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Care of the Geriatric Horse<br />Jenifer R Gold, DVM, DACVIM<br />Mountain Horse Medical Center<br />April 2011<br />
Definition of a Geriatric Horse<br />General Care<br />Nutrition<br />BCS<br />Gastrointestinal tract<br />Dentistry<br />...
A horse > 20 years of age<br />Recent study indicates anywhere from 7.5-20% of equine population in the US is geriatric1-2...
 Horses do not age at the same rate as humans.<br />Geriatric Horses<br />
Provide a safe and comfortable environment<br />Adequate feeding protocols<br />Provide good nutrition <br />Attention to ...
One of the most important parts of geriatric care is maintenance of body condition.<br />Older horses tend to lose weight ...
The Henneke System is an objective evaluation of a horse's body condition<br />Developed in 1983 by Don R. Henneke, Ph.D.<...
Poor — Animal is extremely emaciated. <br />Spinousprocesses,ribs, tailhead, tuber coxae, and tuber ischii project promine...
Moderate <br />Back is level. <br />Ribs cannot be visually distinguished but can be felt easily. <br />Fat around tailhea...
Extremely fat <br />Obvious crease is seen down the back.<br />Patchy fat appears over ribs. <br />Bulging fat is seen aro...
Horses too thin or too fat are prone to develop secondary diseases<br />Of particular concern<br />Hepatic Lipidosis<br />...
If an animal is too fat or too thin<br />They go off feed for a short time for any reason<br />Mobilize fat<br />Blood bec...
Lethargy<br />Weakness<br />Anorexia<br />Decreased water intake<br />Diarrhea<br />Clinical Signs of Hepatic Lipidosis<br />
Intravenous fluids<br />Nutritional support<br />Treatment of underlying issue<br />Treatment<br />
A well balanced diet is important for the geriatric horse because…<br />Digestion of fiber decreases<br />Ability to manuf...
Confinement? <br />No-Turnout with a friend!<br />Weight loss reasons: Poor dentition <br />Reduction in digestion - paras...
Selection of Feed<br />Highly palatable<br />Easy to chew & swallow<br />Clean & dust free<br />Highly digestible pellets ...
Geriatric horses should be fed a senior feed<br />Senior feeds offer the horse increased protein, minerals, and vitamins.<...
Older horses are prone to weight loss, especially in the colder months, and require more calories to maintain their body c...
Review of Equine Digestion<br />
Comparisons of digestion <br />
Differences in rates of passage<br />Equine<br />rush through foregut <br />time delay in cecum<br />rush through rectum<b...
Water <br />Essential for all body functions<br />Temperature regulation<br />Feed digestion<br />Amount of water intake<b...
Dentition<br />
Aged horses may lose some of their teeth<br />Have sharp edges on their teeth or a "wave mouth”<br />Leads to an impaired ...
Parasite Control<br />
Fecal egg counts are important<br />False negative tests can occur especially with encysted stronglyes.<br />Important to ...
Experts consider them the #1 nematode problem in horses today.<br />They can account for up to 90% or more of a horse’s wo...
It has a 3-stage life cycle<br />Unlike many parasites it can do something in its larval stage that creates a huge danger ...
No way of knowing how heavy an encysted small strongyle load a horse is carrying<br />Fecal analysis cannot measure worms ...
Encysted small strongyles can cause severe clinical signs and even death.<br /> When thousands to millions of the fourth s...
Listlessness, weakness<br />Anorexia<br />Recurring colic<br />Diarrhea<br />Weight loss<br />Peripheral edema (swelling)<...
Fenbendazole is the only de-wormer that treats the encysted strongyles.<br />Other de-wormers ieIvermectin, Moxidectin and...
If your horse is on a daily de-wormer<br />It’s still important to have your veterinarian perform a fecal egg count twice ...
When a new horse arrives on your property<br />Quarantine the newcomer and <br />Monitor the horse for signs of contagious...
An effective parasite management program includes more than just de-wormers. <br />Rotate pastures if possible. <br />Idea...
Remove manure from pastures and paddocks.<br />Harrow pastures only during hot, dry periods and keep horses off for severa...
Older horses often lose their place in the herd hierarchy <br />May be bullied by younger horses in the pasture. <br />All...
Additional considerations<br />Placing older horses in a pasture with a flat surface <br />Monitor weather conditions<br /...
Geriatric horses are more sensitive to extreme weather conditions than younger horses<br />Older horses often have hirsuti...
Pituitary Pars Intermedia Dysfunction (PPID)<br />Heaves<br />Laminitis<br />Uveitis<br /> Common Diseases of Geriatric Ho...
Otherwise known as Cushings disease<br />Usually seen in horses > 15 years of age<br />Malfunction/micro/macroadenoma of t...
Cushings versus PPID<br />Equine<br />Intermediate lobe<br />Dopamine-dependant<br />No negative feed back<br />Dog<br />A...
HPA axis and Homeostasis<br />Hypothalamus<br />CRH<br />Corticotropinreleasing hormone<br />(+)<br />Anterior Pituitary<b...
