Libro Resumenes 2

Proceedings
WEVA CONGRESS
2023
Proceedings
WEVA CONGRESS
2023
1
WEVA BOARD DIRECTORS
2020-2023
Eric Richard
President
Sandro Barbacini
Senior Vice-President
Maria Paz Zuñiga

Junior Vice-President
Warwick Bayly
Treasurer
Chris Riggs
Secretary
Raquel Baccarin
Board Member
Phiroz Khambatta
Board Member
Henry Tremaine
Board Member
Julia Wilson
Board Member
Jennifer Yuan Zhou

Board Member
ACHVE
María Paz Zuñiga DVM, MSc

President
Mauro Rodriguez DVM

Vicepresident
Pamela Donoso DVM, MSc

Secretary
Cristian García DVM

Treasurer
Santiago Alegría DVM

Director
Romina Risetto DVM

Community Manager
ACHVE
SCIENTIFIC COMMITTEE ACHVE EQUINE WELFARE
ADVISOR COMMITTEE
Paula Soza Ossandón DVM, PhD
Tamara Tadich Gallo DVM, MSc, PhD
Felipe Lara DVM, MSc

Beatriz Montero DVM, MSc
Carolina Duran DVM,

MSc, PhD, ACVIM
Proceedings
Session 1 WEVA CONGRESS
2023
IMPACT OF HISTEROSCOPY IN THE MARE IN DAYLY

PRACTICE
1
H. Ramirez Castex(*); 1F. Belmar; 1
Bioteq, Equine Reproductive Medicine Clinic, Chile
1
Most reproductive abnormalities in mares can be detected using common procedures such as palpation,
vaginoscopy and ultrasonography and are sometimes supplemented by microbiological culture, cytology
and biopsy. However, sometimes it is necessary to apply more sensitive procedures to achieve a definitive
diagnosis and/or to objectively classify the severity of a problem when interpreted with ultrasonography.
One of these techniques is endoscopy, which provides a real-time visualization of the inside of the uterus
without the need for interpretation1,2,3.
Endoscopy is commonly used in equine medicine for observation of the upper respiratory system and the
first portion of the digestive system such as oral cavity, esophagus and stomach. In the mare an endoscope
can be used to detect intrauterine abnormalities that most of the time are not observable by ultrasound
such as adhesions, endometrial cysts, foreign bodies, volume increases, hemorrhages, biofilms, mucus,
retention of endometrial cups, etc. Also an endoscope achieves images with more detail of problems at the
vaginal level such as vaginal varicose veins, lacerations and accumulation of urine in the vaginal fundus as
well as a more accurate evaluation of cervical integrity. In addition, an endoscope can be used to perform
deep artificial insemination with low doses of semen on the utero-tubal papilla1,2.
It is an uncommon procedure and therefore not routine in the daily practice of the reproductive clinic in
mare. Since the necessary endoscopy or video-endoscopy equipment demands a high investment, often
difficult to transport to the field and need adequate facilities for a good examination and proceed1.
In 2017 in Bioteq®, we acquired a video-endoscope and in these 6 years we have performed a total of 147
hysteroscopies in mares of different breeds and ages. 130 of them (89%) were performed for a diagnostic
purpose in mares with a history of subfertility or infertility and 17 of them (11%) for a therapeutic purpose in
mares with an undergoing problem and already diagnose. Of the 130 diagnostic hysteroscopies, 82 of them
did not have a previous ultrasound finding, so 56% of the cases had a finding only with endoscopy. Of the
44% (65 endoscopies) who had a previous ultrasound finding, in 37% (24 cases) their previous ultrasound
finding was of lower clinical magnitude in its interpretation than the observed reality and in 63% of cases
(41 cases) endoscopy revealed and confirmed something very similar to what was observed by ultrasound.
This denotes and confirms the importance that this real-time image generator tool can have and the poten-
tial it offers to make correct therapeutic decisions and therefore better prognoses.
References
1. Brinsko SP. How to perform and Histeroscopy in the Mare. Proceedings of the 60th Annu-
al Convention of the AAEP. December 6-10, 2014.
2. LeBlanc MM. Endoscopia. En: McKinnon AO y Voss JL, eds. Reproducción equina. Fil-
adelfia, PA: Lea y Fe- más grande; 1993:255–257.
3. Wilson GL. Histeroscopia equina: Una ventana al tracto reproductivo interno. Vet Med
Small Anim Clin 1983;78:1455– 1459.
4.
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Proceedings
2023
Hernán Andrés Ramírez Castex, DVM, MSc, Dipl.
Veterinarian graduated from Universidad de Chile on 2003, Santiago, Chile. Diplomated in Animal Reproduc-
tion, Equine Mention on 2003 from the same University and Master degree in Equine Production at Universi-
dad Nacional de Rio Cuarto, Cordoba, Argentina on 2016.
He has dedicated complete time to equine reproduction. He started as a resident veterinarian at a Thourough-
bred farm and afterwards as consultant of several farms between 2002 and 2007.
After several trips to Argentina, Brasil, and the United States for training and gaining more experience he
founded his own business, Bioteq®, being an Equine Reproduction Center on 2006 to dedicate complete time
to equine assisted reproduction.
Towards 2023 and with 17 years functioning of Bioteq®, this center stands as one of the main equine repro-
duction centers in Chile, with a solid contacts web, agreements and heterogeneous client list.
His teaching participation at veterinary schools is very active as well as graduate and post graduate collabo-
ration with various investigations projects.
Nowadays he has founded a new and innovative project concerning sex sorting semen using nano-technol-
ogy and creating his new business BioseXYng®.
Recent publications-presentations
• Ramírez Castex H., Losinno L. (2016). Utilización de Nano-partículas magnéticas para separar esper-
matozoides X de Y en semen equino (Magnetic Nanoparticles for equine X sperm sorting) . Master of
Sience Thesis, Rio Cuarto National University, Argentina.
• Ramirez H., Losinno L. (2017). Magnetic Nano particles for X sperm Separation from Donkey semen.
In: Zeng S and Losinno L (Editors-in Chief): Proceedings of the First International Symposium in Don-
key Science, Beijing, China (201-205).
• Ramírez Castex H; Domínguez E; Flores Bragulat A; Flores S; Pérez Barrios P; Ugaz C; Clemente H;
Ayarza E; Mutto A; Giojalas L; Losinno L. (2017). Nanopartículas magnéticas para separación de
espermatozoides X en semen equino. Resultados preliminares. (Magnetic Nanoparticles for X equine
sperm sorting. Preliminary results). Argentine Embryo Tecnologies Society anual meeting. Buenos
Aires, Argentina, September 16-17th 2017.
• Ramírez Castex H; Domínguez E; Flores Bragulat A; Flores S; Pérez Barrios P; Ugaz C; Clemente
H; Ayarza E; Mutto A; Giojalas L; Losinno L. (2017). Nanopartículas magnéticas para separación
de espermatozoides X en semen equino. Resultados preliminares. . Preliminary results of Magnetic
Nanoparticles for X equine sperm sorting (La Especie Equina, Argentina, Diciembre, 2017.
• Ramírez Castex H., Losinno L (2018). Magnetic Nano particles for X sperm Separation from Donkey
semen. Journal of Equine Veterinary Science, Elsevier, USA (2018).
• Ramírez Castex H; Domínguez E; Flores Bragulat A; Flores S; Pérez Barrios P; Ugaz C; Clemente H;
Ayarza E; Mutto A; Giojalas L; Losinno L. Preliminary results on magnetic nanoparticles X and Y
separation of equids (horses and donkeys) sperms. First International Equine Assisted Reproduction
Symposium, Bogota, Colombia, November 14-17th, 2017.
• Ramirez Castex H.; Losinno L. (2018). Colt or Filly? Breeders soon Might be able to choose. The Horse
Magazine, January 2018.
http://www.thehorse.com/articles/40000/colt-or-filly-breeders-soon-might-be-able-to-choose#st-
hash.5tQ5JDyq.xiqq
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Proceedings
2023
Biofilm: is it real and how do we manage it in equine

reproduction
Dr. Ryan Ferris, DVM, MS, DACT
Summit Equine, Gervais Oregon USA
Bacteria utilize numerous methods to survive degradation by the host immune system and antibiotic ther-
apy. One survival tool utilized by bacteria is the production of a biofilm. Biofilms allow bacteria to be un-
recognized by the host immune system, prevent exposure to antibiotics, and allow for exchange of genetic
material leading to antibiotic resistance. Until recently very little was known about the importance of biofilm
in cases of equine endometritis. Recent studies have identified bacteria residing in a biofilm on the endo-
metrial surface of mares using a model of endometritis. Currently there is not a good diagnostic technique
for detecting a biofilm associated infection in clinical practice. Clinicians should strongly suspect a biofilm in
mares that are identified to have an infection, appropriate treatment is applied to the case and the infection
is not readily cleared.
Biofilm infections have a high rate of failure due to the bacteria being protected from antibiotics by being
in the biofilm lifestyle. Non-antibiotics can be effectively used to disrupt the biofilm that is protecting the
bacteria allowing antibiotic treatments to effectively eradicate the infection. Caution should be used when
mixing antibiotics with non-antibiotics as many were found to result in inactivation of the antibiotics used
in the treatment. Commonly used effective compounds are presented in Table 1.
Overall the incidence of biofilm or latent bacteria is unknown in the broodmare population. However, with
overall pregnancy rates in the broodmare population being relatively high per cycle it is suspected that
the incidence rate of biofilm or latent bacteria is low. In individual mares failing to become pregnant biofilm
and latent bacteria should be a consideration as a cause of subfertility. Fortunately, research has described
how these infections might develop, improved diagnostic techniques and effective treatment strategies for
biofilm or latent bacterial endometritis.
Table 1. Antibiotic and Non-Antibiotic Combinations For The Treatment Of

Biofilm Associated Bacterial Endometritis In Mares
Tris EDTA- final concentration in the syringe should be 50 mM Tris and 3.5 mM EDTA
Note: Tris-EDTA and Tricide are similar; however Tricide is not equivalent to Tris-EDTA in regards to bacterial killing
To make Tris-EDTA: 16oz bottle of Dechra Triz-EDTA crystals; add 8 oz of sterile water (this is different than the bottle instruc-
tions). The 2x concentration of Tris-EDTA solution will be further diluted by the antibiotics below to the proper final concentra-
tion.
Antibiotic Drug Amount Tris EDTA QS Final volume Notes:
16 mls sterile fluid 10 mls of 8.4% sodium

Amikacin (250 mg/ml) 4 mls (1 gram) 30 mls (Saline, LRS, Sterile 60 mls bicarbonate should be
H2O) added to the amikacin
Ceftiofur (1 gram re- 10 mls sterile fluid

20 mls (1 gram) 30 mls 60 mls
constituted in 20 mls) (Sterile H2O)
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Proceedings
2023
Ciprofloxacin (10 mg/ Split between two syrin-

40 mls (400 mg) 40 mls 0 80 mls
ml) ges
H2O2- 1% final concentration in the syringe

A 3% stock solution is available at many drug stores and veterinary distributors
Antibiotic Drug Amount H2O2 QS Final volume Notes:
26 mls sterile fluid 10 mls of 8.4% sodium

Amikacin (250 mg/ml) 4 mls (1 gram) 20 mls (Saline, LRS, Sterile 60 mls bicarbonate should be
H2O) added to the amikacin
Ciprofloxacin (10 mg/

40 mls (400 mg) 20 mls 0 60 mls
ml)
DMSO- 30% final concentration in the syringe
99% stock solution is used for calculations below
Antibiotic Drug Amount DMSO QS Final volume Notes:
Ceftiofur (1 gram re- 20 mls sterile fluid

20 mls (1 gram) 20 mls 60 mls
constituted in 20 mls) (Sterile H2O)
Ciprofloxacin (10 mg/

40 mls (400 mg) 20 mls 0 60 mls
ml)
Ryan A Ferris, DVM, MS.
Diplomate, American College of Theriogenologists, Owner, Summit Equine, Inc. Newberg Oregon Dr. Ferris
graduated from veterinary school at Washington State University in 2007. Ryan completed an internship in
equine surgery, medicine and reproducJon at the Equine Medical Center of Ocala in 2008. Followed by a
residency in Equine ReproducJon at Colorado State University. He received a MS in Clinical Science from
Colorado State University, passed the board examinaJons for the College of Theriogenologists and was an
assistant professor at Colorado State University from 2010-2017. In 2017 Dr. Ferris and his family moved to
Newberg, Oregon and established Summit Equine, Inc. Summit Equine is a referral equine reproducJon
pracJce for mares and stallions. Offering services in breeding management (fresh, cooled or frozen), embryo
transfer, problem mares, oocyte aspiraJon, stallion collecJons for fresh, cooled or frozen semen, internaJonal
shipment of semen, stallion evaluaJons. Interests: Bacterial and fungal endometriJs, biofilm, post maJng in-
duced endometriJs, and embryo transfer.
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Proceedings
2023
COMMON REPRODUCTIVE PROBLEMS IN STALLIONS

Marco Alvarenga . DVM , MSc, PhD . Faculty of Veterinary Medicine and Animal Sciences ,SãoPaulo State
University (UNESP) , BRASIL
Similar with the literature on our clinical experience problems related with spermatogenesis (testicle de-
generation) and ejaculatory dysfunctions are the most frequent reproductive problems of stallions. Most
of problems are related with disturbs on testicle thermoregulation. Equine Piroplasmosis (Babesiose) is
endemic in most states from Brazil and is an important factor related with the testicle degeneration instal-
lation because of high fever induced by the disease. The increase on testicle temperature will induce an
increase on cell metabolism with a consequent increase on oxygen needs. As the blood supply to testicle
is poor and few oxygen is available the cell dies. The sequence of sperm abnormalities is related with the
severity of the injury. The evolution of the sperm abnormalities and daily sperm production is important to
determine a testicle degeneration prognosis that usually is favorable. The hormonal profile can also help to
determine the degree of testicular damage being important to measure the estrogen levels. The recovery
of normal testis tone and sperm production is possible in most of cases if the cause is discharged. The use
of anabolic steroids is also related with disturbs of semen production causing a more profound reduction
in scrotal circumference. Disturbs of sexual behavior are the second more frequent clinical problems
observed in our ambulatory routine of horse andrology and most of them are characterized by ejaculation
dysfunction, these problems can have a physical or psychogenic origin. Most of times is difficult to make a
differential diagnosis between physical and psychogenic problems. On psychogenic cases the adoption of
good practices of reproductive management are important for the recovery. On cases where the problem
is physical is important to determine if pain is interfering with the sexual copulatory function, and several
strategies (pharmacological and management) can be adopted to help the stallion to achieve ejaculation.
Other observed problems are pathologies of the internal glands as vesiculitis and blocked ampullas. The
treatment of vesiculitis is most of time frustranting with a high probability of recurrence. The ejaculated
most of times contain large amount of blood and inflammatory cells. For blocked ampullas the differential
diagnosis with testicle azoospermia is made with the dosage of alkaline phosphatase levels on the semi-
nal plasma. The treatment involves sequential semen collection associated with trnsrectal massage of the
ampullas. The principal penile pathology is the penile haematoma induced by trauma during the breeding
or semen collection on this case its very important to drain the blood, hydrotherapy and the penis must
remain suspended.
1. Papa, FO . Reprodução do Garanhão (Textbook) , 336 pages , 2020.
2. Blanchard T, Varner D. Testicle degeneration. In: McKinnon AO and Voss JL (Ed.). Equine repro-
duction., 1993. p.855-860.
3. McDonnell SM. Ejaculation, phisiology and disfunction. Vet Clin North Am Equine Pract, v.8, p
57-70, 1992.
4. McDonnell SM. Stallion sexual behavior. In: Samper JC (Ed.). Equine breeding management and
artificial insemination. 2.ed., 2009. p 41-55.
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2023
Marco Antonio Alvarenga
Nationality – Brazilian
Birth date- 20 th June 1960
Associated Professor from Veterinary School of São Paulo State University (UNESP)– Brazil since 1989.
Bachelor’s in Veterinary Medicine at Universidade Federal Rural do Rio de Janeiro (1983), master science
on Veterinary Medicine at Universidade Estadual Paulista (1989) and PhD on Clinical Pathology on Medical
School from São Paulo State University -UNESP(1996).
Post Doctorate and Visiting Scientist at Equine Reproduction Laboratory from Colorado State Universi-
ty-USA (1997-1999).
Formal President of the Brazilian Embryo Transfer Society (SBTE) (2004-2005).
President of the Brazilian Association of Equine Practitioners –ABRAVEQ (2021 -2025
Member of the International Committee International Symposium on Stallion Reproduction
Has experience in Equine Theriogenology, focusing on mare infertility, stallion and donkey semen preserva-
tion and embryo transfer in horses.
Is author and co-author of more then 100 scientific articles.
Is author of several chapters’ on Equine Reproduction books.
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Proceedings
2023
HOW TO PROCESS SEMEN FROM DIFFICULT

STALLIONS
Marco Alvarenga . DVM , MSc, PhD . Faculty of Veterinary Medicine and Animal Sciences , SãoPaulo State
University (UNESP) , BRASIL
Selection of stallions is performed by phenotypic assessments, such as the conformation of the animal and
their athletic performance,9 unlike bovines where reproductive parameters are assessed in bulls before
becoming a commercial sire. Another factor that affects sperm quality is age, and often owners decide
to freeze semen from stallions that have advanced age and may be subfertile. Also is knowed that some
breeds as Spanish and Mangalarga stallions are less resistant to semen preservation.
Consequently, several techniques have been developed to increase the sperm quality of stallions. Stallions
whose semen does not resist the centrifugation process, the use of such techniques as SpermFilter, and
cushioned centrifugation may be beneficial. For stallions whose semen has a low resistance to cryopres-
ervation, the use of extenders with specific cryoprotectants, such as amines, in general improve sperm
cryosurvival and fertility.
When the initial quality of semen is poor, sperm selection using commercially available density gradients,
such as EquiPure (Nidacon) or Androcoll-E (Minitube) can be performed before cryopreservation.These
gradients select the sperm that exhibit better progressive motility, cell integrity, and no morphologic de-
fects . Another alternative is to select sperm after thawing. For this procedure, the contents of four straws
are gently layered on top of 2 mL of Equipure, centrifuged at 300 to 400 G for 20 minutes, and the pellet
resuspended with the freezing extender. Based in our experience this protocol improves the motility and
the fertility of frozen semen of some stallions. It is postulated that the removal of bad quality or dead sperm
that can generate oxidative reagents can improve the fertility.
Cushion centrifugation (CC) is an alternative technique for removing SP from semen. This method aims to
maximize the sperm recovery using a high G force (1000 G/ 30 minuts). Another possibility for removal of
seminal plasma is to use a filtering method composed of a synthetic hydrophilic membrane (Spermfilter
, Botupharma Brasil) ) that retains the sperm cells and allows for the passage of SP , concentrating the
sperm cells with less damage and also less cell compactation. Recently publications have been shown an
increase on fertility of cooled semen that was reprocessed by Spermfilter after 24 hours of refrigeration.
Methylformamide has been used as the preferential cryoprotector for Stallion semen it causes less osmot-
ic damage to sperm than glycerol because of the lower molecular weight and viscosity.7 For stallions with
semen that has satisfactory freezability (“good freezers”), the use of extenders containing dimethylforma-
mide or methylformamide may not result in a significant increase in post thaw sperm motility; however, it
does increase the fertility of the frozen semen. In stallions whose semen has low resistance to cryopreser-
vation (“bad freezers”), the use of extenders containing dimethylformamide or methylformamide provides
a significant improvement in sperm motility and fertility compared with extenders containing only glycerol.
The use of a combination of cryoprotectants affords better protection to sperm compared with the use of
single agents. Several equine reproduction centers in Europe, the United States, and Brazil have prefer-
entially used a commercial extender (BotuCrio), which includes a combination of methylformamide and
glycerol.
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2023
For semen cooling and transportation, the use of the new formulation of extenders containing casein and
cholesterol have been show to increase the cooling ability and also membrane integrity. Casein is a milk
protein that avoid the binding of seminal plasma proteins that usually destabilize the sperm membrane
inducing damage and precocious capacitation. Cholesterol increases membrane fluidity improving the
ability of the sperm cell to resist to osmotic stress.
Recommended Literature : Advances in stallion semen cryoprervation . Alvarenga, MA, Papa, FO, Ramires
Neto, Vet Clin North Am Equine Pract, v.32 p 521-530 , 2016
Papa, FO. Reprodução do Garanhão (Textbook) 336 pages , 2020.
Marco Antonio Alvarenga
Nationality – Brazilian
Birth date- 20 th June 1960
Associated Professor from Veterinary School of São Paulo State University (UNESP)– Brazil since 1989.
Bachelor’s in Veterinary Medicine at Universidade Federal Rural do Rio de Janeiro (1983), master science
on Veterinary Medicine at Universidade Estadual Paulista (1989) and PhD on Clinical Pathology on Medical
School from São Paulo State University -UNESP(1996).
Post Doctorate and Visiting Scientist at Equine Reproduction Laboratory from Colorado State Universi-
ty-USA (1997-1999).
Formal President of the Brazilian Embryo Transfer Society (SBTE) (2004-2005).
President of the Brazilian Association of Equine Practitioners –ABRAVEQ (2021 -2025
Member of the International Committee International Symposium on Stallion Reproduction
Has experience in Equine Theriogenology, focusing on mare infertility, stallion and donkey semen preserva-
tion and embryo transfer in horses.
Is author and co-author of more then 100 scientific articles.
Is author of several chapters’ on Equine Reproduction books.
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2023
What’s new for embryo transfer?

Juan Cuervo-Arango MSc, PhD, DVM, Dipl. ECAR (Equine)
Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia (Spain)
The collection and transfer of horse embryos (ET) was first reported in 1972 [1-2]. The uptake in equine
clinical practice was relatively slow, until an upsurge in ET in Argentina during the 1990s, primarily because
of the increasing commercial demand for high-goal Polo Pony horses, combined with a shift from non-sur-
gical to surgical transfer [3-4]. Since then, ET has become the most popular assisted reproductive tech-
nique (ART) in the horse. During the current decade, the ET industry is shifting towards the use of in vitro
produced embryos, especially in sport horse breeds, owing to the increase in the efficiency of OPU-ICSI:
an ART capable of producing several embryos per session with the use of a very small amount of sperm.
Furthermore, this technique allows the successful cryopreservation of embryos which results in a more ef-
ficient management of recipient mares and marketing of embryos worldwide [5]. The most relevant factors
involved in the success of this technique are: 1) the number of recovered oocytes per session, 2) the donor
mare (individual variation) and 3) the ICSI lab’s experience [5]. Regarding the production and collection of
in vivo derived embryos, the quality of sperm, age of donor’s mare, and the operator’s experience and flush-
ing technique [6] appear to be the main factors that influence embryo recovery rates. Furthermore, several
studies have shown a beneficial effect of the length of estrus on both embryo recovery (donor mares) [7]
and post-transfer pregnancy rates (recipient mares) [8]. The correlation between length of estrus and fer-
tility appears to be related to the development of a more receptive endometrial environment for embryo
survival. Advances in the cryopreservation techniques of in vivo derived blastocysts seem to have overcome
the dogma about unsuccessful pregnancy results following cryopreservation of embryos >300 μm. These
advances are: 1) the collapse and aspiration of blastocysts by micromanipulation prior to cryopreservation
[9]; and 2) the use of a new vitrification technique that allows successful cryopreservation of blastocysts
of up to 500 μm without the need of previous collapse [10]. Finally, the development and refinement of re-
combinant equine FSH (reFSH) has produced an apparently practical and consistent solution to the lifelong
quest for super-ovulation in donor mares [11]: Treatment of deep anestrous mares with 1.3 mg of reFSH
once daily for 7 days resulted in the mean ovulation and recovery of 5.5 follicles and 2.6 embryos per mare,
respectively. However, this product is yet to become commercially available. The selection of suitable recip-
ient mares and the technique of ET are key points to the success of a commercial embryo transfer program.
While the transfer of in vivo derived embryos allows a wider window of donor-recipient asynchrony without
compromising pregnancy rates (recipients may ovulate between 1 day before and up to 4 days after the
donor mare without differences in pregnancy rates), the optimal window for in vitro produced embryos is
much shorter (i.e. 24 to 36 h), obtaining best results from transfers to Day 4 recipients [12]. A recent study,
contrary to previous belief, has shown that the vascularization of the CL of the recipient mare, as deter-
mined by doppler ultrasonography, at the time of transfer is positively correlated with pregnancy [13]. Finally,
the transfer of embryos with the aid of a speculum and cervical forceps, as described by Wilsher and Allen
in 2004, has recently shown to consistently improve post-transfer pregnancy rates and reduce variation in
pregnancy results amongst operators, compared with the traditional manual technique [14].
Bibliography
• Oguri N, Tsuts umi Y. Non-surgical recovery of equine eggs, and an attempt at non-surgical egg trans-
fer in horses. J Reprod Fertil 1972;31:187–95.
• Allen WR, Rowson LEA. Transfer of ova between horses and donkeys. In: Proceedings 7th ICAR and
AI. Munich, 1972:484–7.
• Pashen RL, Lascombes FA, Darrow MD. The application of embryo transfer to polo ponies in Argenti-
na. Equine Vet J Suppl 1993;15:119–21.
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• Riera FL, Mcdonough J. Commercial embryo transfer in polo ponies in Argentina. Equine Vet J Suppl
1993;25:116–8.
• Cuervo-Arango J, Claes AN, Stout TAE. A retrospective comparison of the efficiency of different as-
sisted reproductive techniques in the horse, emphasizing the impact of maternal age. Theriogenology
2019, 132:36-44.
• Sala-Ayala L, Martínez-Boví R, Arnal-Arnal G, Querol-Paajanen A, Plaza-Dávila M, Cuervo-Arango J.
Effect of embryo flushing technique, number of flushing attempt and previous experience of operator
on embryo recovery in mares. J Equine Vet Sci 2023;125: 104.
• Pietrani M, Losinno L, Cuervo-Arango J. Effect of the interval from prostaglandin F2alpha treatment to
ovulation on reproductive efficiency rates in a commercial equine embryo transfer program. J Equine
Vet Sci 2019, 78:123-6.
• Cuervo-Arango J, Claes AN, Ruijter-Villani M, Stout TA. Likelihood of pregnancy after embryo transfer
is reduced in recipient mares with a short preceding oestrus. Equine Vet J 2018, 50:386-90.
• Hinrichs K. Advances in holding and cryopreservation of equine oocytes and embryos. J Equine Vet
Sci 2020; 89:102990.
• Wilsher S, Rigali F, Couto G, Camargo S, Allen WR. Vitrification of equine expanded blastocysts fol-
lowing puncture with or without aspiration of the blastocoele fluid. Equine Vet J 2019;51(4):500-505.
• Roser JF, Etcharren MV, Miragaya MH, Mutto A, Colgin M, Losinno L, Ross PJ. Superovulation, embryo
recovery, and pregnancy rates from seasonally anovulatory donor mares treated with recombinant
equine FSH (reFSH). Theriogenology 2020;142:291-295.
• Cuervo-Arango J, Claes AN, Stout TAE. In vitro-produced horse embryos exhibit a very narrow win-
dow of acceptable recipient mare uterine synchrony compared with in vivo-derived embryos. Reprod
Fertil Dev 2019; 31:1904-1911.
• G Morelli, Gilberto G Lourenço, Vinicius ‘ R Marangon, Isabella R Feltrin, Thaís S.I. Oshiro, Guilherme
Pugliesi. Doppler ultrasonography: an improvement in real-time recipient selection in equine ET pro-
grams. J Equine Vet Sci 2023;125:104665.
• Cuervo-Arango J, Claes AN, Stout TA. Effect of embryo transfer technique on the likelihood of preg-
nancy in the mare: a comparison of conventional and Wilsher’s forceps-assisted transfer. Vet Rec
2018; 183:323.
Juan graduated in Veterinary Medicine in Murcia (Spain) in 2003, and did his MSc in Equine Science in the
University of Edinburgh (Scotland) in 2006. He completed his Residency in Large Animals Theriogenology
in the Royal Veterinary College (University of London, 2008) under the co-supervision of Prof. John R. New-
combe, and became a Diplomate of the European College of Animal Reproduction (Dipl. ECAR, Equine) in
2009. Finalized his PhD in 2010 in the University of Helsinki supervised by Prof. Terttu Katila. Juan worked as
Assistant Professor in Equine Reproduction at the Faculty of Veterinary Medicine, Universidad UCH-CEU in
Valencia, Spain (2010 to 2016) and in the Veterinary School of Utrecht University, The Netherlands from 2016
to 2019. During his time in academia, he completed several research placements in different laboratories over
the world working with Prof. Terttu Katila (Helsinki, Finland), Prof. O.J. Ginther (Wisconsin, USA) and Prof.
Luis Losinno and Javier Aguilar (Rio Cuarto, Argentina). After his time in The Netherlands, he worked as stud
veterinarian during two breeding seasons in Australia and Sweden. Currently he is working again as Assistant
Professor in Facultad de Veterinaria, Universidad CEU Cardenal Herrera, in Spain. His research and clinical
interests are breeding management of mares, anovulatory disorders, induction of ovulation, ultrasonography
of the corpus luteum, embryo transfer and ovum pick-up in mares, amongst others. He has published over 60
articles on equine reproduction in international indexed JCR journals and lectured in numerous international
congresses on equine reproduction over the world.
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2023
Ovulation induction and failure in mares: What’s new?

Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia (Spain)
Human chorionic gonadotropin (hCG) is still the most used ovulation induction drug in the mare, at least
in Europe. Doses of 750 to 3000 IU (administered subcutaneously, intramuscularly, and intravenously) have
been proven to be successful at inducing ovulation within 48 h of treatment. However, it is well known
that its efficacy decreases after the second treatment when administered in the same mare and season,
due to the development of antibodies against hCG. In some mares, these antibodies may last for several
years. Therefore, some studies have reported a reduction in the ovulatory response to hCG in aged mares
(i.e. > 10 years old). As a result, the use of GnRH agonists has become popular as an alternative to hCG to
induce ovulation in the mare. Several compounds of different potency, formulations and doses have been
tried successfully in the mare for induction of ovulation. Deslorelin, buserelin, and histrelin have been used
successfully as single treatment and are commercially available (either licenced for horses or humans) to
induce ovulation in mares. Most recently, tripterolin has been shown to induce ovulation in mares as ef-
ficaciously as hCG or buserelin. The efficacy of GnRH agonists in inducing ovulation is reduced in spring
transitional mares, as the LH pituitary reserves are low in non-cyclic mares. Therefore, in transitional mares,
a combination of hCG and a GnRH agonist may be used to improve timely ovulation induction. In cyclic
mares, higher doses of GnRH agonists are often needed when the drug is produced in a slow-release
(long-acting) formulation (i.e. >1.25 mg per treatment; for example Ovuplant®: 2.1 mg; Sucromate®: 1.8 mg;
BioRelease®> 1.25 mg, etc.). On the other hand, GnRH agonists formulated in saline or aqueous excipients
can induce ovulation at a much lower dose. Buserelin (Suprefact®) at a dose as low as 125 μg (0.125 mg) in
single treatment induced ovulation within 48 h in 85% of treated mares [1]. Although there have not been
direct comparisons between hCG, GnRH agonists in aqueous and in slow-release formulations, it appears
that hCG and GnRH agonists in aqueous solutions induce a slightly lower ovulatory response within 48 h
when treated in a random population of mares (breeding stud, and varies between 78 and 90%) compared
to slow-release formulations of GnRH agonists (deslorelin) which report ovulatory responses within 48 h
from 87 to 93%, despite earlier start of treatment (i.e. follicular diameter at induction of ≥30 mm in diameter).
However, the latter compounds are usually not available in many countries and their cost is high compared
with hCG and other GnRH agonists licenced for humans (in aqueous formulations). Nevertheless, following
the use of ovulatory induction drugs in mares, ovulatory failure or delayed ovulation are relatively common
and frustrating outcomes. It is important to differentiate amongst these two outcomes, as the mechanisms
underlying the causes are completely different. In the first place, and the most likely outcome, is the de-
layed ovulation. In this case, the ovulation induction drug is administered in what is believed to be the right
moment: a growing dominant follicle of 35 mm or larger in diameter, from an estrous mare with obvious
endometrial edema. However, the mare does not ovulate within the expected time frame after induction
(36 to 48 h). On the contrary, the follicle continues to grow, and the endometrial edema remains similar or
increases in intensity for an extra 24 to 96 h, before the follicle finally ovulates. This represents typically a
7 to 20% of induced cycles in cyclic mares, and the main reason for this is that the mare was too far from
spontaneous ovulation to respond to the ovulatory drug, despite having a follicle size of what is considered
enough to respond (and most mares would) to the ovulatory induction drug. The statistical analyses of large
data sets of mares that did not respond to the ovulatory induction drug in a timely manner often show that
the single most relevant factor was the follicle diameter at the time of induction (significantly lower diameter
compared to that of responding mares). The percentage of delayed ovulations is significantly increased in
transitional mares, before the first ovulation of the breeding season, owing to the reduced LH reserve of the
pituitary in spring transitional mares. The second possible outcome is a true ovulatory failure, and this has
two possible presentations. In the first presentation, the leading follicle on which the drug was administered
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Proceedings
2023
and intended to induce ovulation, does not ovulate but undergoes atresia or “follicle regression”. These fol-
licles are more commonly found in a) spring transition, b) mares with two major follicular waves (diestrous
follicles), and less frequently c) in post-partum mares which after producing a dominant sized follicle during
the foal heat, enter a temporary anestrous phase in which the follicle remains static or regresses. On such
occasions, the regressing follicles do not luteinize despite showing a varying number of echoic specks with-
in the antrum, and the mare feels anestrous on rectal palpation unless it has a CL (option b). The second
presentation to a true ovulatory failure, is the development of a hemorrgahic anovulatory follicle (HAF), in
which the oocyte is not released, and fertilization is not possible. This may occur in up to 5-8% of all cycles,
with an increased incidence during the months of the peak breeding season (June-July in the N.H.). In fact,
the ovulatory drugs function well, as the HAF cycles has the similar LH and estradiol hormonal patterns as
ovulatory cycles. The HAF luteinizes and functions as a CL, producing progesterone, and therefore the mare
enters a standard period of diestrus (13 to 16 days), after which the HAF regresses and the mare comes
back in heat and a new dominant follicle can be induced. The aetiology of HAF still remains unknown.
However, in an experimental model, they were reverted to ovulatory follicles by intrafollicular administration
of PGE2 and PGF2α .
Juan graduated in Veterinary Medicine in Murcia (Spain) in 2003, and did his MSc in Equine Science in the
University of Edinburgh (Scotland) in 2006. He completed his Residency in Large Animals Theriogenology
in the Royal Veterinary College (University of London, 2008) under the co-supervision of Prof. John R. New-
combe, and became a Diplomate of the European College of Animal Reproduction (Dipl. ECAR, Equine) in
2009. Finalized his PhD in 2010 in the University of Helsinki supervised by Prof. Terttu Katila. Juan worked as
Assistant Professor in Equine Reproduction at the Faculty of Veterinary Medicine, Universidad UCH-CEU in
Valencia, Spain (2010 to 2016) and in the Veterinary School of Utrecht University, The Netherlands from 2016
to 2019. During his time in academia, he completed several research placements in different laboratories over
the world working with Prof. Terttu Katila (Helsinki, Finland), Prof. O.J. Ginther (Wisconsin, USA) and Prof. Luis
Losinno and Javier Aguilar (Rio Cuarto, Argentina). After his time in The Netherlands, he worked as stud vet-
erinarian during two breeding seasons in Australia and Sweden. Currently he is working again as Assistant
Professor in Facultad de Veterinaria, Universidad CEU Cardenal Herrera, in Spain. His research and clinical
interests are breeding management of mares, anovulatory disorders, induction of ovulation, ultrasonography
of the corpus luteum, embryo transfer and ovum pick-up in mares, amongst others. He has published over 60
articles on equine reproduction in international indexed JCR journals and lectured in numerous international
congresses on equine reproduction over the world.
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Proceedings
2023
Real World Approaches to ART in Practice

Ghislaine Dujovne, DVM, MS, Diplomate ACT
Associate Professor University of California Davis
Several Artificial Reproductive Technologies (ART) have been used in horses for a few decades, starting
with artificial insemination and progressing to embryo transfer, in-vitro produced embryos, and cloning.
Currently artificial insemination is the most common ART used for breeding horses (except for thorough-
breds) and embryo flushing and transfer is the most common way to obtain more than one offspring per
mare per season.
During the last 5 years, with the increase in success rates of in vitro fertilization using ICSI (Intracytoplas-
mic sperm injection) there has been a significant expansion in the use of aspiration of immature oocytes
for in vitro embryo production for commercial purposes. This procedure is called TVA (Transvaginal As-
piration) or OPU (ovum pick-up) and recently this practice is getting more and more common, switching
from being performed exclusively at specialized centers to becoming available for practitioners in the field.
The TVA of oocytes is performed with mares restrained in stocks, standing and under sedation (usually
with a combination of detomidine and butorphanol). The procedure requires the use of a transvaginal ul-
trasound probe with a needle guide, a tubing system, and a pump. Usually, 2 practitioners will be on the
back of the mare; one with the arm in the rectum fixing the ovaries and the other one manipulating the
needle to puncture and scrape the follicles. A third person will be infusing the flush media into the follicles.
For the procedure to be safe and successful a high level of communication and coordination between all
the team members is required. Each follicle is aspirated and flushed several times (6-10) to be able to ob-
tain the oocyte. The procedure is repeated for every follicle visible on ultrasound.
Not every follicle will yield an oocyte. The reported recovery rate of oocytes on TVA varies from 10-30%
at the beginning of the learning process to over 50-60% in practices with more experience. The recovery
rate can be influenced by individual mare, breed, age and size of the follicles. There is a learning curve for
this procedure; practitioners that are new to it start with low recoveries and success significantly increases
with practice. Some colleagues suggest that a minimum of 100 aspirations are needed to become suc-
cessful and confident with TVA.
This procedure is usually very safe but severe complications such as hemorrhage, abscesses, or rectal
tears have been reported in a few occasions.
The TVA is more invasive than a traditional embryo transfer and there is an expected level of inflammation
in the mares after the procedure, particularly detectable using abdominocentesis that may be subclinical
or clinically evident. Clinical signs of pain or discomfort in the first 24hrs are not uncommon.
The number of oocytes obtained per procedure is highly variable but reports show an average 5-13 oo-
cytes per aspiration. There are many factors affecting successful embryo production and one of the most
important is the number of oocytes obtained in the aspiration, different reports show an average of 0.6-2
blastocysts per aspiration. The team at Utrecht University reported that one or more blastocyst will be
obtained in 78% of the aspirations.
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2023
Most embryos are frozen or vitrified without a significant loss in viability, this is an advantage of in-vitro
embryo production (IVEP)when compared with in vivo produced embryos.
The success rate for pregnancy has been reported to be between 70-78%, but some of those pregnancies
will be lost before foaling (approximately 15%). Based on reported success rates, an in vitro produced em-
bryo will generate a foal 50-60% of the time (Claes and Stout 2020).
An important benefit of in vitro produced embryos is that of time efficiency; TVA/ICSI is a quick procedure
and doesn’t require the cycle of the mares to be monitored. Additionally, the procedure can be performed
year-round and beyond the breeding season.
In vitro production of embryos is becoming the most important way to produce foals out of mares with
severe fertility issues (chronic infections, incompetent cervix or infertility of unknown origin) or very busy
performance schedule. This technique also provides the opportunity to generate embryos from stallions
with very low availability of sperm (low quality or deceased stallions). With the growth trend of these
procedures, probably IVEP will be soon the most common way to obtain multiple embryos per year from
the same mare.
Ghislaine Dujovne
Dr Ghislaine Dujovne is originally from Chile she graduated from Universidad de Chile in 2004, after gradu-
ation she did a year advance training in Animal Reproduction with Equine emphasis at the same institution.
After working in private practice for 4 years, mostly in thoroughbred breeding industry she moved to the US
to perform a Residency in Equine Reproduction and a Master of Science at Auburn University in Alabama.
She obtained her American College of Theriogenologist diplomat status in 2010 and stayed as a lecturer in
Auburn University before moving to California. Dr Dujovne works at University of California Davis since 2012
as Associate Professor in Equine Theriogenologist. Her work is mostly clinical in combination with applied
research in Mare subfertility and Advanced reproductive technologies. Her daily work is focused in equine
reproduction clinical cases at the Veterinary Teaching Hospital, UC Davis; teaching veterinary students and
training Theriogenology Residents to become specialists.
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Proceedings
2023
How to recognize and manage the high-risk pregnancy

mare
Juan C Samper DVM, PhD. Diplomate ACT
School of Vet. Med. Texas A&M University
Introduction
The early diagnosis of a pregnancy that is in jeopardy could be a challenging issue for veterinarians. There
are many conditions that could put the pregnancy of the mare at risk, particularly during the last trimester
of pregnancy.
Mares could become high risk of carrying a foal to term either because they have medical/reproductive
issues at the time of breeding that can be exacerbated during the pregnancy, or because they develop
medical conditions during the gestation. Examples of pre-existing conditions include metabolic syndrome,
osteo-arthritis, metabolic syndrome and poor perineal conformation/uterine health. Examples of condi-
tions that may develop as gestation advances include Undiagnosed twins, placental infection, excessive
abdominal distention, abdominal or Musculo-skeletal pain. Some of these although not directly related to
the reproductive tract can put the mare and/or the fetus at risk.
Conditions causing the risk of the mare or the fetus
It is important particularly for mares with a history of reproductive problems to monitor the pregnancy on
a regular basis. Things that should be evaluated include the placental thickness, the nature of the allantoic
and of amniotic fluid and the viability of the fetus gauge through the fetal heart rate. It is not uncommon for
mares with history of previous pregnancy losses to be maintained on a progestagen such as altrenogest
for prolonged period of periods of time. Failure to monitor mirrors that are on prolonged therapies can
result in the death of the fetus with a consequent mummification or maceration.
Poor perineal confirmation coupled with poor breeding management could result in seeding the vagina
or the cervix with bacteria that could colonize the pregnant uterus and the placenta provoking a placental
infection jeopardizing the viability of the fetus.
Hydropic conditions such as hydro-allantois or hydro amnion Our conditions that have a sudden onset of
large abdominal distension with the mere slightly painful and on the rectal exam it is difficult to identify the
foal due to the large volume of fluid and the tightness of the uterus. Depending on the length of gestation
it is often recommended to induce abortion.
Colic in the late term pregnant mare could be challenging because of the size of the uterus occupying a
large portion of the abdominal cavity. Clinical signs become a critical part of making a diagnosis. Colleague
of gastrointestinal origin we’ll have a mayor with moderate to severe pain. Oftentimes the rectal exam could
be difficult and other signs such as fecal production and gastrointestinal motility become hallmarks for the
diagnosis. Uterine torsion is another important differential in colic. However, these mares often will present
with low grade pain of prolonged duration That most of the time is refractory to painkillers. Rectal exam is
the most important procedure for diagnosis.
Musculoskeletal problems include weakening of the ventral abdominal musculature With the develop-
ment of herniation or pre pubic tendon rupture. Treatment for these conditions include pain management
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2023
and support of the ventral abdominal musculature. In addition these mares should be considered candi-
dates for following induction. Depending on the situation the reproductive future of these mares is likely to
be limited to assisted reproductive technologies such as embryo transfer.
Osteoarthritic conditions, or soft tissue problems of the feet and legs could also represent a problem for
late term pregnant mares. As the fetus increases in size and the mare becomes heavier, chronic pain could
become an issue. Orthopedic management as well as pain management become an important part for a
good prognosis.
Often owners as well as veterinarians are concerned because of excessively prolonged gestations in mares.
In the southern United States it is common that mares that have been fed fescue gras contaminated with
the fungus Acremonium Coenophialum will have a low prolactin level particularly in the last trimester of
pregnancy making these mares delay the readiness for birth. As a consequence, these mares often will
have a thickened placenta and weak foals that often ha foals are week. Other reasons why mares could
have prolonged gestations include uterine fibrosis reducing utero-placental contact, time of breeding and
a sire effect.
Summary
In summary, there are several conditions that can put the health of the mare and or the fetus at risk. Con-
sequently the veterinarian must be vigilant to the sudden a d sublte changes that could indicate possible
problems. Early detection becomes paramount in order to be able to support both mare and fetus in order
to carry a pregnancy to term. Veterinarians attending high risk mares must always keep in mind that high
risk mares may have a higher incidence or be prone to dystocia. In addition foals born from high risk mares
even though they might appear healthy in the first few hours of life, need to be observed closely to insure
that they normal.

Additional Reading
S Bucca Diagnosis of the compromised equine pregnancy Vet. Clinics NA Equine Practice, 2006
MHT Troedsson High risk pregnant mare Acta Veterinaria Scandinavica, 2007
CD Renaudin, MHT Troedsson, CL Gillis, VL King Ultrasonographic evaluation of the equine placenta by
transrectal and transabdominal approach in the normal pregnant mare. Theriogenology, 1997
A Tibary, LK Pearson - Mare problems in the last month of pregnancy. Proc. of the 58th AAEP Convention
2012
Juan C. Samper, DVM, MSc, PhD, Diplomate ACT

Professor, Lecturer, & Research Associate
Department of Large Animal Clinical Sciences
Dr. Juan C. Samper is a visiting professor of equine theriogenology in the Department of Large Animal Clini-
cal Sciences (VLCS) at the Texas A&M School of Veterinary Medicine & Biomedical Sciences (VMBS). He is a
world-renowned equine theriogenologist and is respected by students, staff, faculty, and clients throughout
the academic, equine, and veterinary industries.
He received his DVM from the National University in his native Colombia and went on to serve in private
practice before owning his own multi-veterinarian practice for more than 25 years. He received a Masters
and PhD from the University of Minnesota and has served in several faculty and administrative positions at
colleges of veterinary medicine in the U.S., Canada, and the Caribbean, mentoring numerous future veteri-
narians and graduate students.
He has published several peer-reviewed manuscripts on numerous topics related to equine reproduction
and is the author of two editions of Equine Breeding Management and Artificial Insemination and a co-au-
thor of Current Therapy in Equine Reproduction. He was recently appointed as a specialty chief editor for
the Animal Science – Theriogenology section of Frontiers in Veterinary Science.
Dr. Samper’s current research focuses on the implementation of sexed stallion semen in the equine industry.
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2023
Update on Placentitis
Karen Wolfsdorf, DVM, DACT
Hagyard Equine Medical Institute
Lexington, KY 40511
A recent report estimated that the proportion of annual lost pregnancies in Thoroughbred mares ranges
from 7.9% to 15.2% in the UK, Ireland, and Kentucky. MaCleay et al, showed that the most common causes
of pregnancy loss world-wide from 1960-2020 include EHV-1, placentitis, leptospirosis, twining, congeni-
tal abnormalities, EHV-4, umbilical cord torsion and equine amnionitis/mare reproductive loss syndrome.
Therefore, if reproductive problems that arise during gestation, especially placentitis are diagnosed early,
and treated appropriately fetal viability may increase, producing a live foal.
Placentitis accounts for 20% of reproductive failures in Kentucky verses 9.8% in the United Kingdom.
There are three different categories by which placentitis can be defined depending on where bacteria gain
access to the fetus: ascending, focal mucoid, and hematogenous. Although bacteria such as S. Zooepi-
demicus, E. Coli, Pseudomonas Pasteurella, Crosiella Equi, Amycolatopsis and Aspergillus spp. have been
the norm, new bacteria are being identified such as Mycobacterium spp. Cellulosimicrobium cellulans,
Pantoea agglomerans, Stenotrophomonas maltophilia.
Mares that may be considered high risk for pregnancy loss or placentitis can undergo, monitoring of the
utero-placental and fetal units by screening monthly with transrectal and transabdominal ultrasonogra-
phy, with measurement of hormone and inflammatory biomarkers so early detection of abnormalities is
possible. Trans-rectal ultrasonographic evaluation of the caudal reproductive allows determination of fetal
presentation, combined utero-placental thickness at the cervical star, orbital diameter, umbilical chord
and blood flow of the fetus. Integrity of the utero-placental unit at the cervical star region helps to identify
opening and measurements of the cervix, placental separation, placental or uterine edema or the pres-
ence of exudate. Qualitative and quantitative assessment of fetal fluids can be monitored by trans-rectal
ultrasonography. Fluids that have increased echodensity may have increased cellularity from infection or
inflammation and therefore should be re-evaluated. Bucca determined that measurement of the intra-cra-
nial blood flow impendence of the middle cerebral artery can also help identify a compromised fetus.
Trans-abdominal ultrasonography is useful in evaluating multiple fetuses, fetal growth, activity, mobility,
presentation, viability as well as placental abnormalities, fetal fluid volume and echogenicity. A rapid ex-
amination protocol (fetal heart rate, aortic diameter and CTUP) can be used or a more indepth evaluation
of heart rate and rhythm, fetal activity, size, stomach measurements, cervical pole and fetal fluid depth
can be done. Although placental thickening is difficult to interpret trans-abdominally, due to the stretch-
ing and contracture of the different regions of the pregnant uterus and fetal positioning, separation of the
chorioallantois from the endometrium and the presence of exudate as seen with mucoid or hematogenous
placentitis can be identified.
In the normal physiology of pregnancy, progesterone (P4) is synthesized by the ovaries until about 150
days of gestation. During the second half of pregnancy little if any P4 is present because it is rapidly
metabolized into progestagens. These progestagens increase gradually during the last few weeks prior
to parturition (>300 days) but decline within a few days or even hours of delivery. In the first trimester im-
pending abortion is preceded by declining or low P4 levels. However, fetal losses or premature deliveries
in late gestation, particularly those caused by placentitis are associated with high concentrations of total
progestagens in the maternal plasma. Ousey et al further demonstrated using gas chromatography-mass
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Proceedings
2023
spectrometry that progestagen profiles for mares with placentitis had increased P5 and/or P4 production
by the fetus, probably caused by chronic fetal stress, leading to increased metabolism and elevation of
several other progestagens. In mares with avillous placenta, placental edema, fetal distress (colic, uter-
ine torsion) production of progestagens was dramatically reduced indicating the importance of a healthy
feto-placental unit for progestagen formation and suggesting lack of functional placental. Care must be
taken when evaluating progestagen levels that it is known which progestagens cross-react with the par-
ticular laboratory assay and what the normal reference ranges are for that specific laboratory.
Although commercially only total serum estrogens from the mare can be assessed at this time, recent stud-
ies have looked at circulating concentrations of steroid hormones and AFP during ascending and mucoid
placentitis. Comparing serum concentrations of progestagens, estradiol-17β, the ratio of estradiol-17β to
progestagens, and AFP of mares with ascending placentitis to gestationally age-matched control mares,
there is a significant increase in progestagen and AFP noted in ascending placentitis in the weeks preced-
ing parturition. Additionally, a significant decrease in both estradiol-17β and the ratio of estradiol-17β to pro-
gesterone was noted in the diseased group when compared to controls. (Fedorka et al 2020/2021) Serum
Amyloid A(SAA) an acute phase protein has also been identified to be elevated in experimental placentitis
compared to normal pregnancies. (Canisso 2014, Russolillo 2023). It is important however to remember that
natural placentitis is potentially a slow progressive process verses experimental. A recent study in which
there were normal matched gestational aged mares, in pre-onset and early onset of ascending placentitis
found no differences between groups and timepoints for immunological and inflammatory parameters in-
cluding SAA and AFP. In hormonal assays no difference was found in plasma progestogen levels and es-
tradiol 17B/progestogen ratio. Plasma estradiol-17B concentrations approached significance. (Feijo 2023)
In an effort to identify the mechanisms by which to treat placentitis, Fedorka et al, identified pro and an-
ti-inflammatory cytokines within the different compartments of the fetal placental unit and serum of the
mare. Tissues in contact with the cervical migration of bacteria (endometrium and chorioallantois) experi-
ence a pro-inflammatory response (IL-1β, IL-8). The fetus then produces pro- (IL-1β, GRO), anti- (IL-10), and
inflammatory-modulating (IL-6) cytokines that are excreted into the amniotic fluid. These cytokines then
signal to the mare that the fetus is active and return through either diffusion across the fetal membranes
(amnioallantois) and allantoic fluid, or via umbilical blood. Using this work further studies from the University
of Kentucky Gluck Equine Research Center (UKGRC) have assessed genomics, transcriptomics and pro-
teomics in normal pregnancy as well as in pregnancies affected by placentitis. They have determined that
three primary events occur in equine placentitis that prompt preterm delivery of the neonate: Myometrial
activation – induced by inflammation, cervical ripening and placental separation and rupture (El-Sheikh
2021). Therefore, while control of bacterial infection is a primary approach to treatment of placentitis, in-
flammatory modulation is essential to disease management.
Systemic treatment can include antimicrobials, exogenous progestagens, estradiol 17B/Estradiol cypio-
nate, anti-inflammatories, and rheostatic agents. Specific antibiotics have been documented as crossing
the placenta and achieving therapeutic values in the fetus and fetal fluids. These include; Penicillin, Gen-
tocin, Trimethoprim Sulfadiazine, most recently Doxycycline, and Enrofloxacin. (Canisso 2023) Further
long-term studies using Enrofloxacin need to be performed to determine the long-term effects in foals
past 30 days of age. Monthly antibiotic treatment has been suggested for the prevention of focal mucoid
placentitis, however in a retrospective study Fedorka et al concluded that administration of prophylactic
antimicrobials or altrenogest throughout gestation did NOT decrease the risk of disease or improve neo-
natal outcomes.
Anti-inflammatories used consists of Flunixin Meglamine and Firocoxib. A combination of Firocoxib,

trimethroprim sulfamethoxazole and altrenogest improved foal survival after administration to mares with
experimentally induced placentitis. (Burden 2023) Pentoxifylline was identified in fetal fluids of normal
treated mares and mares with placentitis and has been used with antimicrobials and progestins to suc-
cessfully treat clinical disease. Acetylsalicyclic acid improves uterine and ovarian perfusion and increases
plasma progesterone concentration in nonpregnant mares and results indicate increased uterine blood
flow in mares during late pregnancy. (Sielhorst 2022) Therefore, it may be a good adjunct therapy for
perfusion and inflammation in placentitis. Finally adding estrogen (estradiol 17b or estradiol cypionate),
for short periods of time in clinically induced placentitis, showed foals to have increased birth weights.
(Curcio 2017) Further studies need to assess the feasible of continued long term use in chronic placentitis
and foaling rate.
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2023
New discoveries, such as the components of the normal placental microbiome, modifications of steroid’s
pathways such as DHEA and cortisol, options to interrupt the inflammatory pathways, combined with
modern technology available and affordable to the equine practitioner will hopefully aid in early diagnosis
and more successful treatment of placentitis.
Further Reading:
1. Bucca S, Sousa De Oliveira IR, Cunanan JC, Vinardell T, Troedsson MHT. Doppler indices of the
equine fetal carotid artery throughout gestation. Theriogenology 156 (2020) 196e204
2. Abraham M, Bauquier J. Causes of equine perinatal mortality. The Veterinary Journal 273 (2021)
105675
3. Canisso IF, Loux SC, Lima FS. Biomarkers for placental disease in mares. Theriogenology 150
(2020) 302e307
4. Fedorka CE, Ball BB, Walker OF, et al. Alterations of Circulating Biomarkers During Late Term
Pregnancy Complications in the Horse Part I: Cytokines. Journal of Equine Veterinary Science 99
(2021) 103425
5. Fedorka CE, Ball BB, Wynn MA et al. Alterations of Circulating Biomarkers During Late Term
Pregnancy Complications in the Horse Part II: Steroid Hormones and Alpha-Fetoprotein. Journal
of Equine Veterinary Science 99 (2021) 103395
6. Renaudin CD, Troedsson MHT, Gillis CL. Transrectal ultrasonographic evaluation of the normal
equine placenta. Equine Vet Educ. 1999: 11:75-6.
7. Ousey JC, Houghton E, Grainger L, Rossdale PD, Fowden AL. Progestagen profiles during the last
trimester of gestation in Thoroughbred mares with normal or compromised pregnancies. Ther-
iogenology. 2004:1844-1856.
8. Linhares Boakar Y. et al. Serum amyloid A, Serum Amyloid A1 and Haptoglobin in pregnant mares
and their fetuses after experimental induction of placentitis. An. Reprod. Sci (2021)229
9. Fedorka CE, Ball BB, Scoggins KE et al. The Fetal Maternal immune response to placentitis. An.
Repro. Sci (2021)229
10. Sielhorst J, Roggel-Buecker U, Neudeck KC, et al. Effect of Acetylsalicylic Acid on Uterine Blood
Flow, Gestation Length, Foal Birth Weight and Placental Weight in Pregnant Thoroughbred Mares
– A Clinical Pilot Study. J Eq Vet Sci (2022)118.
11. Van Heule M, Monteiro HF, Bazzazan A et al. Characterization of the equine placental microbial
population in healthy pregnancies. Therio (2023)206: 60e70
12. Russolillo J, Macpherson M, Pozor M et al. Comparison of serum amyloid A concentrations in
mares with experimentally induced placentitis to normal, pregnant mares using a commercially
available, stall-side device. J eq Vet Sci (2023) 125:212.
13. Burden CB, Macpherson M, Pozor M et al. Effects of Firocoxib, trimethoprim sulfamethoxazole
and altrenogest on inflammation and foal survival after administration to mares with experimen-
tally induced placentitis. J eq Vet Sci (2023) 125:230.
Karen Wolfsdorf DVM, Dipl. ACT
Dr. Wolfsdorf attended veterinary school at the University of Florida. She completed an equine field intern-
ship at North Carolina State University, followed by a theriogenology residency at University of Florida, be-
coming a diplomate of the American College of Theriogenology in 1995. Dr. Wolfsdorf is a shareholder , field
veterinarian and specialist at Hagyard Equine medical institute whose main focus is diagnosing and treating
the problem mare. She has authored or co-authored many publications and book chapters as well as lec-
tured at local, national and international meetings. Dr. Wolfsdorf is very involved in numerous organizations
and their boards benefiting the horse and equine reproduction.
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Proceedings
2023
Field solutions for dystocia management

