Equinevet March 2015 by The Modern Equine Vet

The Modern

Equine Vet www.modernequinevet.com

An udder mother for

orphan foals

Horse Cents: Taking Inventory Colic, Lameness, New Vaccine and More

Vol 5 Issue 3 2015

Table of Contents

Cover story:

4 An udder mother for orphan foals Cover Photo: Shutterstock/Elena11

Neonatal Care

What do pharmacokinetics mean to foal dosing?........................................................8 Horse Cents

Taking inventory: Go Lean..................................................................................................10 Technician Update

Using standing MRI to diagnose lameness..................................................................13 Feedbag

Prebiotic additive may blunt inflamm-aging.......................................................16 News

New vaccine for equine Pigeon fever............................................................12 Merial acquires two equine health care products................................12 Cornell gets new standing MRI.....................................................................15 Geography may influence colic risk................................................................17 advertisers Merck Animal Health.................................................. 3 Hallmarq Standing MRI.............................................. 5

AAEVT............................................................................14

The Modern

Equine Vet Sales: Robin Geller • newbucks99@yahoo.com Editor: Marie Rosenthal • mrosenthal@percybo.com Art Director: Jennifer Barlow • jbarlow@percybo.com contributing writerS: Paul Basillo • Kathleen Ogle COPY EDITOR: Patty Wall Published by PO Box 935 • Morrisville, PA 19067 Marie Rosenthal and Jennifer Barlow, Publishers percybo media  publishing

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Cover Story

‘ Udder Mother’

nourishes orphaned foals An automated milk-feeding

device built from easily purchased equipment offers several advantages over alternatives for feeding orphaned foals. The device can be rented or purchased by owners when a dam is deceased, rejects her foal, or is unable to produce milk. Jenni Schroeder, DVM, of Waller Equine Hospital in Texas, described how to build the device at the 60th annual convention of the American Association of Equine Practitioners. “The simple automated device refrigerates mare’s milk or milk replacer and pumps allocated amounts

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into a bucket at programmed time intervals,” Dr. Schroeder said. Nicknamed “The Udder Mother,” the Waller Equine Hospital has used the automated device to feed more than 20 orphaned foals. “The foals quickly learn the sound of the pump when it is activated and run to the bucket to drink.” The foals gained weight at an average pace, and there was no significant diarrhea, colic or constipation problems that required treatment, Dr. Schroeder reported. Options for feeding an orphaned foal include securing a nurse mare, hormonally-induced

K a t h l e e n

lactation of a barren mare and bottle feeding. They each have significant drawbacks. “A nurse mare is ideal,” Dr. Schroeder said. “They are good for social development and natural milk source, is the best source of nutrition; but it can be expensive and takes time to arrange with no guaranteed lack of rejection. And in the mean time, you still have to feed the foal.” Hormonally induced lactation of a barren mare takes 7 to 12 days of injections and no guaranteed acceptance, she said, adding, “in the meantime, you still have to feed the foal. “Bottle feedings every few hours

O g l e

Shutterstock/ 8045159901

Automated milk-feeding device

C lear D iagnostiCs . Better outComes . standing mri offers no stress, no anesthesia, just information. CASE STUDY NO. 1

HISTORY

A 9-year-old WB Jumper gelding presenting with Grade 2/5 right forelimb lameness noted after jumping. DI AGNOSTIC S

l Physical exam: Unrevealing l Nerve blocks: Localized lameness to proximal metacarpal bone region l Radiographs: Upper cannon bone area showed mild lucency in

3 3 3 3 Ultrasound: l

NEGATIVE

l Treatment:

Anti-inflammatories, ice; referred for standing MRI

upper metacarpal cortex (fig 1 ).

Two days post-examination, horse became non-weight bearing; right forelimb swollen in proximal metacarpal bone area.

Fig. 1

STA N DI NG M R I Findings

1. Focal fiber disruption and/or severe degenerative injury in the medial lobe of the l suspensory Treatment: and ice; referred for a standing MRI of the subcarpal region. ligamentanti-inflammatories (fig 2). 2. An incomplete non-displaced avulsion fracture in the palmar medial cortex of the third metacarpal bone at the level of the suspensory ligament injury (fig 3).

