I’ve mentioned in a few previous posts that when I’m not thinking about horses and how to keep them healthy and fit, I spend a lot of time thinking about (and sometimes doing some things about) my own health and fitness. This summer I indulged the fitness enthusiast (and super nerd) in me by attending first ever The Radiance Retreat in the beautiful mountains of Ashville, NC. Hosted by fitness experts (and seriously kick-a$$ chicas) Jen Sinkler, Neghar Fonooni and Jill Coleman, this 3 day women’s only fitness and mindset retreat covered everything from perfecting your snatch (a tough but awesome Olympic Weightlifting technique) to eating to fuel your body and soul and learning to recognize and radiate your inner awesomeness. If fitness and being the best version of yourself is something you’re into, I highly recommend this event (which will be held again in Santa Monica in January, so sign up now cause spots are going fast!).
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On of the nutritional techniques we briefly talked about was intermittent fasting (aka IF), something I’ve been dabbling in since May of this year. The idea behind intermittent fasting is that you have set windows of “feeding time” followed by prolonged periods of fasting. I won’t go into the details of how and why because I’m sure I wouldn’t do it justice but if you’re interested in learning more check out LeanGains or EatStopEat. It's certainly not for everyone, but for me it works because I am not a breakfast eater, I’m just not hungry in the mornings and eating a meal before 8am guarantees that I’ll be gnawing off my own arm off by 10:30am and will seriously blow my daily caloric intake by lunchtime. Also, I like to feel full after I eat, and not just “not hungry” or sated but really truly “food baby” full. And eating 3-5 small meals a day (and not consuming enough calories to rival Michael Phelps or a sumo wrestler) for me means never being really full. So I’ve been happy with my venture into IF, it’s helping me make smarter food choices (knowing I’m going to be fasting has helped me lay off the sugar spike/crash foods that I normally abuse), my body composition is improving without feeling like I’m “dieting” and I still get to feel full.

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   But I always worry when there is a hot new trend in human medicine/fitness that equestrians will grab onto it and try applying it to our equine athletes. Remember those neon strips on every Olympic athlete last summer? I’m not even sure I believe that Kinesio Tape helps humans (the MDs aren't sure either) but now we’re strapping up our horses in neon strips? So while I’ve been pleased with IF and think you should give it a try if you’re looking for a new way to structure your meals, I don’t want anyone thinking I would be a proponent of intermittent fasting in horses. Horses and fasting are two words that should never be used in the same sentence (unless you’re prepping for a veterinary procedure like a gastroscopy, insulin testing or surgery). In the wild horses were designed to live on the open plains, constantly on the move, covering up to 25 miles a day in search of food and water supplies. Because they mainly live in grassland regions they have to constantly graze for up to 18 hours a day to meet their caloric needs. And because they are prey animals and designed to flee at first sign of a predator they can’t have a heavy meal weighing them down, they have small stomachs and a streamlined GI tract.

PictureGrade 3/3 Bleeding Gastric Ulcer in a Horse
    So what would happen if a horse was placed on an IF program? If we fed them one to two very large meals a day with nothing in between? (sadly the way many stabled horses are fed) Well the number one thing that would develop would be gastric ulcers. When a horse constantly grazes they are constantly producing saliva with each bite that coats the lining of the stomach, buffering the gastric acids and helping to prevent ulcers. When we feed very large meal, especially grain meals, horses produce even more stomach acids than when eating a small hay or grass meal and they produce much LESS saliva per bite of grain compared to per bite of hay. So we’re doing double damage by increasing the acid and decreasing the buffer. And what happens between meals, when they’re in a fasted state? Well they continue to have acidic fluid in their stomachs but because they are not chewing, there is no saliva production. Fasting is so effective and reliable at producing gastric ulcers that that’s how researchers induce ulcers in their experimental horses in order to study how they heal!

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    So while I prefer an eating pattern that involves 8 hours of munching followed by 16 hours of fasting (most of which are spent sleeping), this is the exact opposite of what our horses should be doing. In this case what's good for the goose is NOT good for the gander!
   We should strive to feed our horses multiple small meals throughout the day while always having some kind of forage (grass or hay) in front of them all day long to help buffer their stomach acids and prevent painful gastric ulcers.


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(Originally posted July 2012)

      This post is being written 30,000ft in the air as I head from Indy to NYC for a weekend full of a little bit of work and a lot of fun with friends and family. And I have to say, I’m pretty glad to be getting out of the Midwest. Today’s highs in Indianapolis are predicted to be 102F and that’s not counting the humidity! It was already 80 when we left home for the airport at 4:30AM and by 5:15 they had giant fans trying to cool passengers in line at security. While the East Coast is set to be a bit cooler over the next few days, these record highs at home has me worried about our equine friends, most of whom do not have A/C in their stalls.
I’m not the only one concerned. Officials at Churchill Downs in Louisville, KY cancelled racing for both yesterday and today, citing extreme temperatures and humidity. I spoke with the track veterinarian at my local track, Hoosier Park last night (where it was only in the 80s at race time) and while they are most likely going to continue the meet (the humidity is low and 20 mph breezes are predicted) they will have hoses placed all along the paddock and track-side as well as tubs of ice water to help cool horses before and after races.


