themodernequinevetjuly2012

1 July 2012 | TheModernEquineVeterinarian.com

July 2012 Vol1 No2

Equine VeterinarianThe Modern

Changing paradigmHow to fight parasite resistance

Inventory is money!Best insemination technique?Biopsy accurate in endometriosis evaluation


TaBle of ConTenTs

RepRoducTiVe MediciNe

comparing insemination techniques: Which is best? ................. 8New study compares hysteroscopic and transrectally guided deep-horn insemination with low sperm count samples

Biopsy accurate for evaluating endometriosis ............................12Current grading system for biopsy coincides with the results from a whole-wall sample.

TechNiciaN updaTe

inventory is money! ...............................................................................16Effective inventory management means more than just ordering new supplies

eMeRgiNg diseasesLawsonia intracellularis:

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saving a precious resourceThree experts tell you how to develop an individualized program and explain why you should

The FeedBag: 21 Fatter than they lookNeWsNoTes15 Motion detectors locate lameness sooner20 Rescue partnership gives horses a second chance

coVeR sToRy4

species specific ............................18Stop blaming pigs when foals come down with EPE

TheModernEquineVeterinarian.com | July 2012 3


Today’s parasite control requires an individualized program that involves testing, selective deworming and environmental controls.

saving a

Cover sTory

precious resourceB y M a r i e R o s e n t h a l , M s


Since many anthelmintic drug classes have developed resis-tance, veterinarians should be in the forefront of designing indi-vidualized parasite control pro-grams to preserve this precious resource. The threat of resistance should change parasite control strategies from routine prophy-lactic deworming of the entire herd to more individualized pro-grams.

New strategies require sur-veillance and testing, selective deworming and environmental controls.

Clients may resist this advice because it could increase the cost of deworming, at least initially. Tell them they should see a sav-ings later because they will de-worm their horses less often.

Changing the practice para-digm just might delay the emer-gence of parasites that are totally resistant to available anthelmin-tic drugs.

“Most common equine para-sites are resistant to at least one class of dewormer,” said Craig R. Reinemeyer, DVM, PhD,

president of East Tennessee Clinical Research in Rock-

wood, Tenn. “And it has to do with how intensely various products have been used. We need to deworm less, and we need to deworm more intelligently.”

The equine industry desperately needs new anthelmintics because no novel agents have

been introduced in the United States since the

introduction of ivermectin in 1981. Monepantel has

been approved in other coun-tries but is not available in the

United States.Anthelmintic resistance is not

just a U.S. issue; it is a world-wide phenomenon, according to Ray M. Kaplan, DVM, PhD, DEVPC, professor of parasitol-ogy at the University of Geor-gia College of Veterinary Medi-cine in Athens, who wrote a report on the problem last year in


Veterinary Parasitology. “Over the past 10 to 15 years,

we have witnessed a rapid in-crease in both the prevalence and magnitude of anthelmintic resis-tance, and this increase appears to be a worldwide phenomenon,” he wrote.

surveillance Mary G. Rossano, PhD, as-

sistant professor, equine epide-miology and parasitology at the University of Kentucky Col-lege of Agriculture, suggested that owners stop looking at the calendar when deciding when to deworm and instead use an evidenced-based approach to de-velop a deworming schedule.

“Get fecal egg count test re-

sults and follow up to see how effective the drugs are on the parasites,” she said. Each of the common drug classes must be evaluated for efficacy.

The first step is to find out which anthelmintic treatments are effective within the herd and how long they suppress egg pro-duction.

Fecal egg count reduction testing (FECRT) will also pro-vide an idea of the worm bur-den on the farm and among the horses. A small percentage of any given herd will harbor most of the parasites, explained Kaplan.

“Remember the 20-80 rule — about 20% of the horses have about 80% of the parasites.”

Regardless of herd size, try to test at least 5 or 6 individual horses, Reinemeyer suggested. For very large herds, test about 10% of the horses, or 6 animals, whichever number is larger. In either case, remember to test the same horses before and after treatment to compare the results, he added.

Treatment frequency can be based on results if it has been at least 4 months since the most re-cent deworming. Horses that are low or moderate shedders (<200 eggs/g to 500 eggs/g) only need deworming once or twice a year. High shedders (>500 eggs/g)

should be dewormed more often.

Treat the high shedders

and then do another fecal egg count in 2 weeks to see

if the product is effective. If the egg counts do not go down by at least 90%, the product is resistant on that farm, and the veterinarian should advise the owner to switch products. [{(pre – post) / pre} × 100 = % efficacy.]

If the egg counts go down, wait a bit and test again to deter-mine the “egg reappearance pe-riod,” which is the time it takes for egg counts to rise. Once they do, the high shedders may need to be retreated, depending on the time of year.

“Emerging research is now demonstrating that we can get

away with much less frequent deworming in horses that are shedding relatively few eggs. So, if you test a large group of adult horses, you might find that only 10% to 20% of the horses are shedding enough eggs to be worth treating,” Rossano said. “By doing that, we are lessening the selection pressure that causes resistance in parasites.”

Small strongyles are not nor-mally a health concern, so low and medium shedders could be treated once or twice a year to help control large strongyles, bots and tapeworms. “All horses prob-ably could use two treatments a year at 6-month intervals. I use what I call the equinox sched-ule — autumn and spring. If one uses a product that is larvicidal for large strongyles at least once every 6 months, it should eradi-

cate these dangerous worms from your herd,” Reinemeyer said.

