2015 Equine Guide

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New Developments in an Old Problem: Pituitary Pars Intermedia Dysfunction (PPID)

by Marian G. Little, DVM, Field Equine Professional Services, Boehringer Ingelheim PPID DEFINED Pituitary Pars Intermedia Dysfunction (PPID), also known as Equine Cushing’s Disease, is the most common endocrine disorder in horses. An estimated 21% of horses and ponies over the age of 15 are affected by PPID, and the prevalence increases for each year of age.1 Although the pathophysiology differs from humans and dogs with Cushing’s, PPID is now the preferred scientific name as it specifies the exact area of the pituitary gland affected in the horse.

PPID is a chronic progressive disease. PPID causes multiple health problems for the horse, including laminitis and recurrent infections. Ponies and Morgans are overrepresented, but all breeds and types of equids may be affected.2 Horses with a history of Equine Metabolic Syndrome (EMS) are thought to be at higher risk of developing disease at a younger age.2

PATHOPHYSIOLOGY The equine pituitary is divided into three regions: the pars distalis (anterior pituitary), the pars intermedia (intermediate lobe), and the pars tuberalis (posterior pituitary). Dopaminergic neurons originating from the hypothalamus innervate and inhibit the secretory activity of the melanotrophs of the pars intermedia. Dopaminergic inhibition to the pars intermedia normally decreases with aging. However, degeneration of dopaminergic neurons occurs at an accelerated rate in PPID. The exact cause of degeneration is poorly understood, but is thought to result from chronic oxidative damage.3 As dopaminergic inhibition decreases, melanotrophs of the pars intermedia become hyperplastic, increasing secretion of proopiomelanocortin (POMC) peptides such as α-MSH, β-endorphin, CLIP, and now ACTH, which is not normally produced in significant amounts from this region. Elevated ACTH from the intermediate lobe acts on the adrenal glands to stimulate cortisol which, along with multiple other hormones, results in the unique, individual clinical presentation of PPID. With hyperplasia of the pars intermedia, functional pituitary adenomas develop over time.

CLINICAL SIGNS Hypertrichosis (previously termed hirsutism) and muscle atrophy are commonly recognized in PPID. However, a variety of non- specific clinical signs have been associated with early or advanced disease: Early signs of PPID may include: Advanced signs of PPID may include: • Regional hypertrichosis; subtle haircoat abnormalities • Generalized hypertrichosis; long, curly, dull haircoat that fails to shed despite change in season • Metabolism shift; from an “easy keeper” to lean body condition • Muscle atrophy with regional adiposity; loss of topline, pot-bellied appearance • Regional adiposity; cresty neck, tailhead, supraorbital region • Recurrent infections; white line disease, subsolar abscesses, scratches, periodontal disease, sinusitis • Poor performance; attitude/behavioral changes, dullness, docility • Inappropriate sweating; hyperhidrosis or anhidrosis • Reproductive problems; subfertility, pseudolactation • Polyuria/polydipsia • Laminitis • Neurologic disorders; blindness, seizure, ataxia • Laminitis

Signs of PPID may be discounted to the normal aging process, but it is important to recognize that this disease develops very slowly over time, making early detection difficult. Owners should record when their horse sheds its winter haircoat and compare this time with herdmates to detect delayed shedding.2 Regional alterations in length, subtle changes in color, texture, or thickness of hair may indicate early PPID. Generalized hypertrichosis (persistence of hair follicles in anagen) is easily recognized and considered pathognomonic for PPID.4 The presence of this retained haircoat is considered advanced disease and efforts at detection of PPID should begin long before this textbook sign is observed. Chronic, recurrent infections that fail to respond appropriately to treatment may also occur due to immunosuppression. In some cases, diagnosis of PPID may be missed altogether due to focus on treatment of the obvious infection and lack of other overt signs of PPID. A common client complaint in early and advanced PPID is lameness or “foot soreness” associated with insidious onset laminitis which progresses to debilitating laminitis over time. Laminitis may be the only presenting sign, and may be difficult to recognize unless the horse is examined on a hard surface. Laminitis has been associated with the presence of hyperinsulinemia and suggests a poorer prognosis for long-term management of PPID.1 Pituitary Pars Intermedia Dysfunction (PPID) continued

