The Modern Equine Vet January 2016

Vol 6 Issue 1 2016www.modernequinevet.com

Fine tuning doping testsOxygen before anesthesia?Technician Update: Standing MRI, stem cells to improve lameness

Equine VetThe Modern

AAEP Meeting:

The Stateof the Industry

2 Issue 1/2016 | ModernEquineVet.com

Table of ConTenTs

sporTs MedIcIneFine tuning doping tests .......................................................................................................8

GeneTIcsUnlocking genetic secrets of the dunn coat ................................................................10

TechnIcIan UpdaTestanding MrI, stem cells help put the spring back into jumper's step .............12

newshorses tolerate preanesthetic oxygen .....................................15sunshine vitamin linked to improved fertility in wild animals ..................................................................15controlling mosquitoes? watch the flowers ..........................16cT proves useful in diagnosing conchal bullae disease ...........17UK vets' antibiotic prescribing habits .......................................18BI strengthens position in animal health ...............................19

LEGAL DISCLAIMER: The content in this digital issue is for general informational purposes only. PercyBo Publishing Media LLC makes no representations or warranties of any kind about the completeness, accuracy, timeliness, reliability or suitability of any of the information, including content or advertisements, contained in any of its digital content and expressly disclaims liability of any errors or omissions that may be presented within its content. PercyBo Publishing Media LLC reserves the right to alter or correct any content without any obligations. Furthermore, PercyBo disclaims any and all liability for any direct, indirect, or other damages arising from the use or misuse of the information presented in its digital content. The views expressed in its digital content are those of sources and authors and do not necessarily reflect the opinion or policy of PercyBo. The content is for veterinary professionals. ALL RIGHTS RESERVED. Reproduction in whole or in part without permission is prohibited.

state of the equine industry

coVer sTory:

4Cover photo Shutterstock/Makarova Viktoria

SaleS: Matthew Todd • [email protected]

edITOR: Marie rosenthal • [email protected]

aRT dIRecTOR: Jennifer Barlow • [email protected]

cOnTRIbUTIng wRITeRS: paul Basillo • Kathleen ogle

cOPY edITOR: patty wall

Published by

p E r c y b omedia publishing


adveRTISeRSUniversal Imaging ...................................................... 3Vetstem ......................................................................... 5Merck animal health ................................................. 7

hallmarq ....................................................................... 9aaeVT ...........................................................................13

PO Box 935 • Morrisville, PA 19067Marie Rosenthal and Jennifer Barlow, Publishers

Universal ImagingSee the difference

UNIVERSAL I M A G I N G TM

TRANSFORMTHE QUALITY OF CARE

Ultrasound Digital Radiography Cloud & PACS Continued EducationLeading-edge systems tailored to the equine

practitioner.

Ultra-light, fully wireless systems with auto X-ray detection technology.

Comprehensive cloud-based image storage

and management.

Focused on improving the quality of care that you offer your patients.

Innovative Mobile Solutions For Today’s Equine Practitioner

800.842.0607 | www.universalimaginginc.com

myRad D-EVODigital Radiography

ULTRA-LIGHT DIGITAL RADIOGRAPHY FOR TODAY’S EQUINE PRACTITIONER.

FujiFilm’s sophisticated imaging technologies and advanced processing bring the image quality of myRad D-EVO to the next level.

ISS Technology improves signal strength and dose efficiency, resulting in images with an unprecedented level of diagnostic content.

SmartSwitch (AED) Technology eliminates generator synchronization problems by automatically sensing x-ray photons to initiate image acquisition.

ULTRA-PORTABLE ULTRASOUND DESIGNED FOR VETERINARY MEDICINE

Compact, powerful and easily transportable, EXAGO offers veterinary practices exceptional image quality and unparalleled ease-of-use.

Best image quality of any 6-lb. system - B, B+B, B+M modes, Color Flow Mapping, Pulsed Wave-Power Doppler, Cardiac, Video Clips, MSK – All Standard

Industry leading battery run time of up to 6 hours enhances the portability by eliminating the need for a power source.

EQUINE PRO PACKAGE SPECIALPurchase a myRad-DEVO with a C24i (10x12) or P35i (14x17) detector before February 15, 2016 and get

an EXAGO ultrasound with one probe for $10,000, PLUS a free one or two day VetPD Continued Edu-cation course held anywhere in the world.

CLICK HERE TO LEARN MORE

BUY THIS GET THIS FOR $10,000

15 lbs. 6 lbs.

B y p a u l B a s i l i o

There was a significant downturn in key economic indi-cators for equine practices from 2008 to 2010, including revenues, invoices and number of active patients and clients. This was fol-lowed by a rebound in 2011 and 2012, but not a complete recovery, according to the National Equine Veterinary Economic Study, spon-sored by Merck Animal Health and Henry Schein Animal Health, in partnership with the American Association of Equine practitio-ners (AAEp).

All measures of economic ac-tivity such as total revenue, num-ber of patients, number of clients

and number of transactions or invoices declined significantly through the Great recession and rebounded somewhat in 2011 and 2012, according to equine vet-erinary market research specialist and practice management consul-tant, Edward L. Blach, DVM, MS, MbA, and assisted by Andrew R. Clark, DVM, MbA, leading equine practice management con-sultant, who lead the study.

