The Modern Equine Vet October 2017

The Modern

Equine Vet www.modernequinevet.com

Vol 7 Issue 10 2017

Veterinarian-Farrier Partnership

Teaming Up to Help Horses Technician Update: Managing a Serious Wound Saliva Test for Monitoring Tapeworm Ultrasonography Vs. Radiography Sepsis of the Navicular Bursa

TABLE OF CONTENTS

ORTHOPEDICS

Veterinarians-Farriers Team Up

4 In Cutting-Edge Partnership Cover photo: Shutterstock/cynoclub

RADIOLOGY

Ultrasonography Superior to X-ray for Pneumothorax ...............................................10 INFECTIOUS DISEASES

Case Study: New Formulation for Equine Antimicrobial Use.....................................17 TECHNICIAN UPDATE

Managing a Serious Wound...................................................................16 NEWS

Saliva Test Successful for Monitoring Tapeworm .......................... 3 Bursotomy Effective for Sepsis of the Navicular Bursa .............13 UC Davis Emphasizes Equine Rescue..................................................13

ADVERTISERS Shanks Veterinary Equipment.................................. 3 Merck Animal Health.................................................. 5 Standlee Premium Western Forage......................... 7

Equinosis........................................................................ 8 AAEVT............................................................................21

The Modern

Equine Vet SALES: Matthew Todd • ModernEquineVet@gmail.com EDITOR: Marie Rosenthal • mrosenthal@percybo.com ART DIRECTOR: Jennifer Barlow • jbarlow@percybo.com CONTRIBUTING WRITERS: Paul Basillo • Carol Jean Ellis Kathleen Ogle 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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Issue 10/2017 | ModernEquineVet.com

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NEWS NOTES

Biannual use of a saliva test may be an effective method of monitoring for tapeworm infestation and directing treatment to affected individuals, reducing selection pressure for resistance, according to a recent study from several U.K. organizations.

The retrospective longitudinal study evaluated a saliva-based test for Anoplocephala perfoliata and its effect on subsequent anthelmintic use. The study included 1,000 saliva samples from horses at a U.K. welfare charity from autumn 2015 to autumn 2016.

Samples were predominantly collected in autumn and spring using a commercial test (EquiSal, Austin Davis Biologics) that measures tapeworm-specific antibody levels in saliva samples to give a score of low, borderline, moderate or high.

Horses with a score of borderline or above are considered positive and should receive anthelmintic treatment, the researchers said.

During the study period, 71% of horses remained below treatment threshold at all three points measured and did not receive any tapeworm treatment, the remaining 29% received praziquantel on at least one occasion. Only 3% were above the treatment threshold in all three tests.

Younger horses required more treatments: 55% of 1- to 5-year-olds on at least one occasion and 26% on more than one occasion. Notably, 41% of new arrivals to the herd had antibody levels above treatment threshold, highlighting the importance of testing horses introduced to a herd.

During the study period, 99 doses of praziquantel were administered, representing an 86% reduction in administration compared with blanket biannual use.

Despite this, the prevalence of tapeworm infestation did not increase over the study period, according to the researchers. “Compared with an all-group treatment strategy, the diagnostic-led approach used here considerably reduced application of anticestode anthelmintics.

This could reduce selection pressure for anthelmintic resistance,� the researchers wrote.

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Courtesy of the Equine Veterinary Journal

Saliva Test Successful for Monitoring Tapeworm Infestation

Tapeworm

Lifting Large Animals Since 1957

For more information: Lightbody KL, Matthews JB, Kemp-Symonds JG, et al. Use of a saliva-based diagnostic test to identify tapeworm infection in horses in the UK. Equine Vet J. 2017 Sept 6 [Epub ahead of print]. http://onlinelibrary.wiley.com/doi/10.1111/evj.12742/full

www.shanksvet.com • info@shanksvet.com ModernEquineVet.com | Issue 10/2017

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FARRIERY

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Veterinarians Farriers Team Up IN CUTTING-EDGE PARTNERSHIP

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Not only is technology cutting edge at New Bolton Center, so is teamwork, with one of the nation’s oldest farrier programs working hand-in-hand with top board-certified internists, surgeons and sports medicine specialists.

