The Modern Equine Vet January 2017 by The Modern Equine Vet

The Modern

Equine Vet www.modernequinevet.com

Practical Advice

Diagnosing and Managing PPID

Vol 7 Issue 1 2017

Can I Getta Little Help Here? Sweet! Immunotherapy Shows Promise for Sweet Itch A Little Over the Top Reliability of URT Endoscopic Grading

Table of Contents

Endocrinology

Diagnosing and

4 Managing PPID

Cover photo: Dr. Nicola Menzies-Gow

GeriatRic Medicine

Having the 'Talk': Deciding When to Euthanize................................................................. 8 Nutrition

Tail Hairs Reveal Dietary Choices............................................................................................10 Topping It Off...................................................................................................................................12 Behavior

Can I Getta Little Help Here?...................................14 News

Reliability of URT Endoscopic Grading................. 3 AAEP Foundation Awards $75,000 Scholarship ...................................................................... 3 Sweet! Novel Immunotherapy for Itch..................16 Andrew Van Epps Joins Penn Vet............................................................................................16 Options for Equine Joint Therapy...........................................................................................17 advertisers Merck Animal Health.................................................. 5

AAEVT............................................................................13

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

Issue 1/2017 | ModernEquineVet.com

LEGAL DISCLAIMER: The content in this digital issue is for general informational purposes only. PercyBo Publishing Media LLC makes no representations or warranties of any kind about the completeness, accuracy, timeliness, reliability or suitability of any of the information, including content or advertisements, contained in any of its digital content and expressly disclaims liability of any errors or omissions that may be presented within its content. PercyBo Publishing Media LLC reserves the right to alter or correct any content without any obligations. Furthermore, PercyBo disclaims any and all liability for any direct, indirect, or other damages arising from the use or misuse of the information presented in its digital content. The views expressed in its digital content are those of sources and authors and do not necessarily reflect the opinion or policy of PercyBo. The content is for veterinary professionals. ALL RIGHTS RESERVED. Reproduction in whole or in part without permission is prohibited.

News notes

Shutterstock/Nastenok

Options for Equine Joint Therapy With unique joint health needs, individual training regimens and demanding competition schedules, it can be a challenge for owners to properly manage joint health. Hyaluronate sodium (Legend, Merial) is the first FDA-approved synovitis treatment available for both IV and intra-articular (IA) administration, which provides flexibility to help meet the needs of performance horses. There are several factors to consider when deciding which might be best for a particular performance horse after the veterinarian completes the diagnostic work up: • What are the horse’s current risk factors for joint issues—is it just starting a training program and showing few signs of joint stress, or is it a seasoned competition horse that may have ongoing inflammation or even changes in his joints? • How close is it to competing? • Can the horse be laid up for a short time after treatment? IV administration treats multiple joints (carpus and fetlock) with a single injection, while IA administration (often with a steroid) allows the veterinarian to treat a specific affected joint. “Some diagnoses may warrant IA injection, while IV therapy may be a better fit at other times—including closer to competition where downtime isn’t an option,” said Hoyt Cheramie, DVM, MS, Manager, Merial Large Animal Veterinary Services. “Some horses in continuous work with only subclinical synovitis may only be candidates for IV treatment, while horses identified with individual joint changes may get an IA injection followed by periodic IV injections to treat ongoing low-level or intermittent issues, as Legend is labeled to be used for three weekly treatments. It’s a huge reassurance to have options with two routes of administration to fit into your training and competition schedules.” Whether delivered IV or IA, Legend treats non-infectious synovitis, and when administered once weekly for three weeks, Legend significantly reduced joint inflammation and resulting lameness for at least 45 days. Hyaluronic acid (HA) is produced through a 12-step microfiltration process that removes foreign proteins and other impurities that may increase the potential for in-

fection or joint flares. The safety of Legend has not been evaluated in breeding stallions or in breeding, pregnant or lactating mares. The following adverse reactions have been reported following use of Legend Injectable Solution: Following IV use: occasional depression, lethargy and fever. Following intra-articular use (Legend Injectable Solution—2 mL only): lameness, joint effusion, joint or injection site swelling and joint pain. MeV

For more information: Lameness & Joint Medications. American Association of Equine Practitioners. Available at: http://www.aaep.org/info/horse-health?publication=844. Accessed Oct. 10, 2016 Kawcak CE, Frisbie DD, Trotter GW, et al. Effects of intravenous administration of sodium hyaluronate on carpal joints in exercising horses after arthroscopic surgery and osteochondral fragmentation. Am J Vet Res. 1997;58(10):1132-1140. https://www.ncbi.nlm.nih.gov/pubmed/?term=Am+J+Vet+Res.+1997%3B58(10)%3A1132-1140

