Hello all,

Here's to some fresh blogging this winter, along with the launch of our new practice logo - what do you think of it? Comments, both pro and con, are greatly appreciated.



I believe that education is the key to evolution.I believe that animals are the key to compassion.I believe the learning never stops.

Fall Clinic Schedule

                                                           

Reduced clinic fees still held over from 2009!

As always I’m there to answer your questions, and also offer routine health care services on clinic days. Routine fall health care includes vaccination against Influenza and Rhinopneumonitis plus deworming, an oral exam,  and sheath cleaning for geldings.

Call the office to reserve an appointment.

BE SURE TO LEAVE THE FOLLOWING INFORMATION:

Name, Phone #,  Date you request, Number of Animals, and the Services needed.

We will return your call three days before your clinic with an estimated time of arrival at your address.  Please be sure horses are caught and haltered 30 minutes beforehand.

Location                                               Date

Rancho Haven/Sierra Ranchos1.............Sun  Sep 11 

Rancho Haven/Sierra Ranchos2............ Fri  Sep 16

Red Rock North/Silver Knolls 1...............Sat Sep 17

Red Rock North/Silver Knolls 2...............Fri Sep 23

SpanSprings/Palomino Valley 1.............Sat Sep 10

SpanSprings/Palomino Valley 2.............Fri Sep 23

Antelope/Golden/Lemmon Valley 1........Sat Sep 24

Antelope/Golden/Lemmon Valley 2........Thur Sep 29  

South & West Reno 1...............................Sun Sep 25

South & West Reno 2.............................. Fri Sep 30

For additional savings, you can schedule your own mini-clinic as long as you have at least 7 horses at a single location.  Call the office to make such arrangements.

Discounted Price List – Clinic day only

Farm Call/Fall Exam               $15.00

West Nile (Prevenile)               $30.00

FluRhino                                    $26.00

Tetanus/ Encephalitis              $15.00

Intranasal Strangles                  $30.00

Ivermectin Deworm                  $14.00

Coggins Test                             $25.00

Sheath Clean w/sedation         $35.00

Fecal parasite exam                 $15.00

Oral Exam (w/o sedation)         No charge!

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I believe that education is the key to evolution. I believe that animals are the key to compassion. I believe the learning never stops.

Continuing Education

Sharing New Knowledge

Although this picture looks like my life is one big vacation, the truth is that in addition to lots of hard work, continuing education is a vital part of my commitment to your animal’s care. This spring I attended the American College of Veterinary Internal Medicine Annual Forum. I thought you all might be interested in a few highlights of what I learned:

Topic: Neurologic EHV-1 – In a research setting, treatment with the anti-viral drugs Valacyclovir or Gencyclovir decreased the severity and improved recovery from neurologic signs even when the medication was not given until 5 days after the known time of infection with EHV-1.

Topic: Melanomas –A fascinating DNA based vaccine has been available for dogs with malignant melanoma for several years. Application of this vaccine to horses with melanoma has yielded promising results. The vaccine is expensive, and multiple doses are required, but for those of you who have experienced the heartbreak of progressive melanoma in horses, this represents a great breakthrough in treatment/prevention options. A second novel therapy for melanomas combines a hyperthermia unit with chemotherapy. In the pilot clinical study a positive response rate of 81% was reported with this treatment.

Topic:Insulin Resistance - Low carbohydrate diets are the standard recommendation for Metabolic Syndrome horses. Occasionally these horses are in work that requires a higher caloric intake and we have traditionally recommended adding fat as a caloric source. This may not be a good idea. Recent research shows that fat may be detrimental to the metabolism of insulin resistant horses, and that beet pulp and soy hull feeds are a better source for increase calories in these horses’ diets.

Topic – Stem Cells for Laminitis – Regenerative therapy is rapidly expanding field in medicine. Stem cells are now being injected as a regional limb perfusion in horses with laminitis (founder). The work is early, but positive results have been reported in horses that failed to respond to conventional treatments. Next week I will be administering stem cells to a horse with a chronic quarter crack and underlying laminar damage.