At the University of Pennsylvania’s New Bolton Center, “a cutting-edge partnership between farrier and veterinarian is a natural extension of our daily interactions,” said Patrick Reilly, chief of Farrier Services and director

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of the Applied Polymer Research Laboratory in Kenneth Square, Pa. As in so many other things in science today, no veterinarian can be an expert in all aspects of equine care. “There’s a reason we have so much specialization in veterinary medicine,” explained Dean W. Richardson, DVM, DACVS. “The more sophisticated treatment protocols become, the more specialization is required to stay in front of cutting-edge clinical practice and the more likely a

beneficial partnership between veterinarian and farrier will develop.”

A Blend of Art & Science

“Admittedly,” said Dr. Richardson, who is Charles W. Raker Professor of Equine Surgery and chief of Large Animal Surgery at Penn’s School of Veterinary Medicine, “I’m spoiled—I mean unequivocally terribly spoiled—because I have always lived in this environment where we’ve had support from our internal

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FARRIERY

farrier. And if you get used to it, you vastly appreciate it.”

When he was in college, Dr. Richardson apprenticed with a farrier, just so he could learn something about it.

“And I can tell you that a surgeon who has worked with a farrier or who has spent any time working under a horse will be more appreciative of farriers. It’s hard, very challenging work.”

Farriery takes an exacting mindset, as the equine foot is constantly growing and changing its form.

“I don’t merely fit a shoe upon the hoof. First, I have to reduce the hoof to proper proportions,” Mr. Reilly said, adding that because the hoof is simply the outer covering of a complex and sensitive foot, damage to the exterior surface may injure structures within.

Farriers have been debating some aspects of farrier work for centuries

Healthy farrierveterinarian interactions rely on respect, trust and specific skill sets to benefit patients. (see Measuring Force), even the correct way to shoe a horse. “Because the surfaces we work on are highly variable, our job really is a combination of art and science,” Mr. Reilly explained.

Since healthy veterinarian-farri-

Measuring Force Some aspects of farrier work have been debated for centuries, and the inability to directly measure the effect of horseshoes is one reason for lack of consensus. Force plates can be helpful in determining the effect of horseshoes, said Patrick Reilly, chief of Farrier Services at New Bolton Center, but they measure the force between the shoe and the ground.

“I’m more interested in measuring the force between the horseshoe and the hoof, so we have been working with a company on developing a system capable of measuring the force at this level. This system also allows us to measure the horse in the environment of athletic events (eg, racetrack, riding arenas).

The brief video of a horse with sensors on both front feet demonstrates the influence of trimming and shoes on hoof “balance.”

er interactions rely on respect, trust and specific skill sets, the partnership shared by Dr. Richardson and Mr. Reilly directly benefits their patients. “What I need from a veterinarian more than anything is a diagnosis—I need to know if the horse is sore or in pain and what structure is involved,” Mr. Reilly said.

He not only relies on the skill sets of veterinarians at New Bolton Center, Mr. Reilly also has access to cutting-edge imaging—computed tomography scans, magnetic resonance imaging, digital radiography—along with computer analysis.

“We have state-of-the-art Metron hoof software that measures and stores information related to hoof morphology and have been using collected data to study the influence of farrier practices, such as long-term effects of glue-on shoes and hoof distortion,” Mr. Reilly explained.

Armed with up-to-the-minute information, it then becomes Mr. Reilly’s job to design an orthotic that will protect the area of pain, soreness and/or lameness. That can be the real challenge, as farriery is an inexact science. “There’s no textbook recipe saying ‘this is the problem, therefore that is the solution.’

So, figuring out the best solution sometimes involves a bit of educated guesswork, coupled with bona fide experience,” he said.

Fracture Repair

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Click here to watch video

In equine medicine, there may be no more suitable example of groundbreaking farriery meeting cuttingedge orthopedics than PIII fracture repair (see Picture This: Farriers & Veterinarians Working in Tandem).

What makes this fracture unique, Mr. Reilly said, is its location within the hoof capsule, and that is capsule, and that is his domain, as the hoof wall cannot be sutured nor heal on its own.

The most common discipline affected by PIII fracture is the Stand-

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FARRIERY

ardbred racehorse because these horses train and race on very hard surfaces. The break is mechanically predictable, Dr. Richardson said, because when these horses go around a turn, 90% of these breaks involve the lateral wing of the left front foot or medial wing of the right front foot, as those are the parts of bone that bear overload. Although horses in other disciplines, including pleasure riding, may fracture their coffin or navicular bone by kicking walls or stepping on a rock just the wrong way, the single most common discipline is the Standardbred racehorse, he added.