In addition, there is no need to deworm if there is no threat. This means that even high shedders should only be treated certain times of the year, depending on the weather.

“In a very cold climate, mod-erate temperature climate or the deep south, the timing of de-worming will be different,” said Kaplan. “We want to time treat-ments to coincide with transmis-sion of the parasites to get the most benefit.” Horses in cold climates generally benefit most if treatments are concentrated between spring and autumn,

Cover sTory

Horses that shed <200 eggs/g to 500 eggs/g only need deworming once or twice a year. High shedders (>500 eggs/g) should be dewormed more often.

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whereas autumn to spring timing is more appropriate for those in warm climates.

Rotational deworming in which drug classes are alter-nated with each treatment does not work, he added. “It makes no sense to rotate from a drug that works to a drug that doesn’t work,” Kaplan explained. “You want to use drugs that are effec-tive at appropriate times of year to kill the various species of para-sites that need to be killed.”

Veterinarians must have buy-in from owners, so they should explain why horses that are de-wormed less often are not at risk for disease. Horses have evolved with parasites, and small worm burdens will not hurt them, ac-cording to Reinemeyer.

“If you feed a decent diet and maintain a reasonable stocking rate, you’re not going to have horses dropping dead from para-sites,” Reinemeyer said. “If you have parasitic disease in a popu-lation of horses, you don’t have a worm problem, you have a management problem. Either you have too many horses on too few acres, their diet is poor quality or they are experiencing excessive stress.”

The biggest problem in the fight against resistance is the lack of long-term data and lack of good diagnostic tools to determine long-term consequences of selec-tive therapy programs, accord-ing to Martin Krarup Nielsen, DVM, PhD, an assistant professor in the department of large ani-mal sciences at the University of Copenhagen in Denmark.

“There is general agreement that the traditional treat-all at fre-quent interval approach should be abandoned, and that optimal par-asite control can be maintained with far fewer anthelmintic treatments. But better diagnostic techniques and more evidence documenting the long-term con-sequences of selective therapy

programs are needed to develop and validate systems for sustain-able equine parasite control,” he wrote in Veterinary Parasitology.

environmental controlsHorses have instinctively

found a way to reduce their worm burden. If they have enough room, horses will segregate their pasture into lawns and roughs. So, do not overstock horses.

“There is a huge difference in the amount of manure in dif-ferent areas of a pasture. If the horse has enough pasture, he will avoid grazing where he def-ecates. If they are overstocked and there is not enough pasture, he will be forced to graze closer to the manure and will acquire more parasites,” said Kaplan. “Pasture management is an im-portant piece of the parasite con-trol puzzle.”

Pick up manure and place it in

an active compost pile because the heat that comes from com-posting is lethal to strongyle lar-vae and ascarid eggs. By the time the compost is ready to be applied to pastures or gardens, the para-sites are dead.

“If you are doing selective deworming that targets the high shedders, cleaning up the manure and composting it, you can bring down the larval contamination of your pasture very effectively,” Rossano said. Mev

For more information:Reinemeyer CR. Anthelmintic resistance in non-strongylid parasites of horses. Vet Para-sitol 185(1):9-15, 2012.

Rossano MG. Shortened strongyle-type egg reappearance periods in naturally infected horses treated with moxidectin and failure of a larvicidal dose of fenbendazole to re-duce fecal egg counts. Vet Parasitol 173:349-352, 2010.

Parascaris equorum, an ascarid, is a rigid, heavy-bodied roundworm that can grow to 50 cm long.

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Hysteroscopic (HYS) and transrectally guided (TRG) deep-horn insemination both resulted in simi-lar pregnancy rates, even when very low sperm numbers were used to inseminate the mares, ac-cording to a recent study that com-pared the two techniques.

Deep-horn insemination, which involves placing semen at the tip

of the uterine horn on the same side as the ovary containing the preovulatory follicle, requires less sperm to impregnate a mare than traditional uterine body insemina-tion.

Multiple studies have compared pregnancy rates following HYS or TRG deep-horn insemination, but they have had conflicting results,

according to Shelby Hayden, DVM, DACT, clinical assistant professor, theriogenology at Okla-homa State University Center for Veterinary Health Sciences.

Two studies, one done in Colo-rado and one in Texas, compared pregnancy rates obtained with HYS and TRG using 5 million motile, fresh sperm and 5 million

reProDUCTIve MeDICIne

B y M a r i e R o s e n t h a l , M s

comparing insemination techniques:

which is best?

Dr. Shelby Hayden carries the 75-cm flexible, intrauterine insemination pipette and 80-cm flexible inner catheter (re-inserted) into the vagina, followed by passage of the pipette through the cervix.

Dr. Shelby Hayden examines the inner catheter for semen following insemination during the transrectally guided deep-horn insemination procedure. She is assisted by technician Katrina LaCaze.

Transrectally Guided Technique

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total, chilled sperm. The Colo-rado researchers found that the pregnancy rates were significantly higher using the HYS technique, whereas, the Texas researchers found no difference in pregnancy rates between the HYS and TRG techniques. Twelve mares became pregnant with HYS and 10 became pregnant with TRG.