ModernEquineVet.com | Issue 1/2017

Endocrinology

Practical Advice for

Although the most recognized sign of equine pituitary pars intermedia dysfunction (PPID)—changes in hair coat—occurs in most horses, it does not occur in all—at least not immediately, so diagnosing PPID can be a challenge that requires an understanding of the subtle signs, a good history, and testing, according to Nicola Menzies-Gow, MA, VetMB, PPhD, DECEIM, Cert EM (Int. med), MRCVS, reader in equine medicine, Royal Veterinary College. “The differential diagnoses for an individual animal will depend on the clinical signs that are being displayed. If they are only displaying a single clinical sign, it can be more challenging,” said Dr. Menzies-Gow, who spoke about metabolic conditions in a webinar from the British Equine Veterinarian Association (BEVA). When PPID occurs, the pituitary pars intermedia overproduces α-MSH, β-endorphin and ACTH, which cause a myriad of signs. “PPID is slowly progressive,” she said, “and management requires controlling symptoms and trying to slow down progression. There is no cure.” The condition is more likely to occur in older horses, with prevalence ranging from about 15% to 21% of horses older than 10, but it has been seen in animals as young as 7. The average age for PPID is about 19, according to Dr. Menzies-Gow. “There is no apparent sex prediction, but it appears ponies are more likely to be predisposed than horses,” she said. B y 4

Issue 1/2017 | ModernEquineVet.com

M a r i e

R o s e n t h a l ,

M S

Photo courtesy of www.boblangrish.com

Diagnosing and Managing PPID

The Science of Exceptional Stop flu where it starts.

Trust Flu Avert® I.N. for superior protection against relevant flu strains threatening the U.S. horse population.1 • Just ONE dose required - An ideal first flu vaccine for young horses - Provides protection at the site of infection and long-lasting immunity • Proven safe and effective - Intranasal application leaves no risk for injection site reactions to interfere with training or competing • Rapid onset of protection - Onset of flu protection within five to seven days following one dose – no matter when your horse was last vaccinated for flu.2 Now that’s exceptional.

Visit us online to learn more about Merck Animal Health and the equine products and programs that help you keep horses healthy.

The Science of Healthier Animals 2 Giralda Farms • Madison, NJ 07940 • merck-animal-health-usa.com • 800-521-5767 Copyright © 2016 Intervet Inc., d/b/a/ Merck Animal Health, a subsidiary of Merck & Co., Inc. All rights reserved. 3526 EQ-FluAvert-PM

UC Davis (Nicola Pusterla) & Merck Animal Health. Infectious Upper Respiratory Surveillance Program. Ongoing Research 2008-present. Townsend HGG. Onset of protection against live-virus equine influenza challenge following vaccination naive horses with a modified-live vaccine. Unpublished data.

Endocrinology

A large range of early and advanced clinical signs are associated with the disease. “Earlier signs are vague, such as decreased athletic performance, change in attitude or lethargy; the more traditionally recognized signs are delayed hair coat shedding, regional hypertrichosis, change in body conformation, regional adiposity and laminitis. “As the disease progresses, and the changes in the pituitary continue, a larger array of signs are recognized, including lethargy, generalized hypertrichosis, loss of seasonal

hair coat shedding, skeletal muscle atrophy, rounded abdomen, abnormal sweating (which is either increased or decreased), polyuria/ polydipsia, recurrent infections, regional adiposity, changes in reproduction cycling, laminitis and neurologic defects,” she said. The sign that most people recognize is the changes in the hair coat, but more subtle hair changes had probably been occurring for years. “Hypertrichosis is a common, also specific sign associated with PPID. And it varies from delayed hair coat

Endocrine Group Releases Recommendations for Diagnosis, Treatment of Metabolic Syndrome The Equine Endocrinology Group (EEG) released updated recommendations for the diagnosis and treatment of equine metabolic syndrome (EMS), which include information about the detection, testing, assessment and management of EMS. EMS is characterized by three main features: 1. obesity or regional adiposity, 2. insulin resistance and 3. a high risk for laminitis. EMS is known to begin with a genetic predisposition, and these horses are often referred to as “easy keepers,” but the environment also plays a role with cases often occurring during periods of rapid pasture growth. EMS can also be perpetuated with improper diets that provide more calories than needed. Horses detected with EMS can be managed through diet and exercise. The group recommended that positive horses that are obese reduce body fat by limiting calories and increasing exercise. These horses should be on a low-sugar/low starch diet without access to grass. Those that are lean should receive a diet that maintains body condition: lower sugar, lower starch, higher fat that includes goodquality fiber and restricted access to grass. Horses with both body conditions should receive exercise. If a horse has clinical signs of pituitary pars immune dysfunction (PPID), which is a common comorbidity—especially in horses older than 10 years—they should receive pergolide (Prascend, Boehringer-Ingelheim Vetmedica [BIVI]) and an appropriate diet, based on the post prandial insulin response. The EEG updates its recommendations every two years. The EEG is composed of experts in the field of equine endocrinology who provide advice in the form of written recommendations to help veterinary practitioners diagnose and manage equine endocrine disorders. “These guidelines are important because they provide the most up-to-date, concise, accurate information in a reference guide that veterinarians can easily carry and review,” said Steve Grubbs, DVM, PhD, DACVIM, equine technical manager for BIVI.

