ModernEquineVetOct12

Equine vets take hard hit

Recession:

Relieving laminitis painConsider acupuncture for pain reliefAVMA: Issues over prescriptionsExporting horses

Equine VetThe Modern

October 2012 | Vol 1 No 4www.modernequinevet.com

2 October 2012 | ModernEquineVet.com

TAblE of ConTEnTs

OrThOpedics

pain relief in laminitis ............................................................................ 8Recent study found adding ketamine to tramadol helps

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Alternative method of pain relief ....................................................11Acupuncture might be good choice for pain relief

TechNiciAN UpdATe

Lots of oversight when exporting horses ...... 16Protect our nation’s horses is the primary goal

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Unsettling pictureEquine medicine hit hard by recession

FeedbAg

20 hay or haylage appropriate for performance horsesNUTriTiON 19 Nutraceuticals for OA? Where’s the science?iNFecTiOUs diseAses 14 Keys and doors found for tick-borne bacteria

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Cover photo by Nastenok/shutterstock

ModernEquineVet.com | October 2012 3

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[email protected]



Equine medicine, which grew during the past two decades, has been harder hit by the current economic recession than most other vet-erinary practices and that is causing significant changes to the industry, according to the Na-tional Academy of Sciences (NAS).

A new report, “Workforce Needs in Vet-erinary Medicine,” highlights trends that are affecting veterinary practices, most notably a decrease in the number of equine practitioners.

“An estimated 122 new equine veterinar-ians are needed each year to maintain the size of the current workforce,” the report said, cit-ing American Veterinary Medical Association (AVMA) annual surveys of new veterinary school graduates, which found “a much smaller number of new veterinarians are taking jobs in

equine practice, ranging from a high of 66 in 2006 to 37 in 2011.”

As a result, equine veterinarians are aging. The average age of equine practitioners in-creased from 44 to 46 years between 2001 and 2007, according to the American Association of Equine Practitioners (AAEP), and AVMA projected that by 2013 only about 50% of its members who are equine practitioners will be younger than 50.

NAS cited a number of inter-connected fac-tors driving the advancing age of equine practi-tioners. “First, there is an inadequate number of new graduates willing to make long-term com-mitments to equine practice, a situation likely to be exacerbated by increasing levels of student debt that put practice ownership out of reach.” m

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Where the Money Isn’t:The mean starting salary for an equine veterinarian, carrying more than

$142,000 college debt is $43,405.

Don’t worry new graduates .... the expected earnings loses will eventually fade in 8 to 10 years!

Where the Money Is:Total personal income among AAEP members shows that respondents

50-59 commanded average salaries of $155,740, while those older than 60 averaged $160,240.

-- NAS report: Workforce Needs of Veterinary Medicine



How bad is the debt load for new vets? “In 2011, it was $142,613, a 6.5% increase over the previous year,” the report said, noting that translates into annual debt payments of more than $10,000 for starting vets. “With the starting pay offered in equine practice, a new graduate with a family would have few earnings on which to live,” the report warned.

One-third of graduates entering equine practice in 2009 had debt equivalent to four times their starting salary. “It is difficult to see how new graduates can make ends meet let alone consider practice ownership, without a supplementary source of income,” the report said.

The mean starting salary for equine practitioners was $43,405 a year in 2010, less than the $46,971 annual salary for all vets, which was a decrease of 3.5% from the year be-fore. Which is why, the report stated, “Young equine practitioners are aware that their classmates in small animal practice have higher starting salaries, better work hours and expe-rience less stress, risk of injury and emergency work.”

These factors are leading to a significant trend: more women are joining a once male-dominated pro-fession. In the next several years, women could outnumber men. The report points to a 5:1 female-to-male ratio among current AAEP student members and among members in the under-30-year-old category.

“In the foreseeable future, a ma-jority of new graduates entering equine practice will be women, who may be likely to seek accommoda-tions to fulfill family responsibilities while being no less committed to succeeding in practice,” the report said. “Large group practices, re-gional equine centers, involvement of paraprofessionals, and part-time work can accommodate the sharing of clinical duties and provide cover-age for family emergencies, mater-nity leave and elder care.”

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— NAS report: Workforce Needs of Veterinary Medicine

No. of U.S. Horses by Activityracing (Thoroughbred and standard bred) 844,531showing (jumping, dressage, reining, performance) >2.7 million

recreation (trail riding) >3.9 millionOther (includes draft, ranch, rodeo, police and carriage) >1.7 million

ToTAl >9.2 million

Equine Practices Devoted to Horses % of practice devoted to equine % of AAep membership 100 44.9 75-99 21 50-74 8.4 25-49 9.1 1-24 12.2 not reported 4.3



For more information:

Kelly MA, Allen SW, et al “Workforce Needs in Veterinary Medicine” Available online. National Academy Press Washington, D.C. Accessed October 5, 2012 at http://dels.nas.edu/Report/Workforce-Needs-Veterinary-Medicine/13413

Despite the starting salary, equine medicine can be lucrative. The report cited a 2007 survey of total personal income among AAEP members that revealed that respondents 50 to 59 years old had average salaries of $155,740 while those older than 60 averaged $160,240. “At $190,000, practitioners who focused on the racing industry have traditionally earned the highest salaries, and most practitioners in this category were men. Those working with increas-ingly valuable performance horses now vie with racetrack veterinarians for the best salaries.”

Practitioners younger than 30 are mainly women, and earn an average of $48,280 per year because of their junior status. “For those graduating in 2009 with the misfortune of en-tering the workforce during a reces-sion, the initial earning losses can be expected to eventually fade away after 8 to 10 years, according to an optimistic study on short- and long-term career effects of graduating in a recession,” the report said.

The report pointed to another result. “Senior equine veterinarians are unable to sell their practices and are, therefore, continuing beyond their originally planned retirement age. Thus, the aging of equine prac-titioners appears to be a result of the inadequate number of younger vet-erinarians entering equine medicine to replace those leaving and retiring.

“The difficulty of delivering equine care in rural areas, where the population of mixed equine/food-animal practitioners who have tradi-tionally provided services to most of these animals is now declining.

