The Modern Equine Vet August 2017 by The Modern Equine Vet

The Modern

Equine Vet www.modernequinevet.com

Back Pain

Is It the Saddle?

A Little Resistance Training Does Season Affect Birthweight? Staying in the Black Technician Update: An Unfortunate Lump

Vol 7 Issue 8 2017

TABLE OF CONTENTS

PAIN

Evaluating Poor Saddle Fit,

12 Back Pain and More Cover photo: Shutterstock/lenina11only

BUSINESS

Tools to Help Stay Above the Bottom Line........................................................................... 4 ORTHOPEDICS

Are Glucocorticoids a Cause of Laminitis? Maybe, Maybe Not..................................10 TECHNICIAN UPDATE

An Unfortunate Lump.................................................................................................................20 NEWS

Horses May Benefit From Resistance Training ............................... 3 Atypical Myopathy in the U.K.: Factors for Survival ..................... 8 Thirty-Three Veterinary Students Rewarded for Leadership, Commitment to Equine Medicine .............................11 Seasonal Effects: Winter Foals Smaller Than Foals Born in Summer ..................................................................18

ADVERTISERS Shanks Veterinary Equipment.................................. 3 Merial/Equioxx............................................................. 5 Merck Animal Health.................................................. 7 Standlee Premium Forage......................................... 9

Avalon Medical...........................................................11 NEAEP...........................................................................19 AAEVT............................................................................21

The Modern

Equine Vet SALES: Matthew Todd • ModernEquineVet@gmail.com EDITOR: Marie Rosenthal • mrosenthal@percybo.com ART DIRECTOR: Jennifer Barlow • jbarlow@percybo.com CONTRIBUTING WRITERS: Paul Basillo • Kathleen Ogle COPY EDITOR: Patty Wall Published by PO Box 935 • Morrisville, PA 19067 Marie Rosenthal and Jennifer Barlow, Publishers PERCYBO media  publishing

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NEWS NOTES

A system of abdominal and hindquarter resistance bands appears to improve stability of the vertebral column in the thoracolumbar region during trot exercise, according to a recent study. Researchers from the United Kingdom, the United States and Germany set out to evaluate the effects of a four-week training program using resistance bands on the equine back and core stability. They included seven horses in daily ridden exercise without clinical signs of back pain. Inertial sensors enabled accurate measurement of small back movements; these were attached at the poll, withers, T16, L4–6, sacrum, left and right tuber coxae and tail base. A commercial equine resistance band system was used, which comprised an abdominal band to encourage recruitment of core abdominal muscles and a hindquarter band to increase proprioception of hind limb movement. During week one of the study, the horses were acclimatized to the resistance bands and thereafter they were used for increasing periods each week up to 30 minutes three times a week. Normal daily exercise was reduced to compensate for the increased exercise done during band training. Data were collected—with and without bands in a straight line—on a left rein circle or on a right rein circle. With the bands, researchers said that there was significantly less withers roll and pitch and reduced mediolateral movement in both thoracic and lumbar regions. This provided some evidence that resistance bands may aid in improving stability of the vertebral column during trot exercise. No differences occurred caudal to the lumbar region. Although the bands do not directly cause increased lumbosacral flexion, the degree of dorsoventral displacement was increased at week four, they said. Researchers noted that more work is required to further elucidate the stabilizing effects of resistance bands and assess whether these effects are due to increased activation of core musculature. MeV

Resistance bands

Courtesy of The Equine Veterinary Journal

Horses May Benefit From Resistance Training

Lifting Large Animals Since 1957

For more information: Pfau T, Simons V, Rombach N, et al. Effect of a 4-week elastic resistance band training regimen on back kinematics in horses trotting in-hand and on the lunge. Equine Vet J 2017 Jun 19 (Epub ahead of print). http://onlinelibrary.wiley.com/doi/10.1111/evj.12690/full

www.shanksvet.com • info@shanksvet.com ModernEquineVet.com | Issue 8/2017

BUSINESS

Tools to Help Stay

Shutterstock/totojang1977

Above the Bottom Line There are two constants in equine veterinary practice management: every practice is different, and change is inevitable. Every decision that a practice owner makes alters the business functions, whether it’s the acquisition of a new piece of equipment, the addition or cancellation of a provided service, or the addition of a new associate. Unless an owner is actively engaged, it is likely that one or more aspects of the business are failing, according to William A. Jackson, DVM, MBA, DACVS, founder B 4

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and president of WJ Consulting Group, LLC. “Just looking at the financial statements can provide a foundation for individuals to make informed decisions,” he said. “Financial statements are readily available and easy to use. They’re certainly underutilized and extremely powerful management tools.”

