Medication Safety

Handle and store your horse's medications safely

by Dave Sauter, DVM

Previous articles have discussed how to administer medications to horses, whether injectable, oral or topical. This month, I'd like to focus on proper handling of medications to ensure the stability, safety and effectiveness of the products.

Temperature

Many medications need to be stored within specific temperature ranges. Temperatures outside these ranges can alter the chemical nature and stability of the components. For example, vaccines are very sensitive to storage temperatures. Freezing can cause some vaccines to lose their effectiveness and become much more reactive--in other words, much more likely to cause heat, swelling and pain at the injection site.

Another example is penicillin. The most common type of penicillin used in horses is Procaine Penicillin G, which is supposed to be refrigerated but not frozen. There are different types of penicillin injection reactions, and all of them are pretty scary. One of the reactions (disorientation, fear response, seizure and collapse) is thought to be related to the procaine. The procaine in Procaine Penicillin G is bound to another chemical. Storage at room temperature has been shown to result in more release of the procaine from this other chemical and to increase the chance of this reaction.

To keep medications stable, safe and effective until their expiration dates, follow label recommendations for storage temperatures. If refrigeration is required, do not store medications in the door of the fridge, where temperatures fluctuate more; keep them near the center.

Sunlight

Many medications are sensitive to sunlight. For example, sunlight inactivates ReguMate. Medications in dark-colored bottles often are light sensitive (e.g., Acepromazine). Direct sunlight can be particularly damaging to vaccines, resulting in less immunological effect (which is the goal of vaccination in the first place) and greater injection site reaction (which we all strive to prevent).

Transport

It is important to maintain proper storage conditions during the transport of medications. If you have a long drive from the veterinary clinic to the farm, putting medications on the dash where heat and sunlight can damage them is not a good plan. Use a small cooler to keep your refrigerated products cool, but do not place products like vaccines directly onto an ice block. Similar precautions should be taken when necessary to protect products from direct sunlight and extreme temperatures when they are taken out of storage for use in the horse.

Cleanliness

This is particularly critical with injectable products. Products such as Procaine Penicillin G, Naxcel or Banamine are in multi-dose vials. Each time the needle enters the bottle there is the potential for contamination. Injection of a contaminated product into the horse can result in cellulitis, deep abscesses, and other serious complications like tetanus. Store these products in a clean environment. Clean the surface of the rubber injection cap, if it is dirty, with gauze soaked in 70% isopropyl alcohol (rubbing alcohol) before inserting the needle. Always use a new needle and keep the cap on it. Never touch the needle or allow it to touch anything but the medicine and the horse it is intended for.

Dosage

Follow the label directions as closely as possible.

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Make sure to prepare and deliver the correct amount at the proper interval. Always double and triple check that the prescribed amount of medication is prepared. For instance, it is easy to overdose an oral medication in a multidose cartridge, such as Bute, if the dial is not set properly.

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Do what is safe and necessary to administer the medication to the horse. If the medication ends up on the wall or the floor instead of in the horse, then the horse is not going to maintain therapeutic levels in its body.

· Follow the instructions on dosing interval. Shortening the interval can result in toxicity. The medication will drop below therapeutic levels if the interval is increased. This is especially problematic with antibiotics because it will cause drug resistance. Once a day means every 24 hours, twice a day every 12 hours, three times a day every 8 hours, four times a day every 6 hours, etc.

Personal Safety

Many of the medications we use in horses are powerful drugs that can affect us. I am still amazed when I give less than one cc of sedative to a one ton draft horse and see the powerful effect that tiny little bit has on such a huge animal. During the preparation or administration of medication, small amounts can get on our hands. Rubbing one’s eyes or mouth can inadvertently result in absorption of these drugs into our own bodies. Ventipulmin syrup can cause your heart to race. Atropine eye ointment can cause your pupils to dilate. ReguMate can absorb through the skin and affect the female reproductive system (and probably the male, also). Take precautions with all medications. Use gloves when so instructed and avoid rubbing your eyes or touching your face until you have washed your hands. Always wash your hands after handling any medications.

Proper Disposal

Children and other animals, often dogs, are at the highest risk of getting into contact with used oral medication cartridges, tubes of topical medications, used vials, etc. Children and pets can be very curious and very fast. One example I recall is that of a border collie that licked the end of a dewormer cartridge that had been dropped on the floor after use. There was a little paste on the end, enough to cause neurotoxicity. Fortunately, the dog survived. The owner still lets the dog follow him around the barn, but he doesn’t throw used cartridges on the floor anymore.

Needles deserve special mention. The EPA estimates that eight million people use more than three billion sharps (needles, syringes and lancets) per year in the United States. Leftover needles not only carry the risk of pain from accidental puncture, but also the risk of disease. In many counties and cities, it is against the law to dispose of used needles in garbage cans or recycling bins. Check with your county Department of Health for rules and guidelines for the proper disposal of used needles in your area. Here are some websites with more useful information:

· Coalition for Safety Community Needle Disposal - www.safeneedledisposal.org

· Centers for Disease Control - www.cdc.gov/needledisposal

· Whatcom County Health Department - www.co.whatcom.wa.us/health

· www.sharpsdisposal.com

· www.stericycle.com/mailback.html

General Wound Care

Get familiar with basic equine wound care before you hit the trails and shows 

by R. Paul Schwab, DVM 

Everybody has a wound spray, ointment, powder, or miracle paint to sell to treat wounds. In fact, the more strange the product, the more people think it works (especially if it’s blue, smells like turpentine, and was made in a jar in someone’s garage). Do these products work? Maybe. Who says? The neighbor, the vet, the feed store? Probably not the FDA. What is the best way to treat a wound? Is there a best way? In this article I hope to cover some basic wound care concepts. 

When to Call the Vet

Obviously, anything that looks like it requires suturing (i.e., gaping wounds, visible bone, excessive bleeding, etc.), has loss of function or excessive swelling should be seen by a veterinarian. Wounds that require sutures should be looked at within 12 hours to have the best outcome. Also, horses that are acting sick or running a fever (temperature greater than 101 degrees) should be seen. Other cases that may warrant veterinary attention are wounds that are slow to heal or have excessive granulation tissue, known commonly as proud flesh.

What Can You Do?

General wound cleaning and irrigation goes a long way. One of the first things we like to do, especially on a deep wound, is clip the hair around the wound to keep it from matting up with serum, blood and other debris. Clipping all wounds is a good idea because it often reveals a much larger wound than was seen without clipping. Gentle scrubbing with warm water and a mild soap such as Ivory liquid soap is helpful for removing debris. Povidone-iodine scrubs are excellent for cleaning and disinfecting the skin, but might be a bit too strong for inside a deep wound. Please, no peroxide! Hydrogen peroxide damages healthy tissue.

Wound irrigation is best done with saline solution. You can buy bags or bottles of sterile saline solution from your veterinarian (not a bad thing to have in a first aid kit). You can also make your own saline solution by adding two teaspoons of salt to one liter of water. Obviously, the cleaner the water is, the better. For small wounds, a 35-60cc syringe fitted with an 18 gauge needle works well to spray the saline over the wound. (Don’t inject the wound, spray it...yes, it has happened.)  Clean spray bottles also work well as saline wound irrigators. For larger wounds, a garden sprayer used to spray weeds (a new one, or at least a really clean one) makes an excellent large volume irrigator, as well as a good giant water pick for your horse’s mouth.

After the wound is thoroughly cleaned, it should be bandaged if possible. Keeping a wound covered helps keep the skin supple and elastic. Wounds that are not covered can be treated with triple antibiotic ointment to help with infection and to keep the skin edges soft. 