I believe that education is the key to evolution. I believe that animals are the key to compassion. I believe the learning never stops.

AAEP release on EHV-1 reporting

The American Association of Equine Practicioners (AAEP) has released the following regarding reporting of any suspect EHV-1 exposed horses:

American Horse Council and AAEP work with USDA to Facilitate Coordination of EHV-1 and EHM Case Reporting Horses exposed to the Equine Herpes Virus (EHV-1) based on attending an event held in Utah will now be monitored through a national case reporting system.  In addition, a guidance document was sent to State Animal Health Officials and Area Veterinarians in Charge (AVIC) in each state on Tuesday, May 17, 2011, courtesy of the U.S. Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS), Veterinary Service (VS). In response to confirmed cases of Equine Herpes Virus (EHV-1) and Equine Herpes Virus Myeloencephalopathy (EHM) in horses that attended a cutting horse event in Ogden, Utah held from April 29 to May 8, 2011, the American Horse Council (AHC) and the American Association of Equine Practitioners (AAEP) contacted the USDA:APHIS:VS and requested federal coordination for data collection, dissemination, and communication efforts among state and federal veterinarians. The purpose of collecting this data is to protect the health of horses and mitigate the economic implications of further EHV-1 transmission to horses not yet affected. In response, USDA:APHIS:VS has reached out to State Animal Health Officials, federal Area-Veterinarians-In-Charge (AVICs) and private practitioners to collect current information on the EHV-1 disease incident and develop a coordinated response among state, federal and industry partners.  The full scope of the current EHV-1 situation and a complete accounting for the number of horses affected and/or exposed is underway. "We want to applaud the quick response and efforts of the USDA:APHIS:VS," said William A. Moyer, DVM, 2011 AAEP president. "Having the support and coordination of this effort by the USDA:APHIS:VS working in collaboration with State Animal Health Officials, will be key in providing accurate and timely information to the equine and veterinary communities during this outbreak." "USDA can play a critical and timely role in collecting, verifying, and disseminating accurate information to state animal health officials and industry partners," said Jay Hickey, President of the American Horse Council.  "These efforts are essential to mitigating the health and economic implications of this current EHV-1 situation. Misinformation can often be an epidemic in and of itself.  This latest disease incident only underscores the importance of implementing a pro-active national equine health program." USDA and State Animal Health Officials have initiated an investigation and incident response effort.  The USDA plans to release the initial report through summarization of information provided by the State Animal Health Officials and AVIC's including the number of horses suspected and confirmed as EHV-1 cases and EHM cases along with fatalities in the coming days. The USDA will update and release future reports on the current EHV-1 outbreak on a weekly basis.  If the current incident results in wide-spread exposure or a large influx of infected horses, the USDA will provide that information as it becomes available. Practitioners are encouraged to notify their State Animal Health Official of suspect or confirmed cases of EHV-1 and EHM.  The State Animal Health Officials can assist with guidelines on diagnostic testing and management to reduce risk of spread of EHV-1. There have been numerous scientific articles citing a wide variation in the number of suspect and confirmed cases of the EHV-1 and the neurological form of the disease (EHM) in horses.  This large disparity in reported information underscores the importance of allowing USDA and State Animal Health Officials to collect data, based on the use of consistent case definitions, to then verify information gathered and disseminate factual summary information. Until state and federal animal health officials are able to gather, verify and disseminate accurate information on the scope of the current incident, it is critical for individual horse owners and organizations to undertake appropriate and responsible actions to mitigate the welfare and economic implications of potential future transmissions. At the time this release was issued, only Colorado and Wyoming had implemented enhanced state entry requirements in response to the on-going EHV-1 disease situation. Additionally, if you anticipate transporting your horse across state lines it is recommended you contact each respective state/provincial veterinarian's office prior to departure to determine if there are any restrictions or enhanced entry requirements due to the current EHV-1 incident.  To find your state or provincial animal health office, visit www.aaep.org/us_canada_statehealthoffice.htm. In the interim, the AHC and AAEP stress the importance of responsible ownership practices and informed communication among industry organizations.  Please visit the AAEP's website at www.aaep.org for additional information on these diseases, as well as updated horse owner and veterinary resources including an FAQ feature about the diseases, biosecurity recommendations, updates from various states and more. The American Association of Equine Practitioners, headquartered in Lexington, Ky., was founded in 1954 as a non-profit organization dedicated to the health and welfare of the horse.  Currently, the AAEP reaches more than 5 million horse owners through its over 10,000 members worldwide and is actively involved in ethics issues, practice management, research and continuing education in the equine veterinary profession and horse industry.  As the national association representing all segments of the horse industry in Washington, D.C., the American Horse Council works daily to represent equine interests and opportunities. Organized in 1969, the AHC promotes and protects the industry by communicating with Congress, federal agencies, the media and the industry on behalf of all horse related interests each and every day. The AHC is member supported by individuals and organizations representing virtually every facet of the horse world from owners, breeders, veterinarians, farriers, breed registries and horsemen's associations to horse shows, race tracks, rodeos, commercial suppliers and state horse councils. ####

