Practitioner Issue 2, 2019 by FVMA

Published by the Florida Association of Equine Practitioners, an Equine-Exclusive Division of the Florida Veterinary Medical Association Issue 2 • 2019

PAIN MANAGEMENT IN HORSES – IS THERE ANYTHING NEW? L. CHRIS SANCHEZ DVM, Ph.D., DACVIM

OVER THE GROUND ENDOSCOPY JOHN B. MADISON VMD, DACVS

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SUPPRESSION OF UNDESIRABLE (ESTROUS) BEHAVIOR IN MARES STEVEN P. BRINSKO DVM, MS, Ph.D., DACT

The President's Line EXECUTIVE COUNCIL RUTH-ANNE RICHTER

BSc(Hon), DVM, MS FAEP COUNCIL PAST PRESIDENT

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ADAM CAYOT DVM

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AMANDA M. HOUSE DVM, DACVIM

housea@ufl.edu

COREY MILLER DVM, MS, DACT

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ANNE L. MORETTA VMD, MS, CVSMT

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JACQUELINE S. SHELLOW DVM, MS REPRESENTATIVE TO FVMA EXECUTIVE BOARD

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PHILIP J. HINKLE EXECUTIVE DIRECTOR

phinkle@fvma.org

Dear Fellow Equine Practitioners, Hopefully everyone is winding down a bit after a busy spring. Although we always appreciate a busy spring season, it is important to remember to spend time away from work, remembering how to have fun out on the water or wherever your relaxation takes you. I had the honor of being present at the 90th FVMA Annual Conference, where nowFAEP immediate past president Dr. Ruth-Anne Richter passed the gavel onto me during the FVMA Annual Awards Ceremony & Installation of Officers on Friday, May 17. It was a very special night that marked the transition of FAEP leadership, and I am very excited of what the year to come will bring. Registration is now open for the 15th Annual Promoting Excellence Symposium (PES), which will be held October 10-13, 2019, at the Sanibel Harbour Marriott Resort & Spa in Ft. Myers, Florida. The resort is just a short distance from both Sanibel and Captiva islands with their beautiful beaches and popular attractions — allowing for not just a learning opportunity but an opportunity to unwind in paradise. The planning committee has been hard at work putting together a great program this year! As the leading equine-exclusive continuing education program, PES provides unique opportunities for learning, leisure and networking for equine veterinary practitioners and industry professionals. Offering an exceptional CE program, attendees can earn up to 30 CE credits from the 48 credits offered. The 2019 program will cover equine-related veterinary medicine topics, including lameness, medicine, imaging, nutrition and rehabilitation. The program will also offer the Comprehensive Equine Ultrasound Wet Lab featuring Drs. Sally DeNotta, Amanda House, Susan Oakley, Ruth-Anne Richter and Kurt Selberg. With other exciting program highlights, like FAEP News Hour and Rehabilitation Case Study sessions, the 15th Annual PES is sure to once again be a great program that will provide many professional development opportunities for equine professionals. As always, the FAEP will continue to provide practitioners with high-quality continuing education and maintain vigilance when it comes to legislature that would affect our profession. Have a great summer everyone, and use it as a time of rest and relaxation to gear up for the fall!

Armon Blair, DVM FAEP Council President

Opinions and statements expressed in The Practitioner reflect the views of the contributors and do not represent the official policy of the Florida Association of Equine Practitioners or the Florida Veterinary Medical Association, unless so stated. Placement of an advertisement does not represent the FAEP’s or FVMA’s endorsement of the product or service. FAEP | 7207 MONETARY DRIVE, ORLANDO, FL 32809 | PH: 800.992.3862 | FAX: 407.240.3710 | EMAIL: INFO@FVMA.ORG | WEBSITE: WWW.FAEP.NET

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PAIN MANAGEMENT IN HORSES — IS THERE ANYTHING NEW? L. CHRIS SANCHEZ | DVM, Ph.D., DACVIM

OVERVIEW

Colic and lameness are two of the most clinically and economically important medical problems facing horses and their owners. Pain is a critical component of each disease process, and its alleviation is critical to a successful outcome. A limited number of analgesics are available for use in horses, and many are associated with significant untoward effects. This article will focus on methods used for recognition of pain in horses and available options for analgesic drug use.

for analgesia. Acetaminophen provides an alternative option and was recently shown to have similar efficacy to flunixin in a foot pain model when used alone and similar efficacy to phenylbutazone when combined with firocoxib (Foreman, Foreman et al. 2015).

Opioids

All opioids have the potential for adverse effects in horses, including increased locomotion and excitement, and decreased gastrointestinal motility. Butorphanol has been the most widely used opioid in horses. Intravenous use can be associated Useful pain scoring systems should include the following traits: with excitement, ataxia and increased locomotion when used clearly defined assessment criteria, usable by all observers, simple alone. For short procedures, it is best combined with a α-2 and quick to use, sensitive, identified strengths and weaknesses, agonist. Intramuscular administration results in decreased and validated. Possible deficiencies include bias, inter- and intrasystemic availability (37 percent). When used as a constant rate observer variability. A lack of agreement between observers is infusion (CRI), behavioral and gastrointestinal adverse effects one of the flaws of simple scoring systems, such as the visual are reduced (relative to single injection) in normal horses. One analogue scale (VAS) in which pain is scored on a numerical report demonstrated decreased weight loss, improved recovery scale when used in humans. Continuous video assessment characteristics and earlier discharge from the hospital when allows for quantification of either time budgets (locations within administered for 24 hours after colic surgery (Sellon, Roberts et the stall, ear position, head position, eating, lying down, etc.) al. 2004). Morphine has been used with varying success in horses. or events (vocalizing, stomping feet, shifting weight, etc.). This Some practitioners and researchers have reported fantastic results, relatively objective form of analysis has been performed on while others have concerns. It’s a great analgesic but has a short horses following arthroscopy (Price, Catriona et al. 2003). A duration of action and, as with all opioids, delays gastrointestinal numerical rating system was used to show the beneficial effect of transit. Buprenorphine appears to have a good safety and efficacy a butorphanol constant rate infusion for analgesia following colic profile in horses, with the advantage of a longer (eight to12 hour) surgery (Sellon, Roberts et al. 2004). Facial pain scoring systems duration of action (Love, Pelligand et al. 2015). Buprenorphine have recently been proposed for use in horses (Dalla Costa, is a fantastic option as it has all of the positive attributes needed Minero et al. 2014; Gleerup, Forkman et al. 2015). Similar scoring for a good opioid — the major downside is cost in the US. systems have been used in humans and rodents, and clearly show Transdermal fentanyl patches would, theoretically, provide a promise for use in horses as well. Objective measures, such as fantastic route of opioid administration in horses. Unfortunately, vital signs, plasma cortisol concentration and force plate analyses, uptake from the patches is highly variable and extremely high alleviate the subjective nature of assessment, but vital signs and plasma concentrations (associated with agitation in some horses) cortisol are affected by a variety of factors in addition to pain, are needed for MAC reduction (Thomasy, Steffey et al. 2006), or including hydration status, perfusion, sepsis and/or endotoxemia, visceral or somatic anti-nociception in healthy horses (Sanchez, fear and anxiety. Because of this, they are not specifically useful Robertson et al. 2007). Tramadol is an analogue of codeine, but indicators of pain. it has less abuse potential and fewer cardiorespiratory side effects than drugs classified as opioids. Tramadol has a short half-life and very low oral bioavailability (~3 percent) in horses and does not appear to provide effective analgesia when used alone. In Nonsteroidal anti-inflammatory drugs (NSAIDs) a clinical setting, tramadol alone failed to provide pain relief in A complete discussion of NSAID use in the horse is beyond horses with naturally occurring laminitis but did appear to help the scope of these proceedings. Flunixin and phenylbutazone when used in combination with ketamine (Guedes, Matthews et are used most commonly. Firocoxib has demonstrated COX-1 al. 2012). sparing effects in the horse; an initial loading dose is important

