Dr. Baer in Honduras-Veterinary volunteer work with Equitarian Initiative

While most of you were hunkered down during the frigid week of February 8-15, I was warm and hard at work in Honduras. During this time, I was fortunate enough to have been selected for a volunteer veterinary trip with the Equitarian Initiative. Originally scheduled for November 2024, this trip was initially postponed due to tropical storms and flooding in the area.

The Equitarian Initiative is a non-profit organization providing philanthropic veterinary care for working horses, donkeys, and mules. Projects are focused in locations that lack access to basic veterinary care and work to align with local veterinary students and organizations to provide owner education. Conclusion of a successful project means that communities have been able to establish local care and no longer rely on outside help from EI. Current project locations include Haiti, Nicaragua, Honduras, Guatemala, Peru, Dominican Republic, Costa Rica, and the Pine Ridge Reservation in South Dakota.

After flying into Comayagua, Honduras, we headed almost 3 hours south to the Choluteca region. Each day involved setting up a clinic in a different community, as close as 30 minutes away or as far as a few hours away. Getting to our most remote clinic location involved a 1.5-hour drive, a river crossing by rowboat, and a 1.5-mile hike! We had an international group of 8 veterinarians and 18 Honduran vet students. EQUHS (Equinos de Honduras) a local group, worked closely with us during the trip as well. EQUHS helps EI partner with various communities, provides owner education and resources, educates veterinary students, and promotes establishment of animal welfare curricula.  We also had local farriers working at the clinic sites every day.

Each clinic day, teams composed of one veterinarian and two veterinary students were assigned to either triage, surgery, anesthesia, or dentistry services. There was also a registration team from EQUHS assigning numbers to the horses in order of arrival. The triage teams were responsible for initial intake exams on all horses. Under the supervision of their team vet, the vet students performed these initial examinations, including physical exams, body condition scores, dental checks, administration of rabies vaccinations and dewormer, and application of topical parasite treatments. Working in triage provided a great opportunity for client education (and for me to work on my Spanish!). It was excellent practice for the students to explain their exam findings to horse owners. From triage, horses requiring dentistry, farriery, or surgery were then moved on to those stations. Anesthesia teams were responsible for pre-anesthetic exams and medication calculations prior to surgery. At surgery, anesthesia teams were responsible for laying the horse down, monitoring anesthesia, and helping the horse recover after surgery. Surgery teams were set up primarily to provide castrations, but an additional surgical case required flushing and debriding a severe hock wound while the horse was anesthetized. Dentistry teams provided dentistry services including sedated oral exams, floats, and extractions.

My communication with the students was sometimes challenging due to my limited technical vocabulary in Spanish, but they truly did a great job throughout the week and benefitted from this opportunity to practice their clinical skills. Hopefully some of these students will consider future career opportunities in equine veterinary medicine.

The days were long and hot, leaving us physically and mentally exhausted, but also extremely fulfilling and gratifying. Some of the horse owners traveled great distances to get care for their equine partners, and they were appreciative and invested in the process. The whole experience provided me with a new perspective on equine veterinary medicine, and I am grateful to have had this amazing opportunity. I hope to volunteer with EI again soon!

For more information about the Equitarian Initiative and how you can help, check out the EI website, https://equitarianinitiative.org/

State of the Equine Veterinary Industry

I had the honor last year to be asked to be part of the team that puts together and presents the Business News Hour at the annual AAEP convention.  If you’re not familiar with it, AAEP (American Association of Equine Practitioners) puts on an annual conference hosting equine veterinarians from around the world (usually between 4,000 and 5,000 attendees).  The Business News Hour presentation is just what it sounds like – a collection of things in the news over the previous year, specific to the equine veterinary community, that affect the equine and/or veterinary world. It is presented by 3 veterinarians. 

In this blog post, I thought it worth discussing some of the highlights of the News Hour to give our clients and readers insight into what the equine veterinary community is talking and worried about.

State of the Horse Industry

Starting with the Horse Industry as a whole: The American Horse Council did an economic impact study with data collected in 2023 and released in early 2024.  This data shows a shrinking horse population across the United States, although the dollars spent continues to rise.  The equine industry is a $177 billion (with a B) industry, with 2.2 million jobs associated! 

Veterinary Cost Increases

Per the American Veterinary Medical Association (AVMA), equine veterinarians make up about 3.4% of the veterinary population.  There are currently a couple of shifts occurring within this population: 1) there is an increasing number of ambulatory practitioners and 2) there is an increasing number of equine veterinarians employed by corporations or consolidators. 