COMPLICATING FACTORS Hyperinsulinemia and insulin resistance/IR now collectively referred to as insulin dysregulation2 is a common finding in It is important to note that horses can exhibit concurrent history and clinical signs consistent with both EMS and PPID. It is highly approximately 30% of horses with PPID.1 Insulin resistance/IR is defined as decreased tissue response to insulin, or decreased uptake recommended that when screening for PPID, insulin parameters be evaluated; and when screening for EMS, diagnostics for PPID be of insulin. In IR, the pancreas continues to secrete more insulin to compensate for the decreased tissue response, thus blood insulin included. As the relationship between EMS and PPID is emerging, a complete diagnostic evaluation should include comprehensive levels will be elevated when IR occurs (hyperinsulinemia). As the condition worsens, the pancreas can fail to secrete enough insulin, testing parameters for both. Proper nutritional management of the PPID horse must include knowledge of insulin status (i.e., which may lead to a true uncompensated diabetic state. The concern with insulin dysregulation is with decreased tissue response presence of insulin dysregulation), and hence, laminitis risk. Fasting insulin is easily performed and may be combined with resting to insulin, laminar tissues can be deprived of proper nutrients. Hyperinsulinemia has been shown to precipitate laminitis in horses ACTH, however fasting insulin is limited by low sensitivity compared to the dynamic Oral Sugar Test (OST). The oral sugar test is and ponies and PPID must be controlled before it exacerbates underlying insulin dysregulation.2 Insulin dysregulation occurs in a now considered the first choice for evaluation of insulin status. A panel consisting of OST, leptin and triglycerides may be helpful for minority of horses with PPID, but is a defining component of Equine Metabolic Syndrome (EMS). a thorough assessment of the PPID horse.7 The author wishes to thank the Equine Endocrinology Group for providing updates to diagnostic recommendations. http://sites.tufts.edu/equineendogroup/

MANAGEMENT OF PPID PPID is a chronic, lifelong condition for which there is no cure. Treatment of PPID focuses on administration of pergolide and attention to concurrent issues impacting the horse’s health, such as laminitis, dental disease and maintenance of proper diet. Pergolide is the gold standard for treatment of PPID. Pergolide, an ergot alkaloid dopamine receptor agonist, binds to D2 receptors of melanotrophs of the intermediate lobe, inhibiting the production of excessive POMC hormones, namely αMSH and ACTH. Until 2011, only compounded pergolide was available. Compounded pergolide products have been shown to be highly susceptible to light and temperature, and have also been associated with rapid declines in stability over time. In a 2010 study, initial concentrations of all 14 formulations were highly variable, with many well below the label claim. In the same study, a high degree of variation was observed “between two containers of same product ordered from same pharmacy on the same date.”8 Unpublished 2012 data on 21 additional compounded pergolide formulations supports previous findings.9 In September 2011, the FDA approved an equine pergolide UPDATES IN PPID DIAGNOSIS formulation, Prascend® (www.prascend.com). Prascend® is now the standard of care for PPID with a starting dose of 2 μg/kg PO q24hrs (0.5 mg for 250-kg pony; 1.0 mg for 500-kg horse).10 Diagnostic testing should be performed prior to starting treatment (day 0). Diagnostics for PPID should be conducted in the face of history and clinical signs consistent with disease. Routine CBC may reveal The test used to diagnose PPID (resting ACTH or TRH stimulation) should be rechecked after 30 days to assess treatment response, a relative neutrophilia and lymphopenia. Chemistry is usually unremarkable with exception of hyperglycemia present in diabetes and a minimum of 60 days is required before evaluation of improvement in clinical signs. Photographs taken at initiation of treatment mellitus. Hypertriglyceridemia may also occur.2 Diagnosis of PPID can be challenging in early stages, as no gold standard exists for and at six-month intervals are recommended to document physical changes and provide motivation for clients to continue long-term detection of early disease. Horses with early PPID may test negative due to inability of certain tests to detect subtle pituitary changes. treatment. In refractory PPID where daily pergolide dose has reached 6 μg/kg/day (3 mg for 500-kg horse), horses may require the There have been a variety of tests suggested historically for PPID diagnosis. Long thought to be the diagnostic “gold standard,” the addition of cyproheptadine (Periactin®) a serotonin antagonist, at a dose of 0.25 mg/kg PO q12h or 0.5 mg/kg PO q24hrs.2, 11 It should Overnight Dexamethasone Suppression Test (ODST) has not proven superior in sensitivity or specificity. Diagnosis of PPID currently be expected that like Parkinson’s disease, PPID will progress over time. At the time of this writing, pergolide