“It is important to note that the transrectally guided tech-

niques and equipment utilized in these two studies were different,” Hayden said. “When Colorado workers performed a follow-up study utilizing the same transrec-tally guided technique utilized by Texas workers, no difference in pregnancy rates between the hys-teroscopic and transrectally guided techniques when 20 million sex-sorted sperm was inseminated. Yet, it has been suggested by Squires

that the hysteroscopic technique may be the preferred method of deep-horn insemination when fewer than 25 to 50 × 106 sperm are used, especially if the semen is frozen-thawed or sex-sorted.”

Because previous studies (most importantly the two studies men-tioned above) did not determine and use insemination doses known to result in subfertile pregnancy rates for the stallions in each study,

comparing insemination techniques:

which is best?

Dr. Shelby Hayden examines the inner catheter for semen following insemination during the transrectally guided deep-horn insemination procedure. She is assisted by technician Katrina LaCaze.

Insertion of air through the 75-cm flexible, intrauterine insemination pipette following removal of the inner catheter to remove semen that may have flowed back into the pipette, especially important if the seal between the inner catheter and outer pipette is not adequate.

75-cm flexible, intrauterine insemination pipette and 80-cm flexible inner catheter (removed) by Minitube of America, Inc.


Hysteroscopic Technique

excessive numbers of sperm could have been inseminated, compen-sating for an inferior technique. Pregnancy can still occur when a subthreshold dose is inseminated, especially when it is immediately below the threshold. However, sub-threshold doses result in lower than ideal fertility rates, she explained.

“We wanted to conduct a study comparing the pregnancy rates fol-lowing hysteroscopic deep-horn insemination and the transrectally guided deep-horn insemination technique utilized by Texas work-ers combined with ventrally ori-enting the tip of uterine horn be-

ing inseminated that would finally answer the question as to whether one of these techniques would re-sult in superior pregnancy rates,” Hayden said.

The researchers tried to impreg-nate 37 mares ranging in age from 4 to 19 years old, whose ovulation was synchronized by daily intra-muscular administration of proges-terone and estradiol and a single

IM injection of cloprostenal given on day 10 of treatment. Deslorelin was given IM once a preovulatory follicle and prominent uterine ede-ma were detected.

Semen was collected from one highly fertile Quarter Horse. Sperm concentration and motility were determined, and the semen was diluted to either 5 × 106 sperm/ml or 1 × 106 sperm/ml for the in-semination dose of 1 × 106 total sperm or 0.5 × 106 total sperm, re-spectively.

Nine of the mares were elimi-nated from the study because of complications or failure to ovulate.

Twenty-eight mares were insemi-nated using both techniques. All 28 mares bred with 1 × 106 and 26/28 mares bred with 0.5 × 106 sperm ovulated with 24 hours of insemi-nation. The remaining two mares bred with 0.5 × 106 sperm ovulated within 48 hours of insemination. Both were bred by HYS and nei-ther was pregnant.

There was no significant dif-

ferent in pregnancy rates when mares were inseminated with 1 × 106 sperm or 0.5 × 106 sperm. Pregnancy rates also did not differ when the insemination doses of 0.5 or 1 million sperm were combined.

Pregnancy rates were higher in mares inseminated with 1 x 106

than in mares inseminated with 0.5 x 106 sperm.

“From these findings, we con-cluded that high fertility can be achieved with very low sperm numbers, but there is a functional threshold below which fertility cannot be improved through these techniques alone,” the researchers

wrote in the study, which appeared in Theriogenology.

“The key factor to achieving optimal pregnancy rates with ei-ther deep-horn technique was to pool the semen on or very close to the oviductal papilla without immediate backflow of the semen down in the uterine bifurcation/body region,” Hayden said.

The inseminator’s skill is im-


Dr. Shelby Hayden passes the 1-meter flexible video-endoscope into the uterus in a manner similar to the transrectally guided method. She is assisted by fellow researcher, Dr. Steven P. Brinsko.

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portant with both techniques, she added. “With the transrectally guided technique, the inseminator must be a competent transrectal palpator and he/she must possess a moderate to high level of com-fort and expertise manipulating the uterus and pipette per rectum. The hysteroscopic technique requires a reasonable level of expertise with the endoscope. So, for some vet-erinarians a transrectally guided technique will be easier while the opposite will be true for other vet-erinarians.”

When performing the trans-rectally guided deep-horn in-

semination technique, Hayden recommended holding the uterine tip in a ventral orientation during insemination and for a short time afterward.

“I try to hold the uterine horn tip in a ventral orientation for at least 3 minutes. If you lose the ability to hold the tip of the uterine horn in a ventral orientation at any time dur-ing or following semen deposition,

do not under any circumstances try to reposition it ventrally,” she said.

Sperm adheres to any piece of equipment that it contacts. Mini-mize the surface area that the se-men contacts in your insemination equipment to maximize the per-centage of sperm actually depos-ited into the uterus. These can be accomplished by using one of the following methods:

• When breeding with frozen semen, use a flexible pipette that has a stylet designed to allow consecutive insemina-tion of 0.5 ml straws without having to move the pipette

from its deep-horn location, when inseminating fresh, frozen, or chilled semen with volumes less than the maxi-mum capacity of the inner catheter, aspirate the semen directly from its container into the inner catheter of the pipette (as shown in the pic-tures supplied), or

• When breeding with frozen

semen, place semen di-rectly into the syringe from the straws, especially when the insemination volume is greater than the volume that the inner catheter of the in-semination pipette can hold.

