The Modern Equine Vet September 2016

The Modern

Equine Vet www.modernequinevet.com

Vol 6 Issue 9 2016

Veterinarians: Because You're Worth It!

Improving Inventory Management How About a Nice Red Wine With That Hay? Technician Update:

Urethroplasty to Solve Reproductive Issues

Table of Contents

The Business of Practice

Veterinarians: Because

4 You’re Worth It

Cover photo: Brazos Valley Equine Hospitals

Improving Inventory Management........................................................................................ 8 Orthopedics

How About a Nice Red Wine With Your Hay?.......... 9 The Mystery of the Barrel Racer.................................12 technician update

Urethroplasty to Solve Reproductive Issues .....................................................................................14 News

Fluids Improve Cardiovascular Status Under Anesthesia............................................. 3 New Indication Granted for Lepto Vaccine.........................................................................17 New Bolton Center Appoints Full-Time Radiologist to Clinical Faculty.................................................................................................17

advertisers PS Broker........................................................................ 3 Merck Animal Health.................................................. 5

Avalon Medical............................................................. 7 AAEVT............................................................................15

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 • 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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News notes

Fluids Improve Cardiovascular Status Under Anesthesia Researchers in the U.K. found that providing concurrent fluid support improved cardiovascular status in anesthetized horses.

In horses anesthetized with isoflurane, a combination of dobutamine and crystalloid fluid bolus achieves significant improvements in femoral blood flow, which improves peripheral perfusion.

dex between the treatments. During treatment with dobutamine, there was a significant increase in arterial oxygen content and hemoglobin concentration to values that were significantly higher than those measured during the combined dobutamine and fluids treatment which saw no significant change in these factors.

There was also a significant increase in oxygen delivery index during dobutamine treatment. However, there was no significant difference in femoral blood flow measurements (a proxy measurement of peripheral perfusion) when dobutamine only was administered. During the combined treatment, femoral blood flow in the upper and lower (dependent) limbs increased significantly over time.

MeV

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Preparing for surgery

Six horses were anesthetized on two separate occasions at least three weeks apart and received either an IV infusion of dobutamine alone or dobutamine infusion with a 20 mL/kg bolus of Hartmanns solution.

The treatments were targeted to achieve a mean arterial blood pressure of 80 mmHg within 30 minutes of the start of the infusion.

There were no significant increases in cardiac in-

For more information: Loughran CM, Raisis AL, Hosgood G., et al. The effect of dobutamine and bolus crystalloid fluids on the cardiovascular function of isoflurane-anaesthetised horses. Equine Vet J. 2016 Aug. 21 [Epub ahead of print]. http://onlinelibrary.wiley.com/doi/10.1111/evj.12605/full

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ModernEquineVet.com | Issue 9/2016

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the business of practice

Veterinarians:

Because You’re Worth It

By Marie Rosenthal, MS

medicine to help animals, but that does not preclude making a living for themselves and their staffs, explained Ben Buchanan, DVM, DACVIM, DACVECC, of Brazos Valley Equine Hospitals, in Texas. Practices have to make a profit.

“Profit is often [considered] a dirty word for us but it is something that’s necessary to grow a business,” Dr. Buchanan said at the 61st Annual Convention of the American Association of Equine Practitioners.

Where veterinarians get into trouble is not determining the true cost of their services or understanding where their profit originates, he explained. “Whether it is a one-doctor practice or a large equine hospital,” Dr. Buchanan said, “the business side has to be analyzed before prices are set.”

The traditional method of setting prices for services was to find out what a nearby veterinarian charged for particular services— such as castration, an examination or a farm call—and charge a little less.

Basing costs on someone else’s business is not a sound business model, he said, because it determines competition based on pricing rather than service. The client should be focused on how well a particular veterinarian cares for his or her animal, how well he or she communicates that care to the client and how well he or she educates that client about their horse.

Although some clients are sensitive to the

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Courtesy of Brazos Valley Equine Hospitals

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the business of practice price of certain items, most “want to have quality service,” he said.

In small animal medicine, pricing is based on skill level and practice type: primary care practice versus a referral practice, for instance. The prices at the referral practice filled with specialists will be higher than those at a primary care practice.

