The Modern
Equine Vet www.modernequinevet.com
Vol 12 Issue 2 2022
DDFT Lesions Often Associated With Distal Pathology NSAIDs Linked to Subclinical Colitis Experimental Treatment Improves Equine Sarcoids Technician Update: You Can Fight City Hall Avoiding Burnout
TABLE OF CONTENTS
COVER STORY
4 DDFT Lesions and
Associated Pathology Cover: Shutterstock/Oleksii Nedolia
GASTROENTEROLOGY
NSAIDs Linked to Subclinical Colitis....................................................................8 CANCER
Visible Success with delNS-Based Immunotherapy Improved Equine Sarcoids..............................................14 TECHNICIAN UPDATE
You Can Fight City Hall: ‘Will Never Happen,’ Happened.....................16 INFECTIOUS DISEASE
U.S. Infectious Disease Update: (January 23–February 13, 2022) ....................................................................19 NEWS NOTES
Prototype ‘Smart Saddle’ Could Help Equestrians Hit Their Stride.................................3 BUSINESS PRACTICE
Redefining Roles to Sustain an Equine Practice........................................................................20 ADVERTISERS Shank's Veterinary Equipment ........................................................................3 American Regent/Adequan...............................................................................7 Arenus Animal Health/Assure Gold.................................................................9 American Regent/BetaVet...............................................................................11
Arenus Animal Health/Aleira..........................................................................15 Arenus Animal Health/Assure Gold...............................................................17 Arenus Animal Health/Releira........................................................................21
The Modern
Equine Vet SALES: Matthew Todd • Matthew Gerald EDITOR: Marie Rosenthal ART DIRECTOR: Jennifer Barlow CONTRIBUTING WRITERS: Paul Basilio • Adam Marcus 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
Prototype ‘Smart Saddle’ Could Help Equestrians Hit Their Stride
Watch the video here
Skilled equestrians make advanced riding maneuvers, like jumps, spins and piaffes, look effortless. But good riding requires balance and subtle cues to the horse, many of which are given through the rider's posture, seat and legs. Researchers developed a prototype “smart saddle” that could help equestrians improve their biomechanics. Moreover, the self-powered saddle can alert others when a rider takes a fall. Big data collection and analysis are becoming important components of many competitive sports because they provide real-time information on athletes' performance and fitness. However, most systems are powered by batteries, often making them bulky and inflexible. In contrast, small, lightweight triboelectric nanogenerators (TENGs), which convert mechanical energy into electricity, are being tested for a variety of applications. In addition to powering themselves, TENGs can convert mechanical stimuli, such as pressure, touch or motion, into electrical signals. The scientists wanted to adapt TENGs to a smart saddle for challenging and potentially dangerous equestrian sports. They made a thin, flexible, disk-shaped TENG that flattens when depressed and then rebounds when the pressure is removed. Under pressure, the internal layers of the TENG transfer electrons from 1 electrode to another and generate a current, which stops when the pressure is released. The team placed an array of 7 TENGs on the top surface of a saddle so they could detect differences in pressure in various regions of the seat, which showed whether a rider was leaning forward, sitting in an upright position or leaning backward. The smart saddle also detected when a person was posting. If a rider falls, the system can transmit a wireless signal to alert others, a safety feature that could allow an injured rider to be quickly found and treated— which is especially important when riding alone. The self-powered smart saddle, which has a response time of 16 ms, could someday provide real-time statistical data and fall detection to equestrians and their coaches, the researchers said. MeV
Triboelectric pressure sensor array
For more information: Hao Y, Wen J, et al. Self-rebound cambered triboelectric nanogenerator array for self-powered sensing in kinematic analytics. ACS Nano. 2022;16(1):1271 DOI: 10.1021/acsnano.1c09096 https://pubs.acs.org/doi/abs/10.1021/acsnano.1c09096
Lifting Large Animals Since 1957 www.shanksvet.com
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LAMENESS
BETTER TARGET TREATMENT
DDFT Lesions in the Pastern Frequently Associated with Distal Pathology
A horse with a deep digital flexor tendon
(DDFT) lesion of the pastern is likely to have concurrent DDFT lesions in other areas of the foot that warrant further assessment for concurrent tendinopathy,” explained Elizabeth V. Acutt, BSc, BVSc, a resident in equine diagnostic imaging at Colorado State University College of Veterinary Medicine. Identifying these lesions allows the veterinarian to target treatment, which may improve the horse’s outcome, she explained at the 67th Annual Convention and Tradeshow of the American Association of Equine Practitioners, held in Nashville, Tenn.
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M a r i e
“We know that deep digital flexor tendon injury is common in equine athletes, and it occurs in a large proportion of horses that present to us for diagnostic imaging of the distal limb,” Dr. Acutt said. In addition, the injuries can occur at several points throughout the length of the tendon. To get an idea of how many horses with DDFT pastern injuries had concurrent tendinopathy and to determine whether different pastern lesion types would be more likely to be concurrent with other lesions, Dr. Acutt and her colleagues at Colorado State performed a medical record search and identified
R o s e n t h a l ,
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Shutterstock/fotorauschen
Images courtesy of Elizabeth V. Acutt, BSc, BVSc
Ultrasound images from a horse with a core lesion in one of the lobes of the DDFT in the pastern (A) and a dorsal border tear of the same lobe in the suprasesamoidean region (B) (all lesions indicated by arrows)
cases of DDFT tearing in the pastern. They reviewed 34 high-field MRI scans of 33 horses and 64 ultrasonography examinations of 58 horses. Ten limbs of 10 horses underwent both ultrasonography and MRI. All the MRIs had been performed under general anesthesia. DDFT lesions in the pastern were classified based upon their configuration as core lesions, dorsal border defects, parasagittal splits or diffuse tendonosis. The goal was to identify the horses
with various configurations of pastern DDFT lesions that had additional tendon injury in the foot. “It's important to note that all of the lesions that we saw on MRI were also identified and characterized appropriately on our ultrasound,” she said. “We found that over 90% of the MRI cases that had deep digital flexor tendinopathy in the pastern also had lesions within the foot, and of the 31 limbs that had more distal tendinopathy, pastern lesions ModernEquineVet.com | Issue 2/2022
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Images courtesy of Elizabeth V. Acutt, BSc, BVSc
LAMENESS
MR images from a horse with core lesions in both lobes of the DDFT in the pastern (A), parasagittal splits in both lobes in the suprasesamoidean region (B) and single lesion at the tendon's insertion (C) (all lesions indicated by arrows)
were classified as core lesions in the majority of those cases,” Dr. Acutt said. All horses with core lesions also had foot lesions. There were none with a core lesion that did not have more distal tendinopathy. All of the horses that had insertional lesions also had lesions at that suprasesamoidean region of the tendon, which can typically be visualized on ultrasound.
