Equine Vet www.modernequinevet.com
Gift of sight See cataract surgery inside
Sustainable parasite control Experts disagree when they assess gait incoordination Technician Update: Guaifenesin Flyfishing & Facebook
Vol 4 Issue 5 2014
Table of Contents
4 The gift of sight: cataract surgery
Cover photo by Shutterstock/Anastasija Popova
Sustainable parasite control................................................................................................ 3 neurology
Experts disagree on assessment of incoordination...................................................10 Technician Update
Guaifenesin: in house or field anesthesia...............................................13 Practice Management
Matching the Hatch: Flyfishing & Facebook.................................................................15 Pharma profile
Passionate about horses...............................................................17 News
AVMA, AAEP oppose federal bill, horse tripping.................... 8 Bayer awards $70,000 in veterinary scholarships................. 9 Lockton Insurance Brokers partners with NTRA To lower racetracks total cost of risk..................... 9 advertisers Shank's Veterinary Equipment............................. 3 Merck Animal Health.........................................6-8
AAEVT.................................................................. 12 Horse Side Vet Guide............................................. 4
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Issue 5/2014 | ModernEquineVet.com
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Sustainable parasite control By Marie Rosenthal, MS When equine experts realized that drug-resistant parasites were occurring, they recommended a change in strategy to protect this precious resource. Instead of routine deworming to the entire herd, experts recommended more sustainable methods that consider refugia, which is the portion of a population of parasites that escape selection with the drug during treatment. Although selective treatment based on fecal egg counts has been recommended for more than 25 years, little is known about how well the method is working, according to Martin K. Nielsen, DVM, PhD, DEVPC, DACVM, a parasitologist at the Gluck Equine Research Center, University of Kentucky in Lexington. Some countries like Denmark were faster to adapt these new strategies than the United States, and as a result, it appears that resistance is less developed there, according to Nielsen, who recently wrote a paper outlining research needs for this issue. “It seems there is a trend toward more egg count surveillance overall in the US, but to which extent this is widely adopted, we cannot say,” he said. “We just completed a questionnaire performed among Kentucky Thoroughbred managers, and about 30% of respondents were using fecal egg counts regularly. Many are running large operations with hundreds of horses, so they are unlikely to be representative of other horse breeds and other types of horse owners.” Clearly, there is a role for veterinarians in educating and persuading US horse owners to follow the recommendations of the American Association of Equine Practitioners. (Click here to read the AAEP Parasite Guidelines.) “The first thing they should be doing is asking their clients if their parasite control program works,” he sug-
gested. “If the clients say ‘yes,’ they should ask them how they know this. The point here is that there is no way to know without doing fecal egg counts. “Given the general prevalence of anthelmintic resistance in equine parasites, a majority of clients are probably using drugs that don’t work. And they will not know this if they are not testing,” he said. Egg counts are the cornerstone of equine parasite control. All they need is about six good parasite egg shedders. Run the egg counts then treat the horses, and run posttreatment counts two weeks later. This should be done for every anthelmintic drug class used on the farm. “Resistance testing is the starting point. Once people realize their horses have resistant parasites, they might be motivated to make changes in their parasite control program,” he said. MeV
Courtesy of Dr. Martin Nielsen
Lifting Large Animals Since 1957
For more information: Nielsen MK. Sustainable equine parasite control: Perspectives and research needs. Vet Parasitol. 2012 Apr 19;185(1):32-44. doi: 10.1016/j.vetpar.2011.10.012. Epub 2011 Oct 18. http://www.ncbi.nlm.nih.gov/pubmed/22055611 Nielsen MK, Pfister K, vonSamson-Himmelstierna G. Selective therapy in equine parasite control-Application and limitations. Vet Parasitol. 2014 May 28;202(3-4):95-103. doi: 10.1016/j. vetpar.2014.03.020. Epub 2014 Mar 22. http://www.sciencedirect.com/science/article/pii/ S0304401714001812 Reinemeyer C, Nielsen MK. Handbook of Equine Parasite Control. November 2012, Wiley-Blackwell. http://www.wiley.com/ WileyCDA/WileyTitle/productCd-0470658711.html
www.shanksvet.com • firstname.lastname@example.org ModernEquineVet.com | Issue 5/2014
The gift of sight:
26% of horses could still see two or more years later
Issue 5/2014 | ModernEquineVet.com
Cataract surgery is in its infancy for equine medicine, but some horses do quite well. In a recent review of visual outcomes of phacoemulsification cataract surgery in horses, 26.3% could still see and continue their natural activity two or more years after surgical intervention.
