Thanks to Equus magazine for letting us share this story. We are always happy for positive outcomes with complicated cases like this one.
Thank you to Deb and Mark Burke, owners of Amethyst Acres Equine Center, Inc. in Buchanan for inviting Drs. Julia Hecking and Tabby Moore to speak at their Alternative Therapies for Horses learning day on November 8. The doctors very much enjoyed a day of learning and fellowship with horse enthusiasts from Southwest Virginia.
Dr. Hecking is certified in equine acupuncture by the Chi Institute in Florida. She gave a PowerPoint presentation, answered questions and explained how successful acupuncture can be for treating painful and/or stressed horses, before demonstrating on the lovely Shady Lady.
Dr. Moore is certified by the American Veterinary Chiropractic Association and gave a presentation on the benefits and uses of equine chiropractic therapy. She demonstrated an adjustment on Shady Lady, who was no doubt feeling relaxed, loose and thoroughly pampered after serving as the equine volunteer for the day.
In fact, Deb shared that when she was turned out the next morning, the 28 year old mare took off running and bucking – a true testimony to the effectiveness of these therapies, according to Deb. We appreciate the Burkes dedication to educating horse lovers on best practices in equine care and for inviting our doctors to be a part of this great learning experience.
From Zoetis, maker of Quest dewormer: Small strongyles are the most prevalent and important internal parasites to adult horses. Unfortunately, effective control presents challenges because of persistent exposure, anthelmintic resistance and encysted stages in the life cycle of small strongyles. A recent Zoetis-funded study compared a single dose of moxidectin (QUEST® Gel) with five consecutive days of double-dose fenbendazole (Panacur® PowerPac) in reducing and suppressing small strongyle fecal egg counts (FECs) in a mare herd originating from 21 different states across the United States.
Researchers analyzed FEC data 14, 45 and 90 days following treatment. At 14 days post-treatment, the mean FEC reduction was 99.9% for moxidectin-treated mares and 41.9% for fenbendazole-treated mares. Statistically significant differences were observed 45 and 90 days post-treatment, as well. This confirms small strongyle resistance to fenbendazole to be widespread, while moxidectin remains effective for controlling these harmful parasites. The rapidly dissolving formula of QUEST PLUS (moxidectin/praziquantel) Gel and QUEST (moxidectin) Gel are proven effective against encysted and larval stages of small strongyles and safe for use in horses and ponies, and foals 6 months of age and older.
IMPORTANT SAFETY INFORMATION: Do not use QUEST Gel or QUEST PLUS Gel in foals less than 6 months of age or in sick, debilitated and underweight horses. Do not use in other animal species, as severe adverse reactions, including fatalities in dogs, may result.
This study was funded by Zoetis the makers of Quest. This study was reviewed and provides valuable information for your veterinarian to use to help make decisions regarding your horses health care. It does not mean that Quest should always be used instead of Panacur but suggests that the potential for resistance should be considered when determining which dewormer is right for your horse. Talk with your veterinarian to decide which dewormers you should be administering to your horses.
Thank goodness there are horse “angels” in our midst, like our client Becky Moore. Becky shares her journey with her rescue horse, Raven, in her own words:
“Raven is a 12 year old Tennessee Walker gelding that arrived at our farm on 6/14/14. I picked him up only knowing that he was underweight but looked better than he did over the winter. He is an owner surrender- the former owner not having a good place to keep him and not able to afford the proper feed. A couple of weeks prior to picking him up I sent sweet feed home with the owner and directions on how to start feeding it. When I picked him up, I was unsure if he had the energy to withstand the trailer ride back to my farm as he was severely malnourished. Upon arrival at my farm he weighed 848 lbs, we dewormed him and introduced him to our herd. Dr. Hecking came out after he had been with us for about two weeks and floated his teeth and checked him over and agreed that it seemed to be a malnourishment issue only and his ideal weight should be somewhere between 1000-1100 lbs. Once his weight increased, Ray received all of his shots and proper deworming medications. Ray’s feeding schedule was quite intense. He was fed a combination of two different sweet feeds, beet pulp, alfalfa, cocoa soya, a weight supplement and free range hay. Ray was extremely nervous and during feeding times I had to stand with him so that he would not leave his food- for the first 2 ½ months I spent a total of 3 hours per day feeing him. I do not know exactly how many pounds of food he was consuming per day but he received 4 – 8 qt buckets of the beet pulp/alfalfa mixture and one 8qt bucket twice a day.
