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By Nora Grenager, VMD, DACVIM Timing of Manure Collection It is important to take a sample when the efficacy of any previous dewormer is out of the system. Dewormer drugs have different durations of efficacy. So, if the last dewormer used was: ivermectin: wait 12 weeks moxidectin: wait 16 weeks pyrantel salts: wait 8 weeks fenbendazole or oxibendazole: wait 8 weeks If this is the first time a FEC has been performed on the horse, discuss with your veterinarian about whether to do a FEC Reduction Test to evaluate if your horse has any parasite resistance to each type of dewormer. The FECRT involves: a FEC at day 0 (an appropriate amount of time after the last dewormer*), administering a dewormer per package recommendations, then a second FEC at day 10-14. This would need to be done for each type of dewormer, if necessary. The first FEC is best done in the spring or fall, not in the heat of summer when there are typically fewer parasites. How to Get the Best Manure Sample Fresh manure is important, as eggs deteriorate with time and temperature. Ideally, collect the sample immediately after your horse has passed it. If you are not sure, but a pile looks fresh, collect sample from the middle of the pile where it is still moist. Collect a large handful of manure in a ziplock bag then push as much air out of the bag as possible before sealing it. Bring the sample to the clinic as soon as possible, certainly within 24 hours. Keep the sample refrigerated until you drop it off at the clinic. Room temperature is fine if you are bringing the sample right away. Do not put it in direct sunlight or store it in a hot car. Drop manure off during regular business hour Monday through Friday; earlier in the day is better so the sample is sure to be run the same day.

By Lindsay Berreth Published in Chronicle of the Horse March 2020 "Whether it’s severe or mild, it’s useful to know how to deal with a horse that’s showing signs of colic and how to prevent it in the first place." Lindsay Berreth of Chronicle of the Horse magazine asked Nora Grenager, VMD, DACVIM, formerly Director of Internal Medicine at Steinbeck Peninsula Equine Clinic – Menlo Park, and Diana Hassel, DVM, Ph.D., DACVS, DACVECC, associate professor of equine emergency surgery and critical care at Colorado State University, some common colic questions from COTH readers. Read the full article...

By Jacquelyn Dietrich, BVSc Coronavirus is an RNA virus that can cause respiratory and gastrointestinal problems in many species. In horses, Equine Coronavirus can result in gastrointestinal problems. Horses can be carriers of coronavirus showing no signs (subclinical), but have been found to shed the virus in feces. Horses that become infected and develop clinical signs can also shed the virus. Thankfully mortality (death) is rare in uncomplicated cases. Seroprevalence of equine coronavirus in the Unites States has been estimated at 9.3% (Kooijman et al., 2017). This means that Equine Coronavirus it ubiquitous within the horse population, many of which never show clinical signs. How can my horse get Equine Coronavirus? Transmission is through fecal-oral route, meaning that your horse becomes infected by ingesting infected fecal material. How long does Equine Coronavirus survive in the environment? Unfortunately, this is unknown. It’s important to practice good biosecurity, including disposing of shedding horses' manure  in an area where no other horses can ingest it. What is the seasonality? Equine Coronavirus can occur anytime of year, however it is commonly seen in the colder months (December –May). How soon will my horse show signs? Every horse reacts different, but typically the incubation period is 2-4 days. How long will my horse be shedding the virus? The exact period a horse will shed the virus is still under investigation; however, horses have been found to shed the virus 5 – 21 days after being infected. Horses with no clinical signs and horses with clinical signs can both shed virus. What are some signs to watch for? Fever >101.5F Lack of appetite Depression Colic signs Laying down frequently Diarrhea (not always present in every case) Low white blood cells How can I confirm (diagnose) Equine Coronavirus? Your veterinarian can confirm Equine Coronavirus by submitting a fresh fecal sample to a lab for testing (PCR test). What is the treatment for Equine Coronavirus? Supportive care based on clinical signs is the best treatment. For more severe cases, hospitalization for IV fluid therapy and treatment for any secondary infections may be required. How likely is it that my horse will get better? Very likely with supportive care and monitoring for secondary infections. How can I prevent my horse from getting Equine Coronavirus? The best method for prevention is good sanitation of facilities, disposing of manure in areas horses can’t be infected, and other good biosecurity practices. Make sure manure cannot contaminate pasture, paddocks, stalls, and drinking water. What about other animals? Equine Coronavirus is a species-specific virus, meaning that is passed from horse to horse only. What do you mean by “good biosecurity”? Wash hands frequently, especially before and after handling each horse. Don’t share equipment and grooming supplies, especially with infected or potentially infected horses. Isolate horses that start to show clinical signs. Do not walk horses around facilities that have been showing clinical signs or that was in close proximity to infected horses. When cleaning stalls, clean infected and potentially infected stall last. Always handle infected or potentially infected horses last. This way stalls of healthy animals cannot come into contact with any fecal material from horses shedding the virus. Manure should be disposed in an area where horses can not reach (ingest). Reduce movement of horses in and out of facilities with horses positive for virus. Horses that are moved from a facility with horses positive for virus should be isolated for 3 weeks. A fecal sample should be taken to confirm no virus is present before removing horse from isolation. Disinfect anything that comes into contact with an infected horse. Remember, you must remove any organic mater (dirt, feces, etc) before using a disinfectant. This is because disinfectant becomes inactive when in contact