The Modern
Equine Vet www.modernequinevet.com
Colic: Time Is Not Your Friend Part 3 of a 4-Part Series on EPM: Advances in Treatment by Dr. Nicola Pusterla Technician Update: River Rescue Using Mesh for Inquinal Hernia
Care Credit: Open Letter to the Profession
Vol 11 Issue 7 2021
TABLE OF CONTENTS
COVER STORY
4 Time Is Not Your Friend When Treating Colic Cover: Shutterstock/Alexia Khruscheva
INFECTIOUS DISEASE
Part 3: EPM Treatment Advances ...............................................................................................10 TECHNICIAN UPDATE
Stuck in the Mud: The Importance of a Team ........................................................................14 NEWS NOTES
Slitted Mesh Appears Safe for Inquinal Hernia.........3 SPONSORED EDITORIAL
An Open Letter to the Equine Veterinary Profession..............................................................8
ADVERTISERS Epicur Pharma......................................................................................................3 Arenus Animal Health/Aleria............................................................................5 American Regent/Adequan...............................................................................7 CareCredit Sponsored Content .........................................................................8
Arenus Animal Health/Assure Gold...............................................................11 Zoetis/iStat..........................................................................................................13 Arenus Animal Health/Releira........................................................................15 Arenus Animal Health/Assure Gold...............................................................17
The Modern
Equine Vet SALES: Matthew Todd • Matthew Gerald EDITOR: Marie Rosenthal ART DIRECTOR: Jennifer Barlow CONTRIBUTING WRITERS: Paul Basillo • 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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Issue 7/2021 | ModernEquineVet.com
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NEWS NOTES
Slitted Mesh Appears Safe, Effective for Indirect Inquinal Herniation The use of slitted mesh appears to be a safe and effective technique for preventing the recurrence of indirect inguinal herniation (IIH) in stallions. IIH is a potentially life-threatening condition. The ideal preventive measure for breeding stallions ensures a minimally invasive closure of the vaginal ring that avoids recurrence of IIH while preserving both testicles. In this retrospective case series, researchers described a novel, minimally invasive laparoscopic tacked intraperitoneal slitted mesh (TISM) technique in the standing horse to close the vaginal rings. They evaluated its efficacy in preventing recurrence of IIH in 17 stallions. In total, 32 laparoscopic vaginal rings closures were performed in 17 horses between 3 and 10 years of age. The IIH was reduced by manual reduction in 14 horses
and at laparotomy in 3 horses. No intestinal resection was performed in any case. The vaginal ring closure was performed between 5 and 37 days (median 14 days) after reduction in horses that did not undergo laparotomy, and between 28 and 67 days (median 42 days) after reduction in horses that underwent laparotomy. No major intra- or postoperative complications occurred. Inguinal herniation did not occur in any of the horses following the procedure. Nine of the 13 active stallions returned to breeding, with similar semen quality as before treatment. The remainder were scheduled to resume breeding during the next season. No horse was castrated, and no owner reported abnormal size or shape of the testicles following the procedure. In 3 stallions, post-operative pain and activity limitations were noted but gradually resolved after 6 months. MeV
For more information: Wilderjans H, Meulyzer M. Laparoscopic closure of the vaginal rings in the standing horse using a tacked intraperitoneal slitted mesh (TISM) technique. Equine Vet J. 17 2021 April 17. https://doi.org/10.1111/evj.13454 https://beva.onlinelibrary.wiley.com/doi/full/10.1111/evj.13454
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GASTROENTEROLOGY
Time is Not Your Friend
WHEN TREATING COLIC y
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Whether a colicky horse is treated on the farm
or in a hospital, time is not your friend. Although an estimated 90% of horses with simple colic treated in the field recover, many quick decisions must be made to increase the horse’s chances, including deciding whether that horse should be referred, according to Anthony Blikslager, DVM, PhD, a surgeon at North Carolina State University College of Veterinary Medicine. Heart rate, for instance, is a primary indicator whether a horse needs to be referred, so an assessment of the cardiovascular system is a priority. “Time is of the essence when making these decisions as I think everyone knows,” Dr. Blikslager said. “What you are doing is trying to reduce the time it takes to get a horse to a referral center if it needs more advanced care. The ultimate goal is to increase survival.” To speed the initial examination, taking an abbreviated history is appropriate, he explained. Obtain the signalment, severity of pain, how long the signs have
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Issue 7/2021 | ModernEquineVet.com
e
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,
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been occurring, and any treatments that were already given. The physical examination should include an estimate of distension, as well as an assessment of the cardiovascular system. More detailed history, such as diet, deworming, etc. can be taken later, according to Dr. Blikslager. Before arrival, it helps to have some initial information, such as signalment, severity of pain and duration. “Are there signs of mild colic or moderate—the horse is starting to go down and get backs up—or is it severe—the horse is staying down and thrashing?” Assessing the heart rate either by a pulse on the facial artery or with a stethoscope, observing mucus membrane color, and capillary refill time are important initial parameters. “The reason for trying to get those important cardiovascular parameters initially is that you can change those with analgesics,” he explained. “The heart rate is the most predictive ultimately of the need for referral.” Find out if the owner has already given the animal
Shutterstock/anjajuli
B
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)
Not all Omega 3’s are the same; use the Researched and Recommended 1500mg Purified DHA formulation. Your Clients Deserve The Best in a Non-Pharmaceutical Solution.