For more information:

The recommendations for EMS and PPID can be found on the EEG web site: http://sites.tufts.edu/equineendogroup and at https://sites.tufts.edu/equineendogroup/files/2016/11/2016-11-2-EMS-EEG-Final.pdf. 6

Issue 1/2017 | ModernEquineVet.com

shedding to a thick curly coat. It affects somewhere between 55% and 80% of cases,” she said. To make a diagnosis requires a review of the history, signalment, clinical signs and testing, including hormone assays and dynamic tests. “The basal ACTH concentration test is a one-off blood sample, and it is useful as a screening test. It is not 100% diagnostic, but it certainly gives you a good idea as to whether the horse has PPID or not,” Dr. Menzies-Gow said. “The result is affected by season. We know that the output of the pituitary varies across the season and the output of all the hormones seem to be highest in the autumn. So, we get a normal seasonal rise in the autumn.” Originally experts advised not testing in the fall to avoid the seasonal rise, but now it is preferable to test then so that the difference between having PPID and not having the condition is more apparent, as long as the laboratory uses a seasonally adjusted range. The test may not detect early cases of this progressive disease. In addition, the sample can be difficult to handle because it must be put on ice and separated before sending it to the lab. “If the ACTH is not giving a good result, either just above or just below normal and you still suspect PPID based on what you see and the history of the animal, it is probably best to move onto a TRH stimulation test,” she said. TRH is a physiologic release factor that stimulates the hormone release by the pituitary gland. Take a basal blood sample, inject the TRH and then take a second sample either 10 or 30 minutes later: ACTH>110 pg/mL @ 10 min or >36 pg/mL @ 30 min = PPID. The sensitivity is 97%, specificity is 93%. There is also a seasonal effect, with greater release in the autumn. However the seasonal effect has

The basal ACTH concentration test results are affected by the season with a seasonal rise of hormones seen in the autumn. Testing then is preferred so that the difference between having PPID and not having the condition is more apparent, as long as the lab uses a seasonally adjusted range. not yet been fully elucidated, so the recommendation for the TRH test is to avoid doing it in the fall. One of the areas that should also be considered is insulin dysregulation (ID), which occurs in some, but not all animals. ID can occur as a consequence of the PPID or animals with equine metabolic syndrome can develop PPID. The presence of ID is associated with a worse prognosis.

heptidine) can be added to the regimen, but is not recommended as a sole therapy. “Once you have initiated therapy, you have to monitor the animals and there are various ways you can do it. You can simply

Treatment

The management of PPID will depend upon which clinical signs the animal is suffering from and how severe they are. “If you have an animal that is just a bit hairy and a bit sweaty, the owner can clip them and the animal can live with being a bit sweaty or drinking a bit more—many owners are good with that management,” she said, although she did suggest altering the diet. “It is usually the laminitis that forces the owner to institute some pharmacologic medications.” First line therapy is pergolide (Prescend, Boehringer Ingelheim Vetmedica), which is a dopamine agonist that replaces the lost inhibition of the pituitary gland. The side effects include diarrhea, depression, anorexia or colic. If the animal is experiencing side effects with a higher dose, decrease the amount, and then increase it gradually to a dose the horse can tolerate, she suggested. A serotonin antagonist (cypro-

PPID Clinical Signs A thick, long and wavy hair coat with an abnormal shedding pattern is evident in 85% of affected horses. Chronic or recurrent laminitis Chronic recurrent skin, pulmonary, urinary, or sinus infections Weight loss or muscle wasting, decreased muscle tone, abnormal bulging of supraorbital fat pads Polyuria and polydipsia Lethargy Persistent sweating Vision disturbances, including blindness Seizures

monitor their clinical response or you can repeat the tests that you did in the first place,” she said. Some signs will respond quite quickly and others will take a little longer. Within the first month, we should see an improved attitude, a reduction in the PU/PD, increased activity and if the animal did have hyperglycemia, it should come under control. Signs that will take up to a year to improve are the hair coat abnormalities, if there has been rounding of the abdomen, changes in skeletal muscle mass, reduced frequency of infections, and fewer or milder episodes of laminitis. “If the tests results return to within the normal reference range, you would want to keep the animal on the drug as prescribed and repeat the testing in another six months. If your tests have stayed abnormal, but the owners report a clinical response, you will need a discussion about whether to stay on that dose or increase it to try and get tests within the normal reference ranges. “However, if the test is abnormal and you’ve had no clinical response, you are going to be forced to increase the dose and maybe add the other drug,” she said. Good communication with owners is important she said, because PPID is a life-long condition, and owners must be aware of this. But a well-managed horse who is responding to therapy can live for five or more years. MeV ModernEquineVet.com | Issue 1/2017

Behavior

Having the ‘Talk’: Shutterstock/WOLF AVNI

As horses live longer and lon-

ger, the human-animal bond grows stronger. But that bond can affect how the owner perceives the geriatric animal’s quality of life (QoL), which can influence long-term care and end-of-life decisions, according to a recent review in Veterinary Clinics of North America Equine Practice. Catherine M. McGowan, BVSc, MACVS, PhD, FHEA, MRCVS, and Joanne L. Ireland, BVMS, PhD, Cert AVP(EM), MRCVS, recommended that veterinarians take a note from the geriatric physician’s playbook in helping owners assess the geriatric horse’s QoL. In human