PPID<br />Hypothalamus<br />Dopamine (-)<br />Intermediate lobe of the pituitary<br />Dopamine (-)<br />Pro-opiomelanacort...
Depend upon the stage of the disease<br />Classic symptom is Hirsuitism<br />Excessively long curly hair coat <br />Early ...
Laminitis<br />Lethargy<br />Excessive drinking and urination (PU/PD)<br />Excessive sweating<br />Excessive muscle loss<b...
No test 100% sensitive/specific<br />Hirsuitism-No other disease causes this process<br />ACTH Hormone Concentrations:<br ...
Dexamethasone Suppression Test-<br />Veterinarian comes out end of day,  takes blood sample, administers (40 μg/kg) which ...
Oral Domperidone Challenge Test:1<br />Your veterinarian comes out<br />Administers one tube (25 mL gel; 2.75 grams) dompe...
Why? Determines Management/Prognosis:<br />Leave one flake grass hay in stall after 10 PM<br />Collect blood sample in the...
Drug Therapy-Pergolide (Compounded):<br />Type: Dopamine agonist <br />Action: Inhibition of PI cells<br />Dose: 1 mg tota...
Increase in “energy” and activity-IT WORKS!<br />Improvement in physical appearance<br />Lower incidence of associated pro...
Cyproheptadine: <br />Synergistic activity with Pergolide; use if no response to Pergolide alone<br />Type: Serotonin anta...
Drug Therapy with Pergolide<br />Lab Monitoring<br />Proper Nutrition<br />IR or non-IR?<br />Hoof Care<br />Routine Denti...
Heaves/Recurrent Airway Obstruction<br />
Old Disease<br />“Heaves are produced upon the diaphragm by too much food in the stomach and bowels and is cured by lessen...
Review of RAO<br />NO LONGER CALLED COPD<br />Not similar to the human form of COPD<br />Similar to human asthma<br />Seen...
Review of RAO<br />12% of mature horses have some degree of environmental-induced lower airway disease<br />50% of horses ...
Etiology of Heaves/RAO<br />Hypersensitivity reaction<br />Primary allergens thought to be<br />Aspergillus fumigatus, <br...
Pathophysiology of Heaves<br />Delayed hypersensitivity reaction<br />Natural defense mechanisms are hyper-reactive<br />I...
Bronchoconstriction<br />Mucosa is thickened by inflammation<br />Increase in mucous secretion<br />Acetylcholine causes c...
Inflammation & Bronchoconstriction Leads to…<br />Pulmonary hypertensions is consistent finding<br />Due to hypoxic vasoco...
Usually based on clinical history and signs<br />Heave line, increased respiratory effort at rest.<br />Bronchoalveolar la...
Bronchoalveolar Lavage Fluid<br />Normal horse<br />Heavy horse<br /><5% Neutrophils<br />>20% Neutrophils<br />
Treatment<br />Environmental management is key<br />Wet hay <br />Pelleted feed<br />Pasture versus stall-unless summer pa...
Anti-inflammatories<br />Corticosteroids are drugs of choice<br />Can be administered intravenously, per os, or inhaled<br...
Corticosterids<br />Horses treated with systemic steroids usually breathing more comfortably <br />In 24-72 hours dependin...
Inhaled Corticosteroids<br />Beclomethasone is less expensive<br />Greater systemic effects than fluticasone<br />Fluticas...
www.equinehaler.com<br />Equine AeromaskTM by TrudellMedical Group<br />Aerohippus by Trudell Medical Group<br />Types of ...
Bronchodilators<br />
Albuterol<br />Albuterol good for rescue therapy<br />Can be used every 15 minutes for up to 2 hours to sequentially dilat...
Clenbuterol<br />Provides long acting β2 stimulated bronchodilation for horses with moderate to severe heaves<br />Also a ...
B2 Agonists<br />Important to continue to administer corticosteroids <br />This prevents down regulation of β2 receptors w...
Mild to Moderate RAO<br />Ideal management is with environmental management<br />Aerosolized corticosteroids<br />Pre-exer...
Horses with moderate to severe RAO<br />May need daily low dose long term aerosolized corticosteroid therapy<br />Have to ...
Laminitis<br />
Suspension of the axial skeleton of the animal within the hoof<br />Dissipate concussive forces during locomotion.<br />Th...
Compromise of this interaction between laminae<br />The mechanism of which remains unclear<br />Currently the subject of m...
The first is classical inflammation, which includes infiltration of potentially destructive white blood cells.<br />The se...
Diseases Associated with Laminitis<br />Due to a plethora of diseases<br />Acute condition<br />Grain overload<br />Strang...
Lameness<br />Depression<br />Anorexia<br />Reluctance to move or lift its feet to be cleaned<br />Increased pulsations in...
Physical examination<br />Examination of hoof<br />Radiographs-if in acute stages may not have radiographic changes<br />V...
Supportive care<br />Deeply bedded stall<br />Pain medication<br />Icing feet-if in the early stages<br />Icing helps if y...