EQUINE PAIN SCORING SYSTEMS

ANALGESIC AGENTS

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Issue 2 • 2019

infusion, is commonly used in horses for its potential analgesic, prokinetic and anti-inflammatory properties. Clinical signs of toxicity in conscious horses include skeletal muscle tremors, altered visual function, anxiety, ataxia and collapse. Moderate evidence in clinical and research settings support its use as a visceral and somatic analgesic agent. Drug accumulation can be noted in a clinical setting after prolonged administration, and lower infusion rates should be used in horses receiving highly protein-bound drugs.

N-methyl-D-aspartate antagonists

Enterolith â&#x20AC;&#x201D; rock inside the intestine â&#x20AC;&#x201D; in the large colon of a horse at colic surgery. Enteroliths can cause intermittent or acute, severe colic in horses.

Alpha2-adrenoceptor agonists Alpha2-adrenergic agonists are frequently used for both sedation and short-term analgesia. These drugs are not ideal for prolonged analgesic therapy as they cause an immediate and profound decrease in gastrointestinal motility, amongst other cardiovascular effects, and have a relatively short duration of action. Importantly, one should note that sedative effects may require lower dosages and/or last longer than analgesic effects with most drugs in this class. Alpha2-adrenergic agonists provide dose-dependent visceral and somatic anti-nociception of varying duration, as well as an opioid-sparing effect. Thus, a combination of an alpha2-adrenergic agonist and opioid provide a variety of commonly used multimodal analgesic protocols.

Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist and can modulate central sensitization and exert an anti-hyperalgesic effect at sub-anesthetic doses. Anti-nociception has not been demonstrated in healthy horses receiving infusions of ketamine (Fielding, Brumbaugh et al. 2006), but, in clinical settings, there seems to be some beneficial effects (Wagner, Mama et al. 2011; Guedes, Matthews et al. 2012). In laminitic horses, addition of ketamine resulted in decreased blood pressure, decreased forelimb offloading frequency and increased forelimb load, relative to tramadol alone (Guedes, Matthews et al. 2012).

Laminitis is a cause of severe lameness in horses. The horse in this image has severe, chronic laminitis with associated changes to the hoof walls.

Antispasmodic medications

Colic is one of the most common causes of pain in horses. This image shows distended small intestine from a horse during an exploratory laparotomy. The small intestine in this image is enlarged, though otherwise appears healthy.

Sodium channel blockers Lidocaine is an aminoamide local anesthetic which prevents propagation of action potentials by binding to voltage-gated sodium channels. Lidocaine, administered as an intravenous

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N-butylscopolammonium bromide (NBB) has both anticholinergic and antispasmodic properties and is labelled for the treatment of spasmodic colic. NBB administration also decreases rectal tone, facilitating rectal examination and may be useful in horses with esophageal obstruction.

Multimodal therapy In severely painful horses, combination of ketamine with lidocaine and/or butorphanol could potentially provide additional analgesia, relative to infusion of a single drug. In healthy horses, butorphanol-containing combinations resulted in delayed total gastrointestinal time and reduced fecal output (Elfenbein, Robertson et al. 2014); thus, one should pay careful attention to fecal output when using said combinations. FLORIDAAEP |

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References • Dalla Costa, E., M. Minero, D. Lebelt, D. Stucke, E. Canali and M. C. Leach (2014). "Development of the Horse Grimace Scale (HGS) as a pain assessment tool in horses undergoing routine castration." PLoS One 9(3): e92281. • Elfenbein, J. R., S. A. Robertson, R. J. MacKay, B. KuKanich and L. Sanchez (2014). "Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and butorphanol infusions alone and in combination in healthy horses." BMC Vet Res 10 Suppl 1: S6. • Fielding, C. L., G. W. Brumbaugh, N. S. Matthews, K. E. Peck and A. J. Roussel (2006). "Pharmacokinetics and clinical effects of a subanesthetic continuous rate infusion of ketamine in awake horses." Am J Vet Res 67(9): 1484-1490. • Foreman, J. H., C. R. Foreman and B. E. Bergstrom (2015). Medical alternatives to conventional cyclooxygenase inhibitors for treatment of acute foot pain in a reversible lameness model in horses. Journal of Veterinary Internal Medicine. • Gleerup, K. B., B. Forkman, C. Lindegaard and P. H. Andersen (2015). "An equine pain face." Vet Anaesth Analg 42(1): 103-114. • Guedes, A. G., N. S. Matthews and D. M. Hood (2012). "Effect of ketamine hydrochloride on the analgesic effects of tramadol hydrochloride in horses with signs of chronic laminitis-associated pain." Am J Vet Res 73(5): 610-619. • Love, E. J., L. Pelligand, P. M. Taylor, J. C. Murrell and J. W. Sear (2015). "Pharmacokinetic-pharmacodynamic modelling of intravenous buprenorphine in conscious horses." Vet Anaesth Analg 42(1): 17-29. • Price, J., S. Catriona, E. M. Welsh and N. K. Waran (2003). "Preliminary evaluation of a behaviour-based system for assessment of post-operative pain in horses following arthroscopic surgery." Veterinary Anaesthesia and Analgesia 30(3): 124-137. • Sanchez, L. C., S. A. Robertson, L. K. Maxwell, K. Zientek and C. Cole (2007). "Effect of fentanyl on visceral and somatic nociception in conscious horses." J Vet Intern.Med 21(5): 1067-1075.

• Sellon, D. C., M. C. Roberts, A. T. Blikslager, C. Ulibarri and M. G. Papich (2004). "Effects of continuous rate intravenous infusion of butorphanol on physiologic and outcome variables in horses after celiotomy." J Vet Intern.Med. 18(4): 555-563. • Thomasy, S. M., E. P. Steffey, K. R. Mama, A. Solano and S. D. Stanley (2006). "The effects of i.v. fentanyl administration on the minimum alveolar concentration of isoflurane in horses." Br.J Anaesth. 97(2): 232-237. • Wagner, A. E., K. R. Mama, E. K. Contino, D. J. Ferris and C. E. Kawcak (2011). "Evaluation of sedation and analgesia in standing horses after administration of xylazine, butorphanol, and subanesthetic doses of ketamine." J Am Vet Med Assoc 238(12): 1629-1633.

