Smart Vaccination Choices

Protect Your Horse with Veterinarian-Administered Vaccinations

With vaccines readily available at farm supplies stores, online pharmacies and other retailers, it's sometimes tempting to save a few dollars by purchasing and administering them to your animals yourself.

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Because there are hidden risks and costs associated with vaccinating animals yourself, "cheaper" vaccines aren't the value they first appear to be. 

Did you know that many veterinarians will develop a customized vaccine program for your horse based on its environmental exposure and other factors?  Coupled with other routine services and check-ups, having your veterinarian administer vaccines is always safer, easier and a better value in the long run than doing it yourself.

Having your horse on the correct vaccination schedule allows the veterinarian to observe the animal regularly and detect early signs of a disease or disorder.  Based on these visits, your veterinarian can suggest other, more in-depth examinations or tests for your horse.

Here are several other good reasons why a veterinarian is your best choice for administering vaccines: 

Proper Handling of the Vaccine

Many vaccines require special handling and storage.  For instance, a particular vaccine may require protection from extremes of temperature or exposure to light to preserve its effectiveness.  Rely on a licensed veterinarian to store and handle the vaccine properly.  Another aspect of proper handling is also making sure that the vaccine has not passed its expiration date.  Veterinarians are keenly aware of the effective life of a given vaccine. 

Safe Administration

Part of safe administration is a clean environment and injection site, otherwise you may be putting pathogens into your horse's system instead of protecting against them.

Some vaccines cannot be given at the same time as other medicines.  Your veterinarian will know which vaccines and medications can react with one another.  Your veterinarian will document the vaccine’s serial number and administration date—especially important in the event of a manufacturer’s recall.  This is one instance when poor documentation could put your animal in peril. 

Availability for treatment of adverse reactions

Any injection can result in adverse effects.  Maybe it's only mild swelling at the injection site.  Or, it could be lethargy and a slight fever for one to two days.  In some animals, it can be as severe as an immediate outbreak of hives or life-threatening anaphylaxis.  If your veterinarian is there administering the vaccine, he'll know what to do to counteract a reaction—and he'll have the medicine to do it.

When you think about the risks of doing it yourself, it only makes good sense to have a licensed professional administer vaccines.

 

Reprinted with permission from the American Association of Equine Practitioners.

Cold Weather Colic - AAEP

The average horse owner is likely well-acquainted with his or her horse’s colic risk regardless of the season, but with cold weather come complicating factors that all owners should prepare for. 

The No. 1 cause of colic during winter is a lack of fresh, unfrozen water. Horses must drink 10-12 gallons of fresh water every day and can dehydrate quickly if water is unavailable. Horses that aren’t getting enough water are at a greater risk for conditions such as simple indigestion or impaction. A frozen water trough is the usual dehydration culprit, but occasionally horses choose to not drink water simply because it is so cold. Heaters for your troughs and buckets are therefore an absolute “must” to ensure continual access to water in the winter. Keep in mind that electrolyte supplements are not a suitable water substitute and do not mitigate the risk of dehydration. There is nothing wrong with adding (appropriate amounts of) electrolytes to your horse’s diet, but offer them in a separate container, leaving the main water supply clean and fresh. Horses might attempt to eat snow to compensate for some fluid loss, but snow is largely composed of air and will not provide the volume of water necessary to hydrate a 1,000-pound animal. 

The treatment for a case of dehydration is fairly obvious: fluid replacement. On the farm, your veterinarian will most likely pass a stomach tube through the horse’s nose and administer oral fluids as well as an intestinal lubricant such as mineral oil. In cases of moderate or severe dehydration, intravenous fluids can be administered via catheter for a much quicker delivery route, but most veterinarians will choose to administer these types of treatments in a more controlled clinic setting. Use of oral or injectable anti-inflammatories such as flunixin meglumine (Banamine) and phenylbutazone (Bute) is also commonplace. 

The second colic risk factor associated with winter is exposure to cold temperatures. A horse with a full hair coat should have no trouble staying warm on the coldest of winter days, even without a blanket, as long as he remains dry and has access to shelter. Blankets are useful for horses that have been body-clipped because they have lost the added layer of insulation the hair provides, but blankets must be applied responsibly. Always replace or remove a soaked blanket immediately because the moisture will freeze, trapping the cold and causing the horse to lose precious body heat. If your horse wears a blanket, there should be at least two or three on hand so a soaked article can be traded out for a dry one. 

Increasing the forage in a horse’s diet will help prevent impactions and will also reduce the risk of hypothermia (low body temperature). Horses require more calories in the winter just to stay warm, and the body’s fermentation process for digesting hay and roughage also generates heat that helps maintain body temperature. The best colic prevention in this situation is to allow a horse 24-hour forage access so the fermentation process never slows or stops. Adding grain and sweet feed supplements (if warranted) is fine, but they do not provide the same warming and digestive benefits as a continual forage supply. 

Shelter is equally important, even to those horses that are accustomed to being outside all the time. A permanent structure built to withstand the force of strong winds and the weight of excessive snow accumulation is ideal, but temporary structures such as canvas or vinyl canopies with steel frames will also work if secured properly. 

If you observe your horse experiencing mild hypothermia (a body temperature lower than 99.5°F, signs of lethargy, and a reluctance to move), remove him from the elements so he can thaw out and recover; the sooner he gets out of the cold, the better. For owners that don’t have a barn, a garage can be a temporary substitute. You can also use warm water baths and blankets to speed up the warming process. 

Nothing seems to function quite as well when it’s really cold, and horses are no exception. Hypothermia or dehydration- induced colic episodes are common occurrences for horses living in winter climates. The good news is that with a few management and husbandry changes, these episodes should occur to a lesser degree and with far less frequency.  

About the Author: Scott Leibsle, DVM, is a deputy state veterinarian for the Idaho State Department of Agriculture, in Boise. 

Article provided courtesy of AAEP Media Partner, The Horse.

Reviewed by original author in 2016.

Importance of Equine Dentistry

This horse presented today for a routine dentistry. Young, good body condition, no noted health issues.

Perfect example of why it is so important to have routine dentistry and oral examinations performed on your horses.

He showed no outward signs of the extreme hooks on his first large premolars (106 and 206) or the matching abnormalities on his last lower molars. They were affecting how his teeth wore and would eventually lead to more serious dental conditions.

These were reduced to the level of his other premolars and molars by Dr Dewar using a speculum and a Power Float with the horse sedated.

His mouth will be examined twice a year and floated as needed to ensure these do not reoccur.

Emergency Care and Preparedness

Emergency Care and Preparedness

If you own horses long enough, sooner or later you are likely to confront a medical emergency. There are several behavioral traits that make horses especially accident-prone: one is their instinctive flight-or-fight response; another is their dominance hierarchy - the need to establish the pecking order within a herd; and a third is their natural curiosity. Such behaviors account for many of the cuts, bruises, and abrasions that horses suffer. In fact, lacerations are probably the most common emergency that horse owners must contend with. There are other types of emergencies as well, such as colic, foaling difficulties, acute lameness, seizures, and illness. As a horse owner, you must know how to recognize serious problems and respond promptly, taking appropriate action while awaiting the arrival of your veterinarian. 

Recognizing Signs Of Distress


When a horse is cut or bleeding, it's obvious that there is a problem. But in cases of colic, illness, or a more subtle injury, it may not be as apparent. That's why it's important to know your horse's normal vital signs, including temperature, pulse, and respiration (TPR), as well as its normal behavior patterns. You must be a good observer so that you readily recognize signs of ill health

What's Normal? 


There will be variations in individual temperature, pulse, and respiration values. Take several baseline measurements when the horse is healthy, rested, and relaxed. Write them down and keep them within easy reach, perhaps with your first aid kit, so you have them to compare to in case of an emergency. 

 

Normal ranges for adult horses are:

•   Pulse rate: 28-44 beats per minute.

•   Respiratory rate: 12-20 breaths per minute.

 Rectal temperature: 99.5° F to 101.5° F. If the horse's temperature exceeds 102.5° F, contact your veterinarian immediately. Temperatures of over 103° F indicate a serious disorder. 

•  Capillary refill time (time it takes for color to return to gum tissue adjacent to teeth after pressing and releasing with your thumb): 2 seconds.

Other observations you should note:

•  Skin pliability is tested by pinching or folding a flap of neck skin and releasing. It should immediately snap back into place. Failure to do so is evidence of dehydration. 

• Color of the mucous membranes of gums, nostrils, conjunctiva (inner eye tissue), and inner lips of vulva should be pink. Bright red, pale pink to white, or bluish-purple coloring may indicate problems. 

• Color, consistency, and volume of feces and urine should be typical of that individual's usual excretions. Straining or failure to excrete should be noted. 

• Signs of distress, anxiety or discomfort.

•  Lethargy, depression or a horse that's "off-feed." 

• Presence or absence of gut sounds.

• Evidence of lameness such as head-bobbing, reluctance to move, odd stance, pain, unwillingness to rise. 

• Bleeding, swelling, evidence of pain.

• Seizures, paralysis, or "tying up" (form of muscle cramps that ranges in severity from mild stiffness to life-threatening illness).

Action Plan

No matter what emergency you may face in the future, mentally rehearse what steps you will take to avoid letting panic take control. Here are some guidelines to help you prepare: 

1.     Keep your veterinarian's number by each phone, including how the practitioner can be reached after-hours. If you have a speed dial system, key it in, but also keep the number posted. 

2. Consult with your regular veterinarian regarding back-up or referring veterinarian's number in case you cannot reach your regular veterinarian quickly enough.