Ultrasonography Results
Almost 70% of the ultrasound cases with DDFT lesions in the pastern also had lesions in the foot, and of the 20 limbs in which tendinopathy was confined to the pastern alone, most had defects at the dorsal border of the tendon. Only 1 horse had a core lesion without a foot lesion. “When we combined our ultrasound and MRI data, it indicated that three-quarters of horses with pastern deep digital flexor tendinopathy also have coexisting distal tendinopathy.” The consistent correlation between core and foot lesions was statistically significant, she added. “There is a significant association between lesion type and the presence of foot lesions with dorsal border lesions, more frequently confined to the pastern; and the core lesions, more frequently having additional distal tendinopathy,” Dr. Acutt explained. In fact, a horse with a core DDFT lesion in the pastern was almost 20 times more likely to have a concurrent foot lesions than those with other pastern lesion types.
These results lead to another question, she said. Which injury came first, or do they occur simultaneously? In their experience, more horses that have foot lesions without pastern injury than have pastern injury without a foot lesion, according to Dr. Acutt. “This may suggest that injury begins in the foot and then propagates proximally, but we don't have longitudinal studies to confirm this,” she said. When they looked at repeat scans they did not observe extension in either direction of DDFT injury. In other words, the lesions were static in this population. Characterizing all the lesions that a horse has would enable veterinarians to direct treatment better, she said, because veterinarians would be able to recommend specific treatment, for instance, if a dorsal border tear occurs at the level of the navicular bursa, bursoscopic debridement might be considered. In addition, knowing exactly what is going on enables a veterinarian to better predict the horse’s recovery and return to work. “Different lesion locations have been associated with different prognoses within the literature,” she said. For instance, “horses with tears in the navicular region have been shown to have a higher likelihood of returning to work and remaining sound than horses with suprasesamoidean injuries. “And there's also been multiple studies that show that horses with multifocal tendinopathy, in general, tend to have worse outcomes than those in which the tear is confined to a single region.” MeV
For more information: Acutt EV, Contino EK, Frisbie DD, et al. Deep digital flexor tendon lesions in the pastern are associated with the presence of distal tendinopathy. Equine Vet J. 2021 May 20. doi: 10.1111/evj.13470 https://beva.onlinelibrary.wiley.com/doi/epdf/10.1111/evj.13470 6
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There’s nothing else like it. For more than 30 years, Adequan® i.m. (polysulfated glycosaminoglycan) has been administered millions of times1 to treat degenerative joint disease, and with good reason. From day one, it’s been 2, 3 the only FDA-Approved equine PSGAG joint treatment available, and the only one proven to. Reduce inflammation Restore synovial joint lubrication Repair joint cartilage Reverse the disease cycle When you start with it early and stay with it as needed, horses may enjoy greater mobility over a 2, 4, 5 lifetime. Discover if Adequan is the right choice. Visit adequan.com/Ordering-Information to find a distributor and place an order today. 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 1-888-354-4857 or email pv@americanregent.com. Please see Full Prescribing Information at www.adequan.com.
www.adequan.com 1 Data on file. 2 Adequan® i.m. Package Insert, Rev 1/19. 3 Burba DJ, Collier MA, DeBault LE, Hanson-Painton O, Thompson HC, Holder CL: In vivo kinetic study on uptake and distribution of intramuscular tritium-labeled polysulfated glycosaminoglycan in equine body fluid compartments and articular cartilage in an osteochondral defect model. J Equine Vet Sci 1993; 13: 696-703. 4 Kim DY, Taylor HW, Moore RM, Paulsen DB, Cho DY. Articular chondrocyte apoptosis in equine osteoarthritis. The Veterinary Journal 2003; 166: 52-57. 5 McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren PR. Joint Disease in the Horse.St. Louis, MO: Elsevier, 2016; 33-48. All trademarks are the property of American Regent, Inc. © 2021, American Regent, Inc. PP-AI-US-0629 05/2021
GASTROENTEROLOGY
NSAIDs B
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NSAIDs are ubiquitous. Despite the risk of adverse
Courtesy of Dr. Rebecca Bishop
gastrointestinal and renal effects, more than 40% of equids are prescribed nonsteroidal anti-inflammatory drugs during veterinary treatment, according to a 2019 study in the Equine Veterinary Journal. Although COX-2 inhibitors—or coxibs—were developed to reduce unwanted effects, traditional NSAIDs like flunixin meglumine and phenylbutazone are still the predominant choice in most clinics.