Some veterinarians use national benchmarking services, but Dr. Buchanan does not think the data are specific enough to each

The Cost of Hospitalization One area that is often not priced properly is hospitalization, according to Ben Buchanan, DVM, DACVIM, DACVECC, of Brazos Valley Equine Hospitals, in Texas.

You have to know the cost to house a horse. “You can apply the same sort of idea to a profit center and specifically cherry pick pieces out of the income statement and in this example we’re going to take feed because that’s 100% goes toward hospitalizing horses, the labor of the stall cleaners, savings, disposal of horses, those are all specific expenses to hospitalization,” he said.

But the hospital also has shared expenses: rent or mortgage, insurance, repair and maintenance, etc.

There are many ways to determine that, according to Dr. Buchanan, but his hospital uses the hospital as a percentage of the building.

So, feed, labor, shavings and disposal of horses in a two-doctor practice costs about $69,000 a year. Rent, insurance, repair, maintenance is $89,000 total for the whole business, the hospital is one-third of the space would be 33% of that $89,000 leaving $29,067. Add that to the $69,000. The total expenses on the income statement for hospitalization is $98,667.

Look at how many days were billed the previous year. If 2,700 days of hospitalization were billed last year, the cost of hospitalization for that year was $98,667, the cost of hospitalizing a horse, $36.50. “So the hospital is charging $38.50, that’s a 5% margin. That’s 5% to compensate associates, that’s 5% to profit, that’s 5% to empathy, to whatever you need, but that’s a 5% margin,” he said, which probably will not be enough.

The hospital also boards and repros and the $28 per day is the breeding board or lay up cost, so on average it’s costing $36 to hospitalize a horse ,and they are charging $28 for lay up, they would lose $8 per day.

He suggested looking at that activity closely before making a decision to add a service.

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equine practice to use for pricing, although they could be the start of the conversation, he said.

Another traditional way of setting a price is to look at the cost of the consumable and then double the consumable to be the professional service fee. And an example of that is flunixin, which costs about a $1 a cc—so at 10 cc’s, it would cost about $10 a dose—the mark up could be 100% to (to $20) to give a shot of flunixin. Although that is a simple way to price services, it is not a balanced approach, he said. It assures that more expensive products are out of the reach of some clients, and is based on product rather than service—as if the veterinary clinic was a feed store, rather than a medical facility. “[It can become] tremendously expensive to the client and so the really expensive drugs we tend to overprice, the less expensive drugs we may tend to underprice, and using this strategy can make it difficult to compensate an associate or a veterinarian on their effort instead of just on inventory sales,” he said.

Charging by the hour is a step “toward where I would like to see us go,” he said. So, if the veterinarian wanted to charge $200 an hour and a castration takes 30 minutes, his or her fee would be $100.

Determining that cost should be based on the cost to run the business, he said, which requires an accurate income statement. Then, price based on that statement. This means making sure that the income statement is accurate and non-business related items are kept out of the statement, he advised.

This also means knowing how long different procedures normally take because time is money “We have timed some of our more common procedures to be able to say this is what it takes us to inject a set of hocks,” he said.

As an example, he looked at a two-doctor practice with total ex-

penses for the year of $1.040 million.

The veterinarian compensation is $260,000 for the two doctors. They spend $260,000 on drugs and consumables. So after subtracting the compensation for the professional staff and inventory, there is a net of $520,000. So that is what we’re going to call the net cost of overhead.

“If you say the doctors work 50 weeks a year, they average around 2,600 hours per doctor per year.

That's 5,200 hours. The net cost of overhead was $520,000, so that leaves us a cost per doctor hour to run the business of $100 an hour. This is off the P&L [profit and loss statement], off of the income statement. These arethe expenses, take out the compensation, take out the drugs, and you have a total,” he said. “Figure out how many hours you work in a year and you can set a cost-per-hour or a cost-per-minute. That is the minimum that a procedure costs before you add any profit, any compensation or anything to the drugs and consumables, what’s necessary to pay the staff, to pay the state, to pay utilities. It does not pay a doctor and it has no profit margin.”

Apply that cost to the procedures to develop a professional service fee.