3.  Know in advance the most direct route to an equine surgery center in case you need to transport the horse. 

4.  Post the names and phone numbers of nearby friends and neighbors who can assist you in an emergency while you wait for the veterinarian.

5.  Prepare a first aid kit and store it in a clean, dry, readily accessible place. Make sure that family members and other barn users know where the kit is. 

6. Also keep a first aid kit in your horse trailer or towing vehicle, and a pared-down version to carry on the trail. 

First Aid Kits

First aid kits can be simple or elaborate, but there are some essential items. Here is a short list to get yours started. (*Material that should be sterile.)

•  * Cotton roll.

•  *Non-Stick bandage/Telfa pad.

• *White Gauze/Cling Wrap.

• *Gauze pads, assorted sizes.

• Brown Gauze.

• Adhesive wrap (vet wrap) and adhesive tape.

• Leg wraps.

• Sharp scissors.

• Hemostats/Tweezer.

• Duct Tape

• Rectal thermometer with string and clip attached. 

• Surgical scrub and antiseptic solution.

• Latex gloves.

• Flashlight and spare batteries.

• Permanent marker pen.

• Pliers (to pull nails from shoe).

• 6 in. diameter PVC tubing cut in half the long way (like a gutter) into lengths of 1-1 /2 to 2 ft. (for emergency splinting).

Emergency Wound Care

The sight of blood may unnerve you, but maintaining your presence of mind can save your horse's life. The initial steps you take to treat a wound can prevent further damage and speed healing. 

How you proceed will depend on your individual circumstances, and you must exercise good judgment. The following should be viewed as guidelines:

1.  Catch and calm the horse to prevent further injury. Move the horse to a stall or other familiar surroundings if this is possible without causing distress or further injury to the horse. Providing hay or grain can also be a good distraction. 

2. Get help before attempting to treat or evaluate a wound. It can be difficult and very dangerous to try to inspect or clean the wound without someone to hold the horse. You cannot help your horse if you are seriously injured yourself. 

3.  Evaluate the location, depth, and severity of the wound. Call your veterinarian for a recommendation anytime you feel your horse is in need of emergency care. Here are some examples of situations where your veterinarian should be called:

A. There appears to be excessive bleeding.

B. The entire skin thickness has been penetrated.

 C. Any structures underlying the skin are visible. 

D. The wound occurs near or over a joint.

 E. A puncture has occurred.

F. A severe wound has occurred in the lower leg at
 or below  knee or hock level.

G. The wound is severely contaminated.

4. Consult with your veterinarian regarding a recommendation before you attempt to clean the wound or remove debris or penetrating objects, as you may cause uncontrollable bleeding or do further damage to the wound. Large objects should be stabilized to avoid damaging movement if possible. Don't put anything on the wound except a compress or cold water. 

5. Stop the bleeding by covering the wound with a sterile, absorbent pad (not cotton), applying firm, steady, even pressure to the wound.

6. Do not medicate or tranquilize the horse unless specifically directed by your veterinarian. If the horse has suffered severe blood loss or shock, the administration of certain drugs can be life-threatening.

7. If the eye is injured, do not attempt to treat. Await your veterinarian. 

8. If a horse steps on a nail or other sharp object and it remains embedded in the hoof, first clean the hoof. Consult with your veterinarian regarding a recommendation before you remove the nail. If your veterinarian advises, carefully remove the nail to prevent the horse from stepping on it and driving it deeper into the hoof cavity. As you remove it, be sure to mark the exact point and depth of entry with tape and/or a marker so the veterinarian can assess the extent of damage. Apply antiseptic to the wound, and wrap to prevent additional contamination.

9. All horses being treated for lacerations or puncture wounds will require a tetanus booster.

 

Other Emergencies

There are far too many types of emergencies - from heat stroke to hyperkalemic periodic paralysis, bone fractures to snake bites, foaling difficulties to colic - to adequately cover them all in this talk. However, regardless of the situation, it's important to remember these points: 

1.  Keep the horse as calm as possible. Your own calm behavior will help achieve this.

2. Move the animal to a safe area where it is unlikely to be injured should it go down.

3.  Get someone to help you, and delegate responsibilities, such as calling the veterinarian, retrieving the first aid kit, holding the horse, etc. 

4. Notify your veterinarian immediately. Be prepared to provide specific information about the horse's condition, as mentioned above, and other data that will help your practitioner assess the immediacy of the danger and instruct you in how to proceed.

5. Listen closely and follow your equine practitioner's instructions.

6. Do not administer drugs, especially tranquilizers or sedatives, unless specifically instructed to do so by the veterinarian. 

Summary

Many accidents can be prevented by taking the time to evaluate your horse's environment and removing potential hazards. Also, assess your management routines to make them safer. Mentally rehearse your emergency action plan. Preparation will help you stay calm in the event of a real emergency. Keep your veterinarian's phone number and your first aid kit handy. In an emergency, time is critical. Don't be concerned with overreacting or annoying your veterinarian. By acting quickly and promptly, you can minimize the consequences of an injury or illness. Your horse's health and well-being depend on it.

 

Locking Stifles

The stifle joint in a horse’s hind leg corresponds anatomically to the knee joint in the human leg. However, instead of appearing halfway down the limb like the human knee, the horse’s stifle doesn’t even look like a joint because it is hidden within the structure of the horse’s upper hind leg. If you put your hand on the front of the horse’s hind leg where it ties into the flank, you can feel the patella, a small bone that is the anatomic equal of the human kneecap. The patella sits just above the stifle joint where the horse’s femur (upper leg bone that ties into the hip) and the tibia (long bone above the hock) meet.

 

The medial patellar ligament has the important function of hooking over a notch in the end of the femur when the horse is standing still. This stabilizes the stifle and allows the standing or snoozing horse to bear weight on the hind leg without muscular effort.

 

Normally, the ligament slides out of the notch when the horse swings its leg forward as it begins to walk. If the ligament gets hung up and doesn’t slip into an unlocked position, the hind leg can’t be flexed forward and the horse has to drag the stiffened limb forward for a few steps before the ligament releases. This is commonly known as a locking or sticking stifle. While veterinarians term the condition “upward fixation of the patella,” old-time horsemen have a simpler descriptive phrase: “That horse is stifled.” They might add, “Back him up a few steps to get it to release,” and this trick often works.  

Locking stifles aren’t limited to one breed or type of horse or pony, but they are somewhat more common in horses that have very upright hindlimb conformation, with overly straight angles of the hock and stifle joints. There isn’t much an owner can do to correct this faulty conformation, but putting the horse in a gradual conditioning program will strengthen the muscles around the stifle and decrease the incidence of locking. The problem of sticking stifles has been relieved in some young horses that gained 55 to 100 lb (25 to 45 kg), possibly because they developed a larger fat pad behind the patella. Any desired weight gain in horses should be the result of a gradual increase in caloric intake, not through drastically increasing the amount of grain given to the horse.

Corrective shoeing helps to eliminate sticking stifles in some horses. The farrier encourages hoof rotation by trimming the inside wall or applying a lateral heel wedge. Better medial breakover can be enhanced by rounding the medial aspect of the toe of the hoof or shoe.

In one study1 that looked at treatments for locking stifles, 40% of horses with locking stifles showed complete recovery, and 20% had marked improvement following corrective shoeing.  Another 10% of affected horses showed improvement when corrective trimming was combined with weight gain and exercise.

If these noninvasive techniques don’t help, veterinarians can use one of several procedures to cause mild scarring of the ligament, decreasing its elasticity. When the ligament is somewhat less flexible, it can be pulled into position more easily rather than stretching and staying locked in place. These procedures eliminate the problem in some horses but are less successful in others.

Sticking stifles are not always a serious problem, and mildly affected horses may be usable as long as the rider takes into account that the horse should not be asked to make smooth, athletic movements as it begins to walk after standing still. These horses may not always show classic locking, but might display more subtle signs such as a shortened stride, difficulty picking up or maintaining a canter lead, or a bit of scrambling while going up or down hills. Horses that regularly display classic locking stifles and don’t achieve a normal gait after a few strides may not be safe to ride.

 If you suspect a problem with legs or joints, ask the veterinarian about your concerns.    

(From the researchers at Kentucky Equine Research)

Potomac Horse Fever

Potomac Horse Fever (Equine Monocytic Ehrlichiosis)

What is Ehrlichiosis?

     A category of diseases caused by a type of gram negative bacteria that infect white blood cells.  They are called "intracellular" bacteria because they live and are only able to reproduce inside the cells of a host animal.  Once inside the host animal's white blood cells they can form circular chains that can often be seen on blood smears and used to diagnose some forms of ehrlichiosis. The two commonly seen forms of ehrlichiosis in horses are Anaplasmosis (transmitted by ticks) and Potomac Horse Fever.

 

How is Potomac Horse Fever Transmitted?

     Potomac Horse Fever (Neorickettsia risticii) is believed be transmitted by horses accidentally ingesting infected small aquatic flies (May flies, Caddis flies) that are infected with Neorickettsia risticii by consuming the larvae of infected snails. Transmission is typically increased in the hot months of July and August, especially in times with lots of standing water for the snail – aquatic fly life cycle to occur. Horses infected with Potomac Horse Fever are not believed to be able to spread the disease to other horses, however other diseases that present with very similar signs can be extremely contagious so biosecurity measures should be put into place as soon as signs are seen or suspected.

 

What is the "Incubation Period"?