The study was a much-needed snapshot of the industry from 2007–2012. Some of the findings in the study were expected, but much of the data are surprising and, in some cases, sobering, they

said at a press briefing at the 61st AAEp Annual convention and Trade Show, held in Las Vegas.

practice owners made very few adjustments to payroll or labor head count through the recession. Instead, they shouldered much of the impact of the recession by taking less in compensation them-selves.

The market has fundamentally changed since the survey began in 2007. The potential pool of cli-ents is smaller, and there are fewer horses to treat. Most practitioners are likely doing more with those clients and those horses, but there are other good expansion oppor-Sh

utte

rstoc

k/pr

etty

boy8

0

Despite a rebound after the downturn, equine veterinarians have not seen a complete recovery.

TaTe OF TheeqUIne IndUSTRY

Cover sTory


TEL: 858.748.2004 ▪ TOLL FREE: 1.88.VETSTEM1 ▪ WEB: www.Vet-Stem.com

Stem Cells for Bleeders

VetStem has launched an Investigational Clinical Research program for Exercise Induced Pulmonary Hemorrhage (EIPH-

Bleeders) What’s the Problem? Exercise induced pulmonary hemorrhage (EIPH, aka “bleeders”) occurs in the majority of strenuous exercise performance horses. EIPH has a negative effect on athletic performance. It is defined as the presence of blood in the bronchi and/or trachea that is detected on endoscopic exam after intense exercise. Preliminary Outcomes We are excited to release the first round of preliminary data for our Bleeders (EIPH Exercise Induced Pulmonary Hemorrhage) Clinical Research Program. We have outcome data on six of the horses, and as we had hoped, the results look very promising. Below are the results. Results: Six horses have completed their first competition as of this date, and all six have competed again without any preventative medications after adipose stem cell therapy (ASCs).

I’m interested, what should I do? Contact Karina Benish, RVT ([email protected]) at VetStem for more details and approval. VetStem will offer a reduced cost program during the initial data gathering period. We would like to enroll a total of 30 horses during this initial research program.

Cover sTory


tunities available, they said. Too few practices used modern

management principles to manage their practices with intent to opti-mize profit and enterprise value. Many opportunities exist for most practices to improve profitabil-ity and to grow the value of their practices.

“In the past, we have not had access to a lot of economic data in the equine veterinary industry,” explained Dr. blach. “We went into the study with the assump-tion that we needed to find a way to get this information out to the practice owners so they could put it to use.”

Dr. clark noted that while there is some good news in the study, some of the data are unsettling. “only 16% of practices use a for-mal budget,” he explained. “only 31% of equine practices lock their pharmacy door. That means there are tens or hundreds of thousands of dollars in drugs and supplies sitting in an unlocked room.”

Dr. clark added that ever-crowded curriculum in universi-ties has been squeezing out the opportunity to learn about the business side of veterinary medi-cine.

“This year’s graduates know more but are good at less than anyone who has ever graduated. Next year’s class will know even more but will be good at even less,” he said. “The light at the end of the tunnel is the student-driven Veterinary business Management Association [VbMA]. It has a curriculum, the students receive a certificate at the end, and it’s the primary opportunity to get a business education in veterinary school. However, the necessity of a student club to teach business should be somewhat embarrassing to the universities.”

prior to the Great recession, there was a sense that there was enough equine business to go

around for everyone. Many prac-titioners put their head down, went to work every day and did not worry too much about closely managing their practice.

“They could get by because there was enough work,” Dr. blach said. “I don’t believe that’s the case now. There is more competition for the available work, and fewer horses among the owners who are there. It’s more important than ever to manage for profitability. There were practices during the recession that had the most prof-itable years they’ve ever had, but those are the ones who managed their practices more closely.”

overall, the study sheds a lot of light on business opportuni-ties that have been overlooked by some veterinary practitioners, ac-cording to Brett Whitehead, di-rector of Equine, Merck Animal Health. “In some instances, mak-ing a few immediate changes [as a result of the study] will equate to quick wins for the clinic and its customers.”

Jeannie Jeffery, national direc-tor of Equine Sales, Henry Schein Animal Health, and one of the early supporters of the study, noted that the study tells a great deal about the issues facing equine practitio-ners as they navigate the challenges inherent to running a business. “Through a greater understanding of their needs, we can ensure that we are offering the products, ser-vices and solutions for operating an efficient practice and delivering quality care,” she said.

Veterinarians are trained to provide the best possible patient outcomes, Dr. clark said. “As far as the financial outcome, we’re not trained for that. We would refer a sick horse to a board-certified spe-cialist if the outcome warranted it. If we look at the health of our practice, we should refer it to someone who specializes in prac-tice health.” Mev

The good, the bad, and the slightly embarrassing

13%

16%

31%

60%

73%

14%

of equine practices belong to a study group—a much higher percentage than in companion animal practices.

use a practice management consultant.

of practices have a formal budget.

of equine practices have written practice goals.

of practices lock their pharmacy door.

of practices have a mission statement.

of practices use email communication, but most of those practices do not have anywhere close to a full client e-mail list.

of practices use practice management software.

of practices text clients, which may create a problem as there is no record of those texts in the medical record.