Together, Dr. Richardson and Mr. Reilly have repaired about 70 to 80 of these fractures with a very high success rate. Because of meticulous prep, cutting-edge surgery and groundbreaking orthotics, most of these horses are expected

to be in training at six to eight months, Dr. Richardson said.

Mr. Reilly explained that his predecessor, Rob Sigafoos, developed some of the techniques involved in surgical correction of fractures, including application of acrylic adhesives. But surgical success also relies on the human factor.

From the surgeon’s perspective, the trick to this surgery is preparation, so Dr. Richardson and his surgical nursing team can know beforehand what precisely needs to be done. “We use CT scanning to allow accurate setup of an aiming device. Proper alignment of this device represents a huge breakthrough in surgery, as we can very meticulously—with almost 100% accuracy—place the screw exactly where we want it to be. The actual surgery—drilling and plac-

ing the screw—becomes relatively simple,” Dr. Richardson said, adding that a gigantic premium is placed on being meticulous.

Thus, he cautioned, when the surgeon places screws, any bacterial or fungal contact puts the horse at high risk for resistant infection, as the contaminant can form a relationship with foreign bodies—such as steel—making it impossible for antibiotic therapy to eliminate the infection. Such infection therefore means undoing the surgical repair and completing what could be an intensive course of antibiotic therapy, possibly followed by repeat surgical repair.

Aseptic closure likewise is critical. “Since traditional suture closing is impossible, closure [ie, postsurgical hoof repair] involves aseptically protecting the surgical site and implant,” Mr. Reilly explained, “which

www.equinosis.com

Picture This: Farriers & Veterinarians Working in Tandem At New Bolton Center, orthopedic success relies on mutual respect and appreciation of each other’s expertise in their respective fields and reflects the confidence they have in one another. This partnership involves shared responsibilities, with Dr. Dean W. Richardson in

charge of all aspects of surgical repair and Patrick Reilly, chief of Farrier Services, handling both preoperative hoof preparation and aseptic closure of the surgical site. Shown are key stages in the surgical repair of PIII fractures as performed by this farrier-veterinarian team.

3A 1 FIGURE 1. Digital radiography showing an articular wing fracture of the coffin bone.

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requires designing an orthotic that can support the whole hoof capsule.”

Hoof repair typically involves placing a fiber-reinforced acrylic patch on the hoof, followed by fitting a specialized shoe with a footplate.

Building Trust & Confidence

A successful farrier-veterinarian partnership requires a combination of confidence, open-mindedness, adaptability and willingness to collaborate, Dr. Richardson stressed, but it definitely is worthwhile—not just in university settings but out in the field as well.

New Bolton Center is located in an area that boasts sizable populations of both performance horses and racehorses, so the center’s staff

successfully relies on precision in preparation—setting up everything so they know in advance exactly what needs to be done. During preop preparation, Mr. Reilly aseptically prepares the hoof, after which the surgical team use CT scanning (A, showing markers) to meticulously set up an aiming device (B) that allows precision screw placement—almost to 100% accuracy (C, two-screw repair of distal phalanx fracture).

likely sees more comprehensive orthopedic cases than many other veterinary teaching institutions.

However, Mr. Reilly noted, various kinds of limb injuries affect all horses and a strong relationship between a local veterinarian and local farrier could benefit the quality of their care. “Clinical teamwork is not limited to orthopedic surgery but involves farrier-veterinarian partnering in such disciplines as rehabilitation, specialized sports medicine and prepurchase examinations at both university and local settings,” Mr. Reilly added.

Although the team concept has not trickled completely into the field, like so many things in veterinary medicine, change typically oc-

3B FIGURE 3 (A AND B). Because traditional suture closure is impossible for

hoof repair, Mr. Reilly designs a special orthotic (individualized for each patient) that supports the entire hoof capsule. For closure, the hoof defect is filled with polymethyl methacrylate adhesive and a second layer of polyester saturated with adhesive. A Sigafoos-style glue-on shoe with a bolted-on hospital plate (A) is applied with silicon impression material (B).

Photos courtesy of Dr. Dean Richardson

FIGURE 2 (A, B, AND C). Performing this surgery

curs in university settings first, then at general hospitals, then at clinical practices in the field.