with organic matter. Talk to your vet about the appropriate disinfectant to use for different outbreaks. For coronavirus, bleach, povidone iodine, and chlorhexidine gluconate are common disinfectants that have been shown to be effective against coronavirus. Chlorhexidine (Nolvasan) is a common product that can be purchased in many stores (feed stores, Target, drug stores, etc) can is effective against the virus even if organic matter is not completely removed. Equine Coronavirus is not a reportable disease in the state of California, as it is much less of a concern due to its high prevalence with low morbiditiy and mortality rates (meaning many horses show no signs of disease and few horses thankfully have furthering clinical signs/secondary disease/issues leading to death) compared to other contagious diseases horses have the potential for acquiring. Our state veterinarian says, "Currently, coronavirus is not a reportable disease in the state of California. Therefore, the state lacks authority to take regulatory action such as quarantine for confirmed cases of coronavirus. As always biosecurity measures, such as isolating horses with clinical signs and avoiding sharing of equipment, should be immediately implemented when there is any evidence of disease on the premises." Call Steinbeck Peninsula Equine Clinics with any concerns or questions. Equine coronavirus is NOT the same as the strain of coronavirus referred to as COVID-19 that is currently in the news (2020) associated with a world-wide outbreak, and is NOT considered as having a risk of transmission to humans. For more information, check out an article called "Can Pets Contract Coronavirus from Humans or Vice Versa" written by Dr. Niels Pedersen at UC, Davis, School of Veterinary Medicine and What is Equine Coronavirus? from thehorse.com. Below are some excellent resources for more information on Equine Coronavirus and biosecurity practices: Equine Disease Communication Center (EDCC): Disease Factsheet on Equine Coronavirus Cornell University College of Veterinary Medicine: Equine Enteric Coronavirus Equus: Coronavirus: An Emerging Threat? California Department of Food and Agriculture: Biosecurity Toolkit for Equine Events Equine Disease Communication Center (EDCC): What is Biosecurity? References: Pusterla, N., Mapes, S., Wademan, C., White, A., Ball, R., Sapp, K., . . . Magdesian, K. (2012). Emerging outbreaks associated with equine coronavirus in adult horses. Journal of Equine Veterinary Science, 32(10). doi:10.1016/j.jevs.2012.08.088 Pusterla, N., Vin, R., Leutenegger, C., Mittel, L., & Divers, T. (2018). Enteric coronavirus infection in adult horses. The Veterinary Journal, 231, 13-18. doi:10.1016/j.tvjl.2017.11.004 (2017). Prevalence of Fecal Shedding of Equine Coronavirus in Hospitalized Horses. Equine Veterinary Education, 29, 8-9.

What is ISELP? You may frequently hear the term “ISELP” used by veterinarians, especially in the sports medicine field. But do you know what it is? ISELP stands for International Society of Equine Locomotor Pathology and is an organization of elite veterinarians focused on lameness problems in the equine athlete. This organization was founded under the direction of Dr. Jean-Marie Denoix in 2006 and continues to rapidly grow, having members on all five continents. The goal of ISELP is to provide extensive knowledge, techniques, and diagnostic plus therapeutic information on the most current practices, which are continually evolving within the field of Equine Sports Medicine. Certified members teach ISELP continuing education modules all over the world. Steinbeck Peninsula Equine Director of Sports Medicine Dr. Russ Peterson was one of the founding members of ISELP, serves on the ISELP Board of Directors, and continues to instruct at ISELP meetings both nationally and internationally. ISELP Education At Steinbeck Peninsula Equine, we frequently express how important education is to us and our clients, which is why we are proud to host ISELP modules. ISELP modules are multiple day events offering a comprehensive program of advanced education in equine lameness issues, such as osteoarticular, musculotendinous, and nervous pathology. There are eight ISELP modules: Distal frontlimb: foot, pastern fetlock joint Middle frontlimb: palmar fetlock, metacarpus and tendons, carpus, carpal canal Proximal frontlimb: forearm, elbow and shoulder Distal hindlimb: foot, pastern, fetlock, metatarsus Middle hindlimb: hock, crus Proximal hindlimb: stifle, thigh Neck and thoracolumbar area Lumbosacral area and pelvis These modules each include advanced education on the descriptive and functional anatomy and biomechanics of each region of the horse. Modules offer training in the clinical (physical and dynamic) examination, including diagnostic blocks, which are the foundation for a thorough and comprehensive lameness examination. They offer education and discussion of diagnostic imaging (radiology, ultrasonography, nuclear scintigraphy, MRI), current treatment and management techniques, and revised information on prognosis and evolution of diseases. What Does it Mean to be ISELP Certified? Before becoming an ISELP-certified member, equine veterinarians must have completed multiple requirements to qualify to complete the certification examination. Veterinarians must have five years of equine practice experience and present a number of documented cases, submit multiple scientific papers for publishing, and have completed all eight modules and wet labs. This rigorous path allows you to complete an intense certification exam resulting in becoming an ISELP-Certified Practitioner. This means the ISELP-certified members have years of extensive advanced education and training compared to non-ISELP certified veterinarians. Members have higher knowledge and experience in equine sports medicine. Their active participation in the advancement of equine locomotor pathology is recognized by the science and academic community internationally. ISELP-certified members are highly qualified veterinarians specializing in advanced sports medicine. ISELP Sponsorship ISELP is an internationally recognized non-profit organization, gaining sponsorship from some of the largest companies in the equine industry. Sponsorship from these companies allow for the advanced continuing education of veterinary practitioners internationally.