In this study, published in Veterinary Ophthalmology, Dennis E. Brooks, DVM, PhD, DACVO, of the University of Florida, and his colleagues reviewed the medical records of 965 foals and horses that had phaco between 1990 and 2013 to assess the long-term visual acuity of the horses, as well as identify
Photo and video courtesy of Dennis E. Brooks
To view a video on cataract surgery: https://www.youtube.com/watch?v=E365GwQyM6o
any unique postoperative complications. Phacoemulsification is a modern method of cataract surgery in which the horse’s internal lens is emulsified using an ultrasonic hand tool. The lens material is then aspirated from the eye. Aspirated fluids are replaced with saline, which maintains the anterior chamber. The 95 horses ranged in age from 22 days to 26 years old. Sixteen horses required surgery in both eyes for the removal of 111 cataracts. Of those, 102 eyes were blind before surgery with 97 eyes regaining vision almost immediate after surgery. Almost half of the surgeries were performed in foals. Cataracts were associated with trauma in 10 horses and equine recurrent uveitis in 24. The cause was unidentified in the remaining horses, according to the study results. Cataracts can be classified as to age of onset, etiology, anatomical location and degree of maturation. Genetic, trauma and inflammation have been linked with cataract development. They are frequently a congenital ocular defect in foals. “The evaluation of surgical therapy in foals and horses with cataracts is related to visual capability. Success equals vision,” the researchers wrote. “A successful outcome postoperatively in horses and foals that have phacoemulsification should also include an assessment of the long-term visual capability. Horses can live for decades, and a successful visual outcome must be present for years to be considered a success.” They found that 83 horses had vision for less than one month postoperatively, 47 had vision for up to six months postoperatively, 33 had
Typical Pre- and Postoperative Medications for Cataract Surgery Topical and systemic antibiotics were typically administered before and after surgery to reduce the risk of infection. Topical atropine was used to dilate the pupil and corticosteroids and NSAIDS were also prescribed before and after surgery to reduce inflammation. Drug Topical corticosteroid prednisolone acetate (1%) Topical antibiotic: chloramphenicol or bacitracin, neomycin, polymyxin B Topical atropine (1%) Topical NSAID, such as diclofenac Systemic omeprazole Systemic flunixin meglumine Systemic trimethoprim sulfamethoxasol
Dose Frequency QID QID QID QID 4 mg.kg PO SID for 28 days 1 mg/kg IV, IM, PO BID 15 mg/kg PO BID
Source: Veterinary Ophthalmology, 20141-12 DOI:10.1111/vop.12168
It is imperative to control any inflammation inside the eye postsurgery. vision for up to 12 months and 25 horses had vision for more than 25 months. Unfortunately, there is a “disconcerting” loss of long-term follow-up for horses that undergo phacoemulsification, the researchers found. “The lack of long-term data in the foals is particularly discouraging due to the fact so many foals are presented for cataracts with the owners considering surgery. Most foal eyes do quite well and exhibit slight iridocyclitis postoperatively. The clinicians and owners then relax their
postoperative medical therapy such that anti-inflammatory medications may be discontinued too soon. It was quite disturbing to us to see the deterioration and loss of vision that occurred rapidly in some foals and young horses that appeared to be a technically perfect cataract surgery,” the researchers wrote. Brooks said that it was imperative to control any inflammation inside the eye for as long as necessary. Visual acuity is important to horses, not only for the horse itself, but also for rider safety, they said. However, before a horse should be considered a candidate for cataract surgery, it should be having vision problems, he said. “We are at the beginning of cataract surgery in horses,” said Brooks. “Some horses do very well, but a majority continue to have vision MeV problems after surgery.”
For more information: Brooks D E, Plummer C E, et al. (2014), Visual outcomes of phacoemulsification cataract surgery in horses: 1990–2013. Veterinary Ophthalmology. doi: 10.1111/vop.12168. http://onlinelibrary.wiley.com/doi/10.1111/vop.12168/abstract ModernEquineVet.com | Issue 5/2014
Easy does it. Equine Protozoal Myeloencephalitis (EPM) can strike anytime, anywhere. Be prepared with Protazil®. Only FDA-approved pelleted top dress for the treatment of EPM Safe and accurate dosing with calibrated scoop Easier to use than paste, less stress for you and the horse Effective, less expensive alternative to Marquis™ Contact your Merck Animal Health representative to ﬁnd out more.
Visit protazil.com We’re for the Horse™
Protazil is contraindicated in horses with known hypersensitivity to diclazuril. Safe use in horses used for breeding purposes, during pregnancy or in lactating mares has not been evaluated. The safety of Protazil with concomitant therapies in horses has not been evaluated. See related page in this issue for details. For use in horses only. Do not use in horses intended for human consumption. Not for human use. Keep out of reach of children. 556 Morris Avenue • Summit, NJ 07901 • merck-animal-health-usa.com • 800-521-5767 Copyright © 2013 Intervet Inc., d/b/a Merck Animal Health, a subsidiary of Merck & Co., Inc. All rights reserved. Photography: Vince Cook. 50035 4/13 EQ-PHARM-VET-1219-AD
