The 4,000 veterinarians expected to attend the 55th American Assn. of Equine Practitioner convention are eagerly awaiting the opportunity to discuss wellness concerns and equine issues with colleagues. Though observations vary region-ally, even those practicing in affluent areas are seeing clients pull back on preventive care for horses and are chalking it up to economic concerns. Some are concerned because the proactive approach is the best for staying ahead of potential disease, parasite and viral issues. “People are doing more of their own routine care [because] of the economy,” says Christi Garfinkel, DVM, of Equine Veterinary Services Inc. in El Cajon, Calif. “This makes preventive care difficult.” Wellness is defined differently by veterinarians, varying by region, client compliance and beliefs, says Harry W. Werner, VMD, of North Granby, Conn., president of the AAEP. “I define wellness as practicing preventive medicine,” Dr. Werner says. “Biannual physical examinations provide baseline findings that tell us what is normal for the patient. Exams help determine which vaccinations, parasite control and care are appropriate and help us identify diseases and problems early. Exam findings can also be valuable comparison points if the horse has health problems in the future.” Preventive Care Werner says widespread vaccinations have reduced disease outbreaks. Yet disease-causing organisms remain in horses’ environment. “It takes only a missed vaccination for disease to reoccur,” he says. “One [disease] I’d like to see practitioners vaccinating against more frequently is strangles, streptococcus equi—and more frequently in high-risk areas.” Dr. Garfinkel says California has a high incidence of dryland strangles, also called pigeon fever. “This is different than what the typical strangles vaccine protects against,” Garfinkel says. “This is the first disease that comes to mind that I’d like to see a vaccine created for.” The AAEP’s infectious disease committee released a revised list of core and risk-based vaccines for adult horses and foals in 2008, providing a list of options based on the horse’s risk, gender, consequence of disease, anticipated effectiveness, potential for adverse reaction and cost. The association cautions veterinarians that there isn’t one standard of care for horses. “I follow AAEP recommendations. There’s no reason to reinvent the wheel,” Garfinkel says. “Mostly, I feel veterinarians need to keep educated on the highest quality of medicine and then educate the client through trust for better compliance. Increasing owner compliance through ensuring they understand the importance of preventive and aftercare like a veterinarian does takes a lot of time and energy in itself.” Equine veterinarians say vaccine awareness isn’t usually something owners need to be told about; the problem is convincing them that each vaccine is important. “There were 50 cases of West Nile in my state,” says Robert Moody, DVM, of Equine and Large Animal Practice in Coupeville, Wash. “This demonstrates that compliance is clearly an issue, considering that of these 50 animals, all were either non-vaccinated or the vaccines had lapsed. This lack of compliance could be due to laziness or the economy.” The 2008 introduction of EquiRab, a vaccine designed specifically for horses, has improved owner compliance, veterinarians say. It is manufactured through Intervet/Schering-Plough Animal Health and offers long-lasting protection against rabies. “The rabies vaccine is on AAEP’s core list, but there aren’t laws that mandate equine rabies vaccination,” Garfinkel notes. “My client compliance is high with this, and it is part of my core vaccine recommendations, but compliance wasn’t always as high. In the past, horses were experiencing a lot of adverse reactions to the previously available rabies vaccines, but the new 1 mL dose as opposed to the old 2 mL dosage has eliminated those side effects.” Another important wellness factor is testing for and treating horses for parasites, experts say. “Some clients don’t want to incur the cost of testing, so they just give deworming medication regularly,” Dr. Moody says. “Unfortunately horse owners don’t often think of parasite control as high a priority as owners of dogs and cats. This may be because it tends to be an ongoing problem—and the animal isn’t living next to them in their house. “Some vets find a low number of parasites during a test, so owners elect to forgo deworming, saying they don’t think the problem is big enough to incur the cost of medication. This is virtually unheard of in companion animal medicine. “The horse’s environment plays a role in deworming frequency,” Moody says. “A good rule of thumb is annual testing and deworming prevention. This will eliminate parasites [as a factor] if an animal becomes thin, and the veterinarian can look at nutrition and dentia as a cause.” Dental Dental care historically has been somewhat archaically approached by many owners, equine specialists say. Awareness campaigns from the AAEP and primary caregivers has improved compliance, but qualified providers are slim pickings in some areas. “Veterinary dental exams and care are key elements of an effective wellness program,” Werner says. “We typically administer sedation and use a dental speculum to examine the horse. This approach keeps the patient and handler safe and allows for more effective treatment and patient comfort during and after the dental procedures. “Using sedation and power dental instruments to perform thorough exams and treatment [results in] less physical and emotional trauma for the patient during and after dental care. [It allows for] earlier detection and correction of problems, better nutrition, fewer handling and training problems and improved safety for horse and handler. “If a veterinarian doesn’t perform dental care procedures, he or she should be able to recommend a licensed, competent person who does,” Werner says. Nutrition Nutrition lays the foundation for equine wellness. The quality of the food supply varies seasonally. “In California, an ongoing drought has diminished the quality of products growing in irrigated fields,” Garfinkel says. “Some hay is dry and dusty, which won’t support a horse’s nutritional requirements, especially if the animal is lactating or highly active. In the case of inadequate feed, I recommend supplements on an individually-based need.” Analyzing hay quality is an option equine practitioners say should be made available to owners to ensure proper nutrition. Veterinarians who don’t offer this service should be able to provide a referral. “People often don’t know how much food they feed their horse,” Moody says. “Clients say they feed a ‘flake’ as opposed to citing the weight measurement. This may mean they aren’t providing enough food to support equine wellness. Vets should encourage clients to know the actual measurement of food to ensure proper nutrition.” Pain Management Pain management is being used more frequently in horses, but the cost of treatment holds some owners back. “Medicating a horse goes by weight, so it will obviously cost more to provide equine medical care than what is found in small-animal medicine,” Moody says. “Right now there are just two nonsteroidals available for arthritis pain in horses and both work well, but I’d like to see more options and a decrease in price.” Wounds Wounds are not brought to veterinary attention in a timely manner. Limb wounds are a big concern, as they have the most potential for infection and could lead to euthanasia. “Less than 25 percent of traumatic wounds to a horse’s leg heal normally following a suture closure,” says Christine Theoret, DMV, Ph.D., Dipl. ACVS. She is a professor of equine surgical anatomy and director of the Comparative Tissue Healing Laboratory at the University of Montreal and president of the Veterinary Wound Management Society. “Horse wounds are frequently contaminated, which may lead to the development of an infection,” Dr. Theoret says. “That is because horses are seen less frequently by veterinarians than are companion animals and they often live in less hygienic environments. “What I found through research is that wounds on horse limbs heal differently than those on the head or body, and this may be attributed to their blood supply.” Theoret studied and compared the availability of oxygen in limbs, the head and the body in horses. Her team found significantly less oxygen in limb wounds, a phenomenon that could interrupt the healing process. Possible treatment options are being investigated for these equine conditions. “Preliminary results show that hyperbaric oxygen therapy (HBOT) may hold promise for treating horses with limb wounds,” Theoret says. “But with only three or four veterinary researchers investigating equine wound care in the world, hard data will take time to collect. “If shown to be effective, the cost of therapy may be a deterrent, but HBOT may be a good investment for large referral practices, where it could be made available to owners of expensive race horses.” This article first appeared in the December 2009 issue of Veterinary Practice News <HOME>
