Neck Injections/Cervical Facet Injections

Neck Injections/Cervical Facet Injections

Look carefully at this radiograph.  These are the fourth, fifth and sixth cervical (neck) vertebrae of a 14 year old equitation horses with severe left forelimb lameness.  Let your eye move along the top edge of the bones from left to right.  Do you see the fracture fragment, irregular boney growth (exostoses), and loss of joint architecture (degenerative joint disease) at the top joint (dorsal facets) between the last two vertebral bodies? This is arthritis, and it can develop in the neck in the same way it can in any other joint in the body. 

The joints between each of our vertebrae, whether horse or human, have the same function as any other joint in the body, which is to cushion compression forces during motion .  In the horse, particularly jumping and dressage horses, flexion of the neck during athletic performance increases the compressive forces on the lower neck joints, or C3 through C7.  Over time, this repetitive trauma can overcome the body's natural ability to dampen these concussive forces.  Inflammation results, with subsequent degradation of joint fluid and intervertebral disc material.  Ultimately, in an effort to stabilize the joint, the body begins to lay down additional bone.  What was once a dynamic, spring-like mechanism, becomes brittle and rigid.  This is degenerative joint disease (DJD), commonly called arthritis.  In the neck, DJD can be responsible for clinical signs as subtle as occasional tripping, progressing up through severe neurologic instability.  Primary forelimb lameness is an unusual, but well documented, clinical sign occasionally caused by cervical DJD.  All other causes of forelimb lameness must be ruled out with a careful lameness evaluation and localizing nerve blocks before such lameness is attributed to cervical DJD.

The dorsal facets are the knobby boney structures at the top of each cervical vertebral body.  The positive clinical outcome of injecting anti-inflammatory and lubricating medications (steroids and hyaluronic acid) into the space between the dorsal facets is well documented.  The sterile injection procedure is done with ultrasound guidance in the standing, sedated horse.  The response to injections varies considerably from horse to horse, both with respect to effectiveness and duration. 

In addition to intra-articular facet injections, modalities including acupuncture, laser therapy and physical therapy by a QUALIFIED equine physical therapist can provide important  benefits to horses with cervical DJD.

 The horse with the radiographic changes pictured here improved 75% after facet injections, however, the severity of these radiographic changes and of his lameness were cause for retirement to pasture turn out.  His owner and trainer were happy to honor him with this option in return for his years of service as a show jumper and equitation horse.

If your horse has unexplained stiffness, difficulty turning, repeated tripping, or undiagnosed forelimb lameness, ask your veterinarian about the possibility of a neck problem.



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

Spring News & Notes

High Desert Veterinary Service

Building Healthy Partnerships

Chrysann Collatos VMD,PhD,DipACVIM

775-969-3495 (Office)          742-2823 (Cell)
HighDesertEquine.com

Spring 2014 News & Notes:

Ø Vaccination Clinic Schedule

Ø Acupuncture & Physical Therapy

Ø Your Mare and Spring Transition

It is time for our seasonal reunion during your horse’s spring wellness exam.  My technician Amanda and I have lots to share as we head into 2014 revitalized by continuing education and new diagnostic equipment.  All to better serve every aspect of your horse’s health care.

CALL TODAY TO SCHEDULE YOUR APPOINTMENT

For the welfare of the horse,

Dr.Chrysann

Spring Vaccination Clinic Schedule

Spring exams include tetanus/encephalitis, flu/rhino and West Nile vaccinations plus deworming or fecal examination, an oral exam, and sheath cleaning.

To reserve an appointment, call the office and leave:

• Name, Phone #, Clinic Date,
• Number of Animals, and Services requested

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 Mar 8
Rancho Haven/Sierra Ranchos2         Fri Mar 14

Red Rock North/Silver Knolls 1          Sun Mar 9

Red Rock North/Silver Knolls 2          Fri Mar 27

Span Springs/Palomino Valley 1        Fri Mar 7

Span Springs/Palomino Valley 2        Sat Mar 22

Antelope/Golden/Lemmon Valley 1   Sun Mar 16

Antelope/Golden/Lemmon Valley 2   Fri Mar 28  
South & West Reno 1                   Sat Mar 29

Discounted Price List – Clinic days only

Farm Call/Fall Exam                 $18.00

West Nile                                   $32.00
FluRhino                                     $27.00
Rabies                                        $21.00
Tetanus/ Encephalitis                $18.00
Intranasal Strangles                   $32.00
Ivermectin Deworm                   $14.00
Coggins Test                                $27.00
Sheath Clean w/sedation            $45.00
Fecal parasite exam                   $18.00
Oral Exam (w/o sedation)         No charge!

