AAEP Convention 2006: Additional Topics
Western Performance Horse Forum
The Western performance horse industry is growing at an astonishing rate, and along with that growth, there are unique health issues that need to be addressed. The Western Performance Horse Forum--moderated by Jerry Black, DVM, of Pioneer Equine Hospital in Oakdale, Calif., and Joe Carter, DVM, of Oklahoma Equine Hospital in Washington, Okla., who both actively participate in the Western performance horse industry--addressed relevant issues and opened a discussion on what role the AAEP should play in this industry.
The Industry Evolves
"Western horses have transitioned from a working class to a performance class in the industry," said Black. "This is a very exciting time for the Western horse industry to be included in the World Equestrian Games, and to be included in the Olympic Games would be a feather in the cap of the reining horse industry."
Carter added, "I would certainly like to see the AAEP get behind promoting reining as an Olympic discipline."
Other audience members said that because of the push for Olympic contention, they had noticed an increase in amateurs competing in Western Performance classes, and organizations were responding by adding more amateur-level divisions.
Another veterinarian commented, "I also see older horses competing longer. There are more geriatric horses involved in showing for longer periods of time, because there are more amateurs who need a seasoned horse."
The forum participants briefly discussed challenges of caring for the older competitive horse, such as the use of anti-inflammatory drugs, and this led to the discussion of drug policies in the sport.
International Drug Rules
"At the Aachen World Equestrian Games, we had 17 countries competing (in the reining competition)," Carter said. "Drug testing is one of the big impediments for the industry right now. However, we've had reining in six large international competitions and had zero (drug) positives. It's the only horse discipline to have zero positives--not just the U.S., but all countries."
Black added, "The American Quarter Horse Association (AQHA) is one of the few (Western) performance horse organizations that have medication and drug rules. But unless the shows are very large events, the role of the veterinarians at the events is strictly an on-call basis."
Several members addressed the fact that many Western performance events, such as the National Reining Horse Association (NRHA) and National Cutting Horse Association (NCHA) futurities, have huge purses that tempt owners and trainers to push their horses to the edge, which sometimes involves using drugs that are prohibited by organizations such as AQHA and FEI (Federation Equestre Interionationale, the ruling body of international equine sports). However, NRHA and NCHA don't have drug policies.
"If you have a $10,000 horse and he has some problems, it's easy to retire him," one veterinarian said. "But, if you have a $2 million horse, it's not so easy."
Black replied, "I can easily argue that the owners of these horses are very conscious about the welfare of the horses. We do use medications, but I wouldn't say the majority of the people are using medications as performance enhancers."
He said he realized there is a minority of people who will always try to abuse the system.
Carter explained that if organizations do implement drug policies, they should concentrate on drugs that are definite performance enhancers. "We need to look at a very narrow scope of drugs that don't have a place in competition," he said "Anti-inflammatory drugs are not performance-enhancing drugs."
Another audience member commented, "We are seeing more and more Surpass (a topical anti-inflammatory drug) being used at the shows. I think it's being used more than what it can sometimes do, but it gives the owners or trainer the feeling they are directly impacting their horses' health."
Another audience member added, "If you have a very athletic, long-term discipline like show jumping, it's unrealistic to expect that most of these horses are going to be sound on their own. If you don't fix basketball players' knees, how many people do you think you are going to get out on the court?"
Forum members briefly discussed the recent equine viral arteritis (EVA) outbreak that affected several western states and quarantined many barns housing Western performance horses.
"Shows were canceled and (the facilities of) several large trainers were quarantined," a veterinarian in attendance commented.
Another forum participant said, "An outbreak can have a tremendous impact on the industry, especially during this time of the year (late in the season, when most championship shows are held)." It can have such an impact that some trainers even broke their quarantines and traveled to shows anyway. "I had a couple of clients wanting to bust their quarantine," one attendee said. "The state vets were overwhelmed, and I was faced with the decision of calling the state vet and ratting out a good client."
