The Modern Equine Vet October 2015 by The Modern Equine Vet

The Modern

Equine Vet www.modernequinevet.com

Vol 5 Issue 10 2015

Stand and split good option for delayed patellar release

PRP: First-line for tendon, joint injury NEAEP Meeting: On the hunt for strangles Using ultrasonography to determine ascarid burden

Table of Contents

Cover story:

Stand and split good 4 option for delayed patellar release Cover:Shutterstock/Anastasija Popova

Orthopedics

PRP: First-line treatment for tendon, joint injuries.....................................................8 Infectious Diseases

On the hunt for strangles....................................................................................................10 Strangles: Pathogenic legacy of War Horse..................................................................13 technician update

Managing a case of fibrotic myopathy.......................................................................17 News

Mare's genes important for gestation length and foal's gender....................................................................3 USDA Commits to Ranching, Farming.......................................12 Using ultrasonography to delineate ascarid burden (with video) ..........................................................................................14 Risk factors for post anesthetic colic..........................................15 New Bolton pioneers use of robotics—controlled imaging.....15 advertisers Shanks Medical Equipment....................................... 3 Lifeline Performance Supplements......................... 5

Luitpold Animal Health.............................................. 7 AAEVT............................................................................16

The Modern

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Issue 10/2015 | ModernEquineVet.com

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news notes

Mare's genes important for gestation length and foal's gender In horse breeding, stallions are usually used to establish a breeding line. In some cases, however, the maternal lineage plays a more important role. Researchers from Vetmeduni Vienna looked at the gestation length of different mare families and discovered that the length of gestation varies significantly from lineage to lineage. Certain families also produce more female offspring than male foals. At the Graf Lehndorff Institute for Equine Science, a joint research institution of Vetmeduni Vienna and the Brandenburg State Stud in Germany, Juliane Kuhl, DrMedVet, and Christine Aurich, DrMedVet, DECAR, investigated the degree to which the maternal lineage influences gestation length and foal characteristics. Together with statistician Kathrin Stock of the agricultural statistics center VIT in Germany, they analysed the data records for 640 pregnancies in 142 mares.

female offspring. For middle-aged mares between 4 and 12 years, the foal sex ratio is balanced. “These results are important for horse breeders. They could possibly choose their mares depending on the desired sex of a foal,” Dr. Kuhl said. The mechanism behind this phenomenon remains unclear, however. “We suspect that these effects are due to the differences in mitochondrial DNA. This specific DNA is inherited over the maternal line and influences cell metabolism and placenta function,” said Dr. Aurich. “We also know that female embryos are more resilient. As 20 to 30% of early pregnancies are lost spontaneously, it is possible that male embryos survive less frequently. This could be a reason for the observed shift in the sex ratio. But it is also possible that embryo survival is influenced by differences in placental function.” MeV

Maternal lineage influences gestation length

The analysis revealed that the average length of gestation, which in horses ranges between 320 and 360 days, varies from family to family. The gestation length of some maternal lineages was on average 10 days longer than in other families. In addition, gestation length for male foals tends to be tends to be longer than for females. “We can still not predict the exact time of birth. The individual fluctuations among individual pregnancies are simply too large. But the information gained from the study can help us to narrow the possible range,” said Dr. Kuhl. “The length of gestation is also of interest for horse breeders. Ideally, a broodmare should give birth to a foal every year. Due to the average gestation which covers approximately 11 months, longer gestation lengths result in a delay in birth of the next foal. Breeders are interested in having foals born at the beginning of the year, as the horses will then compete better against animals born in the same year,” Dr. Kuhl explained. The study also showed that certain maternal lineages produce more female than male foals. The age of the mare also plays a role. Young mares who have their first pregnancy when they are 3 years old will produce more female foals. Older mares also tend to have more

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For more information: Kuhl j, Stock KF, Wulf M, Aurich C. Maternal Lineage of Warmblood Mares contributes to variation of gestation length and bias of foal sex ratio. PLOSONE Epublished Oct. 5, 2015 DOI: 10.1371/journal. pone.0139358 http://journals.plos.org/plosone/article?id=10.1371/journal. pone.0139358

www.shanksvet.com • info@shanksvet.com ModernEquineVet.com | Issue 9/2015

cover story

Stand and Split

Standing medial patellar ligament splitting make good option for delayed patellar release.

Illustration courtesy of Dr. James

A recent retrospective study of horses with delayed patellar release showed that standing medial patellar splitting may be a successful long-term surgical option with few complications and a relatively rapid return to work. Delayed patellar release is an acute inability to flex the hind limb. Upward fixation of the patella occurs when the medial patellar ligament and its parapatellar fibrocartilage remain hooked over the medial trochlear of the femur 4

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and locks the reciprocal apparatus with the limb in extension. “There are a few variations of the syndrome, but the exact mechanism of the problem is unknown,” said Sarah James, DVM, DABVP, of the Steinbeck Country Equine Clinic in Salinas, Calif. “Anything that causes decreased or altered range-of-motion in the hind end can result in this problem.” Some predisposing factors include weak quadriceps or biceps femoris muscles, especially in debilitated horses or young, fit horses who are abruptly confined to a stall. Hind-end conformation is also important. A straight conformation or long-toe/low-heel conformation in the hind end has been associated with the condition, according to Dr. James. Trauma, most likely from hyperextension of the stifle, can also result in upward fixation of the patella. Conservative treatment is often the first step. Developing muscle mass and coordination through exercise, corrective trimming and shoeing, intramuscular administration of estrone sulfate, and/or direct injection of the middle and medial patellar ligaments with counter irritants are typically at the top of the list.