Steinbeck Peninsula Equine Clinics are always proud to offer the latest in regenerative medicine, including Pro-Stride® APS joint therapy, which we've recently added to our extensive arsenal of therapeutic modalities along with regenerative medicine procedures such as IRAP, PRP, and stem cells therapy.. We are extremely happy with the success our patients have had with Pro-Stride. Following a single injection, Pro-Stride has clinically demonstrated pain relief in horses for up to 52-weeks. Pro-Stride is an Autologous Protein Solution (APS) containing a high concentration of cells, platelets, growth factors, and anti-inflammatory proteins to treat inflammatory processes in joints. This all-natural, drug-free option takes 20 minutes to process with no incubation time and treatment can be provided in a single visit. An additional benefit of Pro-Stride is that there is no withholding time for both FEI and USEF events. How It Works In degenerative joint diseases, such as arthritis, inflammatory cells bind to the cell receptors on the joint surface and starts breaking down the cartilage. Cartilage breakdown leads to joint damage and pain. Interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-alpha) are two major pro-inflammatory proteins, also known as cytokines, which lead to the degeneration of the joints. Pro-Stride works by blocking these pro-inflammatory cytokines from binding to the cartilage surface. APS is concentrated plasma with white blood cell proteins and enriched platelet growth factors derived from the horse’s own blood. Specifically, Pro-Stride APS is a high concentration of interleukin-1 receptor antagonist (IRAP) that is 5.8 times more concentrated than blood. These receptor antagonists promote natural joint healing processes. The Process The Pro-Stride processing unit is mobile and the entire process takes about 30 minutes. Blood is drawn from the horse then placed in a centrifuge to be spun down. Then plasma is removed and the remaining PRP suspension is extracted. This extraction is then added to an APS concentration device which undergoes mixing, then is spun down once more. The resulting product is Autologous Protein Solution (APS). This can then be injected into the joint by your veterinarian all at the same appointment. Talk to us to see if Pro-Stride is the best treatment choice for your horse! For more information on Pro-Stride, please see: Pro-Stride web page Publications showing clinical data supporting the effects of Pro-Stride APS Pro-Stride: How It Works (video)

Here are a few things to remember as you and your horse prepare to travel to competitions. Prevent Stress to Keep Your Horse Healthy It’s important to realize that transport to shows, even if your horse seems like a calm traveller, puts stress on their bodies and immune system. Stress can play a large role in the development of gastric ulcers, so prevention is ideal. An in-depth article with the newest ulcer information will be coming soon, but here are some general management guidelines you can follow if you’re concerned about gastric ulcers in your horse: Increase turnout and decrease stall time to minimize stress Increase the amount of time feed is available using a hay net or slow feeder system Feed smaller meals more frequently throughout the day and overnight (ideally 4-6 meals daily) Feed hay before feeding grain – this will create more saliva, which is a buffer of stomach acid Feed more forage and less high concentrate grain Include up to 25% alfalfa in the diet – this can act as a buffer in the stomach Do not exercise on an empty stomach Avoid use of non-specific non-steroidal anti-inflammatory medications such as phenylbutazone (bute) or flunixin meglumine (banamine) unless directed by your veterinarian The respiratory system is another area vulnerable to stress while traveling. Horses have to stay stationary with their heads elevated for abnormally long periods of time and air quality may not be ideal while trailering. Signs of respiratory disease that you can watch out for include the following: Increased respiratory rate Increased respiratory effort Cough Nasal discharge Fever (>101.5F) Pack an Equine Emergency Kit While Traveling One way to be prepared for unexpected situations should they arise is to have an emergency kit with you while traveling. Some of the things we recommend you keep in such a kit: Stethoscope Digital thermometer (sold for people) or equine thermometer Supplies for a pressure bandage – a combine, brown gauze, vetrap, elastikon, white kling, and a non-stick telfa pad – to apply while waiting for a veterinarian Chlorhexidine Saline solution 3x3 gauze Furazone Exam gloves Triple antibiotic ointment Electrolytes Dose syringe to administer oral medications Stall card with all pertinent horse information (see our main Resources page) We also recommend consulting with your regular veterinarian on any prescription needs to have on hand in an emergency – for example, we often recommend having a tube of Banamine paste on hand in case of a colic episode to administer if your veterinarian gives you instructions to do so. Other supplies can be added based on the individual horse and horse owner. Stay Up to Date on Rules, Regulations and Paperwork Some competition organizations like USEF and USHJA require that your horse be microchipped. Those of you traveling out of state or out of country are aware of the paperwork that you should be carrying with your horse, but here is a reminder to keep an up-to-date Certificate of Veterinary Inspection or CVI (commonly known as a ‘health certificate’) and a negative Equine Infectious Anemia test (commonly known as a Coggins) on hand when you cross borders. CVIs must be issued by an accredited veterinarian within 30 days before crossing state lines, while an up-to-date EIA test done by a USDA-approved laboratory is required within six (6) or twelve (12) months dependent on the individual state. If you have any questions regarding your horse’s health prior to showing, please contact the clinic. Happy travels!

At Steinbeck Peninsula Equine Clinics, we have found that integrating complementary medicine techniques to our treatment plans has led to greater success when managing lameness cases, painful conditions, and various disease processes. It also helps us maintain the musculoskeletal health of all our patients from the athletic performer to the retired horse. Several Steinbeck Peninsula Equine veterinarians have attended specialized training programs to become certified in acupuncture. It’s important to be aware that you must be a veterinarian and complete a certified program to be a true equine acupuncturist. What is Acupuncture? Acupuncture is considered to be under the umbrella of Traditional Chinese Medicine (TCM) and involves the stimulation of predetermined spots, called “acupuncture points”. In TCM, acupuncture points are often associated with “meridians” to stimulate movement of qi (“chi”) energy. There are multiple free nerve endings at these acupuncture points, that when stimulated sends messages to the brain. As a result, the brain tells the body to produce different chemicals and hormones that help the body to heal. Some points are associated with different organs or useful when treating specific disease processes, such as laminitis, liver disease, and stomach ulcers. The effects of acupuncture are attributed to multiple mechanisms involving the nervous system, immune system, and endocrine system. In equine practice, we commonly use acupuncture to complement our treatments for lame horses and aid in pain relief. “Trigger points” are also known as acupuncture points, which can be described as reactive areas that are usually associated with muscle tension or knots. We can scan the horse as a diagnostic technique to observe the reactive regions associated with musculoskeletal problems. In addition, the World Health Organization (WHO) recognizes the effectiveness of acupuncture as a form of analgesia, or pain relief. Acupuncture can also be an effective way of treating chronic pain of the musculoskeletal system with restricted joint movements. It has been shown to not only treat pain, but also reduce muscle spasms, which result in abnormal loading of different joints causing the clinical signs associated with pain. Many of our geriatric (older, retired patients) benefit from routine acupuncture treatments to maintain their musculoskeletal health and alleviate pain commonly associated with many of the disease processes that are associated with age, such as arthritis. The Science of Acupuncture Stimulation of acupuncture points near the body surface produces effects carried out by the nervous, immune, endocrine, cardiovascular, and other systems that promote healing. The stimulation of the free nerve endings can result in local and distant effects within the body. Effects can be summarized by five mechanisms of action: local effects, segmental analgesia, extrasegmental analgesia, central regulatory effects, and myofascial trigger points. There are multiple ways for stimulating these nerve endings: Dry needling – the insertion of a needle into a predetermined spot Aquapuncture – injection of a fluid into an acupuncture point, often vitamin B12 Electroacupuncture – attachment of electrodes to acupuncture needles inserted into an acupuncture point. The intensity, frequency, and pulse type can be manipulated to provide appropriate treatment for individual patients Moxibustion – the burning of an herb, often “mugwort” (Artemisia vulgaris) on an acupuncture point or over the skin at am acupuncture point. This is often used for treatment of chronic muscular and arthritic pain. Hemoacupuncture – a procedure where a hypodermic needle causes bleeding at an acupuncture point Cold Laser/Infra-red (IR) Stimulator – the use of a laser to stimulate acupuncture points, often times at extremities. This is also useful with horses that are needle-shy who would benefit from acupuncture. For additional information: AAEP – Veterinary Acupuncture and Chiropractic: What, When, Who? AAEP Proceedings – Acupuncture and Pain Management The Horse – How Does Acupuncture Work? References: Boldt, E. (2016). Veterinary Acupuncture and Chiropractic: What, When, Who? Retrieved February 16, 2018, from https://aaep.org/horsehealth/veterinary-acupuncture-and-chiropractic-what-when-who Kenney, J. (2011). Acupuncture and Pain Management. AAEP Proceedings, 57, 121-137. Larson, E. (2016, June 10). How Does Acupuncture Work? The Horse.