Black said, "Obviously it's a hot topic. It's even a hot topic at the level of the USDA. Sometime in the near future we are looking at stallions that are going to have to have some testing done before they are allowed to travel between states. They want to devise a way to be able to track these particular stallions."
Black said it would be a good practice to test and vaccinate mares and stallions for EVA on all farms..
"Every major racing Quarter Horse broodmare farm in our area is requiring negative test and vaccination for EVA this season," said a veterinarian.
Sales and Ethics
Black touched on professional ethics within the industry, especially focusing on changing the way larger sales are run. "When you have yearlings selling for $250,000, the rules have to change a bit," he explained. "It can't always be a 'buyer beware' market."
Black explained that Western Bloodstock, the contracted sales company for the NCHA sales, put a group of veterinarians together to develop a radiographic repository that mimics what is used in the Thoroughbred industry.
"They made it mandatory for the 2-year-old in training select horse sale last year," Black said. "All the radiographs have to conform to a specific set; there's 22 X rays involved. All of them have to be taken by digital imaging. The owners are asked to sign a consent form and those radiographs will be used in a long-term radiographic study.
"The biggest problem we have in performance Quarter Horses is developmental orthopedic diseases," Black continued. The five-year study will look at lesions and future performance of the sales horses in a similar fashion to what has been done in the Thoroughbred industry.
Black said full disclosure can only help improve the industry's image and the quality of its sales.
Overall, the forum attendees seemed pleased with the direction the Western performance horse industry was headed. The prospect of reining being the next Olympic sport perked the ears of many who would like to see the AAEP play a more active role in promoting and standing behind the Western Performance Horse industry.
Incisor Luxation Fractures
Incisor luxations are the most common oral fractures in horses, according to Lynn Caldwell, DVM, of Silverton Equine Veterinary Services in Silverton, Ore.
When the horse pulls back on a solid object with his teeth, it can cause trauma to the teeth and underlying developing tooth structures. It's important to catch these injuries early.
The first question Caldwell asks when examining a horse with incisor fractures is, "Can I save these teeth?" She first provides non-steroidal anti-inflammatories and antibiotics. "We like to use broad-spectrum antibiotic combinations like penicillin and gentamicin immediately."
She said radiographs are "absolutely essential. If you have deep root fractures, you'll want to extract them, or realize you're going to come back later and extract them. Also, you can see if there are any bone chips that need to come out."
After stabilizing the teeth with surgery, Caldwell uses impression materials to protect the mouth's soft tissues from any sharp edges (similar to putting wax on braces).
Horses should be kept on antibiotics for two to four weeks and the mouth should be flushed with chlorhexidine during that time. Caldwell stressed that it takes months for fracture sites to completely heal.
Biologic and Therapeutic Agents Forum
The forum was facilitated by Craig Barnett, DVM, Intervet Senior Equine Technical Services Specialist, and co-facilitator Carol Clark, DVM, Dipl. ACVIM, of Peterson & Smith Equine Hospital in Ocala, Fla.
The first topic of discussion was the equine viral arteritis (EVA) outbreak in 18 states and two Canadian provinces in 2006. The outbreak was the first in the Quarter Horse industry. (In 2007, EVA reared its head again in the Quarter Horse population, see www.TheHorse.com/emag.aspx?ID=7745).
It was noted by Kevin Hankins of Fort Dodge Animal Health (which makes a vaccine against EVA) that the vaccine available to protect horses from EVA has been used minimally in the Quarter Horse industry in recent years. Once this outbreak started, however, the number of doses produced was upped from 2,000 to 18,0000 to try and meet the demand.
The AAEP Vaccination Guidelines recommendations can be found at http://aaep.org/pdfs/AAEP_vacc_guide.pdf.
The AAEP recommendations state that intact colts intended to be breeding stallions should be given one dose at six to 12 months of age with annual boosters. Document the seronegative nature of these colts prior to vaccination.
