The Modern Equine Vet - March 2024

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Referring a

FOAL NEONATAL

Tips for making the decision

By Marie Rosenthal, MS

An early referral may give a neonatal foal a better chance at survival than treating some problems in the barn, but how does a veterinarian decide which to do when a foal can quickly go from doing okay to not doing so well?

Trust your instincts when assessing a young foal, recommended Emily F. Floyd, BVSc, DACVIM, MRCVS, an internal medicine specialist in neonatology, at Rossdales, in England. Dr. Floyd listed some red flags at the BEVA Congress 2023, held in Liverpool.

Right off the bat, some issues are well-suited for farm care, and some are not, she added. “There are some things that you’re probably not going to treat in the field successfully to start with,” she said.

For instance, most veterinarians can manage a neonatal maladjustment syndrome, infection, colic, diarrhea or isoerythrolysis, if they are mild cases, but if they worsen, don’t hesitate to refer, Dr. Floyd suggested.

“If you are identifying them as a mild case, it may well be something that you can just monitor at home,” she said. “But there are definitely things that are not suited to at-home care.”

The conditions that could be difficult to manage at home include sepsis or organ dysfunction; neurological issues, including persistent seizures; severe colic or diarrhea; inability to tolerate enteral feedings; and issues that may require surgery or recumbency.

“This is not an exhaustive list, but these are the sorts of things that I think personally are difficult to manage at home,” Dr. Floyd said, so it’s a good idea to start talking with the client about a referral early.

“When we think about identifying the need for referral, I think it helps to be logical,” she said. To her that means going through the initial foal examination in a logical fashion to identify any red flags.

The mare’s history can be the biggest red flag, she said. If the pregnancy was difficult or the mare had an illness during the pregnancy, she is less likely to produce a healthy foal, and it might be a

good idea to suggest the client call you when the mare begins foaling, so you can address an issue immediately.

“If you're having any signs that the mare had placentitis or has had premature lactation, there’s going to be greater risk for sepsis in that foal. So, you want to be on the ball before you even get there,” Dr. Floyd said.

Ask the client whether the foal met the milestones of the 1-2-3 rule—healthy foals should stand within 1 hour, nurse within 2 hours and pass the meconium within 3 hours after birth.

“Often you will get a story like this from a client—I think it's one of the most common things I hear —'The foal was a bit slow and then it had been nursing.’ If the foal didn't meet those marks, your alarm bells already should be going,” she said. Sometimes a foal will put its head up to the mare’s nipples, but won’t nurse, and clients mistake that for suckling, she warned.

Entropion, even if the eyes are slightly sunken, is a sign the foal is becoming dehydrated and probably is not nursing.

A dystocia foal is more likely to have at least 1 problem and should be referred.

Look the foal over to see if everything from the hair coat to the eyes and legs look normal.

“When you're looking for the red flags, work through the process. It might be in the history; it might be in your physical exam or maybe the foal's not doing what you expect. And don't be afraid to refer because you haven't got the facilities to [take care of the foal],” she said.

If the foal is living on the outskirts of your practice, it’s probably better to refer because you might not be able to get to it if it starts having problems. “Foals go wrong very quickly,” she warned.

“Even if the foal's not going to need advanced care, it still might be better to give the fuller care it needs straight away” in a referral hospital rather than the barn, she said.

Making the Decision

“You're using your history, you're using your clinical exam, and you're thinking to yourself, ‘Well, I think I've probably got this’, or ‘I haven't got this, and this is what I'm going to do,’” she said. “This is the really critical point.

“If you decide, ‘I've got this, I can treat this foal at home and know what's going on,’ you want to be critical of what's happening when you treat it,” she

RED FLAGS SIGNALING A REFERRAL

Here are the red flags for Emily F. Floyd, BVSc, DACVIM, MRCVS, an internal medicine specialist in neonatology, at Rossdales, in England.

1. SEPSIS

“Sepsis is a big red flag,” Dr. Floyd said, “We still recognize that sepsis is probably the leading cause of foal death across the UK, but it’s actually often a complicating factor of other things.”

The obvious signs are cardiovascular compromise, but sometimes the first sign is just a foal that is lying around. “We had a shire foal this year that came in with early sepsis. You could get this foal up, and it would get on the mare, but as soon as you turned around, it would just flop in a heap,” she said.