“Take advances in radiology,” Dr. Richardson said. “Few practices in the field invested in digital radiography when it first launched.

Rather, the digital modality was established in universities and larger hospitals, then rapidly trickled down to the clinical practice.” Today, practically all practices have digital radiography.

In essence, the same thing is happening with the concept of shared specialization in the field. As mutual respect between farrier and veterinarian becomes more prevalent, so too will lasting partnerships form, Dr. Richardson predicted.

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RADIOLOGY

Ultrasounds Better than X-Rays for Diagnosing Pneumothorax

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Small volume pneumothorax

(PTX) can be a challenge to diagnose, but American and European researchers found that one method—ultrasonography—was better for detecting this condition than radiography.

“Equine veterinarians and techni­ cians should consider ultrasonography as a very reliable diagnostic method for detecting pneumothorax in horses,” Florent David, DVM, MS, DACVS, DCVS, DACVSMR, ECVDI Associate, a specialist in equine surgery, sports medicine and diagnostic imaging at the Equine Veterinary Medical Center, Al Shaqab—a Member of 10

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Qatar Foundation, in Doha, Qatar.

“High x-rays exposure is needed to radiograph the adult horse’s thorax. As ultrasonography is at least as good or a better alternative to radiography, using ultrasound instead of radiograph can reduce radiation exposure for the horse, the client and the veterinary staff when PTX is suspected.”

This should be good news for equine veterinarians because ultrasonography can be done in the barn, according to Dr. David.

“In an emergency situation, turning on your ultrasound machine is usually faster than your digital radiography system. If you don't

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have a digital system, then ultrasonography becomes your only option to diagnose on site the presence of PTX. “Ultrasonography can also be used to rapidly screen for other important syndromes, such as pleural effusion and pericardial effusion,” he said, adding serial ultrasound images can be helpful to monitor those conditions.

Pneumothorax occurs when air abnormally enters the pleural space, collapsing the lungs.

There are many causes including trauma and rib fractures, and complications of thoracic surgery or thoracoscopy, the researchers

explained. Veterinarians can also use ultrasonography to determine if a horse is at risk of developing a clinical PTX after specific procedures, such as lung biopsy, thoracoscopy, or after specific trauma (trachea, esophageal or axillary laceration; chest).

The two methods usually used to diagnose this life-threatening condition are radiography and ultrasonography. The researchers from Canada, Qatar, Australia, Scotland and France wanted to know which was better, so they evaluated the accuracy of both to diagnose PTX induced experimentally in six healthy adult hors-

Ultrasonography was more sensitive than radiography for detecting the presence of small volume pneumothorax.

Photo courtesyImages of XXXXXX courtesy of Dr. David

2D (top) and M-mode (bottom) ultrasound images of the caudodorsal aspect of the thorax in a normal horse (left side) and in a horse on which a pneumothorax (PTX) has been induced (right side).

es of similar age and breed.

Radiography detects the ventral collapse of the lungs below the thoracic vertebral body. “To be able to see air trapped in the pleural space and pushing the dorsal edge of the lungs below the thoracic vertebral body, you need a bigger volume of air than is needed for ultrasound to detect air trapped between the lungs and the thoracic wall,� he said.

In all, ultrasonography (80%– 84%) was found to be more sensitive than radiography (48%) to detect the presence of PTX in the standing horse. The specificity was similar for these diagnostic tests, ModernEquineVet.com | Issue 10/2017

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Images courtesy of Dr. David

RADIOLOGY

Radiographic image of the caudodorsal aspect of the thorax in an adult horse, on which a PTX has been induced. The dorsal border of a collapsed lung is difficult to see in this horse, as the PTX volume is low and the dorsal border of the lung is superimposed with the vertebral body and the diaphragm.

according to Dr. David.

The researchers evaluated two types of ultrasound images: twodimensional (2D), which is the most well-known, and M-mode, a time-motion display.

In 2D ultrasonography, the beam emitted by the transducer penetrates the tissue to be evaluated and then echoes to the transducer to generate the image. Each dot on the screen of the ultrasonography corresponds to a small part of a 2D thin slice of the tissue, he explained. The time elapsed for the ultrasound wave to return to the transducer determines the distance of the dot relative to the transducer; the strength of the echo determines the brightness of the dot. This is how the typical gray-scale images are produced.