For open mares that are seronegative, vaccinate annually before breeding to carrier stallions. Isolate these mares for 21 days after breeding to a carrier stallion. Vaccinated mares do not develop clinical signs even though they become transiently infected and might shed virus for a short time.
For breeding stallions and teasers, vaccinate annually 28 days before start of breeding season. Note that virus might be shed in semen for up to 21 days.
The Forum group also discussed quarantine, since horses can shed the virus for up to 21 days through the respiratory route, and stallions can become affected for longer terms (years) and shed the virus in semen. Veterinarians also warned that while the vaccine is not labeled for use in pregnant mares, thousands of pregnant mares have been vaccinated without problem. The decision to use the vaccine off-label is up to the horse owner and veterinarian.
Young colts should be tested to determine whether they have been exposed, then vaccinated to protect them from becoming carriers when they are sexually mature.
It was noted that if a mare is to be vaccinated, a blood should be drawn from her nursing foal to show it is negative prior to the vaccination. The baby will seroconvert (show positive antibodies to equine arteritis virus) either through his dam's nasal shedding or through ingesting antibodies in the mare's milk.
"You can't tell the difference in titers (of antibodies) whether it's from vaccine or natural exposure," noted one vet.
There was a warning that many horses can become seropositive and never show clinical signs. With the Quarter Horse outbreak in 2006, about 50% of exposed horses developed clinical signs, from abortion to stocking up.
Mary Beth Evans, DVM, MS, senior staff veterinarian, Center for Veterinarian Biologics (CVB), USDA/APHIS Veterinary Services, spoke on proposed regulations on viral strain changes in equine vaccines. The point that has been discussed for the past couple of years is that there needs to be a policy change to better allow for influenza products to be updated with new strains in a timely manner when change occurs due to significant antigenic drift in the field.
Her division has worked to develop guidelines for vaccine manufacturers to allow them to update killed virus vaccines without having to go through new product licensing.
Influenza has a variety of subtypes, and is known to have antigenic drift (changes in the genetics of the virus that make current vaccines not work as well or at all). The decision was that there need to be a mechanism in place to add strains fast due to outbreaks or the potential of an outbreak. Also needed is the ability for vaccine manufacturers to delete a strain no longer causing disease from a licensed vaccine.
The current "Draft VS Memo on Viral Strain Changes in Inactivated Equine and Swine Influenza Vaccines" has been out for public comment and revised and is going through USDA revision. It assumes that replacing/adding strains shouldn't result in substantial production changes in vaccines. The new policy would allow manufacturers to substitute or add strains without repeating efficacy and field safety studies if there is justification of strain replacement/selection. There will be no more than three strains of a subtype per licensed product allowed.
The USDA will allow up to two strain substitutions within each of the subtypes present in the currently licensed vaccine. The antigen/dose of each new strain must be equal to or greater than that of the original strain unless justified by a host challenge study. Manufacturers cannot decrease the antigen/dose of the original strains unless justified by a host challenge study.
Based on adequate justification, strains of new subtypes may be added to a licensed vaccine. For an entirely new product or new process, efficacy and field safety data will be required.
Conditional licensure might be considered for an entirely new flu product or manufacturing process. Where there's a reasonable expectation of efficacy and adequate field safety data, efficacy studies can be pending. In other words, this is a fast-track licensing procedure that requires proof of purity and safety and a reason to expect efficacy. This would mean a vaccine could be on the market in about one-third the time it takes today. This means eight months to one year versus three years without this policy. This is modeled after the human regulations, although human challenge studies are not required.
There is one modified live flu vaccine (Fluavert), and that is not covered in this policy change. Neither are any vectored vaccines.
Josie Traub-Dargatz, DVM, Dipl. ACVIM, of Colorado State University, gave an update on the National Animal Health Monitoring System (NAHMS) 2005 report, which had information released starting in late 2006. She said in early 2007 the group will use event organizers in six states to do a survey on equine events, including testing requirements and procedures.
