Lice and Mites All you need to know about Equine these external parasites
matters WINTER 2018
Nasal PPID update discharge Understanding this hormonal disease affecting horses What could this mean for your horse?
Equine Choke Oesophageal obstruction, problems encountered
Tetanus in horses The importance of regular WIN! tetanus vaccinations £50.00 Joules Gift Card... or details See inside f
contents Winter Edition 2018 the editor Hello and welcome to the Winter edition of Equine Matters.
This issue of Equine Matters finds me writing my 09 17 welcome on board a train home from a Continuing Professional Development course in the Midlands. Disease Respiratory As vets, we are required to undertake a prevention conditions significant number of hours of further learning each year to allow us to remain practising. Although this may be a requirement, updating our knowledge and skills to offer the best care possible to you and your horses is also a cornerstone of Tetanus in horses Abnormal respiratory noises XLVets Equine. I very much hope that via Tom Southall of DS McGregor & Partners Keesjan Cornelisse from Calweton Equine Equine Matters we can also help to keep details this distressing and often fatal describes a range of respiratory conditions you, as horse owners, up to date with the disease. and the noises they create. ever-changing face of equine veterinary care. With that in mind, we have a variety of topics in this edition, including an update on PPID (formerly known as Cushing’s disease) - it’s not all old ponies with teddy-bear coats we are talking about here either, and some very thought-provoking information about equine genetic diseases that you may not have ever considered before. And finally, we wish all our readers a merry Christmas and a happy, healthy 2019. Susan Donaldson Clyde Vets 03 11 19 Equine lice and mites Equine genetic diseases Happy endings - Respiratory Caroline Blake from Torch Equine Vets Lizzie Royce of Hook Norton Veterinary noises provides an explanation of the differences Group explains how genetic diseases are Keesjan Cornelisse from Calweton Equine between lice and mites, and advice on inherited and describes four disorders tells the story of Cleopatra, a one-day-old how best to control them. caused by defective genes. Arab filly, who was snorting and choking on her milk. 05 13 Investigation of a nasal Oesophageal obstruction 20 discharge (Choke) Happy endings - a lameness case Colin Mitchell of Scott Mitchell Associates Gillies Moffat from Seadown Veterinary Charlie Mitchell of Cedar Veterinary Group describes the common causes and Services describes the causes of this reviews the case of Flash, an eight-year-old categories of nasal discharge, and the common problem and the treatment pony who, thanks to his owner’s patience investigation techniques used. options. and high standard of care, made a full recovery from a serious foot problem. 07 15 An update on PPID Nursing the infectious horse XLVets Equine is a group of 27 equine practices spanning the length and breadth of the UK. We work together to PPID used to be called Equine Cushing’s Richard Meers of Fellowes Farm Equine share experience, knowledge, ideas and skills in order to define and deliver the highest standards of equine health, Syndrome. Rachel Pretswell of Northvet Clinic explains the necessary precautions care and welfare. Veterinary Group gives us an update on and care requirements when dealing with this increasingly common condition. an infectious, ill horse. Equine Matters Winter 2018 02
Equine Lice and Mites All you need to know about these irritating external parasites External Parasites
As the colder months approach us, we no longer have the worry of the flies and midges of summer; in the winter months however, there are other external parasites that can cause clinical problems in the horse. The most common of these are lice and mites. There are important differences between lice and mites that all horse owners should be aware of.
Lice There are two different lice types that commonly Lice live their entire life-cycle on the horse. The affect horses in the UK: the sucking louse- eggs are laid and stick to the base of the hair Haematopinus Asini, and the biting or chewing where they hatch into larvae and grow into adults. louse - Damalinia Equis. The eggs take 2-3 weeks to hatch, which is The sucking louse tends to be larger (4-5 mm important to remember when treating these long) and feeds by sucking the blood at the root horses. The whole life cycle from egg to egg of the long mane and tail hairs. laying adult can take 30 - 40 days. The smaller biting louse (1.5-2 mm) (Figure 1) feeds on dead skin cells causing intense irritation and tends to move around the body more Clinical Signs especially in the flank and neck areas. Horses with lice are primarily itchy. They will constantly rub their mane or tails and may chew at themselves (Figure 2). The horse may appear restless. The hair-coat is often dull, with flaky dandruff visible. Caroline Blake There may be patchy hair-loss and bare BVSc Cert ES (Soft Tissue) MRCVS areas. In more severe cases horses will rub Torch Equine Vets areas of skin until they become raw and bleeding. Scabbed areas may be apparent, as well as thickened skin patches. Very severe infestations may lead to anaemia due to the lice sucking blood, and Figure 1: Damalinia Equis such horses fail to thrive and may be in poor The winter months body condition. present the risk of external parasites that Lice thrive in the horse’s denser winter coat and numbers reduce after coat shedding in can cause problems in the spring. the horse. Lice tend to affect horses with a less robust immune system and so more commonly the younger or older animals are affected. Horses with underlying disease such as PPID (see page 7) or malnourished animals also tend to be more severely affected.