18%

32%

70%

Practitioners can create a free account on www.IsMyPracticeHealthy.com, a simple, non-intimidating portal for the results of the national equine veterinary economic Study and other practice management information. The site offers daily, fresh, brief pieces of management education for veterinarians.

Some dewormers claim just one dose of their product is the best way to deworm your horse, but that’s simply not true.

Demand Safety: You won’t find a laundry list of warnings and precautions on the PANACUR® (fenbendazole) POWERPAC label, like those other dewormers, because fenbendazole has a unique mode of action that makes it safe for horses of all ages, sizes and body conditions.

Demand Efficacy: PANACUR POWERPAC is the only dewormer FDA approved to treat ALL STAGES of the encysted small strongyle.1 Other dewormers miss a critical stage, EL

3, which can account for up to 75% of the encysted

small strongyle burden. Plus, it’s the best choice for treating ascarids – which are not just a problem in young horses!

SO WHEN IT COMES TO WHICH DEWORMER TO TRUST, DON’T FORGET THERE’S SAFETY IN NUMBERS.

Consult your veterinarian for assistance in the diagnosis, treatment, and control of parasitism.Do not use in horses intended for human consumption. When using Panacur® (fenbendazole) Paste 10% concomitantly with trichlorfon, refer to the manufacturers labels for use and cautions for trichlorfon.

1 PANACUR (fenbendazole) POWERPAC Equine Dewormer product label. © 2016 Intervet Inc., d/b/a Merck Animal Health, a subsidiary of Merck & Co., Inc. All rights reserved.

sPorTs MedICIne

Standing Equine MRI

COMPLEXLAMENESS CASE ?

www.hallmarq.net

DON’T BE LEFT IN THE DARK,CONSIDER STANDING EQUINE MRI

Hallmarq_ModernEQvet_full pg.indd 1 1/28/16 4:10 PM

Doping in the horseracing industry has spurred regulations banning performance-enhancing drugs, as well as calls for an anti-doping agency in the United States. but as in human sports, testing for certain kinds of prohibited sub-stances has been a challenge. Now scientists report in AcS' journal Analytical chemistry a new de-tection method that could help anti-doping enforcers determine whether a horse has received certain substances.

To give their animals an edge on the track, some individuals might ad-minister a single substance, a cocktail of hormones, hormone-mimicking compounds or other drugs. Most are

prohibited in the racing industry, but catching violators can in some cases be difficult with conventional meth-ods. Existing techniques directly test for the original compounds admin-istered to an animal or their unique metabolites or byproducts. but some of these substances can get processed and eliminated by the animal quick-ly, making the window for detection very short. George Ho Man chan, Terence See Ming Wan and col-leagues are investigating unconven-tional ways to increase the chances of catching cheaters.

The researchers have identified seven biomarkers in urine that po-tentially indicate whether a horse has been given aromatase inhibitors,

a class of compounds also used by bodybuilders to help regulate hor-mones and get an edge on the com-petition. Testing for the changes in these naturally occurring biomark-ers in horse urine could reveal the administration of the substances for about 95 to 195 hours after injec-tion. That's two to 2.5 times longer than conventional screening meth-ods. being able to find evidence for the administration of these drugs for two or more days longer than before could increase the chances that rule-violators will be caught. With further validation studies, this method could be developed into a useful screening tool for detecting the use of aroma-tase inhibitors in horses. Mev Sh

utte

rstoc

k/Su

khan

ova D

aria

doping testsFine tuning


Standing Equine MRI

COMPLEXLAMENESS CASE ?

www.hallmarq.net

DON’T BE LEFT IN THE DARK,CONSIDER STANDING EQUINE MRI

Hallmarq_ModernEQvet_full pg.indd 1 1/28/16 4:10 PM

doping tests


GeneTICs

Although horses come in a variety of coat colors, most lack the camouflaging coat of their ances-tors. However, a trace of that legacy remains in horses with the dun pat-tern, which is characterized by pale hair covering most of the body, a dark stripe along the back and ze-bra-like stripes on the legs.

A recent study revealed a new mechanism that explains the ge-netic roots of the dun pattern and uncovers why the pattern does not appear in most domesticated hors-es—it’s been bred out. The study is the work of an international team of scientists led by Texas A&M

University Institute for Advanced Study (TIAS) scholar Dr. Leif An-dersson and is the result of a col-laboration among groups at Texas A&M University, Uppsala Univer-sity in Sweden, and the Huntsville Institute of biotechnology in Ala-bama.

The dun pattern camouflaged ancient wild horses, protecting them from predators. However, domestic horses—like other do-mestic animals—have been se-lected over many generations to appear different from their wild counterparts. As a result of se-lective breeding, most domestic

horses today are not dun and have coat colors that are more intensely pigmented and uniformly distrib-uted across the body.