“It’s important to give the young horses a little time to develop muscle mass and coordination,” Dr. James said. “They may end up fixing the problem on their own.” Surgical treatment is indicated for horses who do not respond to conservative therapy, who have recurring complete fixation, or who are developing lameness because of the problem. Patellar ligament desmotomy sometimes can provide a permanent cure, but literature shows the procedure can cause instability of the stifle joint, which can lead to fracture or fragmentation of the distal patella, chondromalacia of the patella, or osteoarthritis. Ultrasound-guided patellar ligament splitting has been shown to be fairly effective without short- or long-term complications, but it does come with the extra risk and expense associated with general anesthesia.

The Standing Option

Dr. James and her colleagues performed a retrospective study over a 9-year period. To be included in the study, horses needed to have a diagnosis of delayed patellar release, standard surgical and postoperative management, and be available for follow-up of at least 6 months.

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RESULTS IN JUST 14 DAYS

Photo courtesy of Dr. James

cover story

Standing medial patellar ligament splitting is fairly effective for the repair of delayed patellar release. A line block is done (left) and a #15 blade and incisions are made up the length of the ligament.

Horses with upward fixation, primary lameness, or inadequate follow-up were excluded. Prior to surgery, all horses received a dose of penicillin and phenylbutazone. The horses were placed in standing stocks, and detomidine and butorphanol were administered for sedation. “During the surgery, the medial patellar ligament is fairly easy to identify in a standing horse,” Dr. James said here at the 60th Annual AAEP Convention in Salt Lake City. “It’s a tight, taut structure.” The ligament was identified, and the area over it was clipped and sterilely prepped. A line block over the length of the ligament was performed with 10–12 mL of lidocaine using a 25-gauge needle and an extension set so the veterinarian could stand in the relative safety of the contralateral side. A #15 blade was inserted vertically, directly into the medial patellar ligament and advanced several millimeters proximally. The blade was removed, moved approximately 5 mm or so, and the incision was made again. “We would go up the length of the ligament, which usually took about 10 to 15 incisions, depending on the size of the horse,” she 6

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said. “For 3 or 4 of the incisions, we would take the scalpel blade and turn it 90 degrees to split the fibers in a horizontal plane. The incisions were started a few centimeters proximal to the ligament’s attachment on the tibial tuberosity. You’ll find that the distal aspect of the ligament can only fit about 1 or 2 incisions across the width, but as you move proximally the ligament fans out to its attachment to the parapatellar fiber cartilage and you’re able to fit some more incisions across it.” The incisions were closed with tissue glue and an aerosol bandage was applied. The horses were given trimethoprim-sulfadiazine for 5 days following the procedure. Aftercare consisted of 2 weeks of stall rest with hand walking. During the next 2 weeks, light work was initiated, and the horses were back to full work at 1 month.

Results

The horses were categorized into three groups: • Successful–no signs of delayed patellar release • Improved–the horses showed signs of delayed patellar release, but with much less severity

•U nsuccessful–No change “We were also interested in how long it took for the horses to show signs of improvement,” Dr. James said. “We looked at other postoperative treatment that were used in the horses, as well as whether the horses were able to be used at the owner’s level of desired performance.” The procedure was performed on 92 horses during the 9 years, but only 64 met inclusion criteria. The average age was 8 years, and the breed distribution was wide. “The follow-up period was 4.5 years,” Dr. James said. “We talked to some owners 8 or 9 years out, and it was always interesting to see how the owners and the horses were doing.” About 58% of horses showed complete resolution of delayed patellar release, 31% showed some improvement, and only 11% of horses showed no change. “We were pretty happy with these numbers,” she explained. “When you put the two numbers together, you get 89% of horses that benefitted from the surgery. In addition, 73% of the animals were able to perform at the owner’s desired level of performance. Our job here was to get those horses feeling as good as they could so that they can work cattle,

plod along a trail, or do what the owner wanted them to do.” Dr. James noted 63% of horses took between 30 to 60 days to show signs of improvement, which caused a lot of breath-holding among the study authors. “We would hit that 30-day mark when the horse would go back to work, and they’d still be catching.” Two of the horses in the study did have complications, but they went on to be performance animals. So while adverse effects can occur, they may not necessarily preclude

the horse from doing athletic things. “One thing I learned is that rehabilitation is important,” Dr. James said. “When talking with the owners, 6 of them said that they believed rehab was the reason that the horse did not achieve complete resolution. Some of the horses were just plain ornery and didn’t like stall rest, and some owners had noncompliance issues. The two weeks of rest and slowly getting the horses back to work is important for the best result.” Five of the horses in the non-

successful group ended up being diagnosed with another condition or had a lameness diagnosis following surgery. One horse was diagnosed with silicosis, and one had cervicovertebral issues. “It proves the point that you have to look at these horses carefully,” Dr. James said. “If you perform the procedure and there’s something going on that’s going to continue to change how they are going to move in the hind end, then you’re not going to have the same results or prognoses for those horses.” MeV

For more information: James SJ, Eastman TG, McCormick JD. Long-term outcome of standing medial patellar ligament splitting to manage horses exhibiting delayed patellar release: 64 horses. J Equine Vet Science. 2014;34:479-483. http://www.j-evs.com/article/S0737-0806(13)00620-5/abstract Andersen C, Tnibar A. Medial patellar ligament splitting in horses with upward fixation of the patella: a long-term follow-up. Equine Vet J. 2015 Mar 10. doi: 10.1111/evj.12435. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/25758590

