“Have a Happy ‘Healthy’ New Year”
Dale Brown, DVM
With the arrival of 2010 upon us, it is a good time to revisit a few keys to keeping your horse happy and healthy in this New Year. Simple procedures such as appropriate vaccination, strategic deworming, routine dentistry and annual physical exams can help reduce the risk of more costly medical problems throughout the year.
Although appropriate vaccination does not guarantee 100% protection against disease, it does significantly reduce the risk and/or clinical signs of the disease and is essential to responsible horse ownership. Vaccination requirements vary greatly based on age, sex, breed, intended use, pregnancy status, immune status, and geographic location. There are 5 core vaccinations according to the AAEP guidelines that are recommended for all horses: Rabies, Tetanus, Eastern and Western Encephalitis and West Nile Virus. The five core vaccines are all highly efficacious when administered appropriately and should be given annually to healthy adult horses. Previously unvaccinated horses, pregnant mares, and foals may require additional boosters, but this should be discussed with your regular veterinarian on the requirements and timing. Additional vaccinations that are highly recommended but not considered core vaccines include Equine Influenza and Equine Herpes Viruses. The recommended vaccination frequency of these is highly variable depending on age, pregnancy status, intended use, exposure risk, and transportation. It is important to remember that none of the available Equine Herpes Virus vaccines are protective against the mutant, neurologic form of the herpes virus. Other vaccines that should be considered based on geographic location, risk of exposure, and recommendations of your veterinarian include: Botulism, Rotavirus, Equine Viral Arteritis, Strangles and Potomac Horse Fever. Since Kentucky is an endemic state for botulism, it is highly advised that any horse transporting to the state for show or breeding purposes be vaccinated against this disease.
In the past couple years, there has been a big change in the practice of deworming horses. This is due to the rapid build up of drug resistant intestinal parasites in equine. It is no longer advisable to deworm every horse with the same rotation of dewormers every 60 days as previously recommended. The three primary intestinal parasites of major concern are roundworms (parascarids), small strongyles (cyathostomes) and tapeworms. Older horses (>2) are primarily burdened with small strongyles, while foals, weanlings, and yearlings can be affected by both roundworms and small strongyles. Roundworms are the primary concern in foals and weanlings due to the life threatening clinical disease they can cause at this young age. Luckily, tapeworms have not yet developed resistance and are easily controlled by biannual administration of a dewormer combination that contains the drug praziquantal. Current recommendations are to perform fecal egg counts more regularly to determine which, if any, intestinal parasites are present and then select the appropriate anthelmintic (dewormer) for that particular parasite. Unfortunately, due to the build up of drug resistance to the current dewormers on the market, there is no longer one particular anthelmintic that is effective against all types of intestinal parasites. The ivermectins tend to still be effective against small and large strongyles and to a much lesser extent roundworms. Fenbendazlole/oxibendazole and pyrantel drugs tend to be more effective against the roundworms and have very reduced effectiveness against strongyles. Roundworm eggs (parascarids) are very hardy and can survive the extreme heat and cold and thus remain viable in the environment for years. Foals and weanlings are most susceptible to them and should still be dewormed every 60 days with a suitable dewormer (fenbendazole/oxibendazole/pyrantel) and fecal egg counts performed periodically to monitor effectiveness of the dewormer. Adults should be dewormed a minimum of two times a year (spring/fall) with an ivermectin/praziquantal combination to control tapeworms, bots, and strongyles. Deworming in adults can be done an additional 2-3 times, if needed, based on their individual fecal egg counts.
Routine dentistry is another essential aspect of responsible horse ownership even though it is sometimes overlooked. Adult horses benefit from an annual oral exam and floating of the teeth. This aids to prevent more serious dental issues from arising. Younger horses (2-5 years of age) should receive routine dental care annually or biannually as they can develop sharp points/hooks more quickly than adults.
Finally, a general physical exam should be done annually to look for any signs of other medical issues that may be undiagnosed or ongoing. This is easily done at the time of vaccinations or a dental exam. Physical exams are especially important for geriatric or immunocompromised horses since they are more susceptible to various diseases.
Hopefully by discussing these few points with your regular veterinarian, developing an appropriate vaccination and deworming program and having an annual physical and dental exam performed, you and your horse will have a ‘Happy and Healthy New Year.’