B y

Issue 1/2017 | ModernEquineVet.com

Assessing Quality of Life and THE NEED to Euthanize as Horses Age

medicine, patients are frequently assessed by their daily activities and how those activities affect their lives. Small animal veterinarians have used similar questionnaires to assess a dog’s QoL. The results help to provide a concrete sense of how the animal (or person) is doing. Geriatric horses should be seen at least yearly, and more frequently if they have metabolic issues, such as pituitary pars intermedia dysfunction, hoof or dental disorders or some other chronic illness. With the yearly health check of a horse, Dr. Ireland recommended that veterinarians include an as-

M a r i e

sessment of activities and functional tasks (See box). “Although veterinarians are often better at assessing equine health, owners know their horses better and see them more frequently, so veterinarians should involve the owner in the QoL assessment. Some owners may perceive health issues differently than veterinarians, but in all cases, if performing a QoL assessment, then changes over time are less disputable than a one-off examination,” explained Dr. McGowan. An ounce of prevention is worth a pound of cure when it

R o s e n t h a l ,

M S

comes to geriatric medicine, so a proactive approach is best. “The best time to be proactive is at the yearly health check, and we would encourages all practices to set up a geriatric health package that encourage owners of older horses to sign up,” Dr. McGowan told The Modern Equine Vet. You might not think so, based on some of the discussions you have with owners, but most owners do look to their horses’ veterinarians for advice, therefore, use the questionnaire and the yearly health check as opportunities to discuss how the horse is getting along, they suggested. Compare the results from the previous questionnaire to the newest answers and note any changes that the owner might not fully realize because they see the horse every day. Some changes are subtle but are more recognizable when one looks at a chunk of time. Prepare them for the possibility that the horse’s QoL might become so poor that euthanasia would be the best, most humane, option. “Our research has found that owners look to vets as the ones to give the advice about the prognosis of a disease or condition that leads to a hopeless or poor prognosis, and ultimately to the decision to euthanize a horse,” Dr. McGowan said. “Therefore, first and foremost, veterinarians need to give clear and sound advice communicated in a professional manner.” That communication—before, during and after the euthanasia— can help support owners through

Questions to Ask Owners During the Yearly Assessment 1. How satisfied are you with the horse’s general health? 2. To what extent does its age limit its normal daily activities? 3. To what extent does pain limit daily activities?

6. How active is the horse when turned out? 7. Does the horse lie down when stabled or resting? 8. Has lying-down behavior changed with aging? 9. Is the horse able to lie down and get up easily?

4. To what extent does the horse interact with people?

10. How would you rate the horse’s appetite?

5. To what extent does the horse interact with other horses?

12. How would you rate the horse’s quality of life?

the end of life of their beloved horse. “Many veterinarians are excellent at this and have developed their own methods to ensure the owners can say goodbye to their horses in the least stressful way,” Dr. McGowan said. Empathy is important, she added, especially among veterinarians who have treated a horse over many years or have managed a prolonged condition toward the end of the life. “Being someone who knew the horse, [the veterinarian] can empathize with the owner about the loss of their horse and the subsequent grieving. “Many owners feel suddenly isolated with a huge burden of grief from the loss of a lifestyle, as well as an animal—especially if they do not have many other horses—and veterinarians can help owners by offering their condolences, their time to discuss the horse and directing them to grievance support in their area—be it formal or infor-

11. Does the horse have difficulty eating?

mal support,” Dr. McGowan said. “Veterinarians should also be aware that owners find the loss of the horse more distressing than the act of euthanasia as highlighted by our research and they should not underestimate the power of the human-horse bond and the void the loss of a horse creates in an owner’s lifestyle,” Dr. Ireland said. “As shown by our research looking at owner personality and euthanasia—owners, especially women with certain personality traits, such as a tendency to experience states of frustration and bitterness, and susceptibility to experiencing guilt, sadness and loneliness—will find the experience harder,” Dr. McGowan warned. “Try to identify these individuals—they may be clients who may appear somewhat difficult or demanding, but in reality are just having a harder time of it,” Dr. MeV McGowan suggested.

—Anim Welf 2011;20:483-495.

For more information: McGowan CM, Ireland JL. Welfare, quality of life, and euthanasia of aged horses. Vet Clin North Am Equine 2016;32:355-367. McGowan TW, Phillips CJ, Hodgson DR, et al. Euthanasia in aged horses: relationship between the owner’s personality and their opinions on, and experience of, euthanasia of horses. Anthrozoös 2012;25(3):261–75. Ireland JL, Clegg PD, McGowan CM, et al. Owners’ perceptions of quality of life in geriatric horses: a cross-sectional study. Anim Welf 2011;20:483–95. ModernEquineVet.com | Issue 12/2016

Nutrition

Tail Hairs Reveal Dietary Choices

Shutterstock/loflo69

Przewalski’s horse, a species

of wild horse that has been successfully reintroduced to the Gobi Desert, shares its pasture grounds with wild asses and free-roaming domestic horses. A scarce supply of food could lead to food competition among the different species, especially if they make the same dietary choices. A team led by researchers from the University of Veterinary Medicine Vienna (Vetmeduni Vienna) in Austria chemically analyzed the tail hairs of the animals to determine the seasonal dietary habits of the three species. While the wild ass switches from being a grazer in the sum-

