My Old Friend

So many of us have one of these among our pets, no more so than with our horses. The older horse who has been a part of someone’s life for 20+ years is a blessing and a treasure. I count myself lucky every time I get to be a part of one of these special relationships. These days I am seeing many of my patients cruising through their twenties and enjoying life in their thirties. As this becomes more common, I find myself answering more questions about what special care may be required to keep these horses happy. Here are some insights into issues older horses may face.

Arthritis to some degree is something with which many older horses have to deal. This is most often mild and may be noticed only as stiffness when first getting out of the stall after a night’s rest. Occasionally it is more significant and may be localized to a particular area and cause obvious lameness and reluctance to move as much as they used to do. Loss of muscle mass can also be seen as a result of decreased activity associated with arthritis. Treatment for arthritis may be as simple as keeping horses turned out for the mildest of cases or daily treatment with joint supplements or pain relievers such as phenylbutazone or firocoxib (Equioxx) for those that need it. If tolerated, slow and steady regular exercise can help keep these horses active and healthy.

As horses age, they often have trouble maintaining their weight. There are several factors that can contribute to this. First, decreased exercise will cause muscles to atrophy especially along the topline, making horses appear skinnier and often sway backed. Those horses that are able to be ridden lightly will maintain a topline better than those that are sidelined for one reason or another. Secondly, older horses may have dental problems associated with coming to the end of their teeth. Horses’ teeth continue to erupt throughout their lifetime but as horses live longer they will run out of tooth root and teeth will begin to fall out. Proper dental care can ease discomfort by removing excessively loose teeth and smoothing any sharp points or transitions in the remaining teeth. With missing teeth or poor dentition it is likely that these horses will need special feed and may even need it soaked so that they can get all the nutrients that they need. Thirdly, the g.i. system becomes much less capable of digesting feeds with age and more of what you feed is wasted and simply passes through the system. The best way to help our older friends through this is with senior feeds that are designed to be more digestible so nutrients are readily available for absorption through the intestines.

Another issue with which our senior horses can be faced is an endocrine disease commonly referred to as equine Cushing’s disease, caused by a tumor on the pituitary gland. While this is a tumor, it is usually slow growing and doesn’t seem to spread to other places in the body. What it does cause are a number of changes in the body associated with excessive hormone production by the affected tissue in the pituitary gland. Outwardly, what you can see is long hair that often doesn’t shed and they can look skinny but have abnormal deposits of fat especially near the tail. These horses also tend to drink more, are more prone to infections, and more susceptible to laminitis. There is a blood test that can help diagnose this problem and medication to help control it (Prascend).

Finally, vision and muscle coordination can sometimes diminish with age. Horses can get cataracts associated with age similar to people. In horses it is called lenticular sclerosis and usually doesn’t lead to blindness but can certainly make it harder to see detail especially in low light. Coordination can diminish for many reasons and most of the time it can be difficult to determine the exact cause, but closer examination may reveal some clues as to whether it is arthritis or infection or something else.

Knowing all this may make some folks wonder why anyone would ever want to have an older horse. But anyone who has had the privilege of caring for that special horse that has taken care of them for so many years will tell you how profound a relationship develops between horse and rider. The joy they get out of seeing that horse respond to them every day when they arrive to take care of all that they need is worth every bit of trouble.

New Equine Leptospirosis Vaccine Available

Leptospirosis is a bacterial disease of worldwide distribution that can cause illness in many species of mammals, including people. In horses, leptospiral infection has been associated with kidney failure, pregnancy loss, and equine recurrent uveitis, which can lead to blindness. Horses become infected with leptospirosis through contact of mucus membranes or broken skin with infected water.  The kidney is the target organ of the bacteria, and the horse can spread the disease through infected urine. Disease may be asymptomatic, limited to mild fever and malaise, or may cause acute renal failure, uterine infections leading to abortion in mares, or recurrent bouts of uveitis that may affect one or both eyes.