“The transrectally guided tech-nique may be the method of choice because it requires less time for setup and cleanup, and utilizes less expensive equipment,” said Hayden.

Deep-horn insemination may not improve pregnancy rates if the semen quality is poor, she re-minded. Mev

Intrafallopian insemination catheter (Cook Veterinary Products, Spencer, IN, USA)

From left: Drs. Terry L. Blanchard, Steven P. Brinsko and Shelby Haden, who co-authored the paper, prepare to place the 1-meter flexible video-endoscope into the uterine horn ipsilateral to the dominant follicle using transrectal manipulation; transrectal compression of the distal end of the uterine horn ipsilateral to the dominant follicle followed by insufflation of the proximal end of the uterine horn ipsilateral to the dominant follicle; advancement of the endoscope to the tip of the horn ipsilateral to the dominant follicle.

From left: Drs. Terry L. Blanchard, Steven P. Brinsko and Shelby Haden place the semen directly on the oviductal papilla.


Biopsy accurate in

Veterinarians can feel comfortable when depending on uterine biopsy to evaluate and grade endometriosis and the fertility of the mare with the disease, according to a recent study published in the Journal of Veterinary Science.

“Results from this study confirmed that biopsy can be an indispensable clin-ical diagnostic tool for evaluating the fertility of mares,” the researchers wrote in the paper

Equine endometriosis, or chronic en-dometrial degeneration, which is associ-ated with decreased fertility, early em-bryonic death and abortion, is common among older mares. Many factors may contribute to the problem, including age, repeated pregnancies, parturition, chronic inflammation and endocrine problems.

The disease is progressive and involves endometrial changes, such as periglandu-lar and stromal fibrosis, chronic inflamma-tion and atrophy. However, until now, no study had evaluated the role that inflam-mation and extracellular matrix (ECM) remodeling might play in endometriosis.

In addition, recent studies have ques-

tioned the validity of biopsy to assess the grade of the disease, according to lead researcher Luca Aresu, DVM, PhD, assistant professor in Padua School of Veterinary Medicine in the department of comparative biomedicine and food science in Italy.

“Despite the widespread use of this technique [biopsy], recent studies have questioned the efficacy of such methods due to the low reliability of a single en-dometrial biopsy to accurately assess the grade of endometriosis,” the researchers wrote.

study goalsIn the study, researchers looked at his-

tomorphologic lesions in 35 endometrial samples. They took the samples from vari-ous breeds, whose reproductive histories were unknown to them at the time. (Twen-ty-five of the mares were in oestrus and 10 were in diestrus.) The researchers tested both uterine biopsies and uterine-wall samples and compared the results.

Seventeen samples were stained with antibodies against MMP-2, MMP-9,

Current grading system for biopsy coincides with results from whole-wall sample.

endometriosis


evaluationB y M a r i e R o s e n t h a l , M s


Histopathology of the equine endometrial specimens. A1 and 2: grade I, B1 and 2: grade IIA, C1 and 2: grade IIB, D1 and 2: grade III. Specimens were classified according to Kenney and Doig classification of endometriosis. Hematoxylin and eosin stain (A1, B1, C1, and D1) and Masson’s trichrome stain (A2, B2, C2, and D2), ×40 [J Vet Sci (2012), 13 (2), 171-177].

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MMP-14 and TIMP-2. Matrix metalloproteinases (MMPs) are calcium and zinc-dependent pro-teases thought to be responsible for the degradation and removal of extracellular matrix remodel-ing, according to the paper.

The goals of the study were fourfold:

1. To evaluate the reliability of biopsy samples with entire uterine wall sam-ples for diagnosing and grading.

2. To examine the relation-ship between the degree of endometriosis and the mare’s age.

3. To look at the role of in-flammation in the disease.

4. To look at the expression of different MMPs in the equine endometrium.

“The research was organized in two steps,” Aresu said. “The first was to analyze quantitatively the role of inflammatory cells and fibrosis in equine endometriosis, based on the different grades of Kenney classification. In the sec-ond step, we concentrated on the MMPs and their distribution in different specimens.”

Researchers of human disease have found that MMPs are im-

portant for many physiologic and pathologic processes, including development of embryos, tissue remodeling, angiogenesis, wound healing and metastasis.

In horses, the role of MMPs is still being explored, but it is believed that they play a role in various pathologic processes, including laminitis, arthritis and other degenerative diseases, as well as cancer.

ResultsFor practicing veterinarians,

the most significant finding of this study is that the current grad-ing systems for biopsies coincid-ed the results from a whole-wall sample.

As was expected, younger mares tended to have lower endo-metriosis grades than older mares. In addition, the researchers found that the number of fibrotic nests and fibrosis grade were the best predictive factors when veterinar-ians evaluate fertility.

Inflammation, however, cor-related poorly with endometrio-sis grade. Aresu said this could be due to the biopsy site, grade of endometriosis, correlation be-tween the amount of fibrotic tis-sue and the number of inflamma-

tory cells or the mare’s cycle.“Endometrial degeneration and

fibrosis are known to originate from repetitive inflammatory in-juries,” the researchers wrote. “Damage from chronic inflam-mation triggers a complex tissue reaction resulting in ECM deposi-tion and accumulation within the interstitium. Fibrosis continues to progress even after the inflam-matory process has ended. There-fore, progression of the fibrotic process after a critical point be-comes independent of inflam-mation despite the presence of inflammation preceding fibrosis that affects the pathogenesis of endometriosis. This explains the low correlation between inflam-mation and endometriosis grade observed in the present study.”