     So how do these high temperatures and humidity levels affect our horses? Most of the research has been done on exercising horses and has universally shown that horses exercising in both high temps and high humidity have higher core body and blood temperatures, higher heart and respiratory rates, lower cardiac output, worse sweat response, longer recovery and a decreased ability to dissipate heat from their bodies. And while the horses in these studies were being run on treadmills at increased ambient temps you can imagine that even a horse just standing in a sun baked field would experience the same changes.     While we can’t bring our horses into our homes to enjoy the cool refreshment of central air (or even a window unit), we can take some simple steps to keep our horses cool and prevent heat stress.

1)    Shade- Temperatures in direct sunlight are going to be much higher than in the shade, so make sure your horses have the option to get out of the sun. Run in sheds, large trees or even keeping them in the barn can help keep them cool.

2)    Water- In high temperatures, and even more so in high humidity, more water is lost through sweat and increased respiration. Horses should always have access to fresh water but it’s even more important in this weather. So make sure your water troughs and buckets are full (and clean) at all times. If you’re not able to make it to the barn to refill them throughout the day, think about adding extra buckets to your stalls or paddocks.

3)    Electrolytes- Offering a salt or mineral block, placing an E-lyte powder on their feed or administering an electrolyte paste will not only replace important electrolytes lost through sweat but can also increase your horses’ drive to drink plenty of the aforementioned water.

4)    Baths- Cold hosing a horse and allowing them to air dry can help lower body temperature. The cold water will feel great and their wet hair will cool the skin through evaporation. For extreme conditions, water can be mixed 50/50 with rubbing alcohol to increase the evaporative effects. ** but make sure never to get any alcohol mix anywhere near your horses eyes!!**

5)    Ventilation- We all know how good a cool breeze feels. Placing fans in your barn aisles and in front of stalls can help keep things cool. Make sure barn doors and windows are open to let the air flow.

6)    Rest- Though we spend all winter dreaming of the days when we can ride across the fields, basking in the sunshine, extreme temperatures may be a good excuse to catch up on your favorite summer TV and give your horse a break. We discussed earlier that horses exercised in heat and humidity have much higher stress markers and much slower recovery. If you don’t have to train, don’t risk it. If you are getting ready for a big event, or use your horse in your work, plan activities early in the morning or in the evening when the temperatures are cooler.

7)    Protection from the Elements- The hot weather is caused by the sun’s rays, which also causes sunburns. Make sure to apply sunscreen to white noses which can become burnt just as easy as I turn into a lobster at the mere mention of UV rays! Warm weather also brings along biting insects which irritate and agitate your horses. Use fly sprays, fly masks and sheets to help keep your horse comfortable and bug-free.

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Hopefully with these measures we can prevent the ill effects of heat stress. But how do you know if your horse is too hot? Signs of heat stress can include prolonged increased heart rate >60bpm and increased respiratory rate >80bpm (horses use deep breaths to try to blow off some of the steam, much like dogs panting, which helps cool blood flow to the brain). Hot horses should sweat as a natural cooling response but excessive sweat (especially in an inactive horse) should be a sign of excessive heat, and horses that stop sweating, despite other signs of overheating should be tending to immediately. Some horses will become agitated and display signs of colic as heat stress mounts. Rectal temperature gives you an estimate of core body temp and horses that reach 103F without having been recently exercised should be treated.

     Treatments include many of the same steps as prevention. Obviously you should immediately stop whatever activity you are doing and get the overheated horse out of the sun, under a hose and in front of a fan. Offer fresh water. Extreme cases, or cases that do not respond to the above measures should be seen by a veterinarian immediately. Prolonged high body temperatures can lead to systemic inflammation, denaturation of proteins and even multi-organ failure. You veterinarian can help lower your horses core temp by lavaging the stomach with cool water (via nasogastric tube) and administering cool fluids intravenously.  Bute or Banamine can also be administered, not necessarily to lower the body temperature but to prevent some of the ill effect of the inflammation induced by excessive heat.

    While every horse is at risk for heat stress, there are some that should be given special considerations. Older horses suffering from Cushing’s Disease will not shed out their winter coats. This extra fuzz traps heat in and prevents cooling. These horses should be body clipped to help them keep cool (don’t worry, clipping the hair now won’t affect its ability to grow back once the weather turns cooler). Horses with known respiratory problems such as Inflammatory Airway Disease or Heaves should also be monitored closely. Hot dry conditions can exacerbate their airway disease and decreased air exchange may contribute to higher body temps. Finally, foals who are being treated with a macrolide antimicrobial (erythromycin, azithromycin or clarithromycin) for Rhodococcus pneumonia should be kept in out of the sun. There have been reports of idiosyncratic hyperthermia in foals on erythromycin (though we should be cautious with all three) and drug induced heat combined with high ambient temps is a recipe for heat stroke.

     So as the numbers on the thermostat continue to rise, take some simple precautions to help keep your horses cool and healthy and keep a close eye out for any signs of heat stress.

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Don't forget the dogs!
Dogs can also develop heat stroke in these high temps. Make sure if they are outside they have plenty of shade and fresh water (and a kiddie pool can go a long way to cool them down). And NEVER leave a dog in a car in the summer, even with the windows rolled down the temperatures inside can be lethal!