“This is likely to require new ways of delivering equine veteri-nary services and may provide the

needed impetus for the creation of emergency equine services.”

With the decline in horse racing because of the economic downturn, there has been a shift in veterinary care away from the track to sport,

performance and recreational hors-es because of their increased popu-larity. That represents a bright spot for the industry.

“In contrast to the thoroughbred industry, values of performance horses, dressage, show jumping, bar-rel racing, and endurance event ani-mals have risen significantly in the past 20 years, and owners now ex-pect standards of care comparable to that historically provided to the best thoroughbreds,” the report stated.

“In response, regional equine centers have developed to provide advanced care to sick and injured sports horses, and veterinary para-professionals are increasingly need-ed to provide all-hours care in these

centers,” the report continued. “Be-cause of the unique demands placed on horses in different sports, each activity is associated with distinctive health problems, and many equine veterinarians are specialized to serve one or more of these specific con-stituencies.”

While noting that “show jump-ing, dressage, barrel racing events, pleasure riding and other equine sports remain energetic,” the re-port cautioned, “given the present conditions of practice and financial circumstances, it is difficult to at-tract and retain adequate numbers of young graduates in the profession.”

The industry must consider the challenges related to low starting sal-aries, a shift in gender and an aging workforce to address future work-force needs.

“The NAS report confirms sev-eral trends that the AAEP has been noting in recent years, particularly rising student debt, demographic shifts and lower starting salaries for new graduates,” said Sally Baker, AAEP director of marketing and public relations. “The AAEP is bringing personal and professional wellness issues to the attention of our membership, including the need for alternative work sched-ules, which are important to the new generation of equine practitioners. Many new graduates are choosing internships, which produce long-term career benefits but contribute to lower starting salaries during the first year of practice. And certainly the recession affects both new and veteran equine practitioners. The AAEP is committed to helping the profession navigate this challenging time, and the NAS report is an ex-tremely valuable tool.” MeV

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“Pain due to laminitis is com-mon in horses and may cause severe suffering and debilita-tion. Yet, effective and safe pain therapies are limited,” said Alon-so G.P. Guedes, DVM, PhD, DACVA, assistant professor of anesthesiology at University of California, Davis, College of Veterinary Medicine. “There is a great need for novel, more effec-tive and safer therapeutic modali-ties to control pain in horses.”

The researchers wanted to evaluate whether the two pain killers, tramadol and ketamine, could provide relief to horses with naturally occurring pain due to laminitis. Tramadol is com-monly prescribed to people for pain relief, and ketamine is a general anesthetic. In this study, ketamine was used at a sub-anes-thetic dose, Guedes explained.

In the randomized, crossover study, the researchers treated 15 privately owned horses with lam-initis. Each horse received either tramadol alone or with ketamine. The tramadol (5 mg/kg) was

given every 12 hours for 7 days. When appropriate, infused ket-amine (0.6 mg/kg/h) was added

to the regimen and given for 6 hours for the first 3 days. Because of the nature of the crossover de-

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Recent study found that adding ketamine to tramadol significantly decreased pain in horses with laminitis.

The four independent plates measure the weight distribution on each limb. While healthy horses carry approximately 60% of the body weight on the forelimbs, horses with forelimb to laminitis shift some of that weight to the hindlimbs (down to approximately 50% in their study). The weight is shifted back to the forelimbs as the pain is relieved.

laminitis


sign, each horse served as its own control.

“The minimum exposure to ketamine (dose and duration) that is still capable of producing beneficial effects is unknown. We showed that three days of ex-posure to ketamine, for a period of six hours each day, produced beneficial results. This proto-col was chosen largely based on NMDA-receptor physiology, which is targeted by ketamine, and also practicality in adminis-tering ketamine.

“Clinically, we have adminis-tered infusions of sub-anesthetic doses of ketamine continuously for days without seeing important ad-verse effects. However, each case should be evaluated and treated in-dividually,” Guedes said.

The researchers assessed re-sponse by quantifying changes in forelimb off-loading frequen-cies and in total forelimb load. In addition, they assessed changes in arterial blood pressure and plasma concentrations of tumor necrosis factor-alpha (TNF-α), a pro-inflammatory and pro-noci-ceptive molecule.

They found that horses receiv-ing tramadol and ketamine ex-perienced a significant decrease in arterial blood pressure, while those that received just tramadol did not. In addition, off-loading frequency was reduced in the ket-amine-treated horses both during and after treatment.

“These findings strongly sug-gest that tramadol when com-bined with ketamine may be used

to reduce pain and suffering in horses with laminitis,” he said, adding that ketamine significant-ly improved the analgesic effects of tramadol.

Guedes could not say whether combining ketamine with other analgesics would be useful, since other medications were not stud-ied. “However, in cases of lamini-tis that are not responding well to analgesics, such as NSAIDs and opioids, ketamine may be very beneficial since NMDA receptors play an important role in persis-tent pain states,” Guedes said.

The researchers chose trama-dol and ketamine because there is evidence in laboratory animals, as well as human studies, which demonstrate these two medica-tions can reduce neuropathic

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The force plate system used to quantify the limb load distribution on the horses used in the study.


pain, as well as, decrease the plasma levels of pro-inflamma-tory/pro-nociceptive substances, such as TNF-α.

“Neuropathic pain is likely present in horses with lamini-tis and is typically difficult to control with NSAIDs alone,” he said. “Plasma concentration of TNF-α is substantially elevat-ed in horses with laminitis and likely contributes to neuropathic pain. Treatment with tramadol plus ketamine caused significant reduction in both pain level and plasma concentrations of TNF-α.

“Ketamine may not be as ben-eficial in cases where neuropathic pain is not present, but likely will

not cause adverse effects when used at a sub-anesthetic dose as was done in our study,” he said.

Some horses became slightly hypersensitive to noise or showed mild muscle fasciculations during ketamine administration. It would be prudent to avoid ketamine or use it with caution in horses al-ready showing these types of be-haviors or signs, he warned.

Horses with laminitis show behavioral and neurobiological changes suggestive of “wind-up” pain. Much of this pain stems from changes in nociceptive neurons that are mediated by the activity of NMDA receptors that are chronically and/or maximally

activated. Ketamine is a good NMDA-receptor antagonist and might prevent or reverse some of these changes. “The result is that the pain relief can last well beyond the normal expected du-ration of drug action, as we dem-onstrated in our study,” he said.