– 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
ModernEquineVet.com | Issue 7/2021
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GASTROENTEROLOGY
THE DECISION TO REFER Examination
Normal
Refer
Colic
None
Recurrent, unresponsive
Pulse
<48 bpm
60–80 bpm
Membrane color
Pink
Congested
Gut sounds
Gurgle q 4–5 sec
No sound
Rectal
Cecal band, pelvic flexure
Distended intestine
Nasogastric reflux
<2 L
>2 L
Abdominocentesis
Light yellow TP <1.5 g/dL, TNCC <5,000 cells/µL
Serosanguinous TP >1.5 g/dL, TNCC >5,000 cells/µL
bpm, beats per minute; TNCC, total nuceated cell count; TP, total protein.
Source: AAEP 2020 AAEP Proceedings, December 2020
something for pain because that will affect the heart rate, he said. Dr. Blikslager likes to start with a short-term analgesic, such as a combination of xylazine and butorphanol. This enables the animal to be more comfortable during the initial examination, which also includes auscultation of the chest and abdomen, and nasogastric intubation. During this time, Dr. Blikslager can get a sense of how the animal is responding to the analgesia. If needed, he will consider a longer-term analgesia like flunixin meglumine if the animal is still uncomfortable. If there is no response to analgesia—and the pain is severe—he would consider detomidine and referring that animal. The remainder of the physical examination should include taking a temperature, which is useful for differentiating enteritis or colitis from a simple colic, he said. Rectal palpation also is useful for localizing lesions. Abdominocentesis can be useful. “Although typically, I am going to reserve abdominocentesis for a patient where I’m pretty sure it’s not a large colon problem. If
it’s a small intestinal problem, it’s far more useful.” Abdominocentesis results can provide “more additional convincing evidence,” if the owner is trying to make the decision to refer, he explained. Look at the color of the fluid, he said. A light yellow is normal, if there is frank blood, it’s a clear-cut sign that the horse needs to be referred. Ultrasonography is used heavily in referral centers, he said, but it can also be useful in the field in assessing both large and small intestinal issues. Another useful tool is measuring lactate. A significantly elevated lactate level can be a marker of an intestinal strangulating obstruction and ischemia, according to Dr. Blikslager. Treatment for a field colic is typically pain management, laxatives, such as mineral oil, dioctyl sodium sulfosuccinate or Epsom salts, and a fluid therapy plan to manage dehydration. Although many animals do respond, if the animal does not—the pain is unrelenting, there are signs of endotoxemia, more serious disease or the veterinarian is called for a second colic—the animal should be referred. “I’d like to break down the reasons for referral a little bit more simply,” he said. “It doesn’t matter what the other findings are showing you, if you cannot control the pain, it’s the horse making the decision for you. “And in case you are wondering, we do the same thing [in the hospital]. If the horse arrives upside down on the trailer in unrelenting pain, we go right to the induction stall for anesthesia,” he said. The best success will come from having a rapid, set system for evaluating the horse and deciding if a referral is warranted, he said, but it is essential to let owners know their options and help them understand why that referral might be needed. MeV
BE READY Being prepared is not just for Boy Scouts. Dr. Anthony Blikslager suggested that owners and stables be ready for an emergency like colic. On large farms or stables, or for horses owned by a syndicate, have a legal waiver prepared and signed that gives the veterinarian some indication of the owners’ intentions.
REFER OR NOT?