     An incubation period is the time during which a disease establishes itself in the body.  During this time the animal is infected with the organism (bacteria in this case), but does not show clinical signs of the disease.  The incubation period for Potomac Horse Fever is typically 3-9 days. Horses may start to show a fever and depression about on day 5 and diarrhea about day 14 post infection.  

 

What are the Clinical Signs of Potomac Horse Fever?

     Horses with typically present with fever, depression, anorexia, and diarrhea. The first sign that a veterinarian is called for may be colic or abdominal discomfort prior to the development of diarrhea. This is typically seen in adult horses, and presents very similarly to Salmenelosis. Laminitis is a very common sequelae to Potomac Horse Fever.

 

How is it Diagnosed?

     Most forms of ehrlichiosis can be diagnosed by viewing the characteristic circular chains of bacteria inside white blood cells.  Potomac Horse Fever, however is not able to always be diagnosed this way.  A polymerase chain reaction (PCR) test on blood samples can be used to identify the presence of the Neorickettsia risticii bacteria in the blood.

 

How is Potomac Horse Fever Treated?

      If diagnosed early a tetracycline antibiotic such as Oxytetracycline or Doxycycline is commonly used, along with supportive care to treat clinical signs such as colic, fever, laminitis, edema, or diarrhea.  Treatment can be successful in most cases if diagnosed early.  It can be life threatening when associated with colic and/or laminitis, and should be treated quickly and aggressively.

 

What can be done to Prevent Potomac Horse Fever?

 

     There is a vaccine for Potomac Horse Fever, however it is not protective against ALL of the disease causing strains of the bacteria. Horses that are affected by Potomac Horse Fever and recover have been found to be protected for up to 20 months from reinfection.

PPID - Equine Cushings Disorder

Equine Cushings Disease (ECD) is also referred to as Pituitary Pars Intermedia Dysfunction (PPID) because it is caused by an enlarged pituitary gland or a tumor within the pituitary gland known as an adenoma.  The pituitary gland is a hormone producing organ located at the base of the skull.  It is controlled by the hypothalamus, a part of the brain that controls many parts of the nervous system related to movement, hormones, food and water intake, and the sleep/wake cycle.

     The pituitary is made up of three sections, anterior, posterior, and intermediate.  In Equine Cushings Disease, the intermediate section becomes enlarged and and over produces ACTH (adrenocorticotropic hormone).  This hormone causes the body to increase its production of glucocorticoids (normally produced steroids).  This increases the level of cortisol in the blood, which in turn causes the clinical signs of Equine Cushings Disease.

This is different from the cause of Canine Cushings Disease, hence we now prefer to diagnose this as PPID.

 

Clinical Signs

     Horses with PPID are often prone to laminitis, and may have elevated blood insulin and/or glucose levels because cortisol decreases the body's normal response to insulin, which causes it to produce more insulin in an effort to decrease high glucose levels.  The elevated glucose levels mimic the effects seen when glucose sensitive horses develop laminitis on fresh spring grass.

     PPID horses often present with a long, curly coat that doesn't shed normally as the season changes, called hirsutism.  They may lose their topline as their back muscles weaken.  A "hay bellied" appearance may be seen as they deposit fat around their abdomen, tail head, and neck.  They may appear to have a cresty neck without much muscling or body condition in normal locations.  They may be lethargic, sweat easily, and often drink more water and urinate more frequently than unaffected horses.

 

Testing

     The preferred test to diagnose PPID is Resting Adrenal Corticotropic Hormone (ACTH) level. Plasma ACTH is increased in the presence of pituitary hyperactivity and hypersecretion. This may be caused by PPID but is also known to occur in most normal horses and ponies in the autumn. Although this has been considered a reason to avoid testing for PPID in the autumn, this potential problem may be overcome by applying properly derived and calculated seasonally adjusted reference ranges. Testing in the autumn may actually allow the greatest differentiation between PPID cases from normal horses and there is no reason at all to avoid testing for PPID in the autumn. ACTH may also be affected by pain and stress (e.g. from laminitis) although this does not appear to have a large effect in most horses unless pain is marked.

 

What about Testing Blood Glucose/Insulin Levels?

     Many PPID horses are insulin resistant and will have elevated insulin and/or blood glucose levels, however this is not recommended as the only method of testing for PPID because it is not specific.  There are many diseases that can cause elevated insulin/glucose levels.  It is most accurate to test the function of the pituitary via ACTH levels, because the disease is caused by a malfunctioning pituitary.

 

Treatment

     Diet is an important factor in treating PPID horses.  Starches and simple sugars should be decreased, and lush grass and sweet grains should be avoided.  This is especially helpful in preventing the development of laminitis in these horses.  Hay with low levels of non structural carbohydrates (sugar) should be fed, and can be soaked for 30 minutes prior to feeding to decrease sugar levels even more.

     Medical treatment when needed is most commonly Pergolide (Prascend).  An PPID horse needs to be treated with pergolide if it has elevated levels of fat and glucose in its blood, has developed laminitis, showing signs of muscle wasting, lethargy, depositing fat in abnormal places, is having fertility problems, or any of the many other symptoms of PPID.  Pergolide can also help PPID horses shed and grow their coat normally.  Pergolide is a dopamine receptor agonist and acts on receptors within the nervous system. ACTH levels should be used to monitor treatment effectiveness at 6 to 12 month intervals.

 

Fecal Egg Counts and Parasite Management Plans

What is a Fecal Egg Count (FEC)?

FEC is a quantitative assessment of internal parasite eggs shed by your horse in its manure.  A measured volume of manure is mixed with a flotation solution and evaluated on a specially calibrated microscope slide.  This allows us to calculate the number of parasite eggs per gram of manure.

The current recommendation is to deworm based off fecal egg counts rather than an every other month rotation.  FEC’s are useful to determine:

  • Which dewormers are effective on a particular farm
  • Which horses are high vs low shedders by nature (creating a customized parasite management program for your horse)
  • The interval between dewormers that is required (decreasing unnecessary chemicals in our horses when they don’t need it)
  •  If parasite resistance is developing on a farm (monitoring trends to see if resistance is developing or going away)

 

Why Do Some Horses Shed More Eggs Than Others?

Horses on the same pasture or management plan may be found to consistently have very different amounts of internal parasite eggs in the manure.  Approximately 20% of horses will carry 80% of the parasites on most farms!

All horses are exposed to parasites throughout their life.  They develop varying levels of intestinal immunity which allows them to hold adult intestinal parasites in check.  

The immune systems of young horses (<3yrs) and aged horses are less able to adapt to and hold intestinal parasites at low levels.

 

What is a High, Medium, or Low Shedder?

Adult healthy horses consistently carry similar worm burdens through the year, which allows us to customize parasite management plans based on the level of intestinal parasite eggs that they are shedding.

High Shedding horses will need more frequent strategic deworming, compared to Medium or Low shedders.

This allows us to decrease unnecessary use of dewormers by using them strategically in the horses with less natural immunity to intestinal parasites

Henderson Equine Clinic recommends a Fecal Egg Count be performed every Spring (April/May) and Fall (October/November) to assess your horse’s parasite burden/shedding status and to allow us to create a customized Parasite Management Program.  

Follow up Fecal Egg Counts may need to be performed at specific times throughout the year depending on your parasite management program.


What else can we do to control Parasites on farm?
In our area, the highest risk for parasite eggs on pasture is May/June through October.

 

Techniques for Pasture Management:

  • Don't overstock your pastures (over grazed pastures increase ingestion of parasite eggs)
  • Regularly dispose of manure and don't spread onto pastures currently being grazed
  • Drag/harrow paddocks to break up manure piles and leave open for 2-3 weeks
  • Use feeders for hay or grain rather than feeding off the ground
  • Keep foals and weanlings separate from yearlings to help prevent ascarid infections

 

Why do we care about changing the way we deworm?

     Across the country, all types of horse farms have reported resistance to certain dewormer classes.  The most commonly reported resistance is to fenbendazole and ivermectin products.  There are very few new deworming drugs being developed (and none for horses).  Our goal is to use the options we have intelligently to minimize the further development of parasite resistance. Many serious conditions have been almost eliminated by modern deworming programs and we would like to keep it that way.  New deworming and Fecal Egg Count recommendations are aimed at achieving this by focusing on individual horses.

 

Henderson Equine Clinic's Deworming Recommendations

Collect and submit a fecal sample on each horse (or a grouped sample on horses kept in large groups) in the spring (March/April) and fall.

  • For each horse to be tested a fecal sample is submitted BEFORE to deworming. 
  • To collect a fecal sample:

1.  Collect 2 fecal balls of manure ideally passed within 1-2 hours but definitely less than 24 hours
2.  Place the manure in a plastic ziplock bag, removing all air possible
3.  Store the sample in a refrigerator until it can be picked up or delivered to the clinic.

You will receive a custom Parasite Management Plan for each horse (or group). 

  • Most low shedding horses will have Fecal Egg Counts and be treated biannually (early spring and fall)
  • Moderate and high shedding horses will need additional deworming and strategic Fecal Egg Count Assessments during times of highest parasite risk.
  • Foals and Senior horses will require different strategic deworming programs than mature horses.

Once per year a Fecal Egg Count Reduction should be performed on atleast one horse on your farm.

  • Submit a fecal sample just prior to deworming and ten days to two weeks after deworming depending on dewormer used.
  • Comparing the Fecal Egg Count results from just prior to deworming to those two weeks after deworming provides a quantitative measure of resistance.  These results will help determine if this deworming product is effective on your property and for your horse(s), and therefore whether it should or should not be used again in the future.