“Dun is clearly one of the most interesting coat color variants in domestic animals because it does not just change the color but the color pattern,” Dr. Andersson stated. “We were really curious to understand the underlying mo-lecular mechanism of why the dun pigment dilution does not affect all parts of the body.”

“Unlike the hair of most well-studied mammals, the dilute-colored hairs from dun horses are

of the dun coat in horses

Three dun stallions. From left: bay dun, blue dun, and red dun.

Phot

o cou

rtesy

of Fr

eyja

Imsla

nd

Unlocking genetic Secrets

ModernEquineVet.com | Issue 1/2016 11

sign up Today * we promise not to bombard you with emails. Just a notice when new information is available. send us your email address

not evenly pigmented,” explained Freyja Imsland, a phD student in Dr. Andersson's group. “They have a section of intense pigmen-tation along the length of the hair, on the side that faces out from the body of the horse, while the rest of the hair has more or less no pig-ment. The hairs from the dark ar-eas of dun horses are in contrast intensely pigmented all around each individual hair. In spite of scientists having studied hair pig-mentation in detail, this kind of pigmentation is novel to science and quite unlike that seen in ro-dents, primates and carnivores.”

Genetic analysis and DNA se-quencing revealed that the dun color is determined by a single gene, which codes for the T-box 3 (TbX3) transcription factor, which controls several critical processes in develop-ment that affect bones, breast tissue and cardiac conduction, according to Dr. Greg Barsh, whose group at Huntsville led the tissue analy-sis. “We were surprised to find that

TbX3 also plays a critical role in skin and hair development.”

researchers measured TbX3 distribution in individual hairs rela-tive to other molecules known to regulate pigmentation. They sug-gested that the signals governing where TbX3 is expressed could help to explain zebra stripes. In horses that have lost their dun color, TbX3 mutations do not inactivate TbX3 protein function and instead only affect where—both on the individ-ual hair and on the horse’s body—the gene is expressed.

“In growing hairs, TbX3 mir-rors the distribution of melano-cytes, the cells that produce pig-ment,” explained Kelly McGowan, a senior scientist in Dr. barsh’s lab. “our results suggest that TbX3 affects differentiation of specific cells in the hair, creating a micro-environment that inhibits mela-nocytes from living in the ‘inner’ half of the hair.”

The team also discovered that there are two forms of dark, non-

dun color: non-dun1 and non-dun2, which are caused by differ-ent mutations. Non-dun1 horses differ from dun horses in that they have a darker coat and less con-trast between the stripes and the rest of the body. on the other hand, non-dun2 horses show no stripes at all.

The study results indicated that the non-dun2 variant occurred recently—most likely after domes-tication. In contrast, the dun and non-dun1 variants predate domes-tication. Evidence of this conclu-sion can be found in the DNA of a horse that lived about 43,000 years ago—long before horses were do-mesticated—which carried both dun and non-dun1 variants.

“This demonstrates that horse domestication involved two dif-ferent color morphs—dun and non-dun1—and future studies of ancient DNA will be able to reveal the geographic distribution and the abundance of the two morphs,” Dr. Andersson said. Mev

Imsland F, McGowan K, Rubin CJ, et al. Regulatory mutations in TBX3 disrupt asymmetric hair pigmentation that underlies dun camouflage color in horses. Nature Genetics 2015 Dec. 21 [Epub ahead of print].

For more information:

Unlocking genetic Secrets


By Nicole LaGrange, RVT

An 11-year-old Warm-blood gelding used for hunter jumper competition presented in october 2014 for lameness after jumping the day before. He had been

purchased approximately one month prior to the onset of this injury after a thorough prepurchase examination during which no abnormal findings were discovered.

on clinical examination, the horse showed no sig-nificant findings upon palpation and inspection of the limbs with the exception of mild left-front proximal suspensory pain upon deep palpation. He was nega-tive to hoof testers. Digital pulses were normal. Neck and back palpations were considered unremarkable.

Examination on the lunge line on soft ground re-vealed a left forelimb 3/5 lameness on the circle right and 1/5 lameness on the circle left, the lameness was less apparent when lunging on hard ground in both directions.

Flexion tests revealed 2/5 on the left front fetlock, 2/5 right front fetlock, 3/5 left hock, and 3/5 on the right hock.

Distal nerve blocks did not resolve the left front lameness (pD, fetlock, and low 4-point performed). After local anesthesia infiltration of the proximal sus-pensory origin, the gelding showed 100% improve-ment 5 minutes post injection. Advanced imaging was recommended.

November 2014 scintigraphy revealed in the soft tissue phase an “increased radiopharmaceutical up-take in the left distal carpus and proximal metacarpal region, moderate to severe and focal in the region of the palmar soft tissues.” The bone phase of the scan revealed “Left palmar distal carpus and proximal metacarpal region, severe and focal.”