WHICH VETERINARIAN SHOULD RESPOND?
SURGERY OR NOT?
INSURANCE POLICY INFORMATION
The waiver should also specify who can make decisions if the owner is not available. However, one should always confirm directly with the owner if possible. Encourage farms to have a truck and trailer ready to go in case the animal does need to go to a referral hospital.
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Issue 7/2021 | ModernEquineVet.com
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
An open letter to the
equine veterinary
The past year has brought rapid-fire change to the industry. While you’ve been adapting to help horses and clients, we’ve been adapting to help you. FOR ME, IT ALL STARTED WITH PONY CLUB IN ENGLAND. I became inseparable from my horse, Flicka, and soon grew to love all things horse-related. In fact, I’ve spent much of my career in animal health dedicated to causes around horse health and welfare. Many of you equine veterinary professionals could tell a similar story. I’ve known enough of you over the years to understand that your love for horses lights up the core of your being and has done so since you were young. Whether through riding club, 4-H involvement, growing up on a ranch or any of the innumerable paths that lead to equine obsession, you live and breathe horses in a way that’s unique
among your colleagues in other segments of veterinary medicine. Unfortunately, I also know that for too many of you, your passion is offset by struggle. You have sacrificed incredibly to do what you love. For one thing, you could easily make more money in small animal practice. And if you are a woman, the income gap is even greater. You recent graduates are likely to be carrying a large student debt load. And irrespective of age or gender, you have accepted the physical risks associated with working around thousand-pound beasts and given up huge chunks of personal time to serve horse owners in their hour and place of need. Yes, there are moments of glorious reward, moments that remind you why you chose this profession in the first place. But for every wobbly new foal you deliver or soft look you get from a horse after relieving its pain, there’s a devastating diagnosis or treatment estimate to deliver that makes your client’s shoulders sag. We all recognize how frustrating it is when economics and emotion meet. In fact, from my 15-plus years working with equine veterinarians, I would go so far as to say it’s highly likely that most of your frustrations and challenges are financial in nature. The business of equine practice is no picnic. Providing top-level medical care to huge animals is expensive—your own costs may be rising every year—but when these costs run up against a client’s limited ability to pay, your passion for the horse often wins out. This makes it all too easy to discount fees, give away services and otherwise limit your revenue. And this is simply not sustainable for your personal or professional financial health. Let’s also talk about accounts receivable for a bit. How many management experts have you heard expound on the need to collect payment at the time of service? And how many of you have been able to successfully make this shift in your practice? From our research, it appears that this is still a challenge for the equine veterinary profession. Just as your medical tools and technology have evolved to meet your unique needs and challenges, your financial tools need to evolve as well. At CareCredit, we want to be part of the solution. We have worked with about 85 percent of eligible vet-
By Boo Larsen, General Manager and Vice President, Veterinary, CareCredit
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Issue 7/2021 | ModernEquineVet.com
SPECIAL ADVERTISING SECTION
profession
FROM CARECREDIT
erinary practices to deliver a financial patients involves a Lifetime of Care and We want to solution that has helped millions of pet collaboration, and the financial relationowners pay for veterinary care, which in ship is just as important as care of the keep you at the turn helps those practices deliver care. horse. In fact, clients want a healthy fiAnd we want to do the same for nancial relationship with you. They’re heart of equine you, the equine veterinarian. This is the seeking options that empower them to moment where we declare our commitprovide care for their horse. And as your care by bridging ment going forward. We are stepping partner, we are dedicated to making that into the gap because we want to ease happen. We’re setting out to provide a the gap between the financial pain points you experilevel of support to the profession and ulence on a daily basis. We are committimately the client in a way that reduces ted to getting it right by partnering with financial stress and helps provide greater economics and you in an unprecedented fashion. We access to horse care. We are here today will be supporting the things that make to move forward in that commitment. emotion. your lives better, and we will be comUltimately, we believe a cultural municating with you directly about fishift is within reach—from “the way nancial solutions that can help you, your clients and it’s always been” to “the way it should be.” We know your patients. CareCredit is not the silver bullet that will solve every Bottom line? We want to keep you, the equine vetproblem you’ve ever had. But we hope that helping erinarian, at the heart of horse care by being wherever you reimagine what’s possible will lead to renewed you are when you’re delivering that care. Think about excitement in your chosen career and a greater sense of it: Over time, diagnostic companies have developed wellbeing. And if we can help you change entrenched their technology to support you when you’re out in patterns (like sending invoices instead of collecting at the field—consider all your mobile radiography and the time of service), we think practice will be more ultrasonography options—so providing financial care fun again … and even a little more rewarding. needs to be as flexible and versatile as the other tools If there’s anything being in the veterinary industry you rely on. That’s our goal. has taught us at CareCredit, it’s that financial solutions But our commitment extends beyond the transaccan lessen the stress, frustration tional moment. Your relationship with your clients and and heartbreak so common in practice. And that there is a way out of awkward and uncomfortable financial conversations. When horse owners are prepared with an option that helps them manage the cost of care—whether it’s a one-time bill for $5,000 or the $500 necessary for ongoing wellness needs—you can get to work. And you’re more likely to get to do the right thing for every horse, which is why you got into this field to begin with. We want to keep you at the heart of equine care by bridging the gap between economics and emotion. This is how we make your care possible. Our journey together begins today.