Raven is now 1020lbs and the leader of herd. He has a great personality and is super friendly with most people. He still has some weight left to gain but he is eating an almost normal diet and feeding time is down to a total of 45 minutes per day. Raven seems to be very happy in his forever home, he has lots of energy and likes the attention from my children. Over the next few weeks I do hope to take him for a test drive as I am told he was an excellent trail horse.
Thank you to Blue Ridge Equine for promptly visiting Raven and examining him so quickly and providing me with information on ways to achieve his ideal weight. Floating his teeth and shots have been a key part in his recovery.”
Probably every horse owner has had the experience of feeling sticker shock when the cost of treating a horse’s malady is revealed by the veterinarian. The cost of pharmaceuticals is high because of development and production expenditures, and horses are really big patients (generally 10 times the size of the average adult human). But often, cheaper alternatives exist, and are often touted as “generic” formulations. Veterinarians may be reluctant to prescribe these less expensive alternatives, which may lead clients to wonder why they have to pay more for name brand medications. There are actually a number of reasons, and they all boil down to providing safe, effective medication to our equine patients.
First, it is important to clarify the terminology. Both name-brand and generic FDA approved medications are manufactured and labeled according to standards set by the Food and Drug Administration, a government agency charged with, among other things, assuring that medications are safe and effective. Compounded medications are either drugs that are somehow altered from their FDA approved formulation (for example, adding flavoring to children’s antibiotics to make them more palatable), or are formulated from the chemical grade drug or substance in other than FDA approved processes or facilities. The important part of this distinction is that medications with FDA approval are required to adhere to FDA standards for manufacture and labeling. Because compounding pharmacies are not under these requirements, the standards for manufacture are lower and label claims are not under the regular scrutiny of a regulatory body. Why does this matter? Let’s review a few examples.
In April of 2009, 21 polo ponies died as a result of the administration of a selenium product that, because of a clerical error, was 10 times more concentrated that it should have been according to the label. Similarly, this year, 4 horses died and 6 more were sickened when they received a pyrimethamine/toltrazuril combination in which the amount of one of the drugs was inappropriate. (Toltrazuril is not approved for use in the United States, so any complications from the use of these drugs could potentially put the prescribing veterinarians in an awkward spot with the FDA.
Compounding concerns are not limited to veterinary medicine, however. In the fall of 2012, reports began to surface of people suffering from fungal meningitis after having spinal injections with compounded steroids. Sixty four people have died, and 700 more are under long term treatment for persistent infections. The fungus was isolated out of the room in which the drug was prepared.
In addition to safety concerns, the formulation of compounded medications does not always provide the active ingredient in a form that the body can use properly to achieve the desired effect. There are a few important examples of this in equine medicine one of which is omeprazole. The FDA approved omeprazole products (GastroGard® and UlcerGard®) are very expensive to use, driving the desire for a less expensive alternative. Unfortunately, omeprazole is very difficult to formulate in a way that it is useful to horses. In order to be useful, the drug must pass through the stomach to be absorbed in the small intestine, then travel through the blood to the acid-producing cells in the stomach, where it blocks the cellular pumps that produce acid. The challenging part of this is the fact that omeprazole is inactivated by acid, which fills the stomach. GastroGard® is made using a patented process that encapsulates the drug into enteric-coated microspheres that are kept in suspension; the omeprazole is protected from the acid in the stomach so that it can be absorbed in the small intestine. Other formulations of omeprazole which use antacids and buffers in an attempt to protect it through the stomach have consistently failed to achieve blood levels of omeprazole that are sufficient to be effective. (Birkmann et. al, J Vet Int Med 2014) Another related issue is that there is no assurance that the concentration of active ingredient listed on the label is what is actually in the product. Variations from label claims have been documented in numerous compounded medications.
Furthermore, the veterinarian her/himself is bound by law. It is permissible to compound medications, which is good, since it is also necessary in many occasions. However, it is not permissible if an effective FDA alternative is available. Conditions that allow for using compounded products include availability (when pergolide was first off of the human market, only compounded pergolide was available for horses) and patient factors (an infant can’t take a pill, an individual is allergic to a dye or filler in an approved product). The cost of a medication is NOT legal justification for using a compounded product. A doctor or veterinarian who prescribes a compounded medication inappropriately bears all of the legal responsibility for that medication, and is 100% culpable if something goes wrong.