FOR ORAL USE IN HORSES ONLY For the treatment of equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona in horses. CAUTION Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. NADA #141-268 Approved by FDA DESCRIPTION Diclazuril, (±)-2,6-dichloro-α-(4-chlorophenyl)-4-(4,5 dihydro-3,5-dioxo-1,2,4-triazin-2(3H)-yl) benzeneacetonitrile, has a molecular formula of C17 H 9 CI 3 N4O2, a molecular weight of 407.64, and a molecular structure as follows:
Diclazuril is an anticoccidial (antiprotozoal) compound with activity against several genera of the phylum Apicomplexa. PROTAZIL® (diclazuril) is supplied as oral pellets containing 1.56% diclazuril to be mixed as a top-dress in feed. Inert ingredients include dehydrated alfalfa meal, wheat middlings, cane molasses and propionic acid (preservative). INDICATIONS PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets are indicated for the treatment of equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona in horses. DOSAGE AND ADMINISTRATION Dosage: PROTAZIL® (1.56% diclazuril) is administered as a top dress in the horse’s daily grain ration at a rate of 1 mg diclazuril per kg (0.45 mg diclazuril/lb) of body weight for 28 days. The quantity of PROTAZIL® necessary to deliver this dose is 64 mg pellets per kg (29 mg pellets/ lb) of body weight. Administration: To achieve this dose, weigh the horse (or use a weigh tape)). Scoop up PROTAZIL® to the level (cup mark) corresponding to the dose for the horse’s body weight using the following chart: Weight Range of Horse (lb) 275 - 524 525 - 774 775 - 1024 1025 - 1274
mLs of Pellets 20 30 40 50
Weight Range of Horse (lb) 1275 - 1524 1525 - 1774 1775 - 2074 -
mLs of Pellets 60 70 80 -
One 2-lb bucket of PROTAZIL® will treat one 1100-lb horse for 28 days. One 10-lb bucket of PROTAZIL® will treat five 1100-lb horses for 28 days. CONTRAINDICATIONS Use of PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets is contraindicated in horses with known hypersensitivity to diclazuril. WARNINGS For use in horses only. Do not use in horses intended for human consumption. Not for human use. Keep out of reach of children. PRECAUTIONS The safe use of PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets in horses used for breeding purposes, during pregnancy, or in lactating mares has not been evaluated. The safety of PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets with concomitant therapies in horses has not been evaluated. ADVERSE REACTIONS There were no adverse effects noted in the field study which could be ascribed to diclazuril. To report suspected adverse reactions, to obtain a MSDS, or for technical assistance call 1-800-224-5318. CLINICAL PHARMACOLOGY The effectiveness of diclazuril in inhibiting merozoite production of Sarcocystis neurona and S. 1 falcatula in bovine turbinate cell cultures was studied by Lindsay and Dubey (2000). Diclazuril inhibited merozoite production by more than 80% in cultures of S. neurona or S. falcatula treated with 0.1 ng/mL diclazuril and greater than 95% inhibition of merozoite production (IC 95 ) was observed when infected cultures were treated with 1.0 ng/mL diclazuril. The clinical relevance of the in vitro cell culture data has not been determined. PHARMACOKINETICS IN THE HORSE The oral bioavailability of diclazuril from the PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets at a 5 mg/kg dose rate is approximately 5%. Related diclazuril concentrations in the cerebrospinal fluid (CSF) range between 1% and 5% of the concentrations observed in the plasma. Nevertheless, based upon equine pilot study data, CSF concentrations are expected to 2 substantially exceed the in vitro IC 95 estimates for merozoite production (Dirikolu et al., 1999) . Due to its long terminal elimination half-life in horses (approximately 43-65 hours), diclazuril accumulation occurs with once-daily dosing. Corresponding steady state blood levels are achieved by approximately Day 10 of administration. EFFECTIVENESS Two hundred and fourteen mares, stallions, and geldings of various breeds, ranging in age from 9.6 months to 30 years, were enrolled in a multi-center field study. All horses were confirmed EPM-positive based on the results of clinical examinations and laboratory testing, including CSF Western Blot analyses. Horses were administered PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets at doses of 1, 5, or 10 mg diclazuril/kg body weight as a top-dress on their daily grain ration for 28 days. The horses were then evaluated for clinical changes via a modified Mayhew neurological scale on Day 48 as follows: 0. Normal, neurological deficits not detected. 1. Neurological deficits may be detectable at normal gaits; signs exacerbated with manipulative procedures (e.g., backing, turning in tight circles, walking with head elevation, truncal swaying, etc.). 2. Neurological deficit obvious at normal gaits or posture; signs exacerbated with manipulative procedures. 3. Neurological deficit very prominent at normal gaits: horses give the impression they may fall (but do not) and buckle or fall with manipulative procedures. 4. Neurological deficit is profound at normal gait: horse frequently stumbles or trips and may fall at normal gaits or when manipulative procedures were utilized. 