News from Wellington
Alex Emerson, DVM
Hello from sunny and frigid South Florida. I hope you don’t plan on drinking a lot of fresh squeezed orange juice this year, because you’re going to have to take out a loan to buy a gallon. We’ve been doing our best to stay warm, along with the rest of the country. All the horses down here were freshly clipped, and with the open, airy barns we have in Wellington, there isn’t a horse blanket to be found in any of the local shops. I fully expected to see a lot of colics this week, but there hasn’t been that many for us (touching wood). I was by one of the local clinics on Saturday, and they didn’t have any colics in the hospital at that time. So we’ll keep our fingers crossed, and keep reminding people to make sure their horses are drinking plenty of water.
It looks like we’re going to have a later start to the silly season this year than usual. Normally, we see trailer loads full of horses lined up down Lake Worth Boulevard, inching their way to town, between Christmas and New Year. This year, there hasn’t been the same amount of trailer traffic, from what I’ve seen. There are still plenty of horses hacking on the trails though, and we’re starting to see the polo teams stick-and-balling on fields around town. So we’ll chalk up the slow start to weather. And while the lower numbers have kept all the vets and farriers a little less busy than at this point in years past, there still seems to be some health in the industry. Dr. Peterson and I had a few purchase exams last week, so horses are getting sold, and that means good things for everyone. The upside to the slower economy is that we now have time to sharpen our skills, and to reconnect with clients. Do you have a question you’ve always wanted to ask your vet, but always felt embarrassed to take their time? Now is the time to ask it.
Ocala seems do be about on par with Wellington this year. I’ve been up there a couple of times already to help take care of our clients, and they seem to be coming in a little later there as well. Again, there are plenty of horses already there, and plenty more coming. I anticipate being in Ocala a couple of days per week this year once we get really cooking with show season. I hope it’s warmer than it was when I was there last week. Brrrr. The moist air, stiff breeze over flat terrain, open air barns and lack of one piece snowsuits conspire to make Florida one heck of a cold place when the mercury dips below 40. We never get sympathy from the rest of the country, but it doesn’t keep us from complaining to each other. So stay warm, give the horses a little extra food to keep them warm, and make sure they’re drinking. And if you’re up north reading this, take heart. At least you’re not standing under a palm tree wearing a down coat - because that’s just depressing!
Rood & Riddle is now serving clients at the Winter Equestrian Festival and surrounding areas in Florida. Dr. Alex Emerson and Dr. Fred Peterson from our Sport Horse Division reside in Florida during the winter show season. Dr. Scott Morrison and Certified Journeyman Farrier, Rodney King, from our Podiatry Division travel to Florida once a month and are available by appointment. For contact information for the Sport Horse Division, please call Charlotte Chilton at (859) 233-0371; for Podiatry appointments, please call Natalie King at (859) 233-0371.
Stem Cells and Regenerative Medicine in Horses
Scott Hopper DVM, MS, Dipl. ACVS
On February 1, 2010 Rood and Riddle Equine Hospital will open a state of the art stem cell laboratory. Researchers from the UC-Davis Regenerative Medicine Laboratory have been instrumental in the planning and development of our stem cell laboratory. This will be a full service stem cell laboratory that will allow us to provide the latest in regenerative cell medicine to our clients and the veterinary community.
Regenerative cell medicine and the use of stem cells in treating horses have become more popular over the last few years. There are news stories of stem cell research and stem cell therapy in both human and veterinary medicine constantly. Anecdotal stories of horses being treated successfully with stem cells often make national news. Despite all the positive press and excitement for stem cell therapy there is still very little science currently available. In this article I will discuss what a stem cell is, where they come from and the science supporting the use of stem cells in equine medicine.
Stem Cell Basics
Stem cells are undifferentiated cells that have the ability to replicate and differentiate into a diverse range of cell types. These cell types include tendon, ligament, cartilage, muscle and bone. There are two basic types of stem cells, hematopoetic and mesenchymal. We are primarily concerned with mesenchymal stem cells (MSC) because they appear to have the best potential for regenerative medicine. These MSC are found in bone marrow, fat, umbilical cord blood and tissue, and many other organs throughout the body. The younger or more immature the stem cell, the more potential they have. The younger stem cells have an increased ability to heal and regenerate tissue compared to the adult stem cells. This is the reason for the recent interest in storing umbilical cord blood in horses.