The results of MMP and TIMP-2 (tissue inhibitors of metallopro-teinases) testing were inconclusive, and the researchers indicated that further studies are needed to under-stand more fully the role of metal-loproteinases in the pathogenesis of endometriosis.

“Veterinarians should keep doing biopsy [to evaluate endometriosis],” Aresu said. “Mucosal biopsy, rather than whole-wall sample, should be sufficient for a diagnosis.” Mev


as was expected, younger mares tended to have lower endometriosis grades than older mares. In addition, the researchers found that the number of fibrotic nests and fibrosis grade were the best predictive factors when veterinarians evaluate fertility.

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Motion detectors locate lameness soonerLameness treatment is more effective if the problem

is found early. A professor of equine surgery has devel-oped a technique that enables veterinarians to quickly determine where lameness is occurring.

“If veterinarians can detect lameness ear-lier, before it gets too bad, it makes treatment much easier,” said Kevin Keegan, DVM, a professor of equine surgery at the University of Missouri College of Veterinary Medicine. “Lameness often goes undetected or undiag-nosed entirely, which can cause owners to retire horses earlier than needed, simply be-

cause they cannot figure out why the horses are un-healthy. The Lameness Locator should be able to help with that as well.”

Keegan developed a motion detection system to detect lameness earlier than most veterinarians can using the traditional methods for diagnosis.

The Lameness Locator places small sensors on the horse’s head, right front limb and croup, near the tail. The sensors monitor and record the horse’s torso movement while the horse is trotting. The recorded information is then transferred to a com-puter or mobile device and compared against da-tabases recorded from the movement of healthy horses and other lame horses. The computer then diagnoses whether the horse is lame. The device costs around $15,000 depending on the configu-ration. Contact Equinosis for more information. http://equinosis.com

In a new study published in the Equine Veterinary Journal, Keegan and his colleagues put special adjust-able shoes on horses that temporarily induced signs of lameness. The horses were monitored by the Lameness Locator, as well as by a number of veterinarians using any lameness testing methods they wished.

If no lameness was detected by either the veterinar-ians or the Lameness Locator, the special shoes were adjusted slightly to increase the signs of lameness. This

process was repeated un-til both the Lameness Lo-cator and the participat-ing veterinarians properly identified in which leg of the horse the lameness was occurring. Keegan and McCracken found that the Lameness Loca-tor correctly identified lameness earlier than vet-

erinarians using subjective eye test meth-ods more than 58% of the time and more than 67% of the time when the lameness occurred in the hind legs of the horse. Keegan attributed this to the sensor’s high sensitivity levels.

“There are two reasons why the Lame-ness Locator is better than the naked eye,” Keegan said. “It samples motion at a higher frequency beyond the capability of the human eye, and it removes the bias that frequently accompanies human sub-jective evaluation.”

Because equine lameness may begin subtly and can range from a simple mild problem affecting a single limb to a more complicated one affecting multiple limbs, early detection is the key to successful out-comes. Mev

The Lameness Locator places small sensors on the horse’s head, right front limb and croup, near the tail. The sensors monitor and record the horse’s torso movement while the horse is trotting.


TeCHnICIan UPDaTe

An inventory manager is more than someone who orders supplies because inventory is money. Un-fortunately, equine clinicians do not always think about inventory that way.

“The next time you go into your inventory room, just picture that inventory as dollar bills,” sug-gested Deborah B. Reeder, BA, RVT, VTS (EVN), executive di-rector of the American Association of Equine Veterinary Technicians and Assistants. “Take a picture of

a big room full of dollar bills and post that on the door.

Inventory is the second largest expense in the veterinary practice, after the cost of labor, taking up to 20% of gross revenue. Lost profits from ineffective inventory man-agement will affect all areas of the practice.

What really makes inventory management a challenge in many clinics is that inventory managers do not always have the authority to manage inventory properly, Reed-

er said during a presentation at the Western Veterinary Conference.

Anyone can order supplies and stock a shelf, but an inventory manager is someone who

• can reconcile those orders, • make sure that older drugs

are used before their expira-tion date,

• properly dispose of those that aren’t,

• consult with distributors to find the best pricing and

• restrict access to certain products.

Practices face three primary challenges in handling inventory:

• absence of a designated inventory manager

• multiple locations for drugs and supplies, and

• unrestricted access to drugs and supplies.

“Often there is no designated inventory manager with author-ity,” said Reeder, “and that is an important part. The clinic can

inventory is

Managing inventory effectively means more than just ordering new supplies

moneyB y M a r i e R o s e n t h a l , M s


give someone the job but doesn’t always give that person the re-sponsibility to make the changes that ensure he or she can manage inventory appropriately.”

Effective inventory manage-ment means knowing what is on hand, where it is used, how it is used and when to replace that sup-ply. In its simplest form, inven-tory management tries to balance the needs and requirements of the practice with the need to minimize costs that result from obtaining and holding that inventory.

Reeder suggested these tactics to control inventory.

• Designate an inventory man-ager, who has the authority to manage the inventory. That person should go through the inventory periodically and make sure that products are shelved according to expira-tion date and make sure that older supplies are used first.

• Stop providing unrestricted access to drugs and supplies. Bar codes, coded pharmacy and supply entries, making people sign in and out, and locking the door to the sup-ply closet or dispensary are ways to prevent unlimited access.