Special Considerations

Puncture wounds can be especially problematic. They appear small on the surface but often have deep pockets under the skin that can become infected. They will look fine for 24 hours or so, and then swell up with infection under the skin. These wounds typically need to be opened at the bottom to allow drainage.

Tetanus should be a consideration with any wound. If the horse has not had a tetanus vaccination within six months, it should get a booster.

Healing wounds should be monitored carefully for proud flesh. When a deep wound is healing, it fills with granulation tissue. This is the pink, lumpy tissue that quickly fills in the gap between the separated skin edges. The skin then slowly contracts over this granulation tissue until it is healed. Occasionally the granulation tissue keeps growing higher than the skin edges, preventing the skin from coming together. We call this "exuberant granulation tissue" or "proud flesh." Lower leg wounds in horses are especially prone to proud flesh formation because of poor blood perfusion and high motion. There are numerous ointments that claim to prevent proud flesh formation, but once it has developed, it has to be trimmed off to the level of the skin. You should get your veterinarian involved at this point; it can be dangerous, and granulation tissue bleeds heavily when cut.

In general, wound care is basic. Keep it clean, flush with saline, and monitor the whole horse (i.e., temperature, attitude, swelling, etc.). Worry more about what not to put on a wound, rather than what to put on it. If you wouldn’t put it on your own wound, don’t put it on your horse’s wound. Above all, keep in touch with your veterinarian regarding wounds on your horse. Every horse is different, and every wound is different. 

Pigeon Fever

A look at the forms and symptoms of an uncommon but serious infection

by Dave Sauter, DVM

Other than their name, pigeons have nothing to do with Pigeon Fever, a highly contagious disease of horses. Pigeon Fever has been considered endemic to California, but in recent years the incidence has been increasing in other western states such as Colorado, Wyoming, Montana, Idaho and Washington. It has also increased in southern states such as Kentucky.

Pigeon Fever is caused by bacteria that live in the soil and are found worldwide. The bacterium that causes the disease has an impressive name, especially useful for those who enjoy equine trivial pursuits: with two 7-syllable words, Corynebacterium pseudotuberculosis is a mouthful. 

The bacterium prefers dry, cooler environmental conditions. Although it can occur any time of the year, it is most prevalent in early fall. The bacteria gain access into the horse’s body through breaks in the skin, through small wounds on the body or through mucous membranes (e.g., the gums). Although not yet proven, many experts believe insects such as the housefly and horn fly play a role in transmission, literally carrying the bacteria from one horse to the next. There is no vaccine for the disease.

After invading through the skin or mucous membranes, it can take weeks for Pigeon Fever to incubate before clinical signs of disease develop. The bacteria spreads locally (i.e., wherever it gains access) and via lymphatics (vessels that connect lymph nodes together). Early in the course of the disease, symptoms can be vague and non-specific, such as fever, depression, weight loss and lameness. There are three principle forms the disease can take in the horse:

1. External Abscesses

This is the most common form of the infection in the United States. Abscesses can range from very small to deep, massive abscesses containing quarts of tan colored malodorous pus. They can occur anywhere in the body, but one of the most common areas is in the pectoral muscles. The resulting greatly enlarged pectoral area reminded someone of pigeon breasts, hence the name "Pigeon Fever." There are many other names for this form of the disease, including Pigeon Pox, Dryland Distemper, Dryland Strangles, and Breastbone Fever. 

Other common areas for the abscesses to form include the sheath, the mammary glands, under the belly and between the hind legs. When lesions develop on the ventral midline, they tend to form large, painful plaques of edema with multiple draining tracts (similar to what happens on the legs with Ulcerative Lymphangitis, described below) rather than the large pus abscesses seen in the pectoral muscles. Horses with the external abscess form have a good prognosis for full recovery.

Treatment centers on establishing good drainage. Poultices and hot packs can encourage superficial abscesses to open. The deeper abscesses and many of the superficial ones require surgical lancing to establish drainage. Ultrasound can be helpful in locating and directing the veterinarian’s scalpel to the center of these deeper abscesses. Disinfectants can be used to flush out the opened abscesses. Non steroidal anti-inflammatory medication such as Bute, Banamine or Equioxx might be indicated to help manage pain and fever. Antibiotic therapy is controversial. 

Although humans generally don’t get the disease, we unfortunately can carry it in the form of pus and other discharge from infected to uninfected horses. Other animals, including insects, can also act as transmitters of the disease. Affected horses should be isolated to try to contain this highly contagious disease. Everything should be kept separate (clothing, feed tubs, water buckets, water hose, barn equipment, etc.) to maintain biosecurity. 

2. Internal Abscesses

In some cases, the bacteria can penetrate beyond the region of the body where they first gain access and spread deeper into the horse’s insides, reaching into the thoracic and/or abdominal cavity. Internal lymph nodes and organs can develop abscesses. This dissemination into the body poses far greater risk of loss of life. 

Because these abscesses are out of sight, diagnosis is more elusive. In addition to fever, weight loss, and depression, other symptoms might be present, reflecting the organ system affected (e.g., nasal discharge for pulmonary, colic for abdominal, bloody urine for kidney, ventral edema for liver). Since drainage might be impossible to establish, long term antibiotic therapy generally is indicated, from one to six months. Mortality rate from this rarer form of the disease is much higher, over 40% in some reports. 

3. Ulcerative Lymphangitis

In this form of the disease, the bacteria gain a foothold in the lower limbs and eventually make their way into the lymphatics of the legs, most often the hind limbs below the hocks. As the bacteria spreads up the lymphatic vessels, chains of nodules appear on the limbs that ultimately abscess, ulcerate and drain. New lesions develop as older ones heal. Commonly, the limb becomes swollen and painful. Damage to the limb can cause permanent thickening, disfigurement and debilitation. 

In Europe and other parts of the world, Ulcerative Lymphangitis is the most common form of Corynebacterium pseudotuberculosis infection. Treatment includes long term use of high levels of penicillin. Note that other bacteria are capable of causing similar symptoms. Culture is necessary to confirm that Corynebacterium pseudotuberculosis is the culprit.

Animals at Risk

It is important to mention that ruminants are also susceptible to Corynebacterium pseudotuberculosis infection. Small ruminants, such as sheep and goats, are affected by a different subtype that does not affect horses. In sheep and goats, it is referred to as Caseous Lymphandenitis, more commonly known as Cheesy Gland, Lympho or Thin Ewe Syndrome. This highly contagious disease can cause significant economic losses from culling, carcass condemnation, etc. 

Cattle are susceptible to both sub-types of Corynebacterium pseudotuberculosis infection, the equine form and the small ruminant form, but are more likely to have the small ruminant sub-type. Laboratory testing can be done to identify which sub-type is present.

Although fairly uncommon, Pigeon Fever is a disease of growing concern. An awareness of what it is and the symptoms of the various forms can help to expedite its identification and containment if and when it shows up. 

What to do About Worms

Resistance to dewormers is increasing. How does a horse owner cope?

by R. Paul Schwab, DVM

If you haven’t heard already, I’ll break the bad news: we are already starting to see resistance to our current dewormers for horses. The worse news is that there are no new dewormers due to come out anytime soon. What does this mean? We need to utilize other methods of parasite control besides just giving dewormers every eight weeks. 

Dewormer resistance is not a new problem, especially on the East Coast. There has been resistance to most dewormers in goats and sheep for several years, but more recently it has become an issue in the horse population. We are just starting to see some of this resistance here in the Northwest now.

Without going into too much detail, resistance has probably developed over the years from our various rotational deworming strategies. Slow rotation, or using one product at regular intervals, without monitoring by checking fecal egg counts may allow resistant worm populations to dominate the pasture without being killed. Fast rotation schedules, or rotation of different products at regular intervals, may be selecting for resistance in all the classes used in the rotation if not monitored with fecal egg counts. 