As for the corporations, there is a lot said in the mainstream media blaming them for the price increases that clients see on their vet bills, both small animal and equine.  While those increases are definitely real, corporations/big business don’t carry all of the blame.  There have also been steep increases in equipment and medication costs that impact all veterinarians, as well as increasing wage and other employment costs. 

Veterinary Shortages

Another frequent issue in the news has been a “veterinary shortage”.  There may be some relief on the horizon as there are currently 13 new veterinary schools in the pipeline for accreditation, which – if all 13 are accredited – would equate to a 40% increase in the number of vets in 10 years. This will affect the equine community a little less since the percentage of graduating students from vet school that go into equine medicine is usually only around 5 %, but it will still constitute some relief, if those equine veterinarians can be retained. 

The difficulty in retaining equine veterinarians is a very real issue, with two essential facts at the foundation of this problem.  The first is the reality of life as an equine veterinarian. A lot is asked of the average equine veterinarian – normal daily duty, on-call (emergency) duty, keeping up medical records, client communications, often long driving hours – and that doesn’t begin to take into consideration the business aspects of the profession for any solo practitioner or clinic owner (marketing, accounting, etc.). It’s an immense amount of work.

Secondly, the equine sector has always been a fair measure behind the small animal (dogs and cats) in the salary realm.  The “average salary” of the equine veterinarian is usually presented as significantly less than the “average salary” for a small animal practitioner.

This could be aptly summarized as “more work for less pay.”  The comfort of working in a small animal hospital versus the barn aisle could start to look pretty appealing if you don’t love what you do!  In response to these realities, the AAEP has been very intentional about making it known that we (equine veterinarians) can be paid better but we have to be better at business.  Most of us went to school to be veterinarians, not business owners, and we learn by the school of hard knocks. 

I will expand on these realities further in the coming months, because I believe that the average horse owner should understand the challenges that horse veterinarians face (since they directly impact your horses), but there is the basic layout.

New Laws affecting Veterinary Care

From a legislative standpoint, there are some significant changes either in the works, or already passed, that will affect the veterinary community. 

  1. The PAWs Act of 2024 has bipartisan support and should go through.  It allows consumers to utilize HSA (health savings accounts) or FSA (flex spending accounts) to pay for vet bills or pet insurance. 
  2. The definition of a VCPR (veterinary/ client/ patient relationship) is changing as well.  How we as vets establish this VCPR was drastically changed in California in 2024.  A telehealth consultation is now sufficient to create a VCPR and from that telehealth consult, a veterinarian can prescribe medications.  These are slippery slopes as these kinds of laws could open a Pandora’s Box of problems.  In my mind, something like this creates more potential issues than solves problems.  Colorado (in the last week) has introduced a bill that looks a lot like the California bill. 
  3. In the veterinary world, one of the hottest legislative topics has been the passage of Prop 129 here in Colorado.  Because there was very little support from the veterinary community (virtually all of the professional organizations within veterinary medicine opposed Prop 129), there is some shock that the proposition was passed.  Prop 129 in Colorado creates a “Mid-Level Practitioner,” who will theoretically be allowed to practice veterinary medicine – able to diagnose, create a treatment plan, and perform surgery.  This, with an educational experience of 53 credit hours – 40 of which would be online – and only 13 hours of in-person training.  Put plainly, this is dangerous for animals, consumers, and our food supply.  It is honestly an insult to the veterinary students putting in time and money to become veterinarians. 

New Practice Models

Many of the factors listed above are contributing to changing models of how equine practices work.  As horse owners, when you see your vet change their hours, how they provide emergency services, and generally make an effort to carry less workload in a weeks’ time, don’t be surprised.  Trying to be efficient in an inherently inefficient business that has us driving all over the countryside is the new target for most of us. 

Some examples of these efforts are: cooperatives of smaller practices coming together to provide emergency care; emergency-only practices to relieve the “normal” vet after 5 pm; and veterinarians providing tele-triage services for the overnight hours.  All of these and many more novel ideas are being tested to help decrease attrition and attract new veterinary talent into the equine veterinary workforce. 

I could write pages more from the Business News Hour, but we will call these the highlights and pertinent things for Colorado in particular.  I could also write a tome regarding the state of the equine veterinary industry. It’s a passion of mine, and our industry is changing at many levels, including economics, shrinkage, and technological changes. Just to name a few of the vital ones. 