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Orthopedics

PRP:

First-line treatment for tendon, joint injuries

can be an effective treatment for equine tendon and joint injuries, but care must be taken because of variability in platelet and leukocyte concentrations according to the method of PRP preparation, said Lisa A. Fortier, DVM, PhD, DACVS, a professor of equine surgery at Cornell University College of Veterinary Medicine. For equine tendon injuries, PRP has been shown to increase tendon matrix. In joint injuries, PRP does not grow new cartilage but it can relieve pain and improve lubrication, aiding rehabilitation. Equipment for preparing PRP can be generally categorized as either buffy-coat-based or plasma based. Speaking at the 60th annual convention of the American Association of Equine Practitioners, Dr. Fortier reviewed the latest research on PRP for tendon and joint injuries and discussed her approach. “PRP is my first line of therapy for

Leukocyte-low PRP preparations with platelet concentrations twoto four-fold over baseline are optimal for tissue repair. joint disease, as well as tendonopathies,” Dr. Fortier said. When Dr. Fortier and her colleagues found that a high white blood cell (WBC) concentration was correlated to a loss of matrix and an increase in inflammation, they set out to find the best PRP with respect to platelet and WBC concentrations. The buffy-coat-based PRP systems produce PRP with higher concentrations of platelets as well

B y K a t h l e e n O g l e 8

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as more WBCs and the plasmabased PRP systems produce PRP with fewer WBCs. Instead of comparing the PRP produced with the various machines available, they made PRP in a laboratory with various platelet:WBC ratios and platelet counts to determine the optimal ratio. They found that the optimal platelet:WBC ratio was 2000:1—“pure platelets and very few WBCs”—which would mean the most tendon matrix generation and the least amount of inflammation, according to Dr. Fortier.

More is not better

Holding the ratio constant, they then looked at the number of platelets and found that lower concentrations of platelets resulted in the most matrix synthesis and the most cell division. “When you get up to a higher concentration you actually shut down the amount of tendon matrix that’s produced,” Dr. Fortier said. “We all think a little bit linearly,”

shutterstock/Yurii Andreichyn

Platelet rich plasma (PRP)

she added. “If some platelets are good, more must better. It’s a really common platform for a company who is trying to sell you their system to say that when a company gives you ‘two-fold, well I can give you four-fold, oh really, I can give you tenfold, so I must be better.’ That’s absolutely not true. More is not better and it’s actually detrimental. We thought it would reach a plateau and you wouldn’t see anything more but that’s not really true.” Leukocyte-low PRP preparations with platelet concentrations two- to four-fold over baseline are optimal for increased tissue repair, Dr. Fortier said.

Thrombin not needed

Dr. Fortier said she is often asked if thrombin is needed with PRP injections, and it is not. “It’s one of the banes of our existence that when you do this type of research—when you put PRP onto this tissue—it clots. That’s what platelets are supposed to do in the body. So you don’t need to add thrombin if you are going to inject PRP into a tendon, into a joint. Those platelets are going to degranulate as soon as they see tissue. On top of that, most thrombins are bovine in origin and you are risking xenograft rejection,” she said. In addition to the method of preparation there are other factors that affect platelet concentrations in PRP, including stress, according to Dr. Fortier. “It doesn’t work in all cases and this is probably why. This is not a drug. So what you ate for dinner last night and how much you partied last night, all those things are going to af-

fect your platelets. They are diurnal in variation and there’s a tremendous degree of variability,” she said. She pointed to examples in which a volume of blood from one person was distributed equally among three machines and one machine made PRP and the others did not. “It’s very highly variable. It’s not going to work in all the cases, and it would be really nice to know what you are giving to your patient,” Dr. Fortier said. To ensure that she has made PRP, Dr. Fortier takes a smear of whole blood at the venous end of the PRP, lets it air dry and then later counts the platelets and the WBCs. “Some animals, just like in stem cells, are going to be super responders and super PRP makers and others are not,” she said.

Ultrasound-guided injections

Dr. Fortier performs ultrasoundguided injections, and she does not use a predetermined volume. “I fill it until, based on ultrasound, the lesion is full,” she said. She injects 1–3 mLs of PRP for small joints and 3–5 mLs of PRP for larger joints using a small needle (<20 gauge). If she is injecting stem cells she uses a needle larger than 23 gauge, she said. She recommended rechecking the ultrasound every 2 to 4 weeks. Because her practice is geographically isolated, horses are typically rechecked at 30 days. She also jogs and palpates the horses. If the horse is 50% better she will reinject. “If you don’t get a response with the first injection, you are not going to get a response. If you get a response, about 2–4 weeks later

How Many Injections Should I Give? If you don’t get a response with the first injection, you are not going to get a response. If you get a response, about 2-4 weeks later you can give a second injection. If you don’t get a better response, don’t give a second injection. Most veterinarians only give 2 injections spaced anywhere from 10 to 14 days apart. First injection Response Yes

2nd injection

Stop

Response?

Yes 3rd injection, when? Must stop at 2

How Much Should I Give? For a small joint 1-3 mL For a large joint 3-5 mL

you can give a second injection. If you don’t get a better response then stop,” she said. “Most people are doing no more than two injections spaced anywhere from 10 to 14 days apart.” MeV Dr. Fortier is a consultant to Arthrex Inc.