has not been definitively focuses on one screening test: Resting plasma ACTH concentration, and one evocative test: Thyrotropin-releasing hormone (TRH) shown to improve insulin parameters, thus management of laminitis due to insulin dysregulation should be primarily addressed stimulation measuring ACTH. Resting ACTH can be interpreted year-round and is easy to perform in the field as a single blood draw. with diet, exercise, +/- medical therapies. Although PPID is primarily managed medically, nutrition, body clipping, farrier care, regular Resting ACTH is primarily recommended when obvious clinical signs are present (moderate-advanced PPID). TRH stimulation (1.0 mg deworming and routine dentistry are important. Additional water should be provided if the horse drinks and urinates excessively. TRH IV) measuring ACTH at 0 and 10 minutes is currently advocated as a more sensitive test for detection of early PPID, when subtle Twice yearly re-assessment of haircoat, body condition and endocrine test results is recommended for ongoing monitoring of clinical signs may exist.5 TRH stimulation may also be used when resting ACTH is equivocal, or to confirm a positive or negative result. disease progression. TRH is available as protirelin or synthetic TRH, and is now available commercially to practitioners. AUTHOR Both tests are affected by normal hormonal processes that occur in the fall, when the body is triggered to prepare for winter. Both Marian G. Little, DVM, Field Equine Professional Services, Boehringer Ingelheim, Paris, Kentucky. [email protected] normal and PPID horses experience the seasonal rise in ACTH and other hormones, generally August-October, with PPID horses exhibiting a more profound hormonal rise. Thus, for resting ACTH, positive test results obtained in the fall should be interpreted REFERENCES carefully utilizing laboratory seasonally-adjusted reference ranges. As laboratory ACTH assays vary significantly, it is also important to 1 McGowan TW, Pinchbeck GP, McGowan CM. Prevalence, risk factors and clinical signs predictive for equine pituitary pars intermedia dysfunction in aged horses. Equine Vet J 2012;45:74-79. standardize sampling times, be consistent with the laboratory used, and confirm the laboratory’s familiarity with equine endocrine 2 Frank N. Pituitary pars intermedia dysfunction. Current Therapy 2013. samples and updated testing recommendations.6 Currently, TRH stimulation measuring ACTH can only be performed December- 3 McFarlane D, Cribb AE. Systemic and pituitary pars intermedia antioxidant capacity associated with pars intermedia oxidative stress and dysfunction in horses. Am J Vet Res 2005;66:2065-2072. June as seasonally-adjusted reference ranges have not been established for this test. Test results should be interpreted alongside 4Innera M, et al. Veterinary Dermatology. In press. 2013. clinical signs. It is recommended that prior to initiating medical treatment, baseline test results (day 0) be obtained via either test in 5 Goodale L, Hermida P, Oench SD, Frank N. Assessment of compounded thyrotropin releasing hormone for diagnosis of pituitary pars intermedia dysfunction. ACVIM abstract, 2013. order to accurately judge clinical response to drug. Follow-up testing at 30 days is recommended with dose titration (if necessary) 6 Schott HC, et al. Comparison of assay kits for measurement of plasma Adrenocorticotropin Concentration. ACVIM abstract, Seattle, WA. 2013. and the horse placed on a six-month recheck schedule with one appointment occurring August-October.2 This protocol ensures 7 Frank N. Oral sugar test used to diagnose insulin resistance in horses. AAEP Proceedings 2012; 58: 576. assessment of the horse during the seasonal rise in ACTH, and ensures treatment is adequate during this time. 8 Stanley SD, Knych HD. DVM, Ph.D. Comparison of pharmaceutical equivalence for compounded preparations of pergolide mesylate. AAEP Proceedings 2012; 56: 274-276. 9 Davidson G, Davis J. Potency and stability of compounded pergolide formulations for use in the horse. Unpublished. 2012. Detection of early PPID remains difficult, although this is the time period in which medical intervention can be most satisfying. In 10 PRASCEND® (pergolide mesylate) [Freedom of Information Summary]. St. Joseph, MO: Boehringer Ingelheim Vetmedica, Inc.; 2011. horses with negative or equivocal test results, tests should be repeated in six months or alternatively, the TRH stimulation test used. If 11 Schott HC. Medical management of PPID. 2012. animalhealthinternational.com test results remain negative in the presence of clinical signs, a six-month treatment trial with pergolide (Prascend®) can be considered. In advanced disease, the most accurate diagnostic “test” is the observation of generalized hypertrichosis. This classic haircoat abnormality provides high specificity for an abnormally functioning pituitary, although with end-stage disease, medical treatment is palliative. EQUILIFE PRODUCTS Premium Equine & Small Animal USP Grade Nutritional Supplements For Pure Performance Biotin Plus Small K-9 Arthroflex Animal Formula Ultimate Joint Protection