Treat primary or underlying disease<br />Farrier work is key especially with chronicity<br />If severe rotation, sinking o...
Horses with PPID have higher rate of foot abscessation<br />Must be treated aggressively<br />Important to not mistake lam...
Equine Recurrent Uveitis one of the most common ocular diseases of the horse<br />Most common cause of blindness <br />Tho...
Photophobia<br />Swelling and reddening of the conjunctiva<br />Excessive tear production<br />Discharge from eye<br />Cor...
Trauma<br />Leptosporosis<br />Brucellosis<br />Onchocerciasis<br />Strangles<br />Influenza<br />Tooth abscessation<br />...
Ophthalmic examination<br />Blood work: CBC, Biochemistry panel<br />Serology for lepto and other diseases<br />Diagnosis<...
Based on underlying clinical disease<br />Topical and systemic anti-inflammatory medications<br />Antimicrobial medication...
Surgical intervention<br />Vitrectomy-removal of vitrous<br />Seems to work better than Europe than here…<br />Suprachorod...
Tough decision<br />Sometimes the decision is made for you…<br />Quality of life<br />Suffering?<br />We are blessed with ...
<ul><li>The following are AAEP guidelines to assist in making humane decisions  regarding euthanasia of horses.1
A horse should not have to endure continuous or unmanageable pain from a condition that is chronic and incurable.
A horse should not have to endure a medical or surgical condition that has a hopeless chance of survival.
A horse should not have to remain alive if it has an unmanageable medical condition that renders it a hazard to itself or ...
<ul><li>A horse should not have to receive continuous analgesic medication for the relief of pain for the rest of its life.
A horse should not have to endure a lifetime of continuous individual box stall confinement for prevention or relief of un...
Questions?<br />
<ul><li>Initial breakdown of feeds
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The Geriatric Horse

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'Care of the Geriatric Horse,' presented by Dr. Jen Gold, DACVIM-LAIM internal medicine specialist. This presentation is a great resource for all horse owners!

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  • B vitamins and Vit C are generally produced by the microbes in the hind gut. In aged horses they have shown a decreased ability to manufacture these vitamins.
  • 85% of horses diagnosed with PPID are greater than 15, has been seen in horses as young as 7. All breeds can get this disease more common in Morgans and ponies
  • Transcript of "The Geriatric Horse"

    1. 1. Care of the Geriatric Horse<br />Jenifer R Gold, DVM, DACVIM<br />Mountain Horse Medical Center<br />April 2011<br />
    2. 2. Definition of a Geriatric Horse<br />General Care<br />Nutrition<br />BCS<br />Gastrointestinal tract<br />Dentistry<br />Pasture<br />Diseases<br />Euthanasia<br />Outline<br />
    3. 3. A horse > 20 years of age<br />Recent study indicates anywhere from 7.5-20% of equine population in the US is geriatric1-2<br />Definition-What is a Geriatric Horse?<br />1Baseline reference UDSA:APHIS 1998<br />2Harper F.Large Anim Vet 1992<br />
    4. 4. Horses do not age at the same rate as humans.<br />Geriatric Horses<br />
    5. 5. Provide a safe and comfortable environment<br />Adequate feeding protocols<br />Provide good nutrition <br />Attention to ambient temperatures<br />Grooming care<br />Parasite Control<br />Dental Care<br />General Care<br />
    6. 6. One of the most important parts of geriatric care is maintenance of body condition.<br />Older horses tend to lose weight to due <br />Parasites<br />Poor dentition<br />Competition with pasture mates<br />Disease<br />Nutrition<br />
    7. 7. The Henneke System is an objective evaluation of a horse's body condition<br />Developed in 1983 by Don R. Henneke, Ph.D.<br />Based on both visual appraisal and palpable fat cover of the six major points of the horse that are most responsive to changes in body fat.<br />Neck<br /> withers (where the neck ends and the back begins)<br />the shoulder area<br /> ribs<br /> loins<br />the tailhead area<br />What is Body Condition Score (BCS)?<br />
    8. 8.
