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Farewell with Parting Tips

By Grant Miller, DVM, December 31, 2014

This marks my final post for Horse Journal - it has been a wonderful four years of collaborating with a truly exceptional group of horse experts.  

I hope that our no-nonsense approach to everything equine has proven valuable to you, our loyal readers.  Of course, I won't pass up this opportunity to impart the best advice I can think of, taking into account my experience and training as a horse vet.  Here goes:

 1) There is no such thing as a silver bullet.  Trite?  No.  Tried and True?  YES.  When some guy at a county fair tries to sell you raspberry juice and tells you that it will cure everything that ails your horse, please remember that this is the oldest archetype in the book.  The fabled panacea - oh how it has given veterinarians headaches over the years!  Many a horse have been puzzled as to why they are being given the concoction, many owners have pulled all-nighter blog fests trying to convince everyone that they have found the fountain of youth, and many, many sales folk have laughed (hard) all the way to the bank. 

2)  With that said, keep an open mind.  There are new products, devices, therapies and methods emerging every day.  While some are, ahem, minimally useful, others can actually help.  As you come across new ideas, take some time to really look into them.

3)  Always talk to your veterinarian when researching new items.  In fact, you should talk to your vet about anything that concerns you with your horse.  A scab that isn't healing could be just a minor issue of management.  But then again, it could be cancer.  So skip the chat rooms, don't worry about the opinion of the woman with eight horses who reuses paper towels to save on expenses, just pick up the phone and ask your vet. 

4)  If your horse is acting up, whether it is under saddle or in hand, don't pull the "behavior" card until you have thoroughly explored all physical possibilities for the behavior.  Teeth.  Ulcers.  Hocks.  The list goes on and on.  If your horse is basically happy, yet uncharacteristically acts out only under specific circumstances, it is possible that pain may be involved.  Check it out - you may be surprised at what you find.

5)  Remember that horses age just like we do.  If your horse is older, his or her needs may change.  Dietary, medical and management practices should evolve to match your horse's needs.  For instance, an older horse may need a blanket, and just because he or she has "never had a blanket before" does not negate the present requirement.

6)  Finally, from the sum of everything I have come to know about horses, enjoy each and every day with your horse because you never know which day will be the last.  I have seen things happen to horses that I would have never imagined possible, all of which serve a reminder that our time with them is fleeting.  Take some time each day to enjoy their presence in your life - it is a truly special gift.

 And with that, my loyal friends, I bid you farewell.

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Fungus Among Us

By Grant Miller, DVM, December 30, 2014

 

Thinkstock Photo
Credit: Thinkstock Photo

Most of the country is experiencing the throws of winter with cooler temperatures and high moisture content in the air.  Long hair coats and blankets worn round the clock provide a perfect environment for fungi to flourish, especially if your horse gets wet.  Commonly, a horse may sweat underneath a blanket or a blanket may fail and let moisture through to the skin.  Body heat can then incubate fungal hyphae, which then rapidly grow.

 

Most of us are familiar with the signs of skin fungal infection or “rain rot”- it causes hair loss and itchy, red skin.  The hair comes off in clumps and literally breaks off at the root with a kind of dusty, crumbly powder being left behind.  Sometimes the horse’s coat will even smell like mildew.  Rain rot can pop up just about anywhere on the body and in extreme cases, can become fulminant.  There is nothing more for a horse (and its owner) than having to walk around looking like a lizard!  Here are some tips on managing rain rot:

 

1.   When over the counter medicated shampoos and sprays are not doing the trick, move to more powerful products available through your veterinarian.  Fungal hyphae can be incredibly resilient but can respond well to antifungal medications such as chlorhexidine or ketoconazole.

2.   If you use betadine scrub to treat fungal infections use caution and be mindful that betadine used daily will dry skin out and create its own problems. 

3.   Air out blankets since most of the time the fungal hyphae incubate and replicate in an environment with little oxygen.

4.   Spray athletes foot spray on the inside of blankets.  It is an antifungal and can slow down the rate of hyphae growth.

5.   Consider having two blankets for your horse so that you can launder each regularly but still keep your horse protected from the weather.