Moving the ultrasound transducer over the body produces a sweep of the ultrasound beam. Then, mul-

Ultrasonography can provide data on the laterality of PTX. tiple 2D images of the body can then be generated.

In M-mode ultrasonography, the echo signal is recorded continuously (think echocardiograph), with the transducer kept in a fixed position. This mode is important to evaluate tissue or organs that are moving rhythmically, such as the heart and the lung surface.

The M-mode images obtained in the presence (stratosphere sign) or absence (seashore sign) of PTX are very different and easily seen.

“We hypothesized it would be eas-

ier for the clinicians involved in this study to diagnose PTX with the M-mode,” he said. “However, the results of the study found that 2D-ultrasound videos were slightly more accurate—although not statistically significant—than the review of M-mode ultrasound images to detect the presence of PTX,” Dr. David explained.

In addition, ultrasonography can provide reliable information on the laterality of the problem (left, right or bilateral PTX) while it is more difficult with radiography.

There were some limitations to the study because it was experimentally induced, he said. “As pneumothorax in the horse often occurs following a thoracic trauma, wounds can be present on the chest [in real-live circumstances].

As a consequence, air can be dissecting under the skin and markedly alter the quality of the chest ultrasound examination.

“In these cases, if the outer surface of two consecutive ribs and the pleural surface cannot be readily seen in the caudodorsal lung field in the standing horse or at the highest point of the chest in a recumbent horse/foal, then ultrasound cannot be used to confirm or rule out PTX,” he said.

Also, it is unclear whether radiography would perform as well as ultrasonography for bigger PTX (> 250 mL), he added.

The volume of air introduced in the pleural space was very small relative to the size of the horse and none of the horses experienced ventilation problems at rest during the entire study, he explained.

MeV

For more information: Partlow J, David F, Hunt LM, et al. Comparison of the thoracic ultrasonography and radiography for the detection of induced small volume pneumothorax in the horse. Vet Radiol Ultrasound 2017 Mar 6. (Epub ahead of print). http://onlinelibrary.wiley.com/doi/10.1111/vru.12480/abstract;jsessionid=DD74AE34FDF0BDFB2765DDE5DA4B52B5.f01t04 12

Issue 10/2017 | ModernEquineVet.com

NEWS NOTES

Bursotomy Effective for Sepsis of the Navicular Bursa Bursotomy coupled with regional antimicrobial perfusion and remedial farriery is an alternative to bursoscopy with sepsis of the navicular bursa, according to a new study from Iowa State University in Ames.

“Contaminated or septic navicular bursitis has been reported to have a guarded prognosis after surgical treatment with navicular bursotomy only. In our experience, the use of navicular bursotomy for the treatment of this disease in combination with systemic and local delivery of antimicrobials can provide a good prognosis, even in horses with chronic disease,” the researchers wrote.

The researchers did a case series to evaluate the outcome of 19 horses with septic navicular bursitis that underwent navicular bursotomy. In the majority, the sepsis related to a penetrating foot injury.

A standard surgical technique was used to remove part of the deep digital flexor tendon to expose the navicular bursa and perform sterile lavage. The wound was packed and a treatment plate fixed to the affected foot. Systemic antimicrobials were given and IV regional limb perfusion with antimicrobials was performed at surgery and on two to three more occasions postoperatively. The median duration of

clinical signs before surgery was 14 days, with most horses affected for at least seven days.

All of the horses survived to discharge from the hospital.

Owners were instructed on remedial farriery in the postoperative period. Follow-up owner telephone interviews revealed 16 of 19 horses returned to their previous level of performance, with the median time to return to function being four months. Seven of 10 with an athletic use preoperatively were returned to work at their previous level, with the remaining horses either returning at a lower level or retired. No horses were euthanized or required a repeat surgery, according to the researchers.

The alternative approach of bursoscopy offers several advantages over bursotomy, the researchers said, including being less invasive, reduced recovery time and potentially better chances of performing at a high athletic level postoperatively.

However, in chronic cases or where there are financial limitations, this case series demonstrated that bursotomy may offer a feasible alternative, especially when concurrent regional limb perfusion and postoperative remedial farriery are employed. MeV

For more information: Suarez-Fuentes DG, Caston SS, Tatarnuik DM, et al. Outcome of horses undergoing navicular bursotomy for the treatment of contaminated or septic navicular bursitis: 19 cases (2002–2016). Equine Vet J. 2017 Sept. 4 (Epub ahead of print). http://onlinelibrary.wiley.com/doi/10.1111/evj.12733/full

Recent natural disasters emphasize the importance of considering animal safety and welfare.