• Use itemized check sheets in both exam rooms and trucks to keep track of what was dis-pensed or used.

• Record items that are used or dispensed and reconcile that list at the end of the day or week.

• Use the practice management software as much as pos-

sible. Practice management software can be a big help, but Reeder has yet to find the perfect software for an equine practice. “We’re a weird beast,” she said.

• Limit the veterinarian’s access to his or her “favorite” drug. Drugs should be chosen based on medical science, side effect profile and cost.

• Maintain and establish an in-ventory budget.

• Keep up with regulatory logs. Even in ambulatory practices, there needs to be a controlled drug log in the truck, and in the satellite clinic, and it needs

to be brought into the main clinic at least once a week and reconciled.

• Keep an adverse reaction log. Keep a log for any drug reac-tions that might occur in the clinic and turn that informa-tion over to the distributor and the pharmaceutical reps. Adverse events can also be reported to the FDA.

“Inventory is a large expense in any practice,” Reeder said. “Successful management must address the challenges, some of which are unique to an equine practice.” Mev

Tactics to Control Inventory

Designate an Inventory Manager Make sure that person has the authority to properly manage the inventory.

Restrict Access Preventing unlimited access helps the manger keep track of supplies.

Use Itemized Check Sheets Keep track of what was dispensed in the truck or exam room.

Maintain Drug Logs Drug logs should be in every truck and satellite clinic and reconciled once a week.

Maintain Adverse Reaction Log Keep track of adverse events and report them to the company and regulatory agencies.


Pigs are not the source of infection when foals come down with EPE

Lawsonia

Don’t blame the pig when a foal comes down with equine prolif-erative enteropathy (EPE), a gas-trointestinal disease, said Nicola Pusterla, DVM, DACVIM, of the University of California at Davis.

Lawsonia intracellularis is an obligately intracellular bacterium that causes proliferative enteropa-thy, an enteric disease that affects both pigs and horses.

“But people need to stop blaming pigs as the source of L. intracellularis infection for foals,” Pusterla said. “I believe that environmental contamination should be avoided, i.e. feed off the ground, cover feed, clean water troughs, monitor foals daily and isolate foals with confirmed EPE or signs compatible with EPE.”

EPE appears to be increasing in horses, but experts are not sure whether the increase is due to more cases or just better recognition in sick foals. Most of what is known about Lawsonia infection comes from the swine industry, where it is a costly problem.

“My strong belief having in-

vestigated several farms with spo-radic and endemic occurrence of EPE is that in closed herds the first horse(s) becomes exposed likely

via ingestion of infectious L. intra-cellularis through contamination of feed and/or water originating from the feces of a wild, feral or

nonequine domestic animal,” he said.

“We have established that most foals become infected with-out developing clinical disease, however, during this time, they are amplifying L. intracellularis organisms, and that contributes heavily to environmental contam-ination. This environmental con-tamination, similar to the shed-ding of Rhodococcus equi from clinically and/or subclinically in-fected foals, allows the exposure of more foals.

Thereafter, it is a numbers game, with 5% to 15% of exposed animals developing EPE.

“Why do certain foals develop EPE and others don’t? This is like-ly a multifactorial disease process combining known and unknown host, environmental and patho-gen factors,” he told The Modern Equine Veterinarian.

Lawsonia bacteria from pigs and horses with this disease are the same species and identical in ev-ery characteristic except for a few slight genetic differences, accord-

appear species-specific

B y M a r i e R o s e n t h a l , M s

intracellularis organisms

eMergIng DIseases

ePe appears to be increasing in horses, but experts are not

sure whether the increase is due to more cases or just better recognition

in sick foals.


ing to Connie Gebhart, MS, PhD, of the University of Minnesota, who with Pusterla has been study-ing this organism for years.

“We wondered if these genetic differences suggested that the horse and pig isolates of Lawso-nia were species-specific, meaning that they can infect and cause dis-ease only in the species that they were isolated from,” she said.

To evaluate this, the research-ers infected horses with either an equine or porcine Lawsonia isolate and then infected pigs with either an equine or porcine Lawsonia iso-late. They found that only horses infected with the equine isolate and pigs infected with the porcine isolate developed clinical, sero-logic and pathologic signs typical of proliferative enteropathy. The results appeared recently in the journal Veterinary Research.

“Cross-infected animals con-tinued to be normal. Therefore,

the results show that Lawsonia isolates are host specific. Pig and horse isolates do not cross-infect those species,” Gebhart explained.

“It is unlikely, from our re-search, that a horse could get the disease of proliferative enteropa-thy from a pig,” she said. “Equine isolates infect horses, and porcine isolates infect pigs. There does not appear to be any cross-infection or host adaptation between strains (strains being equine or porcine).”

There is a swine vaccine avail-able, but it is not labeled for use in foals. However, Gebhart and Pusterla have done extensive re-search with the vaccine, Enteri-sol Ileitis (Boehringer Ingelheim Vetmedica), and found that the vaccine protects foals against the disease. Mev

Foal with equine proliferative enteropathy, an emerging intestinal disease primarily affecting recently weaned animals. Although disease development is sporadic, infection can become endemic on farms. Caused by Lawsonia intracellularis, signs include ventral edema, depression, fever, wasting, colic and diarrhea.