Issue 1/2017 | ModernEquineVet.com

mer to also browsing in the winter, the wild and domestic horses eat exclusively grass all year round. In the lean winter months, this leads to increased food competition between wild and domestic horses. This realization could help improve wildlife management measures for the Przewalski’s horse, according to the study published in the Journal of Applied Ecology. Przewalski’s horses went extinct in the wild in 1968. Successful breeding programs at zoos around the world helped to reintroduce the animals in the Great Gobi B protected area in southwestern Mongolia since 1992. The wild horses share the extreme habitat of the

Gobi Desert with two other equid species: the Asiatic wild ass, also called Khulan, and the free-ranging domestic horses of local nomads. For the preservation of the wild Przewalski’s horse, it is important to understand if and how the three related species compete for food in the protected area. Martina Burnik Šturm, PhD, and Petra Kaczensky, DrRerSilv, from the Research Institute of Wildlife Ecology at Vetmeduni Vienna, with the Leibnitz Institute for Zoo and Wildlife Research in Berlin, did a chemical analysis of tail hairs to investigate the dietary habits of the animals. The analysis allowed them to determine the

The high potential for pasture competition between domestic and wild horses highlights the need for stricter regulation. The establishment of artificial water sources should also be considered.

composition of the diet of each of the three species, which led to the discovery of increased dietary competition in the winter months. The chemical analysis of the tail hairs revealed that Przewalski’s horses and domestic horses are year-round grazers. Khulan, on the other hand, switch from grazing in the summer to a high proportion of foliage in the winter. “When food becomes scarce in the long winter months, competition can be expected—especially between the two species of horse,” Dr. Burnik Šturm said. In the summer, the food supply is relatively high. At the same time, the local nomads leave the Gobi

and take their horses to the high pastures of the surrounding mountains. “In the hot season, Przewalski’s horses mainly graze near sources of water. Khulan, on the other hand, also graze on pastures far from water sources as they are better able to conserve water. The potential for pasture competition in the summer is therefore relatively low among the three species in the Great Gobi B protected area,” Dr. Kaczensky added. The chemical analysis used by Drs. Burnik Šturm and Kaczensky measured the stable isotopes in the tail hairs. “Stable isotopes are atoms of the same chemical element with the same number of protons but a different number of neutrons and thus with different masses. The isotope values in the body tissue of living organisms are the result of the isotope values in the environment and of the animal’s metabolism,” Dr. Burnik Šturm explained. Grasses and shrubs in the Gobi Desert exhibit different values of carbon isotopes, which make it possible to differentiate between grazers and browsers. Because the tail hairs of horses grow at a regular rate, they act as an archive storing the isotope values at each growth stage. The longer

the hair, the farther back into the past the researchers can look. “If you know how fast the hairs grow, you can date specific hair segments and clearly assign them to a certain season. Consecutive hair segments therefore provide valuable information about the diet and water balance of an individual animal,” Dr. Burnik Šturm said. International research teams, under the direction of Vetmeduni Vienna and in close cooperation with the Great Gobi B protected area, have for years been committed to the reintroduction program in the Gobi Desert. The long-term goal is to establish a self-sustaining and viable population of Przewalski’s horses, but also to protect other key species such as the Khulan. An exact understanding of the dietary behavior of the Przewalski’s horse and the Khulan are important for improving the conditions in the protected area. The high potential for pasture competition between domestic and wild horses highlights the need for stricter regulation and a restriction on the grazing of domestic horses. The establishment of artificial water sources should be well considered to avoid infringing on the Khulan's areas of retreat. MeV

For more information: Burnik Šturm M, Ganbaatar O, Voigt CC, Kaczensky P. Sequential stable isotope analysis reveals differences in dietary history of three sympatric equid species in the Mongolian Gobi. J Appl Ecol. 2016 Nov 16 [Epub ahead of print] DOI: 10.1111/1365-2664.12825 http://onlinelibrary.wiley.com/doi/10.1111/1365-2664.12825/full ModernEquineVet.com | Issue 1/2017

Nutrition

Topping It Off

Topline Grading Made Easy B y

P a u l

B a s i l i o

Issue 1/2017 | ModernEquineVet.com

When a client hears that their horse needs more mass over the topline, they tend to reach for a fat supplement to even things out, or they try to work the horse harder to build muscle. These two choices are not optimal, according to Abby Keegan, MS, equine innovation and application lead for Cargill Animal Nutrition. “The topline is not fat,” she said here at the 62nd AAEP Convention in Orlando. “Exercise is always important, but if you just exercise and you don’t provide fuel for the horse’s body, then you end up in a wash or a negative balance regarding the topline. You’re stimulating muscle protein synthesis with the exercise, but that exercise is going to catabolize muscle without proper nutrition.” To help veterinarians with this potentially frustrating topic, Cargill Animal Nutrition has put together a topline assessment method (toplinebalance.com) to assess a horse’s topline and identify options to build, rebuild, or maintain the trapezius and the

