+  Equine Living Will +  Equine Metabolic Syndrome +  Lyme Disease +  West Nile Virus +  Dewormer Schedule Options +  Extracorporeal Shock Wave Therapy

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Equine Metabolic Syndrome

The disease is caused by insufficient exercise (inactivity, stall confinement) and excess dietary intake (high starch rations).  The development of obesity  leads to an increased risk of laminitis.

The syndrome is characterized by laminitis occurring in relatively young horses 5-15 years old. It is caused, not by dysfunction of the thyroid or pituitary glands; rather, the syndrome is caused by insulin insensitivity similar to Type II diabetes in humans. Morgans, Pasos, Mustangs and ponies are especially susceptible. As with pituitary gland tumors(= Cushings Disease), equine metabolic syndrome or peripheral Cushings is caused by the effects of excess glucocorticoids.  The signs of sustained excess cortisol include: non-shedding, long curly haircoat, recurrent low grade infections, laminitis, ôcrestyöneck, abnormal fat deposits, persistent elevated blood insulin levels (=insulin resistance).  Obesity causes insulin resistance; adipose tissue (body fat) also acts as an endocrine gland by producing excess cortisol.

Treatment

• Exercise- obviously not with acute laminitis cases
• Grass/alfalfa hay mix (mature grass hay only)
• No turnout on spring grass
• Increase protein, decrease carbohydrate in diet
• Vitamin E supplement: 4000 units/day
• Aspirin: 15 grain tablet once daily- anti-coagulant (increases blood flow to feet by preventing small blood clots)
• In acute cases of laminitis immediate veterinary care is recommended. 
  

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West Nile Virus

Encephalomyelitis similar to Eastern and Western encephalitis.
Mosquito management necessary as well as vaccine to prevent disease. The virus cannot be controlled by vaccine alone; the vaccine is not effective until at least three weeks after the vaccine is boostered.
Mosquitoes can breed in standing water, manure and organic debris found around stables.

• Clean up standing water.
• Use insect sprays, fans for air movement (insects canÆt fly against an air current), remove manure.
• Change water troughs at least every other day to prevent mosquito breeding.
• Clinical signs vary and may include depression; lethargy; personality changes with hypersensitivity to sound and touch; anxiety; facial and muscle twitching; sweating; shivering; monotonous chewing, blindness, ataxia (staggering and loss of balance); fever in 60% of cases. Supportive care is the only treatment available although an anti-virus has been developed; its effectiveness has not yet been determined.
• Vaccinate prior to insect season in March/April and again in July/August.
• Pregnant mares may be vaccinated.
• Vaccinate foals of vaccinated mares starting at five months; start at two months with foals of unvaccinated mares.
• The West Nile encephalitis and Eastern and Western vaccines should be boostered four and eight weeks after the initial vaccine. 
  

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Lyme Disease

Source is the deer tick- Ixodes scapularis. The tick carries the spirochete Borrelia burgdorferi which causes Lyme. Signs in horses include: depression, fever, fatigue, generalized musculoskeletal pain, shifting lameness, arthritis of the stifle, hocks, and knees. Signs usually are recurrent, especially the joint pain. Finding deer ticks imbedded in a horse's skin >24 hours, along with clinical signs, is the best diagnostic for Lyme disease. A positive blood sample will confirm the diagnosis, but may only indicate exposure rather than a persistant infection. 

Prevention:

• Avoid pasturing horses close to woods.
• Use pesticides labelled for horses containing a combination of repellants and synthetic pyrethroids. [Toxic: Amitraz should not be used around horses.]  Apply repellants prior to turnout: under jaw/ throatlatch area, legs and chest. Check horses daily for tiny larval ticks.
• There is no vaccine for horses.

Liberty by Intervet insecticide        

Dewormer Schedule Options

1. Yearly rotation: one class of dewormers only for a year or until fecal worm/egg counts rise; deworm every 60 days if high risk, every 90 days if low risk.

2. Sixty or ninety day rotation: rotate drug classes every 60-90 days
depending on the horseÆs risk factor for parasite infestation.

3. Deworm seasonally: based on fecal counts for low risk horses only; in spring at thaw when egg counts tend to be high and after the first frost. Fall and spring tend to be the best times to double dose with Strongid or Panacur.

4. Daily dewormer: a feed additive such as Strongid C 2x by Pfizer; may accelerate parasite resistance to the dewormer; need to monitor fecal/egg counts, especially before starting with a daily dewormer. They do not have broad spectrum coverage as does ivermectin, moxidectin, or a double dose of fenbendazole; in addition to the daily dewormer, a moxidectin-praziquantel or ivermectin-praziquantel combination dewormer will be needed to cover bots and tapeworms. Not to be used in foals, old/sick horses or instead of ivermectin or moxidectin in lactating mares. The pyrantel dewormer will not cross through the mammary gland in the milk to the nursing foal.