What Can We Do? 

First of all, remember how horses actually pick up worms: the worm eggs and larvae live in the horses’ manure or the grass and ground just around the manure pile. If the horse grazes on pasture contaminated with these parasites (we are talking thousands of eggs in one manure pile), they will eat the eggs or larvae. These eggs or larvae then go through several stages of development within the horse and turn into adult worms that lay more eggs in the manure to contaminate your pasture. Removal of this manure is one strategy to reduce pasture contamination. 

What about harrowing? Remember, the worms stay within the manure pat. If you spread it around, you are actually spreading the larvae and eggs around the whole pasture instead of containing them in the manure pile. If you are not removing manure, you are better off leaving the “islands” of manure pats because usually—though not always—horses will avoid eating around the manure. Harrowing will help only if the ambient temperature is above 85˚, sunny, and the pasture can have no animals on it for at least four weeks (two months or more would be better).

Other practices that may help with reducing pasture burden include grazing on fields used recently for hay and rotating pastures with other livestock species (cattle, sheep, etc.).

Multiple-Horse Areas

We have always treated herds as a whole. If you deworm one, you assume they all have the same exposure and deworm everyone at the same time. We may need to rethink our strategies and identify individual animals that have more susceptibility to parasites. Geriatric and young horses, in general, are more prone to parasite infestation, but there also adult horses that may shed more worms and have less immunity to fight off parasite burdens. Using fecal sample monitoring, we can try to identify these animals and utilize that information to determine how often to deworm individual animals that shed more eggs into the environment.

Monitoring Egg Counts

Another way to utilize fecal egg counts is to monitor the effectiveness of individual deworming medications on the parasites on your farm. This is done by having a fecal test done the day that you deworm your horse. A follow-up fecal sample should then be taken ten to fourteen days after deworming. The formula for reduction is as follows:

[(Pre-Treatment Eggs/gram feces – Post-treatment Eggs/gram) / Pre-Tx EPG X 100]

Numbers above 90% indicate that the product is efficacious, and numbers below 80% indicate resistance. Numbers between 80-90% are questionable. This formula is a good tool but was developed with other species, not horses, so it should not be a gold standard. Further research may adjust this formula in the future, but for now it is very helpful to give you a general idea.

This is a very hot topic right now and much is still to be learned. As equine veterinarians and horse owners, we are in for a challenge over the next few years to get our arms around this issue. We have all trained ourselves to follow a schedule that until now has been the most consistent way to keep horses healthy and free of parasites. My advice is to sit down with your veterinarian to discuss a plan for parasite control for your individual farm situation. Utilize your veterinarian’s lab to assess your horses’ parasite load. You may actually find that your horses need to be dewormed far less often than you thought. 

AAEP Convention Highlights

A review of the 54th annual AAEP convention

by Dave Sauter, DVM, Kulshan Veterinary Hospital

The American Association of Equine Practitioners (AAEP) is a non-profit organization for equine veterinarians.  Founded in 1954 in the basement of a Louisville, Kentucky hotel with eleven charter members, the AAEP has expanded to over 9,000 veterinarian and student members in 64 countries.  The mission of the AAEP is to protect the health and welfare of the horse through equine research, public education programs, involvement with animal welfare affairs and ethics, and professional development programs for its members.  

2008 Convention Highlights

This year over 3200 veterinarians, students and veterinary technicians from around the globe gathered in San Diego, California from December 6-10 for the annual AAEP convention.  Total attendance exceeded 6500, representing the third-largest turnout in the convention's history.  Over 100 scientific papers were presented along with a huge selection of less formal “Table Topic” meetings on myriad subjects including lameness, an in-depth focus on laminitis, neurology, reproduction, dentistry, internal medicine, imaging, neonatology, emergency care at equine events and more.  

The “Kester News Hour,” designed to present topics either too recent or too brief to be included in the regular meeting, was one of the highlights. The late General Wayne “Sage” Kester, a native of Nebraska, helped form the AAEP in 1954 and was instrumental in forming the American Horse Council and numerous specialty groups within veterinary medicine.  Dr. Kester was an avid horseman who remarked at age 90 that little had changed for him as he got older except life insurance salesman didn’t pursue him anymore and he no longer purchased green bananas.  

Another highlight was the Frank Milne State of the Art lecture. This year’s speaker was Dr. Stephen Reed, a 1976 graduate of The Ohio State University who is considered an expert in the field of equine neurology.  He is the author of over 150 published articles, editor of Equine Internal Medicine (a textbook for veterinarians) and co-editor of the book Equine Neurology.  He lectured on many aspects of equine neurology, including the neurological examination of the horse, wobblers syndrome, equine protozoal myelitis (EPM), and herpes (Rhino).  Dr. Reed reviewed many advances in equine neurological diagnostics and treatments that are helping horses survive, commenting that “neurological disease is no longer a euphemism for necropsy.”

Scholarships and Charity

The AAEP Foundation is the charitable arm of the AAEP, founded in 1994 to unite individuals and organizations dedicated to improving horse health and well being.  The foundation supports research in equine lameness, laminitis, colic and other areas. This year, the foundation's live and silent auctions raised over $118,000.  In 2008 alone, the foundation awarded 48 scholarships totaling $190,000 to help fund the education of veterinary students committed to equine careers, assisting them with the estimated $106,000 of debt the average new veterinary graduate faces.

Horse Owner Highlights

Veterinarians aren't the only ones who benefit from attending the convention. The Healthy Horses Workshop, an educational day designed just for horse owners, featured seminars on subjects such as eye diseases, training and control from the ground, pain-free saddle fitting and nutrition.  Also, Gina Miles spoke about her experiences as a silver medalist in eventing at the Olympics.  

Recognizing the vital role of farriery and podiatry to the health and welfare of the horse, the AAEP once again organized a Farrier Program at this year’s convention.  Farriers were invited to participate in this day-long session on issues such as management of hoof wall separations and quarter cracks, the use of composites, foot and limb deformities in foals, breakover enhancement and other issues surrounding the prevention and treatment of lameness. Having farriers and veterinarians come together was informative and a lot of fun, too!

The trade show was another enjoyable aspect of the convention.  Watching veterinarians and technicians wander the huge trade show hall to view the hundreds of exhibits was like watching kids in a candy store.  It was a great opportunity to shop and compare equipment and supplies.  

If the Healthy Horses Expo or the Farrier Program sound interesting, mark your calendar for the 55th annual convention, to be held in Las Vegas, Nevada the first week of December. This is the same week as the National Finals Rodeo, so the trip should be both informative and fun.

Check out the AAEP web site at www.aaep.org to learn more about horse health, unwanted horses, and other topics of interest to horse owners.  

Think Before Breeding

Consider several factors before you decide to breed

by R. Paul Schwab, D.V.M., Kulshan Veterinary Hospital

Breeding horses, especially with artificial insemination, takes a fair amount of preplanning and organization. What stallion to breed to? Artificial or natural cover? How much does it cost? How old is the mare? What potential medical problems may come up when your mare gets close to foaling? Do you need to take on the responsibility of another horse? What about all the unwanted horses right now?

My original intention was to discuss the typical pre-breeding considerations, but then I started thinking about what is going on right now with the horse population and the economy, and I thought it better to step back and look at what we can do to address the unwanted horse issue.

There has been a growing concern to the point of epidemic about horses that are unwanted. Unwanted horses may be classified in several ways:
• Older “retired” horses that are healthy but need more care than the owner can give
• Unsafe horses with behavior issues
• Horses that have decreased use because of musculoskeletal issues or other medical problems
• Bureau of Land Management mustangs and burros that are not adopted out
• Perfectly normal horses, young and old, that cannot be cared for because of lack of room, money, food, or time

This last one is where I would like to focus some attention. The market is flooded with these horses, and they can be difficult to sell. Over the last year, feed costs and fuel costs have risen to an all-time high, and unfortunately the horses are the ones that suffer. Our clinic has definitely seen a rise in rescue horse farm visits this year, especially during the months when pasture was scarce. Reports are very common about abandoned horses left to scavenge on their own or dropped off into other people’s pastures. Basically, people can’t afford to raise the horses they already have, and the market is full of horses to sell.