6.   Wash saddle pads and clean tack regularly since they can both serve as physical vectors for fungal spread.

7.   Grooming your horse daily will reduce rain rot because it physically removes fungal spores from your horse’s coat.

8.   Routinely clean brushes by letting them soak in water with dilute bleach (usually 1 part bleach to 9 parts water will do the trick if you soak for 2 or more hours.)

9.   Don’t share blankets, saddle pads, tack or grooming equipment with other horses- sharing can potentiate the spread of fungus.

10.  Bathing horses in medicated shampoo may not be possible this time of year due to weather constraints.  In this situation, treating fungus “hot spots” with medicated sprays or ointments is the next best thing.  Veterinarians all have their favorite brands- consult your vet to find out which topical treatment would be best for your horse.

 

With winter solstice just past, we are on our way back to warmer weather… eventually. For the time being, keep your horse’s skin as healthy as possible by following the tips above.

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Ticks Are Rearing Their Ugly Heads Again

By Grant Miller, DVM, December 15, 2014


Ticks can number in the hundreds on an infested horse.
 

Despite the cold of winter, ticks are busy at work hitching a ride on our horses and helping themselves to a warm blood meal in order to continue their life cycles and propagate for Spring. 

Ticks are slow moving arthropods that insidiously creep in numbers onto our horses when they lay down, walk through grass, or put their heads down to graze.  Ticks burrow their heads deep into the skin and inject saliva into the bite site.  The saliva causes an inflammatory reaction in the horse which in turn increases blood circulation to the area.  Unfortunately, ticks can carry a number of diseases in their saliva.  These diseases can be life-threatening if not diagnosed and treated early.

Anaplasmosis

Anaplasmosis (previously called Erlichiosis) is an intracellular bacterial infection that causes high fever, anemia, limb swelling and diarrhea. It can rapidly progress to death in some instances. In others, horses can overcome the infection and gain immunity naturally. The vast majority of cases involve veterinary intervention using antibiotics, anti-inflammatories, and IV fluid therapy support. 

This disease is transmitted by deer ticks and usually appears about a month after the horse is bitten. Veterinarians can diagnose anaplasmosis with blood testing but generally must make an on-the-spot executive decision to treat it based on physical signs, since horses are usually so sick that they cannot wait for days while test results come back.  Luckily, the infection subsides with 7 to 10 days of daily antibiotic therapy- sometimes given intravenously or sometimes given orally. 

Horses can fully recover from an anaplasmosis infection within a couple of weeks. Anemia caused by the disease can be corrected thanks to the large reserve or red blood cells that the horse stores in its spleen. Unfortunately, being clinically infected with anaplasmosis does not guarantee that the horse will have long standing immunity to the disease. Some horses are reported to contract the disease twice in the same year!

Lyme disease

Lyme disease occurs in varying degrees depending on geographic location. It is virtually unheard of on the West Coast, but far more common on the East Coast. Most horses that are bitten by the Ixodes tick that carries the bacteria that cause Lyme disease never become sick - they simply develop immunity to the bacteria without incident. 

For the small subset of horses that do become sick, fever, stiffness, muscle pain and swollen joints are most commonly reported.  It is possible that longstanding infection with Lyme disease can cause permanent arthritic changes in multiple joints. While some testing methods for this disease have been developed, results can be difficult to interpret. Many veterinarians empirically treat for the disease if they see clinical signs that are consistent with it. Treatment is similar to that for anaplasmosis and most often, horses recover without incident.

Piroplasmosis

With the increased importation of horses from countries in which this tick-borne disease is endemic, we are hearing more and more reports about horses that carry it.  Piroplasmosis is caused by parasites called Babesia or Theileria.  The parasites gain entry into the horse by inoculation from the mouthpiece of a biting Dermacentor or Boophilus tick.  Horses can take 1 to 3 weeks to show signs of infection post-bite.

Mild forms of the disease present as weakness and inappetence, while more acute cases show fever, anemia, jaundiced (yellow) gums and eyelids, a swollen abdomen, and labored breathing. Other signs of EP include central nervous system disturbances, roughened-hair coats, constipation, colic, red urine. In some cases, death may occur. 