Acupuncture & Physical Therapy

As our understanding of medicine evolves, many practioners and patients alike are coming to a deeper appreciation of alternative medical interventions. Modalities such as acupuncture can play a vital role in healing, and can complement traditional western medicine treatments. 

I am excited to announce my enrollment at the Chi Instititute, located in Ocala, Florida.  Over the next 6 months I will be studying the art of Traditional Chinese Veterinary Medicine, with particular emphasis on equine acupuncture.  The first segment of this intensive training program happens on line, and as I watch the initial lecture series, my hard-wired analytical intellect is doing  some serious adjusting as I listen to discussions of Chi and Bian Zheng and Yin Yang theory and wonder if my young anglo-arab has a fire, wood, water, earth, or metal constitution!

My course lecturers are veterinarians with advanced degrees, one is Associate Professor of Neurology & Neurosurgery at the University of Florida College of Veterinary Medicine, another a Diplomate of the American College of Veterinary Internal Medicine board certified in Neurology.  These veterinarians have taken their advanced western training and embraced Traditional Chinese Veterinary Medicine because they have discovered, through years of practice, that acupuncture can provide healing opportunities that cannot be achieved with the current tools of Western Veterinary medicine.

In addition to acupuncture, another important aspect of our integrative approach to whole horse health is equine physical therapy.  Denise Montagne PT, an equine physical therapist registered with the Nevada State Veterinary Board, has been assisting me in treating horses with complex musculoskeletal conditions.  Denise’s knowledge of anatomy combined with her empathic nature and years of manual therapy skills make her a smokin’ addition to our horse healing practice.

Denise and I are excited about combining acupuncture, western medicine and manual therapy to ensure long, comfortable athletic careers for our equine partners.  Is your horse girthy?  Unwilling to engage or move forward? Unbalanced in one direction? Stiff turning one way? Call me to discuss your concerns. Let’s work together to make your horse the best he/she can be.

   

The Mare's Transitional Period

In the past week I've had conversations with clients concerned about performance mares exhibiting unusual behavior or brood mares showing irregular heat cycles.  Both of these problems are related to the seasonal nature of the mare's reproductive cycle, and specifically the transitional period that affects many mares between January and April.

Seasonal variation in the duration of daylight has a profound influence on equine reproductive performance.  The horse is a seasonal breeder - increasing daylight improves the mare's reproductive efficiency while short days result in poor reproductive regulation.  Daylight is believed to act by stimulating the production of melatonin by the brain’s pineal gland.  This melatonin in turn causes the hypothalamus to release reproductive hormones which influence the ovaries to develop and release follicles. 

The transition from the short days of winter when most mares stop cycling all together, to the long days of June, when fertility is at its highest, is a gradual process.  During the spring and fall, mares enter a period of anovulatory receptivity, or the transitional period.  At this time, they often exhibit erratic estrus behavior, and while they appear to be in standing heat and accept a stallion, there often is not an associated ovulation of a mature follicle.  Even if a transitional mare does ovulate appropriately, the hormonal sequence necessary to maintain pregnancy may not be in place and the conceptus is lost.  Particularly in the spring, this transitional period is characterized by long, erratic heat cycles without ovulation. 

During the transition period performance horses often exhibit irritable behavior and are difficult to train.  There are many oral supplements available over the counter which claim to improve the demeanor of irritable mares. The effectiveness of these supplements is variable.  For years people have used cattle subcutaneous hormonal implants to control mare's heat cycles, but multiple research trials have been performed using these implants and no one has ever been able to show that they have any real effect on the mare's hormonal regulation. In the past the only truly reliable means of preventing cycling was the daily administration of  oral Regumate liquid (altrenogest, a synthetic progesterone). Now we also have a time released injectable altrenogest manufactured by BET Pharm, which provides 30 days of active estrus suppression.

