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Nasal Strips: They definitely don’t harm

By Grant Miller, DVM, June 02, 2014


The equine nasal strip from Flair.
All this talk about California Chrome running in the Belmont on Saturday, June 7, for a chance to be the 12th horse in history and the next since 1978 to win the coveted Triple Crown (Kentucky Derby, Preakness Cup, and Belmont Stakes) has centered on the use of nasal strips.  The controversy has been whether or not the use of the nasal strip was performance enhancing.  

Do the strips give horses a competitive edge?  Experts say no, and thus the State of New York Racing Commission cleared the use of the strip for the Belmont Stakes.  However upon further investigation, research results are conflicting.  

In a 2001 study, conducted on nasal strips, it was shown that they had no effect on gas exchange, exercise-induced pulmonary hemorrhage, or lactate build-up due to anaerobic metabolism.  But a more recent study conducted in 2004 suggests that horses wearing nasal strips had a reduction in bleeding in the lungs.


The disposable 3-inch strip laid across the dorsum of the horse’s nose is said to expand the diameter of the nasal passages to allow more airflow with less restriction.  Since horses are obligate nasal breathers (meaning that they can only breathe through their nose and not through their mouth like us humans) an open nasal passage is extremely important.  Sold under the brand name Flair, the equine nasal strip was invented by two veterinarians in the early 2000s.   


For the $10 that it costs for a nasal strip, if they can help your horse to breathe easier and more freely - why not try them?  Even if they help the smallest amount, every little bit helps, especially in cases of speed.  


Bottom Line: They won’t harm your horse if you choose to be adventurous and give them a try. Whether you feel they truly make a difference for your horse is something we'd like to hear about. 

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Equine Coronavirus (ECoV)

By Grant Miller, DVM, May 27, 2014

Credit: horses-with-coronavirus-often-need-iv-fluids.
Historically, equine corona virus has been associated with gastrointestinal problems in newborn foals.  However from 2012 to the present, an adult form has popped up all over the country.  Leave it to a virus to adapt and find new ways to infect a host!  Here is the 411 on Equine Corona Virus:

What horses are at risk?  This virus is non-discriminate- it can affect horses as young as 1 year of age all the way up to 32 years or older!  Most commonly it affects older horses (in the late teens and twenties).  Horses in a stressful situation (such as during transit, at a show, or moving to a new barn) are also at a greater risk of becoming ill.

How do horses get infected?   By fecal-oral transmission.  This means sniffing other horse’s manure piles, sniffing the manure cart, manure fork, or being touched by the unwashed hands of a person who has been in contact with these objects can infect a horse.   

How long can it stick around in the environment?    We really do not know for sure.  Therefore, feces from suspect horses should be removed from the property altogether.

Is there a time of year that it appears to be more prevalent?   Equine Coronavirus has most commonly been detected during the cold weather months (in the Northeast areas) from November to May.

What are the signs associated with active infection?

  • Anorexia
  • Lethargy
  • Fever (usually 104 F or higher)
  • Soft “cow pie” feces, but rarely diarrhea
  • Mild colic (laying down; looking at sides)
  • Neurologic abnormalities (ataxia, depression, recumbency) – these occur secondary to having too much ammonia in the blood stream.
  • Low white cell counts on blood work
  • Low blood protein on blood work (called Hypoalbuminemia)

What are the chances that my horse will become sick if there is another horse in my barn with the infection?   Many horses can be exposed to corona virus and not show any outward signs of illness.  Their bodies can create an immune response and neutralize the infection.  Studies show that anywhere from 20 to 60% of horses that are exposed to the virus will become clinically ill. 

Can my horse die from Equine Corona virus?  Although some deaths have been reported, it is not likely going to kill your horse.  Horses that die from it usually have problems from secondary complications such as dehydration, poor tissue perfusion due to low body water content, and blood borne bacterial infection secondary to the viral infection.  Also, high blood ammonia levels are associated with neurological signs and may result in death.

How long does it last?  Signs generally resolve in 1-4 days with supportive care and outbreaks typically last for about 3 weeks. 

What does treatment involve?  Affected horses are treated with Banamine and supportive care. Antibiotics are ineffective against corona virus because they do not treat viruses. Horses that are off feed or water or have severe diarrhea should be seen by a veterinarian and treated with IV fluids to prevent dehydration. 