The University of California Davis School of Veterinary Medicine (SVM) and the UC Fire Department recently orchestrated a large animal rescue exercise for Urban Shield 2017, which tests the abilities of regional first responders to prevent, protect, respond and recover in high-threat, high-density urban areas.

Jim Green, director and cofounder of the British Animal Rescue and Trauma Care Association (BARTA) and a fire officer in the United Kingdom, helped to integrate the actions of the first responders and veterinarians in emergen-

cies and disasters involving animals. In the U.K., 90% of fire departments have animal rescue components, and veterinarians receive augmented training through BARTA. The exercise scenario involved a trailriding accident with a fallen horse that suffered a repairable fractured leg. The horse owner and riding companions remained at risk from the injured animal (represented by a life-sized mannequin), and the presence of live animals and riders from the Alameda County Sheriff’s Mounted Posse enhanced the reality of the exercise.

Claudia Sonder, DVM, an equine specialist and director of outreach at the SVM’s Center for Equine Health, as-

Photos courtesy of UC Davis

UC Davis Emphasizes Equine Rescue

sessed the situation and went through the steps involved to anesthetize the horse.

The mannequin was then packaged on a glide sheet for recovery from a difficult canyon location using rope systems into an awaiting horse trailer. Dr. Sonder worked closely with the teams to develop an extrication plan, considering the welfare of the horse and the time constraints associated with field anesthesia.

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TECHNICIAN UPDATE

Managing a Serious Wound

By Sally Schwartz CVT

Photos courtesy of Sally Schwartz

A 3-day-old Quarter horse filly and her mare presented to Wisconsin Equine Clinic and Hospital for a laceration on her forehead.

The owners reported that it had somehow happened overnight while the filly was in her stall.

Upon presentation, the filly was very active in her stall and her temperature, pulse rate and respiration (TPR) were within normal limits (101.1° F, 104 beats/minute, 48 breaths/minute) and she showed no abnormalities other than the wound to her head. The wound was a large laceration to her forehead with an open fracture of the frontal bone, which had displaced into her sinus.

After the initial examination, the surgeon anesthetized her near the stall to further explore the wound and begin treatment. The mare was sedated with acepromazine and detomidine IV; the patient was anesthetized with xylazine and ketamine IV. The affected area was cleaned and prepared for examination. The surgeon noted an inverted ‘V’ laceration to the skin that was approximately 7 cm long and 5 cm wide. The frontal bone was fractured and had collapsed into the frontal sinus. It was then decided to move the filly into the surgical room for further treatment of the wound. The patient was given diazepam IV, intubated, and was placed on .05% isoflurane.

The patient was positioned in right lateral recumbency and radiographs were taken to determine the ex-

tent of the trauma. The patient was prepped and had a long-term 16-gauge IV catheter placed in her left jugular vein. She was given potassium penicillin, amikacin and flunixin meglumine. A slow CRI of 5% dextrose and dobutamine and a 1L 5% dextrose were started as well.

The laceration was then prepped for surgery using dilute chlorohexidine and sterile water.

The patient was able to be maintained mostly at 0.5% for a majority of the surgery. On occasions when she became light and responsive to pain, the isoflurane was increased, and several breaths were given manually. When the patient responded to the increase in the isoflurane, it was decreased back to 0.5%. An ECG and pulse oximeter were used to monitor the patient during anesthesia; the left hind metatarsal artery was used for an arterial catheter to monitor her blood pressure. Her heart rate averaged 60–70 beats/min, MAP ranged from 80–90 mm, and her respiration rate averaged around 20 breaths per minute. Overall, the patient handled anesthesia very well and induction and recovery were unremarkable.

Bony fragments from the fracture were elevated to become flush with the surrounding bone. The majority of the periosteum had been stripped away from the fractured fragments, which prevented additional stabilization. The entire area was cleaned and flushed prior to closing. 2-0 Biosyn (an absorbable polyester suture) was used to close the remaining periosteum and 2-0 nylon was used to close the skin. To further protect the sinus, a non-adherent foam pad was placed over the wound. In addition, a double-thickness strip of 2" casting tape was used as a protective splint over the wound and sutured

The surgeon noted an inverted "V" laceration. The frontal bone was fractured.