    9. 9. Poor — Animal is extremely emaciated. <br />Spinousprocesses,ribs, tailhead, tuber coxae, and tuber ischii project prominently<br />Bone structure of withers, shoulders, and neck is noticeable <br />No fatty tissue can be felt.<br />BCS- 1<br />
    10. 10. Moderate <br />Back is level. <br />Ribs cannot be visually distinguished but can be felt easily. <br />Fat around tailhead is somewhat spongy. <br />Withers appear rounded over spinousprocesses<br />shoulders and neck blend smoothly into the body.<br />BSC-5<br />
    11. 11. Extremely fat <br />Obvious crease is seen down the back.<br />Patchy fat appears over ribs. <br />Bulging fat is seen around tailhead<br />Bulging fat along withers, behind shoulders, and along neck. <br />Fatalong inner thighs may cause thighs to rub together. Flank is filled with fat.<br />BSC-9<br />
    12. 12. Horses too thin or too fat are prone to develop secondary diseases<br />Of particular concern<br />Hepatic Lipidosis<br />Why is BSC important?<br />
    13. 13. If an animal is too fat or too thin<br />They go off feed for a short time for any reason<br />Mobilize fat<br />Blood becomes lipidemic/lipemic<br />Fat accumulates in the liver<br />Hepatic Lipidosis<br />
    14. 14. Lethargy<br />Weakness<br />Anorexia<br />Decreased water intake<br />Diarrhea<br />Clinical Signs of Hepatic Lipidosis<br />
    15. 15. Intravenous fluids<br />Nutritional support<br />Treatment of underlying issue<br />Treatment<br />
    16. 16. A well balanced diet is important for the geriatric horse because…<br />Digestion of fiber decreases<br />Ability to manufacture and absorb vitamins decrease<br />B vitamins<br />Vitamin C<br />Decrease in kidney function<br />Calcium stones may build up<br />Decrease in liver function<br />Jaundice, weight loss, lethargy, loss of appetite, intolerance for fat and protein in diet.<br />Nutrition<br />
    17. 17. Confinement? <br />No-Turnout with a friend!<br />Weight loss reasons: Poor dentition <br />Reduction in digestion - parasites, microbial constituents, B Vitamins<br />Nutrition<br />
    18. 18. Selection of Feed<br />Highly palatable<br />Easy to chew & swallow<br />Clean & dust free<br />Highly digestible pellets or extruded feeds<br />Contain enough high quality fiber to aid digestion. High quality hay – no alfalfa.<br />Chopped hay, hay cubes or pellets<br />Soaked feeds or mashes…Enough so they are easily palatable, doesn’t have to be a soup<br />Nutrition<br />
    19. 19. Geriatric horses should be fed a senior feed<br />Senior feeds offer the horse increased protein, minerals, and vitamins.<br />Specially formulated for our older horses<br />Small feedings three to four times a day is ideal. <br />¼ to ½ cup of corn or vegetable oil may be added daily as an extra source of calories. <br />Nutrition<br />
    20. 20. Older horses are prone to weight loss, especially in the colder months, and require more calories to maintain their body condition.<br /> Soaked alfalfa cubes or pellets are also a good feed to offer older horses. <br />Dengie hay is a good choice for older horses too<br />because it is less dusty, <br />minimizing any flare-ups of heaves,<br />a disease that will be discussed later.<br />Nutrition<br />
    21. 21. Review of Equine Digestion<br />
    22. 22. Comparisons of digestion <br />
    23. 23. Differences in rates of passage<br />Equine<br />rush through foregut <br />time delay in cecum<br />rush through rectum<br />Ruminant<br />Slow recycling flow of digesta<br />
    24. 24. Water <br />Essential for all body functions<br />Temperature regulation<br />Feed digestion<br />Amount of water intake<br />Level of exercise<br />Ambient temperature<br />Quality of feeds in ration<br />Proportion of diet that is forage<br />Minimum 1 gallon/100 lbs BW/day<br />
    25. 25. Dentition<br />
    26. 26. Aged horses may lose some of their teeth<br />Have sharp edges on their teeth or a "wave mouth”<br />Leads to an impaired ability to chew hay, grain, or hay cubes. <br />Frequent teeth floating by a veterinarian will ensure good oral health<br />Correct any defects that may impact a horse's ability to chew<br />MUST NOT BE OVERFLOATED!<br />Dentition<br />
    27. 27. Parasite Control<br />
    28. 28. Fecal egg counts are important<br />False negative tests can occur especially with encysted stronglyes.<br />Important to work out de-worming program with your veterinarian<br /> specific to your horse/ranch<br />De-worming<br />Help maintain good body condition<br />Keeps geriatric horses <br />Parasite Control<br />
    29. 29. Experts consider them the #1 nematode problem in horses today.<br />They can account for up to 90% or more of a horse’s worm burden (and 75% of them may be encysted)<br />Encysted small strongyles: <br />Are undetectable in routine fecal examinations<br />Usually don’t visibly affect the horse until he becomes ill<br />Can survive the effects of most common de-wormers <br />Small Stronglyes<br />