Christine Sanchez, DVM, Ph.D. University of Florida Dr. Christine Sanchez received her DVM degree from the University of Florida in 1995. She then completed an internship at Equine Medical Associates in Edmond, Oklahoma. After finishing a residency in large animal internal medicine at the University of Florida, she became a Diplomate of the American College of Veterinary Internal Medicine in 1999. She completed her Ph.D. at the University of Florida in 2003 and is currently a professor of large animal internal medicine. She is also currently the director of the Hofmann Equine Neonatal ICU and the chief medical officer of the UF Large Animal Hospital. Dr. Sanchez' clinical interests include general equine internal medicine, neonatology and gastroenterology. Her research focus has been veterinary gastroenterology with a special interest in visceral pain and gastric ulceration.

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OVER THE GROUND ENDOSCOPY JOHN B. MADISON | VMD, DACVS

When horses are examined for upper airway problems, in most cases, the condition can be diagnosed with an accurate history, laryngeal palpation and a resting endoscopic exam. Occasionally, however, these findings are normal or not diagnostic of the problem, and a dynamic exam must be performed in order to figure out the cause of the problem. In the past, these horses were examined on a high-speed treadmill (HSTM). The introduction of HSTM exams in the 1980s led to a renaissance in the understanding of dynamic upper airway conditions and greatly improved our ability to diagnose and treat these conditions in the equine athlete. The endoscopic appearance of horses exercising at near racing speed on a treadmill, along with the measurement of upper airway pressures, led to a tremendous leap forward in our understanding of dynamic conditions of the upper airway. This technique also allowed us to better understand why some surgical procedures were failing and resulted in modifications of some of the surgical procedures that were being performed. There were, however, some disadvantages to the use of HSTM exams on clinical cases. The horse had to be shipped to a facility with a high-speed treadmill, and the horse had to be acclimated to the treadmill before the exam could be performed. Depending on the skill of the operators, this could take the better part of a day. The ability to elicit the problem seen while the horse was under tack was also partly dependent on the skills of the treadmill operator but was also dependent on the problem being investigated (e.g. not all problems would be readily induced on the HSTM). If the operator did not have the experience and confidence to exercise the horse to near exhaustion, some dynamic conditions were missed (e.g. dynamic collapse of the left arytenoid). Other problems — like dorsal displacement of the soft palate and pharyngeal collapse — were frequently not reproduced on the HSTM because the horses were not wearing a bridle, were not in the same head set, and were not exercising under conditions similar to what they experience during competition so the competitive drive or anxiety that can sometimes accompany exercise during competition could not be reproduced leading to many false negative exams.

8 The Practitioner

The introduction of over the ground videoendoscopy (OTGE) has all but eliminated these false negative exams by allowing the horses to be examined under the exact conditions under which the problem occurs. As long as the horse exhibits the problem during the examination, it is highly likely that the cause will be identified. For these reasons, OTGE has replaced the HSTM as the “gold standard” in the diagnosis of dynamic upper airway conditions. The HSTM, in my opinion, is obsolete as a tool for use in clinical cases and now is an instrument used primarily in research. Conditions that are more commonly observed with OTGE (e.g. frequent false negatives on HSTM endoscopy) include: • dynamic collapse of the left arytenoid, particularly in horses with normal (grade 1 or 2) resting laryngeal function • ventral deviation of the apex of the corniculate process • axial deviation of the aryepiglottic (AE) folds • dorsal displacement of the soft palate (DDSP) • pharyngeal collapse The primary indication for performing an OTGE exam is to evaluate poor performance or upper airway noise with negative or equivocal resting endoscopic findings. It is also useful in evaluating the significance of resting endoscopic findings of unknown clinical importance. OTGE is also an excellent tool in evaluating the causes of poor outcomes in post-surgical patients. OTGE also has potential use in pre-purchase evaluations, although this use has not yet been widely exploited. Finally, OTGE exams may be of some value in evaluating coughing during exercise in sport horses. We have had several cases that coughed when the palate was dorsally displaced that have responded to surgical treatment for DDSP. The minimal equipment necessary for an OTGE exam are a videoendoscope that attaches to the bridle with a battery powered light source and the capability to record video images. Other features found on some of the scopes are the ability to wirelessly transmit video to a stationary viewing station, pumps to clear mucus from the scope intermittently, remote control adjustment of the scope using a joystick, GPS positioning which allows speed calculations, and a microphone to record respiratory noise.

Issue 2 • 2019

OTGE Dynamic Airway Problems Still images of OTGE videos demonstrating a variety of dynamic airway problems seen during exercise.

Figure 1: Left arytenoid collapse

OTGE exams are commonly performed to evaluate marginal or questionable resting arytenoid function (e.g. resting grade 3a or 3b). It is important to recognize, however, that severe left arytenoid collapse can be seen during high-speed exercise in horses with normal resting function (grades 1 or 2).

Figure 2: Ventral deviation of the apex of the corniculate process

This condition has been recognized much more frequently since the advent of OTGE. It was rarely seen during HSTM exams. It can be seen as a primary problem in horses or more commonly as a complication of horses with well-abducted arytenoids following laryngoplasty. The pathomechanics of the condition is still not well understood; however, the author has suggested that it may be related to primary loss of function of the medial belly of the cricoarytenoideus dorsalis (CAD) muscle.

Figure 3: Axial deviation of the aryepiglottic (AE) folds

This is a common finding in horses exercising at high speed and causes an inspiratory noise and variable amounts of restriction to airflow. The current treatment is to excise wedge sections of the AE folds either with a laser or with instruments via laryngotomy. Note in this case, there is also associated ventral deviation of the apex of both corniculate processes. In the authorâ&#x20AC;&#x2122;s experience, this only occurs in association with significant axial deviation of the AE folds. Pure ventral deviation of the apex of the corniculate process, not associated with axial deviation of the AE folds, is almost always a unilateral left-sided problem.

Figure 4: Evaluation of airway post arytenoidectomy

OTGE can be valuable in assessing problems occurring after a variety of surgeries. In the horse in Figure 4, the resting endoscopic exam post-left partial arytenoidectomy looked very good; however, the horse made an inspiratory noise and was exercise intolerant. The OTGE exam showed collapse of the soft tissues on the left side of the larynx, presumably due to loss of structural support from removing the arytenoid.

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A diagnosis of DDSP can frequently be made from the history and character of the noise. Resting endoscopic exam findings are not helpful in diagnosing intermittent DDSP other than in ruling out other upper airway problems. During OTGE, it is very common for the palate to intermittently dorsally displace during the “slow” portions of the exam, and this is common and of no predictive value. Likewise, in racehorses, it is very common for them to displace their palate immediately after a breeze (exercise at racing speed), and this is also normal. For a diagnosis of DDSP to be made on OTGE, the palate should displace during the speed portion of the exam and be present for at least six strides. Treatment options include equipment changes, a tongue tie, a sternothyroideus tenotomy (Llewelyn procedure) with or without a palate trim, and a tie forward. OTGE has also been useful in a small number of cases in documenting DDSP as the cause of coughing during exercise in sport horses.