All this is not to say that there is no place for compounding pharmacies in human and veterinary medicine. There are many very reputable pharmacies that have high standards for production and are very concerned about product quality. These pharmacies make available to practitioners medications that, for one reason or another, are not available in an FDA approved form. However, it is important to realize that when a veterinarian prescribes such a drug, he or she is personally taking on the full responsibility of standing behind that product, and there may be a number of very good reasons not to do so in a particular circumstance. If you have a question about a product, the best way to learn more is to open a dialogue with your veterinarian to determine the best, most cost effective product for your horse.
Recently my horse Mocha fractured a small bone in the sinus region of her face causing subcutaneous emphysema, which means gas or air is trapped beneath the layer of skin. It is not a hot or hard swelling; it feels like it crackles and is crunchy to the touch, a sensation known as crepitus. I had never seen anything like this before, and called Dr. Julia Hecking right away. She asked me to look for a puncture wound that could be leaking air into the skin, however there was not a wound present.
Dr.Hecking thought it was best to take radiographs of her head to look for any fracture that may be causing air leakage. There was indeed a small fracture in her sinus region which explained her head being enlarged. However, we were unsure if that was causing the enlarged throat latch area and neck, or if there could be a secondary problem. We passed a scope through her nostril into her trachea and esophagus to make sure there were no tears or bleeding present. There were no tears or bleeding that she could see, however the scope the doctors use in the field is much shorter than the one we have at the hospital, so it’s hard to see the entire area. This is often the reason a doctor chooses to refer a horse into the hospital for a better look with a longer endoscope.
If you ever encounter this type of swelling in the head or neck region of one of your horses, it is important to call your veterinarian immediately, and keep the horse quiet and in a confined area until the vet arrives. He/she will appreciate knowing if your horse is eating, drinking, breathing normally, and if a fever is present.
After one week, the swelling is decreasing. Mocha continues to eat, drink, breathe and act normally with no indication of fever or discomfort, so we expect it to resolve on its own. Dr. Steve Trostle has seen similar cases and says it may be a few weeks until the swelling completely disappears.
An Internal Medicine Specialist is a veterinarian who specializes in conditions that affect the general health and well- being of her/his patients, including conditions affecting the GI tract, respiratory system, blood and lymphatics, liver, muscles, kidneys and bladder, neurologic system, infectious diseases, and care of neonates (newborn foals). Specialty training in Internal Medicine emphasizes critical thinking, excellent history taking and physical examination skills, and a problem based approach to reaching a diagnosis and appropriate treatment.
Board certification in Internal Medicine requires several years of training with specialists, passing multiple examinations, completing research, and publishing at least one peer-reviewed article. Equine Internal Medicine specialists are employed in many diverse fields, including critical care medicine, cardiology, pulmonology, neurology, sports medicine, neonatology, general practice, industry, and academia, to name a few.
At Blue Ridge Equine Clinic, we are fortunate to have two Internal Medicine Specialists: Dr. Abby Sage, based in our Earlysville clinic, and Dr. Tracy Norman, in our Valley Division. They are tremendous resources for our veterinarians, clients and patients, as they are up to date on the very latest research concerning all aspects of equine health. Having two Internal Medicine Specialists on staff enables us to provide our clients and patients with the most complete, cutting edge treatment and care for your horse.
As always, let us know how we may best serve as a resource for your equine care needs.
Over one hundred horse owners/ enthusiasts gathered at the Virginia Horse Center on March 19 for dinner and an educational seminar sponsored by Blue Ridge Equine Clinic, Augusta Cooperative Farm Bureau and the Virginia Horse Center. We were delighted to see old friends, clients and to get acquainted with new friends from our horse community.
Dr. Abby Sage, VMD from Blue Ridge Equine Clinic, gave an excellent presentation on Equine Lyme Disease: What We Know and What We Still Don’t Know. Although there are been a few studies on the disease, the frustrating reality is that there is still much that has not been proven scientifically about Lyme Disease in horses, which has reached epidemic levels in our region since 2009.