    30. 30. It has a 3-stage life cycle<br />Unlike many parasites it can do something in its larval stage that creates a huge danger to horses <br />Under certain (common) conditions, stronglyescan bury themselves in the wall of the large colon and “encyst”<br />When they do, hard to kill and even harder to detect<br />Can remain in this state for up to three years.<br />Encysted stronglyes<br />
    31. 31. No way of knowing how heavy an encysted small strongyle load a horse is carrying<br />Fecal analysis cannot measure worms in the encysted state. <br />Horses may not show outward sighs of a parasite problem until it is too late.<br />Encysted Strongyles<br />
    32. 32. Encysted small strongyles can cause severe clinical signs and even death.<br /> When thousands to millions of the fourth stage larvae (L4) emerge simultaneously from the intestine wall. <br />Encysted Strongyles<br />
    33. 33. Listlessness, weakness<br />Anorexia<br />Recurring colic<br />Diarrhea<br />Weight loss<br />Peripheral edema (swelling)<br />Death<br />In less severe cases, horses may exhibit decreased performance, poor food utilization, and a dull hair coat.<br />Clinical Signs<br />
    34. 34. Fenbendazole is the only de-wormer that treats the encysted strongyles.<br />Other de-wormers ieIvermectin, Moxidectin and pyrantel get the other stages.<br />Moxidectin does get the L3 stage but that’s not encysted. <br />Treatment<br />
    35. 35. If your horse is on a daily de-wormer<br />It’s still important to have your veterinarian perform a fecal egg count twice a year during spring and fall. <br />That way you’ll know if your horse needs a supplemental treatment to reduce a specific parasite population. <br />Horses on daily dewormer still need additional treatments to target encysted small strongyles, bots and tapeworms.<br />Daily De-wormer<br />
    36. 36. When a new horse arrives on your property<br />Quarantine the newcomer and <br />Monitor the horse for signs of contagious respiratory diseases and fecal parasites. <br />Obtain a fecal sample and treat the newcomer for parasites before turning the horse out on your pastures. <br />For long-term additions to your herd, treat the horse with a larvicidal dose of Fenbendazole<br /> Followed by ivermectin or moxidectin with or without a tapeworm treatment.<br />New Horses<br />
    37. 37. An effective parasite management program includes more than just de-wormers. <br />Rotate pastures if possible. <br />Ideally it is best to rest pastures when the weather is hot and dry.<br />Cross-graze pastures with cattle or other ruminants.<br />Beyond Deworming…<br />
    38. 38. Remove manure from pastures and paddocks.<br />Harrow pastures only during hot, dry periods and keep horses off for several weeks.<br />Consult your extension agent regarding proper composting techniques.<br />Avoid overstocking your pastures.<br />Beyond Deworming<br />
    39. 39. Older horses often lose their place in the herd hierarchy <br />May be bullied by younger horses in the pasture. <br />Allow them time in the pasture alone or with another older horse. <br />This will eliminate stress on the horse and allow them proper grazing time. <br />Adequate pasture time is vital to minimize orthopedic issues and stiffness. <br />Pasture Environment<br />
    40. 40. Additional considerations<br />Placing older horses in a pasture with a flat surface <br />Monitor weather conditions<br />Often have significant osteoarthritis<br /> May have stiffness and weakness in the hind-end<br />Predisposing them to fall in slippery conditions such as severe rain, snow, or ice. <br />Pasture Environment<br />
    41. 41. Geriatric horses are more sensitive to extreme weather conditions than younger horses<br />Older horses often have hirsutism (an overlong haircoat)<br />Not able to thermoregulatecorrectly<br />They may also have areas of patchy sweating <br />Important to clip them<br />Use blankets in colder weather<br />Provide a cool environment during hot months.<br />Daily brushing is advisableto help with circulation<br />Temperature and Grooming<br />
    42. 42. Pituitary Pars Intermedia Dysfunction (PPID)<br />Heaves<br />Laminitis<br />Uveitis<br /> Common Diseases of Geriatric Horses<br />
    43. 43. Otherwise known as Cushings disease<br />Usually seen in horses > 15 years of age<br />Malfunction/micro/macroadenoma of the intermediate lobe of the pituitary<br />PPID<br />
    44. 44. Cushings versus PPID<br />Equine<br />Intermediate lobe<br />Dopamine-dependant<br />No negative feed back<br />Dog<br />Adrenal or Anterior Pituitary<br />Cortisol-dependant<br />Negative feedback<br />
    45. 45. HPA axis and Homeostasis<br />Hypothalamus<br />CRH<br />Corticotropinreleasing hormone<br />(+)<br />Anterior Pituitary<br />Cortisol (-)<br />ACTH<br />Adrenocorticotropin hormone<br /> (+)<br />Cortisol (-)<br />Adrenal Gland<br />Cortisol (-)<br />Cortisol<br />
    46. 46. PPID<br />Hypothalamus<br />Dopamine (-)<br />Intermediate lobe of the pituitary<br />Dopamine (-)<br />Pro-opiomelanacortin (POMC)<br />Excess Cortisol Side-effects<br />ACTH<br />Β-Lipotropin<br />ϒ-MSH<br />CLIP<br />ϒ-Lipotropin<br />α-MSH<br />Β-Endorphin<br />Adrenal Gland<br />β-MSH<br />ϒ-Endorphin<br />α-Endorphin<br />Adrenal Hyperplasia < 20%<br />