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COX Recap
NSAIDs rely on inhibition of the COX pathways, which are responsible for constitutive functions in gastroprotection, renal homeostasis and platelet func-
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tion (COX-1), and inducible functions, including pain, fever and inflammation (COX-2). “Traditional NSAIDs are non-specific, in that they work both at the level of COX-2, which affects the therapeutic effects, but they also impact COX-1 production, which results in delayed mucosal healing, increased intestinal permeability, right dorsal colitis, gastric ulceration and kidney damage,” said Rebecca Bishop, DVM, MS, resident in equine surgery at the University of Illinois, College of Veterinary Medicine. To avoid the negative effects, COX-2 specific inhibitors—such as firocoxib—were devel-
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GASTROENTEROLOGY
COX PATHWAYS
Arachidonic Acid
COX-1
PGI2
Gastroprotection
Renal homeostasis
COX-2
TXA2
Platelet function
PGE2
VSM contraction
oped to specifically target the COX-2 pathway while avoiding the dangers involved in COX-1 inhibition. “However, recent studies have shown that COX-2 pathways also play a role in renal blood flow in states of hypoperfusion, as well as gastric ulcer repair,” Dr. Bishop said at the 67th Annual AAEP Convention in Nashville. “This led my team to wonder if there could be adverse lower intestinal effects in horses, which are also seen in human medicine with coxib administration.”
The Study
Prior research on the subject showed no difference in clinical signs of NSAID-associated colitis in horses administered firocoxib vs. flunixin or phenylbutazone. However, monitoring for subclinical colonic inflammation rarely was reported in those studies. Dr. Bishop’s team created a model to evaluate the 2 classes of drugs and their impact on colonic inflammation in healthy horses. The prospective study involved 12 healthy adult horses from the University of Illinois teaching hospital herd in a controlled but non-randomized block design. The first treatment consisted of flunixin meglumine via IV catheter at 1.1 mg/kg every 12 hours for 5 days. Following a 6-month washout period, firocoxib was
Pain
Fever
Bone formation
Renal blood flow
Gastric ulcer repair
administered to the same horses to achieve a rapid, steady state concentration. The dosage followed current recommendations of a single 0.3 mg/kg dose orally followed by 0.1 mg/kg orally every 24 hours. Each horse received omeprazole at 1 mg/kg orally every 24 hours, to mitigate effects of gastric ulceration for each treatment arm. Edema of the large colon was subjectively evaluated on a score of 0-to-2 on transabdominal ultrasonography, and maximal colon thickness was evaluated via a single ultrasonographic measurement. Blood samples were collected for a complete blood count and biochemistry to assess markers of colonic and renal injury.
Increase in Wall Thickness, Edema
The primary finding of the study was a significant increase in colon wall thickness and colonic edema following treatment with firocoxib, but not flunixin. “Eleven of 12 horses had subjective evidence of colonic inflammation or edema after receiving firocoxib, compared with 1 horse following flunixin,” Dr. Bishop said. There was also a statistically significant increase in total protein following firocoxib and a decrease
Courtesy of Dr. Rebecca Bishop
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Ultrasonographic images were obtained of the right dorsal colon before and after treatment. Subjective assessments were made of colonic edema, which was scored on a scale of 0-to-2 where 0 was no edema and 2 was severe edema, and the wall thickness was measured, with the maximum thickness recorded at the time of each examination. The + symbol marks the boundaries of wall measurement in each image. (A) Before treatment (day 0), edema score zero, maximum thickness 3.6 mm. (B) After treatment (day 7), edema score 2, maximum thickness 8.2 mm
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The only dual ingredient injectable corticosteroid approved by the FDA for use in horses
The link between RAPID ONSET and LONG-ACTING RELIEF of pain & inflammation 1
BetaVet® (betamethasone sodium phosphate and betamethasone acetate injectable suspension) is indicated for the control of pain and inflammation associated with osteoarthritis in horses. Learn more at www.betavetequine.com or call 1-800-458-0163. Please see Brief Summary of Full Prescribing Information on the following page. INDICATION BetaVet® (betamethasone sodium phosphate and betamethasone acetate injectable suspension) is indicated for the control of pain and inflammation associated with osteoarthritis in horses. IMPORTANT SAFETY INFORMATION For Intra-articular (I.A.) use in Horses. CONTRAINDICATIONS BetaVet® is contraindicated in horses with hypersensitivity to betamethasone. Intra-articular injection of corticosteroids for local effect is contraindicated in the presence of septic arthritis. WARNINGS: Do not use in horses intended for human consumption. Clinical and experimental data have demonstrated that corticosteroids administered orally or parenterally to animals may induce the first stage of parturition when administered during the last trimester of pregnancy and may precipitate premature parturition followed by dystocia, fetal death, retained placenta, and metritis. Additionally, corticosteroids administered to dogs, rabbits and rodents during pregnancy have resulted in congenital anomalies. Before use of corticosteroids in pregnant animals, the possible benefits should be weighed against potential hazards. Human Warnings: Not for use in humans. Keep this and all medications out of the reach of children. PRECAUTIONS: Corticosteroids, including BetaVet,® administered intra-articularly are systemically absorbed. Do not use in horses with acute infections. Acute moderate to severe exacerbation of pain, further loss of joint motion, fever, or malaise within several days following intra-articular injection may indicate a septic process. Because of the anti-inflammatory action of corticosteroids, signs of infection in the treated joint may be masked. Due to the potential for exacerbation of clinical signs of laminitis, glucocorticoids should be used with caution in horses with a history of laminitis, or horses
otherwise at a higher risk for laminitis. Use with caution in horses with chronic nephritis, equine pituitary pars intermedia dysfunction (PPID), and congestive heart failure. Concurrent use of other anti-inflammatory drugs, should be approached with caution. Consider appropriate wash out times prior to administering additional NSAIDs or corticosteroids. ADVERSE REACTIONS: Adverse reactions reported during a field study of 239 horses of various breeds which had been administered either BetaVet® (n=119) or a saline control (n=120) at five percent (5%) and above were: acute joint effusion and/ or local injection site swelling (within 2 days of injection), 15% BetaVet® and 13% saline control; increased lameness (within the first 5 days), 6.7% BetaVet® and 8.3% saline control; loose stool, 5.9% BetaVet® and 8.3% saline control; increased heat in joint, 2.5% BetaVet® and 5% saline control; and depression, 5.9% BetaVet® and 1.6% saline control. SHAKE WELL IMMEDIATELY BEFORE USE. For additional safety information, please see full prescribing information. CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. References: 1. Trotter GW. Intra-articular corticosteroids. In: McIlwraith CW, Trotter GW, eds. Joint Disease in the Horse. Philadelphia: W.B. Saunders; 1996; 237–256.