The I believe that education is the key to evolution. I believe that animals are the key to compassion. I believe the learning never stops.

EHV-1 vaccination

The question of the day seems to be about vaccination and EHV-1.  Here is my opinion:
There are two types of EHV-1 virus.  The first is the wild type EHV-1, which causes upper respiratory disease, abortion, and rarely, neurologic disease. The second is  neuropathogenic EHV-1, which is the virus identified in horses from the Ogden event.  This type has a genetic mutation that makes it much better at attacking the central nervous system, and therefore much more likely to cause neurologic disease, or EHVM (equine herpes virus myeloencephalitis).

 There is no vaccine known to protect against  EHVM.

The EHV-1 vaccines currently on the market have been shown to decrease the incidence of disease and the severity of signs in horses that get sick with wild type EHV-1.  There may be some cross-protection with these vaccines against infection with neuropathogenic EHV-1, but only if the horse is vaccinated at least 2 weeks prior to exposure to the neuropathogenic EHV-1, and even then this protection has not been proven.  Many horses currently clinically ill with EHVM were vaccinated against wild type EHV-1. Unfortunately, the interaction of the vaccine reaction and the neuropathogenic EHV-1 is very complex and not well understood.  If the vaccine is administered very close in time to exposure to the neuropathogenic EHV-1, vaccination may actually be harmful.

Based on this, here is my recommendation:
If there is any risk that your horse may have been exposed to neuropathogenic EHV-1 (the virus responsible for the current outbreak) do NOT vaccinate your horse. 
If there is NO risk that your horse has been exposed, and your horse is being housed in a closed facility so that there will be no new horses introduced within the next 2 weeks,  and your horse has not received a flurhino shot this year, then it is safe to proceed with routine spring vaccination.


I believe that education is the key to evolution. I believe that animals are the key to compassion. I believe the learning never stops.

Veterinary Networking

Veterinary Networking

     Last week a local veterinarian called me to discuss a horse he was treating for metabolic syndrome.  The horse had been treated with a specially designed diet and exercise program for the past 6 months to address a problem of abnormal weight gain, high blood sugar and insulin levels.  She was being re-evaluated and the veterinarian had some questions about interpretation of her latest laboratory values.  He called me because I am a diplomate of the American College of Veterinary Internal Medicine, which means I successfully completed a 3 year clinical large animal residency training program and a rigorous examination process to ensure my advanced knowledge and experience diagnosing and treating internal medicine problems in large animal species.

      I stopped by to visit with Dr. Shane Miller at Comstock Large Animal Hospital yesterday.  Shane is a diplomate of the American College of Veterinary Surgeons.  I had taken some x-rays of a foal with an unusual stifle lameness and had some questions about the abnormalities I had seen on the radiographs.  Shane and I sat down and looked at the films together.  He gave me his opinion on the radiographic changes and some suggestions on treatment options for the foal. 

