Equine Sports Medicine & Surgery

Foal Delivery Program

2011-10-18T11:37:00.001-07:00

Many of you are anxiously awaiting the arrival of your new foals in the spring of 2012!

"This is a great time to remind everyone to make sure your pregnant mares are on schedule with their vaccination for equine herpesvirus (EHV-1). It is important to understand that as many as 80% of horses are latently infected with EHV-1 and can shed virus when stressed as can occur with changing environments such as moving to a foaling facility. Vaccination reduces the likelihood of shedding virus and thus helps prevent viral abortion in a group of pregnant mares." Dr. Fairfield Bain, Chief of Medicine

See the attached for details on our Healthy Delivery and Foal Kick Start Programs. Please note that upon arrival, docoumentaion is required for the vaccintions Dr. Bain mentions above.

NCHA Futurity Specials are here!!!

2011-10-18T11:36:00.001-07:00

Added Incentive for the Healthy Horse Program

2011-10-18T11:35:00.000-07:00

Healthy Horse Program

2011-10-18T11:34:00.000-07:00

Check out our Healthy Horse Program! This is a great way to save money!

Equine Herpesvirus Update

2011-06-10T06:45:00.000-07:00

"According to the statement released by the Texas Animal Health Commission (TAHC) things appear to have settled down and we should be able to get back to our usual routine with our horses. The one thing we all should learn from this is the concept of "biosecurity." Anytime we mix horses at an event we risk transmission of infectious diseases - and have commonly seen things like influenza, Strangles, and even respiratory herpes viral infection. Going forward, the points outlined in the TAHC are good practical things to follow as a matter of routine to reduce the risk of infectious disease. Now that we are seeing the Texas heat, lets get back to business." ~ Dr. Fairfield Bain, Chief of Medicine, ESMS
See the blog post below for the TAHC Biosecurity Tips

TAHC Biosecurity Tips

2011-06-10T06:28:00.000-07:00

Horse Survives Barn Fire - Receives Treatment at ESMS - Now Back at Track

2011-06-01T08:37:00.001-07:00

Copy and paste this link into your browser to learn more about this amazing horse.

http://www.drf.com/news/louisiana-downs-keep-smokin-gets-back-track-after-surviving-barn-fire

Summary for the EHV-1 meeting Thursday at the Sheriff's Posse Pavilion

2011-05-31T09:16:00.000-07:00

Below is a summary of our public forum on Equine Herpesvirus from Dr. Fairfield Bain.

We had a great turnout with excellent questions.

The presenters reviewed the facts about the virus and the disease conditions associated with it in horses. The most important thing to understand is that essentially all horses are infected with some strain of EHV-1 early in life – and it then stays in the horses body in a dormant form – a condition termed latency – and can remerge later during some stress – called recrudescence. This process of latency and intermittent reemergence goes on throughout life. The example of how herpes behaves in humans with the appearance of fever blisters or “shingles” was used as how it behaves in a similar manner in humans. During recrudescence, there may be shedding of virus from the nasal passages and nasal secretions into air and subsequent infection of other horses. This is the cause of the usual pattern of spread o respiratory disease that we have always observed, and similarly, is the manner of spread for the neurologic form of the disease as well as infection of pregnant mares with subsequent abortion or delivery of weak neonatal foals that often die in the first few days of age. We also know that the viral shedding process declines over 14 to 21 days and that after that period the animal generally become non-contagious, but the virus may have returned to its latent form – as with the usual behavior of herpes virus. The issue is that there are some percentage of horses in the world that are latently infected with the so-called “neurotropic” strain. Reactivation of this could produce outbreaks like we saw from the event in Utah. There have always been single cases of EHV-1 associated spinal cord disease scattered around – often as an individual case. These may be from the “wild type” or more common strain of the virus in that there is less of a contagious spread.

What we have learned about EHV-1 is that there are different strains with a certain strain recently called the “neurotropic” strain being more associated with the outbreaks of spinal cord disease, but all strains can cause this condition. The issue with the “neurotropic” strain is that this particular strain divides much more rapidly and producing shedding of much higher levels of virus in the nasal secretions and thus much more contagious within an air space. It is this feature that justifies the restriction of movement of horses.