Figure 5: Dorsal displacement of soft palate

Figure 6: Retroversion of the epiglottis

Retroversion of the epiglottis is a very uncommon condition that can cause severe exercise intolerance. It can occur as a presumably primary problem with damage to the hypoglossal nerve or secondary to previous laryngeal surgery (resection of subepiglottic cyst or abscess). Several surgical procedures have been tried to correct this problem with mixed results. Figure 7: Fourth branchial arch defects (4-BAD) are seen frequently Fourth branchial enough as a cause of upper airway problems that they must be arch defects in the differential diagnosis for any loss of arytenoid function with normal endoscopic anatomy. The embryonic fourth branchial arches are responsible for the formation of the wings of the thyroid cartilages, the cricothyroid articulations, the cricothyroid muscles, and the cricopharyngeus and thyropharyngeus muscles (upper esophageal sphincter). The primary clinical signs are exercise intolerance and upper airway noise. The CAD muscle is normal, but the arytenoid does not abduct due to loss of the caudal cornu of the thyroid cartilage on the affected side. The distribution of 4-BAD References defects is 65 percent right sided, 10 percent left sided and 25 1. Lane, JG, Fourth Branchial Arch Defects In Thoroughbred Horses: A Review of 60 Cases. Proceedings of the Second World percent bilateral1. All horses with loss of right-sided function Equine Airways Symposium, Scotland 2001. should have an ultrasound exam of the larynx performed to rule out 4-BAD before considering tie back surgery. The ultrasound findings that would occur are: no detectable John B. Madison, VMD, DACVS cricothyroid articulation, the thyroid cartilage extends dorsal Ocala Equine Hospital, PA to the muscular process and the CAL muscle is in an abnormal location (the space between the thyroid and cricoid cartilages). Dr. John Madison is a 1981 graduate of Some suggestion of the problem can be detected on careful the University of Pennsylvania School of palpation of the larynx. There is a palpable space between the Veterinary Medicine. He did an internship caudal cornu of the thyroid cartilage and the cricoid cartilage and surgery residency at New Bolton (no articulation), and the muscular process may not be palpable Center, and he remained at New Bolton as a lecturer until joining the faculty of the on the affected side. The degree of exercise intolerance with University of Florida in 1989. He left the the condition is extremely variable with some horses unable University of Florida in 1997 and opened Ocala Equine Hospital, to perform even low-level athletic activity while others (Figure a referral equine surgical practice. The surgical practice merged 7) are able to race successfully. OTGE is not particularly with two ambulatory practices in 2001 as the current Ocala helpful in making a diagnosis of 4-BAD, but it can be helpful Equine Hospital, PA. Dr. Madison is an avid hockey player and in assessing any secondary airway problems that can be treated. woodworker. There is currently no surgical treatment for the condition.

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There’s nothing else like it. Over the past 30 years, Adequan® i.m. (polysulfated glycosaminoglycan) has been recommended millions of times1 to treat degenerative disease, and with good reason. From day one, it’s been 2, 3 the only FDA-Approved equine PSGAG joint precription available, and the only one proven to. Restore synovial joint lubrication Repair joint cartilage Reverse the disease cycle Reduce inflammation When you start with it early and stay with it as needed, horses may enjoy greater mobility 2, 4, 5 over a lifetime. Discover if Adequan is the right choice. Talk to your American Regent Animal Health sales representative or call (800) 458-0163 to order. BRIEF SUMMARY: Prior to use please consult the product insert, a summary of which follows: CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: Adequan® i.m. is recommended for the intramuscular treatment of non-infectious degenerative and/or traumatic joint dysfunction and associated lameness of the carpal and hock joints in horses. CONTRAINDICATIONS: There are no known contraindications to the use of intramuscular Polysulfated Glycosaminoglycan. WARNINGS: Do not use in horses intended for human consumption. Not for use in humans. Keep this and all medications out of the reach of children. PRECAUTIONS: The safe use of Adequan® i.m. in horses used for breeding purposes, during pregnancy, or in lactating mares has not been evaluated. For customer care, or to obtain product information, visit www.adequan.com. To report an adverse event please contact American Regent, Inc. at (800) 734-9236 or email pv@americanregent.com. Please see Full Prescribing Information at www.adequan.com.

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GUY DAMON LESTER BSc (Hon), BVMS, Ph.D., DACVIM (LAIM)

DAVID G. LEVINE DVM, DACVS, DACSMR

ALAN NIXON BVSc, MS, DACVS

TONYA OLSON MSPT, DPT, OCS, MTC

SHEILA SCHILS MS, Ph.D.

KURT SELBERG MS, DVM, DACVR

TRACY TURNER DVM, MS, DACVS, DACVSMR

KELLY R. VINEYARD PAS, MS, Ph.D.

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Rehabilitation Case Studies

Friday, October 11 Time

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8:55 a.m. 9:45 a.m.

Case studies presented by each speaker will follow the progression from diagnosis through the rehabilitation process. The focus will be on the following: 1. Preventing injury and improving poor performance 2. Science-based rehabilitation protocols when injury occurs

Attendees will leave with some solid ideas on protocols that can be used in their practices!

10:30 a.m. 11:20 a.m.

11:25 a.m. 12:15 p.m.

Feeding the Equine Athlete Dr. Vineyard

2:40 p.m. 3:30 p.m.

Nutritional Management of Endocrine and Muscle Disorders Sponsored by Dr. Vineyard

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1:45 p.m. 2:35 p.m.

2:40 p.m. 3:30 p.m.

4:55 p.m. 5:45 p.m.

Imaging the Equine Neck Dr. Selberg Imaging-guided Treatment Dr. Selberg

THOMAS DIVERS DVM, ACVIM, ACVECC

ALAN NIXON BVSc, MS, DACVS

Update on the Epidemiology of R. Equi Pneumonia Dr. Cohen Standard and Alternative Treatment of Rhodococcus Equi Pneumonia in Foals Dr. Cohen

Stem Cell Distribution After Tendon and Joint Injection – Do We Hit the Target?

Control and Prevention of Rhodococcus Equi Foal Pneumonia

Dr. Nixon

Dr. Cohen

Advanced Imaging in Lameness and Surgery of the Foot and Fetlock Dr. Nixon

Equine Liver Viruses Dr. Divers

3:30 p.m. - 4:00 p.m. | Break - Visit the Exhibit Hall

3:30 p.m. - 4:00 p.m. | Break

4:00 p.m. 4:50 p.m.

A discussion of current topics on equine medicine, surgery and lameness.

12:15 p.m. - 1:45 p.m. | Complimentary Lunch in the Exhibit Hall

Room 1

1:45 p.m. 2:35 p.m.