“And essentially you need to decide what profit that you want; in this case we’re going to use a 10% profit margin, a compensation to the doctors of 25%, and then—historically in practices—there’s either excessive discounting or problems with accounts receivable, so it’s what I call loss; it may be things that you just want to give away. In this case I built it into this cost,” he said “Take the cost per hour and you divide it by 1 minus those percentages, so $100 divided by 55% is $182 per hour. So if we charge $182 per hour for a procedure, we will cover our costs, we will compensate the associate veterinarians at 25%, we will have some money there for the empathy issues where I want to discount a case. But at $182 per hour, you will

Courtesy of Brazos Valley Equine Hospitals

cover costs, make profits and compensate the veterinarians,” he said.

Now, add the cost of consumables. “So the drugs, the sedatives, antibiotics, tetanus, pain medicine—whatever it is that you’re going to use that you took out of the initial alculation—needs to be added back in on that particular procedure,” he said.

When determining the cost of consumables, allow for shrinkage— loss, expired medications, spillage, theft, etc. “Because my income statement doesn’t break it down to the syringes and to the needles that we do use from the inventory—consumables that we don’t actually charge back for—marking the consumables up also covers those sorts of issues.

We bundle those into a price where the castration is going to be $210. I know that it’s going to take 30 minutes, it’s going to cover the cost, it’s

going to cover the expenses of the consumables and it’s going to generate the profit that I want,” he said.

If a practice wants to purchase a specific piece of equipment—say digital radiograph equipment— determine the life span (use three years because veterinarians and

technicians can be pretty hard on equipment) and then add the service fee. For an example, he used $5,000 a year, which gives an annual cost of about $24,000 to have that piece of equipment in the building.

“If we took 1,000 radiographs last year, that’s $24 from each radiograph,

Caption

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the business of practice

4 Tips to Improve Inventory Management

By Tawni L. Karle Next to labor, inventory is the second highest cost in an equine practice.

Managing and tracking inventory can be a tedious process if done manually, and the chance for human error is great. In addition, the cost to purchase inventory can change significantly from day to day, so it’s possible to sell a product for less than you paid for it.

Practice management software can make inventory management easier and keep you from losing unnecessary profits. Here are a few tips to keep in mind.

1. Price It Right Certainly, the cost of your inventory items should influence the price at which you sell them, either through fixed pricing or mark-up pricing.

In a fixed-pricing structure, the selling price of an item does not change as the cost for the item changes. This can be dangerous if not managed regularly. Price increases can sneak up on you, causing your costs to exceed your sales price.

Mark-up pricing uses a set mark-up amount, usually a percentage, to determine the selling price. When the cost goes up, the selling price goes up, and you will maintain your desired margin. However, it’s important to constantly review the mark-up percentage to make sure your products are priced competitively.

In either case, your practice management software should make inventory pricing easier. For example, some software has several tools that can quickly identify inventory concerns, such as alerting you if cost has increased and automatically adjusting the selling price to compensate. This eliminates the need for staff members to remember to do this, keeping your profit margins consistent.

2. Store It Right Equine practices generally have more than one storage location. It is important to use your practice management software to separate storage locations for accountability and proper stocking levels.

If your practice management software cannot track inventory in multiple storage locations, it will be difficult to identify high- and low-performing locations, which makes it difficult to manage and make changes. Your practice management software should track each location separately, allowing you to transfer inventory between locations, identify which trucks/ locations are selling more of certain items, investigate trends, better stock your locations, and actively drive sales of more inventory. $24 from each radiograph to pay for the machine to be there. It costs $1 to archive them so we’re going to add $1 for an archiving fee and if it takes us 10 minutes to do a radiograph, that’s $30.16 for 10 minutes of service at our $181 per hour. So if you add those together, it should cost $55 to 8

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3. Reduce Shrinkage Shrinkage (loss of products between receipt and point of sale) has many different causes. One cause is improper setup of inventory in your software. When receiving your inventory items, make sure you receive them in your software at the lowest possible size. For example, if you sell Banamine injections by the mL, receive the Banamine by the mL, not the vial. That will help you keep track of each mL you receive and sell and track waste of anything not used.

Another unfortunate cause of shrinkage is employee theft. If not invoiced to the client or used in the practice, it should be on the shelf or in the truck. Your practice management software should provide reports that make it easier to track missing inventory.