Once the transitional period is over and mares are cycling regularly, reproductive efficiency rapidly improves.  The "normal" mare has a 21 day heat cycle.  She is not receptive for 14-15 days (diestrus), then comes into heat for 4-7 days (estrus), ovulating 12-24 hours before behavioral signs of estrus disappear. Regarding performance horses, some mares continue to be difficult during the days close to ovulation, but in general the number of days when undesirable behavior is exhibited are markedly reduced.

So, when your mare is acting like a maniac in February and March, remember that part of her behavior may be attributed to temporary hormonal imbalance  Mares, just like people, are very individual in their reaction to their internal chemistryIf you own a mare you are trying to breed in the early spring, or a performance horse with seasonal behavior problems, ask me about management practices that may improve your breeding success or help your mare's disposition. 

Don’t forget to “Like” us on Facebook at HighDesertEquine.com, and call today to schedule your clinic appointment!

 

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

A Preventale winter Problem: The Subsolar Abscess

 A preventable mid-winter problem: The Subsolar Abscess

This time of year I commonly see horses with lameness caused by subsolar abscessation. It seems like part of the winter cycle - we discussed what you can do to avoid cold related problems during our December crazy cold spell, then we talked about the dangers of icy footing around Christmas time, and now as mid-winter arrives the preventable problem of the season is the foot abscess. 

Here is what happens: First, horses are likely to be confined to smaller areas and get less exercise (and therefore less grooming) during the winter months.  Second, weather conditions make manure collection and disposal challenging, so pens tend to be dirtier than normal.  Third, freeze/thaw cycles, urine spots and collected manure all contribute to the creation of deep, wet, bacteria rich footing in our horses pens.  Moisture and bacteria enter the sole through small defects that occur naturally.  But now the foot may not be getting picked out daily, the sole never dries, and bacteria migrate through the horny sole and begin to replicate in the space between the horny, insensitive sole tissue and the deeper soft, sensitive tissues of the hoof.  The body tries to fight this slow growing infection by sending white blood cells to the area.  The white blood cells break down to form a gooey, black semi-liquid pus.  This pus spreads between the superficial and deep sole layers, building up pressure until one day your horse is suddenly extremely lame. 

As with all abscesses, drainage is the key to cure.  Subsolar abscesses are resolved by aggressively removing the overlying dead sole and exposing the infected area and underlying sensitive tissue to air.  The area is packed and bandaged for 7 to 10 days to prevent re-abscessation and allow the exposed tissue to cornify and begin the transition from sensitive to insensitive sole.  Antibiotics are not part of my routine care of subsolar abscesses, but tetanus vaccination status must be confirmed, and pain control with phenylbutazone is usually warranted. So your horse gets better, but in the mean time he/she experiences severe lameness, and you are out there in the freezing cold when you get home from work every night in the dark struggling to change the darn bandage!

The good news is these winter weather condition related abscesses are preventable!  Your job is to work hard to keep you horse's pen as clean and dry as possible, not to neglect regular farrier visits every 6-8 weeks through the winter, and to pick out your horse's feet thoroughly every day through the winter months.  Some of these slow developing winter abscesses, such as the one pictured above, can be deep and extensive.  Please be a good partner to your horse and pay special attention to foot care during the off season, and you can spare your horse this painful problem.


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

2013 Fall New & Notes

 High Desert Veterinary Service

Fall 2013 News and Notes:
Chrysann Collatos VMD, PhD, DACVIM

775-969-3495 (Office)          742-2823 (Cell)

hidvet@gmail.com

HighDesertEquine.com

• Vaccination Clinic Schedule   
• Interstate Travel Regulations
• Colic: Thinking Ahead

End of summer greetings to you all!