 
 
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I recently uploaded a new lecture to our online education courses; Equine Metabolic Syndrome.  I worry a little that the while the subject matter is one that most of my readers and students should know, the name may be confusing. Do you know what Equine Metabolic Syndrome means? Do you know about Insulin Resistance and what it means for your horses and their health?  It's when an overweight or obese horse develops a condition related to the obesity. They have abnormal fat deposition, exercise intolerance (lethargic and out of shape) and can develop serious medical conditions like laminitis. It's a little bit like Type II Diabetes in humans, but not close enough to use the same nomenclature (cause that would make it too easy for all of us).  While its something that has been going on in horses for as long as we’ve been putting them in stables and supplementing their feed but its something the scientific community has only been investigating for the last handful of years. And because the syndrome is old but the research is new, there is a lot of misinformation out there about why horses are fat and what we can do to fix it. One of the myths I have the hardest time debunking is that of Hypothyroidism. When people tell me their horse is hypothyroid I think of that line from A Princess Bride, “You keep using that word. I do not think it means what you think it means.” So let me tell you the schpeal that I give clients and other vets who call me for advice.

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Hypothyroidism in a dog.
Back in the day, well not too long ago, people would notice that they had a horse that had become overweight and lethargic and they wanted to know why. In people and in dogs hypothyroidism is a real, documented disease and is somewhat common. Humans with thyroid dysfunction are fatigued, weak, irritable and gain weight, or have trouble losing weight. Dogs will become dull and listless, reluctant to engage in their normal activities and will gain weight despite no change in appetite or feedings. So it would only make sense that if your horse was now dull and pudgy that hypothyroidism would be the answer. So we started testing horses thyroid hormone levels and guess what? Sometimes they were low. ">Problem solved!!!  And thus hypothyroidism was blamed for a variety of equine problems such as obesity, laminitis, anhidrosis (inability to sweat), recurrent rhabdomyolysis (tying-up) and poor fertility.  But here’s the problem with that theory…. Thyroid hormone levels that we measure in the blood may not tell us about true thyroid function. And who cares what the numbers from the lab say if the thyroid gland itself is functioning properly and doing its job to aid in growth and regulation of metabolism? We also know that certain medications (Bute & dexamethasone), strenuous exercise and diets high in energy, protein, zinc and copper will falsely alter the levels of circulating hormones in the bloodstream. The only way to know about how the thyroid functions is to perform thyroid function tests, which are rarely done in the field because the medications needed to stimulate the thyroid (to prove to us that its working) are not readily available. But when horses that are showing the “classic” signs of hypothyroidism, and have low thyroid hormone levels are tested for true thyroid function, they are found to be normal. Researchers have even tried to prove this association by removing horse’s thyroid glands to see what happens. Well what doesn’t happen is they do not become obese and they do not develop laminitis.

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“But I don’t understand!” you say. “I had a hypothyroid horse and we treated her and she got better! Was my vet wrong?” Well, yes and no. For all those years, we have been treating your horses correctly, using all of the knowledge that we knew at the time, but we were doing it for the wrong reasons. It has only been within the last few years that the veterinary community has come to define Equine Metabolic Syndrome. EMS is an endocrine disease of horses that is characterized by insulin resistance, meaning your horse’s cells don’t respond to insulin they way they should and the energy (glucose) they consume can’t be metabolized properly. It’s similar to Type II Diabetes in humans, in that it is often a result of obesity, rather than a cause. Some horses are more predisposed to being overweight, “easy keepers.” Obesity leads to insulin resistance, which in turn makes weight loss even harder to achieve. Horses with EMS are more prone to episodes of laminitis because of alterations in glucose and insulin in their blood streams. Many “hypothyroid” horses that have normal thyroid function will test positive for EMS and insulin resistance.

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“So why does treating with thyroid medication make these horses better if they don’t have a thyroid problem?” you say. Excellent question! Well thyroid supplementation causes an increase in metabolism. By increasing the horse’s metabolism they are able to loose weight and correct their insulin resistance. It works so well that researchers are now recommending treating these types of horses with a much higher dose of thyroid supplementation, a “supraphysiologic dose.” So while we have been doing the right thing all along, we only now understand why it was working. It is important to understand one other big difference. True hypothyroidism, in dogs and people, will require life long treatment. Horses who have been successfully treated for EMS do not, and unnecessary treatment with thyroid supplementation over extended periods of time is not only a waste of money, but also a potential health risk.

   So if you have a horse that is slow, sluggish and fat, or one that has been previously diagnosed as hypothyroid, learn more about Equine Metabolic Syndrome by taking our online course and talk to your vet about what you can do to test and treat this very common condition.

 
 
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Have you ever wondered what the difference is between the brand name veterinary products your veterinarian sells and the products in catalogues and tack stores that claim to be exactly the same but cheaper and without a prescription? Most people think of these as generics, over the counter versions of these medications much like we have generic and OTC versions of our human products like allergy medications and painkillers. But this is may not be true and the distinction between prescription, generic and a compounded drug is very important to understand. A brand named prescription medication is one that is FDA approved and comes with all the bells and whistles of a newly developed product. Once this new product’s patent expires, other companies can produce the same drug, using the same formula, same dosage, same ingredients and same form, but usually at a lower cost. Generic medications go through the same rigorous FDA approval process to assure efficacy and safety before they are on allowed on the shelves.

To “compound” a medication is to mix drugs to create a product that is not commercially available (most common in vet med) or to change the delivery (pill to liquid) or flavor (most common in pediatric med). Compounding pharmacies are mostly self-regulated and have little to no external oversight, meaning no one is making sure their products contain what the label claims. This is different from a “generic” medication, which has FDA approval and regulations.