James R. Crabtree BVM&S CertEM(StudMed) FRCVS.
Equine Reproductive Services (UK) Ltd. Trigger Castle, Malton, North Yorkshire, United Kingdom
Dystocia is encountered in approximately 10 % of births (McCue and Ferris 2012).. The approach to dystocia
in the field setting is governed by the level of experience of the attending clinician and assistance provid-
ed by mare owner or stud manager. If manipulation of the fetus (mutation) does not rapidly correct the
malposture one has to decide if delivery is to be attempted via a controlled vaginal delivery under general
anaesthesia, fetotomy, or refer for caesarean section. Many referral centres will have a dystocia manage-
ment protocol (Lynch Norton et al. 2007), designed to minimise the time from admission to foal delivery or
surgical incision, to maximise foal survival rates. In some cases economic and geographic considerations
mean that there is not an opportunity to refer and clients look to the attending clinician to resolve the situ-
ation one way or another.
One needs to quickly take control of the situation. A brief physical examination of the mare should be
performed to determine her physical status, followed by evaluation of the reproductive tract to identify the
problem and determine if the fetus is alive. Fetal viability is determined using limb withdrawal, ocular reflex,
swallowing reflex, heart beat, and anal reflex, however it is not always easy to determine conclusively that a
foal is dead. History should be taken from the attendees; when was she due, when was she last observed,
how long has she been foaling for, what actions have been taken, has the mare had any previous prob-
lems? In order to restrain the mare intravenous sedation may be indicated, the author prefers romifidine
(without butorphanol) for initial sedation and this is advantageous if the situation progresses to anaesthe-
sia however. Alpha2 agonist can be used in combination with butorphanol and/or acetylpromazine.
Assisted vaginal delivery
Any abnormal combination of the extremities, single limb, fore and hind limbs, three limbs, absence or pres-
ence only of the head indicates a maldisposition. The duration of the dystocia, state of the reproductive tract
and fetal viability will dictate what happens next. The ability to deal with these cases quickly lies not only in
experience with techniques but in the decision making process. It is important for the attending clinician to
ask themselves have they got the equipment and the expertise to deal with this within the next 15 minutes,
if not, does one need to have an alternate plan?
In order to even start the following obstetrical equipment should be available: Clean obstetrical chains (or
ropes) with handles: 2 x leg @ 1100mm; 1 x head @ 1400 to 2000mm, obstetrical lubricant and buckets,
clean stomach tube and pump, tail bandage.
Liberal application of lubrication around the fetus and within the uterus will greatly aid in fetal repositioning
and subsequent extraction. Once the fetus has been correctly aligned traction can be applied, as a general
rule the force applied to should not exceed that which can be applied by two people; excess force inevitably
leads to damage to the reproductive tract of the mare and potentially to the foetus. Traction is best applied
along with straining of the mare, alternate-limb traction (up to 10 cm) applied until both forelimbs extended
and then simultaneous traction applied to extract the chest, minimises the force required. The use of a head
rope will spread the tractional forces between the extremities and offers a significant advantage in tight
situations. Ideally two assistants will apply traction under direction of the clinician allowing them to have
hands free to monitor progress of the delivery. Traction should be applied in a downward direction and if
the mare is recumbent this can be applied towards or between the mare’s hind legs resulting in flexion of
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2023
the fetal spine which is advantageous when the fetal hindquarters engage. Rocking of the fetus from side
to side can aid extraction.
Controlled vaginal delivery
If the foal is viable and assisted vaginal delivery is not possible one could consider a controlled vaginal de-
livery under GA, however beware maldispositions such as anterior ventro-vertical with bilateral hip flexion
(dog-sitter), posterior bilateral hip flexion (breech) and transverse presentations (ventro- or dorso-trans-
verse), as they can be extremely difficult if not impossible to correct even with the benefits of anaesthesia.
The author induces anaesthesia using ketamine and diazepam and has top-ups of ketamine and romifidine
available as required. Skilled assistance in such situations is extremely valuable so if professional assistance
is available, it should be called for. Elevation of the hind limbs during anaesthesia can be advantageous to
increase the space available in the caudal abdominal cavity enabling the clinician to repel fetal parts to
correct a maldisposition and align the fetus.
Fetotomy
Fetotomy can be an extremely valuable procedure that can avoid the need for prolonged manipulations or
caesarean section. In the hands of a clinician experienced in the technique, mare survival and future fer-
tility can be better than cesarean section. However in inexperienced hands it has the potential to damage
a mare, compromising future fertility or put the mare’s life at risk. Although one may find oneself requiring
the technique as a last resort, for the best outcome for the mare the decision to perform a fetotomy should
be made as early as possible. If fetotomy is to be in the clinicians ‘toolkit’ one should make a plan in ad-
vance as specialised equipment is essential for anything but the simplest of cuts.
I would like to take this opportunity to thank my sponsors, without whose support I would not have been
able to present at the conference. With many thanks to BOVA Specials UK Ltd, MSD Animal Health UK &
Equine Reproductive Services (UK) Limited.
Bibliography
McCue, P. M. and Ferris, R. A. (2012) Parturition, dystocia and foal survival: a retrospective study of 1047
births. Equine Veterinary Journal Suppl. 44, Supp 41, 22-25.
https://doi.org/10.1111/j.2042-3306.2011.00476.x
Lynch Norton, J., Dallas, B. L., Johnston, J. K., Palmer, J. E., Sertich, P. L., Boston, R. and Wilkins, P. A.
(2007) Retrospective study of dystocia in mares at a referral hospital. Equine Veterinary Journal. 39, 37-
41.
https://doi.org/10.2746/042516407X165414
James graduated from the Royal (Dick) School of Veterinary Studies, Edinburgh in 2001. After four years in
mixed practice he travelled between the hemispheres working for a number of years in specialist stud prac-
tice in the UK, Australia and New Zealand. In 2010 he was awarded the RCVS certificate in Equine Stud Med-
icine and in 2011 became a lecturer at Liverpool University examining the stud medicine certificate since 2012.
James has published work on many topics relevant to clinical practitioners including material on breeding
soundness evaluation, infectious disease, peri-partum problems, ovarian abnormalities, oestrus suppression,
persistent endometrial cups, management of spring transition and twin pregnancy. James continues to per-
form and publish practice based research and collaborates widely. In 2013, he became director of Equine
Reproductive Services (UK) Limited growing and developing a busy first opinion and referral equine practice
in Yorkshire. James is recognised as an Advanced Practitioner in Equine Stud Medicine, he is a current BEVA
council member and trustee of the International Equine Reproduction Trust.
James has made a sustained and significant contribution to veterinary professional development with formal
and informal teaching and assessment of post graduates. James has organised and delivered many CPD
courses and congresses in the UK and Europe and has delivered presentations on material ranging from
basic to advanced topics around the World. In 2022, his efforts were recognised by the Royal College of
Veterinary Surgeons who awarded James with a Fellowship for meritorious contributions to clinical practice.
If you require a different style of biography or photograph please do not hesitate to let me know.
24
Proceedings
2023
Retained placenta in the mare: An Up-Date

Karen Wolfsdorf DVM DACT
Hagyard Equine Medical Institute
Lexington KY
In the mare placental separation from the endometrium occurs during third stage of labor. Postpartum
uterine contractions along with the decreased blood supply from the fetal placental vessels and endome-
trium allow maternal crypts to relax and the chorionic villi to shrink. The progression of the chorioallantois
into the vaginal vault through the cervix stimulates continued release of oxytocin and placental delivery.
The cause of a retained placenta is unclear. However, it is the most common postpartum complication with
an incidence of 2-10.5%. A higher incidence has been reported in draft mares, increased age, prolonged
gestation, hydrops, abortion, stillbirth, twinning, dystocia, placentitis and cesarean sections. A placenta
is generally considered “retained” if it is still attached to the endometrium 3 hours after parturition. The
non-pregnant horn is more commonly retained than the edematous pregnant horn, however the amount
retained can be variable from a small piece to the entire membrane. Devitalized and autolyzed tissue,
together with delayed uterine involution, provide a suitable environment for bacterial growth. Increased
nitric oxide production during the inflammatory process decreases uterine contractility so debris, bacteria,
endotoxins and inflammatory byproducts are not expelled, allowing translocation of bacteria or endotoxin
into the systemic circulation resulting in life-threatening endotoxemia, septicemia, laminitis and death.
Early identification and treatment are therefore essential.
Clinical signs:
The fetal membranes may be either visible and partly expelled, or completely contained in the uterus.
Commonly, the mare becomes pyretic, depressed, and anorexic with an exudative discharge from her
vulva lips if the retained placenta is not identified promptly. With continued uterine contractions or invag-
ination of a uterine horn, signs of mild colic may also ensue.
Diagnosis:
Examination of the placenta soon after expulsion is imperative to determine if the placenta is complete and
initiation of therapy is needed. Examination of the chorionic and allantoic surface by placing the placenta
in a “F” shaped pattern allows for the body and both horns including the tips (identified by the avillus area
of the oviductal opening) to be examined in the entirety. One of the most common types of retention is
when a small piece of the chorio-allantois remains attached within the non-pregnant horn after tearing
and expulsion of the detached portion. If gross examination of the placenta lacks a horn or is shredded
examination of the uterus is imperative.
Transrectal ultrasound examination after delivery or abortion, can sometimes aid in the visualization of the
placenta as a mass of tissue within the uterus. However, this can be difficult if uterine involution leaves
little or no fluid outlining the tissue within the lumen. Most retained placentas are best felt and identified
during manual uterine examination. If the tip however is retained and the uterus is still very big, this may
not be possible as it can be difficult to traverse the entire horn and palpation only possible to the bifurca-
tion of the uterus. Fetid thick fluid or exudate may be an indicator that placenta is still present. If there is
any uncertainty in the completeness of the placenta, a uterine lavage should be performed, as the retained
piece may become lodged in the tip of the tube. Culture of the uterine contents prior to lavage allows for
specific bacteria to be isolated and sensitivity patterns assessed. Trans-abdominal ultrasonography can
also aid in detecting the presence of retained placenta, again more easily if intra-luminal fluid is present.
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Treatment:
The uterus during parturition is naturally contaminated with bacteria, therefore after eight hours of reten-
tion with autolyzing retained fetal membranes an environment is produced that is conducive to exponen-
tial bacteria growth. The increased number of bacteria and inflammatory products can produce a metritis
allowing absorption of bacteria and toxins causing septicemia, endotoxemia and laminitis. Initial therapy
should focus on removing the nidus of bacteria (the retained placenta) as well as the endotoxin producing
bacteria. In the author’s opinion a good initial therapy is to use Oxytocin, 10-20 IU every 15 minutes until
placental release or for a maximum of three treatments, if treated within the first 3-8 hours. Most placen-
tas will release after the first two doses, and minimal additional treatment may be necessary. Different
regimens of oxytocin may be used including addition to 1-5 liters of saline + / - calcium borogluconate as
a drip (care must be taken because oxytocin seems to accumulate at the bottom and signs of colic may
be evident as the fluids are finished). Pulling on the membranes is not recommended if they are firmly
attached, due to the potential of endometrial hemorrhage, tear, contamination, retention of the tip of a
placental horn, uterine tip invagination, permanent endometrial damage and delayed uterine involution.
If a piece of placenta is felt in a horn, the author will start by culturing the endometrial contents, then
perform a large volume lavage using a bucket of warm water +/- salt and dilute betadine (1% solution), or
if there is concern about the integrity of the uterus, sterile fluids may be used. It is imperative whichever
method is used to use large volume in and out so that dilution of bacteria and endotoxins occurs. In addi-
tion, as the uterus is distended a twisting motion of the retained piece of tissue at the base of attachment
can help peel the placenta gently from the endometrium. Infusion with the appropriate broad-spectrum
antibiotic such as Ticarcillin plus clavulanic acid, nitrofurantoin, ceftiofur, Trimethoprim Sulfamethoxazole
tablets can combat the variety of endotoxin producing bacteria. After lavage and infusion N-butylsco-
polammonium bromide systemically can be given to relax the uterus which will be alternated with oxy-
tocin. The author has found that the dynamic relaxation and contraction of the uterus aids in placental
release.
Another recent technique described by Burden et al allows for gentle manual separation of the placenta
from the endometrium with the tips of the fingers and a circumferential hand motion towards the tip of
the horn. This allows for complete removal while on the farm if the ability to perform lavage twice daily or
return to the farm is not feasible. If the chorioallantois is still completely intact, infusion of the sac with sa-
line allows distention of the uterus with subsequent placental release. This technique was first described
by Burns et al in 1977. The fluid needs to be kept in the allantoic space by holding the membranes tightly
around the nasogastric tube. Membrane expulsion usually occurs in 5-30 minutes. An old technique
initially described by Zeddam has been revisited by Dr. Meijer from Holland and subsequently others.
The procedure incorporates introduction of a 9mm diameter nasogastric tube into the umbilical vessel
toward the root of the umbilical attachment on the placenta. The nasogastric tube is attached to a garden
hose and water is continuously infused into the umbilical vessel under low pressure for approximately 5
minutes. As the umbilical vessel distends the umbilical cord and nasogastric tube are held tightly by hand
to prevent retrograde leakage of water from the umbilical vessels. It appears that the infusion of water
induces edema and swelling of the tissue causing separation of the chorioallantois from the endometrium.
In most cases the placenta has been released completely as the procedure is completed. This technique
unfortunately does not seem to work after an abortion or after cesarean section. If the placenta remains
fixed firmly or after initial removal of the placenta, further treatment should focus on removal of inflamma-
tory debris and bacteria by intrauterine lavage with large volumes of fluid as described above. Flushing
should continue until the solution is the same color going in as coming out. This procedure may need to
be done twice a day depending on the amount, consistency, and smell of the intrauterine fluid. If the pla-
centa remains retained after oxytocin, manipulation and lavage, supplemental systemic broad-spectrum
antibiotics such as Procaine Penicillin or sulfamethoxazole and Gentocin as well as anti-endotoxemia/
laminitis therapy consisting of Flunixin Meglumine, and Pentoxifylline are essential and should be initiated
to help prevent complications such as laminitis. Icing the mares’ feet can be a precautionary procedure.
Administration of intrauterine antibiotics is controversial due to their potential irritation to the uterus and
inactivation by autolyzed tissue and bacteria. Suggested antibiotics include Ampicillin, Ticarcillin, Genta-
micin, polymyxin B, metronidazole, Nitrofurazone-urea boluses, or Trimethoprim Sulfa tablets. This author
prefers to administer Ticarcillin and clavulanic acid diluted in 60cc saline intrauterine.
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2023
One of the most important aspects of treating retained fetal membranes is recognition of their presence.
Not all retained placentas are visible and unless a placenta has been examined for completion it may not
be discovered until the mare presents depressed, febrile, anorexic, tachypneic, toxic with bounding digital
pulses. Therefore, it is imperative to stress the importance of placental evaluation by whomever is present
at delivery. Examination of the fetal membranes ascertains completeness, in addition to being able to iden-
tify any other abnormalities such as placentitis, which can allow the veterinarian to gain time and insight
into the treatment of potential problems in the mare and foal.
Further Reading:
1. Lofstedt RM. Miscellaneous Diseases of Pregnancy and Parturition. In: AO Mckinnon and JL Voss
(ed). Equine Reproduction. Lea and Febiger, 1993;600-602.
2. Sertich PL. Periparturient Emergencies. Vet. Clinics North America. 1994;10:19-36.
3. Threfall WR. Retained Placenta. In: AO Mckinnon and JL Voss (ed), Equine Reproduction. Lea and
Febiger, 1993;614-621
4. McNaughten JW, Meijer M, Macpherson ML. A novel approach to removing retained fetal mem-
branes in the mare. Clinical Therio. 2015;7:3:338.
5. Burden CA et al. Fetal Membrane Removal in the Mare: Proactive Versus Reactive Approaches.
Vet Clin. North Am Eq Prac. 2019;35(2):289-298.
6. Meyer M. et al. How to Use Umvilical Vessel Water Infusion to Treat Retained Fetal Membranes in
Mares. Am Assoc Equ Pract Ann Con. 2015;16: 478-484.
Karen Wolfsdorf DVM, Dipl. ACT
Dr. Wolfsdorf attended veterinary school at the University of Florida. She completed an equine field internship
at North Carolina State University, followed by a theriogenology residency at University of Florida, becoming
a diplomate of the American College of Theriogenology in 1995. Dr. Wolfsdorf is a shareholder , field veteri-
narian and specialist at Hagyard Equine medical institute whose main focus is diagnosing and treating the
problem mare. She has authored or co-authored many publications and book chapters as well as lectured at
local, national and international meetings. Dr. Wolfsdorf is very involved in numerous organizations and their
boards benefiting the horse and equine reproduction.
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2023
Beyond retained fetal membranes: Managing

conditions affecting the postpartum mare
James R. Crabtree BVM&S CertEM(StudMed) FRCVS.
Equine Reproductive Services (UK) Ltd. Trigger Castle, Malton, North Yorkshire, United Kingdom
Complications in the early postpartum period are a common and challenging problem for the equine
clinician. This presentation reviews some of the specific problems encountered in the postpartum mare.
Periparturient haemorrhage
The most frequent cause of haemorrhage during parturition is rupture of the middle uterine artery and the
risks of rupture are greater in older mares especially those that have had multiple foals. The majority of
bleeds are contained within the broad ligament resulting in a haematoma however the bleed can occur di-
rectly into the abdominal cavity or into the uterus. Broad ligament, uterine or pelvic wall haematomas often
result in colic due to the stretching of the tissues. If an artery ruptures directly into the peritoneal cavity the
mare may not be painful but the haemorrhage may be more profuse and rapidly fatal.
In the acute phase of haemorrhage haematology may show an increase, decrease, or no change in packed
cell volume (PCV) due to splenic contraction, hypoproteinemia and hyperlactatemia would be suggestive
of blood loss in a horse. If the mare survives the acute phase, a drop in PCV is usually observed over the
following days before a regenerative red cell response can be made. Transabdominal ultrasound can be
performed to detect free fluid in the abdomen and abdominocentesis can be obtained to confirm an ele-
vated red cell count indicative of haemoabdomen. In cases with broad ligament haematoma the peritoneal
fluid protein levels can be significantly elevated (up to 50 g/l) with normal white cell count.
Treatment is challenging and often controversial. If the mare survives the initial haemorrhage, it is likely
that a clot has formed. In all cases, keeping the mare quiet is paramount to her survival. If the mare is ac-
tively haemorrhaging the approach is governed by the facilities available and the economics of the partic-
ular case. In some instances, an extreme hypotensive state may actually offer the best chance for survival,
whereas in others an attempt to restore intravascular pressures and circulatory volume with iv fluid thera-
py could be indicated. The need to support cardiac output and ensure oxygen delivery must be balanced
against the prospect of the increased arterial pressure promoting further haemorrhage. Conservatively
mild sedation (alpha-2 agonist), pain relief with butorphanol and/or flunixin meglumine are recommended.
Prophylactic broad-spectrum antibiotic coverage is warranted and low dose (10 iu) oxytocin therapy may
be useful to promote uterine involution.
Aminocaproic or tranexamic acid may be beneficial; in horses an extrapolated dose of 10mg/kg tranexam-
ic acid is given by slow i/v injection up to three times in the first 24 hours depending on the severity
of bleeding. Fletcher and co-workers (2013) showed that the minimum concentrations of aminocaproic
and tranexamic acid required to inhibit fibrinolysis in horses were approximately 1/20 those required in
humans. Although controversial, formalin (16 ml of 10% buffered formalin diluted in 45 ml of 0.9% saline
solution and administered by slow i/v injection has also been used to treat uncontrolled haemorrhage in
horses and appears to have short term safety (Moreno et al. 2021).
Metritis
Incidence of metritis is low but increases with birth trauma and retained fetal membranes. It usually pres-
ents within 2-4 days postpartum and is often associated with a pronounced neutropenia. Inflammation
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of the uterine wall permits bacteria and toxins to enter the systemic circulation, resulting in bacteraemia
and endotoxaemia. Any postpartum mare with fever and anorexia should be suspected of having metritis.
A large volume of toxic, red-brown, watery fluid may accumulate within the postpartum uterus before any
obvious vaginal discharge becomes apparent.
Treatment should include broad-spectrum antibiotics, anti-inflammatory drugs and intravenous fluids if
indicated. A combination of procaine penicillin and gentamicin are widely used to provide broad-spectrum
systemic coverage. Anti-endotoxic doses of flunixin meglumine (0.25 mg/kg bodyweight three times a
day) should be considered as a minimum; 10-20 iu oxytocin every 4-6 hours will promote uterine clearance
and involution. Daily or twice daily large volume uterine lavages with 0.9 per cent saline solution are a rou-
tine part of managing mares with metritis. Homemade (non-sterile) saline can be used in the post-foaling
mare by mixing 90 g of table salt with 10 litres of tap water. The lavage is repeated until the recovered fluids
are free from gross contamination.
Uterine laceration
Uterine lacerations occur most frequently after dystocia but can occur in mares that foal normally. The
most common sites of laceration are the ventral and dorsal uterine body and the tip of the pregnant horn.
In the early stages there may be no obvious outward clinical signs. Subsequent signs are dependent upon
the degree of contamination of the uterus and abdominal cavity. If peritonitis develops the mare becomes
increasingly ill over 24-72 hours with fever, inappetence, reduced gut motility and abdominal pain. Ab-
dominocentesis will reveal signs consistent with septic peritonitis and changes in haematological and
biochemical parameters may also be present. One should be aware that peritonitis due traumatised and
devitalised bowel is a major differential.
Uterine horn tip inversion

Inversion of the tip of the uterine horn may result in mild to severe colic symptoms. A short and thickened
uterine horn with a tense mesovarium may be identified on rectal palpation. Manual reduction can be per-
formed from within the uterine lumen; infusion of several litres of saline into the uterus will aid replacement;
10-20 iu oxytocin every 4-6 hours will promote uterine involution.
I would like to take this opportunity to thank my sponsors, without whose support I would not have been
able to present at the conference. With many thanks to BOVA Specials UK Ltd, MSD Animal Health UK &
Equine Reproductive Services (UK) Limited.
Bibliography
Fletcher, D. J., Brained, B. M., Epstein, K., Radcliffe, R. and Divers, T. (2013) Therapeutic Plasma Con-
centrations of Epsilon Aminocaproic Acid and Tranexamic Acid in Horses. J Vet Intern Med. 27, 1589
- 1595.https://doi.org/10.1111/jvim.12202
Moreno, C. R., Delph, K. M., and Beard, W. L. (2021) Intravenous formalin for treatment of haemorrhage
in horses. Equine Veterinary Education. 33 (12) e460-e465
https://doi.org/10.1111/eve.13451
James graduated from the Royal (Dick) School of Veterinary Studies, Edinburgh in 2001. After four years in
mixed practice he travelled between the hemispheres working for a number of years in specialist stud practice
in the UK, Australia and New Zealand. In 2010 he was awarded the RCVS certificate in Equine Stud Medicine
and in 2011 became a lecturer at Liverpool University examining the stud medicine certificate since 2012.
James has published work on many topics relevant to clinical practitioners including material on breeding
soundness evaluation, infectious disease, peri-partum problems, ovarian abnormalities, oestrus suppression,
persistent endometrial cups, management of spring transition and twin pregnancy. James continues to per-
form and publish practice based research and collaborates widely. In 2013, he became director of Equine
Reproductive Services (UK) Limited growing and developing a busy first opinion and referral equine practice
in Yorkshire. James is recognised as an Advanced Practitioner in Equine Stud Medicine, he is a current BEVA
council member and trustee of the International Equine Reproduction Trust.
29
Proceedings
2023
James has made a sustained and significant contribution to veterinary professional development with formal
and informal teaching and assessment of post graduates. James has organised and delivered many CPD
courses and congresses in the UK and Europe and has delivered presentations on material ranging from
basic to advanced topics around the World. In 2022, his efforts were recognised by the Royal College of
Veterinary Surgeons who awarded James with a Fellowship for meritorious contributions to clinical practice.
If you require a different style of biography or photograph please do not hesitate to let me know.
30
Proceedings
2023
How to manage the anovulatory mare during breeding

season
Juan C Samper DVM, PhD. Diplomate ACT
School of Vet. Med. Texas A&M University
Introduction
The female of the equine species is stimulated to cycle with increasing exposure to day length. Conse-
quently, mares are considered seasonally polyestrus which means that they have a long period of regular
cyclicity also known as the breeding season where mares have inter estrus intervals of 15-16 days and
inter-ovulatory intervals of 20-21 days. In the northen hemisphere the breeding season extends from late
March or early April until early October. In the majority of the mares this period of regular cyclicity is
marked by variable transitional phase on both the early (spring) and late (fall) in which mares might show
behavioral estrus but fail to have regular ovulatory cycles. The start of the ovulatory season in mares is
determined by the first ovulation of the year, except in mares that foal early in the year (January, February)
and have not been exposed to artificial light. These mares often will have an initial ovulation and revert
to anestrus for another few weeks. In between the late fall transition and the early spring transition most
mares have a period of anestrus where follicular activity is suppressed. Since the breeding season is limit-
ed in the northern and southern hemispheres, mares that fail to cycle during this period pose an economic
burden to the breeding operation.
Conditions that interfere with regular cyclicity

a) Inter-estrus and inter-ovulatory intervals for mares that are bred to carry their own pregnancies in-
ter-estrus intervals (16 days) and inter-ovulatory intervals (19-22 days) or are key indices for brood mare
management. Prolonged luteal phases are presumably caused by a block of the endometrial release of
prostaglandin at around 15 days. On the other hand, short luteal phases are likely caused by an early re-
lease of uterine prostaglandin causing a premature lysis of the CL. Both of these conditions are not normal
and should be investigated further either with a culture and/or preferably by evaluating a uterine biopsy
to insure that the uterine health is normal. It is imperative that veterinarians have an exact day of ovulation
from the previous cycle in order to accurately evaluate those indices. Pregnancy and possible early embry-
onic death after day 14 must also be ruled out in cases of prolonged luteal phases.
b) Anovulatory follicles- Follicles that fail to ovulate are a frustrating condition for veterinarians especially
when mares are being bred by artificial insemination. Anovulatory follicles either bleed into the antrum
creating a localized hemorrhage or keep growing after the expected day of ovulation. In either case these
follicles fail to release an oocyte and consequently the mare is not able to become pregnant. It is important
that veterinarians recognize the failure ton evacuate follicular fluid and ovulation since often the organized
anovulatory hemorrhagic follicle (AHF) could be similar to a corpus luteum or a hemorrhagic CL Unfortu-
nately there are no markers or indicators that would reliably help predict the formation of an AHF. Howev-
er, in the author’s experience there are certain mare conditions that increase the risk of developing AHF.
Some of these conditions include:

1- Failure to ovulate within 48 hrs after an ovulatory agent is administered- Timely administration of ovula-
tory inducing agents is imperative for good mare breeding management and efficient stallion use. Howev-
er mares that are treated with the appropriate dose when a dominant follicle(s) is present and the mare has
marked uterine edema and fail to ovulate within 48 hrs of administration are at a high risk of developing
AHF’s.
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2023
2- Mares with insulin resistance or other endocinological issues- These mares although not completely
acyclic, characteristically will have multiple small to medium follicles for several weeks and fail to ovulate
on a regular basis. For these mares it is recommended to place them on constant pergolide therapy.

3- Delayed follicular growth due to endometritis- As discussed above mares with uterine infections can
have a long period of poor follicular growth and in extreme cases anestrus. This can be often seen in
post-partum mares that have foaled under poor hygienic conditions.

4- Chronic stress/pain- Social stress in a herd situation or the stress from pain due to osteoarthritic con-
ditions, laminitis or social stress have the potential to interfere with follicular growth and ovulation and
consequently the development of AHF’s.

Conditions that result in acyclicity
Permanent lack of cyclicity although not common in general is due to either permanent conditions such
as chromosomal or genetic or to acquired conditions that have conditions that have been failed to be
diagnosed.
A clinician evaluating a mare for lack of regular cycles or anestrus mut insure that there is no iatrogenic
cause for the condition such as exogenous use of progesterone, progestogens, estrogens or anaboloic
steroids.
Chromosomal problems most commonly the 63 XO condition also known as Turners syndrome. These
mares will have a smaller body, small genitalia and underdeveloped uterus and ovaries. However with
more recent techniques and the sequencing of the equine genome, new conditions of permanent a cy-
clicity have been surfacing in the face of a normal 64 XX karyotype. These mares in contrast to the 63XO
mares, have normal body size, and genitalia but have very small ovaries with follicles that do not grow past
5-10 mm and have an inability to respond to exogenous gonadotropin stimulation.
Breeds such as Arabians and ponies are well known for their longevity. In addition with mares from other
breeds with proper husbandry and veterinary care can also reach advanced age. In addition mares that are
in regular and prolonged Transvaginal Oocyte Aspiration programs are likely to go through “menopause”
due to lack of follicles for recruitment.
As described above, mares that foal under poor hygienic conditions are at high risk of having uterine con-
taminants that could affect cyclicity. In some of these mares one could argue that they have a period of
lactational anestrus. However in my experience primary lactational anestrus as seen in other species is a
rare condition in the horse, unless the mares are under a severe malnutrition and with very low body con-
ditions scores while nursing a foal. Mares without a foal at foot but under a constant plane of poor nutrition
are also at a high risk of falling into a prolonged period of acyclicity.
The endometrial cups which result from the invasion of the embryonic chorionic girdle/trophoblast into
the endometrium are an important phenomenon for the development of secondary follicles and the conse-
quent formation of accessory or secondary CL’s. The endometrial cups that start to form at around 35 days
of gestation and reach maximum maturity by 60 days produce equine chorionic gonadotropin (eCG). Thse
structures have a finite life span and ~ 120 days they have regressed and eCG returns to undetectable levels.
Although not very common the condition of retained or persistent endometrial cups has been described in
mares. They can occur in mares that lose the gestation after 60 days and in other occasions persist through
out gestation and post-foaling. Mares with this condition characteristically with have medium size follicles
that regularly become luteinized. Diagnosis is done by clinical signs, ultrasonography, endoscopic visualiza-
tion of the structures and by detectable levels of eCG in serum. Therapy consists on scraping the retained
cups from the uterus.
Endocrinologically active ovarian tumors will cause prolonged periods of acyclicity. The most common
ones are Granulosa or Granulosa Thecal Cell tumors (GCT or GCTC) depending on the type of cell in-
volved. Although behavioral signs can vary from permanent estrus to aggressive stallion-like behavior ini-
tial diagnosis is made by identifying the enlarged ovary with the concomitant atrophy of the contralateral
ovary. Endocrinological diagnosis is done by obtaining no progesterone, and high inhibin with variable
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levels of testosterone in serum. Final and definitive diagnosis is done by finding high levels of Anti-Mulleri-
an Hormone (AMH) in serum. Therapy consists of the removal of the affected ovary and return to cyclicity
on the remaining ovary is expected in 6-9 months post surgery.
Summary
Lack of regular cyclicity or acyclicity in mares is a problem that can severely impact the results of a breed-
ing operation, particularly in temperate climates where breeding seasons are finite. There are many causes
for these problems and consequently the diagnosis requires of evaluation of adequate husbandry practic-
es, proper history, fine attention to clinical signs and diagnostic procedures.
Additional Reading
• SS King, BL Douglas, JF Roser, WJ Silvia Differential luteolytic function between the physiological
breeding season, autumn transition and persistent winter cyclicity in the mare. An Reprod. Sc. 2010
•
• EM Carnevale, DR Bergfelt, OJ Ginther Follicular activity and concentrations of FSH and LH associat-
ed with senescence in mares. An. Repro Sc. 1994
•
• MG Blue, AN Bruère, HF Dewes The significance of the XO syndrome in infertility of the mare New
Zealand veterinary journal, 1978
•
• Prado, JC Follicular Dynamics in Insulin Resistant Mares. Ms Thesis University of Tennessee 2016
•
• BA Ball, AJ Conley, DT MacLaughlin, SA Grundy Expression of anti-Müllerian hormone (AMH)
in equine granulosa-cell tumors and in normal equine ovaries. Theriogenology, 2008
•
• JR Crabtree, Y Chang AM Maestre Clinical presentation, treatment and possible causes of per-
sistent endometrial cups illustrated by two cases. Eq. Vet J. 2012
Juan C. Samper, DVM, MSc, PhD, Diplomate ACT

Professor, Lecturer, & Research Associate
Department of Large Animal Clinical Sciences
Dr. Juan C. Samper is a visiting professor of equine theriogenology in the Department of Large Animal Clini-
cal Sciences (VLCS) at the Texas A&M School of Veterinary Medicine & Biomedical Sciences (VMBS). He is a
world-renowned equine theriogenologist and is respected by students, staff, faculty, and clients throughout
the academic, equine, and veterinary industries.
He received his DVM from the National University in his native Colombia and went on to serve in private
practice before owning his own multi-veterinarian practice for more than 25 years. He received a Masters
and PhD from the University of Minnesota and has served in several faculty and administrative positions at
colleges of veterinary medicine in the U.S., Canada, and the Caribbean, mentoring numerous future veteri-
narians and graduate students.
He has published several peer-reviewed manuscripts on numerous topics related to equine reproduction
and is the author of two editions of Equine Breeding Management and Artificial Insemination and a co-au-
thor of Current Therapy in Equine Reproduction. He was recently appointed as a specialty chief editor for
the Animal Science – Theriogenology section of Frontiers in Veterinary Science.
Dr. Samper’s current research focuses on the implementation of sexed stallion semen in the equine industry.
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Proceedings
2023
Achieving a definitive diagnosis of pain in the foot in

the horse
Dr Ellen Singer BA DVM, DVSc., Diplomate ACVS/ECVS, FRCVS
Sussex Equine Hospital, IVC Evidensia, West Sussex, UK
Introduction
Reaching a diagnosis of general foot pain in the horse is usually straight forward; however, the bigger
challenge is to reach a specific diagnosis of which structure or structures within the foot are causing the
pain. The most specific diagnosis possible is important to develop a targeted treatment plan and to provide
the client with a prognosis. Some conditions such as a foot abscess or injuries with clear external clinical
abnormalities of the foot or pastern regions are easy to diagnose, compared to lameness without any de-
finitive clinical exam findings apart from the lameness. This session will concentrate on lameness cases
without any obvious clinical abnormalities which easily localise lameness to a particular area or structure
within the foot.
Discerning pain in the foot from pain in the more proximal limb is usually straight forward; however, dis-
cerning the exact structure in the foot responsible for the pain can be more challenging. Diagnostic nerve
blocks remain the gold standard for diagnosis; however, the perineural and intra-synovial anaesthetic
techniques lack anatomic specificity so nerve blocks require careful interpretation.
History and clinical examination

Information regarding the lameness is important such as: suspected limb(s), duration and severity of lame-
ness, any known traumatic incidents and any alterations in shoeing. Identification of the lame limb or
limbs is essential, so evaluation of the horse in a straight line and in a circle on a hard and soft surface in
each direction is recommended. The degree and character of the lameness provides important clues to
the potential differential diagnoses. Moderate unilateral fore foot lameness would have a different list of
differential diagnoses compared to a mild bilateral lameness.
Examination of the digit

A careful examination of the digit involves observation of the external structures, from the fetlock distally.
Since the horn of the hoof capsule conceals many of the important structures of the equine digit, a clear
knowledge of the underlying internal structures is essential so that any external abnormalities detect-
ed can be interpreted related to the potential dysfunction occurring within the foot. As two examples,
swelling dorsally proximal to the coronary band would indicate effusion of the distal interphalangeal joint
and an increased digital pulse would be indicative of an abnormality within the hoof. A sensible routine
for clinical examination includes: observation of the horse’s stance, comparison of the right and left dig-
its (anatomy, foot balance, shoeing), palpation of the pastern and coronary band regions with the limb
weight-bearing and non-weight-bearing, palpation of the hoof capsule, examination of the solar surface of
the foot and the application of hoof testers.
Diagnostic anaesthesia
The role of diagnostic anaesthesia cannot be underestimated in the diagnosis of foot lameness; however,
the veterinary surgeon must remain aware of the potential for diffusion of the local anaesthetic to sur-
rounding structure or proximal to the site of injection (Nagy et al. 2015). Excellent detailed reviews of the
techniques for perineural and intra-synovial diagnostic techniques are available (Bassage and Ross 2011,
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Schumacher et al. 2013). In addition, the equine literature contains multiple articles that detail the poten-
tial diffusion distances and locations for the perineural and intra-synovial diagnostic nerve blocks of the
equine digit (Schumacher et al. 2013, Pilsworth and Dyson 2015).
Perineural (local) anaesthesia

The palmar digital and abaxial sesamoid nerve blocks are the main perineural techniques used to diag-
nose general foot pain in the horse. These blocks should be performed with the smallest amount of local
anaesthetic needed, in an effort to limit diffusion of the local anaesthetic proximally; however, some diffu-
sion may still occur. In the majority of cases, a positive response the palmar digital nerve blocks (signifi-
cant improvement or abolition of lameness) would indicate that pain associated with lameness was within
the structures contained in the hoof capsule. When a positive response is found to the abaxial sesamoid
nerve block, the lameness may also include structures of the palmar pastern region as well as the foot
and the coffin joint. On occasion, these blocks can also desensitize the fetlock joint region, leading to a
conclusion of foot pain when a problem is present proximal to that region.
Intra-synovial anaesthesia
Once the lameness is localised to the digit, intra-synovial diagnostic anaesthesia can help to further lo-
calise the lameness; however, these intra-synovial techniques are not easy to interpret. Diagnostic an-
aesthetic placed in distal the interphalangeal (DIP, coffin joint) can diffuse into the navicular bursa (NB),
leading to desensitisation of both structures (DIPJ and navicular bursa). In addition, the nerves adjacent
to the collateral sesamoidean ligaments may be in contact with the local anaesthetic, so desensitisation of
the palmar/plantar extra-synovial structures may occur. Duration of time between placing intra-articular
diagnostic anaesthesia in the DIPJ and observation of the horse could influence the conclusions, therefore
the general recommendation is to reassess the lameness within 5 minutes following the block. A rapid
response has been thought to indicate pain originating from the DIPJ.
Local anaesthetic delivered into the NB demonstrated less diffusion into the DIPJ compared with diffusion
into the NB when the DIPJ is injected (Gough et al. 2002). Therefore, the NB block appeared more specific
for this synovial structure, compared to the DIPJ block. The NB block should be performed with a small
amount of contrast material to ensure correct placement of the local anaesthetic, and to facilitate correct
interpretation of the block. Recent work further exploring the confusion of intra-synovial anaesthesia of
the foot demonstrated that DIPJ analgesia took longer to improve a foot lameness, compared to more
rapid improvement following a NB block (Katrinaki et al. 2023).
The above short description provides an outline of the challenges associated with localising lameness
of the equine digit to a specific area of the foot. Proximal diffusion from perineural blocks and diffusion
between synovial and extra-synovial structures occurs and should be considered when interpreting nerve
blocks of the foot. The diagnostic anaesthesia remains an important step in reaching a diagnosis of foot
lameness; however, a definitive diagnosis requires interpretation of diagnostic imaging (radiography, MRI,
CT, PetCT) in relation to the nerve block results.
References
1. Bassage, L.H., Ross, M. W., Diagnostic Analgesia (Chapter 10) in Ross, M.W., and Dyson, S.J.
(2011) Diagnosis and Management of Lameness in the Horse, 2nd Ed. Elsevier, Saunders, Missou-
ri, USA. pp100-135.
2. Gough M.R., Mayhew, G., Munroe, G.A., (2002) Diffusion of mepivacaine between adjacent sy-
novial structures in the horse. Part 1: forelimb foot and carpus Equine Vet J 34(1):80-84 doi:
10.2746/042516402776181097.
3. Katrinaki, V., Estrada, R.J., Mahlmann, K., Kolokythas, P., Lischer, C.J. (2023) Objective evaluation
for analgesia of the distal interphalangeal joint, the navicular bursa and perineural analgesia in
horses with naturally occurring forelimb lameness localised to the foot Equine Vet J 55 (2): 253-
260 doi: 10.1111/evj.13583. Epub 2022 Jun 6.
4. Nagy, A, Malton, R. (2015) Diffusion of radiodense contrast medium after perineural injection of the
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2023
palmar digital nerves. Equine vet. Educ. (2015) 27 (12) 648-654 doi: 10.1111/eve.12369
5. Pilsworth, R., & Dyson,S.J. (2015) Where does it hurt? Problems with interpretation of regional and
intra-synovial diagnostic analgesia. Equine Vet Educ 27, 595-603.
6. Schumacher, J., Schramme, M., Schumacher, J., DeGraves F.J., (2013 Diagnostic analgesia of the
equine digit Equine vet. Educ. (2013) 25 (8) 408-421 doi: 10.1111/eve.12001
Dr Ellen Singer BA DVM, DVSc., Diplomate ACVS/ECVS, FRCVS
Ellen graduated from Tufts University School of Veterinary Medicine (1987), after which she spent three years
in general equine practice in the Northeast United States. Following a Surgical Residency and Doctor of
Veterinary Science Degree at the Ontario Veterinary College, Ellen worked at the Koret School of Veterinary
Medicine in Israel. In 1995, Ellen joined the University of Liverpool where she was Senior Lecturer and a key
member of the Orthopaedics and Surgery team for 22 years. Ellen then worked as an orthopaedic and surgi-
cal consultant, until accepting a position as a Surgeon at the Sussex Equine Hospital (February 2023). Ellen
has Diplomate status in the European and the American College of Veterinary Surgeons and was honoured
to become a Fellow of the RCVS in 2018. Ellen’s main passion is surgery and the equine athlete. Clinical
interests are primarily lameness diagnosis and orthopaedic surgery, but she also loves colic surgery, the
reason she became interested in being a surgeon in the first place. Ellen’s research projects have included
clinical projects related to common orthopaedic problems and surgical anatomy, as well as more basic sci-
ence projects that focus on the biomechanics of bone in the fetlock joint, in particular the bone biology of the
first phalanx and the response of this bone to exercise. Ellen loves nothing more than figuring out why horses
are lame and providing a practical and hopefully, successful solution for the horse’s owners. Ellen continues
to be amazed at the varied athletic capabilities of the horse, and by this creature’s generous nature.
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Managing hoof wall defects

Stephen E. O’Grady, DVM, MRCVS
Authors address: Virginia Therapeutic Farriery, 833 Zion Hill Rd, Keswick, Virginia 22947; e-mail: so-
grady@look.net
Introduction
Full thickness hoof wall defects such as quarter and toe cracks, result in a loss of the structural integrity of
the hoof wall. They are not uncommon in equine practice and often manifest in lameness. Successful man-
agement of these hoof wall defects involves identifying and addressing the underlying cause(s), stabiliza-
tion of the foot, and committed follow-up 1,2. Treatment is most successful when the cause is investigated,
the appropriate farriery is initiated as early as possible, and when the biomechanical properties of the foot
are thoroughly understood. Inadequate attention to these factors accounts for the many failures encoun-
tered and the recurring nature of hoof wall defects. The two generally encountered defects are quarter
cracks and toe cracks both of which originate at the coronet and migrate distally. Both of these hoof wall
defects often lead to infection, lameness and are a common cause of decreased athletic performance in
competition horses. Hoof wall defects are generally associated with a hoof capsule distortion, for example,
with a quarter crack, the distortion will be associated with a sheared heel on the affected side 3. There is a
myriad of materials and techniques described for repairing hoof cracks, but none will be successful unless
the cause of the hoof wall defect is determined and addressed through the appropriate farriery 1,2,3
Pathophysiology of Quarter Cracks and Toe Cracks

Many causes for full thickness quarter cracks and toe cracks have been described including coronet in-
juries, inappropriate farrier practices, poor quality hoof walls (because of genetics, nutrition, and/or envi-
ronment), white line disease, and hoof capsule distortion. In the author’s experience, the most common
underlying cause of full thickness quarter cracks and toe cracks is a hoof capsule distortion 4.
Quarter Cracks
It is well accepted that the hoof capsule adapts and changes shape according to how it is loaded. Faulty
limb conformation adversely affects how the hoof is loaded, and habitual disproportionate loading will
change the shape of the hoof capsule over time. The resulting distortion of the hoof may negatively affect
its mechanical behavior, resulting in abnormal force and stress within its tissues. The hoof capsule dis-
tortion most associated with a full thickness quarter crack is a sheared heel. A sheared heel is defined
as a hoof capsule distortion resulting in a proximal displacement of one quarter/heel bulb relative to the
contralateral side of the hoof 3,5. If the changes in forces and stress become excessive, the hoof wall will be
predisposed to injuries such as a full thickness quarter crack.
Toe Cracks
Full thickness toe cracks originate at the coronet at the center of the dorsal toe and extend distally. There
is generally a proximal to distal concavity present in the dorsal hoof wall. The crack will open when the
foot is unloaded and close when the load is applied to the foot. Toe cracks are generally seen in horses
with excessively upright or club feet 2. With this conformation, the heels are generally allowed to migrate
dorsally and/or the shoe is too small. This limits the solar surface of the foot in the heel area and places
further load and leverage on the toe section of the foot.
Management of Quarter Cracks

Affected feet should be trimmed appropriately using the guidelines of a parallel hoof-pastern axis, center
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2023
of rotation bisecting the weight bearing surface of the foot, and the heels of the hoof capsule extending to
the base of the frog or trimming the heel area to ensure the frog and the hoof wall are on the same plane.1
If the situation permits, the horse’s shoes should be removed, the feet are trimmed as described above and
the horse is then stood on a hard surface for at least 24 hours prior to trimming and shoeing. This allows
the affected side of the foot to settle into a more acceptable conformation prior to completing the farriery.
A “double trimming” technique can be used where the affected foot is first trimmed as described above,
a shoe is fitted and then before attaching the shoe, a second trim is performed under the proximally dis-
placed quarter/heel. The second trim begins at the ipsilateral toe and is trimmed in a tapered toward the
heel. The foot is then shod with a symmetrically fitted wide web steel straight bar shoe, with the trim cre-
ating a space that resembles a wedge between the affected quarter/heel and the shoe. This will effectively
unload the distorted side of the foot
Ideally, horses with full thickness quarter cracks should be taken out of work allowing time for inflammation
to resolve and the crack to begin to be replaced by new wall at the coronet before they are repaired. If the
horse has to continue in work, my preferred technique for stabilizing quarter cracks involves inserting an
implant composed of stainless steel wires first, and then reinforcing the wires with a “patch” consisting of a
mix of fiberglass strands and polymethylmethacrylate adhesive (Equilox® Pine Island, MN).
Management of Toe Cracks

A toe crack associated with an upright or club foot hoof conformation should be trimmed to establish a
parallel hoof-pastern axis along with attempting to shift the load away from the toe and onto the palmar
section of the foot. This can be accomplished by beginning the trim in the middle of the foot and trimming
the foot in a tapered fashion toward the heels. The concavity is removed from the outer dorsal hoof wall
and a larger size shoe is applied.
Toe cracks can be stabilized, if necessary, using a metal plate that bridges the crack and is anchored on
each side of the crack with screws. A lightweight, approximately 3X8 cm metal plate (steel, aluminum, or
brass) is used. The plate is bent to conform to the contour of the coronary band and the curvature of the
hoof wall and is positioned approximately 1cm distal to the coronary band. The plate is applied with small
sheet metal screws. It is extremely important to attach the plate with the foot off the ground to ensure the
defect is affixed in the open position to reduce any compression on the dermal papillae producing horn
tubules that will hinder healing.
Summary
Quarter and toe cracks which result in loss of the structural integrity of the hoof wall are not uncommon
and usually manifest in lameness. From the perspective of pathogenesis and stabilization, these cracks
should be thought of as “wall fractures”. From the perspective of healing, the cracks can only be eliminat-
ed by new stable growth at the coronet. Successful management involves identifying and addressing the
underlying cause(s), applying the appropriate farriery, stabilization of the defect, and committed follow-up
in order to prevent reoccurrence.
References
1. O’Grady SE. Farriery for common hoof problems. In: Baxter GM, ed. Adams and Stashak’s lame-
ness in horses 7th ed. Ames: Wiley-Blackwell, 2020;1112–1133.
2. Pleasant RS., O’Grady SE, McKinlay I. Farriery for Hoof Wall Defects: Quarter Cracks and Toe
Cracks. Vet Clin N Am Equine 2012; 28:393-407.
3. O’Grady SE, Castelijns, HH. Sheared heels and the correlation to spontaneous quarter cracks
Equine vet edu 2011; 23:262-269.
4. O’Grady SE. Hoof capsule distortions: an overview. in Proceedings. Am Assoc Equine Pract 20118;
64:352–365.