The smoke is clearing and it is time to prepare for great autumn riding and oncoming winter months.  Don’t shortchange your equine companions.  Schedule your clinic appointment so we can be sure they are ready for the season change.  For the health of the horse,

Dr.Chrysann

Fall Vaccination Clinic Schedule

I am always here to answer your questions.. Fall health care includes Flu/Rhino vaccination plus deworming or fecal examination, an oral exam, and sheath cleaning.  Also West Nile Vaccination if not given in spring!

To reserve an appointment, call the office and leave:

Name, Phone #, Clinic Date,

Number of Animals, and Services requested.

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         Fri  Sep 6 

Rancho Haven/Sierra Ranchos2         Sat Sep 14

Red Rock North/Silver Knolls 1            Sun Sep 8

Red Rock North/Silver Knolls 2            Sat Sep 21

Span Springs/Palomino Valley 1        Sat Sep 7

Span Springs/Palomino Valley 2        Fri Sep 13

Antelope/Golden/Lemmon Valley 1    Sun Sep 15

Antelope/Golden/Lemmon Valley 2    Fri Sep 20    

South & West Reno 1                Sun Sep 22 

South & West Reno 2                Fri Sep 27

Sierra Valley/California                       Sat Sep 28

Reduced Prices - Clinic Dates Only
Farm Call/Fall Exam                   $18.00

West Nile                                   $32.00

FluRhino                                     $27.00

Rabies                                        $21.00

Tetanus/ Encephalitis                $18.00

Intranasal Strangles                   $32.00

Ivermectin Deworm                    $14.00

Coggins Test                               $27.00

Sheath Clean w/sedation            $45.00

Fecal parasite exam                    $18.00

Oral Exam (w/o sedation)          No charge!

Interstate Travel Regulations

I am fielding lots of calls about increased scrutiny of paperwork at the California border.  I spoke with an official at the California Department of Food and Agriculture (CDFA)  last week to clarify their enforcement policy regarding horse transport.  First of all, despite a lot of buzz on the internet earlier this year, there has been NO CHANGE in the law regarding interstate horse transport.  The federal government is gearing up to get involved in regulating animal movement, but that HAS NOT YET HAPPENED.  Interstate transport of horses is still regulated at the state level. 

Both Nevada and California require a Coggins (Equine Infectious Anemia) test current within 6 months, and an interstate health certificate of veterinary inspection (CVI) issued within 30 days. Nevada also requires a brand inspection.

The people at the California border inspection stations are not authorized to detain you or fine you if your paperwork is not in order.  They do have a form which they are supposed to fill out that identifies you and establishes that your brand inspection, CVI, and coggins are in order.  If they find that your paperwork is not correct, then they contact a CDFA Health Inspector and pass along your information.  It is the Health Inspector’s job to track you down and issue a warning or citation as they see fit.  In Nevada, brand inspectors travelling on the highways can pull over any vehicle transporting horses and ask to see paperwork and issue warnings and fines.

The CDFA official I spoke with explained that the California inspection station border guards can use their discretion regarding completion of the livestock identification form for horses. If they are busy, they may verbally question you, ask to see Coggins or CVI, or just wave you on through. However, they do have the right to ask you to pull over, come inside, produce your paper work and supply personal identification information which they will record. 

Bottom line: if you chose to transport your horse across state lines without current Coggins, CVI, and brand inspection, you are liable to be fined.  You are required to pull over and answer questions at the California border stations at the border guards’ request.

Finally, there is a certificate of veterinary inspection (CVI) issued in Oregon, Washington, Idaho, and Montana that is good for 6 months.  California does not issue 6 month CVI’s but they do accept them.  Nevada does not issue or recognize the 6 month CVI.  

Colic

Just like you, I dread the thought that one of my horses may show signs of colic one day.  I spent 4 years studying equine colic completing my PhD research, I accepted literally hundreds of colic emergencies into the hospital during my clinical residency, and I now have 20+ years experience treating colic in the field.  And still, I can’t guarantee that your horse with colic will not experience a serious complication.