As these times change, I believe the interaction and the exchange of care for our equine patients will change as well.  The level of accountability of the horse owner (or an agent of that owner), will have to increase.  For example, in an emergency situation, it may become regular to begin with a telehealth consult, followed by (depending on the state of the horse), trailering the horse to the veterinarian, rather than the vet coming to you. 

Costs of equine veterinary care are already on the rise, and without understanding and the horse owning community taking some of the above-mentioned accountability, there will be fewer equine veterinarians, which will lead to a supply and demand issue, driving prices even higher.  Helping and understanding the conditions and nuances that are happening with equine vets will at some level allow horse owners to control their own destiny.

Basic Life Skills for Horses

As a horse owner, have you taken responsibility for your horse’s ability to handle potentially stressful situations? Are you prepared for the inevitable emergency situation? Taking the time to evaluate you and your horse’s ability to handle these situations BEFORE they happen will help ensure better outcomes. Here is a list of basic life skills important for all horses, regardless of age or location!

  1. Basic handling, including catching, haltering , and leading your horse. You should be able to touch your horse’s body and legs and pick up all 4 feet. If you cannot catch your horse, how can your veterinarian examine him? If you never catch your horse, waiting until he is sick or wounded will not make the situation easier. If you cannot touch your horse’s legs or pick his feet, it is unfair to expect he will allow the farrier to do so safely. Remember that consistent handling is key to success and progress!
  2. Temperature- If you own a horse, you need to own a thermometer, know how to use it, and be able to safely take your horse’s temperature.
  3. Oral medications- There is no reason why your horse cannot learn to have his mouth touched and have oral medications administered (including dewormer!) It is highly likely that at some point, you will need to give your horse an oral medication. Your horse may not sip it eagerly from a syringe, but he needs to allow you (and your veterinarian) to administer an oral medication safely- without rearing, striking, running backwards, etc. If this is a weak skill for your horse, check out some of the resource links below for how to help your horse.
  4. Trailer loading- Even if your horse is retired at home, in the event of a fire or other life-threatening emergency, your horse will need to load on a trailer. This is a skill that comes with practice! Waiting until a stressful event forces this scenario is a good way to ensure that your horse does not load safely or in a reasonable amount of time. If you do not own a trailer, it is your responsibility to plan ahead- does a friend or neighbor have a trailer to help you? If your horse does not load reliably, consult with a reputable trainer to help him learn and practice.
  5. Safe behavior for veterinary exams- Your horse might be nervous about your veterinarian administering vaccinations or medications- that’s ok! Let your veterinarian know in advance and be aware of what works best for your horse in these situations- some treats, a twitch, etc- your veterinarian will appreciate the heads up and your respect for their safety. It is not acceptable for your horse to behave dangerously or violently, and such behavior will eventually mean less than ideal outcomes for your horse following illness or injury. Being a rescue is NOT an excuse for dangerous behavior. Consistent practice and de-sensitization training is a worthy investment for you and your horse!

Here are some great resource videos with training and desensitization tips:

  • Dr. Gemma Pearson, demonstration of techniques to make veterinary care less stressful for horses and safer for those involved. This is a long video but worth a watch https://www.youtube.com/watch?app=desktop&v=JI3xjvPPzzI
  • The British Equine Veterinary Association has a helpful Youtube channel “Don’t Break Your Vet” with short videos of densensitization training techniques to help horses stay safe and relaxed for injections, clipping, deworming, exams, and other veterinary procedures.

Equine Skin Cancers

Skin tumors in horses are not uncommon. While a tissue biopsy is the definitive way to identify the tumor type, location and appearance can offer clues for identification.

Sarcoids

Sarcoids are the most common skin tumor in horses and can be separated into different types depending on appearance.

  • Occult sarcoids are the earliest form of sarcoids and can progress to other forms or remain quiet for years. They vary in size and range from a roundish area of slightly different hair type to a gray hairless circular area. The skin can feel thickened and may resemble a rub from tack or ringworm lesion.
  • Verrucous sarcoids appear gray and scaly or wart-like. They can also become ulcerated and the skin in this area may crack easily.
  • Nodular sarcoids are obvious firm masses which may be attached within the skin or the skin may be separate from the nodules. The axilla (arm pit), eyelid, and inner thigh are common locations for nodular sarcoids.
  • Fibroblastic sarcoids are aggressive and ulcerative in appearance. They can occur anywhere on the horse’s body. The other types of sarcoids can evolve into the fibroblastic type from local trauma and irritation. Fibroblastic sarcoids are further divided into subtypes based on the extent of their attachment to deeper tissue.
  • Mixed sarcoids have characteristics of some or all the types listed above.
  • Malevolent sarcoids are fortunately the rarest form. These sarcoids are highly aggressive and spread extensively throughout the skin, with ulcerative and nodular cords of tumor tissue.