All trademarks are the property of American Regent, Inc. © 2021 American Regent, Inc. PP-BV-US-0035 (v2.0) 09/2021
BRIEF SUMMARY OF PRESCRIBING INFORMATION (Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension) 6 mg betamethasone per mL For Intra-Articular (I.A.) Use in Horses CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. INDICATION: BetaVet® is indicated for the control of pain and inflammation associated with osteoarthritis in horses. DOSAGE AND ADMINISTRATION: Shake well immediately before use. CONTRAINDICATIONS: BetaVet® is contraindicated in horses with hypersensitivity to betamethasone. Intra-articular injection of corticosteroids for local effect is contraindicated in the presence of septic arthritis. WARNINGS: Do not use in horses intended for human consumption. Clinical and experimental data have demonstrated that corticosteroids administered orally or parenterally to animals may induce the first stage of parturition when administered during the last trimester of pregnancy and may precipitate premature parturition followed by dystocia, fetal death, retained placenta, and metritis. Additionally, corticosteroids administered to dogs, rabbits and rodents during pregnancy have resulted in cleft palate in offspring. Corticosteroids administered to dogs during pregnancy have also resulted in other congenital anomalies including deformed forelegs, phocomelia and anasarca. Therefore, before use of corticosteroids in pregnant animals, the possible benefits to the pregnant animal should be weighed against potential hazards to its developing embryo or fetus. Human Warnings: Not for use in humans. For use in animals only. Keep this and all medications out of the reach of children. Consult a physician in the case of accidental human exposure. PRECAUTIONS: Corticosteroids, including BetaVet®, administered intra-articularly are systemically absorbed. Do not use in horses with acute infections. Acute moderate to severe exacerbation of pain, further loss of joint motion, fever, or malaise within several days following intra-articular injection may indicate a septic process. Because of the anti-inflammatory action of corticosteroids, signs of infection in the treated joint may be masked. Appropriate examination of joint fluid is necessary to exclude a septic process. If a bacterial infection is present, appropriate antibacterial therapy should be instituted immediately. Additional doses of corticosteroids should not be administered until joint sepsis has been definitively ruled out. Due to the potential for exacerbation of clinical signs of laminitis, glucocorticoids should be used with caution in horses with a history of laminitis, or horses otherwise at a higher risk for laminitis. Use with caution in horses with chronic nephritis, equine pituitary pars intermedia dysfunction (PPID), and congestive heart failure. Concurrent use of other anti-inflammatory drugs, such as NSAIDs or other corticosteroids, should be approached with caution. Due to the potential for systemic exposure, concomitant use of NSAIDs and corticosteroids may increase the risk of gastrointestinal, renal, and other toxicity. Consider appropriate wash out times prior to administering additional NSAIDs or corticosteroids. ADVERSE REACTIONS: Adverse reactions reported during a field study of 239 horses of various breeds which had been administered either BetaVet® (n=119) or a saline control (n=120) were: acute joint effusion and/or local injection site swelling (within 2 days of injection), 15% BetaVet® and 13% saline control; increased lameness (within the first 5 days), 6.7% BetaVet® and 8.3% saline control; loose stool, 5.9% BetaVet® and 8.3% saline control; increased heat in joint, 2.5% BetaVet® and 5% saline control; depression, 5.9% BetaVet® and 1.6% saline control; agitation/anxiety, 4.2% BetaVet® and 2.5% saline control; delayed swelling of treated joint (5 or more days after injection), 2.5% BetaVet® and 3.3% saline control; inappetance, 3.4% BetaVet® and 2.5% saline control; dry stool, 1.7% BetaVet® and 0% saline control; excessive sweating, 0.8% BetaVet® and 0% saline control; acute non-weight bearing lameness, 0.8% BetaVet®and 0% saline control; and laminitis, 0.8% BetaVet® and 0% saline control.