Figure 2: Horse chewing flanks
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Mites
The most clinically important mite in Based on the history and clinical signs, horses is the feather mite - Chorioptes treatment will often be initiated even if Equi (Figure 4). live mites have not been detected under the microscope. Chorioptic mites are far smaller than lice and not visible to the naked eye. They live on the horse’s hair and skin and can Treatment deep burrow into the skin causing Successful treatment of feather mites intense irritation. These mites particularly can be more difficult than lice as some love to inhabit the long hair on the limbs horses may be infected without showing of rough legged animals, typically the clinical signs, thereby providing a source heavy feathered legs of cobs and the Figure 3: Lice in hair coat of re-infection for those horses which heavy horses. The condition may also be have been treated. Re-infection can also known as heel mange, chorioptic mange occur due to the ability of the mites to or feather mites. live in the environment off the host for Diagnosis As with lice, the life cycle is completed several days in dark warm conditions. Regular grooming to remove dead lice and Diagnosing lice on your horse does not from egg to adult on the horse within Cleaning and disinfecting the stable eggsapproximately after treatment 2-3 weeks.is very important. and removing and replacing bedding is require a vet, just a careful examination Clipping the hair in severely affected cases of the hair coat and good eyesight! therefore important. canClinical help. Lice spreadSigns by direct contact with Living lice can be seen with the naked affected horses so treatment of in-contact There is currently no licensed veterinary product to treat chorioptic mange in eye, as small flattened wingless insects animalsAffected may horses be necessary. are usually It very is also itchy. sensi- horses, however the off-licence use that are yellow-brown in colour. They are bleTypically, to wash theyrugs andwill stamp avoid sharingand rub groom-at their of doramectin injection has proved easier to see if you part the hair coat and inglegs equipment. and may bite and chew them. Raw effective. This should only be look carefully at the base of the hairs, sore patches may develop on the back of administered by your vet who will ensure particularly on the mane and tailhead the fetlock and pastern areas and the accurate dosing and provide advice on (Figure 3). back of the knee (Figure 5). Often the potential side-effects. It is also advisable skin also becomes very flaky. In more The lice eggs may also be seen as small to repeat the injection after about 2-3 chronically affected animals the skin of white oval structures stuck to the hairs weeks in order to effectively reduce the the lower limb can become thickened near the base of the hair-shafts. mite population. and this can make the condition more difficult to treat. In more severe cases To further reduce the numbers of mites Treatment and control the mites can spread all over the body. present, especially in more severely affected cases, it is advisable to closely Treatment of lice is relatively clip the feathers off. straightforward and usually requires an insecticidal formulation such as a spray, Topical washes with sulphur or shampoo or spot-on to be applied ivermectin can be helpful especially if directly onto the horse’s coat. The active sponged onto clipped limbs. Also, certain ingredients are usually based on preparations containing fipronil have permethrin or pyrethroids, and kill the been shown to have some effect, adult lice and so in all cases it is advisable however they are unlicensed for to repeat treatment after 14 days to 4 5 horses so should only be used under ensure that any further lice which hatch veterinary supervision. from eggs are also then killed. Figure 4: Chorioptic mite In all cases, it is best to ask your vet to Cypermethrin is used in a diluted form and Figure 5: Chorioptic mange help you design a suitable treatment sponged or sprayed onto the coat. plan which may include a number of the treatments mentioned above, as Other recommended treatments include no one treatment is 100% effective. pyrethroid-based insecticidal shampoos. Diagnosis Early, aggressive and thorough Spot-on/pour-on treatments containing treatment will really help to keep permethrin can also be very useful when Unlike lice, mites cannot be seen with horses problem-free. However, it is it is inconvenient or difficult to bathe the naked eye. Therefore, diagnosis almost impossible to completely or spray. relies on your vet taking coat brushings or sellotape strips from the affected eradicate the infestation and so it Some spot-on treatments containing areas and examining them under a will recur in many cases, requiring deltamethrin can be very effective but microscope. However, even then live ongoing management and often are not licensed for use in horses and mites may not be apparent. repeated treatments. should only be used under veterinary supervision.
Equine Matters Winter 2018 04
Investigation of a Nasal Discharge
Nasal discharge A nasal discharge in the horse (Figure 1) is a clinical sign which is seldom missed by owners. An owner’s description of the discharge, if not present at the time of examination, can provide useful information in the investigation.
Figure 1: Purulent nasal discharge
If your horse has a nasal discharge, the answers A discharge can be categorised: to the following questions can be helpful in determining the cause:
1. Mucoid (clear or slightly white) G Is the discharge from one nostril (unilateral) Colin Mitchell or both (bilateral)? BVM&S CertEP CertVBM 2. Purulent (pus) G MRCVS What is the nature of the discharge (mucoid / purulent / haemorrhagic or food)? Scott Mitchell Associates 3. Muco-purulent (a combination of G Does the discharge have a foul smell? the above) G Have you noticed any swelling on the side of 4. Haemorrhagic (blood) the horse’s head?
G Is there a discharge from the eyes? A majority of cases of 5. Food material / saliva G Does your horse have a cough? nasal discharge can be resolved, eventually. G Is the discharge related to exercise? After a full clinical examination, a tentative diagnosis of the cause of the discharge may be possible. Horse’s with ‘choke’ (an obstruction, usually food material, within the oesophagus between the throat and the stomach - see page 13) will usually cough frequently, appear quite distressed and there may be a history of recent feeding.
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Figure 2: An endoscope Figure 3: Endoscopic view of the larynx Figure 4: Endoscopic view of inside of the guttural pouch
These horses may show food material presence of mucus, lymph node used to hold the head at different heights and/or saliva running from one or both enlargement and foreign bodies. In many and positions. Various views will be taken nostrils. Another, less common possibility cases, horses will tolerate the examination of the head to ensure the area of interest which may appear similar, is acute Grass very well, since their respiratory tract is not is thoroughly examined. Sickness or other causes of obstructive colic. as sensitive as ours. Sedation is usually If there are inconclusive findings at this In these horses, stomach contents/fluids required, but not always. stage in the investigation, a computed may spontaneously reflux (be expelled) During this procedure, the endoscope is topography (CT) scan may be from the nostrils. These horses are usually likely to be passed into the guttural recommended. This is a form of advanced quite sick and if this is seen in association pouches of the horse (Figure 4). These imaging which allows the bony and soft with colic signs, a favourable outcome is not structures are pouches on either side of tissues of the head to be examined. usually likely. This is unusual however, and the throat that form as an enlargement of Images are taken at various ‘slices’ across quite different to the sudden onset distress the narrow tube that connects the horse’s the head, then a computer can ‘build up’ seen in horses with choke. throat to the middle ear. Some respiratory these sliced images to provide an image If a small amount of blood is seen at the infections (e.g. ‘Strangles’) can localise in of the whole. nostril(s) within a few hours of strenuous the guttural pouches. Following infection some horses can become carriers of ridden work, this may be a sign of Exercise The common causes of nasal Induced Pulmonary Haemorrhage (EIPH). infection and may show intermittent This is a condition which occurs when tiny nasal discharge. discharges are: blood vessels in the lungs rupture when The sinuses naturally drain into the back large differences in pressure exist between of the horse’s nasal cavity, near the G EIPH the inside of the blood vessel and the air in throat. This area can also be visualised the lungs. Inflammatory airway disease can endoscopically, confirming if a discharge G Choke exacerbate this condition. The exercise is coming from the sinuses. Causes of required to cause EIPH is usually a fast sinus related nasal discharge include canter, or gallop. primary sinusitis, a sinus cyst, sinusitis G Respiratory infection caused by dental disease, or occasionally In many cases, further tests such as an neoplasia (a tumour). G Inflammatory airway disease endoscopic examination will be needed to confirm the presence, nature, and possible Another procedure that may be required source of a nasal discharge. This is a is radiography (X-ray) of the head. This G Primary sinusitis procedure where a flexible camera called will allow your vet to examine the sinuses, an endoscope (Figure 2) is passed up the teeth and tooth roots and ethmoid bones G Sinusitis secondary to dental nostrils, across the back of the throat and (a delicate arrangement of small, fragile disease then down into the windpipe to the bones at the back of the horse’s nasal entrance of the lungs. The area from the cavity). This procedure is usually done G Guttural pouch disease larynx (voice box) to the nostrils is known under sedation and a headstand may be as the upper respiratory tract (URT), while the windpipe and lungs are known as the lower respiratory tract (LRT). A logical investigation, utilising further diagnostic tests where A source of a nasal discharge can be upper required, does, in most cases, lead to an accurate diagnosis. or lower respiratory tract. The endoscopic From this, a management plan can be worked out to treat the view of the larynx is shown in Figure 3. discharge appropriately. Most cases of nasal discharge can be Along this ‘journey’, the vet is examining resolved, eventually. the respiratory tract for swellings, the
Equine Matters Winter 2018 06
An update on PPID
Pituitary Pars Intermedia Dysfunction (PPID) is a common, chronically progressive hormonal disease affecting horses. Formerly known as Equine Cushing’s disease, PPID was once thought to be a rare disease only Physiotherapy affecting older horses.