4. Automate Re-Ordering Keeping the right amount of product on hand is another important part of inventory management. If you keep too much on hand, it could expire and go to waste. If not enough, clients may purchase needed products from a competitor.

It is important to accurately set re-order levels so that your practice management software is automating the re-order process for you. If set up properly on the front end, your practice management software will tell you when to order and how much of each item to order.

Look at three months’ worth of ordering to see your trends and make sure you are ordering the correct amount. Also, account for the different seasons, such as breeding season; you will most likely need to stock more of certain inventory based on each busy season. Check your practice management software to see if you can set re-order levels so you can re-order easily and quickly.

Inventory is a huge asset for an equine practice — and it can be a huge expense. Your practice management software should provide you with the management tools and reporting you need to properly set up and manage your inventory and identify areas of improvement.

This can make a big difference in your practice’s financial health and ability to grow in the future.

ABOUT THE AUTHOR Tawni Karle is Product Manager for the ImproMed Triple Crown practice management software platform from Henry Schein, as well as an avid horse lover. She has owned and shown horses for nearly 20 years.

take a radiograph,” he said.

When determining a fee for a service look at all the costs, he suggested.

“Looking at your income statement can help you to understand where profit comes from,” he said.

Then, when you talk to a client or staff about the cost of a proce-

dure, you can feel comfortable that this is the true cost of the service.

Veterinary business software can help veterinarians determine their costs, as well as improve inventory control, and might be worth the investment. But don’t forget to determine their true cost.

MeV

Orthopedics

How about a

nice red wine wit h yo u r h ay ?

Resveratrol Appears to Reduce Lameness ness in performance horses with lameness localized to the distal tarsal joints,” said Ashlee W. Watts, DVM, PhD, lead author of the study.

Based on their results, Dr. Watts, who is assistant professor at the Department of Veterinary Medicine & Biomedical Sciences at Texas A&M University, said that she would consider using res-

barn manager asking, “Would you like a nice red wine with your hay?” Of course, you would never actually give a horse red wine, but the substance that makes red wine so healthy for humans—resveratrol—might also be beneficial for performance horses.

“Oral resveratrol supplementation can be used to reduce lame-

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veratrol to reduce lameness in the horses she treats.

Lameness that results from arthritis and wear and tear on the joint are among the most common performance-limiting problems in horses and these problems are commonly treated with rest, intra-articular administration of corticosteroids, non-steroidal antiinflammatory drugs (NSAIDs)

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Images courtesy of Dr. Watts

A new study might have the

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Orthopedics

Images courtesy of Dr. Watts

and supplements, such as glucosamine, the researchers said.

Steroids and NSAIDs have side effects that limit their long-term use, and despite their popularity, the data supporting the use of supplements, such as glucosamine, to reduce the severity of lameness are

Performing flexion testing at Texas A&M.

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lacking, the researchers said.

The researchers wanted to know whether another supplement—resveratrol, a natural polyphenolic compound found in many plants, including grapes— could affect lameness.

Over the study period of 2.5 years, 45 horses with distal tarsal joint lameness were assigned to a resveratrol (Equithrive) or placebo supplement. Lameness was determined by physical examination, diagnostic anesthesia and objective testing.

Horses were observed walking on asphalt in a straight line, as well as on a trot in a U-shaped pattern for a total of 100 m, which was repeated after passive flexion.

In addition, the horses underwent an objective lameness test using an inertial-based, body-attached sensor system (Equinosis), and the horses were walked again in a straight line back and forth for 40 m.

Afterward, diagnostic anesthesia was performed in the more severely affected hind limb.

Regardless of the treatment arm, each horse was injected with triamcinolone acetonid in the tarsometatarsal joints of both hind limbs. Four horses treated by the same veterinarian also received amikacin in each joint. Phenylbutazone was also given to each horse after the intra-articular injections.

The horses were then discharged under the owner’s care with the resveratrol supplement or placebo and instructed to add two scoops to the horses' feed twice daily, administer pheylbutazone for up to seven days and return the horse to full work in three to seven days. Other than these additions, owners were told not to vary the horse’s normal routine: diet, turnout and exercise.

Owners documented whenever medications or supplements were

added or removed from the regimen.

The owners were given questionnaires at two and four months, and the horses were re-examined at the hospital four months after enrollment when they underwent the same examinations and objective tests for lameness.