     This type of congenial exchange of information goes on all the time behind the scenes as a routine part of your animal's care. In addition to consulting with local specialists, there are larger networks we utilize to keep up with the constantly expanding subject matter concerning veterinary medicine.

    I allocate a portion of every day to reading two listserves that I follow on line- one is supported by the American College of Large Animal Veterinary Internal Medicine, the other by the American Association of Equine Practicioners.  These internet based conversation groups provide a wonderful, interactive forum for veterinarians to discuss cases they are treating and get input from colleagues worldwide.

    The variety of problems presented to the ambulatory veterinarian is enormous, and maintaining this network of colleagues is a critical part of my service to you.  After 22 years as a practicing veterinarian, the majority of patients I see exhibit clinical signs with which I am familiar, and diagnostic and treatment plans are relatively routine.  However, when an animal presents with an unusual history or presenting complaint, it is wonderful to have a network of specialists to consult.  Sometimes the initial conversation with a specialist leads to the referral of the patient for advanced diagnostics or treatment.  

Last month I sent a patient to the UC Davis Veterinary Teaching hospital not only for advanced diagnostic services, but also to ensure a level of intensive care treatment and monitoring that could not be provided in the field.  

     Deciding when to consult or refer with a specialist is not always a cut and dry matter - a crucial part of my job is to be sure to keep lines of communication open, and to present all your options to you as a horse owner.  If you ever have unanswered questions about your horse, discuss them with me until you are completely satisfied, and ask for a referral for a second opinion if you feel it is warranted -  I am happy to comply.
    There are 21 specialty colleges of veterinary medicine recognized by the American Veterinary Medical Association. In the greater Reno area we have 2 board certified surgeons practicing on horses, 1 large animal internist, and a board certified ophthalmologist who sees both large and small animal patients.  UC Davis is 3 hours away and offers specialists in most of the large animal disciplines.  To learn more about veterinary specialists, google AVMA specialty organizations.

   

I believe that education is the key to evolution. I believe that animals are the key to compassion. I believe the learning never stops.

Going the Distance - 

to a Happy Ending

     I think of it most commonly in murder mysteries.  You know, the Sherlock Holmes guy who recognizes the connection between several apparently unrelated events that no one else thinks are important and the next thing you know - voila! the murderer is exposed. This story is a bit like that.  It is about Spring, a 9 yo mare who has beaten the odds, thanks to an observant veterinarian and a dedicated owner.  

       Last summer  I was called out to see Spring twice because she had a severe dermatitis affecting the white part of her muzzle.  I treated her for photosensitization, a common problem in northern Nevada where horses with white skin fed alfalfa have a dramatic reaction to sunlight that results in a painful, sunburn like inflammation, seen most commonly on the nose and white areas of the lower legs.  In January Spring's owner called me because once again the white skin of Spring's nose was severely inflamed.  At this point I became concerned about an underlying problem.  A few things didn't make sense: 1) Spring's diet had been carefully managed to eliminate consumption of ingredients, such as alfalfa, that might contribute to photosensitization, and 2) it was January - the days were short and we had had lots of bad weather, meaning there wasn't enough sunshine to trigger a typical episode. I began to wonder about the health of Spring's liver.  

      The liver plays an important role in detoxifying phylloerythrins, the photodynamic substances that cause photosensitization.  Thus an unexplained episode of this problem may be an early sign of liver disease.  Consequently we began an extensive evaluation of Spring's liver, which included serial blood work, hepatic ultrasound and finally a percutaneous liver biopsy.  All the news was bad.

     Spring had persistent elevations in the active hepatocellular enzymes that indicate ongoing damage to liver cells.  Her biopsy showed extensive fibrosis, or scarring of the liver, indicating that the disease process had been going on for a prolonged period of time.  Ultrasound revealed that her liver was smaller than normal. There are several diseases that result in the findings observed in Spring.  The one that fit Spring's findings most closely  is called Chronic Active Hepatitis (CAH).  It is a poorly understood disease process, most likely immune-mediated. It carries a very poor prognosis for long term survival, and in general does not respond well to medical treatment.