    47. 47. Depend upon the stage of the disease<br />Classic symptom is Hirsuitism<br />Excessively long curly hair coat <br />Early signs<br />Late shedding out<br />Excessive hair on legs and face<br />Clinical Signs<br />
    48. 48. Laminitis<br />Lethargy<br />Excessive drinking and urination (PU/PD)<br />Excessive sweating<br />Excessive muscle loss<br />Repeated infections<br />Sinusitis (primary)<br />Sole abscesses<br />Tooth root abscesses<br />Infertility<br />Bulging supraorbital fat pads<br />Other Clinical Signs<br />
    49. 49. No test 100% sensitive/specific<br />Hirsuitism-No other disease causes this process<br />ACTH Hormone Concentrations:<br />Veterinarian draws a blood sample (except in fall-End of August-end of October)<br />Can still have false negatives/positives<br />Consider PPID if ACTH > 50 pg/ml any other time of year<br />Consider PPID if ACTH > 100 pg/mL in autumn<br />Diagnosis<br />
    50. 50. Dexamethasone Suppression Test-<br />Veterinarian comes out end of day, takes blood sample, administers (40 μg/kg) which is typically 20 mg of dexamethasone. Comes out next day around noon.<br />If cortisol values are not decreases ie < 1 ng/dl cortisol =PPID<br />Diagnosis<br />
    51. 51. Oral Domperidone Challenge Test:1<br />Your veterinarian comes out<br />Administers one tube (25 mL gel; 2.75 grams) domperidone (Equi-Tox®) orally <br />Collect EDTA blood samples at 0, 2, and 4h<br />If single sample method is used, <br />collect a blood sample 2h (Fall) or 4h (rest of year) after the owner administers the domperidone<br />Measure ACTH concentrations; + if > 100 pg/mL<br />Diagnosis<br />1Miller et al. Vet Pathol2008<br />
    52. 52. Why? Determines Management/Prognosis:<br />Leave one flake grass hay in stall after 10 PM<br />Collect blood sample in the morning (no stress)<br />Insulin concentration > 20 μIU/mL (mU/L) indicates hyperinsulinemia (presumed insulin resistance)<br />Check glucose for evidence of hyperglycemia<br />Within reference range in majority of case <br />Insulin Resistance (IR)<br />
    53. 53. Drug Therapy-Pergolide (Compounded):<br />Type: Dopamine agonist <br />Action: Inhibition of PI cells<br />Dose: 1 mg total dose/day (up to 5 mg)<br />Response: Improved “energy” / activity, muscle mass, haircoat<br />Side-effects: Transient anorexia / depression <br /> "Pergolide cloud or veil" <br /> <br />Take off Pergolide for 2 days, then re-start at lower dose, working back up to 1 mg total daily dose<br />**If no response to one type of compounded Pergolide, then switch to another.<br /> <br />Pergolide<br />
    54. 54. Increase in “energy” and activity-IT WORKS!<br />Improvement in physical appearance<br />Lower incidence of associated problems<br />Laminitis<br />Sole abscesses<br />Sinusitis<br />PUPD<br />Proper shedding of the winter hair coat the following season<br />Back to ”old self”!<br /> <br />What to expect with Pergolide<br />
    55. 55. Cyproheptadine: <br />Synergistic activity with Pergolide; use if no response to Pergolide alone<br />Type: Serotonin antagonist<br />Action: Reduces excitation of PI cells<br />Dose: 0.25 mg/kg SID for 2 weeks<br />Increase to BID for 2 months<br />125 mg for 500-kg horse<br />Response: Improvements in hirsutism, laminitis, lethargy, ACTH levels, and DST results<br />Side-effects: Drowsiness and ataxia<br />Adjunct Therapy<br />
    56. 56. Drug Therapy with Pergolide<br />Lab Monitoring<br />Proper Nutrition<br />IR or non-IR?<br />Hoof Care<br />Routine Dentistry<br />Custom Wellness Programs<br />Body Clipping<br />Activity<br />Laminitic, or non-laminitic<br />IT WORKS!!!<br />Treatment-Whole Horse Management<br />
    57. 57. Heaves/Recurrent Airway Obstruction<br />
    58. 58. Old Disease<br />“Heaves are produced upon the diaphragm by too much food in the stomach and bowels and is cured by lessening the quantity of food to occupy the same space. After the horse is turned out to grass a few days, the heaves will usually disappear, from the fact that the bowels are generally relaxed by exercise and pure air”… 1903 D. Magner2<br />2B Rush ACVIM 2006<br />
    59. 59. Review of RAO<br />NO LONGER CALLED COPD<br />Not similar to the human form of COPD<br />Similar to human asthma<br />Seen mostly in horses > 7 years of age<br />Most common exacerbation is winter and spring<br />No gender or breed predilection, though females seem to be more prone.<br />
    60. 60. Review of RAO<br />12% of mature horses have some degree of environmental-induced lower airway disease<br />50% of horses that present for evaluation of respiratory disease have heaves<br />Heritable component<br />10% incidence in horses with healthy parents<br />44% incidence in horses with 2 affected parents<br />Intermediate incidence in horses with one parent affected<br />
    61. 61. Etiology of Heaves/RAO<br />Hypersensitivity reaction<br />Primary allergens thought to be<br />Aspergillus fumigatus, <br />Thermoactinomyces vulgaris, <br />Faenia rectivirgula<br />