Three horses were lost to follow up, and the researchers ended up with 21 resveratrol treated and 20 placebo treated horses when the results were unblinded.

Two months after beginning treatment, 20 of the resveratrol group versus 14 of the placebo group said that the horse’s performance was better (P=0.05). At four months, 18 of the resveratrol versus 10 of the placebo group reported that the horse’s performance was better (P=0.02).

Other parameters, owner satisfaction with treatment, whether the horse returned to full work, signs of lameness, palatability of the supplement and whether the horse performed as expected were similar in both groups.

Follow-up injections, use of NSAIDS and other medication and supplements also was not significantly different between the two groups, nor did the reports of adverse events.

Only one horse in the resveratrol group missed more than seven doses.

Although many of the subjective parameters where similar in both groups after four months, the change in the A1:A2 ratio, which is the measure of vertical pelvic movement versus expected pelvic movement for each stride, was significantly better in the resveratrol group over the placebo.

“Although the inertial sensor system used in the present study revealed a significant difference in the change in A1:A2 ratio between groups in the present study, the distribution of lameness scores and

the percentage of horses with an improved subjective scoring system did not differ between groups,” the researchers wrote. “We believe this can be attributed to inherent limitations of a subjective scoring system under which a single lameness grade can cover a broad range of lameness severities.”

However, the objective findings had several advantages, including repeatability, consistency and the ability to detect subtle lameness, they added.

“Results of the present study suggested that in performance horses with lameness localized in the distal tarsal joints, injection with triamcinolone in the centrodistal and tarsometatarsal joints of both hind limbs followed by oral supplementation with resveratrol for four months resulted in

reduced lameness, compared with triamcinolone injection and supplementation with a placebo,” the researchers said.

Dr. Watts said that she thought the results could be extrapolated to other types of lameness. In addition, she told The Modern Equine Vet that she would consider continuing or adding glucosamine to the horse’s regimen because each supplement had a different effect on the horse. “Many/most other joint supplements contain the building blocks of normal cartilage, such as glucosamine, chondroitin, which is a different mechanism of action compared with resveratrol. If those supplements work, it would be by a different mechanism, so it could make sense to give both types (i.e. glucosamine/chondroitin and resveratrol),” she said.

MeV

Images courtesy of Dr. Watts

In this study, oral resveratrol supplementation reduced lameness localized to the distal tarsal joints.

A lameness exam.

For more information: Watts AE, Dabareiner R, Marsch C, et al. A randomized, controlled trial of the effects of resveratrol administration in performance horses with lameness localized to the distal tarsal joints. J Am Vet Med Asso. 2016;249:650-659.

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ModernEquineVet.com | Issue 9/2016

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Orthopedics

The Mystery

The barrel racer’s bone scan showed a hot spot right where the spine attaches to the base of the skull, indicating an injury. But the radiographs were inconclusive, so he was sent to PennVet where a revolutionary imaging technique enabled veterinarians to diagnose and manage the animal.

Hammer, a Quarter horse, was a candidate for a clinical trial using New Bolton Center’s Equimagine B 12

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robotics-controlled imaging system, which captures three-dimensional, high-resolution computed tomography (CT) images in the standing and moving horse without the need for anesthesia.

“If he had a neck fracture or any other serious lesion, we would be concerned about the recovery from anesthesia,” said Christopher Ryan, DVM, a radiologist at the New Bolton Center. “A standing

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CT was a good option.”

Nikki Becker, of Saratoga, N.Y., bought 9-year-old Hammer, whose registered name is CC Fancy Big Shine, in September of 2015. A competitive rodeo rider, Ms. Becker was actually looking for a roping horse for her husband, but wanted a horse that also “had a barrel-racing pattern” as a back-up.

The two were just getting started on their promising rodeo sea-

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of the Barrel Racer

son, placing in race after race on the barrel-racing circuit, turning in times in the 16-second range. Then Hammer had two freak trailer accidents one right after the other.

First he got his head caught in the trailer window bars on the way home from a rodeo on June 17.

Three days later, he spooked and reared up while tied to the trailer, and his two front legs came down full force on the lead rope.