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Immunohistochemical stained section of small intestine from a 7-month-old foal with proliferative enteropathy. L. intracellularis-specific antibody stains the bacteria lining the apical cytoplasm of the affected crypts (red areas). Similar staining is seen in affected pig intestines.

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Horses have been silent victims of the economic downturn, as horse owners are voluntarily surrendering their animals in record num-bers, putting a huge burden on rescue organizations.

The relationship between The Oaks Veterinary Clinic in Smithfield, Va., and the Dia-monds in the Rough Rescue in Windsor, Va., shows what can be done to help horses when veterinary clinics part-ner with rescue organizations.

“We saw these cases on the rise, and a longtime client of ours started doing rescues out of her existing boarding facilities and asked us to help her out, which we were happy to do,” said Cathy Lombardi, DVM, who has been with The Oaks since 2004.

Diamonds in the Rough takes in as many as 20 horses a month, and Lombardi has a standing weekly appointment to oversee the health care of new and existing horses in the program.

“Diamonds in the Rough has a program built around the four R’s — Rescue, Restore, Retrain and Rehome

— and we are pleased that we can be part of that program,” Lombardi said. “We work primarily with the Rescue and Restore portions of the program to determine the res-cues’ medical needs and to get them in shape for adoption.”

Diamonds in the Rough has many volunteers, but the cost to run a quality rescue is tremendous, making dona-tions critical.

“Many of the horses that come in to the rescue are un-derweight and have no vac-cination records,” Dr. Lom-bardi said. “This combination

makes them more susceptible, and when you look at the money allocation in a nonprofit, vaccines sometimes have to go by the wayside.”

Lombardi and her colleagues at The Oaks reached out to Pfizer Animal Health earlier this year seeking a donation of vaccines to help with their work, and Pfizer was glad to help. The company donated 100 doses of West Nile-INNOVATOR + VEWT vaccine, which helps prevent West Nile virus; and Eastern, Western and Venezuelan encephalomyelitis viruses; and tetanus.

“We work very closely with our veterinary partners, and when doctors at The Oaks reached out to us for help, we jumped at the chance,” says Palmer Valen-tine, Territory manager, equine division at Pfizer Ani-mal Health.

Vaccines not only protect against disease but also in-crease the animal’s chance for adoption, because that is one less expense a new owner has to undertake. “This makes adoption easier and starts the horse out on the right foot in its new home,” Lombardi said.

Across the country, many rescue organizations are working to rehabilitate surrendered horses and put them in good homes. “In talking with our veterinary partners, we know that the need is there for horses across the country,” Valentine says. “At Pfizer Animal Health, we try to do our part, but there is so much that these organi-zations need beyond monetary donations.”

If you are in Virginia and would like to get involved with Diamonds in the Rough, you can find them at www.adoptditr.org. If you are not, consider volunteer-ing at another organization. They need your help. Mev

rescue Partnership gives Horses a second Chance

Dr. Cathy Lombardi of The Oaks Veterinary Clinic and an assistant conduct an examination on a rescue horse. Dr. Lombardi partners with Diamonds in the Rough of Windsor, Va., on its equine rescue program.

Dr. Miller’s cartoons and videos are available for sale at www.robertmmiller.com

By Dr

. Rob

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By Marie Rosenthal, MS

Any veterinarian will tell you that America’s companion animals are getting too fat, and horses are no exception.

Part of the problem, said Alex Dugdale, MA, VetMB, DVA, DECVA, MRCVS, is that owners fre-quently do not recognize that their horses are over-weight, and then, once the veterinarian convinces owners to restrict the horse’s calories, they might not recognize that the dieting horse is losing weight be-cause its body condition score (BCS) doesn’t change much in the beginning of the diet. This can make it difficult to remain committed to a diet plan.

“My biggest worry with obesity is that many of us don’t recognize it,” said Dugdale, senior lecturer at the University of Liverpool School of Veterinary Medicine. “Obesity creeps up on us, as well as our animals. A horse or pony in ideal body condition should actually have easily palpable ribs.”

Dugdale and her colleagues conducted a study published in the Equine Veterinary Journal [2010; 42:600-610] that pro-vided scientific evidence for man-aging weight loss in obese animals. They restricted food in-take in five over-weight or obese Welsh mountain pony mares for

3 months and monitored changes in their overall health, behavior, body weight, body fat content and BCS. They restricted daily dry-matter intake to 1% of the animal’s body mass.

During the study, the researchers monitored the health of the ponies by taking weekly blood samples and observing their behavior. They weighed the po-nies on a weighbridge and used a tape measure to assess heart girth, umbilical belly girth and rump width. They also used ultrasonography every week to measure the depth of the fat beneath the skin at several sites. Finally, they calculated the body fat content using deuterium oxide dilution.

“We found that, on average, ponies lost 30 kg of weight over 3 months and that about half of this [weight loss] was fat, although the ponies that were fatter at the start lost a relatively greater proportion of fat,” Dugdale said.

Despite losing weight, the ponies’ appearance and BCS did not change much. “This surprised us,” she said, “but highlights that once a horse or pony carries too much fat, it has to lose quite a lot before

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its BCS will decrease.”As expected, weight loss was marked over the

first week of the trial, reflecting the decrease in gut-fill associated with feeding smaller amounts. In addition, the muscles were probably depleted of glycogen.