Although the combined medi-cations did have a positive bio-logical and clinical effect on the horses, the horses were still very painful, Guedes reminded.

“We still don’t fully under-stand the underlying mechanisms of this painful condition. Further studies are clearly warranted and much needed,” he said. MeV

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Guedes AGP, Matthews NS, Hood DM. Effect of ketamine hydrochloride on the analgesic effects of tramadol hydrochloride in horses with signs of chronic laminitis-associated pain. AJVR. 2012;73:610-619. http://www.ncbi.nlm.nih.gov/pubmed/22533391

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— AVMA 2012 US Pet Ownership and Demographics Sourcebook

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CAM

Acupuncture could be a good modality for some painful patients. However, some veterinarians might be reluctant to suggest it because at first glance, traditional Chinese medicine does not seem to “jive” with science.

Yet, acupuncture can increase the choices that a veterinarian who practices conventional West-ern medicine can offer his or her equine patients.

“Acupuncture appears to work because it dampens pain transmis-sion in the nervous system, which means it turns down the ‘volume’ of painful impulses entering the spinal cord and brain, and changes our emotional state and reaction to painful stimuli, said Narda G. Robinson, DO, DVM, MS, DABMA, FAAMA, director of the Center for Comparative and Inte-grative Medicine at Colorado State University and assistant professor in the department of clinical sci-ences. “Sophisticated brain imag-ing techniques have told us which parts of the brain are responding to acupuncture and when, provid-

ing a ‘real time’ window into brain function during and after acupunc-ture,” Robinson told The Modern Equine Vet.

Acupuncture affects many ar-eas of the nervous system simulta-neously. It affects the nerves near the needle in the periphery, as well as, those entering the spinal cord that interact with nerves affecting multiple functions, including inter-nal organ activities.

It can be helpful for many pain-ful conditions, including musculo-skeletal pain and colic.

“That’s where the intricate in-ner workings of the nervous sys-tem come into play, where the knowledge of where acupuncture signals from one part of the body interact with others illuminates re-flex activity that connects points on the body surface to the health and responsiveness of organ system activities,” said Robinson, who founded the medical acupuncture for veterinarians program at CSU.

According to Chinese medi-cine, the invasion of environ-mental agents, such as cold, wind,

dampness and heat cause pain, and “Yin and Yang upset” dis-rupts organ function. Acupuncture corrects these disruptions, but to many of today’s veterinarians that does not sound like science.

“The practitioner develops the ability to feel the ‘chi flow’ or life-force as it moves through the points and channels. She or he then works with this to achieve the results. This chi can be measured with in-struments just like air flow can be felt and measured,” explained Al-lan Moffatt, B.Sc., B.Acup, direc-tor of the International College of Equiine Therapies, Australia.

Acpuncture has positive effects on the nervous system. “Acupunc-

Acupuncture

Can be helpful for many painful conditions like musculoskeletal pain and colic.



might be good choice for someequine pain

Photo courtesy of Allan Moffatt D.Sc., B.Acup

Horse receives acupuncture for pain.


ture is real medicine, based on anatomy and physiology. Getting the best results comes from seeing what’s right in front of us — mus-cle tension, imbalances in the ner-vous system and the health impact of stress, malnutrition and under-

or over-exercise,” she said, adding that it is not mysticism.

Acupuncture can be comple-mentary. Veterinarians can treat the horse with Western medicines and also recommend acupuncture as an adjunct therapy. And owners are fa-miliar with acupuncture; many use it for their own pain. A recent report by the National Institutes of Health found that 7 in 10 adults and 1 in 9 children are receiving some type of complementary or alternative medicine treatments.

Among the first to consider CAM options were doctors, such as surgeons and oncologists, who managed painful patients. They recognized early that add-ing CAM to conventional medi-cine can have positive effects on the pain receptors. The American College of Physicians even listed

acupuncture, chiropractic adjust-ment and massage therapy among its recommendations for treat-ing human back pain in its 2008 guidelines.

Before recommending an acupuncture practitioner, Robin-son suggested that veterinarians find out the facts about Chinese medicine. “Gain a feel for what’s ‘hype’ and what’s real. Find a practitioner who can explain how the treatments work, whether they be acupuncture, massage, herbs, or dietary supplements, so that you understand, and find out the relative risks and benefits of various treatments first,” she said.

If you feel uncomfortable about their claims, credentials, or how the animal responds to them, recommend a different practitio-ner. MeV

CAM


Robinson NG. “Making sense of the metaphor: how acupuncture works neurophysiologically.” The Journal of Equine Veterinary Science. 2009;29:642-644. http://www.j-evs.com/article/S0737-0806(09)00550-4/abstract

For a more traditional approach to understanding how equine acupuncture works see this article;http://horse2spirit.blogspot.com.au/2009/03/how-does-equine-acupuncture-work.html

The Center for Veterinary Health Sciences, Oklahoma State University is looking for someone to head the department of veteri-nary clinical sciences. Candidates must hold a DVM or equivalent veterinary degree, board certifica-tion and/or a PhD degree, and the credentials necessary for appoint-ment to Professor. The successful candidate will direct and maintain excellence in departmental teach-ing, research and clinical services and promote individual faculty development and scholarship. Well-developed organizational

and interpersonal skills are a must, as well a the ability to pursue indi-vidual professional goals in teach-ing, clinical service, or research.

The department has about 35

faculty, 23 house officers, and 70 hospital and department staff members who provide care for more than 11,000 clinical cases/year. MeV

oklahoma state University seeks head veterinarian

Submit letter, CV and statement of educational, research and service philosophies, and the names and addresses of 3 references by Nov. 15 to:

Dr. James MeinkothChair of the Search Committee Center for Veterinary Health Sciences,250 McElroy Hall, Stillwater, Oklahoma 74078-2005phone: 405-744-452 • email: [email protected].

Review of applications will continue until a suitable candidate is identified.