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The Enemy Smart horse owners know the best offense against equine parasites is a strong defense based on identifying *A fecal exam is the most reliable way to be sure you’re treating your horse for the right and understanding the enemies that threaten your horse’s health.* Check out the six worst offenders below. parasites. Check with your veterinarian before starting any deworming program.

Roundworms Encysted Small Strongyles Large Strongyles Pinworms Tapeworms Bots Threat: High to Severe Threat: Moderate to Severe Threat: Moderate to Severe Threat: Moderate Threat: Moderate Threat: Low

LIFECYCLE: Mature eggs are ingested LIFECYCLE: Eggs in feces; 1st & 2nd LIFECYCLE: Eggs in feces; 1st & 2nd LIFECYCLE: Eggs are laid around the LIFECYCLE: Horse ingests a mite LIFECYCLE: Bot flies (three species) when eaten through the feces and stage larvae in soil or feces; 3rd stage larvae stage larvae in soil or feces; 3rd stage anus of an infected horse; eggs fall to the infected with larval tapeworm; larvae lay yellow or gray eggs on horse’s hair on environment; larvae migrate through ingested by horses from mangers, grass, feed, larvae ingested by horses from mangers, ground and are ingested by other horses; develop into adult tapeworms in the legs, mane, flanks, jaws, throat or lips in late intestinal wall to the liver; blood carries etc.; larvae burrow (encyst) into intestinal grass, feed, etc.; larvae migrate from large eggs hatch in the stomach (occasionally intestine in about two months; adult summer; eggs enter the mouth when licked larvae from the liver to lungs; larvae enter walls for months or even years; when large intestine through blood vessel walls other organs) and remain there until tapeworms live in intestine and absorb food by horse; eggs hatch into larvae, remaining in airways and are coughed up into mouth; numbers of cyathostomes emerge from or other organs; adults live in the large larvae are mature; larvae migrate to the as it passes by; adults produce eggs that are the mouth up to three weeks; larvae migrate larvae are swallowed and become adults in “hibernation” within the intestinal wall and intestine and produce millions of eggs large intestine and colon; adults migrate passed in horse feces; mites eat eggs; eggs to stomach and small intestine and attach the small intestine; adults lay up to 200,000 re-enter the intestines, severe disease can expelled in feces. to the anus and lay eggs there before produce larval tapeworms inside the mites to the lining for about seven months; larvae eggs per day; eggs are expelled in feces. occur; adults live in large intestine and withdrawing back inside. in two to four months. pass out in feces and enter the soil; over two Approximate 80-day cycle. produce millions of eggs expelled in feces. months, larvae develop into adult flies; adult flies lay eggs on hair on horse’s legs and trunk.

SYMPTOMS: Signs of respiratory SYMPTOMS: During the encysted stage, SYMPTOMS: Weight loss, digestive SYMPTOMS: The adhesive nature of SYMPTOMS: Poor growth in young SYMPTOMS: Digestive problems, dull disease including nasal discharge and the horse may have poor feed conversion problems due to obstructed blood flow to the deposited eggs is irritating and causes horses, poor condition overall, inflamed coat, and colic. cough. Signs of intestinal disease including and lethargy. Upon sudden emergence from portions of the large intestine, dull coat, horses to rub their tail and rectal area to intestines, intermittent diarrhea, and/or weight loss, pot belly, poor condition, encysted stage, loss of appetite, diarrhea, poor appetite, lethargy, pot belly, liver relieve the itching resulting in damage to colic. digestive problems, impaction colic, bowel anemia, lethargy, colic, and even death in problems, colic, and even death in extreme hair and skin. rupture, and death in some cases. extreme cases can occur. cases.

AFFECTS: Foals and young horses AFFECTS: All ages are vulnerable, but AFFECTS: Especially dangerous to AFFECTS: Can affect all ages. Although AFFECTS: All ages are affected, as AFFECTS: All ages can be affected. Bot under age two are most vulnerable, as young horses and immunocompromised young horses under age two, and all horses relatively harmless to a horse’s overall immunity isn’t apparent. Young horses larvae damage the lining of the stomach an infestation can severely affect both adults are most susceptible. Upon if infestation is left unchecked. Migrating health, itching from pinworms can cause under age two may be more susceptible and small intestine, interfere with the respiratory and digestive systems. Adult emergence, severe inflammation and larvae damage blood vessels, intestinal damage to hair and skin. to problems. Heavy infestation may affect passage of food, and may cause other horses develop some immunity unless bleeding in the intestine causes normal gut walls, and organs such as the liver. various areas of the intestinal tract, causing digestive problems. infestation is extreme and unchecked. action to be affected, resulting in diarrhea, scarring or severe inflammation. anemia, colic, and occasionally death. animalhealthinternational.com Intestinal Parasite Info

The Plan Once parasite enemies are known and understood, the right deworming program can be planned for each individual horse, based first on age and then on other conditions that may include regional climate conditions, stocking density, history of dewormer use, and results of fecal testing. Good management includes providing a clean environment and reviewing deworming programs each year.

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Recombinant animalhealthinternational.com animalhealthinternational.com 9 Tips to Prevent Colic in Horses

Colic can seriously affect the health and well-being of a horse, no matter its age. In fact, the abdominal pain remains a major cause of sickness in equines, affecting about 10 percent of all horses at least once in the lifetimes. It is essential for horse owners to not only recognize early signs of colic (because the sooner a horse is treated, the better its chance of recovery), but to also take steps to help prevent it.

Check out these tips to steer clear of colic in horses:

Keep a routine: It’s important for horses to maintain a daily routine—timing and consistency are cornerstones of avoiding gastrointestinal problems. This is because the enzyme production in a horse’s stomach is time-dependent. Enzymes are released based on the animal’s internal clock, and food needs to be present during gastric acid formation, otherwise the acid may cause damage to the stomach lining and trigger other problems. Feeding your horse at the same time of day is considered the best practice.

Deworm regularly: Internal parasites can thrive in pastures where your horse grazes, plays and exercises; and it’s no surprise that a stomach full of parasites can cause bellyaches. Get rid of the worms by establishing a deworming program with your veterinarian. Consider implementing a five-day double worming program to eliminate encysted small strongyles. Also, all horses should be dewormed with Quest Plus for tapeworms once a year.

Unfortunately, deworming is not a one-size-fits-all solution. An effective program hinges on a number of factors that can vary between horses, including age, location, season, travel amount, pasture load and other horses in the pasture. Plus, half of all horses have tapeworms even though most mixed animal vets don’t know this.

