Question: “I have a friend who has a beautiful paint mare who suffered a suspensory injury. This horse owner was pregnant at the time and shortly after the mare’s injury the owner was put on bed rest and had surgery after the deliver of her baby. The mare received bute and stall rest initially when she was injured but when the owner was unable to take care of her horse’s injury, she was put in a small paddock. The mare made some recovery until one stormy day when she did some running around, since then she showed signs of lameness and regressed in her recovery. It has been 8 months now since the initial injury. My question is, can a horse be treated for a suspensory injury after 8 months. Can anything be done. The mare shows lameness at a trot.”

As you know, an injury to the suspensory ligament can result in serious and potentially debilitating lameness. Above all, restricted and controlled exercise and rest are the keys to recovery in horses with suspensory ligament injuries. When time and rest have not healed the injury, where the suspensory ligament injury is chronic in nature, more intensive and aggressive treatment may be indicated.

When after months of resting and rehabilitating a soft tissue injury lameness is still present, it is important to review the initial diagnosis. A repeat lameness examination is in order. Diagnostic nerve blocks to localize the pain should be repeated to ensure that the suspensory ligament is still the primary source of the lameness.

If the lameness is again localized to the suspensory ligament, digital ultrasonography of the ligament is indicated in order to assess the current level of fiber disruption. Even if the suspensory ligament is not localized as the primary area causing the horse’s lameness, the ligament should still be reevaluated via ultrasound to assess the level of healing, scarring, etc. in the ligament.

In cases of chronic suspensory ligament injury, there are a number of therapies to consider. Shock wave therapy is often used in the treatment of soft tissue (and sometimes bone) injuries. Shock wave therapy uses acoustic pulses, similar to sound waves, that travel through soft tissues and stimulate healing, decrease inflammation, and decrease pain. It has proven very effective in acute and chronic suspensory desmitis.

Another relatively common treatment, especially for severe suspensory injuries, is the injection of the the horse’s own harvested bone marrow into the area of the injury. The injected bone marrow helps to heal the soft tissue injury.

Along the same lines as the bone marrow is the injection of “stem cells” into the area of injury. Adipose (fat) tissue is harvested from the horse in order to derive stem cells that are then injected (using ultrasound as a guide) into the area of injury.

In addition to the above treatments there is also the option of what is called “splitting” the ligament. “Splitting” the ligament is done with the guidance of an ultrasound and involves “stab incisions” at the area of injury using a scalpel or needles. The goal is to decrease overall inflammation, minimize scar tissue, and promote restoration of normal ligament structure. Please note that this technique is primarily used for “core” lesions of the suspensory ligament branches as opposed to other types of suspensory ligament injury.

All of the above therapies are STILL coupled with restricted, controlled and slowly progressive exercise.

As you can see, there are a lot of options for this horse and owner. Good luck and thank you for the great question!

Dr. Aimee Eggleston

A couple days ago over 600 hundred concerned equestrians in the Wellington Florida area attended a meeting concerning the most recent outbreak of Equine Herpes Virus or EHV. The outbreak has already claimed the lives of several horses. The outbreak threatens to create havoc in the midst of the Florida winter show circuit.

What is EHV?

Most of you have probably heard of the Rhinopneumonitis or “Rhino” vaccine. Rhinopneumonitis is Equine Herpes Virus (EHV). There are many different strains of the virus including EHV-1, EHV-4, and several others that do not affect horses. Both EHV-1 and EHV-4 cause respiratory tract problems in horses. EHV-1 can lead to abortion in pregnant mares and neonatal mortality. EHV-1 can also cause severe paralytic neurological disease. EHV-1 is the strain currently wreaking havoc in Florida.

EHV-1 routinely causes upper respiratory disease, primarily in young horses. Clinical signs generally include a snotty nose, loss of appetite, and a nagging cough. This presentation of the virus has what is known as a high morbidity but low mortality rate. That is, it is highly contagious and many horses may get sick but most young horses recover uneventfully. This presentation of EHV-1 is not normally fatal.

EHV-1 can also cause pregnant mares to abort their foals late in pregnancy or to deliver stillborn or weak foals that die within days of birth. Some of you may be familiar with the Pneumabort-K vaccine that is given to pregnant mares. This vaccine helps protect against abortion and neonatal mortality due to EHV-1 infection.