While microchips are required for some competitors, we also want to remind you about the additional benefits of a microchip in your horse and answer some commonly asked questions. Microchipping for Competitors As many of you are aware, the United States Equestrian Federation (USEF) and United States Hunter Jumper Association (USHJA) have rules requiring a microchip for horses and ponies competing in classes that require horse registration. The microchip verifies the horse’s ID, which allows the horse to compete for points and prize money and to be eligible for certain US Equestrian and USHJA programs and awards. US Equestrian requires microchips to be ISO 11784/11785 compliant (see USEF Microchip FAQ). This microchip has a unique 15-digit number that will be assigned only to your horse. Why Microchipping is Important for All Horses Microchips are a great way keep your horse identifiable in many situations, even if you are not participating in competitions that require them. The recent fires in Northern and Southern California serve as a reminder that disaster preparedness is essential and a microchip can significantly increase the odds that you and your horse are reunited as soon as possible. While other means of identification certainly have their use in these situations, such as information taped onto the halter or animal-safe paint directly on the horse, these methods are not permanent – halters can come off and paint can fade. A common misconception is that microchips can be used for tracking purposes, but this is not the case. Microchips contain a small amount of information that is only accessible when scanned and read with specialized scanners. They are also very safe, as is the procedure to insert them – we have seen no adverse reactions in decades of use. Getting the microchip is a quick, easy process. If you do choose to have your veterinarian microchip your horse, please remember that you are responsible for registering the microchip number. The USEF provides an informative video on microchipping, as well

By Jacquelyn Dietrich, BVSc and Russ Peterson, DVM, MS, DACVSMR, cert. ISELP Regenerative Medicine is the most recent and promising area of both veterinary and human medicine exploration. It has emerging application to both disease therapy and sports medicine related injuries. Regenerative medicine focuses on stimulating (known as upregulating) the body’s inherent immune and disease mitigating capabilities rather than relying upon drugs and medications. Unmasking (upregulating) protective portions of the patient’s genome is one key goal in addition to stimulating protective proteins which combat inflammatory agents, such as cytokines, which are produced during disease. Some approaches utilize autologous (derived from the same patient) products and others incorporate allogeneic (derived from other patients) mechanisms of action. IRAP II IRAP II™ is an autologous conditioned serum (ACS) and is obtained by culturing whole blood with borosilicate glass beads and harvesting the serum for treatments. IRAP stands for interleukin-1 receptor antagonist protein and is used most often in chronic, progressive osteoarthritis (or acute-on-chronic injuries). Whole blood is drawn in a syringe system containing glass beads, which is then cultured for 24-hours. The blood is then centrifuged to obtain an IRAP-enhanced serum product which can then be injected intra-articularly or intra-lesion. IRAP aims to block, or tie-up, IL-1, a potent cytokine that causes a pro-inflammatory state. Mechanism: Aims to up-regulate Interleukin Receptor Antagonist Protein (IRAP) to block and tie-up IL-1 before it can attach to the joint capsule and initiate the “inflammatory cascade”. This helps prevent inflammation in an injured or diseased joint and allow healing to occur. When to use: Osteoarthritis Joint treatment in metabolic horses/ponies Good to use for showing horses Post-surgical (ex. Arthroscopy) treatment Goal of treatment: To inhibit the inflammatory cascade incited by IL-1, particularly in OA. It does not aim to directly repair or regenerate cartilage damage. Pro-Stride Pro-Stride® is an Autologous Protein Solution (APS) containing a high concentration of cells, platelets, growth factors, and anti-inflammatory proteins to treat inflammatory processes in joints. This all-natural, drug-free option takes 20-30 minutes to process with no incubation time and treatment can be provided in a single visit. An additional benefit to Pro-Stride is that it is not a drug or medication; therefore, has no withholding time for both FEI and USEF events. Pro-Stride works by blocking interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-alpha from binding to the cartilage surface. These are two major pro-inflammatory proteins, also known as cytokines (proteins which cause inflammation), which lead to the degeneration of the joints. APS is concentrated plasma with white blood cell proteins and enriched platelet growth factors derived from the horse’s own blood (ie. autologous). Specifically, Pro-Stride APS is a high concentration of interleukin-1 receptor antagonist (IRAP) that is 5.8 times more concentrated than blood. These receptor antagonists promote natural joint healing processes. Mechanism: Aims to block IL-1 and TNF-alpha, thus helps prevent inflammation in an injured or diseased joint When to use: Osteoarthritis Joint treatment in metabolic horses/ponies Good to use for showing horses Duration of effect is longer than IRAP products in general, due to broader spectrum of cytokine suppression and higher levels of prokinetic (healing) growth factors contained. Goal of treatment: To inhibit the inflammatory cascade incited by IL-1, particularly in OA. It does not aim to directly repair or regenerate tissue. PRP Platelet-rich plasma (PRP) are high in the absolute number of platelets and therapeutically used for the platelet growth factor content. Platelet cells activation result in a pro-coagulant state, and specifically alpha granules carrying a variety of growth factors are released. The predominant growth factors in platelets are platelet-derived growth factor (PDGF) and transforming growth factor beta (TGF-b). These growth factors play a role in platelet-enhanced healing. PRP is often used for tendon, ligament, and joint injury through percutaneous, ultrasound-guided, and intralesional injection. Often a single injection will be utilized with PRP, but repeated administrations are not uncommon. PRP also has been shown to result in some analgesic effects through stimulation of thrombin receptors (PAR-1), which increases pain threshold (ie. Decreases the patient’s perceived pain level) via opioid pathways. PRP is an autologous biological agent, and therefore very safe. PRP is also highly utilized in treating human sports medicine injuries. Platelets are considered inflammatory cells, however, there are also leukocytes (white blood cells) present in PRP as well. Due to this, acute pain following injection may occur, especially if they are present in too high a number. PRP processing machines are specifically designed to attain the “optimal” number of cells and growth factors for therapy. Non-steroidal anti-inflammatories (NSAIDs) may help decrease this pain, however some NSAIDs or steroids may decrease the efficacy of the treatment. In horses, phenylbutazone and naproxen have shown little effect of the treatment’s efficacy and can be used to help decrease some discomfort following injection. Mechanism: After platelet activation, numerous growth factors are released: Large amounts: transforming growth factor beta, platelet derived growth factor Small amounts: insulin-like growth