Treating colic can be expensive.  A routine after hours colic call in my practice costs about $250. This includes an emergency call fee, physical exam and rectal palpation, sedation,  medication to reduce pain and enhance gastrointestinal motiliy , and nasogastric intubation.  About 80% of horses recover uneventfully after a single visit, if that visit occurs within the first hour of onset of signs.  More serious cases, or those in which initial treatment is delayed, can require multiple visits or warrant hospitalization.  Complicated medical cases and surgical colics can cost $6000-$10,000.

Early intervention is the key to successful treatment.  So what can YOU do to help ensure that your horse recovers from a colic episode and save money at the same time?  Be observant, and learn to do a basic physical examination!  Get a cheap stethoscope at the local nursing supply store. Buy a digital thermometer at the drug store.  And then ASK ME to teach you during your fall clinic appointment.  How many  of you “experienced horsemen” know how to do a physical??

If you can get temperature, pulse , respiration, and evaluate gut sounds and oral mucous membranes you can convey critical information on your first call to me at the onset of signs of colic. High heart rate, no gut sounds, and escalating pain indicate the need for intensive veterinary treatment.  In milder cases, after we review  your clinical findings it may be reasonable for you to administer medication orally to your horse.  Discuss the option of having oral Banamine paste on your property with me. 

When I evaluate your colicky horse, in addition to history and physical exam findings, I will perform a rectal palpation and pass a stomach tube.  This will provide me with information that you cannot obtain which  will guide specific treatment decisions.

Until I teach you how to do a complete physical examinantion, here are the basics:

v  What to watch for (in order of severity):

Ø  Poor appetite

Ø  Reduced manure production

Ø  Lying down more than normal

Ø  Stretching out as if trying to urinate

Ø  Pawing, getting up and down, looking at flank

Ø  Rolling violently

v  What to do:

Ø  CALL YOUR VETERINARIAN IMMEDIATELY

Ø  Take food away

Ø  Walk your horse if he attempts  to lie down/roll

Colic is serious, but in most cases treatable.  When a serious colic strikes, it happens very quickly.  I urge you to think ahead – establish a savings account for your horses if you can, look into equine medical insurance and Care Credit (CareCredit.com), and decide now how much you can afford to spend in a critical situation.  Planning in advance makes those difficult decisions a little easier in times of crisis.

 Take advantage of your fall clinic appointment to ask me more specific questions about colic prevention and treatment, and to get your physical exam training!

Educate yourself, for the health of the horse.

See you in September,

Dr. Chrysann

Equine Metabolic Syndrome - Treatment

Equine Metabolic Syndrome: Treatment

 Before you get on line and Google Equine Metabolic Syndrome (EMS) and Treatment be sure to take some Advil because you are likely to end up with a headache! There are many companies marketing supplements aimed at horse owners desperate to help their insulin resistant laminitic horses, and it is very easy to become confused and tap out your checking account trying to help your horse and not really accomplishing much.

Try to keep going back to basics when you think about EMS:  it is a disorder of energy metabolism.  Any effective treatment should be directly related to diet, exercise, and/or the body's energy processing mechanisms.  Here I will go down the list of things that we KNOW, based on clinical and laboratory research, can help the EMS horse.

1) DIET.  

Most horses with EMS, unless their athletic activity  specifically increases caloric needs, should eat 1 - 1.5% of body weight daily.  For a 1000 pound horse this is 10-15 pounds total daily food (this includes EVERYTHING that passes their lips).  This diet should be low in high glycemic index food stuffs.  Grains have relatively high glycemic indexes, as do some hays which are high in certain sugars. All hay fed to insulin resistant horses should be analyzed for sugar content.  Sugars are complexed into carbohydrates and starches, which are converted to sugar during the digestive process.  Because or variations in each horse's digestive environment, it is impossible to precisely predict the amount of sugar a given hay will produce in each individual horse, therefore we follow certain guidelines in choosing hay to feed insulin resistant horses. These guidelines are based on the hay's carbohydrate and starch content.

Trying to interpret hay analysis lingo can be challenging.  For an excellent review, go to 

http://www.safergrass.org/pdf/testing_for_sugar.pdf

Historically, the recommendation for insulin resistant horses is to feed hay that is less than 10% non-structural carbohydrate (NSC).  