Equine Parasite Control Part 1: Common Internal Parasites

Equine internal parasite management is a confusing and seemingly ever changing subject.  Daily dewormers? PowerPaks? Rotate dewormers? Don't rotate dewormers? Fecal flotations? High, Medium, Low shedding programs? 

Parasitologists are constantly updating their parasite control recommendations based on new research to try to control parasite resistance to dewormers while continuing the excellent control of internal parasites that we have become accustomed to. 

Let's start from the beginning. Part 1 of this discussion will be.....

What are the common internal parasites we are attempting to control in our horses?


Small Strongyles (Cyathostomes) - Have become an important group of intestinal parasites in horses.  Larvae burrow into the lining of the intestine and remain dormant or "encysted" for several months before completing their life cycle.  During this time the larvae are resistant to most dewormers.

Small strongyle larvae can cause severe damage to the lining of the intestine, especially when large numbers of larvae emerge from the encysted stage all at once.  Colic and diarrhea are common in heavily infected horses.  These parasites also cause weight loss, slowed growth in young horses, poor coat condition and lethargy, or lack of energy.  While lighter infections are not obvious, it is common for a horse's general health and performance to improve after treatment for these parasites.

The early and late larval stages (before and after they burrow into the lining of the intestine) and the adult parasites are susceptible to several dewormers.  But currently there are only two types of dewormers that are effective against the encysted larval stage.

Large Strongyles - As larvae they penetrate the lining of the bowel and migrate along the blood vessels that supply the intestines.  Even small numbers of these larvae can cause extensive damage.  Infection with large strongyles can cause unthriftiness, weight loss, poor growth in young horses, anemia (low number of red blood cells) and colic.  In most cases, colic caused by these parasites is relatively mild, but severe infections can result in loss of blood supply to a portion of the intestine, leading to severe and potentially fatal colic.  These intestinal parasites have been controlled for the most part by our routine deworming protocols.

Roundworms (Ascarids) - Greatest concern for horses under 6mo of age.  Healthy older horses have immunity but may still shed eggs (mostly eliminated by modern deworming programs).  Adults cluster in the small intestine causing impaction, often with colic, can result in rupture and death

Most often a problem in young horses (especially foals, weanlings, and yearlings).  Adult roundworms are several inches long and almost the width of a pencil; in large numbers they can cause blockage (or impaction) of the intestine.  In addition, roundworm larvae migrate through the internal organs until they reach the lungs.  They are then coughed up and swallowed back into the digestive tract to complete their lifecycle.  Large infections can lead to damage to the liver or lungs due to migration of these larval forms.  

Roundworm infection in young horses can cause coughing, poor body condition and growth, rough coat, pot belly, and colic. Colic is most likely in older foals (over 3months of age) that are heavily parasitized with roundworms when dewormed for the first time.

Tapeworms - Found in virtually all grazing animals.  Contribute to colic by causing inflammation, ulceration and bowel obstruction.  The tapeworm lifecycle involves a tiny mite as an intermediate host, and horses are at risk of developing tapeworm infection when they eat this mite in grass, hay or grain.   Praziquantel has been demonstrated to be highly effective against tapeworms.  

Pinworms - Lay eggs on the skin around the horse's anus.  The irritation they cause makes the horse repeatedly rub its tail. The eggs can sometimes be found by placing a piece of scotch tape on the skin around the horse's anus and then viewing under a microscope.

Bots - Not usually a cause of major health problems, although they can damage the lining of the stomach where they attach.  They may also cause small areas of ulceration in the mouth where the larvae burrow into the tissue for a time after the eggs are taken into the mouth.  

Stay tuned for Part 2 of Equine Parasite Control; Fecal Egg Counts and Control Programs

Learn to Recognize your Horse’s Dental Problems

 

Cold weather increases a horse's caloric requirements and this need for increased feed may exacerbate weight loss or other chronic problems in horses with dental problems. 

Horses with dental problems may show obvious signs, such as pain or irritation, or they may show no noticeable signs at all.  This is because some horses simply adapt to their discomfort.  For this reason, periodic dental examinations are essential to your horse’s health. 

      It is important to catch dental problems early.  If a horse starts behaving abnormally, dental problems should be considered as a potential cause.  Waiting too long may increase the difficulty of remedying certain conditions or may even make remedy impossible.  Look for the following indicators of dental problems from the American Association of Equine Practitioners (AAEP) to know when to seek veterinary attention for your horse:

 

  1. Loss of feed from mouth while eating, difficulty with chewing, or excessive salivation.
  2. Loss of body condition.
  3. Large or undigested feed particles (long stems or whole grain) in manure.
  4. Head tilting or tossing, bit chewing, tongue lolling, fighting the bit, or resisting bridling.
  5. Poor performance, such as lugging on the bridle, failing to turn or stop, even bucking.
  6. Foul odor from mouth or nostrils, or traces of blood from the mouth.
  7. Nasal discharge or swelling of the face, jaw or mouth tissues.

 

Oral exams should be an essential part of an annual physical examination by a veterinarian.  Every dental exam provides the opportunity to perform routine preventative dental maintenance. Mature horses should get a thorough dental exam at least once a year, and horses 2 –5 years old should be examined twice yearly.

Early and regular examination of your horse's mouth will decrease the chances of broken teeth, requiring extractions. or pain and oral ulcers.  

 

Additional information is available on the AAEP’s website www.aaep.org/horseowner.

 

Sections reprinted with permission from the American Association of Equine Practitioners. 

RAO/COPD/Heaves

Good infographic about Heaves (Recurrent Airway Obstruction or Chronic Obstructive Pulmonary Disease - depending on your veterinarians diagnosis and preferred terminology)

This time of year we start to see an increase in respiratory cases due to horses spending more time in closed barns or being fed from round bales where they may bury their faces into areas of the bale with high levels of allergens.

Controlling this condition is easiest when identified quickly and changes in management used as well as medical therapy.


On Farm Physical

What Every Horse Owner Should Know….

 

As you head out to feed your horse in the evening you notice that he/she has some dirt or shavings on their back and this morning’s hay is still on the ground.  He doesn’t seem interested in dinner and instead starts pawing and rolling on the ground. 

 

Its time to call your veterinarian and they may ask you to check your horse’s heart rate, gut sounds and mucous membrane color.

 

Knowing how to perform a basic physical examination is a skill every horse owner should know. It is also important to know your horses' normal vital signs. Horse’s have a wide range of normal values for physical exam parameters, and it is useful to compare values in an emergency to your horses' known normal values. As a general rule, the equine heart rate ranges from 32-44 beats per min (bpm), respiratory (breath) rate between 8-16 breaths per min (bpm), and normal temperature between 99.5°-101.5°F.

 

To take your horse's heart rate, place a stethoscope just behind their elbow on the left side of their chest. You will hear a "lub-dub", which constitutes one heart beat. You can also use their pulse to estimate their heart rate. Feel under the round aspect of the back of the jaw and you will feel a round artery and vein. Place light pressure with your fingertips until you can feel a pulse.

 

To take your horse's respiratory rate, you can watch the rise and fall of their chest or abdominal wall with their breaths. In normal horses it may be a subtle movement. You can also place your hand just in front of the horse’s nostril and feel for the breath on your palm, though some horses may increase their respiratory rate due to something in front of their face.

 

To take your horse's temperature, stand behind them and to the side. Gently lift their tail, and insert a lubed thermometer into their rectum. If you have a non digital thermometer, be sure to hold it in place or tie a string from the thermometer to their tail and leave in place for a full 2 minutes. Make sure you stand in a safe position, as some horses will kick during this procedure.

 

Some other parameters that are good to look at include mucous membranes. To look at a horse’s mucous membranes, gently flip their upper lip and look at their gums. Normally their gums should be light pink and moist. You also can check a capillary refill time (CRT), which is an indicator of systemic perfusion. To do this, press your thumb into their gum until the tissue underneath it blanches white. Then release the pressure and count how many seconds it takes for the pink color to return to the area. Normal CRT is less than 2 seconds.

Gastrointestinal sounds (Gut sounds) are another parameter that your veterinarian may ask you to listen to. They can vary between horses and depending on time of day and what they are being fed.  The best way to learn what your horse’s normal gut sounds are is to listen to them at least once a season (green grass gurgles, normal pasture noises, grain gas bubbles, etc). Gut sounds are particularly useful in colic cases, where gut sounds may be increased or decreased.

 

Digital pulses are a key parameter, particularly in laminitis or lameness cases. To feel for digital pulses, feel on the outside of the pastern about mid between the coronary band and fetlock for a group of round structures.  Palpate gently over this area to see whether you feel a pulse. It is common to not feel digital pulses in normal horses, but very strong pulses to their hooves can indicate a problem.

 

By performing a brief physical examination on your horse, you can provide important information to your veterinarian before they are able to reach the farm, and give some direction as to whether there are any treatments that can be initiated immediately. However, always be sure to contact a veterinarian before administering any medications or starting treatment.

Navicular Syndrome

(From the researchers at Kentucky Equine Research)

Navicular syndrome (or navicular disease, or caudal heel pain syndrome) is a degenerative condition of structures in the horse's heel. The navicular bone lies at the back of the heel, and the deep digital flexor tendon runs down the leg and wraps under the navicular bone before anchoring to the coffin bone. Pain results from changes in the bones, bursa (fluid-filled joint structures designed to absorb shock and reduce friction), tendons, and ligaments in this area.


What signs does an affected horse show?