For more information: Boswell SG, Schnabel LV, Mohammed HO, et al. Increasing platelet concentrations in leukocyte-reduced platelet-rich plasma decreases collagen gene synthesis in tendons. Am J Sports Med. 2014 Jan;42(1):42-9. doi: 10.1177/0363546513507566. Epub 2013 Oct 17. http://www.ncbi.nlm.nih.gov/pubmed/24136860 ModernEquineVet.com | Issue 10/2015

Infectious Diseases

On The Hunt for

Strangles Some veterinarians might be able to eradicate strangles on certain farms.

Bob Langrish/www.boblangrish.com

The eradication of strangles is

fairly implausible without the elimination of carriers and the development of new vaccines and methods of testing, but the science is at a point where veterinarians can talk about eradication on specific farms. According to Ashley G. Boyle, DVM, DACVIM, important topics that warrant more examination include the importance of the atypical presentation of strangles, the development of a diagnostic gold standard, the role of serology and the use of new technology. She discussed these points and her work on an upcoming ACVIM consensus statement here at the recent meeting of

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the Northeast Association of Equine Practitioners held in Pittsburgh, Pa.

Atypical Presentation

Clinical signs can correlate poorly with results of PCR and culture in the acute stage of the disease. Many horses may not have lymphadenopathy, which is a common sign. “There was a case in Denmark where a farmer on a breeding farm with 112 yearlings had 60% of the horses with positive culture or PCRpositive rostral nasal swabs that lacked any clinical signs in the acute phase of the index cases,” said Dr. Boyle, who is an assistant professor of medicine, section field service, at

the New Bolton Center in Kennett Square, Pa. “Part of this was because there was an outbreak during the previous year, and immunity played a role in how the animals presented clinically. This is one of the reasons we don’t always see the classic signs.” Death is typically associated with asphyxiation, dysphagia and metastatic abscess. In a retrospective soon to be published in the Journal of the Veterinary Medical Association, Dr. Boyle and colleagues will characterize modern outbreaks on small farms. “The outbreaks we looked at only had 2% of metastatic disease, with 0.9% mortality,” she explained. “The

Strangles in a Strange Land

larger herds seem to have a larger incidence of mortality, which is typically associated with metastatic disease. Some of these cases did not have previous signs of clinical disease.”

Diagnostic Gold Standard

Dr. Boyle emphasized the need to conduct widespread testing with high-sensitivity, high-specificity tests and posited that culture should no longer be considered the gold standard. “Culture misses about 40% of the positive horses,” she explained. “The 2005 ACVIM consensus statement talked about obtaining three nasopharyngeal samples because the

sensitivity and specificity was so low with just one sample.” A relatively new PCR test in Europe has excellent sensitivity and specificity. It is a triplex PCR that looks at three genes. Two of the genes are targets that are specific to Streptococcus zooepidemicus and can rule that out and eliminate some of the cross-reactivity that comes with some of the S. equi-specific genes and SeM genes. The test is not available in the United States. The type of sample (swab or wash), the anatomic location from where it was obtained (nares, nasopharynx) and the disease state are also important factors. “You’re

The use of vaccination in the face of an outbreak is controversial, but Ashley G. Boyle, DVM, DACVIM does not like to do it. “You can’t test those horses serologically or via the guttural pouch,” she said. “If you’re using the intranasal vaccine, those horses will potentially be positive on guttural pouch testing for up to six weeks.” In addition, the ACVIM Consensus Group does not advocate the use of the European vaccine. “The vaccine is administered subcutaneously under the lip, and submucosal pustules were forming in the horses,” explained Dr. Boyle, of the New Bolton Center in Kennett Square, Pa., “It’s hard to administer. Veterinarians were inadvertently stabbing themselves and developing abscesses. The group is also against vaccines that interfere with diagnostic tests, which all of these vaccines do.” To that end, a group in Sweden has been working on a DIVA (Differentiating Infected from Vaccinated Animals) vaccine that will not detect S. equi by PCR if the horse has been vaccinated. It is still in the pipeline. Current information states that the immunity does not last particularly long, but it is safe and can be administered frequently in endemic areas.

ModernEquineVet.com | Issue 10/2015

Infectious Diseases going to have a lot higher sensitivity if you’ve got a horse that is pouring snot and is at the early part of the outbreak,” Dr. Boyle said. “However, you may still get a false negative at the very beginning of the outbreak versus a horse where you’re trying to see if they have cleaned up and are negative.” Dr. Boyle also conducted a study of 192 samples that investigated whether direct PCR or culture is more effective at isolating the pathogen, and whether anatomic location or swab type made a difference. “It turns out direct PCR was most sensitive,” she explained. “We were also more likely to pick up S. equi in guttural pouch washes when compared with nasopharyngeal washes. That’s going to hopefully lead to a new study.” The guttural pouch is a wellknown reservoir where S. equi likes to hide, but clinicians can be reluctant to go looking for it there because of the need for an endoscope and time constraints. It can be much easier to simply obtain three nasopharyngeal samples. “A lot of times clients don’t want you to do three samples,” Dr. Boyle said. “Plus, you have to go out to the farm three times. Sometimes you can actually save the client some time or money by using the endoscope.” Dr. Boyle recently looked at client-owned horses that were recovering from natural strangles outbreaks. Three samples were

obtained from each horse via nasopharyngeal flocked swab, nasopharyngeal wash collected in rectal sleeves, and then a guttural pouch lavage specimen that was split into three aliquots. One aliquot received a culture, one was examined by direct PCR, and one was examined via the loop mediated isothermal amplification (LAMP) assay. “In these convalescent horses, we were 48 times more likely to find S. equi using the guttural pouch than we were with the nasopharyngeal flocked swab, and 6.4 times more likely than with the nasopharyngeal wash,” she said.

