Question: “I have two questions. The first question is regarding testing for Gastric Ulcers. I have been reading about the “Sucrose Permeability Test,” for a couple of years, but still haven’t heard of any (Local) vets offering this test in lieu of traditional endoscopy. I was wondering what the reason may be for this, since it sounds, easier, cheaper, and less stressful to the horse, as well as being accurate?

My next question is regarding Lyme disease. I was reading a hot debate on whether or not “Lyme” is caused by borrelia burgdorferi, and if we aren’t treating for a disease that at this time is still unproven to cause illness in horses. What’s your take on this idea? Then if you do treat for Lyme, what’s the best course of testing, treatment? I have also read that the “SNAP” test is very accurate, but again, haven’t heard any local Vets using this test.”

That’s a lot to tackle in a relatively short blog entry. I would direct you to an article I wrote on Lyme Disease previously (link) for some answers to your questions. The controversy surrounding the existence of Lyme is too complex to tackle here, at least right now. I will focus on your questions regarding testing — both for gastric ulcers and on the SNAP Lyme test.

There was a paper presented at the 2003 AAEP convention which discussed Sucrose Permeability Testing as an alternative to scoping a horse’s stomach for the diagnosis of gastric ulcers (link, PDF 116k). The paper found that horses with gastric ulceration, when given sucrose in high levels on a fasted stomach, have higher levels of sucrose in their urine versus horses with healthy stomachs.

There are a number of important points to know about this study and the suitability of Sucrose Permeability Testing for gastric ulcers in horses. 1) The study only looked at 13 horses. The researchers were only able to induce gastric ulceration in 11 of those horses. The study size is small and it may be unwise to draw broad conclusion on such a small sample size. 2) The study showed an 83% and 90% correlation between gastric ucleration and urine sucrose concentrations of .7 mg/ml and 1.0 mg/ml, respectively. These percentages represent a reasonably strong correlation, but also leave a lot of room for error. 3) The performance of Sucrose Permeability Testing requires a 24 hour period of fasting, the administration of sucrose via nasogastric intubation, and then the collection of urine form the horse via catheterization at time intervals post sucrose administration (2 hours and 4 hours in the study). In other words, the test cannot be performed by an owner, and is ideally suited to a controlled clinic (non-ambulatory) environment. The test is also more time consuming and as invasive as scoping and it may not even be cheaper than traditional scoping. 4) Scoping gives information about the state of the esophagus, sphincters, proximal small intestine and more information about the state of a horse’s stomach. I have scoped horses fitting the profile of a gastric ulcer afflicted horse to a T, only to find horrendous esophageal ulceration or congenital outflow problems in the pyloric sphincter and small intestine.

You can find a good, general and fairly technical discussion of Equine Gastric Ulcer Syndrome (EGUS) here (PDF 168k).

As for the Lyme test, you are referring to the IDEXX Laboratories SNAP 3Dx Test (link). The test is actually labeled for use in dogs, though I and other veterinarians have used it with good results in horses (i.e. I have seen good correlations between reported positive titers on the SNAP test and full ELISA titers performed by outside laboratories). I use the test to screen for the potential of Lyme infection. The test only looks for the presence of antibodies to the Lyme bacterium and cannot tell you if a horse does or does not have active Lyme infection. On a positive SNAP Test result I send the horse’s blood to an outside lab for a full ELISA titer and Western Blot.

If a horse is negative on the SNAP test it probably means that the horse does not have active infection with the Lyme bacterium. I have not found that the strength of color change on the SNAP test to be a good indicator of the strength of Lyme infection. I use the SNAP test as a reasonably reliable and inexpensive screening test, only.

Ok, this isn’t horse related at all. Stan has taken up residence at 483 Center Road. Tim & I don’t mind in the least. We expect him to be gone by the end of October. Take a look at more photos here.

Stan & Tulsa

Dr. Eggleston tells a simple story of how and when she decided to become a veterinarian. She was nine and at a family get together of mostly adults, her and her two brothers and a few cousins. An aunt asked her, in that condescending yet well-meaning way adults often talk to other people’s young children, “what do you want to be when you grow up?” Aimee’s father, I can call her Aimee because I’m her husband and because I know her too well to call her Doctor, was at her side and answered for her: “She is going to be a veterinarian.”

It is unclear how Aimee’s father got the idea. To that point Aimee had never expressed the idea herself. But maybe seeing her daughter’s love of horses, growing stronger since her first pony ride at the age of five, and maybe because even then Aimee seemed a child of ability, the idea crystallized in his head.

When Aimee’s father spoke that word, “veterinarian,” the idea also crystallized in Aimee’s head. From that moment forward, she would answer the same way her father did, substituting 1st person for 2nd: “I am going to be a veterinarian.” I don’t know what it feels like to know the profession, the meaningful work of one’s adult years — as a child. But Aimee did and it started, in a real way, at age nine with her father’s pronouncement.