factor, epidermal growth factor In general, optimal response to PRP treatment of joints occurs more rapidly than in tendon and ligament injuries. When to use: Joints, tendons, and ligament injuries; best used after acute traumatic injury to musculoskeletal tissues Goal of treatment: Accelerate and improve the quality of healing; intended to support and enhance tissue healing as an anabolic agent Stem Cells Stem cell therapy has received much attention in the recent years, and their use and development is being closely monitored and regulated by the CDC and FDA. Stem cells (aka Mesenchymal Stem Cells = MSCs) have recently had a terminology change to Mesenchymal Signaling Cells, due to their lay role as “cellular healing directors” becoming actual new cell in the repair. Stem cells were originally obtained from bone marrow or adipose tissue (fat), but over the past few years sources have included allogeneic embryonic pluripotent cells, cord blood/placental tissue, dental pulp, and peripheral blood. Two basic types of stem cells are hematopoetic and mesenchymal. Mesenchymal cells have the best potential for regenerative medicine purposes in the tendon, ligament, cartilage, muscle and bone (ie. pluripotent). Bone marrow aspirate can be cultured for 2-3 weeks to obtain bone marrow-derived mesenchymal cells (BM-MSCs). Adipose tissue is generally taken from the tail head region or by liposuction. Processing involves a collagenase digestion and then cultured for several weeks to obtain adipose tissue-derived mesenchymal cells (AT-MSCs). The effectiveness of these sources of MSCs is highly dependent on the tissue type of the injury, and newer techniques are emerging to control the ultimate cell type which occurs (ie. bone, muscle, nerve, tendon/ligament and even entire functional organs). Mechanism: Immature stem cells differentiate to lead to tissue regeneration When to use: For treatment of equine musculoskeletal disorders including tendonitis, osteoarthritis, discrete core lesions, IV regional perfusion for tendon/ligament injuries Goal of treatment: New tissue regeneration, increased ability to heal, disease conditions, organogenesis, wound healing and more. In other words, all aspects of medicine and sports medicine are striving to improve their overall outcome!

By Timothy G. Eastman, DVM, DACVS, MPVM Published in Bay Area Equestrian Network July 2006 Veterinarians are frequently called upon to help horse owners control the estrus behavior (“heat”) in mares used as performance horses or as show animals. When some mares come in heat, the hormonal and behavioral shifts that takes place distracts from their ability to perform their sport. Mares have a 21 day heat cycle. They are in “estrus” for about 1 week and then in “diestrus” (out of heat) for approximately 2 weeks. While in estrus, the ovaries produce large quantities of estrogen that is responsible for the changes in behavior. After they ovulate, the ovary produces the overriding hormone progesterone, which is responsible for suppressing the estrus behavior. Before deciding to manipulate your mare’s hormones, you should consult with your veterinarian. Sometimes a mare’s history can be suggestive of a hormonal problem. For example, a mare with a Granulosa thecal cell tumor of one of her ovaries often displays stallion like behavior. There are several ways to maintain a high level of progesterone in mares thereby suppressing estrus behavior. The most reliable and the most common method is to administer an oral form of progesterone known as Regu-Mate®. This is the only method of progesterone supplementation in mares that has been approved by the Food and Drug Administration. Regu-mate works very well at suppressing estrus behavior, is easy to administer, and does not have any long term adverse effects associated with its use. The down side is it is relatively expensive (about $4.00/day) and can cause menstrual cramps in women if it comes in contact with their skin. If administering this drug you should make sure you have one of the dosing “guns” they sell for safer delivery. There are also intramuscular shots of progesterone available that provide the desired effect in some mares. The down side is the need to administer shots on a regular basis, expense involved, off label drug use, and reduced efficacy. For many years, veterinarians would use cattle progesterone implants placed under the skin of horses to prevent estrus. This involved a minor surgical procedure and off-label use of the product. Research has shown that this method of progesterone supplementation is largely ineffective in horses and has been abandoned by many. One of the newest methods of estrus suppression was suggested at a fairly recent meeting of the American Association of Equine Practitioners and involves placing a Uterine Glass Ball (UGB) in a mare’s uterus at the end of her heat cycle. Uterine glass ball is just a little more medical sounding than marble, which is what it is. We get them at the toy store and they need to be 35mm in diameter (a “shooter”). Nobody has proven why this can be effective but some feel that the marble signals the uterus similar to a pregnancy. Our experience has been that this technique is effective in about 50% of mares which is similar to the published data. The marble should be removed towards the fall when mares typically stop cycling. Another way to suppress estrus behavior that often goes overlooked is spaying. People think of spaying oftentimes as a procedure for just dogs and cats but it can be a very feasible option for owners of performance mares with no plans to ever breed. Spaying mares has had a precarious past as it used to involve a dangerous procedure with a scary complication rate. The widespread use of laparoscopy in horses has revolutionized spaying of mares. There are many laparoscopic techniques available to do this, and all have advantages and disadvantages. Dr. Tom Yarbrough, a boarded surgeon from the Sacramento area has developed an exciting technique that is probably the least traumatic way to spay a mare yet. One of the main issues with spaying a mare by any means is how to control bleeding where the ovary is removed. Laparoscopic sutures can be difficult to place and laparoscopic stapling equipment is very expensive. Dr. Yarbrough found that if you occlude the blood supply of mare’s ovaries, you do not have to remove them. Left in place and with no blood supply, the ovaries appear to turn to fat and not produce anymore hormones. This is accomplished with a “zip-tie”, yes the thousand-and-one use zip ties you have in your kitchen drawer. The zip-tie is introduced into the mare’s abdomen through a laparoscopic instrument. The ovary is manipulated through the loop which is carefully tightened and the free end cut short. The procedure has been effective at reducing or eliminating estrus behavior in about 100 test mares. To get a feel for the behavioral changes you can expect, try a several week course of Regu-Mate first. Once spayed, the mare’s behavior should be close to what it was like while on Regu-Mate. Mares are held a gradually decreasing diet for several days before surgery because it is important to have their intestines as empty as possible prior to surgery to aid in visualization. The procedure generally takes about an hour and leaves two stitches on either side of the abdomen which are removed in several weeks. While other procedures to spay mares oftentimes cause abdominal discomfort for several days, mares undergoing the laparoscopic zip-tie procedure generally are back on full feed that night. Hospitalization is typically for about 4 days and they go back to work in several weeks.