Lameness is the classic sign of navicular syndrome. This can appear suddenly, but a more common pattern is mild lameness that becomes progressively worse over time. A horse with navicular syndrome feels pain in the heels of the front feet, and its movements reflect attempts to keep pressure off this area. At rest, the more painful foot is often "pointed," or held slightly in front of the other forefoot, thus bearing little or no weight. Because the horse tries to impact the ground flat-footed or toe-first instead of the more normal heel-first pattern, the gaits are short-strided and stiff. A horse with navicular syndrome has difficulty turning sharply, going downhill, and moving on rocky or hard ground. Picking up one front foot for trimming or shoeing is painful because weight is concentrated on the other foreleg, and affected animals may become quite uncooperative during farrier visits.

Does navicular syndrome affect all types of horses?

While there's no guarantee that a particular horse will or will not develop navicular trouble, the problem is most common in stock-type horses (Quarter Horses, Paints, Appaloosas). There is a fairly high incidence in Thoroughbreds and some warmblood breeds. Arabians, on the other hand, are rarely affected. Lameness from navicular syndrome is most often diagnosed in horses between the ages of seven and fourteen.

What causes this condition?

No one knows precisely what causes navicular syndrome. Like some other lamenesses, a combination of factors is probably to blame. Conformation seems to be important, with more cases occurring in horses with heavy bodies, upright pasterns, and small hooves. A large number of affected horses have a history of work involving front-leg impact (jumping, cutting, roping, and reining) or increased concussion (parade work or other use involving hard or rocky surfaces). Suspicion has also been directed at irregular farrier care, unbalanced hooves, and shoeing practices that reduce contact between the frog and the ground. A common thread seems to be the combination of increased stress and limited oxygenation of structures in the heel area, but the exact cause of tissue damage and inflammation has not yet been determined.

How is the diagnosis made?

Heel pain is not always caused by navicular disease: temporary lameness from bone fractures, muscle strains, and trauma to tendons or ligaments can mimic the syndrome. A vet may need to use a combination of flexion tests, hoof and frog pressure tests, nerve blocks, X-rays, scintigraphy, thermography, ultrasound, venograms, and magnetic resonance imaging (MRI) to determine the cause of the horse's discomfort. Diagnosis is made after a consideration of the horse's history, use, conformation, and test results.

 

At one time the appearance of lollipop-shaped invaginations (holes) in the navicular bone on X-rays was considered to be definitive evidence of navicular syndrome. However, it has been found that not all horses with such invaginations exhibit clinical signs of lameness, and some acutely lame horses fail to show any trace of bone abnormality. Interestingly, research at the Idaho Museum of Natural History found lollipops in 17% of navicular bones recovered from equine skeletons up to three million years old, showing that the phenomenon is not of strictly modern origin. In the "history repeats itself" category, bones from large-bodied horses were more likely to show invaginations, and animals living in areas of hard and rocky terrain were also more often affected than grassland-dwelling animals.

Can navicular syndrome be cured?

Consultations with a veterinarian and a farrier are the first steps in combating navicular syndrome. While there is no cure, a prompt diagnosis allows treatment-farrier, medical, or surgical-to begin early in the course of the disease. Proper trimming and therapeutic shoeing can provide pain relief for many horses. Farrier care is aimed at correcting broken-back or broken-forward pastern angles and normalizing underrun or contracted heels. Generally a shortened toe, either through trimming or shoe design, is a goal. Heel support afforded by egg bar or wide-web shoes reduces pain in some horses, and a shock-absorbing polyurethane shoe from Switzerland is being tested as a possible therapeutic aid. Overall, proper trimming and shoeing can relieve discomfort in about 30% of horses with navicular syndrome.

Polysulfated glycosaminoglycans and hyaluronic acid sometimes lead to improvement, possibly by inhibiting enzymes involved in tissue breakdown. Anti-inflammatory medications can be injected into the heel area or given orally for pain relief. Medical treatment combined with therapeutic shoeing can help about 60% of affected horses.

Palmar digital neurectomy, a surgical procedure to sever the nerves to the painful area, is a last resort in treating navicular syndrome. This option eliminates sensation in the rear third of the foot, thus ending pain and lameness, but it is not a permanent cure. Degenerative changes continue to occur within the hoof, and about one-third of treated horses are lame again within two years.

Can feeding practices help to prevent or treat navicular syndrome?

Navicular syndrome is not directly caused by feeding practices, but as with any condition affecting the legs and feet, an overweight horse puts excessive strain on its musculoskeletal system. With the strong correlation between heavy-bodied, small-footed horses and navicular syndrome, common sense should warn owners not to allow their horses to become too fat. 

Pasture intake can be limited by muzzling or dry-lotting horses, and easy-keeping animals can be fed a low-calorie supplement pellet such as All-Phase, thus providing essential vitamins and minerals without an overabundance of calories. Increasing exercise is also beneficial for keeping horses in trim condition. Although turnout and light exercise are preferred to stall rest for navicular horses, heavy work is usually ruled out as a conditioning measure for these animals. Keeping a horse at a mid-range body weight may delay the onset of navicular syndrome in susceptible individuals, and can also help to keep affected animals more comfortable.

 

 

Equine Protozoal Myeloencephalitis (EPM)

Equine Protozoal Myeloencephalitis (EPM) is a master of disguise. This is a serious disease, which attacks the horse’s central nervous system.  It can be difficult to diagnose because its signs often mimic other health problems in the horse and signs can range from mild to severe.

EPM is caused by one of two protozoal organisms, Sarcocystis neurona or Neospora hughesi, though almost all infections in the United States are caused by S. neurona. More than 50 percent of all U.S. horses have been exposed to S. neurona, which is carried by the opossum and spread through hay, water and pasture contaminated with opossum feces.  Fortunately, not all horses exposed to the parasite develop the disease. Many horses are able to mount an immune response to the protozoa before it is able to affect the central nervous system.  These horses will carry the antibodies generated by this immune response for life.  Future diagnostic testing will read these antibodies as a positive sign of the disease, complicating the interpretation of the test results. Researchers are unable to identify why some horses are able to successfully fight the protozoa and some are not.


If the protozoa are able to cross the blood-brain barrier and enter the central nervous system, they live inside cells in the central nervous system and are not able to be attacked by the immune system.  Changes in the body’s chemistry typically caused by significant or stressful events (trailering, high levels of athletic performance, injury, pregnancy, poor nutrition/weight loss, etc) cause the protozoa to reproduce and the stressed immune system cannot stop their spread into other areas of the brain or spinal cord.  As they spread they cause lesions and inflammation that cause the clinical signs of EPM.  The amount of time from horse consuming the protozoa and clinical disease can be anywhere from weeks to two years.


The clinical signs of EPM can be quite varied, depending on the severity and location of the lesions that develop in the brain, brain stem or spinal cord. Clinical signs are usually asymmetrical (not the same on both sides of the horse). The American Association of Equine Practitioners (AAEP) uses the following checklist of symptoms from when assessing a  horse’s condition for the possibility of EPM:


  • Ataxia (incoordination), spasticity (stiff, stilted movements), abnormal gait or lameness.

  • Incoordination and weakness which worsens when going up or down hills or when head is elevated.

  • Muscle atrophy, most noticeable along the topline or in the large muscles of the hindquarters, but can sometimes involve the muscles of the face or front limbs.

  • Paralysis of muscles of the eyes, face or mouth, evident by drooping eyes, ears or lips.

  • Difficulty swallowing.

  • Abnormal sweating.

  • Loss of sensation along the face, neck or body.

  • Head tilt with poor balance; horse may assume a splay-footed stance or lean against stall walls for support.

  • Seizures or collapse.


If left undiagnosed and untreated, EPM can cause devastating and lasting neurological damage.  Contact your veterinarian immediately if you suspect your horse has developed signs of a neurological disease.  The sooner a diagnosis is made and treatment begins, the better the horse’s chances for recovery.  For more information on methods of prevention and the treatment options (there are many options, opinions, and varied results for all), contact your veterinarian.


When Mosquitoes Go Bad part 1.......(West Nile Virus)

WHEN MOSQUITOES GO BAD, PART 1

West Nile Virus

When you hear about West Nile Virus, it brings to mind images of dead crows and mosquito laden swamps.  In the past few years, West Nile Virus (WNV) has been diagnosed in multiple horses in Western New York.  Last year (2013) The New York Department of Agriculture and Markets reported 13 WNV positive horses throughout the state!

 

While the immune system of most horses infected by WNV can prevent the virus from crossing the blood-brain barrier, clinical signs are seen in some horses when the virus breaches the blood-brain barrier and causes encephalomyelitis, damaging the brain and spinal cord.  The clinical signs of WNV encephalomyelitis vary in range and severity, with the most frequently observed signs include incoordination or ataxia (especially of the hind limbs); twitching of the muzzle and lower lip, and twitching of the muscles in the neck, shoulders or pectoral (chest) region. Signs may be the same on the left and the right of the horse or may be one sided. Also reported are behavioral abnormalities such as depression or heightened sensitivity to external stimuli, stumbling, toe dragging, leaning to one side and in severe cases, paralysis of the hindquarters, recumbency, coma and death. Other clinical signs that may be noted include fever, generalized weakness, impaired vision, inability to swallow, aimless wandering, and convulsions. The nature and severity of clinical signs depend largely on the area(s) of the central nervous system affected by the virus and the extent of damage. There are reports of WNV occurring more commonly in older horses; however, last years cases in New York ranged from yearlings to aged horses.   