To determine your horse’s deworming needs, have your vet perform a fecal exam to check for the presence of worm eggs. A fecal egg count reduction test should be performed every one to two years.

Float teeth: When teeth are left unattended, they form sharp points that can trigger ulcers in your horse’s mouth. Besides causing ulcers, if a horse’s chewing teeth do not have a flat surface, they cannot properly chew food, which in turn hinders the process of digestion. Call your vet to float your horse’s teeth. All horses of every age should have their teeth floated at least once a year. A simple test can go a long way.

Offer fresh water at all times: Although it may sound obvious, Muck stalls frequently: Use manure forks and suitable Your equine veterinarian may suggest that newly bought horses need clean, fresh, potable water at all times. While the stall should buckets to clean out stalls. A filthy, unkempt stall encourages a horses should be Power Packed dewormed. This is because be equipped with at least one large automatic waterer or large bucket, habitable environment for bacteria and parasites. Also, harrow worms can become logged at the mesenteric arteries, which make sure you clean and fill the water tub in the field too. To avoid fecal pastures to break up manure and help disrupt the parasitic life cycle. reduces blood flow to the intestines, in turn causing the guts impaction, provide water above 50 degrees at all times. Remove noxious weeds: Pull weeds and other indigestible to twist. As unpleasant as it sounds, worms can remain lodged If swapping feeds, do so gradually: If you’re switching from substances from pasture grass, hay and bedding. in the arteries for years before coming loose and traveling one feed to another, such as timothy to alfalfa, be sure to do it slowly. An down to plug the mesenteric arteries. All horse owners should abrupt shift in feed can lead to an upset stomach. For a smooth transition, Use digestive supplements to promote healthy visit their equine veterinarian to find out which drugs the mix the two feeds together for a week while gradually removing the old bacteria growth: The equine gastrointestinal system is parasites have become resistant to, for health check and and increasing the new. complex and delicate in certain horses. That’s why Finish Line® diagnosis as needed, and treatment. developed U-7™ Gastric Aid with the specific aim of supporting a Spread out grazing schedules: Imitate natural grazing healthy stomach, intestine, cecum and colon. schedules by providing two or three smaller portions of feed throughout the day, rather than one single feeding that overloads the digestive tract. animalhealthinternational.com animalhealthinternational.com Total Gut Health

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animalhealthinternational.com Equine Botulism by Joe Lyman, DVM, MS, Professional Services Veterinarian, Neogen Corporation

Equine Botulism is a disease caused by the botulinum neurotoxin produced by the bacterium Clostridium botulinum. Exposure to the neurotoxin causes horses to become progressively weak and paralyzed due to blockage of the neuromuscular transmission. Rapid progression is characteristic, with respiratory failure due to muscle paralysis resulting in many untreated cases.

Neurotoxin Diagnosis The botulinum neurotoxin can be found worldwide and is known Diagnosis of equine botulism can be difficult in the early stages as a major source of food poisoning in humans. It is one of the most due to the clinical signs mimicking many other diseases. Botulism is potent toxins known, with a single teaspoon of the toxin being frequently mistaken for colic. A common test for on-farm diagnosis enough to kill thousands of horses. The toxin is produced by the is the ‘grain test.’ Horses are offered a small amount of grain/sweet bacterium Clostridium botulinum. This bacterium grows in warm, feed and observed. The inability of affected horses to apprehend and anaerobic conditions, but can sporulate and remain dormant for swallow feed is readily apparent. Laboratory diagnosis is possible years waiting for appropriate growth conditions. The neurotoxin with both PCR and neurotoxin assays, but results typically are not comes in many forms (types A - G), but the most common form available until well after treatment is required. affecting horses is type B. Type B botulism can be found throughout the U.S. but is found most commonly in the Ohio Valley, northeast Treatment and mid-Atlantic regions. Initial treatment of equine botulism should include prompt administration of antitoxin. Only circulating toxin will be bound Exposure by antitoxin, meaning that clinical signs will not be resolved by The most common form of exposure in horses is forage poisoning. administration of antitoxin. Supportive therapy is required, and This is ingestion of preformed toxin which is present in feed due to severe cases will require intensive care. Clinical signs will persist for improper storage, improper processing or contamination with animal more than a week, with most horses regaining the ability to consume carcasses. While large round bales and haylage are usually associated feed in 7-8 days. with this route, all feed types can be associated with botulism. The perception that only horses fed round bales are at risk is false, as any Prognosis stored or processed feed source can harbor botulism. Overall survival rate for horses with botulism is approximately 50%. Horses that become recumbent have a grave prognosis, with survival Wound botulism occurs when a wound has the correct conditions rates being less than 20%. Early treatment with antitoxin improves for growth of the bacterium and has been exposed to C. botulinum survival rate and reduces progression of clinical signs. spores. Deep wounds, umbilical infections and castration sites are typical locations. The C. botulinum bacteria proliferate and begin to Prevention produce the neurotoxin in these conditions. Prevention of exposure to the toxin is an important part of prevention of the disease, but is not always possible. Vaccination Toxicoinfectious botulism, also known as Shaker Foal Syndrome, with BotVax B is effective for prevention of type B botulism (the most results when foals ingest the bacterial spores. Conditions in the foal common type in horses), but does not confer protection against gastrointestinal tract allow for growth of the bacteria and production other types. An initial series of three doses is required with an annual of the neurotoxin. Foals are typically affected before two months of booster thereafter. The vaccine is safe for use in pregnant mares and age. foals older than two weeks. AAEP vaccination guidelines include vaccination against botulism in the risk-based category. Clinical Signs Clinical signs and progression are dose-dependent and seen within 24 hours of exposure to the toxin. Reduced tongue tone Reduced eyelid tone Generalized weakness Muscle fasciculation Recumbency Respiratory failure Reduced tail tone Dysphagia animalhealthinternational.com animalhealthinternational.com Equine Check List