Signs of hypoxia and vasodilation are signals that the foal has a more severe sepsis. “If you're seeing a coronary band hyperemia even before the foal has collapsed in a heap, it's a good sign to you that you've got inappropriate vasodilation. You're starting to have cardiovascular dysfunction. So that to me is always a real red flag. Those foals could have bigger problems developing that you may not be seeing,” she said.

2. ORGAN DYSFUNCTION

“If you're seeing obvious signs of problems in any of the big organ systems,” such as abnormal respiratory problems, it’s time to refer. These problems are prevalent in premature foals.

“If they're not able to maintain their thoracic inflation, they're very difficult to treat,” she said.

3. NEUROLOGIC PROBLEMS

If the foal has nystagmus; seizures; does not reach its milestones; or the client thought the foal was doing well but now is not; and it has increased muscle tension, rigidity and has trouble with its balance, it should be referred.

“You're picking up first neurologic signs in a foal that has perhaps a history of dystocia or something else, this is a point to intervene and say, ‘This foal is getting on the slippery slope of downwards,’” Dr. Floyd said. “If you act now, you’re much more likely to be successful.”

Neurological problems and seizures, even partial seizures are difficult to manage at home. It’s better for the foal if you can intervene before it has full seizures.

4. GI ISSUES

If a foal has a small amount of diarrhea that is not typically a problem, but if it’s got a marked abdominal distension or goes beyond a “normal” meconium impaction, “don’t keep persevering. Either do some more diagnostics or think about what you can do to help this foal.

“I think one of the other common things that people get tricked is that you have these foals that are maybe a bit immature or they've got mild maladjustment, and they do have a meconium impaction, and GI delayed transit, but they also maybe have a small bladder tear. And so, you get sort of trapped in thinking this foal's got a meconium impaction, and you're treating it for that for the first 24 hours. But the foal may have [have another issue, too].”

It is important to be critical about reassessing the foal to assure you are not missing other signs that this isn't just a simple problem.

“I think if they're refluxing—and we do get that syndrome in foals that are a few hours to 24 hours of age—this sort of syndrome of ileus after, maybe it's part of maladjustment, maybe it's an inflammatory thing, but they don't tolerate milk well.

“And I think if you have a foal that's not tolerating milk well for more than a day, it's very difficult to give them adequate nutrition at home,” Dr. Floyd said. “I would get them into the clinic.”

5. SEVERE RIB FRACTURES

Rib fractures are common, but if there are several cracked ribs and the rib cage is unstable, the foal should be referred for surgery.

6. RECUMBENCY

“The final red flag for me for referral is a foal that's recumbent for whatever reason, if they're recumbent and they stay recumbent, it's hard to keep them at home,” she said. There are many reasons for recumbency from orthopedic to neurologic to gastrologic issues, so get them into the clinic.

said. Is the foal progressing the way you expected? If you are going to treat, what do you hope to see to demonstrate the foal is improving?

If not, alarm bells should again be ringing loudly, according to Dr. Floyd.

If you aren’t sure, it is entirely appropriate to run some routine blood tests. If any of the ranges are abnormal that could help you make your decision faster. The results could “prompt you to say, ‘Actually I think I might be underestimating this foal’s severity of disease.’”

Ultrasonography is useful, she said. “Your ultrasound machine is your friend; it's so quick, it's so easy,” she said.

If you aren’t sure what to do, reassess and get the client to call you in about 30 minutes to see how the

foal is doing. “If things aren't going the right way, don't just keep persevering,” she said. If you still aren’t sure, pick up the phone and talk with a colleague, she suggested.

If you do decide to refer, talk with the center and ask about costs to help with the client’s expectations, Dr. Floyd suggested.

There are always exceptions, Dr. Floyd said. Larger breeding facilities with state-of-the-art facilities and highly trained staff might be able to manage a difficult case, but for the most part, a quick referral means the best chance for the foal, she added.

“Trust your instincts. If it doesn't seem right, it probably isn't right. Act on it straight away,” Dr. Floyd said. MeV

No Effect on SAA Response Linked to Penicillin G or Flunixin in Healthy Horses

By Landon Gray

There does not appear to be an associated effect on serum amyloid A (SAA) response in healthy adult horses treated with procaine penicillin G (PPG) given in multiple injections sites and/or flunixin meglumine, according to data shared at the 69th annual meeting of the American Association of Equine Practitioners.

The researchers decided to look at PPG after elective procedures, because “we usually give high volume PPG in the muscle,” which theoretically could damage it, said Jurica Trsan, DMV, a large animal internal medicine specialist at the David and Bonnie Brunner Purdue Veterinary Medical Hospital, in West Lafayette, Ind.

