Spring 2008 Issue
Controlling Strangles: Education, Screening and Biosecurity Measures—Dr. Mark Reilly outlines approaches to education, techniques for testing and biosecurity measures after a client’s horse tested positive for Streptococcus equi at a boarding barn. Monitoring a Foal with a Hock Wound and Fever—Dr. Kristin Broussard describes how having in-house diagnostics saved time and money for her client and provided a better outcome for her patient. Equine Health Stories—Send yours in! If we publish it, you'll get a $25 gift card for L.L.Bean. Sample Dilutions for High Enzyme Concentrations in Rhabdomyolysis—Ky Carter, RVT, of Equine Sports Medicine and Surgery in Weatherford, Texas, describes his techniques for diluting samples with high concentrations of muscle enzymes for analysis with the VetTest® Chemistry Analyzer. IDEXX Practice Developer® Program— Are you missing out on valuable rewards?		MORE INFORMATION Newsletter Archive Subscribe now Print this issue

Adding Another Digital Radiography System to an Equine Ambulatory Practice—In separate interviews, two California veterinarians, Dr. Don Shields and Dr. Jerry Parker, describe their reasons for adding a second digital imaging system to their busy practices.

Training and Events—IDEXX is pleased to continue sponsorship of events at the 83^rd Hambletonian Festival of Racing.

Special Offers this issue—IDEXX EquiView® DR 810 and SURPASS® (1% diclofenac sodium) topical anti-inflammatory cream for use in horses.

Controlling Strangles: Education, Screening and Biosecurity Measures

Streptococcus equi can cause a highly contagious bacterial infection that spreads rapidly from horse to horse through exchange of nasal secretions and shared equipment. Clinical signs of S. equi include fever, bilateral nasal discharge and swollen lymph nodes.

Horses may or may not develop long-term immunity after exposure. Positive horses may be asymptomatic and can shed the bacterium for weeks, months or even years, making it difficult to identify them without diagnostic testing.

In a recent interview, Mark Reilly, DVM, Dipl. ABVP, outlined how testing, combined with careful biosecurity measures and education, can help mitigate outbreaks.

Testing the Herd—Dr. Reilly’s Recommendations

1. Act quickly. Perform diagnostics in a timely manner. PCR with culture testing performed on the rest of the horses in the barn can be helpful keeping the outbreak in check.
2. Separate horses according to test result. Move positive horses to one side of the barn and negative horses to another, placing a barrier between the two areas.
3. Test negative horses once a week for three weeks until there are three consecutive negatives.
4. Perform guttural pouch endoscopic exams on horses that test positive. Send guttural pouch washes for submission to the lab for PCR with culture.
5. Treat positive horses with lavage and antibiotics. Examine these horses and give them guttural pouch lavage every other day for a week to remove concretions of bacteria (chondroids) that can cause the horse to shed S. equi and lead to future outbreaks. (Note: Guttural pouch lavage should be performed by someone experienced in the technique to avoid damage to the Eustachian tubes and further spread of bacteria.)
6. Treat symptomatic horses with severe signs by draining and flushing lymph nodes, and providing fever relief and analgesia with phenylbutazone or flunixin meglumine to maintain appetite.

Biosecurity Measures
Dr. Reilly emphasizes the need for communication before implementing biosecurity measures. Make sure that people know why there is a change in the routine. Although owners are aware of the disease, they may not be familiar with infectious disease protocol. The ACVIM Consensus Statement (2005) and the AAEP provide good background materials, says Reilly. He also provides educational materials on his Web site.

Prepare owners for the cost. Each owner, no matter what the status of the horse, is going to spend money for farm calls, testing and sedation, if necessary. Encourage them to consider the cost of the testing within the context of competition expenses. Removing a horse from competition during the show season can be costly.

Dr. Reilly implemented these biosecurity procedures:

• Quarantine and testing. The general recommendation for clearing a horse of S. equi is for three consecutive negative PCR test results.
• Limit entrances and exits to and from the barn. Establish one entrance and one exit. At the affected barn, all boarders, farriers, vets, etc. should enter through one door and leave through another. As horses are determined to be free of strangles, they can be allowed exit through a third door that has been shut down during the testing period.
• Restrict unnecessary traffic. Have any necessary shoeing or veterinary work done near the door without going too far into the barn.
• Establish foot-dipping tanks containing disinfectants—every three to four stalls, or as appropriate.
• Provide exam gloves outside each stall to be used when any horse is handled.
• Separate tack and equipment. Every horse should have his own halter, lead, and water/feed bucket. It is very important not to interchange tack and equipment between horses.
• When bathing, bathe sick horses last.
• Educate the younger boarders. Require parental supervision for very young children. Do not allow children to visit horses other than their own.
• Quarantine new horses. Because barns have varying requirements for testing, it is not always possible to know the S. equi status of a new horse. Ideally, any new horses should have a recent PCR test and receive another test a week after arrival. It is good practice to isolate new horses by keeping them at least 30 feet away from the others.
• Visit the “sick” barn last, and wash all clothing that may be exposed to infected nasal secretions.