There is a tremendous amount of information available to the public, and more is being compiled and released. This information can be found at www.aphis.usda.gov/vs/ceah/ncahs/nahms/equine. (To find articles written from the NAHMS report on www.TheHorse.com, simply type in NAHMS in the keyword search box at the top of any page.)
Traub-Dargatz said horse owners should let the federal government know that a seven-year gap between reports of the equine industry are too broad. Horse owners should request more frequent studies since the information is being used and is helpful.
The question was raised by Rob Holland, DVM, a private practitioner in Kentucky and a senior veterinarian with Pfizer Animal Health, whether horse owners should vaccinate against strangles in the face of an outbreak?
The consensus of the group was no, because a horse can become a carrier or might be sick already and develop additional problems such as purpura. A horse that is exposed and asymptomatic that is then vaccinated could have an immune-mediated crisis.
One vet said he was comfortable vaccinating in the face of a strangles outbreak. Rocky Bigbie, DVM, of Fort Dodge Animal Health, said that the adjuvant in vaccines that makes them work better could cause a problem if the horse is vaccinated at the wrong time; the vaccine could actually make the horse worse.
It was noted that reporting of adverse reactions to the USDA by veterinarians is very low. "If an owner or vet thinks there was an adverse reaction, report it either to USDA or to the manufacturer" was the consensus. This can be done on the USDA web site http://www.aphis.usda.gov/vs/cvb/html/adverseeventreport.html.
Equine infectious anemia (EIA) was reported for the first time in Ireland in 2006. The source was an illegal plasma product. This brought up the discussion of unregulated plasma in the United States, a source of heated controversy for several years in this forum. One veterinarian in the audience said there is a concern this type of disease outbreak could happen in the United States because several distributors of equine serum are not USDA licensed and the products are not tested.
There are USDA-licensed plasma products that are tested for the presence of EIA, noted Tim Cordes, DVM, of USDA/APHIS. Non-licensed plasma products are not regulated.
"Normal" plasma and serum that does not make disease claims does not have to be tested, said Evans of the Center for Veterinary Biologics. She noted that the USDA/APHIS does not have staff or budget to inspect all of these products. If there is a claim on the product that it is a treatment for failure of passive transfer, R. equi, or West Nile virus, the FDA would be responsible for it because it would be considered a new animal drug.
In response to a question from the audience on how veterinarians and those in the horse industry could push for testing of all equine plasma products, Evans said the group could petition the government. "If you are aware of a manufacturer making claims, we'd like to hear about them," said Evans. "If we have evidence, we can generally investigate."
Barnett said the EIA outbreak in Ireland sends a strong message regarding the potential for disease outbreaks as it relates to unregulated equine plasma products, and that the industry needs to take a stand. Another vet brought up the potential problem of liability when using a product not licensed by the USDA.
A recommendation from the Forum was sent to the AAEP Board recommending, "That the AAEP petition USDA Veterinary Services regarding the need to regulate unlicensed, unregulated products."
The Forum also send the AAEP Board a recommendation stating, "That the AAEP utilize the Guardian and Spur of the Moment (newsletters), possibly through assistance from the Education Committee, to educate and heighten the awareness of the membership regarding the use of licensed and unlicensed plasma products."
The Forum also sent a recommendation to the AAEP Board, "That a quick reference list of equine medications be provided to the membership outlining those are approved, generics, and those for which veterinarians may need to utilize legally compounded products." And the Forum also recommended, "That an updated article with brief and specific compounding guidelines be placed in the Guardian and/or Spur of the Moment."
Therapeutic Options Forum
Jim Kenney, DVM, and Kevin May, DVM, co-facilitated a small gathering at the Therapeutic Options Forum. The first item on the agenda was research.
Kenney noted that for the topic of acupuncture, at the University of Florida there are five research projects ongoing, including acupuncture treatment of equine anhydrosis (failure to sweat), cancer, pain management, equine recurrent airway obstruction, and persistent equine endometritis.