Understanding of this disease however, has relation to the age of the horse and refer instead increased greatly in the past decade with to the stage of disease i.e. a 15-year-old horse advances in diagnosis and treatment allowing can present with advanced symptoms and for better management of cases and earlier equally a 23-year-old horse can present with diagnosis. early symptoms. PPID occurs due to dysfunction of part of the Rachel Pretswell pituitary gland at the base of the brain. The BVMS MRCVS pituitary gland produces many different Advanced signs of the disease tend Northvet Veterinary hormones and proteins which control processes to be more obvious and those that Group in the body and is regulated by the chemical we traditionally associate with PPID dopamine. While the exact cause of PPID is including: currently unknown, in patients with PPID inadequate dopamine is produced resulting in poor regulation of the pituitary gland and over G Hirsutism - abnormal coat shedding production of the hormones and proteins resulting in a long curly coat Testing of previously released there. While there are some similarities undiagnosed laminitic between PPID and Cushing’s disease in dogs G Abnormal fat deposits - bulging fat pads animals for PPID is and humans, the cause, clinical signs and typically above the eyes extremely important. treatment have been found to differ hence the preferred name PPID as opposed to Equine G Muscle wastage - commonly seen as a Cushing’s Syndrome. loss of topline While most cases of PPID are diagnosed in horses over 15 years old, it is now known that it can be G Recurrent infections - e.g. ringworm, seen in younger horses, although cases in animals sole abscesses younger than 10 years old are rare. The clinical signs of PPID are thought to be related to the G Increased drinking and urination increased levels of certain hormones produced by the pituitary gland, however the exact link has yet G Pot-bellied appearance to be established.
Clinical signs of PPID can be grouped into early G Recurrent laminitis and advanced signs. These terms have no
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In the past it was common for PPID not to be suspected until the animal was displaying these advanced signs of the disease (Figure 1) however, we now know that more subtle signs can be present much earlier in the disease.
These include:
G Subtle coat changes - abnormally long hair over the jugular groove and on the back of the legs or delayed coat shedding compared to herd mates
G Changes in attitude/lethargy
G Laminitis - can be the only clinical sign Figure 1: A pony showing signs of advanced PPID
Of all the clinical signs of PPID, laminitis is A diagnosis is generally straightforward both safe and effective with an of greatest concern. The exact cause of once PPID is suspected. The most improvement in clinical signs usually laminitis in PPID is poorly understood and commonly used test is a single blood observed in 4-12 weeks. Following the is an area of much active research. We sample looking at the hormone start of treatment your vet will retest know that underlying PPID is extremely Adrenocorticotrophic Hormone (ACTH) ACTH levels to check the response to common in cases of laminitis with one (Figure 2). In cases of PPID, ACTH is treatment. Depending on the result the study demonstrating as many as 70% of overproduced so a high ACTH result is dose may be increased or reduced at horses with laminitis suffering from PPID. indicative of PPID. Levels of ACTH are this point. naturally higher in horses during the One theory for the link between PPID and Side effects of Prascend are few and autumn months so results are compared laminitis is that many horses with PPID generally transient. The most common to a seasonally adjusted reference range. show insulin resistance. Insulin resistance issues relating to Prascend treatment is characterised by an abnormally high Basal ACTH is a quick and simple test are a reduction in appetite and difficulties level of insulin in the blood following making it the preferred test for diagnosis in administration due to poor palatability ingestion of dietary sugars. We know that of PPID. However, it does have some of the tablets. Poor appetite is generally a high levels of insulin in the blood can cause limitations. The sensitivity of this test in temporary issue however, if this is not the laminitis but confusingly not all animals older horses is not perfect meaning that case your vet may choose to reduce the with PPID will be resistant to insulin. not all cases of PPID will test positive. For dose. Administration of the tablets can be Regardless of the cause, we now know that this reason, your vet will interpret results difficult with horses often finding the in many PPID cases laminitis may be the taking into account the animal’s clinical tablets when hidden in feed. For some only clinical sign meaning that testing of signs. If PPID is still suspected following a horses hiding the tablet in a piece of previously undiagnosed laminitic animals normal ACTH result, your vet may choose apple or carrot may be sufficient but for for PPID is extremely important. to re-test ACTH later in the year or do particularly stubborn patients your vet another test called a TRH-Stimulation may be able to give you empty gelatine test. This test involves evaluating the capsules to hide the tablet which should response of the pituitary following disguise the taste. stimulation with a drug called Thyroptropin-Releasing Hormone. Horses with PPID will have an exaggerated response compared to Unfortunately, there is no known normal horses. For most of the year, way to prevent PPID. However, excluding the autumn months, this is with prompt diagnosis and the most sensitive test for PPID. appropriate management there is Treatment for PPID involves daily no reason a horse with PPID can’t administration of Prascend (pergolide continue to lead a normal life. Figure 2: PPID can be easily diagnosed mesylate) tablets. This is the only licensed on blood sample treatment for PPID and has proven to be
Equine Matters Winter 2018 08
Tetanus in horses
Tetanus is a disease of mammals caused by the harmful toxins that can be released by the bacterium Clostridium tetani . Of the domestic species affected, horses are the most susceptible, whereas dogs and cats are Tetanus disease more resistant.