By Nora Grenager, VMD Published in Bay Area Equestrian Network April 2007 Biosecurity is the undertaking of management practices that can reduce the risk of outbreaks and minimize the spread of infectious disease. Until fairly recently this word was not often associated with the horse industry even though many horse operations maintain some general biosecurity practices. However, recent infectious disease outbreaks (such as neurologic herpes virus and diarrhea caused by Salmonella) have brought to light the necessity for applying biosecurity practices, to some extent, at all horse facilities. There are many aspects of the horse industry that make implementation of biosecurity practices potentially challenging. The horse population is increasingly mobile – horses travel to shows, clinics, go on trail rides, and even travel abroad. Many facilities have a transient resident population. There is also a lot of human traffic associated with horse facilities and events, and this is obviously an integral part of the industry. With an awareness of the importance of biosecurity, and a degree of conscientious planning, practical measures can be put in place that will benefit everyone in the long run. There are numerous benefits of having a good biosecurity protocol at both an individual horse and facility-wide level. The most obvious benefit is the decrease in the risk of illness or death of a horse from infectious disease. This extends to include prevention of a stable-wide outbreak of infectious disease. Infectious disease has not only the potential to cause suffering, but it can be devastating emotionally and very expensive in terms of veterinary costs, loss of time in training, and even loss of event entrance fees. Decreasing the risk of an infectious disease is, therefore, valuable on many levels. The most frequently implicated modes of infectious disease transmission are horse-to-horse contact, human and equipment contact, and wildlife and pests. Infectious diseases of concern affect a variety of different body systems and therefore have a wide range of clinical signs (symptoms). Special consideration should be given to the different categories of horses: pregnant mares, weanlings, yearlings, horses in training, geriatric horses, breeding stallions. Some diseases should be reported to the state veterinarian for tracking purposes, and some must be reported by law. There are a few infectious diseases that can be zoonotic, or transmitted from animals to humans. Part of the Routine It should become a habit to follow basic biosecurity measures as a part of your daily horse routine. Hand-washing is under-utilized as an indispensable way to control the spread of infectious disease. Wash your hands before and after working with each horse. Do not share equipment if possible – if necessary, clean and disinfect thoroughly between uses. Monitor and know your horse’s appetite, attitude, and manure production. Consult with your veterinarian if you have any concerns, as catching an illness early is pivotal in minimizing duration of illness and limiting the exposure of other horses. Maintain clean feed and water sources. Store feed in closed bins to prevent fecal contamination from other animals. Clean stalls as frequently as possible and dispose of manure promptly and properly. This not only limits the fecal-oral route of transmission but also decreases insect populations. Incorporate insect prevention into the daily routine; for example – frequent manure removal, feed-through insecticides, fly larvae predators, topical insecticides, good deworming programs, removal of any standing water. Traveling Try to prevent nose-to-nose contact with unknown horses at events. Do not share equipment such as water or feed buckets, brushes, tack. Clean and disinfect your equipment and trailer prior to returning home. Ideally every horse should be isolated for 2 weeks after traveling to an event to prevent the spread of any infectious diseases to which the horse was possibly exposed at the event. If even one horse on the property travels, all the horses in contact with that horse should be up-to-date on vaccines. Consult with your veterinarian as to which vaccines your horse needs, as it can vary with geographic location, activity level, and age of horse. New Horses Every new horse on the property should be isolated for 30 days. During this time, any evidence of illness (such as nasal discharge, cough, enlarged lymph nodes, inappetance, diarrhea) warrants consultation with your veterinarian. Ideally the rectal temperature should be obtained once daily because often an increased rectal temperature (greater than 101.5 o Fahrenheit) is the first detectable sign of illness. New horses should meet the vaccination and deworming recommendations or requirements of the facility. This may include having a negative Coggins test, or a recent health certificate. Sick Horses It is important to have a plan on how to isolate sick horses that can be easily put into effect. The stress of having a sick horse does not need to be added to by inadequate planning. Length of isolation time will vary with type of illness. Isolation As previously discussed, new horses, sick horses, and horses returning from traveling should all be isolated. “Restricted Access” signs should be posted at the clearly demarcated perimeter of the isolation area. Ideally, isolation stalls should be completely separate from the remainder of the horses, as some infectious diseases can be aerosolized and travel up to 50 meters. Quarantined horses should be worked with after all the other horses on the property. Alternatively, or additionally, separate clothing and shoes should be worn when working with quarantined horses, or coveralls/disposable gowns and disposable booties should be worn. Hands should be washed before and after, and disposable gloves must be worn. All of these items can be kept in a plastic tub with a lid near the stall. A separate trash bag should be placed stall-side. Equipment should not be shared; the specified isolation equipment can be marked with colored tape to prevent confusion. If equipment must be shared it should be used last in the day and thoroughly cleaned and disinfected afterwards. A foot dip tub containing disinfectant at the entrance to the isolation facility is an excellent way to minimize foot traffic contamination. This tub can contain any one of a number of disinfectant types. Disinfection Recommendations Hands should be washed for a minimum of 15 seconds with a pump-dispensed liquid soap. Alternatively, hands that are not visibly dirty can be cleaned with an alcohol-based (at least 62% ethyl alcohol) gel or foam disinfectant and allowed to dry. Equipment and non-porous surfaces (metal, varnished wood, concrete, stall mats, etc.) should be thoroughly cleaned