Consider Before Breeding
The American Horse Council estimated that there may be 9.2 million horses in the U.S. right now. Approximately 90,000-100,000 horses were slaughtered annually before the slaughter ban in the US. What does this mean? There may be additional 90-100,000 horses per year in need of homes.

I don’t want to discourage all breeding. The horse industry needs the constant exchange of horses to stay alive, not to mention the genetics that can be improved annually by experienced breeders. A huge part of the equine economy is based on breeding horses and raising foals. My own job partly depends on the constant cycle of breeding and the prevention and treatment of diseases in the growing foal.

Just consider what is involved in breeding a mare, caring for and training a young horse, and what you will do with that horse when it has grown. It takes almost a year from breeding to the delivery of a foal and another two years to have a horse to ride. That's three years of breeding, training, feeding, and health care expenses. Ask yourself if you could adopt a horse and get the same results or find a horse at a reasonable price. Do you want to breed your mare because she is awesome and it would be cool to get a foal out of her, or is there some other reason? Are you contributing to the problem by over-breeding?

This is certainly a complicated and controversial issue, but it is one we should all be involved in. For more information on unwanted horses, the American Veterinary Medical Association and the American Association of Equine Practitioners both have sections on their websites with information and links. The Unwanted Horse Coalition (www.unwantedhorsecoalition.org) has a great website dedicated to this issue.

Red, The Rescue Horse

One horse's journey from neglect into health
by Dave Sauter, DVM, Kulshan Veterinary Hospital

Dealing with an animal neglect case can be a heart-wrenching experience. Unfortunately, animal neglect happens and someone has to cope with the consequences. With rising feed costs and hard times economically, such cases are regrettably on the rise. Today’s article is a story describing one such instance. In this situation, as in many cases of neglect, the owners simply lacked the knowledge and experience to care for the number of horses they had. The resulting condition of some of their horses was life-threatening. 

The Whatcom Humane Society (WHS) is the designated animal control agency of Whatcom County, assigned with the task of enforcing the codes, regulations and laws concerning animal care. They were called on earlier this year to investigate a case of animal neglect involving a large group of horses. The WHS examined all of the horses at the location and also inspected the shelter, the amount of space for the number of animals, the availability of feed and water, feed stores, fencing, etc. Ignorance of basic feed requirements had caused three of the horses to be at a state of starvation that was life-threatening. The WHS used its legal authority to seize the three horses. One of these three emaciated horses was “Red” (named by her eventual adoptive home). Based on her teeth and appearance, she was a twenty-something chestnut Arab cross mare. One of the other two horses was Red’s three-year-old daughter.

When the WHS removes horses in an emergency situation like this, they need a suitable location to provide food, water, safe housing and proper medical attention for the horses until a permanent new home can be arranged. Generally, one of several horse rescue facilities is called upon, but at the time of this seizure all the local facilities were full. Fortunately, a “foster home" was found. A local animal lover with a big heart, Lynn Larson, agreed to take Red and her daughter temporarily. Lynn has taken in foster animals before, including peacocks, llamas and poodles. In fact, she recently was awarded the WHS Act of Kindness Award. Lynn teamed up with a veterinarian, Dr. Christine Monroe, to tackle the horse rescue project. The starved, lice-infested, wormy pair of horses were taken in with loving arms. Proper food, water, shelter, blankets, and medicine for the internal and external parasites were generously provided. Lynn and Christine grew especially fond of Red because of “her kindness and will to live.”

After about a month in foster care, a home was found for Red and her three-year-old daughter. The new owners were initially very enthusiastic. Unfortunately, the two horses were more of a project than expected and they became too much of a burden. Red and her daughter returned to Lynn’s.

The filly’s condition improved faster than Red’s, and with that and her more youthful years, it wasn’t too long before a suitable home for the filly was found. Red, however, wasn’t improving as quickly. Although she gained greatly in strength and energy, she continued to look horribly underweight and rough. With her advanced years, a willing home couldn’t be found. Several people came out to look at her, but quickly lost interest and left. As the weeks turned into months, the options for Red were dwindling. The WHS was struggling to find homes for numerous horse cases. In spite of the fondness for Red, time, patience and resources were running thin.

Red’s guardian angel came in the form a veterinary assistant intern named Ruben from the Bellingham Technical College. In addition to his veterinary assistant duties, he was working for Lynn and knew about Red. While interning at Village Veterinary Hospital, he told one of their veterinarians, Dr. Rachel Bangert, about Red. He told her how Red had been starved, how Lynn and Christine had been providing a home for her for over three months, and how, because she couldn’t be placed into a permanent home, she might have to be euthanized. Although Red had improved considerably over the three months, her condition was still very poor. It wasn’t clear if she could ever recover from her emaciated condition. In spite of these doubts, Rachel and her husband, Ken, decided to take Red into their home and continue the battle to save her. The kindness in the mare's eyes may have influenced their decision.

After several more months of patience and numerous bills for feed, blankets, lab tests, deworming, trimming, delousing powder, dentistry, etc., Red has finally returned to good health, seven months after WHS seized her. She has made an incredible transformation from a near death rack of bones with a gut full of worms to an easy keeper that may need to go on a diet. Rachel has even started riding her. And she still has her kind eyes, which are perhaps a bit more grateful to be in her new home. 

A few observations concerning the subject of neglect:
• Horses that have been starved so severely that they have lost over 50% of their normal body weight are much less likely to survive.
• Taking on a starved horse is a formidable project. There is no guarantee of success and there is a lot of potential heartache and expense along the way.
• The WHS and the various local rescue facilities are always in need of financial support. Donation is another way to try to help these horses out.
• Feeding starved horses requires great care and patience. Starved horses are depleted of fat and carbohydrate stores and are burning protein from muscles for fuel. Their bodies are running in an altered metabolic state and they cannot be fed like normal horses. Feeding concentrated calories to the starved horse can lead to heart, respiratory and kidney damage, not to mention colic. Instead, numerous meals of good quality forage are recommended. Consulting with your veterinarian to outline a feeding program after an examination and laboratory tests is highly advisable.
• Expect six months or more for the emaciated horse to recover. Emaciated horses are in a fragile state – be patient. Feed changes must be gradual.
• Not all skinny horses are skinny because of neglect. Some skinny horses have owners who love them and provide them with everything possible to keep them as healthy as possible with special feed and care to try to get weight on them. Some old horses are like some very old people who simply stay skinny. Some of these old, skinny horses are active, happy and love to eat the gruel their owners provide. They have proper shelter and regular farrier and veterinary care. These horses do not need to be seized and the decision as to if and when they should be euthanized is between the owners and their veterinarian.

Happy Holidays!

Essential Health: Equine Dental Care

Prevent common dental problems in your geriatric horse
By Brooke Johnson, DVM, Kulshan Veterinary Hospital

As many of our horses live into their third and fourth decades of life, proper oral care is essential to the overall health of a senior citizen equine. Dental care is so important that the American Association of Equine Practitioners recently began a campaign to strive for yearly dental exams of every horse. Regular exams and preventative care beginning at an early age will help identify and correct problems that can be devastating or much more serious when present in the geriatric mouth. The goal of this article is to briefly discuss several of the most common dental problems identified in the older horse.