Umbilical Cord Blood
The ability to successfully harvest equine umbilical cord blood for future use is one of the most recent advances. The University of California-Davis recently published that they were able to collect, store and expand MSC to therapeutic doses in 80% of the cases. If there was greater than 21,000 nucleated cells per microliter harvested from the cord blood, then 91% of the cases yielded an adequate number of MSC. This is the best result harvesting MSC from cord blood reported to date. This is the exact technique that will be used in the Rood and Riddle Stem Cell Laboratory. Cord blood allows us to harvest the most immature and possibly a more potent stem cell with a better potential to differentiate into the tissue we desire. An example of this was recently reported where the University of Copenhagen evaluated the chondrogenic potential (ability to produce cartilage) of MSC derived from both bone marrow and umbilical cord blood. Research showed that MSC’s from both sources were able to produce hyaline like cartilage but MSC from umbilical cord blood had an increased chondrogenic potential based upon certain testing parameters.
Bone Marrow Derived Stem Cells
Bone marrow derived MSC can be harvested from the sternum (chest) or the tuber coxae (hip). The procedure is done standing under sedation. The bone marrow is then processed and the MSC cultures and expanded to approximately 10 million cells. This process takes approximately 3 weeks. The cells are then suspended in bone marrow supernatant or saline and injected ultrasonographically into the tendon or ligament lesion or in the joint. Concensus among researchers is that the sooner a horse is treated the better. Chronic tendon or ligament injuries have already formed scar tissue which increases the chances of re-injury. Stem cell therapy cannot remove scar tissue. The goal is to treat injuries within the first 30 days if possible.
Tendon and ligament injuries are currently the most common injuries being treated with stem cell therapy. The majority of the research has been of injuries involving the superficial digital flexor tendon. One researcher in the UK has shown an 82% success rate in National Hunt horses, 87% success in other sport horses and 50% success in flat racing horses. Research evaluating the use of stem cells in deep digital flexor tendon injuries and suspensory ligament injures is currently ongoing.
Researchers are also evaluating the use of stem cells in treating degenerative joint disease. Research in goats has shown that stifles treated with stem cells had less arthritic change than controls. This research is currently being done in horses. A recent paper from the University of Colorado reported that based upon several factors stem cells could not be recommended for osteoarthritis of the middle carpal joint in horses. Even though a greater response was seen with bone marrow derived stem cells compared to adipose (fat) derived stem cells and controls, the changes were not statistically significant. More research is needed.
Adipose Derived Stem Cells
While Rood & Riddle and the University of California prefer stem cells derived from cord blood or bone marrow, adipose or fat derived stem cell therapy is commercially available. Fat is harvested from either side of the tail head in the standing sedated horse. The fat is processed and returned in 48 hours. Even though this therapy has had some success, the exact composition and number of actual stem cells in the fluid returned for injection is not known, which is a concern. One advantage of this therapy is that you can treat the injury more quickly because the stem cells are not cultured and expanded to a minimum of 10 million stem cells as is done with bone marrow derived MSC. A recent paper has shown that treatment using adipose derived cells improved tendon organization in a bowed tendon model, while another paper has shown that bone marrow derived MSC have a greater ability than adipose derived cells to produce cartilage in experimental models. Further research into the effectiveness of adipose derived stem cells compared to bone marrow derived cells in certain injuries is needed.
Potential uses for stem cells in the future include fracture healing, subchondral bone cysts, laminitis and cartilage repair. There is much we do not know about stem cell therapy. We are still looking for answers to the following questions:
1. What injuries are best treated with stem cells?
2. How many stem cells do we need?
3. Do stem cells need to be triggered to produce the desired tissue?
4. How important are growth factors?
5. What is the best type of stem cells to be used?
6. What is the proper time table to treat specific injuries?
Stem cell therapy is an exciting new area of treatment for equine injuries. Although there is still much we still need to learn, early research is very encouraging. Current ongoing research will begin to offer answers and to shed some light on the best applications and techniques for the use of stem cell therapy.
The goal of the Rood and Riddle Stem Cell Laboratory is to provide this exciting new treatment to our clients and referring veterinarians. Our collaboration with the University California-Davis Regenerative Medicine laboratory will allow us to stay on the cutting edge of this technology. We want to expand on the research performed at the university by performing clinical trials in hopes to better understand the most effective way to treat horses with stem cell therapy. It is important to understand that stem cell therapy is not the silver bullet to treat tendon, ligament, fractures and degenerative joint disease at this time. The continued research at the university level and at Rood and Riddle will bring us closer each day to a fuller understanding of regenerative cell medicine and to unlock the potential of stem cell therapy.