Until recently, control measures for leptospirosis in horses were limited to providing access to clean drinking water, vaccinating other susceptible in-contact animals such as cattle and dogs, and using ruminant vaccines off label. Recently, an equine specific vaccine was introduced (LEPTO EQ EQ INNOVATOR ®) to protect horses against Leptospira pomona, which is reported to be the species of leptospirosis most commonly associated with clinical disease in horses. This vaccine may be especially helpful broodmares, horses with access to ponds or other natural water sources, and horses with equine recurrent uveitis. Please contact your veterinarian to learn more about whether your horse would benefit from this vaccine.

Navigating Back To Normal: General Care Of Neglected Horses

Horses that have suffered from prolonged neglect have special needs that extend beyond malnutrition. Many may have health problems need to be addressed in addition to the horse’s nutritional needs. The first step in making a plan for the long term care of horse that has suffered neglect is to have a veterinarian perform a full physical examination to determine the needs of that individual horse, and to document the condition of the horse when it arrives at its foster facility. Without previous records for healthcare, it should be assumed that the horse has not received any attention or preventative care, and the horse should be quarantined from the healthy herd initially.

Farrier care: Horses that are neglected may have significant hoof problems. Poor nutrition contributes to weak hooves, lack of good hygiene can lead to thrush, and lack of trimming leads to severe overgrowth and cracking. An early evaluation with a farrier is needed to make a plan for returning the hoof to a more normal condition. Depending on the condition of the feet, the farrier may request radiographs to evaluate the interior structures of the foot. Changing the foot is a gradual process, and may require frequent visits from the farrier for the first few months.

Deworming: Horses that have not been well cared for are at risk for significant parasitism. The best way to document the parasite burden in a horse is to have a fecal flotation performed. While it is true that parasites contribute to malnutrition in a horse, it is also true that severely debilitated horses lack the internal resources to withstand the damage to the intestinal tract that can occur when parasites die off and are eliminated from the body. Also, it is very difficult without a scale to determine the weight of an emaciated horse to determine proper dosing of anthelminthic drugs. There is no clear consensus in the veterinary community about the exact method that is best for deworming debilitated horses, but there is agreement that the gravest danger to these horses is the emergence of encysted cyathostomes (small strongyles) from the gut wall. When the adult forms of these parasites are killed by drugs like ivermectin, the larvae emerge from the gut wall, causing bleeding, inflammation, and loss of protein. Thus, recommendations most commonly include using a larvacidal medication (a single dose of moxidectin (Quest®) or 5 double doses of fenbendazole (Panacur®) to prevent this rapid emergence. Because there is still damage done to the gut lining, however, it is prudent to wait until the horse is acclimated to a normal plane of nutrition and gaining strength and condition prior to administering any anthelminthic. A veterinarian can help to determine when and how often to address parasite issues in recovering horses.

Vaccination: Horses suffering the effects of chronic malnutrition do not have the ability to respond normally to vaccination. The immune system depends on the body’s ability to produce proteins and build tissues, which is crippled during starvation. Vaccination should not be initiated until the horse is beginning to improve in condition after acclimating to a normal diet; vaccination is an important defense against infectious agents, but is secondary to rebuilding the body from strict survival mode. An initial series of each vaccination will be required, unless there are records to prove previous vaccination. During recovery, a staggered vaccination schedule is preferred, as debilitated horses are not able to withstand the challenges of vaccination that healthy horses are. The American Association of Equine Practitioners deems rabies, tetanus, Eastern Equine Encephalitis, Western Equine Encephalitis, and West Nile Virus to the core vaccines that all horses should receive. Additional recommended vaccinations for different geographical areas should be determined through consultation with the attending veterinarian.

General considerations: Very thin horses lack the intrinsic resources to withstand changes in weather. Providing shelter and blankets helps to avoid further depleting the horse’s energy stores in cold weather. Fresh, clean water and minerals should be available at all times. Meticulous wound care and general hygiene are important, as the immune system is damaged in starvation, and unable to fight against infection. When possible, stress should be minimized; horses should not have to compete for food or shelter, but should have other horses within sight to reduce anxiety. Dental care, which is important, should be delayed until the horse is stronger and gaining weight, as sedation and dental work are often poorly tolerated by debilitated horses. Many horses are rescued from neglectful situations with diseases that are a consequence of their poor care. Frequent veterinary evaluation, including blood work if a problem is suspected, can help to guide treatment and improve outcomes.