ModernEquineVet.com | Issue 7/2021
9
INFECTIOUS DISEASES
3
PART
Advancements in Treatment: In this series, Nicola Pusterla, DVM, PhD, DACVIM, has been guiding us through a reflective account of equine protozoal myeloencephalitis (EPM), including advances in testing and diagnosing, as well as treatment and preventive measures. Part 1 of this series provided a brief review of the causes of EPM, while part 2 dug into the diagnostic challenges.
B y
N i c o l a
P u s t e r l a ,
D V M ,
P h D ,
D A C V I M
After the challenge of making an equine pro-
1. Diclazuril—Also known as Protazil (1.56% diclazuril, Intervet/Merck) Antiprotozoal Pellets, diclazuril is administered in a unique alfalfabased pelleted formulation for 28 days. It is dosed and administered as a daily topdressing that is highly palatable to horses. Of the triazine-derivative antiprotozoals, it has the highest bioavailability. The drug reaches therapeutic levels quickly, and no loading dose or vegetable oil is required. 2. Ponazuril—Marketed under the trade name Marquis (15% w/w ponazuril, Boehringer Engleheim), ponazuril is an orally delivered antiprotozoal paste that requires a loading dose to reach steady state more quickly. It is beneficial to give this drug with vegetable oil for improved bioavailability. It is also administered for 28 days.
tozoal myeloencephalitis (EPM) diagnosis, you are faced with the all-important treatment decision knowing the horse’s prognosis is tied to early intervention. Science has kept pace with this disease, and safe, effective treatments are available to help equine practitioners manage EPM cases. In this third of our 4-part series on EPM, FDA-approved pharmaceutical options are discussed, along with warnings when it comes to compounding.
Trio of FDA-Approved Treatments
There are currently 3 FDA-approved EPM treatments in the U.S. market (Table 1). All 3 are effective when used according to the manufacturer’s recommendation, but each option is administered differently.
TABLE 1: FDA-Approved EPM Treatments Available in the U.S.
10
Drug
Brand
Form
Dose
Duration
Considerations
Diclazuril
Protazil (1.56% diclazuril) Antiprotozoal Pellets
Pellet
1 mg/kg
28 days
N/A
Ponazuril
Marquis (15% w/w ponazuril)
Paste
5 mg/kg
28 days
• Loading dose • Add vegetable oil
Sulfadiazine/ pyrimethamine
ReBalance (sulfadiazine/pyrimethamine oral suspension)
Suspension
20/1 mg/kg
90-270 days
Given on empty stomach
Issue 7/2021 | ModernEquineVet.com
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INFECTIOUS DISEASES
COMPOUNDING: DON’T OPEN THAT CAN OF WORMS There have been a few cautionary tales shared throughout this 4-part article series, but none greater than compounding. Prescribing a compounded drug for EPM when an FDA-approved treatment is available puts not just the health of the horse at risk, but also your veterinary license. Compounded products have not been evaluated by the FDA for safety and effectiveness and are not FDA-approved for use in animals. As recent events have demonstrated, incorrectly formulated compounded products can result in lethal toxicity to horses and legal nightmares for the prescribing veterinarian. It is simply not worth the risk.
KEY POINT: It is illegal to prescribe a compounded product for the treatment of EPM if an FDA-approved option is available. Doing so could result in the loss of your veterinary license.
3. Sulfadiazine/pyrimethamine—Known by its trade name ReBalance (sulfadiazine/pyrimethamine oral suspension), this option is administered orally with a syringe and must be given on an empty stomach. Of FDA-approved options, this treatment is typically administered for the longest time (generally 90 to 120 days and up to 270 days). 4. For more information about these products, see the package inserts.