Kevin Haussler, DVM, PhD, DC, at Colorado State University, is studying the effects of spinal mobilization and manipulation on thoracolumbar kinematics on back stiffness in standing horses Haussler is also using pressure algometry to assess treatment options for back pain in which he compares chiropractic, massage therapy, phenylbutazone, stall rest, and a control group.
A research project by P.R. van Weeren, associate professor, Department of Equine Sciences at Utrecht University in the Netherlands, is looking at asymptomatic horses and patients before and after chiropractic treatment. Data analysis appears to demonstrate significant differences in both groups.
There was a study published in the American Journal of Veterinary Medicine on lavender used to relieve travel anxiety in dogs.
There was discussion on therapeutic options in veterinary schools, and it was amazing how many schools are offering programs. For example, the University of Florida has four faculty clinicians and two full-time interns in the Acupuncture Service at the Animal Medical Center. CSU has the first endowed professorship devoted to the study of alternative and complementary medicine that is held by Narda Robinson, DVM, DO (doctor of osteopathy in human medicine), MS, Dipl. ABMA.
There has been a movement to include more therapeutic options in mainstream veterinary education events, with a new publication entitled The American Journal of Traditional Chinese Veterinary Medicine edited by Cheryl Chrisman, DVM, Ed.S. MS, Dipl. ACVIM, professor and chief of the Neurology Service at the University of Florida School of Veterinary Medicine. (For more information contact email@example.com.)
There was quite a bit of discussion about non-veterinarians performing modalities on horses. The major problem with non-vets, according to one veterinarian in the audience, is that they don't always understand equine pathology. For example, a horse is given chiropractic treatments six times for a hind end lameness and it's a hoof abscess.
There was some discussion over the term "lay." Is it a non-trained person or a non-vet who is trained in a modality? In reality, the term chiropractic should only be used in regard to treatment of humans.
Veterinarians discussed how to train fellow veterinarians who want to have these modalities done on client horses, but who don't want to do the treatments themselves. There was a question of whether the veterinarian could be liable if the client is referred to a non-veterinarian for treatment of a disease or health problem. If that non-vet does something wrong, the veterinarian's insurance might not cover malpractice or might cause your insurance to be invalid.
When the discussion arose about a client who wants therapeutic options and that person's veterinarian won't refer, one veterinarian said it's up to the client to do what's best for the horse. "If a veterinarian won't provide a service, the clients will seek it out," said one veterinarian.
The Forum members wanted to request the AAEP conduct a survey of members to see how many are performing therapeutic options, have someone in the practice who is providing these, services, or are referring clients to other practitioners and whether they are lay persons or veterinarians.
Preparing a Veterinary Practice for a Hurricane
Careful planning can help a veterinary practice, its patients, and the area equestrian community to ride through and recover from a hurricane. Dana N. Zimmel, DVM, Dipl. ACVIM, Dipl. ABVP, clinical assistant professor in the University of Florida's College of Veterinary Medicine, described steps for veterinarians in hurricane-prone areas to take long before a storm hits.
Before a storm is even forecast, evaluate your location. Consider what wind speed any buildings at your practice can sustain, as well as their proximity to water in case of a storm surge. Zimmel noted that some horses that were not evacuated before Hurricane Katrina in 2005 drowned in their stalls, trapped in the 12-foot storm surge. Also consider the number of large trees and electrical lines in the area, and the damage they could cause if they fall.
Ask if your water source will be sustainable in the case of a power outage. If you have a generator, what is it capable of powering and how much fuel will it require? If you need to make a choice between the refrigerator and other appliances, consider the implications of the loss of vaccines and drugs requiring a consistent temperature.
"(The refrigerator) may not seem to be too important, but in Marion County following Frances, we were without power for 14 days," Zimmel said.
Having a phone tree or command center already in place before a storm hits can decrease confusion among staff members and clients. If phones go out, having a contingency plan, such as every staff member listening to a particular radio station at a predetermined time, can also help.