The first title ‘Managing hoof wall defects’ is perfect. The second title ‘Radical hoof surgery for laminitis’ pres-
ents a problem. I am not familiar with any radical hoof surgery other than the resections that were performed
years ago, nor do I practice any radical procedures in my own practice. I have an extensive podiatry practice
and the only surgery I do for laminitis is an occasional DDF tenotomy.
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2023
As an alternative, I would like to suggest ‘Understanding barefoot methodology: advantages and limitations. I
have always used barefoot methodology as an option to rehabilitate hoof capsule distortions with great suc-
cess. I published a paper on this topic in 2015 in EVE. Since the Olympics in Japan where the gold and silver
medal winners in the jumpers were barefoot, there has been a renewed interest in competing horses without
shoes. This has become popular in Europe and currently, there is a study going on in Sweden. Allowing the
horse to compete barefoot for many varied reasons is a viable option to traditional farriery. However, there is
a process…determining if the hoof has the structural integrity or can the current structures be improved to
remain barefoot, an adaption period that is required, and the hoof care needs to be modified…all of which
would be described in the paper. I currently have over seventy upper-level competition horses competing
barefoot. To summarize, the paper would describe both using barefoot methodology to rehabilitate problem
feet and why/how it can be used in competition horses.
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2023
Description of the most common sport induced foot

injuries in Chilean Rodeo Horses:
David Parra Gaete, MV, Director Clínica Veterinaria Las Troyas
Clínica, Imagenología y Cirugía Ortopédica Equina
Santiago,Chile.-
Chilean Rodeo is one of the most demanding equine sport disciplines there is andit is the only athletic
activity where horses compete 3 times on one lead (going to the right) and only one time on the left lead.
In addition, in order to achieve their task, these horses must canter sideways and then suddenly push for-
ward, doing this several times in a single 2 or 3 day meet or show.
This type of physical effort induces a high number of foot related injuries in the front limbs, where the co-
lateral ligaments and podotroclear apparatus suffer the most, but with a certain pattern and presentation
we don’t see in other disciplines.
Advanced imaging such as MRI was introduced in our country 2 years ago and it has helped us tremen-
dously to better characterize these lesions.
This talk will focus on the description of the most common, significant and many times career ending inju-
ries specific to the discipline and to this anatomical area.
David Parra
MV egresado de la universidad de chile el año 2001. ejerciendo en práctica privada con foco exlusivo en orto-
pedia equina en chile, emiratos árabes, europa y estados unidos. veterinario de múltiples equipos nacionales
de enduro, equitación y adiestramiento en campeonatos internacionales. instructor de alapile desde que esta
organización internacional de educación continua fue formada hasta la fecha. socio propietario de clinica
veterinaria equina las troyas fundada en el año 2012.
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2023
Lameness arising from the digital flexor tendon sheath

Smith, R.K.W. MA VetMB PhD DEO FHEA DipECVSMR DipECVS FRCVS
Professor of Equine Orthopaedics
Dept. of Clinical Sciences and Services
The Royal Veterinary College
London, U.K.
Lameness associated with the digital flexor tendon sheath (DFTS) is common and usually presents as
asymmetric synovial effusion, often accompanied by pain on palpation in the acute stages. Diagnostic
analgesia is used to confirm the location of the lameness to the DFTS by the instillation of local anaesthetic
solution via one of the four access sites of the sheath. The easiest and most reliable access can be gained
via the distal palmar pouch of the sheath, which extends between the two distal branches of the SDFT
and between the two digital annular ligaments, along the palmar surface of the deep digital flexor tendon
(DDFT). The needle can be introduced through the skin to one side of the midline and, to avoid iatrogenic
damage to the deep digital flexor tendon, gently and slowly advanced at approximately 45 degrees to the
skin surface until synovial fluid is seen at the needle hub. 7-10mls of local anaesthetic solution is injected
for adequate desensitization of the DFTS. However, it is now routine to combine diagnostic analgesia with
contrast tenography because it can indicate injuries to specific structures within the DFTS and indicate
possible palmar/plantar annular ligament constriction. For this, 5mls of a water-soluble iodine-containing
contrast agent is combined with 10mls local anaesthetic and a lateromedial radiography obtained after
walking the horse for a few steps.
Ultrasonography is effective at identifying mid-substance pathology within a tendon sheath. However,

intra-thecal DDFT tears are more difficult to identify and it can also be challenging to determine whether
mid-substance injuries communicate with the synovial environment. Improvement in identifying tendon
tears is achieved by using non-weight-bearing views and assessing the DDFT in oblique images obtained
just distal to the proximal sesamoid bones, and displacement and thickening of the manica flexoria in
longitudinal (and transverse) mid-line scans at the level of the apices of the proximal sesamoid bones.
Movement of the tendons can also be assessed in non-weight bearing views where gapping between the
tendons can signify adhesion formation or a fully torn manica flexoria.
Magnetic resonance imaging has superior soft tissue contrast and may be of use to identify occult lesions
not seen radiographically or ultrasonographically. However, the standing MRI images may have inferior
quality, especially in hindlimbs, because of greater movement artefacts which makes the diagnosis of
intra-thecal tendon tears difficult. Tenoscopy is the best imaging modality for evaluating the internal struc-
tures of tendon sheaths.
Specific conditions and treatments

1. Primary tenosynovitis
While a common diagnosis in the past, better imaging and the advent of tenoscopy has revealed that
the majority of tenosynovitis cases are secondary to an intra- or peri-thecal soft tissue injury. Traumat-
ic tearing of the wall of the tendon sheath does occur [1]. Most of these will heal spontaneously with
rest but a small proportion can progress to the formation of a synovial outpouching or synoviocoele.
They are not always significant but can cause pain and lameness if non-compressible when the limb
is raised. Treatment is best achieved by tenoscopic enlargement of the synovioceole opening using
ultrasound guidance [2].
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2023
2. Palmar/Plantar annular ligament syndrome
Reduced contrast within the fetlock canal and the ease of passage of the arthroscope through the
fetlock canal are the best ways of determining constriction by the palmar/plantar annular ligament.
Constriction of the PAL is usually secondary to other pathology within the digital sheath and hence
transection should only be performed with concurrent tenoscopic evaluation of the sheath.
3. Mid-substance tendon lesions
Mid-substance lesions are those within the superficial digital tendon tendon (SDFT) or DDFT within
the extent of the DFTS. They can be managed conservatively but, as they are contained, they lend
themselves to intra-tendinous administration using the orthobiologicals. Ideally, in this location, such
intra-tendinous treatments should be performed under combined tenoscopic and ultrasonographic
control because of the difficulty in identifying any surface defects pre-operatively through which the
product could leak, thereby reducing its potential benefit.
4. Tendon/ligament tears which communicate with the synovial cavity
a) Deep digital flexor tendon tears
The deep digital flexor tendon can be injured throughout the length of the digital sheath. These inju-
ries can be either mid-substance tears where only hyperaemia may be evident tenoscopically or have
marginal tears which are usually where the tendon is under maximal compression, at the level of the
fetlock joint. Treatment of these injuries involves debridement of the tear and removal of the torn fi-
bres using a synovial resector and/or arthroscopic scissors or suction punch rongeurs. However, it is
rarely possible to leave the defect completely free of prolapsed tendon fibres and subsequent healing
of the defect is limited within the synovial environment resulting is a guarded prognosis, varying from
18%-40% depending on extent [3, 4].
b) Manica flexoria tears
The manica flexoria is a thin loop of tendon tissue that is attached to both medial and lateral borders
of the superficial digital flexor tendon and surrounds the deep digital flexor tendon within the proximal
digital sheath. With the advent of tenoscopy, tearing of one or both of the attachments of this structure
to the superficial digital flexor tendon has been found to be a common cause of digital sheath tenosy-
novitis and lameness, most commonly in the hindlimb. The tear will not heal and recurrent lameness
is common with conservative management. Hence the best treatment is for the manica flexoria to be
removed, which can be done tenoscopically. In contrast to the deep digital flexor tendon tears, these
cases carry a good prognosis of approximately 80% returning to the same level of performance after
surgery [3, 5].
c) Ligament tears into the digital sheath
The straight and oblique, distal sesamoidean ligaments lie on the dorsal border of the DFTS and inju-
ries frequently blocked to DFTS diagnostic analgesia [6]. Most of these injuries are managed conser-
vatively but when they communicate with the digital sheath cavity and so are amenable to tenoscopic
debridement. These lesions can be debrided as for DDFFT tears. The proximal scutum can also tear
into the sheath and be managed in the same way tenoscopically.
References
1. Crawford, A., et al., Digital sheath synovial ganglion cysts in horses. Vet Surg, 2011. 40(1): p. 66-72.
2. Hawkins, A., et al., Ultrasound-guided tenoscopic decompression of digital sheath synoviocoeles
in 10 horses. Vet Surg, 2022. 51(2): p. 311-319.
3. Smith, M.R. and I.M. Wright, Noninfected tenosynovitis of the digital flexor tendon sheath: a retro-
spective analysis of 76 cases. Equine Vet J, 2006. 38(2): p. 134-41.
4. Arensburg, L., et al., Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitu-
dinal tears in the digital flexor tendons: a retrospective study of 135 tenoscopic procedures. Equine
Vet J, 2011. 43(6): p. 660-8.
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5. Findley, J.A., F. De Oliveira, and B. Bladon, Tenoscopic surgical treatment of tears of the manica
flexoria in 53 horses. Vet Surg, 2012. 41(8): p. 924-30.
6. Hawkins, A., et al., Retrospective analysis of oblique and straight distal sesamoidean ligament
desmitis in 52 horses. Equine Vet J, 2022. 54(2): p. 312-322.
Professor Roger K.W. Smith MA VetMB PhD FHEA DEO DipECVSMR DipECVS FRCVS
Large Animal Imaging Associate of the European College of Veterinary Diagnostic Imaging
Roger Smith is Professor of Equine Orthopaedics at the Royal Veterinary College (RVC) with particular inter-
ests in orthopaedic surgery, imaging, lameness, and tendon research. He qualified with a First from Cam-
bridge University in 1987. After 2 years in general practice, he undertook a residency in equine surgery at the
RVC and then a PhD on the extracellular matrix of equine tendons. He remained at the RVC and was appoint-
ed Professor in December 2003. He holds the Diploma of Equine Orthopaedics, is Diplomate of two Europe-
an Specialist Colleges (Veterinary Surgery (ECVS) and Veterinary Sports Medicine and Rehabilitation), and is
a Royal College of Veterinary Surgeon’s Specialist in Equine Surgery. He was awarded an RCVS Fellowship in
2016 and was ECVS President in 2017. He is currently President-Elect of British Equine Veterinary Association.
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Podiatric management for lower limb lameness

contitions
Tracy A. Turner, DVM, MS, Dipl.ACVS, Dipl.ACVSMR
Turner Equine Sports Medicine and Surgery
The effect of hoof imbalance on fore limb lameness has been well documented. The fore limb hoof has
little effect above the fetlock. But the rear hoof has much greater effect on the upper leg and back. The
purpose of this paper is to discuss the common hoof imbalances that have been described in the rear hoof,
compare those to the fore foot, discuss possible pathophysiology and finally discuss the effect these rear
hoof imbalances have on lameness of the rear leg.
Different biomechanics exist between the forelimb and rear limb. Also rear hoof biomechanics effect the
movement (biomechanics) of the upper limb perhaps and these alterations in biomechanics can result in
lameness.
The most successful approach to shoeing is that based on individual case needs rather than a standard
formula. The following principles should be followed: (1) Correct any pre-existing problems of the hoof,
such as underrun heels, contracted heels, sheared heels, mismatched hoof angles, broken hoof/pastern
axis. (2) Use all weight bearing structures of the foot. (3) Allow for hoof expansion. (4) Decrease the work
of moving the foot. Shoeing is most effective when corrections are made within the first 10 months of
lameness, up to 96% success. This is in contrast to when shoeing changes are not made until after 1 year
of lameness, where only 56% of the cases have been successfully treated.
These principles can be accomplished using many different methods and techniques. Shoeing is of utmost
importance in dealing with hoof pain causing the signs associated with navicular syndrome or remodeling
of the bone (osseous form). It is necessary to ensure proper hoof balance and support in order to eliminate
the pain and stop or decrease the stresses that are causing the problem.
Turner TA. Navicular disease management: shoeing principles, in Proceedings. Am Assoc Equine Pract
1986;32:625-633.

Tracy Turner began his professional career as a farrier and used those skills to help finance his education.
He received his DVM degree from Colorado State University in 1978. He completed an internship at the
University of Georgia and a surgical residency as well as a Master of Science degree at Purdue University
in 1981. His Master’s thesis was “Thermography of the Lower Limb of the Horse.” He served on the faculty of
the Universities of Illinois, Florida and Minnesota. At Minnesota, he was Head of Large Animal Surgery and
attained the rank of full Professor before leaving academics to join Anoka Equine Clinic in 2004. In 2016, he
started his own practice dedicated to Sports Medicine and Surgery.
Turner’s primary research efforts have focused on equine lameness with particular interest in equine podiatry,
back issues in horses, rehabilitation and thermography. His podiatry research has evaluated the radiograph-
ic and morphologic characteristics of hoof imbalance, as well as the differential diagnosis of palmar foot pain
(PFP) and the development of PFP treatment strategies. Turner has researched the use of diagnostic imag-
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Proceedings
2023
ing techniques for evaluation of equine back problems (including saddle fit) and developed epidemiological
data on overriding spinous processes in horses. He pioneered the use of thermography as a diagnostic aid
in lameness evaluation, as well as its use in horse welfare regulation. Turner has extensively published on
these topics and been invited to lecture nationally and internationally. In 2004, Turner was inducted into the
International Equine Veterinarian’s Hall of Fame.
Turner is a Diplomate of the American College of Veterinary Surgeons, a Diplomate of the American College
of Sports Medicine and Rehabilitation and is a Fellow of the American Academy of Thermology (AAT). He is
an active member of the AVMA, AAEP, AAT and the American Horse Council. Turner has served as chairman
of the AAEP’s Farrier Liaison Committee, served on the AAEP Foundation Advisory Council, the AAEP Edu-
cational Programs Committee and the AAEP Board of Directors. He is currently Vice-President of the AAEP.
He is past-president of the American Academy of Thermology. He has consulted for United States Equestrian
Federation, The USDA Horse Protection and Federation Equestriene Internationale (FEI). He has served as a
Veterinarian Official at 4 Pan America games, 2 World Equestrian Games, at the 2016 Olympic Games in Rio
de Janeiro and 2021Tokyo Olympics. He has participated as an instructor at Equitarian Workshops in Mexi-
co, Nicaragua, and Costa Rica and has participated in the Equitarian projects in Honduras, Costa Rica and
Peru. He is married to veterinarian Julia Wilson and has two sons. He loves the outdoors and rides whenever
possible.
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SOFT TISSUE LESIONS OF THE DIGIT

Giorgio Ricardi, DVM CertISELP
Donnington Grove Veterinary Group
Newbury, UK
The equine digit includes the region distal to the fetlock joint, wit the first, second and third phalanx as
skeletal frame. It is a region of utmost clinical importance in horses involved in all equestrian and racing
disciplines and its soundness is paramount for performance.
Soft tissues associated with the digit are numerous and all exposed to possible pathological entities. The
anatomy of the region is complex and its thorough knowledge, including its biomechanics, is a prerequi-
site to understand the aethiopatogenesis, and formulate diagnosis, prognosis and rational for treatment
of different clinical conditions. The following is a list of the soft tissues of the equine digit, which can all be
affected by injury:
- Tendon of common and lateral digital extensor tendon;

- Proximal and distal digital annular ligament;
- Distal sesamoidean ligaments (short, cruciate, oblique, straight) and extensor branches of the
suspensory ligament;
- Superficial and deep digital flexor tendon and distal portion of the digital flexor tendon sheath;
- Joint capsules and synovial lining of the proximal and distal interphalangeal joints;
- Collateral and palmar (axial and abaxial) ligaments of the proximal interphalangeal joint);
- Collateral ligaments of the distal interphalangeal joints;
- The middle scutum and associated (scutocompedal) ligament;
- The navicular bursa and associated ligaments (collateral sesamoidean ligament, impar ligament);
- Collateral cartilages and associated ligaments (chondroungueal, chondrosesamoidean, chondro-
coronal and chondrocompedal);
- Digital cushion;
- Dermal laminae and papillae responsible for growth of the hoof capsule.
Clinical examination and dynamic assessment is the first step in diagnosis of injuries associated with the
digit; diagnostic anesthetic blocks remain a mainstay in the diagnostic investigation, although their spec-
ificity has been proved to be relative in accurately identifying the source of lameness.
Diagnostic imaging has been revolutionized by the advent of Magnetic Resonance Imaging (MRI) since
the last decade of the last century, particularly in the foot region. Accurate and careful use of first level di-
agnostic imaging, particularly ultrasonography is however still fundamental in the initial screening and will
often allow a definitive diagnosis, avoiding more expensive and not always available second level imaging
such as MRI. A notable exception to this is diagnosis of deep digital flexor tendon injuries within the foot
where MRI is usually the only technique allowing precise imaging and quantification of lesions.
Most common soft tissue injuries of the digit in our caseload are those affecting the deep digital flexor
tendon within the foot or in the pastern region, collateral ligaments of the distal interphalangeal joint, the
oblique sesamoidean ligaments, the branches of the superficial digital flexor tendon, straight sesamoidean
ligament.
Therapy for injuries of soft tissue injuries of the digit involves rest and adjunctive treatments such as ste-
roid injections or intralesional injections of biologic agents. Adequate foot care and corrective/therapeutic
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shoeing is a cornerstone of treatment and failure to understand the rationale of biomechanics and shoeing
strategies will have a negative impact on the outcome.
Soft tissue injuries of the digit can be career ending but correct diagnosis and therapeutic management
will often allow recovery or ability to cope with chronic wear and tear disease.
Giorgio Ricardi
Qualified University of Turin, Italy 1989
Internship Equine Surgery 1991-1992 Animal Health Trust, Newmarket, UK
In private practice in Italy 1993-2014, areas of interest lameness and surgery. During this time he has been
Contract Professor in Equine Surgery at University of Pisa – and Visiting Equine Surgeon at University of
Milan.
2014-2015 Senior Clinician Wrsan Racing Stables, Abu Dhabi, UAE.
2015- current, Lameness Clinician and Surgeon, Donnington Grove Veterinary Group, Newbury, UK.
Past president of SIVE (Italian Association of Equine Practitioners) and FEEVA (Federation of European
Equine Veterinary Associations).
ISELP certified member since 2018.
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How to treat deep digital flexor tendon injuries more

accurately and effectively:
David Parra Gaete, MV, Director Clínica Veterinaria Las Troyas
Clínica, Imagenología y Cirugía Ortopédica Equina
Santiago,Chile.-
Tendinopathies of the deep digital flexor tendon are a very common cause of lameness in sport horses.
Our athletic horse population is affected by the same types of injuries that have been widely described in
different studies and treatment of these lesions strongly depends on the accurate localization of the site
of injury or injuries in the same tendon at different levels and the characterization of these (extensive; mild,
moderate, severe,etc). However, we have seen a more specific discipline induced presentation of injury
in our Chilean Rodeo horses.
To describe DDFT lesion location in a proximodistal direction, four levels were established. Level 1 was
proximal to the collateral sesamoidean ligaments and to the proximal recess of the navicular bursa in the
sagittal plane. Level 2 corresponded to the level of the collateral sesamoidean ligaments and proximal
recess of the navicular bursa. Level 3 was between the proximal and distal extents of the distal sesamoid
bone. Level 4 extended from the distal border of the distal sesamoid bone distally.
The anatomy of the digit and association of the DDFT with other structures provides an explanation for the
presence of multiple sites of injections. Within the hoof capsule the DDFT is moulded to the palmar surface
of the navicular bone and separated from it by the podotrochlear or navicular bursa. The distal recess of
the bursa separates the DDFT and the distal sesmoidean impar ligament (DSIL) (Dyson 2003). The DDFT
has a terminal fan like expansion containing cartilage that occupies the entire space between the medial
and lateral palmar processes of the distal phalanx and inserts on the facies flexoria and semilunar crest of
the distal phalanx. The dorsal portion of the DDFT joins with the DSIL immediately before insertion on the
facies flexoria of the distal phalanx (Dyson 2003) and understanding the normal anatomy is essential for
the detection of abnormalities, injuries and potential sites of local therapy.
References:
1. Peterfy CG, Linares R, Steinbach LS. Recent advances in magnetic resonance imaging of the
musculoskeletal system. Radiol Clin North Am 1994;32:291–309.
2. Denoix JM, Crevier N, Roger B, Lebas JF. Magnetic resonance imaging of the equine foot. Vet
Radiol Ultrasound 1993;34:405–411.
3. Mehl ML, Tucker RL, Ragle CA, Schneider RK. The use of MRI in the diagnosis of equine limb
disorders. Equine Pract 1998;20: 14–17.
4. Kleiter M, Kneissl S, Stanek C, Mayrhofer E, Baulain U, Deegen E. Evaluation of magnetic reso-

nance imaging techniques in the equine digit. Vet Radiol Ultrasound 1999;40:15–22.
5. Tucker RL, Sande RD. Computed tomography and magnetic resonance imaging in equine mus-
culoskeletal conditions. Vet Clin North Am: Equine Pract 2001;17:145–157.
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6. Whitton C, Murray RC, Dyson SJ. Magnetic resonance imaging. In: Dyson SJ, Ross MW (eds):
Diagnosis and management of lameness in the horse. Philadelphia: WB Saunders, 2003;216–222.
7. Whitton RC, Buckley C, Donovan T, Wales AD, Dennis R. The diagnosis of lameness associated
with distal limb pathology in a horse: comparison of radiography, computed tomography and
magnetic resonance imaging. Vet J 1998;155:223–229.
8. Widmer WR, Buckwalter KA, Fessler JF, Hill MA, VanSickle DC, Ivancevich S. Use of radiography,
computed tomography and magnetic resonance imaging for evaluation of navicular syndrome in
the horse. Vet Radiol Ultrasound 2000;41:108–116.
9. Dyson S, Murray R, Schramme M, Branch M. Magnetic resonance imaging of the equine foot: 15
horses. Equine Vet J 2003;35:18–26.
10. Blunden, A., Dyson, S., Murray, R. and Schramme, M. (2006a) Histopathology in horses with
chronic palmar foot pain and age matched controls. Part 1: Navicular bone and related structures.
Equine vet. J. 38, 15-22.
11. Blunden, A., Dyson, S., Murray, R. and Schramme, M. (2006b) Histopathology in horses with
chronic palmar foot pain and age- matched controls. Part 2: The deep digital flexor tendon. Equine
vet. J. 38, 23-27.
12. Bowker, R.M., Atkinson, P.J., Atkinson, T.S. and Haut, R.C. (2001) Effect of contact stress in bones
of the distal interphalangeal joint on microscopic changes in articular cartilage and ligaments.
Am. J. vet. Res. 62, 414-424.
David Parra
Mv Egresado de la Universidad de Chile El Año 2001. Ejerciendo en práctica privada con foco exlusivo en
ortopedia equina en Chile, Emiratos Árabes, Europa y Estados Unidos. Veterinario de múltiples equipos
nacionales de enduro, equitación y adiestramiento en Campeonatos Internacionales. Instructor de ALAPILE
desde que esta organización internacional de educación continua fue formada hasta la fecha. Socio propi-
etario de clinica veterinaria Equina Las Troyas Fundada en el año 2012.
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Where to go when nerve blocks don’t reveal the source

of pain
When systematic nerve blocks fail to eliminate the lameness, this results in diagnostic dilemmas. Palpation
is a crucial part of every examination. It is the systematic evaluation of the limb by touch (i.e., feel for struc-
tural changes and pain).1 The examination needs to look at all portions of the limb but should be gauged
so the most time is spent in examining the most common areas of injury. Manipulative tests or flexion tests
are important adjunct to a lameness exam and can often give an important (lead to establish the cause(s)
of lameness.1-3 In many cases the pain caused by manipulation is so severe that the horse will retract the
limb. In more subtle cases, the only satisfactory way of evaluating the effect of manipulation is to trot the
horse immediately and note any exacerbation of a problem.
Thermography offers the veterinarian new diagnostic insight for their patients. Interpretation of thermal
images must be based on good quality, properly positioned images. Thermal cameras are highly accurate
instruments for measuring temperature and can provide invaluable information to determine a site of
lameness, pain, or autonomic dysfunction. Scanning over an object will not magically show a “hot spot”
at the site of the problem. A standard examination protocol for each body segment evaluated should be
used.5,6 Each point of focus on the body should include dorsal, palmar/plantar, medial, and lateral views
when possible. Contralateral and dorsal views should be equidistant and fill the image screen. Whenever
possible, it is recommended that the contralateral extremity should be captured in the same image. Im-
aging is contraindicated if bilaterally symmetrical images cannot be evaluated. Injured or diseased tissues
will invariably have altered circulation.4-6 One of the cardinal signs of inflammation is heat due to increased
circulation. Thermographically, the “hot spot” associated with the localized inflammation will generally be
seen in the skin directly overlying the injury. However, diseased tissues may, in fact, have a reduced blood
supply either due to swelling, thrombosis of vessels, infarction of tissues or change in sympathetic tone.
With such lesions the area of decreased heat is usually surrounded by increased thermal emissions, likely
due to shunting of blood.
Multiple thermographic images of a suspect area should be made.5 The area in question should be eval-
uated from at least two directions approximately 90o apart, to determine if a “hot spot” or “cold spot” is
consistently present. The horse’s extremities should be examined from 4 directions (circumferentially).4-6
Significant areas of inflammation will appear over the same spot on each replicate thermogram.
1. Baxter GM, Stashak TS: History, Visual Exam, Palpation and Manipulation in Baxter GM(ed) Ad-
ams and Stashak’s Lameness in Horses. West Sussex, Wiley-Blackwell, 2011, pp109-150.
2. Turner TA: Examination of the equine foot. Vet Clin NA: Eq Prac, 19(2): 309-332, 2003.
3. Turner TA: How to Use Manipulative Tests to Diagnose and Manage Equine Foot Pain in 60th An-
nual Meeting Am Assoc Eq Practnr, 2014:59-61. 2. Purohit RC, McCoy MD: Thermography in the
diagnosis of inflammatory processes in the horse. Am J Vet Res 1980;41:1167-1169
4. Turner TA, Purohit RC, Fessler JF: Thermography: A review in equine medicine. Comp Cont Ed
1986;8:855-858
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5. Turner TA: Diagnostic thermography. Vet Clin North Am (Equine Pract) 2001;17:95-114.
6. Turner TA: Thermography, in G M Baxter: Adams and Stashak’s Lameness in Horses, 6th ed, West
Sussex: Wiley and Sons,2011;466-473.
Tracy Turner began his professional career as a farrier and used those skills to help finance his education. He
received his DVM degree from Colorado State University in 1978. He completed an internship at the University
of Georgia and a surgical residency as well as a Master of Science degree at Purdue University in 1981. His
Master’s thesis was “Thermography of the Lower Limb of the Horse.” He served on the faculty of the Univer-
sities of Illinois, Florida and Minnesota. At Minnesota, he was Head of Large Animal Surgery and attained the
rank of full Professor before leaving academics to join Anoka Equine Clinic in 2004. In 2016, he started his own
practice dedicated to Sports Medicine and Surgery.
back issues in horses, rehabilitation and thermography. His podiatry research has evaluated the radiographic
and morphologic characteristics of hoof imbalance, as well as the differential diagnosis of palmar foot pain
(PFP) and the development of PFP treatment strategies. Turner has researched the use of diagnostic imaging
techniques for evaluation of equine back problems (including saddle fit) and developed epidemiological data
on overriding spinous processes in horses. He pioneered the use of thermography as a diagnostic aid in lame-
ness evaluation, as well as its use in horse welfare regulation. Turner has extensively published on these topics
and been invited to lecture nationally and internationally. In 2004, Turner was inducted into the International
Equine Veterinarian’s Hall of Fame.
possible.
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2023
Lameness after synovial sepsis

Author: Luis M. Rubio-Martínez DVM DVSc PhD DipACVS DipECVS DipACVSMR MRCVS. Sussex Equine
Hospital. Billingshurst Road, Ashington RH203BB, United Kingdom
Text
Synovial sepsis is a relatively common condition affecting horses and causes acute lameness and pain.
It is a serious condition and prompt, aggressive and early treatment is associated with better outcome.
Bacterial synovial infection causes a severe inflammatory reaction in the synovial environment, and this
process can trigger degenerative changes. Even with acute aggressive treatment, eradication of the in-
fection may be challenging in some cases. Some cases may develop protracted synovial infection with
chronic lameness. In other cases, involvement of tendinous or osteochondral components may cause
persistent lameness.
Unfortunately, the clinician may face the scenario when a horse shows lameness after treatment of a sy-
novial infection and the question to answer is: Is the infection eradicated? Or is the infection persistent?
As clinicians, we strongly rely on synovial fluid analysis. Bacterial culture is considered the gold standard
for diagnosis of synovial sepsis; however, it is considered that only about 35-45% of those cases with
suspected synovial infections may yield a positive bacterial culture. Cytology of the synovial fluid is also
used to guide our decisions; however, any intrasynovial intervention, being synoviocentesis, needle flush,
surgery or intraarticular medications can each and all have important inflammatory effects, which lead to
increased inflammatory markers. As a consequence, synovial fluid analysis in these cases quite commonly
yields results that fall within what is considered the grey area as to the diagnosis of persistent synovial
sepsis, and this makes interpretation and decision-making difficult. The absence of a gold standard for the
diagnosis of synovial sepsis is limiting.
Clinical scenarios will be reviewed where the dilemma of what is happening, what the cause of persistent
lameness is and a discussion on how to approach and manage these cases will be presented and dis-
cussed with the audience.
Luis M Rubio-Martínez DVM DVSc PhD DACVS DECVS DACVSMR MRCVS
RCVS, European and American Specialist in Equine Surgery

American Specialist in Equine Sports Medicine & Rehabilitation
Luis is originally from Spain and graduated from the University of Zaragoza (Spain). He followed this with a
rotating equine internship at the Veterinary School of Hannover (Germany). After two years of equine practice
in Mexico, Spain and Argentina, he completed a PhD in equine orthopaedic infections at the Complutense
University of Madrid (Spain). He then returned as an equine clinician to the University of Zaragoza, followed
by a surgical residency and a doctoral degree (DVSc) in subchondral bone disease in racehorses at the
Ontario Veterinary College (Canada). Luis has held faculty positions at the Universities of Guelph (Canada),
Pretoria (South Africa) and Liverpool (UK). In December 2017 Luis joined the Sussex Equine Hospital, where
Luis is currently a Clinical Director.
Luis regularly speaks at national and international congresses, has over 50 publications in peer-reviewed
journals and has contributed to textbook chapters. He is also the co-editor of the recently published textbook
Complications in Equine Surgery.
During his free time Luis enjoys attempting skiing, running, swimming and spending time with his wife and
2 kids.
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Managing Proximal Suspensory Desmitis: fore & hind

limbs
Andrew P. Bathe MA VetMB DipECVS Dip ACVSMR DEO MRCVS
Rossdales Equine Hospital, Newmarket, Suffolk, England
Summary
My current treatment regime involves a combination of the techniques described below. Extracorporeal
shockwave therapy is used in persistent lameness due to proximal suspensory desmitis in the forelimb
and low-grade cases of hindlimb proximal suspensory desmitis. In hindlimb proximal suspensory de-
smitis a plantar metatarsal neurectomy and fasciotomy is employed if the block pattern is appropriate.
In cases with marked hypoechogenicity this is combined with a PRP injection. With aggressive surgical
management I would consider that the prognosis is dramatically improved in a large number of cases.
Follow-up of these cases during the rehabilitation period is important in optimising the outcome.
Conservative and medical management

Management of acute injuries should involve rest, anti-inflammatory therapy and controlled exercise un-
der serial ultrasound monitoring. One-off regional infiltration with corticosteroids (e.g. 10mg triamcinolone
in 3mls of local anaesthetic) can be beneficial in decreasing the inflammation in acute cases. It can also
be useful in managing low-grade chronic/active cases in the short term. This is often the most appro-
priate form of treating flat racing Thoroughbreds, as there is not time in their short careers for the lay-off
associated with surgery.
Platelet rich plasma (PRP) is the currently favoured biological product for the treatment of PSD. It contains
a number of anabolic growth factors, and there are a number of commercially available systems that allow
the product to be easily used in practice. It can be used on its own in cases of acute desmitis, especially
in forelimbs, but in hindlimbs it is most commonly employed along with other forms of treatment – for the
reasons outlined above that lead to the chronic pain state. I prefer to use autologous conditioned serum
(Irap) in marginal lesions in the mid-body and branches, as it is less fibrinogenic and should be less likely
to cause adhesions. Intravenous infusion of bisphosphonates has been useful in some cases of enthe-
sis-related pain.
Extracorporeal Shockwave Therapy (ESWT)

ESWT has now been employed for a number of years in the treatment of proximal suspensory desmitis. In
my experience it has been extremely helpful in the management of chronic active cases of proximal sus-
pensory desmitis in the forelimb. Crowe et al (2004) reported on a series of cases of hindlimb PSD treated
with radial ESWT, and improved the prognosis to around 41%. This is significantly better than with con-
servative treatment, but still poorer than the surgical treatments that will be described. Lischer et al (2006)
reported on 22 cases of hindlimb PSD treated with focused ESWT, which also had a 41% success rate at
six months. This supports my clinical impression that there does not seem to be any difference between
radial and focused machines in the outcome following treatment. In the hindlimb I tend to use it in either
mild, acute cases or for the management of low-grade, chronic cases, and continued treatments may be
necessary. Clinically there does not seem to be any difference between radial and focused machines in
the outcome following treatment. I now use higher settings for the hindlimb than the forelimb: with the
EMS Swiss DolorClast Vet 2500 pulses at 3.5 bar with a 10mm applicator versus 2000 pulses at 3 bar. I
would normally combine this with medical management.
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Plantar metatarsal neurectomy and fasciotomy

This treatment was developed as the surgical option for the management of proximal suspensory ligament
desmitis in the hindlimb. This procedure combines decompressive fasciotomy of the deep laminar plantar
metatarsal fascia with neurectomy of the deep branch of the lateral plantar nerve. This nerve branch is
the common origin of the medial and lateral plantar metatarsal nerves, which apply sensory innervation
to the origin of the suspensory ligament. Surgery should be restricted to those cases that have had a very
good response to a block of the deep branch of the lateral plantar nerve. Long term follow-up has yielded
a long term success rate of 75% returning to normal function. The surgical technique will be described,
and approximately 4-5cm of nerve is removed through a 3.5cm incision.
The same procedure has also been used successfully in forelimb cases, but there is generally less need
for this.
Andrew P. Bathe MA, VetMB, DEO, DipECVS, DipACVSMR, MRCVS
Andy qualified from Cambridge University Veterinary School and subsequently trained in surgery at the
University of Bristol and then at Rossdales in Newmarket. After working as University Equine Surgeon at the
Queen’s Veterinary School Hospital, University of Cambridge he returned to Rossdales, where he became a
partner and, in 2021, a clinical director. Andy’s main areas of speciality lie in orthopaedic surgery and lame-
ness, especially related to competition horses. He has always been interested in the application of novel
diagnostic and therapeutic techniques to lameness problems and poor performance. He is a Diplomate of
the European College of Veterinary Surgeons and holds the Royal College of Veterinary Surgeons (RCVS)
Diploma in Equine Orthopaedics. He is recognised by the RCVS as a Specialist in Equine Surgery. He is team
vet to the Japanese Three Day Event Team. He has previously been team vet to the British Three Day Event
and British Pony Showjumping Teams; the Japanese Showjumping and Dressage Teams; the Hong Kong
Dressage Team; as well as working for numerous private competitors at competitions and championships.
He was an official treating vet for the 2012 Olympics in London. In 2015, Andy was awarded Diplomate status
by the American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR), which means that he
now holds diplomas in three separate areas of expertise (surgery, orthopaedics and equine sports medicine).
He is a Board Director of British Showjumping. He enjoys skiing, ski mountaineering and racing cycling in his
spare time.
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2023
Managing osteoarthritis in the tarsus

Luis M. Rubio-Martínez DVM DVSc PhD DipACVS DipECVS DipACVSMR MRCVS. Sussex Equine Hos-
pital. Billingshurst Road, Ashington RH203BB, United Kingdom
Text
Osteoarthritis of the distal tarsal (distal intertarsal and tarsometatarsal) joints is a common cause of lame-
ness in horses. Different treatment options have been investigated and used in equine practice over the
years.
Adequate hoof trimming and balance aiming to help to unload the medial aspect of the tarsus, with the
use of wider, thicker outside branch or lateral extension to help unload the medial aspect of the tarsus have
been recommended, especially for those horses with bowleg conformation.
Extracorporeal shockwave therapy has recognised analgesic effects and is often used over painful tarsal
joints.
Administration of NSAIDs is also common adjunct therapy in horses suffering from tarsal joint pain, but
potential side effects of these drugs need to be considered.
Intraarticular injection with corticosteroids remains a main cornerstone when treating distal tarsal pain. As
the joints involved are low motion joints, type of corticosteroid and their associated potential detrimental
chondral effects are not of such a concern as when treating high motion joints.
Options for facilitated or accelerated ankylosis using chemical drugs have been used over the years.
Chemical fusion agents include sodium monoiodoacetate (MIA) and, more recently, ethyl alcohol. MIA
affect chondrocyte metabolism leading to chondrocyte death. MIA was associated with marked inflam-
matory response and pain and its use has therefore become less common. Ethyl alcohol has detrimental
effects on the cartilage, which are expected to accelerate the process of ankylosis. Ethanol has also been
associated with neurolytic effects, which leads to sensory innervation blockage at the intraarticular level. It
is important to highlight that for any chemical fusion treatment approach, a pre-surgical contrast radiolog-
ical study to assess the communication with proximal interatarsal/tarsocrural joints must be performed as
diffusion of the chemical agent into these joints would cause severely detrimental effects. Laser can also
be applied intra-articularly to produce ankylosis. These options of chemical fusion all have effects toward
joint ankylosis, but the process to achieve to a sufficient ankylosis and pain-free sate may be prolonged
and require repeated treatments.
Surgical approaches to distal tarsal joint pain from osteoarthritis include articular drilling and plate fixation.
Articular drilling has been used for many years and the reported outcome is good. The produced causes
destruction of the articular cartilage and subchondral bone with exposure of the subchondral bone allow-
ing bone fusion to occur. The amount of cartilage damage is limited to the drilled tracts. A good amount
of drilling is preferred to expedite he ankylosis process; however, excessive drilling or entering the plantar
tarsal canal may cause instability and pain.
Most recently, arthrodesis with use of a trans-articular plate has been reported. A T plate is used and both
affected joints are bridged. This procedure is more involved but produces a more stable, solid construct,
which may decrease risk of pain and convalescence.
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University of Madrid (Spain). He then returned as an equine clinician to the University of Zaragoza, followed
by a surgical residency and a doctoral degree (DVSc) in subchondral bone disease in racehorses at the
Ontario Veterinary College (Canada). Luis has held faculty positions at the Universities of Guelph (Canada),
Pretoria (South Africa) and Liverpool (UK). In December 2017 Luis joined the Sussex Equine Hospital, where
Luis is currently a Clinical Director.
During his free time Luis enjoys attempting skiing, running, swimming and spending time with his wife and
2 kids.
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Understanding Biomechanics Of The Stifle

Author: Jairo Jaramillo Cardenas
Degree: Mv. Msc. Phd.
Titles: Alapile And Iselp Certified
Institutional Affiliation: Equarter Continuing Education
Text And Bibliography:
The femorotibiopatelar region is directly related to the pelvis. All of the gluteal and femoral muscles, 14
ligaments, 2 meniscus, 3 joints and its innervation (Direct innervation: Femoral/gluteal nerve and caudal/
obturator nerve; Indirect Innervation: sciatic nerve) makes this a complex area in terms of biomechanics
but also very exciting to study.
The biomechanical mechanisms of this region have been well described and can easily help understand-
ing the different pathologies of this part of the body.
The hind limb reciprocal apparatus is part of the biomechanical mechanism of this region where the fem-
orotibiopatelar joint maximizes its efficiency spending less energy. The flexion of the femorotibiopatelar
and coxofemoral joints induce simultaneously the flexion of the tarsal and fetlock joints. The opposite
movement of extension of the limb is also a combined and balanced action of both peroneus tertius and
superficial digital flexor muscles.
The capacity to extend the femorotibiopatelar joint by the stay apparatus, the dorsal locking and unlocking
of the patella by the proximal traction of the quadriceps femoris muscle, the medial rotation caused by
the sartorius muscle, the lateral rotation action of the gluteus femoris muscle over the patella, the caudal
movement of the meniscus during femorotibial joint flexion, the understanding of the coxofemoral luxation
as a consequence of an untreated upward fixation of the patella, the cranial meniscotibial ligament des-
mopathy and many others can only be fully understood by knowing well the biomechanics of the femoro-
tibiopatelar region.
MV. MSc.PhD. Iselp/Alapile Certified. Jairo Jaramillo Cárdenas
se formó hace 24 años por la Universidad de La Salle-ULS en Bogotá, Colombia; Allí realizó su residencia
en clínica y cirugía de grandes animales. Es maestro en cirugía equina por la FCAV / UNESP Jaboticabal,
y doctor en cirugía equina por la FMVZ / UNESP Botucatu. Se enfocó su especialización profesional en el
aparato locomotor de los equinos, terminando el programa, y siendo titulado por ALAPILE (Asociación Lati-
noamericana de Patología e Imagenología del Sistema Locomotor del Equino); en la secuencia, también ter-
minó y se certiﬁcó por el ISELP (International Society of Equine Locomotor Pathology). Durante la titulación
y certiﬁcación de estos programas, realizó un internado en el departamento de “Equine Field Service” en la
Universidad de Davis (UCDAVIS) en el estado de California en Estados Unidos. Actualmente es el socio-ge-
rente de la empresa “EQUARTER” (actuando en educación continuada) en Brasil, América Latina y algunos
países de Europa y Ásia.
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Stifle lameness: Update on subchondral bone cyst

management
Alvaro G. Bonilla, LV, MS, Dipl. ACVS
Tennessee Equine Hospital
Subchondral bone cysts (SBCs), and more specifically medial femoral condyle (MFC) cysts, are associat-
ed with lameness and poor performance in sport and racehorses and research has focused on them for
years. Unfortunately, their etiology remains unclear although most studies suggest a traumatic origin. In
fact, SBCs have been experimentally created after performing a small cartilage lesion with or without an
additional subchondral lesion in the MFC of horses and ponies.
SBC scan cause lameness due to the inflammatory and morphological changes produced in the subchon-
dral bone plate. With time, SBCs have been suggested to be also associated with mechanical abrasion of
the meniscus and tibial plateau and with changes in the biomechanical environment of the joint. Ex-vivo
and finite element studies performed have found that the medial meniscus and the tibial plateau uncov-
ered by meniscus are subject to additional stresses and prone to damage when a defect in the MFC was
present.
Several techniques are used to treat MFC SBCs, from conservative treatment to intracystic injection of ste-
roids to surgical procedures. While conservative treatments were used in the past, they are currently not
recommended unless the cyst is only a subtle concavity. Intracystic injection of triamcinolone (10-18 mg in
several spots within the cyst) is used to minimize the inflammatory environment and bone resorption that
has been histologically identified in naturally occurring cysts. This technique can be used ultrasonograph-
ically or radiographically-guided but best results are obtained when performed arthroscopically-guided.
Additionally, higher success rates are obtained when attempted in younger animals, non-arthritic joints or
smaller cysts.
Cyst debridement with or without cyst filling and resurfacing is another surgical possibility. However, only
performing cyst debridement (traditional surgical technique) have been suggested to potentially cause
meniscal and tibial damage and rarely promotes radiographic healing. Thus, it could be considered out
of favor by many. Different materials can be used for cyst filling +/- resurfacing such as cancellous bone,
bone marrow concentrate , tricalcium phosphate granules or chondrocytes. Debridement in conjunction
with cyst filling led to a successful outcome in up to 74% of cases.
In the last decade, a novel surgical technique consisting of placing a transcondylar cortical screw through
the cyst via an extra-articular approach has obtained encouraging results with success rates of 75% and
higher. The benefits of this technique are thought to be associated with the preservation of the cartilage
overlying the SBC and with the high rate of radiographic cyst healing (up to 75%). Additionally, debride-
ment of the inflammatory cyst lining is achieved during drilling for screw placement. Some special drills
can be used to maximize this debridement. Transcondylar screw placement is currently the gold standard
for many surgeons as it achieves radiographic healing and lameness resolution in most cases. However,
prognosis still depends on the health of the joint compartment (i.e: lack of additional damage to the medial
meniscus, tibial plateau or femoral condyle surface), especially when older horses or chronic cases are
considered.
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Thus, pre-operative radiographic and ultrasonographic screening in addition to arthroscopic assessment

of the joint during screw placement are key for patient selection and the success of the surgical technique.
In recent years, the use of a reabsorbable interference screw has been tested for SBC in the stifle and other
locations. The use of these screws rather than cortical screws was introduced due to concerns regarding
horse selling value when stainless steel implants were radiographically visualized later in life, especially
in young Thoroughbreds going to auctions. Despite the fact that these implants produce radiographic
healing and lameness resolutions in short term rates similar to the cortical screw, their long term effects
are still to be proven. Bone healing seems to be produced due to the osteoinductive and osteoconductive
properties of the screw materials rather than to biomechanics as is the case for the cortical screw. Differ-
ent healing patterns can be seen at the subchondral bone plate level with both techniques.
Newer techniques such as subchondroplasty are being extrapolated from human medicine and results
will be available soon. Similar to screw placement, the cyst is accessed extra-articularly with a cannulated
drill and then a biomaterial +/- PRP or BMAC are injected to achieve cyst filling. This material is replaced
overtime by bone.
Alvaro G. Bonilla, DVM, MS, Dipl. ACVS
Alvaro Garcia Bonilla obtained his Veterinary Degree in 2005 from University of Cordoba (Spain), followed
by two internships in Spain. One at a private practice and the second one at University of Barcelona (2006-
08). Then, he moved to Canada where he completed a surgical internship at Milton Equine Hospital, followed
by an orthopedic research fellowship at University of Pennsylvania (USA) (2009-11). After all this training, he
went to The Ohio State University where he obtained a Master of Science focus on the stifle and subchondral
cystic lesions at the same time that he completed an equine surgical residency (2011-14). In February 2015, he
became a Diplomate of the American College of Veterinary Surgeons. After finishing his residency, he stayed
at The Ohio State University as an Emergency and Surgery Clinical Instructor for one year followed by locums
at University of Montreal (Canada), Charles Sturt University (Australia) and Langford Equine Centre (Uni-
versity of Bristol, UK) before joining the surgery team at University of Montreal as an Assistant professor in
equine surgery in October 2016. He is now an Associate professor and director of the research lab in clinically
applicable and minimally invasive surgery at the University of Montreal. He has published numerous articles
in peer-reviewed journals and has participated in several national and international conferences.
Field of interest: Sinoscopy and sinus surgery, subchondral cystic lesions in the stifle, orthopedic and ar-
throscopic surgery, standing arthroscopy and minimally invasive procedures.
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The Impact of Animal Neglect on Human Welfare

Julia H. Wilson, DVM, Diplomate, ACVIM; Equitarian Initiative; Stillwater, MN, USA
Over centuries, horses, donkeys, and mules have played a critical role in human welfare and the evolution
of civilization. Equids carry humans, pull wagons and plows, herd livestock, and more. In many impover-
ished regions of the world, an equid remains the main source of transportation for people, food, water,
and materials which a family relies upon to live. Even partial loss of the equid’s contribution to a family’s
income and daily work can be devastating to their welfare. Viewed through the lens of One Health, many
neglect issues of working equids closely parallel those of the families that rely upon them and share com-
mon causes.
Human perception of the needs of working equids is far from uniform and varies across cultures, gender
and age. Animal neglect can be the result of many factors including ignorance of its needs, lack of time
or money to deliver care, paucity of essential resources such as feed, water, hoof care, functional harness,
and health care. Common examples of neglect are malnutrition, excessive work without rest or water, poor
hoof care and harness wounds. Diseases and parasitism might not be recognized and hence not treated.
Neglect can also be intentional.
The greater the economic reliance of a family on its equid, the greater the impact of any reduction in its
ability to work due to neglect. Children are most directly affected, physically and mentally. Reduction in
family income leads to less food, poorer health, and too often, dropping out of school because of loss of
transportation or inability to pay school fees. Too often, a malnourished donkey comes to an equid health
clinic in the care of a malnourished child. If a child recognizes that the animal is suffering, especially if pre-
ventable, this is very stressful, even more so if the child perceives the equid as a friend. Families that have
lost their “horsepower” in water-poor regions, require women and children to bear the heavy daily burden
of fetching water for the household from distant wells. Loss of the working equid has also been shown to
limit a family’s ability to travel to medical care facilities.
Visible neglect or signs of abuse of an equid should trigger a concern for vulnerable family members. For
example, pervasive alcoholism may lead to physical abuse directed at the equid and family members.
Partnering with a human welfare organization in the community may enable social and medical services
for otherwise invisible family members.
Uplifting working equid health through sustainable interventions will improve the welfare of the families
that rely upon them.
Bibliography
1. Lane J. Links between working equid health and human livelihoods and health. Proceedings of
the 61st Annual Convention of the American Association of Equine Practitioners, Las Vegas, Ne-
vada, USA, December 5–9, 2015. American Association of Equine Practitioners (AAEP); 2015. pp.
301–304.
2. Luna D., Tadich, T. Why should human-animal interactions be included in research of working
equids’ welfare. Animals 2019, 9, 42; doi:10.3390/ani9020042
3. Dr. Julia Wilson graduated from Cornell University in 1978. She pursued an internship in large an-
imal medicine at the Ontario Veterinary College followed by a residency at the University of Flor-
ida. She is a Diplomate of the American College of Veterinary Internal Medicine. She served the
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majority of her career as a faculty member, first at the University of Florida and then the University
of Minnesota. She now works as the Executive Director of the Minnesota Board of Veterinary
Medicine. As an academic, beyond the joy of teaching and clinical work, her research focused
on topics of neonatology, gastroenterology and infectious diseases. Dr. Wilson has served on the
Board of Directors of the American Association of Equine Practitioners as well as on many AAEP
Committees.
Dr. Wilson’s international childhood, opportunities to lecture in other countries and experience on the Board
of Directors of Heifer International led her to partner with Dr. Jay Merriam to create Equitarian Initiative, a U.S.
non-profit organization that works to improve the health and welfare of working horses, donkeys and mules
and the families that depend on them. This organization currently has programs in nine countries. Many
include collaboration with local veterinary colleges to enhance the equine curriculum through teaching and
provision of veterinary care in communities in need. She is currently on the Board of Directors of Brooke USA
Foundation, another nonprofit organization that supports working equids. She is married to Tracy Turner,
DVM, MS, DACVS, DACVSMR who shares her passion for international service.
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Equine activities – social licence to operate.

