FEI Updates On Prohibited Substances

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The FEI Veterinary Department would like to update you with some notes on Prohibited Substances.
The FEI has recently seen a substantial increase in the number of positive cases of medroxyprogesterone acetate and triamcinolone acetonide. We would like veterinarians to take the following information into consideration when treating horses and advising clients.
 
1.    Medroxyprogesterone Acetate
Medroxyprogesterone acetate is listed on the Equine Prohibited Substances List as a Controlled Medication. Its use in FEI events is therefore prohibited, despite it being permitted for use under national regulations in some National Federations. Please kindly note that altrenogest is the only substance that can be used to control oestrus in mares during FEI events. A Veterinary Form 2 must always be submitted to the event’s Veterinary Delegate for mares treated with altrenogest.
 
2.    Triamcinolone Acetonide
The FEI publishes a detection time of 7 days for the intra-articular use of triamcinolone acetonide. Consideration must be given to the potential of the substance to leak into surrounding soft tissue, resulting in longer detection times. In the event of a positive case, we would like to highlight that the Person Responsible (i.e. rider, driver or vaulter) will still potentially be sanctioned regardless of following any advice given by their veterinarian.
 
3.    Tildruonate
The FEI is pleased to announce that a detection time has been published for tildruonate. Please click here to access the FEI List of Detection Times from the Clean Sport website.
 
4.    Elective Testing
We would like to make all FEI Veterinarians aware of the elective testing service carried out by FEI Approved Laboratories. The service allows testing for a maximum of four Controlled Medications. Further details and submission forms can be found on the FEI website as follows: https://inside.fei.org/fei/veterinarians/cleansport/elective-testing  

Dr. LaPlume’s Fall Newsletter

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  • Pasture management: Now is the time to have your soil tested and possibly apply the appropriate products, such as lime.
  • Fall preventative Health Care: It’s time for Fall Vaccinations and Dentistry
  • Body condition/weight gain: If your horse is on the thin side, please call to discuss. Do not wait until winter to try to put weight on your horse.
  • Parasite management: Clean up your pasture and horses now before winter. Now is an excellent time to drag and rest your pasture while using the appropriate new deworming schedule. OCTOBER is the time to perform fecal egg counts to monitor your deworming program.
  • Hay: If you have not been feeding hay, now is the time to start, before it gets cold and the grass dies off. You should at least be investigating a hay source for winter!
  • This continues to be Potomac Horse Fever season-turn off your outdoor lights at night!
  • TICKS! Don’t forget your tick control. They are back in full force.

FALL DENTAL REMINDER:

Make sure your horse has been floated this year. Floating is important for the health and comfort of your horse.

SECURE YOUR FEED!

A metal Trash Can and Lid does keep feed safe from mice and rats. Trash Cans do not keep feed secure from horses! Horses tip them over and get access to the entire can of feed. The best place for feed is behind a closed and locked stall or regular door.

NEW WOUNDS

How to treat a NEW wound is a common question among horse owners. One of the most import issues is not to damage the tissue any further. Many old remedies have been found to be harmful.

If a wound if bleeding profusely, is over a joint or tendon sheath, the horse is very lame, or the wound is very large and deep, please call before you do any treatment besides a pressure wrap for bleeding.

If you find a simple new wound, first use fresh cold water (from a hose is ok), and wash the wound. Clipping the hair around the wound at this point can be helpful.

Then use very clean or sterile material, such as a clean wash cloth or gauze squares, and a small amount of soap, such as ivory, Betadine scrub or Chlorohexadine scrub to gently clean the wound. Rinse ALL the soap out of the wound.

Pat dry the wound with different clean or sterile material. Follow drying with either nothing, silvadeen/thermazine or triple antibiotic on the wound. If on a leg, wrap appropriately.

Agents to AVOID with fresh wounds include hydrogen peroxide, alcohol, iodine, betadine solution, furacin, icthamol, bag balm, DMSO, caustic powder, gentian violet, scarlet oil, and hydrocortisone. Please do not infuse any medication deep into a wound without veterinary instruction.

Please call to discuss any wound. In general, if the wound is less than 6 hours old, is on the head or below the knee or hock and the skin gapes, the wound should be closed with suturing. How to proceed with subsequent wound care will depend on size, depth, location and age.

Finally, do not forget to check the tetanus status of your horse!

10 Tips for Preventing Colic

Colic is a killer of horses. Colic is not a disease, but rather a combination of signs that alert us to abdominal pain in the horse. Colic can range from mild to severe, but it should never be ignored. Many of the conditions that cause colic can become life threatening in a relatively short period of time. Only by quickly and accurately recognizing colic – and seeking qualified veterinary help – can the chance for recovery be maximized.