with a detergent (such as Tide  ) and water (allow detergent to sit for 5-10 minutes), rinsed, then disinfected, followed by a final rinse. Equipment that cannot be effectively disinfected should not be shared between horses. Cloth items can be laundered and dried completely. Disinfectant can be purchased at a veterinary or farm supply store. There are many types of disinfectants on the market. Choose one with which you are comfortable working, and that has documented efficacy in the presence of 10% organic matter. Diluted bleach (typically 2oz:1gallon of bleach:water but check the bottle as there are different concentrations available) is often used. It is very important to thoroughly clean with a detergent to remove organic debris (visible dirt and grime) otherwise disinfects are rendered ineffective. Be familiar with the proper safety precautions for the disinfectant you use and wear proper safety gear. Manure and bedding from isolated horses should not be spread onto pastures or put into open air piles/pits. All infectious agents, not just organisms shed in the manure, can be spread via used bedding. Conclusion Formulating an effective and straightforward biosecurity protocol for your horse and facility is essential in this day and age of mobile horse and human populations. Routine daily biosecurity measures as well as isolation protocols for horses that are new, sick, or returning from travel is imperative. Infectious disease can cause loss of productive time, financial losses, and even loss of life. While the task of implementing a biosecurity protocol may seem daunting, the risks of not having one in place are even more so. Think about your situation and consult with your barn manager and veterinarian as to what will best suit your situation. Time spent now will minimize problems in the future.

By Nora Grenager, VMD Published in Bay Area Equestrian Network May 2009 Nasal discharge can vary in significance, from being innocuous to being indicative of a serious problem. It is important to have an understanding about which types of nasal discharge signify a problem worthy of an immediate call to your veterinarian, and how best to describe the discharge to your veterinarian. It is essential to note that if your horse is having difficulty breathing, making any noise while breathing, has feed material coming from the nose, or is very ill, you need to call your veterinarian immediately. The respiratory tract can be divided into upper and lower parts; upper includes the nasal passages, paranasal sinuses, guttural pouches (air-filled outpouchings of the Eustachian tubes unique to horses), pharynx (area where the entrance to trachea and esophagus meet at the larynx (voice box) at the back of the nasal passage and mouth), and upper trachea. The lower respiratory tract includes the lower trachea and lungs. There are many different types of nasal discharge. Defining some of the characteristics can help you better describe it to your veterinarian, who will use this information, along with the exam, to discern the cause. Discharge can be serous (clear, watery), mucoid (yellow and mucous-like), purulent (green-yellow, thick, looks like pus), sanguineous (bloody), or contain feed material and saliva. Nasal discharge can be unilateral (only ever from one nostril) or bilateral (has come from both nostrils at some point in time), which helps identify the source of the discharge. Discharge that is unilateral typically comes from the nasal passage, the sinus, or occasionally the guttural pouch. Discharge that is bilateral can arise from the guttural pouches, the pharynx, or the lower respiratory tract (trachea and lungs). Discharge can be constant or intermittent or only associated with certain activities like eating or exercise. Discharge can be acute in onset (within hours to a couple days) or chronic (lasting more than 2-3 days). Nasal discharge may be the only clinical sign (symptom) or there may be other clinical signs such as ocular discharge, enlarged lymph nodes (which is nonspecific and present with many types of nasal discharge), fever, cough, facial deformity, abnormal noise when breathing or exercising, exercise intolerance or poor performance, poor appetite, difficulty eating, lethargy, or weight loss. Sometimes nasal discharge can have a foul odor, which can be specific to certain types of bacterial infections, tissue damage, or sinus infections secondary to tooth root infections. There are other historical factors that are important in helping diagnose a cause of nasal discharge. Does only one horse have clinical signs and nasal discharge or do many horses at the stable have clinical signs? Has the horse recently been to a show or clinic or been exposed to new horses in the barn? Have there been any recent management changes, travel, or other illnesses? When and for what has the horse been vaccinated? How old is the horse? A typical workup for nasal discharge will include a complete history and physical examination, and may include a rebreathing lung examination, blood work, nasal swab evaluation, upper airway endoscopy, skull radiographs (x-rays), thoracic ultrasound or radiographs, and possibly sampling of the guttural pouch or airway for laboratory evaluation. The physical examination will probably include taking the rectal temperature, heart rate, evaluation for facial swelling, symmetry of the airflow from the nostrils, breathing depth and rate, palpation of lymph nodes, and possibly sinus percussion. Since we cannot ask your horse to take a deep breath to hear the lungs better, a rebreathing exam involves briefly placing a bag over the horse’s nose to encourage deeper breathing so lung sounds can be heard better. Blood work would be useful to identify infection, inflammation, or other systemic disease. A nasal swab can be evaluated at the laboratory for some of the more common viruses and bacteria that cause upper respiratory tract infections. Endoscopy of the upper airway is when a small camera is passed into the upper airway to evaluate the nasal passages, pharynx, guttural pouches, and entrances to the sinuses. This is useful to visualize where the discharge is coming from, to see masses in the nasal passages, to look in the guttural pouches, to evaluate the larynx, and even to look down into the trachea. Radiographs of the skull would be used to evaluate for disorders of the sinuses or nasal passages not identified with endoscopy. Radiographs can often be done in the field, and endoscopy can be done in the field or at a veterinary hospital, depending on your veterinarian’s setup. Oral examination may be performed if a tooth root infection is suspected. Thoracic ultrasound can be performed in the field or at a veterinary hospital (a more complete exam can be done in the hospital with a larger ultrasound) and