Diagnostic ultrasound was performed and inter-preted as normal. radiography examination of the left metacarpus and carpus was performed and re-vealed the trabecular pattern of the proximal medial third metacarpus was mildly sclerotic.

based on these findings, the horse was recom-mended for standing magnetic resonance imaging (MrI, Hallmarq) of the left front proximal metacar-pal region. Findings enumerated on the radiologist report included “moderate fluid of the third metacar-pal bone of the left fore and mildly irregular palmar

standing MrI, stem cells help put the spring back into jumper's step

nuclear scintigraphy

Initial MRI

AAEVT MembershipBi-Annual NewsletterWeekly “HoofBeats” Email NewsblastFull access to www.aaevt.org, including the Career Center and the LibraryUp-to-date information on the AAEVTDiscounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT ConventionNTRA, Working Advantage and Platinum Performance BenefitsThe 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 ObjectivesProvide opportunities for CE, training, communication, and networkingEducate the equine veterinary community and the public about our professionInform Members of issues affecting our professionAssist in providing the best medical care to improve the health and welfare of the horse

••••

AAEVT Online Equine Certification ProgramA three course, 10 module, equine-only online program offered through ACTGeared toward Credentialed Veterinary Technicians, Assistants, Support staff, & StudentsAreas 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 proceduresA 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 labsThose 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 AVMAFor more information go to www.aaevt.4act.com or call 800-357-3182

•••

•

•

•

For more inf or mat ion vist www.aae vt.org*American Association of Equine Veterinary Technicians and Assistants

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.

AAEV T M E M b E r s h i pMembership 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.

TeCHnICIan uPdaTe

AAEVT MembershipBi-Annual NewsletterWeekly “HoofBeats” Email NewsblastFull access to www.aaevt.org, including the Career Center and the LibraryUp-to-date information on the AAEVTDiscounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT ConventionNTRA, Working Advantage and Platinum Performance BenefitsThe 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 ObjectivesProvide opportunities for CE, training, communication, and networkingEducate the equine veterinary community and the public about our professionInform Members of issues affecting our professionAssist in providing the best medical care to improve the health and welfare of the horse

••••

AAEVT Online Equine Certification ProgramA three course, 10 module, equine-only online program offered through ACTGeared toward Credentialed Veterinary Technicians, Assistants, Support staff, & StudentsAreas 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 proceduresA 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 labsThose 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 AVMAFor more information go to www.aaevt.4act.com or call 800-357-3182

•••

•

•

•

For mo re in f o r mat i on vi st www.aae vt.org*American Association of Equine Veterinary Technicians and Assistants

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.

AAEV T M E M b E r s h i pMembership 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.


margin, third metacarpal bone, left fore.” The veterinarian recommended a follow-up MrI

in 6 weeks to ensure that the healing was progressing normally and to rule out any soft tissue injury devel-opment, as well as to assess the osseous fluid in the third metacarpal bone.

In addition, the veterinarian decided the horse was a good candidate for stem cell therapy. Stem cells are regenerative cells that can differentiate into many tis-sue types, as well as reduce pain and inflammation thus helping to restore range of motion and stimulate re-generation of tendon, ligament and joint tissues. Stem cell harvest was performed using the bilateral gluteal liposuction technique. The fatty-tissue was sent to Vet Stem lab in San Diego for processing. once processed, the stem cells are quality checked and then injectable doses of the patient’s stem cells are returned. Two days later, the stem cells were injected periligamentous at the proximal suspensory origin.

The horse received stall rest for 30 days with twice daily NSAIDS, 30-minute hand walks and 20 minutes of ice therapy.

Additional stem cells were injected periligamen-tous at the proximal suspensory origin in December 2014. Follow-up examination showed that the horse was sound at the trot in a straight line and on the lunge line on hard ground without using NSAIDs. He showed mild sensitivity to firm palpation of the proximal suspensory origin of the left front. At this point it was advised to turn the horse out in a small paddock and continue hand walking and cold thera-py until his recheck MrI in February.

In February 2015, recheck MrI findings included “resolved fluid, third metacarpal bone, left fore, focal mild to moderate sclerosis, third metacarpal bone, left fore, and mildly irregular palmar margin, third metacarpal bone, left fore.”

March 2015, following the recheck MrI a series of shockwave therapy treatments of the left front proxi-mal suspensory region were begun at monthly inter-vals for six months. concurrently, tiludronate diso-dium (Tildren, ceva) was administered (1 vial IV) at each shockwave session.

Additionally, it was recommended that the patient be started under saddle walking 20 minutes per day the first week, and beginning the second week, add in trot-work at 2 minutes additional per week. Each af-ternoon the gelding was walked for 30 minutes. After 6 weeks (12 minutes of trot-work per day) he began the canter-work at 2 minutes per week, adding 2 ad-ditional minutes each week. He was allowed turn out daily. Aspirin at one scoop twice daily was started.

As of July 2015, the gelding was in full flatwork and had started jump schooling and remains sound. proximal suspensory syndrome is a complex of sev-eral interrelated pathologies that require careful management. Mev

about the authorNicole LaGrange, RVT, is a veterinary technician with San Dieguito Equine Group in San Diego, Calif. She works in the field as well as performing standing MRI for the clinic. Her primary interests are in sport horse management including lameness and imaging. Ms. LaGrange is a regional contact for AAEVT.