While horses seem predisposed to colic due to the anatomy and function of their digestive tracts, management can play a key role in prevention. Although not every case is avoidable, can maximize the horse’s health and reduce the risk of colic:

  1. Establish a daily routine – include feeding and exercise schedules – and stick to it.
  2. Feed a high quality diet comprised primarily of roughage.
  3. Avoid feeding excessive grain and energy-dense supplements. (At least half the horse’s

energy should be supplied through hay or forage. A better guide is that twice as much energy should be supplied from a roughage source than from concentrates.)

  1. Divide daily concentrate rations into two or more smaller feedings rather than one large one to avoid overloading the horse’s digestive tract. Hay is best fed free-choice.
  2. Set up a regular parasite control program with the help of Dr. LaPlume.
  3. Provide exercise and/or turnout on a daily basis. Change the intensity and duration of an exercise regimen gradually.
  4. Provide fresh, clean water at all times. (The only exception is when the horse is excessively hot, and then it should be given small sips of luke-warm water until it has recovered.)
  5. Avoid putting feed on the ground, especially in sandy soils. Use mats if you have to feed on sand or blue stone, even for hay.
  6. Check hay, bedding, pasture, and environment for potentially toxic substances, such as blister beetles, noxious weeds, and other ingestible foreign matter.
  7. Reduce stress. Horses experiencing changes in environment or workloads are at high risk of intestinal dysfunction. Pay special attention to horses when transporting them or changing their surroundings, such as at shows. Discuss gastric ulcer preventative therapy with your vet.

Virtually any horse is susceptible to colic. Age, sex, and breed differences in susceptibility seem to be relatively minor. The type of colic seen appears to relate to geographic or regional differences, probably due to environmental factors such as sandy soil or climatic stress. Importantly, what this tells us is that, with conscientious care and management, we have the potential to reduce and control colic, a killer of horses.

Reprinted with permission from the American Association of Equine Practitioners.

Rabies

September 28th is the World Rabies Awareness Day.

In VIRGINIA, 2014, (2015 statistics are not available yet) 236 raccoons,162 skunks, 45 foxes, 28 cats, 23 Bats, 12 cows, 1 dog, 0 horses, 1 Bob cat, 1 goat, 5 groundhogs, 1 coyote, 1 Otter were tested positive.

Rabies is a zoonotic (can be passed from animals to humans) disease. The vaccination available to our domestic animals is very effective. Rabies is almost always fatal.

Most horses have the “dumb” or “paralytic” form of rabies, and diagnosis is often delayed, causing many people to be exposed.

Please make sure ALL your animals are up to date on their rabies vaccinations!

 

CHOKE, Pellets and Beet Pulp

To Avoid “CHOKE” -Please feed all pellets and Beet Pulp WET! What feeds are pellets you may ask? They include:

Any senior type feed (Purina, Blue Seal, etc)

Alfalfa pellets

Beet pulp pellets

Rice bran pellets

Any nugget like feed (Blue Seal common)

Some Textured feed will have a large pellet component, and very greedy eaters can choke on it!

 

Equine Asthma AKA HEAVES study at BREC:

If your horse is over age four and has been diagnosed with Recurrent Airway Obstruction (RAO) or Summer Pasture Associated Obstructive Pulmonary Disease (SPAOPD), your horse may be eligible to participate in this FDA-regulated clinical study of an investigational medication that will help bring much-needed quality research to the equine community.

Afflicted horses are now being recruited for this study to carefully evaluate an investigational drug with the potential to treat RAO and SPAOPD. Our hope is that the research will result in an approved treatment – because today there are far too few FDA-approved drugs for horses afflicted with these diseases.

Please call our practice if you own or know a horse with one of these debilitating diseases. Visit EquineStudy.com to see if your horse may qualify.

 

 

Considering Vaccinating Your Horse Yourself?

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WHOA! Consider these issues before you do your own vaccinations!

The benefits of having a veterinarian perform your horse’s vaccinations are numerous! Here are just a few:

1. Creates a Valid Veterinary-client-patient-relationship. This means you have an agreement with your veterinarian who knows you and your horse, allowing them to treat, advise and dispense medications for your horse.

2. Health exam and history before vaccination. Your horse needs to be healthy to receive the vaccines. Your veterinarian is trained to catch early and subtle issues that might make vaccination contraindicated. Current illness, PPID, uveitis, laminitis, pregnancy, allergies, previous vaccine reactions, exposure to Strangles may be red flags to your doctor to change recommendations for vaccination.

3. A farm call gives the opportunity for nutrition consult and husbandry issues. Your veterinarian needs to see your horse and farm to know how to manage their weight and herd issues.

4. Other routine procedures can be performed at the same visit, such as sheath cleaning dental exam/float, Coggins, fecal. This saves money on farm calls.