“As you know, flunixin meglumine reduces inflammation, and we don’t know actually, [the effects] PPG—or any kind of intramuscular injections—causes,” Dr. Trsan said.

Crossover Study

The researchers collected blood at 0, 24, 48, 72, 96 and 120 hours after initial administration of the medications to measure SAA (washout period, 30 days). In the control group, they found that every horse except 1 had individual SAA values that were within the reference range (≤20 µg/mL). The 1 exception had a SAA value of 28 µg/mL at 72 hours.

Similarly, in the flunixin meglumine group, 5 horses showed normal SAA values, with 1 showing an SAA value of 24 µg/mL at 96 hours.

Five horses in the combined PPG and flunixin meglumine group also showed normal SAA values within the reference range, but the sixth had increased SAA values of 32 µg/mL to 45 µg/mL between 48 hours and 96 hours post-drug administration.

Administering PPG or flunixin during an elective procedure should not alter the SAA kinetics.

The researchers aimed to evaluate the effect of PPG and/or flunixin meglumine on SAA response in healthy horses when used at clinical dosing regimens. They conducted a crossover design study and enrolled 6 healthy adult horses. The study had 4 arms:

1. PPG group (intramuscularly every 12 hours for 72 hours),

2. flunixin meglumine group (IV every 24 hours for 72 hours),

3. a combined PPG (intramuscularly every 12 hours for 72 hours) and flunixin meglumine group (IV every 24h for 72 hours) and

4. a control group.

PPG Injections alternated between the right and left neck, right and left semitendinosus muscles. Flunixin meglumine was given in the jugular vein.

For more information:

However, in the PPG alone group, all the horses displayed normal SAA values throughout the study.

No Differences

The researchers determined there was no difference in the area under the SAA time curve between the control and treatment groups (P>0.05). They concluded that there was no inflammatory response that induced an SAA value above the reference range in most healthy adult horses triggered by the administration of intramuscular PPG and/or IV flunixin meglumine.

Dr. Trsan noted the study was limited by the small sample size, potential carry-over risk and unforeseen environmental conditions.

“As a conclusion from our study, administration of PPG and/or flunixin meglumine during elective procedures should not alter the SAA kinetics, especially if given in multiple, [alternating] administration sites, and it shouldn't be attributed to PPG [or flunixin meglumine] if you have SAA elevation,” Dr. Trsan concluded. MeV

Trsan J, Nottle BF, Pusterla N. Effect of procaine penicillin G and flunixin meglumine on serum amyloid A response in healthy adult horses. J Equine Vet Sci. 2023;129:104876. doi:10.1016/j.jevs.2023.104876. https://pubmed.ncbi.nlm.nih.gov/37451522/

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 the only FDA-Approved equine PSGAG joint treatment available, and the only one proven to.2, 3

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 lifetime.2, 4, 5

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

Managing Insulin Dysregulation

Rethink That Protein in Your Insulin-Dysregulated Horses

When feeding horses with insulin dysregulation (ID), high-protein ration balancers have historically been the go-to treatment recommendation, despite the fact that the influence of dietary protein on disease control is not well understood.

Recent evidence, however, suggests that highprotein meals may actually exacerbate postpran-

dial hyperinsulinemia in equids with ID, according to Allison T. Palmer, DVM, an equine internal medicine resident at The Ohio State University College of Veterinary Medicine. The new evidence is compelling enough to call into question the safety of this nutritional intervention in patients with ID.

By Paul Basilio

Shutterstock/anjun

Break free

Help your equine patients

by controlling the clinical signs associated with osteoarthritis

• The only FDA approved pentosan polysulfate sodium injection

• Convenient; only 4 intramuscular injections required

• Not limited to use for specific joints1

To learn more about Zycosan®, please scan the QR code or visit go.dechra-us.com/zycosan