Mark Reilly, DVM, Dipl. ABVP, has over 17 years of experience working on competitive horses of all disciplines. At South Shore Equine Clinic and Diagnostic Center his interests are lameness, surgery, respiratory disease, diagnostic imaging (x-rays, ultrasonography, MRI), preventive health care and internal medicine. He has been president of the Cape Cod Veterinary Medical Association, as well as chairman of the Massachusetts Veterinary Medical Association Large Animal Committee. Recently, Dr. Reilly presented a paper on a novel castration technique at the 2005 international convention for equine practitioners (AAEP) in Seattle. When not spending time with his family and friends, he is an avid sports fan and still plays in a men's baseball league on Cape Cod.

Biosecurity: A Focus on the Triad of Disease
Josie Traub-Dargatz, DVM, MS, DACVIM, discusses steps for preventing infectious diseases on horse farms.

Using the S. equi PCR as Part of a Best Practices Approach to Broodmare Management and Care
Jeff Cook, DVM, of Rood and Riddle Equine Hospital, Lexington, Kentucky, discusses best practices for testing.

Techniques for Streptococcus equi PCR Testing - Guttural Pouch Wash
Jeff Cook, DVM. Rood and Riddle Equine Hospital. Lexington, Kentucky.

IDEXX Equine Biodiagnostics (IDEXX/EBI) offers Streptococcus equi PCR and ELISA testing. For more information about these or other diagnostic tests provided by IDEXX/EBI, please visit www.idexx.com/equine/laboratory.

Monitoring a Foal with a Hock Wound and Fever

Kristin B. Broussard, DVM, of Coteau Ridge Equine shared the following story about the value of having on-site hematology capabilities. Coteau Ridge Equine was founded in 2005 in Arnaudville, Louisiana, by Dr. Broussard and Dr. Julie P. Cubbage. The doctors and their staff provide ambulatory services for medical care and treatment, preventative care, general reproduction and emergencies at home.

Dr. Broussard’s Story:
As an ambulatory equine practice, we are very concerned with always having the proper equipment and medications fully stocked on our trucks to eliminate multiple unnecessary trips to a particular farm. When we started our practice, we immediately realized the importance of quick turnaround on blood work. Obtaining results in a timely manner allows us to make treatment decisions, and then begin treatment that same day.

I left the office early that morning in order to accommodate my increasingly busy schedule.
It was the end of the day, and I was looking forward to a long awaited rest when my cell phone rang. A nervous voice described Crafty, a foal with a chronic draining wound located on the lateral aspect of his left hock. I made it out to see Crafty at 4 p.m. and was surprised to see only a small wound with minimal draining, but an almost non-weight bearing left rear limb. The foal had a fever of 105° F, so I decided to run blood work on our LaserCyte® analyzer. Results showed Crafty had a very high white cell count which, in conjunction with his clinical signs and radiographs, also taken at that time indicated a presumptive diagnosis of osteomyelitis. Although he was bouncy and energetic, the outlook for the future was not as pleasant.

The client had financial limitations so referral was not an option. Rather than take a passive approach to treatment (i.e. wait until Monday), or send the foal to another facility over the weekend, I knew that starting him on the proper antibiotic and treatment protocol was extremely important. With a LaserCyte analyzer in the practice, I was able to monitor Crafty’s progress every week. The ongoing testing helped the owner decide whether or not to continue treatment. Two months after the initial diagnosis, Crafty is running in the pasture and doing great!

* Fibrinogen results were not obtained on the LaserCyte Analyzer.

Do you have a case study or a story in which your use of an IDEXX product made a difference? Do you have practical hints for using IDEXX products that you would like to share with others? Do you have an equine patient with an unusual or challenging diagnosis?

The Equine Edge relies on the expertise of equine practitioners in the field for our editorial content. Each quarter we search for stories we can develop from your experiences that will have practical applications in day-to-day practice.

We’d like to publish your qualified case study. We’ll send you a $25.00 L.L. Bean gift certificate for submissions we use in the Equine Edge.

With your submission, please send:

• Patient’s name, history and details of physical examination
• Testing and testing results
• Diagnosis
• Plan
• Follow-up and outcome
• Photos if possible

Submit cases to: idexxhorse@idexx.com

Sample Dilutions for High Enzyme Concentrations in Rhabdomyolysis

Tracking muscle enzymes over time can help diagnose trends that indicate the type and extent of muscle damage when a horse presents with rhabdomyolysis. Serum creatine kinase (CK) is released immediately after muscle injury and peaks quickly. Serum aspartate transaminase (AST) rises more slowly after injury and may take as long as two to three weeks to return to normal after a tying up incident. Tracking these enzymes over time helps determine the extent of muscle injury for diagnoses and treatment.