5. Horse is recumbent, unable to rise. Each horse’s response to treatment was compared to its pre-treatment values. Successful response to treatment was defined as clinical improvement of at least one grade by Day 48 ± conversion of CSF to Western Blot-negative status for S. neurona or achievement of Western Blot-negative CSF status without improvement of 1 ataxia grade. Forty-two horses were initially evaluated for effectiveness and 214 horses were evaluated for safety. Clinical condition was evaluated by the clinical investigator’s subjective scoring and then corroborated by evaluation of the neurological examination videotapes by a masked panel of three equine veterinarians. Although 42 horses were evaluated for clinical effectiveness, corroboration of clinical effectiveness via videotape evaluation was not possible for one horse due to missing neurologic examination videotapes. Therefore, this horse was not included in the success rate calculation. Based on the numbers of horses that seroconverted to negative Western Blot status, and the numbers of horses classified as successes by the clinical investigators, 28 of 42 horses (67%) at 1 mg/kg were considered successes. With regard to independent expert masked videotape assessments, 10 of 24 horses (42%) at 1 mg/kg were considered successes. There was no clinical difference in effectiveness among the 1, 5, and 10 mg/kg treatment group results. Adverse events were reported for two of the 214 horses evaluated for safety. In the first case, a horse was enrolled showing severe neurologic signs. Within 24 hours of dosing, the horse was recumbent, biting, and exhibiting signs of dementia. The horse died, and no cause of death was determined. In the second case, the horse began walking stiffly approximately 13 days after the start of dosing. The referring veterinarian reported that the horse had been fed grass clippings and possibly had laminitis. ANIMAL SAFETY PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets were administered to 30 horses (15 males and 15 females, ranging from 5 to 9 months of age) in a target animal safety study. Five groups of 6 horses each (3 males and 3 females) received 0, 5 (5X), 15 (15X), 25 (25X) or 50 (50X) mg diclazuril/kg (2.27mg/lb) body weight/day for 42 consecutive days as a top-dress on the grain ration of the horse. The variables measured during the study included: clinical and physical observations, body weights, food and water consumption, hematology, serum chemistry, urinalysis, fecal analysis, necropsy, organ weights, gross and histopathologic examinations. The safety of diclazuril top-dress administered to horses at 1 mg/kg once daily cannot be determined based solely on this study because of the lack of an adequate control group (control horses tested positive for the test drug in plasma and CSF). However, possible findings associated with the drug were limited to elevations in BUN, creatinine, and SDH and less than anticipated weight gain. Definitive test article-related effects were decreased grain/top-dress consumption in horses in the 50 mg/kg group. In a second target animal safety study, PROTAZIL® (1.56% diclazuril) Antiprotozoal Pellets were administered to 24 horses (12 males and 12 females, ranging from 2 to 8 years of age). Three groups of 4 horses/sex/group received 0, 1, or 5 mg diclazuril/kg body weight/day for 42 days as a top-dress on the grain ration of the horse. The variables measured during the study included physical examinations, body weights, food and water consumption, hematology, and serum chemistry. There were no test article-related findings seen during the study. STORAGE INFORMATION Store between 15°C to 30°C (59°F to 86°F). HOW SUPPLIED PROTAZIL® (1.56 % diclazuril) Antiprotozoal Pellets are supplied in 2-lb (0.9 kg) and 10-lb (4.5 kg) buckets. REFERENCES 1. Lindsay, D. S., and Dubey, J. P. 2000. Determination of the activity of diclazuril against Sarcocystis neurona and Sarcocystis falcatula in cell cultures. J. Parasitology, 86(1):164–166. 2. Dirikolu, L., Lehner, F., Nattrass, C., Bentz, B. G., Woods, W. E., Carter, W. E., Karpiesiuk, W. G., Jacobs, J., Boyles, J., Harkins, J. D., Granstrom, D. E. and Tobin, T. 1999. Diclazuril in the horse: Its identification and detection and preliminary pharmacokinetics. J. Vet. Pharmacol. Therap. 22:374–379. May 2010 Intervet Inc. 56 Livingston Ave, Roseland, New Jersey 07068 © 2010 Intervet Inc. All rights reserved. 08-10 211.x.3.1.0
AAEP, AVMA oppose H.R. 4098 soring bill, also campaigning against tripping The American Association of Equine Practitioners joined the American Veterinary Medical Association and many others in opposing new legislation introduced on Capitol Hill that is being promoted as an alternative to the Prevent All Soring Tactics (PAST) Act (HR 1518/S 1406). The AAEP staunchly opposes HR 4098, the Horse Protection Amendments Act of 2014, because its For more information, implementation will not protect visit www.avma.org Tennessee Walking Horses, Spotted Saddle horses and Racking horses from the abusive practice of soring. Soring is the intentional infliction of pain to create the exaggerated gait known as the “big lick” in the show ring. Unlike the PAST Act, HR 4098 does not make the actual act of soring illegal; it only continues the existing prohibitions on the sale, auction, transport and exhibition of sored horses. In addition, the new legislation does not prohibit Watch the video on soring, which includes interviews the use of action devices and perwith Elizabeth Graves, a licensed Tennessee Walking formance packages, which are ofHorse judge and gaited horse trainer and Nat Messer, DVM, a member of both the AVMA’s and the AAEP’s ten used to intensify the painful Animal Welfare Committees. effects of soring. Both the AAEP and the AVMA called for a ban on the use of these devices in 2012. HR 4098 seeks to continue the industry’s ineffective self-regulation instead of giving the Department of Agriculture the authority it needs to license, train and oversee independent horse show inspectors. "The AAEP supports the passage of the Prevent All Soring Tactics (PAST) Act (S 1406/HR 1518) because it will strengthen the Horse Protection Act and significantly increase the effort to end the abuse of the Tennessee Walking Horse," said AAEP President Jeff Blea, DVM. "All veterinarians and horse owners are urged to contact their legislators to voice support for the PAST Act legislation and oppose H.R. 4098.”