First isolated in Uganda in 1937, WNV is transmitted principally by mosquitoes and can cause inflammation of the brain and spinal cord (encephalomyelitis). Clinical disease caused by this virus is seen primarily in birds, equines and humans and very infrequently in goats, sheep, dogs, llamas, various reptiles and bears, among other species. Prior to its discovery in the northeastern U.S. in 1999, WNV was widely distributed in Africa, the Middle East, southwest Asia, and parts of Europe. 

WNV was first recognized in the western hemisphere in September 1999, when it was isolated from the tissues of sick flamingoes and pheasants at the Bronx Zoo and from dead crows in the New York City area. By 2002 over 15,000 horses were diagnosed with WNV in 41 states.

WNV circulates in nature between birds and mosquitoes. Various species of birds serve as hosts of the virus, allowing it to replicate within them.  Mosquitoes act as vectors of WNV by biting the infected birds and then transmitting it to a wide range of animals, including humans. The strains of WNV present in North America also cause disease in crows and blue jays, in which the infection is usually fatal. Humans, horses, and a wide variety of other species can also be infected with WNV.  Because there is only a very small amount of the virus in the blood of infected horses, mosquitoes are unable to transmit the virus from horse to horse or from horse to human. The virus is transmitted when a mosquito takes a blood meal from an infected bird and then feeds on a horse. During the process of taking a blood meal from the horse, the virus is transmitted by the infected mosquito.

As is typical of numerous other viral infections, many horses experience no clinical illness following exposure to the virus for the first time. 

WNV infection diagnosis is usually based on the nature of the clinical signs displayed by an affected horse, together with the detection of antibodies to the virus in the blood by laboratory examination. It is important to remember that many of the clinical signs of WNV encephalomyelitis closely resemble those of many other equine neurological diseases (e.g., Eastern equine encephalitis, rabies, equine protozoal myeloencephalitis, equine herpesvirus-1 and botulism).  Testing and progression of clinical signs will help to differentiate between these diseases. However, cases of WNV encephalomyelitis tend to occur during late summer or early fall when viremia (the level of infective virus in the blood) in the bird population is higher and mosquito populations are numerous and active.

Treatment

Currently, there is no specific anti-viral treatment for WNV encephalomyelitis. Treatment focuses on controlling pain and inflammation. Anti-inflammatory drugs will be provided to control inflammatory changes in the central nervous system. Other supportive measures such as intravenous fluids, sedatives and nutritional support can be important components of therapy. It is important to consult your veterinarian immediately if you suspect your horse is showing neurological signs so that the appropriate treatment measures can be implemented without delay.

Prevention

A number of measures can be taken to help protect your horse against WNV. These are comprised of vaccinating against the disease coupled with management strategies to reduce exposure to mosquitoes and. Horses vaccinated against Eastern, Western or Venezuelan equine encephalomyelitis are not protected against WNV.   A separate WNV vaccine is currently available as well as combination products that combine Eastern, Western, Tetanus as well as West Nile Virus.

The vaccine should be administered as a series of two doses given three to six weeks apart. Foals should receive three immunizations starting at 6 months of age if the mare was immunized against WNV 30 days prior to foaling. The duration of immunity from vaccination is not known. It is recommended to vaccinate every four to six months in regions where the virus is active. Contact your veterinarian for the appropriate vaccination schedule for your location.  In New York we typically recommend bi-annual vaccination against WNV in the spring and a booster during the early fall months.

Aside from vaccination against WNV, other measures should be taken to reduce the risk of your horse being bitten by a virus-infected mosquito. Eliminate or reduce potential mosquito breeding sites by disposing of old receptacles, such as tires and containers and eliminating areas of standing water in areas where horses congregate. 

Clean clogged roof gutters and turn over plastic wading pools or wheelbarrows when not in use. Thoroughly clean livestock watering troughs at least monthly. Screen stalls (if possible) or at least install fans over the horses to help deter mosquitoes. Avoid turning on lights inside the stable during the evening or overnight. Because mosquitoes are attracted to light, placing incandescent bulbs around the perimeter of the stable will attract mosquitoes away from the horses. Lights can also be used to draw mosquitoes to electric bug zappers. 

The use of insect repellant that contains pyrethrin on horses can also reduce the chance of being bitten by mosquitoes. Remove any birds (including chickens) located in or close to a stable. Some veterinarians have success by hanging cattle ear tags on horse halters. These ear tags have been impregnated with insecticide and often reduce the effects of not only mosquito biting, but also midges and the effects of “fly-strike” dermatitis around the ears.  Our Mosquito and Fly Control Measures blog post has additional information on vector control!

Because WNV can affect humans as well as horses, don’t forget to take actions to protect yourself as well. When outdoors in the evening, wear clothing that covers your skin and apply plenty of mosquito repellent.

Prevention is key to the control of this infection.




 

Recognizing the Signs of Laminitis

Spring is a time when veterinarians begin to see increased cases of laminitis, a painful disease that affects the feet of horses. Laminitis results from the disruption of blood flow to the sensitive and insensitive laminae within the foot, which secure the coffin bone (P3) to the hoof wall. While the exact mechanisms by which the feet are damaged is still being determined, certain precipitating events can produce laminitis. Although laminitis occurs in the feet, the underlying cause is often a disturbance elsewhere in the horse’s body.

Recent research has led to the description of the laminae in a horse’s foot as a ‘shock organ.’ That is, an organ that fails related to some sort of systemic disease. In people, the lung is considered a “shock organ”, and they are finding that the laminae in a horse’s foot reacts very similarly. This suggests that treating other diseases more effectively — like colitis, or a mare with a retained placenta, or a horse with pleurao pneumonia — we can better protect the foot from becoming the shock organ that ultimately fails and results in a crippling disease.

Laminitis can also occur after a carbohydrate overload, where your horse eats to much rich young grass or grain. An injury or trauma that causes the horse to bear less weight on one leg may also induce laminitis, as in the case of Barbaro. The continuous increased stress placed on the weight bearing limb strains the lamina that hold the coffin bone stable in the hoof, resulting in inflammation and laminitis. It is important to provide support and cushioning to all feet and legs for a horse being treated for any injury or lameness that changes how it bears weight.

Researchers have also identified a “Pre-Laminitic Metabolic Syndrome (PLMS)” in horses similar to the metabolic syndromes in people that are considered risk factors for Type II diabetes or coronary heart disease. These horses are especially sensitive to carbohydrate overload and can ‘founder’ for no apparent reason. The researchers have used cut off points for Insulin Sensitivity, Pancreatic Beta cell Response (Insulin levels compared to glucose levels), Body Condition Score and Serum Triglyceride levels to identify these PLMS ponies which are at a higher risk of developing laminitis. Identification of PLMS in ponies (and possibly horses) would allow owners and veterinarians to manage nutrition and feeding practices appropriately to prevent laminitis prior to clinical disease.

As a horse owner, it is important to recognize the signs of laminitis and seek veterinary help immediately. Signs of acute laminitis include the following:

  • Lameness, especially when a horse is turning in circles; shifting lameness when standing

  • Heat in the feet

  • Increased digital pulse in the feet

  • Pain in the toe region when pressure is applied with hoof testers

  • Reluctant or hesitant gait, as if “walking on eggshells”

  • A “rocking horse stance” in the front, with the front feet stretched out in front to alleviate pressure on the toes

Signs of chronic laminitis may include the following:

  • Rings in hoof wall that become wider as they are followed from toe to heel

  • Dished hooves, which are the result of unequal rates of hoof growth

  • Thick, “cresty” neck and abnormal fat deposits (signs of metabolic disorders that often cause laminitis)

  • Bruised soles or “stone bruises”

  • Widened white line, commonly called “seedy toe,” with occurrence of blood pockets

and/or abscesses

  • Dropped soles or flat feet

 

If you suspect laminitis or your horse has gotten more than a normal amount of carbohydrates (grass or grain), consider it a medical emergency and notify your veterinarian immediately. Early intervention in acute laminitis carries the best prognosis. The sooner treatment begins, the better the chance for recovery.

Your veterinarian may recommend icing your horse’s feet if it is an acute case, and placing him on deep, soft bedding with no or limited grain and lower quality hay until they are able to see them. They may also recommend applying cushion/support to your horse’s feet via boots or pads made of foam insulation sheets and duct tape.

Treating laminitis requires a multi-modal approach. Your veterinarian will need to work closely with your farrier to develop a plan and identify any changes to the coffin bone-hoof structure. X-rays may be needed to look for rotation and/or sinking of the coffin bone. Close communication between your veterinarian, farrier and yourself is essential to prevent any further changes from occurring while keeping your horse comfortable during recovery.

Maintaining Your Horse's Well-Being with a Healthy Mouth

 

The old adage "straight from the horse's mouth" may seem more meaningful when you consider that a licensed practitioner can learn so much about an animal's health by examining its mouth.

 

A Broader Look at Health

Equine dentistry is more than just floating teeth.  Floating—the term for rasping or filing the horse's teeth—ensures that the horse maintains an even, properly aligned bite plane.  While floating is a physical or mechanical process, equine dentistry is much broader and examines the horse's health more systemically.

 

The general goals of equine dentistry include:

  •  Improving the chewing of food
  •  Relieving pain and treating or curing infection and disease
  •  Promoting general health, productivity and longevity

Though most people think dentistry is primarily concerned with the teeth and mouth, it also includes the associated structures of the head – for instance the sinuses – and the effect of dental diseases on the health of the rest of the body.

Beyond the comfort and good health of your horse, there are other benefits to proper dental care.  Your horse will consume feed more efficiently with less spillage or waste and may perform better and live longer.