TR E ATM E N T: Post MRI Results

Fig. 2

Fig. 3

• Horse remained non-weight bearing. • Placed in a heavy Robert Jones bandage reinforced by a PVC splint. • Treated with broad-spectrum antibiotics and by regional limb perfusion. Radiographs taken six months post onset showed the fracture was healing. Horse jogged sound in hand and is beginning slow return to work.

To locate a Hallmarq standing equine MRI machine near you, visit www.hallmarq.net.

Standing Equine MRI

cover story

are labor-intensive for you, the staff or the owner, and can lead to behavioral problems,” she explained. “Bucketed milk left overnight leads to overconsumption, which can cause colic, diarrhea, gastric ulceration and lack of weight gain.” The automatic milk-feeding device, Dr. Schroeder emphasized, is simple to build with materials that can cost less than $400. Her practice rents the device to clients who also pay a deposit that is refunded when the device is returned. Some owners purchase the device so they do not have to return it. “It can earn you revenue ‘while

you sleep,’” she said. “It can ease the stress of feeding an orphan foal for you, your staff and your clients.” She said that owners told her it was easy and functional. Dr. Schroeder recommends a four-step process: 1. Build the device. 2. Ensure the foal has received adequate antibodies through colostrum or plasma administration. 3. Teach the foal to drink from a bucket. “We use a shallow pan first. We start by having them suckle a finger,” she said. “Have them suckle on it,

How to assemble the “Udder Mother” Unpack the refrigerator and ensure the milk receptacle fits inside with the door shut. Choose whether to mount the pump on top or to the side of the refrigerator. Decide whether to use the sliding bracket provided or screws. Ensure that screws will not interfere with the cooling coils. Ensure the pump fits within the 4 L storage unit. Use utility knife to cut exit holes in the container for the power cord and milk tubing. Place the pump in the selected mounting position and use marker to mark the mounting screw placement. Drill (3/16-inch drill bit) the mounting holes in the top or side of the refrigerator and then use the hammer to place the dry wall anchors provided with the pump in the holes. Mount the peristaltic pump and the protective container using the screws or mounting bracket and a Phillips head screw driver. Mark the suction hose entrance through the side of the refrigerator just below the freezer unit. Then use the ¼-inch drill bit to drill through the thin metal hosing and foam insulation of the fridge. Cut the desired length of suction tubing to run between the pump and the bottom of the milk receptacle. Feed a section of suction tubing through the hole just cut and to the bottom of the receptacle. Attach the stiff standpipe tubing provided with the pump to the distal end of the suction tube and place within the milk receptacle so it touches the bottom. The standpipe tubing keeps the suction tubing stiff so it does not curl up at the bottom of the milk receptacle. Attach the proximal end of the tube to the intake (suction) side of the peristaltic pump using the provided squeeze tube fittings. Silicone may be used to seal the exit hole through the wall of the refrigerator if desired. Attach the remaining section of the tubing to the output port on the pump. Place refrigerator near the stall and run the section of output tubing to distribute milk into a chosen receptacle in the stall from which the foal is to drink. Use cable ties as needed to fasten the tubing in place. Source: Jenni Schroeder, DVM, Waller Equine Hospital

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and then lead it slowly into the pan. Do not force them. Don’t manhandle, they’ll just fight you. You just have to be patient.” 4. Ensure that a 110 V electrical outlet and a stall or pen area are protected from the elements. Supplies needed to build the device include a compact (dormitory-style) refrigerator; a rectangular milk storage container that fits inside the refrigerator (remove the refrigerator shelves); and a peristaltic dosing pump with a timer. Dr. Schroeder uses the 115 VAC Beta

Photo Courtesy of Dr. Schroeder

DR-2000 Clock Based Chemical Feed System, which comes with the tubing and fittings needed for installation. It pumps an average of 150 mL/min of fluid and can be preprogrammed to cycle for up to 20 minutes of pumping, which would provide maximum output of 3 L per cycle. The timer has 24 cycles so it can be programmed to pump once an hour or every 12 hours, Dr. Schroeder said. She uses a clear plastic 4 L storage container to protect the pump from water and dust in a barn-type environment.