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Surgical repair

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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

Photos courtesy of Sally Schwartz

TECHNICIAN UPDATE

Images show the progression of healing for the foals' wound.

into place. A 4" stockinette was used to act as a cover for the area. She was moved back into the stall with her dam and was recovered by hand.

The patient adjusted well to her sinus splint and facial bandaging. She was maintained on potassium penicillin four times a day, amikacin once daily and a decreasing dose of flunixin meglumine for five days post-op. The patient had a slight bloody nasal discharge for the first 48 hours post-surgery‌ decreasing each day. The supervising veterinarian was pleased with her progress, and she was discharged to her owners. She was to be given 5 cc daily for four days then 5 cc every other day of azithromycin paste and was to return in two weeks for a recheck and suture removal.

When she returned, the patient had grown and was as energetic as any other foal. The sinus splint had stayed in place and the area appeared to be heal16

Issue 10/2017 | ModernEquineVet.com

ing well. She was sedated standing (torbugesic and xylazine) and the sutures were removed. There was a small area of necrotic skin and a mild depression in the proximal area of the sinus. She was kept on azithromycin paste for an additional two weeks. The owners were asked to monitor the area closely and to keep us informed of her progress.

Since her procedure she has been doing well and no further cosmetic work has been needed.

MeV

About the author

Sally Schwartz has been working as a Certified Vet Tech since 1987; she has been at Wisconsin Equine for the past 24 years specializing in surgery, anesthesia and lameness. She is happily married with 2 grown children, and an array of 4-legged furry critters.

INFECTIOUS DISEASES

Novel Formulations for Equine Antimicrobial Use A unique formulation of penicillin in a gel formulation that can be instilled quickly and easily into the guttural pouch of horses that carry strangles may be an effective treatment, according to a report in a new open access journal, Veterinary Evidence.

Strangles is a common condition with high morbidity. Management of outbreaks is complicated by the development of asymptomatic carriers, with the causative organism, Streptococcus equi var equi, being retained within the guttural pouch. Treatment of carriers relies on removing physical infection and administering antimicrobials directly into the guttural pouch using a slow-setting penicillin and gelatin solution.

This has proved to be an awkward and lengthy process, usually only successful in a hospital environment.

Reverse thermodynamic agents, which are liquid when cool and solidify as they warm, have been used to treat canine otitis externa and provided the inspiration for the novel treatment for strangles carriers. A veterinary compounder (BOVA UK) formulated benzyl penicillin in poloxamer gel, and it was quickly and efficiently administered to a confirmed strangles carrier through a specially adapted uterine catheter.

The gel partially set within the pouch in just more than 4 minutes. The treatment was repeated over three consecutive days and a cure was determined by three guttural pouch lavages taken at weekly intervals, starting one week after the last treatment.

“This exciting report confirms the value of locally infused antibiotics in the management of strangles carriers.

The reverse thermodynamic poloxamer gel proved to be a practical method to retain antibiotics within the pouch without the need for complex mixing or prolonged rais-

Photos courtesy of Redwings Horse Sanctuary

Treating carriers is an awkward and lengthy process not usually effective in the field.

Horses displaying clinical signs of strangles

ing of the horse’s head. The case also highlights the value of specially formulated medicines in the management of complex diseases by providing novel delivery vehicles,” said Mark Bowen, BVetMed MMedSci (MedEd), PhD, Cert VA Cert EM (IntMed), DACVIM-LAIM, PFHEA, FRCVS, Oakham Veterinary Hospital in the U.K. Compounded products are tailored medications, produced in specific dosages and formulations to meet the particular needs of individual patients.

MeV

For more information: George JL, et al. "Identification of carriers of Streptococcus equi in a naturally infected herd." JAVMA 1983; 183: 80-84.

Newton JR, Verheyen K, Talbot NC, Timoney, et al. Control of strangles outbreaks by isolation of guttural pouch carriers identified using PCR and culture of Streptococcus equi. Equine Vet J. 2000;32:515–526. doi:10.2746/042516400777584721 Verheyen K, Newton JR, Talbot NC, et al. Elimination of guttural pouch infection and inflammation in asymptomatic carriers of Streptococcus equi. Equine Vet J. 2000;32:527–532. doi:10.2746/042516400777584703 ModernEquineVet.com | Issue 10/2017

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