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It might seem unlikely, but grazing horses might help save a child from needing an emergency room during an asthma attack. Virginia Buechner-Max-well, DVM, MS, DACVIM, is studying equine re-spiratory disorders in hopes of finding better treat-ments for human asthma.

About 25.7 million people with asthma live in the United States. Asthma accounts for 1.1 million non-emergency hospital visits, 1.9 million emergency room visits, and 440,000 hospitalizations in the Unit-ed States each year, according to Centers for Dis-ease Control and Prevention (CDC). Approximately 3,400 people die from asthma attacks annually.

Equine and human immune responses are trig-gered by such things as pollen, dust, exercise, weath-er and debris from mites. When the immune system battles invasive materials, the airways become in-flamed, mucus builds up and airway muscles tighten.

Equine heaves are similar to asthma in older people because both may experience worsening dis-ease and long-term lung damage. Younger horses also experience equine inflammatory airway disease, which shares some similarities with human pediatric asthma.

In either case, treatment for horses and people is the same: eliminating as many triggers as possible and taking some of the same drugs. Horses can be fitted with mask-type devices that cover their nostril and allows them to breath in the medication just like people.

“Horses are superb models for studying airway

diseases because they develop these illnesses spon-taneously like humans,” said Buechner-Maxwell, professor, clinical services/medicine/equine and pro-duction management medicine at Virginia-Maryland Regional College of Veterinary Medicine. “They are the only animal besides people that experience

chronic changes in the disease as they age.”She is studying the reasons for airway

inflammation and remodeling, as well as how the treatments affect immune response and the long-term ramifications.

“Because horses and humans respond to similar therapies, information learned from studying horses may allow us to better understand how these medications affect people,” Buechner-Maxwell said.

“My hope is that by better understand-ing the events that lead to the ‘inappro-priate’ response of the immune system in diseases like heaves and asthma, more can be learned about what promotes and maintains the normal immune response,” Buechner-Maxwell said. MeV

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helping horses and children breathe easier

Because horses and people with respiratory problems share similar symptoms, Dr. Virginia Buechner-Maxwell is looking at the equine respiratory system and problems that it has in hopes of finding better treatments for people with asthma.

nIh accepting applications for loan repayment program

Veterinarians can receive up to $35,000 annually to repay student loans through the National Institutes of Health Loan Repayment Program. An applicant must be a U.S. citizen, U.S. national, or permanent resident of the U.S. and must have a doc-toral degree from an accredited institution. The program ben-efits individuals who are or will be conducting nonprofit bio-medical or behavioral research. Opportunities are available in

five research areas — clinical, pediatric, health disparities, contraception and infertility, and clinical research for

individuals from disadvantaged backgrounds. The application deadline is Nov. 15. MeV

Learn more at www.lrp.nih.gov

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Virginia Commonwealth University School of Medicine researchers have identified the “keys” and “doors” of a bacterium responsible for a series of tick-borne diseases. These findings may point researchers toward the development of a single vaccine that protects against members of an entire family of bacteria that cause disease in humans, horses, and other animals.

Survival for many bacteria depends on their ability to invade human or animal cells. And it needs to be precise. Bacteria use a specific set of “keys” on their surfaces to unlock specific “doors,” or entry ways into their host cells.

By understanding how these bacteria invade cells, researchers are able to identify potential targets to block the spread of infection, and from there, develop safe and effective vaccines.

In the study, published recently in the journal Infection and Immunity, a journal of the American Society for Microbiology, researchers reported that a protein called OmpA on the surface of Ana-

plasma phagocytophilum is important for invad-ing host cells. A. phagocytophilum is an Anaplas-mataceae bacterium that infects humans to cause granulocytic anaplasmosis. It is the second most common tick-borne disease in the United States after Lyme disease, and it also is found in Europe and Asia.

The team also identified the particular sugar residue on the surfaces of host cells to which OmpA binds.

“In other words, we identified both a key and door that together promote A. phagocytophilum infec-tion,” said lead investigator Jason A. Carlyon, PhD, associate professor and a George and Lavinia Blick Scholar in the department of microbiology and im-munology in the VCU School of Medicine.

“These findings are important because our data also establish a direction for development of a single vaccine that protects against members of an entire family of bacteria that cause disease in humans, domestic animals and livestock,” he said.

According to Carlyon, the region of OmpA that mediates infection is shared among other Anaplas-mataceae bacteria.

Experts have seen a steady rise in the incidence of human infections caused by tick-transmitted bacterial pathogens in the past several years. However, evidence suggests that many of these infections go unrecognized, signifying that the prevalence of human diseases caused by Anaplas-mataceae pathogens is even higher, said Carlyon. Livestock infections carry a significant economic burden, costing the U.S. cattle industry $100 mil-lion per year, he added.

Researchers in Carlyon’s lab are presently re-fining their understanding of how OmpA promotes infection and testing its efficacy in protecting against infection by A. phagocytophilum and other Anaplasmataceae members.

The team is seeking commercial partners to fur-ther develop this technology. MeV

Researchers find ‘keys’ and ‘doors’ that help tick-borne diseases beat the immune system

Two Anaplasma phagocytophilum bacteria that are bound to the surfaces of host cells. The bacterium on the right is invading its host cell by triggering its own uptake. A team of VCU researchers led by Jason Carlyon, Ph.D., has identified a key mechanism by which this pathogen invades host cells. Their findings provide a direction for developing a vaccine against A. phagocytophilum and related bacterial pathogens.


Ojogun N, Kahlon A, Ragland SA, et al. Anaplasma phagocytophilum outer membrane protein A interacts with sialylated glycoproteins to promote infection of mammalian host cells. Infect Immun. 2012 Nov;80(11):3748-60. doi: 10.1128/IAI.00654-12. Epub 2012 Aug 20. http://iai.asm.org/content/80/11/3748.abstract?etoc stract

The American Veterinary Medical Association (AVMA) reported issues with two government agen-cies over the writing of prescriptions.

The AVMA spoke out against a proposed federal mandate on prescription writing during an Oct. 2 workshop hosted by the Federal Trade Commission (FTC) that looked at competition and consumer pro-tection issues dealing with pet medications.