 

Schedule Exams Regularly

Dental disease is a source of pain and infection—it can affect the systemic health of your horse, especially if undetected or left untreated.  Routine examination by an experienced, licensed veterinarian will help detect dental disease and other health problems early—before they threaten the well-being of your horse.  These examinations make it much easier to diagnose and treat oral diseases early, preventing more severe and costly problems later.

 

A juvenile horse should have a dental examination when it is foaled, at three months and then every six months until age five. For healthy adult horses, a yearly dental examination is recommended.  Horses older than 20 or with a history of dental problems should return to a twice yearly schedule.

 

Trust Your Veterinarian

Certain observations in your horse may be clues to you or your veterinarian that a complete physical examination and a thorough dental exam may be in order.  Has your horse’s general attitude changed? Is the appetite normal? What about the ability to chew? How long does it take to eat? What’s the stool consistency? Is long stem hay present? Are there well-formed fecal balls?

The veterinarian may perform a complete physical examination, and other tests if needed, in order to evaluate the horse for possible risks (i.e., fever, severe anemia, ataxia, etc.) prior to carrying out the dental examination

Veterinary practitioners are best qualified to perform dental care on your animal because they are:

  •  Trained in equine dentistry, medicine and surgery
  •  Licensed to practice dentistry
  •  Equipped with the proper resources to examine, diagnose, and treat dental disease
  •  Prepared to refer particularly severe or complicated cases to specialists with extensive experience

 

To safely perform a thorough oral examination, sedation and adequate restraint is recommended.

Treatment may include antibiotics and anti-inflammatories.  All are things that a veterinarian is licensed to provide but an owner or layperson is not.

An oral exam should be an essential part of an annual examination by a veterinarian.  Every dental exam provides the opportunity to perform routine preventative dental care as well. The end result is a healthier, more comfortable horse.

 

 

Reprinted courtesy of the American Association of Equine Practitioners. 

 

Equine Emergency Preparedness

This time of year we often sit staring longly out the window wishing it was warmer, the ground wasn't frozen, we hadn't pulled shoes, or we had an indoor.  Instead of sitting around pining, consider writing an emergency management plan for your farm.  

 

 

First step in creating an Emergency Preparedness Plan is determining what risks your farm is likely to encounter.

  • Fire
  • Flooding
  • Severe weather (hurricaine/tornado/blizzard)
  • Power outages
  • Fencing failure
  • Disease outbreak
  • State or National level disaster

Next walk your property and consider various scenarios: What would you do and what can you do to make things easier?

  • Can trees and brush be trimmed?  Can fence lines be improved or reinforced?  Can structures be reinforced with tie-downs or upgrades?  Secure or store any items which can become airborne
  • Keep barn aisles clear from all excess items such as trunks, chairs, etc
  • Consider installing lightening rods and sprinkler systems.  Paint your main power supply box with fluorescent paint (to stand out in the dark) and be sure that the area leading to the main power source is clearly marked
  • What would you do if you were without power for an extended period of time?  If you have a well will you have access to water?  Do your horses have medications, etc that need to be refrigerated? Consider installing a generator. 
  • Always have ABC fire extinguishers in barns, trucks, and home.  Also have horse and human First Aid Kits.
  • Review your insurance policies annually.  NEVER assume something is covered -- always check with your agent.  Go over all policies: homeowners, auto, equine liability/surgical/mortality
  • In winter, make sure to keep driveways, gates and doorways clear of snow, and clear enough so that emergency vehicles have enough space for access.
  • Make sure your address is visibile from the road!  Emergency crews waste valuable time if they cannot find the entrance to your property.

Plan an evacuation route, what method of transport you will use and who will assist you:

  • Organize an emergency team
  • Create an emergency phone tree for contact purposes and give to your town's emergency planners as well as any one else who may need it
  • If your horse is difficult to load, work on training NOW - do not wait until an emergency
  • Identify alternate evacuation routes in advance.  Some routes may be closed either due to weather, or by local authorities.  Have maps on hand, and check to see if alternate routes are suitable for trucks/trailers.

Where to Go?

  • Plan now for where you would go should you need to evacuate.
  • Consider multiple scenarios and wether the type of facility you might move to can handle the types of horses you have (stallions, pregnant mares, foals), will your horses respect the fencing?
  • Work on agreements now: do not wait until an event to discuss costs, expectations, reservation of stalls.  Get everything in writing, either in a contract or as a Memorandum of Understanding.  Who is responsible for caring for your horses, and who is providing supplies?  How far in advance do you need to notify them?  Make sure they have multiple ways of contacting you in case they need to alert you to changes.

Create an "Emergency Box" for your horses

  • Consider a plastic tack trunk - preferably in bright colors such as orange or red.  Store necessary items in advance so that you can quickly and effectively evacuate without wasting time trying to gather or find items you will need.
  • This should include only "necessary" items to save space, but you should include anything that will be important for you to bring along.....the folowing items are basic recommentations and are just a starting point
    • Cotton lead ropes
    • Longe line
    • Multiple rubber buckets
    • Double ended snaps
    • Duct tape
    • Masking tape
    • Fly mask
    • Pocket knife
    • Scissors
    • Hole punch
    • Leg wraps
    • Towels
    • Handi-wipes
    • Spare halter
    • Permanent marker
    • Halter/bridle tags (can be used to identify horses, blankets, tack, buckets, etc)
    • Pen and notepad
    • Copies (not originals) of coggins/vaccine documentation in ziplock bags
    • Flyspray
    • Hoofpick/Hoof knife/Rasp
    • Twitch
    • Wire cutters
    • Trashbags
    • Shovel
    • Tarps
    • Bungee cords
    • Heavy gloves
    • Maps of area
    • Small tool kit (screwdriver, pliers, etc)
    • Fire extinguisher
    • Equine First Aid Kit
    • Roll of string/twine
    • Flashlight and extra batteries

Create a Horse First Aid Kit

  • These are just guidelines and your veterinarian can help make recommendations specific to your horses and your area!
    • Antibiotic wound ointment
    • Antibiotic eye ointment
    • Bandage Scissors
    • Bandage tape
    • Vet Wrap
    • Betadine scrub
    • Cotton rolls
    • Sterile eye rinse
    • Saline wound rinse
    • Gauze pads
    • Hydrogen peroxide
    • Isopropyl alcohol
    • Latex or Nitrile gloves
    • Non-stick wound pads (Telfa pads)
    • Digital Thermometer
    • Tweezers
    • Clean Towels
    • Masking Tape
    • Clippers
    • Hoofpick
    • Tongue depressors (for applying ointment)
    • Large syringe (wound flushing)
    • Any Medications you routinely give your horses
    • 3x5 card with the names and phone numbers of your Veterinarian, Farrier, and any other contact info that may be necessary.
  • Medicines/Drugs should be rotated out periodically to ensure they're not expired.
  • Never use prescribed drugs without instructions from a veterinarian.  Only use drugs as specifically directed.  A veterinarian should always be consulted first.

Always keep a 2 weeks supply of food, supplements, and medications on hand. These are likely to be hard to acquire in the event of a disaster.

Paperwork

  • Be prepared to identify your horse if it gets lost or loose.  Authorities will require some identification in order to return your horse.  Think about how many bay horses with no markings there are - give as much information as possible.
  • Take photos of your horses in advance: One from each side, and front and back.  Write down all tattoos, brands, and make note of scars.
  • Make copies of all important documents.  Registration paperwork, bill of sale, coggins, health certificates, vaccination records, show records, insurance policy and any identifying information.  Keep the copies and the originals in ziplock bags.
  • Consider scanning all documents and storing on a USB drive or CD and keeping in a safe place for ease of storage.
  • Take photos of your property in advance, as well as any vehicles and equipment.  These might be needed for insurance purposes or identification.

Will you have water access during an emergency?

  • Horses need on average approx. 1 gallon of water for every 100lbs of body weight.  A 1,000lb horse might consume 10-12 gallons/day, however consumption varies dependant on weather, age of horse, activity and stress levels
  • Plan on filling troughs immediately prior to an event and have a supply of 55 gallon drums that can be filled for future use by you or emergency teams.
  • If there are ponds or streams on your farm, look at how safe they would be for your horses to access and if appropriate, write down how to prepare an area for them to access the water.
  • If your land tends to flood, access to streams or ponds may not be feasible
  • Be aware that wells and ponds may be contaminated if severe flooding occurs.  
  • To purify water, add 2 drops of chlorine bleach per quart and let stand for half hour.
  • Never trust automatic waterers if you have to leave your horses on their own -- fill buckets and troughs for horses to obtain water.
  • Be careful about what types of containers are used to store water.  Certain types of chemical containers are not suitable due to potential residue.

Choose an ID method, either permanent or temporary you will use on your horses and test the temporary method well before an emergency. (You may want to discuss with your vet which of these methods they have seen work the best)

  • Permanent Identification
    • Tattoos
    • Brands
    • Etched Hooves
    • Microchip
    • Photos (front, rear, left, right)
  • Temporary Identification
    • Halter Tags (luggage tags or zip-tied cattle ear tags will work!)
    • Fetlock ID Bands
    • Neck Bands
    • Torso Painting (nontoxic)
    • Hoof Marking
    • Index card with pertinent information, wrap in plastic baggie, wrap with duct tape to inside of halter
    • Body clip Phone number on Horse's Neck
  • Note: When using tags or ties - do NOT tie directly around the base of the tail - this may cut off circulation. Braid tags into main/tail hair instead.