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CLINICAL PHARMACOLOGY: Betamethasone is a potent glucocorticoid steroid with anti-inflammatory and immunosuppressive properties. Depending upon their physico-chemical properties, drugs administered intra-articularly may enter the general circulation because the synovial joint cavity is in direct equilibrium with the surrounding blood supply. After the intra-articular administration of 9 mg BetaVet® in horses, there were quantifiable concentrations of betamethasone (above 1.0 ng/mL) in the plasma. EFFECTIVENESS: A negative control, randomized, masked field study provided data to evaluate the effectiveness of BetaVet® administered at 1.5 mL (9 mg betamethasone) once intra-articularly for the control of pain and inflammation associated with osteoarthritis in horses. Clinical success was defined as improvement in one lameness grade according to the AAEP lameness scoring system on Day 5 following treatment. The success rate for horses in the BetaVet® group was statistically significantly different (p=0.0061) than that in the saline group, with success rates of 75.73% and 52.52%, respectively (back-transformed from the logistic regression). ANIMAL SAFETY: A 3-week target animal safety (TAS) study was conducted to evaluate the safety of BetaVet® in mature, healthy horses. Treatment groups included a control (isotonic saline at a volume equivalent to the 4x group); 1X (0.0225 mg betamethasone per pound bodyweight; BetaVet®); 2X (0.045 mg betamethasone per pound bodyweight; BetaVet®) and 4X (0.09 mg betamethasone per pound bodyweight; BetaVet®). Treatments were administered by intra-articular injection into the left middle carpal joint once every 5-days for 3 treatments. Injection site reactions were the most common observations in all treatment groups. Injection site reactions were observed within 1 hour of dosing and included swelling at the injection site, lameness/stiffness of the left front limb, and flexing the left front knee at rest. The injection site reactions ranged from slight swelling (in many horses on multiple days in all treatment groups) to excessive fluid with swelling, pain, and lameness (4x group only). Injection site reactions were observed most commonly on treatment days, and generally decreased in number and severity over subsequent days. The incidence of injection site reactions increased after the second and third injection (number of abnormalities noted on day 10 > day 5 > day 0). In the BetaVet® treated groups the number and severity of the injection site reactions were dose dependent. The 4X BetaVet® group had the highest overall incidence of and severity of injection site reactions, which included heat, swelling, pain, bleeding, and holding the limb up at rest. The control group and 4X group (which received similar injection volumes) had a similar incidence of injection site reactions; however, the severity of reactions was greater in the 4X group. Absolute neutrophils were statistically significantly higher in the BetaVet® treated groups as compared to the control group. Trends toward a decrease in lymphocytes and eosinophils, and an increase in monocytes were identified in the BetaVet® treated groups after the initial dose of BetaVet®. Individual animal values for white blood cells generally remained within the reference range. BetaVet® treated horses also had a trend toward increased blood glucose after the initial dose. Some individual animals showed mild increases in blood glucose above the reference range. SHAKE WELL BEFORE USING NADA 141-418, Approved by FDA For For customer customer care care or or to to obtain obtain product product information information visit visit www.betavetequine.com www.betavetequine.com or or call call 1-800-458-0163. 1-800-458-0163. To report an adverse event please contact American Regent Animal Health at at 1-888-354-4857 or email pv@americanregent.com. (800) 734-9236 or email pv@americanregent.com.
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in protein following flunixin. “That was surprising, especially given that decreases in total protein are typically associated with colon inflammation and protein-losing enteropathy,” she said. “There was no difference in packed-cell volume preand post-treatment in the 2 groups, so changes in total protein cannot be attributed to hydration status.” For creatinine, there was a significant increase following both treatments, but there was no significant difference between the groups. “Creatinine could be attributed to subclinical kidney injury or dehydration, but there was no evidence of clinical dehydration in the study horses,” she explained. There was also a significant decrease in phosphorus following firocoxib, but not flunixin. Hypophosphatemia can be associated with either renal injury or colitis due to decreased absorption or increased loss of phosphorus. “Overall, we did not see any clinically significant changes in the biochemical parameters,” Dr. Bishop added. “They all remained within normal limits, even though there were statistically significant differences over time.” Overall, the findings suggest that subclinical colonic inflammation occurred following firocoxib, but not flunixin, as evidenced by increased colon wall thickness and more frequent colonic edema. “Horses were administered omeprazole in both treatment groups to mitigate effects of gastric ulceration and to satisfy the IACUC [Institutional Animal Care and Use Committee] protocol, However, a recent study found that there was seeming interaction between omeprazole and phenylbutazone, in which horses administered the 2 drugs concurrently had increased incidence of lower intestinal complications, which included impactions and signs of colic,” she said. “The relationship between NSAIDs and omeprazole warrants further investigation, and we’re not sure how that may
Courtesy of Dr. Rebecca Bishop
GASTROENTEROLOGY
The University of Illinois teaching hospital herd.
have impacted our results.” Dr. Bishop also noted that the availability of firocoxib during the study period necessitated the use of an oral formulation of the drug. “We assume that the drug should have been absorbed before it reached the level of the large intestine, but there’s a possibility that the differing routes of administration altered the effect of the medication on the lower intestine,” she said. Although the sample size was small and consisted of healthy horses, the findings do point to subclinical colon inflammation following firocoxib administration. “COX-2 selective NSAIDs may carry a risk of subclinical colitis,” Dr. Bishop concluded. “Although [coxibs] are still regarded as the safer option for gastrointestinal health if an NSAID must be administered, it is important to remember that no medication is without risk of side effects.” MeV
For more information: Duz M, et al. Proportion of nonsteroidal anti-inflammatory drug prescription in equine practice. Equine Vet J. 2019;51(2):147-153. https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.12997 Cook VL, Meyer CT, Campbell NB, et al. Effect of firocoxib or flunixin meglumine on recovery of ischemic-injured equine jejunum. Am J Vet Res. 2009;70:992-1000. https://avmajournals.avma.org/view/journals/ajvr/70/8/ajvr.70.8.992.xml Cook VL, Blikslager AT. The use of nonsteroidal anti-inflammatory drugs in critically ill horses. J Vet Emerg Crit Care. 2015;25:76-88. https://onlinelibrary.wiley.com/doi/10.1111/vec.12271 K. Morrissey N, R. Bellenger C, T. Ryan M, et al. Cyclooxygenase-2 mRNA expression in equine nonglandular and glandular gastric mucosal biopsy specimens obtained before and after induction of gastric ulceration via intermittent feed deprivation. Am J Vet Res. 2010;71:1312-1320. Ricord M, et al. Impact of concurrent treatment with omeprazole on phenylbutazone-induced equine gastric ulcer syndrome (EGUS). Equine Vet J. 2021;53(2):356-363. https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13323 ModernEquineVet.com | Issue 2/2022
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ONCOLOGY
Visible Success with delNS-Based Immunotherapy Improved Equine Sarcoids Scientists from the Viennese biotech company BlueSky Immunotherapies have used their experimental viral vector platform, delNS, to treat sarcoids in horses. The oncology team of the University of Veterinary Medicine Vienna—led by Sabine Brandt and the sarcoid expert Edmund Hainisch—have achieved success that may lead the way toward the development of innovative and easy-on-the-body cancer therapies in humans, the company said. Equine sarcoids are locally aggressive skin tumors, induced by the tumor antigens E6 and E7 of the bovine papillomavirus, which seriously compromise the health and welfare of the affected animals. Conventional treatment options such as surgical excision or chemotherapy have only limited effect and the tumors typically recur. The equine sarcoids treated with delNS/E6E7 were completely and permanently eliminated, according to the paper. Moreover, the systemic delNS-mediated immune stimulation also eliminated non-injected sarcoids. The researchers also demonstrated that the papillo-
Intratumoral injection with iNSA/E6E7equ and/or iNSB/E6E7equ led to tumor regression even in equine patients with severe disease. A mare (ANC) with multiple, severe sarcoids affecting the right axilla, abdomen and inner thigh responded to intratumoral therapy. Injection of a single lesion with iNSA/E6E7equ on days 0, 2 and 4, and iNSB/E6E7equ on days 7, 9 and 11 by (white arrow indicates injection site) led to complete regression of the injected and all non-injected sarcoids within 13 months as exemplarily shown for the right axilla. d0: day 0; m4: month 4; m10: month 10; m13: month 13.