Dr Joe Collins MVB PhD CSci CBiol FRSB MRCVS CertEP CertVR
Chief Veterinary Advisor at The Donkey Sanctuary
Social licence to operate (SLO) is an unwritten contract between society and those who pursue an activity.
It arose in relation to industrial activities about which an increasingly aware public might have concerns –
think mining for precious metals or burning fossil fuels to generate electricity. One such activity is the use
of animals by humans to serve the latter’s purpose, in ways ranging from slaughter for food to confinement
for entertainment.
In the equine world SLO has largely been considered in the context of our use of horses for sporting pur-
poses, in particular where such activities may place horses in the way of harm – think racing and eventing
- in essence riding and jumping large obstacles at speed. In times past the approval of the general public,
largely comprised of persons not engaged in the activity themselves, could be taken almost for granted, or
perhaps not thought to matter. But attitudes change and the public’s opinion does matter. Those involved
directly in equine sports may consider otherwise; but I suggest that such an attitude is itself outdated
and could at best be described as naïve. The state of an industry’s SLO often determines its ability to
operate with minimal formalised restrictions or constricting legislative provisions. Operating in such an
environment should, in my opinion, be seen as an invaluable privilege, one to be guarded jealously and
assiduously preserved.
Public attitudes toward animal welfare, and indeed animal rights, are changing and tolerance of animal
welfare compromises (real or perceived) ever diminishing. Even if not funded by the public purse (and
many equestrian activities are) we cannot ignore public perception and its view of ‘acceptable use of
equines’. Whether they like it or not, those who keep and use horses for sporting purposes are exposed to
increasing scrutiny and more widespread criticism. (Blame social media if you wish.) The consequences of
a loss of public confidence leading to loss of privilege can be readily seen in the removal of jumps racing
from the calendar in South Australia and the horse phase in modern pentathlon following events at the
Tokyo Olympics.
But I’d like to broaden discussion of SLO and equines to a consideration of other common uses of equines
by humans in order to ‘extract value’ from them. Take the management of mares on ‘blood farms’ to harvest
eCG-rich plasma; the product may be destined for a high return market in a highly regulated environment
(such as the EU) but the raw material is often extracted from horses far away and not subject to similar
standards of scrutiny or oversight. As the hormone yield falls pregnancies are aborted, often brutally (and
we vets know how difficult this is to do in mid trimester). Similar considerations apply to the wholesale
slaughter and global trade in donkeys simply so their skins can be used to make ejiao. The Donkey Sanctu-
ary advocates for a moratorium on this senseless practice. The keeping of wild animals, including asses, in
zoo cages and use of animals, including horses, in circuses is under increased scrutiny: loss of SLO leads
to legislative restrictions and bans. What of ‘equine-assisted activities’ – the use of horses and donkeys in
the service of human health - what’s in it for them? What of equine welfare organisations keeping aging
equines ‘safe’ in sanctuaries – is this always best for them? There is an increasing sense that we should
look at matters more from their and not our perspective – fundamentally, what is it to be a horse or donkey?
‘Working equids’ is a category receiving some more positive consideration, as a sustainable alternative to
fossil-fuel dependent power. But a category also not immune from criticism: I can vividly remember being
berated on descending from a licensed horse-drawn carriage in a European city centre once and being
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criticised publicly for tacitly ‘endorsing’ the use of equines for tourism activities. The EU Platform on Ani-
mal welfare, whose equines subgroup I chair, has engaged in developing official guidelines for such use.
Not everyone agrees with this approach. But we do have donkeys carrying tourists up steep hillsides on
Greek islands as there are mules carrying supplies for trekkers up the Andes. Guides, education, training,
engagement represent the pragmatic approach. Does it render such activities immune from criticism – no!
Could such scrutiny in the future lead to increased restriction and/or regulation - possibly! Such is the very
definition of loss of Social Licence to Operate.
The veterinary profession itself should not, I believe, consider ourselves above the fray. We don’t have
a licence to operate with impunity, to do as we wish for reasons we alone choose. We must continue
to examine the ethics of how we practice, of the surgical procedures we perform, of the life-prolonging
treatments we apply, the medicines we supply, and ask ourselves – Why? Is this in the individual equine
patient’s interest? Is this ’advance’ in treatment in the equine species’ interest?
None of us, nor the equine-related activities we engage in, are immune from public scrutiny, from criticism
(warranted, well-informed or not) and none should be complacent about the loss of SLO and what the
consequences might be. Trust is everything – hard won but easily lost!
References
1. Social licence to operate: what can equestrian sports learn from other industries? J Douglas, R
Owers, MLH Campbell - Animals, 2022; https://www.mdpi.com/2076-2615/12/15/1987
2. Social license and animal welfare: Developments from the past decade in Australia. JO Hampton,
B Jones, PD McGreevy - Animals, 2020; https://www.mdpi.com/2076-2615/10/12/2237
3. Social License to Operate–Why Public Perception Matters for Horse Sport–Some Personal Re-
flections. CR Heleski - Journal of Equine Veterinary Science, 2023; https://www.sciencedirect.
com/science/article/abs/pii/S0737080623000576
4. What is a social licence to operate? World Horse Welfare: https://www.worldhorsewelfare.org/

what-we-do/sport-and-leisure-horses/what-is-a-social-licence-to-operate
5. Grand or not-so-grand National? The social licence and equestrianism conundrum, D Rendle,
BEVA President; https://www.veterinary-practice.com/article/social-licence-and-equestrianism
Dr. Joe Collins MVB PhD CSci CBiol FSB MRCVS CertEP CertVR
Joe graduated from the School of Veterinary Medicine in Dublin in 1987. He has since worked in Ireland and
the UK in private equine practice, as a clinical resident at Cambridge University Veterinary School, in the
pharmaceutical industry and in the NGO sector. Joe is currently Chief Veterinary Advisor at The Donkey Sanc-
tuary, a UK headquartered global NGO; an appointed expert at the EU Platform on Animal Welfare where
he chairs their subgroup on the Welfare of Equids; a member of the EU Reference Centre on the Welfare of
Animals subgroup on Working Equids; and chair of the EuroGroup for Animals Equines Working Group.
Joe has previously been President of Veterinary Ireland and FEEVA (the Federation of European Equine Veter-
inary Associations), and served on both BEVA Council and the Veterinary Council of Ireland. Joe holds a PhD
in equine welfare and is a Chartered Scientist, Chartered Biologist and Fellow of the Royal Society of Biolo-
gists. His main interests are in equine welfare & protection, veterinary medicines and professional standards.
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Practical approach to working equids welfare

Mariano Hernández Gil
MVZ MC
Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México.
During work, one exerts innate or acquired abilities to achieve a purpose or result. Considering that a
working animal is one whose faculties facilitate the accomplishment of a task, every equid involved in
human labor or pursuit, exerting physical and mental effort, is strictly a working equid.
For millennia,1, 2 humankind has relied on equids to succeed, by sensibly taking advantage of their biome-
chanical, biochemical and behavioral characteristics.
Biomechanics is the application of mechanical laws to living structures. By studying the forces that act
on a biological object, as well as the effects that such forces produce, biomechanics can extend from the
function of simple proteins to the motion of an organism as a whole. Biochemistry is, in turn, the chemistry
of those living organisms, including their chemical constituents and vital processes. It focuses on the mo-
lecular nature and functioning of life, as well as on changes occurring in cells; relying on biology, chemistry,
physics and immunology to understand the ways molecules interact to form cells, tissues, and complete
organisms.
Behavior is the study of how animals move in their environment, how they interrelate socially, how they
learn about the environment, and how they achieve a cognitive understanding of it.3 Involving the interac-
tion of the animal with its physical environment, with other members of the same species, and with organ-
isms of other species, behavior also denotes changes in response to stimuli; a fact particularly important in
working equids, because their performance depends both on the ability of the handler to elicit a response,
and on the extent at which conditions let the equid be mentally and physically able.
Current biological characteristics of equids are the result of more than 50 million years of evolution.4 From
a welfare perspective, in the course of evolution,5 equids succeeded in coping with the changing envi-
ronment by developing a phenotype that, besides favoring species preservation,6, 7 must have guaranteed
the quality of life, with the eventual genetic assimilation of those traits through the process of natural se-
lection.8 In more recent times, just after domestication some millennia ago, human-driven management
has influenced the phenotype of domestic equids in such a manner, that hundreds of breeds with diverse
morphological and behavioral traits9 have thrived in different conditions, for the diverse purposes of work
at human activities.
Whether for loading, riding, pulling or dragging, humans discovered how to harness the biology of equids
to satisfy physical, cultural, social, economic, ecologic and emotional needs. However, science and tech-
nology, besides experience and traditional knowledge, show that welfare is essential for performance and,
although in origin is simply how well the individual is faring through life;10 the concept of welfare has also
evolved.11
The “one-welfare” approach promotes that animal, human and environmental welfare is integrated. No
matter the domain of practice, this more ecological philosophy must sensibly be promoted among the
equine veterinary profession, especially because, from the perspective of antrhozoology, the biology of
horses and the use of equipment to harness their natural traits for human development, meant that vet-
erinary care was a core component for a mutually effective human–equid relationship around the world.12
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With this motivating statement, the veterinary profession is legitimated to promote welfare and performance
of working equids, just as it was the first time in history the word “veterinārius” was used and “la medicina
veterinaria” was mentioned as the practice of medicine in the “bestia veterinaria”, namely beast of burden.13
As professional practice is conceived, working equids welfare must be promoted with a practical approach.
However, before outlining a practical approach to working equids welfare, a concept of practical is needed.
In a classic reference,14 “Science” is described as the art of “knowing what”, whilst “Technology” as “the
art of knowing how” and “Theory” as “the art of knowing why”. As a practical art, “Technique” is “the art
of doing”, founded on our knowledge of what, how and why. Therefore, by saying “practical” we mean
actual experience, in the real world, but always based on evidence. Evidence that comes from science, but
may also come from traditional knowledge, which plays an important role in all aspects of human life and
livelihoods.15
Working equids play an essential role in the lives and livelihoods of millions of people around the world.16
Activities in which horses, donkeys, mules and hinnies are involved differ according to environmental,
human and animal aspects.17 In consequence, issues affecting to, and depending on, equine welfare and
performance, as well as resources to manage them, do also vary across regions.
Assessing animal welfare and proposing practices to promote it has become an essential competency
in the veterinary profession.18 Evaluating the quality of life of an equid is requested to practitioners more
often than before, not only for the good purposes of charity and education, but also for the own benefit of
the equids and individuals, communities, and ecosystems reliant on their functioning as living beings or
working animals.
There are, fortunately, strong indicators and a significant number of tools to assess equine welfare,19,20,21,22
some of them specific for working equids. 23,24 Whichever the tool, it is advisable that the practitioner con-
ceives welfare as the animal’s state as regards its attempts to cope with its environment,10 and, in the par-
ticular case of working equids, it is not only about succeeding to cope with the conditions at which they
live, but also at those where they perform, because the degree at which their faculties contribute to achieve
a purpose or result, may also determine their welfare.
Therefore, whilst approaching welfare, one has to begin by the animal in terms of its biomechanics, bio-
chemistry and behavior, assessed through physical, physiological and behavioral parameters related to
their demeanor, nutrition, soundness, movement and health, always considering the animal, human and
environmental aspects that affect welfare and performance.
This practical approach enables not only to observe normal function and recognize alterations, but also to
propose practices to manage conditions and faculties to cope, and to eventually guarantee that working
equid welfare for performance is promoted.
1. Todd ET, Tonasso-Calvière L, Chauvey L et al. (2022) The genomic history and global expansion of
domestic donkeys. Science 377 (6611): 1172 – 1180. DOI: 10.1126/science.abo3503
2. Librado P, Khan N, Fages A et al. (2021) The origins and spread of domestic horses from the West-
ern Eurasian steppes. Nature 598, 634 – 640 DOI: 10.1038/s41586-021-04018-9
3. Breed MD, Moore J (2022) Of Cockroaches and Wolves: Framing Animal Behavior. In: Breed
MD and Moore J (Eds.) Animal Behavior (Third Edition). Academic Press. 2022. Pp: 1-27. ISBN
9780128195581. DOI: 10.1016/B978-0-12-819558-1.00001-4
4. Librado P and Orlando L (2021) Genomics and the Evolutionary History of Equids. Annual Review
of Animal Biosciences 9: 81–101. DOI: 10.1146/annurev-animal-061220-023118
5. Dawkins MS (1998). Evolution and Animal Welfare. The Quarterly Review of Biology 73(3): 305 –
328. http://www.jstor.org/stable/3036918
6. Janis CM and Bernor RL (2019) The evolution of equid monodactyly: A reviw including a new hy-
pothesis. Frontiers in Ecology and Evolution 7: 119. DOI: 10.3389/fevo.2019.00119
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7. Janis C (1976) The evolutionary strategy of the Equidae and the origins of rumen and cecal diges-
tion. Evolution 30: 754 – 774. https://www.jstor.org/stable/2407816
8. Waddington CH (1953) Genetic assimilation of an acquired character. Evolution 7(2): 118 – 126.
https://www.jstor.org/stable/2405747
9. Librado P, Fages A, Gaunitz C et al. (2016) The evolutionary origin and genetic makeup of domes-
tic horses. Genetics 204: 423-434. DOI: 10.1534/genetics.116.194860
10. Broom D (1996) Animal welfare defined in terms of attempts to cope with the environment. Acta
Agriculturae Scandinavica Section A Animal Science Supplement 27: 22 – 28.
11. Arndt SS, Goerlich VC and van der Staay FJ. (2022) A dynamic concept of animal welfare: The role
of appetitive and adverse internal and external factors and the animal’s ability to adapt to them.
Frontiers in Animal Science 3: 908513. DOI: 10.3389/fanim.2022.908513
12. Taylor WTT, Bayarsaikhan J, Tuvshinjargal T et al. (2018) Origins of equine dentistry. PNAS 115 (29):
E6707 – E6715. DOI:10.1073/pnas.1721189115/-/DCSupplemental
13. Bols PEJ and de Porte HFM (2016) The horse catalyzed birth of modern veterinary medicine in
18th-Century France. Journal of Equine Veterinary Science 41: 35 – 41. DOI: 10.1016/j.jevs.2016.04.003
14. Zimann J (1976) The Force of Knowledge: The Scientific Dimension of Society. Cambridge Univer-
sity Press. Great Britain. ISBN 10: 0521206499 / ISBN 13: 9780521206495
15. Ray S (2023) Weaving the links: Traditional knowledge into modern science. Futures 145: 103081.
DOI: 10.1016/j.futures.2022.103081
16. Grace DC, Diall O, Saville K et al. (2022) The global contributions of working equids to sustainable
agriculture and livelihoods in agenda 2030. Ecohealth 19(3): 342 – 353. DOI: 10.1007/s10393-022-
01613-8.
17. Tadich TA (2020) Working equids: linking human and animal welfare. Veterinary Record 187(11):
442 – 444. DOI: 10.1136/vr.m4572
18. Matthew SM, Bok HGJ, Chaney KP et al. (2020) Collaborative development of a shared framework
for competency-based veterinary education. Journal of Veterinary Medical Education 47(5): 578 –
593. DOI: 10.3138/jvme.2019-0082
19. Lesimple C (2020) Indicators of horse welfare: state-of-the-art. Animals 10: 294. DOI: 10.3390/
ani10020294
20. AWIN (2015) AWIN welfare assessment protocol for donkeys. DOI: 10.13130/AWIN_DONKEYS_2015
21. AWIN (2015) AWIN welfare assessment protocol for horses. DOI: 10.13130/AWIN_HORSES_2015
22. Hausberger M, Lerch N, Guilbaud E et al. (2020) On-farm welfare assessment of horses: the risks
of putting the cart before the horse. Animals 10: 371. DOI: 10.3390/ani10030371
23. Raw Z, Rodrigues JB, Rickards K et al. (2020) Equid assessment, research and scoping (EARS):
The development and implementation of a new equid welfare assessment and monitoring tool.
Animals 10: 297. DOI: 10.3390/ani10020297
24. Sommerville R, Brown AF and Upjohn M (2018) A standardized equine-based welfare assess-
ment tool used for six years in low and middle income countries. PLoS ONE 13(2): e0192354 DOI:
10.1371/journal.pone.0192354
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Mariano Hernández-Gil
MVZ Cert. MC
Equine Welfare and Performance
National Autonomous University of Mexico
Enjoying equitation since childhood, Mariano qualified in Veterinary Medicine and Animal Science by the
National Autonomous University of México (UNAM) in 2000, and two years later obtained a Master’s Degree
in Animal Nutrition by the Autonomous University of Yucatán.
Certified in Equine Practice by the Mexican Council of Veterinary Certification, his professional development
has been committed to welfare where equids are essential; always promoting the good traditional knowledge,
whilst introducing science and technology to facilitate effective human-equid relationships.
Practicing in diverse equine contexts and interplaying with stakeholders with distinct backgrounds, his main
interests are in behavior, nutrition, soundness, locomotion and health, as well as in sustainable development
and veterinary education.
Mariano is a full-time Equine Professor at UNAM. As an educator with expertise in work, production, leisure
and sport equids, he balances agricultural and medical models of veterinary education, to promote compe-
tence for equine welfare, health and performance at every context.
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WELFARE OF WORKING MULES

Tamara Tadich G
Programa Équidos and Programa de Bienestar Animal, Universidad Austral de Chile. Instituto de Ciencia
Animal, Facultad de Ciencias Veterinarias, Universidad Austral de Chile.
Although mules (E. asinus x E. caballus) are essential for pack work and increase in resilience in moun-
tainous areas, little research has been done on this species. Working mules, as other working equids, are
confronted with different risks for their welfare, these include inadequate human-animal interactions, in-
appropriate working practices, problems in the correct design of harnessing systems and a lack of under-
standing of their behavior and biology which may lead to negative perceptions about this hybrid. During
the last years we have tried to understand better some of these risk factor in order to develop welfare
strategies.
Many people consider mules as more aggressive than horses and donkeys, reason why we studied the
perceptions, attitudes, empathy and pain perception of soldiers about mules used by the Chilean Army. By
using different instruments to assess these constructs we found that there was a wide range of ages and
years of experience working with equids among soldiers, which may affect their perceptions. Significant
positive correlations were found between human empathy, animal empathy and pain perception. Soldiers
show a preference for working with mules over donkeys and horses, since they describe them as more
intelligent and stronger, in particular when logistic work in mountain areas is required. Nevertheless, they
were described as more aggressive than horses and donkeys. Donkeys were the least preferred species
to work with by soldiers. Text mining analysis showed three clusters associated with the mules’ needs
according to soldiers’ knowledge, these clusters represented nutritional, environmental and health needs.
In the same line, relevant relations were found for the word “attention” with “load”, “food”, and “harness”.
When asked what mules signify for them, two clusters were found, associated with mules’ working capac-
ity and their role in the army. Relevant relations were found between the terms “mountain”, “support”, and
“logistics”, and also between “intelligent” and “noble”.
Another intrinsic risk factor for working mules’ welfare could be the selection of morphological attributes
that are less suitable for work. Physical attributes are important features that can affect management,
performance, and welfare. We have assessed 16 morphometric traits and six morphofunctional indexes
of army mules in order to understand their aptitude for work but also to understand which type of mules
soldiers prefer to work with. The studied mules were well-balanced, with more riding and saddle type ap-
titude than for load work. According to responses, the ideal pack mule should be docile, medium size, re-
sistant and suitable for load work in mountainous terrain. Medium size mules, with a height to the withers
of 140cm were preferred, probably because they are easier to handle and pack than large mules of around
160cm to the withers, making the work of soldiers easier.
Size and morphology could also influence load and work capacity, this is why we investigated the perfor-
mance and recovery capacity of three different sizes of mules (small, medium and large) while carrying dif-
ferent loads (80, 105 and 130 kg) after a 2km and an 8km walk. Physiological indicators associated to heart
rate, respiratory rate and rectal temperature were assessed. Only for the 130kg load, after a 2km walk,
mules were not able to recover basal frequencies after 10 minutes (P< 0.05). In terms of blood indicators,
only serum cortisol showed significant changes for all loads (P< 0.05), recovering basal concentrations
after 2 hours finished the 2km walk. For the 8km walk only the 105kg load was assessed, the heart rate and
respiratory rates showed significant increases, recovering basal frequency after 10 minutes past the end
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of the walk. In terms of blood indicators, only potassium, fibrinogen, and cortisol showed significant differ-
ences between sampling times (P< 0.05). Potassium decreased after 2h past work, fibrinogen showed an
increase 5 days after work, and cortisol showed a significant increase at arrival, but then returned to basal
concentrations 2 hours later. We did not find an effect of mule size on their physiological response to work.
Another welfare concern when mules perform pack work is that the can develop skin wounds and lesions
on harness related areas of the body, but also muscular and bone damage that are not always visible
during clinical examination. In particular, this can happen with a harnessing system that does not fit ap-
propriately. We have used thermographic imaging and pressure sensors as non-invasive diagnostic alter-
natives to understand the effect of different loads on the back of mules. A crossover design was used with
twelve mules carrying three different loads (80, 105, and 130 kg) for two kilometers. Four pressure sensors
were placed in the harnessing system to assess the pressure (N) of the loads. Thermographic images of
the back were taken daily before and up to five days after the harnessing work. We found that heavier
loads (105 and 130 kg) generated a significant increase of temperature (P< 0.05) in all the analysed areas
of the mules’ back, with no significant differences between anatomical areas. The pressure sensors did
not reveal significant differences between load treatments or between anatomical areas, also there was no
evidence of a correlation between pressure and temperature.
There are still grey areas that need to be investigated, in particular in terms of mules’ behavior and biology.
Also we need to consider that the variability of mules features between countries is huge, since many char-
acteristics will depend on the selection of the jack and mares breed, so it is difficult to generalize findings
from one groups of mules under a particular geographic and cultural system to another.
References
1. 2023. Lagos J, González I, Tadich T. Use of thermography and pressure sensors as indicators of
the effect of load on pack mules. Austral Journal of Veterinary Sciences 55, 69-75 https://doi.
org/10.4067/S0719-81322023000100069 Special Issue Working Equids.
2. 2022. Lagos J, Rojas M, Tadich T. Morphological characteristics, preferences, and perceptions of

the ideal working mule. Journal of Equine Veterinary Sciences. 108, 103821
3. 2021. Lagos J, Rojas M, Rodrigues JB, Tadich T. Perceptions and attitudes towards mules in a
group of soldiers. Animals 11, 1009. https://doi.org/10.3390/ani11041009
4. 2019. Lagos J, Tadich T*. “Hematological and biochemical reference intervals for mules in Chile”.
Frontiers in Veterinary Science. DOI: 10.3389/fvets.2019.00400
Tamara Tadich is a veterinarian with a Master of Science in Equine Sciences from the University of Edin-
burgh and a PhD in Veterinary Sciences from Universidad Austral de Chile. She is currently an Associate
Professor at the Animal Science Institute of the Universidad Austral de Chile and Director of the Animal Wel-
fare Programme, which is part of the World Organisation for Animal Health Collaborating Centre for Animal
Welfare and Sustainable Livestock Systems. Her research focuses in working equids welfare.
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Innovative approaches for better health and welfare

of working donkeys.
João B. Rodrigues, DVM, PhD. The Donkey Sanctuary
The most recent official data points to there being a total of 60,842,839 donkeys and hybrids in the world
(53,033,466 donkeys and 7,809,373 hybrids), with 96% and 93% of these equids being present in Low-
and Middle-Income countries, respectively1.
These figures illustrate the importance of equids as working animals for millions of people worldwide, play-
ing a key role as clean, accessible, and sustainable co-workers across numerous contexts, contributing to
resilience, productivity, economic growth, and diversification2,3.
The fundamental work carried out by these animals should always be framed within respect for their
physical and mental limits, their dignity, the presence of adequate working conditions (including the use
of appropriate harness and implements) and ensuring that their health and welfare are seen as priorities.
Unfortunately, these assumptions are still far from reality, due to socio-economic and cultural aspects
affecting many owners and users of working equids worldwide. Owners and users demonstrate limited
knowledge regarding welfare indicators, with a direct impact on the health and welfare of their animals.
Such reality is exacerbated if we add the lack of qualified professionals who can provide health services to
working equids and should have an active role in the education and awareness of owners. Selected data
pointed that 90% of the world population of equids only receive 10% of the veterinary care4, with working
equids clearly suffering the most from this discrepancy.
Another aspect to consider is the lack of curricular content and subjects dedicated to donkeys and hybrids,
in hundreds of universities around the world. In countries with some of the largest populations of working
donkeys and hybrids, a lack of formal education for future professionals represents a real obstacle to en-
suring that more working equids receive appropriate care.
As part of the new strategy, The Donkey Sanctuary (TDS) outlined some truly ambitious objectives for the
next 5 years, both in terms of the number of people, and the animals that they intend to reach. Education
is a crucial part in this process, through which values and knowledge acquired by TDS can be shared and
applied with those who will benefit the most: donkeys and hybrids. For that, TDS developed The Donkey
Academy, an innovative online education and knowledge sharing platform.
The talk will focus on the Donkey Academy University Partnerships and Alumni Programme, a joint pro-
gramme between TDS and Equitarian Initiative launched in 2023 for Latin America, is in its early stage, but
has the aim of creating strategic partnerships with universities from all over the world. The project includes
the development of online courses directly focused on professionals / future professionals, in areas such
as veterinary medicine, animal welfare, and animal husbandry, and will provide trainees with both theoret-
ical and practical knowledge in different areas directly related to the health and welfare of working equids,
so that can be incorporated into their daily / future professional work.
The Programme includes other educational, scientific, and technical actions and activities that create
and disseminate knowledge about working equids, while raising their profile. Innovative pedagogical ap-
proaches, moving from didactic to participatory and problem-based learning, in line with modern academ-
ic curricula will be applied.
As main aims, this project intends to engage in university-level educational activities focused on promoting
health and welfare of working equids; promote interest among the academic community about donkeys
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and mules, to raise their status; provide curricular support and fill the existing curricular gaps; and raise
awareness about the unique nature and specific needs of working equids, mainly donkeys and hybrids. As
a final aim, the Programme intends to promote a vibrant online Alumni community who regularly meet to
share knowledge and problem solve issues from different cultural contexts.
Ensuring that future generations of professionals understand the value and importance of working equids
in the world, at the most varied levels, and that they apply the acquired knowledge in favour of these
animals, is certainly an effective way of contributing to their health and welfare and ensure that working
equids live and work in the dignified conditions they so deserve.
References:
1. FAOSTAT. FAO Statistical Yearbook. Food and Agricultural Organisation of the United Nations.
Available online: http://www.fao.org/faostat/en/#home (accessed on 15 August 2023).
2. HLPE (2016). Sustainable agricultural development for food security and nutrition: what roles for
livestock? A report by the High-Level Panel of Experts on Food Security and Nutrition of the Com-
mittee on World Food Security, Rome. Available from: https://www.fao.org/3/i5795e/i5795e.pdf
3. EuroGroup For Animals, World Horse Welfare, The Donkey Sanctuary (2022). Working Equids in
the European Union. Available from: https://www.eurogroupforanimals.org/files/eurogroupfor-
animals/2022-12/2022-12-15-Working%20equids%20in%20the%20European%20Union-Report.
pdf
4. Merriam J., Hernandez-Gil M., Anzuino J. (2010). Introduction to Veracruz Equitarian workshop.
Veracruz, Mexico.
5. The Donkey Sanctuary (2022). The Donkey Academy. Available fro:m https://thedonkeysanctuary.
eu-west.catalog.canvaslms.com
João B. Rodrigues
Senior Lead – Welfare Assessment. The Donkey Sanctuary.
João B. Rodrigues is a Portuguese Veterinarian, qualified at the University of Trás-os-Montes and Alto Douro
(Portugal), in 2007. In 2011 was classified as an Expert in Veterinary Dentistry and Maxillofacial Surgery by the
Complutense University of Madrid (Spain), and in 2013 obtained a Ph.D. focusing on research in the field of
donkey dentistry. He was appointed as Professor of Medicine and Surgery of Equids in Portugal in 2013, and
joined The Donkey Sanctuary in 2016. João has extensive donkey medical and welfare experience globally,
with a special interest in working donkeys. He is a regular lecturer, tutor, and practical assessor in different
topics related with working equids worldwide, and has published numerous articles and contributions to
books. He is the chair of the Portuguese Association of Animal Traction (APTRAN) and the FECTU - European
Draught Horse Federation.
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Behavior as a Tool to Improve the Welfare of Horses,

Mules and Donkeys
Julia H. Wilson, DVM, Diplomate, ACVIM; Equitarian Initiative; Stillwater, MN, USA
The behavior of horses, donkeys and mules and the behavior of the humans they interact with are inextri-
cably linked and exert a strong influence on the welfare of both groups. Why are most behavioral issues
that impact equid welfare caused by people? There are many reasons, some of which can be addressed
with education and hands-on training. In some impoverished developing countries, equids may not be
perceived as sentient animals and therefore treating them as a disposable tool may be acceptable. The
region may not have a culture of horsemanship so knowledge of horse handling and health care may be
minimal. Traditional training techniques may be harsh, creating an interaction where the animal learns
through negative reinforcement. Culturally acceptable cruelty, particularly in men, is ingrained in many
communities and hard to change.
Using patience and positive reinforcement, an equid’s behavior is easier to improve than the behavior of
their humans. Veterinarians must recognize that behavioral modification to allow examination and treat-
ment can seldom be achieved quickly. Most misbehavior by horses, donkeys and mules during their
human interactions is learned or reactionary. Avoidance or defensive behaviors may be triggered by pain,
often unrecognized by the human. Addressing the source of the pain, if present, is necessary to begin
to change that behavior. Control of the working environment to minimize stress is also key for training.
Absent distraction, the animal can focus on its lesson which may be successful in a shorter period. Differ-
ences in training approaches between horses, donkeys and mules should always be considered.
Improving human behavior to improve equid welfare is more challenging. Culturally sensitive approaches
seem to be the most effective. Creation of an interest or incentive for behavioral change is key. Partici-
patory learning within a community has been most successful. Demonstration of a calmer, gentler way of
handling the animal is a great start and is ideally provided by a person who is similar to the owner (gender,
language, background, etc). Interactive, informal small learning groups with short lessons over several
days give the learners time to practice the techniques at home before the next lesson as well as finish their
normal day’s work. Role playing can be an effective exercise to emphasize the importance of clear com-
munication with the equid: one owner plays the role of the “equid” who can only respond to cues from the
owner. The “owner” then must learn to communicate speed and direction to the “equid” using reins to a
dowel in the “equid’s” mouth, voice, and a stick. Education on foot trimming/shoeing and common sources
of pain such as harness and bits can also be imparted. One or two of the owners may then become instruc-
tors to others in the community using the same techniques.
Children and women may be the primary caretakers of a working equid, or at least look after it when it is
not working. Children are often the most receptive to gentler training techniques and basic health care
lessons. Utilizing the same principles, using role playing, and interjecting humor has been successful in
many communities. Women’s groups within a community can also be engaged and are frequently more
receptive to new ideas and techniques.
Emerging research from social scientists as well as animal professionals will continue to generate ideas
and techniques to improve human behavior and demonstrate the effectiveness of positive reinforcement
in equid – human interactions.
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2023
Bibliography
Madariaga-Najera M, Torres-Sevilla MA. Perception and relationship changes of owners towards their
mules to improve animal-human welfare in Tlaxcala, Mexico. In: 7th International Colloquium on Working
Equids. Royal Holloway, University of London; 2014. p. 120–1.
C.R. Heleski, A. K. McLean, and J. C. Swanson. 2010. Practical Methods for Improving the Welfare of Hors-
es, Donkeys, and other Working Draught Animals in Developing Areas, Pp 252-73. In: Improving Animal
Welfare a Practical Approach, ed. Temple Grandin. CAB International.
Dr. Julia Wilson graduated from Cornell University in 1978. She pursued an internship in large animal
medicine at the Ontario Veterinary College followed by a residency at the University of Florida. She is a
Diplomate of the American College of Veterinary Internal Medicine. She served the majority of her career
as a faculty member, first at the University of Florida and then the University of Minnesota. She now works
as the Executive Director of the Minnesota Board of Veterinary Medicine. As an academic, beyond the joy
of teaching and clinical work, her research focused on topics of neonatology, gastroenterology and infec-
tious diseases. Dr. Wilson has served on the Board of Directors of the American Association of Equine
Practitioners as well as on many AAEP Committees.
Dr. Wilson’s international childhood, opportunities to lecture in other countries and experience on the Board
of Directors of Heifer International led her to partner with Dr. Jay Merriam to create Equitarian Initiative, a U.S.
non-profit organization that works to improve the health and welfare of working horses, donkeys and mules
and the families that depend on them. This organization currently has programs in nine countries. Many
include collaboration with local veterinary colleges to enhance the equine curriculum through teaching and
provision of veterinary care in communities in need. She is currently on the Board of Directors of Brooke USA
Foundation, another nonprofit organization that supports working equids. She is married to Tracy Turner,
DVM, MS, DACVS, DACVSMR who shares her passion for international service.
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Working Equid Biomechanics

Rebecca S. V. Parkes
BSc BVetMed PhD Cert AVP PG Cert (Vet Ed) FHEA MRCVS
Associate Professor, Large Animal Medicine and Surgery Department, School of Veterinary Medicine, St
George’s University, Grenada, West Indies
Working equids play a key role in supporting the livelihoods of many people in low and middle income
countries (LMICs). They are typically used for work involving load carrying or draft power for transporting
either people or goods, and their welfare is inextricably linked to that of their owners (Tadich, 2020). His-
torically, their economic importance has been overlooked as it is less easy to quantify than the contribution
of production animals, but this is beginning to change. The loads that they carry and pull are usually far
more than what is expected of competition or leisure horses, and often they will transport these loads for
a prolonged period of time, and under challenging environmental conditions. For example, while there
is regional variation, a quarter of donkeys in Pakistan have been reported to carry loads equal to 90% or
more of their own bodyweight, with some donkeys estimated by their owners to be carrying more than
150% of their bodyweight (Bukhari et al., 2022). This is far from unusual, and has been reported in multiple
locations.
Given the obvious welfare issues faced by working equids, such as poor body condition, musculoskeletal
problems, parasitism, behavioral issues and poor access to veterinary care, biomechanics may seem an
odd topic to cover. However, biomechanics are simply how the animal (and its load) moves, and this has
a key impact on musculoskeletal conditions, which are a leading cause of poor welfare in working equids.
An understanding of how this works is helpful when considering problems and developing interventions,
although most work on biomechanics has been conducted on sports horses and Thoroughbred racehors-
es, and may not be directly transferable to donkeys or mules.
In terms of locomotor abnormalities when load carrying, increasing loads can lead to a reduction in gait
symmetry and gait stability, as well as alterations to stance time (the time each hoof is in contact with
the ground) and the horse’s head and neck position (Bukhari et al., 2021). These changes may occur at
a relatively low load, and could provide a useful tool for professionals to assess load appropriateness in
conjunction with behavioral and physiological indicators. The biomechanics of load pulling have been less
well-studied than load carrying. The impact of pulling a load is different to carrying one, and depends on
the type of vehicle or load (e.g., two or four wheeled cart, sled, log, etc.). Draught force can be defined as
the force required to pull a load in the same direction of travel as the animal, and this and the harness have
a large impact on the forces experienced by the animal (Bukhari and Parkes, 2023). For example, when
donkeys are used in logging, a greater force is required to pull a sled compared to a wheeled vehicle, and
more force still is required to pull a log alone (Rodrigues et al, 2023). In addition, full collars, shaped or ad-
justed to take into account the different shape of a donkey’s neck in comparison to a horse’s, spread force
more effectively and are likely to result in improved welfare (Garrett et al., 2021). This knowledge, alongside
practical considerations such as availability and cost of materials, may impact on an owner’s choice of
draught equipment.
When considering interventions for working equids, it is essential to keep in mind the function of the ani-
mal, the environment in which they work, and what resources are available locally. For example, it is more
helpful to an owner to help them redesign their donkey’s collar using locally available material, so that
they can undertake future modifications and repair themselves, than it is to give them an imported item
of equipment. Novel approaches to problems (e.g., looking at biomechanics research in horses used for
sports) can help in answering some questions and provide solutions. Future work should focus on using
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an understanding of working equid biomechanics to identify areas for practical improvements, help those
working in the field, and inform policy.
References
1. Bukhari, S. S. U. H., McElligott, A. G., & Parkes, R. S. V. (2021) Quantifying the Impact of Mounted
Load Carrying on Equids : A Review. Animals, 11, 1333. https://doi.org/10.3390/ani11051333
2. Bukhari, S. S. U. H., Rosanowski, S. M., McElligott, A. G., & Parkes, R. S. V. (2022) Welfare concerns
for mounted load carrying by working donkeys in Pakistan. Frontiers in Veterinary Science, 9,
886020. https://doi.org/10.1101/2022.03.07.483371
3. Bukhari, S. S. U. H., & Parkes, R. S. V. (2023) Assessing the impact of draught load pulling on
welfare in equids. Frontiers in Veterinary Science, 10. https://doi.org/10.3389/fvets.2023.1214015
4. Garrett, C., Norris, S. L., Rodrigues, J. B., Queijo, L., Cooke, F., & Judge, A. (2021) Collar pressure
mapping : An evaluation of seven collar types used on working donkeys in Europe. Veterinary
Record, e772(June), 1–10. https://doi.org/10.1002/vetr.772
5. Rodrigues, J. B., Garrett, C., Norris, S. L., Albuquerque, F., Queijo, L., Coelho, J. P., Cooke, F., &
Judge, A. (2023) May the force be with you: an investigation into logging methods using donkeys.
Austral J Vet Sci 55(1), 23-33. http://dx.doi.org/10.4067/S0719-81322023000100023
6. Tadich, T. A. (2020) Working equids : linking human and animal welfare. Veterinary Record, 187(11),
442–444. https://doi.org/10.1136/vr.m4572
Dr Rebecca Parkes is Associate Professor in the Department of Large Animal Medicine and Surgery at St
George’s University School of Veterinary Medicine, Grenada.
Rebecca graduated from the Royal Veterinary College and undertook an internship in equine orthopaedics
before spending a period of time volunteering for a working equid charity in Luxor, Egypt. She then returned
to the RVC for her PhD in equine locomotor biomechanics before moving to Hong Kong to work for the Hong
Kong Jockey Club as a clinician. After this, she took on an Assistant Professor position at the Jockey Club
College of Veterinary Medicine and Life Sciences at City University of Hong Kong, before her most recent
move to Grenada.
Rebecca’s research is predominantly focused on musculoskeletal conditions and she has particular interests
in working equids and veterinary education. She is currently supervising a PhD student from Pakistan on
the project ‘How Much Can a Donkey Carry?’, investigating biomechanical, physiological and behavioural
markers in load carrying in working donkeys in Pakistan. She is interested in community engagement and
developing scientifically sound, practical solutions to issues facing working equids.
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Clinical Diagnosis Of Dental Disease

Author: Sebastián Guerra Díaz, DVM, MS, PhD
Universidad Nacional Andrés Bello (Escuela de Medicina Veterinaria); SGVet Servicios dentales para
caballos
Dental diseases are common in horses, reported by several studies in the past 10 years with prevalences
from 49 to 99% with at least one pathology identified. The most common associated signs are low body
condition score, abnormal head movement during exercises or bitting problems, among others, they can
impact severely the horse performance and reproductive succes rate.
In this lecture we will review important steps in clinical diagnosis of dental problems in horses, including
sedation, equipment and common dental diseases
The clinical examination of the horses mouth should start with clinical history, follow by complete physi-
cal and head exam, looking facial asymetries or swellings, halitosis, among others. Sedation is critical for
achieved detailed visualization of soft and hard tissues, and for severe pain pathologies should be nece-
sary nerve blocks. Equipment for exploration should include a power light, rinse syringe or flusher, mirrors,
cheek retractors, dental explorers and scalers, periodontal probes and alligators fórceps or periodontal
fórceps. Radiology still is the most common complementary exam used, but in the past few year great
advances have been shown in oroscopy and computed tomography of the equine head.
Is neccesary a comprehensive knowledge of teeth anatomy for detecting pathologies, especial concern
and detailed examination of oclusal surface (mesial/distal infundibulum, secondary dentin and hard tis-
sues of the clinical Crown), interdental spaces and every arcade surface or side (Buccal and lingual/pal-
atal). Frequent sites for soft tissue damage are rostral tongue, bars of the mandible, oral mucosa close to
cheek teeth.
Common pathologies are dental maloclussions (focal overgrowths or tipe I) in horses of all ages with
reports from 25 to 99%, and Periodontal disease with reports from 3,9 to 85%. Less frequent we can can
oberved congenital diseases (Braquignatism, rotated or displaced teeth), eruption abnormalities (retained
deciduous teeth) and caries.
References:
1. Nutall at al. 2019. Prevalence and análisis of equine periodontal disease, diastemata and peripher-
al caries in a first opinión horse population in UK. The Veterinary Journal 246 (2019) 98-102
2. Casey. M, 2013. A new understanding of oral and dental pathology of the equine cheek teeth. Vet
Clin Equine 29 (2013) 301 – 324
3. .- Gorski K. et al, 2022. Maloclusions and dental diseases in privately owned horses in the Mazovia
región of Poland. Animals 2022, 12, 3120.
4. Salem S.E. et al, 2017. Prevalence of orodental pathology in a working horse population in Egypt
and its relation to equine health. Equine Veterinary Journal (2017), 26-33
5. Guerra S. et al, 2016. Frequency of dental disorders in Chilean rodeo horses evaluated between
2010 -2013. SAFER (Sustainability, Agri, Food and Enviromental Research) 4 (3) 2016, 37-43
ISSN:0719-3726
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6. Nichols V., Townsend N. 2016. Dental diseases in aged horses and its management. Vet Clin
Equine 32 (2016) 215-227
Médico Veterinario de la Universidad Mayor (Chile), Doctorado en Medicina Veterinaria, de la Universidad

Andrés Bello (Chile), Magíster en Pedagogía Universitaria de la Universidad Mayor, Diplomado Internacional
en Medicina Equina Universidad Mayor – Michigan State University (USA), Profesor e Instructor Diploma-
do en Odontología Equina (IBVET Brasil); Profesor y Académico Hospital Docente UNAB; Miembro ABOE
(Asociación Brasileña de Odontología Equina); Miembro ACHVE (Asociación Chilena de Veterinaria Equina);
Médico Veterinario Certificado FEI***(Enduro); Manager y Propietario de SGVet Servicios dentales para ca-
ballos desde 2004. Expositor e instructor en odontología equina, de cursos, seminarios y congresos en Chile,
Brasil, España y México.
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2023
Odontoplasty – are we rasping too much?

Leena Karma, DVM, EVDC (Equine) resident, fNCED, Finland
Sharp enamel points of equine teeth has been rasped for centuries and it is the most commonly performed
procedure in equine dentistry. In modern dentistry odontoplasty procedure (rasping/floating) provides
a healthy and functional occlusion of all teeth by occlusal equilibration. Althought there is worldwide
practical knowledge how to perform this practice, the evidence based scientific research is still minimal
or none. Veterinarians need to take special care to do no harm to the teeth of the horse when performing
these procedures. Hence it is essential to know equine dental anatomy and physiology. Treament plan
should always be based on diagnosis of dental related problems. This should be followed by complete
ja thorouhg oral examination. When perfoming odontoplastic procedures without adequate knowledge,
irreverible damages (iatrogenic pulpitis) can be caused, which in turn can lead to extraction of the tooth.
Unnecessary floating should also be avoided to ensure that when the horse reaches its geriatric age, there
is still reserve crown left as much as possible.
DVM, EVDC (Equine) resident, Leena Karma – Finland
Leena Karma works as an equine veterinarian in south Finland in private equine dental clinic (Porvoon He-
vosklinikka, Porvoo, Finland) since 2010. She graduated as a DVM from Tartu Agricultural University, Estonia
1999 and from University of Helsinki 2003. She started her EVDC equine alternative dental recidency in 2020.
Before she established her equine dental clinic, she worked in different private equine clinics as both first and
second opinion veterinarian. In her clinic she provides referral services in advanced equine dentistry including
dental and sinus surgerys. She lectures nationally and internationally in the field of equine dentistry. She is
also involved in teaching equine dentistry to the students at the University of Helsinki, Finland. She also pro-
vides equine dental CPD courses in her clinic. Her main professional interest is in restorative and endodontic
therapies. She is still eager to learn more and curious about new techniques in equine dentistry. If she has
free time from that, she likes to play golf and go for a walk with her beagles.
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Periodontal disease in the horse – Are we making any

progress?
W. Henry Tremaine B.Vet.Med., MPhil, Cert.ES, Dipl. ECVS, Dipl. EVDC, FHEA, FRCVS
B& W, Equine Hospital, Breadstone, Berkeley, UK, GL139HG.
Periodontal disease has been recognised in domesticated horses since the early literature 1 and afflicts
horses of all breeds in domestic management with a prevalence in the uk reported as 13.8% 2 and with
increasing prevalence with age3. It is also prevalent in aged donkeys.
The disease is undoubtedly chronically painful and can lead to reduced weight gain, masticatory pain,
depressed demeanour and reduced athletic output. The clinical signs that are well known and include
dysmastication, hypersalivation, halitosis and particularly of preserved long-fibre forage, hypersalivation,
oral pain and intolerance of harness. Less common signs include trigeminal neuropathic pain that mani-
fests as pain, dental loss and osteomyelitis.
The aetiolpathogenesis and risk factors are described 3. These include the presence of diastemata be-
tween the cheek teeth, and dental misalignment, the presence of impacted food in these diastemata
which in turn putrefies with the release of inflammatory mediators 4,5,6,7 . These stimulate the progressive
destruction of the collagen fibres of the periodontal ligament 4 in an apical direction, and in severe cases,
lysis of interproximal bone. More recently the microbiology of periodontitis has revealed it to be a complex
interaction between pathogens and host immune responses 5 This becomes non-reversible in chronic
cases which can progress to loosening and loss of dentition. Primary periodontitis appears to be unusual
in horses. Lesions are more prevalent in the mandibular arcade than the maxilla1.
Management of the disease is multi-modal and persistence is necessary. The predisposing anatomical
risk factors may be persistent. Regular oral examinations to identify the pathology are advisable for most
domestic horses. Odontoplasty to improve mastication and occlusion will help to minimise drift and mis-
alignments if there is a tendency to these trends. However empirical excessive odontoplasty that flattens
the occlusal surfaces is both pointless and contra-indicated. However, reduction of excessive transverse
ridges precisely can be helpful to prevent these acting as plunger cusps that impact food into diastemata.
The key to short term improvement is the removal of impacted food material from diastemata. This deep,
firmly impacted, putrefying material can be troublesome and challenging to remove. Commonly used
techniques involve using metal interdental picks, high pressure irrigation and specially made forceps to
manually retrieve food fibres. This can be challenging technically, time consuming and difficult. The hors-
es will generally be painful and require moderately heavy sedation to achieve this and this may require
supplementation using regional analgesia. In some cases food clearance is impossible without interprox-
imal odontoplasty 8,9 . This has been shown to be effective in the treatment of periodontitis, particularly
for valve-confirmation diastema. This involves very precise removal of the interproximal mesial and distal
margins of teeth inter-proximally to enable food clearance (to a width of 3-4mm) taking care not to expos-
es superficial dental pulp that can lie just a few mm beneath the interproximal peripheral cementum and
enamel
Irrigation of the periodontal pockets after food clearance helps to remove residual food, inflammatory medi-
ators and non-vital tissue. This often exposes painful gingiva with mucosal ulceration that can extend deep
to the alveolar crest. Topical medication of the periodontal pocket with perioceuticals such as oxytetracy-
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clene, or haemostatic sponges is practiced but not yet validated. The challenge is to prevent-re-impaction
once periodontal debridement has been achieved. Clearly frequent repetition is often impractical although
this would probably be effective. Insertion of material to obturate the diastemata has become fashionable
but efficacy remains unproven. Temporary stenting using polyvinylsiloxane is widely practiced that can
enable salivary flow and prevents food impaction. This appears to be effective in the short term but such
products should be removed after a few weeks to mitigate any cytoxicity 10. More recently it has become
fashionable to use temporary luting cement containing calcium hydroxide to obturate such diastemata
although the rationale for using such long-lasting materials is obscure. Possibly the calcium hydroxide
contributes to disinfection of the diastemata, although careful freeing of any debris from the periodontal
pocket is necessary. In order to bridge the diastema then careful preparation etc. bonding and adherence
of a composite to either interproximal space is necessary. This can only be performed with after controlling
haemorrhage and reducing acute inflammation. Inevitably there is relative movement between the teeth
so bonding to both interproximal surfaces is contra-indicated. Such diastema bridges are semi-permanent
and can remain in situ to manage toe disease during the course of a season. However they require careful
pre-preparation and are time consuming to place and may not be available t all patients.
Prevention of the disease is also possible using dietary modification. Afflicted horses can be fed a modified
diet avoiding preserved long- fibre forage (such as chaff, haylage and hay) substituting it with grazing and
fibre or grass pellets. These do not become so firmly entrapped in the diastemata. There is possibly an
effect of the oral pH resulting from certain food types but much research needs to be done to determine
the effect of different feeds on salivary buffering and its significance as a risk factor for this syndrome.
Analgesia using non-steroidal drugs is an important component in managing severe cases. In addition to
the effect on inflammation such drugs enable more normal mastication by providing analgesia. Antimicro-
bials not usually indicated unless there is systemic or sever disease affecting the mandible.
References
1. Colyer, F. (1906) Variations and diseases of the teeth of horses. Trans. Odontol. Soc. Great Britain.
39, 154- 163
2. H.E. Nuttall a, P.J. Ravenhill (2019) Prevalence and analysis of equine periodontal disease, diaste-
mata and peripheral caries in a first-opinion horse population in the UK. The Veterinary Journal.
246, April 2019, Pages 98-102.
3. Walker, H., Chinn, E., Holmes, S., Barwise-Munro, L., Robertson, V., Mould, R., Bradley, S., Shaw,
D.J. and Dixon, P.M. (2012) Prevalence and some clinical characteristics of equine cheek teeth
diastemata in 471 horses examined in a UK first-opinion equine practice (2008 to 2009). Vet Rec.
171, 44- 47.
4. Cox A, Dixon P.M. , Smith, S (2012) Histopathological lesions associated with equine periodontal
disease. The Veterinary Journal. Volume 194, Issue 3, December 2012, Pages 386-39.
5. Staszyk C; Wulff W; Jacob HG; Gasse H, (2006) Collagen fiber architecture of the periodontal lig-
ament in equine cheek teeth. Journal of veterinary 23 (3), pp. 143-7;
6. Staszyk, C., Suske, A. and Pöschke, A. (2015) Equine dental and periodontal anatomy: a tutorial
review. Equine Vet. Educ. 27, 474- 481.
7. Kennedy, R.S. and Dixon, P.M. (2018), The aetiopathogenesis of equine periodontal disease – a
fresh perspective. Equine Vet Educ, 30: 161-168.
8. Dixon, P.M., Barakzai, S., Collins, N. and Yates, J. (2008) Treatment of equine cheek teeth by me-
chanical widening of diastemata in 60 horses (2000-2006). Equine Vet. J. 40, 22- 28.
9. Dixon, P.M., Ceen, S., Barnett, T., O’Leary, J.M., Parkin, T. and Barakzai, S. (2014) A long-term study
on the clinical effects of mechanical widening of cheek teeth diastemata for treatment of peri-
odontitis in 202 horses (2008-2011). Equine Vet. J. 46, 76- 80.
10. Ringeisen, H.; Poschke, A.; Krahling, B.; Schrock, C.; Stoll, M.; Vogelsberg, J.; Failing, K.; Staszyk,
(2018) Influence of dental materials on cells of the equine periodontium: Equine Veterinary Journal.
50 Issue 3, p363,
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Henry Tremaine spent 20+ years as a clinical academic at the Universities of Edinburgh, Ohio State and
Bristol, before joining B&W equine hospital in the west of England, a 50+ veterinarian practice owned by CVS
Ltd. His caseload comprises largely advanced dental and maxillofacial surgical cases in addition to surgical
emergencies, and reviewing CT images of the head. He is widely published in these fields, has contributed
to numerous textbooks and has presented internationally and is a Diplomate of ECVS and EVDC, and is cur-
rently EVDC president and WEVA board member.
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How radiographs can help with dental disease?

Leena Karma, DVM, EVDC (Equine) resident, fNCED, Finland
In modern dentistry, diagnosis of the head and dental pathologies should always be placed after complete
and through oral examination. Identificaiton of the relevant dental structures and associated pahtologies
with radiographs is possible in many cases. Radiographs are often taken to investigate dental pathologies
with possible periapical infection, diastema associated periodontitis, supernumerary teeth, missing teeth,
displaced teeth, unilateral nasal discharge, facial swelling or draining tracts etc. Despite the development
and availability of other imaging modalities like computer tomografy, cone beam computer tomography,
nuclear scintigragphy and MRI, radiographic examination has remaiden the most practical and most com-
mon imaging modality in equine dentistry. The development of direct and wireless systems has made it
very achievable for veterinarians both in the clinics and in the field. To get good quality diagnostical images
it is essential to know the right technique and the horse shoud be adeaquately sedated to avoid movement
artifacts and ensure radiation safety. It is also important to recognize its limitations. The equine head has
complex three dimensional anatomy and because radiograps gives two dimensional images, there are
superimposition of head and tooth structures.
DVM, EVDC (Equine) resident, Leena Karma – Finland
Leena Karma works as an equine veterinarian in south Finland in private equine dental clinic (Porvoon He-
vosklinikka, Porvoo, Finland) since 2010. She graduated as a DVM from Tartu Agricultural University, Estonia
1999 and from University of Helsinki 2003. She started her EVDC equine alternative dental recidency in 2020.
Before she established her equine dental clinic, she worked in different private equine clinics as both first and
second opinion veterinarian. In her clinic she provides referral services in advanced equine dentistry including
dental and sinus surgerys. She lectures nationally and internationally in the field of equine dentistry. She is
also involved in teaching equine dentistry to the students at the University of Helsinki, Finland. She also pro-
vides equine dental CPD courses in her clinic. Her main professional interest is in restorative and endodontic
therapies. She is still eager to learn more and curious about new techniques in equine dentistry. If she has
free time from that, she likes to play golf and go for a walk with her beagles.
82
Proceedings
2023
Oral extractions in the field: When and How

Author: Sebastián Guerra Díaz, DVM, MS, PhD
Universidad Andres Bello, Escuela de Medicina Veterinaria; SGVet Servicios dentales para caballos
Oral extractions is a procedure that follows several steps, nevertheless, always is important to ensure good
anatomy and pathology knowledge, as well as managing different techniques for a good case selection
and succes rate.
In this lecture we will review decisión making for extractions in the field, as well as common indications,
complications and techniques.
One of the most common causes for dental extraction is apical infection (62%) that can be produced in
maxilary teeth by anachoresis (51%), infundibular caries, periodontal spread, displastic teeth, fracture and
pulp exposure. Even if there is a incisor, canine or cheek teeth involved it needs to be confirmed by radiol-
ogy. Clinically in pulpitis we can observed under mirror or endoscope pulpar exposures of different levels
from small changes in secondary dentin until food trapped inside. Fractures can be classified if they com-
promised or not sensitive tissue, and must be carefully assesed. Periodontal disease also is well known like
a possible extraction indication in advanced cases not responding to conservative therapies.
Intraoral technique has an outcome around 80%, and for a good procedure will be likely to have a good
amount of clinical crown. Complications are reported from 6-20%. So case selection for extraction at the
field is very sensitive especially in cheek teeth. If the CT doesnt have a good clinical crown could be a good
reason for referral, because it will need advanced extraction procedures and post-operative cares. Never-
theles (in this autor opinión) most of the incisor and canines extractions can be performed at the field with
minimal complications.
The most common complication are alveolar sequestration, retention of fragments, damage to adjacent
teeth, damage to mandibular/maxilary nerves or parotid duct, chronic sinusitis and oro-antral fistular
among others.
Post alveolar manage is a very crucial step and also should be take in consideration for procedures at the
field, specially with preexisting complications, location of the horse, and kind of technique used. For a stan-
dard procedure should be necessary at least 2 examinations every 10-15 days for ensure good granulation
and alveolar care, including lavage, packing change and/or curetagge if needed.
1. Dacre et al, 2008. Pathological studies of cheek teeth apical infections in the horse: 5. Aetiopatho-
logical findings in 57 apically infected cheek teeh and histological and ultrastructural findings. The
Veterinary Journal 178 (2008, 352 – 363.
2. Dixon P. 2022. Complications of equine cheek teeth extractions. Equine Vet Educ 2023, 35: 384-
392
3. Caramello et al., 2020. Equine cheek tooth extraction: Comparison of outcomes for five extractions
methods. Equine Vet J 52, (2020), 181 – 186.
4. Tremaine H. 2004. Oral extraction of equine cheek teeth. Equine Vet Educ (2004), 16(3) 151-158
5. Kennedy at al., 2020. A long term study of equine cheek teeth post extraction complications: 428
cheek teeth (2004 – 2018). Equine Vet J (2020) 52,811-822
6. Reardon R. 2022. Exodontia complications and treatment. In: Equine Dentistry and Maxilofacial
Surgery , 1st Edition, Newcastle-upon-tyne UK. Cambridge Scholar Publishing, pp. 553-566
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Sebastián Guerra Díaz, DVM, MS, PhD
Médico Veterinario de la Universidad Mayor (Chile), Doctorado en Medicina Veterinaria, de la Universidad

Andrés Bello (Chile), Magíster en Pedagogía Universitaria de la Universidad Mayor, Diplomado Internacional
en Medicina Equina Universidad Mayor – Michigan State University (USA), Profesor e Instructor Diploma-
do en Odontología Equina (IBVET Brasil); Profesor y Académico Hospital Docente UNAB; Miembro ABOE
(Asociación Brasileña de Odontología Equina); Miembro ACHVE (Asociación Chilena de Veterinaria Equina);
Médico Veterinario Certificado FEI***(Enduro); Manager y Propietario de SGVet Servicios dentales para ca-
ballos desde 2004. Expositor e instructor en odontología equina, de cursos, seminarios y congresos en Chile,
Brasil, España y México.
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Dental problems that get complicated?