Don't forget the "Small Animals"

  • Make plans in advance for barn cats and dogs too.  Be aware if you plan to head to a shelter, most human shelters DO NOT allow pets.
  • Have extra food and meds on hand for barn dogs/cats.
  • Have leashes and crates enough for all animals.  You should not place more than one animal in each crate.  Even friendly animals can become aggressive when under stress.
  • Dogs should be wearing collars and tags at all times.  Consider microchipping all small animals
  • Keep copies handy of all vaccination and health paperwork- including rabies certificates.
  • Be aware that often small animals will sense urgency and they may flee or hide if you start taking action.  Consider addressing small animal needs first, or confining them until you can get them secured as well.
  • If you must leave small animals, leave enough food and water for several days.  Also post signs notifying emergency personel to their existence.

Decide what is the safest housing for your horse.....indoor or outdoor:

  • This is often a personal preference.  If you plan on leaving your horses; the pre-planning step of preparing your pastures and paddocks is critical.
  • Make special note of natural features such as ponds or streams if they are near barns or pastures.  These could cause flooding during the event.
  • In the case of a fire, decide where your horses will go.  Can you safely and quickly load onto a trailer and remove from the premises, is there a securely fenced pasture/paddock away from structures and emergency access to turn out?  What would happen if they were turned loose? (location of highways, driveways, or other hazards)

Sheltering in Place with Your Horses

  • Be aware that you may not have access to veterinary care or feed and grain supplies for some time after an event. 
  • Have portable radios and flashlights as well as enough batteries
  • Properly mark your farm entrances with LARGE reflective numbers, so your property can be seen by first responders.
  • If you have advance notice of an impending storm/disaster - remember to charge laptops, rechargable flashlights and batteries, walkie talkies, etc.

Plan for After the Emergency

  • Assess the damage.  If possible, notify friends/relatives that you are safe.
  • Do not immediately turn horses out if they are inside: inspect all pastures and fencelines first.  Pay particular attention to fallen wires, or debris blown into the pasture areas.  Check gates to see if they are still in working order.  Do not allow horses loose in any areas that have standing water, as the water may be contaminated or have unseen debris underneath. 
  • Never assume downed wires are dead! Electricity will travel, and power might not have been shut down.
  • In the case of a blizzard, beware drifts or ice under snow.  Check rooftops to see if there is a large amount of snow -- barns have been known to collapse from snow.  Beware of the footing, horses can fall on ice and injure themselves.
  • Photograph any damage, and immediately notify your insurance company.
  • Secure items and facilities as much as possible: remove debris, etc.
  • Check feed and grain for moisture.  Inspect closely: never feed moldy/mildewed hay/grain as it can cause colic or death.  Any feedstuffs that have been submerged in water or have chemical residue should be discarded.

The Unpleasant Issues

  • After an emergency you may need to euthanize animals or dispose of carcasses.  Carefully consider what you would do if you had one or more large animal carcasses that needed to be removed.  Some options inculde burial, composting, rendering, incinerating or landfill disposal.  It is important to consider this issue now, so that you are not having to make important decisions about an emotional issue during a stressful time.  Ultimately your choice of disposal will be based on financial, emotional, practical and safety issues.
  • Discuss the issue of euthanasia with your veterinarian in advance.
  • Burying a carcass is not always advisable or possible.  Know your town ordinances.  Some towns prohibit burying large animals.  If you must bury a horse, make sure it is not near wells or streams, so that you do not inadvertently contaminate water supplies.  Take precautions so that barn dogs or local wildlife cannot dig up the carcass.  Burial should be atleast 300ft up gradient or 150ft down gradient from any well.  Atleast 165ft from a property line or public use area, and atleast 100ft from a water body, stream, or drainage way.
  • In some cases, it is possible to compost carcasses, again, discussion with your vet or the department of agriculture in advance is strongly recommended.  Simply covering a carcass with manure is NOT considered composting.  It is a complex process which requires certain amounts of moisture and other elements to ensure that proper breakdown takes place.  Under optimum conditions, composting a carcass completely may take 6 to 9 months.

Remember:

  • Redundancy is key. Every plan should have a back up plan.  You cannot prepare for every possibility but you can prepare to deal with the unexpected.
  • Documentation is vital: photograph, make copies, and keep in multiple places
  • Say hello to your first responders (fire company, police station, etc) and introduce yourself now.  Do not wait for an emergency to have contact.  Explain who you are and what facilities you have.  Give them contact info and invite them to see your property. 
  • Review state laws and town ordinances now:  does your town allow you to bury horses? Does state law protect you from liability?  Is your town required to include horses in disaster plans, and have they done so?
  • Do not rely solely on one method of communication or means of gathering information.  Use both high tech and low tech - cell phones, land lines, e-mail, walkie talkies, TV, radio, etc
  • If you decide to purchase large emergency items such as generators, tow vehicles, sprinkler systems etc, take the time to do research first.  Make sure you know how to use the item, and if the item fits your needs.  Do not wait until the day before a storm or just afer an emergency to make purchases or install items.

Additional Resources for Emergency Preparedness

  • Ready gov  www.ready.gov
  • The American Red Cross (ARC)  www.redcross.org
  • The American Society for Prevention of Cruelty to Animals (ASPCA)   www.aspca.org
  • National Oceanic and Atmospheric Administration (NOAA)   www.noaa.gov
  • Federal Emergency Management Agency (FEMA)  www.fema.gov
  • U.S. Rider   www.usrider.org
  • New York State Horse Council   www.nyshc.org

FAQ about Class 4 Therapeutic Laser Treatment

What is Laser Therapy?

Laser Therapy, or “photobiomodulation”, is the use of specific wavelengths of light (red and near-infrared) to create therapeutic effects. These effects include improved healing time, pain reduction, increased circulation and decreased swelling. Laser Therapy has been widely utilized in Europe by physical therapists, nurses and doctors as far back as the 1970’s. Now, after FDA clearance, Laser Therapy is being used extensively in the United States.

 

Patient Benefits of Laser Therapy

Laser Therapy is proven to biostimulate tissue repair and growth. The Laser accelerates wound healing and decreases inflammation, pain, and scar tissue formation. In the management of chronic pain Class IV Laser Therapy can provide dramatic results, and is virtually free of side effects.

 

Has effectiveness been demonstrated scientifically?

Yes. There are thousands of published studies demonstrating the clinical effectiveness of Laser Therapy. Among these, there are more than one hundred rigorously controlled, scientific studies that document the effectiveness of laser for many clinical conditions.

A great resource for scientific studies involving animals and Laser Therapy is http://www.k-laserusa.com/results-research/k-laser-library/

 

Cellular Effects of Laser Therapy

During Laser Therapy the infrared laser light interacts with tissues at the cellular level and metabolic activity increases within the cell, improving the transport of nutrients across the cell membrane. This initiates the production of cellular energy (ATP) that leads to a cascade of beneficial effects, increasing cellular function and health.

 

Laser Therapeutic Effects

During each painless treatment laser energy increases circulation, drawing water, oxygen, and nutrients to the damaged area. This creates an optimal healing environment that reduces inflammation, swelling, muscle spasms, stiffness, and pain. As the injured area returns to normal, function is restored and pain is relieved.

 

K-Laser Advanced Technology

K-Laser is leading the way in pain management, tissue repair, safe treatments, and fast treatment times. K-Laser offers:

  • Four-Wavelength Beam that Penetrates Deep into the Tissue
  • SuperPulse Mode for Deeper Therapeutic Penetration

 

Four Wavelength/Triple Delivery Mode

The K-Laser employs three infrared wavelengths simultaneously of 800 nm, 905 nm, and 970 nm and combines them with a 660 nm visible beam. These Four Wavelengths are more efficient, healing the tissue while also aiding in pain relief. Combine this with Three Distinct Delivery Modes (Continuous Wave, Frequency Modulated, and Intense SuperPulse), and you have a therapeutic laser solution that offers as much variety as the conditions and patients you treat.

 

Does it hurt? What does a treatment feel like? There is little or no sensation during treatment. Occasionally the patient feels mild, soothing warmth or tingling. Areas of pain or inflammation may be sensitive briefly before pain reduction.  

 

Are there any side effects or associated risks? During more than twenty years of use by healthcare providers all over the world, very few side effects have ever been reported. Occasionally some old injuries or pain syndromes may feel aggravated for a few days, as the healing response is more active after treatment. 

 

How long does each treatment take? The typical treatment is 3 to 9 minutes, depending on the size of the area being treated. 

 

How often should a patient be treated? Acute conditions may be treated daily, particularly if they are accompanied by significant pain. More chronic problems respond better when treatments are received 2 to 3 times a week, tapering to once a week or once every other week, with improvement.

 

How many treatments does it take? This depends on the nature of the condition being treated. For some acute conditions 1 to 6 treatments may be sufficient. Those of a more chronic nature may require 10 to 15 (or more) treatments. Conditions such as severe arthritis may require ongoing periodic care to control pain. 

 

How long before the results are felt? You may feel improvement in your condition (usually pain reduction) after the very first treatment. Sometimes you will not feel improvement for a number of treatments. This does not mean that nothing is happening. Each treatment is cumulative and results are often felt after 3 or 4 sessions. 

 

Can it be used in conjunction with other forms of treatment? Yes! Laser Therapy is often used with other forms of therapy, including physical therapy, chiropractic adjustments, anti-inflammatories, massage, soft tissue mobilization, electrotherapy and even following surgery. Other healing modalities are complementary and can be used with laser to increase the effectiveness of the treatment.