The Clostridium tetani bacteria are widespread. G Often the first sign is a change in the horse’s They can be found in the digestive tract of many gait, with a low foot elevation and the action animals, including horses and man, and their becoming stilted and stiff. spores can be found in soil, particularly in soils that have been cultivated. These spores are highly G There is also a change in demeanour, the resistant in these environments and can survive horse becoming more nervous and sensitive, for many years. reacting violently to sound, movement and touch, as these stimuli cause painful The disease generally occurs after the bacteria muscle spasms. invade the susceptible horse’s body via a wound. Given the right conditions, the bacteria can then G The horse will develop an anxious expression produce their harmful toxins, which affect the with nostrils flared, eyes wide open, and nervous system. Any wound can allow entry of ears erect. tetanus, but deep penetrating wounds, such as a puncture to the hoof, are more liable to permit G As the disease progresses, so does the severity proliferation of the bacteria. This is because of the muscle spasms. The horse will stand the bacteria favour low oxygen (anaerobic) square on four stiff limbs, with the legs rigid, conditions, as can be found in deep punctures, and the head and neck extended and tail hoof wounds and dead (necrotic) tissue. Other raised. This is described as a 'saw-horse' common sites include surgical wounds (e.g. post appearance. castration), umbilical cords in young foals and retained placentas in the mare. The nature and G The stiff neck and back means there is a conditions of the wound also influence the reluctance to eat from the floor, and spasm amount of toxin that is produced, and hence of the muscles of the jaw eventually prevent the severity of the symptoms that develop. eating and drinking. This symptom is known as ‘lockjaw’. Tom Southall BVM&S MRCVS Clinical signs: G In the later stages of the disease, the DS McGregor & The symptoms of tetanus develop after an horse may fall over and then be unable Partners incubation period of anything from a few days to get up, as all of the horse’s muscles are to a few weeks. The symptoms, which can be in spasm. Further progression leads to varied, are due to the effects of the tetanus toxin generalised convulsions and fits, and on the horse’s nervous system, where they result ultimately, respiratory or cardiac arrest in continual spasm of the horse’s various muscles: and death.
All equine animals should receive regular tetanus vaccinations.
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Treatment: Vaccination As the more severe cases of tetanus are Vaccination is the only proven Of course, if we could keep our horses usually fatal, horses suffering from the method of protecting against the from ever getting a wound, that would disease often have to be humanely disease. And in this country, we are go a long way towards preventing the euthanised on welfare grounds. lucky to have effective tetanus disease also. Sadly, this is not practical. vaccines that are widely available However, promptly identifying any and inexpensive. wounds, especially deep wounds, so Milder cases can occasionally be that they can be cleaned and receive There are several brands of tetanus treated, but treatment must be appropriate veterinary management, vaccine available, and the exact protocol started early and be aggressive to will help reduce the risk. This is will depend upon which one is used. have any chance of success. particularly important in the Your vet will be able to advise you in unvaccinated horse. detail, but in general a primary course of two injections, given approximately 4-6 G Affected horses are kept in a quiet weeks apart is initially required. environment, with minimal light Vaccination schedule: and noise. The vaccines contain tetanus toxoid, an inactivated form of tetanus that stimulates the horse’s immune system Primary course of two injections G The intensive supportive care to produce its own antibodies to of tetanus toxoid vaccine given and nursing required may include tetanus. The immunity wanes over 4-6 weeks apart. intravenous fluids, feeding tubes time, and so booster vaccinations are as well as physical support. required every 2 to 3 years in order to maintain sufficient levels of This can be started in foals from protection. G Horses also receive various 4-6 months of age. painkillers and sedatives to keep Pregnant mares are usually given a them comfortable. booster vaccination in the later stages of pregnancy to increase the antibodies Booster injections required every that will be available to their foal 2 - 3 years. G Identifying the site of entry is through their colostrum. This will important to limit further give temporary protection to the foal, proliferation of the bacteria. who should then receive their own Pregnant mares should receive an primary vaccination course once they additional booster in their last are 4-6 months old. Tetanus antitoxin G Antibiotics such as penicillin are trimester. used, as is tetanus antitoxin. can also be used to give more rapid protection for unvaccinated horses which suffer a condition making them Although treatment in some cases is susceptible to tetanus. It is important Your vet will give you specific possible, the road to recovery can be both to realise that this offers short-lived guidelines based on the brand of long and expensive, as well as stressful for protection only and does not replace vaccine being used. both owner and horse. Clearly, in the case vaccination. of tetanus, prevention really is better than cure.
Summary
Tetanus is a very distressing and usually fatal disease in the horse. Fortunately, in this country it has become a rare occurrence. This is largely thanks to the widespread use of effective vaccinations, either alone or in combination with vaccination against equine influenza. However, the tetanus bacteria are still present in the environment, and so owners are encouraged to ensure their horses continue to receive regular tetanus vaccinations as outlined by their local vet.
Equine Matters Winter 2018 10
Equine genetic diseases
A genetic disease is a disease which is caused by a specific mutated gene
Genetics and is passed directly from the sire or dam to the foal in its DNA (inherited). Genetic diseases may be caused by a recessive or a dominant gene.
For a recessive condition, the individual horse Signs include: must inherit two copies of the defective gene in order to show the disease whereas for a G Skin lesions all over the body but particularly dominant condition only one copy is required, on pressure points such as the limbs, withers making disease more likely. Fortunately, many and joints genetic diseases in horses are caused by recessive G Hyperextension of limb joints genes and are therefore seen less frequently (Figure 1). G Accumulation of fluid or air under the skin or in body cavities Warmblood Fragile Foal G Haematoma (A swelling filled with blood) Syndrome (WFFS) Severely affected foals are often euthanised shortly after birth due to their very poor WFFS affects approximately 7-8% of Warmblood prognosis. A genetic cause of the disease has foals causing them to be born with extremely thin been definitively determined only in the last five and fragile skin. years. The mutation responsible is in the PLOD-1
Lizzie Royce BVSc MRCVS Hook Norton Veterinary Group
We look at a few of the equine genetic diseases caused by a specific mutated gene passed on in DNA.