5. Heavy parasite burden: the only means of killing parasite larvae is
with moxidectin, ivermectin, or a 5-day double dose of fenbendazole (Panacur).  Isolate new horses before they contaminate your pasture. First do a fecal test, deworm, retest in 2-3 weeks. If the parasite burden has not been eliminated, then deworm with a different class of dewormer. High risk horses, such as pregnant and lactating mares, weanlings, yearlings, older or sick horses, may need to be dewormed more frequently.

Maintenance

1. Good sanitation with regular manure removal.  Spreading manure on the pasture will disperse the parasite load over the field. To kill off the parasite eggs and larvae, and to break the cycle, the manure must be thoroughly desiccated (ambient temperature >90 degrees) and the pasture ôrestedö (not used for >70 days).

2. Do not feed on the ground; use feed buckets instead.

3. Avoid overcrowding horses on pasture.

4. Maintain horses at a good nutritional level for optimal immune system support. A healthy immune system will help eliminate the parasite burden naturally.

5. Deworm at the exact weight dose. Under-dosing will facilitate
resistance. While ivermectin has offered the broadest spectrum effectiveness with the widest safety margin, its regular usage has resulted in parasite resistance, similar to antibiotic resistance. Once a parasite has become resistant to ivermectin, it will have at least partial resistance to other dewormers in its class: avermectin and moxidectin (Quest).

Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy (ESWT) is being used successfully in veterinary medicine to relieve pain, reduce inflammation, and improve the rate of healing and tissue repair. ESWT focuses a beam of energy waves similar to ultrasound that penetrates to injured tissue.

In horses, ESWT is beneficial for tendon and ligament injuries, stress fractures and shin splints, navicular syndrome, and degenerative joint disease. Similarly, ESWT with small animals is helpful for orthopedic cases such as fractures, hip and elbow dysplasia, tendon and tendon sheath injuries. Shockwave treatment is recommended for athletic- induced injuries as well as geriatric musculoskeletal disorders. It can be used in combination with or as a substitute for anti-inflammatory drugs, surgical intervention, and physical therapy.

Treatment will decrease lay up time. Most cases demonstrate significant improvement within a week; frequently, positive results are achieved where conventional methods failed. Bony structures treated with ESWT usually get a positive response with a single treatment whereas soft tissue requires at least three treatments. Horses require standing sedation for treatment. Horse show regulations and the racing commissions restrict participation five to ten days post-treatment; plus, the sedation necessary for treatment will prohibit competition within that period. Anesthesia is required for small animals as the procedure takes 10 to 20 minutes, and can be performed on an out-patient basis in a veterinary clinic.

The FDA has approved use of ESWT in human medicine for chronic orthopedic cases such as heel spurs and tennis elbow.

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Equine Living Will

Decide your wishes about your horseÆs care before an emergency occurs. Should an illness or injury require veterinary treatment or intervention and you are not available, advance directions already have been established. Informing caregivers is especially important if you board your horse or leave him in anotherÆs care while traveling. If these decisions are made in advance youÆll be less likely to make choices that you will later regret. YouÆll avoid unintentionally transferring responsibility for a difficult decision to someone not prepared to determine your horseÆs fate and decide the financial burden that you will bear as a result. Too often, in a crisis, when you want to do everything to save your horse, itÆs very easy to agree to spend more than you reasonably can afford. Consider the financial implications when you can be practical about your situation and budget.

1. Where can you usually and eventually be reached? Cell phones are not always dependable- include home, business, daytime and evening, plus the number(s) of any other individuals who also have the authority to make decisions with and for you.
   
   
2. Decide who has the authority to make decisions, both financial and medical, about your horse. Include the name and numbers of your veterinarian, plus another veterinarian should your regular vet be out of town or unreachable. Decide on your preferred referral center in your area, with contact names, numbers, and directions if the horse needs to be trailered to an emergency facility. If the horse is insured, the company name, agent, telephone numbers, policy number, and provisions of the policy, i.e. coverage of loss of use, colic surgery, mortality, etc.
   
   
3. A medical history, including allergies and a history of reactions to medications and/or vaccinations, should be part of the living will. Date of birth, breed, sex, color and markings, tattoos or brands that distinguish your horse in a disaster situation. Prioritize which animals to save in such an event where horses need to be evacuated.
   
   
4. If a horse suffers severe injury or illness from which it is not expected to recover,   humane euthanasia is the only alternative. When making that decision consider quality of life: if the condition is chronic and incurable, career-ending or if the horse potentially would remain ôpasture soundö. Would you be able to live with your horse being a shadow of his former self? Does the immediate condition have a hopeless prognosis for life? Would he be a hazard to himself or his handlers? Will he require continuous medication for pain relief?
   
   
5. What should be done with the horseÆs remains? Does your property border on a water source? If you live within city limits you are not entitled to bury carcasses on your property. Determine disposal, burial, or cremation.
   
   
6. Consult appropriate legal advisors when designing a template related to your horseÆs needs. A living will must be signed and dated by named parties, witnessed by two people, and signed in front of a notary.
   

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