     If you received our most recent e-news letter, you read my article on veterinary networking.  Spring's case is a wonderful example of how networking makes us all smarter.  I presented Spring's case to the American College of Veterinary Internal Medicine Specialists' list serve and asked for input from my colleagues.  Most agreed that a diagnosis of CAH was correct and treatment with steroids and anti-fibrosing agents should be attempted, but the outcome was not hopeful.  However, one of my colleagues and mentors from the University of Georgia where I completed my residency and PhD program, suggested another possibility.  Dr. Michelle Barton wondered about the possibility of a stone in the common bile duct, which would not be visible on ultrasound.  Although Spring's diagnostic findings did not fit this picture perfectly, Dr. Barton pointed out that this was the only disease she could have with any hope of treatment, and that the only way to rule it out would be an exploratory surgery, because in the horse the common bile duct can only be visualized and fully examined at surgery.

       Horses don't have gall bladders.  The liver makes bile, which is excreted through the common bile duct into the small intestine.  In order to access the bile duct, the horse is placed on its back under general anesthesia.  A large incision is made along the midline of the abdomen - the same incision made for colic surgery, but much longer, extending forward almost to the sternum.  The surgeon must lift much of the gastrointestinal organs out of the abdomen, then reach far down and forward into the abdominal cavity to find the bile duct as it exits the back of the liver along with the hepatic vein and artery.  It is a very difficult surgical exposure. 

    Now Spring's owner had to make a really tough decision. The odds of Spring having a bile duct obstruction that could be resolved at surgery were small.  The anesthesia and stress of surgery could precipitate a crisis and push Spring from a state of compensated liver disease into full blown liver failure which would almost certainly be fatal.  On the other hand, if Spring did have a bile stone that the surgeon could loosen up and move from the bile duct into the small intestine, Spring's prognosis for long term survival would improve markedly.  I spent a long time talking to Spring's owner, explaining the options, looking at things from various perspectives, talking about possible outcomes, and listening to her owner's thoughts and concerns about Spring's quality of life.  My recommendation was to go forward with surgery because it provided the only hope of a significant positive impact on the disease process progressing in Spring's liver.  

      The picture at the top of the page tells the story.  I took it during Spring's surgery, conducted by Dr. Shane Miller, a board certified equine surgeon. At surgery the liver was found to be small, with a markedly fibrotic right lobe.  Dr. Miller did not feel a discrete bile stone in the bile duct, but the duct was very firm on palpation, and Dr Miller massaged and manipulated the duct in hope of freeing any bile "sludge" that might be occluding the flow of bile through the duct.  At surgery we all were pretty disappointed, and thought that our best hopes of improving Spring's outcome had not been realized.

     After surgery everything began to change. Spring had no difficulty at all related to the surgical procedure.  She recovered uneventfully from anesthesia and had no problems with her large surgical incision.  Her liver enzymes were carefully monitored for 3 days post-operatively for signs of deterioration secondary to the stress of surgery.  Surprise surprise surprise.  The enzymes that indicate bile obstruction and active liver cell damage began to decrease immediately after surgery and continued to move toward normal numbers.  Four weeks after surgery Spring's blood work is normal!  Just like mud in a hose, the firm material that Dr. Miller felt on palpation of the bile duct was most likely stagnant, thickened bile "sludge" that he loosened up with his manipulation at surgery.

    Currently Spring is being maintained on a grass hay and beet pulp based diet, which is rich in branched chain amino acids, readily metabolized by the liver.  She also is receiving pentoxyphylline, a medication that acts to reduce fibrosis.  She looks great and can't wait for her incision to finish healing so that she can be turned out to pasture and then get back to work!

    Spring's story is far from over, but at this point I cannot thank all the people involved in the Spring network enough for their contributions to her diagnosis, treatment, and recovery.  First of all her wonderful owner, who listened, digested and formulated her decisions with only one thing in mind: her horse's well being.  And then to the team of veterinarians, especially Dr. Barton and Dr. Miller, who contributed their knowledge, experience and clinical expertise to Spring's case.  It truly does take a Village. 