Prescribing generic forms of medications is completely legal because the FDA has approved these products. In veterinary medicine the FDA only allows for compounding of drugs that are not commercially available in an FDA approved form. Prescribing and using a compounded drug that is commercially available, besides being against the law, may not give you the results you are looking for, or worse, can be dangerous.

An FDA study showed that 34% of compounded drugs do not meet the potency standards compared to their approved counterparts, and most of these had less than 70% of the active ingredient the label claimed!!!  Another recent study presented at last year’s AAEP Convention compared compounded omeprazole products (lower cost versions of Gastrogard for the treatment of ulcers). The compounded forms had less than 63% of the label claim of omeprazole. Meaning, you’d have to give almost two tubes of compounded omeprazole to get the same effect as a single tube of Gastrogard! Additionally the materials used to make these medications do not always come from high quality sources or FDA approved manufacturers making their safety and stability questionable as well.

One of the most common examples of proper compounding in veterinary medicine is pergolide, the medication used to treat Cushing’s Disease in horses. Years ago there was an FDA approved human formulation of the drug that we were able to give to our horses. But more recently they had stopped making this medication for humans and we were forced to use a compounded form to continue treatment on these Cushing’s cases. Because these were not regulated formulations there was always a question as to whether or not there was the right amount of drug in the compound. Was the horse not responding because the diagnosis was wrong or the condition was worsening? Or was it just that we wanted to give 1mg of drug per day but the formulation only contained 0.5mg? Often times finding the right dose for each horse was a guessing game. Thankfully a new FDA-approved equine formulation of pergolide is on the market- Prascend® (Boehringer Ingelheim). Though many people have become used to using the compounded powder or suspension, veterinarians will be switching over to the approved product because we can be confident that it is efficacious and safe for our patients.

While we will always need to compound some drugs in order to have the full arsenal available to keep our animals healthy, when we do compound, we closely research the company and often employ outside labs to verify the concentration and purity.  So talk to your veterinarian about compounded medications and beware of online companies offering compounded versions of medications at reduced prices (especially if it is a prescription med and they do not ask for a script!) because you may not be getting what you need!

 
 
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Last post we talked about my horrible eating habits as a child and my misconceptions on how to formulate an equine nutrition protocol. Remember hay is not just a side salad, it is the basis of a diet, and grain is not a meal, just a multivitamin. So with that in mind let’s think about how we should adjust the horse’s diet to alter the number of calories being fed. First we have to do some math. Let’s say your dressage horse was burns ~23,000 calories per day. To get all of those calories into him, you gave 14,990 calories a day in hay and an additional 8,010 calories a day in the form of a complete performance feed. This is a diet that meets your calories requirements and is balanced and complete in vitamins and minerals.

Now imagine what will happen when your horse enters retirement and trades in his days of half-passes and piaffe for light hacks and trail rides. Because of his decreased activity he is now only burning 16,500 calories per day. If you continue to feed his old diet he will surely get fat! So what do you do? How do you decrease the amount of calories while maintaining a complete and balanced diet?

Most people will say, “Just cut back on his grain.” This is both good and bad advice. It is good that most people recognize that if we are going to alter anything we should alter the grain and leave the hay (the uber important fiber source) alone. The bad thing about just cutting back on the amount grain is you’re not just cutting calories.

This brings us back to the multivitamin analogy. Let’s say you take a multivitamin that for some reason contains 1000 calories but you are looking to loose a little weight by cutting back on your calorie intake (and exercising, right?). If you cut that multivitamin in half you will save yourself 3500 calories a week, that’s enough to lose a whole pound! Great right? Wrong, because by cutting that multivitamin in half, you may be halving your calories but you are also halving the amount of vitamins and minerals you are ingesting…not ideal.

That’s the same thing we do to our horses by just cutting back on the amount of the same old grain. You can’t keep giving him the same amount of grain because of the calories but you want to make sure you are providing the right levels of the essential vitamins and minerals. And if you feed a 1,000 pound horse half of the recommended amount of feed (the amount of complete performance feed intended for a 500 pound horse) you will be giving half the calories, sure, but also be giving half the nutrients. So what can we do? Well what would you do if it were you and the 1,000-calorie vitamin? You’d get a new vitamin! Right?!?

And that’s exactly what we should do for our horses, don’t just give a smaller amount of the same grain, get a different grain, one that has a more appropriate level of calories for your horse’s needs. There are so many good product lines on the market that contain multiple options for a complete balanced feed for horses at different activity levels. Pick one that’s right for your horse. Find a feed that will only provide 1,500 calories but still 100% of the recommended vitamins and minerals. Reed the feeding recommendations, they tell you what class of horse the feed is intended for: Maintenance (the lawn art), Light Work, Heavy Work, Pregnant/Lactating. Make sure you are always providing a complete balanced diet to your horse; regardless of how many calories he needs to keep his waistline in check and keep him eating out of your hands.
 
 
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When I was little I used to help with the evening feedings at the barn after my lessons. In the same sequence every time, we dropped bales of hay down from the loft and I threw a few flakes into every stall while the barn manager mixed up everyone’s feed. As soon as that first bale hit the ground all hell broke loose! The barn shook with kicks to the wooden walls, buckets rattled on their hooks and teeth ran down the metal stall guards like a prisoner banging a tin cup across the bars. But as soon as I finished with the hay calm was restored and the barn sank into a satisfied silence of quiet chewing. The feed cart was then wheeled down the aisle and grain could be dumped into bins without fear of flying hooves or gnashing teeth.