Placentitis: Important Facts
Michelle LeBlanc, DVM, Dipl. ACT
Placental infection (placentitis)during the last 3 to 4 months of gestation is devastating both economically and emotionally because most foals are born prematurely and do not survive unless the infection is identified early and the dam treated appropriately. Unfortunately, many mares do not exhibit classical signs of infection, premature udder development and a vaginal discharge, so infections are commonly missed. Placentitis will occur in 3 to 7% of pregnant mares. Ninety percent of infections are due to bacteria entering the vagina, traveling up to the cervix and penetrating the cervical barrier. Bacteria gain access to the uterus in the cervical star portion of the fetal membranes (Figure 1), where they quickly multiply. Fetal membranes thicken in response to bacterial contamination and eventually separate from the dam’s endometrium at the site of the infection. This results in a decrease in oxygen transfer and nutrients to the fetus and a buildup of toxins within the fetus as blood supply is diminished. The dam responds to this insult with an inflammatory response which consists of white blood cells migrating to the site of the infection, production of pus and release of pro-inflammatory cytokines. While this defense mechanism may block the spread of bacterial infection the pro-inflammatory cytokines stimulate uterine contractions and may induce abortion even though the fetus is not infected. The fetus will respond to a persistent, low grade bacterial placentitis by maturing more quickly in-utero. If the infection is chronic, lasting for 2 to 3 weeks, a foal may be born as early as 310 days and be viable because the stress induces maturation. Unfortunately, not all of the foal’s organs mature at the same rate during a stressful event so most affected foals need significant neonatal care. Inducing parturition in mares with placentitis is not recommended as the foal’s final maturation only occurs in the last 3 to 5 days of gestation and we can’t predict when that will occur in a mare with placentitis. Delivery of a foal before final maturation results in birth of a premature, non-viable foal.
So, what can we do to improve the chances of delivering a viable foal whose dam has placentitis? Early identification followed by appropriate treatment has been shown in experimental models to improve foal survival. Changes in the hormones, progestins and total estrogens and thickening of the placental unit and separation of the fetal membranes from the uterus (most commonly in the region of the cervical region) as seen on ultrasonography are used to identify problems in mares, especially those that exhibit no clinical signs. Progestins are metabolites of progesterone produced by the placental unit from day 120 of gestation until foaling. We are able to measure progestins because they cross react with the progesterone assay used at Rood and Riddle Equine Hospital. In a mare carrying a normal pregnancy, plasma progestins are stable and do not fluctuate, remaining below 10 to 12 ng/ml, until the last 3 weeks of gestation when they begin to rise peaking at levels that exceed 25 ng/ml the day before delivery. The rise in progestins is associated with an increase in fetal adrenal function. Unlike women or other domestic species, the fetal adrenals are unable to produce cortisol, the hormone that stimulates final maturation until the last 3 to 5 days of gestation. The enzyme needed to convert progesterone, (the precursor to cortisol), to cortisol in the fetal adrenals is not produced in adequate amounts until the last week of pregnancy. Therefore, if the fetus is stressed after 260 days of gestation, the fetal adrenals pump out progesterone that is converted to progestins in the placenta. Progestins spill over into the dam’s blood and a change in their concentration indicates fetal stress. We recommend taking 3 blood samples at 48 to 72 h intervals to determine if progestins are prematurely rising (before 310 days of gestation)-an indicator of fetal stress-or falling (anytime in the last 3 months)-an indicator of hypoxia, fetal demise or a positive response to treatment- in mares at risk of placental abnormalities. Total estrogens can also be measured. Estrogens rise dramatically in the dam’s blood in mid-gestation and begin to fall around 7 months of gestation. Estrogens are a by-product of the fetal gonads and placenta and are thought to be an indicator of placental blood flow. The horse is unique in that the fetal gonads grow during mid-gestation and then decrease in size in late gestation. Estrogen levels > 1000 ng/ml is associated with a viable fetus. Levels below 500 ng/ml have been associated with a compromised fetus. The test is not conclusive after 10 months of gestation when the gonads are decreasing in size as total estrogens are rapidly falling. Only one blood sample is needed. We recommend that both progestins and estrogens are measured in mares at risk of abortion.