At Equine Sports Medicine and Surgery in Weatherford, Texas, tying up is a common diagnosis. In a recent interview, Ky Carter, RVT, described his approach to serum dilutions when tracking muscle enzymes over time.

First, I run a raw sample and try to determine a starting point for the dilutions. A client’s cutting horse was working twice a day to prepare for a competition. After working in the morning with a limited cool-out, the horse tied up after the afternoon work. It was the first time we had seen the horse so we did a full profile (CBC and chemistry). The CK was elevated to 500 U/L and AST was high but within normal ranges at 450 U/L. We treated the horse systemically for one day and reran the CK and AST with a dilution of 1:3. CK was 900 U/L and AST was 610 U/L. We treated the horse for two more days and ran the test CK 1100 U/L and AST 800 U/L using a dilution of 1:5. We sent the patient home for stall rest and checked levels a week later and the CK had returned to 164 U/L but the AST was still elevated to 623 U/L.

When muscle or other enzymes rise, they can often go out of the reportable range of our equipment. We dilute the sample to bring it back into those reportable ranges. When diluting your sample, make sure to use a sterile and or noninterfering substance; this eliminates interference with different test media. I use sterile water.

I like to use tuberculin syringes; they help keep sample size down. I place 0.10 mL serum into a sample container, and then add the diluent. In this case, I use sterile water to dilute the sample—anywhere from 0.10 mL to 0.90 mL depending on the severity of the case.

About Dilutions on the VetTest® Chemistry Analyzer

A dilution is one part sample to “X” parts of the diluent (X equals the total number of parts of sample and diluent). For example, a 1:5 is one part sample and four parts diluent, which is expressed as 1:5.

IDEXX VetTest Chemistry Analyzer: Dilution Protocol: Plasma and Serum  (82 KB)

Make the most of the parameter-trending feature of your IDEXX VetLab® Station

 

Are you missing out on valuable rewards?
When you become an IDEXX Equine Practice Developer® member, every time you buy IDEXX products you can earn Practice Developer points and then use them toward the purchase of IDEXX products or services (1 point = $1 at redemption).

As a member, you will receive points on a broad range of IDEXX products and services, including:

• SNAP® Foal IgG Test
• IDEXX Reference Laboratories Services
• LaserCyte® and QBC® VetAutoread™ Tubes
• VetTest® Chemistry Slides
• Equine Pharmaceuticals
   

And, you can redeem points at any time toward any IDEXX product or service. Your quarterly statement lets you know how many points you’ve earned and highlights specials. You save on everything from Extended Maintenance Agreements and IDEXX VetLab® analyzers to SNAP® tests, reference laboratory services and educational opportunities. You can even use your points to purchase Pizza Hut® gift certificates for your practice!

Don't miss out! Enroll today!

For more information on Practice Developer, including more ways to redeem your points, visit us at www.idexx.com/equine/practicedeveloper! If you have questions, call us at 1-800-248-2483.

Adding Another Digital Radiography System

With its instant image capture capability, sharp image quality and portability, digital radiography provides many advantages. For highvolume work such as radiographs for racetrack prepurchase exams, the digital system can pay for itself and bring in new business at the same time, generating enough work to justify the purchase of an additional system. Adding a second portable digital radiography provides three main benefits:

• The first system provides efficiencies that make it feasible to buy a second one more quickly.
• A second system allows the practice to add more prepurchase exams to the practice while continuing to serve existing clients.
• At the racetrack, the ability to provide images at stall-side allows veterinarians to meet the client’s expectations for efficient, high quality service.

In separate interviews with two busy practices, one in Northern California (Belmont) and one in Southern California (Arcadia), veterinarians discussed how an increase in pre-purchase exams at local racetracks drove the decision to buy an additional system. Dr. Don Shields uses his system all the time. “We have plenty of use whether it generates business at a track, or whether we x-ray horses at rehabilitation facilities,” says Shields. “A second system allows us to provide service to our clients on the ranch while the other machine is at the track.” Dr. Jerry Parker needed help with additional business as well. “Prepurchase exams were taking time we needed for the practice, and we were passing it back and forth between the field and our practice. Often the machine would be out of town for a week preventing others in the practice from using it. We opted for a second one instead of passing it back and forth.”

For both veterinarians, the economical benefits are clear without extensive financial analysis. With the efficiencies provided by digital imaging, adding a second machine allows Dr. Shields to handle the existing workload and obtain more work. “I use my system all the time,” he says. “It paid for itself in less than a year. A fast return on the investment of the first machine can provide the justification for purchasing a second one.“

“We had no set formula for deciding when to buy a second machine,” says Dr. Parker. “With the extra sales made from the first machine, we decided that it made economic sense. Also, if the machine is unusable for some reason, we have an extra that we can use instead of delaying the work.”