MRI after treatment

Proximal suspensory syndrome is a complex of several interrelated pathologies that require careful management.


Proximal suspensory syndrome is a complex of several interrelated pathologies that require careful management.

pre-oxygenation via a nasal cannula before induction of general anesthesia is well tolerated, results in sig-nificantly increased arterial oxygen levels in the im-mediate post-induction period and does not increase intrapulmonary shunting, according to a recent study.

Although performed in other species, there are no reports of the use of oxygen supplementation in horses prior to anesthetic induction. This randomized prospective clinical trial set out to determine whether pre-oxygenation via a nasal cannula raised arterial partial pressures of oxygen following induction of general anesthesia. Nine healthy adult horses were given oxygen at a flow rate of 15 L/min for 3 minutes prior to anesthetic induction. In nine controls, the na-

horses tolerate pre-oxygenation before general anesthesia

getting ready for surgery. Should it include pre-induction oxygen?

Phot

o cou

rtesy

of th

e Equ

ine Ve

terina

ry Jo

urna

l


Van Oostrom H, Schapp MWH, Van Loon JPAM. Oxygen supplementation before induction of general anesthesia in horses Equine Vet J. 2015 Dec 25. [Epub ahead of print]

http://onlinelibrary.wiley.com/enhanced/doi/10.1111/evj.12526/

sal cannula was inserted but oxygen was not given. All horses received the same premedication and

were induced with ketamine and midazolam before being placed in left lateral recumbency. The horses were intubated, attached to a circle breathing system and then received isoflurane and oxygen with an in-spired oxygen fraction of 50% at a flow rate of 4–6 L/min. During this time the horses were breathing spontaneously.

Immediately after induction, the pao2 measured in the oxygenated group was significantly higher than in the control group. only one animal in the oxygen-ated group had pao2 less than the level at which in-tervention to treat hypoxemia is deemed necessary, in contrast to the control group in which all but one had pao2 below this cut-off value (8–9.3kpa).

There was no significant difference in pao2 of the two groups in a 30-minute sample and there was no significant difference in intrapulmonary shunt frac-tion between groups, indicating it was unlikely that oxygen supplementation results in intrapulmonary shunts via resorption atelectasis. Acceptance of the nasal cannula was scored as “moderate” in two horses and described in all the others as “good.”

More study is required to determine whether us-ing this method results in better clinical outcomes, the researchers said. Mev

High levels of vitamin D are linked to improved fertility and repro-ductive success, a study of wild sheep has found. The study, carried out on a remote Hebridean island, adds to growing evidence that the sunshine vitamin is associated with reproductive health.

researchers led by the University of Edinburgh measured vitamin D concentrations of an unmanaged population of Soay sheep. They found that sheep with higher blood levels of vita-min D at the end of the summer had more lambs the follow-ing spring. The study offers the first evidence that an animal’s

vitamin D status is associated with an evolutionary advantage. Vitamin D is essential for healthy bones and teeth and has been linked to other health benefits.

Laboratories have linked vitamin D to reproductive health in domestic animals and humans. This is the first evidence of the link in wild animals. Scientists carried out the research as part of a long-term study on the evolution of Soay sheep, which have lived wild for thousands of years on the islands of St Kilda, a world Heritage site owned and managed by the National Trust for Scotland. Mev

Sunshine vitamin linked to improved fertility in wild animals

Handel I, Watt KA, Pilkington JG, et al. Vitamin D status predicts reproductive fitness in a wild sheep population. Scientific Reports 2016 [Epub Jan. 13] http://www.nature.com/articles/srep18986


news noTes


news noTes

certain mosquitoes are more likely to lay eggs in wa-ter sources near flowers than in water sources without flowers, according to an article published in the Jour-nal of Medical Entomology.

researchers from the Department of Agriculture and the University of Florida studied the Asian tiger mosquito (Aedes albopictus) and its egg-laying pref-erences. This mosquito transmits West Nile virus and Eastern equine encephalitis, canine heartworm, as well as human diseases, such as yellow fever, dengue and chikungunya, and it has been spreading through-out the United States.

Asian tiger mosquitoes prefer to lay eggs in con-tainers, so the first thing the scientists decided to test was whether the size of the containers made any dif-ference. They were also curious about whether or not the presence of flowers might affect the egg-laying be-havior, due to the fact that mosquitoes drink flower nectar.

The researchers studied female mosquitoes that had been fed blood meals and released in large cages with water containers and flowering butterfly bushes (Buddleja davidii).

They found significantly more eggs in the largest containers, and they found more eggs in containers next to flowering bushes than in containers without flowers.

The researchers hope that these findings lead to new methods of controlling the mosquito.

“one of the potential outcomes of this study might be that someone could look at the flower fragrances as a way to lure egg-laying female mosquitoes to some sort of trap,” said Dr. Phil Kaufman, one of the re-searchers.