24-hour Veterinary Technical Support available: (866) 933-2472

Nonurgent Technical Support available: support@dechra.com

Important Satefy Information

As with all drugs, side effects may occur. For intramuscular use in horses only. Not for use in humans. Pentosan polysulfate sodium is a weak anticoagulant. Caution should be used when administering Zycosan if you are taking an anticoagulant. In case of accidental self-injection, seek immediate medical attention. If product comes into contact with skin, rinse skin thoroughly with water and seek medical attention if needed. Horses with hypersensitivity to pentosan polysulfate sodium should not receive Zycosan. Do not use Zycosan concurrently with other anticoagulant drugs. Do not use in horses with clotting disorders or within 24 hours of surgical procedures. Caution should be used when administering this drug before or after strenuous activities. Caution should be used when NSAIDS are administered concurrently due to the anticoagulant effects of Zycosan. If Zycosan and NSAIDS are used concurrently, horses should be monitored for hemorrhage or other clinical signs of abnormal bleeding. The safe use of Zycosan has not been evaluated in breeding, pregnant, or lactating horses. The safety of long-term repeat use of Zycosan has not been evaluated. The most frequently reported adverse reactions are injection site reactions, prolongation of coagulation parameters (activated partial thromboplastin time (aPTT) and prothrombin time (PT). Refer to the prescribing information for complete details or visit www.dechra-us.com.

1. Zycosan® Freedom of Information Summary NADA 141-559

©

Feeding the ID Equid

“Current recommendations for feeding horses with ID principally focus on 2 primary goals,”

Dr. Palmer said during a presentation sponsored by Purina at the 69th Annual AAEP Convention in San Diego. “The first goal is to encourage weight loss where appropriate, and the second goal is to minimize postprandial hyperinsulinemia. The amount of hydrolysable dietary carbohydrates in the diet frequently is manipulated to achieve these aims.”

Often the goal for horses with insulin dysregulation is to minimize the postprandial insulin secretion.

Most current dietary strategies for equine ID patients involve feeding low-nonstructural carbohydrate (NSC) forage and low-NSC, high-protein ration balancers to minimize the risk for trace mineral and vitamin deficiencies over time. NSCs include starch, monosaccharides like glucose and fructose, disaccharides and fructans, according to Dr. Palmer.

Pasture grass, cured hay and other forages can contain high levels of NSCs, which are associated with postprandial hyperinsulinemia.

Zycosan®

(pentosan polysulfate sodium injection)

250 mg/mL

For intramuscular use in horses only.

Brief Summary (For Full Prescribing Information, see package insert)

CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

DESCRIPTION: Zycosan contains pentosan polysulfate sodium, a semi-synthetic polysulfated xylan.

It is a pale yellow to brownish yellow, clear, sterile solution.

INDICATION: For the control of clinical signs associated with osteoarthritis in horses.

CONTRAINDICATIONS: Horses with hypersensitivity to pentosan polysulfate sodium or any of the inactive ingredients in Zycosan should not receive Zycosan. Do not use Zycosan concurrently with other anticoagulant drugs. Do not use in horses with clotting disorders or within 24 hours of surgical procedures (see Warnings and Precautions).

WARNINGS AND PRECAUTIONS:

User Safety Warnings: Not for use in humans. Keep out of reach of children. Pentosan polysulfate sodium is a weak anticoagulant. Caution should be used when administering Zycosan if you are taking an anticoagulant. In case of accidental self-injection, seek immediate medical attention. If product comes into contact with skin, rinse skin thoroughly with water and seek medical attention if needed. To obtain a Safety Data Sheet (SDS), contact Dechra at (866) 933-2472.

Animal Safety Warnings and Precautions:

Zycosan has been shown to prolong coagulation parameters up to 24 hours after injection, therefore caution should be used when administering this drug before or after strenuous activities (see Target Animal Safety). Due to the anticoagulant effects, this drug may exacerbate Exercise Induced Pulmonary Hemorrhage (EIPH).

“Most of the research effort [in this area] in humans is focused on the role of dietary protein and amino acids in improving systemic insulin sensitivity, encouraging weight loss, and improving gain of lean muscle mass,” Dr. Palmer said.

Different From Human Medicine

Several studies in human medicine have shown that high-protein diets in patients with type 2 diabetes mellitus result in significantly enhanced insulin secretion over time, independent of weight loss.

That’s great for humans who want to reduce their dose of exogenous insulin, but that’s not quite so great for horses with ID, where a principal therapeutic goal is minimizing hyperinsulinemia.

“Actually, the opposite is almost always the goal in horses,” Dr. Palmer explained. “We want to minimize this postprandial insulin secretion. Hyperinsulinemia is the most important risk factor for endocrinopathic laminitis.”