The AVMA and AAEP also oppose the practice of horse tripping, which involves roping the front or hind legs of a galloping horse while on foot or horseback, causing it to trip and fall for entertainment purposes. Horse tripping is a tradition in charreadas (Mexican rodeos). The three events during a charreada that include horse tripping are: • Piales en lienzo: roping the hind legs of a horse. • Manganas a pie: roping the front legs of a horse while on foot. • Manganas a caballo: roping the front legs of a horse while on horseback. Points are awarded for how quickly the “charro,” or roper, can rope the horse. Reported horse injuries include lacerations, dislocated joints, fractured bones, and teeth, neck and shoulder injuries. Horses used for these rodeos often are underfed, overused and repeatedly roped until lame, sometimes with rope burns down to the bone. The practice is banned in 11 states, including Texas, California, New Mexico, and Arizona, but continues at county and local events. MeV 8
Issue 5/2014 | ModernEquineVet.com
Lockton Insurance Brokers partners with NTRA To lower racetracks' total cost of risk The National Thoroughbred Racing Association (NTRA) announced that Lockton, the world's largest privately held insurance broker, has entered into a three-year exclusive agreement with the NTRA to lower racetracks' total cost of risk while offering discounts to tracks accredited by the Safety and Integrity Alliance. The partnership will offer racetracks a wide range of creative and cost effective risk management solutions through Lockton's Gaming, Entertainment and Sports Practice. “Lockton's partnership with the NTRA is a game changer for the horse racing industry with respect to risk management,” said Jared Mitilier, Lockton’s Gaming, Entertainment, and Sports Practice Leader. “Our deep understanding of the evolving risks faced by racetrack owners coupled with our ability to deliver unique-
ly crafted product solutions for the industry will lead to significantly lower total costs of risk.” Lockton will offer tailored insurance products to racetracks and racinos, including: property and casualty, workers' compensation, promotion and events, jockey accident, group medical, dental, vision, life and accidental death and dismemberment, as well as voluntary benefits products. Additional services include policy analysis, loss control and safety, and claims advocacy. “We are delighted to welcome Lockton into a partnership that will make a positive impact on the sport,” said Mike Ziegler, executive director of the NTRA Safety and Integrity Alliance. “This deal allows us to reward the tracks that do the right thing by implementing best practices in areas that impact equine safety and operational integrity.” MeV
Bayer HealthCare LLC Animal Health announced that Katherine Nadolny, a senior at the University of Missouri’s College of Veterinary Medicine, is the national winner of the second annual Bayer Excellence in Communication Award (BECA). Incorporating effective communication skills in veterinary practice, as well as other medical professions, has long been recognized as one of the main tasks in delivering comprehensive medical care to clients. BECA, established to recognize effective communication in the veterinary profession, rewards veterinary students who are executing this critical core skill that needs to be taught and learned to the same degree as other clinical skills. Twenty-seven veterinary schools participated in the 2014 competition that presented a total of $70,000 in scholarship awards. The BECA is one facet of a larger initiative aimed at advancing the communication skills of the next generation of veterinarians. In 2002, Bayer partnered with the Institute for Healthcare Communication to establish the Bayer Communication Project. This collaborative partnership resulted in communication skills training modules offered to colleges of veterinary medicine for incorporation into their curriculum. Selected faculty from all U.S. veterinary colleges has been trained via the Bayer Communication Project “Train the Trainer” program. The winning veterinary students from the other schools in the 2014 Bayer Excellence in Communication Award program are: • Magdalene Stewart, Auburn University • Ayshea M. Quintana, University of California-Davis • Jenny Ross, Colorado State University • Elizabeth Ann Glucksman, Cornell University • Andrew Torchia, University of Florida • Kristin Scarlett Timmons, University of Georgia • Erica Morton, University of Illinois • Stephanie Turner, Iowa State University
PRNewsFoto/Bayer HealthCare Animal Health
Bayer awards $70,000 in veterinary scholarships
• Arthur Charles, Kansas State University • Jacque Stahl, Louisiana State University • Allison Peterson, Michigan State University • Jessica Carmack, University of Minnesota • Hillary May, Mississippi State University • Cassandra Horvath, Ohio State University • Jill Weber, Oklahoma State University • Jamie Senthirajah, Oregon State University • Tiffany Premo, Purdue University • Elliot Williams, Ross University • Kelsey Quinn, University of Tennessee • Odeliah Bouganim, Texas A&M University • Kim-Khanh Tran, Tufts University • Emily Coates, Tuskegee University • John Gil, Virginia Tech • Kyle Heaton, Washington State University • Megan Williams, Western University • Seth Oberschlake, University of Wisconsin
National winner and University of Missouri College of Veterinary Medicine senior, Katherine Nadolny, receives the second annual Bayer Excellence in Communication Award (BECA). Left to right: Dr. Neil C. Olson, Dean, College of Veterinary Medicine; Katherine Nadolny, BECA National Winner; Dr. Ronald Cott, Associate Dean for Student & Alumni Affairs; Dr. Adrienne Willette, Veterinary Technical Services, Bayer.
ModernEquineVet.com | Issue 5/2014
Experts disagree on assessment of
horses with incoordination B
At some point it its life, at least
1:100 horses will lose the ability to control its gait as a result of developing the neurological disorder ataxia. Once a horse is found to be ataxic, veterinarians frequently recommend surgical intervention or euthanasia. However, there is marked disagreement among veterinarians about whether or not a horse is ataxic or how severe the problem is, even among those one would consider skilled at diagnosing this problem, according to a recent study done by researchers from
Issue 5/2014 | ModernEquineVet.com
the University of Copenhagen and the Royal Veterinary College in the United Kingdom. It is particularly a problem if the ataxia is subtle, as this makes it more difficult to assess, according to the article which was published in the Journal of Veterinary Internal Medicine. â€œIt is a problem for both the horse and the owner if the specialists disagree. A horse which could potentially recover might be put down, as an ataxic horse eventually becomes a hazard to the owner due to the risk of a fall during riding or
handling,â€? said Emil Olsen, DVM, PhD, from the department of large animal sciences at the University of Copenhagen, who headed the new research.