Abnormal Wear Patterns
Terms such as ramps, hooks, rims, steps, and waves are used to describe abnormal wear patterns of the cheek teeth. Normal cheek teeth have a flat, relatively even grinding surface that functions to break down a tough roughage diet. Daily grinding of coarse plant material continually wears down the cheek teeth. This is countered by the fact that equine teeth continue to erupt for the majority of a horse's life. As this dynamic process unfolds, substantial problems with the grinding surfaces can form. These problems greatly limit the ability of the horse to adequately grind food. Routine dental floating can identify and correct problems before they have the opportunity to begin hindering the chewing process. Older horses lacking regular dental care may have abnormal wear patterns present on a massive scale. Once a problem develops on the grinding surface it tends to self-perpetuate. If a horse is having noticeable trouble chewing because of an abnormal wear pattern, the problem is likely at an advanced stage.

Periodontal Disease
Studies show that 60% of horses over age 15 have periodontal disease. Periodontal disease is inflammation of the gums that can result in pain and destruction of the gums or deeper tissues that anchor teeth firmly in place. In advanced stages this “domino cycle” of inflammation, plaque build-up, swelling, tissue destruction and bone loss will lead to tooth loss. Periodontal disease is best addressed with prevention since advanced stages with large amounts of gum loss and erosion can not be reversed. Periodontal disease is painful and often a reason horses quid, or drop feed from their mouths.

Diastemata
Diastemata (singular: diastama) are alignment problems between adjacent teeth that make ideal environments for periodontal disease to begin. Normally, horse teeth sit so closely together that no food can be pushed between them. If a small gap forms between teeth, then feed material packs tightly into the space. Since horses don’t floss regularly, the entrapped food begins to rot and ferment. Sometimes a foul odor is present. Food tightly packed between teeth can be exquisitely painful. If this problem is identified during a dental exam, the gap between the teeth can be shaped with a power float tool so feed doesn’t remain trapped within the space.

Sinusitis
Sinus infection of the older horse is often secondary to dental problems. Horse cheek teeth are very long and the roots of several of the upper cheek teeth actually sit within the sinus cavity. If a path opens for bacteria to migrate along the tooth because of a fractured tooth or severe periodontal disease, then a sinus infection can form. Sinus infections become obvious to owners when the horse develops nasal discharge (usually only on one side) that has a very pungent, foul odor. To completely clear the infection the sinus needs to be flushed, antibiotics given, and the offending tooth removed.

In conclusion, one of the most important activities older horses do during their day is eat! A horse does not need to have one of the problems described above to greatly benefit from an oral exam and routine dentistry. Dentistry is the most important routine care given to older horses. Geriatric horses need one and sometimes two dental exams per year. The goal is to identify and address problems before they begin to cause chewing problems, quidding, oral pain or weight loss.

About the Author
Dr. Johnson grew up in Oakridge, OR and received a BS in Microbiology from Oregon State University. After graduating with a DVM degree from Cornell University, she completed a year-long equine surgery and medicine internship at Pilchuck Veterinary Hospital in Snohomish, WA. As a doctor at Kulshan Veterinary Hospital she especially enjoys equine medicine with specific interests in ultrasound imaging, chiropractic care, neonatology, and technical large animal emergency rescue.

Outside of work, Brooke lives with her dog, Mulak, and cat, Simon. She enjoys mountaineering and hiking in the North Cascades, listening to live music, telemark skiing, quilting and traveling.

Infectious Disease Part Two: Prevention

Keep your farm and family safe with Farm Biosecurity
by Dave Sauter, DVM

Last month Dr. Schwab reviewed five major infectious diseases that affect horses. This month we’ll examine methods and strategies aimed at preventing the movement of infectious disease onto your farm, otherwise known as Farm Biosecurity.

There are many reasons horses have to be hauled, including training, lessons, shows, breeding, racing, sales, trail riding and vacations, to mention just a few. The distances they travel are all across the map, from down the road a piece to across the country. Whether for business or pleasure, travel is part of life for most horses. Traveling does, however, create a pathway for transmission of infectious disease from the outside world to an individual farm.

Strategies that reduce the chance of bringing home unwanted pathogens begin before you leave the farm. They include items such as:

· Avoid compounding stressors. Travel causes stress that we have little or no control over; for example, the hours horses spend on their feet on the road, constantly making adjustments to maintain balance. They may be staying in strange facilities with unfamiliar horses, perhaps in far away locations with drastically different weather. The immune system is weakened by such stress, resulting in lower resistance to infection, and this comes at a critically vulnerable time (during travel) when there is increased exposure to pathogens. Many of our preventative medicine procedures also cause some temporary stress to the system, so plan ahead and schedule procedures such as vaccination, teeth floating, sheath cleaning and deworming at least three weeks prior to the scheduled event.

· Vaccinate appropriately and in a timely manner. Check your records or with your veterinarian to be sure the necessary vaccinations for the intended destination(s) are up to date. Vaccinations need to be given at least three weeks in advance to get the desired protective effect. Vaccination can, unfortunately, result in complications, such as fever and inflammation at the injection site. The three week minimum rule will allow enough time for recovery, just in case complications occur.

· Clean your supplies, tack and trailer prior to the trip. It is easier to keep things clean if they start out that way. Attention to cleanliness and hygiene is important at a time of heightened susceptibility to infection.

· Lighten up on grain meals a day or two prior to the trip. The digestive system is affected by travel. Lowering starch levels by reducing grain is beneficial.

· Make a checklist of supplies. Include such items as first aid kits (human and equine) and tools to pull a shoe. Consider bringing your own bedding, feed, water, buckets, and implements. Having a variety of dependable light sources can be invaluable as well.

· Begin monitoring your horse’s temperature before the trip, so you have a baseline.

When at the destination, check out the facilities. Probably the last thing you want to do when finally reaching your destination is inspect the stall, but it is important to take the time to ensure it is safe and secure. Strip the stall (horses love to eat strange, nasty bedding) and sweep out rodent and bird droppings that can harbor pathogens like Salmonella. Bed the stall with bedding from home that your horse is accustomed to. Knock down cobwebs (harbingers of pathogens). Check for nails sticking out of boards, remove any buckets and feed tubs and replace with your own, and check door latches. Discourage contact between your horse and other horses. Use your own tack and implements and avoid sharing them with others.

When an inanimate object acts as a vehicle to transport infectious material (e.g., mucus from an infected horse), it is referred to as a fomite. Don’t be a fomite. Just as tack and implements can carry infectious material on their surfaces, so can you. When you do come in contact with other horses, wash your hands afterward. A water hose is an excellent fomite, especially for diseases such as Strangles. Do not submerge water hoses into your water buckets; instead, fill them at a distance. Before heading home, clean supplies and tack again to avoid carrying infectious materials back to the farm.

Once you return home, it is ideal to separate the horses that traveled from the ones that didn’t. If possible, keep them separated for two weeks, monitoring and recording their temperatures daily. Ideally, new arrivals to a farm should be separated into yet another area for a 30-day period. Consider the separated areas potentially contagious, even if the horses appear outwardly normal. Organize chores so that the separated areas are the last you work on. Coveralls and different footwear can be put on as these isolated areas are entered, then removed when exiting. Keep separate implements, feed tubs, water buckets and water sources.

Cleaning and Disinfecting
Removing germs can be a challenge, especially in barns and trailers. Porous surfaces contaminated with soil and manure are particularly difficult. Although cleansers are not effective at killing bacteria, they can physically remove them, especially from non-porous surfaces. Use a detergent and a scrub brush to clean. Do not use a pressure washer because too much pressure will aerosolize contagious material, sending it into the air to circulate through the barn or trailer. A regular hose with a spray nozzle will generate adequate but not excessive pressure. After cleaning, allow surfaces to dry prior to disinfecting. Leftover water from cleaning will dilute the disinfectant, weakening its killing affect on the germs.