Identify equine transportation companies that will be able to help evacuate horses.
The hospital might become unsafe to use or it might not be large enough for the patient load following a disaster. Making arrangements for an equine hospital and rescue center at an alternate location before it's needed and publicizing this information will assist staff members and horse owners in knowing where to go in a storm's aftermath. These facilities can be sales facilities or show grounds.
Evaluate the number and type of stalls at the facility, amount of accesible power, and water availability. Consider manure removal and where you will obtain basic farm supplies--are there enough buckets? Are there snaps for buckets to affix them to stall walls? Are there enough pitchforks to clean stalls for the number of horses you anticipate?
"All these basic things really become tremendous when you have no power and it's not set up like a good horse farm," Zimmel said.
Along with supplies, evaluate the facility to see if there's sufficient space to store hay and bedding in a dry location. An isolation area is also necessary in case a horse starts showing clinical signs of a potentially contagious disease.
When a storm is forecast, move quickly. Evacuate horses at least 48 hours before winds over 40 mph are projected to hit. Contact the emergency command center to secure permits for government fuel and a badge to be out after any imposed curfew.
Communicate what will be available to clients after the storm, and tell them how to contact you if the phones go out. Zimmel suggested a dry erase board system-- clients can come to clinic and sign up for the services they require on the board which is treated as a check list. If they can't get to the clinic, the veterinarians will try to get to them at their locations.
If it is necessary to rescue horses from outside locations, organization is key. Document the horses as they come in. Look for tattoos or microchips (you'll need a scanner) and record where horses were picked up. Be strict in requiring proof of ownership when horses are claimed. Zimmel noted that many horses were stolen following Hurricane Andrew.
Designate one person to coordinate all the personnel working with rescued horses. Zimmel noted that while veterinarians and veterinary students make excellent volunteers, a lot of the work required of volunteers is basic animal husbandry, including feeding and stall cleaning. It's crucial to have a group of core volunteers there for the duration. Continuity with the horses is important so slight variations in a horse's condition and behavior are properly noted. All volunteers must sign a waiver releasing liability.
Another important position within the rescue operation is a donation coordinator, who keeps track of all the veterinary supplies and donations available and knows where they are located.
"The events of 2005 underscore the importance of being self-sufficient and investigating pathways to protect your practice and your community," Zimmel concluded.
Breathing Easy: Air Quality Testing in the Equine Barn
"I used to look at a beam of light with the motes of dust in it and think it was aesthetically pleasing," said Melissa R. Mazan, DVM, Dipl. ACVIM, of the Tufts University School of Veterinary Medicine in Massachusetts. "Now that I know what's in those dust motes, the pleasure is gone." Mazan described air quality testing in the equine barn.
Mazan explained that 25-80% of stabled horses develop neutrophilic airway inflammation (inflammation caused by a type of white blood cell that helps kill and digest microorganisms). However, air quality testing along with owner education, modification of barn and field setups, and improved management practices can go a long way to clear the air.
"It is difficult to persuade trainers and owners that there might be anything wrong with a barn," Mazan said. "We've found that hard data can be worth a thousand words."
You can collect data on air quality using a calibrated air pump and a host of filters to collect particulate in the air. You can choose filters for various sizes of particulates as well as filters specific to endotoxins and molds.
"Anything you'd like to look for you can have analyzed on those filters," Mazan said. She submits her filters to an Environmental Protection Agency laboratory for the analysis.
Filters and pumps can be worn by horses fitted with surcingles, or they can be worn by employees for real-time analysis.
According to Mazan, the average barn has levels of particulates that are "off the chart," referring to acceptable and unacceptable levels of various airborne particulates set for human environments. Mazan said comparing levels of particulates commonly found in equine barns and those allowed by workplace regulatory agencies shows that barns have extremely high loads. Grain dust, for example, is so high in endotoxins that it is associated with occupational asthma in humans. h
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