Drs. Divers and Nixon

9:45 a.m. - 10:30 a.m. | Break - Visit the Exhibit Hall

Thursday, October 10 Time

Room 2

NEWS HOUR

Subchondral Bone Cysts: Navigating the Choices for Treatment

4:00 p.m. 4:50 p.m.

Dr. Nixon Fetlock Disease in Thoroughbred and Sport Horses Dr. Nixon

5:45 p.m. - 7:00 p.m. | Welcome Reception - Exhibit Hall

4:55 p.m. 5:45 p.m.

Diagnosing Back and SI Pain Clinical Features and Diagnostic Imaging

Treatment of Severe Sepsis and Septic Shock in Horses and Foals

Dr. Contino

Dr. Divers

Treatment and Rehabilitation of Back and SI Pain

Leptospirosis in Horses

Dr. Contino

Dr. Divers

5:45 p.m. - 7:00 p.m. | Reception - Exhibit Hall

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Sunday, October 13 Time

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8:00 a.m. 8:50 a.m.

An Update on Control and Prevention of Equine Strangles Dr. Cohen

The Biomechanics and Kinesiology of the Equine Spine and its Relationship to Rehabilitation Dr. Schils

8:55 a.m. 9:45 a.m.

Diagnosing Fore and Hind Limb Suspensory Ligament Injury Dr. Selberg

Part I: Current Concepts in Treatment of Spinal Injuries in Human Physical Therapy and the Potential for Comparison to Equine Practice Dr. Olson

Room 1

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FLORIDA LICENSED VETERINARIANS Florida Laws & Rules Governing the Practice of Veterinary Medicine Mr. Bayó (Satisfies Florida’s 2-hour CE requirement for Florida Laws & Rules Governing the Practice of Veterinary Medicine)

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Rehab Case Studies I Drs. Turner, Olson and Schils 9:45 a.m. - 10:30 a.m. | Morning Break

10:30 a.m. 11:20 a.m.

Rehab Case Studies II Drs. Turner, Olson and Schils

Rehab Case Studies III Drs. Turner, Olson and Schils

9:45 a.m. - 10:30 a.m. | Break - Visit the Exhibit Hall

10:30 a.m. 11:20 a.m.

11:25 a.m. 12:15 p.m.

Advanced Diagnostic Imaging of Carpus and Tarsus Sponsored by Dr. Levine

Diagnosis and Management of Equine Spinal Issues: How the Foot Matters Dr. Turner

11:25 a.m. 12:15 p.m.

Current Techniques in Treating Tendon/Ligaments with Cases

The Interaction of the Spine as a Whole in the Evaluation and Rehabilitation of Equine Back Problems Dr. Schils

Florida Licensed Veterinarians

Dr. Levine

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12:15 p.m. - 1:35 p.m. | Complimentary Lunch in the Exhibit Hall

1:35 p.m. 2:25 p.m.

2:30 p.m. 3:20 p.m.

Part II: Current Concepts in Treatment of Spinal Injuries in Human Physical Therapy and the Potential for Comparison to Equine Practice Dr. Olson

CT-guided Surgery Dr. Levine

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A Look at Nontraditional Causes of Poor Performance Dr. Contino

Success and Failure in the Advancement of Equine Rehabilitation Protocols Dr. Turner

DISPENSING LEGEND DRUGS & LAWS AND RULES GOVERNING THE PRACTICE OF VETERINARY MEDICINE Satisfies Florida’s 3-hour CE requirement

 2 hours in Laws & Rules Governing the Practice of Veterinary Medicine in Florida October 13, 2019 | 7 - 8:50 a.m.

3:20 p.m. - 4:20 p.m. | Break - Visit the Exhibit Hall

4:20 p.m. 5:10 p.m.

5:15 p.m. 6:05 p.m.

EIPH - Current Thoughts and Opinions Dr. Lester Gastric Ulceration – Practicing in a World of Generic Compounds Dr. Lester

Shoe Design and Function for Human and Equine Athletes. Are There Some Useful Comparisons? Drs. Turner and Olson How to Utilize the Concepts of Human Gait Analysis in Equine Rehabilitation Drs. Schils and Olson

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CANCELLATION POLICY: CANCELLATION DEADLINE FOR A FULL REFUND OF REGISTRATION FEES MINUS A $50 ADMINISTRATIVE CHARGE IS SEPTEMBER 12, 2019. CANCELLATIONS SHOULD BE RECEIVED IN WRITING AND ACKNOWLEDGED BY THE FAEP BY THE ABOVE DATE TO BE ELIGIBLE FOR A REFUND. CANCELLATIONS AFTER THAT DATE AND NO-SHOWS ARE NON-REFUNDABLE.

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FAEP/FVMA Member On or Before September 12 q $525.00 After September 12 q $575.00 Your 2019 FAEP/FVMA dues must be current to register at the discounted member rate! FAEP/FVMA Recent Graduate Member $225.00 After September 12 q $275.00 2019 Year of Graduation On or Before September 12 q 2017-18 Year of Graduation On or Before September 12 q $375.00 After September 12 q $425.00

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@FLORIDA_VMA | The Practitioner 11

TREATMENT OPTIONS FOR COLITIS CASES IN THE FIELD SALLYANNE L. D ENOTTA | DVM, Ph.D., DACVIM

Diarrhea in the adult horse represents a medical emergency requiring immediate veterinary attention. Initiating on-farm therapy can often resolve mild to moderate cases of colitis and likely prevents some from deteriorating to the point of requiring hospitalization and intensive care. Field management may also be attempted for cases where referral to a hospital isolation facility is not possible for logistical or economical reasons. Common causes of diarrhea in the adult horse include infectious agents (Salmonella, Clostridia spp, Coronavirus, Potomac Horse Fever), sand enteropathy, cyathastomiasis and inflammatory bowel disease. Regardless of etiology, initial therapy is generally supportive and aimed at maintaining hydration, restoring intestinal microbiota and preventing complications such as laminitis.

knowledge, SAA has not been demonstrated to be helpful in the diagnosis or monitoring of horses with colitis. Fresh feces should be tested for Salmonella, Clostridium difficile toxin A and B, Clostridium perfringens enterotoxin and Equine Coronavirus. In regions endemic with Neorickettsia risticii, diagnostics for Potomac Horse Fever (PHF) should also be submitted (whole blood PCR, fecal PCR, serum IFA), and any horse with compelling signs of PHF (fever and diarrhea during the summer and fall) should be treated with oxytetracycline empirically prior to diagnostic results. Horses vaccinated for PHF should also be treated, as the vaccine is only partially protective against the field strains known to affect horses, and there is individual variability in seroconversion following vaccination.