Clinical signs of disease

We know that the first clinically detectable sign of infection is a fever, thus it is recommended to monitor the temperature of potentially exposed horses twice daily and it is a good practice to monitor the temperature of all horses at events at least once daily. The “incubation period” of the virus – the time from exposure to development of clinical signs can be anywhere from 2 to 10 days. The first clinical signs are usually dribbling of urine, weakness of the tail, dangling of the penis in males, and abnormal rear limb gait that can progress to recumbency. These signs are because the virus seems to affect the spinal cord more toward the back end of the horse, but it can affect all areas of the spinal cord and the brain. A good neurologic examination is important to determine the pattern of involvement of the nervous system as there are many other diseases that can affect the nervous system of the horse such as botulism, other viral encephalitis (Eastern, West Nile, Rabies), or EPM.

Diagnosis of the disease condition Equine Herpes Myeloencephalitis (EHM) requires the following for precise definition by the USDA… exposure to a known case, positive test for the virus (nasal swab for PCR usually), and clinical signs of neurologic disease consistent with the effects of the EHV-1 virus.

Diagnostic testing of affected horses will include a minimum of nasal swabs for PCR testing, and possibly cerebrospinal fluid sampling to determine if changes are consistent with EHV-1.

The panel discussed the issues of diagnostic testing being restricted to select groups of horses – those showing clinical signs or those having been directly exposed to a clinical case. It is not recommended to test clinically normal, unexposed horses in the general population as we know that the virus normally cycles in horses with low levels of detection being possible in a certain percentage of horses at any given time. This is the reason why a so-called “positive” test could be found in a clinically normal horse. It does not mean the horse will develop the disease. This makes life more complicated in that the “positive” test result is officially reportable and could result in restriction of the horse’s movement for 21-28 days. It is so important to understand that this “cycling” of virus in horses is probably occurring intermittently in many horses.

Prevention of the disease

The audience heard the term “biosecurity” several times in the discussion. The concepts of avoiding mixing horses in a confined air space, avoiding sharing water buckets and tack, and hand washing were emphasized in helping prevent spread of not only EHV-1, but also Strangles and influenza at events. The only sure way to avoid contact with horses that might be shedding virus – of any type – is to avoid mixing horses . The issue of the time frame of 21 days was discussed after the Utah event in that this should allow horses to stop shedding. If a new clinical case showed up on a premise, then the clock for that premise would be reset from the last clinical signs.

Common disinfectants were recommended for cleaning tack, stalls, trailers, and equipment. Bleach diluted in a 1 to 20 solution (4 ounces per gallon) is an excellent disinfectant, but requires removal or organic material like fecal matter and thick secretions first. Other disinfectants in the quaternary ammonium category are also very effective against the virus. It can live for several days in the environment, but it is very susceptible to ultraviolet light.

The discussion also covered vaccination. We know that there are no commercially available vaccines that are specific for the neurologic form and that well-vaccinated animals have developed the neurologic disease. What is know that vaccinated animals shed much lower levels of virus and it is that benefit of routine vaccination that could help reduce severity and lessen spread of the virus in groups of horses.

The bottom line

We have always had herpes with us in the horse population. The conditions at the Utah event led to the “perfect storm” situation in that horses shedding the neurotropic form exposed a larger number of horses that subsequently dispersed to many locations throughout the west with potential secondary exposure of horses. Authorities in the different states and groups like the NCHA took appropriately responsible steps in limiting the spread by restricting movement and canceling events for a time to allow potentially infected horses to stop shedding and being contagious. We should be able to get back to business as usual in the next couple of weeks, but the opportunity of this outbreak is that we all should make the effort to become much more vigilant in paying attention to biosecurity when we attend events.

Equine Herpesvirus Meeting For The Public

2011-05-23T19:04:00.000-07:00

ESMS Management of the EHV-1 Problem

2011-05-18T09:10:00.000-07:00

Here at ESMS, we are being as proactive as possible to provide the best preventative measures to protect your horses from potential spread of infection of this viral disease. You will observe similar precautions being taken at many University and private veterinary facilities around the country in the wake of this outbreak. The goal is to be responsible with your horses’ health and to help prevent this from being something on a larger scale that causes further damage to the industry.