While sarcoids can be locally invasive, they typically do not spread throughout the rest of the body. However, they can be frustrating to treat, become very inflamed, and occur in locations that interfere with tack.

Unlike some of the other types of skin cancers, there does not seem to be a color predisposition to development of sarcoids. The development of sarcoids is the result of an individual horse’s immune system/genetic susceptibility and exposure to the bovine papilloma virus.

The location and type of sarcoid determines the best treatment. Unfortunately, there is not any one treatment approach effective for all sarcoids, and individual sarcoids of the same type may respond differently to the same treatment. Treatment can involve topical chemotherapy or chemotherapy injected into the sarcoid, surgical excision, laser surgical excision, immune therapy, electrochemotherapy, or radiation. Incomplete removal of a sarcoid can lead to recurrence at the same site and a more aggressive sarcoid.

Squamous cell carcinoma

Squamous cell carcinoma (SCC) is the second most common skin cancer in horses. This tumor type develops from skin cells and is seen more commonly on pink skin. Common locations include the eyelids and external genitalia. In addition to horses with pink skin, such as Appaloosas and paints, Belgians and Haflingers may be predisposed to SCC.

Early SCC can appear as a depigmented patch of skin or dry crusting area, progressing to an ulcerated, raised, or cauliflower-like mass. It is best to be proactive about these lesions early, since removal becomes more challenging with increasing size. Always closely monitor areas of pink skin on your horse.

Treatment options for SCC include surgical removal of the mass, local treatment with chemotherapy, CO2 laser treatment, and cryotherapy. Larger and more complex masses, or those involving significant portions of the eye or eyelid might require removal in a hospital setting by a surgeon. At-risk horses benefit from wearing a UV-protective sheet when UV-exposure is high, as well as a UV-protective fly mask. Remember to check your horse’s eyes daily when wearing a fly mask.

Melanomas

Although human melanomas are frequently associated with UV-exposure, melanomas in horses are usually associated with coat color, with up to 80% of gray horses developing melanomas at some point during their lifetime. Melanomas arise from melanocyte cells, which produce the pigment of the skin. Depending on tumor location, melanomas can dramatically impact the horse’s quality of life. At times they may ulcerate and exude a tarry dark substance (melanin).

Common locations of melanomas include the underside of the tail, around the rectum and external genitalia, and around the mouth. Melanomas can also spread to internal organs, such as the liver, spleen, and lungs. Surgical removal of external masses when they are small is recommended, and surgical removal is more effective than medical therapies.

Medical therapies include local injection with chemotherapy, cimetidine (an antihistamine, with mixed results), and a newer option: a melanoma vaccine. A canine melanoma vaccine has already been developed, so similar research is underway for an equine melanoma vaccine. The idea is to create a vaccine unique to that horse to stimulate the immune system to target melanoma cells. While the vaccine does show some promise in reducing tumor size, it unfortunately isn’t a guaranteed cure.

Bottom line: be proactive in monitoring your horse’s skin, and contact your veterinarian if you observe any suspicious skin lesions.

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Saying Goodbye: responsible end-of-life horse stewardship

This is a hard post to write. Euthanasia is very difficult topic, and one that none of us want to think about, but it’s something that we, as horse owners, will all have to deal with at some point. 

Responsible horse stewardship includes making the decision to say goodbye to our equine partners when the time comes. Knowing what to expect, and understanding some of the practicalities of the process, can help us to be prepared to offer our beloved horse companions as pain, and stress-free an exit from this life as we can provide. 

How to make the decision 

“What do you think, Doc?” 

As veterinarians we get asked this question all of the time.  It can pertain to anything from how to deal with a lameness issue, to when it’s “the right time to say goodbye.”  The “when to say goodbye” question is arguably the most difficult we – both as horse owners and as veterinarians – have to face. 

Sometimes it is certainly far more clear cut than others.  Emergencies such a broken leg or a very sick or colicky horse can leave horse owners no choice but to end the suffering. On the other hand, the aging horse which is not holding weight or is limping around on a chronic basis can be a far more difficult and nuanced discussion.

That is the important part though – the discussion. 

It can be a very difficult thing to discuss or even think about, but your veterinarian should be able to guide you through the process so that you and your family can make an educated decision.  Elements such as chronic pain or lameness, weight loss, and inappetence are three common issues which often start the concern that it “might be time.” 