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On August 25, 2007, Australian government authorities reported an outbreak of equine influenza (EI). Prior to this outbreak only Australia, Iceland and New Zealand had never reported an occurrence of equine influenza. You can read a short report on the outbreak at the United States Department of Agriculture web site (here, PDF 129k).

A couple things… 1) Given the size of the Australian horse industry and given the prevalence of regional and international horse shipping, it is amazing that Australia hasn’t reported EI to this point. 2) Because Australia’s equine population has never been exposed to EI, the horses there have no built up immunity (based on vaccination or on natural exposure). Australia is importing large quantities of EI vaccine and vaccinating its equine population. It’s a long way to go, starting at 0. 3) The risk to your horse and mine, of course, is very low given that we’re half a world away. But it’s an interesting story (no EI to this point down under) and it’s still a good reminder to be mindful of infectious disease — to develop a holistic plan to combat infectious disease in your horse and facility.

The Quiet Corner’s Ride for the Cure is this weekend, September 30th. The ride supports the Susan G. Komen Breast Cancer Foundation. It is too late to register to ride, but you can still donate. You can do so through the Ride for the Cure web site or at the Susan G. Komen web site.

I recently received a call from a worried client. She had just fed Rusty, an aging and adorable Shetland Pony, his evening grain. Rusty dove into his grain, as usual, and my client went about a few chores. When she came back to check on Rusty, she found him standing in the corner, head low, neck stretched with foam and brown discharge coming from his nostrils and mouth. Rusty had only finished half his grain and he kept arching his neck and coughing. He looked like he was trying to throw up.

Rusty was choking.

I have seen a number of horses for choke in the past month. Most horse owners know immediately when their horse is choking but sometimes owners are unsure of what is happening to their horse — and of what to do next. Because choke can lead to serious, even life-threatening, complications in a horse, it is important to understand the signs of choke, and what to do (and not do) in the face of a choking horse.

Choke, also known as esophageal obstruction, can happen to any horse at any time — though certain horses can be more likely to choke. Horses that “bolt” their grain or hay, like the stereotypical overzealous pony, may be prone to choke. Horses having poor dentition (often older horses) may also be prone to choke, as they are less able to break down their feed.

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Concrete information on continued Pergolide availability is difficult to come by. I did receive this update from an AAEP email announcement on 5/11/07:

“The AAEP has, for the past several years, been working closely with the Center for Veterinary Medicine at the Food and Drug Administration to understand the policies governing compounding as it relates to equine practice. As a result of the recent withdrawal of pergolide from the market due to human health concerns, the AAEP contacted the FDA in an effort to educate and emphasize the importance of this drug to equine practitioners and their clientele. The AAEP received the communication below from the FDA and with it we feel that there will not be a crisis due to a pergolide shortage. The FDA recognizes the importance of these drugs and because of a healthy alliance with the AAEP, the Agency learned of the situation quickly and made its decision to apply regulatory discretion to the compounding of pergolide from bulk sources. Compounding pharmacies should not experience any shortage of the bulk product.”

Recent article from thehorse.com about the situation surrounding pergolide:

http://www.thehorse.com/viewarticle.aspx?ID=9526 

Recent announcement from the AAEP:

“As you may be aware, the FDA has withdrawn the drug pergolide from the market for use in humans. In order for the drug to continue to be available for use in veterinary medicine, the FDA must approve an exception for pergolide to be used by veterinarians and to be compounded in bulk quantities.

The AAEP, through its Drug Compounding Task Force, has been in contact with the FDA, and they are aware of the significant impact of pergolide’’s withdrawal from the market on equine medicine. The FDA Center for Veterinary Medicine is working with its counterpart for human medicine, the Center for Drug Evaluation and Research, to allow importation of pergolide for use by compounding pharmacies. The FDA expects to have an official announcement by the end of this week.

The AAEP will continue to communicate with the FDA on this issue. For updates, please visit the AAEP Web site.

Sincerely,
The AAEP”

Article from thehorse.com: Pergolide: Veterinarians, Horse Owners Fighting for Availability

Another article from thehorse.com providing background on the issue: Equine Cushing’s Drug Pergolide to be Withdrawn for Human Use

The Center for Emerging Issues (CEI), part of the Unite States Department of Agriculture (USDA), has released an emerging disease notice regarding the neurologic form of equine herpesvirus.

The CEI report, released in January of this year, reports on the EHV-1 disease situation in the United States and tracks historical reports of the disease.

From the report: “It appears that neurologic EHV-1 is emerging as a more virulent strain of the disease than seen previously in the United States. Many data gaps exist, and more investigations need to be done to better understand the situation and to identify factors playing a role in possible emergence.”

To view the complete report, visit the Center for Emerging Issues web site, and clink on the link titled “Equine herpesvirus myeloencephalopathy: A potentially emerging disease.”