mavirus that caused the sarcoids was eliminated. With its proprietary delNS technology, the biotech company BlueSky Immunotherapies GmbH (Ltd.) has created a viral vector platform for the induction of interferon and the expression of tumor antigens. delNS-based vectors have many properties for overcoming the immunosuppressive environment of tumors, including: • inducing a strong interferon response; • activating T cells, dendritic cells and natural killer cells; and • inhibiting immunosuppressive cells. They designed, manufactured and used 2 types of delNS vectors for the local treatment (direct injection into the tumors) of the horses. Over 3 years, 29 horses received different treatment regimes. Visible and very significant regression of the sarcoids was achieved in 20 of the treated horses, and 100% regression of the sarcoids occurred in 10 equine patients. Three horses had transient regression and 6 horses had no regression. MeV
Intratumoral injection with iNSA/E6E7equ on d0, d28, d86 led to tumor regression and no BPV1 DNA was detectable anymore from the tumor site. A mare (BEG) suffering from periocular mixed sarcoids (fibroblastic, nodular and verrucous components) shows complete tumor regression 10 months after intratumoral injections (white arrow indicates injection site) with iNSA/E6E7equ on days 0, 28 and 86. Importantly, BPV1 E5 PCR from DNA of crusts collected from scarified skin (month 10) scored negative (see inserted gel photo; BEG: patient DNA; L: GeneRuler DNA Ladder mix [ThermoScientific]; +c: sarcoid DNA as positive control: -c: equine intact skin DNA as negative control; ntc: sterile water as no-template control); d0: day 0; m5: month 5; m7: month 7; m10: month 10.
For more information: Jindra C, Hainisch EK, Rümmele A, et al. Influenza virus vector iNS1 expressing bovine papillomavirus 1 (BPV1) antigens efficiently induces tumour regression in equine sarcoid patients. PLoS ONE. 2021;16(11):e0260155. https://doi.org/10.1371/journal.pone.0260155 14
Issue 2/2022 | ModernEquineVet.com
IN A WORLD OF ITS OWN
Researched Respiratory Support Researched and Proven as an aid in controlling IAD and RAO Recommended in the ACVIM Consensus Statement on Respiratory Disease (1)
(2)
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– Using the Best Matters References: [1] Nogradi N, Couetil LL, Messick J, Stochelski MA, Burgess JA. Evaluation of an Omega-3 Fatty Acid Containing Feed Supplement in the Management of Horses with Chronic Lower Airway Inflammatory Diseases. J Vet Intern Med 2015; 29:299-306. [2] Couetil LL, Cardwell J.M, Gerber V, Lavoie J.-P, Leguillette R, Richard E.A. Inflammatory Airway Disease of Horses. ACVIM Consensus Statement J of Vet Intern Med 2016; 30:503-515 p. 508-510.
Check with Arenus on how Aleira can help your equine patients effectively cope with respiratory and immune function disorders. See how Aleira can help you to reduce or eliminate pharmaceutical interventions.
Arenus Animal Health | 866-791-3344 | www.arenus.com
TECHNICIAN UPDATE
You Can Fight City Hall: ‘Will Never Happen,’ Happened By Marcia Cantrell, CVT
Courtesy of Marcia Cantrell
In 2021, Montana passed a law allowing the licensure of veterinary technicians. It was an accomplishment that took perseverance and patience, and I am very proud of the part I played in it. I was told over and over again from veterinarians, lobbyists, and even veterinary technicians, that legislation to license veterinary technicians “will never happen” in Montana. The Big Sky Veterinary Technician Association (BSVTA) was on the verge of collapse in 2014 due, I think, to burn out. Our association is small, and few volunteers were doing the work necessary to maintain certifications. I and some of my colleagues, both veterinary technicians and veterinarians, thought that being licensed under the Montana Veterinary Medical Board would standardize certifications and improve the process. In addition, we were hoping it would breathe some life into BSVTA and encourage technicians to seek certification, which in the end, would be better for our patients. In addition to carrying out the duties that assistants already were doing, we hoped the bill could expand the ability of Montana veterinarians to tap into a resource that veterinarians in other states rely on—educated and experienced veterinary techni-
I was there (right) when the bill was signed into law.