Figure 1: Genetic diagrams showing some of the possible outcomes when breeding two parent horses of different genetic status. ‘A’ denotes a dominant (healthy) allele whilst ‘a’ denotes a mutant (disease-causing) allele
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gene, which plays an important role in the synthesis of collagen and the crosslinking required for strength and stability of collagen fibres in the skin. The condition Figure 3: A case of hoof wall separation is recessive, meaning that a copy of the disease. (Photo by permission of Ben Benson AWCF) defective gene must be inherited from both the dam and the sire in order for a foal to be affected. Both parents will most Foal Immunodeficiency likely appear clinically normal. Interestingly, mutations in the same gene in humans Syndrome (FIS) in Fell are known to cause a similar condition and Dales ponies called Ehlers-Danlos Syndrome. Fortunately, Figure 2: Dio owned by Debbie Clarke, a genetic test is available for this condition competing successfully despite having Foal immunodeficiency syndrome is a and Warmblood broodmares and stallions PSSM relatively recently recognised condition should be tested prior to breeding. All and can affect both Fell and Dales active KWPN-approved breeding stallions ponies. Affected foals appear normal at have been tested for the condition this There is no ‘cure’ for the condition but birth but quickly become severely unwell year and the results of this test are publicly management is usually successful and over the first few weeks or months of available on the KWPN website. It is consists of a special high fat, low starch life, usually dying within three months. important to note that carrier stallions diet and an established exercise routine The condition causes severe immune can and should still be bred from, but only with consistent daily exercise, good warm system deficiency with a lack of white to a non-carrier mare. Non-carrier stallions up periods, no rest days, plenty of turnout blood cells (important in fighting may be bred to either a carrier mare or a and no breaks in routine. Many horses are infections and disease), a lack of red non-carrier mare. able to be ridden and compete successfully blood cells (anaemia), and severe if the condition is well managed (Figure 2). damage to other important components of the immune system. In all foals, Polysaccharide Storage important maternally-derived antibodies Myopathy (PSSM) Hoof Wall Separation must be received from the dam through Disease (HWSD) in colostrum (first milk). These provide PSSM can affect any breed of horse except protection against disease for a short for full thoroughbreds. Breeds such as Connemara Ponies time after birth and as this protection Belgian Drafts, Quarter Horses and wanes foals must begin to produce their Warmbloods tend to be affected more HWSD is an inherited genetic disease own antibodies. Normal foals are able to commonly than other breeds. Typically affecting Connemara ponies. It is caused do this but foals affected by FIS are not. horses with PSSM look as though they have by a single gene mutation and the FIS foals are therefore unable to fight ‘tied up’ showing signs such as hindlimb condition is recessive. In affected ponies infection and disease and so are quickly muscle stiffness, reluctance to move, the outer layer of hoof wall loses overwhelmed as the protection from painful, swollen muscles and sweating up. connection with the inner layers leading to their dams decreases. However, in contrast to tying up, PSSM is cracking and breaks (Figure 3). All four feet caused by a genetic mutation in the are usually affected and clinical signs begin Signs of FIS include: glycogen synthase enzyme (GYS1) which to appear when ponies are young. Ponies G Dullness and depression leads to higher than normal glycogen often become lame, develop abscesses and concentrations in skeletal muscle. laminitis and don’t hold shoes well. G Diarrhoea Unfortunately, this condition is caused by Depending on the severity of the condition, G Weight loss a dominant gene, meaning that only one some ponies may be able to stay in work copy of the mutated gene must be but the most severe cases may require G Nasal discharge, coughing and inherited to cause disease. This may be euthanasia. There is no ‘cure’ for the pneumonia disease but some less severely affected inherited from either the dam or the sire Treatment of these foals is unsuccessful ponies may be able to be managed with a and so affected animals should not be bred and they will often die or be put to sleep combination of remedial farriery, dietary from. The condition can be diagnosed by within three months of birth. Genetic supplementation and modified living a combination of: testing is available and the condition is conditions. Genetic testing for this recessive (two copies of the gene must G Blood sampling to measure the levels condition has been available since 2014 be inherited to cause disease, see of muscle enzymes released in response and allows categorisation of ponies as Figure 1). Due to the already small to muscle damage either carriers (one copy of the gene), gene pool of Fell and Dales ponies, it is affected (two copies of the gene), or G Muscle biopsy (taking a small sample important that carrier animals are not negative (no copies of the gene). As with of muscle tissue and examining it excluded from breeding completely but Warmblood Fragile Foal Syndrome, carrier under a microscope following special instead should be bred to non-carrier ponies can still be bred from but only to staining) animals only. ponies which are known to be genetically G Genetic testing negative for the condition.
Equine Matters Winter 2018 12
Oesophageal Obstruction (Choke)
Equine Choke Oesophageal obstruction, or choke, is a commonly encountered problem in equine practice, and may be primary or secondary; this article will concentrate on the primary causes.
What is Choke? Primary Causes: Choke refers to an obstruction in the horse’s oesophagus (gullet) rather than in the airway (trachea) and as such, although dramatic in Although foreign bodies may be involved appearance, is not the immediate life-threatening e.g. twigs or brambles, primary obstruction is emergency it is in humans, and a significant most commonly caused by impaction with proportion of chokes resolve themselves. feedstuffs. Inadequately soaked feed such as sugar beet pulp or cubes which continue However, complications, which can include to swell and inadequately or inappropriately aspiration pneumonia, oesophageal chopped carrots and apples are frequent damage/scarring, or possible rupture of the causes of obstruction. oesophagus, are indeed serious if an obstruction is not cleared. Ultimately these complications and Dental problems in the older horse such as the fact that the horse cannot eat or drink can, missing teeth, large hooks, or wave mouth in very rare cases, lead to the death/euthanasia can prevent adequate mastication of the of the horse. food before swallowing; in young horses erupting teeth or deciduous caps can lead Horses chew (masticate) food until it forms a to oesophageal obstruction (Figure 1). bolus, and then push this bolus to the back of the mouth (pharynx). As the horse swallows, the epiglottis moves up and the cartilages in the voice box (larynx) close, thus preventing food from entering the trachea; the oesophageal sphincter then opens allowing food to travel from the pharynx to the oesophagus. Gillies Moffat BVSc BSc GP Cert(EP) The bolus moves down the oesophagus (which MRCVS is on the left side of the neck), through the chest Seadown Veterinary cavity and into the stomach. Services Ltd Obstructions tend to occur in certain regions, Figure 1: Tooth fragment causing where the diameter of the oesophagus narrows oesophageal obstruction and/or changes direction. Most obstructions occur in the cervical (upper) oesophagus; the Choke is often seen in hierarchal scenarios, oesophageal entrance to the chest cavity e.g. the situation where a horse bolts its (thoracic inlet); and occasionally at the entrance feed so that it does not lose out to another of the stomach (cardiac sphincter). horse, or so that it can push another horse away from their food. Sedatives and anaesthetics affect the co-ordinated muscular motility of the oesophagus. Therefore, horses recovering from heavy sedation or general anaesthesia that are prematurely permitted access to feed may become obstructed. Dehydration and exhaustion may predispose a horse to oesophageal obstruction.
13 Equine Matters Winter 2018
Diagnosis: The diagnosis of oesophageal obstruction is based upon clinical signs, an accurate history particularly with reference to recent feed intake, and clinical examination.
Treatment: Initial management involves the prevention of further intake of food Figure 2: Nasal discharge containing or water and allowing the horse to food matter ‘relax’ quietly in a stable or small area. Frequently mild cases of choke will resolve spontaneously within 30 minutes or so. Secondary Causes: Figure 3: Introduction of nasogastric If, however, the horse is significantly tube via nares distressed, or the obstruction does not These include oesophageal strictures, seem to be clearing your veterinary the obstructing food matter either out diverticulum or megaoesophagus; surgeon should be contacted. problems with the motility of the via the nose or down into the stomach. oesophagus; neurologic disease Your vet will take a history particularly Sedation has a very important role in affecting the nerves involved in in relation to the type of feed the this process in that by lowering the swallowing e.g. guttural pouch mycosis. horse has had access to, and then horse’s head, it reduces the risk of clinically examine your horse. This may aspiration into the lungs. include an examination of the mouth Occasionally carbonated water is used, looking for obvious causes e.g. bits of as this seems to help in the clearing of stick, which can get stuck across the Signs of choke include: obstructions by either agitating the hard palate between the dental arcades; surface of obstructions such as sugar and palpating the oesophagus to try G Distress - the horse may panic at the beet, or indeed by possibly gently to locate a site / cause of the initial inability to swallow. causing a dilation of the oesophagus obstruction. G Not interested in food. by positive internal pressure. The vet will then sedate your horse Once the obstruction is resolved the G Repeated extension of the head which helps to relax the horse and nasogastric tube will pass through to and neck. lower its head. This makes the passing the stomach and water flows easily of a nasogastric tube easier, as well G Difficulty swallowing. through the tube. Often this will be as relaxing the muscles of the neck achieved quickly but be warned in some G Coughing. and throat. Anti-spasmodic drugs cases it may take a couple of hours! may also be used for this purpose. G Nasal discharge containing saliva Anti-inflammatories and antibiotics and/or food material (Figure 2). A nasogastric tube is then introduced may be required and your vet will then G Saliva drooling from the mouth. through the nostril and gently passed prescribe any required medication in the into the pharynx and oesophagus until form of anti-inflammatories or advise G Sweating in the neck region. the site of the obstruction is located further examination with an endoscope.