The foal drinks from the bucket, which is filled by the Udder Mother.

Dr. Schroeder advised that the receptacle needs to be small enough, placed at the proper height and at a slight angle, so that the foal’s muzzle can fit to the bottom and drink the entire amount. Also, it’s important that the mare or foal cannot tip over the receptacle. She recommended checking the level of milk in the device at least every 12 hours to refill and ensure it is working properly. For foals that drink well from a bottle but have difficulty learning to drink from a bucket, Dr. Schroeder recommended a Calf-Mate nursing bucket (Nasco) and modified by cutting the end off of a smaller human or goat nipple to fit the output. Foal-specific milk replacers can be ordered online or found at local feed stores. Dr. Schroeder mentioned that some choose to dilute the foal replacer to half strength for the first few feedings to acclimate the foal to taste if it was originally nursing from a mare and to avoid constipation. She advised avoiding sudden change in brands of milk replacer. With the automatic milk-feeding device, the foal will not depend on another horse for milk; however, Dr. Schroeder recommended that the foal be paired with a companion horse, either an older mare or gelding or even a goat “to learn manners.” Asked if she was planning to patent the device, Dr. Schroeder responded, “I just wanted to find something to help the average MeV practitioner.”

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Neonatal Care

What do

pharmaco mean to foal dosing? The pharmacokinetics of

many drugs differ in the neonate versus the adult horse, so equine veterinarians must make adjustments to minimize the toxic impact on patients in this age category, said Elsabeth A. Swain, DVM, DACVIM, at the annual convention of the American Association for Equine Practitioners in Salt Lake City, Utah. Consider just a few neonatal characteristics that have an effect on pharmacokinetics: • The body water content in neonates is much higher, often as high as 20% more than adults, which would lead to a larger volume distribution of watersoluble drugs. • At the same time, they have less body fat, which can lead to a decreased volume of distribution for lipid-soluble drugs. • Blood-brain barrier permeability is increased compared with adults. • The hepatic metabolic capacity is reduced.

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Dr. Swain and her colleagues showed that these foal characteristics resulted in an increased absorption and reduced volume of distribution for lipid-soluble medications, such as metronidazole, compared with adult horses, which may lead to their accumulation if adult dosing parameters are used. They looked at the effects of metronidazole because it is a common antimicrobial in equine practice for its protozoal and anaerobic activity. “In foals, it is used most frequently to treat Clostridium enterocolitis, C perferinges and C. difficile infections.” She added that Bacteroides fragilis is a rare cause of foal enterocolitis as are anaerobes. Metronidazole is a lipid-soluble medication that can cross cell membranes and is able to penetrate the blood-brain barrier. It requires hepatic metabolism for its activity. Adult horses are typically given

M a r i e

metronidazole at ranges of 15 mg/ kg to 25 mg/kg, every eight hours. The studied routes of administration includes oral, IV and rectal in adults. “Prior to this study, foal doses were extrapolated from previous studies in adults,” said Dr. Swain, who is a field service veterinarian at the University of Colorado College of Veterinary Medicine. Adverse effects of metronidazole range from inappetence to hepatopathy, peripheral neuropathy, or central neurotoxicity in horses. “These reports combined with metronidazole’s lipophilic nature and hepatic metabolism stimulated our group to investigate metronidazole in foals,” she said. They wanted to find out the unique pharmacokinetic profiles for metronidazole in foals compared with adult horses. They also wanted to know if maturational changes would influence these pharmacokinetic profiles even as early as 10–12 days of age. They looked at 12 healthy foals,