“Every transaction that you record through Quickbooks [bookkeeping software] or submit to your bookkeeper is likely going to end up changing the balance sheet in one way or another,” Dr. Jackson said. “It measures the company’s financial position, its assets and its liabilities.” Assets include cash on hand, cash in savings and accounts receivable, which is the amount of money owed to a business by clients or other vendors. Fixed assets include some of the more substan-

Balance Sheet

The balance sheet is a highly dynamic document that represents a snapshot of a business at a particular point.

ain Because managing OA p in. shouldn’t cause more pa ty profile.

ceptional safe ex an ith w y ac fic ef s er liv EQUIOXX de

pain and e for treating osteoarthritis oic ch ht rig the is XX UIO EQ you’ll find When you do the research, . inflammation for your clients X-1 AID for horses – spares CO

NS XX – the first and only coxib • First and Only – EQUIO 1 , including while inhibiting COX-2 * effective than phenylbutazone re mo 2 or ive ect eff as ed rat vement scores EQUIOXX was pro dy, im l stu a ral In ove – e and tiv e ec enc Eff fer re • Mo , joint circum 3,4 nipulation, range of motion improvement in pain on ma dies than any other NSAID; stu ety saf in ses hor re mo n tested on • Safety – EQUIOXX has bee ects most horses had no side eff e, dos at the recommended aid in compliance to 24 hours which can also up n pai ls tro con e dos e On • Convenient – been determined. *Clinical relevance has not

D out to pasture. See how Time to put your old NSAI nce for your clients. re ffe di a e ak m n ca X OX EQUI

EQUIOXX.com

Available in three formulations to fit in and out of competition needs: Injection, Paste and Tablet. IMPORTANT SAFETY INFORMATION: As with any prescription medication, prior to use, a veterinarian should perform a physical examination and review the horse’s medical history. A veterinarian should advise horse owners to observe for signs of potential drug toxicity. As a class, nonsteroidal anti-inflammatory drugs may be associated with gastrointestinal, hepatic and renal toxicity. Use with other NSAIDs, corticosteroids or nephrotoxic medication should be avoided. EQUIOXX has not been tested in horses less than 1 year of age or in breeding horses, or pregnant or lactating mares. For additional information, please refer to the prescribing information or visit www.equioxx.com. Data on file at Merial, Safety Study, PR&D 0144901. Doucet MY, Bertone AL, et al. Comparison of efficacy and safety of paste formulations of firocoxib and phenylbutazone in horses with naturally occurring osteoarthritis. J Am Vet Med Assoc. 2008;232(1):91-97. 3 EQUIOXX product labels and FOI summaries and supplements. 4 Data on file at Merial, Clinical Experience Report PHN 471, PR&D 0030701. 1

BUSINESS

The Big Three Forms

CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. EQUIOXX® (firocoxib) is indicated for the control of pain and inflammation associated with osteoarthritis in horses. Firocoxib belongs to the coxib class of non-narcotic, nonsteroidal anti-inflammatory drugs (NSAID). CONTRAINDICATIONS: Horses with hypersensitivity to firocoxib should not receive EQUIOXX. WARNINGS: EQUIOXX is for use in horses only. Do not use in horses intended for human consumption. Do not use in humans. Store EQUIOXX Tablets out of the reach of dogs, children, and other pets in a secured location in order to prevent accidental ingestion or overdose. Consult a physician in case of accidental human exposure. Horses should undergo a thorough history and physical examination before initiation of NSAID therapy. Appropriate laboratory tests should be conducted to establish hematological and serum biochemical baseline data before and periodically during administration of any NSAID. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Treatment with EQUIOXX should be terminated if signs such as inappetance, colic, abnormal feces, or lethargy are observed. As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal, and hepatic toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Horses that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Patients at greatest risk for adverse events are those that are dehydrated, on diuretic therapy, or those with existing renal, cardiovascular, and/ or hepatic dysfunction. The majority of patients with drug-related adverse reactions recover when the signs are recognized, drug administration is stopped, and veterinary care is initiated. Concurrent administration of potentially nephrotoxic drugs should be carefully approached or avoided. Since many NSAIDs possess the potential to produce gastrointestinal ulcerations and/or gastrointestinal perforation, concomitant use of EQUIOXX with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. The concomitant use of protein bound drugs with EQUIOXX has not been studied in horses. The influence of concomitant drugs that may inhibit the metabolism of EQUIOXX has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. The safe use of EQUIOXX in horses less than one year of age, horses used for breeding, or in pregnant or lactating mares has not been evaluated. Consider appropriate washout times when switching from one NSAID to another NSAID or corticosteroid. The Safety Data Sheet (SDS) contains more detailed occupational safety information. For technical assistance, to request an SDS, or to report suspected adverse events call 1-877-217-3543. For additional information about adverse event reporting for animal drugs, contact FDA at 1-888-FDA-VETS, or http://www.fda.gov/AnimalVeterinary. Rev 10/2016

tial assets that are difficult to turn into cash, such as the physical building, vehicles and equipment. Liabilities, in short, are accounts and salaries payable. This is what the company owes vendors and employees. Fixed long-term liabilities include mortgages and loans. The third component of the balance sheet is the stockholders’ equity, which is the difference between the total assets and liabilities. This is the net worth of the company.

Profit-and-Loss Statement

This statement represents the financial condition of a business for a period. It details income (minus costs of goods sold, or COGS), and is broken down into fixed and variable costs. “Fixed and variable costs are important,” Dr. Jackson said. “These are vital for determining your operating costs, which is how much it costs to open the practice each morning, independent of the amount of business that you do that day.” Fixed costs include salaries and rent. Variable costs include production supplies, commissions and things that depend on sales volume.

Statement of Cash Flow

The statement of cash flow takes information from the balance sheet and income statement and summarizes changes in cash flows due to business activity over time. This statement represents the cash position of the business, and reflects the ability of a business to pay its debts. The projections are made with the expected 6

Issue 8/2017 | ModernEquineVet.com

Shutterstock/VectorHot

• B ALANCE SHEET: Snapshot of assets, liabilities and stockholder equity at one particular point in time. • PROFIT-AND-LOSS STATEMENT: The financial condition of a business over a period. • STATEMENT OF CASH FLOWS: The cash position of a business and the ability of a business to pay its debts. cash receipts used to schedule payments to vendors.