I equated this pre-grain hay to the tiny salad brought out by the waiter at a nice restaurant. Placed on a tiny plate and consisting of a few pieces of lettuce, a ring of onion, one cherry tomato and a few croutons. It was meant to bridge the gap between the time when your mother cut you off from the bread basket (after your third or fourth breadstick) until your meal arrived. It wasn’t the meal itself and to me had no impact on my daily intake (I didn’t even factor it in when deciding what to order).

I know now that I was wrong. Salads can make fine meal, wonderful meals in fact, where all of your nutritional requirements are met and you are left sated. For humans we should strive to make the components of a salad the bulk of our diets, I bet we would be a lot healthier as a population. In horses it is even more important than that. Hay is not a side salad intended to keep horses calm while waiting for the real meal, in fact it should be the whole meal, the main component of a horse’s diet. It delivers calories, protein, and carbohydrates and as part of the carbohydrates, the most important element: fiber! Horses are hindgut fermenters; the microbes that live in their cecum and colon digest the fiber and produce molecules the horse can use for energy. Without fiber these good microbes would die, the horse would have no energy and worst of all the bad microbes (Salmonella and Clostridum to name a few) would take over and then we’re really in trouble.

So when I was a kid I was thinking about nutrition all wrong (for horses and probably for myself as well). We don’t build a diet around grain, adding hay just to keep the barn from being torn down at feeding time. We must build our horses entire nutritional program around hay. To do this we really should have our hay tested (every field and every cutting is a little different), to know exactly how many calories there are per pound and how much protein and carbohydrates our horses are getting. That way we can calculate exactly how much hay each horse needs (think 2-3% of their bodyweight per day, yes this means doing math and weighing your hay to know how much each flake weighs). The grain is the additive, only there to provide the vitamins and minerals that may be deficient in the hay (like Vitamin E and selenium) as well as some extra calories for the high performance horses who can’t eat enough hay to meet their caloric requirements. Rather than thinking of the hay as salad and the grain as the meal, we need to be thinking of the hay as the meal and the grain as a multivitamin, just filling in the gaps to make our total diet balance and complete.

 
 
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Gathering information from an owner before seeing an emergency is key. It’s especially important for the equine veterinarian. With the exception of those who work at large hospitals or clinics with a haul-in facility, we are bringing the ER to you! Stocked in our truck is most all of the equipment we could possibly need for an emergency, bandages, suture, sedation, antibiotics, you name it, we’ve tried to find a spot for it. But some tools that we may need might not live in our vehicles. Ultrasound and radiograph (x-ray) machines may be too big and take up too much room to always be in the truck, or we have to share it amongst our coworkers. Certain drugs that have a short shelf life, or are not used on a regular basis may not always be at our fingertips. Therefore before we come out to see your emergency, we may need to swing by the office and pick up a few supplies. And that is why it is so important for us to gather as much information about the case before we hit the road.  It’s not that we don’t think it’s an emergency, or our secretary is just trying to make idle chit-chat, we need all the details we can get so we will be prepared. And I’ve learned that to get that info, you need to ask the right questions. Don’t ask, “Did you give your horse any medications today?” ask, “Did you give any Bute or Banamine,” as those meds are so common place in today's barns that owners may not even think to mention them, like if you went to your doctor and the nurse asked you what medications you were on, you may not even think to mention the two aspirin you took for that headache this morning. And as much as it’s our job to ask the right questions, it’s your job, as the owner/trainer/caretaker to give the right answers (to the best of your ability of course). And I want to make sure your ability is at its best! 

It happens more often than we’d like, usually when we’re talking about lacerations, that an owner describes one thing, and you find something entirely different when you reach the farm. This difference may mean that we would have prepared differently or brought different equipment with us. The confusion is usually due to terminology. There are many different names for all the parts of a horse, from the fancy Latin phrase to the layman’s term. Using the same vocabulary can help us (the vet) communicate with you (the owner) to take better care of them (our horses). Having a common language will lead to more efficient and effective communication and better care for your horse!

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Directions of the horse.

TOP TO BOTTOM

Dorsal: Near the topline or back. Think dorsal fin on a shark. 

If you run your hand down the middle of your horse’s back, you are touching the dorsal midline. The withers are dorsal to the shoulder.  

Ventral: The bottom or towards the belly. A horse that has colic surgery will have an incision made on the ventral midline. The udder is on the ventral abdomen.


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These terms apply to dogs too!

FRONT TO BACK

Cranial: Towards the head (or the cranium). The point of the hip is cranial to the tail. 

Caudal: Towards the tail. You place the saddle caudal to the horse’s neck.

Now when we’re talking about the head you’re already as cranial as you can be so you really can’t say something is more cranial than something else on the cranium. 

Rostral: Towards the tip of the nose. The nostrils are more rostral than the eyes. 

Just because we like to make it confusing, terms change when we talk about things below the knees and the hocks.

We still use dorsal to indicate the front of the limbs. But for the back of the legs we use palmar and plantar (depending on if it’s a front of back leg):

Palmar: front legs. Like our hands have palms. The flexor tendons run down the palmar surface of the front leg.