He had to be cut loose. Even after that dramatic accident, Hammer showed no signs of injury, and Becker continued workouts and competitions. Weeks after the incidents, Hammer exhibited “small changes,” but nothing that would indicate an injury, Becker said.

Until the weekend of July 17.

Hammer wasn’t quite himself during the barrel race at the pro rodeo in Vermont that Saturday. The champion went wide on the first barrel, stumbled a bit on the second, then rounded the third barrel perfectly, crossing the finish line in 16.5 seconds. He earned third place.

Ms. Becker took him to a local jackpot the next day, confident he would perform better. So when Hammer ran by the first barrel, refused the second, and toured the ring on the third, Becker was embarrassed, and very concerned.

Hammer’s primary veterinarian, Steven Sedrish, DVM, of Upstate Medical Center in Schuylerville, NY, took radiographs, but could not see anything definitive. Then he took a bone scan, and a “hot spot” showed up in Hammer’s cervical vertebra, where the halter lies.

Ms. Becker brought him to New Bolton Center for the CT scan on August 4. Drs. Ryan and Dean Richardson, chief of Surgery, handled the case. Hammer was the first adult horse to have a scan of the neck in the imaging system.

“We were actually able to see a tiny avulsion fracture on the CT

Above: Robotic imaging. Below: The CT Scan picked up a tiny avulsion fracture on the first cervical vertebra, called the atlas.

scan,” Dr. Ryan said. “It’s a fragment of bone that got pulled off of the parent bone by a ligament that attaches there,” he continued. “It’s on the first cervical vertebra, called the atlas.”

The bone scan and the CT scan correlated well with each other.

“The bone scan provided us with the right general area to search in and the CT scan was able to identify the exact injury,” Dr. Ryan said.

“Without the CT scan we may never have known what the exact cause of the ‘hot spot’ on the bone scan was or even if it was a significant finding.”

“We knew, theoretically, that this CT imaging system would be a huge advantage,” Dr. Ryan continued. “To have it prove itself was nice.”

Ms. Becker was relieved to get an answer. “They found something that we couldn’t see before,” she said.

“Finding something is better than nothing, since it told us where to go from there.”

Knowing the extent of the injury, Hammer was limited to stall rest to give the bone and ligaments time to heal.

MeV —Adapted with permission from a PennVet post.

ModernEquineVet.com | Issue 9/2016

13

technician update

By Brandi Larsen, CVT Reproduction season in the equine world is a hectic time not only for owners but for veterinary staff worldwide. Many complications can arise, even in an ideal situation. However, with quick recognition of a problem, proper diagnosis and treatment, these complications can turn around to a positive outcome.

During the summer, an 8-year-old Quarter horse mare presented for a second opinion for a reproductive issue. The primary complaint of the owner was the mare's inability to successfully conceive despite having had several healthy prior pregnancies. The mare had severe urine scalding bilaterally on the hind limbs and has a previous history of Caslick’s procedures. The referring veterinarian noted that during his examination, the mare presented with vesicovaginal reflux and that he felt more comfortable referring her for further evaluation and a second opinion.

A patient history found that the mare had a successful racing career and was bought to become a broodmare following her retirement. She produced three healthy foals with uncomplicated pregnancies prior to his ownership and had Caslick’s procedures due to the poor conformation of her vulva to her rectum. He has owned her approximately one year and has attempted to breed this mare several times unsuccessfully. After this discussion, a physical examination was performed and found to be unremarkable. Her heart was in normal sinus rhythm and no murmurs were ausculted. Her mentation was bright,

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alert and responsive with no apparent systemic abnormalities observed.

Following her physical examination, the clinician opted to perform a reproductive ultrasonography and gross examination to confirm the referring veterinarian's diagnosis of vesicovaginal reflux and to assess any other abnormalities or infections. She was placed in the stocks and her perineum, vulva and rectum were cleansed to remove any debris or contaminants.