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cians. A licensed veterinary technician requires less veterinarian supervision than an assistant, which can increase the veterinarian’s ability to care for more patients, while improving their care. At one time, Montana did license veterinary technicians, but the regulation lapsed in the early 1980s, due to vague language. The responsibility for credentialing reverted to the BSVTA with oversight by the Montana Veterinary Medical Association (MVMA). Many veterinary leaders wanted to reinstate licensure, but there were many obstacles, including the difficulty of bringing a vet tech program to the state that was approved by the American Veterinary Medical Association (AVMA). But really, change—an ugly word—was the primary obstacle. So, how did I get involved? I was “volunteered” after opening my mouth. In 2014, my practice hired a certified veterinary technician from Colorado, who wanted to become certified in Montana after she started. But she found the process difficult. Even getting information about certification was challenging. Her experience got me thinking. At a continuing education event/BSVTA general membership meeting, I was “volunteered” to research what would be needed to obtain licensure after I asked why we didn’t pursue it. My efforts kept coming back to the same advice: “Will never happen.” From my first meeting with Rick Scherr, DVM, the chair of the MVMA Vet Tech Committee, to discussions with various state legislators, I was met with the same resistance. I’m not a lobbyist, in fact, I have very little interest in politics, but I do care about my profession, and I was determined to see this through. In 2015, I met with the MVMA’s executive officer and lobbyist Stuart Doggett, who was very nice. He met with me and the BSVTA’s secretary at the capitol, where we toured the building and sat in on a house hearing. When I told him that we were working toward licensure for veterinary technicians, he said: “Will never happen.” Our next move was to obtain the Veterinary Board of Governor’s support, which we were told was a necessary step for achieving our goal. Someone from BSVTA attended every meeting, even if we weren’t on the agenda. Our presence was met with suspicion and trepidation because we were new to the process and spoke openly about our goals. Eventually, how-
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TECHNICIAN UPDATE
Shutterstock/nelelena
Teaching Points Change is hard for everyone, but being the instrument of that change is even more difficult. But it is not impossible. Working with others improves your odds, especially if you want to make an institutional change, such as getting legislation passed. The long road from idea to law is just that: a journey. It takes the help of many people. There were many people who were instrumental in getting this law passed, including Eli Olind, CVT; Steve Watters, DVM; Sarah Coffield; Leah Anderson, CVT; Shawni Hansen, CVT; Stuart Doggatt; Rick Scherr, DVM; Jeanne Rankin, DVM; Tierney Olson, DVM; State Rep. Walt Sales, and BSVTA past and present leadership. In addition, we needed financial support, and several companies helped us. We are grateful for the industry support we received from MWI, Elanco, Hill’s Pet Nutrition and Royal Canin.
ever, we gained the veterinary board’s support. But we still needed the community’s support, and that took a multipronged approach. We reached out to industry supporters to fund our efforts and started holding meetings throughout the major cities in the state—offering free continuing education and food. We attended job fairs and agricultural youth meetings and reached out to veterinarians, shelters and even the Montana Nurses Association. Recognizing our organization’s role would change, we also reached out to the National Association of Veterinary Technicians in America (NAVTA) to grow our local/ state leadership. NAVTA and AVMA both gave us letters of support to present at the hearings. There were several contentious meetings while we drafted the final bill. The opposition was concerned that assistants wouldn’t be able to do basic tasks anymore, that clinics would be required to hire LVTs, and that LVTs would need to be paid more. But we stuck to our guns: the legislation would help our profession and the underserved rural areas of our state. COVID-19 threw another obstacle in our path be18
Issue 2/2022 | ModernEquineVet.com
cause we could not hold the usual regional meetings. We did meet with the State Sen. Brian Hoven, who tabled our bill in the Senate in 2019. Although we didn’t change his mind, we understood his reasoning that there should be less governmental restrictions in the workforce. We held virtual meetings to discuss the new proposed bill and made some concessions to help move it forward. We finally had a workable bill and a strong sponsor in State Rep. Walt Sales to present to the Senate Agricultural Committee. After the first committee hearing, the bill was almost tabled again because animal shelters were worried that their employees would not be able to administer vaccinations and simple treatments. After much discussion, clarification and compromise, we gained their support. All our efforts started to pay off when the bill was passed out of the committee, where it went to the House. But it was still far from becoming a law. The House committee hearing was our next obstacle. In the Senate hearing we had 2 opponents; the House hearing had 1. To pass out of the hearing, the committee requested an amendment to decrease the required hours and not give a time limit on the grandfather clause. Although we felt this was less than ideal, it was a concession we felt we could make. Ultimately the bill passed the House floor 87-10, was returned to the Senate floor for a 50-0 approval of amendments, and history was written. On April 29, 2021, Governor Gregg Gianforte signed SB106 into Montana state law, and we were there to witness the signing. MeV Originally published in The NAVTA Journal. https://www. navta.net Used with permission and edited for style.
About the Author
I was always interested in helping animals. After several years of experience, I took the VTNE in 1995 in Washington State under the grandfather clause. I mostly worked on the companion animal side until moving to Livingston, Mont., to help fulfill my husband's dream of building a ranch and raising horses. For more than 15 years, we have been having a lot of fun perfecting our breeding program and showing in the cutting pen. I am active in Montana’s BSVTA, as secretary in 2007, and now as certification coordinator, a post I have held since 2014. In August 2020, I became a regional contact for the AAEVT. I also work part time in both small and large animal practice as inventory manager and enjoy getting my hands dirty in the field doing cattle work during the busy seasons.