Plantar: back legs. Like we get plantar fasciitis in our hind limbs (our feet). The ergot is on the plantar surface of the hind fetlocks.

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NOT a horse, but a great diagram!

SIDE TO SIDE

Lateral: Towards the side, away from midline, the outside. The ear is lateral to the forelock.

Medial: Towards midline, the inside. The chestnut is on the medial side of the leg.

NEAR AND FAR

Proximal: Closer to the origin (the body). The knee is proximal to the foot.

Distal: Away from the origin (body). Think distal=distant. The fetlock is distal to the knee.


THIS AND THAT

With horses having so many appendages, we sometimes have to describe a location in relation to the first location and it can either be on the same side or the opposite side. These are much less commonly used terms;

Contralateral: The opposite side of the horse. A horse with a broken leg it at risk of developing contralateral limb laminitis after putting too much weight on the good leg.

Ipsilateral: The same side of the horse. When the horse fell on its side, it injured the right eye and the ipsilateral shoulder (the right shoulder).
 
 
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You know how the old saying goes, “April showers bring May flowers and what do May flowers bring?”  SCRATCHES!!! Yes, its that time of year again, when the weather gets warm and the fields get muddy and your horses start to develop these crusted, irritated, painful lesions on their pasterns. It is one of the most common questions posed to online equine forums and when you plug “scratches treatment” into Google you get 13,200,000 results! While I will admit there is often “more than one way to skin a cat,” as they say, I also believe that if there a hundred different (and often conflicting) ways to treat a problem, it’s probably because we just haven’t figured out the right way yet.
Equine Pastern Dermatitis (EPD), aka “scratches,” “greasy heel,” or “mud fever” is a skin disease of the lower limbs. Most commonly seen on the hind limbs, the dermatitis affects the backs of the pasterns and occasionally moves to the front of the limb. Draft breeds and draft crosses with feathers on their distal limbs and horses with white socks  (ie: unpigmented skin) are predisposed to this condition. It is often seen in horses in muddy paddocks, rough prickly pastures and unsanitary condition, due to the high Generally the overall health of the horse is unaffected but severe cases can cause distal limb edema (swelling) and significant lameness.

The exact cause of EPD can be different in each case, but the pathogenesis (which is not entirely understood) is most likely as follows: a small break in the skin allows bacteria in (unpigmented skin is more delicate, and prickly fields more abrasive) and horses in mucky conditions or with long feathers that trap dirt, heat and moisture cannot clear the infection on their own.  There will be pain and swelling with crusted lesions. If not treated properly fissures and a foul odor may develop. In draft horses we sometimes see granulomatous growths of inflamed tissue at these sites.
The causative agents are usually bacteria including, Staph. aureus or Dermatophilus congolensis. There can occasionally be a fungal component and horses infected with mites or lice are at risk for developing infection where the parasites break the skin. While the diagnosis is often made just based on clinical signs, the only way to truly know what’s causing the infection is to have your veterinarian perform a culture and in some chronic cases a biopsy is required.
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While there may be a million and one creams, ointments and sprays out there to fix this problem, the mainstay of treatment should always be to remove all the scabs (another warm moist place where bacteria love to hide) and clean the area thoroughly and often. Clipping the hair short (with a 40# blade) will help getting down to the skin with cleaning and any topical treatments. Clipping, scrubbing and picking all the crusted areas off can be a very painful procedure and many horses have to be sedated by your vet in order to do a proper job. So be safe, especially because you will most likely be working on the hind legs!
Once the scabs are removed and the area is all suds up with an anti-septic solution such as 2% chlorhexidine, povidone iodine or benzoyl peroxide, I like to let the area sit for 5-10 minutes. This give the anti-septic plenty of “contact time” to kill the bacteria. After you rinse the cleanser off completely (dried soap can be irritating and itchy) the leg must be dried. And I mean really dried, not just wipe the excess water off with my hand like a human sweat scraper, or giving it one swipe with an already damp towl. The leg needs to be REALLY dry. For those of you with feathered horses who can’t bear the thought of clipping their lovely locks (or can’t for the summer show season) I recommend a hair dryer on a low setting to help really dry off the leg.

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The next part is where it gets confusing. Ointment or no ointment? To wrap or not to wrap? Systemic anit-biotics or no? Unfortunately we may not have the perfect answer just yet. Anti-biotic creams, or sprays can be applied twice daily to aid in fighting the infection. I like to stay away from petroleum-based ointments, in favor of creams or sprays. These Vaseline like substances water resistant and can be very difficult to completely clean off so that your scrub can reach the skin the next day. The only way to know what topical treatment will really work is to know what bacteria you are dealing with, and for that you must do a culture. Horses with lots of swelling in the lower leg or that have open fissures may benefit from a bandage but I do worry in many cases that bandages will just trap in dirt and moisture. The vast majority of cases do not require systemic antibiotics but in some cases we will treat with a course of oral or injectable medications. Obviously, you must consult with your veterinarian before beginning treatments. I think that all horses benefit from (and appreciate) the use of anti-inflammatories such as Bute or Banamine. Again, check with your vet for appropriate dosing.