Horses that survive the acute phase of infection continue to carry the parasites for long periods of time. These horses are potential sources of infection to other horses through tick-borne transmission or mechanical transfer by biting ticks, needles, or surgical instruments. Horses infected with Piroplasmosis can be treated with varying degrees of success. Treatments can take many months and have to be repeated several times. They are also costly. 

The United States Department of Agriculture has a disease surveillance branch that works to identify and contain any sources of Piroplasmosis in the country. They do not permit import of any horses that test positive for the disease. Despite the federal effort to stop the disease from occurring here, there are still horses in almost every state that are considered carriers. Most of these horses tested negative for the disease during import but then reverted back to a positive carrier state later on. The mechanism by which this reversion occurs is unknown.

For all of the diseases listed above, no vaccination is available.  Therefore, prevention and/or early detection and intervention to treat infection are key.  Here are some tips for each:

Prevention

Clear brush and plant debris out of your horse’s living area since ticks tend to be concentrated in high numbers there.

Groom and carefully inspect your horse daily to look for invaders. You can pick ticks off with your fingers- but make sure to put them into a container with rubbing alcohol or some other caustic agent to kill them.  Simply throwing them on the ground will result in them being back. Ticks seem to love the throat latch area, under the elbows and between the front legs, along the crest of the mane, and around the tail. With tht said, they can latch on just about anywhere so no bump should go unexamined.

Fly sprays and spot on insecticides have varying degrees of efficacy when it comes to repelling ticks. Use of products like EquiSpot has been reported to be beneficial, especially when it is applied every two to three weeks.

Early Detection and Intervention

If you happen to find a tick on your horse, identifying it may help to narrow the list of potential horse-specific diseases it can be carrying. Check out this useful mobile App to help you identify ticks on-the-spot!Because most of the diseases that ticks transmit have an incubation period of weeks, it can be difficult to remember to watch for signs of the diseases over time.  

One practice that can be easily added to the daily management regimen is to take your horse’s rectal temperature with a digital thermometer. Fever is one of the first signs of all of the tick-transmitted diseases, and it can take just seconds to detect a fever if you use a thermometer daily. If you are able to catch a disease in the early stages, treatment can be shorter, less invasive and less expensive than if you have to address the problem at its worst.

Closing Thoughts

Stay tick-vigilant this holiday season!  They can hide in our horses’ long hair and evade detection for long periods of time.  Take your horse’s temperature daily as a matter of routine- temperatures greater than 101 F should be considered to be suspicious- especially if your horse shows any other signs consistent with a tick-borne disease. Early veterinary intervention and mean the difference between life and death in the some cases of tick-borne illness, so don’t delay in calling if you suspect one of these diseases.

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Odd and Ends: Pentosan Availability and Horse Transport Law Pending

By Grant Miller, DVM, December 08, 2014

FDA-Approved Pentosan Now Available 

Between 2009 and 2012, we had the luxury of accessing an injectable joint supplement from Matrix Animal Health called PentAussie.  It combined Pentosan and glucosamine in a 12 cc intramuscular injection which provided systemic anti-inflammatory joint therapy similar to that of Adequan and Legend.  But in 2013, the supply of PentAussie became scarce, and currently there is no official date that it will become available again. 

Recently, the international pharmaceutical company CEVA introduced an FDA-approved pentosan injectable called Pentosan EQ.  It comes in 6 cc vials (1 vial= 1 dose) and is available through your veterinarian. 

HJ has compared Legend, Adequan and Pentosan and determined that all three can be useful- but their efficacy varies on a case-by-case basis most likely due to inherent factors that create the inflammatory profile of each horse.  All three joint supplements require a veterinary prescription. Legend is administered by intravenous route while Adequan and Pentosan can be injected in the muscle. While several dosing schedules have been described, the majority of horse owners find that a loading series followed by monthly injections works well to ward off aches and pains in most horses. 