W. Henry Tremaine, B.Vet.Med., M.Phil., Cert.ES, Dipl. ECVS, Dipl. EVDC, FHEA, FRCVS
B& W, Equine Hospital, Breadstone, Berkeley, UK, GL139HG.
The steady output of publications on the subject of equine dentistry on the literature has fueled improv-
ing understanding of the aetiology and risk factors associated with equine dental disease. Technologi-
cal advances coupled with this have resulted in increased ambition from veterinary dental professionals,
technicians and a temptation to attempt any procedure in a field situation. While the efficacy of many
treatments remains unvalidated, the complications associated with some of these techniques have been
documented. Opportunities for dental training are widespread now but only a minority attend a rigorous
assessed post-graduate training programme, as is common in other specialities. It is therefore important
for the veterinary dentist, particularly when working alone in a peripatetic setting, to be aware of the pos-
sible complications of any procedure, be cognisant of the limitations of their equipment and expertise and
to guard against their medical judgement being swayed by excessive ambition, commercial interest or
owner pressure.
Most dental procedures are carried out in conscious sedated horses. The planning of any procedure
should be preceded by a thorough examination including diagnostic imaging where needed and appropri-
ate, detailed planning and informed consent of the procedure that may be staged on a different occasion.
The planning should include: consideration of location and facilities; technical assistance; instrumentation
and contingency plans for anticipated complications. Intrinsic to this is the safety of the veterinarian, as-
sistants, owners and the horse itself as a result of a dangerous response of the animal to the stimulation,
and the risk of iatrogenic damage if procedures are undertaken in compromised circumstances.
The majority of horses respond favourably to sedative analgesic protocols combined with regional anal-
gesia. These enable quite intrusive surgical and dental procedures to be carried out safely. However with
some intolerant patients the risks associated with these outweigh the perceived risks of doing the proce-
dure with the horse anaesthetised and this should be remembered as an option 1.
The trend for motorised mechanical devices to perform odontoplasty has improved the efficiency and pre-
cision of this when done safely and precisely. Nevertheless in poorly restrained animals such instruments
are capable of afflicting iatrogenic dental pulp exposure unwittingly if used improperly.
Odontoplasty for the treatment of periodontal disease removes interproximal dentine that can lie just a few
mm superficial to mesial and distal pulp horns. Good restraint and precise treatment guided by oroscopic
observation minimise the risk of this. The veterinarian should know and be equipped to performed first aid
measures on any iatrogenically exposed dental pulp 2 .
Dental extraction per os if performed competently has a low incidence of complications (9%) 3 and is the
most effective technique for equine dental extraction. However not all teeth can be extracted thus. Patho-
logically diseased, fractured or impacted teeth require some form of surgical extraction. All of the more
invasive technique require specialised instrumentation, additional training and considerable experience
to undertake without high complication rates 4, 5. Newer minimally invasive techniques have superced-
ed traditional repulsion which is largely obsolete due to the unacceptable rate of complications. Such
techniques require greater precision, more technical assistance and very careful case selection to enable
consistent results 6,7.
Removal of teeth with fractured crowns, particularly maxillary teeth associated with the paranasal sinuses,
caudal mandibular molars and impacted teeth can be particularly challenging. A large array of different
equipment is needed to enable all technical possibilities 8,9. The benefit of CT images that inform treatment
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selection and possibilities is unquestioned but this three-dimensional imaging modality of only widely
available in selected geographical areas such as the United States and Europe. Treatment failure can
manifest as failure of exodontia, persistent sinusitis, sequestrum formation, fistula formation and iatrogenic
supporting bone fracture 10, 11, 12. When considering a potentially complex treatment the veterinary dentist
must consider the resources available to them, the resources of the owner, the availability locally of spe-
cialist knowledge and equipment and the contingency for complications to avoid iatrogenic damage, and
predict and avoid any of these complications .
References
1. Tanner, R. Brad; Hubbell, John A. E. (2019) A Retrospective Study of the Incidence and Manage-
ment of Complications Associated With Regional Nerve Blocks in Equine Dental Patients. Journal
of Veterinary Dentistry , Vol. 36 Issue 1, p40-45.
2. Dixon, P.M., Barakzai, S., Collins, N. and Yates, J. (2008) Treatment of equine cheek teeth by me-
chanical widening of diastemata in 60 horses (2000-2006). Equine Vet. J. 40, 22- 28.
3. DIXON, P.M., DACRE, I., DACRE, K., TREMAINE, W.H., McCANN, J. and BARAKZAI, S. (2005),
Standing oral extraction of cheek teeth in 100 horses (1998-2003). Equine Veterinary Journal, 37:
105-112.
4. Earley, Edward T.; Galloway, Stephen S.(2020) Equine Standing Surgical Extraction Techniques. In
Veterinary Clinics of North America: Equine Practice. 36(3):575-612 Vol. 36 Issue 1, p40-45.
5. Galloway, Stephen S.; Earley, Edward T.(2020) . Minimizing Equine Tooth Extraction Complica-
tions In Veterinary Clinics of North America: Equine Practice. December 36(3):641-658.
6. Kennedy, Rebekah; Reardon, Richard J. M.; James, Oliver; Wilson, Cherith; Dixon, Padraic M.
(2020) A long-term study of equine cheek teeth post-extraction complications: 428 cheek teeth
(2004-2018). In: Equine Veterinary Journal. Vol. 52 Issue 6, p811, 12
7. Dixon, Padraic M. Complications of Equine Oral Surgery (2023) . Equine Veterinary Education. Vol.
35 Issue 7, p384-392.
8. Earley, Edward T.; Rawlinson, Jennifer E.; Baratt, Robert M. (2013) Complications Associated with
Cheek Tooth Extraction in the Horse. Journal of Veterinary Dentistry, Vol. 30 Issue 4, p220-235,
9. Pearce, D. J.; Brown, J. A. (2019) Extraction of 22 equine cheek teeth with displaced sagittal frac-
tures using polymethylmethacrylate stabilisation (2011–2016). Equine Veterinary Education., Vol.
31 Issue 8, p421-426
10. Tremaine, W. Henry; McCluskie, Laura K. (2010). Removal of 11 Incompletely Erupted, Impacted
Cheek Teeth in 10 Horses using a Dental Alveolar Transcortical Osteotomy and Buccotomy Ap-
proach In: Veterinary Surgery., Vol. 39 Issue 7, p884
11. O’NEILL, H.D., BOUSSAUW, B., BLADON, B.M. and FRASER, B.S. (2011), Extraction of cheek
teeth using a lateral buccotomy approach in 114 horses (1999–2009). Equine Veterinary Journal,
43: 348-353.
12. Caramello, V., Zarucco, L., Foster, D., Boston, R., Stefanovski, D. and Orsini, J.A. (2020), Equine
cheek-tooth extraction: Comparison of outcomes for five extraction methods. Equine Vet J, 52:
181-186.
Henry Tremaine spent 20+ years as a clinical academic at the Universities of Edinburgh, Ohio State and
Bristol, before joining B&W equine hospital in the west of England, a 50+ veterinarian practice owned by CVS
Ltd. His caseload comprises largely advanced dental and maxillofacial surgical cases in addition to surgical
emergencies, and reviewing CT images of the head. He is widely published in these fields, has contributed
to numerous textbooks and has presented internationally and is a Diplomate of ECVS and EVDC, and is cur-
rently EVDC president and WEVA board member.
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How to perform a neurologic exam in the horse

Monica Aleman, MVZ Cert., PhD, Dipl. ACVIM (LAIM, Neurology)
Professor
University of California Davis
Introduction
The neurologic examination in the horse must include the evaluation of behavior, state of consciousness,
cranial nerves, posture, and postural reactions, segmental (spinal) reflexes, palpation, gait evaluation, and
nociception in recumbent horses with no obvious voluntary movement. Do not forget the autonomic ner-
vous system which includes the sympathetic, parasympathetic, and intrinsic enteric plexuses. Most of the
neurologic exam is based on observation. Key points include safety first, observation, know what is normal,
and tailor the exam to the individual (safety, domestication, cooperation, severity of deficits). A comprehen-
sive examination will aid in the localization of disease. A complete history including vaccination status and
determination of the overall health of the horse are essential to obtain.
Precaution must be practiced when dealing with a horse with acute rapidly progressive onset of disease
and rabies must be a consideration, particularly in endemic areas. Furthermore, highly contagious diseas-
es such as herpes-1 myeloencephalopathy must be considered in horses with fever.
Neurologic examination
The goals of the neurologic examination are to determine: 1) If the horse is normal or abnormal, 2) neu-
roanatomical localization, 3) list most likely causes of disease. To determine the most likely causes of
disease, the following essential information is required: 1) Neuroanatomical localization, 2) signalment, 3)
onset (rapid versus insidious), 4) duration (acute, subacute, chronic), 5) progression (+/-), 6) fever (+/-), 7)
pain (+/-), and 8) one animal versus multiple in the same facility. The examination consists of evaluating
the neurologic status while the horse is at rest (static) and during movement (dynamic).
Examination at rest:
1. Behavior and mentation
2. Cranial nerves
3. Posture (head, neck, trunk, limbs, tail)
4. Postural reactions (i.e., proprioceptive positioning)
5. Segmental (spinal) reflexes
6. Palpation
Examination during movement:

1. Gait evaluation + head, neck, trunk, limbs and tail posture while moving
2. Nociception (pain perception only in non-ambulatory animals with no obvious voluntary move-
ment)
Behavior. Normal: Bright, alert, responsive. Abnormal: Any compulsive behavior (e.g. walking, playing
with water, chewing), barking, star gazing, looking at his flanks.
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Mentation/state of consciousness. Normal: Bright, alert, responsive. Abnormal: 1) Obtundation, 2) Stu-

por, 3) Coma. Obtundation: From mild to severe (recumbent) but always responsive to non-painful stimuli
(e.g., touch, sound, palpation). Stupor: Recumbent not moving, appearing unconscious, and only responsive
while applying painful stimuli (e.g. pinched with forceps, electric probe). Coma: Recumbent not moving,
appearing unconscious and not responsive to any kind of stimuli (you might observe reflexive movement,
but the animal does not respond consciously to stimuli).
Cranial nerves. These include olfactory (I), optic (II), oculomotor (III), trochlear (IV), trigeminal (V with its
3 branches: maxillary, mandibular, ophthalmic), abducens (VI), facial (VII), vestibulocochlear (VIII), glosso-
pharyngeal (IX), vagus (X), spinal accessory (XI), and hypoglossal (XII). Cranial nerve responses, reactions,
and reflexes must be evaluated. Simple observation of the horse while standing and eating, and response
to noise can reveal deficiencies. For detailed specific function of each cranial nerve, the reader is referred
elsewhere.
Posture and postural reactions. Posture of the head, neck, trunk, tail, and limbs is important. Head tilt,
neck turn, whole body leaning, trunk turned, hunched back, wide- or narrow-based stance, tail down or up
or pulled to the side could be observed with neurologic disease. Postural reactions (including propriocep-
tive placing and hopping tests) can be performed with caution. Again, examiner observation is essential to
note placement of the limbs.
Segmental (spinal) reflexes. The evaluation of segmental reflexes is limited in the horse, but should be
tested whenever possible. Segmental reflexes that can be readily evaluated include cervicofacial/auricular,
cutaneous trunci, perianal, and perineal. For appropriate performance and interpretation of other reflexes,
the horse must be relaxed (no tone, recumbent and relaxed). Therefore, not tested in standing animals.
However, these reflexes are easily tested in neonatal foals when placed in recumbency and performed
when relaxed.
Palpation. Palpation of the horse’s body including the head can reveal abnormalities not obvious on vi-
sual inspection. Check for symmetry, shape, pain, swelling, temperature, sweating, and masses. Palpate
muscles, bones, and joints; do flexion and extension of joints to assess for pain and mobility. Examine the
horse carefully for any muscle atrophy. Check tail tone and anal tone. Look for any loss of skin sensation
(hypalgesia or analgesia), increased sensitivity (hyperesthesia), or abnormal sweating (sympathetic de-
nervation).
Gait evaluation. Causes of lameness or abnormal gait could be due to orthopedic/musculoskeletal, neu-
rologic disease or a combination of both. Whenever possible, try to rule out orthopedic disease. Become
familiar with the different gaits depending on breed. Horses should be evaluated at the walk-in straight
line, backing, zigzag, different surfaces due to visual compensation, up and down a hill/curb, head eleva-
tion, and tight circles. If safe, the horse can be observed at the trot and canter. There might be situations
when full gait evaluation is not possible due to safety concerns.
Abnormalities that might be observed include ataxia (incoordination), dysmetria (e.g., hypermetria, hypo-
metria), paresis (decreased voluntary movement), weakness (lack of strength), hyperextension/hyperflex-
ion, and specific gait deficits associated with nerves deficits (i.e. radial, femoral, sciatic, peroneal, tibial). If
motor deficits, it is important to note upper (exaggerated) versus lower (reduced) motor dysfunction. The
grades of ataxia according to a modified grading scale include grade 1 – Inconsistent subtle deficits, grade
2 – consistent mild deficits, grade 3 – consistent moderate deficits (an untrained eye can readily identify
“something is wrong” without doing too much with the horse), grade 4 – consistent severe deficits at high
risk of collapse, grade 5 – recumbent.
Nociception. Nociception or pain perception (conscious perception of pain = “cortical awareness” of pain)
must be tested in horses with NO voluntary movement or when voluntary movement is questionable or not
observed. When testing for nociception, 2 things are expected normally: 1) conscious response to painful
stimuli (i.e., head turn or any other response that demonstrates that the patient feels what we are doing),
and 2) reflex movement away from painful stimulus. Both are different and each is testing different things
and final pathways.
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Functional neuroanatomy
The nervous system is divided in 1) Brain, 2) spinal cord, and 3) peripheral. The brain is further divided in 3
functional areas: 1) Forebrain (cerebrothalamus), 2) brainstem, and 3) cerebellum. The spinal cord is divid-
ed in spinal cord segments: C1-C5/6, C6-T2, T3-L3, L4-S2, and S-caudal. The peripheral nervous system
includes nerve rootles, roots, ganglia, nerves, and the neuromuscular junction with its subdivisions: pre-
synaptic (nerve ending), synaptic (space), and postsynaptic (muscle membrane).
References
1. Aleman M. Neurologic examination in the foal. Proc Am Assoc Equine Pract 2020;66:216-228.
2. Aleman M. Neurologic examination in horses. Proc Am Assoc Equine Pract 2015;61.
Dr. Monica Aleman obtained her veterinary degree at the University UNAM-Mexico. She completed residen-
cies in large animal internal medicine (equine emphasis) and neurology and neurosurgery at UC Davis; and
achieved board certification for both specialties by the American College of Veterinary Internal Medicine. Dr.
Aleman has received awards for outstanding work in clinics, research, and service from both residencies with
recognition by the American Association of Veterinary Clinicians for excellence in neurology. Dr. Aleman com-
pleted a PhD in comparative pathology in neuromuscular disorders at UC Davis which led to the discovery
of a genetic mutation of the ryanodine receptor 1 gene (RyR1) that causes malignant hyperthermia in Quarter
Horses. This mutation is located at a locus on which humans have 6 different mutations causing disease and
a novel mechanism of defective RyR1 activation was discovered. Dr. Aleman’s research and clinical interest
have focused in neurology, neuromuscular and muscle disorders in all species with equine emphasis. She
is a full professor of the equine internal medicine and neurology services, chief of service of equine internal
medicine, and co-Director of the Neuromuscular Disease Laboratory and the Clinical Neurophysiology Labo-
ratory at UC Davis which studies disease in several species including human disease. Dr. Aleman is one of the
founding members of the Equine and Comparative Neurology Research Group. Dr. Aleman is author of over
130 peer reviewed medical publications, over 100 proceedings and abstracts, and over 30 book chapters; and
is a regular speaker in national and international (over 25 countries) continuing education and research meet-
ings. Dr. Aleman has served as a reviewer for multiple scientific journals and research grants in both human
and veterinary medicine; and is currently an associate editor for Frontiers in Veterinary Science in Neurology.
Dr. Aleman is regularly consulted in challenging cases with neurologic and muscle disease throughout the
world. Main areas of study include epilepsy and sleep disorders. Currently, she works in the investigation
of neurologic and neuromuscular disorders in multiple species including humans. Dr. Aleman was recently
appointed the Terry Holliday Presidential Endowed Chair in Comparative Neurology by the University of
California at Davis, awarded for neurology research and clinical work by UCD at the American Association
of Equine Practitioners (AAEP), and awarded an alumni recognition for Excellence in teaching, research, and
service by the National Autonomous University of Mexico.
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2023
Headshaking in the horse: what do we know?

Professor
University of California Davis
Introduction
Trigeminal-mediated headshaking (HSK) in horses is a potentially life-threatening disorder that can affect
performance, daily activities, and quality of life that might lead to euthanasia. Common clinical manifesta-
tions include a violent vertical headshake that resembles an electrical shock to the horse’s nose. Horses
have an anxious facial expression, rub their noses in the ground or against objects, strike at their nose
wiht their thoracic limbs, and display excessive snorting. Episodes of headshaking can be spontaneous
or associated with exposure to UV light, wind, exercise (triggers or exacerbates), and sharp sounds. Most
horses are young mature geldings (72-76%) with a mean age at presentation of 8 to 10 years old. Clinical
manifestations can occur all year round but most commonly present in a seasonal fashion (spring, sum-
mer, and early fall). These observations have led our research group to suspect a multifactorial etiology
including hormonal, dietary, and environmental factors all playing a role in the pathogenesis of disease.
The exact cause(s) remains unknown.
Pathophysiology
Trigeminal-mediated headshaking is associated to inappropriate firing of the trigeminal nerve due to
a low threshold for firing which underlying cause is unknown. The trigeminal complex is composed by
central (brainstem, spinal cord tracts) and peripheral components (branches of the trigeminal nerve and
trigeminal ganglia). Another central component is the sensory cerebral cortex which is responsible for
the perception (awareness) of pain. Histochemical studies have not shown abnormalities of the trigemi-
nal complex. Therefore, this disorder involves a functional abnormality. Sensory nerve conduction of the
trigeminal complex from affected horses appears normal in terms of amplitude, duration, and velocity.
However, the difference between affected and healthy horses is the low threshold for firing in horses with
trigeminal-mediated headshaking (stimulus intensity < 5 mA) compared to healthy horses (> 10 mA). This
low stimulus for threshold explains why some apparently innocuous stimuli (e.g., wind on face, exposure
to light, sound, exercise) can trigger violent headshaking.
Diagnosis
It is important to consider and rule out other causes of headshaking such as middle and inner ear infection,
temporohyoid osteoarthropathy, ear ticks (Otobius megnini), ear mites (Trombicula autumnalis), guttural
pouch disorders, periapical dental osteitis, other dental problems (e.g. wolf teeth abnormalities), allergic
rhinitis, vasomotor rhinitis, ocular disorders (cysts, masses), intranasal masses, sinusitis, sinus surgery
(complications), nuchal crest avulsion, cervical vertebral osteoarthritis, apparent neck pain, inappropriate
tack, bridle or bit, and poor rider skills. Herpes virus infection causing neuritis and/or ganglionitis of the
trigeminal ganglia must also be considered. Anesthesia of the infraorbital and maxillary nerves is not spe-
cific for trigeminal-mediated HSK because this perineural block will anesthetize any area innervated by
these nerves. Diagnostic modalities to rule out some of the disorders listed here include radiographs (skull,
neck), endoscopy (upper airway including guttural pouches), ophthalmic and otoscopic examination, and
computed tomography and magnetic resonance of the head when available. Nasal swabs for PCR testing
for equine herpesvirus 1 should be considered. Allergy testing or allergy medicine can be tried as a diag-
nostic aid (evaluate response).
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Treatment
Several physical devices such as nose and head nets, masks, and goggles with UV light protection have
been used successfully in some horses. Riding practices at night for the photo activated headshakers
has helped but rendered impractical. Various medications including antidepressants, anticonvulsants,
channels blockers, and anesthetics have been used with variable results. Pharmacokinetics of many of
these drugs and their mode of action in the horse are unknown, plus possible adverse effects must be
considered. Several other therapies such as pulse therapy with steroids, compression or excision of the
infraorbital nerve, and percutaneous electrical nerve stimulator (PENS) of the infraorbital nerve have had
variable results.
Novel findings
Transient effects of acidification and alkalinization of blood in headshaking
It is known that alterations in blood pH can influence binding of calcium and magnesium to proteins,
further influencing the amount of free physiologically active calcium and magnesium (ionized calcium
and magnesium). These ions are important modulators of nerve function and have been implicated in
neuropathic pain. Therefore, we investigated the effects of various intravenous solutions with varying pH
and electrolytes to study the effects on pH, concentrations of Ca++, Mg++, and headshaking in diseased
and healthy horses. These IV solutions included 8.5% sodium bicarbonate (2 mmol/kg to alkalinize), 7.5%
hypertonic saline (4 mL/kg to acidify), and 5% dextrose (control solution). Changes in blood composition
were transient and the greatest decrease in headshaking (> 50%) occurred with IV sodium bicarbonate.
Transient effects of IV administration of magnesium sulfate in headshaking

Administration of 50% magnesium sulfate at 40 mg/kg IV resulted in transient alterations of pH and var-
ious electrolytes. As expected, this solution increased total and ionized magnesium in blood. Elevation of
magnesium concentrations in blood resulted in a 29% reduction in headshaking. These results led the
bases to study oral supplementation of magnesium.
Effects of oral administration of magnesium in headshaking

Horses were on a hay diet and received 3 different supplemental feeds with a washout period of 1 week
in between protocols. The protocols consisted of 1) pelleted feed (PF), 2) magnesium citrate (M) at 24.2
mg/kg of body weight (BW), and 3) magnesium boron at 2 mg/kg BW of elemental boron (boron citrate
= 40 mg/kg). From these diets, magnesium and magnesium boron increased ionized magnesium. Head-
shaking was reduced with all diets (PF 44%, M 52%, MB 64%; respectively). The greatest reduction of
headshaking occurred with MB diet. Boron has been reported to increase the absorption of magnesium.
We recommend providing oral magnesium in the diet for horses with trigeminal-mediated headshaking
independent of other treatment modalities.
Note: For further in-depth information, the reader is referred elsewhere.
References
1. Aleman M, Williams DC, Brosnan RJ, et al. Sensory nerve conduction and somatosensory evoked
potentials of the trigeminal nerve in horses with idiopathic headshaking. J Vet Intern Med 2013:
27:1571-1580.
2. Sheldon SA, Aleman M, Costa LRR, Santoyo AC, Howey Q, Madigan JE. Alterations in metabolic
status and headshaking behavior following intravenous administration of hypertonic solutions in
horses with trigeminal-mediated headshaking. Animals 2018. DOI:10.3390/ani8070102.
3. Sheldon SA, Aleman M, Costa LRR, Santoyo AC, Howey Q, Madigan JE. Intravenous infusion of
magnesium sulfate and its effect on horses with trigeminal-mediated headshaking. J Vet Intern
Med 2019. DOI:10.1111/jvim.15410.
4. Sheldon SA, Aleman M, Costa LRR, Weich K, Howey Q, Madigan JE. Effects of magnesium with
or without boron on headshaking behavior in horses with trigeminal-mediated headshaking. J Vet
Intern Med 2019. DOI:10.1111/jvim.15499.
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Dr. Monica Aleman obtained her veterinary degree at the University UNAM-Mexico. She completed residen-
cies in large animal internal medicine (equine emphasis) and neurology and neurosurgery at UC Davis; and
achieved board certification for both specialties by the American College of Veterinary Internal Medicine. Dr.
Aleman has received awards for outstanding work in clinics, research, and service from both residencies with
recognition by the American Association of Veterinary Clinicians for excellence in neurology. Dr. Aleman com-
pleted a PhD in comparative pathology in neuromuscular disorders at UC Davis which led to the discovery
of a genetic mutation of the ryanodine receptor 1 gene (RyR1) that causes malignant hyperthermia in Quarter
Horses. This mutation is located at a locus on which humans have 6 different mutations causing disease and
a novel mechanism of defective RyR1 activation was discovered. Dr. Aleman’s research and clinical interest
have focused in neurology, neuromuscular and muscle disorders in all species with equine emphasis. She
is a full professor of the equine internal medicine and neurology services, chief of service of equine internal
medicine, and co-Director of the Neuromuscular Disease Laboratory and the Clinical Neurophysiology Labo-
ratory at UC Davis which studies disease in several species including human disease. Dr. Aleman is one of the
founding members of the Equine and Comparative Neurology Research Group. Dr. Aleman is author of over
130 peer reviewed medical publications, over 100 proceedings and abstracts, and over 30 book chapters; and
is a regular speaker in national and international (over 25 countries) continuing education and research meet-
ings. Dr. Aleman has served as a reviewer for multiple scientific journals and research grants in both human
and veterinary medicine; and is currently an associate editor for Frontiers in Veterinary Science in Neurology.
Dr. Aleman is regularly consulted in challenging cases with neurologic and muscle disease throughout the
world. Main areas of study include epilepsy and sleep disorders. Currently, she works in the investigation
of neurologic and neuromuscular disorders in multiple species including humans. Dr. Aleman was recently
appointed the Terry Holliday Presidential Endowed Chair in Comparative Neurology by the University of
California at Davis, awarded for neurology research and clinical work by UCD at the American Association
of Equine Practitioners (AAEP), and awarded an alumni recognition for Excellence in teaching, research, and
service by the National Autonomous University of Mexico.
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Proceedings
2023
Management of neuropathic pain

Sheilah A Robertson, BVMS (Hons), CertVA, PhD, DACVAA, DECVAA, DACAW, DECAWBM (AWSEL),
FRCVS.
Senior Medical Director Lap of Love Veterinary Hospice, Lutz, Florida, USA and Courtesy Professor, Uni-
versity of Florida, Gainesville, Florida, USA.
The International Association for the Study of Pain [IASP] states that neuropathic pain is “pain caused by
a lesion or disease of the somatosensory system” and it may be further categorized as central or periph-
eral. A Neuropathic pain is a descriptive term, and a diagnosis requires that a lesion in the somatosensory
nervous system can be demonstrated (e.g., Magnetic resonance imaging [MRI], neurophysiologic testing,
histologic methods post-mortem). Neuropathic pain is termed maladaptive as it serves no biologic func-
tion (i.e., it neither protects nor supports healing and repair). People describe the pain related to nerve
damages as shooting, burning, tingling or prickling. It is also characterized by hypersensitivity to stimuli
(hyperalgesia) and abnormal responses to normally non-noxious stimuli (allodynia). Neuropathic pain is
difficult to diagnose in animals because they cannot self-report and is often assumed to be present by a
process of elimination (e.g., inflammatory pain) and based on behaviours, response to stimuli including
touch and electrodiagnostic (sensory nerve action and somatosensory evoked potential testing).1 In some
cases, non-response to traditional analgesics raises the possibility of an underlying neuropathic cause.
Neuropathic pain is implicated in several equine conditions including head shaking (trigeminal nerve in-
volvement),1,2 dangerous behaviours secondary to ganglioneuritis,3 post-operative neuropathy,4 laminitis,
navicular disease5 and osteoarthritis.6
Treating neuropathic pain is challenging in all species including humans. The most common drugs used
include antiepileptic drugs (e.g., gabapentin, pregabalin, phenobarbital, carbamazepine), nonsteroidal an-
ti-inflammatory drugs, corticosteroids, N-methyl-D-aspartate [NMDA] receptor antagonists (e.g., amanta-
dine, ketamine, magnesium sulphate), sodium and calcium channel blockers, tricyclic antidepressants and
drugs that alter serotonin release or uptake.
In horses with naturally occurring laminitis, tramadol provided limited pain relief, but the addition of ket-
amine at sub-anaesthetic doses significantly improved objective measures of pain such as forelimb load-
ing.7 Gabapentin was used successfully to treat pain associated with post-anaesthetic neuropathy in a
mare4 and in a horse with temporohyoid osteoarthropathy. 8 Some horses with “headshaking” showed a
positive response to carbamazepine but several dosing regimens may need to be tested before a response
is observed.9 Magnesium sulphate acts at NMDA receptors and was successful in decreasing headshak-
ing behaviours in a small clinical study.10
Neuropathic pain is likely underdiagnosed in horses, involves complex changes in the somatosensory
nervous system and has a negative impact on quality of life. Treatment options are limited and there are
no authorized equine specific drugs. Treatment responses are variable, and “trial and error” may be re-
quired to find a drug that an individual horse will respond to. In the face of treatment failure, euthanasia is
often chosen. There is a clear need for more studies into neuropathic pain in horses and reliable treatment
options.
References
A. www.iasp-pain.org/resources/terminology
1. Aleman M, Williams DC, Brosnan RJ, et al. Sensory nerve conduction and somatosensory evoked
potentials of the trigeminal nerve in horses with idiopathic headshaking. J Vet Intern Med 2013;
27:1571-1580.
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2. Pickles K, Madigan J, Aleman M. Idiopathic headshaking: is it still idiopathic? Vet J 2014; 201:21-30.
3. Story MR, Nout-Lomas YS, Aboellail TA, et al. Dangerous Behavior and Intractable Axial Skeletal
Pain in Performance Horses: A Possible Role for Ganglioneuritis (14 Cases; 2014-2019). Front Vet
Sci 2021; 8:734218.
4. Davis JL, Posner LP, Elce Y. Gabapentin for the treatment of neuropathic pain in a pregnant horse.
J Am Vet Med Assoc 2007; 231:755-758.
5. Jones E, Viñuela-Fernandez I, Eager RA, et al. Neuropathic changes in equine laminitis pain. Pain
2007; 132:321-331.
6. Pujol R, Girard CA, Richard H, et al. Synovial nerve fiber density decreases with naturally-occur-
ring osteoarthritis in horses. Osteoarthritis Cartilage 2018; 26:1379-1388.
7. Guedes AG, Matthews NS, Hood DM. Effect of ketamine hydrochloride on the analgesic effects
of tramadol hydrochloride in horses with signs of chronic laminitis-associated pain. Am J Vet Res
2012; 73:610-619.
8. Readford PK, Lester GD, Secombe CJ. Temporohyoid osteoarthropathy in two young horses. Aust
Vet J 2013; 91:209-212.
9. Newton SA, Knottenbelt DC, Eldridge PR. Headshaking in horses: possible aetiopathogenesis
suggested by the results of diagnostic tests and several treatment regimes used in 20 cases.
Equine Vet J 2000; 32:208-216.
10. Sheldon SA, Aleman M, Costa LRR, et al. Intravenous infusion of magnesium sulfate and its effect
on horses with trigeminal-mediated headshaking. J Vet Intern Med 2019; 33:923-932.
Dr Sheilah A Robertson BVMS (Hons), PhD, DACVAA, DECVAA, DACAW, DECAWBM (WSEL), CVA,
MRCVS.
After graduating from the University of Glasgow Dr Robertson undertook specialized training in anesthesia
and pain management. She earned her PhD from Bristol University in the United Kingdom for her thesis on
the metabolic and hormonal changes associated with anesthesia and surgery in the horse. She has published
extensively on the topic of equine pain and its alleviation and on the anesthetic management of horses and
foals. She is board certified in anesthesia and in animal welfare by the respective American and European
Colleges. She is the senior medical director of Lap of Love Veterinary Hospice, a large network of veterinar-
ians dedicated to end-of-life care. Dr Robertson is also a courtesy Professor at the College of Veterinary
Medicine, University of Florida, Gainesville, Florida.
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Diagnosis and Treatment of Neck Pain

Raquel Y. A. Baccarin, DVM, PhD
Paula K. A. Tokawa, DVM, Ms.
School of Veterinary Medicine and Animal Science, University of São Paulo
Neck disorders in horses, leading to cervical pain and/or dysfunction, have diverse and unspecific clinical
presentations being the diagnosis frequently challenging. History of trauma or complaints such as limb
paresis, ataxia, inability to bend the neck or neck stiffness are common to this region, but subtle changes
such as poor performance, behavioral changes, stumbling or complex forelimb lameness, abnormalities
on hind limb gait, inefficient impulsion or resistance to the bit are also reported by trainers and/or owners.
Cervical pain and dysfunction can be present simultaneously or individually in horses and these are asso-
ciated to a broad-spectrum of clinical signs. Horses with a painful neck may manifest sings of discomfort
on palpation or when different types of movement are requested or performed (active motion on work,
stretching, etc.). Cervical dysfunction, on the other hand, may be present without overt pain, and in such
cases, more subtle limitations are present (e.g.: muscle atrophy).
The variety of clinical presentations owns to the different structures that can be involved and therefore, a
comprehensive knowledge is necessary for a better understanding of each case. Pain and/or dysfunction
can be originated from changes on bone, soft tissues, or nervous system components (central or peripher-
al) and many steps can be followed in attempt to distinguish which are the structures involved.
Osseous sources leading to neck pain/dysfunction can include articular process joint disease, morpho-
logic variations affecting the vertebrae and fractures, while soft tissue sources include densification and
fibrosis of cervical fascia, cervical muscles changes, nuchal ligament desmopathy, nuchal bursitis, inter-
vertebral disc disease, joint capsule fibrosis and synovitis. A neurologic source may also be involved such
as nerve roots changes leading to impingement risk or radiculopathy (similar to human cases), or, more
commonly, cervical vertebral compressive myelopathy, leading to spinal cord compression.
Among the cited disordes, there is a crescent concern in relation to the pathologic changes of the artic-
ular process joints (APJs), which involves both bone and soft tissues sources that can lead to pain and
dysfunction, being also associated to neurologic structures that can trigger spinal cord compression and
nerve root damage. Osteoarthritis (OA) of the APJs has been the disease that we have most diagnosed
and treated in our clinical routine. Therefore, due to the limited time available for this lecture, we chose to
approach it with greater emphasis.
Post-mortem studies have shown high prevalence of osseous changes within APJs along the cervical
spine from horses of different breeds and ages and cervical OA was shown to be highly prevalent in dres-
sage and showjumping horses.
Diagnosis of APJ OA is usually difficult and even sometimes, frustrating as morphologic changes of APJ
are not always related to clinical signs. Even so, it relies on the association of clinical presentation and
findings from physical examination and diagnostic imaging tools.
Usually, for equine cervical evaluation, we start with static inspection, aiming to identify changes in head
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and neck positioning, localized sweating spots and muscle atrophies. Myofascial examination also can be
used at this time, but we do not have experience with this approach. In sequence, a dynamic inspection is
performed, with horse at walk and trot, aiming to identify lameness or ataxia. After that, we start with the
palpation of the oblique cervical cranial and caudal muscles, splenium and semispinatus capitis, rhom-
boid, serratus cervical, cervical trapezius, omotransverse and brachiocephalic and subclavian muscles.
Then we performed the passive mobilization test, in order to evaluate sensibility or reduced range of mo-
tion of the atlanto-occipital flexion, altanto-axial rotation and lateroflexion between the following segments
from C2-C3 to C7-T1. Finally, we evaluated the presence of thoracic limb paresis.
Regarding imaging tools that are allies in the diagnosis of cervical pain/dysfunction in horses, the radio-
graphic examination is usually the first choice. It has been employed for years and there are several studies
in the current literature that investigated its diagnostic power. It has shown to be a good screening tool
despite having low specificity. Ultrasonography is also employed in conjunction to the radiographic exam-
ination. Ultrasonographic images were reported to have a good concordance with anatomic transverse
slides in an ex vivo study, but this technique is mostly reported as an auxiliar for intra-articular injections
of the APJs for treatment. Findings of ultrasonographic changes were recently reported and aims only the
caudal cervical APJs.
Another complementary diagnostic imaging modalities includes nuclear scintigraphy, electrodiagnostic

evaluation, computed tomography (CT), CT myelography and magnetic resonance imaging (MRI) but
among these, CT and MRI are the mostly employed for diagnosis of APJs disorders.
Treatment of APJ OA relies on a multimodal approach, including non-steroidal anti-inflammatory drugs,

muscle relaxants and amitriptyline. Some authors also recommend the use of bisphosphonates. Physio-
therapy must be associated, and we usually recommend therapeutic exercises, acupuncture, and elas-
tic therapeutic tape. In some specific cases, mesotherapy, electrotherapy and extracorporeal shockwave
therapy are also employed. The authors do not have experience with chiropractic as treatment for APJ OA.
In addition, in many cases, intra-articular injections of the APJ are performed. This procedure requires to
be always ultrasound-guided and in general, corticosteroids are employed. Horses with APJ OA frequently
benefit from this therapy but studies investigating its effects are scarce and effects rely mostly on results
from clinical experience. Orthobiologics (autologous conditioned serum, platelet-rich plasma, platelet ly-
sate) could also be considered as an alternative to corticosteroids, mainly when intra-articular injections
are required on horses diagnosed with endocrine disease (e.g., insulin dysregulation) as these are sug-
gested to be in increased risk of laminitis associated to corticosteroid injections.
In summary, there are many therapies available, but the multimodal approach is the best option to improve
the overall outcome.
Raquel Y. A. Baccarin is a Full Professor at the Department of Internal Medicine at the School of Veterinary
Medicine and Animal Science at the University of São Paulo—Brazil. She graduated in Veterinary Medicine
and had a residency training in Large Animal Surgery at School of Veterinary Medicine and Animal Science
at the São Paulo State University—UNESP/Botucatu. She obtained master’s degree in Veterinary Surgery
and PhD in Veterinary Science from the University of São Paulo and a Post-Doc training in Molecular Biology
at Escola Paulista de Medicina—Federal University of São Paulo (UNIFESP). Along several years she has
been on the board of the Brazilian Association of Equine Veterinarian (ABRAVEQ), and she was Regional
Ambassador (Latin America) and a board member of the World Equine Veterinary Association (WEVA). She
has extensive experience in teaching Equine Medicine and her research interests are focused on joint disor-
ders, regenerative therapies, and rehabilitation of the locomotor system.
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Reproductive management of donkeys under

productive programs
Luis Losinno DVM, PhD; 1Ana Flores Bragulat DVM, PhD(c); 2Luisina Chapero DVM, PhD(c); 3Melina Pi-
1
etrani DVM, MSc, PhD(c)
Universidad Nacional de Rio Cuarto, Argentina; 2Universidad Nacional de La Pampa, Argentina; 3Univer-
1
sidad Nacional de Villa María, Argentina.
Domestic donkey (Equus africanus asinus) production programs for commercial purposes have gained
special relevance in recent years, mainly due to clinical evidence proving that donkey milk is a natural alter-
native for food management of children with cow’s milk allergy (CMA). Donkey´s milk composition is similar
to human milk, has a proven tolerability, palatability, and an adequate concentration of nutrients, as well
as a large number of bioactive compounds (Sarti et al., 2019; Martini et al., 2021; Di Salvo E et al., 2022)).
This led to a significant increase in scientific information flow regarding this species, historically relegated
by science. Donkey milk production in the world is currently limited to a few countries, most of them in the
Mediterranean area (Italy, Portugal, Spain, France, Serbia, Croatia; Greece), Asia (China) and very few in
America (Chile, Mexico, Brazil, Argentina). Donkey milk production systems are mainly based on “semi-in-
tensive” reproductive management, using natural breeding, with pregnancy rates between 85 and 90%
(personal data). However, to implement genetic improvement programs and avoiding inbreeding risk, it is
necessary to improve certain aspects of directional reproduction using assisted reproductive technologies
(ART). Most ART applied to donkeys are adapted from horses (Oliveira, 2006), extrapolating information
and knowledge and creating new information specific to donkeys. One of the first ART that can be applied
is artificial insemination (AI) with fresh, cooled and frozen semen. Pregnancy rates/cycle with frozen se-
men (0-36%) are significantly lower than those obtained with fresh (86%) or cooled (78%) semen (Watson,
2000). Frozen semen induces a more severe inflammatory reaction in the uterus of the jenny than fresh
semen (Kotilainen, 1994), and was hypothesize (Canisso, 2019), but not prove, that may be the cause of the
low pregnancy rates obtained with frozen donkey semen in this species. In vivo embryo production by AI
and subsequent uterine lavage for embryo recovery in donkeys shares numerous similarities with horses;
uterine lavage is performed using the same technique, between 7 and 9 days post-ovulation, embryos are
processed and transferred to synchronized recipient donkeys with pregnancy rates of 45-50%. Regarding
in vitro embryo production, despite the fact that highly complex ART such as cloning, Intracytoplasmic
Sperm Injection (ICSI), follicular aspiration and in vitro maturation have gained relevance and experience
in horses in recent years, there are very few reports on this subject in donkeys and they are still in initial
phases of development (Panzani, 2020; Flores Bragulat 2023). Although these complex biotechnologies
may not be applied in milk production systems, they could be extremely important for the preservation of
certain breeds of donkeys that are considered endangered.
Even though all aspects of a production system are important, such as genetics, reproduction and animal
health; animal welfare and respect for the biological and behavioral aspects of this species are essential to
work properly and obtain optimum results. Donkeys have been much less genetically manipulated by hu-
mans, so intensive management that entails changes in social groups, isolation, aggressiveness, and sud-
den changes in diets generate significant stress that negatively impacts reproduction and their productive
health status, especially in milk production programs. So it is advisable to consider all these aspects when
designing a reproductive program for donkeys and that changes or management guidelines such as serial
ultrasounds, insemination, flushings, etc. are introduced sequentially and in a friendly manner.
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Luis Losinno, DVM, PhD
Full Professor of Equine Sciences; Director of the Equine Sciences & Animal Biotechnology Laboratory and
Director of the Master’s Degree in Equine Production, Faculty of Agronomy and Veterinary Medicine, National
University of Rio Cuarto. Director of PhD (8) and Master’s (12) thesis and more than 350 assistantships and
scholarship in Veterinary Medicine Faculty (1987-2022). Director of 39 research projects (1987-2022) spon-
sored by national, private and international public organizations (3 currently in progress). The scientific pro-
duction (1989-2022) includes refereed abstracts in national (25) and international (45) meetings; publications
in national (45) and international (61) scientific journals; 17 books and book chapters as Editor and Co-editor
(2009-2022); evaluator of international scientific journals: Livestock Science; Journal of Equine Veterinary
Science; Veterinary Record; Reproduction in Domestic Animals; Theriogenology; Journal of Veterinary Sci-
ences (Chile); Veterinary Research (INVET) (Argentina) and research projects for the National Agency for
Scientific and Technological Promotion (Argentina) and Uruguay; National Commission for University Eval-
uation and Accreditation and research and thesis projects for 8 universities from Argentina, Chile, Uruguay
and Colombia. Invited speaker at 342 conferences / seminars in 13 countries (Argentina, Chile, Brazil, Uruguay,
Peru, Ecuador, Colombia, Mexico, Spain, Portugal, United States, China, Qatar. Co-founder and first Presi-
dent of the Latin American Society for Animal Reproduction; Member of the organizing committee of the XIII
International Symposium on Equine Reproduction (2023); Member of the scientific committee of the Equine
Reproduction International Committee (2022). National and international consultant for Equine Production
and Reproduction programs, particularly reproductive biotechnologies, design, management and analysis
of productive systems in horses, donkeys and mules. Main research areas are development of reproductive
biotechnologies applied to individuals and equine production systems under sustainable grazing conditions;
reproduction and reproductive biotechnologies in donkeys. Development of donkey milk production systems
for human consumption. Co-founder and partner of CARD Solutions (Consultants in Animal Research &
Development), a global consultancy company for Research and Development programs in Animal Science
(2022). Academic Director of Equine Academy- UFarm University since 2023.
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In vitro embryo production in Equids: cloning, IVF and

ICSI updates.
DVM, Ph.D., Andres Gambini
School of Agriculture and Food Sustainability and School of Veterinary Sciences, The University of
Queensland, Gatton, Queensland, 4343, Australia.
This presentation delves into the latest breakthroughs in cloning, In Vitro Fertilization (IVF), and Intracyto-
plasmic Sperm Injection (ICSI) techniques within the equine realm, highlighting their profound relevance
to both the horse breeding industry and the vital conservation efforts aimed at preserving wild equids. We
explore cutting-edge cloning methods, encompassing somatic cell nuclear transfer and donor cell selec-
tion, in conjunction with ICSI and IVF technology, becoming a standard practice for some equine breeding
programs. Our discussion centers on the applications of these innovative techniques in the preservation
of wild equids and, also to underscore their transformative impact on the horse breeding industry. Recent
advancements in equine reproduction have yielded not only significantly improved success rates in equine
cloning and ICSI but have also heralded groundbreaking achievements. These include the development
of new conventional IVF protocols tailored to horses and, notably, the successful production of the first
donkey, mules, and zebra in vitro embryos. These milestones represent a remarkable shift in equine re-
production practices, ushering in an era of exciting possibilities for equine breeding programs and the en-
hancement of genetic diversity. This is especially pertinent in the context of the equine industry, where the
pursuit of superior genetics, health, and vigor is a constant endeavor. Moreover, the implications of these
advancements extend beyond the breeding industry, directly impacting the preservation of both wild and
domesticated equids. We discuss the establishment of genetic banks, reintroduction programs, and the
complexities associated with applying these techniques to wild populations.
Ph.D., DVM, Gambini, Andres.