5. A visit can allow other important biosecurity measures to be discussed. Vaccination is just one very small part in the overall biosecurity of your horse and farm.

6. Your veterinarian will make the proper choice of vaccine brand, type and schedule. They will use current research and experience to make these choices. Your veterinarian will give you the most up to date advice using risk based analysis on which vaccines to give. They will be able to give you the current evidence based advice on core vs non-core vaccines needed in your area.

They will also make sure the vaccines are given at the right time of year and inform if any boosters are needed. This will make sure you also do not over vaccinate your horse. This ensures your horse has been properly vaccinated. Most vaccine failure is due to improper scheduling.

They will also remind you of boosters if you like. Foals, weanlings and geriatric horses also need different vaccines than do adults.

7. Vaccines must be handled properly. This means that they must remain at a constant temperature (35-45F), some stored in the dark, and “in date”. Thermometers are kept in all refrigerators in veterinary hospitals (required by the state) and trucks. If they become frozen or hot, they are ineffective and

more prone to adverse events. No online pharmacy or farm store can guarantee their vaccines have this type of chain of command of quality control.

8. New vaccines are often available. Your veterinarian will have the inside scoop on whether to use them, as manufactures will always host educational seminars for veterinarians before a new vaccine launch.

9. Outbreaks of disease such as Strangles, Botulism, EHV-1, Potomac Horse Fever, Eastern Encephalitis and West Nile will often lead to changes in vaccination recommendations. Your veterinarian will be the first to know about these issues and have educated trained advice to give.

10. Proper vaccination site and route selections will occur due to Veterinary training and experience. Many lay people do not know the correct site to inject or proper technique. Improper site or technique leads to an increase in adverse events such as muscle neck pain, abscess formation, and poor immune response.

11. Immediate treatment for anaphylaxis by your veterinarian who is trained for this serious adverse event. The most serious form of anaphylaxis must be treated immediately, which is not possible if your veterinarian must travel to your farm. They also know how to report these serious reactions to make sure other horses do not suffer the same problem.

12. The cost for treatment of adverse events is covered by the manufacturer if the vaccine has been administered by a veterinarian. Vaccines are “labeled” to be given by a veterinarian.

13. Most Insured horses must be vaccinated by a veterinarian according to the contract.

14. Manufacturer Vaccine Assurance Programs cover costs for treatment of vaccinated horses that contract the disease (vaccine break). But only if vaccine administered by a veterinarian!

15. Rabies vaccine is only recognized by state of Virginia if given by a veterinarian. While rare, this means that if you vaccinate your horse and an exposure to a rabid animal occurs, the horse will be required to be euthanized.

16. Wellness and colic programs coverage only remains intact when vaccines are given by a vet.

17. Paperwork for shows (such as the new USEF GR845) is completed correctly and always available.

 

 

 

 

USEF Vaccination Rule for Equine Herpesvirus-1 (EHV-1) and Equine Influenza Virus (EIV)

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The United States Equestrian Federation (USEF) has instituted a rule that requires a veterinary certification of vaccination against Equine Herpesvirus-1 (EHV-1) and Equine Influenza Virus (EIV) within 6 months of a horse entering the grounds of a Federation licensed competition. The rule change was made in response to inconsistent requirements on the part of show venues that could potentially lead to infectious disease outbreaks. The USEF hopes to optimize individual horse health and reduce risks of infectious disease outbreaks by implementing this rule, which follows the vaccination recommendations published by the American Association of Equine Practitioners.

Equine Herpesvirus-1 is a virus that is spread chiefly through respiratory secretions and which causes a variety of syndromes in adult horses, including respiratory disease, pregnancy loss, and neurologic disease (EHM). The virus is highly contagious, and a strain of the virus that leads to neurologic disease can be particularly contagious, with high concentrations of the virus in the blood and secretions. Currently, a farm in Pennsylvania is under quarantine for this disease, with 6 horses affected, and 4 of these having been euthanized because of the severity of their condition. In the last 5 years, there have been several high profile EHM outbreaks associated with equine competitions. Although no vaccine has been proven to prevent EHM, vaccination reduces the amount of virus reproduction in the horse, which may help to contain spread of the disease by making horses less infectious to others if they are infected.

Equine Influenza Virus is a highly contagious respiratory disease that can cause high fever, cough, upper respiratory disease, and pneumonia. The virus is spread not only through contact with respiratory secretions, but through aerosolized viral particles in the air. Although rarely fatal, EIV can cause serious disease that can require hospitalization and intensive care of patients.

If you are planning on competing in USEF licensed shows this year, plan on setting up appointments for twice yearly EHV/EIV vaccinations, and have your veterinarian provide the required documentation to ensure compliance with the rule.

Equine Medication Prices: Why Can’t I Get Something Cheaper?

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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 PrascendFDA 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.