Part of the conversation that I personally have with clients is that often the horse “tells us.”  Their eye may change and become dull. They may start to lack the zest for life which they had years (or even weeks) ago.  They may become disinterested in food, or companionship, or just stand and stare off into the distance as they retreat into themselves. It can be different for different horses, but as the person who knows your horse the best, you will probably recognize it. 

When horses start to have difficulty just being horses, the term “quality of life” comes into play.  Defining that concept can be difficult to pin down, but in the end it is the most important piece of the puzzle. As the stewards for our horses, if the quality of life has significantly changed I believe it is our duty to end their suffering.

 What to Expect

 Your veterinarian should walk you through the practicalities, but generally it is done by your veterinarian with a lethal injection. There is no need to move the horse to a clinic or hospital for the procedure. It can be done where your horse lives, in a familiar and reassuring location. If possible it’s good to conduct the procedure in an area that will be accessible by removal equipment or a backhoe, depending on what you do with the physical remains (we’ll discuss that more below). 

Typically, a sedative is given first via intravenous injection in the neck, to help the horse fall more easily and so the horse doesn’t get distressed as they start to feel sleepy. After this an overdose of an anesthetic type drug is given, stopping the horses’ heart. Sometimes the horse makes involuntary movements, jerking limbs or gasping. Although this can be disconcerting, it is important to remember that the horse is unconscious, and is feeling no pain or distress.

 The drugs take effect very quickly. Your veterinarian will confirm death, and allow you to have some time alone with your horse if you desire.

 How to Deal with Remains

Once a horse has been euthanized with lethal injection, the body is toxic.  It must therefore be dealt with properly. Here in Jefferson County, we have 3 options for the remains: communal burial, plotted burial, and cremation. In all instances an animal removal service is used to transport the body to its final location.  This is often referred to as the “rendering” truck, but nothing does in fact go to the rendering plant.  Communal burial is a mass grave at a non-visitation location. If you feel that you may want to visit a site in the years to follow, there are plotted burial options.  These, and cremation, are significantly more costly, but they are viable options.

Because of their size, there are only a limited number of places which can deal with a horse either for burial or cremation, so planning and discussion of what to do with the remains months or even years before can make the whole process run a little smoother.  Euthanasia discussions are not easy ones to have, but for the sake of our equine companions, they are a necessary one.

EGUS Series Part 3: Management of the horse with Equine Gastric Ulcer Syndrome (EGUS)

So, we now know how to recognize horses afflicted with EGUS and also the proven therapeutic methods used to treat such horses.  This begs the question, how do we manage these ulcer patients?   Numerous studies have shown that intense training and competition schedules, frequent shipping, high concentrate (starch) diets, decreased availability of pasture and insufficient ingestion of hay are all common contributing factors to the development of EGUS.  Our goals as veterinary professionals are multifaceted and include neutralization of acid, promotion of mucosal repair, and the improvement of management processes. 

Photo Courtesy Public Domain Photos via Flickr

Knowing that the equine stomach produces 1.5L of acidic stomach juices on an hourly basis, we can already begin to recognize the benefits of having a constant input of hay into the horse’s GI tract. Additionally, if your horse can handle some alfalfa in his diet, there are several benefits to ingesting this leafy legume.  When compared to timothy, brome and orchard grass, alfalfa is higher in calcium and protein, both of which act as literal chemical buffers to stomach acid.  Additionally, if we consider that alfalfa often has a coarser texture, this means the horse is required to take more chews before swallowing the feed.  As the horse masticates, he produces saliva.  This gooey substance is high in bicarbonate, a chemically basic molecule which also aids in the neutralization of stomach acid.  If your horse is an easy keeper or has some metabolic/nutritional restrictions, high quality straw can also be incorporated into the horse’s forage regime to provide valuable roughage without adding starch or calories.  

Why do we avoid diets high in starch?  As starch is broken down in the stomach, it is fermented by the resident bacteria into volatile fatty acids and lactic acids, all of which contribute to the already acidic environment of the stomach.  If your horse is in an intensive training program and consuming large amounts of grain, breaking the total volume of grain into multiple small feedings throughout the day will help to reduce the amount of acid produced at the time of ingestion.  Additionally, fats can be substituted for starches in the form of rice bran, bean meal, and oils as a means to provide calories without the detrimental by-products of starch fermentation. 

In addition to the continuous ingestion of fiber products, care should also be taken to reduce the stresses of competition and travel.  For those equine athletes where the stresses of competition are unavoidable, the use of PPIs or H2 blockers to prevent the development of gastric ulcers is highly recommended.  Finally, while there is no direct link today between the use of probiotics and the prevention of gastric ulcers, such products may be helpful in maintaining hindgut health in stressed equines. 