Ultrasonographic changes in the placental unit may be seen transrectally, especially in the cervical region (Figure 1) or transabdominally in cases of Nocardia placentitis (Figure 2). The placental unit may thicken in response to ascending infection to more than 1.5 cm in diameter. Normal thickness of the uterus and placenta ranges between 0.9 to 1.2 cm in the 10th and 11th months. The fetal membranes may separate from the uterus and pus may be seen swirling between the membranes and uterus. As over 90% of placentitis cases are due to ascending bacterial infections, most placental lesions are seen transrectally in the area of the cervix. However, in central KY, Nocardia infections are common. This organism resides in the space between the uterus and placenta in the area of the uterine body or at the junction of the uterine body and uterine horn. Nocardia infections cause the placenta to separation from the uterus but the organisms do not cross the placenta so the foal does not become infected. Mares with Nocardia placentitis will usually develop an udder prematurely but will not have a vaginal discharge. The condition is identified by transabdominal ultrasonography. Not all mares with placentitis will exhibit ultrasonographic abnormalities in the placental unit. Fetal heart rate, fetal motion and the clarity of fetal fluids also can be measured by transabdominal ultrasonography and changes in these parameters also indicate fetal compromise.
If a mare delivers a foal prematurely, the fetal membranes need to be examined closely. The membranes need to be turned inside out because the damage occurs on the side attached to the dam’s uterus (Figures 1 and 2 ). If there are abnormalities, a veterinarian should be notified immediately ever if the foal appears normal as these foals typically don’t show signs of disease for 12 to 72 h, when it is too late to institute successful treatment. Any mare that has placentitis should have a uterine culture taken within 24 h of foaling because most of them will continue to harbor bacteria even if they were treated aggressively during pregnancy. These mares should be treated appropriately and soon after foaling as prolonged uterine infection during pregnancy will hamper their ability to get pregnant and if they do conceive, many will abort in the subsequent breeding season. A close working relationship with your veterinarian is needed to make vital decisions about mares at risk of early delivery, not only to save the foal but to ensure that the mare’s uterus is healthy for subsequent breeding.
Treatment must be instituted early if a pregnancy is to be saved and is directed at 1). Stopping spread of the infection; 2). Maintaining uterine quiescence; and 3) blocking production of pro-inflammatory cytokines. If a mare is suspected of having placentitis, a complete physical examination should be performed, transrectal ultrasonography of the placental unit, culture of vaginal discharge (if any is present) and blood drawn for hormonal values. A common treatment for mares includes administration of trimethoprim sulfa orally given to prevent infection, flunixin meglumine (Banamine®) given to block production of pro-inflammatory cytokines and double dose altrenogest (Regumate®) or a long acting progesterone compound given to block pro-inflammatory cytokines thereby decreasing the likelihood of pre-mature uterine contractions. Not all bacteria, however, are sensitive to sulfa drugs so it is best if a vaginal or cervical culture can be obtained. Other drugs that show promise in experimental models include pentoxifylline (Trental®, this drug has tripled in price in 2010 as it is not commonly used in human medicine anymore), aspirin and dexamethasone. Use of these drugs in experimental placentitis in combination with antibiotics and/or Regumate or Banamine improved foal survival. How long should mares be kept on drug combinations? If the problem occurs late in gestation, after 10 months, it is prudent to keep the mare on the antibiotic and progesterone compound until she foals. The other drugs can be given for 3 to 10 days, upon the advice of your veterinarian. If the condition occurs sooner, one needs to consider the long term effects of antibiotics on the mare and her fetus. Long term sulfa drugs can induce gastro-intestinal problems in the dam. Gentamicin remains in the fetal compartment much longer than it remains in the dam’s circulation. Prolonged use may damage fetal kidneys. A treatment method that has gained favor in mares that have previously lost their foal to placentitis, although there is not scientific data to support the protocol, is to give these mares, antibiotics and flunixin meglumine, for the first 10 days of the month beginning around the 7th month of gestation. These mares remain on progesterone or Regumate throughout their pregnancy.
Compounding Pharmacies - The Real Truth
Bart Barber, DVM
“Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health [and] the relief of animal suffering…….” Veterinary oath
The ability of the veterinarian to relieve animal suffering has made enormous advances in the past 50 years. Our understanding of disease processes, the development and refinement of surgical technique and our diagnostic abilities have been vastly improved over recent decades. Imagine what James Herrriot would think of digital radiography or MRI. It’s a great day to be a veterinarian!
The advancement that has probably had the broadest affect is the improvement in our drug arsenal. Diseases that were death sentences for animals a few years ago are now cured by a few simple injections or a course of tablets. What can currently be done with pharmaceuticals is nothing short of a miracle. It seems certain that the greatest improvements that lie ahead of us will also come from this avenue.