Serology

There are two common types of serologic tests. The SeM antibody titer, available through IDEXX and Equine Diagnostic Solutions, is available in the United States, and a combined antigen A and C test is available in Europe. Currently, all strangles vaccines on the market interact with all serologic tests. In Europe, vaccination rates are much lower so they tend to be stronger proponents of serologic testing. “The purpose of serologic testing is not to determine whether a horse has strangles,” Dr. Boyle said. “It should not be used in the outbreak setting unless you’re months into the outbreak. It’s also not a test to determine whether a horse is a carrier, and it also has a lower sensitivity and specificity than the

European combined antigen test.” Because horses aren’t routinely vaccinated in Europe, they can detect infections as early as two weeks after exposure. If the horse is vaccinated, those results would be slightly garbled. There are strong proponents of using this combined test as a screening tool for asymptomatic persistent carriers, and there is talk of bringing the test to the United States, but Dr. Boyle asserted that it will have markedly different behavior here because of the higher use of strangles vaccination. “Here in the US, use the guttural pouch lavage if you want to test horses before they come on to the farm,” she said. “The other test is just going to cross-react with the vaccine.” MeV

Take-Home Messages Clinical signs for strangles that have historically been described as atypical are actually quite common. In horses without obvious clinical signs, use PCR testing. One negative result on PCR of a guttural pouch lavage specimen with endoscopy is enough to declare a horse “clean.” The use of serology depends on which test you’re using and in what setting it is being used. We need a better vaccine

USDA Commits to Ranching, Farming The average age of the American farmer now exceeds 58 years, and data show that almost 10% of farmland in the continental United States will change hands in the next five years, the USDA said. To help these new farmers and ranchers, the agency has committed $5.6 billion over the next two 12

Issue 10/2015 | ModernEquineVet.com

years for programs, and they will be able to use a new web tool to help them. The site was designed based on feedback from new farmers and ranchers who cited unfamiliarity with programs and resources as a challenge to starting and expanding their operations. The site

features advice on everything a new farm business owner needs to know, from writing a business plan to filing taxes. The USDA wants to increase beginning farmer and rancher participation by 6.6% across key programs, which were established or strengthened by the 2014 Farm Bill. MeV

news notes

Strangles: A Pathogenic Legacy of the War Horse high mortality rates among the horses and their replacement with young susceptible horses, could explain what we see around the world today. While loss of diversity could be considered detrimental to bacterial populations, S. equi still infects more than 20,000 horses in the United Kingdom alone each year. Its success, researchers believe, is due to its ability to persist in some horses for years after they have recovered from strangles, where the organism can evolve to evade the horse’s immune system. Andrew Waller, PhD, Head of Bacteriology at the Animal Health Trust said, “The data we have gathered in this study has enabled us to pinpoint the genes that help the bacteria to persist, spread and thrive in the horse population. This research provides an unprecedented opportunity to reduce the impact of and prevent strangles in future generations of horses.” The ability of S. equi to adapt to living in a persistent state within its host and still infect new horses mirrors the situation with HIV and the bacteria that causes tuberculosis in humans. “Unraveling the complex population dynamics of S. equi sheds new light on the balancing act between acute and persistent infection that is going on in many pathogens,” said Matthew Holden, PhD, from the Wellcome Trust Sanger Institute and the University of St. Andrews. “Not only does this collection of wholegenome sequences for S. equi offer hope for an effective Strangles vaccine, it also provides us with a useful model for understanding persistent infection in humans.” MeV Photo courtesy of Animal Health Trust

In the largest study ever conducted into Streptococcus equi, the bacteria responsible for the development of strangles, experts have come one step closer to designing an effective vaccine to prevent this devastating disease. Strangles is characterized by a fever followed by abscesses of the lymph nodes of the head and neck. Despite more than 100 years of research, the disease remains the most frequently diagnosed infection of horses worldwide. In new research, scientists from the Animal Health Trust, the Wellcome Trust Sanger Institute and the University of St. Andrews joined forces to examine the history and evolution of the disease. The researchers examined 224 samples of S. equi procured from horses around the globe to try and find a common bacterial ancestor from which modern strains would have developed. Despite the disease first being described in 1251, the researchers were surprised at the genetic similarity of the samples and identified a total population replacement at the 19th or early 20th century. This corresponds to a period when horses from around the world were brought together in global conflicts including World War I, where an estimated 8 million horses died on the battlefield. “The mobilization and mixing of horses in conflicts such as WWI provided perfect conditions for S. equi to thrive,” said Dr. Simon Harris, PhD, from the Wellcome Trust Sanger Institute. This, combined with