BIOSECURITY

FLUID THERAPY

Horses with diarrhea should be isolated as far from other horses as Fluid replacement is critical to prevent dehydration and possible and all traffic on or off the property should be minimized. hypovolemia and can be achieved through intravenous and/or Horses in isolation should be handled/fed last to minimize cross- enteral routes. Commercially available balanced isotonic solutions contamination with healthy animals, and personnel should wear are appropriate for intravenous therapy, while enteral isotonic changeable coveralls, gloves and nonpermeable footwear. Frequent solutions can be inexpensively made by adding 15 cc of table salt handwashing with liquid soap (not bar) and/or hand sanitizer and 15 cc of Lite salt to 4 liters of tap water. The goal of fluid therapy (at least 61percent alcohol) should be practiced by everyone on should be to correct any existing deficit over 12-24 hours and then the property. Designated equipment (feed tubs, water buckets, continue maintenance fluid therapy, adjusting as needed based stall-cleaning tools, grooming supplies, etc.) should be assigned on parameters of hydration status (mucous membrane moisture, to the isolation area and cleaned/disinfected prior to returning to capillary refill time, skin tent, jugular fill, urine production, PCV/ communal use. Diluted bleach (1:10 in water) is an effective and TP, etc.). Horses with severe diarrhea often require two to three practical disinfectant and can be used for foot baths, spraying down times maintenance fluid rates to keep up with fecal losses. stall walls and cleaning tools. Bleach is inactivated by organic matter, and thorough cleaning of surfaces with a detergent may Volume deficit (L) = Bwt (kg) x % dehydration be necessary prior to disinfecting. Maintenance fluid volume = 50 to 100 mL/kg per 24 More detailed instructions for biosecurity and on-farm isolation hours (25-50 liters/day) can be found in the AAEP Biosecurity Guidelines at: https://aaep. org/sites/default/files/Documents/BiosecurityGuidelines_Sept2018. pdf

TRANSFAUNATION

DIAGNOSTICS Basic bloodwork, including complete blood count (CBC) and serum biochemistry, are helpful for assessing organ function and severity of endotoxemia, and monitoring electrolyte derangements. Packed cell volume (PCV) and total protein can be serially monitored to monitor hydration status and assess for albumin loss as an indirect indicator of colonic mucosal integrity. Blood lactate is frequently elevated and usually reflects a combination of dehydration, poor perfusion and systemic inflammatory response. To the authorâ&#x20AC;&#x2122;s WWW.FAEP.NET |

The intestinal microbiome has been extensively studied over the past decade in both animals and humans, and feces has come to light as a biologically active population of living organisms with much therapeutic potential for restoring healthy microbial populations in patients suffering from gastrointestinal disease. As opposed to commercially marketed probiotics, which may contain only one or a few bacteria species, feces from a healthy donor contains thousands of diverse microbial populations and may be better able to colonize the intestine and restore FLORIDAAEP |

@FLORIDA_VMA | The Practitionerâ&#x20AC;&#x201A; 19

Figure 1: Fresh feces emulsified with warm water (first left) and then strained through stockinette (second left) to produce liquid transfaunate (above) for administration to a horse with colitis. Photo courtesy of: Dr. Diego Gomez.

normal microbiota. “Fecal transplantation” or “transfaunation” can be performed with fresh feces from a healthy donor horse. Donor horses should not have been recently treated with any antimicrobials and, ideally, should be confirmed negative for Salmonella shedding if time allows. Recipients may be pre-treated with omeprazole to mitigate any deleterious effects of gastric acid on transfaunate bacterial populations. There are currently no published data available regarding treatment frequency or dose, but it is common to perform fecal transplantation once daily until a clinical improvement in fecal consistency is observed. Concurrent administration of di-tri-octahedral smectite (Bio-Sponge®) (1-3 lbs per day, mixed with water and delivered via nasogastric tube) may additionally help absorb bacterial exotoxins. To prepare a fecal transfaunate solution (Figure 1): 1. Collect one pile of fresh manure from donor horse. Collect either directly from rectum or from ground if fresh. 2. Emulsify feces in warm water using manual or electric mixing device. 3. Strain fecal slurry by pouring over wire mesh strainer or into a fabric tube made from tied-off stockinette.

4. Administer the strained fluid (usually 3-8 liters) to recipient via nasogastric tube.

CRYOTHERAPY Digital cryotherapy has been shown to be effective for preventing laminitis in horses with colitis and can be achieved using icefilled, 5-liter fluid bags secured around the pastern with duct tape. Alternatively, commercially available, sleeve-style ice boots that do not incorporate the bottom of the hoof (Figure 2) may also be used. Both methods are equally effective at cooling the digit to approximately 50° F. The primary mechanisms by which digital cryotherapy prevents laminitis are hypometabolism with a reduction in lamellar enzymatic activity, vasoconstriction and antiinflammation. Lamellar enzymatic activity is reduced by about 50 percent for every 10° F drop in digital temperature. Owners may be instructed to refill the ice boots every few hours to maintain continued digital hypothermia. Crushed ice/water slurries appear to be associated with less trauma to the underlying limb skin than cubed ice alone. With regular monitoring for the development of cellulitis, dermatitis or coronitis, digital cryotherapy can be continuously applied for multiple days.

Figure 2: Digital cryotherapy using plastic grain sacks on a draft horse (left) and commercially available, sleeve-style boots (right) in two horses being treated for colitis.

20 The Practitioner

Issue 2 • 2019

WHEN TO REFER

Horses that fail to rapidly respond to therapy and/or deteriorate despite treatment should be referred for intensive management in a hospital isolation facility. Severe leukopenia (<2000 WBC/ uL), toxic mucous membranes and/or rising PCV in the face of decreasing serum protein are all indicative of severe intestinal mucosal compromise. Many of these cases require high-volume intravenous fluids, colloid support and intensive supportive care to survive. In most cases, it is better to refer sooner rather than later, particularly in horses at risk for developing laminitis as the mechanical stress of transport can further injure already compromised hoof laminae and worsen hoof wall separation.

Additional Resources: AAEP General Biosecurity Guidelines: https://aaep.org/sites/ default/files/Documents/BiosecurityGuidelines_Sept2018.pdf Shaw SD, Stampfli H. Diagnosis and treatment of undifferentiated and infectious acute diarrhea in the adult horse. Vet Clin North Am Equine Pract 2018: 34(1): 39-53. https://doi.org/10.1016/j.cveq.2017.11.002 Kullmann A, Holcombe SJ, Hurcombe SD, Roessner HA, Hauptman JG, Geor RJ, Belknap J. Prophylactic digital cryotherapy is associated with decreased incidence of laminitis in horses diagnosed with colitis. Equine Vet J 2014: 46(5):554-9. https://doi.org/10.1111/evj.12156 Mullen K, Yasuda K, Divers T, Weese J. Equine faecal microbial transplant: Current knowledge, proposed guidelines and future directions. Eq Vet Educ 2018:30(3):151-160. https://doi.org/10.1111/eve.12559

Sally DeNotta, DVM, Ph.D., DACVIM University of Florida Dr. Sally DeNotta is board certified by the American College of Veterinary Internal Medicine and serves on the clinical faculty at the University of Florida College of Veterinary Medicine. She is also acts as the UF Equine Veterinary Extension coordiantor. Dr. DeNotta grew up on the rural Oregon coast and received her veterinary degree from Oregon State University. She spent time in private practice in both Colorado and Oregon before heading to upstate New York where she completed an internal medicine residency at Cornell University. Following residency, she joined the clinical faculty at Cornell while obtaining a Ph.D. developing optical techniques for in-vivo imaging of the central nervous system. She joined the UF faculty in 2018, where her clinical interests include infectious disease, neurologic disorders, colic, coagulation and neonatology.