No scanners for horses
The most common neurological diseases of horses affect the spinal cord and result in changes in gait caused by proprioceptive deficits and paresis. Ataxia is one of the greatest sources of missed training days and frustration for horse owners and veterinarians alike. One form, Wobblers syndrome, is
Photo courtesy of Rita Kochmarjova/Fotolia
frequently due to pressure on the cervical spinal cord, which can be diagnosed in humans and small animals by MRI or CT scans, but there are no scanners with a diameter large enough to accommodate a horse’s neck and shoulders. Therefore, the mainstay of the veterinarian’s assessment is the clinical examination looking for small changes and irregularities in the horse’s gait. Olsen and his colleagues wanted to know if that assessment was reliable in most cases. In this study, specialists in the areas of large animal internal medicine, equine surgery and residents, evaluated the gait during a neurological examination of 25 (12 mares and 13 geldings) horses that were between 3 and 16 years old. All horses underwent an identical neurological gait work-up. The assessment included walking and trotting in a straight line, walking with the head elevated, walking with a blindfold, walking and standing tail pull, walking in small circles in both directions, backing up, lateral placement of distal thoracic limbs, crossing over of distal thoracic limbs, hopping on each thoracic limb, bilateral cervicofacial and panniculus reflexes, walking over an obstacle, walking up and down a slope with and without head elevation. Each horse was graded by between 3 and 6 graders. The gaits were graded according to a 5-point ataxia scale first proposed by Mayhew and colleagues and later modified by Reed. The horses were also assessed and graded for lameness according to an 11-point scale. The grades were assigned after walk and trot and
rescored with an overall grade after the complete examination. The specialists also looked at 10 videos of the neurological examination. Afterward, “they completed a questionnaire, and based on their responses we could see that there was wide disagreement on whether or not they believed a horse was ataxic, and particularly on the severity of the ataxia,” said Olsen.
Current assessment is not optimum for clinical use, and the researchers hope that better criteria and grading can be developed. The researchers found that the reliability for each section of the gait assessment ranged from poor to good. For instance, one horse with a median grade of 2 was just as likely to be graded as normal or grade 3. In addition, if clinicians knew the history of the horse, they were more likely to grade it as ataxic, Olsen explained. The best agreement was found when horses were backing up or walking over an obstacle, according to the researchers. “Reproducible assessment of gait during a neurologic examination in horses is essential for the diagnostic process and for deci-
sionmaking in prepurchase examinations, for considering treatment options, safety for handlers and riders and animal euthanasia,” the researchers wrote in their paper.
The researchers said that the neurological examination should have good reliability, high agreement and results of the examination should be accurate. Based on their findings, neither the individual criteria for gait assessment within a neurological examination, nor the modified ataxia-grading scale itself would be acceptable for clinical use, the researchers wrote, and they hoped better criteria and grading can be developed. “We hope that our findings will lead to the establishment of clearer definitions for what constitutes normal and abnormal gait patterns in horses, and the relationship between spinal cord disease and ataxia. This could lead to greater agreement among specialists and practicing veterinarians. The current disparity also raises the need for quantitative diagnostics, using equipment that can measure the horse's movements in detail,” Olsen said. Until then, what should veterinarians do, The Modern Equine Vet asked. “This is difficult to answer,” Olsen said, “but in my opinion there are two solutions. First, have your colleagues look at the horse at the same time as you look at it and always include walk with the head elevated, blindfolding, circling and walking down hill as parts of your examination.” MeV
For more information: Olsen E, Dunkel B, Barker WHJ, et al. (2014), Rater Agreement on Gait Assessment during Neurologic Examination of Horses. J Vet Internal Med. 28: 630–638. doi: 10.1111/jvim.12320 http://onlinelibrary.wiley.com/doi/10.1111/jvim.12320/abstract
ModernEquineVet.com | Issue 5/2014
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
Guaifenesin: in house or field anesthesia By Lisa Meloy, RVT Guaifenesin is a muscle relaxant that is used inmany equine anesthetic protocols. Researchers do not know its precise mechanism of action, but it results in the relaxation of skeletal muscles, mild analgesic and mild sedative properties. This enables the use of lower doses of other sedatives and anesthetic agents. Guaifenesin is used for induction before inhalation anesthesia, during inhalation anesthesia and with total intravenous anesthesia (TIVA) for short procedures. Here is a brief guaifenesin primer for equine technicians.
Concentrations and drug dosages of GKX
Guaifenisen is a 50 mg/mL concentration with 5% D5W. Four years ago it was a 15% D5W that was found to be causing hematuria. Companies reduced the percentage, and there have not been any more cases of hematuria since it was reduced to 5%. We use the 1 L bag or bottle and put 1 g of ketamine and 500 mg of xylazine in the bag, thus creating the GKX (guaifenisen/ketamine/xylazine) mixture. If the patient is a donkey or mule, it is better to double the dose to 2 g ketamine and 1 g xylazine because their metabolism is so much higher, and they seem more resistant to the anesthesia. Induction drugs used prior to maintenance total intravenous anesthesia (TIVA) include, 1.1 mg/kg xylazine (not to exceed 500 mg), 2.2 mg/kg ketamine, 0.015 mg/lb diazepam and 0 .05 mg/lb butorphanol.
General Uses of GKX (TIVA)
GKX anesthesia or “triple drip” can be used for various surgeries or procedures. It is not recommended to use it if the procedure lasts more than 1½ hrs; 2 hrs max. At our practice, we use GKX on about 85% of our surgeries. These surgeries include arthroscopies, neurectomies, desmotomies, hernia repairs, cryptorchid castrations and other shorter elective procedures. However, it is not ideal to use TIVA on neonatal or geriatric patients. If the horse is in good physical condition and the bloodwork is within normal limits, TIVA is an appropriate choice. Nasal oxygen is used at 5L/hr through the endotracheal tube. If we know that the patient has had mood altering medication
given on the track, I tend to run gas instead to avoid potential unwanted drug interactions.
Pros and Cons of TIVA
TIVA is more cost and time effective than inhalant anesthesia for shorter surgeries, and it is just as safe on a healthy horse. In my experience, the horses recovery after TIVA is smoother when compared with those that have been under gas anesthesia. There is less cleanup time in the surgery room because the technician doesn’t have to clean the anesthesia machine and change the soda lime crystals. With Guaifenisen now available in a 1 L bag instead of a bottle, it is much easier to store, calculate usage and hang. Additionally, the one L bag is already reconstituted, so that you do not have to use warm water to reconstitute it. Blood gases do not need to be performed under TIVA, as I do with inhalants, therefore, another reason that it is cheaper than gas.