Vertical vs Horizontal

At first glance, the obvious method of analyzing these statements would be to look at them vertically to get the bottom line. This is an important way to look at them, but a horizontal analysis can give an owner an idea of trends and anomalies. For example, a look at a profit and loss statement may show a net income of $150,000, but that is far from the total profit for the practice. “If you are the owner of an LLC [limited liability corporation], net income does not reflect the income you have taken on your own behalf,” Dr. Jackson said. “That is not reflected in your profit-and-loss or income statements.” In addition, that number does not consider things that may be financed, such as a digital radiography unit. “You start subtracting pretty quickly and pretty substantially from your net income,” he added. A horizontal analysis of these forms would involve looking at the net income from the income statement, then searching for distributions and payments on liabilities in the balance sheet. Businesses with high profits and high debt loads may have unsustainable practices.

Ratios

Further analysis of the financial statements using different ratios can also help clarify the financial health of a business. The quick ratio measures the liquidity of a business and its ability to meet its short- and long-term responsibilities. It

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BUSINESS

does not include inventory. In general, a score of greater than 1 is viewed as satisfactory. For example, a quick ratio of 1.6 means that for every dollar of liabilities, the company has $1.60 of liquid assets that can be used to satisfy immediate obligations. “The current ratio has one glaring difference,” Dr. Jackson said. “It includes inventory, where the quick ratio does not. I will use these concurrently, even though they both measure the liquidity of a business.” He used the example of the high failure rate in restaurants to illustrate the key differences between the two ratios. Restaurants tend to have high inventory, which can

skew results. If a business has a 1.6 quick ratio and a 2.2 current ratio, a trend can begin to be mapped. “You can look at your inventory and see if the percentage begins to increase,” Dr. Jackson said. “That can allow you to see that your inventory control measures need to be addressed.” The return on assets ratio can be used to identify whether your assets are paying for themselves. A score less than 1 indicates that the company may have too much invested in assets given the annual income. The days-receivable ratio is a simple mathematical equation that determines the average amount of time it takes for a client to pay the

business back. A business with a days-receivable ratio of 62 days, for example, is fairly undesirable. “I would argue [that score] is unsustainable, inefficient and starting to border on uncollectable,” he said. “The effect of those 62 days is that it decreases current assets, the ability to pay bills, and borrowing power.” As a jumping off point, Dr. Jackson believes these ratios and types of financial analyses can greatly improve a practice’s overall situation. “The big take-home message is how powerful a management tool these financial statements are,” he said. “Every single one of them is available to you.” MeV

Atypical Myopathy in the U.K.: Factors for Survival

Photo courtesy of the Equine Veterinary Journal

Full-time turnout and younger age were associated with decreased odds of survival in U.K. horses with atypical myopathy, while vitamin and mineral supplementation and veterinarian treatment that included vitamin preparations were associated with increased survival. The researchers obtained data about 224 U.K. cases that occurred over five years submitted to the Atypical Myopathy Alert Group website. Most cases (73.3%) occurred in the fall months of October and November. The majority occurred in England (87.9%), with smaller numbers in Wales (8.5%) and Scotland (2.7%). Hampshire, Wiltshire and Gloucestershire reported the highest numbers of cases.

The median age of the affected horses was 6 years. Middleaged horses were more likely to survive than those younger than 5 years. There were 60% males and 40% females and more than two-thirds were in good body condition. Almost all horses (98.6%) had access to pasture, with the majority (72.5%) being turned out for 24 hours a day. In 59% of cases, the paddocks of affected horses were used for grazing all year round; this group had decreased odds of survival. Supplementary feeding was being given to 68% of horses. Horses with access to a salt lick and those receiving a vitamin or mineral supplement had significantly increased odds of survival compared with those who did not, according to the researchers. In most cases (96%), sycamore seeds were found in the paddocks; sycamore seedlings were found in 67.6% of cases. Often, the sycamore trees were within, or near the paddock. The most common presenting signs were dark urine, stiffness and muscle fasciculations. For the 189 cases for which outcome was known, 74 (38.6%) survived. Fourteen percent of cases died or were euthanized within 24 hours of the onset of clinical signs. Recumbency was strongly associated with decreased survival. Veterinary treatment with vitamin preparations was associated significantly with increased survival. MeV

For more information: González-Medina S, Ireland JL, Piercy RJ, et al. Equine atypical myopathy in the U.K.: Epidemiological characteristics of cases reported from 2011 to 2015 and factors associated with survival. Equine Vet J. 2017 Jun 19 (Epub ahead of print). http://onlinelibrary.wiley.com/doi/10.1111/evj.12694/full Atypical myopathy

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ORTHOPEDICS

Are glucocorticoids a cause of laminitis?