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SUPPRESSION OF UNDESIRABLE (ESTROUS) BEHAVIOR IN MARES STEVEN P. BRINSKO | DVM, MS, Ph.D., DACT Owners and trainers frequently ask veterinarians to diagnose and treat undesirable behavior that they attribute to estrus in performance mares and fillies. The key to providing an appropriate diagnosis and treatment in these cases is a detailed history and description of the undesirable behavior. One of the most common complaints is that the mare is “always in heat.” In the almost 30 years of being a board-certified theriogenologist, the author has rarely found this to be the case. More often than not, it is a misinterpretation of the mare’s behavior. Usually, it is frequent urination and other signs of agitation which prompts this complaint.

Important information to obtain, in order to determine if the behavior is associated with estrus or ovulation, includes but is not limited to: What behavior(s) are we trying to prevent? • Frequent urination? • Lack of focus? • Sexually receptive behavior toward stallions, geldings or mares? • Aggression to other horses or humans? • Resistance to saddling/cinching? When did the behavior start, and when does it occur? • Is the behavior cyclic, seasonal, intermittent or constant? – Having the client record the behavior on a calendar is very helpful for documenting this. • Changes in training, tack or riders? The time of the year that the behavior occurs, in addition to when the examination is performed, can have a significant impact on the evaluation. As day length increases with the approaching physiologic breeding season, mares go through a transitional estrus period prior to attaining true cyclicity. Increasing GnRH pulses result in FSH secretion from the anterior pituitary and the recruitment of small to medium follicles on the ovaries; however, there is insufficient LH at this time to induce these follicles

Figure 1: Mare demonstrating typical receptive estrous behavior with erect ears, deviated tail, posturing and urination.

Identifying the Problem As so often happens, clients want a quick fix to the problem they are encountering; however, a thorough evaluation of behavioral problems frequently requires more than a single examination, particularly if the reported undesirable behavior is not demonstrable at the time of the examination. Since a thorough and accurate history is imperative to diagnosing the problem, prior to examining the mare, it is often helpful to have the client document the type of undesirable behavior and when it occurs, as initial verbal exchanges are often haphazard and incomplete. Having the client provide videos of the behavior can be very advantageous.

22 The Practitioner

Figure 2: Mare demonstrating typical agitated behavior with ears pinned and ringing of tail. Frequent small amounts of urine are often voided, which is often mistaken for the mare being in estrus.

Issue 2 • 2019

to mature and ovulate. With the waxing and waning of these follicles accompanied by their estrogen secretion in the absence of progesterone, mares tend to show erratic periods of estrous behavior without true cyclicity because they are not ovulating. Therefore, it is informative to ask if the objectionable behavior occurs sporadically early in the breeding season, if it changes throughout the year and if it is cyclic in nature. Mares demonstrating true estrous behavior (Figure 1) will have their ears up, will posture with an elevated and deviated tail, urinate and rhythmically evert the clitoris (“winking”). Irritated mares will pin their ears, ring their tail and void frequent small amounts of urine (Figure 2). It is this latter behavior that is commonly misinterpreted as the mare being in heat and is often associated with changes in training or activity, as well as problems associated with tack or riders. Bilateral ovariectomy has long been advocated as a method to suppress or eliminate undesirable behavior in mares; however, this is only effective for mares with adverse behavior that is truly associated with the estrous cycle. There are some mares, especially young post-pubertal fillies, that experience pain during estrus or ovulation known as “mittelschmerz.” This is probably due to stretching of the peritoneum with the development of large follicles or ovarian sensitivity. Many of these fillies outgrow this phenomenon as they mature. If this is the cause, the behavior should only be expressed during the ovulatory season. Behavioral improvement has been reported in performance mares in that they exhibit more consistent behavior. It should be noted that bilateral ovariectomy is not effective in eliminating overt estrous behavior that occurs during the ovulatory season or during anestrus.

Suppression of Estrous Behavior

can cause muscle irritation, swelling and pain; thus, this method may not be suitable for performance mares. A long-acting form (P4 LA Biorelease, BETPharm, Lexington, Kentucky) is available and is recommended to be administered every seven to 10 days to maintain serum progesterone levels of > 2 ng/mL. There are anecdotal reports of the successful use of off-label progestogen products such as medroxyprogesterone acetate (Depo-Provera®), hydroxyprogesterone caproate (Makena®) and megestrol acetate (MGA 200 Premix®); however, controlled studies have failed to demonstrate their effectiveness, which is likely due to their inability to bind equine progesterone receptors. Cattle implants, such as Synovex®S, also have anecdotal success stories. But as with off-label progestogens, controlled studies using one, four or 10 implants demonstrated that progesterone levels remained below 0.5 ng/mL, which resulted in a failure to inhibit mares returning to estrus.

Intrauterine Devices

Intrauterine marbles (25-35 mm) are commonly used in attempts to prolong the luteal phase of mares. The results are quite variable and even in some of the published reports claiming good efficacy, the data is presented in such a manner as to skew the results to a more favorable outcome. Most failures result from expulsion of the marble from the uterus. Additionally, there are numerous reports of serious complications, especially when the large, multicolored glass marbles are used. Complications include pyometra and fragmentation of the marble, resulting in shards of glass becoming imbedded in the endometrium causing significant damage (Figure 3). The author has witnessed this numerous times in mares admitted to our referral hospital after a practitioner had placed multicolored marbles in the mare’s uterus.

Progestogens

Progestogens are commonly used to suppress estrous behavior in mares. For many years, the “gold standard” has been the use of Altrenogest, which is FDA approved for daily oral administration. Suppression of estrous behavior is generally achieved within three days of initial administration. More recently, compounded, long-acting and injectable forms of Altrenogest have become available, which obviate the need for daily administration and mitigate the risks involved with transcutaneous absorption of the product by the administrator. A 12-day formulation (Altrenogest BioRelease LA 150, BETPharm, Lexington, Kentucky) contains 450 mg of Altrenogest per dose, and a 30-day formulation (MP 500, BETPharm, Lexington, Kentucky) contains 500 mg per dose, releasing 16.6 mg per day. Circulating levels of ≥ 1 ng/mL of natural progesterone are necessary to block estrous behavior. A dose of 100 mg per day IM in a compounded, oil-based base form will achieve this with suppression occurring in one to two days. Daily IM injections

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Figure 3: Hysteroscopic image of severe necrotic endometritis caused by fragmentation of an intrauterine marble.