Not all disinfectants are created equal. Some, such as bleach, don’t work at all in the face of organic material. Its use should be limited to surfaces where nearly all organic material can be cleaned off first, such as shoes, buckets, grooming supplies, shovels, etc. Proper dilution of bleach for use as a disinfectant is 1 part bleach to 10 parts water, or three quarters of a cup of bleach to a gallon of water. Be sure to thoroughly rinse out feed tubs and water buckets after disinfecting them.

It is impossible to remove all organic material from some surfaces, such as stall walls, floors, floor mats, aisleways, etc., but there are disinfectants that are effective even when there is some organic material present, although these disinfectants can be more toxic and caustic. One example is Trifectant (peroxymonosulfate). With any disinfectant, carefully read the instructions to ensure the chemical is mixed and applied properly. Also follow label recommendations concerning protective gear and other safety issues. Do not mix chemicals.

Some diseases are zoonotic, which means they can pass from horse to human (e.g., Salmonella and MRSA). Planning ahead and good hygiene can help protect your farm, your horses and yourself.

Top 5 Infectious Diseases

Keep your horse safe on the road and in the barn, part 1 of 2
by R. Paul Schwab, D.V.M.

This month Dr. Sauter and I were asked, “What are the top five infectious diseases to worry about when bringing horses to a show or event?" Tough question.

Several factors need to be considered:
1) Where is the horse going (state, country, distance, etc.)
2) What diseases are prevalent in that region
3) Where are the animals at the event coming from, and
4) What vaccinations has your horse been given and how long ago?

Dr. Sauter and I came up with a long list to choose from:

Influenza
Rhinopneumonitis
Equine Infectious Anemia
Strangles
Salmonella
Potomac Horse Fever
Rabies
West Nile Disease
Vesicular Stomatitis
Ringworm
Lawsonia
Anaplasmosis
Pleuropneumonia
Lyme Disease
MERSA
Botulism
Tetanus
Corynebacterium pseudotuberculosis
Misc. Fungal Infections
EPM
Eastern and Western Encephalitis


To narrow down this long list we tried to think of the top five that horses are likely to come into contact with when in a show situation in a specific region. Below are our choices. Next month, part two of this article will discuss prevention and control of these syndromes as well as general disease prevention and health tips for going to events.

Equine Influenza
In Equine Infectious Diseases, author Debra Sellon states, “Influenza is the most frequently diagnosed and economically important cause of viral respiratory disease of the horse.” As in people, Influenza or “flu” is seen throughout the world. The Influenza virus has a very short incubation period with clinical signs occurring within 48 hours post infection. Horses are exposed to the virus via nasal secretions from infected horses or horses still shedding the virus up to a week after clinical disease. The virus can be transmitted not only directly, but also through the air in confined areas (stalls and barns), and it can survive in the environment for 72 hours on moist surfaces. Clinical signs include fever (up to 106°F), clear nasal discharge followed by cloudy discharge within 48-72 hours, coughing, and lethargy. Affected horses usually don’t eat well and may have swollen lymph nodes under the jaw or neck. Other signs may include muscle soreness, secondary pneumonia, and limb swelling. There is no treatment aside from supportive care, anti-inflammatory medications, and antibiotics to prevent or treat secondary bacterial infections.

Equine Herpesvirus
There are two types of Equine Herpesvirus of concern: EHV-1 and EHV-4. Both are capable of causing respiratory disease or Rhinopneumonitis (Rhino). EHV-4 is a common cause of viral respiratory disease in horses, especially in young animals. Affected animals will have a “biphasic” fever that goes up and down, often for several days. Coughing and clear nasal discharge are common, as are secondary bacterial infections. EHV-1 can also cause abortions in pregnant mares and neurologic disease in horses. The neurologic form has gotten recent press because of several outbreaks between 2000 and 2006. Clinical signs of the neurologic form include hind-limb weakness or paralysis, bladder and/or tail paralysis, and recumbency. Unfortunately, horses can hold onto the virus in their nerve ganglia for years, ending up in a lifelong carrier state. This makes control more difficult. Transmission from horse to horse is via direct contact and indirectly from fomites (any agent capable of absorbing and transmitting a disease organism) such as people, tack, and contaminated surfaces. Aborted fetuses, placentas, and fluids are particularly high in the virus.

Strangles
No list would be complete without this one. Strangles is the common name for the infection caused by the bacteria Streptococcus equi. It’s known for the classic abscesses that it causes under the jaw, which swell up and “strangle” the horse. This bacterium is extremely contagious and is spread easily through contact with nasal secretions, whether directly or indirectly from water troughs, tack, or people. Infected horses can shed the bacteria for weeks after clinical disease, and in some cases harbor the bacteria in their guttural pouches and become shedders for life. Clinical signs for Strangles are commonly high fever (104°F) and copious amounts of cloudy white nasal discharge, along with the abovementioned abscesses.

West Nile Virus
I debated whether or not to add this to the list. West Nile virus (WNV) is not very prevalent in Washington, though there have been a number of cases in Eastern Washington, as well as Oregon, Idaho and California. For those traveling with their horses through these and other areas, especially during the summer and fall, there is a higher risk. The disease is caused by a virus that is spread to horses (and people) through mosquitoes. The virus damages the neurologic tissue in the brain and/or spinal cord, causing symptoms such as extreme lethargy, depression, difficulty eating, and difficulty walking. Thirty percent of unvaccinated horses that get infected with WNV will die.

Everything Else/Honorable Mentions
We couldn’t quite decide on the last disease to put on this list. There are several that could fit here, depending on where you live. Eastern and Western Equine Encephalitis are of concern in the Southeast; Potomac Horse Fever is of concern on the East Coast. Lawsonia intercellularis is a bacterial disease that causes severe diarrhea in young horses, especially those stressed by weaning or traveling. And, of course, Equine Infectious Anemia is the viral disease that we test for with a Coggins Test for health certificates. It is not extremely common, but the equine community and federal and state governments have worked hard to keep it so.

It’s best to talk to local event officials or veterinarians to help decide which diseases are of more concern for a particular area. Check back with us next month for tips on disease prevention at shows and events.

Prescription Drugs for Horses

The FDA regulates drugs for your horses' protection
by Dave Sauter, DVM

The Food and Drug Administration (FDA) is the governing body that regulates the development, production and sale of medications in the United States, both human and animal. Here, we’ll review the basic rules and regulations governing the pharmaceutical industry.

FDA Approval
All new drugs must be approved by the FDA before they go to market. Pharmaceuticals have to demonstrate through mandated, standardized methods--including blinded control studies--that the new drug is safe and effective for the intended animal and medical purpose. The company must establish that the drug can be manufactured consistently, batch after batch; that it remains stable; and determine a reliable shelf life. Monitoring continues once the drug is in production, and the FDA also regulates marketing and advertising activities associated with the drug.

Generic Drugs
Generic drugs must be approved by the FDA just like name-brand drugs. After the patent has expired on the “pioneer” drug, other companies are then permitted to produce it. They must demonstrate that the generic is the bioequivalent to the brand-name version in dosage form, efficacy, safety, strength, route of administration, quality and intended use. Like the pioneer drug, they must follow the same Good Manufacturing Practices (GMP) mandated by the FDA in federally inspected plants. Once generics are allowed, consumer prices for the product go down substantially.

Extra-label Use
The costs associated with bringing drugs to market are enormous. Consequently, it is not surprising that there are many situations where approved veterinary medications are simply unavailable. The necessary research and development, not to mention the formidable FDA approval process and subsequent monitoring requirements, are economically unattractive to manufacturers. Fortunately, practitioners are permitted to use their discretion and utilize medications beyond the label indications. For example, Adequan is labeled for arthritis in the knee but is commonly employed for arthritis of other joints. Naxcel is an antibiotic labeled for respiratory infections but is commonly used for other infections. Prior to Gastroguard, there were no gastric ulcer medications approved for horses. Human ulcer products were routinely prescribed “extra-label.”