Is there a vaccine available to protect my horse from the disease?   Not currently. 

What can I do to minimize risk of infection?  During an outbreak, affected horses should be isolated and handled/treated last or by separate personnel. In addition, stall cleaning equipment should be kept separate. Hands should be washed (or cleaned with a hand sanitizer) after handling affected horses, and stalls and equipment should be disinfected under guidance of a veterinarian. Separate boots should be worn with affected animals, and disinfectant foot baths should be used.

Early intervention is key - you do not want your horse to become dehydrated or develop high ammonia levels in the blood!  Therefore, getting IV fluids on board early may be necessary, especially if your horse stops eating and drinking.  Banamine can help keep the fever down and reduce harmful inflammation in the body- so get your vet out ASAP if your horse shows any suspicious signs.

See also: This report from the NYS Veterinary School at Cornell.

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Tildren Now Approved in the USA!

By Grant Miller, DVM, May 19, 2014


The United States Food and Drug Administration (FDA) Center for Veterinary Medicine recently approved Tildren for use in horses in the United States.  For those of you who are unfamiliar with Tildren, it is a pretty remarkable drug that has been used around the world for nearly two decades now to treat bone-related lameness in horses.


According to its maker CEVA, Tiludronic acid (also called Tildren) is a bisphosphonate therapeutic drug which exerts activity on bone metabolism. The main pharmacological property of Tildren is to reduce bone resorption by inhibiting the activity of osteoclasts (cells that break down bone.)  Some readers may be familiar with bisphosphonates since they are widely used in women to slow the progression of osteoporosis.


Tildren essentially acts as a regulator of bone remodelling in all situations involving excessive bone resorption, such as arthritis or navicular syndrome in horses. This regulator effect is not associated with a negative effect on bone formation or bone mineralization at the recommended therapeutic dosage. Tildren is officially labelled to treat navicular syndrome, but veterinarians who have been able to obtain it from overseas report excellent results with its application for arthritis, ringbone, and kissing spines.  Basically- if your horse’s lameness is bone-related, Tildren may be able to help!


Although Tildren can be given once daily for 10 days to achieve the therapeutic effect, it is much safer and reportedly more effective to give it once, but slowly over 1 to 3 hours’ time.  This can be easily accomplished by diluting the medication in intravenous fluids and then letting it run in on an IV drip. 


Side effects are few and far between- some horses have reportedly become colicky after the treatment, but the colic is usually mild and resolves spontaneously on its own.  Also, it is not approved for use in young, growing animals under 2 years of age due to its competitive binding of Calcium. 


Tildren works slowly over time with effects most commonly being reported at 5 to 8 weeks post administration.  However, some horse owners report effects in as little as 2 days to 2 weeks following a Tildren injection!  The effects are long-lived and often last for several years.  Most horses that receive Tildren do not get a second dose however no deleterious side effects have been described to date as a result of repeated dosing.


Sounds like a wonder-drug… right?  Some may wonder, “where has it been all my life?!”  The FDA has rigorous approval procedures in which a drug manufacturer must prove product safety and efficacy prior to it being available in the United States.  As a result, Tildren has, until recently, been unavailable here.  Those who have imported Tildren under the federal FDA personal importation policy have paid high prices.  Tildren sells for far less in other parts of the world than it does in the USA.  This is due not only to opportunistic “supply and demand” mark-up, but also to overseas shipping costs and administrative import paperwork. 


Now that Tildren is available here, hundreds of lame horses may be kicking up their heals once again as veterinarians everywhere will begin to stock it!  How many readers have horses that have received Tildren?  Any stories that you wish to share? 

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Wobble Boards - Who Knew?

By Grant Miller, DVM, May 12, 2014

My clients never cease to amaze me.  More often these days, that is meant as a compliment!  I am constantly learning about new products, training methods, events and other goings-on in the horse world and it is just incredible all of the things one can discover among the equestrian community.  Recently, a client mentioned to me that she was doing a lot of work with her horse on a teeter-totter.  Remember those from our childhoods?  Two participants sit at opposite ends of a long board centered on a fulcrum and take turns rocking up and down.  OK, sure - we all know what one is.  But have you ever seen a horse on a teeter-totter?