Horse Show Drug Rules For Dummies

dressage Memory1Whenever a horse is competing in a horse show or event, it is the owner, rider, and trainer’s responsibility to know and follow the rules or else risk fines or elimination.  Most horse shows are governed by the United States Equestrian Federation (USEF).  The USEF publishes a rulebook with guidelines for the use of therapeutic medications and drug testing.  The rulebook can be found at  They also offer an APP for smartphones.

We often receive questions about which medications are allowed and the proper dosage to give to prevent a positive drug test.  In this blog, I will discuss some of the important drug rules about commonly used medications.  A good rule of thumb is if you aren’t sure about the rule, do not give the drug until you look it up in the rulebook or call and ask USEF or your veterinarian!

NSAIDs or nonsteroidal anti-inflammatory drugs refer to commonly used drugs Phenylbutazone (Bute), Flunixin meglumine (Banamine), Firocoxib (Equioxx or Previcox), Diclofenac (Surpass), Ketofen, Meclofenamic Acid (Arquel), or Naproxen. These drugs are restricted medications, which means they are allowed but only at a specific dosage.  All NSAIDS should be administered no sooner than 12 hours before the horse shows.  A 1000 lb horse is allowed to have a maximum of 2 grams of Phenylbutazone (Bute) every 24 hours.  This is best given as 1 gram orally twice daily.    Flunixin meglumine (Banamine) is permitted at a maximum of 500mg every 24 hours for a 1000lb horse.  This is equivalent to 10cc of injectable or 1000 lb dose of paste.  Both Phenylbutazone and Flunixin are permitted daily for a maximum of 5 days in a row.

In 2011, the USEF passed a rule change that allowed only the use of one NSAID at a time.  This means that a horse may have only one drug classified as a NSAID in its bloodstream at the time of the drug test.  This is important not only on the day that you show but also the week before you show.  For example, if your horse is treated for colic a few days before the show and the veterinarian administers Flunixin, you can not give the horse Phenylbutazone at the show because he will test positive for both Phenylbutazone and Flunixin, resulting in a positive drug test!   Depending on the dosage, it takes minimum of 3 – 5 days for these drugs to be eliminated in the horse.

People often ask about Equioxx versus Previcox, both are a drug call Firocoxib.  Previcox is FDA approved for use in dogs and Equioxx is FDA approved for use in horses.  A 1000 lb horse is allowed a maximum dose of 45.5 mg of Firocoxib every 24 hours.  This means if your horse only weighs 1000 lbs and you gave him a 57 mg tablet of Previcox, he may test over the legal limit.  This can also happen if the horse is given a higher dose or loading dose of Equioxx.  Firocoxib is permitted once every 24 hours for 14 days in a row.

Farrier/Veterinarian Discussion Recap

Many thanks to all who attended the seminar last night at the Clinic, especially to Dr. Scott Pleasant and Travis Burns from Virginia Tech. There was a good turnout and an excellent presentation by the Virginia Tech team.

We will plan to have another one this winter. Travis Burns, the farrier from Tech, is going to give us a list of subjects that he feels are pertinent. We also welcome suggestions from area farriers and veterinarians. These sessions are a good opportunity for vets to interact with the farriers that we depend on for support.  We had a very good turnout of farriers from the Valley and fewer from Albemarle, but a lot of new faces.

We appreciate the support and expertise of the farriers in our area and look forward to our next get together.

Muzzle Management For Your Horse

Muzzles are very helpful in keeping ponies and horses at a healthy weight. Please make sure you are using them safely!

* Always use muzzles with some type of safety release in case the muzzle gets caught. Use a muzzle with a quick release built in or attach the muzzle to a leather halter or one with a leather headstall.

* Train your horse gradually to the muzzle. Make sure they will and can drink with it on before leaving it on for 12 hours.

* Check for rubs daily and pad as necessary.

* In hot weather (over 85 degrees), remove the muzzle during the day. Put your horse in a stall of sacrifice paddock if needed for weight control. Horses can have heat stroke when left in their muzzles during hot weather.

* Wash the muzzle weekly in soapy water.