Maybe, maybe not B

While the use of glucocorticoids is fairly common in other areas of veterinary medicine, administration of prednisolone in horses is shaded by a perception that the drug is a precipitating cause of laminitis because there have been reports linking the two. Explanations for the link may include weakening of the lamella due to protein catabolism, and increased intestinal permeability to toxins, among others. A recent study conducted in the U.K. led by Victoria Jordan, MA, VetMB, MRCVS, set out to quantify the incidence of laminitis following oral treatment with prednisolone, and to identify potential factors within the horse that may be associated with laminitis. The study added to the evidence, but hasn’t clarified the issue. The results of one study does not let prednisolone or other corticosteroids off of the hook where laminitis is concerned, according to Sue Dyson, MA, VetMB, PhD, DEO, FRCVS, who was asked to comment on the study. “Corticosteroid associated laminitis is a relatively rare occurrence,”

said Dr. Dyson, head of Clinical Orthopedics at the Animal Health Trust in the U.K.. “I think that you would have to have a much larger study and be as sure as you possibly could be that corticosteroids are not implicated as a causal factor—perhaps in association with other factors. Corticosteroid-associated laminitis is a devastating condition, and any practitioner that has experienced it is likely to err on the side of caution.” The retrospective study by Dr. Jordan and her colleagues involved horses treated at the ambulatory service at Liphook Equine Hospital between January 2001 and November 2014. Two timematched controls that received veterinary attention without being given prednisolone were selected. Collected data included age breed, diagnosis, prior history of laminitis, and dose and duration of prednisolone treatment. Investigators also identified diagnoses of pituitary pars intermedia dysfunction or equine metabolic syndrome. The incidence of laminitis was then compared between the two groups, and a Cox regression analy-

sis was used to identify factors associated with laminitis. Results showed that of the 416 horses treated with prednisolone, 16 (3.8%) were diagnosed with laminitis following initiation of treatment with prednisolone. Seven horses (1.7%) developed laminitis during the treatment course, and three horses were ultimately euthanized due to laminitis (0.7%). For the control group, 46 of 814 horses (5.7%) were diagnosed with laminitis during the study. Of these, 12 (1.5%) were euthanized due to laminitis. No significant differences were noted in the overall incidence of laminitis, the incidence of laminitis during treatment with prednisolone, or the probability of developing laminitis between the two groups, according to the researchers. However, mean survival time was greater in the group treated with prednisolone when compared with the control group, they found. The researchers found that equine metabolic syndrome was one factor associated with an increased risk of laminitis in general. MeV

For more information: Jordan VJ, Ireland JL, Rendle DI. Does oral prednisolone treatment increase the incidence of acute laminitis? Equine Vet J. 2017 Jan;49(1):19-25. doi: 10.1111/ evj.12565. Epub 2016 Feb 15. https://www.ncbi.nlm.nih.gov/pubmed/?term=Does+oral+prednisolone+treatment+increase+the+incidence+of+acute+laminitis%3F 10

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NEWS NOTES

Thirty-Three Veterinary Students Rewarded for Leadership, Commitment to Equine Medicine Thirty-three veterinary students preparing for a career in equine medicine received a combined $102,000 in financial support through the 2017 Winner’s Circle Scholarship Program, co-sponsored by the American Association of Equine Practitioners’ (AAEP) Foundation, Platinum Performance and The Race for Education. The Winner’s Circle scholarships, managed by The Race for Education, are intended to help ease the financial burden of a veterinary education by offering third- and fourth-year students at each of the AAEP’s 39 full or full-affiliate student chapters an opportunity to earn scholarships ranging from $1,500 to $5,000, depending on the needs of the individual student. Students are selected for scholarships based on their leadership roles and dedication to a future in equine healthcare. Since its establishment in 2008, the Winner’s Circle Scholarship Program has provided nearly $1.5

million in scholarships to 315 veterinary students. “The rising cost of veterinary school continues to present challenges to talented students who endeavor to enter the equine veterinary profession,” said Richard Mitchell, DVM, MRCVS, DACVSMR, chairman of the AAEP Foundation Advisory Council. In 2017, 18 students received $1,500 scholarships; 15 others received $5,000 scholarships— which for $4,000 in scholarship funds from The Race for Education’s Assets for Independence Program—a federal grant program in partnership with the Department of Health and Human Services’ Administration. Only U.S. students attending veterinary school in the United States were eligible for awards through the federal matching grant. An additional 19 applicants not selected for Winner’s Circle scholarships are also eligible to received $4,000 awards through the Race for Education’s Assets for Independence Program. MeV

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PAIN

Evaluating

Poor Saddle Fit, Back Pain and More Following 6 simple steps may be the perfect solution B y

C a r o l j e a n

E l l i s

saddle exam can be handy tools in identifying the source of back pain and whether an ill-fitting saddle is the likely culprit. “Practitioners need to recognize when a saddle is a source of discomfort,” offered Scott W. Anderson, DVM, of Woodside Equine Clinic in Ashland, Virginia. “We have all witnessed poor performance, behavior and focal swelling that has been linked to an ill-fitting saddle and have palpated areas of soreness under the saddle.” For that reason, Dr. Anderson stressed the importance of periodically performing saddle evaluations: This isn’t a once-and-done type of examination, he added. “Saddles can change with time, especially if they are used on multiple horses,” he noted at the AAEP 62nd Annual Convention, reminding veterinarians that not only do saddles change, but the horse’s back can change with age, weight, muscle development and atrophy. “A simple step-by-step examination—in contrast to a complete saddle fitting that typically includes observing the rider and horse in motion—can help practitioners determine whether a saddle is a primary cause or an additional source of soreness,” Dr. Anderson said. 12

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Shutterstock/JNT Visual

Keen observations and an easy-to-follow

Anatomy of a Saddle

Let’s start with some simple saddle anatomy: pommel, cantle and panel (Figure 1A); then underneath, another panel, the gullet (indentation between panels) and the areas of the tree itself (Figure 1B).