Experts discussed the distribution of pet medications and whether H.R. 1406, the proposed federal law that would mandate pet owners receive a copy of veterinary prescriptions, is necessary. The AVMA pointed out that many state regulations mandate prescription portability and the AVMA’s Principles of Veterinary Medical Eth-ics state that veterinarians should provide clients with a written prescription when requested.

The AVMA maintains that veterinarians are uniquely qualified to deliver professional guidance, support and education to pet owners when it comes to providing clients with prescriptions for their pets and assisting them in learning to properly administer medications.

Veterinary clinics are just one of many supply chan-nels for pharmaceuticals sold in the United States.

“Essentially this is a solution without a problem,” said panelist Mark Cushing , founding partner of the Animal Policy Group and partner at Tonkon Torp LLP. “Vet-erinarians routinely provide prescrip-tions to their cli-ents.”

Ve t e r i n a r i a n s maintain that com-plying with mandatory regulations included in H.R. 1406 would prove burdensome to the aver-age veterinary practice, which is generally a small business with only one vet-erinarian and approximately six employees.

In addition, the proposed federal legislation leaves vet-erinarians open to potential ethical and legal liabilities, as well as a great deal of confu-sion. Seventeen states require a veterinarian to provide pre-

scriptions upon request. An additional 10 states have adopted into law or included in their regulations the AVMA Principles of Veterinary Medical Ethics, which state that veterinarians should honor a client’s request for a prescription. Veterinarians worry that, should the new law pass, those filling the prescriptions will not be trained in veterinary pharmacology and, as a result, mistakes will be made and adverse events will esca-late, some possibly proving to be fatal.

More than 500 comments about the issue have been submitted to the FTC. The comment period clos-es Nov. 1. The AVMA encouraged all veterinarians to add their voices and experiences to those of their colleagues by commenting on the FTC site. https://ftcpublic.commentworks.com/ftc/petmedsworkshop/

In other AVMA news, Congress might consider legislation to counteract federal drug rules that prohib-it many veterinarians from carrying and administering controlled substances at clients’ properties. This could have many implications for equine practitioners.

Officials with the Drug Enforcement Administra-tion claim veterinarians need to keep controlled sub-stances in one place or register every location where they will be used. The agency indicates the restrictions

are mandated by federal law, and leg-islation would be needed to change them.

Jeff A. Blea, DVM, vice presi-dent of the American Association of Equine Practitioners and a racetrack practitioner in Southern California, hopes the controlled substances laws will be re-evaluated and rewritten so that it does not ignore the needs of equine patients and veterinar-ians.

Many equine veterinar-ians work out of their trucks and can drive 30 miles between calls to see pa-tients. They must be able to treat patients in their barns. Clients will suf-fer if the veterinarian cannot access seda-tives, muscle relax-ants, and euthana-sia solution when needed. MeV

AVMA: Issues over writing prescriptions

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Veterinary technicians can play an important role in help-ing veterinarians make sure that horses exported from the United States are healthy. The quarantine process is filled with hurdles and

paperwork, so familiarize yourself with the process and the required paperwork.

“A lot of documentation is re-quired. The best way to negotiate through the reams of paperwork is to talk to someone who has done it before. Hook up with someone who is experienced with importing and exporting horses,” said Tra-cy Norman, VMD, DACVIM, clinical assistant professor, Texas A&M University College of Vet-erinary Medicine.

To export a horse, the veteri-narian and technician must under-stand the export health require-ments of the destination country, and of any requirements in any country the horse might travel through during its journey to its final destination.

Each country develops its own regulations about importing and exporting animals. The require-ments will determine the quar-antine times, and which health certificates, tests and vaccinations are needed before the animal can be shipped, according to Kenneth S. Davis, DVM, director of the USDA-APHIS New York Animal Import Center. Davis suggested

that veterinary clinics contact the USDA with any questions or con-cerns. (www.aphis.usda.gov/im-port_export/index.shtml)

“The veterinarian should work with a qualified horse ship-ping agent,” suggested David Hasenauer, president and CEO of JetPets Inc., located in Los Angeles, a privately owned and operated quarantine facility under contract with USDA. “They will help the vet with the proper ex-port health certificate and advise them on required shots and test-ing. They are not veterinarians but do this on a daily basis and should be up on all the latest regulations. They will also help coordinate the timing for tests and inoculations.”

Although private veterinarians normally are not involved in the actual importation of horses into the United States, they might play a role in the purchase of the animal, often reviewing radiographs be-fore the animal is purchased. Some even have the opportunity to travel to the country of origin to examine the animal. Once the animal is re-leased from quarantine, they might be asked to examine it, give it its initial vaccinations and deworm-


TEChnICIAn UPDATE

Lots of oversight needed toexport horses

Getting ready to fly.

Each country develops its own regs about importing and exporting animals.


ing, and coordinate its introduction into the barn.

The primary purpose of regula-tions for importing a horse in the United States is to protect the na-tion’s horse population. A horse imported into the United States must have a current health certifi-cate signed by a veterinarian and certified by officials from the coun-try of origin to assure the horse is healthy and does not carry any in-fectious diseases or ectoparasites.

In addition, the health certificate must certify that the horse stayed in the exporting country for 60 days immediately before importation, and had not visited a facility that had an outbreak of African horse sickness, dourine, glanders, surra, epizootic lymphangitis, ulcerative lymphangitis, equine piroplas-mosis, equine infectious anemia (EIA), contagious equine metritis, vesicular stomatitis or Venezuelan equine encephalomyelitis, within 60 days of the shipping date.

The certificate also ensures that the horse has not been in a country where contagious equine metri-tis (CEM) exists, nor has had any contact with horses from such a country for the 12 months preced-ing exportation.

The USDA does not require any vaccinations before shipping a horse to the United States. It still might be a good idea to make sure horses are up-to-date on their vaccinations, but they cannot be shipped to the United States if they received a live, attenuated or inac-tivated vaccines within 14 days of the trip. The health certificate must note if the horse was vaccinated before shipping and when that was done.

Once its documentation is in or-der, the horse is shipped, usually by air in a jet stall, which is a specially

made shipping stall that houses about three horses or five foals.