R o s e n t h a l ,

M S

which were assigned randomly to two groups. The first group of six foals was given oral metronidazole (15 mg/kg) by nasogastric tube to assure they received the entire drug. They were studied at 1–3 days of age. The second group received an IV infusion over 20 minutes of the injectable metronidazole. This group was studied at two age points once at 1–3 days of age and then again at 10–12 days of age after a washout period of 8–10 days. They collected blood through an IV catheter over a 24-hour period to measure the metronidazole concentration over time. No adverse effects were observed in any of the foals. “Our results showed that the peak plasma concentration of metronidazole in all the foals given at 15 mg/kg was comparable to those reported in adults,” she said, “and the oral bioavailability was about 100%.” Metronidazole in foals given at 15 mg/kg IV or orally does reach plasma concentrations adequate to inhibit common anaerobes, she said. However, the decay over time differed with older foals-seeing a more rapid clearance over time

than younger foals. The elimination half-life was 11.8 hours in foals versus the average reported in adults of 3.26 hours (P=0.006). Dr. Swain said that this was the most surprising result of their study—that the halflife for metronidazole for foals was almost three times as long compared with adults. As the foals aged, even by just 10 days, the clearance was faster. “Because metronidazole is cleared by the liver, this probably shows improved hepatic metabolic function with age,” she said. Because of the reduced clearance, she recommended altering the dosing recommendations in neonates to increase the dosing interval to every 12 hours rather than using the adult protocol of every 6–8 hours. This should help reduce accumulation of the drug and prevent adverse effects from metronidazole in these patients. In premature foals or those with hepatic dysfunction or susceptible anaerobic infections, she recommended possibly reducing the dose further to 10 mg/kg every 12 to 24 hours. MeV The session was sponsored by Luitbold Animal Health.

Shutterstock/ Bhakpong

kinetics

ModernEquineVet.com | Issue 3/2015

horse cents

Taking inventory:

Go Lean B y

Lean inventory management can increase profits

M a r i e

R o s e n t h a l ,

For a small one or two veteri-

nary ambulatory practice, inventory is among the largest expenses, explained Jorge Colón, DVM, MBA, who owns Jorge L. Colón, DVM, PLC in Lexington, Ky. Veterinary medicine may be a noble profession, Dr. Colón said, but if veterinarians don’t think of

M S

themselves as “professionals in the business of providing veterinary care,” they will not make the best decisions for their practice. Think: “What can I do to make sure that I have more for me at the end?” He suggested. One way to increase profit is to have a lean inventory management. That means stocking only what you need when you need it and using it by the time you get the bill for it. There are some items that are used infrequently that you have to keep on hand for emergencies or rare problems, but items that are used all the time that have frequent turnover can be managed to reduce costs and increase profits, according to Dr. Colón.

In addition, sometimes purchasing in bulk saves on the unit price. However, if it sits on your shelf too long, it winds up costing you because it ties up your money, so it might not be worth it, he explained. “Holding something on the shelf costs money,” he said. If the item is sitting on your shelf, it is not producing revenue, and if it sits on a shelf longer than your billing cycle, you’ve basically given your business a no-interest loan. You’ve already paid for it and you don’t make a profit on it until you use it. The longer you hold onto inventory, the more it costs you. Shrinkage is another inventory issue. Any time a drug is spilt, is dropped or expires before you use it, costs your business money. Discounts cost your business money. They all shrink your profits. “Going lean is a pain. It’s not easy and it takes you away from practicing veterinary medicine,” Dr. Colón said. It requires a new “philosophy.” “You are in the business of providing veterinary care. This is important, but you have to have a philosophy that guides you toward the things that you want and have an attitude to be able to do the things that you want to do,” he said. Set a goal, dream of achieving it and create an attitude that helps you get it done. To go lean, consider your three costs: 1. Purchase costs: take advantage of promotions and specials; look at the value of buying in bulk but remember that it should not sit on your shelf too long. 2. Order costs: who is ordering and how often? 3. Holding costs: how quickly can you resell it?