One of the resources that we have for obtaining medications is through compounding. Compounding is defined as the manipulation of one or more drugs to form a new one. Many times an animal may require a medication that is not commercially available in the appropriate strength, in a flavor for maximum palatability, or a suitable method of administration. Compounding encompasses everything from something as simple as mixing two injections, to far more complex formulas. It is an essential part of our own human health care system as well as veterinary medicine. Without this resource many of the tools we have to combat disease and suffering would be unavailable to us and we would, in fact, be no better off than we were 50 years ago.
One truth in compounding is that not all compounding pharmacies are equal. Compounding pharmacies are not subject to the same oversight and regulations that drug manufacturers are. There have been some who, because of this lack of oversight, have produced compounded medications of poor standards, or have produced compounds to make a profit rather than to fill a legitimate need. These bad practices have given compounding in general a black eye. It has also left many wondering who they can trust and what is legal and ethical in compounding. The issues are broad and there are many interpretations. Those who are very familiar with compounding talk about the black and white issues as well as the gray ones. For the casual observer it can be very confusing and time consuming to sort out the issues.
One of the easiest rules to understand is that for a drug to be legally compounded there can be no commercial drug available. Omeprazole is a common example of a drug that is compounded by bad actors. Omeprazole is a commercially available medication found in the form of Gastroguard and Ulcerguard. Because it is commercially available there is no reason or justification for compounding omeprazole. Some compounding pharmacies continue to disregard this rule and compound it anyway and sell it to consumers who buy it willingly because it is less expensive than the manufactured drug. This practice is clearly illegal and both the buyer and the seller are in violation of the rules.
For compounds to be dispensed to patients a veterinarian must issue a prescription to the pharmacy. A valid Veterinarian-Client-Patient relationship must exist for the veterinarian to legally prescribe a compounded product. This means that the veterinarian must actually have knowledge of the animal, be familiar with its health problems. The veterinarian must also be readily available to oversee treatment, or must have arranged for follow-up evaluation in the event of adverse reactions or the failure of the treatment regiment.
These are just a few of the rules governing compounding. The AVMA website offers more detailed insight and can be viewed on http://www.avma.org/issues/drugs/compounding/veterinary_compounding_brochure.asp.
The gray issues regarding the use of compounds have a tendency to become better defined to black and white as solid principles are observed. If relieving animal suffering and doing what is best for the animal is the primary goal the issues become much clearer. In fact, there are few decisions to be made, only principles to be acted upon.
In 2007, the partners of Rood and Riddle Equine Hospital opened Rood and Riddle Veterinary Pharmacy. While we recognized that there were several reputable compounding pharmacies already doing business, we felt we could add our own vision and expertise to the market.
Veterinary compounding is unique. With this in mind we hired pharmacists and staff with extensive knowledge of the horse and the horse industry. It is the goal of our pharmacy staff to be not just a retailer but a resource for veterinarians and horse owners. It is not realistic to expect horse owners or even veterinarians to know all of the rules that apply to compounding. When someone uses our pharmacy they can be comfortable that all rules are strictly adhered to, relieving them of the responsibility of understanding pharmacy law themselves.The veterinarians of Rood and Riddle are also customers of the pharmacy. We use compounds from the pharmacy on a daily basis and are confident that our products are safe and efficacious. We continually receive feedback from those administering the medications and have made them as convenient and palatable as possible. Our customers may use our products with the assurance that Rood and Riddle’s veterinarians use them in our hospital and in the field, and are readily available for consultations with our clients and our veterinary colleagues.
Biosecurity and Your Horse
Bonnie S. Barr, VMD, Dipl. ACVIM
Biosecurity is on the minds of veterinarians in central Kentucky and was the featured presentation during a recent meeting of Kentucky Equine Practitioners and Kentucky Thoroughbred Farm Managers Club. Speakers from Hagyard Equine Medical Institute, Woodford Equine Hospital and Rood and Riddle Equine Hospital described not only the importance of individual infectious diseases of horses presented to equine hospitals but also the need for the entire equine community to be aware of the presence of contagious diseases in the general equine population. An overview of some of the important principles discussed at that meeting is presented here. Biosecurity is defined as all practices intended to prevent introduction and spread of infectious (contagious) diseases within a group of horses and their human caregivers. The term “biosecurity” is often times used interchangeably with “infectious disease control”. Application of the concepts of biosecurity are important not only in veterinary hospitals, but also for ambulatory practices, equine breeding facilities, training facilities, and any other facilities that house horse populations. Contagious diseases significantly endanger the well-being of horses in addition to having potentially devastating financial and emotional effects. The most important contagious disease for equine facilities include Clostridium difficile, equine herpesvirus 1-5, equine influenza virus, rotavirus, Streptococcus equi subs equi (strangles) and Salmonella species.