The concurrent use of NSAIDs with Zycosan has not been evaluated. Due to the anticoagulant effects of Zycosan and known anticoagulant effects of some NSAIDs, caution should be used if NSAIDs are concurrently administered. Horses concurrently treated with Zycosan and NSAIDs should be monitored for hemorrhage or other clinical signs of abnormal bleeding (e.g., petechiae, ecchymosis, or epistaxis). The safety of long-term repeat use of Zycosan has not been evaluated. Pigmentary changes in the retina (pigmentary maculopathy) have been reported in human patients following long-term oral use of pentosan polysulfate sodium. It is not known if a similar finding occurs in horses. The safe use of Zycosan has not been evaluated in breeding, pregnant, or lactating horses.

Other Warnings: Do not use in horses intended for human consumption.

ADVERSE REACTIONS:

Injection site reactions were the most frequently reported adverse reactions in the field study. Injection site reactions were associated with clinicopathology changes in some cases. Other adverse reactions reported in more than one horse were prolongation of coagulation parameters (activated partial thromboplastin time (aPTT) and prothrombin time (PT)), lethargy, behavior changes, and colic. To report suspected adverse events, for technical assistance or to obtain a copy of the Safety Data Sheet (SDS), contact Dechra at (866) 933-2472 . For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/reportanimalae.

STORAGE CONDITIONS: Store at room temperature 68-77°F (20-25°C), with excursions to 59-86°F (15-30°C).

MANUFACTURED FOR:

Dechra Veterinary Products

7015 College Boulevard, Suite 525

Overland Park, KS 66211 USA

Approved by FDA under NADA # 141-559

Zycosan is a trademark of Dechra Limited. R 01 2023

Equid-Centric Research

Despite the difficulties in extrapolating human studies to an equid population, relatively little attention has been given to the effect of dietary protein on insulin and glucose dynamics in equids. However, this is starting to become an active area of investigation for several research groups.

“While NSC appears to be a principal nutritional factor driving the equine postprandial response, high-protein meals have also been associated with exacerbated insulin responses in horses with ID,” Dr. Palmer noted.

One such equid-centric study found that when the insulinemic responses to a high-protein meal (31% crude protein fed at 4 g/kg) was fed to healthy horses and ID horses, there was a 9-fold greater insulin response in the ID horses over a 4-hour period.

Scrutinize other aspects of a horse's diet if insulin dysregulation is poorly controlled after switching to a low-nonstructural carbohydrate diet.

Another study that’s currently in preparation for publication appears to echo these results. In that study, 7 metabolically healthy horses were fed a high-protein meal as part of a feed trial. Later, those same 7 horses underwent induction of experimental insulin dysregulation via 7 days of oral dexamethasone at 0.08 mg/kg. The feed trial was repeated while the horses were dysregulated.

“Those horses had a much more exaggerated insulin response when they were insulin dysregulated compared with their baseline state,” Dr. Palmer stated, adding: “These studies strongly suggest that highprotein ration balancers may exacerbate insulinemic responses in the setting of equine ID.”

Enter mTOR

When evaluating the role of feed in equine metabolic disease, Dr. Palmer said that it is important to understand that dietary protein and amino acids are robust activators of mechanistic target of rapamycin (mTOR) at the tissue level. mTOR plays a huge anabolic role in a horse’s response to nutrient ingestion,

but prolonged mTOR activation can also cause local and systemic insulin resistance.

“mTOR activation has also been associated with changes in the epithelial phenotypes in horses,” Dr. Palmer said. “Activation of mTOR signaling has been demonstrated within the digital lamellae in horses subjected to experimental models of all 3 forms of equine laminitis: sepsis-related, hyperinsulinemia-associated and supportlimb laminitis.”

The role of dietary protein and amino acids in laminitis does require further investigation, but she said that preliminary studies have validated the concern.

Clinical Next Steps

“When managing a patient whose insulin dysregulation is poorly controlled in the face of a low NSC diet, other aspects of the patient’s diet should be scrutinized to assess the influence on the animal’s persistent hyperinsulinemia,” Dr. Palmer explained.

She added a feed trial can be performed to evaluate the degree of postprandial hyperinsulinemia in response to certain components of the diet, including the ration balancer. This test can be done in a similar manner to an oral glucose test.

In 1 example, she said that a horse can be fed 1 flake of grass hay the night before the test and then muzzled afterward. In the morning, a baseline blood sample can be collected, and then the horse could be fed the specific dietary component (e.g., the ration balancer at the manufacturer’s recommended dose).

Additional blood samples can be drawn at 60 and 90 minutes (or longer) postprandially to determine the insulinemic response.