    62. 62. Pathophysiology of Heaves<br />Delayed hypersensitivity reaction<br />Natural defense mechanisms are hyper-reactive<br />Inflammation occurs in excess<br />Massive infiltration of neutrophils<br />Proliferation of mucosal cells <br />Leads to thickening in the airway walls and obstruction of normal air flow during breathing<br />
    63. 63. Bronchoconstriction<br />Mucosa is thickened by inflammation<br />Increase in mucous secretion<br />Acetylcholine causes constriction of smooth muscle<br /> Thus…BRONCHOCONSTRICTION<br />
    64. 64. Inflammation & Bronchoconstriction Leads to…<br />Pulmonary hypertensions is consistent finding<br />Due to hypoxic vasoconstriction and alveolar hyperinflation<br />Horses with end stage heaves have increasedright heart size<br />
    65. 65. Usually based on clinical history and signs<br />Heave line, increased respiratory effort at rest.<br />Bronchoalveolar lavage<br />Presence of neutrophils<br />Can be as high as 50-70% neutrophils<br />Horses with >20% neutrophils will likely have impaired lung function<br />Diagnosis<br />
    66. 66. Bronchoalveolar Lavage Fluid<br />Normal horse<br />Heavy horse<br /><5% Neutrophils<br />>20% Neutrophils<br />
    67. 67. Treatment<br />Environmental management is key<br />Wet hay <br />Pelleted feed<br />Pasture versus stall-unless summer pasture associated disease<br />Improve ventilation of barn<br />
    68. 68. Anti-inflammatories<br />Corticosteroids are drugs of choice<br />Can be administered intravenously, per os, or inhaled<br />Inhaled steroids allows high dose of steroids with much less systemic side effects.<br />
    69. 69. Corticosterids<br />Horses treated with systemic steroids usually breathing more comfortably <br />In 24-72 hours depending upon the severity of disease<br />
    70. 70. Inhaled Corticosteroids<br />Beclomethasone is less expensive<br />Greater systemic effects than fluticasone<br />Fluticasone expensive<br />Less systemic effects, better efficacy<br />Potency of Aerosolized Corticosteroids-<br />fluticasone>beclomethasone>flunisolide<br />Need to be used with bronchodilators<br />Bronchodilator given several minutes<br />Prior to corticosteroid<br />
    71. 71. www.equinehaler.com<br />Equine AeromaskTM by TrudellMedical Group<br />Aerohippus by Trudell Medical Group<br />Types of Inhalers<br />
    72. 72. Bronchodilators<br />
    73. 73. Albuterol<br />Albuterol good for rescue therapy<br />Can be used every 15 minutes for up to 2 hours to sequentially dilate small airways<br />Also improves pulmonary distribution of aersolized medications<br />Speeds mucociliary clearance<br />Salmeterol-long acting bronchodilator<br />Good for 6-8 hours<br />
    74. 74. Clenbuterol<br />Provides long acting β2 stimulated bronchodilation for horses with moderate to severe heaves<br />Also a mucokinetic agent which increases mucociliary clearance<br />Can cause cardiac problems with long term use<br />Terbutaline not effacious<br />
    75. 75. B2 Agonists<br />Important to continue to administer corticosteroids <br />This prevents down regulation of β2 receptors which comes with regular use or overuse<br />In humans with asthma that use bronchodilators alone-deterioration of asthma control<br />Down regulation of β2 receptors documented in horses after 12 days of clenbuterol<br />Corticosteroid administration accelerates recovery from down regulation in horses tx with clenbuterol<br />
    76. 76. Mild to Moderate RAO<br />Ideal management is with environmental management<br />Aerosolized corticosteroids<br />Pre-exercise bronchodilation<br />
    77. 77. Horses with moderate to severe RAO<br />May need daily low dose long term aerosolized corticosteroid therapy<br />Have to judge depending upon the horses response to tx.<br />Cannot treat horses with systemic steroids long term due to side effects. <br /> Thus…..<br />Environmental management and inhaled corticosteriods are the key!!!!<br />
    78. 78. Laminitis<br />
    79. 79. Suspension of the axial skeleton of the animal within the hoof<br />Dissipate concussive forces during locomotion.<br />There are about 600 pairs of interleaved laminae<br />The epidermal laminae attached to the hoof wall and the dermal laminae attached to the coffin bone. <br />Digital Laminae<br />
    80. 80. Compromise of this interaction between laminae<br />The mechanism of which remains unclear<br />Currently the subject of much research.<br />Laminitis literally means inflammation of the laminae<br />Controversial whether this is the primary mechanism of disease<br />Evidence of inflammation occurs very early in some instances <br />Laminitis<br />
    81. 81. The first is classical inflammation, which includes infiltration of potentially destructive white blood cells.<br />The second is ischemia-reperfusion injury. <br />Researchers have observed both decreased and increased blood flow to the laminae. <br />Ischemia-reperfusion injury reconciles both observations<br />Third is metabolic derangements<br />Lead to impaired cell function<br />Proteolyticenzyme activation has been proposed to be the primary mechanism for development of laminitis.<br />Three Mechanisms Proposed<br />