Another important aspect of biosecurity is prevention of zoonotic infections (infections from horses to humans). People working with animals have inherently increased risks of infection with zoonotic agents compared to the general public. Infection control programs must be tailored to each individual operation, and the same general principles guiding design of a hospital infection control program can be applied to any facility with a number of horses on the operation. The guidelines are designed with all animals in mind, not only those suspected of having an infectious disease. For example, implementation of hand hygiene protocols and appropriate disinfection should be encouraged as a part of basic standard care. Good biosecurity practices may prevent the spread of infectious agents from subclinical shedders, those that do not show signs of disease but are capable of infecting another animal or their environment.
Hand hygiene is a proven aid to preventing transmission of infectious agents. In addition to soap and water, alcohol-based hand sanitizers (such as Purell®) can be a useful adjunct to hand washing. Barrier techniques, used to prevent contamination of clothes and hands with pathogens from animals or their environment, have been an important part of the infection control program for decades. Protective barrier clothing includes gloves, disposable boots and coverall or gowns.
Effective cleaning and disinfection are critical for breaking transmission cycles for contagious agents. Foot dips can be filled with disinfectant and placed stall side or at the entrance/exit to a barn to allow proper disinfection of footwear. Care should be taken to ensure that proper dilutions of disinfectants are used and that the disinfectant used is effective against the organism in question. Proper cleaning and disinfection should be employed regularly for areas used to house and manage all patients, not only those known to be or suspected of being infected with contagious agents. Monitoring for occurrence of infectious disease through observation of clinical signs is critical and if needed appropriate testing should be performed. Affected animals should be isolated and appropriately treated if disease occurs. New horses should be quarantined and monitored for a period of time prior to introducing them to the resident population.
One of the most challenging aspects of a biosecurity program is identifying and segregating horses that show no signs of disease but carry the organism and could shed it to another animal. Just like a farm that receives new horses from another location a veterinary hospital must assess the horses that are admitted to its premises and establish what if any risk they pose to the resident population. Some diseases have obvious clinical signs prior to admission to the hospital and are easily identified and segregated. Other infectious diseases, such as Salmonella sp, Streptococcus equi subs equi (strangles) or equine herpes virus 1-5 can cause obvious clinical signs or can be shed without clinicalsigns. In fact, between 0.8% and 26% of horses can shed Salmonella in their feces. Scientific studies have identified certain circumstances that increase the risk of a horse shedding an infectious disease. These include long transport, antimicrobial therapy, change in diet, parturition, colic and use of dewormers.
At Rood and Riddle Equine Hospital we have used an extensive review of scientific literature, state of the art facility and our experience to design and implement a biosecurity program to prevent the potential spread of infectious disease and to develop an early warning system for the detection of disease causing organisms. Protocols that are in place to help decrease the spread of infectious disease include: segregation and housing of patients based on the reason for admission, hand washing/hand disinfection, sanitation of footwear, decreasing unnecessary traffic flow throughout the clinic, aggressive environmental disinfection and the use of protective barrier clothing. Patients that are admitted to the hospital fall into two broad categories: unstressed horses and stressed horses. The unstressed horses are typically admitted for lameness evaluation, elective procedures (ie arthroscopy, upper airway surgery), or any other scheduled evaluation. The stressed horses are usually admitted as an emergency for colic, diarrhea, or pneumonia, to name a few. These patients are more at risk for shedding or acquiring an infectious disease due to depressed immune function or abnormal gastrointestinal flora because of stress, dietary changes, and antibiotic therapy. Therefore these patients are segregated from the unstressed population of horses and extra precautions are taken when handling and treating them. We have different levels of segregation for stressed horses depending on the risk they pose of shedding infectious organisms whether by aerosolized particles or manure. If your horse is considered a systemically stressed “at risk” patient, we will make every effort to notify you of this risk. The most important aspect of the early warning system is the surveillance program, which entails performing bacterial cultures, DNA testing (PCR) and viral isolation on samples from patients, stalls and random areas around the clinic. This testing allows us to identify patients who are shedding potentially infectious organisms and to closely monitor the effectiveness of our biosecurity protocols.