latissimus and longissimus dorsi. “We developed the tool to help veterinarians explain to clients the difference between BCS and a topline score,” Ms. Keegan said. “The BCS tells us whether we need more or fewer calories, and the topline score tells us whether the horse has enough amino acids in the diet.” If a horse has a poor topline and no muscle development around the spine, Ms. Keegan explained that it is typically due to an amino acid deficiency, which can also affect other parts of the body. “If you take the water out of the hoof, it’s 95% amino acids,” she said. “If the horse is already deficient in amino acids, and it is affecting the muscle, then what do you think is going on in the hoof?” The topline assessment tool uses a simplified version of the Henneke scoring system used in BCS assessments. Each area of the horse’s topline is scored individually, and then that number is divided by 4. “Everyone has a client who wants to argue about their horse’s BCS score,” Ms. Keegan said. “With the Topline Balance tool, you can have the owner read through and pick which of the three images best describes their horse. It’s a foolproof way to identify horses that need some help.” For older horses past their working years, it is common for owners to restrict their diet at the same time exercise is decreased. The horse’s BCS score may be within normal limits, but the topline will go away. Without the muscles for support, the horse will end up with a swayback. “If the horse is already swayback then we won’t be able to fix it,” Ms. Keegan said. “However, we can support the muscles and keep the back where it’s at. Every horse can have a good topline for their genetic potential. If a horse is high-withered then it will always be high-withered, but we MeV can fill in the muscles.”

AAEV T M E M b E r s h i p Membership in the AAEVT is open to all veterinary technicians, assistants, support staff and those employed in the veterinary health care industry worldwide. Student membership is open to those currently enrolled in an AVMA/CVMA accredited veterinary technology program.

AAEVT Membership • • • • • • • • • • •

Bi-Annual Newsletter Weekly “HoofBeats” Email Newsblast Full access to www.aaevt.org, including the Career Center and the Library Up-to-date information on the AAEVT Discounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT Convention NTRA, Working Advantage and Platinum Performance Benefits The opportunity to participate in the AAEVT Online Certification Program or to become a member of the AEVNT Academy-Specialty in Equine Veterinary Nursing Scholarship opportunities. AAEVT’s Equine Manual for Veterinary Technicians (Blackwell Publishing 20% discount on purchase price) Opportunity to attend Purina’s Annual Equine Veterinary Technician Conference - All Expenses paid!

AAEVT Objectives • • • •

Provide opportunities for CE, training, communication, and networking Educate the equine veterinary community and the public about our profession Inform Members of issues affecting our profession Assist in providing the best medical care to improve the health and welfare of the horse

AAEVT Online Equine Certification Program

• A three course, 10 module, equine-only online program offered through ACT • Geared toward Credentialed Veterinary Technicians, Assistants, Support staff, & Students • Areas of study include: equine medical terminology, anatomy and physiology, parasitology, laboratory, diagnostics, equine basics (breeds, wellness, husbandry,) diagnostic procedures, emergency medicine, restraint, pharmacology, surgical assistance and anesthesia, equine office procedures • A certificate of completion is awarded to those who: Successfully complete required courses Complete the list of required skills (per a supervising DVM who is an AAEP member) Attend an AAEVT regional CE symposium and participate in the we labs • Those individuals who successfully complete the programs will be recognized as AAEVT Certified Equine Veterinary Technicians / AAEVT Certified Equine Veterinary Assistants depending on their current designation. The certificate is recognized by the AAEVT and the AAEP but does not grant the credentialed status by the AVMA • For more information go to www.aaevt.4act.com or call 800-357-3182

AAEVT Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.

Fo r m o re i n f o r m a t ion v ist w w w.a ae vt.or g

*American Association of Equine Veterinary Technicians and Assistants

Behavior

Can I Getta Little Help Here? When horses are in trouble they look toward humans for help. When horses face unsolvable

Credit: Kobe University

problems they try to get a person’s attention with visual and tactile signals to ask for help, according to researchers at Kobe University in Japan. In addition, horses appear to alter their communicative behavior based on the person’s knowledge of the situation, according to the study in Animal Cognition. Communicating with other individuals to get information about foraging sites and predators is a valuable survival skill. Chimpanzees, which are evolutionarily close to humans, are especially skilled at understanding

others. Studies suggest that chimpanzees distinguish the attentional states of other individuals (whether they see or not see the situation), and they are also able to understand others' knowledge states (they understand or don’t understand the problem). Dogs are also very good at communicating with humans. Recent studies of dogs have revealed that they are excellent at understanding various human gestures and expressions. These abilities probably were influenced by the domestication process. Since they were domesticated

6,000 years ago, horses have contributed to human society in various ways, from transportation to companionship. Horse-riding has recently drawn attention for its positive effects on our physical and mental health. Horses have a close relationship to humans and previous studies have indicated that they are sensitive to body signals and the attentional state of individuals. The researchers wanted to know whether they try to communicate with people and understand the knowledge state of the individuals. “Our first question was wheth-

Food is hidden inside one of the two silver buckets behind them. When horses cannot obtain this food by themselves, they give humans visual and tactile signals. The horse a) lightly pushes and b) looks at the caretaker standing outside the paddock.