Dr. Andrés Gambini graduated with honors as a veterinarian at the University of Río Cuarto, Argentina, in
2008. After a period in farm practice, he spent five years at the University of Buenos Aires (UBA), completing a
Ph.D. program and teaching Animal Physiology in the Animal Production Department. His Ph.D. research fo-
cused on in vitro embryo production in horses, particularly studying new strategies to improve horse cloning.
In 2015, he started a postdoctoral study at the National Institute of Environmental Health Sciences (NIEHS)
in North Carolina, USA, where he developed a research project to study mechanisms governing embryonic
genome activation.
Andrés was invited as a professor at the University of Torino, Italy, in 2019 and the University of Cordoba,
Spain, in 2022. He continues his research in horse cloning, ICSI, and other reproductive biotechnologies. As
result of his research, he reported the first equine cloned foals in Argentina (2010) and in Australia (2018), and
the first embryos produced in vitro in ze,bras (2020) and donkeys (2022). From 2017 to 2022, he was Assistant
Professor at the University of Buenos Aires. Since 2022, Dr. Gambini is Senior Lecturer at the School of Agri-
culture and Food Sciences, University of Queensland in Australia. He has participated as a speaker in more
than 20 conferences/seminars and provided private training courses worldwide.
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A thorough ophthalmic examination in the field

Bianca C. Schwarz, Dr. med. vet., DipECEIM, Pferdeinternist, Saarlouis, Germany
Approximately 10 % of equine emergencies involve the ocular region. In general, it is thought that more
than 50 % of horses have some kind of ophthalmic lesion. Therefore, a thorough ophthalmic examination
is extremely important for the equine practitioner. The knowledge of anatomy (and the range of normal
appearances of ocular and periocular structures) and physiology/pathophysiology are the basis for an
ophthalmic examination, but also the how to assess ocular function and perform ocular diagnostic tests.
Before starting the clinical exam obtaining a thorough general and specific history and noticing the sig-
nalment of the patient will help to look for certain problems, like insidious ERU (equine recurrent uveitis) in
horses with leopard complex (like Appaloosas or Knabstruppers) or squamous cell carcinoma in Hafling-
ers. Young horses or foals are more likely to present with congenital defects and geriatric horses might
present with senescent ocular changes or ocular problems related to a concurrent disease, like PPID (pi-
tuitary pars intermedia dysfunction). Regarding the history it has to be noted, that most eye diseases have
already been treated and it is paramount to get information on applied medication, etc.
The first assessment of the patient should include the observation from a distance with regards to general
condition, behaviour, comfort, and visual deficits. Before starting the ophthalmic examination, a clinical ex-
amination must be performed, not only to look for comorbidities but also because many systemic diseases
have ocular manifestations. Furthermore, the majority of horses, especially when there is a painful eye
condition, need to be sedated for a complete eye examination. In some performing periocular nerve blocks
and using topical ophthalmic anaesthetic and a mydriatic agent can further facilitate ocular examination.
First, facial and ocular symmetry should be assessed, followed by an evaluation of cranial nerve function
and vision testing (for example palpebral reflex, menace response, dazzle reflex and pupillary light reflexes)
and palpation of the orbital rim as well as digital tonometry to subjectively assess ocular pressure. Fol-
lowing a standardised approach minimises the risk to miss lesions. Always both eyes must be examined.
Detailed examination of ocular structures should be performed starting from the outside and proceeding
to the inside of the eye using a bright light source and a direct ophthalmoscope: specifically, eyelids, third
eyelid, conjunctiva, sclera, cornea, anterior chamber, iris, lens, vitreous and fundus. An additional test,
which is easy to perform, is the fluorescein stain for corneal assessment and nasolacrimal patency. Ad-
ditional examinations, which can be performed in the field, also depending on equipment and complaint
are tonometry, further stains (like Rose Bengal) or a Schirmer tear test (which has to be performed before
manipulation of the eye), taking samples for cytology and culture and very importantly, in case of a “cloudy
eye”, which prevents evaluation of deeper structures, ocular ultrasound.
Summarising all detected ocular abnormalities and test results should lead to an ophthalmic diagnosis
and a decision, if further complementary tests need to be performed or if referral is needed as well as the
selection of the most appropriate (initial) treatment.
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Bibliography
1. Seruca C, Lowe R: Equine ophthalmic examination: Routine diagnostic techniques. Equine Vet
Edu 2016; 28:455-469
2. Dwyer AE, de Linde Henriksen M: Equine ocular examination and treatment techniques. In:
Equine Ophthalmology. 4th edition. Gilger BC (ed.); Wiley Blackwell 2022; p. 1-90
Bianca Schwarz, Dr. med. vet., DipECEIM
- 1996 – 2002 Veterinary medicine in Munich and Zurich

- 2002 – 2005 doctoral thesis in Munich
- 2005 – 2006 Internship in Equine Studies, Royal Veterinary College, University of London
- 2007 – 2011 Residency in Equine Internal Medicine, Vetmeduni Vienna
- 2011 DipECEIM
- 2011 – 2018 Head of Internal Medicine and owner of a private equine clinic in Germany
- Since 2019 Equine Internal Medicine consultant: www.pferdeinternist.de
- Member (2012-2015) and chair (2013) of the examination committee of the ECEIM
- WEVA board member 2013–2018
- Member of various committees (Veterinary Chamber of the Saarland) (since 2014)
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Identifying Corneal Disease and First Aid

Brian C. Gilger, DVM, MS, Dipl. ACVO, Dipl. ABT
College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA; bgilger@
ncsu.edu.
Introduction
Infectious keratitis is the most common ocular disease in horses, often leading to blindness. The equine
cornea is relatively slow to heal, prone to infection, and receives much trauma (because of the prominent
location of the eyes on a horse and because of the propen-
sity for horses to throw their heads).
Ulcerative Corneal Disease

Corneal ulceration is usually the result of trauma, but sec-
ondary infection is common.1 A corneal ulcer is present
when there is a break in the corneal epithelium (Figure 1).
Clinically, this results in lacrimation, blepharospasm, pho-
tophobia, conjunctival hyperemia, corneal edema, and pos-
sibly miosis and aqueous flare. The diagnosis of a corneal
ulcer is made based on these clinical signs and fluorescein
staining of the cornea. Bacterial and fungal cultures should
be submitted on any ulcer that has not healed in 3-7 days.
Mixed bacterial and fungal infections are common. It is
essential with all corneal ulcers to find the cause of the ul-
ceration and eliminate it. Topical corticosteroids must not
be administered in the presence of a corneal ulcer, and a
history of previous topical corticosteroid therapy increases
the likelihood of infectious, especially fungal, keratitis.1
Simple uncomplicated corneal ulcers have characteristics of corneal epithelial cell loss with exposed
corneal stroma, acute onset, absence of signs associated with infection (stromal malacia, cellular infiltrate,
stromal defects). Treatment should consist of a topical broad-spectrum antibiotic every 6 hours (e.g.,
oxytetracycline; neomycin, bacitracin, gramicidin; ofloxacin); topical 1% atropine once daily; and treatment
of any secondary uveitis, if present (e.g., systemic non-steroidal anti-inflammatory medications [NSAIDS]).
Topical corticosteroids are contraindicated in equine ulcerative keratitis, and topical NSAIDS may delay
re-epithelialization of the cornea and therefore are also contraindicated.
Complicated corneal ulcers

Complicated corneal ulcers are those that: do NOT heal within 72 hours, have a collagenase component
(i.e., melting corneal ulcers or stromal loss), have a mechanical obstruction to healing (i.e., foreign body,
indolent), are infected (either with bacteria or fungus), and or are in danger of perforation.
Indolent corneal ulcers in horses are similar to small animal indolent ulcers. They are chronic, superficial
corneal ulcers where the corneal epithelium will not adhere to the underlying corneal stroma. The charac-
teristic appearance is a superficial ulcer with a redundant epithelial border. Other signs include minimal
corneal neovascularization, focal edema, and moderate discomfort. Indolent ulcer treatment is similar to
that for small animals (debridement, diamond burr keratotomy, soft contact lenses, topical broad-spec-
trum antibiotics [esp. tetracycline class], serum). 2
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Bacterial keratitis generally has stromal involvement that produces edema, cellular infiltration, and stro-
mal defects, potentially accompanied by keratomalacia, or “melting”. Secondary anterior uveitis may be
severe, resulting in miosis, aqueous flare, hypopyon, and hypotony. Culture and cytology should be collect-
ed in cases of stromal ulcers. Treatment should include frequent use of broad-spectrum topical antibiotics
(e.g., moxifloxacin every 1-2 hours), topical atropine (q12 hours), systemic NSAIDs, and an anti-collagenase
medication (autogenous serum (q1-2 hours) or EDTA). Rapidly progressing lesions should be managed
surgically with the use of a keratectomy followed by a conjunctival graft.
Deep corneal ulceration in the horse is almost always the result of infections. A descemetocele is a
severe deep corneal ulcer where the overlying corneal stroma has sloughed, exposing Descemet’s mem-
brane (DM). DM is easy to identify because it is usually transparent (i.e., does not become edematous)
and does not retain fluorescein dye. DM is surgical emergency in most horses and a corneal graft, either
fresh or synthetic, with an overlying conjunctival graft gives the best chance for the successful healing. 3,4
Mycotic corneal ulcers / Mycotic keratitis - Fungal or mycotic keratitis is particularly common in hors-
es, especially in areas in which the climate is warm and humid.5 Corneal infections most commonly in-
volve Aspergillus spp. or Fusarium spp., but other fungal organisms have been reported.6 Most commonly,
fungal keratitis appears clinically as worsening, sub-acute keratitis that generally appears very painful with
severe secondary uveitis. The diagnosis of fungal keratitis carries a poor prognosis and requires long-term
aggressive therapy. Antifungal therapy needs to be started early and involve both topical (i.e., voriconazole)
and systemic therapy (e.g., fluconazole).1 Surgical treatment (e.g., keratectomy, penetrating keratoplasty,
conjunctival graft, or a combination) of fungal keratitis is generally indicated especially when there is
minimal response to medical management if a corneal furrow develops, or if the lesion is very deep in the
cornea.
Conclusions
Infectious corneal disease is common due to the high rate of injuries horses sustain to their cornea. Many
corneal ulcers heal without incident, but when infections develop, they can be severe and vision-threat-
ening. Globe-saving surgery may be needed if the lesion does not respond to initial medical therapy,
progresses, or exists at or beyond 50% depth of the cornea.
References
1. Brooks, D.E., and Plummer, C.E. (2022). Diseases of the Equine Cornea. Equine Ophthalmol.,
253–440.
2. Lassaline-Utter, M., Cutler, T.J., Michau, T.M., and Nunnery, C.M. (2014). Treatment of nonhealing
corneal ulcers in 60 horses with diamond burr debridement (2010–2013). Vet. Ophthalmol. 17, 76–81.
3. McMullen Jr, R.J., Gilger, B.C., and Michau, T.M. (2015). Modified lamellar keratoplasties for the
treatment of deep stromal abscesses in horses. Vet. Ophthalmol. 18, 393–403.
4. Mancuso, L.A., Lassaline, M., and Scherrer, N.M. (2016). Porcine urinary bladder extracellular matrix
grafts (AC ell V et® C orneal D iscs) for keratomalacia in 17 equids (2012–2013). Vet. Ophthalmol.
19, 3–10.
5. Cullen, M., Jacob, M.E., Cornish, V., VanderSchel, I.Q., Cotter, H.V.T., Cubeta, M.A., Carbone, I., and
Gilger, B.C. (2019). Multi-locus DNA sequence analysis, antifungal agent susceptibility, and fungal
keratitis outcome in horses from Southeastern United States. Plos One 14, e0214214.
6. Roberts, D., Cotter, H.V.T., Cubeta, M., and Gilger, B.C. (2020). In vitro susceptibility of Aspergil-
lus and Fusarium associated with equine keratitis to new antifungal drugs. Vet. Ophthalmol. 23,
918–922.
Dr. Brian Gilger is a Professor of Ophthalmology at North Carolina State University and a Diplomate of the
American College of Veterinary Ophthalmologists and American Board of Toxicologists. He was recognized
as a distinguished alumnus of The Ohio State University in 2018 and Auburn University in 2020. He was
awarded the American Veterinary Medical Association Clinical Research Award in 2018 and the Zoetis Re-
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search Award in 2021. Dr. Gilger’s research is focused on ocular immunology, uveitis, and innovative therapies
for equine ocular disease. He has authored over 180 peer-reviewed scientific manuscripts and is the editor of
seven textbooks, including Equine Ophthalmology, now in its fourth edition.
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Addressing the issue of eye disease in working and

performance horses
Derek C Knottenbelt OBE, BVM&S, DVM&S, DipECEIM, DACVIM(LA), MRCVS
Equine Medical Solutions Ltd, 146 DRIP ROAD, STIRLING, SCOTLAND
knotty@equinesarcoid.co.uk
Human and to a somewhat lesser extent small animals ophthalmology has developed dramatically over
the last 30-50 years but equine ophthalmology continues to rely on relatively few specialists and specialist
centers. However, the horse donkey, and mule are badly neglected in this respect, and it is unfortunate
therefore that amongst working populations of horses, eye disease is very prevalent. Even in leisure and
performance horses eye disease is often overlooked as being trivial. The range of pathology is extremely
wide but on presentation, it is almost invariably in an advanced state and therefore usually in a state where
repair or resolution, or even some element of visual restoration, is out of the question. This is particularly
regrettable since the e eye does have remarkable powers of healing in spite of its incredible complexity
and delicacy.
A number of studies have culminated in at least a recognition that there is a problem that needs to be
addressed on a global basis rather than just a local basis. A study carried out in several different countries
by Pritchard et al. (2005) showed that 66% of horses and 86% of donkeys had an ocular abnormality.
These included discharges, ocular pain, keratitis, uveitis, and blindness. Individual measures may have
been taken to try to prevent disease and of course, as always, prevention is better than cure. For example,
the simple expedient of developing a “steering head collar” in Mauritania and Mali resulted in a dramatic
reduction in the number of cases of ophthalmic disease suggesting that there was a strong management
role in the instigation and maintenance of pathology of the eyes (Scantlebury et al., (2019); (Doumbia A
and Reed K, personal communications). It is however very true to say that the circumstances under which
working animals are forced to endure their existence are very often conducive to the development of se-
rious eye pathology ranging from physical insult, infection, and neoplasia via almost every other potential
class of etiology. A study carried out by Scantlebury et al. (2019) in Ethiopia identified that eye disease was
extremely prevalent and that there were some interesting potential factors involved. For example, right
eye pathology seemed more common than left eye pathology and this was then ascribed to the poten-
tial at least of a right-handed driver holding a whip in the right hand implying that there was a physical
trauma involved in the instigation of some of the eye pathology. Anecdotal reports from Central America
also identify interesting potential etiological, aspects that could be extrapolated from data derived from
surveys of horses presented for other reasons as well as for ophthalmic disease. All these reports show
a remarkable similarity in identifying the presence of advanced pathology on initial presentation and very
little recognition that there was a problem at all by the owner/user. Of course, so long as the working horse
works, there is probably little effort to seek professional guidance on the potential presence of pathology.
Of course, again, there are few facilities for either diagnosis or treatment in any event and that is a matter
of considerable concern.
The veterinary profession for the most part in such circumstances tends to have a rather more ambivalent
attitude toward ophthalmic disease than we would like to see. There is little doubt at all that a little effort
and a lot of publicity coupled with extra training in ophthalmic medicine and surgery would have a pro-
found influence on the betterment of the welfare of working horses and donkeys. There are countless other
diseases of course that are not necessarily easily managed, and, in this respect, infections are a major
player. Infections such as viral or bacterial diseases or even fungal or parasitic diseases are very common
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in various parts of the world. For example, in Ethiopia, ophthalmic forms of epizootic lymphangitis are rel-
atively common and are extremely difficult to manage. Indeed, there is very little that can be done to help
affected animals when the infection gets into the circumstance. On the other hand, Setaria digitata is a
very common intraocular parasite in parts of India and Pakistan, and the veterinarians there are extremely
adept at managing it by removing the parasites surgically – often without any need for general anesthesia.
Once owners/users recognize the benefit of presenting their horses for early treatment, progress can be
made and significant benefits in welfare can be accrued. Common things occur commonly in individual
areas of the world and have significant differences in the implication and the ability of the veterinary pro-
fession to both recognize and manage ophthalmic disease in working animals. There is a massive demand
for further information, expertise, and publicity amongst users and owners alike. When presented with an
ophthalmic condition, the clinician needs a really logical thorough, and practical examination method that
provides useful diagnostic and therapeutic information. It is of course far better to prevent ophthalmic dis-
ease than it is to cure it but until we take a very much more proactive stance, we will continue to encounter
serious /advanced ophthalmic pathology – usually in a situation where the animal is already blind and
where any prospects of site restoration have already been lost. The eye does not tolerate chronic insult
or disease even though it has amazing powers of repair. Simple measures to prevent eye disease include
proper fitment of harnesses around the head, the education of drivers/users of working horses in terms of
cal solutions that can improve the short medium and long-term welfare of these valuable working animals
as well as the more expensive sport horses can be devised and applied. It is remarkable how simple treat-
ments can be if the conditions are dealt with early enough – and how complex and disappointing they can
be in advanced, neglected or mistreated cases. The role of the horse in global society is immeasurable and
their ability to see is a precious sense that we have no right to remove from any animal
The prevention of physical injury, and the early detection of infection of a relevant nature in the environ-
ment concerned, all help.
Figure 1: Traumatic eye damage is very common in equine practice worldwide. In working horses ill-fitting harness
and poor handling also contribute significantly to this. This horse was diagnosed "incidentally) with a sever infected
corneal ulceration that probably originated from poor fitting blinkers and a whip related injury
Figure 2: Primary and secondary infections involving the adnexal structures or the globe itself are common in working
horses. Early recognition is not usually made however so many are presented very late. LEFT: A case of African Horse
Sickness with severe chemosis and hemorrhage . CENTRE: A case of ocular leptospirosis resulting in sight threatening
chronic uveitis and pain. Fungal infections are also encountered commonly. This case shows marked signs of epizootic
]ymphangitis(histoplasmosis)m in a working horse in Ethiopia. Fungal infection of corneal ulceration is very serious and
often results in perforation and sight loss.
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References:
1. PRITCHARD, J. C., LINDBERG, A. C., MAIN, D. C. J. & WHAY, H. R. Assessment of the wel-
fare of working horses, mules and donkeys, using health and behaviour parameters. Preventive
Veterinary Medicine 2005; 69, 265–283
2. SCANTLEBURY C et al. Ocular disease in working horses in Ethiopia: a cross-sectional study.

Vet Rec, 2012; 172(4); 93-99
Emeritus Professor Derek C. Knottenbelt

OBE, BVM&S, DVM&S, DipECEIM, DACVIM, MRCVS
Professor Derek Knottenbelt qualified from Edinburgh in 1970 and retired from his personal Chair in Equine
Internal Medicine Liverpool in 2010. He is a Diplomat of the European College of Equine Internal Medicine
and of the American College of Veterinary Internal Medicine. He is the Director of Equine Medical Solutions
Ltd and through this provides an advisory service in equine oncology. He is the primary author of 10 recog-
nized textbooks and over 90 refereed scientific papers. He has been awarded honorary life membership of
ECEIM, BEVA, VWHA and ACVIM. He received the Animal Health Trust Scientific Award in 2003, the BEVA
(Blue Cross) Welfare award in 2004, and the Merk -WEVA Welfare Award in 2006. In 2005 he was appointed
OBE by the Queen for his services to equine medicine. Through Equine Medical Solutions Ltd he continues
to provide a consultancy service in equine oncology and other challenging clinical conditions for veterinar-
ians worldwide. His main interests are in oncology, ophthalmology, wound management, and dermatology.
He is actively involved in animal and human charity work both in the UK and abroad.
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Ocular Manifestations of Trauma

Brian C. Gilger, DVM, MS, Dipl ACVO, Dipl ABT
College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
bgilger@ncsu.edu.
Introduction
Common ocular manifestations of trauma will be reviewed, including eyelid and corneal lacerations, hy-
phema and blunt trauma, and retinal detachments.
Eyelid lacerations are common in performance horses.1 The extent of eyelid injury can vary from involv-
ing only a portion of a single eyelid or can affect large sections of both the upper and lower eyelids. During
the initial evaluation, a complete ocular examination should be performed to identify the extent of the trau-
ma and identify any concurrent abnormalities such as corneal ulceration, uveitis, ocular hemorrhage, or
retinal damage (e.g., retinal detachment). Even with severe lacerations, the eyelids are highly vascularized
and often heal well with primary closure. In rare cases, when eyelid trauma is so severe that repair is not
possible such that the eyelids are completely severed and/or there is extensive concurrent ocular damage
(globe rupture, large corneal laceration with iris prolapse), then enucleation is generally indicated. Eyelid
lacerations should be repaired surgically. When repairing an eyelid laceration, the goal is to maintain
integrity of the eyelid margin with as perfect apposition as possible. Gentle debridement of any necrotic
tissue may be needed to obtain clean, fresh wound edges; however, overly aggressive eyelid debridement
or excision of too much eyelid margin can result in persistent exposure keratitis and discomfort. Postop-
eratively, the horse should be fitted with a protective visor to prevent self-trauma. Treatment consists of
topical antimicrobials administered three to four times daily, systemic anti-inflammatories for 3-5 days,
and often systemic antibiotics. Topical treatment should be continued until skin sutures are removed in
10-14 days. Prognosis for eyelid lacerations is generally good as long as surgery was performed accurately.
Corneal lacerations - When treating a corneal ulcer, if the lesion is greater than 50 percent of the depth
of the cornea, then surgical therapy, such as a conjunctival or amnion graft, should be considered to pre-
vent possible perforation. 2 The prognosis is worse if the corneal laceration involves the limbus; significant
hyphema is present; the lens is perforated; if a large uveal prolapse through the incision is present; or if the
dazzle and consensual pupillary light reflexes are absent. Examination of a perforated eye should include
complete ophthalmic examination (including evaluation of dazzle and consensual pupillary light reflexes)
with the horse adequately tranquilized and eyelid nerve blocks done to ensure that no further damage is
done as a result of the examination. If the posterior segment (vitreous and retina) of the eye cannot be
visualized on the ophthalmic examination, then an ultrasound should be considered. If the vitreous is
hyperechoic (i.e., blood or cellular infiltrate) or a retinal detachment is observed on the ultrasound, then
the prognosis for return to vision is very poor. Repair of the laceration should be done as soon as possible
to prevent further inflammation and contamination of the intraocular structures. Enucleation should be
considered if there is no consensual PLR; a large uveal prolapse is present; or if ultrasound results suggest
a poor prognosis for return of vision.
Hyphema and Blunt trauma - Blunt trauma can manifest as eyelid swelling, eyelid lacerations, corneal
ulceration, cornea rupture, hyphema, lens luxation or cataract, vitreous hemorrhage and/or retinal detach-
ment. If the clinician suspects blunt trauma, a complete ophthalmic examination is performed. If this is not
possible due to opacities of the ocular media, , then an ocular ultrasound should be performed to assess
the ocular posterior segment. Very commonly with severe blunt trauma, there is blepharoedema, limbal
corneal rupture with iris prolapse, hyphema, and retinal detachment. Such severe trauma is generally not
reparable, generally requiring an enucleation be performed.
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In a recent study,3 the most frequent ocular findings after blunt ocular trauma included cataract (36/55,
65.5%), corneal edema (26/55, 47.2%), decreased intraocular pressure (23/55, 41.8%), aqueous flare
(19/55, 34.5%), lens subluxation, luxation, or lens loss (18/55, 32.7%), fibrin in the anterior chamber (18/55,
32.7%), hyphema (16/55, 29.1%), peripapillary depigmentation (“butterfly lesion”) (16/55, 29.1%), conjuncti-
val hyperemia (16/55, 29.1%), corneal fibrosis (15/55, 27.3%), corpora nigra avulsion (14/55, 25.5%), bleph-
arospasm (13/55, 23.6%), and iridodialysis (11/55, 20.0%).
Retinal Detachment - A retinal detachment is the separation of the neurosensory retina (NSR) from the
outer retinal pigmented epithelium (RPE). The retina can detach as a result of fluid accumulation between
the NSR and RPE, a retinal tear and migration of fluid from the vitreous into the intraretinal space, blunt
force trauma, or traction toward the vitreous secondary to resolution of vitreal hemorrhage or after hyalitis.
Accumulation of fluid between the NSR and RPE is most commonly the result of inflammation, with ERU
being the most common cause. The retina may re-attach with folds or wrinkles, most commonly radiating
outward from the optic nerve. In a retrospective study of 40 horses (46 eyes) with retinal detachment,4 the
detachment was partial in 14 horses and complete in 32 horses. The etiology was diagnosed to be ERU
in 27 horses (33 eyes) (67.5%) and trauma in 10 horses (10 eyes) (25%). The prognosis for vision in horses
with retinal detachment is grave with many eyes going on to enucleation or evisceration. The underlying
cause of inflammation needs to be managed, and if management is successful, a bullous detachment may
re-attach if the inflammation is resolved and the RPE is able to pump the fluid out of the intraretinal space.
References
1. Smith, S.M., and Giuliano, E. (2022). Diseases of the Nasolacrimal System and Ocular Adnexa.
Equine Ophthalmol., 187–252.
2. Brooks, D.E., and Plummer, C.E. (2022). Diseases of the Equine Cornea. Equine Ophthalmol.,
253–440.
3. Charnock, L.N., Keys, D.A., and McMullen Jr, R.J. (2022). Clinical findings associated with blunt
ocular trauma in horses: a retrospective analysis. Vet. Ophthalmol. 25, 52–61.
4. Strobel, B.W., Wilkie, D.A., and Gilger, B.C. (2007). Retinal detachment in horses: 40 cases (1998–
2005). Vet. Ophthalmol. 10, 380–385.
American College of Veterinary Ophthalmologists and American Board of Toxicologists. He was recog-
nized as a distinguished alumnus of The Ohio State University in 2018 and Auburn University in 2020. He
was awarded the American Veterinary Medical Association Clinical Research Award in 2018 and the Zoetis
Research Award in 2021. Dr. Gilger’s research is focused on ocular immunology, uveitis, and innovative ther-
apies for equine ocular disease. He has authored over 180 peer-reviewed scientific manuscripts and is the
editor of seven textbooks, including Equine Ophthalmology, now in its fourth edition.
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Eye diseases in foals

Bianca C. Schwarz, Dr. med. vet., DipECEIM, Pferdeinternist, Saarlouis, Germany
Knowledge of the different morphology and function of the neonate eye is essential for examining foals
and understanding the different diseases. In general, eye diseases of foals can be categorised in congen-
ital, inherited and acquired with congenital and inherited disease probably diagnosed more often in foals
than in adult horses.
Specifically, it should be considered for examining foals, that the menace response is not a reflex and
develops later in live, approximately within the first 2 weeks after birth. But depending for example on
postnatal problems this period can be longer. The dazzle reflex is present from birth, also the pupillary
light reflex, although this might be sluggish and incomplete for the first days of life. In neonates the globe
appears to have a mild ventromedial orientation, which resolves after two to four weeks. Furthermore,
eyelids might appear droopy and bilateral conjunctival congestion may appear for the first three weeks
of life. Conjunctival haemorrhage, located dorsally, extending to the corneoscleral junction might be seen
uni- or bilaterally and usually resolve spontaneously within the first two weeks. Bilaterally a perilimbal
vascular ring, associated with diffuse corneal oedema has been reported in 1-day old foals, thought to fol-
low the insult of amniotic or allantoic fluid over the cornea during the last days of gestation. The iris might
be slightly grey in colour and the pupil is rounder than in adult horses. Lens suture lines are sometimes
more prominent and hyaloid artery remnants might be seen. The optic disc appears more rounded than
later in life. Optic nerve head congestion and multifocal haemorrhage within the tapetal area have been
reported to occur in neonates, probably following increased intracranial pressure during birth or due to
birth trauma. The cornea of foals has a decreased sensitivity, which explains why pain and discomfort are
less evident compared to adults.
Congenital diseases can affect all parts of the globe, with some diseases being more common than others.
A common congenital disease is entropion, but also other problems like ankyloblepharon, megalocornea,
anterior segment dysgenesis, cataract, or different types of colobomas have been reported to occur in ne-
onates. Congenital (sometimes inherited) diseases can affect one ocular structure or multiple structures,
like MCOA (multiple congenital ocular abnormalities). For some of the diseases, like MCOA or CSNB (con-
genital stationary night blindness) there are clear predispositions, like coat colour or breed.
Acquired diseases like traumatic injuries, ulcerative or non-ulcerative keratitis are similar to the ones seen
in adult horses. But some disease like uveitis associated with septicaemia are more common in foals.
Bibliography
1. Leiva M, Pena T: Ophthalmic diseases of foals. In: Equine Ophthalmology. 3rd edition. Gilger BC
(ed.); Wiley Blackwell 2017; p. 112-150
2. Sandmeyer LS, Bellone R: Inherited ocular disorders. In: Equine Ophthalmology. 4th edition. Gilger
BC (ed.); Wiley Blackwell 2022; p. 661-690
Bianca Schwarz, Dr. med. vet., DipECEIM

1996 – 2002 Veterinary medicine in Munich and Zurich
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2002 – 2005 doctoral thesis in Munich

2005 – 2006 Internship in Equine Studies, Royal Veterinary College, University of London
2007 – 2011 Residency in Equine Internal Medicine, Vetmeduni Vienna
2011 DipECEIM
2011 – 2018 Head of Internal Medicine and owner of a private equine clinic in Germany
Since 2019 Equine Internal Medicine consultant: www.pferdeinternist.de
Member (2012-2015) and chair (2013) of the examination committee of the ECEIM
WEVA board member 2013–2018
Member of various committees (Veterinary Chamber of the Saarland) (since 2014)
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Equine uveitis
Brian C. Gilger, DVM, MS, Dipl ACVO, Dipl ABT
College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA; bgilger@
ncsu.edu.
Introduction
Equine uveitis, especially recurrent uveitis, is the most common cause of blindness in horses, and under-
standing the pathogenesis, diagnosis, and treatment of these uveitis diseases is essential for any veteri-
narian.
Uveitis is inflammation of the uveal tract of the eye. This inflammation may involve primarily the iris and
ciliary body (anterior uveitis) or the choroid and retina (posterior uveitis), but most commonly all anatomic
areas of the uveal tract are inflamed (pan-uveitis). In the horse, the inflammation can be acute in onset,
chronic, or recurrent.1–4 Further, recurrent uveitis can be active or quiescent (no inflammation). It is im-
portant that the equine clinician differentiates between acute uveitis, which has many underlying causes,
and equine recurrent uveitis (ERU), which is an immune-mediated disorder.
Therefore, when the clinician examines a horse with suspected uveitis, they answer three important ques-
tions to best diagnose and manage the case:
1. Does the horse have signs of active or quiescent uveitis?
2. Is the uveitis acute in onset, chronic (unresolved), or recurrent?
3. Is the uveitis primary (endogenous) or secondary to an ocular or systemic abnormality?
Common signs of active uveitis include photophobia, blepharospasm, diffuse corneal edema, aqueous
flare and cells, hypopyon, miosis, iris hyperemia, synechia, vitreous haze and cells, and chorioretinitis. Note
that corneal opacities of any color, other than diffuse edema, are not common in primary uveitis (including
ERU); instead, when corneal opacities are present, primary corneal disease should be considered.
Chronic uveitis may develop after a few days of unrelenting severe inflammation or following multiple
recurrent episodes of uveitis. Common signs of chronic uveitis include corneal edema, keratic precipitates,
iris fibrosis and hyperpigmentation, posterior synechia, corpora nigra degeneration (smooth edges), mi-
osis, cataract formation, vitreous degeneration and discoloration, and peripapillary retinal degeneration.
End-stage uveitis is an advanced stage of chronic uveitis when the eye has developed phthisis bulbi, a
small and shrunken eye.
Equine Recurrent uveitis is characterized by episodes of intraocular inflammation that develop weeks
to months after an initial uveitis episode subsides; however, not every case of initial equine uveitis will
develop into ERU.
Three main clinical syndromes are observed in ERU: the “classic,” “insidious,” and “posterior” types of
ERU.1 “Classic” ERU is most common and is characterized by active inflammatory episodes in the eye fol-
lowed by periods of minimal ocular inflammation. The acute, active phase of ERU predominantly involves
inflammation of the iris, ciliary body, and choroid, with concurrent involvement of the cornea, anterior
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chamber, lens, retina, and vitreous. The signs of active, acute uveitis can recede, and the disease enters
a quiescent or chronic phase. After variable periods of time, the quiescent phase is generally followed
by further and increasingly severe episodes of uveitis. It is the recurrent, progressive nature that causes
cataract, intraocular adhesions, and phthisis bulbi (end-stage eye). In the “insidious” type of ERU, however,
the inflammation never completely resolves, and a low-grade inflammatory response continues that leads
to progression to chronic clinical signs of ERU. This type of uveitis is most commonly seen in Appaloosa
and draft breed horses. The posterior type of ERU has clinical signs existing entirely in the vitreous and
retina, with little or no anterior signs of uveitis. In this syndrome, there are vitreal opacities and retinal
inflammation and degeneration.
Medical Therapy for Uveitis - Because vision loss is a common long-term manifestation of chronic uve-
itis, initial therapy must be aggressive. In acute cases, treatment in the form of systemic and local therapy
consisting of antibiotics, corticosteroids, and non-steroidal anti-inflammatory drugs is used, many times
simultaneously. Many horses respond well to intermittent topical and/or systemic therapy of their active
episodes of ERU. Other horses, however, do not respond to traditional therapy and may experience fre-
quent recurrences of uveitis.
Traditional treatments used for uveitis (i.e., corticosteroids and non-steroidal anti-inflammatory medica-
tions) are aimed at reducing inflammation and minimizing permanent ocular damage at each active epi-
sode. They are not effective in preventing the recurrence of disease (such as in ERU).
Low-dose intravitreal gentamicin - Use of intravitreal injections of low-dose gentamicin has been
increasingly popular for treatment of uveitis and ERU. Single injections of 4-6 mg of gentamicin into the
vitreous body are reported to minimize or eliminate recurrent episodes of uveitis in cases of both leptospi-
ral-associated and non-leptospiral ERU.1,5,6 Further study is needed to determine mechanisms of action
and long-term complications, both of which are currently not understood.
Surgical procedures are aimed at preventing the recurrence of uveitis and therefore provide long-term
control of the disease: sustained-release cyclosporine devices (CsA) and vitrectomy (CV). Both proce-
dures are performed on a referral basis.
Conclusions
Equine uveitis, especially recurrent uveitis, is the most common cause of blindness in horses, and under-
standing the pathogenesis, diagnosis, and treatment of these uveitic diseases is essential for any veteri-
narian. Advanced therapies are being developed, including methods to prevent some infectious causes
of uveitis.
References
1. Gilger, B.C., Degroote, R., and Deeg, C. (2022). Diseases of the uvea, uveitis, and recurrent uveitis.
Equine Ophthalmol., 441–498.
2. Deeg, C.A., Hauck, S.M., Amann, B., Pompetzki, D., Altmann, F., Raith, A., Schmalzl, T., Stangas-
singer, M., and Ueffing, M. (2008). Equine recurrent uveitis–a spontaneous horse model of uveitis.
Ophthalmic Res. 40, 151–153.
3. Gerding, J., and Gilger, B. (2016). Prognosis and impact of equine recurrent uveitis. Equine Vet. J.
48, 290–298.
4. Malalana, F., Stylianides, A., and McGowan, C. (2015). Equine recurrent uveitis: Human and equine
perspectives. Vet. J. 206, 22–29.
5. Fischer, B.M., McMullen, R.J., Reese, S., and Brehm, W. (2019). Intravitreal injection of low-dose
gentamicin for the treatment of recurrent or persistent uveitis in horses: Preliminary results. BMC
Vet. Res. 15, 1–12.
6. Launois, T., Hilarión, L.M.G., Barbe, F., Leurquin, C., Bihin, B., Hontoir, F., Dugdale, A., and Vande-
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weerd, J.-M. (2019). Use of intravitreal injection of gentamicin in 71 horses with equine recurrent
uveitis. J. Equine Vet. Sci. 77, 93–97.
American College of Veterinary Ophthalmologists and American Board of Toxicologists. He was recog-
nized as a distinguished alumnus of The Ohio State University in 2018 and Auburn University in 2020. He
was awarded the American Veterinary Medical Association Clinical Research Award in 2018 and the Zoetis
Research Award in 2021. Dr. Gilger’s research is focused on ocular immunology, uveitis, and innovative ther-
apies for equine ocular disease. He has authored over 180 peer-reviewed scientific manuscripts and is the
editor of seven textbooks, including Equine Ophthalmology, now in its fourth edition.
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Wounds in Horses: An Overview

MVZ Cert. Elena Garcia-Seco, MVZ Ms. Cert. Mariano Hernández Gil
Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México
Wounds in horses are common and can have significant implications for their health and well-being.
Understanding the different types of wounds, their causes, and appropriate treatment options is cru-
cial for equine owners, veterinarians, and caretakers. Wounds can be classified into several cate-
gories, including incised wounds, lacerations, puncture wounds, abrasions, and avulsions. Incised
wounds are characterized by clean, sharp cuts, whereas lacerations refer to irregular, torn wounds.
Puncture wounds are caused by sharp objects penetrating the skin, while abrasions result from
friction or scraping injuries. Avulsions involve the tearing away of tissue from its attachment site.
Several factors contribute to the occurrence of wounds in horses. External factors such as accidents, falls, or
interactions with sharp objects can lead to traumatic injuries. Additionally, horses housed in crowded or poor-
ly maintained environments are more prone to injuries. Internal factors, including poor nutrition, weakened
immune systems, or underlying health conditions, can also increase the susceptibility of horses to wounds.
Proper wound management is essential to minimize complications and promote healing. The initial step
involves cleaning the wound thoroughly to remove debris and reduce bacterial contamination. For larger
wounds or those involving vital structures, immediate veterinary attention is necessary. Wound closure
techniques, such as suturing, stapling, or tissue adhesives, may be employed depending on the severity
and location of the wound. Antibiotics and tetanus prophylaxis are often administered to prevent infection.
Preventing wounds in horses involves implementing various strategies. Regular inspection of the
horse’s environment, including fencing, stalls, and pasture, can help identify potential hazards. Provid-
ing proper nutrition and maintaining a healthy immune system through balanced diets and appropri-
ate vaccinations can also reduce the risk of wounds. Additionally, implementing safe handling practices
and using protective equipment, such as leg wraps or boots, can minimize the occurrence of injuries.
By implementing appropriate wound management techniques and preventive measures, the occurrence
of wounds in horses can be minimized, promoting a healthy and safe environment for these magnificent
animals. Enviado desde mi iPhone
Bibliography:
1. Baxter, G. M. (2008). Equine wound management. John Wiley & Sons.
2. Edwards, G. B., & Edwards, J. F. (2009). Wound healing and wound management in horses. Vet-
erinary Clinics: Equine Practice, 25(1), 1-14.
3. Theoret, C. L. (2005). Wound repair in horses: Fundamental principles and techniques. Veteri-
nary Clinics: Equine Practice, 21(1), 1-20.
4. Thomason, J. J., & Theoret, C. L. (2012). Wound healing in horses. Veterinary Clinics: Equine
Practice, 28(2), 349-361.
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5. Williams, K. J. (2013). Wound management in horses. Veterinary Clinics: Equine Practice, 29(1),
1-20.
MVZ Cert. Elena García Seco

Born in Mexico, Elena obtained a First Degree (Hons.) in Veterinary Medicine and Animal Science by the Na-
tional Autonomous University of Mexico (UNAM). She performed externships at the University of California
Davis and the University of Minnesota. She then achieved an Equine Internship at Louisiana State University,
a Residency in Equine Surgery at the University of Missouri and a Clinical Instructorship in Surgery at the
Marion duPont Scott Equine Medical Center of Virginia Tech. Worked as a professor and surgeon at the
Universidad Alfonso X in Madrid and since 2013, she is a Faculty Member of the Equine Department at the
College of Veterinary Medicine (UNAM) taking part as an equine professor and a senior surgeon.
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Making the best of Limited Resources for Difficult

Wounds
Nov 10th 2023 – Hall 2 (9:00 – 9:30)
Francesca Compostella
DVM, MRCVS, MSC(One Health)
SEA Exec Director of Veterinary and Welfare for Saudi Arabia and WVS Int Project Director (Large Animal)
Are wounds a prevalent condition veterinarians face in the field? Data demonstrates that wounds are in the
top 3 most diagnosed conditions amongst working horses. And while you
may feel that not much can be done when you don’t have many medications and drugs available, even few
resources can be extremely efficient when the wound is best assessed.
So when faced by challenge, try to remember this invaluable statement:
Triaging and assessing a wound is one of the most important steps in wound therapy.
More repaired wounds fail because of improper preparation and assessment rather than improper therapy.
And while there is no doubt that working with limited resources can be challenging, and that the condi-
tions will test your “inventive” nature… with careful monitoring of the progression and evolvement of these
wounds, we can still treat the vast majority of them.
During this brief talk we will walk through the steps required to address a wound, sharing some tricks of
the trade, picked up over years of addressing wounds with nothing more than a few items in our treatment
bag.
The triage steps we will review and address will include:
An objective evaluation of your patient’s behavior and general health
A detailed examination and assessment of the wound itself.
Review of the potential cause/reason of injury
Assessment of the space/time and resources (both in equipment and man skills) available for and during
the recovery phase
Wound preparation, treatment and dressing.
Ongoing management
This is a highly interactive session where all participants are welcome to share their hands on experiences
and thoughts.
Francesca Compostella, DVM, MRCVS, MSc

Veterinary & Welfare International Director WVS
Dr. Francesca Compostella has worked in the development sector since completing a surgical residency
in 2012. Having grown up in Mozambique she has always been passionate about the human animal bond,
and the incredible role animals hold in supporting communities. Her focus is on promoting education at all
levels, where she applies a One Health approach to maximize the limited resources faced in some parts of
the world. She is currently designing, implementing, and leading International projects on behalf of WVS.
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The infected wound

Christoph Koch, DACVS & ECVS, Prof. Dr. med. vet., Division of Equine Surgery, ISME Equine Clinic Bern,
Vetuisse Faculty of the University of Bern, Switzerland
Wounds that have been managed by primary (or delayed primary) closure as well as wounds that have
been left to heal by second intention can get infected and often require veterinary attention. Understand-
ing the basics of wound healing and knowing underlying problems and factors that predispose to wound
infection are essential in helping prevent, recognize, and adequately address wound infection in equids.
Excessive swelling, pain on palpation or associated with movement (lameness), wound discharge, and
sometimes systemic signs of infection like fever, are indications of wound infection. Wounds managed
by primary closure may get infected because of pre- or intraoperative bacterial contamination, and/or
because factors like inadequate vascular supply (including bone sequestration), inadequate drainage, or
excessive tension on the primarily adapted wound margins could not be eliminated or were simply not rec-
ognized and addressed as such. Infected primarily closed wounds are treated by removing suture material
to provide passive drainage, additional incisions and lavage with dilute antiseptic solutions if needed, and
if needed (depending on the nature and anatomic localization of the wound) systemic antimicrobial ther-
apy based on antimicrobial sensitivity testing. Examples include incisional infection after primarily closed
orthopedic lacerations and injuries with or without implants, or abdominal incisions after colic surgery.
Infected wounds left to heal by second intention, may present as slowly healing wounds with a prolonged
inflammatory or proliferative phase with excessive discharge, or with a distinct lack of granulation tis-
sue, or dark red and disrupted surfaces of granulation tissue, or with the formation of proud flesh. Gross
contamination with bacteria or foreign material, particularly of deeper wound cavities and wounds with
substantial disruption of the underlying blood supply, the presence of necrotic tissue (including bone
sequestration), and excessive movement (particularly on wounds of the distal extremities) are causes of
wound infection and wound healing disorders. In first aid situations, meticulous wound debridement and
ensuring unrestricted drainage are important measures to help prevent wound infection for deep, contam-
inated wounds that are left open to heal by second intention. Thus, wounds healing by second intention
may get infected days and even weeks after the initial insult, because they lack an epidermal and dermal
tissue barrier to prevent bacterial colonization of deeper tissue layers until these are protected by a healthy
bed of granulation tissue. Examples include degloving injuries or comminuted, open fractures of proximal
splint bones. Moreover, traumatic extremity wounds may be predisposed to wound infection because the
formation of protective granulation tissue can be delayed by the constant movement of exposed ligaments
or tendons. These factors need to be recognized and considered when presented with such wounds in
acute or chronic stages. Different possibilities and equipment for surgical and biological debridement of
necrotic tissues, and bandaging techniques to optimize the wound environment with the correct choice of
wound dressings, splints or casts for effective immobilization will be presented and discussed.
Christoph Koch Mercier, Prof. Dr. med. vet.

Computer-assisted surgery, Equine sarcoid disease, general large animal surgery topics
Head of Equine Surgery and Deputy Head of the ISME Equine Clinic Berne, Vetsuisse, University of Berne,
Switzerland.
Supervising Clinical Faculty / Lecturer in Equine Surgery, ISME Equine Clinic Berne, Switzerland.
Resident in Large Animal Surgery, University of Wisconsin Madison, Madison WI, USA.
Intern in Equine Surgery, Hagyard Equine Medical Institute, Lexington KY, USA.
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Fistulous tracts in the horse

Msc. Rubén Anguiano Estrella
Veterinario de equinos Universidad de Guadalajara, Universidad de Michigan, USA diplomado y certifi-
cado en Medicina y Cirugía de Equinos Cel: 33 3667 7803/ 33 3199 9956 e. Mail: rubenanguianomsc@
gmail.com
S.S.A. 876 CED. PROF. 236228 ANER480722-P46 PROF.DEL.EDO.20(12-2) S.C. DE SALUD PUB.
EDO.4191
Abstract
Fistula “Fistulous tracts” Is an abnormal passage or communication usually between two internal organs
or leading from one organ to the surface of the skin.
Some of the fistulous tracts include a tendon sheet and a joint (synovial fistula), from the intestine trough
the abdominal wall (enterocutaneous or parietal fistula), between the mouth and skin (orocutaneous fistu-
la). Fistulas could have one entrance and multiple “rabbit hutch’s” (meerkat).
Many other structures, organs, tissues and any bone of the horse could fistulated to the body surface
(Bone secuestra).
Sinus tract is an abnormal cavity, channel or fistula permitting the escape of pus through the skin. Fistulas
and sinus tracts are often used interchangeably or considered similar.
Fistulas commonly occur secondary to trauma, surgical or accidentally, foreign bodies (wood, metal, sands,
small rocks, plastic, suture material, implants like mesh and orthopedic material).
Fistula could have genetic and iatrogenic etiology.
Fistula diagnosis requires scrupulous clinical exploration. Fistulas produce soft tissue chronic draining,
soft tissue swelling, thickening, gas densities, periosteal reaction and chronic draining. Complement of the
diagnosis include X-Ray, ultrasound, fistulougrams and bacterial cultures.
Therapy requires surgery, medical therapy and bacterial sensitivity (antibiogram).
MVZ. MSc. Ruben Anguiano Estrella

Equine academic and researcher at the Veterinary Sciences Division of the University of Guadalajara (UDG).
Mexico, for 52 years. Post-graduated at Michigan State University USA. Director and Chief Surgeon of the
Equine Health Center “Los Alamitos” in Guadalajara, Jalisco, Mexico. Founder and Director of the Program
for the Protection and Comprehensive Health of Equines belonging to owners without financial resources in
Guadalajara, Jalisco, Mexico. National and International Consultant in Equine Medicine and Surgery. Ambas-
sador of the World Association of Equine Veterinarians WEVA for Mexico, Central America and the Caribbean
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Tumor transformation causes significant wound

healing failure; always consider this when a wound
fails to heal as expected.
DEREK C KNOTTENBELT OBE, BVM&S, DVM&S, DipECEIM, DACVIM(LA), MRCVS
Equine Medical Solutions Ltd, 146 DRIP ROAD, STIRLING, SCOTLAND G63 9QB
There is always a reason why a wound does not heal. Furthermore, the relationship between a normal
healing process and the development of a de novo tumor within the wound bed is well recognized. It has
been said that a wound is a tumor that heals and a tumor is a wound that does not heal and it is this rela-
tionship that arises in the horse in particular. Mesenchymal stem cells (MSC’s) that localize at perivascular
sites respond rapidly to external stimuli and with the vascular and immune systems lead to successful
wound healing. Cancer in some circumstances can be considered to be a wound that never heals; this is
accompanied by changes in MSCs that parallel the wound-healing response. MSCs are now recognized
as key players in tumorigenesis (Li et al., 2019). It is easy to imagine that the healing process can be
transformed into an unstable genetic situation culminating in primary tumorigenesis. Tumor dormancy is
also considered to be one of the major unsolved questions in cancer biology. Increasing evidence points
to tissue trauma and subsequent wound healing as contributing events in escape from dormancy leading
to tumor development.
INHIBITORY FACTOR
1. INFECTION
2. MOVEMENT
3. FOREIGN BODY
4. NECROTIC TISSUE
5. TISSUE DEFICIT A. DESICCATION
6. CONTINUED TRAUMA B. MACERATION
7. IMPAIRED BLOOD SUPPLY C. HIGH/LOW TEMPERATURE
8. POOR OXYGENATION D. pH
9. HEALTH STATUS E. DEAD SPACE
10. LOCAL FACTORS F. FLUID ACCUMULATION
11. IATROGENIC FACTORS G. EXUDATE / DISCHARGES
12. TUMOR TRANSFORMATION H. TENSION
TABLE1: The recognized acquired factors that inhibit healing processes in wound sites – these apply no
matter what the cause of the wound in the first place.
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It is important to identify the common regulators of wound repair and tumor formation and to unravel their
functions and mechanisms of action. The recognized factors that are involved in inhibiting wound heal-
ing are shown in Table 1. This table illustrates the diagnostic process that should be considered when a
wound fails to heal; there are clear relationships between the various factors making the management of
non-healing wounds problematic. For sure, tumor transformation is a very serious long-term challenge
and while tumor cells exist in the wound bed, healing will be inhibited usually to a significant degree either
focally or more generally in the periphery or the wound bed or both.
Although neoplastic reasons for wound healing failure are probably are they are extremely important since
no matter what other measures are undertaken the wound will not heal if any component of neoplastic
tissue is present. Of course, there are several pathways that have an influence on the healing process in
respect of neoplastic inhibition of wound healing.
1. The systemic cancer case: The first is the concept that horses with significant tumors affecting
any part of the body are likely to have paracrine/paraneoplastic subtle effects on the function of
the immune system and specifically on wound healing. Wounds on unhealthy horses often fail to
heal. There are many complex reasons for this. Advanced age, immunosuppression, malnutrition,
and co-morbidity, particularly with systemic tumors such as lymphoma often have a profound
influence on the healing process. Wounds do not present detached from the patient! There is
always a horse involved and so it is incumbent upon the clinician to examine the patient to estab-
lish the presence of factors that might inhibit the healing process including neoplastic disease.
However, systemic or cutaneous neoplasia is not always obvious and in the former group, parane-
oplastic signs may be all that are detectable clinically at the time.
2. Tumor development within a wound site (spontaneous tumorigenesis): The link between
wound healing and tumorigenesis has attracted much attention in the human medical sphere.
( Dillekås & Straume, 2019) Following an acute injury, resident and non-resident cell populations
instigate the natural [beneficial] wound healing responses; classically these involve temporary,
controlled, and coordinated increases in inflammation, extracellular matrix production, and prolifer-
ation with the objective of restoring normal organ architecture leading to a functional repair. How-
ever, the ongoing failure of wound healing evokes a perpetuating wound-healing response in which
cytokine activity, including low-grade persistence of TGF-β, is abnormal (Wilmink, van Weeren et
al., 1999) promoting the development of fibrosis, organ failure, and cancer.
3. Toll-like receptors (TLRs) act as sensors of danger signals in injured tissue to switch the wound
healing response toward fibrogenesis and regeneration as a protective response to imminent
danger at the cost of an increased long-term risk of developing cancer transformation.
The commonest spontaneous tumor occurring in wound sites in horses is carcinoma (Fig 1).
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Hemangiosarcoma is probably the third most common tumor transformation in a wound site (Figure 2). It
is perhaps a little more understandable than the other tumor types in view of the prominent role neovas-
cularisation has in the healing process as mentioned above.
The traumatized cancer site: Here the tumor pre-exits the wound either obviously or undetectably. Trau-
matizing a tumor is a well-recognized cause of tumor progression. A good example of this is the equine
sarcoid; here this effect is very common. In this situation, it is likely that the vast majority of affected sites
that are traumatized, either accidentally or intentionally by incomplete surgical removal or by biopsy (with-
out the expectation of a total tumor removal of course), results in an “expected” significant exacerbation of
the tumor both in growth rate and aggression.
As might be expected incomplete removal of tumor results in a failed surgical site – even a single cell can
create a significant delay in healing and oftentimes the proliferation of the tumor is often mistaken for [ex-
uberant] granulation tissue (Figure 5).
Figure 2 a/b : A: An intramuscular injection of procaine penicillin was administered here 8 weeks previously. The
horse had no other obvious sarcoids but sarcoid was confirmed at the site histologically
B. An intravenous sedative had been administered 3 weeks previously to facilitate a biopsy of a sarcoid-like lesion on
the tarsal region. A complex sarcoid lesion developed here within the time scale. The moral of this is to remember
that a wound does not have to be big for tumour to develop within I and that all due precautions are needed.
The second way in which a wound can be transformed is a rather unique process involving the equine
sarcoid. Transference of cells from one sarcoid site to a second site (whether the destination is another
sarcoid tumor or not) is entirely possible. .
Notwithstanding the complexity of the pathogenesis of tumor transformation in general and in wound
sites in particular, this possibility is one of the most dangerous causes of incipient wound healing failure.
The “transformed wound” is often immunocompromised locally and so infection and other issues are often
considered first. The value of an early histologic investigation in identifying any significant factor respon-
sible for wound healing failure cannot be overstated. The fact is however that we have no meaningful
data on the incidence of tumour-inhibited wounds and even less on the full range of potential neoplasms
involved.
References:
1. Dillekås H, Straume O. The link between wound healing and escape from tumor dormancy. O.
Surg Oncol. 2019 Mar;28:50-56.
2. Knottenbelt DC. Equine wound management: are there significant differences in healing at differ-
ent sites on the body? Vet Dermatol. 1997 Dec;8(4):273-290
3. Knottenbelt DC, Schumacher J &, Toth F. : Sarcoid transformation at wound sites. . In: Equine
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Wound Management 3rd Edition, 2017, Wiley Blackwell pp 490-507
4. Knottenbelt DC Factors inhibiting healing. Chapter **. Handbook of Equine Wound Manage-
ment. 2003; Saunders, London. pp. 31
5. Li P, Gong Z, Shultz LD, Ren G. Mesenchymal stem cells: From regeneration to cancer. Pharmacol
Ther. 2019 Aug;200:42-54
6. Sundaram GM, Quah S, Sampath P. Cancer: the dark side of wound healing. P.FEBS J. 2018
Dec;285(24):4516-4534
7. Wilmink JM, Stolk PW, van Weeren PR, Barneveld A. Differences in second-intention wound heal-
ing between horses and ponies: macroscopic aspects. Equine Vet J. 1999 Jan;31(1):53-60
8. Wilmink JM, van Weeren PR, Stolk PW, Van Mil FN, Barneveld A. Differences in second-intention
wound healing between horses and ponies: histological aspects.Equine Vet J. 1999 Jan;31(1):61-7
9. Wilmink JM, Nederbragt H, van Weeren PR, Stolk PW, Barneveld A. Differences in wound con-
traction between horses and ponies: the in vitro contraction capacity of fibroblasts. Equine Vet J.
2001 Sep;33(5):499-505
10. Emeritus Professor Derek C. Knottenbelt
11. OBE, BVM&S, DVM&S, DipECEIM, DACVIM, MRCVS
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What is the value of cancer surgery in horses? Is it

practicable, humane and to the betterment of the
welfare of affected horses?
DEREK C KNOTTENBELT OBE, BVM&S, DVM&S, DipECEIM, DACVIM(LA)), MRCVS
Equine Medical Solutions 146 DRIP ROAD, STIRLING, SCOTLAND
Neoplastic prevalence surveys in equids confirm that most primary tumors are cutaneous. These are for-
tunately easily seen/palpated and sampled. Non-cutaneous neoplasms are less accessible and more dif-
ficult to diagnose. Surgery is widely regarded as the mainstay of cancer therapy in horses, The options
for surgical intervention include sharp surgery, laser excision, cryosurgery, RF-electro cautery, electro-
chemotherapy, and surgical ligation. Additionally, chemotherapeutic immunotherapy and radiotherapeutic
options can be used adjunctively where relevant. It is certainly true that for almost all cancer therapy in
other species including man, the use of multimodality treatment is de rigeur. In equine cancer medicine,
however, this is regrettably not the case and while surgery is clearly a major player in the potential resolu-
tion of tumors, good results possibly rely more on good fortune than oncological rationale. The concept of
multimodality treatment with surgery needs to be developed. However, the range of therapeutic options
with evidence is very narrow and limited by circumstance, availability, and expertise.
Since most accessible tumors will be either sarcoid, melanoma, carcinoma or mast cell tumors, these are
the main target for most surgical treatment.
1. Is surgery and effective way of resolving the equine sarcoid?

This is one of the most dangerous tumors in terms of the requirement to remove every single solitary cell.
Leaving a single cell behind is probably going to result in a significant recurrence and usually with signif-
icant exacerbation. A rather benign-looking occult or verrucose sarcoid that is incompletely removed will
almost always develop into an invasive dangerous and difficult fibroblastic complex and in any case the
resulting wound will fail to heal (Figure 1).
2. Does surgery work for the removal of melanoma lesions?

Historically, the profession has carried a negative and harmful dogma of neglect that stated that dissemi-
nated malignancy was certain after minor surgical interference. In fact, over 80% of melanoma lesions will
become malignant if they are left long enough, and there is absolutely no justification to leave them. The
metastatic spread of equine melanoma is extremely inefficient. The blood-borne metastatic cells are deliv-
ered to the pulmonary circulation where they are filtered out in congregated masses. Thisfiltration system
is extremely efficient but some cells will escape this filtration mechanism. According to Paget hypothesis,
neoplastic cells in the pulmonary parenchyma are held in G0 and cannot grow into meaningful tumors;
the environment is not suitable for the development of metastatic tumor in the lung tissue itself. However,
any cells that escape this filtration mechanism can invade any organ or structure – some with greater
tolerance and higher replicative speed and devastating consequences. The metastatic spread occurs very
early – often long before tumors become apparent; malignancy starts with a single cell – it does not start
in big tumors or little tumors – it just starts wherever it needs to. This therefore means that there is an
obligation and a professional responsibility to remove all external melanoma lesions as early as possible;
if they are malignant already, they must be removed to reduce the amount of metastatic spread and if they
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are not malignant yet, they are likely to become so and therefore, must be removed. There is absolutely no
justification to allow any melanoma lesion on any horse at any time. Melanoma in non-grey horses is even
more serious and there can be absolutely no delay here; histology is critical in these cases.
3. Can squamous cell carcinoma be resolved surgically

The challenge with squamous cell carcinoma is the definition of the outer limit of the tumor since there in-
vade lymphatics and blood vessels and the fact that squamous cell carcinoma tumors are quite frequently
destructive. This makes the reconstruction of excised tumor very challenging.
Where they are in the proliferative form, they are technically much easier to remove surgically. Surgical
pathology and concurrent chemotherapy are obligatory in all cases. For example, removal of a small lo-
calized penile carcinoma could reasonably be assumed to have an effective and safe surgical margin but
it may not, and since carcinoma tracks along blood vessels and more particularly along lymphatics, the
lymph-node interpretation proximal to the lesion itself is a very important prognostic indicator as to wheth-
er surgical intervention is likely to be successful or not. On the other hand, phallectomy is often used to
deal with extensive distal penile carcinoma and a variety of different surgical methods are available to cope
with this circumstance.
Figure 1: a total clitoridectomy followed by extensive Figure 2: a highly malignant penile carcinoma
intralesional chemotherapy with carboplatin emul- was identified as a very late presentation having
sion resulted in a very satisfactory conclusion. It had multiple antibiotics and other minor interfer-
was not easy and not every case turns out as well as ences for the past 4 years up a distal phallecto-
this because carcinoma is extremely unpredictable my was performed as a palliative procedure be-
cause the inguinal and sub- iliac lymph-node's
were already grossly enlarged and therefore,
the likelihood a satisfactory outcome was very
low but gave the horse some months of normal
behaviour and relief. Concurrent medication with
piroxicam was instituted from the outset.
4. Once diagnosed, what are the surgical implications for mast cell tumor removal?
There is considerable debate about the true nature of the equine mast cell tumor (mastocytoma). It is
not clear whether this is a genuine tumor or not. In any event, they do have a lot of the characteristics
associated with neoplastic disease, and surgical removal of mast cell tumors is the treatment of choice. .
Therefore histological confirmation. These lesions can become very big and very aggressive and others
are small and easily removed; it is always better to remove a small tumor in the expectation of it getting
larger and becoming impossible rather than waiting until it is impossible and then regretting having not
interfered earlier. All mast cell tumor lesions should be removed surgically. Partial removal does not appear
to be harmful and therefore, whilst in some circumstances, some dangers are easily envisaged, removal
of the bulk of the tumor seems to result in a significant long-term benefit. Malignant mast cell tumors are
extremely rare in horses and there is no evidence one way or the other as to whether dissemination can
follow a surgical intervention – it just seems unlikely!
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5. What about surgery for other tumors?