“If they have an exaggerated response, that could warrant modification of that portion of the diet,” she said. “Patients receiving high-protein ration balancers whose insulin dysregulation is currently poorly controlled should have this facet of their management critically evaluated.” MeV

It’s just who we are.

We know horse people because we’re horse people. And like you, the love and respect we have for horses is unconditional. Everything we do is for their benefit. If we do right by the horse, we’ll never do wrong. Copyright

Bryant W. Craig, DVM

PRACTICE MANAGEMENT

4th Veterinary Wellbeing Study Shows Progress Made in Improving Staff Emotional Health

Veterinary professionals are taking a more proactive approach to ensure their well-being, according to the latest Veterinary Wellbeing Study by Merck Animal Health and the American Veterinary Medical Association (AVMA).

The goal of the 4th Veterinary Wellbeing Study was to identify and explore the state of veterinary professionals’ mental health and well-being, as well as increase awareness to the challenges veterinarians and support teams face.

This year, the study expanded its scope to examine the mental health and well-being of veterinary team members, including veterinary technicians and office managers, receiving nearly 5 times more responses from these positions than the 2021 survey.

The online study was conducted in September and October 2023 by Brakke Consulting, among a nationally representative sample of 4,636 U.S. veterinarians, both practitioners and non-practitioners. Data were weighted based on age, gender and region. For the sample, the maximum margin of error was +/- 1.4% at 95% confidence level.

To achieve a comprehensive study of veterinary team members, Brakke collaborated with the North American Veterinary Technician Association, the Veterinary Hospital Managers Association and others to sample technicians, assistants, hospital practice managers, reception/client service representatives and other members of a veterinary clinic’s team. A total of 2,271 completed questionnaires were returned.

Almost three-quarters of veterinary professionals expressed personal satisfaction with their careers, but there are still factors that concern them, including high exhaustion, work-life balance and shortage of veterinarians, all of which can contribute to burnout. Results indicate that more veterinarians who needed mental health support received outpatient treatment and counseling for mental health challenges in 2023.

Moreover, there has been a substantial increase in clinics supporting their team’s mental health and emotional well-being, with results showing that 38% of clinics now offer an employee-assistance program as opposed to 31% in 2021 and 27% in 2019.

When it comes to clinic culture, most practicing veterinarians agree there is a high degree of trust within their organization, their input is valued, there is sufficient time for each appointment to provide

high-quality patient care, and there is candid and open communication among team members, which all contribute to a positive work environment. However, clinics still can make improvements by openly discussing well-being and mental health in team meetings, with only 36% of veterinary teams finding that this happens somewhat or to a great extent.

Pride and Satisfaction in the Profession

While veterinarians and support teams—particularly those early in their career—experience stress and burnout, there are many aspects of the job they enjoy, including those related to helping animals. Most veterinarians (98%) and veterinary team members (92%) noted they are invested in their work and take pride in doing a good job. More than 80% also believe the work they do makes a positive contribution on other people’s lives.

“We are committed to bringing critical awareness to the challenges that veterinary professionals face and to ensure they have the appropriate tools and resources to help support mental health and wellbeing,” said Rena Carlson, DVM, AVMA president. “We understand that to sustain the health of animals, we need to ensure the well-being of their caretakers.”

These surveys, which have been done every 2 years since 2017, have inspired key initiatives such as MentorVet, which creates evidence-based programming to empower people to thrive within veterinary medicine, helps facilitate guidance and support for veterinary professionals and plays a crucial role in fostering a supportive environment within the industry.

To date, more than 350 veterinary professionals have been supported with full scholarships awarded by Merck to participate in MentorVet’s programming (MentorVet Tech and MentorVet Leap), helping to bridge the gap when it comes to the well-being of veterinary professionals.

In addition, Merck is an educational partner for MentorVet Connect, a collaboration between the AVMA and MentorVet that brings a structured evidence-based mentor program to newly graduated AVMA members free, beginning with the classes of 2018-2023. MeV

For more survey information, check out this month’s VetStats on page 17. For information about MentorVet: see https://www.mentorvet.net/ourteam

Career satisfaction is high among veterinarians

EXTREMELY SATISFIED

30%

44% SOMEWHAT SATISFIED

10% NEUTRAL

11% 5% SOMEWHAT DISSATISFIED EXTREMELY DISSATISFIED

QUESTION:

How satisfied are you with your career overall in veterinary medicine?