The neurological form of EHV-1 is a debilitating disease of the spinal cord sometimes resulting, in severe cases, in paralysis. Horses with this form may at first simply look uncoordinated. As the virus progresses horses can be unable to stand and can experience lower leg swelling, an inability to urinate or pass manure and reduced tail tone. Rarely do horses develop the neurological form of EHV-1 after first contracting the respiratory form.

Because EHV is a virus, antibiotics are not indicated in the treatment of horses showing clinical signs. Once a horse becomes sick, the only treatment is in a supportive role — maintaining hydration with intravenous fluids, administering anti-inflammatory drugs like Bute or Banamine, administering immune boosting drugs, and slinging those horses unable to stand. For horses afflicted with the neurological from of EHV, those that remain standing have a better prognosis than those that are unable to stand. Recovery may take weeks to months. It should be said that almost all horses recover from EHV infection.

As with many infectious diseases, EHV is spread through coughing and sneezing. Indeed, aerosol transmission of EHV can occur at up to distances of 35 feet from an infected horse! Transmission can also occur in more subtle ways. Contaminated feed and water can be a vector of transmission. Shared and contaminated equipment can also cause infection. Think blankets and other clothing, tack, brushes, trailers, bits, bridles and halters, just to name a few common items!

EHV does not last long in the environment and is easily killed by disinfectants. However, eradication of the virus from a horse population can be much more difficult. A horse, once infected, can become a “latent” carrier of the virus–for the rest of their life! This means that although the horse may not appear sick or affected, in periods of stress (transport, showing, sickness etc.), they may “shed” virus into the environment subsequently infecting others.

Combating infectious diseases such as EHV

Common sense is our best weapon against EHV and other infectious diseases! Follow the vaccination protocol prescribed by your veterinarian. Too often overlooked, practice basic herd management techniques. New horses, sick horses, and horses returning from shows or facilities should be isolated and their temperatures checked and recorded twice daily for at least 7-14 days. At a a facility with a confirmed outbreak, horses should be isolated and “temped” for 3 weeks. Disinfection is key. Be smart, do not share equipment!

Don’t become complacent in guarding against infectious disease. EHV, Strangles, Flu or other infectious diseases could directly affect you and your horse. This year alone, there have been confirmed outbreaks in Europe, Maryland, Ohio, the Meadowlands New Jersey, Colorado State University Vet School, and Wellington Florida. These are just the biggest and highest profile outbreaks. Hundreds of horses have been halted in their transport and forced into isolation protocols. Thousands of horses have been affected with restrictions and testing. A number of horses have been euthanized. Horses of all types have been affected–racehorses, show horses, imported horses and even hospitalized horses!

The outbreak in Wellington Florida has been linked to a recent shipment of imported horses from Europe. The horses were not visibly showing any signs when they were released from quarantine in NY. The state of Florida imposed a mandatory quarantine order for a large number of horses and a voluntary quarantine order for an even larger number. Biosecurity standards have been posted and required under civic penalty for the Wellington show grounds including:

• Limited admittance of personnel into the barns. Only essential individuals are allowed and those that enter must utilize foot baths on entry and exit.
• Wash hands in between the handling of every horse.
• Minimize the use of shared equipment. Disinfect daily and in between each use of any shared equipment.
• Multi-use medications (e.g. Bute, Banamine, Surpass, etc.) must not be shared between horses.

Most of these measures should be standard protocol for horse owners at all times. If you regularly put your horses in high risk situations, you cannot afford to ignore these basic measures.

Visit the Florida Association of Equine Practitioners web site for complete and up to date information on the Wellington outbreak.

From our November Newsletter:

Growing up, my parents imparted a healthy fear of ticks to me and my two brothers. I remember the constant reminders to “check myself” after coming in from a day playing outside. I remember the ashtray and matches my father used to burn ticks and the kerosene jar where we would drown them. And I remember the first time I saw an embedded, engorged tick on my brother Rick. It remains a vivid memory to this day.

Despite these memories and 25 years of growing up and living in the Northeast, it was not until I started private veterinary practice in Connecticut, that I began to realize the devastating effect of tick born disease on humans and horses alike…

Read more in our November newsletter.