The clinician began by placing a vaginal speculum and visually examining the vagina. He noted that urine was visible in the forward portion of the vagina, which is typically seen with a diagnosis of vesicovginal reflux. Following the gross examination, the clinician palpated the mare’s ovaries with no tumor, masses or abnormalities appreciated. She was cleansed once more to remove any debris, lubrication or feces as well as to start with a clean area for the next portion of the examination. The clinician then began a full reproductive examination and ultrasound. The ovaries were visualized ultrasonographically bilaterally and noted to have no follicular activity at this time indicating that she is in anestrus with unremarkable size and shape. A swab of the uterus was taken for a uterine culture and sensitivity prior to the decision to proceed with the urethroplasty. A urethral extension procedure or urethroplasty, is a surgical procedure performed typically with the patient in a standing position, with sedation and under regional anesthesia in which a tunnel is made using existing tissue. The tunnel begins where urine from the bladder is normally expelled through the urethral orifice in the direction of the vulva. The ultimate goal

shutterstock/ WOLF AVNI

Urethroplasty to Solve Reproductive Complications

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.

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) 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.

Fo r m o re i n f o r m a t ion v ist w w w.a ae vt.or g

ModernEquineVet.com | Issue 9/2016

*American Association of Equine Veterinary Technicians and Assistants

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technician update

of the procedure is for urine to be expelled through the new tunnel and vulva instead of allowing it to reflux in the direction of the cervix.

The culture and sensitivity results were negative making the mare a candidate for the urethoplasty based on the negative result and based on clinical examination findings and history.

An IV catheter was placed in the patient’s jugular vein using sterile technique in preparation for the urethroplasty. The mare was given a dose of intramuscular (IM) procaine penicillin G as well as IV gentamicin and flunixin meglumine.

Since a urethroplasty is typically performed with the patient standing, it is preferred to achieve a moderate level of sedation prior to beginning the procedure and the epidural regional anesthesia. The mare was administered a loading dose of detomidine and butorphanol intravenously prior to the administration of an IV sedative constant rate infusion of additional detomidine and butorphanol in sodium chloride 0.9%. The constant rate infusion was administered at a rate of 0.6 ug/kg/min to maintain a moderate level of sedation with minimal ataxia.

During the procedure, her vitals were monitored every 5 minutes and were found to be unremarkable throughout.

Once an acceptable level of sedation was achieved, the mare was then prepared for and administered a caudal epidural for additional analgesia and in an attempt to minimize the amount of sedation needed.

After approximately 10 minutes, the regional anesthesia from the caudal epidural was assessed and proved to be successful. The level of sedation was also assessed at this time and reduced by 15% or to a rate of 0.51 ug/kg/min IV that was then repeated at 15 minute intervals throughout the 60 minute procedure.

The mare’s rectum was evacuated and her perineal region was cleansed to remove debris, feces and contaminants. The clinician began the urethroplasty and created the new urethral aperture, which took a little over an hour. He then placed a foley catheter into the urethra and secured it with stay sutures to avoid irritation, further contamination, and limit strain during urination as well as performing a Caslick's procedure that would stay in place for 14 days barring any complications. When the clinician began closing the incisions, the sedation constant rate infusion was discontinued and the patient was allowed to metabolize the sedatives to safely move her back into her stall.

She did display mild diaphoresis of the head, ears and neck from the IV sedation, however, her vital signs were unremarkable throughout the procedure.

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Silver sulfadiazine cream was applied around the site of the Caslick’s procedure and urinary catheter as well as petroleum jelly along the hind limbs to protect the patient from further urine scalding during healing. The mare was monitored continually in the stocks for approximately 40 minutes when most of the ataxic effects of sedation had worn off. Once she appeared stable enough to become ambulatory, she was led back to her stall without complication. Feed was temporarily withheld until later that evening to avoid aspiration of debris into her lungs and eliminate the choking risk. She was monitored visually overnight every two hours to ensure proper retained placement of the urinary catheter, absence of hemorrhage, abdominal discomfort or colic symptoms, urine and feces output, and mentation. Later that evening, she was given a small flake of alfalfa hay and had an excellent appetite. She received a subsequent postoperative dose of procaine penicillin G intramuscularly and IV flunixin. Over the next several days, she was monitored closely and the surgical site was cleansed daily and she did not appear to be extremely painful or edematous.

The mare returned to a modified feed schedule that morning which included a mash of grain soaked in water and free access to clean fresh water at all times to avoid incisional disturbance by straining to defecate. During her hospitalization, the mare’s physical examinations were unremarkable, however, she did become increasingly agitated during the cleaning of the incision site and required mild sedation prior to the procedure.