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news notes

Using Ultrasonography to Determine Ascarid Burdens adversely affect foal welfare. The interventions can be costly. The researchers wanted to develop a technique for quantifying ascarid burdens in foals and use this in a treatment study and cost-benefit analysis. Martin K. Neilson, DVM, PhD, DEVPC, DACVM, Department of Veterinary Science, M.H. Gluck Equine Research Center, University of Kentucky, Lexington, and his colleagues scanned the foals using a portable ultrasound machine and convex probe. The scan focused on three regions; immediately caudal to the xiphoid, halfway between the xiphoid and umbilicus, and immediately cranial to the umbilicus. The left parainguinal region was also examined if no small intestine had been visualized in the first three locations. The number of ascarid worms visualized was assigned a score from none (score 1) to more than three sections of worm cuticle seen in less than 5 cm (score 4). The quality of the assessment was also scored from A to F based on the amount of small intestine visualized on scan. Over 80% of examinations resulted in useful images with scores of C or above. Ultrasound examinations were repeated every two weeks until the end of the study. Every month, one foal was euthanized and all stages of Parascaris worms counted. The technique was able to reliably identify burdens of more than ten ascarid worms. The ultrasound scores were found to change in line with fecal counts, both peaking at around 5 months. Between 5 and 7 months, fecal egg counts reduced to zero, however, ascarid burdens were still visualized on ultrasonography, supported by the presence of worms in the intestines of several foals of this age at necropsy. A parallel treatment trial was also conducted. Foals were randomly assigned to one of three treatment groups: oxibendazole, ivermection and no treatment. A significant reduction in ascarid burdens identified by ultrasonographic scoring was found from day 3 to 5, and there was a significant reduction in fecal ascarid counts. There was no difference in post-treatment ultrasound scores among the different groups. Within this foal population, the ultrasonographic method was cost-effective when the prevalence rate of ascarid MeV impactions was less than 5%.

Click here to watch video Ultrasonography can reliably identify ascarid burdens of more than 10 worms.

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Photo courtesy of Dr. Neilson

A scoring system using a straightforward, quick and potentially cost-effective ultrasonographic technique can be used to reliably detect clinically significant ascarid burdens, according to a recent study. High ascarid burdens can lead to impaction and

For more information: Nielson MK, Donoghue EM, Stephens ML, et al. An ultrasonographic scoring method for transabdominal monitoring of ascarid burdens in foals. Equine Vet J 2015 Aug. 18 [Epub ahead of print] http://onlinelibrary.wiley.com/doi/10.1111/evj.12478/abstract 14

Issue 10/2015 | ModernEquineVet.com

Risk Factors for Post Anesthetic Colic In a recent study, gastrointestinal problems account for 50% of post-anesthetic complications with a significantly increased risk in Thoroughbreds compared with other breeds, and when sodium benzyl penicillin was used perioperatively. The use of butorphanol perioperatively appeared to reduce the risk. This retrospective observational study aimed to characterize the incidence and risk factors for post-operative complications, including colic, at a single referral center using a standardized anesthetic protocol on a predominantly racing Thoroughbred population. Clinical records from 1,021 horses undergoing a total of 1,067 surgical procedures (both elective and emergency surgeries) under general anesthesia were analyzed. Postoperative complications occurring within a seven-day period of general anesthesia were recorded. Horses that died or were euthanized after this period, but for reasons related to complications which had first occurred within the seven-day period, were included in incidence of postanesthetic complications. The mortality rate in this study was 0.94%, too small to be able to identify risk factors specific for mortality. Post-anesthetic complications developed in 169

horses (15.8%). GI complications accounted for 50% of all complications in the study, with the overall risk of post-anesthetic colic being 10.5%. Thoroughbreds had increase in the risk of GI complications (colic, reduced fecal output and colitis) compared with other breeds. Most of the colic cases (80.2%) occurred on the day of or after surgery; 67.6% responded to one dose of phenylbutazone and electrolyte and liquid paraffin solutions given via nasogastric tube. The majority of the remaining cases were diagnosed with pelvic flexure impaction or dry fecal material in the small colon and rectum, with a small number of other causes. Of the 29 risk factors analyzed in the study, those which significantly affected the risk of post-anesthetic colic were breed, perioperative antimicrobials and use of butorphanol. The use of sodium benzyl penicillin was associated with significantly increased risk of colic compared with other antimicrobials, a finding that warrants further investigation. Use of butorphanol was associated with a lower risk of postanesthetic colic; however, the dose range used was not included as part of the analysis, so again further investigation is warranted. MeV

For more information: Jago RC, Corletto F, Wright IM. Peri-anesthetic complications in an equine referral hospital: Risk factors for post anesthetic colic. Equine Vet J 2015 Aug. 26 [Epub ahead of print]. http://onlinelibrary.wiley.com/doi/10.1111/evj.12475/abstract

New Bolton Center pioneers use of robotics-controlled imaging Penn Vet’s New Bolton Center, in collaboration with Four Dimensional Digital Imaging (4DDI), will pioneer a robotics-controlled imaging system for use in the standing and moving horse. Penn Vet is the first veterinary hospital to own the revolutionary technology. The four-robot system can perform multiple modalities, including computed tomography (CT), and will be used with a high-speed treadmill. The EQUIMAGINE imaging system will be capable of capturing the equine anatomy in a way never before possible, while the horse is awake, load-bearing, as well as moving on a treadmill. “This will revolutionize equine imaging,” said Barbara Dallap Schaer, DVM, medical director of New Bolton Center, the large-animal hospital of the University of Pennsylvania School of Veterinary Medicine. Existing CT systems require the horse to be anesthetized, and are limited to the parts of the animal that fit into the cylindrical machines. The EQUIMAGINE

system’s robotics-driven design provides an unlimited range of motion and unencumbered access to the horse’s entire anatomy. The quality and resolution of the real-time images created with the system far exceeds existing technology. “The open structure of the scanner will allow us to capture high-quality CT images of the standing horse that we have had difficulty imaging before,” Dr. Dallap Schaer said. “We will be working to develop protocols to diagnose problems in the lower neck, back, pelvis, and upper part of the legs.” The system will be important not only for clinical use in the hospital, but also for research and teaching. The equipment will be installed in New Bolton Center’s high-speed treadmill building in December. This acquisition was funded in part by a generous gift from the estate of Mimi Thorington. Additional gifts will be sought to integrate the new technology into the clinical and research programs at New Bolton Center. MeV ModernEquineVet.com | Issue 10/2015