Dispensing vs. Prescribing
Generally, all new pioneer drugs are prescription. In order to provide prescription drugs, a valid veterinarian-client-patient relationship must be established. This means that the veterinarian has examined and is familiar with the patient and has determined that the drug is appropriate. This also provides an opportunity to review proper dosing, storage and administration.

Most veterinary prescription products are dispensed directly by the attending veterinarian. It is permitted and sometimes necessary to prescribe medications through outside sources, such as extra-label use of a human medication not kept in the clinic inventory but available at a local human pharmacy.

The FDA has the authority to change a prescription drug status to over-the-counter (OTC). This is done for products that have been on the market long enough and no longer require veterinarian supervision. An example of this is procaine penicillin, which is readily available from most feed stores. These OTC products are still regulated and monitored, and the manufacturing facilities are inspected by the FDA.

Direct marketing of health products to horse owners through magazines, catalogs, and other publications is becoming commonplace. Also, online pharmacies are becoming more prevalent. These alternative sources are a permitted, legal avenue for prescriptions, just so long as they are licensed pharmacies with a registered pharmacist. If they are not licensed, they are selling products illegally. The products sold illegally might be FDA approved drugs. Worse is if the illegal pharmacies are selling illegal, unapproved products, which could be unsafe, impure and poor quality. If there is no mention of FDA approval on the site, beware. It is easy to check the licensing status of an online pharmacy by calling the State Health Department. When in doubt about a product, check with your veterinarian.

Background on the FDA
The Food and Drug Administration is an agency of the United States Department of Health and Human Services. Its origin dates back to June of 1906, when President Theodore Roosevelt signed into law the Food and Drug Act. This was in response to concern over adulteration and misbranding of food and drugs on the American market. FDA powers were expanded in 1938 by the Food, Drug and Cosmetics Act, granting greater authority over drugs, drug labeling, safety standards, inspections, enforcement and standards for food and cosmetics. This legislation was in response to numerous injurious products that made it to the marketplace, such as radioactive beverages, cosmetics that caused blindness, and the 1937 Elixir Sulfanilamide tragedy, during which over 100 people died because the elixir used an untested toxic solvent.

Today, the FDA regulates companies and industries that account for roughly $1.5 trillion worth of consumer goods and medicines. The agency is responsible for the safety and effectiveness of prescription drugs, biologics (e.g., vaccines and blood products), over-the-counter medicines, medical devices, cosmetics, nutritional supplements and all food products except meat and poultry. The Center for Veterinary Medicine is the branch of the FDA that regulates food, food additives and drugs given to animals. Animal vaccines are regulated by the USDA, not the FDA.

"When There Was no Salt, we Ate Sand”

by R. Paul Schwab, DVM

Have you ever had one of those horses that just wasn’t right no matter what you treated it for? Even if it had good teeth, no parasites, and ate good feed and hay? Sand ingestion could be the culprit.

Horses may unintentionally ingest sand when grazing on loose sandy soils or if they are fed hay on the ground in sandy stalls or paddocks. Horses that are not getting enough forage because of overgrazed or overcrowded pastures are particularly at risk of sand ingestion. Young horses tend to be more curious and may eat sand as well.

Over time, sand accumulates in the large intestine. Gravity and the weight of the sand prevent it from passing completely through. The sand is very irritating to the lining of the intestine and reduces the amount of fluid and nutrients the intestine can absorb. Eventually this leads to diarrhea, and the horse can show signs of colic from intestinal irritation and spasms. With large amounts of sand, the large intestine can become impacted or blocked, often requiring surgical intervention.

Clinical signs of sand accumulation in the intestine include loose manure, ill-thrift (similar to the "ADR" mentioned in last month's article), mild to severe colic, lethargy, dehydration, and possibly sand in the manure. Often you can hear the sand in the intestine when listening under the belly with a stethoscope (sounds like the beach).

Colic from sand ingestion is treated with pain relief, large amounts of oral or intravenous fluids and electrolytes, mineral oil and psyllium. Psyllium is a bulk laxative fiber supplement (basically Metamucil) that is thought to suspend the sand granules and make it easier for the horse to clear the sand. In refractory cases that do not respond to this treatment, surgery is needed to remove the sand from the large intestine. I’ve heard of equine surgeons removing several trash cans worth of sand from the intestines of some horses. Radiographs are sometimes taken to make a diagnosis or double-check removal of the sand after treatment.

Diagnosis of sand ingestion can be made by clinical signs, history, and testing the manure. Sometimes you can see the sand in the manure if there is quite a bit. An easy way to test the manure is by placing 3-5 fecal balls in a rectal examination sleeve and mixing them with water to make a watery slurry. Hang the open end on the fence and let it settle for several minutes. If there is sand in the manure, it will settle into the fingertips. Unfortunately, this test isn’t always accurate. Horses can have sand in the intestine but not always in the manure.
Testing manure for sand

Prevention of sand colic is centered on preventing ingestion. Feed good quality and quantity of forage (hay and pasture) and use hay bags or racks when possible. Also feed grains in grain tubs or buckets. Salt and trace minerals should always be available to horses. Horses without salt or minerals will look for them in the dirt or sand.

Finally, there are several brands of psyllium supplements available commercially that can be fed as a preventative measure and/or treatment for horses that live in sandy areas. Talk to your veterinarian if you think your horse may be at risk for sand colic.

Equine First Aid

by Dave Sauter, DVM

Although we had snow in late April, the summer months should be fast approaching. There are more horse activities during these months and people are showing, pleasure riding, trail riding and traveling more with their horses. This is also breeding and foaling season. With all this activity, travel, and commingling of horses, there is more risk of illness, injury and other health related problems. Consequently, it is a good time to review the basics of first aid and what is included in a first aid kit.

Know Your Horse
The first step in first aid happens before a problem develops. Knowing your horse and getting familiar with what is normal will make it easier to recognize when something is abnormal. Whoever has the job of feeding the horses and cleaning their stalls has some of the best information on how they are doing. Horses are eating machines. Like other herbivores, they are capable--with the help of fermenting microorganisms--of digesting parts of plants we cannot. But they need a lot of the raw material and can spend up to 16 hours a day eating. The remaining hours are spent playing, socializing, sleeping, looking around, performing people-related activities and such. When horses are not eating, there is a problem: with all this food intake, there is understandably quite a lot coming out the other end. Horses defecate around a dozen times a day. With this much production, it doesn’t take long for a problem in the plumbing to escalate into something serious.

Horses are creatures of habit; routine and predictability help prey animals like horses feel more secure. Whoever cares for the horses often becomes familiar with their routines and habits and can notice when something deviates from the normal pattern. Subtle changes can be an indication that the horse is ADR. ADR is an abbreviation for the technical medical term, “Ain’t Doin' Right.” As a prey animal, it is to the advantage of the horse to conceal when there is a problem and it is more vulnerable, so subtle changes may be clues of an underlying serious problem. An ADR horse needs further observation, monitoring and investigation.

Know What to Look For
Of course, many signs of problems are more obvious. For instance, a horse with colic is experiencing visceral pain. With milder forms of colic, it might be off feed, stoic, or distant with a stressed look in its eyes. The horse might have a tight abdomen, occasionally paw at the ground or kick at its belly, curl its upper lip, and may lie down excessively. More severe visceral pain can lead to more violent symptoms, such as frequently lying down and getting up, more violent rolling and kicking at the belly, sweating, and more difficulty keeping the horse up and moving. Other things to look for include painful conditions of the eye, which result in squinting, excessive tearing, and sometimes swelling of the eyelids.