Other ulcer-inducing risk factors in an equine life may include aggressive pasture/stall mates, lack of turnout, consistent loud noises, persistent radios, systemic illness, chronic pain, long term use of NSAIDs (bute, banamine, etc), intensive breeding programs and routine training on an empty stomach. 

In conclusion, EGUS is a clinical condition requiring both medical and long term nutritional management.  The continuous ingestion of fiber products is by far one of the most important aspects to managing a horse with clinical signs of ulcers, and in achieving long term optimal GI health.

EGUS Series Part 2: Common (Proven) Treatment Methods of horses with Equine Gastric Ulcer Syndrome (EGUS)

Let’s say you’ve just indulged in a rich gourmet meal complete with red wine and a decadent chocolate dessert.  An hour or so later, you’re regretting that decision as some pesky heartburn keeps you awake.  Eventually you swallow some Tums©, Tagamet©, Zantac© or even Nexium© and breathe a sigh of relief as those clinical signs abate and you drift off to sleep.  Believe it or not, many of the medications we use to treat our own heartburn work on horses as well.  The goal of EGUS therapy is not to treat the ulcer itself, but to decrease the acidity of the horse’s stomach to allow its natural healing mechanisms the opportunity to repair the damaged mucosal lining.

The gold standard in the treatment of EGUS is omeprazole, sold under the trade name Gastroguard©.  This product stops the production of gastric acid at the immediate source, and is known in the chemical world as a proton pump inhibitor (PPIs).  By stopping the production of gastric acid, the mucosal lining of the stomach is allowed to heal, which can take anywhere from a couple days to multiple weeks, depending upon the size, severity and location of the ulcer within the stomach.  UlcerGuard© is another omeprazole product, given at a quarter of the dose of Gastroguard©, and utilized in the prevention of gastric ulcers.  Both of these products are given once a day, and elicit the best response when given in the morning on an empty stomach.  They are most effective in the first eight hours after administration.  It must be noted that long term use of PPIs has been shown to impair the digestion of protein, an integral component to a horse’s nutritional demands.  PPIs are safe for use up to 90 days (so your 4 weeks of omeprazole therapy is perfectly safe) but relying on them for longer periods of time is not recommended. 

Ranitidine (Zantac©) and cimetidine (Tagamet©) have also been used routinely in the prevention and treatment of gastric ulcers.  Both drugs are considered H2 receptor antagonists, or H2 blockers.  Where omeprazole prevents the production of gastric acid directly at the source, H2 blockers are one step removed from that process and prevent the H2 signaling molecule (histamine) from binding to the receptor which activates the production of gastric acid.  Sounds complicated, right?  My goal in providing readers with such information is not to overwhelm you, but instead, to illustrate why veterinarians consistently turn to omeprazole when faced with EGUS; it halts the production of acid at the source and has a longer duration of efficacy compared to H2 blockers.  Sometimes, though, weeks of omeprazole therapy are not a viable, financial option for clients, so we may turn to the H2 blockers to help try to achieve similar results in the reduction of clinical signs of EGUS.  For the best efficacy, H2-blockers must be given three times a day, making them slightly more challenging from a management perspective.

Sucralfate is another product occasionally used as a protective agent in horses with ulcers located in the glandular region of the stomach.  When exposed to such acidic environments, this fluid is converted into a sticky substance which coats the lining of the stomach and binds to preexisting ulcerations to form a protective barrier.  This product must be given on an empty stomach (which we try to avoid in horses with EGUS) and may prevent the uptake of other drugs administered simultaneously.  While effective, the size of the dosage and the duration of therapeutic programs often makes this product cost prohibitive. 

A phenomenon which must be mentioned in this discussion is that of rebound acid hypersecretion.  Long term use of PPIs followed by abrupt discontinuation of therapy has been shown to cause a consistent increase in gastric acid production, often worse than the initial stomach condition.  When using PPIs, it is important to wean the horse off of medication using progressively lower doses over the course of 10 days.  There are several studies demonstrating the beneficial effects of using sea buckthorn in the prevention of rebound acid hypersecretion. 

Stay tuned for Part 3 of Dr. Hartman’s blog regarding the management of horses with EGUS!

EGUS Series Part 1: What’s the fuss over gastric ulcers?

Be it in the show ring or over dinner with horse friends, the topic of gastric ulcers always seems to elicit sentiments of frustration and misunderstanding.  What causes these pesky ulcers and what can we do as horseman to combat them?