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

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

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

AAEVT Objectives • • • •

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

AAEVT Online Equine Certification Program

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

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

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

*American Association of Equine Veterinary Technicians and Assistants

technician update

Managing a case of fibrotic myopathy By Tammy Treitline, LVT, VTS-EVN Fibrotic myopathy can be defined as the development of excess fibrous connective tissue within the muscle with or without ossifications. The muscles commonly affected are the semitendinosus, semimembranosus, gracili, or biceps femoris muscle. The fibrotic tissue, denervation, or adhesions increase the tension, resulting in a decrease of the extension of the stifle and hock. This mechanical restriction of the cranial phase produces an abnormal gait. Horses often “slap” down the foot of the affected limb. The gait abnormality is most commonly noticed at a walk and occurs unilaterally, and often appears more severe with ossification. An inflammatory process, such as an abscess from injection site/deep puncture wound; traumatic injury, such as sliding stop getting the hind limb caught in the fence or neurogenic atrophy, can cause this condition. The acute injury will be accompanied by lameness, swelling and pain upon palpation. The gait abnormality may occur months after the precipitating event as the damaged muscle tissue starts to scar and form adhesions. Veterinarians would look for clinical signs, such as an abnormal gait and a tight band in the semitendinosus palpated during the physical examination to diagnosis fibrotic myopathy. Ultrasonography has been used to evaluate the severity of muscle damage and to determine if ossification has formed. In acute injury cases prior to the development of fibrotic myopathy, the goal is to reduce the inflammation to prevent scars and adhesions from forming. Treating at this stage with systemic nonsteriodal anti-inflammatory drugs (NSAIDS), icing—along with physical therapy exercises to stretch the muscles—should help reduce scar tissue and adhesion formation. Treatment options may be limited depending on the severity of the case. Surgery is one option and includes a semitendinosus tenotomy at the tibal insertion, semitendinosus myotomy of the distal semitendinosus muscle, or semitendinosus myotenectomy. We treated a 12-year-old Quarter Horse gelding that presented to our clinic in 2014. The gelding was purchased in late fall of 2013 with the intent to show in western pleasure performance. A prepurchase examination with radiographs of front feet and stifle was

Figure 1: Ultrasound image showing hypoechoic area of trauma.

Figure 2: Ultrasound image showing hypoechoic area of trauma.

Figure 3: Ultrasound image revealing trauma to the semimembranosus and semitendinosus. ModernEquineVet.com | Issue 10/2015

technician update performed. The new owner and trainer noticed that the gelding had been a little off shortly after his arrival, and he had a history of pulling a "hamstring" four months prior to his purchase. They noticed swelling in the left rear flank on the caudalateral aspect of a palpable tight rope-like structure. A lameness evaluation was performed. The gelding showed a grade 3/5 lameness in the left rear leg. On examination, digital pulse was within normal limits, hoof tester was negative, and a small amount of effusion was present in the fetlock, with scabs on the caudal pastern. The lameness was not changed with flexion or extension of the fetlock, stifle or full limb. When walked and trotted in hand, the gelding did not place the heel flat on the ground and was very short-strided. A tight band was palpated on the semitendinosus upon examination. The owners declined

A combination of modalities can be useful in increasing range of motion in fibrotic myopathy. further evaluation of the limb with nerve and joint blocks. They felt that the problem was in the thigh region where swelling and the tight rope structure were present. The veterinary team continued to evaluate the caudal region of the left rear thigh with ultrasonography. The ultrasound image revealed scar tissue present between the semimembranosus and semitendinosus muscles as well as hypoechoic regions of fluid accumulation. (Figures 1, 2, 3.) Based on the history, lameness evaluation and ultrasongraphy evaluation, the gelding was diagnosed with the condition of fibrotic myopathy. The treatment options that were discussed with the owner were: 1. surgical removal of the scar tissue present between the semibranosus and semitendinosus muscle (semitendinosus myotenectomy), 2. medical therapy consisting of multifocal approach with therapeutic ultrasound, laser therapy, functional and kinetic treatment Rehab (FAKTR), physical therapeutic stretching exercise and NSAIDS, and, 3. referral for aquatread therapy. The owner wanted to try medical therapy first and see if the gelding responded. The veterinary team hos18