Basic Saddle Anatomy

As is true with all examinations, the more you do them, the easier they are to perform and interpret, Dr. Anderson said. “A great way to start is to grab 5 or 6 saddles from the tack room and put them on 5 or 6 horses to better observe and visualize the differences among them and what they are showing.” Various studies have linked poor saddle fit, back soreness and overall performance by identifying a broad range of indicators, including: • Reduced performance • Bad behavior (eg, bucking, refusing to go forward) • Cold back • Change in flexion or stride • Reaction while being groomed • Atrophy of back muscles • Swelling under the saddle In addition, there are nonpathologic indications, such as purchase of a new saddle or a new horse. “The saddle is an interface between rider and horse that allows riders to feel and communicate with the horse, while freeing the horse to move in a well-balanced manner without inhibiting cervical, scapular or thoracolumbar motion,” Dr. Anderson explained, adding that in this instance, the following simple evaluation does not reflect horse and rider in motion. Rather, it is done with the horse standing squarely.

COMMON PRESSURE POINTS & BULGES PRESSURE

BULGES

Palpation

Assessment

Ventral and lateral aspects of the tree and the caudal third of the saddle, with no contact in the middle of the panel Dorsal aspect of the tree and the base of the wither, with lack of contact under the caudal aspect of the panel Along the middle third of the panel

Narrow tree with bridging

Focal bulges in panel

Saddle needs reflocking or examination by a saddle fitter

Wide tree Excessively curved panel

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PAIN

One Step at a Time

This examination involves 6 easy-to-learn steps that can take as few as 5 to 10 minutes once you have mastered them, Dr. Anderson said. 1. Is the saddle level? 2. Caudal to cranial stability 3. Pommel clearance 4. Contact between wither and tree 5. Contact between panel and horse’s back 6. Examination of horse’s back Before you begin: With the horse standing squarely, place the saddle caudal to the scapula (on each side), so the caudal excursion of the scapula does not interfere with the saddle during front leg extensions. This is typically 3 to 5 cm caudal to the scapula, Dr. Anderson explained. Initially, the evaluation is done without a pad (he suggests making recommendations on saddle padding after the saddle has been assessed without the use of pads).

1. Check Whether Saddle is Level

STEP 1B. An uphill appearance (ie, saddle tilted back) is caused by a tree that is too narrow. Note that a prominent wither or lordosis can cause a similar appearance. An uphill saddle distributes the weight of the rider to the caudal third of the saddle (blue arrow), often causing soreness in this area.

STEP 1A. Saddles are level when the deepest point of the seat is level with the ground, which is usually about halfway between the pommel and the cantle (blue arrow). Note that a saddle is not necessarily level when the cantle and the pommel are at the same height.

STEP 1C. A downhill appearance (ie, saddle tilted forward) is caused by a tree that is too wide. With lack of support from the tree, the saddle tilts forward, creating a gap between the caudal panel and the back. The rider’s weight is then shifted forward, distributing the pressure to the base of the wither (red and blue arrows).

The examination involves 6 easy-to-learn steps that can take as few as 5 to 10 minutes once they are mastered.

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2. Check Cranial-to-Caudal Stability STEP 2 • To establish cranial-to-caudal stability, place one hand on the pommel and the other on the cantle, then alternate applying back-and-forth pressure. The saddle should be stable, with minimal forward and backward rotation. • If the saddle rocks back and forth, either the tree is too wide or the panels are too curved. The rocking motion causes pressure in the mid to lower thorax.

3. Check Pommel Clearance STEP 3 • The space between the pommel and dorsal processes can vary. If the space appears to be close, it’s a good idea to put a rider on the horse to see whether that compresses the saddle to the point of contact. • Contact can cause signs of bruising to ulceration, which usually result from the tree being too wide or broken.

4. Check Contact Between Wither and Tree STEP 4 • On both sides of the saddle, check the contact between the wither and the tree. Ideally, contact should be over a broad area as opposed to a focal area — that is, about 4 to 5 inches of even contact from dorsal to ventral — and should conform to the wither to allow maximum coverage over a large surface. • Typically, the tree is too wide if a majority of contact is in a focal area near the dorsal aspect of the wither. In contrast, if the greatest contact is lower on the tree, it is too narrow.

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PAIN

5. Check Contact Between Panel and Horse’s Back

panel and the horse’s back is therefore important to determine whether there are areas of excessive pressure. • Check contact on both sides. On the left side of the horse (as shown), use the left hand for placing pressure at a central point on top of the saddle and the right hand for placing pressure between the panel and the horse’s back. The right hand starts cranially at the level of the tree and moves caudally. Panel contact with the horse should cover a broad surface area, with even pressure from wither to cantle. • Repeat this step several times to obtain a consistent evaluation on each side of the horse.

STEP 5 • A key goal is to distribute the weight of the rider over as large of a surface as is evenly possible. Examining the contact between the

• Experience counts: This step becomes easier each time you do it. The goal is to note specific pressure points, bulges in the panel and areas that lack contact (see box Common Pressure Points & Bulges).

6. Assess Horse’s Back (areas under saddle) Tip: It is helpful if the saddle was recently used on the horse or is used regularly. Soreness secondary to saddle wear will become obvious after only a few rides. Look for patterns of pain, rubbed hair coat, swelling, skin abnormalities and white hairs.