Veterinary staff believe their work is important and meaningful

81% Staff is invested and take pride in their work

of respondents strongly agree/agree they are invested and take pride in their work

*From the Veterinary and Veterinary Staff Wellbeing studies by Merck Animal Health and the AVMA. Brakke Consulting performed the electronic survey. For more information, go to https://www.merck-animal-health-usa.com/about-us/veterinary-wellbeing-and-scholarships

Ultrasonography for Oocyte Recovery

By Cara Linse, BS

Transvaginal aspiration (TVA) is an advanced reproductive procedure that uses an ultrasound-guided needle to puncture the ovary and its follicles to recover oocytes. The oocytes will be fertilized by intracytoplasmic sperm injection, and we hope to produce an embryo that can be transplanted into a recipient mare to carry and produce a live foal.

Transvaginal aspiration carries inherent risks, however, and previous studies have explored the effects of this procedure on blood values and abdominal fluid parameters, the timing of the procedure, the number of punctures to the ovary, and the probability of the formation of ovarian abscesses.

We wanted to characterize normal findings and baseline values of free abdominal fluid prior to and following TVA to aid in appropriate and early iden-

tification of pathology in case the mare’s health declines after the procedure.

We did TVA on 17 healthy mares (7 mares were aspirated twice during the length of this study), recording the signalment, sedation, medication and time, and used transabdominal ultrasonography to measure the depth and character of free abdominal fluid.

For consistency, this measurement was taken at the most ventral aspect of the abdomen on midline using a 5-7.5MHz linear rec-

Shutterstock/Inesmeierfotografie

tal transducer (Sonosite Edge II). A larger scan of the abdomen was also performed to determine the distribution of the fluid throughout the abdomen. This scan was repeated at the conclusion of the TVA and the fluid pocket was measured again in similar fashion. The volume of fluid (EmCare Complete Flush Media) infused and recovered was measured based on weight to calculate a presumable volume of fluid lost in the mare from the procedure.

Results

Prior to the TVA, the mean fluid was 0.56 cm, with a range from 0.0 to 1.54 cm. Post-aspiration, the mean depth of the abdominal fluid pocket was 1.17 cm with a range of 0.0 to 3.02 cm. The mean volume of unaccounted fluid post-procedure was 85.7 mL and the mean time of aspiration was 28 minutes.

Pre-aspiration observations of the fluid distribution yielded 42% (13/31) with no fluid; 26% (8/31) had a focal pocket; 13% (4/31) were multifocal; and 19% (6/31) diffuse. Post-aspiration observations of the fluid distribution was 23% (7/31) no fluid; 32% (10/31) a focal pocket; 42% (13/31) mul-

tifocal; and 3% (1/31) diffuse.

Pre-aspiration observations of fluid character were 42% (13/31) no fluid; 26% (8/31) anechoic; 32% (10/31) slightly echogenic; and 0% (0/31) hyperechoic. Post-aspiration, fluid character was 23% (7/31) no fluid; 39% (12/31) anechoic; 35% (11/31) slightly echogenic; and 3% (1/31) hyperechoic.

All mares were healthy and clinically normal in the 24 hours following the transvaginal oocyte aspiration procedure.

These findings help to understand the character, measurements and changes in ultrasound appearance of abdominal fluid following oocyte aspiration. This study size was not large enough to determine the significance of changes in abdominal fluid but does suggest there are some changes in fluid seen following aspiration.

TVA is an advanced reproductive procedure that uses an ultrasound-guided needle to recover oocytes.

The amount of measurable free abdominal fluid is 42% (13/31). Aspirations began with no significant fluid noted in the abdomen at 23% (7/31), and ended with no measurable fluid or 77% (24/31) having measurable fluid postTVA. As one of the goals was to establish normal baseline values, an important measurement was

Performing ultrasonography.

Images courtesy of Cara Linse and M. Schnobrich

the maximum amount of fluid measured in a mare’s abdomen at any point in time was 3.02 centimeters, and that occurred postaspiration.