The best prevention of spread is to stop horse traffic… knowing that the virus is spread rapidly by aerosol – and can spread rapidly by horses sharing the same air space in a facility. Because of this, we are asking that people consider reducing travel to other facilities, including ESMS for a few days. We are still in the process of gathering specific documented information from the authorities in the different states where exposed animals traveled. If someone was at any of the recent events, there is at least some potential for exposure to the virus and we suggest taking a few days off to monitor those horses for any signs of infection by taking their temperatures twice daily. If an exposed horse develops a fever of 102 or above, please have them evaluated, and potentially submit a nasal swab to determine if they are shedding virus. Given that the virus is spread by aerosol, the safest approach is to have this initial examination and any diagnostics performed at home. If there is concern for early signs of infection, we can then discuss appropriate medical intervention.

As for the day-to-day activities at the clinic, we are altering our usual routine of how we handle horses by reducing the mixing of horses from different sources. We enjoy our friendly atmosphere and hope to keep it that way, but we will try to have only individuals or smaller groups of horses from the same source in the exam rooms at the same time – remembering that the virus is spread in the air. The other possibility is that the virus could be spread by people – hands and clothing – so you will see employees being more attentive to keeping themselves clean when handling horses.

Many of the routine hospital functions remain the same as always. We always are very restrictive of any contact with the foaling mares and sick hospitalized horses. Our facilities are designed for just this process and the hospital care remains the same. We will be cautious when admitting a new horse to determine if they have any risk of exposure to the virus, and will be diligent – as usual – in monitoring our hospitalized patient for a fever. Horses that have a fever are always assessed for possible viral respiratory infection and sequestered in isolation until proven that there is no infection. This will not change.

Please know that we are staying in contact with experts in multiple states to keep ourselves abreast of the latest knowledge on the outbreak, and we will try to keep you informed through multiple avenues when we learn valuable information.

Important update from Dr. Fairfield Bain on the recent Herpes cases.

2011-05-16T12:55:00.001-07:00

"By now, the word about the problem of neurologic herpes virus originating with the event in Utah has spread throughout the universe. There is still a lot of needed information that we just do not know as of this afternoon. What we do know is that some horses that left that event and dispersed throughout the west have developed clinical signs of disease associated with infection by the neurologic strain of equine herpesvirus (EHV-1). Until we have more concrete information, we believe it is smart to limit traffic of horses to what is absolutely necessary. That means – mares needing to be bred etc., and when they are elsewhere, limit their potential exposure to other horses (stay on the trailer until necessary). The only way to be certain your horse is protected is to avoid other horses for now. What we do know about this virus is that it can be spread through the air in a facility, so avoiding mixing new horses, especially any horses that were at or have been in contact with horses that were at the event in Utah. This, of course, can become complicated given the everyday typical traffic in our industry. Boostering immunity with vaccines and using immune stimulants can be helpful in enhancing general functions of the immune system, but there is no vaccine currently on the market that is specifically labeled to protect against the neurologic strains. Hopefully, more detailed information will filter out in the next couple of days and we will do our best to keep you informed." ~ Dr. Fairfield Bain

Recent Disease Outbreak Alert

2011-05-15T07:02:00.000-07:00

A recent disease outbreak of Equine Herpes Myeloencephalopathy (EHV-1) (neurological form of herpes virus infection) has been traced to horses who attended the National Cutting Horse Associations' Western National Championships in Ogden, Utah on April 30 - May 8, 2011. If your horses were at that event, or exposed to horses that attended that event, the possibility exists that they could have been exposed to this virus.

The EHV-1 virus spreads quickly from horse to horse and the neurologic form of the virus can large numbers of horses in a group and can result in death – usually due to severe spinal cord injury in severely affected horses. The incubation period (time from actual exposure/infection to showing signs of disease) of EHV-1 can vary from 2-10 days. In horses infected with the neurologic strain of EHV-1, clinical signs may include the following:

nasal discharge
incoordination
hind end weakness
recumbency
lethargy
urine dribbling
decreased tail tone

Horses that show a fever and any of these signs should be isolated and examined by your veterinarian.

The prognosis depends on severity of signs and the period of recumbency. There is no specific treatment for EHV-1. Medical treatment may include intravenous fluids, anti-inflammatory medications, and other appropriate supportive treatment.