Other tumors can be removed successfully including those of the skin. For the most part, however, the
removal of troublesome lesions seems to be the target. Where there are pathological consequences such
as for example a retrobulbar lymphoma, a strangulating pedunculated lipoma, or an obstructive gastro-
intestinal stromal cell tumor, removal can be challenging but very rewarding. Since there are around 60
different tumor types in horses, we need to understand which ones of these are going to carry the best
surgical prognosis. Some will be totally impossible as surgical options – a good example is a gastric carci-
noma but of course whenever surgery is considered in terms of neoplastic disease, all the evidence must
be accumulated and understood so that the right decision is made at the outset. However, as a general
rule, we would advocate strongly that where ever surgery is performed, concurrent chemotherapy should
be considered. The most basic requirement is to establish a diagnosis and to understand the pathological
and therapeutic behavior of each tumor type. Reliance on a sole surgical approach is not usually enough
even for sarcoid and carcinomas.
The problem is that there is very little evidence for any particular pathology–we need the evidence and we
need constructive careful and thinking veterinarians to build this evidence so that we can do right by our
cancer patients – equine oncology is probably 50 years behind anything else and is belittled and ignored
by many in our profession – we must change that!
Further Reading
1. Knottenbelt DC, Patterson Kane J and Snalune K. Clinical Equine Oncology 2015 Elsevier, Oxford
Emeritus Professor Derek C. Knottenbelt

OBE, BVM&S, DVM&S, DipECEIM, DACVIM, MRCVS
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Equine Oncology cases in Chile

Durán Graeff, Carolina1; Ojeda Oyarzún, Javier2
Durán Graeff, Carolina; DVM, MVetSc, PhD, Dipl. ACVIM; Associate Professor UACh;
carolina.duran@uach.cl
Ojeda Oyarzún, Javier; DVM, MSc; Associate Professor UACh; javierojeda@uach.cl
1
Equine Hospital, Institute of Clinical Sciences, Faculty of Veterinary Sciences, Universidad Austral de
Chile, Valdivia, Chile.
2
Small Animal Hospital, Institute of Clinical Sciences, Faculty of Veterinary Sciences, Universidad Austral
de Chile, Valdivia, Chile.
Equine neoplasias in Chile, as in the rest of the word, are rather uncommon. Nevertheless, skin neoplasias
are the most frequent ones, including sarcoids, melanomas, squamous cell carcinomas [1].
Common clinical signs depend on the size and location of the masses, generally small bulging masses
appear on face, neck, extremities and/perineal areas, and speed of growth and appearance will vary de-
pending on the mass. There is no real sex or breed predisposition, but depigmented skin and advanced
age are risk factors to develop melanomas and carcinomas. Definitive diagnosis should be based on histo-
pathology results. Treatments such as surgical excision, cauterization, cryosurgery, radiation, electroche-
motherapy (ECT) have been reported.
ECT is a newer treatment that generally involves intratumoral injection of chemotherapeutic drugs fol-
lowed by repeated electrical current to increase intracellular drug concentrations and by this, increase
exponentially cytotoxic effects in neoplastic cells [2].
In our experience, ECT with local injection of cisplatin or bleomycin alone can be a very good treatment
option with excellent results after 1-3 treatments, with or without surgical resection (Fig. 1). Typically, 1-3
treatments, 2-4 weeks apart are required. More treatments (6-12) are needed with chronic and/or severe
presentations [personal experience]. However, it is common to receive horses in very advanced stages
of disease, with large tumors where ECT alone may not be effective or will require too many treatment
sessions. In these cases, in small animals, the combination of ECT with other treatment modalities is very
effective [3]. The use of intravenous bleomycin is generally recommended for all small animal cases, re-
gardless of the size of the lesion. This route reaches an adequate distribution and concentration of the drug
in the tumor and its margins, avoids leaving areas of the tumor with insufficient drug concentration due to
errors in the intratumoral administration technique, drug administration is safer for the handler, by itself it
is an immune system activator, contributing to the local immune response induced by the treatment [3].
In horses the use of the IV route of bleomycin is costly considering the high volumes of drug required, and
little evidence about the safety of the drug in this species. Also, the IV route should be avoided in animals
that may be destined for human consumption.
We have used systemic bleomycin as an adjuvant chemotherapeutic approach in patients with large skin
neoplasias (2 patients with sarcoids Fig.2, 1 patient with perianal melanomas). Results have shown that the
treatment of ECT combined with local and intravenous administration of chemotherapeutic drugs in hors-
es was well tolerated and successful in treating chronic and large fibroblastic sarcoids and melanomas,
after 2-4 treatment sessions. Although this treatment approach is costly and must be performed under
general anesthesia, increased treatment efficacy implies less treatment sessions.
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ECT in conjunction with local and/or intravenous chemotherapeutic drugs is certainly a promising treat-
ment approach for equine skin neoplasias. Nevertheless, further studies with larger sample sizes are re-
quired to reach consensus about the use of this rather newer therapy approach in horses.
Figures
References
1. Knottenbelt. DC, Snalune. K & Patterson-Kane JC. 2015. Clinical Equine Oncology. Elsevier Health
Sciences
2. Bastrup, F. (2022). Electrochemotherapy for metastatic cutaneous melanoma. Acta oncologica.

vol 61(5).
3. Calvet CY, Famin D, André FM, Mir LM. 2014. Electrochemotherapy with bleomycin induces
hallmarks of immunogenic cell death in murine colon cancer cells. Oncoimmunology. 3:e28131.
10.4161/onci.28131
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Dr. Carolina Durán Graeff graduated from the Universidad de Chile in 2007, worked at Rood and Riddle
Equine Hospital (Lexington, KY, USA) and then completed a 2-year rotating equine internship- and a PhD
at the Equine Clinic of the University of Veterinary Medicine Hannover. Next, she moved then to Canada
where she completed three-year residency in Large Animal Internal Medicine and a master’s in veterinary
sciences at the University of Saskatchewan (Saskatoon, Canada). In July 2016 she became the first Chilean
-board-certified-specialist in large animal medicine of the “American College of Veterinary Internal Medicine
(ACVIM)”. After working as an internist at the Equine Clinic of Ludwig-Maximilians-University for two years,
in 2019 she moved back to Chile where she is an associate professor and now in charge of the Equine Clinic
of the Universidad Austral de Chile.
Her main areas of research are equine infectious diseases, equine oncology, and large animal internal med-
icine. She is a member of the scientific community of ACHVE, as well as of the specialty committee of the
Chilean association of veterinary medicine faculties. Dr. Durán commonly peer-reviews professional publi-
cations including those for Animals, Veterinary Research, Journal of Veterinary Behaviour, Austral Journal of
Veterinary Sciences and other high-quality journals.
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Risk factors for colic

Fernando Malalana DVM PhD DipECEIM FHEA FRCVS
Philip Leverhulme Equine Hospital, University of Liverpool, Leahurst Campus
Colic is a significant problem in terms of welfare and economics. Its incidence differs between populations
but typically varies between 3.5-10.6 episodes per 100 horse years (i.e. if you keep 100 horses for 1 year
expect between 3.5 -10.6 episodes of colic). Estimated case fatality rates are between 6.7-15.6%, but this
depends on the type of population studied (approximately 9% for medical colic vs 30% for surgical colic).
Epidemiological studies have identified a number of risk factors for colic. These can be divided into those
at horse level and those at management level.
At horse level, sex or age have not shown a clear or consistent association with colic. However, certain
breeds or horse types have been associated with certain types of colic; for example, large colon volvulus or
epiploic foramen entrapment are more common in large breeds whereas pedunculated lipomas are seen
more frequently in pony breeds.
A number of variables at management level have been associated with an increase in the risk of colic. For
example, recent changes in feeding, a recent reduction in turn-out time, lack of regular dental treatment or
lack of routine worming programme, have been shown to predispose a horse to colic.
In addition a number of risk factors associated with mortality or complications post-surgery have also
been identified in a number of epidemiological studies.
I graduated from the Complutense University of Madrid in 2001 followed by 6 years in mixed practice in
East Yorkshire, UK. In 2008 I moved to the University of Liverpool where I completed an ECEIM residency in
Equine Internal Medicine. I am a European Specialist in Equine Internal Medicine since 2011 and currently
work as a senior lecturer at the University of Liverpool. In 2021 I completed a PhD on the Epidemiology of
Uveitis. I am interested in all aspects of Equine Medicine but have a particular interest in ophthalmology,
oncology, neurology and gastrointestinal medicine.
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Managing horses with colic on the farm

Macarena Sanz, DVM, PhD, DACVIM-LA
Washington State University, Pullman, WA, USA
Colic is one of the most common medical conditions equine practitioners see in the field. Most of these
colics will resolve with minimal intervention in the field but ~10% may require more intense management.
The clinical signs of colic vary with disease severity but non-gastrointestinal conditions such as laminitis,
pleuropneumonia, and rhabdomyolysis, among others, can also cause similar clinical signs. Thus, it is im-
portant to keep an opened mind when evaluating these cases.
Medical colics include gas/spasmodic colic, large colon impactions or displacements. It is key to identify
horses in need of more aggressive treatment early on as this increases prognosis for survival and decreas-
es the cost of treatment.
Medical management:
1. History, signalment and geographic location are very important when compiling a list of differen-
tial diagnosis.
2. Colics should have a thorough physical examination. If the horse is painful or if it has a high heart
rate (~ 60 bpm), a nasogastric tube (NGT) must be passed immediately to prevent stomach rupture
as horses can’t vomit. The physical examination can be continued once the tube is in place. In se-
vere cases, sedation may be required to assess the horse. In these cases, an abbreviated physical
exam is usually performed.
3. If sedation is needed, a combination of xylazine or romifidine and butorphanol is recommended

prior to transrectal palpation. Butorphanol may not be needed for NGT placement alone. Sedation
decreases HR and GI motility. Whenever possible, record the TPR parameters before drug ad-
ministration. Detomidine is a very potent analgesic, and is best not to use it until a decision about
surgery is made.
4. Borborygmi is usually decreased if the horse has been anorectic.
5. Tacky mucous membranes are an early indicator of dehydration. Other clinical signs like increased
HR and CRT, decreased jugular filling, weak peripheral pulses and cold extremities are observed
in more severe cases.
6. If the heart rate is not high and the horse does not appear overtly painful, transrectal palpation
before passage of a nasogastric tube is of benefit as this will allow to decide on the size of the
NGT (large if distended loops of small intestine are palpated vs small for oral fluid therapy if an
impaction or large colon displacement are identified).
7. Transrectal palpation can be challenging in the field. One should consider the age, size, and tem-
perament of the horse and the facilities available. Sedation using a combination of alpha2-agonists
and butorphanol is advised over alpha2-agonists alone to minimize the risk of being kicked. Ad-
ditional forms of restraint such as a twitch or lip chain may be needed. N-butylscopolammonium
bromide injection (Buscopan®) relaxes the rectum and facilitates rectal palpation. It may also aid
with spasmodic colic, although its duration of action is short, < 30 min.
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8. Ensuring adequate hydration is key. This can be achieved using oral (given by NGT, my prefer-
ence when possible) transrectal or IV fluids. Balanced oral electrolyte solutions should be used for
oral fluids, but plain water should always be used for transrectal fluid therapy. For oral fluids, our
clinic uses an isotonic solution made of 6L of water + 35 g of NaCl (2.5 tablespoons of regular salt)
+ 22 g of NaHCO3 (5 teaspoons of baking soda) and 4 g of KCl (1 teaspoon of Lite salt).
9. Impactions of the large intestine can be managed in the field but may require significant (aggres-
sive) fluid therapy. This can be achieved using an indwelling NGT and having the owner adminis-
ter fluids frequently (if the owner is considered knowledgeable enough).
10. Ultrasound of the abdomen is helpful to assess visible portions of the GI and peritoneal fluid char-
acteristics and amount.
11. Radiographs of the abdomen are limited with portable equipment. Cranioventral evaluation of the
abdomen may reveal sand.
12. Point of care, hand-held devices are available for evaluation of blood gases, creatinine, lactate,
SAA and electrolytes. Some of these tests can be also used in peritoneal fluid. These are not need-
ed in every single colic case but can be helpful for specific cases. Alpha2-agonist administration
significantly decreases PCV but does not affect TP.
13. Abdominocentesis: Evaluation of peritoneal fluid is helpful to diagnose peritonitis or GI rupture,

and to evaluate progression (total protein, lactate values). Normal peritoneal fluid is light yellow
and has a low total protein (<2.5 g/dL). Protein increases with inflammation. Lactate should al-
ways be evaluated in correlation with peripheral (blood) lactate. If the abdominal fluid lactate is
higher than the peripheral lactate, ischemia of a segment of the GI should be suspected.
14. Pain management:
• Mild, medical colics may resolve after NSAID administration (and most likely without it). If a horse
colics after flunixin administration, further work up is required.
• Acetaminophen (20mg/kg PO q12-24h) is a nontraditional NSAID that has analgesic and anti-
pyretic properties but is not a good anti-inflammatory. This drug has not been thoroughly evalu-
ated in colicky horses.
• Dipyrone, a nonclassical NSAID (30mg/kg IV q12h), provides mild to moderate analgesia in other
species, some work suggests that this may also be the case in horses, but more information is
needed.
• Alpha2-agonists and opioids are also analgesics.
• Buscopan® (0.3 mg/kg IV or IM) can provide short-acting (20-30 min) smooth muscle spasm and
pain. Buscapan administration increases HR for about 20 min.
When to refer: When money is taken out of the equation, almost all horses with colic can be saved if the
problem is recognized early and the appropriate treatment is instituted. Unfortunately, economics do play
a very important role and the conversation about cost is very important. More details about referral can be
found elsewhere in these proceedings.
Summary
Colic is a very common condition of horses. Although most horses with colic will improve with medical
treatment, early identification of horses in need of more aggressive treatment is key for success. Field
management of colics should include pain management, treatment of the primary lesion and restoring of
hydration/volemia when needed.
References/Suggested Reading
1. Rhodes DM, Madrigal R. Management of colic in the field. Veterinary Clinics of North America –
Equine, 2021, 37, 421-439.
2. Freeman DE. How to manage severe colic in the field. Proceedings of the American Association
of Equine Practitioners, 2011, 57, 283-289.
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3. Cook VL, Hassel DM. Evaluation of the colic in horses – Decision for referral. Veterinary Clinics of
North America – Equine, 2014, 30, 383-398.
4. Manso-Diaz G. Ultrasound examination of the equine acute abdomen. In Practice, 2021, March,
96-108
Dr. Sanz graduated as a veterinarian in La Plata, Argentina. She completed an Equine Internship, a Large
Animal Internal Medicine Residency and a Master’s of Science degree at Washington State University and
she is a Diplomate of the ACVIM College. She also completed a PhD in equine immunology at the Gluck
Equine Research Center; her research focuses in equine immunology and infectious diseases. She worked
as a Senior Lecturer in Equine Medicine at the Onderstepoort Veterinary School in South Africa for 3 years.
Dr. Sanz is an Associate Professor in Equine Medicine at Washington State University in the US.
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When Does it make Sense to Refer a Colic ?

James L. Carmalt MA, VetMB, MVetSc, PhD, FRCVS, DABVP(Eq), DAVDC(Eq), DACVSMR(Eq), DACVS
Professor – Equine Surgery, Dentistry, Sports Medicine and Rehabilitation, Department of Large Animal
Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK
S7N5B4 Canada.
Colic is a common equine problem and a veterinarian who spends any part of their professional time deal-
ing with horses will have to manage a horse with colic at some point. Deciding whether, and how, to send a
horse with colic to a referral clinic can be a source of stress to the treating clinician and to the client. Some-
times the choice is not really a choice. It is a case of referring the horse, or euthanasing it. This may seem
harsh, but in reality, one part of the job of a veterinarian is to make tough decisions. Addressing the client’s
wishes and concerns is one thing, but ultimately the welfare of the animal needs to remain paramount. It is
also important to remember that referral is an active process in which one professional colleague contacts
another and they agree on a case transfer. Before the animal is sent. “Just take the horse to Dr. X” or “Call
Dr. Y” is not a referral.

There are four reasons when it makes sense to refer a colic. A surgical lesion has been diagnosed (with or
without considerable pain); the horse is in uncontrollable pain; a desire, or need, for a second opinion; or a
situation where the management required to address the problem would be facilitated by referral.
If there is an option to refer, the ultimate questions becomes ones of animal health status and the more
practical ones of whether the clinician has the materials, expertise, staff, and time to deal with this colic? Ir-
respective of the underlying colic problem, if the veterinarian does not have the latter at their disposal, then
referral is the only ethical option. However, it is important that the referring veterinarian only send animals
that they believe will benefit from the transfer. Sending horses that are unlikely to survive the transport, or
those that are so sick that they will not survive the intervention for which they were referred (e.g. surgery),
is irresponsible. If the primary care clinician can determine the packed cell volume (PCV), total protein (TP)
and lactate concentration of the horse’s venous blood it will help them determine the likelihood of a suc-
cessful outcome. This can be combined with an assessment of the lactate concentration of the abdominal
fluid, if it is safe to perform an abdominocentesis.
Horses with colic require management and monitoring. Veterinarians providing after-hours service typ-
ically do so for a wide geographical area, or for more than one person. As such, they typically diagnose
and treat the colic and leave the monitoring of the animal to the owner, trainer, or horse manager. They do
not have the time. Nor can the horse owner afford to have veterinarians sitting and monitoring the animal.
Intravenous (IV) fluids are routinely administered on farm. However, if there is a need for prolonged IV
fluid administration with, or without, intermittent nasogastric intubation (such as an impaction colic) then
moving the animal to a central facility (whether it is a “referral” or not) may be more efficient and result in
improved case management.
Dr. James Carmalt graduated from the University of Cambridge in 1998. He did an internship in large animal
medicine and then went into general practice in Tasmania (Australia). Following that, he did two back-to-
back residencies (Equine Practice and Large Animal Surgery) combined with a Masters degree (Equine
Dentistry) and a Fellowship of the Royal Veterinary College (FRCVS). Dr. Carmalt is currently a full professor,
with tenure, at the University of Saskatchewan in Canada. He holds a PhD and Diplomate-status (by exam-
ination) with multiple internationally recognised speciality Colleges including equine practice (ABVP), equine
dentistry (AVDC), equine surgery (ACVS), sports medicine & rehabilitation (ACVSMR). Dr. Carmalt travels
extensively to work for individual clients, private practices and academic institutions.
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Practical fluid therapy

Fernando Malalana DVM PhD DipECEIM FHEA FRCVS
Philip Leverhulme Equine Hospital, University of Liverpool, Leahurst Campus
The main purpose of fluid therapy is restoring circulating volume in cases dehydration or hypovolaemia.
This will in turn improve cardiac output and increase oxygen delivery to tissues. In addition, fluid therapy is
used to correct metabolic derangements such as electrolyte imbalances or acid-base disturbances.
There are two main types of fluids:

Crystalloid solutions consist of electrolytes in water and can be isotonic, hypertonic or hypotonic. Isotonic
crystalloids have the same osmolality as plasma and can be administered in large volumes. Hypertonic
fluids are used to restore circulating volume rapidly by drawing water from the intracellular fluid. Hypotonic
fluids are typically only used to correct plasma hypertonicity.
Colloids are solutions containing larger molecules, allowing them to persist longer in the circulation whilst
exerting osmotic pressure to draw water into the vascular space in a similar way to hypertonic crystalloids.
Examples of colloids include gelatines, starches or plasma.
Two main routes of administration of fluids are used: intravenous and enteral. The administration of fluids
via the intravenous route is mainly done through the jugular vein but other options are available. The en-
teral route, via a nasogastric or naso-oesophageal tube provides an affordable alternative in cases where
the intestinal function is unaffected. More recently, administration of fluids per rectum has been described.
Any fluid therapy plan must replace the fluid deficit present (as determined by clinical signs or laboratory
markers), provide the daily maintenance requirements and consider any potential ongoing loses (such as
reflux or diarrhoea).
I graduated from the Complutense University of Madrid in 2001 followed by 6 years in mixed practice in
East Yorkshire, UK. In 2008 I moved to the University of Liverpool where I completed an ECEIM residency in
Equine Internal Medicine. I am a European Specialist in Equine Internal Medicine since 2011 and currently
work as a senior lecturer at the University of Liverpool. In 2021 I completed a PhD on the Epidemiology of
Uveitis. I am interested in all aspects of Equine Medicine but have a particular interest in ophthalmology,
oncology, neurology and gastrointestinal medicine.
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Post-surgical management after enterotomy:

Expectations and Outcome
James L. Carmalt MA, VetMB, MVetSc, PhD, FRCVS, DABVP(Eq), DAVDC(Eq), DACVSMR(Eq), DACVS
Professor – Equine Surgery, Dentistry, Sports Medicine and Rehabilitation, Department of Large Animal
Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK
S7N5B4 Canada.
Return an animal to its stall after having “fixed” a colic problem is only the beginning of the journey. Broad-
ly speaking, 80 % of horses undergoing colic surgery survive to hospital discharge. In the long-term (1 yr
or more) survival rates range from 34-90%, depending on age and location of lesion. The post-operative
phase is critical and yet there is little “glory” to be had at this point. This is also the point at which the
client is ever-present, thus the specter of a lawsuit looms in cases with unsuccessful outcomes. The ex-
pectations are that the horse will be free of colic/pain; that it will be able to manage its fluid and nutritional
intake; that the gastrointestinal tract will function normally; and the catheter and incision will remain infec-
tion free. The outcome however, may be very different.
Fluid and Nutritional Management

Fluid therapy is a massive topic that has the potential to directly influence GI motility. Overall, however it
is important to deliver sufficient fluids to address any surgical, or trauma-related, loss as well as ongoing
maintenance. In most cases 1 liter per hour is necessary (in temperate climates) to address normal needs
in a 500kg horse. These can be delivered intravenously using a balanced, isotonic solution, or parenter-
ally via a stomach tube. For post-enterotomy fluid management, either the horse is not administered any
additional fluid (large colon enterotomy at the pelvic flexure) or an appropriate, electrolyte managed fluid
(calcium, potassium or magnesium enriched). The benefit of fluids administered per os (via a stomach
tube) is that no special or expensive materials are needed, and the fluid delivered induces a gastrocolic
reflex, which may actually assist in developing, or improving, large colon motility.
Post-operative nutrition is a very important aspect of the post-operative colic patient. It will not be dis-
cussed in this lecture as it is covered elsewhere
Post-operative ileus (POI)

POI has a prevalence ranging from 10-56%. Risk factors have been reported as being high packed cell
volume (PCV) and heart rate, longer durations of surgery and anesthesia, and small intestinal involvement.
In one study there were no incidences of POI with jejunojejunostomies, but increased risk after jejunoce-
costomies. There is also one study suggesting that a pelvic flexure enterotomy may reduce the risk of POI
but that is not a consistent finding in the literature.
Re-laparotomy & Adhesion formation

Post-operative pain with, or without gastrointestinal ileus, is a reason to re-operate a colic. If there is a
need to go back to surgery, it is better to re-operate early. However, it is important to realize that approx-
imately 50% of horses who are put back on the table are euthanased during the second surgery. There
is also a much higher risk of incisional infection and subsequent herniation with a second surgery in the
post-operative period.
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The development of abdominal adhesions post-celiotomy is well documented in humans as well as in

domestic animals. They are a cause of significant post-operative morbidity, especially in small intestinal
surgery. The majority of adhesions pose no clinical threat, however their prevalence accounts for adhe-
sions being the most common cause of small intestinal obstruction in humans (26-64%), some of which
will necessitate a repeat surgery and adhesionolysis. In a human post-mortem study 67% of patients had
abdominal adhesions after a single celiotomy; whereas 97% of those people having more than one ab-
dominal surgery had adhesions.
In the horse, between 6 and 26% of animals undergoing abdominal surgery will develop adhesions, which
may result in small intestinal obstruction, internal herniation and strangulation post-surgery. These may
result in an acute, emergency situation (usually within the first 60 days post-surgery) or recurrent epi-
sodes of abdominal pain in the post-operative patient. Foals, similar to human children, are considered at
increased risk of developing post-operative abdominal adhesions (33%).
Unfortunately, the presence of adhesions can only be made at a second surgery (laparotomy or lapa-
roscopy) or at post-mortem and thus the true incidence is unknown. The majority of adhesions are likely
asymptomatic however it is not known how many or whether a single adhesion in a particular anatomical
location will be a cause for concern. Common sites of adhesion formation in the horse are between the tip
of the cecum and the ventral body wall and between loops of small intestine.
Overall, the myriad products and multiple interventional strategies aimed at reducing adhesion formation
in the horse (specifically the foal) highlight a lack of basic pathophysiological knowledge that needs to be
addressed before yet another “wonder product” is tested.
Infection (fever of unknown origin (FUO)

FUO is a troubling complication of surgical intervention. There is often a transient post-operative increase
in body temperature. This is usually within the first 12-24 hours after surgery and is thought to be asso-
ciated with the systemic stress of anesthesia. Usually of low grade, this is usually self-limiting and does
not need treatment. Persistence of a fever beyond this time, or development of the same in the 4-5 day
post-operative period needs careful assessment. Common sites of sepsis are the catheter and, or the in-
cision. An adverse behavioral response to gentle palpation, and ultrasound investigation will usually help
determine whether these sites are infected.
Dr. James Carmalt graduated from the University of Cambridge in 1998. He did an internship in large animal
medicine and then went into general practice in Tasmania (Australia). Following that, he did two back-to-
back residencies (Equine Practice and Large Animal Surgery) combined with a Masters degree (Equine
Dentistry) and a Fellowship of the Royal Veterinary College (FRCVS). Dr. Carmalt is currently a full professor,
with tenure, at the University of Saskatchewan in Canada. He holds a PhD and Diplomate-status (by exam-
ination) with multiple internationally recognised speciality Colleges including equine practice (ABVP), equine
dentistry (AVDC), equine surgery (ACVS), sports medicine & rehabilitation (ACVSMR). Dr. Carmalt travels
extensively to work for individual clients, private practices and academic institutions.
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Equine nutrition in the post-operative colic

MVZ Cert. Elena Garcia-Seco, MVZ Ms. Cert. Mariano Hernández Gil
Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México
Postoperative nutrition plays a crucial role in the recovery and overall well-being of horses undergoing colic
surgery. Colic, a common gastrointestinal disorder in horses, can result in surgical intervention, which places
significant stress on the digestive system. The primary goals of postoperative nutrition for colic in horses are to
support the healing process, maintain hydration and electrolyte balance, provide adequate energy and nutri-
ents, and prevent complications such as postoperative ileus and laminitis. The nutritional requirements during
this period may vary depending on the severity of the colic, surgical procedure, and individual horse’s needs.
Several challenges are associated with postoperative nutrition in horses with colic. Postoper-
ative ileus, a condition characterized by decreased intestinal motility, can impair feed intake
and digestion. Pain, stress, and the use of analgesics may also affect appetite and nutrient ab-
sorption. Additionally, horses recovering from colic surgery may have altered gastrointestinal func-
tion and nutrient utilization, requiring careful monitoring and adjustment of the feeding regimen.
To meet the nutritional needs of horses post colic surgery, a gradual reintroduction of feed is typ-
ically recommended. Initially, horses are provided with small, frequent meals of easily digest-
ible feeds such as hay pellets or soaked hay. As the horse’s gastrointestinal function improves, the
amount and complexity of the feed can be increased gradually. Monitoring the horse’s appetite, body
condition, and gastrointestinal function is essential to ensure appropriate feeding adjustments.
Supplemental feeding may be necessary to meet the increased energy and nutrient requirements during
the recovery period. Commercially available complete feeds or specially formulated supplements can pro-
vide the necessary balance of carbohydrates, proteins, fats, vitamins, and minerals. The use of probiot-
ics and prebiotics may also aid in restoring a healthy gut microbiota and improving nutrient absorption.
Water intake is crucial for postoperative recovery, as horses may become dehydrated due to decreased
feed intake or surgical stress. Access to clean, fresh water should be provided at all times, and elec-
trolyte supplementation may be necessary to maintain proper hydration and electrolyte balance.
In conclusion, gradual reintroduction of feed, supplemental feeding, and attention to water intake are es-
sential strategies for successful postoperative nutrition in horses with colic. By implementing appropriate
nutritional support, the recovery process can be optimized, leading to improved outcomes for these valu-
able animals.
Bibliography:
1. Cohen, N. D., & Merritt, A. M. (2014). Nutritional support of the postoperative colic horse. Veteri-
2. Dallap Schaer, B. L., & Cohen, N. D. (2019). Nutritional support of the surgical colic patient. Vet-
erinary Clinics: Equine Practice, 35(1), 1-17.
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3. Geor, R. J., & Harris, P. A. (2013). Nutritional management of postoperative colic patients. Veteri-
4. Merritt, A. M., & Cohen, N. D. (2017). Nutritional support of the colic patient. Veterinary Clinics:
Equine Practice, 33(1), 1-15.
5. Southwood, L. L., & Geor, R. J. (2018). Nutritional management of the postoperative colic patient.
Veterinary Clinics: Equine Practice, 34(1), 1-16.
MVZ Cert. Elena García Seco

Born in Mexico, Elena obtained a First Degree (Hons.) in Veterinary Medicine and Animal Science by the Na-
tional Autonomous University of Mexico (UNAM). She performed externships at the University of California
Davis and the University of Minnesota. She then achieved an Equine Internship at Louisiana State University,
a Residency in Equine Surgery at the University of Missouri and a Clinical Instructorship in Surgery at the
Marion duPont Scott Equine Medical Center of Virginia Tech. Worked as a professor and surgeon at the
Universidad Alfonso X in Madrid and since 2013, she is a Faculty Member of the Equine Department at the
College of Veterinary Medicine (UNAM) taking part as an equine professor and a senior surgeon.
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Antimicrobial strategy for respiratory disease

CJ (Kate) Savage BVSc(Hons), MS, PhD, Diplomate ACVIM
Melbourne, Australia
Knowledgeable use of antimicrobials in horses is essential in the antimicrobial-resistant world in which we

live and work. We all know the gold standard, but what should we do when we need empirical treatment,
if we can’t perform culture and sensitivity for practical and/or economic reasons?!
Firstly, we need to know our region. This means that we require contemporary data of local pathogens and
their antimicrobial sensitivity patterns (aka antibiograms).
Secondly, we need to know that just because a client thinks we should provide antimicrobials in a febrile
horse, we know we shouldn’t if it is likely a viral infection &/or the horse is improving. At least, we can
decide to watch for 12-48 hours and reassess the patient. Thirdly, we must recognise the likelihood of a
certain bacterial species causing certain clinical signs in the horse. Fourthly, we use our knowledge of
what antimicrobials are empirically helpful against distinct bacterial pathogens in choosing an antimicro-
bial. Finally, we need to be ready to firmly advocate for our patients [and indeed humanity (through us not
being responsible for the exacerbation of antimicrobial resistance)] and perform culture and sensitivity on
samples including nasal swabs, guttural pouch lavage, tracheal lavage fluid and pleural fluid. Remember
that if you have diagnosed pleuropneumonia through ultrasonographic examination, then after pleurocen-
tesis, we need to collect and submit pleural fluid samples for both aerobic and anaerobic culture.
Dr CJ (Kate) Savage BVSc(Hons), MS, PhD, Diplomate ACVIM has enjoyed a wonderful career in equine
internal medicine. Kate is now a board member of the Victorian Racing Integrity Board (VRIB) in Australia.
Her interests include cardiology and respiratory medicine in horses, and the advancement of welfare and
health in horses, including those in competition.
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How to manage and pharmacologically treat allergic

respiratory disease
Vinzenz Gerber, DVM, Dipl. ACVIM, Dipl. ECEIM, PhD
Swiss Institute of Equine Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, Univer-
sity of Bern, Bern, Switzerland
“Allergic respiratory disease” can have two different presentations in the horse, anaphylaxis (1) and Equine
Asthma (2, 3).
Anaphylaxis, also known as anaphylactic or allergic shock, is an acute, severe allergic response that af-
fects the entire body. This reaction is characterized by narrowing of the airways, resulting in dyspnea, and
can also be accompanied by non-respiratory signs like hives or cardiovascular shock. In severe cases,
swelling of the upper airways (throat, laryngeal edema) and/or lower airways (bronchospasm, primary
or secondary pulmonary edema) can obstruct air passage to a potentially life-threatening degree. Imme-
diate therapeutic action is indicated and depending on the severity and presentation may include phar-
macological and physical intervention (1): Epinephrine (1 : 1000), 3 - 5 ml/450-500 kg slowly IV in 20-30
ml NaCl (also IM or SQ in less severe cases); holding the head of the patient high; applying ice-cooling;
lidocaine spray, epinephrine 2% or phenylephrine spray (0.1%, 20 - 30 mL) locally to decrease swelling;
furthermore NSAIDs, such as flunixin, 1.1 mg/kg i.v. BID, steroids, such as dexamethasone, 0.05 - 0.2 mg/
kg IV SID, antihistamines, such as Ceterizin 0.2-0.4 mg/kg PO, q12h; and if pulmonary edema is present,
furosemide (1 mg/kg IV slowly, repeat after 30 minutes if necessary) may be used; in severe cases of upper
airway obstruction, tracheostomy can be life-saving and O2 insufflation (10 - 20 ml/kg/min.) may be given
by nasal tube or tracheostomy; in severe allergic shock, crystalloid and colloid fluids may be indicated for
cardio-vascular support.
While anaphylaxis is rare and poorly documented in the horse, Equine Asthma is very common in some
regions and its clinical manifestations and management are well-described. However, the exact etiology
and pathogenesis, particularly the role of allergy in Equine Asthma, are still unclear. Nevertheless, this
syndrome is commonly regarded as an “allergic respiratory disease” in the broader sense (i. e. a hypersen-
sitivity to external “normal” stimuli). This concept is indeed helpful to explain to owners of affected horses
that pharmacological treatment is only symptomatic, and the condition should be treated and controlled
by avoiding or decreasing external triggers. Apart from “summer-pasture associated Equine Asthma”
(prevalent in some regions with hot, humid climates and suspected outdoor “allergens”), most affected
horses are hypersensitive to indoor stable environments, specifically irritants and potential allergens from
hay dust and bedding. The best documented potential allergens in indoor environments are of fungal or-
igin (i. e. mold spores, amplified by non-specific irritants like endotoxin and B-glucans), but currently no
proven allergen testing and desensitization protocols exist. Accordingly, management changes directed at
improving stable air hygiene to decrease dust exposure (e. g. steaming of hay; replacing by haylage, hay
cubes or pelleted feeds; pasture with grass as roughage etc.) are the most important aspects of Equine
Asthma therapy.
Despite measures to improve air hygiene, or when these cannot be fully instituted, many horses still require
medical therapy to control clinical signs. Systemic and aerosolized formulations are available for various
medications, and choice will depend on clinical presentation, availability local regulations, and veterinarian/
owner preferences. In severe exacerbations, bronchodilators can provide relief of airway obstruction. Mus-
carinic receptor antagonists, like hyoscine butylbromide (0.2 - 0.3 mg/kg IV), also known as scopolamine
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butylbromide (brand name Buscopan), is only short-acting but highly effective, and can also be used di-
agnostically to demonstrate reversibility of bronchospasm induced signs. It is well tolerated and does not
have the side-effects and risks of atropine. B-agonist bronchodilators can be administered by inhalation (e.
g. Salmeterol or Albuterol) or orally (Clenbuterol, 0.8 -3.2 μg/kg PO q12h; gradual increase of dose; drug
tolerance with prolonged use). Bronchodilators should not be used as the sole treatment and are often
combined with corticosteroids given systemically (e. g. prednisolone 0.5-2 mg/kg or dexamethasone, 0.03 -
0.1 mg/kg) or by inhalation (e. g. fluticasone, budesonide, beclomethasone, ciclesonide). Ciclesonide (brand
name Aservo EquiHaler) provides the best documented therapeutic efficacy with the least systemic effects
and is registered for the treatment of severe Equine Asthma in many countries. Further options include
sodium cromoglycate, a mast cell stabilizer, for horses with mastocytic mild-moderate Asthma, and supple-
mentation with polyunsaturated omega-3 fatty acids as an adjunct treatment. Mucolytic agents are often
used, but evidence for efficacy, at least as a sole medication, is lacking. Non-steroidal anti-inflammatory
drugs, leukotriene-receptor antagonists and antihistamines do not appear to be helpful in Equine Asthma
therapy.
Further reading
1. Equine Emergencies - Treatment and Procedures, Eds: Orsini JA, Divers TJ, 4th Edition - October
1, 2013, Hardback ISBN: 9781455708925, eBook ISBN: 9781455745425
2. Couëtil LL, Cardwell JM, Gerber V, Lavoie JP, Léguillette R, Richard EA. Inflammatory Airway
Disease of Horses--Revised Consensus Statement. J Vet Intern Med. 2016 Mar-Apr;30(2):503-15.
3. https://www.msdvetmanual.com/respiratory-system/respiratory-diseases-of-horses/asth-
ma-in-horses
All dosages must be checked for correctness and accordance with local regulations and recommenda-
tions.
Vinzenz Gerber, DVM, Dipl. ACVIM, Dipl. ECEIM, PhD
Full Professor and Head of the Swiss Institute of Equine Medicine, University of Bern, Switzerland
Senior Lecturer, Equine Clinic, Dept. Vet. Clin. Sci., Vetsuisse Faculty, University of Bern, Switzerland
Habilitation, Vetsuisse-Faculty, University of Bern, Bern, Switzerland.
Diplomate of the European College of Equine Internal Medicine (ECEIM)
Ph.D., Large Animal Clinical Sciences, Michigan State University, USA
Diplomate American College of Veterinary Internal Medicine, Large Animal Internal Medicine Specialist
National veterinary boards certification, University of Bern, Bern, Switzerland
Specific interests: Lower airway disease / equine asthma, stress and gastro-intestinal disorders, sarcoids
and other neoplastic disorders, infectious Dx,
Board member Foundations “Pro Pferd” and “Tierspital”, WEVA Past-President, AAEP and ACVIM past for-
eign advisory committees
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Understanding the risk of intra-articular medication in

racehorses
Prof Chris Whitton BVSc FANZCVS PhD, University of Melbourne
Intra-articular medication is widely used in the treatment of joint injury and joint disease in horses. Med-
ications such as corticosteroids are very effective for treating soft tissue inflammation and reducing pain.
However, in racehorses a high proportion of joint injury and joint disease results from damage to the
subchondral bone due to the repeated loads generated on joint surfaces in galloping horses. Fortunately,
fractures arising from the subchondral bone are relatively uncommon, however subchondral bone injuries
that remain confined to the joint surface are very common. The inflammation and pain associated with
such injuries can be managed with intra-articular medication, but these medications have no ability to
reverse subchondral bone damage. Therefore medication potentially allows horses that have developed
microdamage to continue to race and train exposing them to the risk of exacerbation of existing injuries. It
has been found that racehorses undergoing local injection of corticosteroids suffer a higher rate of muscu-
loskeletal injury for seven weeks post injection and the injury and fracture rate is higher following injection
on multiple occasions. Clinicians have advocated radiographing joints prior to treatment to mitigate the
risk of subsequent injury. While this approach has merit, radiographs are relatively insensitive for detecting
subchondral bone injury. The use of advanced imaging will increase the detection of subchondral bone
injury however no imaging method developed to date can detect microdamage so we are always ignorant
to the level of subchondral bone injury at the time of treatment. It is therefore prudent to use intra-articular
medication sparingly and to make sure owners and trainers are fully aware of the risks involved.
Chris Whitton BVSc FANZVCS PhD
Chris leads the Equine Limb Injury Prevention Program at the University of Melbourne Equine Centre a multi-
disciplinary research program funded by Racing Victoria, the Victorian State Government and the University
of Melbourne, combining microstructural analysis, histopathology, biomechanics, epidemiology and mathe-
matical modelling, dedicated to developing preventative training and management protocols for racehorses.
Chris trained as a specialist equine surgeon at the University of Sydney, Australia, gaining Fellowship of the
Australian and New Zealand College of Veterinary Scientists in Equine Surgery by examination in 1995. He
also completed a PhD in Carpal disease of racing horses at the University of Sydney in 1998 before moving
to work at the Animal Health Trust in Newmarket, England in 1996. From 1999 to 2004 he ran his own surgical
referral practice at the Newcastle Equine Centre in Australia and has worked at The University of Melbourne
since 2004 as a Specialist surgeon and researcher.
He has published over 70 peer reviewed papers and contributed to 12 book chapters. He has been awarded
over $13million in research grants. He regularly presents educational lectures on injury prevention to trainers
in Australia and has also presented to trainers and racing veterinarians in England, Ireland, Wales, Hong
Kong, Singapore, Korea, Brazil, and Uruguay.
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Rational Antimicrobial Use and Resistance

CJ (Kate) Savage BVSc(Hons), MS, PhD, Diplomate ACVIM
Melbourne, Australia
Knowledgeable and rational use of antimicrobials in horses is essential in the antimicrobial-tolerant and
antimicrobial-resistant world. The tenets in the previous lecture on strategies of antimicrobial use in equine
respiratory disease hold true for use of antimicrobials in other organ systems. The use of topical disinfec-
tants such as chlorhexidine have a place in management of skin wounds and infections.
Important questions to answer are how do we treat horses, achieve client compliance and avoid antimi-
crobial-tolerance and antimicrobial-resistance? Steps should be taken to ensure clients can not obtain
antimicrobials unless prescribed specifically by their veterinarian. Unverified internet sales appear to be
an international crisis. Client education is key, as we all understand that client-determined administration
and brief, inconsistent exposure to an antimicrobial may prime bacteria to become tolerant and eventually
resistant. Veterinarians need to be more aware and engaged in surveillance of antimicrobial resistance in
equine pathogens, especially in their practice region, as well as staying abreast of national and interna-
tional trends. Such knowledge will allow us to ascertain if resistance is increasing and whether previously
unrecognised resistance is occurring. Veterinarians must be vigilant about particular classes of antimicro-
bials being over-represented in resistance patterns and whether a definitive type of resistance is associ-
ated with particular outbreaks.
Dr CJ (Kate) Savage BVSc(Hons), MS, PhD, Diplomate ACVIM has enjoyed a wonderful career in equine
internal medicine. Kate is now a board member of the Victorian Racing Integrity Board (VRIB) in Australia.
Her interests include cardiology and respiratory medicine in horses, and the advancement of welfare and
health in horses, including those in competition.
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Addressing acute diarrhea in horses

Macarena Sanz DVM, PhD, DACVIM-LA
There are multiple causes of acute diarrhea in adult horses. In other species, diarrhea may not be consid-
ered an emergency. However, in horses, acute diarrhea can lead to fast dehydration, endotoxemia, system-
ic inflammatory response syndrome (SIRS) and death. Therefore, all horses with acute diarrhea should be
considered risk patients and should be closely monitored.
The causes of diarrhea differ by geographic localization and age of the patient. Acute diarrhea can be
caused by infectious agents such as Salmonella spp, Clostridium spp, Equine coronavirus, Neorickett-
sia risticii (Potomac Horse fever), Lawsonia intracellularis and encysted small strongyles (Cyathostomes).
Non-infectious causes include administration of NSAIDs, exposure to toxins such as cantharidin, hoary
alyssum, and arsenic, sand accumulation as well infiltrative diseases such as alimentary lymphoma or
inflammatory bowel disease (which can also present as chronic diarrheas or weight loss). Some of these
infectious organisms are contagious. Thus, horses should be isolated until the contagious causes of diar-
rhea are ruled out or a cause can be stablished. In our hospital, isolation is mandatory for horses that show
up with diarrhea, neutropenia, or fever (2 out of these 3 signs).
There are multiple mechanisms for diarrhea: malabsorption, increased osmolarity of the GI content, in-
creased secretion of water and electrolytes into the lumen, inflammation of the GI or altered GI motility.
In adult horses, diarrhea results almost exclusively from disorders of the large intestine (although small
intestine may be involved at the same time). This is less true in foals. Regardless of the mechanism, most
of the treatment focuses on patient maintenance.
Clinical signs:
Aside from diarrhea, the clinical signs are typically those of dehydration and endotoxemia. Horses may
show lethargy, anorexia, tachycardia, tacky mucous membranes that might be congested. Fever and colic
are not uncommon. Some cases develop ileus and acute laminitis.
Diagnosis:
A definitive diagnosis is difficult to obtain in horses. A definitive diagnosis is not achieved in > 50% of the
cases. Clinical signs are too similar between etiologies and are rarely pathognomonic. A proper history
is critical to differentiate infectious (other horses infected, history of fever, travel, etc.) from non-infectious
(NSAID administration, feeding on ground, potential exposure to toxins, etc.).
• Fecal samples (and blood for some pathogens) should be submitted whenever possible for cul-
ture, PCR, and/or toxin identification.
• Bloodwork is useful to assess acid base status, electrolyte abnormalities, dehydration, and overall
organ function. Marked neutropenia and toxic changes in neutrophils are common.
• Abdominal ultrasonography may show fluid in the large colon/cecum, thickening of the wall and
free fluid.
• Abdominal radiographs are useful to assess the presence of sand/gravel.
Treatment:
Treatment is aimed at correcting dehydration and electrolyte imbalances as well as the causative agent
when identified.
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Restoring fluid balance:

• Fluid therapy is typically administered IV in severe cases, but enteral fluid administration can also
be performed using a small nasogastric tube. Both routes allow for electrolyte supplementation.
• Oncotic pressure: Low albumin is not uncommon in these cases. Hydroxyethyl starch solutions or
plasma can be used to correct these. Hydroxyethyl starch solutions can cause coagulation abnor-
malities if administered >20 ml/kg or for multiple days.
Anti-endotoxin treatment:
• DTO smectite (Biosponge®) or activated charcoal can be administered via NGT to decrease endo-
toxin absorption from the GI.
• Polymixin B (6,000 IU IV q 6-8h) can be used to bind circulating endotoxin. This drug is expensive
and can be nephrotoxic.
Analgesia:
• NSAIDs can be used to provide analgesia. However, they should be use cautiously as they are
nephrotoxic and can cause mucosal damage of the colon.
• Butorphanol or other opioids can be added to the pain management plan.
Treating the underlying cause:

• In many cases, empirical treatment is selected based on regional incidence of disease.
• Systemic antibiotics are typically recommended in the case of Clostridium spp., Neorickettsia
risticii and Lawsonia intracellularis. Broad spectrum administration in horses with other causes of
diarrhea can worsen GI dysbiosis. Administration of systemic antibiotics to all neutropenic horses
remains controversial.
• Clostridium spp: Metronidazole, 15 mg/kg PO q8h. IV formulations are available, but their price
restricts its use in adult horses. Per rectum administration can be used in cases of ileus, doubling
the dose to 30 mg/kg is recommended. Anorexia and increased liver enzymes are common after
administration. Ataxia may be seen if the protein is low; more common with IV formulaitons.
• Neorickettsia risticii and Lawsonia intracellularis: Oxytetracycline IV (6.6 mg/kg IV q 12-24h for 3-5
days). Lawsonia may require longer treatment. Improvement is seen within 24h. Oxytetracycline
is nephrotoxic and should be given after the patient is hydrated. or twice daily for 5 days (dilute
in fluids or give slowly). If given fast, it can cause collapse and death. Thus, in the case of sick an-
imals, it is best to use diluted in sterile water.
Isolation: Salmonella spp, Equine coronavirus and Lawsonia intracellularis cases should be isolated until
no longer shedding. This may require prolonged isolation (min 3 weeks)
References:
• Multiple authors. Veterinary clinics of North America: Infectious diseases 2023
• Shaw S, Stamppfli H. Diagnosis and treatment of undifferentiated and infectious acute diarrhea in
the adult horse. Veterinary Clinics: Equine Practice. Vol 34 (1), 2018.
• Uzal F, Arroyo LG, Henderson E. Bacterial and viral enterocolitis in horses: A review. Journal of
veterinary diagnostic investigation. Vol 34 (3), 2021.
Animal Internal Medicine Residency and a Master’s of Science degree at Washington State University and
she is a Diplomate of the ACVIM College. She also completed a PhD in equine immunology at the Gluck
Equine Research Center; her research focuses in equine immunology and infectious diseases. She worked
as a Senior Lecturer in Equine Medicine at the Onderstepoort Veterinary School in South Africa for 3 years.
Dr. Sanz is an Associate Professor in Equine Medicine at Washington State University in the US.
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Alternatives to antimicrobial use in the uterus

Dr. Ryan Ferris, DVM, MS, DACT
Summit Equine, Gervais Oregon USA
The global use of antibiotics over the last several decades has resulted in significant antibiotic resistance
being observed. With a serious concern of antibiotic resistance resulting in the inability to treat com-
mon bacterial infections in the future practitioners are looking for alternative therapies for treating routine
infections. Historically multiple non-antibiotics have been used for the successful treatment of uterine
infections. A few of the more common ones are dilute povidone Solution (titratable iodine 1%, 15 mls povi-
done solution in 1 liter of saline or LRS), hydrogen peroxide (1% solution as infusion or used in lavage) and
tris-EDTA (50 mM tris with 3.5 mM EDTA as a lavage or infusion). Recently there has been a surge in new
alternatives to antibiotics for treating uterine infections such as ozone, anti-microbial peptides or platelet
rich plasma. However, the practitioner needs to use caution when deciding if alternatives to antibiotics will
be better than traditional therapy with antibiotics. The first major decision that needs to be determined is
the safety and efficacy ideally reported both in vitro and in vivo for the compound to be used. The clinical
case you are treating should be evaluated to determine if the clinical case supports consideration of treat-
ment with non-antimicrobials. For example a post breeding antibiotic infusion in a “normal” mare likely
would benefit with non-antibiotic replacement as compared to antibiotic infusion. However a mare diag-
nosed with a uterine infection via endometrial culture and cytology may still require antibiotic treatments.
In the end as you consider alternative antibiotic treatments you must consider as the practitioner are you
doing the right thing for the horse and your client.
Ryan A Ferris, DVM, MS, Diplomate, American College of Theriogenologists, Owner, Summit Equine, Inc.
Newberg Oregon Dr. Ferris graduated from veterinary school at Washington State University in 2007. Ryan
completed an internship in equine surgery, medicine and reproducJon at the Equine Medical Center of
Ocala in 2008. Followed by a residency in Equine ReproducJon at Colorado State University. He received
a MS in Clinical Science from Colorado State University, passed the board examinaJons for the College of
Theriogenologists and was an assistant professor at Colorado State University from 2010-2017. In 2017 Dr.
Ferris and his family moved to Newberg, Oregon and established Summit Equine, Inc. Summit Equine is
a referral equine reproducJon pracJce for mares and stallions. Offering services in breeding management
(fresh, cooled or frozen), embryo transfer, problem mares, oocyte aspiraJon, stallion collecJons for fresh,
cooled or frozen semen, internaJonal shipment of semen, stallion evaluaJons. Interests: Bacterial and fungal
endometriJs, biofilm, post maJng induced endometriJs, and embryo transfer.
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Bisphosphonates - Is their use worth the problems?