Although a second machine has proved to be a good investment from an economic point of view, the best benefits come from fast and accurate imaging to support an accurate diagnosis as quickly as possible. “Everybody thinks digital is better,” says Shields, “and in this case, the reality matches the expectation. It is better in my opinion, and I can get the work done faster.” In the past, Dr. Shields used a portable x-ray only in catastrophic injuries such as breakdowns on the track. As an early adopter of the portable digital radiography technology, he was one of the first veterinarians in the country to own a digital system. “Suddenly, I can walk in, take the x-rays right at the horse’s stall, and get as good or better quality images than what we used to get with the large system at the racetrack hospital. In addition, I don’t have to wait for the horse to be tranquilized and walked down to the hospital as in the past.”

According to Dr. Shields, the instant image has the added advantage of involving the veterinarian in radiology again. “Although the
x-ray technicians at the track do a great job, this lets me take another shot if I see something that I want to investigate further.” When using his system, another veterinarian holds the plate, which provides an immediate second opinion at the stall side. “The level of service that I can provide to my client is the reason for adding another system, as well as the fact that the machine pays for itself.”

What made these veterinarians choose another IDEXX system?
Dr. Parker bought a second machine from IDEXX anticipating compatibility between the two systems.

Like human hospitals, equine veterinary practices are aware of the DICOM standard for exchanging images, and the potential for connecting digital radiography devices to a network. “Networking the machines might be useful for our hospital,” says Parker. “It would be nice to be able to quickly access radiographs that we have taken in the past and pass them around to assess a case. Right now, we keep a backup disk in the office to make sure the images are always available to everyone in the practice.”

Dr. Shields does not have an immediate need for networking. “Because our practice is mobile, we are less concerned with networking our systems,” says Shields. “Most of the time we go to the patients. It might be useful to be able to transmit images if we needed to compare a new film with older films. However, I can do this by storing an index of lower resolution photos that allow me to access a higher resolution image.” Dr. Shields uses a small handheld system device for displaying low resolution images of the radiographs stored on his digital radiography system.

For these California veterinarians, who constantly move between the racetracks and their practices, a second system supports additional prepurchase business while continuing to provide quick, accurate diagnoses for clients who bring horses to the practice.

Jerry W. Parker, DVM, graduated from Colorado State University in 1976. After two years in mixed practice in New Mexico, Dr. Parker has practiced since exclusively on racetracks in Colorado, New Mexico and California.

Don Shields, DVM, has been an equine veterinarian for 20 years practicing exclusively on Southern California's thoroughbred racetrack circuit. As the scientific and technical advisor for Statison Medical, Dr. Shields invented and oversaw the development of the Statison V, a therapeutic ultrasound device. Recently, Dr. Shields and his wife, Janet, opened one of the few equine ranches in Southern California dedicated to the care and rehabilitation of injured racehorses.

IDEXX at the 2008 Hambletonian

IDEXX is pleased to continue its sponsorship of CE events at the 83^rd Hambletonian Festival of Racing.

The IDEXX wet lab program will continue this year at the 2008 Hambletonian. As part of the continuing education seminar for equine veterinarians, IDEXX will sponsor this hands-on learning opportunity for the third year running. The session spotlights the latest medical techniques and technologies, including the use of the IDEXX EquiView® DR 810 Digital Imaging System. In one of the country’s largest equine CE seminar line-ups, presentations will be given on July 31.

On August 1, Dr. David Frisbie, Assistant Professor, Orthopedic Research Center, Colorado State University College of Veterinary and Biomedical Science, will lead the CE session, “Emerging Diagnostics & Treatment for Lameness.” His current research in joint disease focuses on intra-articular therapeutics as well as new methods surrounding cartilage repair. His talk will cover a number of new findings regarding the diagnosis of and a variety of treatments for lameness and osteoarthritis.

Space in the seminar is limited so it’s important to reserve your place now. For more information or to make a reservation, go to www.hambletonian.org or contact Marie Hegarty of First Choice Marketing at 1-908-347-1718 or marie@firstchoicemarketing.us

3,000 Practice Developer® Points FREE

Invest in an additional IDEXX EquiView® Digital Imaging System (your second, third or fourth…) before June 30, 2008, and you’ll get 3,000 Practice Developer points AND 50% off a laptop upgrade.*

Invest in your first IDEXX EquiView® Digital Imaging System before June 30, 2008, and get 3,000 Practice Developer points.* Use them toward the purchase price of the system or as you see fit on other purchases for your practice.

Call now for more information about these limited-time EquiView Digital Imaging System offers: 1-800-814-1016.

*Offers valid on purchases from April 1 to June 30, 2008.

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For more information and your free Roma saddle pad, go to surpasshorse.com.

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