Horse-to-horse contact (nose-to-nose), aerosol transmission, and contaminated hands, equipment, tack, and feed all play a role in disease spread. However, horses with severe clinical signs of neurological EHV-1 illness are thought to have large viral loads in their blood and nasal secretions, and therefore present the greatest danger for spreading the disease. Using separate water buckets for individuals and preventing nose-to-nose contact with new horses is important in preventing spread of this virus just as with other respiratory infections like Strangles or influenza and are good practices to maintain while at events away from home.

It is important to monitor your horses for early signs of illness – as a manner of good infection control habits, especially at events. The simplest and most valuable thing is monitoring the rectal temperature twice daily. A rectal temperature in excess of 102 degrees (0F) commonly precedes other clinical signs. If a temperature above 102 0F is detected you should contact your veterinarian immediately.

Sincere there are many things that can cause a fever, an accurate diagnosis will require collecting samples and submitting to a laboratory for testing. The usual diagnostic samples for virus detection (usually PCR testing) are nasal swabs and blood samples.

Immediate separation and isolation of identified suspect cases and implementation of appropriate infection control measures are key elements for disease control.

What about prevention? There is no specific vaccine that has a label claim for protection against the neurologic form of equine herpes virus. It is reasonable to consider using immune stimulants and booster vaccinations to raise immunity levels at least 10-14 days prior to attending an event.

Please contact out staff if you have any questions.

ACTION ALERT from The H.O.R.S.E (deadline May 9)

2011-05-06T10:24:00.001-07:00

ACTION ALERT

The deadline for bills to be voted out of committees in the House of Representatives is May 9.
As of today, no gaming bills have been voted out.

Representative Mike Hamilton, Chairman of the Committee on Licensing and Administrative Procedures, has indicated he intends to pass one bill out of his committee, which is a bill authored by him. That bill has changed dramatically since being introduced, and authorizes casino gaming as well as slot machines at racetracks and tribal locations. Very recently, there has been movement which adds language which is more favorable to the horse industry, but it is still a work in progress.

We are asking you to call the members of this committee. Their office and district numbers are listed below. Tell whomever answers the phone your name, and that you are in the horse industry. Inform them that HB 2111 addresses all the issues that are critical to saving the Texas horse industry from being destroyed by competition from Louisiana, Oklahoma, and New Mexico. Tell them you are asking the Representative you are calling to please support your industry. While you are at it, please forward this email to family and friends and ask them to call as well. The more calls, the better. Send it to everyone you know and ask them to call.

Licensing & Administrative Committee	Telephone/District	Telephone/Capitol
Mike Hamilton* - Chair	409-745-3644	512-463-0412
Joe Driver	972-276-1556	512-463-0574
Charlie Geren	817-738-8333	512-463-0610
Roland Gutierrez	210-532-2758	512-463-0452
Patricia Harless	281-376-4114	512-463-0496
John Kuempel	830-379-8732	512-463-0602
Jose Menendez	210-673-3579	512-463-0634

Additionally, we want you to call the offices of the Lt. Governor and Speaker of the House. You need to tell them that it is critical the legislature act soon to give the Texas horse industry the necessary tools to restore itself in the face of withering competition from Louisiana, New Mexico, and Oklahoma. Their office numbers are listed below as well.

Lieutenant Governor: David Dewhurst
512-463-0001

Speaker of the House: Joe Straus III
Telephone/Capitol - 512-463-1000
Telephone/District – 210-828-4411

The last time we asked you to call these committee members, those calls were made the same day Texas HORSE succeeded in getting approximately 1200 horse folks into the capitol. At that time there seemed to be no sentiment to address our needs. Your calls helped change that. Now is the time for you to do it again. Your industry is depending on each of you.

For additional information, go to the TEXAS H.O.R.S.E. website.

NEW ESMS WELLNESS PROGRAM

2011-05-05T09:42:00.001-07:00

Dear Valued ESMS Client,

We are excited to launch a new Wellness Program for horses at least one year of age and older. This program is designed to help you provide important preventative care necessary for your horse’s health and to promote their best performance. We feel sure you will find our program to be affordable, and you can take advantage of special perks and discounts while enrolled in the program.

We encourage you to enroll your horse in one of three levels. Our staff and veterinarians are here to help you determine the best preventative care plan for your horse depending on his/her level of performance, exposure and stress. By enrolling in the program, you will receive the care your horse needs at savings of up to 25% off regular price.