“During the initial stages of dieting, the body uses up its glucose stores, so the muscles become depleted of glycogen, and their water content also reduces. This helps explain some of the rapid first-week weight loss.” Dug-dale said.

Dugdale added that own-ers should not overly focus on BCS to monitor weight loss, at least in the early stages of diet-ing. Instead, use a weighbridge, a tape measure to measure the heart girth or a weigh tape to monitor body weight.

other issues“At the level of dietary re-

striction chosen, we were wor-ried about inducing hyperlip-idemia. However, none of our ponies became ill at all,” Dug-dale said.

In fact, blood test results showed that even a little weight loss was associated with im-provement in insulin sensitiv-ity status. “Obese animals often become insulin resistant,” she said. “In people, insulin resis-tance is associated with meta-bolic disorders, such as diabetes mellitus type 2, cardiovascular disease and renal and hepatic disease. In horses and ponies, however, laminitis seems to be the biggest risk.”

One always worries about behavior when horses or ponies are denied access to food, but the researchers did not see any long-term behavior problems.

“No long-term adverse behavioral effects were observed, but sudden severe food restriction is not a normal situation for horses and ponies, which are grazing animals — what we call ‘trickle feeders’ — and are designed to eat for at least half of each

day,” Dugdale explained. She suggested several techniques to extend

mealtime in dieting horses and ponies:• Use double-layered hay nets. • If manger feeding, add obstacles, such as large

stones that the horses have to work around to find their food.

Other forms of environmental enrichment can reduce boredom, Dugdale add-ed. Some horses will play with stable toys. Others may be hap-pier in graze-poor paddocks with their friends, but it is easier to control the horse’s food in-take if he is stabled.

All of the ponies in the study lost some lean tissue, as well as fat, which is why exercise needs to be encouraged when possible, she said.

If putting a horse on a diet, consult a veterinary nutrition-ist if the owner will pay for it. Then decide on the level of di-etary restriction to impose, and encourage owners to follow this diet for at least 2 months. Re-member to warn against giving treats. Just as people can under-mine the best diet with a piece of cake, owners can sabotage a horse’s diet with applies and carrots, which contain many calories. Tell owners to weigh the food allocation, not eyeball it.

Monitor the weight loss ev-ery week at the same time of day. If there is little weight loss over time, veterinarians should reassess the animal because more calories might need to be restricted. Encourage owners to

exercise the animal, which not only burns more calories and encourages lean muscle mass but helps with the animal’s behavior. Exercise also can improve insulin sensitivity.

“Getting [the horse] outdoors and exercising is important for energy expenditure, socializing and general well-being, so grazing-muzzles are useful, but make sure the animal can drink water through the muzzle,” Dugdale said. Mev

“getting [the horse] outdoors and exercising

is important for energy expenditure,

socializing and general well-being, so grazing-muzzles

are useful, but make sure the

animal can drink water through the

muzzle.”Alex Dugdale


Just as we were about to post this issue, The Thoroughbred Owners and Breeders Association (TOBA) an-nounced some good news.

A broad-based list of Thoroughbred owners who are members of TOBA pledged to race their 2-year-olds without race-day medications. These horses will race their entire 2-year-old season without race-day furose-mide and adjunct blood thinners.

Almost every horse in every race is treated just hours before they go to the saddling paddock. These medica-tions are not medically necessary, and do not improve the long-term health of the horse.

“The original purposes of permitted race-day medication were to treat horses that overtly bled from the nose and to provide a larger pool of horses available for entry at a time when racing was proliferating,” said Bill Casner, who has campaigned notable horses, such as Super Saver, Well Armed and Colonel John, among others.

“Trainers and veterinarians soon recognized that horses that raced on fu-rosemide could have a competitive advantage and now almost all horses are being diagnosed as bleeders. Racing commissions, in an effort to level the playing field and eliminate this advantage, relaxed their rules to allow furosemide for any horse. I believe the pervasive use of furosemide, and the dehydration stress it causes requiring more recovery time, has contributed to horses making fewer starts and has fueled the public’s belief that giv-ing medication to performance horses is abusive and nefarious. Our racing industry thrived in a time prior to permitted race-day medications. Horses raced often and consistently. We are a global industry and we are out of step with the rest of the world. Race day medications are a failed experiment and it is time for us to do what is right for our horses and our industry.”

Other owners who want to add their names and campaign their 2-year-olds without race-day medication can be added to the list by contacting the TOBA offices, said Dan Metzger, president of TOBA.

TOBA, based in Lexington, Ky., was formed in 1961 and is a national trade organization of leading Thoroughbred horse breeders and owners. Projects managed by TOBA include the American Graded Stakes Committee, The Racing Game, Sales Integ-rity Program and Claiming Crown. Thoroughbred Charities of America (TCA) is the charitable arm of TOBA. TOBA is the owner of The Blood-Horse Inc., and is represented on the Board of Directors of the National Thoroughbred Racing Association as a founding member.

This is great news and this magazine applauds these owners and hope everyone else follows in their path. It’s better for the horses. And let’s face it, it’s more sporting.

Marie Rosenthal, MSEditorThe Modern Equine Veterinarian

owners Pledge to race 2-year-olds of 2012 without race-Day Medications

fInIsH lIne

reach your veterinarians where ever they are, whenever they want.

Equine VeterinarianThe Modern

FoR adVeRTisiNg RaTes aNd iNFoRMaTioN, eMaiLMarie Rosenthal, MS

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