Regardless of your business, there are two types of ordering “One is: on Mondays, check your inventory. You want 50 bottles of something and you only have 30, so you order 20. It’s simple. The benefit of this strategy is it does not take much time and it is easily managed. The problem is that it is not too accurate. You have no idea what your demand rate is for that product during that time period,” he said. The second, fixed-order quantity is more labor intensive because it requires you to constantly monitor what your inventory is and to purchase based on its use. You are probably going to use more ReguMate during breeding season than in September. With fixed-order quantity, you order when you have a certain number of units left based on the demand for that product at that time. “The lean goal is to have what you need,” he said. “You will always have the quantity on hand that will allow you to produce the services that you want to provide, but without running out because if you run out, someone else will provide that service, and you will lose that client. But you don’t want so much on your shelf it will increase the costs to have that inventory.” Develop a good relationship with vendors so you can take advantage of promotions and discounts, reduce your ordering costs and implement an order system that enables you to avoid longterm holding costs. “My inventory turnover is to the point that I am not holding any item longer than the vendor’s billing cycle. I am using everything before I need to pay MeV for it,” he said.

Shutterstock/Mega Pixel

“Lean management seeks to eliminate any waste of time, effort or money by identifying each step in a business process and then revising or cutting out steps that do not create value to that practice,” he said. Before you can discuss any type of lean management, you need to understand that your inventory costs a lot more than the price that appears on the invoice. There are storage costs, unit costs, shrinkage and other costs that eat into your profits. “The inventory that you have costs more than that number on the invoice. There are purchasing costs, ordering costs and holding costs,” he said. “Purchasing costs are easy to understand; that is your invoice.” There are two different ordering costs. The first has to do with who is placing the orders. If the veterinarian does his or her own ordering and he or she makes $100 per hour and it takes 30 minutes, placing the order costs $50. If an office staffer makes $20 an hour, the ordering cost is $10. Then there is the missed opportunity. If you could be doing something else that earns you money, that half hour is now costing you $100. ($50 time spent + $50 lost revenue). “If I have a lameness, and I bill $100 an hour and I couldn’t go because I had to sit down and do my ordering than, theoretically, it costs me $100,” Dr. Colón said. “It costs me to fill that order because I failed to bill those hours out.” In addition, the more often that you have to order, the more expensive ordering is. If I order once a week at $50 an hour, it costs me $200 a month. If I order once a month at $50 an hour, it costs me $50 a month.

ModernEquineVet.com | Issue 3/2015

news notes

USDA grants conditional license for Equine Pigeon Fever Vaccine The USDA has granted a conditionally-licensed vaccine for Corynbebacterium pseudotuberculosis, more commonly known as pigeon fever, developed by Boehringer Ingelheim Vetmedica Inc. (BIVI). “During the last five-to-seven years, an alarming increase in the number of pigeon fever cases has been reported in the United States, particularly in regions where it has never appeared before,” said Robert Keene, DVM, equine technical manager at BIVI. C. pseudotuberculosis is a soil-borne bacterium that can persist for months in a variety of environmental conditions, and is primarily spread to horses through open wounds or flies. Prevalent in hot, dry climates, the disease was once thought to emerge sporadically in a few Western regions, but has recently appeared in areas such as Florida and Kentucky. Pigeon Fever presents itself most commonly as external abscesses in the pectoral region or ventral abdomen, and less often as internal abscesses or ulcerative lymphangitis. Although less common, internal abscesses located in the liver, kidney, spleen and lungs, have proven to be difficult to diagnose and treat, and

have a mortality rate as high as 40%, even with treatment. While easier to diagnose, treatment of external abscesses may be both very time consuming and expensive as they must be lanced, drained and undergo daily cleaning until the infection in the area subsides. “This vaccine is an important part of our commitment to working with horse owners and veterinarians to diminish the impact of pigeon fever," said Dr. Keene. “To achieve the best possible results, horse owners should work closely with their veterinarian to implement vaccination into their biosecurity programs.” A conditional license is granted when there is a demonstrated need for the product; this is the first vaccine for this condition. A conditionally-licensed vaccine has demonstrated safety and efficacy to be distributed as authorized in each state, and used by, or under the supervision of a veterinarian. Further efficacy and potency test studies are being done. MeV For more information about the new vaccine, contact BIVI Veterinary Technical Services at 866-638-2226.