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So to review, EPD is an infection in the skin (mainly bacterial, maybe fungal) secondary to breaks in the skin (due to delicate skin, rough pastures, mites/lice or normal wear and tear) that develops in wet, muddy and dirty conditions. Treatment includes clipping, cleaning and drying the affected area at least once a day, then apply the anti-microbial cream or spray du jour and keep your horse as clean and dry as possible. It’s a daunting task and may sound impossible, but the diligent committed owner should be able to get on top of a case of scratches.

 
 
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When I was younger I really wanted a Swiss Army knife. I mean really, what kid wouldn’t? It's a knife AND scissors AND a nail file AND tweezers AND there is even a fake plastic toothpick! But as we were taught, with great tools comes great responsibility and Swiss Army knives weren’t just given out on a whim. I can’t remember which birthday it was (9th or 10th) when I finally got the small black Classic SD. But there was a trade off; if I was old enough to receive the coveted multi-tool device that also meant I was old enough to mow the lawn. So to me, mowing the lawn was part of an important rite of passage. I was now deemed responsible enough for not only a small sharp object, but a large, sharper motorized one!  And I enjoyed mowing the lawn, the challenge of getting it started (holding the pull cord with two hands and throwing myself back with all my might), the instant gratification, the smell of fresh cut grass. So when we moved to our current house, that sits on ¼ acre with a small fenced in backyard, I was happy to volunteer for lawn trimming services….until I met our mower.
“Its great,” he said. “It's a real mower.”  “As opposed to a ‘fake’ mower?” I responded. “No, a R-E-E-L mower,” he said with a smile. And then I saw it. It is a modern version of the old fashioned, non-motorized, blades spin in a circle in some scissor like motion, who even knows how the grass gets cut, probably what Tom Sawyer used after he was done white-washing Aunt Polly’s fence, mower. To get it to work, the blades have to be moving fast enough for it to cut the grass, rather than just bend it over, which (without a motor) takes a bit of work, and in such a tiny yard as ours, there’s not a lot of room to get a running start. And if the grass is too long it won’t work, you have to raise the blades, cut it once, lower the blades and cut it again! That is NOT what I consider instant gratification. But as much as I complain and refuse to ever help out in the yard (this also has to do with Chiggers, which we do not have where I grew up and who consider me a delicacy), the reel mower is cheaper (no gas/oil), quieter (he has no excuse not to listen to me while he mows) and is much better for the grass. So that now, just a week into spring, our lawn is thick and lush and needs to be mowed (by someone other than me) at least once a week.

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Rotation of the coffin bone.
And while it is beautiful to look at, fresh, thick lush grass can also be dangerous. Pasture associated laminitis begins to occur after the growth of grass in the spring. In cases of laminitis, the lamina separates between the pedal bone (P3) and the inner hoof wall causing unrelenting pain and characteristic lameness. It is the most serious disease of the equine hoof that leads to devastating loss of function and sometimes loss of the horse. While there are many different conditions that can lead to laminitis, pasture associated laminitis, or “grass founder” can be traced back to the high sugar content of the grass.

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When a horse takes in a large meal containing sugars, they develop a temporary inflammatory condition in the GI tract called “carbohydrate overload.” Starch and sugars are normally digested and absorbed in the stomach and small intestine. The transit time through this portion of the GI tract is about 90 minutes and with a balanced meal, most of the carbohydrates will be absorbed before the feed passes into the cecum and large colon. However, if the meal is too high is sugars, too many sugars enter the small intestine and instead of being properly absorbed, some pass through to the large colon. This leads to a shift in fermentation and acidity of the colon contents and allows dangerous toxins to leak out of the gut into the bloodstream. There is also a large spike in glucose and insulin in the blood stream.  These toxins, inflammatory substances, glucose and insulin reach the hoof and contribute to the formation of laminitis. Prevention of pasture associated laminitis can be as simple as limiting your horses’ access to lush grass.

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However, some horses and ponies are more likely to develop laminitis (have a lower threshold) after consuming a high starch/sugar meal and require more than just limiting turnout time to prevent laminitis. All ponies and some breeds of horses (Warmbloods, Morgans and all “easy keepers”) are genetically predisposed to develop Equine Metabolic Syndrome (EMS). EMS is a disease characterized by obesity, abnormal fat deposition (crest neck, fat around tailhead and above eyes) and insulin resistance (IR). The cells in overweight horses stop responding to insulin and therefore cannot process sugars normally. Because of this, smaller amounts of grass may trigger a laminitic event in these animals. Diagnosis of EMS can be made by clinical signs, body weight and body measurements, and blood testing (insulin and glucose). Once an animal is diagnosed, the condition can be treated with diet, exercise and in some cases, medication.  Dietary recommendations include removing all concentrates (grain) from the diet (or feeding specially formulated low starch feeds), feeding grass hay only (no alfalfa) and limiting access to pasture. Any horse or pony who is obese, considered an “easy keeper,” or who has had a previous laminitic event should be tested for EMS. Equine Cushing’s disease can also lower the threshold for laminitis in horses on pasture. Older horses (>15 years) and horses with clinical signs of Cushing’s (curly haircoat, cresty neck, potbellied appearance, recurrent laminitis) should be tested and appropriately treated. These horses often have IR concurrently and testing for EMS is warranted in all cases of Cushing’s. Horses can be easily treated for Cushing’s disease with daily medication. Like EMS cases, Cushing’s horses should be managed even more carefully on pasture in the spring and summer.

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The following suggestions are just a few things you can do to prevent pasture associated laminitis and keep your horses happy and sound throughout the spring and summer.