G If the obstruction is in the cervical (Figure 3). Once located, warm water If the obstruction cannot be cleared, the oesophagus, it may be palpable. is then passed through the tube via a horse may be referred into the clinic or funnel or gently via pump to help flush hospital for further treatment (Figure 4). Conditions that can present with similar signs include:
G Grass sickness.
G Botulism.
G Oesophageal diverticula (a pouch that protrudes outward in a weak portion of the oesophageal lining).
G Congenital defects.
G Gastric ulceration in foals.
G Pharyngeal trauma/abscess. Figure 4: Tooth fragment causing oesophageal obstruction and requiring surgical removal
Nursing the infectious horse
As is always the case, it is much better to prevent disease through good management, hygiene and where available, through vaccination.
logos with rider element clipping .tif Fellowes Farm Equine Clinic Ltd Infectious diseases VETERINARY SURGEONS
In spite of this, if you have the misfortune to be faced with a horse suffering from a potentially Infectious diseases that may be infectious disease, prompt action may limit the encountered in horses in the UK disease’s effect on your individual horse as well as minimising the risk of spread to other horses at present include: Richard Meers on the premises. All too often owners hope for BVetMed CertAVP(ED) MRCVS the best case scenario and monitor the situation G Strangles (Streptococcus equi subsp.equi) Fellowes Farm Equine rather than seek veterinary advice, which may Clinic allow early intervention and minimise any greater G Equine Herpes Virus problem in the long run. This article will concentrate on the nursing G Ringworm and care of the individual horse rather than management of the disease outbreak itself. For G Salmonella As with people that are information on outbreak control, advice from your veterinary surgeon at an early stage is invaluable. unwell, there are basic An XLVets Equine factsheet on managing a G Clostridial diseases principles to adhere to disease outbreak is also available and contains when managing the some very useful practical information. G Equine Influenza sick horse. Biosecurity is a set of preventative measures put in place to hopefully prevent or at least limit the spread of disease and is the most important consideration when nursing the infectious horse. There are three goals of biosecurity:
G Protect the patient suffering from infectious disease as their immune system is likely to be compromised.
G Prevent the spread of the disease to other horses
G Prevent the spread of disease (if zoonotic) to humans
15 Equine Matters Winter 2018
Some important definitions: Nursing of the patient should include at least twice daily Zoonosis: a disease that can be transmitted checks of the following: to humans from animals. Ringworm, salmonella and the clostridial diseases can all potentially be passed onto staff working barn or stable area. If not feasible, creating G Temperature - normal range 36.5 with infected horses. a physical barrier between stables using - 38.3oC wooden boards and putting a grill above Barrier nursing: the term given to the the horse’s door can be useful. Cones and provision of care of potentially infectious tape at the front of a stable will create a G Breathing rate - normal range 8-15 patients includes careful consideration of further barrier alerting others not to enter breaths per minute biosecurity principles. the area. Signage can also be beneficial. G Heart rate - 25-40 beats per minute Barrier nursing protocols will exist at most equine veterinary practices but there is absolutely no reason why the same Ensure anyone who attends the G Colour of gums and capillary refill principles cannot be applied to a yard premises is aware of the situation and time - it should take less than 2 situation. It is important to apply these any protocols put in place. Keeping quiet seconds for the colour to return procedures as soon as a potentially to avoid affecting a yard reputation after releasing pressure applied to infectious horse is noticed, not once a for example, is only likely to make the the gum diagnosis has been reached. When dealing situation worse, and usually has the with sick horses, waterproof clothing and adverse effect on how people view the G Assess hydration level - are the boots, as well as disposable gloves should yard in the future. gums dry; does the skin on the be utilised. These types of clothing can be neck return quickly to normal after easily disinfected. Disposable suits with being pinched? hoods are ideal but are expensive and should be changed frequently. A changing Moving on from biosecurity, it is also room or area adjacent to isolation facilities important to discuss the nursing needs of G Monitor for nasal discharge or avoids clothing being worn elsewhere. the infectious horse. Meeting the needs of discharge from the eyes Designate specific tools, water and feed these sick horses will lead to less severe buckets, head collars, rugs and brushes clinical signs and a more rapid recovery. G Monitor number of droppings to infectious horses. When filling water Whilst on-the-yard care of many of these and their consistency buckets with a communal hose do not patients will suffice, often horses with more severe signs (especially infectious diarrhoea submerge the end. Ideally separate staff G Monitor water intake or an individual owner would deal with only cases) may necessitate intravenous fluid the infected horse(s). They should not then therapy and other medications only G Observe how horse is standing have contact with any other horses on the available from your veterinary surgeon. and general demeanour yard. If this is not possible then infected As is the case with people that are unwell horses should be dealt with after healthy there are basic principles to adhere to horses. Any soiled bedding or disposable when managing the sick horse. cold water so having slightly warm water can items should be put in bags and ideally help. Electrolytes in water or feed are also incinerated. It is essential it is not dumped Sick horses may often have a reduced invaluable. If offering lukewarm or water on communal muck heaps. When using appetite and although not in work at this spiked with electrolytes, it is always best to disinfectants always follow the instructions time, it is important to encourage them to offer a bucket of ‘normal’ water in case your on the label and choose an appropriate eat. Offering tasty alternatives to kick-start horse does not like the other options. one for your situation. They vary in their a horse’s appetite such as warm bran effectiveness when contending with mashes, molasses and carrots can be Every horse varies in its needs for individual organic matter and hardness of water. helpful, but it is important to wean back attention. Don’t forget they are herd animals VirkonTM is a commonly used product to a normal diet as soon as possible. and you have isolated them from their herd specifically formulated for the animal Supplementing vitamin and minerals can companion so it is important to give them health market. Speak to your veterinary help as well, as stress/disease increases the the care they need to cope with isolation and surgeon about which they would need for B vitamins, in particular. box rest. This can vary from allowing them recommend. Boots, clothing and tools to be able to see other horses, to toys/treat should be regularly disinfected. Despite Many conditions, particularly diarrhoea, balls to regular contact with an owner for wearing gloves, hands should be may lead to dehydration. It is important to grooming, etc. A stressed horse is unlikely to disinfected regularly as well. Hand sanitizer maintain correct hydration to allow your recover as well as a happy horse. gels containing at least 65% alcohol are horse’s body systems to function correctly ideal for this purpose. and fight disease. To reduce the need for your vet to administer fluids via a As with any sick horse, your veterinary Sick horses should be housed as far away stomach tube or intravenously, the key is surgeon will be best placed to advise from other horses as possible in a separate to act early. Horses do not tend to like very you about your individual situation.