INFECTIOUS DISEASES
U.S. Infectious Disease Update: (January 23–February 13, 2022) EQUINE HERPESVIRUS RIVERSIDE COUNTY, CALIFORNIA (FEBRUARY 12) Confirmed
Exposed
Notes
3
45
Neurologic, official quarantine
SAN MATEO COUNTY, CALIFORNIA (FEBRUARY 12) Confirmed
Exposed
Notes
14
300
Neurologic, quarantine, affected and alive; vaccinated
MARION COUNTY, FLORIDA (FEBRUARY 4) Confirmed
Exposed
Notes
1
28
Neurologic; private facility; voluntary quarantine
PARK COUNTY, WYOMING (JANUARY 24) Confirmed
Exposed
Notes
1
42
Neurologic; quarantine; 5 more suspected
STRANGLES DEFINANCE, OHI0 (FEBRUARY 11) Confirmed
Exposed
Notes
1
2
Private facility, horse recovering, unvaccinated
TIPTON COUNTY, TENNESSEE (FEBRUARY 10) Confirmed
Exposed
Notes
Unknown
40
5 suspected, boarding facility, voluntary quarantine
INDIAN RIVERY COUNTY, FLORIDA (FEBRUARY 9) Confirmed
Exposed
Notes
1
1
8 exposed, private facility, affected and alive. As of this date, 10th confirmed case in the state. Linked to a Louisiana kill pen.
LEE COUNTY, FLORIDA (FEBRUARY 8) Confirmed
Exposed
Notes
1
5
Official quarantine, affected and alive
PALM BEACH, FLORIDA (JANUARY 25) Confirmed
Exposed
Notes
2
1
Private facility, quarantine
LOGAN COUNTY, OHIO (JANUARY 25) Confirmed
Exposed
Notes
1
2
10 exposed
DEARBORN, INDIANA (JANUARY 28) Confirmed 1
Exposed
Notes 2 suspected, voluntary quarantine
Information gathered from the EDC—Equine Disease Communication Center. Reports occurred between 1/23–2/13, 2022. More information on each case available at https://equinediseasecc.org/alerts ModernEquineVet.com | Issue 2/2022
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BUSINESS OF PRACTICE
Redefining Roles to Sustain an Equine Practice By Cath Paulhamus Burnout, especially among solo practitioners, is often cited as a reason for leaving equine practice, according to the AAEP Retention Task Force. However, there are many other reasons, too, the task force said. Presenters at the AAEP 67th Annual Convention and Trade Show proposed various strategies for equine practitioners to consider to control their time and redefine their practice to prevent burnout for themselves, their associates and other staff. Begin with limiting your scope of practice. This may seem counterintuitive to the standard business plan of unlimited expansion, serving the needs of more and more clients. However, equine practitioners may find that being more selective improves their profitability and decreases their stress. A more focused practice requires less equipment and inventory. In addition, specializing in areas (such as dentistry) can limit emergency and on-call services. For owners, scaling back time spent on less profitable or less gratifying aspects of their jobs can create personal time away from the practice, preventing practice fatigue. More practices are limiting their scope of practice and specializing, noted Caitlin Daly, DVM, the owner of Mid Coast Equine in Maine. “If you want to be successful, happy and healthy—both physically and emotionally—while in this profession, you need to have strong boundaries. Finding success in solo practice has to come with the understanding that there is no possible way for you to be everything to everyone, all the time. Clients want and need a variety of services, and even if you don’t do them, you can always be the hero that refers them to where they need to go.” However, redefining one’s practice often requires contracting with others to fill additional roles. Associates, technicians, support staff, temporary and emer-
4 FACTORS CONTRIBUTING TO BURNOUT 1. PHYSICAL: work injuries, excessive hours, daily physical demands 2. M ENTAL: stress of treating clients outside one’s expertise or confidence, need to stay informed on research, need to handle the business of practice 3. E MOTIONAL: client expectations, problem or abusive clients, professional isolation, lack of work-life balance and self-care, family/caregiver responsibilities 4. FINANCIAL: debt, business expenses, inventory, accounts receivable
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gency veterinarians and other solo practitioners can be strategic assets to provide necessary services more efficiently and profitably, they said. Potential employees may prefer part-time or flexible hours, allowing practitioners to design a workable schedule that takes better advantage of employees’ capabilities when they’re needed. A better life-work balance is often “perceived as a lack of effort or commitment to the job, and I think that’s a huge problem that many of these newer associates have,” explained Kelly A. Zeytoonian, DVM, MBA, CERP, the owner of Starwood Veterinary Equine Service and Starwood Veterinary Consulting in the San Francisco Bay area. Emergency services—one of the major causes of burnout—can be coordinated among practices, so that no one is on call 24/7. Reassigning practice responsibilities to others—allowing them to care for clients and represent the practitioner—involves assessing capabilities and clarifying expectations, an effort that may require a series of adjustments until the right balance is attained. Exploring the advantages of forming an emergency cooperative among practitioners, Martha Mallicote, DVM, DACVIM, clinical associate professor at University of Florida, who participates in a successful cooperative, explained, “All you have when it comes down to it, is time. You have the opportunity to make plans, when you can truly unplug, know you’re off call, and know that you’re being backed up by a very competent colleague.” Redefined roles and schedules may require rethinking fees and salaries, they said. Practice space, equipment and inventory could be adjusted to decrease expenses. Colleagues who share emergency or other services should discuss fees and billing. Dr. Zeytoonian used the fees charged by her plumbers to illustrate how practitioners should reconsider their fees and the value of their time. “What’s important is [plumbers] know their value, they know they’re in high demand and have a skill set that only they can offer—and so do we. If you hear nothing else from my talk today, it is to be the plumber. And in addition to that, be the plumber that continues increasing your prices. Know your value and continue to raise them,” she said. Additional revenue allows more freedom to implement changes in the practice. Career goals and roles are rapidly evolving to address the demands of a changing society. Changing the old paradigms for practice may help retain talented and enthusiastic equine practitioners. MeV
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Arenus Animal Health | 866-791-3344 | www.arenus.com
ModernEquineVet.com | Issue 2/2022
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The Modern
Equine Vet Reach your veterinarians wherever they are, whenever they want. FOR ADVERTISING RATES AND INFORMATION, EMAIL Matthew Todd or Matthew Gerald