When it arrivesEvery horse that enters the

United States from any country, except Canada, will be quaran-tined for at least three days, but the timing depends on the country of origin, the results of blood tests and whether the horse develops

a fever or other signs of illness while in quarantine. Horses from South America and some other countries require a seven-day quarantine. Horses from Africa and some other countries require a 60-day quarantine.

Horses coming from Canada require a recent health certificate, a negative Coggins test and an in-spection by border veterinarians before entering the country.

Upon arrival, horses are loaded onto a truck and shipped to the

quarantine facility, which is on or near the airport. Three USDA fa-cilities in the United States handle the imported horses: Miami, New-burgh, N.Y., and Los Angeles.

At the quarantine facility, the horse is disinfected to prevent dis-eases, such as hoof and mouth dis-ease, and then isolated. Staff and veterinarians examine the horses and monitor them while they are

in quarantine. Blood is drawn and tested at the laboratory at Ames, Iowa, to test for EIA, dourine, glanders and equine piroplasmo-sis. The horse’s temperature is monitored daily because it must have three temperatures under 101.5° F for the last 24 hours of the required quarantine to be re-leased.

“We don’t release a horse if he has a fever. His stay would be ex-tended until we deem that he is not a threat,” Davis explained.

Animals arriving at JepPets Inc., a privately owned quarantine facility owned and operated under contract with USDA.Ph

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www.aaevt.org

Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.

Are you aware the AAEVT is a professional equine association for not only your technicians and assistants but for your entire support staff as well? Membership is open to all veterinary technicians, assistants, practice managers, support staff and those employed or involved in the veterinary health care industry worldwide. We offer student memberships for those enrolled in an AVMA/CVMA accredited VT program.

The primary objective of the AAEVT is to provide continuing education opportunities and training avenues, as well as to improve communications and enhance networking. By keeping

members updated regarding current skills and issues within the profession, we continue to educate and promote the role of the technician as a profession to the veterinary community and general public. The end result being, to work more effectively and efficiently with veterinarians to continue to add value and provide the best care possible to improve the health and welfare of the horse.

• Equine specific continuing education opportunities which include members only registration fee discounts at AAEVT hosted regional CE meetings and at the annual AAEP convention, including TEVA and NEAEP. (Savings of $200.00 or more!)

• Networking opportunities to enhance staff member’s training opportunities that can add value to any practice.

• Biannual newsletters and our weekly email newsflash “HoofBeats” on Industry news.

• Full website access, including our Career Center with job opportunity postings.

• On-line access to industry articles, proceedings and webinars.

• Eligibility to participate in the ACT AAEVT On-Line Equine Certification Program.

• Eligibility for credentialed technicians to join the AAEVT Academy, AEVNT (Specialty in Equine Nursing).

• 20% discount on purchase price of the AAEVT Equine Manual for Veterinary Technicians published by Blackwell Publishing.

• NTRA, Platinum Performance and Working Advantage member benefits.

• Scholarships toward AVMA programs, AAEVT online Equine Certificate program and attend ing Regional CE meetings

• Eligibility to be invited to attend the Purina Equine Veterinary Technician Conference in St. Louis, October 14th-16th as a guest of Purina – all expenses paid!

Member benefits include:

For additional information, to join online, or to obtain a membership application, visit www.aaevt.org.Encourage and support your staff to join today!

If the blood work is positive for EIA, dourine, glanders or equine piroplasmosis, the United States will refuse the horse entry, and it will be returned to the country of origin. Since the owner could pay more than $10,000 to ship the horse back, most people make sure the horse is healthy before it enters the country, experts said.

Few horses are refused entry to this country. Each facility refuses entry to fewer than 1% of the hors-es in any given year, according to Davis.

The recession has affected the import and export of horses, just as it has affected the rest of the equine industry. “The economy has severely cut back on the im-portation of horses, at least on the West Coast,” said Hasenauer. “We are importing around 700 to 800 a year, which is down from

a high of about 2,600. For the sport horses, we brought in maybe 500 last year. I think we service an area that has around 100,000 sport horses (jumpers, dressage and hunters), so that means we replaced only around 1/1 percent by import. With the attrition by age and injury, the industry shrank drastically.”

Moving targetThe USDA monitors disease

outbreaks all around the world, and can implement temporary requirements during an outbreak that could affect importations and exportations until that outbreak is under control, so it is a good idea to check for updates regularly.

“Our import-export staff moni-tors these situations,” Davis said. “If something arises, they have the authority to temporarily change

the regulations. Our function as veterinary services is to protect our national horse population. That is our first priority.”

Because diseases don’t rec-ognize international borders, it can be difficult to keep them out of the country. It might surprise you to know that the quarantine facility is actually the last line of defense — not the first. The first line of defense is the country of origin.

A 42-hour quarantine period is probably not going to keep out a rare disease, Hasenauer said. “You have to work with your trade partners internationally, and that is what USDA does.”

There are so many ways dis-eases could enter this country that the USDA and people in the busi-ness must keep an eye on what is happening around the world. MeV

TEChnICIAn UPDATE


There is not a lot of good scientific evidence that vi-tamin C cures colds, yet, at the first sign of the sniffles, millions of people start drinking extra orange juice and taking vitamin C tablets.

Using nutraceuticals for equine osteoarthritis is sort of like that, according to a report in the Journal of Vet-erinary Medicine, except that they are a lot more expen-sive than vitamin C tablets. Without good science to go on, veterinarians, owners and trainers are giving their horses nutraceuticals that might not mitigate the effects of osteoarthritis.

It’s not that these nutraceuticals do not work, it is that there are not enough rigorous randomized, controlled trials to demonstrate their efficacy in all animals, espe-cially in horses, said Jean-Michel Vandeweerd, DMV, MSc, PhD, Cert Equine surgery, DECVS, a professor of veterinary medicine at the University of Namur in Belgium.

Vandeweerd and his colleagues performed a sys-temic review of the literature testing the efficacy of nu-traceuticals to alleviate the signs of OA. They looked at five equine studies, 16 canine studies and one feline study and found that there was not good evidence to support their clinical effects in all three species.