This is so cool!  My client is a member of the California State Horsemen’s Association and competes in their trail trials.  Her jubilant black Quarterhorse gelding Otto is particularly fond of the teeter-totter competition.  Basically, as the video shows, he balances on a platform that is centered on a railroad tie.  Otto is a total pro at keeping both ends of the platform in mid-air- he has really figured everything out.  It appears that he really likes it too- since he is essentially ground tied on the platform but never bothers to eat the grass below his feet.  It takes a lot to stop a horse from eating green grass by his own free will!


My client explained to me how trail trials and obstacle course competition works.  Riders are judged on how well they negotiated their horse through an obstacle with an emphasis on calmness and safety.  Time is not a factor in scoring, however, they will ask you to move on if your horse is taking an inordinate amount of time to complete an obstacle.  The judging is very well-developed, strict and methodical. 


Of course, I should have known that there is an association for this type of competition.  There are all sorts of challenging obstacles involved in competitive trail riding, including: barrel board pin wheel, opening gates and the vine simulator.  Needless to say- they all “look” easy- but for those of us who have attempted to convince our horses to engage them, we all know that they are extremely difficult.


Who among us competes in trail trials?  If you have any words of wisdom for enthusiasts, let us know!










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Splints Happen

By Grant Miller, DVM, May 05, 2014

Credit: splint-skyline
A fresh splint on the hind limb.
I was surprised this past weekend when one of my patients presented with a splint on her hind leg.  I was not surprised that a splint had occurred, but surprised that my client had no idea what a splint was!  Most learning in the horse world seems to take place in the School of Hard Knocks; therefore each horse owner’s education is drastically different depending on the various lumps that each of us has taken during our horsey adventures.  For some of us, the lump that makes up a splint is something new. 


Splints can occur in the cannon bone region of all four limbs, on both the outside and the inside of the leg.  Remember, the cannon bones are the ones between the carpus (a.k.a “knee”) and the fetlock on the front leg and between the hock and the fetlock on the hind leg.  The splint itself is actually a result of damage to a non-essential ligament called the interosseous ligament.  These ligaments glue the splint bones to the sides of the cannon bone.  If the horse has an excessive impact such as kicking a fence or landing hard on the leg, the ligament can tear.  The body addresses this by filling the torn area in with calcium mineralization.  Once this hardens, it becomes a sort of cement patch to stabilize the area.  We call these “splints.” 

Credit: diagram-of-the-horse-leg
Splint bone, interosseous ligament and cannon bone.

Mature splints are hard, irregular lumps that protrude off the sides of the cannon bone. They are generally unchanging and non-reactive when touched.  It is quite common for horses to get splints on the inside of their front cannon bone regions, but as mentioned, they can occur on both sides of any of the cannon bones. Very few middle-aged/ geriatric horses have legs that are entirely free of splints. 


In the early stages when a horse first “pops” a splint - the area will be soft, fluctuant (movable and compressible), hot and painful.  It is crucial at this stage to identify the problem as a splint, since failure to treat splints can result in longer term lameness and more serious issues.  In general, treatment of a splint involves the cornerstones of anti-inflammatory therapy:


1. Rest: The horse should be stall rested/hand walked for about 10 to 14 days to give the splint a chance to calcify.  Sometimes it takes longer, depending on the size of the interosseous ligament tear.  Your veterinarian can direct you on an exact course.

2. Ice: Cold therapy helps to reduce inflammation and sooth pain. 

3. Anti-inflammatory therapy:  Feeding bute or firocoxib for 5 to 7 days is often recommended by veterinarians.  Anti-inflammatory medications help to reduce swelling, edema, heat and pain.  Many have also used topical Surpass (diclofenac) cream to assist in reducing inflammation.  Another popular treatment is DMSO gel applied topically- but beware since it can cause skin reactions in some horses!


In addition to these hallmark therapies, folks will often wrap the leg with a standing wrap to help reduce swelling and shield the splint from any further injury. 


By and large, splints really are not considered to be a big deal.  They are usually noted as incidental findings on prepurchase exams, and rarely do they result in ongoing lameness. 


Bottom line: Correct detection and early intervention keep splints from becoming major issues. If you suspect your horse may have popped a splint- rest, ice and anti-inflammatories given at the direction of your veterinarian should solve the problem within a couple of weeks.

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