Pharmaceutical 16479689 Lidocaine 2% 100ml 16541254 Uniprim Powder 37.5GM Mare Care/Breeding Supplies Staples/Dry Goods Lab

17640541 Acepromazine Inj 50ml 16618800 Naxcel 4gm 16623335 Uniprim Powder 400GM 21231839 Catheter Equine Lavage 34” 32 FR various Flex Wrap EX Tear 4” Various Colors 21141865 Dish 4 Well Cluster RND Bottom

16459776 Amiglyde-V250mg 21122781 Phenylbute Inj 100ml 21142075 Uniprim Powder Apple 1200GM 21251167 Catheter Equine Lavage 36” 37 FR 20102749 Bandage Conforming Poly 3” 12s 21251165 Embryo Collection Filter Non-Vent

21248268 Ampicillin 1gm 10ml 21236558 Phenylbute Powder 1.1lb 21233730 Uniprim Powder Apple 200GM 16951247 Chorulon 10,000 IU 5x10ml 13675537 Breeder Sleeve 36” Red 100s 21251165 Embryo Searching Bowl 120cc

21248269 Ampicillin 2gm 10ml 17613258 Phenylbute Powder 2.2lb 21233731 Uniprim Powder Apple 400GM 21239531 Equidone Gel 6x25cc 11300877 Conform Bandage 3” Non Sterile 12s 21251354 Embryo Transfer Gun Disp 0.5cc

12228725 Bactracillin (Pen G) 100ml 20100020 Pributazone 1gm (bute tabs) 18845255 Ventipulmin 100ml 13132897 Estrumate 100ml 14095579 Conform Bandage 4” Non Sterile 12s 21245711 Equine Embryo Recovery Kit

13228725 Bactracillin (Pen G) 250ml 21240414 SMZ 960 100ct 12111548 Ventipulmin 330ml 15234641 Estrumate 20ml 18455889 Cotton Roll 1lb 21134513 EZ Way Embryo Collection Filter ECE051

20110947 Buscopan Inj 21247732 SMZ 960 500ct 12111548 Ventipulmin 330ml 20101561 First Priority O Lube + Pump 2.5 gallon 21132791 Dermacea Bandage Roll 3”x4.1 21253098 Holding Dish RND IRAD 35mmx10mm 10s

15761817 Dexasone 2gm 100ml 20101576 Sodium Bicarbonate Inj 8.4% 100ml 12784193 Ventipulmin 460ml 12691056 General Lube + 1 Pump gallon 21132790 Dermacea Bandage Roll 4”x4.1 21134303 IMV Straw Gamma Irrad 0.25cc 5pk

17748774 Dexasone 4gm 100ml 21230801 Sucralfate 1GM 100s 11265620 Vetameg (Flunixin) 250ml 17778561 Infusion Pipette 21” Drilled/Sterile 25s (J0287E) 17741551 Equisleeve OB Sterile 12s 100s 12100154 Microscope Cover Slip 100s

20107303 Dolorex 50ml 20114463 Sucralfate 1GM 500s 21127498 Aminocoproic Acid 5G/20ml 15852183 Infusion Pipette Blue-EQ Sterile 25s (J0284) 16545501 Equisleeve OB Non/Sterile 100s 16640415 Microscope Slide Clear 72s

20101746 EqStim 5ml 21230812 Timenton 3.1 11792466 Derma Vet 240ml 17380345 J-Lube OB Lube Powder 10oz 16638623 Gauze Brown Cling 3”x5yd 10245514 Microscope Slide Frosted 72s

15376300 Equi Bute Paste 20gm 20107196 Torbugesic 50ml 14412054 Eqstim 50ml 12551472 Lutalyse 100ml 13456594 Gauze Brown Cling 6”x5yd 21251164 Over Sheath Sanitary 21”

13546263 Excede 100ml 16399566 Tucoprim Powder 2000GM 11802847 Naxcel 1gm 12426747 Lutalyse 30ml 21238169 Gauze Sponge 3x3 12-Ply 200s 15122363 Semen Collection Cone