STEP 6A. To assess the horse’s back, palpate using digital pressure or a firm object, such as a needle cap. Some horses may respond/react to palpation, so apply pressure accordingly.

STEP 6B. Start by applying pressure to the dorsal and caudal edges of the scapula. Then palpate with firm pressure along the dorsal midline. Areas along the midline that most often trigger a reaction are on the wither from contact with the pommel and at the base of the wither from the pivot point created by a wide tree.

STEP 6C. Next, using a vertical pattern or grid, palpate over the areas where the panel contacts the back, again looking for areas that trigger a painful response or pressure reaction.

Congratulations! You have finished the 6 simple steps of static saddle examination. 16

Issue 8/2017 | ModernEquineVet.com

The Results Are In

When a horse demonstrates generalized discomfort in saddle areas, it is often difficult to interpret, Dr. Anderson said, as the pain can be caused by problems other than an ill-fitting saddle. Ideally, he recommended looking for focal patterns of soreness, often bilateral, that may correlate with saddle problems found earlier during the evaluation. Common patterns are shown in Figures 2 to 6. “We often are asked to evaluate saddles when a horse exhibits signs of not wanting to be tacked, misbehaves during a ride, shows obvious back pain during grooming, or has swelling or atrophied

back muscles,” he explained. Once you have finished the examination, Dr. Anderson recommended asking about the pads being used. “Pads can affect whether a saddle fits well or poorly. If the saddle fits well, minimal padding is necessary,” Dr. Anderson advised, adding that when a saddle fits properly, excessive padding has been identified as a source of back pain. Conversely, some saddle pad materials can actually improve the load on a horse’s back. As mentioned earlier, a complete saddle-fitting involves observation of the rider on the horse. “There are many opinions on the most objec-

tive way to determine saddle fit,” Dr. Anderson said, explaining that the literature advocates using saddle pressure measurement devices. Other research cites optical motion cameras, force-measuring treadmills, inertial measurement of body motion and electromyography. But practical tools, such as keen observation and pictorial comparisons as described here, also serve practitioners well and can have a great effect on determining a horse’s comfort and performance. “These simple evaluations allow us to determine whether a saddle is or is not a contributing source of pain and inadequate performance,” noted Dr. Anderson. MeV

For more information: Back W. Back in the driver’s seat and the need for an objective evaluation of saddle fit. Vet J. 2013:195(1):12-13. Dyson S, Greve L. Saddles and girths: what is new? Vet J. 2016;207(1):73-79. Greve L, Dyson S. The horse-saddle-rider interaction. Vet J. 2013:195(3):275-281. Kotschwar A, Baltacis A, Peham C. The effects of different saddle pads on forces and pressure distributions beneath a fitting saddle. Equine Vet J. 2010;42(2):114-118. Kotschwar AB, Baltacis A, Peham C. The influence of different saddle pads on force and pressure changes beneath saddles with excessively wide trees. Vet J. 2010;184(3):322-325. Peham C, Licka T, Schobesberger H, Meschan E. Influence of the rider on the variability of the equine gait. Hum Mov Sci. 2004;23(5):663-671.

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ModernEquineVet.com | Issue 8/2017

NEWS NOTES

Seasonal Effects: Winter Foals Smaller Than Foals Born in Summer

Photo courtesy Juliane Kuhl, Vetmeduni Vienna

Seasonal changes during the winter have a strong influence on equine pregnancy and fetal development, according to researchers from the University of Veterinary Medicine, Vienna (Vetmeduni Vienna). Foals born early in the year are smaller than herd mates born later, and these differences persist to at least 12 weeks after birth. Seasonal and diurnal rhythms determine the life cycle of many animal species. In equids this is not only true for wild species, but season-dependent metabolic changes also exist in domesticated horses. Horses can reduce their metabolic activity during the cold season and thus reduce heat loss. The last weeks of pregnancy correspond to a time of rapid fetal growth. This phase is a key moment for development of the foal. “When a foal is born in winter, it is thus likely that the seasonal reduction in energy metabolism affects the fetus,” explained principal investigator Christine Aurich, DVM, PhD, DECAR, Insemination and Embryo transfer Platform at Vetmeduni Vienna.

To test their hypothesis, the scientists studied 27 broodmares and their foals at the Graf Lehndorff Institute, a joint research unit of Vetmeduni Vienna and the Brandenburg State Stud at Neustadt (Dosse), Germany. Mares and foals were allocated to three groups by the date of foaling. Foalings occurred between February and early March in Group 1, from early March until early April in Group 2 and from mid-April to May in Group 3. From all foals, weight and a variety of parameters to assess their size were determined repeatedly from birth to an age of 12 weeks. In addition, weight