Issue 1/2017 | ModernEquineVet.com

change their behavior in response to the knowledge levels of humans. “We then examined whether horses alter their behaviors on the basis of the caretakers’ knowledge of where the food was hidden. We found that horses communicated to their caretakers using visual and tactile signals. The signaling behavior of the horses significantly increased in conditions where the caretakers had not seen the hiding of the food. These results suggest that horses alter their communicative behavior toward humans in accordance with humans’ knowledge state,” they wrote.

Credit: Kobe University

er and how horses send signals to their potentially helpful but ignorant caretakers in a problem-solving situation where a food item was hidden in a bucket that was accessible only to the caretakers,” the researchers wrote. The experiment was carried out in a paddock belonging to the equestrian club at Kobe University, where eight horses from the club participated. For the first experiment, an assistant hid carrots in a bucket that the horse could not reach. The researchers observed whether and how the horse sent signals to the caretaker when the caretaker, who was unaware of the situation, arrived. The horse stayed near the caretaker and looked at, touched and pushed the caretaker. These behaviors occurred over a significantly longer period compared with cases when they carried out the experiment without hiding the food. The results showed that when horses cannot solve problems by themselves they send signals to humans both visually (looking) and physically (touching and pushing). For the second part of the experiment, they tested whether the horses’ behavior changed based on the caretakers’ knowledge of the hidden food. If the caretaker hadn't watched the food being hidden, the horses gave more signals, demonstrating that they can

High Cognitive Skills

These two experiments demonstrated some behaviors horses use to communicate demands to humans. They also suggested that horses possess high cognitive skills that enable them to flexibly alter their behavior toward humans according to person's knowledge of a given situation. This high social cognitive ability may have been acquired during the domestication process. To identify the characteristic that enables horses to form close bonds with humans, the team wants to compare communication among horses, as well as looking more closely at the social cognitive ability of horses in their communication with people, according to the researchers. MeV

Horse with caretaker at the equestrian club.

The experiments suggest that horses have high cognitive skills that enable them to flexibly alter their behavior toward humans according to the person's knowledge of a given situation.

For more information: Ringhofer M, Yamamoto S. Domestic horses send signals to humans when they face with an unsolvable task. Anim Cogn 2016 [Epub ahead of print Nov. 24]. doi:10.1007/s1007101610564 ModernEquineVet.com | Issue 1/2017

news notes

Sweet! Immunotherapy for Sweet Itch Appears Promising Oral treatment of horses with transgenic barley expressing Culicoides proteins results in an allergen-specific response. This might someday be an immunotherapy for insect bite hypersensitivity. The in vivo study investigated a novel immunotherapy approach to Culicoides insect bite hypersensitivity (also called sweet itch). Barley grain expressing hyaluronidase protein originating from Culicoides saliva was fed to four Icelandic horses that were immunologically naïve to Culicoides, while three controls were fed normal barley. Horses were treated six times over a period of 20 weeks with 50–100 g of barley grain each time, up to 400 g in total. Eight months after the last treatment, horses were all boosted with 100 g.

Blood and saliva were collected from the horses before and two weeks after each treatment and tested with an ELISA for IgG antibodies to two Culicoides proteins. After the transgenic barley treatment, three of the four horses showed an IgG1 response and all four horses were successfully the four different from controls. A competitive inhibition ELISA showed that after the boost, transgenic barley-treated horses’ sera inhibited binding of IgE to one of the Culicoides proteins. A further competitive inhibition ELISA showed that the two proteins are not fully cross-reactive. The transgenic barley was effective at inducing an allergen-specific response and that the antibodies produced are able to partially inhibit IgE binding to allergens from Culicoides species. MeV

For more information: Jonsdottir S, Svansson V, Stefansdottir SB, et al. Oral administration of transgenic barley expressing a Culicoides allergen induces specific antibody response. Equine Vet J. 2016 [Epub ahead of print Dec. 15]. http://onlinelibrary.wiley.com/doi/10.1111/evj.12655/full

Equine Laminitis Expert Dr. Andrew van Eps Joins New Bolton Center other musculoskeletal disRenowned equine laminieases. Laminitis is the numtis researcher, Andrew van ber-two killer of horses after Eps, BVSc, PhD, MRCVS, colic. DACVIM, joined the facul“Although I have always ty of Penn Vet’s New Bolton had a strong interest in reCenter as associate professearch, it has taken a back sor of Equine Musculoskelseat to clinics, teaching and etal Research. administrative work in recent Dr. Van Eps has spent years, ” he said. “This position most of his career at The at New Bolton Center allows University of Queensland Andrew van Eps, BVSc, PhD, me to prioritize research, in Australia, most reMRCVS, DACVIM which for me is very exciting. ” cently as director of the Dr. van Eps will also beEquine Hospital and assocome part of the New Bolton Center ciate professor of Equine Medicine. The hospital clinical staff. He said he was University is also his alma mater; he drawn by the “great clinical caseload graduated with his veterinary degree and brilliant colleagues,” as well as the (BVSc) in 1999 and his PhD in 2008. opportunities made possible by the new The move marks a return to New robotics-controlled imaging system. Bolton Center, where he completed his He has co-authored nearly 50 peerresidency in large animal internal medireviewed publications along with 15 cine in 2008 and spent another year as a additional publications. He’s given lecturer and clinician. more than 60 presentations, primarily The focus of van Eps’ research is imon topics related to laminitis, in places proving the understanding, prevention from Hong Kong to Palm Beach. He’s and treatment of equine laminitis and 16