Monitoring patients under GKX
Use direct blood pressures (IBP), ECG, pulse oximetry, physical parameters, eye position, mucous membrane color, CRT, and your eyes to monitor the patients. If a direct line (arterial catheter) is unattainable, then use a cuff (NIBP) for indirect pressures. Blood pressure tends to run mildly higher than if the patient was under gas anesthesia. The horse will always have a palpebral and corneal reflex under TIVA, unless of course the horse is in a high plane of anesthesia. However, try to refrain from running a horse that deep to avoid the hazardous outcome of the patient in that circumstance. If the patient is getting light or waking up, the respiratory rate will increase, as well as blood pressure, heart rate and movement of eye (nystagmus). It is imperative that the patient is monitored very closely, as they can change anesthetic planes more rapidly than they would under gas. It’s better to err on the side of caution when running TIVA, so run them lighter than deeper. I always tell my trainees to never take their eyes off the patient. Not all patients react the same under anesthesia, therefore, their pressure or heart rate may not increase, and all you may see is nystagmus and the patient is moving. Patients that give no fore warning at all and start to move. That is why running GKX or anesthesia in general is an “art” and takes a very observant person. I have to go with my “gut instinct” sometimes, and it usually comes through for me! ModernEquineVet.com | Issue 5/2014
technician update Drip Rates for GKX
When hooking a horse up to GKX, bolus it for approximately 1.5-2 minutes while attaching the EKG and pulse ox lines. Use a 15 drop/mL primary drip set, then slow it down to a moderate drip (about 3 drops/second) while inserting the arterial catheter. Maintain them on that rate or decrease it to 2 drops/ second, just depending on the patient. Some of the horses may require a higher or lower drip rate, and require a ketamine “bump” if they get too light. Bump with 1.5-3 mL of ketamine and bolus the GKX until the horse has gotten into a surgical plane of anesthesia again. In general, most horses will run through about 1 L/hr of GKX, give or take a few milliliters. In rare cases, one might have to hook the horse up to inhalant anesthesia (sevofluorane) if you can’t keep them down deep enough on TIVA .
It is found that using 0.1 mg/lb butorphanol intramuscular for recovery is beneficial for pain management and a smoother recovery. On average, the horses will lay in the recovery stall for 30 minutes.
Issue 5/2014 | ModernEquineVet.com
However, there have been some that will stand within 15 minutes. I like the way they recover on TIVA, since it is generally smooth even on a hot-blooded race horse that induces poorly. The horses do not tend to become as hypothermic or have muscle fasiculations as they do on gas. TIVA (GKX) is easily used in the field for short procedures. All you need is something to hang your bag of GKX on and an IV catheter. Personally, I would rather insert a short term (14G x 5.5” Abbocath) catheter in for the GKX. Shorter catheters can be used, but there is the potential for the catheter to come out of the vein leading to perivascular administration of the anesthetic, however, they work well for foals. TIVA can be run just off the needle instead of using a catheter, but it is not recommended unless you feel comfortable gluing or holding the needle in place throughout the procedure. MeV
About the Author:
Lisa Meloy, RVT, Equine Sports Medicine and Surgery in Weatherford, Texas
Matching the Hatch:
Fly Fishing & Facebook Should you be on Facebook? Things to consider. by Doug Thal, DVM, DABVP I have owned an equine veterinary practice for a number of years. I have a respectable website. I have written many articles on horse health over the years, and I have those archived there. I send (somewhat) regular e-mail newsletters to my clients and referring veterinarians. Dozens of clients have my personal cell phone number handy for latenight emergencies. I have a oneline ad in the yellow pages. But the experts say all of this is not enough. According to them, today’s equine veterinary practices also need to have an active Facebook page, and engage in other forms of social media. So, I have reluctantly learned to use Facebook. This has been timeconsuming and very frustrating at times, but I have slowly begun to get the hang of it and even occasionally to see the value in it. To persist in the endeavor, I had to change my paradigm. I found that by equating Facebook to fly fishing, I made the experience into something of a game, and so made it a shade more tolerable. To those of you who understand the elegance and beauty inherent in fly fishing, I apologize in advance for the blasphemous analogy.
sume content from their newsfeeds in much the same way. The goal of a fly fisherman is to engage the fish’s attention resulting in a strike, a hook-set and the landing of many fish. The marketing goal on Facebook is to repeatedly engage and retain the attention of as many current and potential clients as possible via likes, comments and shares. Success at this should theoretically result in a growing audience.
By making your ideas and thoughts visible on Facebook, the idea is that you become a trusted source of information. Of course, whether this effort results in loyalty or increased revenue remains debatable.
A successful fly-fisherman analyzes the insects active on the stream and attempts to mimic them — matching the hatch. On Facebook, the fly is your piece of content — a joke, a case report, a quiz question, a horse care tip, or (the bane social media posts) a cute animal picture overlaid with an inspirational saying. Importantly, a fly that works one day or at one time may not work the next. Often you can see actively feeding trout feeding on invisible aquatic nymphs in the current, right in front of you, but you aren’t sure ex-
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It is not flattering (sorry, trout) to equate our fellow humans to trout in a river, but they do have a lot in common. Trout consume aquatic insects from the current as they drift by. Facebookers conModernEquineVet.com | Issue 5/2014
actly what they are eating. You can use many of the flies in your box, but the fish often ignore your best offerings, continuing to slurp whatever they are slurping as your flies drift inches by their mouths. Like trout, the average Facebooker often disappoints in term of what ultimately works. The bait-fisher 50 yards downstream from you is repeatedly pulling “highly selective trout” out of the water using garlic-flavored cheeseballs. Your carefully crafted post about colic may get 1 like, while the video of the jumping sheep gets 446 likes, 98 comments and 220 shares.