Merial acquires two equine health care products Merial completed its acquisition of Legend (hyaluronate sodium) and Marquis (15% w/w ponazuril) from Bayer HealthCare. The addition of these two products to the Merial portfolio solidifies the company’s position as a leader in performance horse health care. “We are committed to providing horse owners with proven, safe and effective products, ensuring optimal horse health, which ultimately lays the groundwork for peak performance,” says Steve Mahoney, head of U.S. large animal, Merial. Legend is the first FDA-approved joint therapy product labeled for both intra-articular and IV injection. It is indicated in the treatment of joint dysfunction of the carpus or fetlock in horses due to non-infectious synovitis associated with equine osteoarthritis. Joint therapy is used to block the further release of inflammatory mediators. By decreasing the production and release of these mediators, Legend helps reduce joint inflammation and the resulting pain and lameness. “As a major cause of decreased performance in horses, joint dysfunction can develop from repeated episodes of trauma a horse experiences in everyday use, training or competing,” says Hoyt Cheramie, 12

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DVM, manager, large animal veterinary services, Merial. “In addition to the horse itself, individual horse owners also feel the negative effects of lost performance.” Legend has a proven track record, with millions of doses sold and more than 20 years of treatment success. In field studies, clinical improvement was judged to be excellent or good in 90% of the cases treated with I.V. Legend and in 96% of the cases treated with I.A. Legend. Marquis is the first FDA-approved product for the treatment of equine protozoal myeloencephalitis (EPM), a neurological disease caused by Sarcocystis neurona, a parasite that invades the brain and spinal cord. If left untreated, it can lead to serious, permanent damage to the central nervous system (CNS) or death. Horses become infected with EPM through contact with opossum feces by grazing or eating contaminated feed. The clinical signs can be subtle and similar to other equine disorders, so it can be difficult to detect. When used as directed, Marquis is proven to cross the blood-brain barrier to kill S. neurona, stopping the parasite from inflicting further damage to the horse’s CNS. MeV

technician update

Using standing MRI in diagnosis of single-limb lameness

diagnosed with kissing spines. Coffin joint injections with IRAP therapy have been performed since July of 2009 as needed to treat 1/5–2/5 intermittent lameness. Intra-articular corticosteroid use has been avoided since the horse had an adverse reaction to an IA injection in the spring of 2009. Flexion tests of the right-front fetlock were

Ms Lagrange checking the MRI images.

Photo Courtesy of Nicole Lagrange

It can be challenging for veterinarians to isolate clinical lameness by distal limb nerve blocking. Research suggests that distal nerve blocks can travel proximal quickly even when placed accurately. We have found that imaging of single-limb lameness that blocks to a palmar digital block may result in identifying pathology proximal to the placement of the distal nerve block. The Hallmarq low-field standing magnetic resonance imaging (MRI) is frequently useful in gaining additional images both distal and proximal of “successful” blocking patterns. One of our patients, a 19-year-old, Oldenburg gelding, which used for novice-level eventing currently, but was an upper level dressage horse when it was younger, presented with lameness. During his dressage years, the patient’s training was frequently interrupted by orthopedic issues, commonly ascribed to the right front foot because of blocking patterns. In fact, he had an MRI of the right front foot and contra lateral limb in 2009 that had minimal pathology. Later he developed a right fore medial suspensory branch injury in 2010 that was successfully treated with rest and stem cell treatment. He was also

Photo Courtesy of Nicole Lagrange

Nicole Lagrange, BS, RVT

Ms. Lagrange setting up a horse to take images with the Hallmarq standing MRI. ModernEquineVet.com | Issue 3/2015

technician update

When the horse was an upper level dressage horse, its training was frequently interrupted by orthopedic issues due to what appeared to be front limb lameness.