To start, it’s important to understand that before horses were domesticated by humans, they spent their days slowly grazing across the plains and grasslands.  The slow ingestion of fibrous plant products creates an integral part of the horse’s digestive mechanism called a fiber mat, which naturally floats on the top of the stomach contents. 

Why is this fiber mat so important?  The horse’s stomach is separated into two regions, glandular and non-glandular.  The glandular region is responsible for the production of gastric acid which is necessary for the digestion of forage.  To avoid self-destruction, the glandular region of the horse’s stomach has protective mechanisms that keep the gastric acid from digesting the very tissue that produces it.  Unfortunately, the non-glandular region does not possess such protection and is susceptible to the destructive effects of the acidic stomach contents.  This is where the fiber mat comes into play.  Horses that graze throughout the course of the day are continuously adding plant fiber to the fiber mat which serves as a protective boundary between the acidic gastric contents and the non-glandular portion of the stomach. 

Let’s jump ahead to our typical domesticated horse which lives in a commercial boarding situation.  These horses are usually fed twice a day, often going more than twelve hours between their evening meal and breakfast.  The detriment here is without the continual ingestion of hay, that fiber mat is quickly digested and sent past the stomach into the rest of the GI tract.  This leaves the non-glandular portion of the stomach exposed and susceptible to the deleterious effects of the acidic stomach juices, as these secretions are produced on a continual basis.  Now, let’s say we decide to ride this horse without his fiber mat and the increased activity level causes more splashing of the stomach contents onto that already sensitive region.  As the acid begins to eat away at the lining of the non-glandular region of the stomach, the horse is thrown into a downward spiraling scenario that, without medical intervention, is quite difficult to recover from. 

How do you know if your horse has ulcers?  Common clinical signs of a horse with ulcers are aversion to tightening of the girth, sensitivity to grooming (especially behind the elbows), finicky eating habits or changes in behavior both on the ground or under saddle.  The only guaranteed diagnostic method to confirm the presence and severity of gastric ulcers is by passing an endoscope into the horse’s stomach and visualizing the integrity of the gastric mucosal lining.  For many of our clients, this is not a viable diagnostic mechanism, so instead, we assess the horse’s response to medical therapy for ulcers.  If there is a vast improvement in clinical signs over the course of therapy, the likelihood of gastric ulceration is high and we can continue with medical intervention and nutritional management. 

Stay tuned next month for part 2 of our blog discussing the treatment and management of horses with Equine Gastric Ulcer Syndrome (EGUS)!

Equine Preventative Medicine Checklist

Along with spring comes vaccinations and preventative care appointments for our equine friends. We all understand the importance of preventative medicine, but it’s easy to miss things, so we’ve prepared a list of what you should be doing with your horse to make sure they’re healthy and prepared for summer riding season.

Vaccinations

We will start with the easiest – vaccinations. Vaccine protocol for the spring varies depending on your geography and your individual horse’s exposure potential and travel schedule. Always consult with your veterinarian if you are going to travel somewhere new with your horse. Here on the Front Range, we typically recommend a 5 way (eastern and western equine encephalitis, tetanus, rhinopneumonitis, and influenza) and a West Nile booster as the basic starting place for spring vaccinations. For a more in depth discussion of the vaccinations we recommended in Colorado and why, see the blog titled Why are the Vaccines we give in Spring So Important Here in Colorado?

Deworming

Deworming used to be easy – give your horse a deworming paste at set intervals and you’re done. But research has shown that deworming is certainly not as straightforward as we once thought it was. There are several options and differing approaches to deworming, and whether you opt to use a classical “rotational” deworming, or a more targeted “Fecal Egg count” approach, spring is a time to think about how to protect your horse from internal parasites. There are pros and cons to different deworming approaches, and we have complete articles on both of these regimes listed below.

Rotational Deworming – What’s the Right Choice?

The Scoop on Fecal Egg Counts

Dentistry

teeth

Although there is nothing tying teeth floating to vaccination, deworming or seasonality, most people (veterinarians included) like the convenience of combining all of the preventative medicine into a single visit. Spring is a critical time to have your horses’ teeth checked comprehensively. Tooth and other mouth issues can have a dramatic impact on your horses’ comfort, performance, and even lameness issues. Dental issues and questions like “Does my horse need a float?” are immense subjects and are covered in detail in previous issues of the blog.

Why is Regular Dentistry so Critical to your Horses’ Health?

How Do I know My Horse Needs a Float?