and size of the placenta were determined at foaling. “Among the foal groups we compared circumference of the thorax, height at withers, the distance from the fetlock to the carpal joint and to the elbow as well as the length of the head from poll to nose. The size parameters clearly demonstrate that foals born in February were smaller than those born later in the year,” said Elisabeth Beythien, first author of the paper. “The winter foals did not completely compensate their size deficit within the first 12 weeks of life.” No difference among foal groups existed for birth weight, although both weight and size of the placenta were smaller in winter-foaling mares than in mares foaling later in the year. “The smaller placenta indicates a reduced nutrient transfer to the fetus via the placenta. However, placental function appears to be sufficient also during winter. The placenta is thus not the only factor that determines fetal growth,” Dr. Beythien said. “Parity, i.e. the number of foals a mare has had, is known to affect foal size but in our study, the seasonal effects were also independent from parity.” In wild or feral horses, foals are rarely born in winter. Most mares show regular estrous cycles only for a limited period in spring and summer. With a pregnancy of 11 months, most foals are born at a time when temperature and nutrient supply would favor their survival in the wild. Modern breeding technologies, however, allow earlier foalings. The genetically fixed reproductive cycle of horse mares can be advanced by artificial light programs, medical treatments but also just by optimizing housing and nutrition under stud farm conditions. In certain breeds, this has strong economic implications. “Although winter foals need at least 12 weeks to make up their size deficit, they can still be several months ahead of their later-born conspecifics. This time window affects performance at competitions when all young horses born in the same year compete in the same class,” Dr. Aurich explained. Effects of differences in nutrition among horse groups in the study could be excluded. All mares were fed similarly throughout the study period, which confirms genetic seasonal changes in maternal metabolism as a cause of fetal development and subsequent size of neonatal foals, according to researchers. MeV

For more information: Beythien E, Aurich C, Wulf M, Aurich J. Effects of season on placental, foetal and neonatal development in horses. Theriogenology 2017;97:98-103. http://www.sciencedirect.com/science/article/pii/S0093691X17301875?via%3Dihub 18

Issue 8/2017 | ModernEquineVet.com

TECHNICIAN UPDATE

An Unfortunate Lump Ryan Corrigan, RVT, LVT

Photo courtesy of Ryan Corrigan, RVT, LVT

On Aug. 10, 2014 a 12year-old Arabian gelding was admitted to Woodside Equine Clinic for evaluation and removal of a mass on the lateral right hind pastern. According to the owners, the mass on the 550-kg gelding had first been seen nine months prior to presentation and had been growing. The referring veterinarian had been treating it with caustic powder and scarlet oil with little-to-no result. The initial work up of the gelding revealed him to be bright, alert and responsive with a Henneke body condition score of 2/9. He was Grade 4/5 lame on the AAEP lameness scale. A physical exam performed by the attending intern veterinarian revealed a mild tachycardia of 52 beats per minute, a respiratory rate of 12 breaths per minute and a rectal temperature of 99.0 °F. Auscultation of his heart and lungs was within normal limits and he had normal gastrointestinal motility. The mass of exuberant granulation tissue on his pastern was about 8 in x 6 in long and oblong shaped. The surface of the mass was excoriated and bleed-

Right hind mass upon presentation

Issue 8/2017 | ModernEquineVet.com

ing, and there were numerous areas of necrotic tissue with maggots present. The right hind hoof and sole were severely overgrown and the heel and frog were macerated and necrotic. The nursing team obtained blood from the gelding while a detailed history was being obtained by the senior clinician. The tests requested were packed cell volume (PCV), total protein, fibrinogen, complete blood count (CBC), and a chemistry profile. Results from the bloodwork showed a slightly low PCV of 24%, a moderate hyperproteinemia of 9.0 g/dL and a mild hyperfibrinogenemia of 500 mg/dL, indicating inflammation. The CBC showed an anemia of 5.62 x 10^12/L and a low hemoglobin of 8.7 g/dL. The chemistry profile showed a hypoalbuminemia of 1.6 g/dL and a hyperglobulinemia of 8.0 g/dL, both showing the inflammatory response to the mass.

Calcification Within the Mass

The gelding was kept comfortable overnight and his work up resumed the next day. I assisted in taking radiographs of the gelding’s pastern—two dorsopalmar views (one focusing on the mass and one focusing on the pastern joint), one lateral view, and one dorsolateral-palmaromedial view. These revealed calcification within the mass and a moderate amount of periosteal reaction of the pastern bone adjacent to the mass. None of the joints appeared to be involved. The mass was thoroughly prepped and the hoof wall trimmed. A 14- gauge, 5¼ inch over-the-needle IV catheter was placed in the gelding’s left jugular vein and secured in place with 2-0 Ethilon on a straight needle suture. I performed a presurgical physical exam that revealed no abnormalities and then administered IV phenylbutazone as a pre-operative medication. Under the veterinarian’s direction, I sedated the gelding with xylazine before inducing him with ketamine and midazolam which went smoothly. The gelding was hoisted up and placed on the surgery table in left lateral recumbency. I placed the gelding on total IV anesthesia (TIVA) and 5 L of lactated Ringer’s solutions (LRS). The TIVA was a combination of ketamine and xylaxine in guaifenesin; it was administered to effect via a drip set. The mass was given a secondary prep while a tourniquet was placed on the right hind leg proximal to the hock joint. The mass was debulked using a gigli wire saw. Once the mass was removed, the area was cauterized to minimize bleeding and the wound was ban-

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TECHNICIAN UPDATE

A 12-year-old Arabian gelding was admitted for evaluation and removal of a mass on the lateral right hind pastern. It had first been seen nine months prior to presentation and had been growing. daged. I monitored the gelding throughout his 45 minute procedure, ensuring that he remained at a surgical plane of anesthesia. The gelding received IV romifidine in recovery although he recovered poorly with copious amounts of hemorrhage from the sur-

gery site. He was assisted with tail and head ropes, however, he still took multiple attempts to stand and thrashed around a great deal. Due to his poor recovery, the surgeon elected to put extra compressive layers over the bandage for 2 hours post recovery. The gelding was returned to his stall and monitored overnight. He was placed on omeprazole paste (Gastrogard, Merial) and sucralfate (four times a day) for the prevention of gastric ulcers. At this time he was also receiving IV phenylbutazone.