Abnormal respiratory noises - some common sounds and conditions explained
Under normal conditions, the breathing activity of horses can hardly be heard at rest and exercise, apart from an innocent blowing noise (‘high blowing’) as a result of the Respiratory noises false nostrils vibrating as the horse breathes out.
Some respiratory disorders may lead to an or flexed head carriage to mimic the triggering abnormal audible noise. These noises are a result conditions. This is usually followed by ‘over the of a partial airway obstruction, either due to an ground’ endoscopy with a mobile endoscopy physical obstruction or a part of the airway not system attached to the horse whilst it performs functioning correctly. This obstruction causes the exercise under the conditions where a noise is airflow to become more turbulent in the airway usually heard. Occasionally x-rays, Computed and hence produces an additional noise. Tomography (CT) and Magnetic Resonance Imaging (MRI) may also be useful. Abnormal respiratory noises may not necessarily be associated with reduced exercise performance. However, they are often a reason Abnormal respiratory noises for a horse owner to consult their veterinary surgeon. Some abnormal respiratory noises may include: clearly be audible at rest with the ear, while other A. Coughing noises are only audible during exercise. Some A reflex-induced forced expiration caused by respiratory conditions produce abnormal noises stimulation of irritant receptors that line the that are best detected by careful examination airways (Figure 1). These receptors get (over) of the lung fields with a stethoscope. stimulated by inhaled particles (e.g. dust, food) In evaluating the presence or absence of or in response to airway inflammation (allergy, abnormal respiratory noise, your veterinary infectious causes, smoke). As such, coughing is surgeon will try to determine which part of the a mechanism to clear the airways from particles, airway is involved. This includes considering the excess mucus and inflammatory debris. Increased timing, duration and typical pitch of the noise as airflow from exercise may precipitate coughing well as influence of exercise. Follow up diagnostic by opening more inflamed and mucus plugged procedures will likely include standing endoscopy airways. Careful examination may allow Dr. Keesjan Cornelisse with a long flexible camera via the nostril into the identification of the affected anatomical location. DVM MS PhD Dipl.ACVIM MRCVS airway when clearly audible at rest. For evaluation For instance, cough responses after squeezing Calweton Equine of noises during exercise, the horse may need to the larynx or trachea suggests upper airway Veterinary Surgeons be ridden at speed or worked with an extended involvement. A soft cough may reflect more marked disease of the lower airways or chest cavity as pain in this area restricts the coughing reflex.
B. Abnormal respiratory noises reported at ‘Some respiratory rest, or audible with a stethoscope disorders may lead to G Wheezes are continuous musical noises an abnormal audible caused by vibration of the walls of narrowed lower airways during the end of inspiration or noise in your horse’ beginning of expiration. They sometimes can be heard at the end of the horse’s nostril at rest or are noticed when the chest is examined with a stethoscope. Wheezes indicate lower airway inflammation and irritation which causes them to go into constriction. In addition, overproduction of mucus adds to a decreasing airway diameter. Figure 1: An overview of the equine upper Thus wheezes are usually associated with and lower airway structures various degrees of laboured breathing that
17 Equine Matters Winter 2018
may already be obvious during rest. Localised absence of lung noises Wheezes are therefore a common indicates lack of airflow in parts of the finding in horses affected with the lung that are collapsed and/or various forms of equine asthma. This obstructed (e.g. pneumonia). Absence includes older horses exposed to dust of the respiratory noises in the lower and mould spores when being fed dry lung fields may indicate the presence roughage and stabled on straw of blood or fluid in the chest that Figure 2: A folded lung lobe drifting bedding (previously known as COPD) muffles the sound. Excess free fluid in pleural exudative fluid resulting and horses struggling to breathe on hot may result from pleuritis (Figure 2), in muffled lung noises in the lower parts of the chest days with high pollen counts (known as tumours, heart disease or severe protein Summer Pasture Associated Obstructive loss. Lack of lung noises in the higher Pulmonary Disease; SPAOPD). lung fields indicates collapse of a lung. Usually this is associated with G Crackles are discontinuous, explosive, infection (pneumonia) or chest ‘popping’ sounds that originate within trauma. Additional diagnostics such the smaller airways. They are heard as ultrasound and radiographs of the with a stethoscope when an obstructed thorax and an aspirate of thoracic fluid airway suddenly opens and the can help making a diagnosis. pressure on either side of the obstruction suddenly equilibrates G Stridor are loud, rather continuous Figure 3: A horse with a respiratory resulting in vibrations in the airway wall. noises that appear loudest over upper stridor caused by a tumor (T) in Crackles are usually associated with airways such as the nostrils, larynx and the nasal passage. The endoscope is inserted through the left nostril obstructive airway disease (e.g. equine trachea. They indicate an upper airway and looking back from the throat asthma) and some rare forms of obstruction and usually are more area (NS = Nasal Septum) restrictive lung disease. intense during inspiration. Assessing the nasal airflow, auscultation and G Pleural rubs are creaking or grating endoscopy can help to pin-point an sounds that sound like walking on fresh area of upper airway obstruction. C. Abnormal respiratory noises snow. They indicate inflammation or Common causes include anatomical associated with exercise infection of the membranes lining the abnormalities, ethmoid haematomas, These noises are associated with chest cavity (pleuritis). cysts and tumours (Figure 3), strangles anatomical or functional abnormalities of G Lack of lung noises may be noticed abscesses, inflammatory oedema the upper airway (nostrils, nasal passages, when listening to the chest. Usually this (smoke inhalation), foreign bodies and pharynx, soft palate, epiglottis, larynx, involves horses that are sick and have tracheal collapse in small equine breeds trachea). The noises are loud and vibrant marked breathing difficulties. and donkeys. and may sound like roaring or choking depending on location in the airway (see Table 1: Examples of upper airway conditions associated with abnormal respiratory noise during exercise Table 1). They can be inspiratory and/or expiratory. Their occurrence may depend Condition Problem Result Sound description on type and intensity of exercise, level of fatigue, and head carriage. These noises Nostril Alar Fold Instability of the Decreased functional A vibrant noise from the may be associated with impaired exercise Collapse nostril structures diameter of the nostril region worse during performance. However, this also depends nostrils expiration on the intensity of the work being required. Diagnosis is usually made via ‘over the Nasopharyngeal Instability of the Narrowing of the Grunt or vibrant noise collapse throat throat area causing at inspiration and/or ground’ endoscopy (Figure 4). impaired airflow expiration
Epiglottis The epiglottis is Billowing membrane A vibrant respiratory noise entrapment constrained by a obstructs the larynx during inspiration and/or covering membrane during expiration expiration
Epiglottic Instability of the Epiglottis sucked into A vibrant respiratory noise retroversion epiglottis position laryngeal opening during inspiration
Dorsal Displacement Instability of the soft Obstruction of the A snoring/choking type of of the soft palette palette laryngeal opening noise at intense exercise (DDSP)
Axial Deviation Instability of small Obstruction of the A harsh inspiratory noise of the Alar Folds membranes connecting laryngeal opening (ADAF) the larynx & epiglottis
Idiopathic Laryngeal Lazy vocal folds Obstruction of the A high pitched inspiratory Hemiplegia (ILH) laryngeal opening whistle type noise Figure 4: Over the ground endoscopy
Happy Endings - Respiratory noises
A newborn foal with a loud respiratory noise and nursing difficulties.