The disease is caused by a bacteria called Borrelia burgdorferi. It is carried by the tiny deer or black legged tick and can be transmitted throughout the year. It is difficult to be certain what the clinical signs of the disease are in the horse. When ponies were experimentally infected with the organism, none of them developed clinical signs even though the organism was recovered from the ponies at necropsy. There have only been six documented cases of Lyme Disease in the horse that have been reported in the scientific literature. However clinical signs that have been attributed to the disease are: stiff, swollen joints, anterior uveitis (moonblindness), neurologic signs, low grade fever, sensitivity to touch, lameness, weight loss, tremors, neck pain, lethargy, laminitis and pseudolymphoma. Unfortunately, these signs may be caused by many other diseases that are commonly seen. Those include anaplasma, EPM, arthritis, typing up, PSSM and many more.
Lyme test results are based on an antibody response. If the horse is infected with the organism, it will develop an antibody response. However, 40-50% of all horses in the mid-atlantic region test positive (75% in New England, where Lyme Disease was first reported) even though they have no clinical signs nor will they develop clinical signs in the future. They have been exposed, develop an antibody response but do not get sick. So a positive test does not mean that the clinical signs the horse is experiencing are definitely caused by the Borrelia organism.
So how do we know if a horse is infected with Lyme Disease? For lack of a better method, veterinarians have adopted the rules for humans the CDC uses:
* the horse must be in an endemic area
* the horse must have compatible clinical signs
* all other potential diseases must be ruled out
* the horse must have a positive test
* if the horse dies, it must have compatible pathology
Results from experiments on treating Lyme Disease have not been definitive. An experiment performed at Cornell University College of Veterinary Medicine divided 16 ponies into 4 groups of four. Horses which were infected with Lyme Disease and treated for 28 days four different ways: Doxycycline (oral form of tetracycline), ceftiofur (antibiotic in Naxcel or Excede), IV Tetracycline or with no medication (control group). The only group that showed a negative antibody test after 28 days of treatment was the IV tetracycline. However another experiment in naturally infected horses did not show a similar effect with IV tetracycline. It is not clear why these horses did not have a negative test after treatment. It may be that they became reinfected or they remain chronically infected.
Considering the results from the first treatment experiment, one may wonder why not just treat all suspected cases with IV Tetracycline? Several reasons: it’s expensive, as it requires a daily visit from the veterinarian for 30 days, horses can collapse if it is giving too quickly, it’s very irritating if it gets outside the vein, it can cause GI upset and renal failure. As you can see, it’s not a treatment decision to be made lightly in a suspected case of Lyme Disease. If you or your veterinarian suspects Lyme’s Disease a discussion about the test and treatment options should follow. Today veterinarians use Monocycline (oral tetracycline) because it is given orally and rises to therapeutic levels in the blood stream of the horse. But there is no clinical evidence confirming if it actually works or how long it should be given.
As you can see, it’s frustrating for all of us that there is so much that is still unknown about Lyme Disease: its prevalence, definitive clinical signs, how to diagnose it and best treatment method. Until more research dollars are invested in further research, the only things we know for sure are the organism that causes it and that tetracycline has some effect on it.
What is the Academy of Equine Veterinary Nursing Technicians (AEVNT)? The AEVNT is recognized as a veterinary technician specialty by the National Association of Veterinary Technicians in America (NAVTA).
In December 2008, the American Association of Equine Veterinary Technicians and Assistants (AAEVT) sent out an inquiry to those members interested in organizing an Academy for Equine Veterinary Technicians. Nine qualified applicants were selected and a committee was formed. The organizing committee researched and drafted an extensive, 88 page proposal, which was presented to the NAVTA Committee on Veterinary Technician Specialists for consideration. The proposal was reviewed, and with a few minor modifications, was accepted by the NAVTA Board at the American Veterinary Medical Association (AVMA) meeting in Seattle.
The AEVNT Mission Statement is to advance the education and professional recognition of credentialed equine veterinary technicians who display excellence in, and dedication to, providing superior nursing care to the equine patient.
I have been a member of the AAEVT and employee at Blue Ridge Equine Clinic since 2008. I learned of the AEVNT through being a member of AAEVT and decided that this was a specialty that I wanted to pursue. Between May 2012 and May 2013, I compiled my application, which included my resume, 50 hours of continuing education over the past three years, two recommendation letters (from our amazing surgeons), and 61 brief cases and 5 extensive cases in which I had taken part. I submitted the application and waited to hear back!