“This study provides evidence of the attractiveness of flowering butterfly bushes to ovipositing (i.e., egg-laying) Aedes albopictus,” said Dr. Timothy Davis, another author. “ovipositing mosquitoes are those that have taken a bloodmeal and, in instances where pathogen transmission is occurring, are the poten-tial vectors as they may have acquired the pathogen through the blood meal. Therefore, exploiting the at-tractiveness of flowering butterfly bushes in develop-ing control techniques could assist in stopping patho-gen transmission.”

controlling mosquitos? watch the flowers

The researchers suggested that female mosquitoes lay eggs near flowers for a variety of reasons. Nectar is an important energy source, so pregnant females are obviously attracted to the flowers to feed themselves. but it could also have something to do with providing food for the next generation in the form of nectar.

“putting eggs in water near a nectar source may be a way of provisioning for the offspring, which do need sugar upon emergence,” said Dr. Kaufman.

The findings of this study may be used one day to increase the effectiveness of mosquito trapping and monitoring efforts, especially if the attractants from flowers can be isolated and replicated.

“Incorporation of phytochemicals that are pro-duced by butterfly bushes may enhance ovitrap effec-tiveness, thereby improving surveillance and control efforts,” the researchers wrote. Mev

an asian tiger mosquito (Aedes albopictus) feeding on the nectar of a flowering butterfly bush (Buddleja davidii).Credit: Entomological Society of America

Davis TJ, Kline DL, Kaufman PE. Aedes albopictus (Diptera: Culicidae) oviposition preference as influenced by container size and Buddleja davidii plants. Journal of Medical Entomology, January 2016 DOI: 10.1093/jme/tjv201



bullae (average 15 cm3) and these were related to head size. In both dorsal and ventral bullae, there were significant differences in the volumes among different age groups (estimated by dentition), with the youngest group (0–5 years) having significantly smaller volumes than those in the oldest (>16 years). In the case of the ventral conchal bullae, this could be explained by the larger size of cheek teeth alveoli protruding into the nasal cavity in younger horses.

The rostral limit of the dorsal conchal bulla was parallel to Triadan 07s in most horses (81.3%). The caudal limit was parallel to Triadan 10s in 61% and the 09s in 30.5%. The rostral limit of the ventral con-chal bulla was parallel to Triadan 07s in 78% and the caudal limit parallel to the 09s in 64.5% and the 10s in 32%.

This anatomical information could help identify which structures are involved in sinus disease, they said. Mev

computed tomography (cT) may prove to be a use-ful tool to diagnose sinus disease in horses, according to recent work from Edinburgh researchers.

Veterinarians are finding infections of the dorsal and ventral nasal conchal bullae, which are causing clinical signs of sinus disease but the anatomy of these two structures has not been well documented.

Diplomats examined cT images of 90 cadaver skulls. Specimens with dental or sinonasal disease (confirmed by skull sectioning and gross examina-tion) were excluded from the study, leaving 60 speci-mens for investigation. Imaging software (osiriX) was used to create multidimensional reconstructions and to measure height, length and width of dorsal and ventral bullae, allowing the volume of each bulla to be calculated. Height, length and width of each head also provided a volume for each skull.

The dorsal conchal bullae were found to be great-er in volume (average 24 cm3) than ventral conchal

cT proves useful in diagnosing conchal bullae disease

Phot

o cou

rtesy

of T

he Eq

uine V

eterin

ary J

ourn

al

left image: ventral multiplanar reconstruction of a cadaver equine head at the level of 08 maxillary cheek tooth. note white arrows indicating septae formation within the dorsal conchal bulla and ventral conchal bulla. Right: Transverse image of a cadaver equine head <4 years old. note the small size of the left and right ventral conchal bullae (arrows) due to protrusion of the tall reserve crowns of the erupting 07 maxillary cheek teeth.

Liuti T, Reardon R, Smith S, Dixon PM. An anatomical study of the dorsal and ventral nasal conchal bullae in normal horses: Computed tomographic anatomical and morphometric findings. Equine Vet J. 2015 Oct 6. [Epub ahead of print]. http://www.ncbi.nlm.nih.gov/pubmed/26440763



news noTes

Antibiotic stewardship in both animal and human medicine is crucial to preserving the efficacy of life-saving antibiotics, but under-dosing of antimicrobi-als or inappropriate prescribing are concerns among veterinarians.

U.K. researchers recommended that veterinarians perform a more accurate estimation of bodyweight to prevent further development of resistance.

They evaluated the selection of antimicrobials for traumatic limb wounds prior to referral to a single equine hospital. This was a good area to evaluate be-cause the U.S. Department of Agriculture found that traumatic injuries or wounds were the most common reason for giving antibiotics to horses with 3.9% of those older than 6 months of age receiving antimi-crobials for traumatic injuries in a 12-month period. More than 96% of U.K. veterinary surgeons said that they too would prescribe antimicrobials for a con-

taminated limb wound, however, no one has investigated if that reflects actual

practice, the researchers said. They classified antibiot-ics according to the british

Equine Veterinary Associ-ation (bEVA) guidelines

as “first line,” “alterna-tive,” “protected,” (e.g. third- or fourth-gen-eration cephalospo-

antibiotic prescribing habits can help or hinder resistancerins and fluoroquinolones) or “inappropriate” (formula-tion is unsuitable for horses). At the referral center, dose rates were calculated using bodyweight measurements and if the dose administered was less than 90% of the reference dose, this was classed as under-dosing using reference doses according to bEVA guidelines.