is useful for evaluating the lungs when lower respiratory tract disease (such as pneumonia) is suspected. Airway sampling can be Thoracic Ultrasound performed in a variety of ways – through the endoscope, through a small hole in the trachea, or directly through the chest wall in cases of pneumonia; this is done to evaluate the type of cells present, and sometimes to culture if there is an infection. Serous (clear or watery) to mucoserous (mixed mucoid and serous) nasal discharge can be benign due to wind or dust irritation, can be due to allergies, can be indicative of an upper respiratory tract viral infection, or can be the early stages of a more serious infection. Wind or dust can cause mild upper airway irritation and serous nasal discharge that is usually mild, bilateral, intermittent, and not associated with any clinical signs of systemic disease. Allergic upper airway disease can have serous nasal and ocular (from the eyes) discharge that is mild, bilateral, intermittent, and not associated with any clinical signs of systemic disease, and is more common in young performance horses. Both could have an intermittent dry cough. Horses that have “heaves,” or recurrent airway obstruction, which is similar to asthma in people, can have mucoid nasal discharge, cough, increased respiratory rate, or other signs of lower airway disease. This is typically a more chronic condition, and is more common in older horses. Horses with viral infections of the upper respiratory tract typically have a high fever, are depressed, inappetent, and may have other systemic signs of disease. The most common upper respiratory tract viruses are equine influenza virus, equine herpes virus, and equine arteritis virus. Purulent or mucopurulent (mixed mucoid and purulent) nasal discharge occurs when there is a bacterial infection in the respiratory tract. Unilateral purulent nasal discharge is most common with a sinus infection, guttural pouch empyema (bacterial infection), or infected nasal passage mass. Bilateral purulent nasal discharge can also be due to guttural pouch empyema, strangles (an upper respiratory tract infection caused by Streptococcus equi subspecies equi), or lower respiratory tract disease such as pneumonia. Sinus infections are most often secondary to a tooth root infection because the cheek teeth in horses protrude into the paranasal sinuses; this is particularly common in older horses. Sinus infections can also be primary (no underlying cause), or secondary to a sinus cyst (benign mass), progressive ethmoid hematoma in the sinus (benign mass), or neoplasia. Guttural pouch empyema most often occurs weeks to months after a strangles infection, but can occur without any previously noted clinical signs of upper respiratory tract infection. Masses in the nasal passage can be benign (cysts or progressive ethmoid hematomas or foreign bodies) or malignant (neoplasia such as adenocarcinoma). Sinus cysts are benign fluid-filled masses that can get very large and even cause deformation of the facial bones (so the face looks swollen on one side). Progressive ethmoid hematomas are benign blood-filled masses that most often cause an intermittent bloody unilateral nasal discharge, but can get secondarily infected and cause mixed bloody-mucopurulent unilateral intermittent nasal discharge. Foreign bodies, other types of masses (such as fungi), or neoplasia in the nasal passages or sinuses are not very common, but could also cause unilateral mucopurulent nasal discharge if secondarily infected. Strangles is an upper respiratory tract infection that causes fever, bilateral mucopurulent nasal discharge, enlarged lymph nodes, and is most common in younger horses. Pneumonia, or infection of the lungs, typically causes fever, increased respiratory rate, cough, lethargy, inappetence, and can have bilateral mucopurulent nasal discharge. Horses with pneumonia are quite ill and generally require extensive treatment. Unilateral bloody nasal discharge can occur with progressive ethmoid hematoma, nasal foreign body, or occasionally with fungal infection of the guttural pouch or exercise induced pulmonary hemorrhage (EIPH) (the latter two can cause bilateral discharge also). Bilateral bloody nasal discharge can occur with fungal infection of the guttural pouch, EIPH, blood clotting abnormalities, or occasionally with severe pneumonia. Fungi can grow on the arteries that course through the guttural pouch and these fungi can eat through the arteries and cause potentially fatal bleeding. Typically there is initially a small amount of bloody nasal discharge, followed by possibly fatal severe bleeding episode. EIPH is a condition that most often happens in performance horses that work at high speeds; a small amount of blood can be seen coming from the nostrils after intense exercise. In EIPH the small blood vessels in the lungs, called capillaries, burst under the pressure of high-intensity exercise and cause mild bleeding. Horses with bilateral bloody nasal discharge can have abnormalities of blood clotting secondary to eating a toxin, to systemic disease, to infection, or can rarely be born with a bleeding abnormality. Horses with severe pneumonia can occasionally have blood-tinged mucopurulent nasal discharge if the infection damages blood vessels in the lungs. Feed or saliva coming from the nose is indicative of acute esophageal obstruction (known as “choke”), swallowing disorders, or uncommonly with congenital abnormalities of the upper airway. Acute obstruction of the esophagus can happen in horses that eat too fast, have poor teeth, or for a variety of other conditions that prevent the esophagus from functioning normally. Horses with acute esophageal obstruction are stressed, can be seen to gag or cough, and often have feed or saliva coming from the nose and mouth. This is an emergency situation that requires immediate removal of food from the horse’s surroundings and a phone call to your veterinarian. Laryngeal or upper airway or esophageal dysfunction can also cause feed and saliva to come from the nose. Swallowing is a complex reflex that involves many nerves and muscles to work in coordination. Discussion of the numerous disorders that can cause dysfunction of swallowing and abnormal nasal discharge secondary to that is beyond the scope of this article. This is again an emergency situation because horses can get severe pneumonia if any feed goes down the trachea instead of the esophagus. Depending on the history and physical examination findings, your veterinarian will decide on what, if any, further diagnostic procedures need to be performed. Treatment will vary depending on the suspected cause. Hopefully this brief discussion on nasal discharge will help you be better prepared to talk about your horse’s nasal discharge with your veterinarian.