Issue 1/2017 | ModernEquineVet.com

been a co-investigator on 15 research grants. Dr. van Eps said his work in the development and scientific validation of foot cooling (digital hypothermia/cryotherapy) as a preventative and also a treatment for acute laminitis is the most significant contribution of his work thus far. “Laminitis used to be a common and fatal complication of systemic illness. Now, with the widespread use of digital hypothermia, this is much less common,” he said. Dr. Van Eps’ research also focuses on solving supporting-limb laminitis, the type that led to the death of 2006 Kentucky Derby winner, Barbaro, who was treated at New Bolton Center for a catastrophic leg fracture during the Preakness Stakes that year. “We have made some significant inroads with regards to the cause of supporting-limb laminitis and potential preventatives,” he said. “I hope to continue this work and develop some practical solutions at New Bolton Center.” MeV

Reliability of URT Endoscopic Grading Many clinicians agreed on a diagnosis when they evaluated the same endoscopy images for upper respiratory tract disorders (URT), but improved clinician training and more defined grading systems, especially for conditions of the epiglottis, would improve this skill, according to a recent study. Researchers performed a blinded cross-over study evaluating observer agreement in URT endoscopy for multiple disorders, during resting and overground endoscopy, which attaches the endoscope to the horse to enable it to be examined while it is performing under normal conditions. The equipment is attached to the horse’s head, and it is attached to a recording device that is normally fitted to the saddle pad. The video of the airway is then wirelessly transmitted to the clinician. Endoscopy videos from 43 Thoroughbreds with URT disorders were evaluated in duplicate by four clinicians and graded according to previously defined scales. Intra-observer and inter-observer reliability were statistically evaluated. Perfect or near-perfect intra-observer agreement was found for arytenoid asymmetry at exercise, epiglot-

tis retroversion and epiglottis entrapment. Substantial intra-observer agreement was seen for arytenoid asymmetry at rest, palatal dysfunction, medial deviation of aryepiglottic folds (MDAF), epiglottic grade at exercise and pharyngeal mucus. Moderate agreement was seen for vocal cord collapse, ventromedial luxation of apex of corniculate process of the arytenoid (VLAC), epiglottic grade at rest and nasopharyngeal collapse, overall suggesting that individual clinicians are consistent in their grading of URT conditions. There was near-perfect agreement in intermittent dorsal displacement of soft palate (DDSP) and moderate agreement for grade-B arytenoid asymmetry at exercise, grade-2 MDAF and grade-2 palatal dysfunction. The results suggested that grading of these disorders is somewhat subjective and based on the clinicians opinion, the researchers said. “Observers were consistent in grading URT disorders. However, significant disparity in grading existed between observers for some conditions—affecting reliability,” the researchers wrote. MeV

For more information: McGivney CL, Sweeney J, David F, et al. Intra- and inter-observer reliability estimates for identification and grading of upper respiratory tract abnormalities recorded in horses at rest and during over ground endoscopy. Equine Vet J. 2016 [Epub before print Dec. 15] http://onlinelibrary.wiley.com/doi/10.1111/evj.12653/full

AAEP Foundation Awards $75,000 Scholarship to Iowa Student The American Association of Equine Practitioners (AAEP) Foundation awarded Alaina Kringen, a fourth-year veterinary student at Iowa State University, was awarded the $75,000 Coyote Rock Ranch Veterinary Scholarship. Ms. Kringen joins American Quarter Horse Foundation recipients, Josh Singer and Jenni Wright, in receiving a Coyote Rock Ranch scholarship. Each intends to pursue a career in equine-focused veterinary medicine after graduation. They were recognized at the 62nd AAEP Annual Convention in Orlando, Fla. Ms. Kringen said her goal as an equine practitioner is to offer exceptional medicine to the horses of her native South Dakota. Penelope Knight, an avid horsewoman and strong advocate for horse health, created the Coyote Rock Ranch Veterinary Scholarships in 2015. “With the help of the AAEP Foundation, I am pleased to offer

this great opportunity to benefit our next generation of veterinarians,” Ms. Knight said. Coyote Rock Ranch, located in Central Oregon, is a breeding operation for high-end cutting horses. For more information about the Foundation’s scholarship programs, visit http://foundation.aaep.org/scholarships-i-20.html.

Alaina Kringen, a fourth-year veterinary student at Iowa State University.

ModernEquineVet.com | Issue 1/2017

The Modern

Equine Vet

Reach your veterinarians wherever they are, whenever they want. FOR ADVERTISING RATES AND INFORMATION, EMAIL Matthew Todd