Each horse entered in the Wellness Program will receive a credit towards colic surgery should your horse need it during the term enrolled. Horse owners will receive a veterinary consult along with the wellness exam. Enrolled horses will receive appropriate vaccinations, yearly dental power floats and a fecal analysis so our veterinarians can recommend the most appropriate deworming protocol for your horse. Our practitioners feel it is important to evaluate the parasite load in each horse in order to treat appropriately, while being cautious to the prevention of parasite resistance to the products used.

Please contact our staff to learn more about this special program. We encourage you to follow our blog by clicking on the link from our home page at www.equinesportsmedicine.com. Follow us on facebook to receive the latest in industry news and special programs.

Please refer to the table on the back to identify the most appropriate level for your horse. All of us at ESMS appreciate you and look forward to caring for your horse.

Sincerely,

ESMS Staff

WELLNESS PROGRAM TERMS AND CONDITIONS

Enrollment may begin at any time during the year. Your horse will be enrolled for one calendar year. For example, if you enroll your horse May 15, 2011, this horse will be an active participant in the program until May 14, 2012. Horses enrolled must be at least 1 year of age.

Payment is due in full at time of enrollment. You are required to pay for the entire wellness package prior to your first appointment. Enrollment may be done over the phone or by printing a form from our website and submitting via fax.
If an enrolled horse dies during the term, you will receive a prorated refund. If a horse is sold, the program may be transferred to the new owner (terms only valid at ESMS).
If you do not take advantage of all services in your plan, there will be no exchanges and/or refunds for those unused services and/or products.
Should your horse require any additional services (such as additional deworming after reviewing your horse’s fecal or additional dental services, etc.), you are required to pay the difference at the time of your appointment.
A colic surgery assistance program will be offered to all active participants in the program. Should your horse need colic surgery during the enrolled term, you may take advantage of a credit toward colic surgery expenses. Level 1 will receive $550 toward colic surgery expenses, Level 2 will receive $350 toward colic surgery expenses and Level 3 will receive $250 toward colic surgery expenses. NOTE: the colic surgery assistance program will begin after your horse has been enrolled and you must have completed your first consult with the veterinarian, which is part of the scheduled program. The colic surgery assistance credit can only be used at ESMS/Weatherford.

ESMS WELLNESS PROGRAM LEVLES

2011-05-05T09:30:00.000-07:00

Important message about the threat from wildfires...

2011-04-20T07:49:00.000-07:00

This is an important message from Dr. Fairfield Bain, our Chief of Medicine. We know many of our customers are being threatened by these terrible fires and want to help you in any way we can.

"With the environmental issues of the fires, we are always concerned about the potential effects the environment changes might have on our horses. Besides the obvious issue of direct burn injury, there are other potentially harmful effects, mainly from the smoke. Some animals may also suffer from heat injury to the skin that is not as readily apparent as typical burn. People and animals in house or barn fires are at risk for smoke inhalation injury to the lungs, which can be recognized as difficulty breathing and coughing. This can appear similar to pneumonia – as it causes similar severe inflammation in the lungs. A more subtle effect is the milder irritant effect of smoke and dust on the small airways in the lungs, which can result in coughing, increased mucus production, and possibly poor performance. While we hope for relief from the fires, and hope everyone’s animals escape any harm, please contact us if you feel your horse may have some of the indications of smoke inhalation." Fairfield Bain, DVM, MBA, Diplomate, ACVIM, ACVP, ACVECC

Healthy Delivery and Foal Kick Start Programs

2010-12-30T12:39:00.000-08:00

Repository X-Ray Special for Western Bloodstock Sales 2010

2010-11-10T07:43:00.000-08:00

Fall Prevention Special

2010-11-10T07:42:00.001-08:00

Strangles - Year After Year

2010-09-10T12:58:00.000-07:00

Why do some ranches have to deal with strangles year after year? Some people would say that it is due to bad luck, bad management or too many horses. The real issue is understanding how strangles is maintained in a group of horses and how it can show up on a ranch for many years. Some people are unaware of how many different ways strangles can be transmitted. Many ranches have successfully cleared up this financially crippling headache.