Recovery

Photos courtesy of Ryan Corrigan, RVT, LVT

Right hind mass after cleaning prior to surgery

The wound at the 3 week recheck

Issue 8/2017 | ModernEquineVet.com

On the morning of Aug. 12, the gelding’s physical exam was all within normal limits with a heart rate of 40 BPM, a respiratory rate of 12 breaths per minute and 100 ° F temperature. Overnight, he’d shown a good appetite and was very eager for his hay. He drank 11 L of water and passed three piles of normal manure. When the gelding was brought down to the exam room for a bandage change he was walking comfortably on the right hind. While he was sedated to have his wound examined and cleaned, a short oral exam was performed which revealed sharp points on the upper and lower molars in all quadrants of the mouth. While the oral exam was being performed, I ran a fecal egg count to check for intestinal parasites. No eggs or sand were seen at the time of the test. The gelding remained systemically healthy although he did start to be more uncomfortable on his right hind. The morning of his discharge his IV catheter was removed and he was transitioned to oral phenylbutazone. The gelding was discharged on phenylbutazone orally twice a day for four days and then once a day for four days. He was also to receive omeprazole paste orally once a day until gone and oral trimethoprim-sulfamethoxazole for six days. It was recommended the bandage should be changed every 2–3 days and silver sulfazidine (SSD) should be applied before replacing the bandage for 10 days. After the first 10 days, nystatin-neomycin sulfatetriamcinolone acetonide (Quadritop, Butler Schien), a topical steroid/antibiotic combination, should be used instead of the SSD to help control the produc-

The most important role I played in this case was the monitoring and management of the gelding while under anesthesia. I prepared a site and placed the IV jugular catheter in the right jugular vein. It was especially important that he have a smooth induction due to his right hind instability, so I calculated his induction drugs on the higher end of the range. Since the surgeons were working on a hind limb, it was critical that I carefully monitor my patient for any sign that he may be getting light and potentially put them in danger. Primarily I monitored his eye for any tearing, nystagmus or change in eye position. I also paid close attention to his heart rate and respiratory rate for any sudden increases that could also indicate that the gelding was getting light. In recovery I tried to hold him down until his nystagmus had passed and he was able to get up calmly and controlledâ&#x20AC;&#x201D;however, he panicked and threw me off leading to his poor recovery. During the surgery I set up the electrocautery system and opened more gauze packs to help control the bleeding from the mass removal. The postsurgery care for this case was minimal but it was still important to monitor the bandage for bleeding since the mass removed was so large. As with any surgical case that receives anesthesia this gelding was closely monitored by myself and the rest of the nursing staff for signs of colic. He was carefully refed and his fecal output was monitored.

tion of proud flesh and prevent infection. I spoke to the owners about the geldings body condition score being too low and recommended they increase his feed to 4 lbs of equine senior feed twice a day. I also spoke to them about the importance of having good quality forage for the gelding and making sure they keep hay available for him at all times. A section of the mass was submitted for histopathology, which came back as reactive granulation tissue with no evidence of neoplasia. The gelding returned to the clinic for a recheck three weeks after his discharge on Sept. 12, 2014. The gelding appeared bright, alert, responsive and systemically healthy and had gained approximately 50 lbs. He was walking well on his right hind although he was still mildly lame. The wound revealed a healthy bed of granulation tissue with formation of new skin around the

Shutterstock/nelelena

Teaching Points

wound edges and evidence of contracture of the wound. It was recommended that the owners continue the prescribed treatment plan of Quadritop and bandaging as well as restricting the gelding to turnout in a small paddock only and then recheck the gelding in six week. Overall, we were very pleased with the progress the wound had made and the weight the gelding had put on. The owners elected to make the six week follow up with their referring veterinarian. This case shows us how extreme granulation tissue can get if left ignored. What assumedly started off as a wound left to heal by second intention had been left unmanaged and progressed until the mass was crippling. Removal of this mass was the primary concern for this case. Managing the hemorrhage, the post-surgical care, and general wellness education were also key in this case. MeV

About the author

Ryan is a Licensed Veterinary Technician that was with Woodside Equine Clinic outside of Richmond, Virginia from March 2014 up until January of 2017. Her educational background includes a Bachelor of Sciences in Veterinary Technology from Purdue University (2010) and in 2015 she passed her Veterinary Technician Specialty (VTS) boards for the Academy of Equine Veterinary Nurses. She interned at Littleton Large Animal Clinic in Denver, CO and after graduation she worked as a medicine technician at Hagyard Equine Medical Institute in Lexington, KY. From there she followed her passion for horse racing and neonatal care to Australia where she worked for Coolmore, one of the biggest thoroughbred racing farms in the world as a veterinary nurse. Before moving to Virginia she lived and worked in San Diego, CA with a sports medicine practice. At Woodside, Ryan was responsible for ICU patient care, anesthesia for the surgeries, and daily outpatient appointments. When she's not caring for her patients she trains and races triathlons, snowboards, and plays with her Rottweiler puppy Denali.

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