17861615 Gentamicin 100mg-100ml 12512455 Tucoprim Powder 400GM 20107195 Torbugesic 10ml 19797570 Oxytocin 100ml 21238170 Gauze Sponge 4x4 12-Ply 200s 15611245 Semen Collection Tube 100s

18105120 Gentamicin 100ml-250ml 13107999 Uniprim Powder 200GM 18380356 Priority Care Lube Jelly 5oz Sterile 17982996 Glove Maxi Sleeve (Brn) 100s 21133446 Semen Extender INRA 96 200ml

21255376 Prostamate Inj 30ml 16585645 Glove Maxi Sleeve (Yellow) 100s 21245710 Sheath Side Delivery Blue 21”

21255375 Prostamate Inj 90ml 11257066 Glove OB Poly Sleeve Sterile 12s 21141858 Splitting Dish Round 60x15mm 20s

21258917 Real Heal Uterine Flush 12393592 Glove Poly Sleeve (Blue) 100s 21141858 Splitting Dish Round 60x15MM 20s

21133970 Recombinant Equine LH 3.75mg 12025489 OB Sleeve Small Hand Pink 35” 100s 21245784 Straw Gamma IRRAD 0.25cc 5pk

12830628 Regumate 1000ml various Vetrap 4” Various Colors 21141856 Straw Gamma IRRAD Yel 0.25cc 5pk

21231842 Settle Equine Endometritis 1.5ml 11152540 Vetscan Equine Profile Plus 12s 19871233 Speculum Vaginal Disp Sterile 18” Sedative/Tranquilizer 21231507 Vetscan Equine Profile Plus 25s 20101564 Sterile Lube Jelly Non-Spermicidal 5oz 17640541 Acepromazine Inj 50ml 21142334 Vigro Equine Holding Media 8ml

18568581 Sucromate Inj 10dose 19784915 Acepromazine Tabs 25mg 100s 17214916 VSPRO Fibrinogen Test 12s

21126725 Swab Culture Kalayjian 17945825 Acepromazine Tabs 25mg 500s 16194127 VSPRO Fibrinogen Test 25s

21249925 Vigro Complete Flush Solution 2L 13771120 Anased 100mg/ml 50ml 21251166 Y Flush Tubing w/Spike

16233512 Dormosedan 20ml

15140369 Dormosedan 5ml

12010672 Dormosedan Gel 10x3ml

16877982 Sedivet Inj 1% 20ml

animalhealthinternational.com Equine Check List

Fluids/Fluid Administration 21231127 Abbocath-T 14x2 21230425 Sodium Chloride 0.9% Irrigation 500ml (Hospira)

21231133 Abbocath-T 14x5.5 16963036 Sodium Chloride Inj 0.9% 1000ml (Abbott)

21120276 Abbocath-T 16x5.5 21141990 Sodium Chloride Inj 0.9% 250ml (Abbott)

12455836 Dextrose 5% + Lactated Ringers inj 1000ml (Abbott) 21230449 Sodium Chloride Inj 0.45% 1000ml (Hospira)

21141993 Dextrose 5% 1000ml (Abbott) 21230446 Sodium Chloride Inj 0.9% 1000ml (Hopsira)

15784324 Dextrose 50% 500ml (Aspen) 21230444 Sodium Chloride Inj 0.9% 250ml (Hospira)

21232659 IV Angiocath 14x5.25” 50s 21230445 Sodium Chloride Inj 0.9% 500ml (Hospira)

21254369 IV Aniset L/A 2 Spike 21141991 Sodium Chloride Inj 500ml (Abbott)

21254368 IV Aniset L/A 4 Spike 21141992 Sodium Chloride Irrigation 0.9% 500ml (Abbott)

21239267 IV Ext Set 7” Large Animal 21231147 Sodium Chloride Irrigation 0.9% (Hospira)

19234543 IV Extension Set 30” 21239279 Transfer Set Disp Large Animal (TS2001)

15982994 IV Set Funnel Type (J0063)

19601321 IV Set Primary 80” Scrub/Antiseptic/Disinfectant

21239931 Lactated Ringer 1000ml 14301506 Accel Concentrate gallon

21241847 Lactated Ringer 250ml 13108650 Accel Wipes

21239930 Lactated Ringer 5000ml 11795782 Alcohol 70% gallon

21141995 Lactated Ringer 500ml 11724721 Alcohol 99% gallon

11843969 Lactated Ringer Bottle 1000ml 15006799 Chloradine Scrub 2% gallon

21245395 Lactated Ringer Irrigation 3000ml 15006690 Chloradine Scrub 4% gallon

21235636 Mila Cath Extended Use 14x5.25” 15194851 Chlorhexidine Solution 2% gallon

21235640 Mila Cath Extended Use 16x3 17214830 Hydrogen Peroxide 3% gallon

21141996 Plasmalyte 148 Inj 1000ml 11238451 Povidine Iodine Scrub gallon For the Foal/Serums 12311541 Plasmalyte A PH 7.4 Inj 1000ml 11595148 Povidine Iodine Solution gallon 21142198 Plasmalyte A PH 7.4 Inj 5000ml 11117731 Triodine 7 16oz 12658945 Derma Cloth Wipe 21257804 Equiplas R 950ml 21133981 Higamm-Equi High Equine IGG 500ml 21230364 Sodium Chloride 0.9% Irrigation 1000ml (Hospira) 21135048 Triodine 7 32oz 21238225 Diagel Diarrhea Gel 30ml 21257804 Equiplas REA 950ml 21124150 Mares Match Foal 20lb