Strangles is caused by the bacteria Streptococcus equi. Strangles can be spread by both direct and indirect transmission. Direct transmission is a result of nose or mouth contact. Indirect transmission is a result of contaminated drinking buckets, feed, stalls, bits, halters, people and many other objects. This may actually be the most common way it is spread. Due to its ubiquity, strangles can be spread through one’s entire barn or a horse show quickly. The first step to fighting the disease is being able to recognize the symptoms. The first clinical signs may be not eating well, fever or change in attitude. Other signs to watch for include nasal discharge, coughing, swelling/abscesses underneath the jaw or difficulty breathing. Not all horses will show the classic abscesses under the jaw. Upon seeing these signs, it is best to isolate the affected animals and contact your veterinarian for further diagnostics and treatments.

There are a couple of ways a farm can have a problem with strangles year after year. They bring sick horses onto their farm without proper isolation or they have horses that are shedding the bacteria without being sick. The horses that are showing no clinical signs of strangles but shedding strangles are usually the cause of repetitive outbreaks. These horses are harboring the bacteria in their guttural pouch (the horse’s inner ear) due to not clearing the infection completely. At ESMS, we are seeing more and more horses with this problem. These horses look, act and work normal but are the reason for the continued outbreak in young horses.

The way to resolve this problem is by screening all horses on the farm by either upper airway cultures or by scoping the upper airway and guttural pouches looking for purulent material (pus) in the guttural pouches. This will allow you to identify the horses that are shedding the bacteria and begin to resolve the problem. This is only the first step at fixing the problem but it gives you the necessary starting point. Other steps that will need to be taken are as follows: isolating affected animals, disinfecting everything that came in contact with that horse (especially water sources) and paying close attention to horses that were around infected horses.

This article only touches the surface of what to consider when strangles emerges but, hopefully it provides a little information on how you can help prevent the spread of strangles on your farm. by Dr. Skeet Gibson

Get to know Dr. Gibson

2010-09-10T12:47:00.000-07:00

Get to know Dr. James Simpson, Jr.

2010-08-24T12:17:00.000-07:00

Complementary Medicine

2010-08-24T12:15:00.000-07:00

Complementary or alternative medicine is being increasingly used in conjunction with conventional western medicine in the human and veterinary fields. At Equine Sports Medicine & Surgery, we use chiropractic care and acupuncture with the western medicine you are familiar with to produce a desirable outcome in the health of your horse. It is a process of taking two different views of possible treatment plans for your horse and using the strengths and weaknesses of each one to our advantage.

Acupuncture in the horse began thousands of years ago in China. Valuable farm animals were treated using stone needles to acupoints transposed from human points. Today, Certified Veterinary Acupuncturists (CVA) use modern steel needles, transposed human points and ancient equine acupoints found in a few surviving texts. This combination allows the CVA a wide range of points to select for treatment using dry needle, electrical acupuncture or aqua puncture. Through modern research we now know that acupuncture works through the nervous system, endocrine system and the immune system to balance the body’s organ system to achieve wellness.

Modern chiropractic technique is purely an American invention. O. D. Palmer of Canada founded the Palmer School of Chiropractics in Iowa in 1897. In 1980, formal chiropractic training for veterinarians began with Sharon Willoughby, DVM, DC. Her program was based on human chiropractic technique, which later evolved into the American Veterinary Chiropractic Association. A true chiropractic adjustment is a precise, low amplitude, high velocity thrust with only the hands on a specific area of the spine.

Chiropractic and acupuncture can be used to treat musculoskeletal and neurologic disorders as well as internal medicine disorders. These treatment modalities are safe and effective when performed by a formally trained and certified veterinarian.

- by Dr. James Simpson

ESMS Virtual Tour

2010-07-21T07:58:00.000-07:00

Come join Bob Tallman as he takes you on a tour of Equine Sports Medicine & Surgery in Weatherford, Texas. Meet a few of our doctors and get a glimpse of our facility and the services we have to offer. For more information, please visit our website: www.equinesportsmedicine.com.

To watch the video click HERE.

Get to know Dr. Reese Hand

2010-07-12T13:41:00.001-07:00

Lameness Therapy in the 21st Century

2010-07-12T13:37:00.000-07:00

Lameness therapy in the 21^st Century

by Dr. Reese Hand

Dealing with lameness in the horse has been around for a long time. Historically, therapies have varied little. Medication types, uses, and frequency have changed but all traditional therapies are targeted at reducing pain and inflammation. Therapies for the 21^st century are not only targeting pain and inflammation, but they are zeroing in on regenerating and primary healing.