With any problem, make an initial appraisal of the horse’s condition from a distance. This allows observation of the horse’s general appearance and behavior, gives you a chance to assess the horse’s safety as well as your own and will help determine what supplies, if any, you will need.

For instance, if there is severe bleeding, some type of pressure will be necessary to apply to the wound. Often it is very helpful to get the vital signs of the horse, which include the temperature, heart rate and respiratory rate. Normal temperature is 99.0 to 101.0 degrees Fahrenheit. The normal heart rate is 30 to 44 beats per minute, and the respiratory rate is 8 to 16 breaths per minute.

Look at the gums by lifting up the upper lip. The gums should be moist, and normal color is pink. Abnormal color can be pale, dark pink, red or bluish. Check capillary refill time (CRT) by pressing on the gums with a finger, releasing, and counting how long it takes for the color to come back. Normal CRT is less than one second.

Skin turgidity is checked by tenting the skin up near the base of the shoulder, releasing it, and watching how fast it bounces back - it should bounce back very rapidly. If it doesn't, this could be a sign of more serious problems.

The First Aid Kit
There are many items that could be included in the list of useful supplies. Here is a list of essentials:

· Bandage materials are necessary to apply pressure to control bleeding; to cover, protect and stabilize a wound; and to support an injured leg. Duct tape is useful as an outer, more resilient layer for foot bandages. A word of caution about bandaging horses: a lot of damage can be done by bandaging a horse improperly. The longer a bandage is going to be in place, the more important it is that it be applied properly and monitored regularly.
· Thermometer
· Stethoscope (for getting the heart rate and listening to gut sounds)
· Antiseptic ointment
· Antiseptic spray
· Pen light
· Flashlight
· Watch with second hand
· Mild surgical scrub (for cleaning wounds--must be rinsed off!)
· Sterile saline (can be purchased at your veterinarian’s office or homemade by adding a heaping teaspoon of table salt to a quart of deionized water)
· Iodine solution (useful for foot baths)
· Epsom salts (useful for foot baths)
· Knife (for cutting rope, twine, etc.)
· Bandage scissors (blunt tip)
· Latex gloves (to protect you from contaminating your horse’s wound and vice versa)
· Fly spray
· Cell phone
· Veterinarian’s phone number(s)

Supplies need to be stored in a clean, dry, safe area in an organized, accessible location so necessary items can be readily found when needed. Tote trays can be helpful to organize smaller items that can be easily carried to the stall, paddock, field, or wherever required. For trail conditions, liquids or ointments can be transferred into properly labeled smaller-sized plastic containers with screw top lids. Watertight containers or Ziploc bags can be used for other supplies. Some type of soft carrying case can be employed to store everything. For those going on more extended rides or trips, talk to your veterinarian about other items to include when you are further from veterinary assistance (e.g., eye medication, anti-inflammatory medication).

We all hope our horses stay strong, healthy and happy. Unfortunately, accidents do happen, as do illnesses and other health problems. Knowing your horse, having basic first aid skills and keeping necessary first aid supplies available will help you be prepared.

Is Your Horse a Weekend Warrior?

by R. Paul Schwab DVM

Since this is the recreational riding issue as well as the beginning of the “nice” time of year around here, I thought I would remind everyone about “tying up” in horses. Just like us, horses don’t do well with a sudden return to heavy exercise without some sort of pre-conditioning. Exercise, as well as nutrition, is extremely important.

Tying up is a term that is frequently used to describe horses that, after some exercise or exertion, tend to get severe muscle cramping and/or stiffness. Horses that are tied up may show anything from slight lameness (usually stiff or shortened stride) to an inability to move or even get up. It is generally most noticeable in the hind limbs and back. The muscles may appear swollen and are often hard and painful to the touch. Other clinical signs such as sweating, elevated heart and respiratory rates, and looking back at the flank are also seen and can make it difficult to differentiate between tying up and colic, although both may occur together.

Medically Speaking
Tying up is the traditional layman’s term for Equine Rhabdomyolysis Syndrome (ERS). Other terms for this condition include azoturia, set fast, Monday morning disease, and exertional rhabdomyolysis. We will refer to it as ERS for the remainder of the article.

Diagnosis of ERS is mostly based on clinical signs and results of treatment, although your veterinarian can measure muscle enzyme levels from a blood sample to confirm the diagnosis. Also, muscle biopsies may be needed to help determine why the horse is tying up.

Treatment consists of stall rest (exercise may cause more muscle damage), Banamine or Phenylbutazone, and fluids. Grains should be avoided during the treatment period. In horses that are reluctant to move, a veterinarian should be called. Severe muscle damage releases myoglobin into the bloodstream, which at high levels is toxic to the kidneys. Horses with this condition may have dark brown urine or no urine at all. Intravenous fluids will help clear the myoglobin and other toxins produced by the muscle damage from the bloodstream.

Blood work can also be an important indicator of prognosis and guide for determining when to start exercising again. Your veterinarian may want to repeat a blood sample after the horse is better to see if muscle damage is still occurring.

Causes and Types of ERS
There are numerous theories about why some horses are more prone to this condition than others. Nutrition and genetics play a key role. The two heritable forms of ERS are Polysaccharide Storage Myopathy (PSSM) and Recurrent Exertional Rhabdomyolysis (RER).

· Horses with PSSM have a problem with sugar storage in their skeletal muscle fibers. Breeds predisposed to PSSM include Quarter Horses, Paints, Appaloosas, and draft breeds. The episodes are usually seen in unfit but good body-conditioned horses at the beginning of training or after a long or hard ride.
· Horses with RER tend to be Thoroughbreds, Standardbreds, or Arabians. Occurrences may be the result of a stress-related disorder of muscle calcium regulation. The classic RER horse is a fit young filly with a nervous temperament. In contrast to PSSM horses, RER episodes tend to increase as fitness increases.

The two factors that tie both of these forms of ERS together are lack of routine exercise and too much starch in the diet.

Feeds with high starch and sugar levels include most grains (corn, oats, and barley) and molasses, and to some extent lush spring grass. High starch and sugar diets result in rapid rises in blood glucose and insulin that seem to be responsible for exacerbating ERS in horses with PSSM. (As a side note, this same type of diet may be responsible for some Developmental Orthopedic Diseases as well.) Rapid rises in blood sugar can also encourage aberrant behavior in horses.

ERS Management
Control of ERS includes diet and exercise management. Reducing starch and sugar content in the feed is of utmost importance. Good quality forage (hay or pasture) should be fed at the rate of at least 1.5% of body weight per day. If extra weight or energy is needed, feeds with low soluble carbohydrates should be used (beet pulp, soy hulls, alfalfa pellets, rice bran, or canola oil). Current research is showing that feeding fats or oils with grains may stabilize the glucose and insulin rises that occur with grain diets. Feeding small meals more often will also level out the glycemic response.

Your veterinarian can help recommend a diet based on your horse’s activity level and body condition. Vitamin E and Selenium supplementation may be important as well.

Exercise is just as--if not more--important for management of ERS. Daily exercise is recommended and stall confinement should not exceed 12 hours per day. Pasture turnout is best. Thoroughbreds and other breeds with exertional rhabdomyolysis are usually quite fit already, but will respond to exercise and stress management such as pasture turnout, companions, etc.

Resources:
Harris, Pat, “Equine Rhabdomyolysis Syndrome,” Current Therapy in Equine Medicine 4, 1997 pp. 115-121
McKenzie, Erica, et.al, “A Review of Dietary Fat Supplementation in Horses With Exertional Rhabdomyolysis,” AAEP Proceedings 2002, pp. 381-386