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Regu-Mate® (Altrenogest) Management Practices and Potential for Exposure in Equine Care Givers

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Regu-Mate® (Altrenogest) Management Practices and Potential for Exposure in Equine Care Givers Regu-Mate® (altrenogest) Management Practices and Potential for Exposure in Equine Care Givers A thesis submitted by Ariel Newman In partial fulfillment of the requirements for the degree of Master of Science in Civil and Environmental Engineering TUFTS UNIVERSITY August 2013 Advisers: Anne Marie C. Desmarais, Mark Woodin and Brett Gaby DVM ABSTRACT Regu-Mate, the synthetic progesterone altrenogest, is used to control estrus in horses. Equine caregivers handling Regu-Mate may be exposed through accidental exposure or inadequate safety procedures. This exposure can result in adverse health effects including menstrual cycle changes, uterine/abdominal cramping, headaches and prolonged pregnancy. Surveys asked equine caregivers about Regu-Mate handling procedures, skin exposure to the drug, symptoms associated with exposure to the drug, and general background information. I analyzed results through descriptive statistics. Most respondents do not take sufficient safety precautions when handling Regu-Mate. Respondents most commonly use rubber/latex gloves or do not wear gloves when handling the drug and/or use a non-locking syringe to withdraw the medication. Respondents become complacent, taking fewer precautions the longer and more often they handle Regu-Mate. I developed a risk communication program that outlines the important safe handling discussion topics between veterinarians and clients and recommends a periodic check- in to evaluate a facility’s procedures. ii ACKNOWLEDGMENTS I would like to express my sincerest gratitude to Anne Marie Desmarais, Mark Woodin and Brett Gaby their wisdom and guidance through this project. Thank you to Karen Vagts for helping navigate the research process. This thesis was made possible by the veterinarians and practices that assisted in the dissemination of my survey: Anoka Equine Veterinary Services, Atlanta Equine Clinic, Battenkill Equine Clinic, Brandywine Equine Veterinary Associates, Cave Creek Equine, Clover Valley Veterinary Services, Eastampton Veterinary Service, El Sol Equine Practice, Equine Reproduction, Equine Reproduction Concepts, Equine Veterinary Services of Leelanau, Essex Equine, Dr. Tera Forbeck DVM, Fox Run Equine Center, Gas Light Equine, Dr. Carlos Gradil DVM, Dr. Paul E. Mennick DVM, Mobile Veterinary Practice, Montana Equine, Ocean State Equine, Pacific Crest Sporthorse, Panhandle Veterinary Services, Piedmont Equine Practice and Hospital, Professional Equine Therapeutics Service, Rutherford Large Animal Services, Santa Sofia Equine, South Shore Equine, Tacoma Equine Hospital, Teigland Franklin and Brokken DVM’s PA and Dr. Karen Wolfsdorf DVM. A special thank you to my family: Mom, Dad and Maris for their never-ending support in every way possible, Brady and Kaylee for “understanding” that the boring computer work truly was more important than a walk in the woods, and Ethan for his constant encouragement. You are all wonderful; thank you for being with me every step along this journey. iii Table of Contents 1 Introduction ............................................................................................................................ 2 1.1 Problem Statement .......................................................................................................... 3 2 Background ............................................................................................................................. 4 2.1 Chemical Information ....................................................................................................... 4 2.2 Pharmakinetics in Horses ................................................................................................. 5 2.2.1 Testing ........................................................................................................................... 6 2.3 Health Effects in Horses ................................................................................................... 6 2.4 Health Effects in Humans ................................................................................................. 7 2.4.1 Non-Carcinogenic Effects .......................................................................................... 7 2.4.2 Carcinogenic Effects .................................................................................................. 8 2.4.3 Sensitive Populations ................................................................................................ 8 2.4.4 Adverse Drug Experience Reports ............................................................................ 8 2.5 Levels of Human Exposure ............................................................................................. 10 2.6 Effects on Plant Life and Soils ........................................................................................ 12 2.7 Routes of Exposure for Humans .................................................................................... 13 2.8 Horse Physiology and the Estrous Cycle ........................................................................ 14 2.9 Altrenogest Usage in Horses and Alternatives............................................................... 15 2.9.1 Behavior Modification ............................................................................................ 16 2.9.2 Breeding Mares ....................................................................................................... 18 2.9.3 Maintaining Pregnancy ........................................................................................... 19 2.10 Administering Altrenogest ............................................................................................. 19 2.10.1 Manufacturer’s Recommendations ........................................................................ 20 2.10.2 Handling Guidelines ................................................................................................ 20 2.10.3 Safety of Recommendations ................................................................................... 21 3 Methods ................................................................................................................................ 27 3.1 Survey Design ................................................................................................................. 27 3.1.1 Languages ............................................................................................................... 27 3.1.2 Participants ............................................................................................................. 27 3.1.3 Institutional Review Board Approval ...................................................................... 28 3.2 Veterinary Professional Recruitment and Survey Distribution ...................................... 28 3.3 Data Entry ....................................................................................................................... 29 3.4 Analysis ........................................................................................................................... 30 3.5 Literature Search ............................................................................................................ 30 iv Table of Contents (continued) 4 Results ................................................................................................................................... 32 4.1 Survey Questions............................................................................................................ 32 4.1.1 Basic Demographics ................................................................................................ 32 4.1.2 Questions about Regu-Mate Interaction ................................................................ 36 4.1.3 Exposure and Symptoms ........................................................................................ 42 4.1.4 Education, learning and restrictions ....................................................................... 44 4.2 Comparisons between Questions .................................................................................. 46 4.1.5 Demographic Comparisons ..................................................................................... 46 4.1.6 Relationship with Horses Comparisons .................................................................. 54 4.1.7 Breeding Industry Comparisons .............................................................................. 68 4.1.8 Reasons for Using Regu-Mate ................................................................................ 76 4.1.9 Number of Horses Comparisons ............................................................................. 78 4.1.10 Years Handling Comparisons .................................................................................. 84 4.1.11 Frequency handling Regu-Mate.............................................................................. 91 4.1.12 Preventative Measures ........................................................................................... 96 4.1.13 Where Respondents Learned About Regu-Mate ................................................. 106 4.1.14 Regu-Mate Education from Veterinarians ............................................................ 112 4.1.15 Reported Symptoms ............................................................................................. 117 4.3 Unable to Compare ...................................................................................................... 121 5 Discussion...........................................................................................................................
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