Horse Transport

The Horse Transportation Safety Act, H.R. 4440/S. 1459 is currently making its way through the United States Congress and could use your support.  The bill places a federal ban on the use of double-decker trailers for the transport of horses.  Double-decker trailers do not provide horses with the adequate headroom they need. In addition, horses often must negotiate a steep ramp in and out of the second level of the trailer, which results in frequent stumbling, falling and pile-ups.  For these reasons, the use of double-decker livestock trailers to haul horses places them at a high risk for injury or death.

 Research has shown that a horse needs a minimum of seven to eight feet in height in order to fully raise its head while traveling. However, no trailer with two or more levels can meet those minimum humane transport requirements while staying within the maximum height limits that are necessary to travel under bridges in urban or rural environments.

 While some states already have laws that prohibit the use of double-decker livestock trailers to transport horses, without a national law, there cannot be consistency to allow law enforcement to stop transporters in every state. 

The USDA’s Animal and Plant Health Inspection Service (APHIS) already published a rule in 2011 that bans the use of double-decker trailers for transporting horses bound for slaughter, however the rule has little use now since horse slaughter is not currently occurring in the United States.  Furthermore, all horses should be afforded the protection of the law, not just those bound for slaughter.  For this reason, it is important to contact your congress representative and senator now and voice your support for the bill.

 

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Medical Technology Never Ceases To Amaze Me

By Grant Miller, DVM, December 01, 2014

Vetigel- a revolutionary new product that stops bleeding in seconds. Photo courtesy Suneris

 

This morning I wound up in the dental chair after biting through yet another night guard (yes… life as a veterinarian actually isn’t a stroll through the daffodil field as so many thought!).  My dentist was very excited to report that he had come across a new product designed to stop bleeding that he hoped to someday use in his own practice.  He mentioned that when he pulls teeth, often times the artery that feeds the tooth bleeds excessively, making smiles far more difficult to muster for everyone involved. For now, the product has only gained FDA approval for use in animals, but the company that makes and markets it hopes to make it available in human medicine soon.

 

The product is called Vetigel and it is made by a New York-based company called Suneris.  It is, in my opinion, and amazing feat of technology that will help save many lives.  It is a plant-based polymer that can stop bleeding in about 3 to 5 seconds post-application.  The gel can be used internally or externally and works on everything from minor bleeds to major arterial hemorrhage.  

 

For horses, the “Achilles heel” when it comes to bleeding is the artery and vein bundle that runs down either side of the fetlock. It is called the Palmar Digital vein, artery and nerve. If you are one of the unlucky souls who has witnessed a horse bleeding from this area, you know it can be quite gruesome. Even veterinarians cringe when they think of having to locate and ligate a bleeding palmar digital artery. Now that a product like Vetigel is coming to the market, what were once life-threatening sources of blood loss are now reduced to mere minor complications.

 
Arrows point to the location of the Palmar Digital arteries.

 

The product comes in a single syringe and can be stored at room temperature.  There is no preparation necessary or special training required to use it- it is safe and easy.  Just open the pack and squirt the contents in the syringe on the bleeding vessel.  The product is completely bioabsorbable - there is no need to remove it.  The company also makes a solidifying agent that can be applied to the gel once the bleeding has been stopped.  The two together can either function as a long-term absorbing bandage, or they can be removed at a later time.  Isn’t technology amazing!?

 

So- how does it work?  VETIGEL accelerates the natural hemostasis (blood clotting) cascade by enabling the activation of Factor XII and platelets and adhering to the wound. Both Factor XII and platelets circulate in our blood and are instrumental components in the clotting cascade. This combination creates a million-fold increase in the production of fibrin (kind of like an “emergency patch” for the body, which leads to a rapidly formed blood clot.

 

The product has a one-year shelf-life and the company is considering offering different size syringes (5 cc and 10 cc) along with different shaped tips for easy application.

 

As I mentioned, it can be used during surgery or for everyday use on external lacerations. We all know how efficient horses can be in slicing themselves to shreds, so in my opinion, having a product like Vetigel available in our emergency kits is a no-brainer. 

 

The product is coming out on the market soon -  ask your veterinarian to look into it and hopefully stock it.  Veterinarians who want to receive a free sample can register here. I believe veterinarians, owners and horses will all breathe easier knowing that this product is within reach!

 

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