    

 

I believe that education is the key to evolution. I believe that animals are the key to compassion. I believe the learning never stops.

Gear up for Spring

Time to Gear up for Spring

 

Here’s to Spring in February! What a winter – Jessie, Hayley, Gina and I were working in our shirtsleeves during Mother’ Nature’s generous gift of a warm early February and now winter is having her last go at us again. I hope you were able to take advantage of those beautiful days to get out with your horses. The ups and downs in temperature have been a bit hard on our equine friends this winter. I’ve been treating an unusual number of impaction colics, most of them mild and responding well to treatment.

They are a reminder of how important it is to keep after hydration during the winter months. On these warm days excercising horses and blanketed horses tend to sweat – loosing precious body water – then the temperature drops at night, water freezes, horses drink less and risk dehydration. Horses require 10-12 gallons of water daily. This amount increases substantially in the face of body fluid loss through sweat. Horses have been shown to decrease their voluntary water intake when the temperature drops below 45 degrees.

In addition, before the weather became warm, we had that nasty stretch of freezing snow that made it difficult for horses to move around comfortably. Lack of exercise also contributes to colic through decreased gut motility and processing of fiber through the intestinal tract.

Finally, while it is true that horses burn more calories during cold weather, erratic increases in grain can cause problems. Sudden change in carbohydrate load to the digestive system can cause gas accumulation, bowel distension, and subsequent abdominal pain. Put it all together and winter is a challenging time for good management. Keep these basics in mind:

1) Check your horse’s water source 2x daily – be sure it is clean and free of ice

2) Exercise your horse – even if it is just taking him out for a nice 20 minute hand walk – even in the worst weather!

3) Make feed changes gradually – good quality hay is always the safest thing to feed – be sure there is adequate fiber in your horse’s diet!

Here is the best news of all – Winter is Almost Over! Thanks for being part of the HIghDesertEqine.com family – I look forward to seeing you on a clinic day in March. See clinic schedule below.

Gratefully,
Chrysann Collatos VMD, PhD, DACVIM
High Desert Veterinary Service

                          Spring Vaccination Clinic Schedule.

 As always I’m there to answer your questions, and also offer routine health care services on clinic days. Routine spring health care includes vaccination against E&W Encephalitis, West Nile, Tetanus, Influenza and Rhinopneumonitis plus deworming, an oral exam and sheath cleaning for geldings.

Call the office to reserve an appointment.

BE SURE TO LEAVE THE FOLLOWING INFORMATION:

Name, Phone #,  Date you request, Number of Animals, and the Services needed.

We will return your call three days before your clinic with an estimated time of arrival at your address.  Please be sure horses are caught and haltered 30 minutes beforehand.

Location                                               Date

Rancho Haven/Sierra Ranchos1              Sat  March 5

Rancho Haven/Sierra Ranchos2              Fri  Mar 11

Red Rock North/Silver Knolls 1                Sun Mar 6

Red Rock North/Silver Knolls 2                Fri Mar 11

SpanSprings/Palomino Valley 1              Mon Mar 7

SpanSprings/Palomino Valley 2              Sat Mar 12

Antelope Valley                                          Sun Mar 13

Golden/Lemmon Valley                            Sun Mar 13    

South & West Reno                                  Tues Mar 15

Golden/Lemon Val/South Reno               Fri Mar 4

For additional savings, you can schedule your own mini-clinic as long as you have at least 10 horses at a single location.  Call the office to make such arrangements.

Price List – Clinic day only

Farm Call/Fall Exam              $17.00              

West Nile (Prevenile)              $32.00

FluRhino                                   $26.00

Tetanus/ Encephalitis             $14.00

Intranasal Strangles                $32.00

Rattlesnake Vaccine*             $32.00*

Ivermectin Deworm                 $14.00

Coggins Test                           $22.00

Sheath Clean w/sedation       $35.00

* 2 boosters are required after this initial dose – call the office or e-mail us if you have questions.

Ask Dr. C what vaccines are best for your horse based on age, environment, and activity level.