There was also generally an increase in multifocal distribution of fluid, and the fluid was most commonly anechoic or slightly echogenic in character post-aspiration. The more echogenic fluid visualized was also not associated with a negative outcome. This study saw similarities to previous studies in that all mares were clinically healthy and there were no adverse health effects such as fever, inappetence, or colic in the 24 hours following an uncomplicated TVA procedure, regardless of the time or number of follicles punctured. MeV

For more information:

Orellana-Guerrero D, Dini P, Santos E, et al. Effects of transvaginal aspiration of oocytes on blood and peritoneal fluid parameters in mares. J Equine Vet Sci. 2022;114:103949. https://pubmed.ncbi.nlm.nih.gov/35417768/

Velez IC, Arnold C, Jacobson CC, et al. Effects of repeated transvaginal aspiration of immature follicles on mare health and ovarian status. Equine Vet J. 2012;43:78-83.

https://pubmed.ncbi.nlm.nih.gov/23447883/

ABOUT THE AUTHOR

Cara Linse's career began in Lexington, Ky., nearly a decade ago working on Thoroughbred breeding farms foaling out mares and raising those foals. Her interactions with veterinarians on those farms piqued her interest in veterinary medicine, and in 2018 she acquired a position at Rood & Riddle Equine Hospital.

Since then, Cara has progressed within the clinic, learning throughout her time on the nursing staff, to the Internal Medicine Department, and is now working within the theriogenology group where she has been able to further her technical skill set assisting in advance theriogenology procedures such as oocyte aspiration and hysteroscopy.

Additionally, she has worked for Equine Analysis Systems, measuring their cardiac ultrasound scans as part of evaluations of performance potential for Thoroughbred public auction sales.

Outside of work, she spends as much time as possible in the outdoors with her Golden Retriever, Rossi, and her off-the-track Thoroughbred, “Paul With All.”

Pre-TVA scan and post-TVA scan.

Stable Life Initiative Aims to Support Equine Veterinarians’ Well-Being

By Paul Basilio

Equine medicine requires many commitments. A commitment to providing the best care possible, a commitment to staying clinically sharp and a commitment to those who trust you with their animals’ lives.

What is often overlooked, however, is the commitment to setting professional boundaries and the commitment to one’s own mental, physical and emotional well-being.

“It’s why we do it, right?” said Andi Davison, LVT, CAPP, APPC, of Flourish Veterinary Consulting, in an interview with Modern Equine Vet at the 69th AAEP Conference in San Diego. “We got into veterinary medicine to speak for those who couldn’t speak for themselves. We want to provide care, we want to be there for our owners when there is an emergency, and we want to do what we can to help. But we don’t want to do it 24/7, and we don’t want to do it when we’re broken.”

To that end, the Stable Life initiative—launched by Boehringer Ingelheim in 2021—aims to support sustainable well-being among equine veterinarians and their staff. Speakers such as Ms. Davison bring targeted information directly to veterinarians via webinars and in-person meetings.

“We deliver evidence-based consulting and coaching services around the idea of culture, leadership, and well-being in the veterinary field,” explained Josh Vaisman, MAPPCP, CCFP, co-founder and owner of Flourish Veterinary Consulting.

At one presentation at the conference, Mr. Vaisman discussed ways to create an environment that allows people to perform at their best and get the most joy from their work—the idea of psychological safety and strong, open collaboration among teams.

“Equine medicine has always had this idea of ‘Put your head down and keep working,’” said Jamie Pribyl, DVM, a professional services veterinarian at Boehringer Ingelheim. “There’s always been a pervasive attitude that if you don’t want to suck it up, then this isn’t the career for you. It’s just what you signed up for.”

She added: “There are things about equine medicine that we can’t change. We will always have emergencies, for example. But we don’t have to run at [full speed] all the time. It doesn’t need to be like that, and we can change it.”

At a time when there is a noticeable shortage of equine veterinarians, the effects of burnout and a lack of personal wellness are laid bare.

“We have a small number of graduates who enter equine practice to begin with,” Dr. Pribyl said. “Within 5 years, 50% or more of those that enter equine practice will leave. It’s a small number to start with, and we lose more as we go along.”

It is not a sustainable equation.

“As an industry, I think we’ve started to reach a precipice where the pain of the status quo is being outweighed by the pain of change,” said Mr. Vaisman, who is also author of Lead to Thrive: The Science of Crafting a Positive Veterinary Culture. “Passion gets people into equine medicine, but the rigors of making a career out of it can allow that passion to wane over time. We can, however, create a space where the passion never wanes.”

That’s an idea that Ms. Davison echoes: “That’s why having support initiatives like the Stable Life is so important,” she said. “It allows you to balance the ability to do what you love long-term and thrive in it.” MeV

For more information:

The Stable Life initiative is dedicated to transforming the future of equine medicine by inspiring a good work-life balance. https://bi-animalhealth. com/equine/initiatives/the-stable-life