Injuries to joints and tendons involving the lower limb accounts for upwards of 80% of the injuries most commonly dealt with in the horse. Due to the competitive level of the equine athlete today, when one gets injured the owner is not looking to simply heal the injury but to restore it to pre-injury status in order to be competitive. Today, two advanced therapies give injured horses the chance to restore to pre-injury status.

Stem cell therapy is the process of harvesting undifferentiated cells and injecting them into the area of injury. Although this process is much more complex, simply speaking they become the environment they are placed in and help restore injured tissue back to normal tissue by regeneration and minimize scar tissue which will limit function. Stem cells can be placed into all types of soft tissue and joints to help repair injured tissue. Reports of 76% healing of suspensory tears, 56% healing joint disease and 77% resolution in tendon injury are common. (Vet-Stem Inc.)

PRP (Platelet rich plasma) is also a forefront therapy to minimize scar tissue from traditional healing and maximize tissue healing and restoration. PRP is a process of concentrating the platelet cell from whole blood and injecting it into injured joints and soft tissue. Platelets contain growth factors which the body uses to heal injured tissue. Using PRP, growth factors are concentrated upwards of 150 times what the body would be able to send to injured tissue. This substantial increase is what leads to restoration and not just healing.

Whether your horse is the next futurity hopeful or just a friendly companion, if they are injured be assured therapy to heal has taken on a new look. We hope your horse never has the need for advanced therapy, but if it does, we are prepared to provide the most up-to-date and best care possible to restore your horse to pre-injury level.

Hyperbaric Oxygen Therapy

2010-06-18T12:52:00.001-07:00

Get to know Dr. Fairfled T. Bain

2010-06-18T12:50:00.000-07:00

ESMS on the Brazos Virtual Tour

2010-06-18T12:26:00.001-07:00

Introducing ESMS on the Brazos - our new reproduction facility!

Notes from The Doctor's Desk - June 18, 2010

2010-06-18T11:10:00.000-07:00

Hyperbaric Oxygen Therapy for Horses

by Fairfield T. Bain, DVM, MBA

Diplomate, ACVIM, ACVP, ACVECC

Internist/Pathologist

Hyperbaric oxygen therapy is certainly not new, but it is relatively recent on the scene in equine medical care. It has a long history in human medicine – most widely known for its use in treatment of decompression sickness (aka “the bends”) for divers – more recently for a variety of medical conditions. Hyperbaric oxygen therapy is an FDA-approved medical therapy for certain conditions in human medicine.

Figure 1. Indications for hyperbaric oxygen therapy for humans (courtesy Duke University – http://hyperbaric.mc.duke.edu/indications.htm)

Air or gas embolism

Decompression illness

Carbon monoxide poisoning and smoke inhalation

Clostridial myonecrosis (gas gangrene)

Crush injury, compartment syndrome and other acute traumatic ischemias

Enhance healing in selected problem wounds

Exceptional blood loss or severe anemia

Necrotizing soft tissue infections (subcutaneous tissue, muscle, fascia)

Refractory osteomyelitis

Radiation tissue damage (osteoradionecrosis and soft tissue radionecrosis)

Compromised skin grafts and flaps

Our horse patients have many conditions similar to those on this list – especially wounds with poor blood supply, those with severe trauma to the skin and underlying tissue, or those with large skip flaps, soft tissue infections (ex. tendon sheath infections), and bone infections (osteomyelitis). We have treated a variety of other conditions including birth asphyxia, peripheral nerve injury (brachial plexus injury), intestinal injuries that compromise the blood supply (colon torsion and small intestinal strangulation), and spinal trauma.