Cleopatra was a one-day old Arab filly that while a small flexible camera was passed via
Happy Endings was seen by our practice for concerns about the left nostril into the upper throat area her occasionally making an odd noise when (nasopharynx). This revealed the presence of a breathing. She was born at her expected due ‘cyst’ like structure in the far edge of the soft date and the foaling process the previous day palate (Figure 3). Subsequent x-rays were taken had been uncomplicated. After delivery, Cleopatra to determine the extent of the cyst (Figure 4). had done all the right things such as getting up From these diagnostic procedures it became clear quickly, frequently nursing, passing the first dung that the cyst lifted the soft palate over the (meconium) and passing urine. laryngeal (voice box) opening. As a result, the soft palate edge would vibrate as the foal breathed On initial examination, Cleopatra was quite out, creating a noise, whilst the main airflow was bright, but a snorting respiratory noise was redirected downwards into the mouth, leading to sometimes audible when listening close to the the cheek billowing. Similarly, milk from the nostrils. This noise was more pronounced when mouth was more difficult to swallow, hence the she was breathing out. Closer examination foal would choke intermittently. revealed some meconium in the nostril which was easily removed. When nursing, no milk was seen As the noise had deteriorated with a risk for milk coming out of the nostrils; this suggested that a aspiration pneumonia, it was decided to lance the cleft palate with milk aspiration into the airway cyst using the endoscope. Again Cleopatra was was an unlikely cause for the noise. Palpation of mildly sedated. A special grab instrument was all the ribs ruled out rib fractures that could have passed through the endoscope in order to ‘nibble’ caused trauma to the lungs or airways. All the away at the wall of the cyst (Figure 5). This took lung fields sounded clear when listened to with a quite some effort as the wall was quite smooth stethoscope. As the foal was bright and nursing and firm and was therefore difficult to grip. well, a course of injectable antibiotics was started However, eventually it deflated. Over the next to protect the foal from potential infection. An twelve hours, the noise, cheek billowing and anti-inflammatory was also given to help with choke became less marked. Antibiotic and any swelling in the airway. anti-inflammatory therapy was continued for Dr. Keesjan Cornelisse another week. By then no signs were noted and DVM MS PhD Dipl.ACVIM However, over the following two days the noise on follow up six months later, no residual signs MRCVS became more marked and Cleopatra would were present. Calweton Equine intermittently choke when nursing (Figure 1). Veterinary Surgeons In addition, her cheeks would billow outwards suggesting air was coming back into the mouth 3 4 (Figure 2), rather than being exhaled via the nose as it should be in horses. In order to determine the cause of the progressive breathing noise and choke problem, endoscopy of the upper airway and throat was performed. For this, Cleopatra was mildly sedated
Figure 3: Endoscopic image of the throat area showing the cyst at the rim of the soft palate (SP) laying over the laryngeal opening (L)
Figure 4: X-ray of the throat area. A cyst like structure pointed out by the arrow lays 1 2 over the laryngeal opening (L) Figure 5: Grabbing the cyst wall Figure 1: The foal choking as milk can be seen dripping from the mouth 5 Figure 2: Cheek billowing
19 Equine Matters Winter 2018 Happy Endings 20 Winter 2018 Equine Matters Flash show jumping a year after the Figure 3: Figure initial injury This was a great outcome for Flash and his owners, as this type of injury can often result in a chronic low-level lameness, meaning horses cannot perform at their previous job. MRI images (Figures 1 and 2) showed a tear in MRI images (Figures tendon and inflammation the deep digital flexor (joint fluid protecting the of the navicular bursa navicular bone) and coffin joint. This diagnosis carries a guarded prognosis and for returning to the previous level of work potential recovery would be a long and it was meticulously controlled process. However of likely that we could improve Flash’s chance returning to eventing by undergoing navicular bursoscopy (keyhole surgery), which involves bursa putting a small camera into the navicular allows to look at the tear directly, a process which to the torn tendon and inflammatory material be removed. to Following his operation, Flash was restricted for box rest with walking and grazing in hand three months to help improve the tendon healing. After a further three months of small to paddock turnout, he began a gradual return full work over four months. became Flash did very well after the surgery and there sound quickly. He never looked back from and thanks to his owner’s dedication to his careful rehabilitation, he was back jumping just a year after his injury (Figure 3). - A lameness case lameness - A MRI images help diagnose the is an eight-year-old pony used for pony club activities and pony used for pony club activities is an eight-year-old e 1 and 2: 1 2 igur problem in Flash’s foot. F Image courtesy of Liphook Equine Hospital eventing. I was called to see him a few days after he had pulled up called to see him a few days after eventing. I was phase at an event. lame after the cross-country Flash Flash presented with significant left forelimb Flash presented with and trot, however on lameness in both walk problems could be examination no obvious found with his leg. When his lameness didn’t rest, improve following an initial period of box further investigation was needed. leg to Nerve blocks were performed on the lower this establish the location of the pain, and from was we were able to conclude that the source of within the foot. We took radiographs (x-rays) of the foot, including some additional images the navicular bone, however these images was showed no abnormalities. As a result Flash referred to a local Equine Hospital for magnetic resonance imaging (MRI). MRI images would of allow assessment of the soft tissue structures been the foot as the x-rays which had already taken could only assess any bony abnormalities.
chell
Cedar Veterinary Group Charlie Mit BVSc BAEDT MRCVS Happy Endings Happy
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