  1. Identify the horses and ponies who are at a higher risk of developing laminitis. Test “easy keepers,” geriatric horses and those with a history of laminitis for EMS and/or Cushing’s Disease.
  2. Treat any predisposing condition with diet, exercise and proper medications.
  3. For horses with a lower threshold, consider a zero grazing environment, such as a dry lot (while providing the horse with suitable forage alternatives).
  4. Limit turnout of pasture when grass is lush and when fructans are high.
  5. Turn horses out to pasture when fructan levels are likely to be at their lowest, such as from late night to early morning, removing them from the pasture by mid-morning.
  6. Employ the use of grazing muzzles to allow horses out on pasture but still limit their intake of grass.
  7. Maintain pastures regularly to prevent grass from becoming mature and stemmy (they contain high levels of fructans). 


If you have any questions about pasture associated laminitis and whether your horse is at a higher risk, contact your veterinarian for proper testing and specific recommendations that will work for you.

 
 
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The birds are chirping, daffodils are popping up all over our yard (despite the demolition done to the bulbs this fall courtesy of a runaway stump-grinder) and the sun is shinning! March 20, 2012 marks the first day of spring in the northern hemisphere. So to kick off the new season here is the first installment of a 3-part series of blog posts. While we may all be excited to get back in the saddle and out on the trail, there are a few horse health topics we can’t forget, the darker side of this influx of warm air… And speaking of warm air, I don’t think anyone can argue that its been a mild winter and at least here in Indiana we seem to be moving right onto summer without much of a transition. Forget “In like a lion.” More like “In like an iguana baking in the desert sun!”  Two weekends ago, I wore long-johns to practice and could barely keep my fingers from turning blue. Last Saturday, it was 80 degrees at the kick-off of our first game. That kind of sudden heat really makes you re-evaluate your fitness level.

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But what else does this sudden heat wave bring to life, besides the flowers and grass (and we’ll get to the evils of the spring grass next week)? Bugs! With no more overnight frosts, mosquito season is upon us, and much earlier than normal. Now I know what that means for me, coating myself in OFF and calamine lotion and being driven to insanity by hundreds of itchy bites. But it also has implications for our horses and their mental well-being. Mosquitoes can carry a group of viruses that cause encephalitis, or infection in the brain. These viruses include West Nile Virus (WNV), Eastern Equine Encephalitis (EEE, often called Triple-E) and Western Equine Encephalitis (WEE). There is also a Venezuelan Equine Encephalitis (VEE) but that hasn’t been seen in this country since the 1970s, though some people in southern Texas and Florida consider it a threat.

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Life Cycle of the Viruses:
The virus has a life cycle that mainly involves wild birds. Remember it was a veterinarian who discovered West Nile Virus in crows in New York City back in 1999. Mosquitoes pick up the virus when they feed on an infected bird and then transfer the virus to horses, or humans, when they bite them. These viruses cannot live outside of a host and do not survive in the environment for long and the virus does not exist in high enough levels in the horse’s blood stream to transmit to other mosquitoes, horses or humans. Therefore isolation of infected cases is not required.

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Clinical Signs:
EEE, WEE and WNV all act very similarly in the horse. The virus replicates in lymph nodes and infects the neurons in the brain. Clinical signs can appear anywhere from 2-3 days to as long as 3 weeks after infection. Signs may include: fever, depression, loss of appetite or neurologic signs (incoordination, staggering, hyperexitable, head pressing, leaning on walls, low head carriage, drooping lips/tongue or recumbency). Some horses may have intense puritis, or itchiness. Many horses infected with West Nile Virus will display very fine fasciculations of the muzzle that are often only noticed by seeing their whiskers quiver.  The course of the disease is between 2 to 14 days and fatality rates range from 33% with WNV, to 50% with WEE and up to a staggering 90% with EEE. The only treatment is supportive care (IV fluids/nutrition, anti-inflammatories and corticosteroids).  Horses that are lucky enough to recover may have residual neurologic deficits.


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Prevention: Prevention includes vaccination and mosquito control (removal of stagnant water sources and liberal use of fly-sprays). When given properly (three initial shots 4-6 weeks apart, followed by an annual booster) the vaccines have been shown to be close to 100% effective.  The American Association of Equine Practitioners recommends that the, “annual re-vaccination must be completed prior to vector season in the spring. In animals of high risk or with limited immunity, more frequent vaccination or appropriately timed vaccination is recommended in order to induce protective immunity during periods of likely exposure. In areas where mosquitoes are active year-round, many veterinarians elect to vaccinate horses at 6 month intervals to ensure uniform protection throughout the year, although this practice is not specifically recommended by manufacturers of vaccines.”

So with the early onset of the warm weather, and hatching of billions upon billions of mosquito eggs, I would strongly recommend moving up your horse’s vaccination schedule to cover them against these devastating diseases as soon as you can. The bugs aren’t going to wait to bite your horse just because you’re not due for your spring shots till April! 

And don't forget about Fido and Fluffy! While dogs and cats rarely get these viral encephalidities, mosquitoes carry heartworm disease and the warm weather will bring out other undesirable critters like fleas and ticks which carry a whole set of diseases of their own like tape worms and Lyme Disease. So, if you take a break from your flea/tick/heartworm prevention in the winter, now is the time to start back up again!!


 

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