    82. 82. Diseases Associated with Laminitis<br />Due to a plethora of diseases<br />Acute condition<br />Grain overload<br />Strangulating gastrointestinal lesions<br />Retained placenta<br />Chronic Condition<br />PPID<br />Metabolic Syndrome<br />Tendon injuries<br />
    83. 83. Lameness<br />Depression<br />Anorexia<br />Reluctance to move or lift its feet to be cleaned<br />Increased pulsations in digital arteries “pounding”<br />Clinical Signs<br />
    84. 84. Physical examination<br />Examination of hoof<br />Radiographs-if in acute stages may not have radiographic changes<br />Venogram<br />Diagnosis<br />
    85. 85. Supportive care<br />Deeply bedded stall<br />Pain medication<br />Icing feet-if in the early stages<br />Icing helps if you start 48 hours before clinical signs start<br />DMSO, acepromazine….<br />Packing hooves/soft rides or other means<br />Multiple therapies really means we don’t understand the disease well…<br />Treatment<br />
    86. 86. Treat primary or underlying disease<br />Farrier work is key especially with chronicity<br />If severe rotation, sinking or both<br />If exceptionally bad; salvage procedure cutting deep <br />digital flexor tendons<br />Euthanasia may be recommended in severe cases <br />Treatment<br />
    87. 87. Horses with PPID have higher rate of foot abscessation<br />Must be treated aggressively<br />Important to not mistake laminitis with foot abscesses and visa versa<br />Abscesses<br />
    88. 88. Equine Recurrent Uveitis one of the most common ocular diseases of the horse<br />Most common cause of blindness <br />Thought to be an immune mediated disease<br />Characterized by periods of inflammation<br />Inactive periods where inflammation may be difficult to discern<br />Uveitis<br />
    89. 89. Photophobia<br />Swelling and reddening of the conjunctiva<br />Excessive tear production<br />Discharge from eye<br />Corneal edema<br />Constriction of pupil<br />Squinting of eye<br />Clinical Signs<br />
    90. 90. Trauma<br />Leptosporosis<br />Brucellosis<br />Onchocerciasis<br />Strangles<br />Influenza<br />Tooth abscessation<br />Causes<br />
    91. 91. Ophthalmic examination<br />Blood work: CBC, Biochemistry panel<br />Serology for lepto and other diseases<br />Diagnosis<br />
    92. 92. Based on underlying clinical disease<br />Topical and systemic anti-inflammatory medications<br />Antimicrobial medications to decrease intraocular inflammation and further damage to eye<br />Antifungals may be added depending upon where you and the horse live.<br />Treatment<br />
    93. 93. Surgical intervention<br />Vitrectomy-removal of vitrous<br />Seems to work better than Europe than here…<br />Suprachorodialcyclosporinimplantion<br />Works well but eye has be be quiescent<br />Chronic Treatments<br />
    94. 94. Tough decision<br />Sometimes the decision is made for you…<br />Quality of life<br />Suffering?<br />We are blessed with the ability to relieve pain and suffering….<br />Saying Goodbye<br />
    95. 95. <ul><li>The following are AAEP guidelines to assist in making humane decisions regarding euthanasia of horses.1
    96. 96. A horse should not have to endure continuous or unmanageable pain from a condition that is chronic and incurable.
    97. 97. A horse should not have to endure a medical or surgical condition that has a hopeless chance of survival.
    98. 98. A horse should not have to remain alive if it has an unmanageable medical condition that renders it a hazard to itself or its handlers.</li></ul>Considerations for Euthanasia<br />1AAEP Guidelines for Euthanasia 2011<br />
    99. 99. <ul><li>A horse should not have to receive continuous analgesic medication for the relief of pain for the rest of its life.
    100. 100. A horse should not have to endure a lifetime of continuous individual box stall confinement for prevention or relief of unmanageable pain or suffering.</li></ul>Considerations for Euthanasia<br />1AAEP Guidelines for Euthanasia 2011<br />
    101. 101. Questions?<br />
    102. 102. <ul><li>Initial breakdown of feeds
    103. 103. Salivary secretions from Parotid gland
    104. 104. Secrete saliva only during eating, ~10 gal/day</li></ul>Mouth<br />
    105. 105. Esophagus<br />Esophagus<br />Can’t vomit, strong cardiac sphincter muscle in stomach prevents<br />Digestive upset = Colic<br />Choke<br />Obstruction within esophagus<br />Fast eaters<br />
    106. 106. Stomach<br />Stomach - small, frequent, meals; initiates digestion, like non-ruminant<br />10% of tract<br />Limited digestion<br />Gastric ulcers <br />
    107. 107. Small Intestine - 30% of tract<br />Digestion of<br />Starch 65-75%<br />Protein, AA’s 60-70%<br />Fat 90%<br />Ca absorption 95-99%<br />Phosphorous 20-25%<br />Fast rate of passage<br />No gall bladder<br />Small Intestine<br />
    108. 108. Large Colon<br />Large Colon<br />Absorbs<br />H20<br />VFA’s<br />AA<br />Phosphorus, 50%<br />NaCl<br />Small Colon<br />Absorption of H20<br />Fecal ball formation<br />

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