1/5–2/5 over a five-year period with at least 1–2 flexion test exams per year. He began a new career as an eventer with a new home at the end of 2011. Starting in March 2014, it was noted that the horse had a persisting 2/5 right-front limb lameness that blocked to a PD nerve block with 100% improvement. Intra articular therapy of both front coffin joints was performed with 6 mg Vetalog, and Amikacin. Two weeks post injection the horse shows a 1/5 lameness of the right front limb. At this point an MRI was recommended. On final exam prior to MRI in March 2014, horse was BAR and found to be 1/5 lame on the right-front limb both on the straight line trot and circling left. Palpation of the limb was within normal limits and the suspensory branches were slightly large as they had been for some time. The right-front lameness blocked to a palmer digital (PD) nerve block 100%. The MRI was performed in May 2014 following the suggested protocol of Dr. Werpy focusing on the rightfront foot and fetlock. MRI of the foot revealed only mild synovitis of the coffin joint, very similar to his 2009 MRI of the foot. Imaging of the right-front fetlock revealed a moderate condylar defect of the lateral fetlock joint articular surface. Current radiographs revealed no significant findings and ultrasound of the soft tissue structures of the fetlock region as well as the sesamoids were within normal limits.

Recheck MRI performed August 2014 showed that the moderate condylar defect was still present, however, it showed less signal intensity on a STIR image and appeared smaller. The patient was treated with NSAIDS (phenylbutazone) as needed, as well as daily hand walking and cold therapy (icing). He was also treated intra-articularly with IRAP. The horse is on continued stall rest in an outdoor pen (24' x 24') with a light hand-walk each day. Recheck MRI was recommended in 6 months to follow the progress of the lesion. What will never be known is if this patient had a fetlock lesion since 2009 that was missed in this horse’s work ups. However, going forward understanding how DNB’s drift and affect structures proximal to the anesthetized region is important in creating a diagnostic imaging plan for each patient. Since 2012, it has been our practice’s policy to MRI proximal to the DNB if the horse blocks 100% to a PD block. This is only one of many cases that horses have been found to have clinically correlated and significant pathology in the fetlock even though the patient blocks to a low palmar digital nerve block. MeV

About the author

Nicole Lagrange, BS, RVT, is an equine technician at San Dieguito Equine Group in San Marcos, Calif.

Cornell Ruffian Equine Specialists to Acquire Standing Equine MRI Cornell Ruffian Equine Specialists signed a lease agreement to install a Hallmarq standing equine magnetic resonance imaging (MRI) at its facility, which sits opposite the backstretch of Belmont Park in New York. The MRI allows imaging of an equine foot and lower limb in a standing position without the time, expense and risk of general anesthesia. The standing equine MRI system allows lameness issues to be clearly identified prior to competitions and can be used to manage the training of equine athletes. Additionally, the standing MRI can reveal lesions, such as fractures weeks before any damage would be visible on an radiograph. “The ability to assess a horse’s soundness prior to competition without the risk of anesthesia is a win-win for all of us who care about the health of equine athletes,” says Alan Nixon, DVM, chief medical officer of Cornell Ruffian Equine Specialists. “The proximity of Cornell Ruffian MRI to elite equine athletes offers a convenient resource to easily diagnose suspected lameness cases before a horse competes. In addition, we can easily treat injuries right after they occur and evaluate horses during recovery.” Cornell Ruffian Equine Specialists extends the reach of the Cornell College of Veterinary Medicine Equine Hospital.

ModernEquineVet.com | Issue 3/2015

Feedbag

Prebiotic additive may blunt 'iflamm-aging' By Paul Basilio

Shutterstock/WOLF AVNI

Older horses have some unique management requirements that can be addressed through proper nutrition and feeding regimens. In addition to “inflamm-aging,” a catch-all term that refers to the chronic, low-grade inflammation that occurs with aging, senior horses have a gradual decline in immune function characterized by a decreased ability to resist infection. Research has shown that older horses can display improvement in important serum parameters, body condition scores and quality of haircoat simply by switching to a senior feed, according to Mary Beth Gordon, PhD, director, Equine Research and New Product Development, Purina Animal Nutrition. “We know from research and practical experience that horses struggle with compromised immune systems and inflammation as they age,” Dr. Gordon said. “We wanted to figure out if further nutritional interventions could help lessen these issues.” Dr. Gordon and her colleagues at Purina collaborated with the Gluck Equine Research Center at the University of Kentucky to study whether certain nutritional additives would help with the alterations in the immune system that occur in the aging horse. “In our first study, a prebiotic additive called Ac-