Why Do I Need to Float my Horses’ Teeth?

Physical Examination

A good general physical exam is a good idea for all horses this time of year so that we (both owner and veterinarian) are assured that there is no need for an alteration to the diet or that some insidious disease process is slowly creeping in unnoticed. It’s also very helpful to have a baseline of your horses’ health so when changes happen they can be noticed, and dealt with, quickly. Summer is riding and show season, and a physical examination will ensure your horse is at the top of their game, making your time together enjoyable for you both. An important aspect of the physical exam that often gets ignored is a very brief (just a few minutes) lameness exam. Whether you have noticed that your horse is tripping a bit more, or he just hasn’t been evaluated, a check of his legs could be invaluable in finding a mild issue before it is a major one. If this is something you are interested in, be sure to let the office know when you schedule your appointment that you would like the veterinarian to spend a bit of time with a lameness evaluation, so that a scheduling issue doesn’t arise.

Spring Preventative Medicine Checklist

Below is a quick reference for when your vet arrives for spring tune ups for the horses. I have had clients use this little outline as a basis for questions they have for the vet when he or she arrives. We all fall victim to “I forgot to ask while you were here” questions! Happy trails and enjoy the beautiful Colorado spring!!

Quick Checklist for Spring:

  • vaccines – 5-way and West Nile Booster
  • deworming or FEC – which is better for your horse?
  • Dental – Does your horse need a teeth float?
  • General Physical including weight evaluation, diet discussion, old age changes (ie cushings), and lameness evaluation

Should my horse get a strangles vaccine?

Most horse people are familiar with the dreaded “s- word”: strangles. But if there is a strangles vaccine available, why isn’t vaccination essential for all horses, like the rabies vaccine?

What is strangles?

Equine strangles is caused by infection with the bacteria Streptococcus equi var equi, causing mild to severe upper respiratory infection. Complications from infection can occasionally be fatal, but most horses fully recover. Strangles is a high morbidity disease, meaning it is extremely contagious in susceptible populations.  Proper biosecurity measures are crucial to limit the scope of an outbreak.

Pony with Strangles shows swelling from abscessed lymph nodes

Signs of strangles include fever, swelling of the lymph nodes (especially in the throat latch area), loss of appetite, cough, and significant mucoid yellow nasal discharge. The bacteria mobilize to the lymph nodes and causes intense immune response, so frequently these lymph nodes abscess open and drain. The term strangles originated from the harsh respiratory noise heard when severe swelling and lymph node abscesses can impair the horse’s ability to breathe.

Most infected horses respond well to supportive care. Supportive measures include anti-inflammatories, hot-packing of abscesses, and rest. More severe cases may benefit from hospitalization and antibiotics. To prevent the spread of strangles, hospitalized cases are managed in the isolation unit.

How does strangles spread?

Strangles is easily spread by horse-to-horse contact and via contaminated surfaces, such as handler clothing and hands, grooming equipment, and water troughs. Most horses will clear the infection within 3-6 weeks, but it is possible for some horses to recover fully and remain shedders of strangles. These horses appear healthy but will shed the bacteria and continue to infect other horses. Upon recovering from strangles, horses will be protected against reinfection for variable periods of time, sometimes even a few years.

Strangles vaccine options

Two types of strangles vaccines are available. One is a “killed” vaccine, meaning it contains dead/inactivated strangles. This vaccine is administered intramuscularly.  Killed vaccines produce a weaker immune response, so it is still possible for a horse vaccinated with this vaccine to develop strangles if exposed. Per the American Association of Equine Practitioners, the killed vaccine should not be expected to prevent disease. It may be effective in lessening the severity of infection. There is also an increased risk of vaccine site reaction with this product.

The second type of vaccine is called a “modified live” vaccine. This vaccine type uses a weakened form of strangles to stimulate a stronger immune response. In order to accomplish this, the vaccine is administered intranasally to target the same tissues as natural strangles infection. However, it is also possible for this modified live vaccine to cause lymph node abscesses, much like natural strangles infection. Horses that have natural immunity to strangles (those who have recovered from infection) have a higher risk of adverse reactions to strangles vaccination.

Should my horse have the strangles vaccine?

The take-home point is that we currently lack a perfect strangles vaccine. If your horse is in a high-risk population, discuss the pros and cons of strangles vaccination with your veterinarian to evaluate if strangles vaccination is worthwhile. It is important to remember that vaccination does not guarantee that your horse will not get strangles. Proper biosecurity is essential to prevent and limit strangles outbreaks.