As hay analysis techniques advance, the reporting nomenclature has changed.  Instead of reporting NSC, you may find water soluble carbohydrate (WSC) and starch on your report.  Add these together to get NSC:

NSC = WSC + Starch

Most recently, WSC has been replaced with ethanol soluble carbohydrate (ESC) which measures a subset of the carbohydrates in WSC which are believed to be those with the highest risk of inducing laminitis in IR horses. If your analysis reports ESC and starch, then add these together to estimate your NSC.

Finding consistent sources of low carbohydrate hay is challenging.  The company most frequently used for analysis is Equi-Analytical.  They have a great website.  Try to establish a relationship with a hay broker, or hay grower who is willing to analyze their hay, and stick with that supplier.

2) Exercise
Regular exercise is a critical part of the management of horses with EMS.  Upcoming posts will be directed at specific conditioning recommendations for various types of sport horses.  Unless afflicted with active laminits, there is no reason your EMS horse cannot be an athlete, even if it is on a limited basis.   

3) Hoof Care
 Whether your EMS horse is laminitic or not, regular attention by an experienced farrier or qualified barefoot trimmer is essential.

4) Levothyroxine. 

Thyroid hormones are responsible for regulating your metabolic rate, or the rate at which you metabolize energy (back to basics: EMS is a defect in energy metabolism). An actual hypothyroid condition in horses has not been recognized, and in general, testing thyroid hormone levels (T3, T4) is not useful or recommended in EMS horses.  Thyroid hormone levels fluctuate throughout the day and unless a complex thyroid stimulation test is conducted in a hospital setting, it is impossible to interpret thyroid hormone levels drawn in the field.  As a result, horses are frequently misdiagnosed as "hypothyroid".

However, because insulin resistant horses do not utilize sugar normally, using thyroid supplementation to artificially increase the metabolic rate in overweight horses with EMS has been shown in a clinical research setting to be useful in improving metabolism and inducing weight loss.  Supplementing thyroid hormone is NOT specifically treating equine metabolic syndrome OR a hypothyroid condition.  It is simply helping your horse improve the utilization of energy which is disturbed by the underlying defect in metabolism inherent in EMS. Supplementation of levothyroxine is usually an intermittent treatment, based on an individual horse's body condition.  To be effective in a weight loss program, levothyroxine should be supplemented at a relatively high dose, under the direction of your veterinarian.

5) Metformin

Metformin is a human medication used to treat type 2 diabetes.  In humans, it lowers blood sugar, decreases glucose production by the liver, improves insulin sensitivity, and decreases glucose absorption from the gastrointestinal tract. Metformin activates AMP-activated protein kinase (AMPK), an enzyme that plays an important role in insulin signaling, whole body energy balance, and the metabolism of glucose and fats.

There is conflicting evidence for the efficacy of metformin in horse with EMS.  The problem is that metformin is not consistently absorbed from the gastrointestinal tract of horses, so the concentration of the drug that is reached in the bloodstream may vary significantly from horse to horse.  However, in at least one research trial, at a dose of 30 mg/kg twice a day, there was a beneficial effect on insulin levels and glucose handling in the group of horses tested.  Because metformin is affordable and has no significant negative side effects, it is widely used in laminitic horses with high insulin levels.

6) Pysillium

Feeding 4 ounces of psyillium daily may have beneficial effect on insulin regulation, based on a recent research trial at Montana State University in a group or normal horses.  Go to our HighDesertEquine Facebook page to find links to more on this topic.  This is another easy, safe addition to your EMS horse's diet that may have beneficial effects.

7) Chromium and Magnesium

Chromium and magnesium are involved in glucose and insulin regulation.  There is evidence in humans that supplementation can benefit people with type 2 diabetes.  Conflicting results with chromium supplementation exist in horses.  It is unlikely that supplementation will do harm, but cost and the quality of products must be taken into consideration.  If you decide to use a chromium/magnesium supplement in your EMS,  first be sure to buy from a reputable company,  be sure that the supplement does not contain additional carbohydrate, and ask the manufacturer for research or clinical trials conducted with their product.  If they cannot produce hard data supporting their product, don't buy it.

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