In June, I learned that the board had accepted my application and I was eligible to sit for the examination at the American Association of Equine Practitioners (AAEP) Conference in Nashville, Tennessee. In December 2013, I took and passed the examination and was inducted into the Academy of Equine Veterinary Nursing Technicians at AAEVT’s annual luncheon. This designation gives me the opportunity to promote the advancement and standard of excellence of the equine nursing practice by communicating, educating, and mentoring others and utilizing my knowledge in performance of duties as an equine veterinary nursing technician.
I feel truly honored to be one of 17 technicians in the world that have this designation and look forward to using my knowledge in teaching and training externs, interns and other technicians who come through our teaching hospital.
When you find a good farrier, do whatever it takes to keep him or her happy. Farriers, sometimes called blacksmiths, have one of the most challenging and difficult jobs in the equine industry. They constantly deal with difficult owners and horses. It is a very competitive business, so they have to work hard to maintain their clientele. Many people think it’s an easy job and pretty simple, but it is definitely an art that takes a lot of patience and skill.
When you are looking to hire a new farrier, make sure they are knowledgeable about the anatomy of the horse and corrective shoeing techniques. The Journeyman farrier designation requires a good deal of training and experience, and is one indication that a farrier is well equipped to handle most corrective shoeing situations. There are other great certification programs as well. Some farriers choose to do an apprenticeship with another, more experienced, farrier instead; this is another great way to learn the trade. It is important that your farrier listens to what you have to say. If you are questioning your horse’s movement, it could be a shoeing issue that can be corrected with time and skill. This may require collaboration between your farrier and veterinarian, so be sure you choose a farrier who is accepting of a veterinarian’s input and advice.
The best way to keep your farrier happy is to have your horse well trained to stand for him/her, whether you have a yearling or a 20 year old horse. In between shoeing or trims, work with your horse on standing and picking up hooves for a length of time. With young horses, practice hammering lightly on their hooves to get them used to the sound and feeling so they will be dull to it when the farrier comes for the first time. Your farrier will also appreciate a well-lit, dry, uncluttered work space, as well as a clean, dry horse when they arrive.
A competent farrier is an essential part of your horse’s well-being. Take good care of them, so they can help you take good care of your horses.
THANKS to all of you who kept me and my horse Joe ( I'm Cotton-Eyed Joe) in your thoughts and prayers after his recent colic. Joe received EXCELLENT care and life-saving surgery from Blue Ridge Equine and Dr. Trostle. I am grateful for the experience of Dr. Trostle, the interns, the great care and frequent communication.
Thank you so much for your excellent care and compassion shown to Zack and me during our visits to the clinic over the past few months. He is such a sensitive guy, and I love him so much – you made a scary and difficult time so much easier to bear. I always know my animals are safe in your hands! I hope you all know how grateful I am.
A heartfelt thank you for the tremendous work your team performed on Sprout and Lulu. The past 2 weeks have been an education for me on the vast medical resources available at BREC. I truly realized the extent and depth of veterinary talents within your organization. I feel totally blessed knowing you are there for me and my equines.
Thank you, Anne, Dr. Hecking, Dr. Moore, and Courtney for being so helpful through this whole journey, and for being respectful and compassionate to the end. I would recommend you all highly to anyone who is in need of a professional and caring veterinary clinic.
Thank you so much, Anne, for your speedy reply and your consideration for giving me a little education in the process. This, along with the wonderful Dr. Hecking is the reason I want to be your customer! You all have a wonderful day.
Just thought you might like to see pictures of Willie and me checking out the ACTHA trail at the Horse Center. Willie and I are also back to taking dressage lessons, and hope to enter Dressage With a View at the Horse Center on June 30th! Just Intro A and B, but not too shabby for all he has been through. None of this would be possible without all of your hard work, expert care and belief in us. Thank you so much!
Blue Ridge Equine Clinic
4510 Mockernut Lane
Earlysville, VA 22936
434.973.7947 phone 434.973.7449 fax
55 Mint Spring Circle
Staunton, VA 24401
540.460.5702 phone 540.324.0220 fax