of the 113 cases included in the study, 94 (83%) had received antimicrobials prior to admission to the referral center and of these, 88% were given a first-line antimicrobial, 1% an alternative, 9% a protected antimicrobial and 2% an inappropriate choice. The most common drugs were gentamicin (65%), pro-caine penicillin (54%) and sodium benzyl penicil-lin (17%). penicillin plus gentamicin was used in 56 cases. There was no association between use of protected antimicrobials and time since graduation, postgraduate qualifications or equine versus mixed practice. Although the number of horses receiving protected antimicrobials was low (n = 7), there was a significant relationship between use of protected antimicrobials and time since injury of more than 24 hours. The researchers argued that this is unlikely to be justified as first-line antibiotics combined with appropriate wound management are still effective in most chronic wounds.

For cases in which complete dosing information was available, 55% were under-dosed with at least one antimicrobial. For the penicillin and gentami-cin combination, 25% of the 52 cases for which in-

Pseudomonas aeruginosa Photo courtesy of Janice Haney Carr

Staphylococcus aureusPhoto courtesy of Frank DeLeo, National Institute

of Allergy and Infectious Diseases (NIAID)

To help prevent resistance, make sure bodyweight estimation is correct before prescribing antibiotics.


Ross Se, Duz, M, Rendel DI. Antimicrobial selection and dosing in the treatment of wounds in the United Kingdom. Equine Vet J. 2015 Dec 25. doi: 10.1111/evj.12535. [Epub ahead of print] http://onlinelibrary.wiley.com/enhanced/doi/10.1111/evj.12535/


boehringer Ingelheim and Sonofi have entered into exclusive negotiations to swap businesses. The pro-posed transaction would consist of an exchange of Merial, the Sanofi animal health business with most of the boehringer Ingelheim consumer health care (cHc). The transaction would also include a gross cash payment from bI to Sanofi of $5.12 billion.

The animal health industry is an attractive in-dustry in terms of innovation, growth potential and profitability, according to a press release from bI. combining the two companies’ complementary strengths would create the second largest player in the global animal health market with pro forma sales of approximately $4.14 billion in 2015 with the ability to compete for global market leadership. The combined portfolios and technology platforms in antiparasitics, vaccines and pharmaceutical special-ties would place the combined company in the key growth segments of the industry. The species portfo-lios are highly complementary, building on Merial’s expertise in companion animals and poultry and bI’s expertise in swine.

“boehringer Ingelheim’s strategic priority is to focus on the company’s core areas of expertise and businesses with an established global scale, or where

boehringer Ingelheim strengthens position in animal health a pathway to a global scale can be achieved and pri-oritized among boehringer Ingelheim’s portfolio op-portunities,” said prof. Dr Andreas Barner, chair-man of the board, bI. “bI Animal Health is—and will stay—strongly committed to bringing novel, innovation-driven solutions to veterinarians and animal owners. our combined Animal Health busi-ness would be well-positioned for growth and emer-gence as a leader globally. I am confident that Sanofi will enable our cHc business to fully live its poten-tial supported by highly professional and committed teams.”

Lyon, France, the headquarters of Merial, would be a key operational center of bI’s Animal Health business. bI will commit to maintain business opera-tions, r&D and Manufacturing centers in France.

As the U.S. market is an important part of Merial’s business, bI would pay particular attention to sustain the momentum of the U.S. operations. the company said. bI will give particular attention to social matters as well as skills and retention sensitivities, the com-pany said.

The execution of definitive agreements is expected in the coming months. Mev

formation was available had been under-dosed with both drugs. Sodium penicillin was the drug most fre-quently under-dosed and by the greatest magnitude, with the median dose administered being only 56% of the recommended dose. There was no relationship between frequency of under-dosing and postgraduate qualification or type of practice; however, a significant relationship was found with time since graduation, with the odds of under-dosing increasing with years since graduation. Horses over 561 kg were more likely to be under-dosed than lighter horses. There was no relationship between under-dosing and breed.

“This study demonstrates the use of certain classes of antimicrobials in situations where typically they would not be considered necessary. If these findings reflect more general attitudes, then there is a need for

greater awareness of—and compliance with—recom-mendations for the controlled use of certain classes of antimicrobials,” the researchers wrote. “The study also provides concerning evidence of widespread un-der-dosing of antimicrobials in equine practice, even among experienced and equine-focused first-opinion practitioners. This situation could easily be rectified by the use of more objective estimates of horse weight, such as validated weigh tapes or portable weighbridg-es, which are now easily affordable for equine prac-tices.” Mev

To help veterinarians ensure responsible use of antimicrobials, BEVA has a new program called Protect Me. Go to www.beva.org.uk/useful-info/Vets/Guidance/AMR.

reach your veterinarians wherever they are, whenever they want.

For adVerTIsInG raTes and InForMaTIon, eMaILMatthew Todd


Documents

The Modern Equine Vet January 2016