Supporting Therapies
When treating a horse with EPM, controlling the infection with an FDA-approved EPM drug is critical to clinical disease improvement. However, the destructive inflammation and neurological deficits in the horse caused by the organism may require additional supportive care. • Anti-inflammatory drugs are essential to help reduce the inflammation of the neurological system.
• Antioxidants, such as vitamin E, are often recommended for horses with neurological and neuromuscular conditions. • A balanced diet and focus on the horse’s wellbeing, including reducing stress, are important for optimal recovery.
A Word on Immunomodulators
Often, I am asked whether immunomodulators can play a role in helping EPM patients. There are no studies showing the benefit of immunomodulators for EPM, and I recommend them on a case-by-case basis, especially if the horse experiences a relapse.
Take-Home Message
When it comes to EPM, time matters. The sooner you treat the disease with an FDA-approved product the better the horse’s chance of recovery. In fact, horses treated with an anticoccidial drug are 10 times more likely to improve than untreated horses. Supportive care, including anti-inflammatories and vitamin E supplementation may also be beneficial to the horse. Steer clear of compounded EPM treatments, which are illegal at best and lethal at worst. It is not worth the risk to your license or patients. MeV
NEXT UP IN THE SERIES—PREVENTION.
About the Author
Nicola Pusterla, DVM, PhD, DACVIM, is a professor of epidemiology and medicine at the University of California, Davis, School of Veterinary Medicine. His research focuses on infectious diseases and molecular epidemiology. Dr. Pusterla wrote this article series in partnership with Merck Animal Health. He was instrumental in setting up the Equine Respiratory Surveillance Program with Merck at UC Davis.
For more information: Hunyadi L, Papich MG, Pusterla N. Pharmacokinetics of a low-dose and FDA-labeled dose of diclazuril administered orally as a pelleted top dressing in adult horses. J of Vet Pharmacol Ther. 2015;38(3):243-248. Reed SM, et al. Equine protozoal myeloencephalitis: an updated consensus statement with a focus on parasite biology, diagnosis, treatment and prevention. J Vet Intern Med. 2016;30:491–502.
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Issue 7/2021 | ModernEquineVet.com
EQUINE FIELD DIAGNOSTICS MADE EASY i-STAT ALINITY v
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i-STAT and Alinity are trademarks of the Abbott Group of Companies in various jurisdictions. All trademarks are the property of Zoetis Services LLC or a related company or a licensor unless otherwise noted. ©2020 Zoetis Services, LLC. All rights reserved. VTS-00125
TECHNICIAN UPDATE
Stuck in the Mud: The Importance of a Team By Tammy Treitline, CVT June 18, 2018 started out the same as any other workday in our northeastern North Dakota hospital: routine equine health care appointments consisting of dental floats, vaccinations and sheath cleaning. I made the mistake of thinking to myself “pretty light day, might even get a lunch break, and—best of all— appointments are inside the clinic and out of the cloudy, cold, potentially rainy weather outside.” Appointments were showing up on time until about 10:30 am and that is when the day started to change. The 11:00 am-scheduled appointment was an equine dental float in the clinic, but the owner called at 10:30 and asked if we could make a farm visit for lacerations instead of a clinic appointment. Apparently, the horse reared up while loading in the trailer, fell over, and now had blood coming from the nostril and lacerations on the head and legs. The owner was extremely concerned, so we canceled the in-clinic appointment, moved the remaining ap-
pointments to another veterinarian and headed out on the road. Luckily, the horse was okay, just minor lacerations and swelling from the fall. While we were at that farm, the clinic called asking if we could go to another emergency call. We agreed and had them move the afternoon appointments to the other available veterinarian. The second emergency was described as, “a horse stuck in mud by a river bank, with water up to his belly and he could not lift up enough to get onto a 2 foot bank to get to dry land.” The owner of the horse called the clinic looking for a horse sling. They wanted some type of sling/ harness to assist the horse forward or to lift the entire horse out of the mud. Unfortunately, our clinic did not have that piece of equipment, but the clinic thought we might be able to assist the horse and owner in the situation. Keep in mind that this is North Dakota so the distance between places is far. It was going to take us close to an hour and 15 minutes to get to there. We finished up at the first farm then headed in the direction of the horse stuck in the mud. We left about 12:45 p.m., just as it started to rain with temperatures in mid-to-upper 60s. I called the cell phone of the owner of the horse to let them know we were en route
We were faced
with finding the
fastest and safest way to remove a 1,000 lb horse
from a river made slippery by mud
Images courtesy of Dr. Kingsley
and grass.