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Because of this, the use of intrauterine marbles to suppress estrus is strongly discouraged. Instead of a marble, a 20 mm diameter, water-filled polypropylene ball, weighing 3.6 grams, was inserted in 12 mares uteri two to four days after ovulation. The balls reportedly prolonged the luteal phase in 75 percent (nine out of 12) of the mares for an average of 57 days (range 44-75 days).1 More recently, a novel intrauterine device consisting of three ovals, weighing 22.5 grams each with a magnetic core and a shatter-proof polymer coating, was evaluated for suppression of estrus in mares. The ovals are inserted independently of each other, whereupon they self-assemble in the uterus. The ovals are inserted and retrieved using an applicator and a magnetic retriever. In their first experiment, 15 mares had the device inserted post-ovulation and the length of diestrus was extended an average of 73 days with a range of 20-155 days. In the second experiment, 15 mares had the device inserted regardless of the stage of the estrous cycle. For mares in which the device was inserted during diestrus, the length of diestrus averaged 40 days with a range of seven-98 days; whereas for mares in which the device was inserted during estrus, the length of diestrus averaged 36 days with a range of 15-67 days. The authors stated that the device can be inserted into the uterus at any stage of the estrous cycle and that none of the devices were expelled.2 Wilsher and Allen reported that 1 mL of either peanut or coconut oil deposited in the uterus on Day 10 prolonged the luteal phase for 30 days in one of 12 mares based upon progesterone levels being above baseline; however, estrous behavior was not documented.3 Subsequently, others studied the effect of 1 mL of fractionated coconut oil in the uterus on Day 10, and all 12 mares returned to estrus with a normal decline in progesterone values.4

Exogenous Oxytocin

Dirk Vanderwall has published a number of studies with various coworkers showing that serial administration of exogenous oxytocin is an efficacious method of prolonging CL function in mares. The most common protocol involves once daily oxytocin administration of 60 units IM on Days 7 through 14. This protocol reportedly prolongs the CL through Day 30. An alternative protocol of 60 units IM for 29 days eliminates the need for cycle monitoring.

Suppression of Ovarian Activity

Ovarian activity can be suppressed through the use of GnRH vaccines which link a GnRH carrier protein with an adjuvant. The immune response generates anti-GnRH antibodies, which neutralize GnRH and thereby decreases gonadotropins and ovarian activity. The most commonly used GnRH vaccine is Equity® (Zoetis Australia PTY Ltd; Rhodes NSW, Australia), which is labeled for use in Australia to suppress estrus in mares and fillies that are not intended for breeding. Two doses administered four weeks apart can result in anestrous-like behavior that lasts, on average, three months, beginning within two weeks of the second injection. The length of the ovarian suppression can be quite variable, however, ranging from 24 The Practitioner

four-23 weeks in 10 of 16 mares with six mares not returning to estrus for ≥ 10-14 weeks.5 As noted above, this vaccine is intended for fillies and mares, NOT intended for breeding. In a retrospective study of retired Thoroughbred racing mares having prolonged abnormal acyclicity for one to three breeding seasons, it was found that they all had a history of receiving the Equity® vaccine.6 There have been a number of reports from practitioners managing broodmares from Australia who have experienced similar phenomena. The GnRH agonist Ovuplant™ (Peptech Animal Health Pty Ltd; North Ryde NSW, Australia) has been used to suppress ovarian activity and estrus. The postulated mechanism is that the GnRH agonist hyperstimulates and eventually desensitizes the anterior pituitary, thereby reducing gonadotropin release. When the implants are left in place, estrus is suppressed; however, the ovarian suppression is short lived, variable and dose dependent. In contrast to GnRH agonists, GnRH antagonist inhibit the action of GnRH and are reported to have a more rapid onset of action. The GnRH antagonist Antarelix™ (Europeptides, Argenteuil, France) when given to mares on Day 8 after ovulation, increased the interovulatory interval by approximately 11 days compared to control mares;7 however, the mare response is highly variable and behavioral estrus is inconsistent. The pharmacologic suppression of ovarian activity targets the hypothalamic-adenohypophyseal-ovarian axis through the downregulation or inhibition of GnRH activity. The reduction in pituitary gonadotropins suppresses follicular growth and their secretion of estrogens. Since no ovulation occurs, there is no progesterone production, and the mare’s behavior will mimic that which occurs during anestrus. Therefore, this method will not be helpful if the mare exhibits estrous behavior in the winter; however, this method could be used as a test for the efficacy of ovariectomy.

Summary

There are a number of options for practitioners to choose from for suppressing undesirable estrous behavior in mares. They vary in mechanism of action, administration route and frequency, as well as efficacy and duration. The best method is an individual choice based upon practitioner preference and the behavior that is desired to be modified. Progestogens are often the first choice for suppression of undesirable behavior. Since progestogens often have a generalized calming effect, it should be noted that if a favorable response is achieved with the use of progestogens, this doesn’t mean that the behavior is necessarily related to estrus. Identifying what the objectionable behavior is and its cause(s) is the key to a successful intervention.

References Author’s note - For a more comprehensive review of this subject with extensive references, readers are referred to: Hornberger K, Lyman C, Coffman E, et al.: Mares behaving badly: A review of methods for estrus suppression in the mare. Clinical Theriogenology 9(4):583-594, 2017.

Issue 2 • 2019

1. del Alamo MMR, Reilas T, Kindahl H, et al.: Mechanisms behind intrauterine device-induced luteal persistence in mares. Anim Reprod Sci 107:94-106, 2008. 2. Gradil C and Schwarz A: IUD modulation of the reproductive cycle. Proc Am Assoc of Equine Practnr 64:246, 2018. 3. Wilsher S and Allen WR: Intrauterine administration of plant oils inhibits luteolysis in the mare. Equine Vet J 43:99-105, 2011. 4. de Amorim MD, Nielson K, Cruz RKS, et al.: Progesterone levels and days to luteolysis in mares treated with intrauterine fractionated coconut oil. Theriogenology 86:545550, 2016. 5. Elhay M, Newbold A, Britton A, et al.: Suppression of behavioural and physiological oestrus in the mare by vaccination against GnRH. Aust Vet J 85:39-45, 2007. 6. Robinson SJ and McKinnon AO: Prolonged ovarian inactivity in broodmares temporally associated with administration of Equity. Aust Eq Vet 25:85-87, 2006. 7. Watson ED, Pedersen HG, Thomson SRM, et al.: Control of follicular development and luteal function in the mare: Effects of a GnRH antagonist. Theriogenology 54:599-609, 2000.

Steven P. Brinsko, DVM, MS, Ph.D., DACT Texas A&M University Dr. Steven Brinsko received his DVM from the University of Florida in 1985. He completed a combined residency and master’s degree program in theriogenology at Texas A&M in 1990, followed by a Ph.D. from Cornell University in 1995. He is currently a professor of theriogenology in the Department of Large Animal Clinical Sciences at the College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, where he also served as associate department head for academics from 2012 to 2018. He has been an invited speaker at numerous national and international meetings and has authored or co-authored more than 100 manuscripts related to the field of reproduction. He is a member of the Grayson Jockey Club Research Advisory Committee, a past president of the American College of Theriogenologists and, since 2011, has served as the chair of the Theriogenology Foundation’s Research Grant Committee.

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