Issue 10/2015 | ModernEquineVet.com

pitalized the gelding for one week. The treatment plan consisted of performing ultrasound therapy and laser therapy once a day, followed by FATKR treatment. Also implemented were physical therapeutic stretching exercises consisting of hip extension, hip extension deep stretch, quadriceps muscle stretch, and hip circles. Hand walking was performed for 15 minutes twice a day. The horse received phenylbutazone for two weeks to reduce inflammation and pain. The alternative therapeutic techniques used were ultrasound and low-level laser therapy. Ultrasound therapy is a form of acoustic energy that has several beneficial properties. It increased heat in deep tissue without harming the skin tissue, and increased blood flow to the affected area, which promotes healing. It reduces scar tissue, increases range of motion and reduces pain. The low-level laser is synergistic with the ultrasound therapy, by activating cells to remove wastes, decrease swelling and increase repair activity to the injury, while stimulating the blood and lymphatic system. Low-level laser causes vasodilatation. Other important effects are acceleration of cell division, and an increasing leucocytic, phagocytosis and fibroblastic activity. All of these effects are important in wound healing. Low-level laser therapy is another form of alternative therapeutic technique that uses an intense beam of light to stimulate the body. FAKTR aids by helping increase collagen remodeling, and improving tissue viscosity. The theory behind FAKTR is that when an injury occurs to tissue fascia, fixation occurs. When fascia contracture occurs, it restricts muscle elongation and limits the range of motion. The manual manipulation with FAKTR helps break down fascia fixations, allowing muscle spindle cells to elongate, thereby causing the range of motion to increase. FAKTR is thought to cause vasodilatation and reduce chronic pain. The physical therapeutic stretching exercise of hip extension, hip extension deep stretch, quadriceps muscle stretch, and hip circle, was used to help increase and sustain the range of motion when the scar tissue was reduced. Stretching exercises help by building and strengthening affected muscles and surrounding muscles. In this particular case, the veterinary team started by walking the gelding for 15 minutes prior to therapy. Then the team used ultrasound therapy continuously for 6 minutes, along the semitendinosus muscle. Then the low-level laser therapy was applied set at F4, with four joules per site, over the semitendinosus muscle. After the low-level laser therapy, the team continued with FAKTR. FAKTR was started at a still standing position on the cranial gluteal muscles, then continued down the semitendinosus muscle. The FAKTR

was performed on the same muscles at a slow controlled walk. The gelding was hand walked for 10 minutes after treatments. Then he was allowed to rest for a few hours in his stall. After a period of rest, the physiologic stretching exercises were performed. The first stretching exercise performed was the hip extension stretch. The hind leg was lifted up, then gently extended cranially to the natural position of movement. The leg was held for a count of 10, then the foot was placed on the ground and continued for five repetitions. The second stretching exercise performed was the hip extension deep stretch. The hind leg was lifted in the same manner, except it was extended higher and further cranially. The third stretching exercise performed was the quadriceps stretch. The hind leg was lifted up in the same manner as the hip extension, then extended cranially and medially. The fourth exercise was the hip circle stretch exercise. The hip circle exercise consisted of extending the rear leg cranially and moving it in a small circle motion for a count of 10. The circular motion was performed in a clockwise and counterclockwise direction. This stretching exercise was performed in five repetitions. All of the stretching exercises were increased gradually in distance of extension, count in hold, and number of repetitions performed as the gelding would tolerate. The physiologic stretching exercise gave relief to tight muscles, increased elasticity of the muscles, increased range of motion, and reduced tension on nerve pathways created from the injured connective tissue. The ultrasound therapy, low-level laser therapy, FAKTR, physiologic stretching exercise, and handwalking were continued throughout the week of hospitalization. The gelding was showing improvement by placing his heel down and was more comfortable turning on the left rear leg. He still was short-strided and the scar tissue between the semimembranosus and semitendinosus muscle was still palpable. The gelding was released from the hospital, with physical therapy exercises to perform two to three times a day. The owner and trainer were instructed to hand

walk or ride lightly, performing long-stride walks, large twenty meter circles, and cavaletti poles. These exercises would encourage the gelding to engage the hindlegs pushing forward, further breaking down scar tissue and strengthening surrounding muscles. The gelding was administered phenylbutazone at one gram PO BID for one more week. Polygycan was injected once a week for four weeks, then monthly for maintenance. It was recommended not to show at this time. The gelding was rechecked and treated again in three weeks and two months after his initial hospitalization. He continued to show improvement with placing of the heel down firmly on the ground, turning more comfortably, and he was able to shown successfully. This particular case was interesting because it combined a multifocal approach, which all helped to reduce scar tissue and stimulate healing tissue. The case combined the use of medications, such as phenylbutazone to control inflammatory responses and polyglycan to support joint health. Then the veterinary team added rehabilitation techniques such as ultrasound therapy, low-level laser, FAKTR and physiologic stretching exercises to reduce scar tissue, muscle tension and contracture. The result was an increased range of motion with muscle elongation. Scar tissue, muscle contracture, and a decreased range of motion can result from fibrotic myopathy. A combination of these techniques can be useful in treatment or managing cases such as fibrotic myopathy by aiding in the breakdown of scar tissue and gradual increase of muscle strength. There are still more advancements that will be discovered in these areas, which may increase the veterinary teamâ&#x20AC;&#x2122;s ability to return many of these horses to athletic function. MeV

About the author

Tammy Treitline, LVT, VTS-EVN, is a licensed veterinary technician at Casselton Veterinary Service in North Dakota.

For more information: Valberg SJ. Traumatic and Anesthetic Myopathies in Horses, revision February 2014. www.merckmanuals.com/vet/musculoskeletal_system/myopathies_in_horses/traumatic_and_anesthetic_myopathies_ in_horses.html. Baxter GM. Manual of Equine Lameness, Wiley-Blackwell, Chapter 7, page 375-376. Dyntron 125 Ultrasound Manual. Low Level Laser 2400XL, Respond Laser Systems, Copyright 2008 Respond Systems, Inc. 20 Baldwin Drive, Branford, CT 06405, www.respondsystems.com. ModernEquineVet.com | Issue 10/2015

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