Issue 3/2015 | ModernEquineVet.com

tivAge was shown to decrease tumor necrosis factor alpha and interferon gamma over time when compared with the control group,” she said. The study also showed that aged horses who were fed the senior formula had increased body condition scores and body weight. “Follow-up testing showed that ActivAge kept inflammatory markers lower than in the control group. The horses also showed improved immune response to influenza vaccination,” Dr. Gordon noted. As a result of these studies, Purina has incorporated ActivAge into senior horse feed formulas. ActivAge is a dried fermentation product that includes yeast cells and cell fragments. It contains multiple bioactive components, including polyphenols, phytosterols, organic acids and beta-glucans. “We now have results that show an ability to positively influence the immunity and inflamm-aging profile of the aged horse via nutrition,” Dr. Gordon explained. “There are many factors related to aging that we can impact through nutrition, and we should tailor nutrition programs to do so. By controlling an increase in inflammatory cytokines, our hope is to fully support the aging horse so they can thrive. ActivAge is another tool in the toolbox to help aging horses remain vibrant in their senior years.” MeV For more information: SeniorActivAge.com

news notes

Geography seems to influence colic risk, UK study shows A particular gastrointestinal disorder, which causes colic, is more prevalent in Lancashire, UK, compared with other nearby counties, according to researchers at the University of Liverpool and Lancaster University in the United Kingdom. They also found that idiopathic focal eosinophilic enteritis (IFEE), lesions causing an obstruction in a horse’s small intestine, is actually seasonal and occurs more often in younger horses. The findings emerged from a collaborative study involving equine specialist Debbie Archer, PhD, professor from the University’s Institute of Infection and Global Health, and Lancaster University statisticians Deborah Costain, PhD, and Chris Sherlock, PhD. The results have been published in the journal Plos ONE. The study used data from horses and ponies admitted over a 10-year period to the University’s Equine Hospital for exploratory examinations to investigate the cause of colic. Of these, 85 were IFEE cases. They also looked at the records of 848 horses without IFEE, which acted as controls. The researchers wanted to examine the effects of age, time of year and geographical location on the risk of the IFEE, the cause of which is unknown.

Environmental factors may play a role in the development of idopathic focal eosinophilic enteritis. Horses in one UK area appear to be at higher risk than those in other areas. “This work enables us to better identify horses at risk of IFEE and has provided some clues about the possible cause of the condition, which requires further research,” said Dr. Archer. “Horse owners in the Lancashire area should be aware that the chances of their horse or pony devel-

oping this condition overall are still relatively low but we appear to see more cases of IFEE here than anywhere else in the study region. It is important that we continue to try to find out what the underlying cause is to determine whether it can be prevented from occurring.”

Caring for a horse with IFEE Photo courtesy of the University of Liverpool.

Increased risk

The study, which covered a region from Leicestershire to Cumbria, showed there was an increased risk of this particular GI disorder in horses from around Lancashire. It added that as factors, such as breed, management practices and feed types, were unlikely to vary according to the observed spatial distribution, it was plausible that environmental factors might play a role in the development of IFEE. The report suggested that future research should, therefore, consider investigation of environmental factors such as soil types and pathogens associated with similar spatial patterns of disease in other species, including humans. A seasonal pattern was evident with the greatest risk of IFEE being identified between July and November. The risk of IFEE was found to decrease with increasing age, with younger horses, from birth to 5 years old, being at greatest risk. MeV

For more information: Archer DC, Costain DA, Sherlock C. Idiopathic focal eosinophilic enteritis (IFEE), an emerging cause of abdominal pain in horses: The Effect of Age, Time and Geographical Location on Risk. PLoS ONE, 2014; 9 (12): e112072 DOI: 10.1371/journal.pone.0112072. ModernEquineVet.com | Issue 3/2015

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