You must make a convincing presentation to both trout and Facebookers. Trout point their noses upstream, watching for food. If they never see your fly, then they can’t take it. If the fly does not look lifelike, or is not in their feeding lane, it will drift right by them without a bit of interest. In fly-fishing, you must get excellent drifts in order for the fly not to look like a phony. That takes skill and practice at both casting and drifting. However, unlike the situation
Today's equine veterinarians should have an active Facebook page. with fishing, Facebook controls your ability to present your fly to the consumer, and this is becoming ever more difficult as there are more fisherman on the water competing for attention. Facebook controls your cast and drift (known as “reach”) based on their “algorithm” — a mysterious and ever-changing formula they use to determine suitability of you and your fly to a given individual’s newsfeed. If, according to their algorithm, your fly is a dud, it gets little attention and will only be visible to a pitiful percentage of the
thousands of trout in the river. In that case, Facebook asks that you Boost Your Post (pay Facebook) in order to get it in front of your followers.
Currently, I create the content and manage our veterinary practice Facebook page. It’s hard to do during busy season but I have not felt that I could outsource. I still get “skunked” pretty regularly but I am gradually figuring it out. I experiment with all kinds of content, and I monitor the results. Studying human nature turns out to be pretty interesting. I had to learn that social media was not about making a sale, but rather about building relationships and trust such that when a follower needs services, they think first of your practice. Now and then I actually see this happen. MeV
About the Author:
Douglas O. Thal, DVM, DABVP, is the owner of Thal Equine, LLC (www.thalequine.com) a full service equine hospital located in Santa Fe, New Mexico and the creator of Horse Side Vet Guide (www.horsesidevetguide.com) a five-star rated equine health care app for horse owners and equine professionals.
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Passionate about horse health Thinking globally but acting locally has been the key to the success of Boehringer Ingelheim Vetmedica Inc. (BIVI), the company said in press materials released at the AAEP annual meeting. The breadth of the parent company, Boehringer Ingelheim, with its 42,000 employees worldwide, makes BIVI an international powerhouse, but being privately held, it has maintained the creative flexibility of a much smaller company. In an era of growth through mergers and acquisitions, it is rare to see the same company under the same family leadership for more than 125 years. BIVI with its more than 1,600 US employees, has steadily capitalized on this unusual dynamic. BIVI answers to animals, their owners and veterinarians, rather than stockholders. And that heritage has kept the company grounded. Nowhere is this philosophy more evident than in its pursuit of products that can enhance the health of a horse. In a relatively short time, BIVI has delivered an array of products that address prevention, as well as acute and chronic conditions. With its roots in the American heartland in St. Joseph, Mo., the mission of the BIVI equine team is as much about helping owners as it is about maintaining the health and well-being of their horses. They understand the special bond that a horse and an owner share, because many of them own horses themselves. For most of the equine division, BIVI is a passion as well as a profession, and their goal is to find the right solutions for the horse and their owner. In a 10-year period, from 2003 to 2013, the company has launched several products that have made a difference in the veterinarian’s ability to provide 21st Century medicine for their equine patients, many of the products are the only ones FDA-approved for horses. They include: • Cutting edge vaccines that keep a horse on its game. The BIVI vaccine portfolio sets the bar high with its Calvenza and Vetera XP Vaccines. Calvenza vaccine protects against equine herpesvirus and influenza. The Vetera vaccine line protects against key diseases, such as equine influenza virus, equine herpes virus types 1 and 4, West Nile virus, Eastern equine encephalomyelitis, Western equine encephalomyelitis, Venezuelan equine encephalomyelitis and tetanus. Offering large and small combinations, as well as monova-
lent vaccines, the Vetera line allows veterinarians to customize their protocol to each horse. And VETERA XP vaccines boasts the latest flu strains available on the market today while also being formulated using the company’s proprietary Ultrafil Purification Technology, which removes most of the extraneous proteins and allows the horse's immune system to focus on the relevant antigens. • An estimated 1:7 horses older than 15 years of age have been diagnosed with pituitary pars intermedia dysfunction (PPID) or equine Cushing’s disease, and this serious problem has also been diagnosed in a number of younger horses. Prascend (pergolide mesylate) is the first and only FDA-approved product for the management of equine Cushing’s disease. Prascend can improve the quality of life for horses with Cushing’s by helping to manage the clinical signs and decrease the risk of complications of the disease, including those that have the potential to be lifethreatening. • The only FDA-approved antispasmodic for use against colic, a leading killer of horses. Buscopan (N. butylscopolammonium bromide) is indicated for the control of abdominal pain associated with spasmodic colic, flatulent colic and simple impactions in horses. In studies, BUSCOPAN was shown to have an 88% success rate in achieving a clinical response within 30 minutes of administration. • The only FDA-approved topical application to help control pain and inflammation associated with osteoarthritis in hock, knee, fetlock and pastern joints in houses. Surpass (1% dicolfenac sodium) offers veterinarians a simple, unique topical delivery of pain relief that owners can apply themselves. MeV
By Marie Rosenthal, MS
ModernEquineVet.com | Issue 5/2014
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