So, how does hyperbaric oxygen therapy work? It works using the principles of gas under pressure. It is a mode of therapy in which the patient breathes 100% oxygen at pressures greater than normal atmospheric pressure. In the hyperbaric chamber, the animal is exposed to almost 100% oxygen under increasing pressure. Some physics lessons are needed to understand what is happening during HBOT treatments. At sea level, breathing air we are exposed to a pressure of 14.7 pounds per square inch (psi) or 760 millimeters of mercury (mmHg). The air we breathe is comprised of 79% nitrogen and 21% oxygen, meaning that it contains a pressure of approximately 160 mmHg of oxygen (21% x 760 mmHg). In hyperbaric medicine, pressure is measured in Atmospheres Absolute (ATA). At sea level, we are exposed to 1 ATA (“normal atmospheric pressure”). In diving, with each 33 feet (or 10 meters) of sea water, the pressure increases one atmosphere. Thus, at 33 feet of sea water (fsw), the absolute pressure is 2 ATA. At 66 feet of sea water, the absolute pressure is 3 ATA. This comparison to depths in sea water is important since these are the relative pressures that a patient is exposed to for clinical hyperbaric oxygen treatments. The critical feature of oxygen under pressure is that the amount that can be breathed into the lungs increases exponentially. Using 100% oxygen, at 2 ATA the animal is breathing in 2 atmospheres worth of 100% oxygen – or 760 mmHg x 2 = 1520 mmHg. At 3 ATA, the animal is breathing in 3 atmospheres worth of 100% oxygen – 760 mmHg x 3 = 2280 mmHg – an incredible 14 times the amount one would breathe in room air at sea level. In medical applications of hyperbaric oxygen therapy, 3 ATA is the maximal pressure that a patient would be treated (due to the increased risk of oxygen toxicity seizures at that concentration of oxygen) with most treatments being between 2 to 2.5 ATA. This high concentration of inspired oxygen has several valuable effects in the body: it causes constriction of blood vessels – reducing swelling, it stimulates tissue healing – increasing cell division in the endothelial cells that line blood capillaries, increasing division in fibroblasts – the cells that make collagen in a variety of tissues. The importance of the effect on blood vessels is that new capillary blood vessel growth is critical in tissue healing in a variety of injuries and increases the body’s ability to deliver antibiotics into areas that previously had poor blood supply. Hyperbaric oxygen also reduces inflammation and may have immune-stimulating effects. It also has been shown to enhance the effects of certain antibiotics – especially those that do not work well in low oxygen environments (especially the aminoglycoside family of antibiotics such as amikacin and gentocin) known to occur in severely infected tissues. Much of the basic research showing these effects has actually been performed in animal models of human disease, and now, we are able to use this information for our horse patients.

What happens when the horse enters the hyperbaric chamber? For the first one or two treatments, the animal may need sedation for the new experience. It is not really any different than riding in a horse trailer or van. The most commonly available equine chamber is an open room design that allows the horse the comfort factor of being able to move around, thus being more relaxed. The technician constantly monitors the horse using a series of video monitors from different perspectives. The pressure is gradually increased – delivering oxygen into the floor of the chamber and gradually removing the air through the roof over several cycles. After about 15 minutes, the treatment pressure (usually 2.0 – 2.5 ATA) and maximal oxygen concentration (usually around 94%) is reached. The total time in the chamber varies from 45 to 60 minutes. The treatment protocols – time of treatment, maximal pressure, and number of treatments depend upon the condition being treated. We have tried to follow the experience in the animal models and in human medicine for our horse patients. In general, a horse might receive up to 10-12 treatments for a bone infection.

Another issue worth considering is the response of the horse patient to pressure. Horses have guttural pouches – a distensible air pouch within the auditory tube. The openings readily open on swallowing and apparently allow ease in equalization of pressure. While disorders of the sinuses or guttural pouches could create an air-trapping scenario, this rarely seems to be the case in the horse patient.

As you might expect, these chambers are large structures and require an environmentally-controlled building to house them. Most chambers operate using liquid oxygen as it is the most cost-effective supply.

One important thing to understand is that hyperbaric oxygen therapy is a supportive or adjunctive treatment. The condition is still being managed with other medical treatments – such as appropriate antibiotics for a bone or tendon sheath infection. Hyperbaric oxygen therapy should be viewed as something to enhance tissue healing. Our goal is to shorten the recovery time in injuries and illnesses – the result being improved survival rates for devastating illnesses like colon torsions, and less time in the hospital overall.

For those interested in more information and training in hyperbaric medicine, the following resources are available:

Veterinary Hyperbaric Medicine Society - http://www.vet.utk.edu/vhms/

The Veterinary Hyperbaric Medicine Society is a recently formed organization to foster communication between facilities and to collate information specific to veterinary applications of hyperbaric oxygen therapy.