Biosecurity is an important issue for anyone involved in the horse industry. We all have a responsibility to be informed about the risks of the spread of infectious disease and how to identify potentially high risk horses and limit risk to other horses. At Rood and Riddle Equine Hospital we take this responsibility to protect your horse very seriously and have implemented a stringent biosecurity protocol to facilitate this goal. In 2006 the American Association of Equine Practitioners established guidelines related to the control of infectious contagious disease outbreaks. These guidelines can be viewed at www.aaep.org and are a valuable resource for any horse operation. If you have any questions or consultation on management of your farm please contact the internal medicine department at RREH or your veterinarian.
Annual Rood & Riddle Client Education Seminar
Rood & Riddle Equine Hospital’s annual client education seminar is scheduled for February 3, 2010, at the Embassy Suites in Lexington, Kentucky. Clients are invited to join us at 6:30pm for refreshments, with educational presentations from 7:00p-8:30pm.
The featured presentations are:
· Advancements in Management of Septic Joints in Foals, presented by Dr. Alan Ruggles, Diplomate ACVS
· Stem Cell Therapy – Fact and Fiction, presented by Dr. Scott Hopper, Diplomate ACVS
· So Why Do We Need to Remove Chip Fractures and OCD's Anyway?, presented by Dr. Larry Bramlage, Diplomate ACVS
RSVP is not required for attendance but requested so that we may properly plan for adequate seating and refreshments. If you plan to attend, please RSVP by February 1, to firstname.lastname@example.org or by phone to (859) 233-0371. We look forward to hosting you at this informative meeting.
Around the Practice
Dr. Brett Woodie recently became the newest partner at Rood & Riddle Equine Hospital. Dr. Woodie joined Rood & Riddle in 2003 from Cornell University where he was an assistant professor of large animal surgery. Dr. Woodie obtained his veterinary degree from North Carolina State and completed an internship and surgical residency at the Ohio State University before obtaining board certification in surgery in 2000. Dr. Woodie’s surgical practice focuses on soft tissue and emergency surgery including gastrointestinal, urogenital/reproductive and neurological surgery. He has special interests in diagnosis and treatment of upper airway conditions in the horse and while at Cornell University was instrumental in the development of the Tie-Forward procedure and the Cornell Collar, both used to correct dorsal displacement of the soft palate. He is also one of a select few surgeons worldwide that performs ventral interbody fusion (basket or wobbler surgery) to stabilize vertebrae in the cervical spine of horses with neurologic deficits from spinal cord compression.
Rood & Riddle Podiatry continues to add to their list of achievements. Farrier Rodney King, already certified in the U.S. and his native country, New Zealand, added to his credentials by successfully completing the Associate of the Worshipful Company of Farriers (AWCF) exam. The Worshipful Company of Farriers, established in 1356 in England, secures adequate standards of competence and conduct among persons in the horse shoeing profession, and actively promotes the art, science, training and education of farriery.
Veterinary podiatrist, Dr. Vern Dryden, recently earned Certified Journeyman Farrier (CJF) certification from the American Farriers Association. The CJF exam, which constitutes the highest level of AFA certification, requires successful completion of written and practical testing, as well as the forging of a specific bar shoe within a prescribed time limit. Farriers sitting for this level of certification are expected to display in-depth knowledge and highly developed performance skills evidencing a level of professional artistry. DID YOU KNOW: Dr. Dan Carter, a current intern at Rood & Riddle is also a Certified Journeyman Farrier? Drs. Carter and Dryden are 2 of only 5 veterinarians in the U.S. to have CJF credentials.
The annual Equine Upper Airway Symposium, organized and co-sponsored by Rood & Riddle Equine Hospital, will be held February 11-14, 2010, in Lexington, Kentucky. The 3 ½ day symposium offers an intense schedule of lectures and labs designed to present in depth, current information regarding pathophysiology, diagnosis, treatment, and prognosis for upper airway (UA) conditions in the horse. The target participants for the meeting are veterinarians in surgical resident training programs and young clinicians who have not had the desired exposure to UA conditions in the horse. Rood & Riddle gratefully acknowledges the support of their educational partners, The American College of Veterinary Surgeons Foundation, Boehringer Ingelheim, and Merial for their support of continuing education for veterinarians.
Coming Soon –Online payments on the Rood & Riddle website. As a new service for clients, Rood & Riddle will soon add an online payments option to our website (www.roodandriddle.com). From our home page, clients will be able to access their account balances and pay by e-check or credit/debit card on a secure site. This new feature is expected to be in place by early spring.