/2018 | ModernEquineVet.com
tive care. She received IV fluids at a rate of 1L per hour for the next 24 hours. She received one more dose of potassium penicillin and flunixin meglumine. Due to cost, the owners elected to switch to procaine penicillin the following day. She still received gentamicin and flunixin for a total of three days. Overall, the mare was bright, alert and comfortable. She had a great appetite. The owners were going out of town and decided to have her stay with us until she foaled. A Foal Alert was placed on day four of her stay. She was moved to a larger foaling stall and placed under careful watch. On day 10 of her stay she decided to foal!!! The mare foaled at about 10:30 pm. Foaling was closely observed and no complications were noted. Within the hour the colt passed meconium stood up and began nursing. His navel was dipped with diluted chlorhexidine and he was given an enema. There were no immediate concerns about his health. The mare passed her placenta. It was noted to be normal in appearance and complete. Immunoglobulin G was tested at 12 hours of age and was low (IgG 143mg/dL). The physical examination showed a healthy active foal so it was tested again at 18 hours, and it was still low. The owners were contacted and it was agreed to run 2 L of hyperimmune plasma. The IgG was checked again 16 hours after administration of plasma, and it was up to 752 gm/dL. The foal was closely monitored to ensure he nursed well and was active. In the meantime the mare developed a low grade fever (102.1° F) and sore feet. Her digital pulsed had increased considerably. She had a slight discharge from her vulva. The reproduction team came back and palpated her uterus and did an ultrasound. No placental tags, increased fluid or debris were present. Her uterus was flushed with oxytetracycline and saline. She was placed on trimethoprim-sulfonamide and a low dose of phenylbutazone. Her uterus was involuting well so no further therapy was necessary. The fever resolved quickly. She still was a bit foot sore but was in need of a trim as well. It was time for the two of them to head home. On day 15 both mare and foal were discharged from our hospital. MeV
About the authors
Sally Schwartz CVT, has been a certified veterinary technician since 1987 and has been working at Wisconsin Equine Hospital for the past 24 years specializing in surgery, anesthesia and lameness. She is happily married with two grown children, and an array of four-legged furry critters.
THE BUSINESS OF EQUINE MEDICINE
Equine Veterinarians in Good Shape By Paul Basilio The results are in, and equine practitioners appear to be doing pretty well, all things considered. According to the recent AAEP-AVMA Economic Survey, equine veterinarians are aging well, generally satisfied with their work and not seeing too many debilitating injuries. While some areas for concern were identified, the profession as a whole is in decent shape. “Our physical health is pretty good,” said Ann E. Dwyer, DVM, of Genesee Valley Equine Clinic in Scottsville, NY, here at the 63rd AAEP Annual Convention in San Antonio, Texas. “The data say it stays good well into advanced age. Most of the reported work injuries are not debilitating. For mental health, we scored pretty well when compared with other professions, but there are about 6% of us who may be at high risk of burnout.” In August 2016, approximately 1 in 5 AAEP members responded to the survey. Their answers were compared with two AVMA surveys to see how equine veterinarians stack up against other veterinarians.
Nearly 80% of respondents reported one or more workrelated injuries, but 48% did not result in lost time at work, and 36% resulted in less than a week of missed work. Men reported nearly double the hospitalizations from work-related injuries compared with women, but the men were an average of almost 17 years older than the women (56 vs 39). For chronic physical injuries, equine veterinarians appear to be quite resilient. “We have a physical job,” Dr. Dwyer said. “We’re always lifting heavy things, we’re driving thousands of miles, and our patients are big. [The survey] asked, ‘How is your health?’ It was great news.” More than 85% of all age groups reported that their health is either “excellent” or “good,” and 10% reported their health was “fair.” When asked how their physical health limited daily activities, the responses from men and women were almost identical. Just over 60% of female respondents reported that their health does not limit their daily activities at all, and 57% of males said the same. Around 34% of each group said their health limits them “a little.” “We’re tough as nails,” Dr. Dwyer said. “There’s more to health than physical well-being,” she explained. “We put in long hours, our on-call schedules compromise our personal downtime, client expectations are ever-rising, and advances in technology have reduced our privacy. This job is just stressful.”
Although there was some deviation for mental health responses, Dr. Dwyer reiterated the age differences between the respondents. The average male respondent had about 30 years of experience, and the average female respondent had about 13 years in the profession. Fifty percent of the men said their mental health was “excellent,” and almost 40% reported “good” mental health. Less than 1% reported “poor” or “very poor.” Only 25% of women reported “excellent” mental health, 52% reported “good,” and a little more than 4% said that their mental health was “poor.” About 10% of respondents in each group reported “fair” mental health.
of respondents reported at least one work-related injury, but
did not result in lost time at work.
In general, practice owners reported better mental health than associates, and male owners and associates reported better mental health than females. Equine practitioners who graduated veterinary school before 1967 nearly all reported either “excellent” or “good” mental health. The mental health scores were fairly linear. The older the veterinarian is, the more likely he or she is to report “excellent” mental health. As the ages skew younger, the number who report “fair” or “poor” mental health begins to rise. Of those who graduated less than 5 years ago, 30% reported a “fair,” “poor,” or “very poor” mental health status. “Graduates from the past 20 years, mostly females, had scores that trended higher on the burnout scale and lower on the compassion satisfaction scale,” Dr. Dwyer reported. “Time will tell, but I believe this survey has helped us identify where we are as a profession. Rather than denying that this job can have its moments, there is no shame in admitting that we are human. Putting a face on this will be a good first step toward addressing some of the challenges that were identified.” MeV
Shutterstock/Park Ji Sun
ModernEquineVet.com | Issue 2/2018
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Published on Feb 25, 2018