On the left: The horse was unable to climb onto the side. On the right, rescue personnel put the horse on a small John boat so he would not drown.
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DON’T LEAVE YOUR BREEDING PROGRAM UP TO CUPID
REDUCE THE STRUGGLE.
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Arenus Animal Health | 866-791-3344 | www.arenus.com
TECHNICIAN UPDATE
Hannah Kingsley, DVM sedated the horse to make it easier to maneuver the gelding. Once on shore, they had to figure out how to get the horse out of the water.
with the estimated time of arrival, and I wanted to get more details on the situation. The owner explained that they found their 24-year-old Arabian gelding in the river around midmorning. They were able to row a small, low-sided (John) boat to the gelding, place a halter on and swim him back to the lowest portion of the river bank in the hope that he could climb out. Unfortunately, he was unable to climb out on the 2-foot embankment, and the river was at midbelly on the horse. The owners did have access to a telehandler and larger equipment to aid in removing the horse from the river. This is the reason the owner was looking for a sling/harness to lift the horse up and out of the river. They also had called the local fire department for assistance and equipment, which were already on the scene. The owner wanted to know if we had any ideas the crew could try while we are on our way to them. Some ideas suggested were to try to knock down a portion of the 2 foot embankment, or try to create a lower shelf for the gelding to step on, or to try to get wide straps or ropes around his chest and front legs to assist him forward. We cautioned them not to force the gelding too much because he might have a leg stuck underneath or was just too exhausted. In a water rescue, the strong underwater currents and debris are always a concern. It is hard to instruct a person how to fix a problem when you can’t exactly see the problem. Although in hindsight cell phone cameras can help with this.
We just turned off the highway—almost to the their farm driveway when the owner called. She wanted to meet us in the driveway because it had rained so much our truck would get stuck in the pasture. So we had to use a 4-wheeler to carry supplies to the scene. The scene had changed, the gelding was getting exhausted, his head was going down, and the river was rising. They had placed the small rowboat partially under him so he didn’t drown. We gathered supplies like clippers, an IV catheter, male ports, sedation drugs, anesthetic drugs, an IV extension set and saline for flush—basically the bare essentials that would fit with us on the 4-wheeler. At the scene, we had to help figure out the quickest, safest and most logical way to remove at least a 1,000 lbs of horse from a river with slippery mud and grass. The best option we had was to anesthetize the horse and pull him out in the John boat. This option would allow us to move the horse without him struggling and injuring himself or any of the emergency personnel— which seemed to be the safest scenario. This would be the fastest way to get the horse out of the water, although it did come with risks. Those risks included: • the small boat not being able to support the horse once anesthetized, • the horse’s legs getting caught with debris under the water, • the support cable to the boat breaking, • the horse waking up in mid transport, and
By the time they arrived, the scene had changed. The horse was exhausted, his head was going down, and the river was rising.
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Issue 7/2021 | ModernEquineVet.com
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Arenus Animal Health | 866-791-3344 | www.arenus.com
TECHNICIAN UPDATE
LEFT: Dr. Kingsley had sedated the horse and stayed with him as they used a wench on the firetruck to pull the entire boat ashore. RIGHT: Tammy Treitline in the barn with horse, who required fluids and medication to reduce inflammation. He was exhausted, and showed some facial nerve damage, but improved steadily.