Two weeks following the urethroplasty, the urinary catheter was removed. The incision was intact and healing well. Following removal of the urinary catheter, the patient returned home and was placed on strict stall rest for an additional two weeks to protect the delicate procedure and to monitor urinary output. Following the additional recovery time, the mare returned for a gross examination and reproductive ultrasound to ensure success of the procedure. No urine was seen in the vestibule and the mucosal tunnel was intact proving success of the procedure and hopefully the ability to carry through another healthy pregnancy.

MeV

About the author

randi Larsen, CVT, is an independent B consultant in Weatherford, Texas. She has piloted and implemented custom veterinary training programs in large animal practices in Texas as well as lent her knowledge as a speaker at veterinary conferences nationwide.

News notes

New Indication Granted for Leptosporosis Vaccine The LEPTO EQ INNOVATOR vaccine (Zoetis), the only equine leptospirosis vaccine against Leptospira interrogans serovar Pomona, received additional approval for use in broodmares for all three trimesters of pregnancy.

Field safety studies, which examined the vaccine when used in the first, second and third trimesters of pregnancy, showed no systemic or local reactions to vaccination.

ditional studies showed 99.8% of vaccinated horses were reaction-free with no adverse events.

“The additional field safety study in first and third trimester mares was conducted following the launch of LEPTO EQ INNOVATOR to provide veterinarians and horse owners confidence in the vaccine across all phases of pregnancy,” said Dr. Boggs. “Additionally, the study highlights the ongoing dedication from Zoetis to provide the equine industry a product they can have confidence in.”

LEPTO EQ INNOVATOR helps prevent leptospiremia caused by L. interrogans serovar Pomona, which could, but has not been demonstrated to, help reduce the potential risk of equine recurrent uveitis infections, abortions or acute renal failure caused by L. interrogans serovar Pomona. Previously unvaccinated healthy mares should receive two doses of LEPTO EQ INNOVATOR approximately three to four weeks apart. Annual revaccination with a single dose is recommended.

CDC/ NCID/ Rob Weyant

New Bolton Center Appoints Full-Time Radiologist to Clinical Faculty

“Leptospires can cause late-term abortion in mares,” said Jacquelin Boggs, DVM, MS, ACVIM, senior veterinarian, Equine Technical Services at Zoetis. “The expanded label claim allows the equine breeding community the flexibility to use LEPTO EQ INNOVATOR to fit their breeding program’s needs and help elevate antibody titer levels when most needed.”

A study showed that 13% of bacterial abortions are caused by L. interrogans serovar Pomona, the most common leptospiral serovar found in horses. Aborting mares have been reported to shed leptospires in their urine for periods up to three months and can transmit Leptospira to exposed animals. Some horses aborting due to a leptospiral infection develop uveitis several weeks to months later. Additionally, the aborted fetus is a source of exposure to other horses on the property.

Prior to launching LEPTO EQ INNOVATOR, Zoetis conducted safety and efficacy trials which showed 0% urinary shedding in vaccinated horses challenged with L. interrogans serovar Pomona. Ad-

Penn Vet’s New Bolton Center, in Kenneth Square, Pa., has appointed Dr. Kathryn Wulster as assistant professor of Diagnostic Imaging.

Dr. Wulster earned her VMD from Penn Vet in 2012. She completed a residency in diagnostic imaging at the Cummings School of Veterinary Medicine at Tufts University in 2016, and was board certified by the American College

of Veterinary Radiology (ACVR).

Her clinical work at New Bolton Center will focus on equine patients using advanced imaging systems, including magnetic resonance imaging (MRI), computed tomography (CT), and the new robotics-controlled imaging system, Equimagine. She joins Dr. Christopher Ryan, a radiologist who has been working at New Bolton Center part-time for the past year, specifically on Equimagine cases.

“The robotic imaging technology is quickly evolving, and there is a lot to learn,” Dr. Wulster said. “It is cutting-edge.”

Having a full-time radiologist dedicated to working with clinicians on advanced imaging studies is a “game changer” for New Bolton Center, said Dr. Barbara Dallap Schaer, New Bolton Center Medical Director.

A resident of Kennett Square, Dr. Wulster has a 14-year-old Holsteiner MeV gelding used as a hunter-jumper.

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