I was at Chepachet Farms and Carriage Works this past weekend. Chepachet Farms offers hay and sleigh rides, their own maple syrup and a lot more. It’s a really cute place for a weekend family outing. If you ever go by Chepachet Farms, make sure you say hi to Briggs the draft horse. While I was there on Saturday, I caught up with Briggs and we snapped a couple pictures. I’m not sure who’s cuter in this picture: Briggs, Santa or my husband. I’m thinking Briggs.

I recently saw a 12 year old Warmblood gelding with the following history:

Highly accomplished fourth level dressage horse in consistent work and training with 4-6 month history of subtle “poor performance.” Owner has horse on intramuscular Adequan, intravenous Legend, and an oral glucosamine/chondroitin and MSM supplement. Horse receives fairly regular massage therapy and chiropractic care. Owner reports horse has had consistent “hock injections” as “maintenance.” Results of intra articular (joint) injections are varied; owner reports that the injections are becoming more frequent (less time between injections).

This history is not uncommon in English and Western sport horses. Mild to moderate hindlimb lameness is commonly blamed on arthritis in the hock or stifle joints or on sore muscles. And indeed hindlimb lameness is often the result of these conditions. However another possibility should not be overlooked: hindlimb proximal suspensory desmitis (inflammation of the upper suspensory ligament).

Hindlimb proximal suspensory desmitis can be easily missed, as the horse continues to compete for weeks, months or even years, and as performance suffers. Many horse owners assume that ligament problems are evidenced by suddenly hot and swollen limbs. Such a presentation does occur, but more commonly the presentation is subtle (especially in the hindlimbs).

Care must be taken in sport horses–especially those in dressage, barrel racing, cutting & reining, and jumping–when presented with a history similar to the above. A thorough assessment of the sport horse will include consideration of possible upper suspensory ligament damage or inflammation. Of course, clinical history, lameness examination with nerve and/or joint blocks, digital radiography and ultrasound are also essential. The assumption that the horse just needs his “hocks done” or “stifles blistered” can lead to costly and ineffective treatment. Worse, a horse’s competitive career can be shortened or ended in the event of a compromised and untreated upper suspensory ligament.

The American Veterinary Medical Association (AVMA) conducted a study of the conditions in the veterinary marketplace in 1998 and recently did a follow-up study. In their recent follow-up study the AVMA found that the discrepancy between male and female earnings has increased in the years since 1998. This fact held for associates in veterinary practices and for practice owners. The gap tended to widen as years of experience increased.

The practice owner discrepancy is what got me. It seems to suggest something in the “psyche” of female veterinarians that contributes to their lower earnings. Indeed, the AVMA study found a few clues: female veterinarians had lower earnings expectations than their male counterparts; female veterinarians tended to price their services lower; female veterinarians had lower self-evaluations of their business, financial and management skills.

The wage discrepancy between men and women in veterinary medicine is not well understood. This much we do know: 1) it is an issue of fundamental equity and 2) it represents a perverse and ironic fact in a world where over 70% of veterinary students are female.

We’re here at the AAEP convention in San Antonio. We expected it to be sunny and warm, as it was 84 degrees only a few days before we arrived. But it’s pretty much just like it was in New England: Cloudy, dull, gray and cold. But never mind, the traditional Texas barbecue is yummy! Onto the issue at hand: Potomac Horse Fever.

To date it has been thought that snails & slugs (parasitized by trematodes) are the only vector for the transmission of Potomac Horse Fever (PHF). Therefore many forego vaccination for PHF because snails & slugs are not prevelant in their area (no water bodies, wetlands, etc.) In a recent study published at the AAEP, it was discovered that a large outbreak of PHF was due to the presence of mayflies. Infected, dessicated (dried up) mayflies blew into the stalls and the water and feed supply of the horses and caused infection.

The study found that in addition to snails & slugs, insects that accumulate around water bodies and wetlands–caddisflies, mayflies, dragonflies, etc.–can also transmit PHF. These insects are known to harbor the trematode parasite and when ingested by a horse can cause PHF infection. A worrisome thought is that the night lighting in our barns attracts these insects. The light attracts and may kill the insect, leaving a infected carcass that can be blown into the water and feed supply of the barn–and infect our horses.

This finding counsels additional caution surrounding the potential vectors of PHF transmission. An additional worriesome thought is that the infectious agent of PHF, trematodes, also live in the intestines of bats and barn swallows. Though not a proven vector of transmission, caution should also be taken with these animals in our barns. In general,these findings reinforce the recommendation of once to twice yearly vaccination for PHF.