10315487 Endoserum 500ml 16103031 Fleet Adult Enema 4.5oz 21123216 Mares Match Foal Pellets 25lb

13622916 Endovac Equi 10ml/10dose 21246910 Foal Lac Instantized Powder 20lb 16540505 Normal Serum Equine Origin 250ml

20111441 Enema Zip Top Bag + Foal Tip 2.5L 12837259 Foal Lac Instantized Powder 40lb 16955215 Nursemate ASAP Foal 30ml

12598772 Equine Coli Endotox 1ds 15252588 Foal Lac Instantized Powder 5lb 21141720 Plasmune Equine IGG 1000ml

15802349 Equine Tracheal Wash Kit 18863749 Foal Lac Pellet 25lb 13506190 Predict-A-Foal Kit 15 test

21257801 Equiplas 950ml 13055802 Foal Lac Pellet 40lb 21233677 Seramune IV IGG 250ml

21257806 Equiplas B Foal 950ml 21252737 Foal Lac Pellet 6lb 21233678 Seramune Oral 300ml

21257802 Equiplas Plus 950ml 21130158 Higamm-Equi High Equine IGG 100ml animalhealthinternational.com

All Your Equipment Needs in One Location

From surgical and dental equipment and tools, to imaging and diagnostics, to consumables, pharmaceuticals, and all your clinic needs, Animal Health International provides what you need, when you need it. We have everything you need from initial start-ups to hospital care.

Animal Health International also provides leasing programs in order to minimize start-up costs and maximize cash flexibility. Leasing allows for immediate write-off of the dollars spent. These are finance leases which qualify for Section 179 (accelerated depreciation). Therefore, the equipment does not have to be depreciated over five to seven years.

Our equipment professionals can assist with all of your equipment challenges and identify the best solutions for your specific needs.

Equipment Repair Center Your first choice for veterinary equipment sales and service

• Extend the life of your equipment with Animal Health International’s Equipment Repair Services • Get your equipment back up and running in no time for a very reasonable price • Quick turnaround time • Full bumper-to-bumper, 90-day warranty on all repairs (parts and labor)

Call 855-FIX-1849, visit our website AnimalHealthInternationalRepair.com or email [email protected]

animalhealthinternational.com Animal Health International

Animal Health International sales representatives are trained professionals who understand the importance of animal health and are here to assist you with all your needs. Corporate Headquarters GREELEY Our experienced sales staff possess the product knowledge and deep-rooted industry experience to assist you with recommendations. We want to help you achieve your overall animal health and business objectives. 822 7th St. Suite 740 Greeley, Colorado 80631 (866) 228-2659 Our sales staff (970) 353-2600 • Provide up-to-date information on products, programs, new technologies Online Ordering Support and animal health issues. Order online 24 hours a day at your convenience! • Are trained in product offering, regulatory compliance, immunology, (800) 203-5620 pharmacology, merchandising and management. Monday-Friday 6:00am-3:00pm MT • Are a resource for improved animal health management and product [email protected] information with our partnered manufacturers. • Network with over 350 outside and inside sales representatives nationwide to assist in your animal health needs. Call Centers: Benefits of working with our sales team Sales and delivery CALIFORNIA NEBRASKA FLORIDA PENNSYLVANIA • Knowledgeable and professional sales staff. Animal Health International provides marketing, distribution, VISALIA HASTINGS OCALA LANCASTER information management and logistics to help make our • Single-source supplier for all your animal health needs. Call Center Vet Call Center Call Center Call Center customers’ job easier. • Emergency and weekend service available. (559) 651-1930 (800) 321-2887 (800) 342-5231 (888) 313-4587 • Split order option. • Large national, multi-location distributor. INDIANA SOUTH DAKOTA IOWA TEXAS • Inventory management. WOLCOTT SIOUX FALLS MANCHESTER SAN ANTONIO • Safe and efficacious products that meet manufacturers’ handling specifications. Call Center Call Center Call Center Call Center (800) 541-5547 (800) 735-8387 (800) 458-4439 (800) 292-5692 • Reliable source of information. • Assured compliance and handling to meet the standards with regulatory IOWA HAWAII MINNESOTA COMPANION agencies and prescription drug handling. SIOUX CENTER KAMUELA BUFFALO ANIMAL • Interface between customer, consulting veterinarian and nutritionist. Vet Call Center Sales Office Vet Call Center Sales Office • Delivery to multiple locations. (800) 735-8387 (808) 885-9015 (800) 959-3836 (888) 787-4483 • Volume purchasing which ensures competitive pricing. • Flexibility and convenience in managing inventory.

animalhealthinternational.com