* Replace your muzzle as needed. The hole at the bottom can become quite large with use, allowing your horse or pony to overeat even with the muzzle on.

Vaccinating Your Horse Yourself

There has been a lot of discussion lately on this topic. Most horse owners prefer to have veterinarians vaccinate their horses, but many are comfortable doing it themselves and have done so for years without any complications. This can save some money and can be more convenient for those people who have been trained to do it. This growing trend has caused some vaccine companies and more recently, insurance companies, to respond to the increased potential for possible problems that could arise. They have started an awareness campaign to let the horse-owning public know that there are advantages to having veterinarians administer the vaccines and potential adverse consequences if owners elect to  vaccinate their horses themselves.

First, the reasons for concern:  vaccines obtained through retail channels may have suffered from improper temperature control or handling making them less effective or potentially harmful. Additionally, poor administration technique or timing may also decrease the effectiveness of the vaccine or cause significant reactions such as abscesses or anaphylaxis. These all lead to more complaints to the vaccine companies, which could result in losses for the vaccine manufacturer in the form of complications costs covered and more adverse drug reaction reports to the FDA. These same concerns exist for the equine insurance companies and have led some insurance companies to stop covering  medical expenses or mortality claims if a horse has a problem associated with vaccines administered by someone other than a veterinarian.

Now, for the advantages of having a veterinarian vaccinate your horse: your veterinarian is well trained in the appropriate timing and technique for vaccinating your horse and has access to the latest information on the best vaccines to use and any emerging diseases that may need to be considered. If your horse does have a reaction, he or she is capable of responding and treating rapidly, especially in the case of anaphylaxis. Vaccine companies have stated that they will guarantee their vaccines and will reimburse expenses associated with any vaccine break or injection site complication, but only if the vaccine was given by a veterinarian. The wellness programs associated with other equine products also often require that a veterinarian administer vaccinations in order for reimbursement in the event that the horse were to colic. Finally, many horse venues now require proof of vaccination from your veterinarian in order to compete.

As always, we are here to help and hope you will call us with any questions you may have.

Farriers And Veterinarians Collaborate At Blue Ridge Equine Clinic

Blue Ridge Equine Clinic hosted a great turnout of 25 farriers on March 19. The farrier/veterinarian discussion went on for 2 hours and touched on improving communications and understanding. It was a diverse group of farriers from the greater Charlottesville area, the Valley and Hanover county. The subject for the evening was low palmar angles and the management of lameness associated with this finding. A number of cases were presented and everyone had an opportunity to express their ideas. The farriers asked that we have more of these and we welcome input as to subjects to cover. We plan to hold another in May or June. Farriers and veterinarians, please call if you’d like us to let you know about the next event.

Equine Ophthalmology: Focus For Virginia Veterinarians On Saturday

The weather may have been dreary, but Saturday was far from dull for fifty equine veterinarians at the Boar’s Head Inn in Charlottesville. Blue Ridge Equine Clinic’s 9th Annual Equine Practitioners Seminar featured Dr. Amber Labelle, DVM, MS, Diplomate ACVO presenting an in-depth look at all aspects of equine ophthalmology.

Dr. Labelle covered:

* Eye exam tips and tactics

* Study of the cornea: anatomy, wound healing, ulcers, treatment, complicating factors, disease

* Equine recurrent uveitis: role of Lepto, relationship to breed, clinical signs, ocular ultrasound, treatment and goals

* Equine ocular neoplasia: squamous cell carcinoma, diagnosis and treatment, third eyelid treatment, periocular sarcoids, eyelid melanoma, extraocular lymphoma, hemanglosarcoma, equine intraocular melanocytic neoplasia, intraocular neuroectodermal tumors, orbital extra-adrenal paraganglioma and orbital neoplasia

*  Case studies

Dr. Katy Cilinski, Secretary of the Virginia Association of Equine Practitioners

(VAEP) gave an overview of the group’s educational offerings and encouraged everyone to take advantage of membership opportunities. The new VAEP board was elected and looks forward to serving equine veterinarians in the 2015.

Many thanks to Dr. Labelle for an informative, entertaining presentation and to our program sponsors: VAEP, Boehringer-Ingelheim, Zoetis, Henry Schein, Merck, Platinum Plus, Abaxis, Sound, Idexx, Adequan and Equine Partners of America. Without their support, this level of quality continuing education for equine veterinarians would not be possible.