According to the criteria of the review, the best evi-dence seems to come from the use of omega 3 fatty ac-ids in dogs, although the authors admit that if they had put more criticism on clinical effects and not only on statistically significant results and not included repeat studies by the same team, the fatty acids would not have reached the highest level, according to Vandeweerd, who wrote a letter to this effect after the review was published.

“The study shows that there is no scientific evidence to use nutraceuticals to improve clinical signs of os-teoarthritis, i.e. lameness and abnormal locomotion,” Vandeweerd told The Modern Equine Vet.

That is not to say that there isn’t some positive ef-fects, he continued. “Those supplements may have a modifying effect of the disease: this means that a bio-logical effect may be present that helps other treatments to work better, for example.”

Without good, clinical trials that are randomized and controlled, there is no way to prove this idea

though, he added. The reviewers only looked at studies published be-

fore 2010. They found 67 studies, but on closer look, only 22 studies met their criteria for inclusion in the re-view. Studies were excluded for a number of reasons, such as not evaluating clinical signs of pain or locomo-tion. They also excluded in vitro studies because they

are harder to “generalize to the population of animals and are less useful to answering clinical questions re-ferring to improvement of signs of pain and abnormal locomotion,” the researchers wrote.

“In this review, it is the potential of nutraceuticals to alleviate the clinical signs of OA that was evaluated, rather than any potential disease (structure)-modifying effects,” they wrote.

What they found is that this lack of scientific evi-dence doesn’t really leave the veterinarian in a good po-sition, because he or she must make treatment decisions without the data to support them. The lack of data makes Vandeweerd leery about recommending nutraceuticals for OA in horses.

However, owners and trainers might insist, he said. In those cases, he recommended that veterinarians ex-plain the scientific limitations in the data supporting the use of nutraceuticals for osteoarthritis.

And he strongly urged that companies and univer-sity undertake more studies in what could be important products. “Nutraceuticals are commonly used or recom-mended nowadays. It is important for veterinarians and consumers to make appropriate decisions based on the best scientific evidence,” he said. “I think more research needs to be done on these.” MeV


Vandeweerd JM, Coisnon C, Clegg P, et al. Systemic review of efficacy of nutraceuticals to alleviate clinical signs of osteoarthritis. J Vet Intern Med. 2012;26(3):448-56. doi: 10.1111/j.1939-1676.2012.00901.x. Epub 2012 Mar 9. http://www.ncbi.nlm.nih.gov/pubmed/22404506

nutraceuticals for oA? science is lacking

nUTRITIon

Veterinarians and consumers must

make appropriate decisions about

treating horses based on the best

scientific evidence.


A diet based on forage instead of concentrates could be a good choice for performance animals, according to a new study out of Sweden.

“Increased high-energy forage allowances ap-pears not to be detrimental to performance but could in fact be positive to performance,” said Anna Jansson, PhD, MS, professor at the Swed-ish University of Agricultural Sciences and Holar University College in Iceland.

Many people consider hay or haylage as only “gut fill or idle pleasure” for a horse, according to Jansson, but they should think of it differently. “It is its real feed,” she told The Modern Equine Vet.

Although horses are designed to eat grass, they are fed diets that include many starch-rich concen-trates, which are difficult to digest.

“Starch-rich diets have been associated with colic, gastric ulcers, and rhabdomyolysis,” she ex-plained. Leisure horses also suffer obesity and lam-initis from diets that are too rich in starches.

“In addition, high concentrate and low forage intakes increase the risk that horses will develop stereotypical behavior,” she said.

Performance horses are fed very high amounts of concentrates to meet their high-energy require-ments because generally, the hay that is pro-

vided is not very high in energy. However, studies have not proved that such diets improve perfor-mance. Some studies have shown that adding fat to replace some of the starch will improve the energy metabolism in the muscle, which is likely to im-prove performance, according to Jansson.

“However, the most natural way to offer a high-fat diet to a horse is in fact to offer it forage, because the fiber in forage is converted into short-chain fat-ty acids by the microorganism in the hindgut. This is why they can survive on grass at all!”

In a recent study published in Animal, the re-searchers tested whether a forage-only diet would improve the aerobic energy supply without any det-rimental effects on performance compared with a traditional high-starch diet.

They compared two diets in six Standardbred geldings in training. The horses were fed a forage-only diet consisting of early cut haylage that was a mixture of Timothy and meadow fescue grasses for 29 days, and then a mixed diet consisting of 50% late cut haylage (Timothy-meadow fescue grass-es) and 50% concentrate (oats, soybean meal and wheat bran) for 29 days. The diets were equivalent in protein, calories and nutrients.

The horses were trained twice a week with two to three days of rest in between, according to Jans-son. Each dietary period also included an exercise test on a treadmill. Researchers recorded body weight and condition, and took muscle and blood samples before, during and after the test.

Diets high in hay or haylage appropriate for performance horses

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ModernEquineVeterinarian.com | October 2012 21

The horses fed the forage-only diet experienced an altered metabolic response during exercise without performance issues. In fact, the metabolic changes might have enhanced performance. Horses on the forage-only diet experienced increased ve-locity when plasma lactate concentration was 4 mmol/L (VLa4), which might indicate better per-formance, she added.

Muscle glycogen levels were slightly lower but so far there is no evidence that such a little differ-ence alters performance, according to Jansson. In addition, horses on the forage-only diet also ex-perienced higher blood pH during exercise, which might indicate that they are better able to counter-act the effects of acidosis that results from strenu-ous exercise.

Jansson said a forage-only diet would not be hard to give to performance horses — just talk to your dairy farmers.

“All countries that have dairy production should have farmers and advisers who know in principle how to produce a hay/haylage with high-energy content and not extremely high crude protein con-tent. However, the forage market for horses is un-developed in many countries I think,” Jansson said. “In countries were hay or haylage production is limited, this probably will not be a realistic way to feed horses. I hope this paper inspires people to produce more forage-like feeds based on other products.”

She called today’s diets, which can endanger a horse’s health, an animal welfare issue and urged people to provide a diet that is more suitable for a horse.

“Match the needs of the horses (energy and crude protein) with forage with a suitable nutri-ent composition. You have to see an analysis of the forage because forages show a large variation. Most forage batches have to be supplemented with some minerals and vitamins. Do not worry about a weight increase on high-energy forage. There will be no, or a very limited weight increase (that is lost with the fecal output during transportation to the competition for example),” she said.