• anesthetizing, recovering and supporting an exhausted horse. Even with all these risks, this method was still our best option in this scenario. The firefighters attached the front cable of the fire truck to the front of the boat with a carabiner clip a firefighter had in his pocket. The cable would pull the boat up the embankment. The firefighters also placed a board in the water next to the boat to help maneuver the front of the boat onto the embankment once it was being pulled by the cable. We also needed to secure the horse with a strap once anesthetized and in the John boat. We did use the life jackets in the boat to support the horse's head when anesthetized, to try to prevent possible facial nerve damage. Again—in hindsight—we probably should have worn life jackets ourselves on the river. One of the most important rules in large-animal rescue is safety, and to make sure you never become the focus of the rescue. Once we anesthetized the horse it was “GO TIME” to pull the boat up the embankment, which 18
Issue 7/2021 | ModernEquineVet.com
worked really well until the cable on the fire truck got entangled. The cable was caught enough so it would not release and reset nor would it continue to pull. The boat with the horse was up on the embankment but not in a location far enough away from the river to recover an anesthetized horse. A simple solution was to back up the fire truck and continue to pull the boat with the horse farther onto land. However, it had rained so much that the fire truck had no traction on the mud and wet grass. So the next solution was to use the telehandler to pull the fire truck and the boat with the horse farther away from river. The reason we needed the anesthesized horse farther on land was to avoid a recovery of the horse on slippery mud and wet grass, and to limit the possibility of the horse having a rough recovery. There was also the likelihood of him falling back into the river. This solution worked and the emergency personnel were able to pull the horse far enough onto land for the recovery phase. The next phase of the rescue was recovering the anesthestized horse. The team was able to tip the John boat and gently slide the horse out onto the grass. The concerns with recovery of the horse were: • The area was slippery, increasing the possibility of the horse not being able to stand up well. • The horse was exhausted, which would affect the cardiovascular and muscular systems. • We were concerned about potential hypothermia.
In my 20 years as a veterinary technician, I can look back on different cases and wonder how incredible it was that the patient survived against all odds. Some situations start out as emergencies bordering on disasters. I have come to appreciate the extent of the teamwork and effort it takes to improve a bad situation. I have learned to appreciate the colleagues who you work and collaborate with every day. They push you to strive to be better and learn new things. Lisa Trader, CVT, is one of those colleagues. I have worked with her for many years. When the horse rescue occurred, she challenged me to learn more about large animal rescue and help her with a presentation for our annual state veterinary technician meeting. So thank you, Lisa, for being interested in large animal rescue, pushing me to learn more. Another inspiring person is Hannah Kingsley, DVM the veterinarian that I had the pleasure of working with on the day of the rescue. Dr. Kingsley is an incredible veterinarian who strives to improve patients care, quality of life, and is determined to find the best solution to any problem she faces. Dr. Kingsley is always willing to discuss the different cases, treatment, or diagnostic options. She has allowed me to view things from a different point of view and become more knowledgeable in different areas—another person pushing me to be better. A few months prior to the water rescue, Lisa found a local seminar held by the state on large animal rescue and emergencies that all 3 of us attended. The seminar discussed different scenarios, dangers posed and different rescue options. A couple of things I learned directly from handling this rescue: • Getting camera phone videos ahead of time might have been helpful in guiding the rescue operations until we arrived. • We were lucky, but we probably should have worn life jackets. • Looking back, I probably should ask more questions before agreeing to help.
The temperature of the horse was 97.8o F, the heart rate was 40 beats per minute, respiration was 8 breaths per minute, and the capillary refill time was less than 2 seconds. The firefighters had a large blanket with a wool liner to cover the horse to increase his temperature. We used portable forced-air heaters to create a warm air flow under the blanket to increase the body temperature. We discussed placing an IV catheter at this time and starting lactated Ringers solution to help support the cardiovascular and muscular systems. Before we could place the catheter, the horse stood up and started to the barn. The recovery phase took 28 minutes from removal from the boat to standing. Once the horse was in the barn, a 14-guage, overthe-needle IV catheter was placed and lactated Ringers fluid started. The fluid therapy helped support the kidney and cardiovascular systems from the exhaustion symptoms observed. The horse did show slight facial nerve damage on the right side. The horse was also given flunixin meglumine to reduce inflammation of the facial nerves and muscles. The horse continued to improve so we instructed
Shutterstock/nelelena
Teaching Points
the owners to monitor him throughout the night and call if they had any concerns. Once we had packed up the supplies in the truck, we headed home soaking wet. On the way home, we had to call Lisa and let her know about our exciting water rescue. I did a follow-up call the next day with the owners. The horse was showing some muscle soreness but was eating and drinking well. The facial nerve paralysis on the right side had improved. The water rescue was an amazing situation, which could have had many different outcomes. Through this experience, I realized how important teamwork is—especially working with other emergency departments and personnel. A career in veterinary medicine can be a very exciting profession with rapidly changing situations. Being as prepared as you can and learning from colleagues will help you grow in this profession. MeV
About the Author
Tammy Treitline, CVT works for Kingsley Equine and loves being outdoors hiking, riding, enjoying each and every day. ModernEquineVet.com | Issue 7/2021
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