How Much Do Hock Injections Cost For A Horse?

Have you ever noticed a substantial range in the cost for hock injections performed by different veterinarians? Ever wondered why that is? Not all “hock injections” are the same, so when your horse is having its hock injected, it helps to be educated on which joints are being injected and with what substance they are being injected.  Prices for hock injections may vary depending on what medications are being injected and how many joints are being injected.

The “hock joint” in the horse is actually comprised of several separate joint spaces –with long medical names –  but for ease, most vets refer to them for injection purposes as the lower, middle and upper hock joints.

In regards to the upper hock joint, it is the one responsible for most of the motion of the hock joint, so when the hock bends, this is the joint that makes that happen. It is pretty uncommon for show horses to have primary upper hock issues, but it can happen. OCD of the upper hock joint can also be a significant issue in young horses just starting into work, often presenting as a very swollen hock.  OCD’s should be evaluated for possible surgical removal, and upper hock joint injections can be done to keep the horse comfortable and reduce swelling.

In most show horses, the most common place that is injected are the lower and middle hock joints. The lower and middle hock joints are two very low motion joint spaces. Basically, they are comprised of several tarsal (hock) bones that are stacked one on top of the other like blocks.  These bones have some cartilage between them and synovial joint capsule surrounding them. While they are technically joint spaces, they only comprise a small amount of the motion of the entire hock joint and are considered low motion joints. Basically, they have just enough cartilage and joint fluid to slide around on top of each other a little bit as the horse puts its foot on the ground.

With horses in work, these lower and middle hock joints undergo a huge amount of stress and strain every time the horse puts its hind leg on the ground.  Genetics (including conformation and breed), along with the stresses/forces we put on our horses when we do things such as ask them to rock back on their hind end, make those tarsal bones twist, slide and grind over each other.

Cartilage is the cushioning between the bones.  When a horse starts to have thinning and degeneration of the cartilage in the lower and middle joint spaces, pain is often the result because there is bone grinding on bone. Horses will also start to form bone spurs along the edges of the bones that are evident on radiographs. This is the beginning of the fusion process in the lower and middle hock joints.

To help relieve pain during the degeneration process, injection of the lower and middle joint spaces is often done.  Often trying to encourage the fusion process in the lower and middle hock joints is a good thing, because if we can get them to fuse, they don’t slide, and therefore they don’t hurt anymore.

There are different combinations of medicines to use in joint injections. In a young horse with hock pain that has minimal changes on xrays, we may use a HA product (hyaluronic acid-both a lubricant and anti-inflammatory) possibly combined with triamcinalone (kenalog) which is more cartilage-preserving than the other steroid choices.

If a horse is older and already showing signs of the fusion process beginning, we may use methyprednisolone only (Depo-medrol-another steroid). Depo is a great drug for these types of joints because it has longer acting pain killing properties and it is thought to speed up the cartilage degradation process and may help speed up the fusion process.  Again, different veterinarians may have different medication preferences depending on the horse’s age or amount of radiographic changes in the hock.  While steroids +/- hyaluronic acid are most commonly injected into the hock joint, other options include IRAP and intra-articular adequan.

Lastly, horses that are not helped by the steroid injections or helped only for a short period of time with injections, may be helped with ethyl alcohol injections in fusing lower and middle hock joints. This is a relatively new procedure that is being done, and must be done after xrays and appropriate contrast dye studies of the lower and/or middle hock joints are done, proving that the joint spaces are not connected to the upper (high motion) joint. In a small percentage of horses there may be communicating joint spaces – so while getting a little steroid in the upper joint during a routine steroid or HA injection is not a problem, getting alcohol in that joint space would be devastating and possibly life ending for the horse.

The ethyl alcohol works in two ways.  It has both a pain-killing property which can make the horse more comfortable, and it can also chemically speed up the fusion process.  More and more veterinarians are becoming familiar with and are performing or referring out for this procedure.

If your horse is getting its hocks injected, discuss with your veterinarian the different options to help choose the best treatment for your horse.