When making the switch, gradually introduce the diet unless the chemical composition of the old diet is similar to the new diet, she suggested. MeV

Dr. Miller’s books and videos are available for sale at www.robertmmiller.com

By Dr

. Rob

ert M

. Mille

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by increasing the amount of forage the risk of many

health problems is reduced or eliminated.

high-forage diets seem to alter the energy metabolism in a

positive way when it comes to performance.

high-forage diets cause an increase in blood ph which could

be beneficial in horses performing intensive exercise where ph is

lowered.


Jansson A, Lindberg JE. A forage-only diet alters the metabolic response of horses in training. Animal. 2012 May 4:1-8. http://www.ncbi.nlm.nih.gov/pubmed/22717208

3 Benefits of a high-forage diet

1. 2. 3.


It probably comes as no surprise to you, but equine veterinarians don’t earn as much on average as their colleagues who care for dogs and cats, even though their job often involves quite a bit of travel from ranch to ranch. And — again no surprise — your job is a little more dangerous. A kick in the knee could ruin your career.

But you both graduate with roughly the same amount of debt — too much!

A recent report by the National Academy of Sci-ences about where veterinarians stand today and what the future needs of the veterinary industry are just does not paint a pretty picture for the future of equine veterinarians.

Although the report discusses all aspects of vet-erinary medicine, our story on page 4 focuses on equine medicine. And it’s kind of grim. According to the NAS, equine medicine, which grew during the past two decades, has been harder hit by the current economic recession than most other veterinary prac-tices and therefore, you have to adjust to challenging circumstances if you are going to survive.

I recently wrote an article for Hoof Beats, the US Trotters Association magazine, about vet vs. value. In the article, I talked to some pretty large horse farm owners and trainers. Most try to do as much as they can themselves, because they do not want to spend the money. And that probably means that many times, by the time they call you, the animal is really sick — so of course, it’s going to cost them.

To overcome this vicious cycle, you have to figure out a way to show the clients that your services and your education are valuable to them and their horses. That means communicate with trainers and owners and managers. Make sure your fees are in line with other equine veterinarians in the area, and if you do not have it already, get yourself some practice man-agement software that will help you capture all your fees.

But most important, show the owners and train-ers that you care. Whether its I’ll Have Another or Ol’ Blaze in the backyard, owners have to feel that you care about their horse. Try not to be judgmen-tal if they can’t afford all the care that you think the horse needs. These are hard times for everyone, and not every owner can afford the Cadillac care for their horses — even if that is what the owner wants to pro-vide. Give them cost-effective options if you can.

The report says that the economic downturn, which began in 2007, did more than just depress sal-aries. It cost veterinary schools some public support. As a result, many have had to increase class sizes and raise tuition — as if young veterinarians today don’t graduate with enough debt.

“As the committee began its work in April 2007, the economy began to move into a recession and the events that unfolded caused a great deal of uncertainty over the projections of the demands for veterinarians and many states began to cut funding for veterinary education, and tuitions started climbing,” explained Dr. Allen M. Kelly at a press conference about the re-port. “We must ensure that schools train qualified vet-erinarians in sync with the diverse and growing array of societal needs,” said Kelly, emeritus professor of pa-thology and pathobiology at the School of Veterinary Medicine, University of Pennsylvania and chair of the committee that wrote the report.

The report suggests that veterinary schools in the United States try to implement alternative options to deliver veterinary education and to provide a good environment for research. In addition, the report calls for a national committee or consortium to focus on the economic sustainability of the profession that includes all sectors of the industry.

“The decade long decline in funding of education and research has jeopardized the profession’s future capacity to serve societal needs,” added Dr. Bennie I. Osburn, of the University of California, Davis

“In the recent past, veterinary medicine has made

great profession, but facing many challenges

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significant contributions to human well-being, as well as, animal health and well-being. But it is losing the breadth of its intellectual base as a consequence of reduced public funding for veterinary education and research.

“This trend has been accelerated by the pro-longed economic downturn over the last 4-5 years and it threatens the profession’s future. All this is tak-ing place at a time when society is expecting more from veterinary medicine. The profession will not be able to fulfill its responsibility to society without maintaining a pool of high quality scientific investi-gators and robust research programs,” Osburn said at the press conference.

He added that the cuts made it difficult to make new hires or to replace retiring faculty, which caused a vicious cycle, with no new faculty to write grants, serve as mentors and recruit outstanding veterinar-ians to teach, programs get cut, tuitions gets raised and research programs go unfunded.

“Academic veterinary medicine is facing a gap in the professionals that are trained to conduct the type of research needed to sustain a leadership in the pro-fession,” he said. “The current return on investment for veterinary education is unsustainable and the cost of veterinary education is at a crisis. The profession is at risk for lowering the quality of applicants to the profession and the quality of veterinary education.”

And that is happening just as owners expect the same quality medicine for their animals as they want for themselves and their children.

I couldn’t help but think of this report when I was writing an article about Dr. Jean-Michel Vande-weerd’s review of supplements for equine arthri-tis. To summarize, Dr. Vandeweerd says there isn’t enough science to back the use of supplements for equine arthritis. He’s not saying the supplements don’t work — he’s saying there is no good, scientific proof that they work in horses.

And that puts you in an awkward position medi-cally, ethically and legally. No doctor wants to rec-ommend a treatment unless he or she knows it works. But because you don’t have access to really good sci-entific studies for so much of equine medicine, you often don’t have a choice.

Companies have to step up to the plate and finance the kind of research you need to prove their products work in the species you are treating — horses.

You can encourage this research by prescribing veterinary products that are labeled for use in equine medicine. After all, they need an incentive to spend all that money on research for an equine indication.

The report is 297 pages long and covers a lot of ground. Yes, it’s kind of a horror story, so maybe you shouldn’t read it right before bedtime, but I urge you to take a look at it.

It’s your profession and it’s a noble one.

Marie Rosenthal, MSEditorThe Modern Equine Vet

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FOr AdVerTisiNg rATes ANd iNFOrMATiON, eMAiLMarie Rosenthal, MS

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