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Ask the Vet, Sallie S. Hyman VMD, DACVIM: 2013 AAEP Convention
2013 AAEP Convention Highlights
This year’s American Association of Equine Practitioners’ Annual Convention in Nashville, Tennessee was like an early Christmas gift for equine practitioners and the clients and patients they are for. Held December 7-11th, nearly 150 topics, presented and researched by over 300 veterinarians, filled the 5 day convention.
I will attempt to highlight as many topics as I was able to attend and will apologize in advance for not getting to cover every topic (which will also reveal my preferences for certain topics). There was just so much learn and not enough time in which to do it!
The convention opened with a motivational talk by Buck Brannaman. This man’s understanding of the equine mind, natural horsemanship, and outlook on life is inspirational. It was also refreshing to hear someone talk about how horsemanship, or the lack thereof, affects veterinarians and our safety. I highly recommend you check out anything you can find on Buck, if only for his wonderfully dry sense of cowboy humor.
On day 2, Dr. Sue Dyson delivered the Frank J. Milne State-of-the-Art Lecture “Equine Lameness: Clinical Judgment Meets Advanced Diagnostic Imaging.” Her many years of work in the evaluation of lameness have given her unprecedented insight into equine lameness workup and imaging. The take home point of her talk was that we now have the ability to image a lot of structures that we may or may not be able to assign as the cause of lameness and even then, we may not have a way to treat them
A group from Michigan State University College of Veterinary Medicine and the Maxwell Gluck Equine Research Center did a study on the effect of non-steroidal anti-inflammatory treatment at the time of vaccination. Many horse owners know that their horse will have an adverse reaction at the vaccination site or a systemic reaction such as fever, lethargy, and inappetence. Often, owners or veterinarians administer anti-inflammatories such as bute, banamine, or previcox prior to vaccination. The group found that this will decrease both the antibody response and the cellular immune response to vaccination (in this case, to influenza). Some horses will always need pretreatment, but it is good to know that their response may not be as strong, so adjustments can be may to keep them protected.
Several new techniques and observations in lameness have been identified this year. A new technique for injecting the navicular bursa that avoids penetrating the deep digital flexor tendon has been described. A new basilar sesamoid approach for digital flexor tendon sheath in the horse was also described. This technique is very easy to perform and has a very high success rate.
Long thought, but finally proven is the lack of specificity of many regional nerve blocks that are used to “block out” areas of lameness. Studies have shown that the analgesic substances used to perform blocks can travel quite a distance from where they are injected, thus causing analgesia to more structures than planned.
Standardization of drug withdrawal times is a concern in the Thoroughbred racing world, so several studies were performed to establish the pharmacokinetics and clearance of triamcinolone acetonide and methylprednisolone acetate (drugs commonly used for joint injections). Both drugs were below detectable levels in plasma by day 8 after intra-articular injection.
A novel treatment for subchondral cystic lesions in the medial femoral condyle (in the stifle) was presented. Horses with large cyst-like lesions of the stifle usually exhibit lameness and fail to become sound with many traditional treatments. 75% of horses treated by placing a transcondylar bone screw across the cyst returned to soundness and were able to work. Radiographic follow-up showed marked filling in of the cyst.
A session on how to treat a horse with excessive tearing was very useful. Many owners know the frustration of owning a horse with drippy eyes. The most common causes of this problem are environmental irritants that should be managed with a fly mask and functional obstructions that can be caused by inflammation, foreign bodies, or stones in the tear duct. These blocked ducts need to be gently flushed. If the duct opens up, then systemic antibiotics and anti-inflammatories are indicated for 2-3 weeks. Severe cases may require surgery to restore tear flow.
Standing enucleation is becoming more of the accepted norm rather than the exception these days. The procedure has been shown to be well tolerated in properly selected cases. Not all horses will be right for this procedure, but it is a good option for horses who are at risk under general anesthesia.
Cushing’s Disease or Pituitary Pars Intermedia Dysfunction (PPID) was the subject of several talks. Better diagnostic tests have become available that are allowing us to identify horses at a much early age and stage of the disease. A resting ACTH will identify those horses with moderate to severe disease, but a Thyrotropin Releasing Hormone stimulation test is useful in horses with suspected disease, but normal ACTH levels. Pergolide is still the mainstay of treatment.
Equine Metabolic Syndrome (EMS) is defined as hyperinsulinemia, abnormal adiposity, abnormal response to oral glucose testing, a predisposition to laminitis, and high triglyerides. We also have a new diagnostic test to help identify at risk horses earlier. Resting (fasting) glucose and insulin levels again, will identify severely affected horses, but the oral sugar test is very good at catching early disease. This is an easy to perform test whereby the horse’s baseline insulin is measured and is then given an oral dose of Karo syrup. Additional insulin measurements are taken at 60 and 90 minutes later. High levels are indicative of EMS. Dietary management is key in treating EMS. Refractive cases may require drugs such as metformin to help manage insulin levels.
The line between PPID and EMS are not as clear as we once thought. Many horses with EMS will go on to develop PPID. Some horses can manifest both diseases at the same time.
A study was conducted to evaluate the incidence of abortions in pregnant mares undergoing colic surgery. The group found that 70% of mares who underwent colic surgery went on to deliver a live foal, even in mares as old as 15 years. Pregnancy loss was usually in mares in early pregnancy (less than 40 days).
Oviductal blockage can be a cause of infertility in mares. Direct application of prostaglandin to the oviduct may help these mares return to fertility, even after several years of infertility.
Anti-Mullerian Hormone may be a better test for mare with granulosa cell tumors of the ovaries. It should be included in the graulosa cell tumor screen along with testosterone and inhibin.
The Skin Prick Test (SPT) was applied to horses to try to identify allergens that may be triggers for those with Reactive Airway Obstruction (RAO). All horses with RAO were positive to at least 5 allergens. Half of the healthy control horses had positive SPT to 1-3 allergens but with a much lesser degree of reactivity. The SPT may be a step toward determining which allergens are triggering RAO and may lead to specific immunotherapy.
The ever controversial Lyme disease was the subject of a table topic where veterinarians were able to discuss their experiences with the disease. The multi-plex test from Cornell was considered the best diagnostic to date. With doxycycline not available or cost prohibitive, the treatments of choice are IV oxytetracycline or oral minocycline. No vaccines are approved for the horse, but many practitioners are using the canine vaccine off label in endemic areas.
This is just a small sampling of the topics that were covered at the 2013 AAEP Convention. It was a great opportunity to meet with colleagues, share experiences, and learn the latest information on everythine equine. Ask your veterinarian what they learned! I am sure they will be happy to tell you.
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