Christopher Riggs
BVSc, PhD, DEO, DipECVS, FRCVS
The Hong Kong Jockey Club Equine Welfare Research Foundation

Sha Tin Racecourse
Hong Kong SAR
CHINA
In the early to mid-noughties bisphosphonates (BPs) were hailed by many equine clinicians as a useful
group of drugs that could treat or prevent a wide host of troublesome skeletal issues. In the intervening
years sentiment has changed dramatically and use of these compounds is now considered contraindicat-
ed in all but older horses with specific degenerative conditions. Bans on their use have been imposed by
many racing jurisdictions and severe penalties exist for violation of embargos. However, knowledge of the
pharmacological and physiological effects of these drugs in the horse is wanting and there may be a call
for a more rational, science-based review of their use in equine medicine.
Not all BPs are equal. Firstly, they can be classified into two broad groups: those that contain an amine
group (so-called nitrogen-containing BPs) and those that do not. The effect of these different groups on
the metabolism of cells is fundamentally different. This is mirrored in their pharmacological properties.
Nitrogen-containing BPs (such as Pamidronate and Zoledronate) are many times more potent at inhibiting
osteoclastic resorption of bone than non-nitrogen containing products (e.g. Tiludronate and Clodronate).
Furthermore, the range of pharmacological effects varies between groups and there is some evidence
that the analgesic properties of non-nitrogen-containing BPs may be the greater of the two. Secondly, the
potency of BPs at inhibiting bone resorption and range of other effects varies greatly between different
products, depending on molecular subgroup substitutions.
Much of the discussion about the effects of BPs in the horse and nearly all of the concerns regarding
potential complications of these drugs in this species has been inferred from studies on laboratory ani-
mals and data from human clinical practice. In fact, only one study has demonstrated that one of the BPs
licensed for use in horses (Tiludronate) inhibits bone resorption in the horse (as determined by serum con-
centrations of a marker of type I collagen degradation, CTX-1) and then only for a short duration [1]. More
recently it was found that while Clodronate (the only other BP licensed for use in horses) administered to a
group of Thoroughbreds at a standard clinical dose did not increase plasma concentration of CTX-1 above
that of a saline placebo administered to a control group, it did decrease concentration of type 5 acid phos-
phatase, which may be a more sensitive indicator of osteoclastic activity [2]. Conversely, others have found
that Tiludronate and Clodronate administered at clinical dose rates do not appear to impact bone structure
or cellular activity in horses [3,4]. Only one study reports the effect of nitrogen-containing BPs in horses
and this did demonstrate that Zolendronate resulted in a profound and prolonged inhibition of bone re-
sorption [5]. These findings suggest that concerns over the clinical use of BPs currently licensed for use
in the horse, namely that they may interfere with bone development and homeostatic repair mechanisms,
may not be as significant as some claim. On the other hand, the off-label use of nitrogen-containing BPs
is clearly a potential concern.
In the absence of profound inhibition of bone resorption, the beneficial clinical effects reported from the
BPs licensed for use in horses may be due to their analgesic or anti-inflammatory properties. Bisphospho-
nates are used in human medicine to manage pain arising from tumours that have metastasised to bone.
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The pharmacological mechanism by which BPs affect analgesia and whether this property is more pro-
found in bone than other tissues remains undetermined. If these drugs do preferentially impact bone pain
they may been beneficial in the management of pain associated with subchondral bone disease, which is
prevalent in racehorses.
Several studies have documented prolonged detection times of BPs in horses, which are measured in
times of months and years. While pragmatic measures can be used to manage evidence of BP administra-
tion in legitimate cases, clinicians considering clandestine use of these products should be aware of the
fact that evidence of their administration to a horse can be detected for such protracted periods.
References
1. Delguste C, Amory H, Doucet M, Piccot-Crézollet C, Thibaud D, Garnero P, Detilleux J, Lepage

OM. Pharmacological effects of tiludronate in horses after long-term immobilization. Bone. 2007
Sep;41(3):414-21. doi: 10.1016/j.bone.2007.05.005. Epub 2007 May 23. PMID: 17604709.
2. Knych HK, Finno CJ, Katzman S, Ryan D, McKemie DS, Kass PH, Arthur RM. Clodronate detec-
tion and effects on markers of bone resorption are prolonged following a single administration
to horses. Equine Vet J. 2023 Jul;55(4):696-706. doi: 10.1111/evj.13866. Epub 2022 Aug 23. PMID:
35871470.
3. Mitchell A, Wright G, Sampson SN, Martin M, Cummings K, Gaddy D, Watts AE. Clodronate
improves lameness in horses without changing bone turnover markers. Equine Vet J. 2019
May;51(3):356-363. doi: 10.1111/evj.13011. Epub 2018 Sep 22. PMID: 30153345
4. Richbourg HA, Mitchell CF, Gillett AN, McNulty MA. Tiludronate and clodronate do not affect
bone structure or remodeling kinetics over a 60 day randomized trial. BMC Vet Res. 2018 Mar
20;14(1):105. doi: 10.1186/s12917-018-1423-2. PMID: 29554967; PMCID: PMC5859757.
5. Nieto JE, Maher O, Stanley SD, Knych HK, Snyder JR. Pharmacokinetics, pharmacodynamics, and
safety of zoledronic acid in horses. Am J Vet Res. 2013 Apr;74(4):550-6. doi: 10.2460/ajvr.74.4.550.
PMID: 23531062.
Dr Chris RIGGS
Chris studied Veterinary Science at the University of Bristol, UK, in the early nineteen eighties. He received
further training in Equine Surgery at the Royal Veterinary College, UK and was awarded a PhD for research
into the causes of racehorse fractures in 1991. He subsequently worked as a Senior Lecturer at the Philip
Leverhulme Equine Hospital, University of Liverpool, where he developed specialist skills in equine sur-
gery. He gained further clinical experience at several equine referral centres in the United Kingdom and
Australia before joining the Hong Kong Jockey Club as Head of Veterinary Clinical Services in 2003. He
was appointed to a new role in the Club as Director, HKJC Equine Welfare Research Foundation/ Chief
Advisor, Mainland Veterinary Engagement in 2019.
Chris has a particular interest, and specialist qualifications, in surgery and orthopaedics. He has published
over 80 scientific papers about fatigue damage in bone and its role in racehorse fractures, among other
topics. He also cares deeply about helping to provide opportunities for young colleagues to further their
clinical skills, with a focus on Mainland China.
Chris is a Fellow of the Royal College of Veterinary Surgeons, UK and holds positions as Adjunct Professor
at the College of Veterinary Medicine and Life Sciences, City University, Hong Kong, Special Professor
at the School of Veterinary Medicine and Science, University of Nottingham, UK, and Guest Professor at
Inner Mongolia Agricultural University.
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Treatment options for RLN (Recurrent laryngeal

neuropathy)
Nicola Lynch MVB MVetMed (Hons) CertAVP Dipl. ECVS MRCVS
Via Nova Equine Hospital, Bree, Belgium
Recurrent Laryngeal Neuropathy (RLN) remains a major cause of poor athletic performance. RLN is a dis-
tal axonopathy that predominantly affects the left recurrent laryngeal nerve1. RLN causes axonal loss, de-
myelination, and subsequent loss of cricoarytenoideus dorsalis (CAD) muscle volume. This results in a loss
of arytenoid abduction particularly during fast exercise. Several studies have identified RLN associated
neuropathological changes in both left and right recurrent laryngeal nerves in thoroughbred horses that
are clinically unaffected, indicating that many horses are subclinical cases2-6. The current standard treat-
ment for RLN is the prosthetic laryngoplasty or tie-back as described by Marks et al (1970) with the goal
of permanently abducting the left arytenoid cartilage. This is commonly performed in combination with a
vocalcordectomy or ventriculocordectomy. In horses that perform at lower exercise intensities where the
main complaint is an upper respiratory noise vocalcordectomy or ventriculocordectomy alone may be
sufficient. Several modifications to the laryngoplasty procedure have been made in recent decades in an
attempt to reduce the adverse effects on upper airway health. The discovery of the close anatomic rela-
tionship between the vestibulum oesophagi and the muscular process of the arytenoid cartilage has made
surgeons aware of the risk of penetrating the oesophageal lumen when placing the prosthesis through
the muscular process7. In many clinics prosthetic laryngoplasty is now performed in the standing horse
avoiding the risk of general anaesthesia. The ability to tighten the suture with the larynx in its normal an-
atomical position under endoscopic visualization may be the most important advantage of performing
laryngoplasty in the standing horse and may reduce the likelihood of inappropriate abduction8.
Laryngeal reinnervation using the first and second cervical nerves9 remains a more physiologically viable
treatment option for horses with RLN. This technique is not suitable for all horses with RLN, particularly
those with advanced disease where minimal CAD muscle remains. Recently the laryngeal reinnervation
procedure has been modified to include transplantation of the ventral branch of the spinal accessory nerve
into the CAD muscle. In many horses this procedure can be performed standing. Evidence of reinnervation
has been seen as early as 3 months with most horses returning to their previous use by 9 months. The
ventral branch of the spinal accessory nerve provides motor innervation to the sternomandibularis muscle
and has the advantage of being activated both at inspiration when horses are galloping, and when horses
are grazing10. This means that exercise is not mandatory for the rehabilitation period and that the horse can
maintain muscle volume at rest even in the absence of training10.
1. Draper ACE, Piercy RJ. Pathological classification of equine recurrent laryngeal neuropathy. J Vet
Intern Med. 2018;32:1397–1409.
2. Cahill JI, Goulden BE. Equine laryngeal hemiplegia. Part I. A lightmicroscopic study of peripheral
nerves.N Z Vet J.1986;34:161–169
3. Duncan ID, Griffiths IR, Madrid RE. A light and electron microscopic study of the neuropathy of
equine idiopathic laryngeal hemiplegia. Neuropathol Appl Neurobiol.1978;4:483–501
4. Duncan ID, Griffiths IR. Pathological changes in equine laryngeal muscles and nerves. In: Pro-
ceedings of the 19th Annual Convention of the American Association of Equine Practitioners,
Atlanta,Georgia. 1973;97–223.
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2023
5. Cahill JI, Goulden BE. Equine laryngeal hemiplegia. Part II. An electronmicroscopic study of pe-
ripheral nerves. N Z Vet J.1986;34:161–165.
6. Cercone, M., Hokanson, C.M., Olsen, E. et al. Asymmetric recurrent laryngeal nerve conduction
velocities and dorsal cricoarytenoid muscle electromyographic characteristics in clinically normal
horses. Sci Rep 9, 2713 (2019). https://doi.org/10.1038/s41598-019-39189-z
7. Brandenberger O., Pamela H., Robert C., Martens A., Vlaminck L., Wiemer P., Barankova K., Van
Bergen T., Brunsting J., Ducharme N., Rossignol F. (2016). Anato- mical description of the bound-
ary of the proximal equine esophagus and its surgical implications on prosthetic laryngoplasty in
horses. Vet Surg 47 942 - 950
8. Rossignol F., Vitte A., Boening J., Maher M., Lechartier L., Brandenberger O., Martin-Flores M.,
Lang H., Walker W., and Ducharme N., (2015) Laryngoplasty in Standing Horses. Vet Surg 44 341
- 347
9. Rossignol F, Brandenberger O, Perkins JD, Marie JP, Mespoulhès-Rivière C, Ducharme NG. Mod-
ified first or second cervical nerve transplantation technique for the treatment of recurrent
laryngeal neuropathy in horses. Equine Vet J. 2018;50(4):457-464.
10. Campos Schweitzer, A., Mespoulhès-Rivière, C., Möller, D., Ducharme, N., Genton, M., Farfan,
M. and Rossignol, F. (2022), Laryngeal reinnervation using the spinal accessory nerve: Elec-
tromyographic study of the sternomandibularis muscle. Equine Vet J. Accepted Author Manu-
script. https://doi.org/10.1111/evj.13859

Graduated from University College Dublin in 2012. Since graduating she has worked predominantly with
performance horses in Ireland, Australia and England with a focus on surgery, and sports medicine. She
completed a residency in Equine Surgery at the RVC, where she remained as a lecturer in Equine Surgery
until October 2022. In 2021 she gained Diplomate status with the European College of Veterinary Surgery.
She was team vet for the Japanese Eventing Team at the 2020 Olympics. Currently she is the equine surgeon
at Via Nova in Belgium. Her main interests are equine surgery, laryngeal reinnervation and sports medicine.
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Complications of Prosthetic Laryngoplasty

Nicolas Ernst DVM, MS, DACVS
Professor of Equine Surgery, Sports Medicine and Lameness
University of Minnesota, Leatherdale Equine Center
St. Paul, Minnesota, USA
Despite good surgical techniques, surgical complications after a laryngoplasty have always been the most
difficult part of managing a case.
Intra-operative Complications
- Hemorrhage: Initial problem reducing visualization, increasing difficulty of surgery, and predisposing
for other incisional complications. During the approach, the linguofacial vein or one of its branches can be
the first source of hemorrhage. Then, when increasing the size of the surgical incision caudally from the
cricoid, the cranial thyroid artery and venous plexus can be lacerated. Identification of the bleeding vessel
and direct ligation usually stops the bleeding. When inserting the needle through the cricoid cartilage and
cricoarytenoideus dorsalis muscle the plexus of laryngeal vessels can be punctured. Temporary packing
with sponges often slows bleeding and allows the placement of the prosthetic sutures. Once sutures are
placed, tightened, and tied, hemorrhage usually stops or reduces significantly.
- Laryngeal and nasopharyngeal penetration: Perforation of the laryngeal mucosa can occur when
placing the needle under the caudal border of the cricoid cartilage. This can cause chronic incisional infec-
tion and coughing. Intra-operative endoscopy should be used to prevent and correct this problem. During
surgery, manipulating the cricoid cartilage and soft tissue caudal to the cartilage can also help avoid this
problem. If mucosal penetration is detected, sutures should be transected at the caudal aspect of the cri-
coid cartilage. The area should be lavage and sutures replaced.
- Suture pullout: This is a serious problem, especially when it affects the muscular process. The suture
must be replaced, avoiding the damaged portion of the muscular process and placing the new suture
down the spine of the muscular process avoiding the penetration of the adventitia of the vestibulum of the
esophagus.
Immediate Post-operative Complications
- Seroma formation: Common problem that usually resolves itself, unless it becomes extensive or infect-
ed. If severe, it can cause a collapse of the pharynx and compression of the esophagus causing dysphagia.
Aseptic aspiration of the seroma with fluid analysis (cytology) can be performed. Usually this is not nec-
essary unless the swelling is extensive. Post-operative anti-inflammatory and anti-microbial medication
should suffice.
- Surgical site infection and dehiscence: Deep wound infection with dehiscence is not a common
problem. This can occur when there is penetration through the laryngeal mucosa. Treatment: opening
the wound, wound lavage and broad-spectrum anti-microbials. Laryngoplasty sutures do not need to be
removed; however, in chronic cases this is the only thing that stops the infection.
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- Loss of abduction: Partial or complete loss of arytenoid abduction occurs in 3–11% cases, usually in the
first week following surgery. Suture pull-through or fractures in the muscular process can be a cause of
this complication. Suture breakage is a less common cause of loss of abduction.
- Dysphagia: This is one of the most feared complications. It has been proposed that this happens due
to: 1) excessive retraction of the cricopharyngeus and thyropharyngeus muscles during surgery affecting
the esophageal sphincter function, 2) excessive surgical abduction of the arytenoid, or 3) penetration in
the adventitia or lumen of the vestibulum esophagus when placing sutures in the muscular process. Good
surgical technique and intra-operative endoscopic assessment should prevent excessive abduction and
help ameliorate this complication.
- Coughing: Incidence of coughing in the immediate post-operative period has been reported to be as
high as 43%. This commonly occurs in the immediate post-operative period and is usually associated
with high levels of arytenoid abduction with concurrent aspiration of food and/or saliva. The presence and
frequency subsides 7–10 days post operatively, but long-term coughing during eating persists in a small
proportion of cases.
Longer-term Complications
- Persistent Coughing: This may or may not be associated with eating, and is usually associated with
cases that have high levels of arytenoid abduction and subclinical aspiration of food/saliva. Aspiration
can lead to a chronic inflammation of the lower respiratory tract affecting the performance of the horse.
Diagnosis can be confirmed via endoscopy. Feeding from the ground, washing the mouth prior to exercise
and muzzling horses shortly after feeding and prior to exercise can improve this problem. Removal of the
prosthesis can resolve the problem if the above does not work.
- Progressive Loss of Abduction: During the first 6 weeks following surgery, nearly all cases can lose
1–2 grades of arytenoid abduction. Further arytenoid abduction loss is rare after 6 weeks. The cause is
unclear, however, several theories have been proposed such as: 1) softer cartilage in younger horses may
predispose to prosthesis pull-through, 2) residual laryngeal adductor function in cases with less severe de-
grees of laryngeal hemiplegia can contribute to loss of abduction due to cyclical loading, or 3) contraction
of the caudal pharyngeal sphincter muscles during swallowing can cause marked medioventral pressure
on the abducted arytenoid. Irrespective of the cause, some post-operative loss of abduction is inevitable in
most horses. Prevention for this problem may be possible by placement of the prosthesis deeper into the
muscular process to prevent pull-through or promoting ankyloses of the cricoarytenoid joint at the time
of surgery.
References:
1. Ahern BJ, Parente EJ. Surgical complications of the equine upper respiratory tract. Vet Clin North
Am Equine Pract. 2008;24(3):465-84.
2. Luedke LK, Cheetham J, Mohammed HO, et al. Management of postoperative dysphagia after
prosthetic laryngoplasty or arytenoidectomy. Vet Surg. 2020;49(3):529–539.
3. Dixon PM, McGorum BC, Railton DI, et al. Long-term survey of laryngoplasty and ventriculocord-
ectomy in an older, mixed-breed population of 200 horses. Part 1: maintenance of surgical aryte-
noid abduction and complications of surgery. Equine Vet J. 2003;35(4):389–396.
4. Vidovic A, Delling U. Aryepiglottic fold augmentation as treatment for late-onset dysphagia fol-
lowing surgical treatment of recurrent laryngeal neuropathy. Tierärztliche Praxis Ausgabe G:
Großtiere/Nutztiere. 2017;45(04): 219–225.
5. Biasutti S, Dart AJ, Jeffcott LB. A review of recent developments in the clinical application of pros-
thetic laryngoplasty for recurrent laryngeal neuropathy: indications, complications and outcome.
Equine Vet Ed. 2017;29(6):337–345.
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6. Froydenlund TJ, Dixon PM. A review of equine laryngoplasty complications. Equine Vet Ed.
2014;26(2):98–106.
Nicolas Ernst DVM, MS

Diplomate American College of Veterinary Surgeons
• Graduated from the University of Chile in 2000.
• Equine Rotating Internship (medicine, surgery, anesthesia and reproduction) at UC Davis in 2000.
• Equine Surgery Internship at Chino Valley Equine Hospital, Chino, California 2000-2001.
• Masters in Clinical Epidemiology at University of Florida 2001-2002.
• Equine Surgery Residency at University of Florida 2003-2006.
• Diplomate American College of Veterinary Surgeons 2007.
• Assistant Professor on Equine Surgery, Emergency and Critical Care at The Ohio State University 2006-
2007
• Professor of Equine Surgery, Sports Medicine and Lameness at University of Minnesota 2007- present.
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Advances in the Approach to DDSP

Via Nova Equine Hospital, Bree, Belgium
Dorsal displacement of the soft palate has been recognized as a common cause of upper airway obstruc-
tion in racehorses with a reported prevalence of 10 – 20% in 2 – 3-year-old racehorses1,2. In affected horses
the caudal border of the soft palate moves dorsal to the epiglottis during exercise. This results in increased
airflow turbulence and respiratory impedance3. Horses will often present with clinical signs of exercise
intolerance and a gurgling or vibrating noise on exhalation. These signs can be exacerbated by head and
neck flexion4. Resting endoscopy often fails to diagnose horses with DDSP, occasionally ulcers will be seen
on the caudal soft palate and there will be bruising in the nasopharynx secondary to DDSP. Exercising en-
doscopy is the gold standard for diagnosis of DDSP5-7. In racehorses’ treadmill endoscopy has been shown
to be superior to overground endoscopy for identification of horses with DDSP8 whereas in sport horses
overground endoscopy is often required for a diagnosis of DDSP9. This is because in racehorses DDSP is
related to exercise intensity and hypothesized thyrohyoid muscle fatigue10 whereas in sport horses it can be
related to rider effects, head, and neck position9 or the presence of equine asthma11. This is evidenced by the
increased prevalence of DDSP in dressage horses when compared with showjumpers9. Numerous etiolo-
gies have been proposed as causative factors in horses with naturally occurring DDSP including dysfunc-
tion of the pharyngeal branch of the vagus nerve12, dysfunction of the hypoglossal nerve13, dysfunction of
the thyrohyoid muscles14, inflammation of the upper and lower airways and the use of certain items of tack
and training methods. Identifying the cause of DDSP in individual cases is essential as treatment should be
tailored to the cause. A wide variety of surgical and conservative treatments are used by clinicians to man-
age horses with this condition with similar published success rates of around 60 – 70%. These treatments
address the proposed etiologies by reducing inflammation, altering the position of the hyoid apparatus or
by increasing the stiffness of the soft palate. Conservative methods include the use of systemic and topical
anti-inflammatories, tack changes such as the use of a tongue tie, spoon bit, Cornell® collar and a cross or
grackle noseband. Surgical treatment options include laryngeal tie-forward with a recent report describing
a technique for performing this in the standing horse15, myectomy, staphylectomy, and palatoplasty to re-
duce compliance of the soft palate including tension, thermal and laser palatoplasty techniques. Recently
injection of the soft palate with Genipin® (a self-polymerizing collagen cross linker) has been utilized to
reduce soft palate compliance. This treatment has the benefit of minimal convalescence and good initial
reported success rate16. There is also emerging evidence for the efficacy of training of inspiratory muscles17
which may alter our future approach to the management of horses with DDSP.
1. Ducharme, N.G. (2006) Pharynx. In: Equine Surgery, Eds: J.A. Auer and J.A. Stick, Elsevier Health
Sciences, St Louis. pp 544-565.
2. Pollock, P.J., Reardon, R.J., Parkin, T.D., Johnston, M.S., Tate, J. and Love,S. (2009) Dynamic respi-
ratory endoscopy in 67 Thoroughbred racehorses training under normal ridden exercise condi-
tions. Equine vet. J.41, 354-360
3. Rehder RS, Ducharme NG, Hackett RP, Nielan GJ. Measurement of upper airway pressures in
exercising horses with dorsal displacement of the soft palate. Am J Vet Res. 1995; 56: 269–274
4. Franklin, S.H., Naylor, J.R. and Lane, J.G. (2006) Videoendoscopic evaluation of the upper respi-
ratory tract in 93 sport horses during exercise testing on a high-speed treadmill. Equine vet. J
Suppl.36 540-545.
5. Parente, E.J., Martin, B.B., Tulleners, E.P. and Ross, M.W. (2002) Dorsal displacement of the
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2023
soft palate in 92 horses duringhigh speed treadmill examination (1993-1998).Vet. Surg.31, 507-512
6. Lane, J.G., Bladon, B., Little, D.M., Naylor, J.R. and Franklin, S.H. (2006b) Dynamic obstructions of
the equine upper respiratory tract. Part 2: comparison of endoscopic findings at rest and during
high-speed treadmill exercise of 600 Thoroughbred racehorses. Equine vet. J.38 401-408
7. Barakzai, S.Z. and Dixon, P.M. (2010) Correlation of resting and exercising endoscopic findings for
horses with dynamic laryngeal collapse and palatal dysfunction. Equine vet. J.
8. Allen, K. and Franklin, S. (2009) Comparisons of overground endoscopy and treadmill endoscopy
in UK Thoroughbred racehorses. In: Proceedings of the 4th World Equine Airways Symposium,
Berne,Eds:C. Tessier and V. Gerber. p 262
9. van Erck-Westergren, E., Frippiat, T., Dupuis, M., Richardm, E., Art, T. and Desmaizieres, L. (2009)
Upper airway dynamic endoscopy: are track and treadmill observations comparable? In: Proceed-
ings of the 4thWorld Equine Airways Symposium, Berne, Eds: C. Tessier andV. Gerber. pp 254-25
10. Cercone M, Olsen E, Perkins JD, Cheetham J, Mitchell LM, Ducharme NG. Investigation into
pathophysiology of naturally occurring palatal instability and intermittent dorsal displacement of
the soft palate (DDSP) in racehorses: Thyro-hyoid muscles fatigue during exercise. PLoS One
2019;14.
11. Joo K., Povazsai A., Nygeres – Bohak Z., Szenci O., and Kutasi O. (2021) Asthmatic Disease as an
Underlying Cause of Dorsal Displacement of the Soft Palate in Horses Journal of Equine Veteri-
nary Science 96
12. Holcombe, S.J., Derksen, F.J., Stick, J.A. and Robinson, N.E. (1998) Bilateral nerve blockade of the
pharyngeal branch of the vagus nerve produces persistent soft palate dysfunction in horses. Am.
J.vet. Res.59, 504-508.
13. Cheetham, J., Pigott, J.H., Hermanson, J.W., Campoy, L., Soderholm,L.V., Thorson, L.M. and
Ducharme, N.G. (2009) Role of the hypoglossal nerve in equine nasopharyngeal stability .J.
appl.Physiol.107, 471-477
14. Ducharme, N.G., Hackett, R.P., Woodie, J.B., Dykes, N., Erb, H.N.,Mitchell, L.M. and Soderholm,
L.V. (2003) Investigations into the role of the thyrohyoid muscles in the pathogenesis of dorsal
displacement of the soft palate in horses. Equine vet. J.35, 258-263
15. Dillon, H.M., O’Brien, E.J.O. & Feeney, C. (2023) Genipin treatment of equine palatal dysfunction: A
preliminary study of safety and efficacy. Equine Veterinary Education, 35, e219–e226
16. Lean N.E., Sole-Guitart A., and Ahern B.J. (2023) Laryngeal tie forward in standing sedated horses
Vet Surg 52:2 229 – 237
17. Fitzharris L.E., Franklin S.H., McConnell A.K., Hezzell M.J., and Allen K.J. (2021) Inspiratory muscle
training for the treatment of dynamic upper airway collapse in racehorses: A preliminary investi-
gation The Veterinary Journal 275
Nicola graduated from University College Dublin in 2012. Since graduating she has worked predominantly
with performance horses in Ireland, Australia and England with a focus on surgery, and sports medicine. She
completed a residency in Equine Surgery at the RVC, where she remained as a lecturer in Equine Surgery
until October 2022. In 2021 she gained Diplomate status with the European College of Veterinary Surgery.
She was team vet for the Japanese Eventing Team at the 2020 Olympics. Currently she is the equine surgeon
at Via Nova in Belgium. Her main interests are equine surgery, laryngeal reinnervation and sports medicine.
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2023
Hernia Repairs
Nov 10th 2023 – Hall 3 (16:30-17:00)
Francesca Compostella
DVM, MRCVS, MSC(One Health)
SEA Exec Director of Veterinary and Welfare for Saudi Arabia and WVS Int Project Director (Large Animal)
Hernias can affect horses of all breeds, ages and sex, but the aetiology differs.
Umbilical hernias are commonly found in foals, affecting approximately 2% of any newborn stock. These
rarely require treatment, unless still present after the age of 4 months and with a diameter wider than 5
cm. Treatment is elective aside from rare cases, when the hernial contents are strangulated. These can be
done standing or recumbent, depending on the severity and type of procedure opted for.
Incisional and or traumatic hernias can affect horses of any age and are not uncommon amongst working
horses as a result of collisions or post abdominal surgery, particularly when the correct postoperative
regime is not observed. As per umbilical ones, these hernias are also treated as an elective procedure, al-
lowing the surgeon to carefully plan the treatment method to be used. Depending on the originating cause,
a period of systemic antibiotics may be required ahead of performing any repair, unless there is a severe
dehiscence and or rupture of the abdominal body wall, in which case an emergency repair is performed.
Lastly, scrotal or inguinal hernias differ as they are usually strangulating and require immediate interven-
tion. The prolapse of small intestine within the scrotum can affect the blood flow of either the entrapped
intestine or the testicle, or both. Such hernias are accompanied by severe signs of pain and are easily
discernible from other types of hernias.
While hernias may initially appear tricky to assess and treat, they usually heal well and allow horses to
return to a full athletic and or working career.
During this talk we will look at some treatment methods and handy pre and post operative measures to
enhance your success rate.
Francesca Compostella, DVM, MRCVS, MSc

Veterinary & Welfare International Director WVS
Dr. Francesca Compostella has worked in the development sector since completing a surgical residency
in 2012. Having grown up in Mozambique she has always been passionate about the human animal bond,
and the incredible role animals hold in supporting communities. Her focus is on promoting education at all
levels, where she applies a One Health approach to maximize the limited resources faced in some parts of
the world. She is currently designing, implementing, and leading International projects on behalf of WVS.
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Cryptorchid Castration
Professor Tim Greet BVMS, MVM, CertEO, DESTS, Dip ECVS, FRCVS
Consultant, Rossdales, Newmarket, UK.
Castration is the commonest surgical procedure carried out in equine practice. With fully descended testi-
cles or even when a testicle is sitting just outside the external inguinal ring, castration is usually uncompli-
cated; either using an open technique in a standing patient, or by a closed or semi-closed technique under
general anaesthesia. However, when a testicle is retained either within the inguinal canal or the abdomen,
it may be necessary to adjust this procedure, or to use an alternative technique.
This presentation will briefly describe the diagnosis and two surgical approaches to castrating equine
cryptorchids. The first method is using a minimally invasive inguinal approach under a general anaesthetic
and the second is a laparoscopic approach in the standing patient under sedation and a local anaesthetic.
Both methods are effective depending upon the location of the retained testicle and have benefits and
disadvantages which will be presented and discussed.
There are basically three types of cryptorchid. A true abdominal cryptorchid where the testicle is located
somewhere in the peritoneal cavity, an abdominal testicle with a long epididymis and an extra-abdominal
epididymal tail, and a testicle within the inguinal canal. The location of the testicle, as assessed preopera-
tively, may encourage the surgeon to use one or other method. Such techniques may also be used when
operating on terratomatous testicles.
Prof Tim Greet BVMS, MVM, Cert EO, DESTS, Dip ECVS, FRCVS
Tim Greet is a Glasgow graduate, who spent most of his career working as an equine surgeon in private prac-
tice in Newmarket, England. A diplomate of the European College of Veterinary Surgeons, he is a past pres-
ident of BEVA, BVA, WEVA and ECVS. He has published widely and spoken at meetings around the world.
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Penile and preputial surgery

Christoph Koch, DACVS & ECVS, Prof. Dr. med. vet., Division of Equine Surgery, ISME Equine Clinic Bern,
Vetuisse Faculty of the University of Bern, Switzerland
Disorders of the equine penis and prepuce amenable to surgery include neoplasia, habronemiasis, chronic
paraphimosis, and rarely priapism or congenital malformations. Squamous cell carcinoma (SCC) is the
most common tumor type affecting the equine male external genitalia in aged horses, mainly affecting
unpigmented skin covering the glans and free part of the penis. Most neoplastic lesions involving the glans
and free part of the penis necessitate partial phallectomy with or without en bloc resection of the prepuce.1
Particularly SCC are malignant tumors with a locally aggressive growth behavior, and (depending on the
stage at presentation) usually require more aggressive forms of excisional surgery. Lesions extending
proximal to the free portion of the penis yet not extensively invading the tunica albuginea or regional
lymph nodes can be treated by sheath ablation and partial phallectomy, creating an urethral stoma at the
level of the former preputial orifice or slightly caudal to that. 2 If solely the glans or the free portion of the
penis are affected, partial phallectomy can be performed, sparing most of the penile shaft. Techniques for
partial phallectomy include those described by Scott, Vinsot, and Williams and mainly differ regarding the
orientation and shape of the surgically created urethral stoma or how hemostasis of the penile cavernous
bodies is achieved.1 If the neoplastic lesion has invaded the tunica albuginea, prepuce and regional lymph
nodes, preputial ablation and penile amputation and creating a perineal urethrostomy are indicated. A
recently described technique using a strangulating latex loop applied with a so-called Callicrate Bander3
can be performed in standing, sedated equids thus offering a well-tolerated4 and cost-effective treatment
option for aged subjects with advanced stages of SCC.
In younger and middle-aged equids, equine sarcoids, melanoma (in grey horses), papilloma, cutaneous
lymphoma, and fibrosarcoma are other neoplastic conditions that may affect the external male genitalia.
However, and unlike with SCC, these usually involve the prepuce and rarely the glans or free part of the pe-
nis. Therefore, segmental posthetomy (or reefing) to remove a circumferential segment of the affected pre-
puce can be curative. Although it is usually recommended to restrict segmental posthetomy to the inner
lamina of the preputial fold1 (i.e. portions of the prepuce distal to the preputial ring), this may also include
the preputial ring and outer lamina of the preputial fold. Such a more extensive posthetomy, often referred
to as “Adam’s procedure”, can also be used to salvage horses with chronic paraphimosis accompanied by
penile paralysis and fibrosis. More extensive surgeries involving the resection of the normally well-vascu-
larized preputial and penile tissues are inherently associated with the risk of postoperative swelling and
hematoma formation. Importantly, intact stallions should be castrated two to three weeks prior to partial
phallectomy or posthetomy surgery to avoid penile erection post-operatively and decrease the risk of
hematoma formation. Whenever a urethral stoma is created in conjunction with a partial phallectomy,
post-urination haemorrhage is a frequently encountered complication of penile surgery. In most cases,
post-urination hemorrhage is self-limiting and transient in nature. If, however, persistent post-urination
hemorrhage develops and needs to be addressed, a perineal incision into the corpus spongiosum reliably
helps resolve this complication.5
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References:
1. Schumacher, James (2018): Penis and Prepuce. In: Jörg Auer, John A. Stick, Jan M. Kümmerle und
Timo Prange (edts.): Equine surgery. Fifth edition. St. Louis, Missouri: Elsevier, S. 1034–1064.
2. Doles, J., Williams, J.W. & Yarbrough, T.B. (2001) Penile amputation and sheath ablation in the
horse. Vet Surg, 30(4): 327–331.
3. Arnold, C.E., Brinsko, S.P., Love, C., Varner, D. (2010). Use of a modified Vinsot technique for partial
phallectomy in 11 standing horses. Journal of the American Veterinary Medical Association 237 (1):
82–86.
4. Maurer, T., Brünisholz, H.P., O’Brien, T., Coleridge, M., Klopfenstein-Bregger, M.D. and Koch, C.
(2022), Complications, outcome and owner satisfaction after Callicrate Bander phallectomy and
perineal urethrostomy in 14 equids. Equine Vet Educ, 34: 570-580.
5. Mählmann, K. & Koch, C. (2014) Perineal incision into the corpus spongiosum penis to resolve per-
sistent post urination haemorrhage after partial phallectomy. Equine Vet Educ, 26(10): 532–535.
6. Christoph Koch Mercier, Prof. Dr. med. vet.
7. Computer-assisted surgery, Equine sarcoid disease, general large animal surgery topics
8. Head of Equine Surgery and Deputy Head of the ISME Equine Clinic Berne, Vetsuisse, University
of Berne, Switzerland
9. Supervising Clinical Faculty / Lecturer in Equine Surgery, ISME Equine Clinic Berne, Switzerland
10. Resident in Large Animal Surgery, University of Wisconsin Madison, Madison WI, USA
11. Intern in Equine Surgery, Hagyard Equine Medical Institute, Lexington KY, USA
Christoph Koch Mercier, Prof. Dr. med. vet.

Computer-assisted surgery, Equine sarcoid disease, general large animal surgery topics
Head of Equine Surgery and Deputy Head of the ISME Equine Clinic Berne, Vetsuisse, University of Berne,
Switzerland
Supervising Clinical Faculty / Lecturer in Equine Surgery, ISME Equine Clinic Berne, Switzerland
Resident in Large Animal Surgery, University of Wisconsin Madison, Madison WI, USA
Intern in Equine Surgery, Hagyard Equine Medical Institute, Lexington KY, USA
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The Basis of Equine Nutrition

Nielsen, Brian D., Ph.D., Dipl. ACAN, PAS
Professor, Equine Exercise Physiology
Michigan State University
Department of Animal Science
East Lansing, Michigan, USA
Equine nutrition plays the basis for maintaining the health, performance, and overall well-being of horses.
Horse owners and caretakers should understand the fundamental principles of equine nutrition, encom-
passing the essential nutrients, dietary requirements, and feeding strategies that are integral to the equine
diet. By understanding these basics, informed decisions to optimize the nutrition of their animals can be
made that are crucial for the health and longevity of horses. A balanced diet ensures the availability of es-
sential nutrients, which are required for growth, reproduction, energy production, and immune function. The
digestive physiology of horses is unique, reflecting their evolutionary history as herbivores. The key compo-
nents of equine nutrition that should be considered include various macronutrients and micronutrients, as
well as feeding management.
Horses require a variety of nutrients for optimal health. Macronutrients include carbohydrates, proteins,
and fats. Carbohydrates, often primarily derived from forages, typically are the main energy source for
horses. Proteins, composed of amino acids, are essential for tissue repair, growth, and enzyme function.
Fats provide concentrated energy and are also can be incorporated into the diet to aid in maintaining coat
condition – a benefit often favored by horse owners. Forages, such as hay and pasture, are integral to the
equine diet. The digestive system of horses is designed for a high-fiber, plant-based diet. The cecum and
colon play a central role in fermentation, breaking down fibrous materials and producing volatile fatty acids
that serve as an energy source. Forages provide fiber for proper gut function and help prevent digestive
disorders like colic. Forages also supply vitamins and minerals, particularly fat-soluble vitamins A, D, and E,
as well as calcium and phosphorus. Access to good-quality forage should be the basis of any equine feed-
ing program. Concentrate feeds, including grains and commercial feeds, are often used to supplement the
diet when additional energy and other nutrients are required. However, overreliance on concentrates can
lead to imbalances and health issues. When introducing concentrates, it is crucial to do so gradually and
in appropriate amounts, taking into consideration the horse’s activity level and metabolic rate. Micronutri-
ents, such as vitamins and minerals, are essential for various physiological functions. Vitamins play roles in
metabolism, immune response, and overall health. Most vitamins are obtained from the diet or synthesized
by gut microbes without need for supplementation. Minerals like calcium, phosphorus, magnesium, and
trace minerals are important for bone health, muscle function, and enzyme systems. Providing a balanced
mineral supplement or through a fortified concentrate is vital when the mineral content of forages is insuffi-
cient, which occurs frequently. Water is often the most overlooked nutrient, yet it is the most critical. Horses
require access to clean, fresh water to support digestion, thermoregulation, and overall health. Dehydration
can lead to colic and reduced performance.
Feeding strategies should be tailored to individual horses based on their age, activity level, metabolism, and
health status. Horses in different life stages have varying nutritional requirements. While the requirements
of mature horses at maintenance can often be met on a diet consisting almost entirely of forages, with
supplementation only required to meet deficient nutrients, optimal nutrition to promote growth and support
performance may require growing, performing, or breeding animals to have requirements that may be more
challenging to meet on an all-roughage diet. Proper body condition scoring is a valuable tool for evaluating
the adequacy of a horse’s diet and adjusting feeding plans accordingly. While some mental and health
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concerns can be alleviated or prevented by maintaining horses on pasture, obesity and related health is-
sues may be more prevalent with such horses if forage intake is unlimited, potentially predisposing horses
to health problems such as insulin resistance or laminitis. These animals often require specialized diets with
limited carbohydrates and controlled calorie intake. Consulting with a veterinarian or equine nutritionist is
crucial when designing diets for horses with special needs.
Equine nutrition is a multifaceted topic with far-reaching implications for the health and performance of
horses. Understanding the basics of equine nutrition, including the role of macronutrients, micronutrients,
forages, and concentrates, allows horse owners to make informed decisions regarding their animals’ diets.
Adhering to proper feeding strategies and considering individual horse requirements will contribute to the
overall well-being of these animals.
Biographical Sketch for Dr. Brian D. Nielsen

Dr. Nielsen completed his undergraduate degree in Animal Science at the University of Wisconsin – River Falls
and received both his M.S. and Ph.D. from Texas A&M University. He currently is a professor of Equine Exer-
cise Physiology in the Department of Animal Science at Michigan State University where he has a teaching
and research appointment. Nielsen has authored 83 peer-reviewed papers and 241 book chapters, confer-
ence papers, and abstracts, as well as 67 popular press articles. He has given 65 invited international talks in
countries such as Australia, Austria, Brazil, Canada, England, France, Germany, Italy, Mexico, Northern Ireland,
Norway, Spain, Slovenia, Sweden, Turkey, and the United Arab Emirates and has given 145 invited talks at
national meetings and within the state of Michigan. He has secured $2.8 million in research funding. He is an
active member of the American Society of Animal Science, the American Registry of Professional Animal Sci-
entists, and served as the President of the Equine Science Society – an organization that presented him with
the “American Feed Industry Association Award in Equine Nutrition Research” in 2017 and the “Outstanding
Young Equine Professional Award” in 2001. Additionally, he was awarded the “Outstanding Teacher Award” at
the Midwest Section of the American Society of Animal Science and the American Dairy Science Association
in 2005 and the “Equine Science Award” by the American Society of Animal Science and Equine Science
Society in 2010. Besides having served on the editorial board for the Journal of Animal Science, the Journal of
Equine Veterinary Science, The Professional Animal Scientist, and the international journals Comparative Ex-
ercise Physiology and the Journal of Istanbul Veterinary Sciences, he is a Diplomat in the American College of
Animal Nutritionists and served on the National Academy of Sciences Committee on Nutrient Requirements
of Horses. Throughout his academic career, he has maintained involvement in the industry by breaking and
galloping racing Quarter Horses and Thoroughbreds for nearly 35 years and became a licensed racehorse
trainer in 1997.
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Feeding the Equine Athlete: Nutritional

Considerations for Optimal Performance
Feeding the equine athlete is a complex endeavor that requires a deep understanding of the unique nutri-
tional needs and physiological demands placed on performance horses. The key factors that must be con-
sidered when formulating diets for equine athletes include energy requirements, protein needs, electrolyte
balance, and timing of feedings. By addressing these aspects, horse owners and trainers can enhance the
performance and well-being of their animals.
Equine athletes, whether competing in racing, show jumping, dressage, or other disciplines, require atten-
tion to their nutritional needs to ensure peak performance and recovery. The energy expended during train-
ing and competition places substantial demands on their bodies, necessitating a diet that provides the nec-
essary fuel and nutrients. Energy is the cornerstone of any equine athlete’s diet. The energy needs of these
animals depend on factors such as exercise intensity, duration, and the individual horse’s metabolism. While
some equine athletes can perform well on a diet that is composed primarily of forage, many performance
horses require grains or concentrates to meet increased energy demands. Carbohydrates are a primary
source of energy, and such concentrate feeds can provide readily available carbohydrates that can aid in
meeting the increased energy requirements needed for exercise. Whether energy demands are being met
or exceeded can be determined by evaluating the body condition scores of horses. Depending upon disci-
pline and type of exercise being performed, the appropriate body condition score will vary. An endurance
horse competing for hours would be expected to have lower body fat stores than would a sprinting horse
competing for less than a minute. While the endurance horse would have much greater energy demands
than would the sprinting horse, carrying the extra weight that accompanies the fat stores is a much greater
disadvantage when traveling long distances compared to when only carrying it a short distance. Thus, any
decrease in glycogen stores (the storage form of carbohydrates which provides rapidly available energy)
that accompanies a body condition score below a 5 in the endurance horse would be offset by the lower
energy requirements that accompany carrying less weight.
Proteins are essential for muscle development, repair, and overall tissue health. Equine athletes require
higher protein levels than their sedentary counterparts due to the breakdown of muscle tissues during ex-
ercise. However, excess dietary protein, beyond their requirements, may not be justified. Also, sometimes
the increase in protein requirements is simply met by increasing the amount of feed being provided to meet
energy requirements. Hence it is important to evaluate protein requirements on a weight basis (such as
grams of protein) rather than the percentage of diet. Further, ensuring the proper supply of amino acids, the
building blocks of proteins, may be even more crucial than evaluating just the amount of protein. Providing
an excess amount of a poor-quality protein may still not meet the requirements for crucial amino acids such
as lysine and methionine.
Equine athletes may lose significant amounts of electrolytes, including sodium, chloride, and potassium
through sweat during exertion. Electrolyte imbalances can lead to muscle cramps, dehydration, and de-
creased performance. Supplementing electrolytes before, during, and after exercise is commonly done to
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help maintain proper balance and supports the horse’s ability to recover efficiently. However, this tends to
be important only if a horse is exercising for sustained periods in warm temperatures when sweat losses
would be great. Providing free access to salt can decrease the need for electrolyte supplementation. Fur-
ther, if providing a commercial concentrate, most feeds would have salt incorporated into the grain mix.
Thus, providing extra salt may not be needed for most horses. Also, the forage consumed by most horses
would typically provide potassium far in excess of requirements. If supplementation is to be provided, it
can be done inexpensively through the provision of regular salt and/or “lite salt” (NaCl and KCl). Water is
often referred to as the “forgotten nutrient,” yet it plays a vital role in the equine athlete’s performance. While
there may be some benefits to mild dehydration during short, high-intensity work such as racing, long-term
dehydration can impair thermoregulation, muscle function, and digestion. Ensuring access to clean, fresh
water, and encouraging adequate consumption after exercise, is essential for maintaining optimal hydra-
tion. Likewise, the timing of feedings is a critical consideration in the equine athlete’s nutritional plan. Care
should be taken to avoid feeding immediately before exercise to prevent digestive discomfort.
Feeding the equine athlete is a dynamic process that involves careful consideration of energy requirements,
protein needs, electrolyte balance, hydration, and feeding timing. Consultation with an equine nutritionist
or veterinarian trained in equine nutrition is crucial for tailoring diets to individual needs. Proper nutrition
is a cornerstone of optimal performance, and a well-balanced diet supports muscle development, energy
production, and overall well-being. By assessing the horse’s condition and performance over time, adjust-
ments can be made to ensure continued optimal nutrition. Horse owners and trainers who prioritize these
factors can contribute to the success and longevity of their competitive equine partners.

trainer in 1997.
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Feeding the orphan foal

There are many reasons for foals to become orphans. Mare rejection, although rare, can occur. More com-
mon scenarios are mare’s disease or death or the use of the mare as a surrogate for a different foal among
others.
Feeding patterns for the orphan foal should mimic natural feeding, thus, foals should be fed often. While
most owner would like to bottle feed, this should be avoided due to the risk of aspiration pneumonia and
inconvenience over time. Natural suckling from a bucket works well and it is a very good alternative to bot-
tle feeding. Foals learn to drink from a bucket easily. To train a foal to drink from a bucket, place your clean
fingers wet with milk replacer in their mouth to stimulate suckling reflex. While they are suckling, bring the
bucket (better to use a flat one first) to their mouth and slowly withdraw your fingers from the foal’s mouth.
These steps may have to be repeated multiple times until the foal learns to drink. Do not force the foal into
the bucket as this will discourage drinking. It is better to lightly warm the milk replacer the first few days.
Once the foal is drinking without assistance, a bucket can be hanged in the stall or pen. It is important not
to leave the bucket on the ground as foals can get their limbs trapped around the handles. They will also
likely dump the bucket by playing or while attempting to drink.
Buckets should be hanged at the foal’s shoulder height and the distance should be adjusted as the foal
grows. Studies suggest that yellow buckets (or bright color buckets) work best.
To get the foal adapted to feeding of milk replacer start slowly: Feed ½ the recommended amount the first
day and gradually increase the amount provided over the next 4-7 days.
While the foal is being trained, a nasogastric tube may be left in place to ensure adequate nutrition. It is
better to train the foal when it is hungry (before feeding by NGT). Patience is of extreme importance for
success. All feeding equipment should be kept clean and should be washed once or twice a day (or more
often if needed).
Daily milk substitute intake: The suckling foal consumes 25% of its body weight (in Kg) of mare’s milk every
day. The amount gradually decreases to 20% of BW in Kg by 3 weeks of age. The amount of milk substitute
recommended per day varies by brand. Therefore, it is very important to follow manufacturer’s recommen-
dations for feeding of these products. Electrolyte toxicities and diarrheas can occur if attention is not paid.
Frequency of feeding: Feed as frequent as possible to mimic natural foal nursing behavior (foals nurse 5-7
times/h!). Feeding large volumes a few times a day predisposes to diarrhea. The advantage of commercial
replacements is that they can be left in the bucket for hours before they are no longer good. Milk replacer
may have to be changed more often if the weather is hot.
Other feeding considerations: Good quality hay and creep feeding should be gradually introduced from the
first days of life to encourage eating. A salt block can also be introduced at ~ 2 weeks of age. Foals should
have access to dirt as this is required for iron supplementation. In addition, add adult horse feces from a
healthy donor. It is best to select a donor without parasite eggs (or < 200/g of feces). Coprophagy is normal
in foals and it is thought to aid healthy GI tract colonization.
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Diarrhea is common with diet changes in foals. In general, nutritional diarrhea is self-limiting and does not
require treatment but foals should be closely monitored as dehydration is possible.
Foals that are 5-8 day-old usually develop diarrhea (“foal-heat” diarrhea), a normal, self-limiting event that
appears to be related to GI microflora population. Environmental temperature should be kept comfortable
for foals (around 20°C or 68°F). Shelter should be provided if weather is too cold or if too hot (shade).
To ensure appropriate nutrition, it is important to evaluate the body condition of the foal often. Orphan foals
have a delay in growth but should achieve normal condition by the time they are 3-4 months of age. At this
age, foals should have an adequate body condition of 6 on a 1 to 9 scale. Foals should not ever be extremely
thin, weak, or lethargic.
Vaccination and deworming: There are no special considerations for vaccination or deworming of orphan
foals. Vaccine and deworming recommendations are available to the public at the AAEP website (https://
aaep.org/guidelines/vaccination-guidelines and https://aaep.org/document/internal-parasite-con-
trol-guidelines)
Weaning: Foals can be weaned of the milk replacer and introduced to milk pellets (creep feeding) at an early
age, usually around 6-8 weeks. The transition from milk replacer to pellets should be gradual. This can be
accomplished by decreasing the amount of milk replacer available while increasing the amount of pellets
(as long as the foal eats the pellets). Fresh water should be always available, especially during this transition.
As the foal ages, milk pellets can be replaced by other pellets that are adequate for growing foals. These
products usually have a higher protein concentration than regular maintenance pellets. In general, a foal
should not be drinking milk supplement after 4 months of age.
Behavior: Behavioral problems are very common in orphan foals that are hand-reared; these are more com-
mon if foals don’t interact with other horses. Excessive attachment to their handlers and failure to properly
socialize with other horses are common problems and may difficult training later. Using an old, nice horse
as companion is beneficial to correct some of the abnormal behaviors. If multiple orphan foals are present
in the farm, they can be managed in small groups to promote interaction.
References/Suggested Reading
1. Nógrádi, N. and Magdesian, K.G. (2017). Physical Examination of the Neonatal Foal. In Man-
ual of Clinical Procedures in the Horse (eds L.R.R. Costa and M.R. Paradis). https://doi.
org/10.1002/9781118939956.ch43
2. Paradis M.R. Feeding the orphan foal. Proceedings of the American Association of Equine Practi-
tioners, 2012, vol 58, 402-6
3. Induction of lactation to create a nurse mare. Equine reproductive procedures. Dascanio J, McCue
P. 2nd Edition, 2021, 383-5
4. Nutritional management and practical feeding of the orphan foal. Stoneham SJ, Morresey P, Ousey
J. Equine Veterinary Education, 2017, 29 (3), 165-73
Animal Internal Medicine Residency and a Master’s of Science degree at Washington State University and she
is a Diplomate of the ACVIM College. She also completed a PhD in equine immunology at the Gluck Equine
Research Center; her research focuses in equine immunology and infectious diseases. She worked as a Se-
nior Lecturer in Equine Medicine at the Onderstepoort Veterinary School in South Africa for 3 years. Dr. Sanz
is an Associate Professor in Equine Medicine at Washington State University in the US.
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Feeding Old Horses

Kathleen Crandell, MS, PhD
Equine Nutritionist
Kentucky Equine Research, Versailles, Kentucky USA
Once horses reach over 20 years of age, they are generally considered senior or aged-normal horses if they
are healthy, regardless of being overweight. Once there are clear signs of senescent changes with possible
concurrent disease then they are considered geriatric. For aged-normal horses there is little adjustment
needed to the diet except working towards the ideal body condition by addressing weight loss or obesity.
With the onset of senescent changes, frequent monitoring to identify, address, and ameliorate the inevitable
age-related diseases is recommended. Some common problems seen in the equine geriatric are dental dis-
ease, arthritis, pituitary pars intermedia dysfunction (PPID), colic, sarcopenia, body mass loss, and attrition
of digestive, neural and immunologic systems. Because of the physiological changes normally associated
with aging, geriatrics may require special adaptations in health care, environment and diet.
Dental disease, one of the biggest challenges facing the older horse, is the loss of teeth, wearing down of
the grinding surface, and diastemata. Older horses have an increased risk of cecal and large colon impac-
tions due to failing dentition, decreased frequency of preventive dental care and reduced intestinal motility.
Signs of dental disease are quidding, food pocketing, hypersalivation, facial swelling, halitosis, weight loss
and increased risk of choke or colic. The aim of dental treatment is to preserve occlusal surface where pos-
sible, remove sources of pain and provide nourishment in a highly digestible form. When long stem forage
and/or pasture become impossible to chew, dietary adaptation to alternative fiber sources will be necessary
to facilitate adequate forage intake. Shorter stem forage, like chopped hay or hay cubes, hay pellets, and hay
replacer served as a wet mash and offered 3 to 4 meals per day compensate for the lack of pasture or hay
intake and reduce choking. The addition of a ration balancer with a concentrated source of protein, vitamins
and minerals will balance out the shortcomings of a forage only diet. For underweight horses, a senior or
high fiber, low NSC type concentrate feed can be served wet. Dietary fat, such as oil or rice bran can be an
additional source of concentrated calories.
Osteoarthritis (OA) is the chronic structural deterioration of articular cartilage, exposure of subchondral
bone and pain. Lameness can be overt or subtle, depending on the location of the arthritis. Treatment
aims to provide comfort and limit progression of the disease. Commonly, NSAIDs are used to manage
pain along with intra-articular corticosteroids or IM PSGAGs. Supplements with glucosamine, chondroi-
tin sulfate, hyaluronate, MSM and other nutrients are commonly used. Omega-3 fatty acid supplements,
particularly ones high in DHA and EPA such as fish oil, have been found to help joint inflammation. Weight
management is important to prevent chronic overloading of joints. Regular hoofcare to properly balance
any abnormal loading through joints is essential. Light exercise is important for maintaining muscle mass
and joint flexion, although should not be done during an acute flair of OA. Older horses benefit from not
being confined to stalls and to have freedom of movement 24/7 to keep the joints lubricated. Modifications
to feed pan location, such as feeding at elbow height instead of ground level may be necessary if OA is in
jaw, forelegs or cervical spine.
Pituitary pars intermedia dysfunction is a progressive degenerative disease commonly seen in older horses.
The origin of the disease is hypertrophy in the pars intermedia affecting hormone regulation. Some of the
signs are hypertrichosis, muscle wasting, lethargy, fat redistribution, laminitis, swelling around upper and
lower eyelids, polyuria, polydipsia, excessive sweating, delayed wound healing and susceptibility to infec-
tions and endoparasites. PPID is diagnosed with a basal ACTH concentration which can be validated with
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thyrotropin-releasing hormone (TRH) stimulation test when ACTH results are equivocal. Testing for insulin
dysregulation (ID) should be done in PPID horses with laminitis. Pergolide mesylate is recommended for
management of PPID. Nutritional management will be dependent on whether the horse is appropriate,
over- or under-weight, as well as ID and/or laminitic. For PPID horses with ID, maintenance on a low
non-structural carbohydrate (NSC) diet is essential. Low NSC hay (< 10%) is ideal, although higher NSC
hay soaked for 60 minutes to leach sugar can be an option. If hay is low in protein or soaked, it is import-
ant to supplement with a ration balancer with quality protein to discourage muscle wastage. Overweight
PPID horses do well on forage balanced with a quality ration balancer, and those with ID may need to be
restricted from pasture. PPID horses that have difficulty maintaining weight may need a low NSC, high fat
concentrate feed. To support a healthy immune system, supplement with antioxidants such as vitamins C,
E and A, selenium, zinc, and alpha lipoic acid. It is important to stay on top of deworming and vaccination
schedules. Clipping the coat may be needed in hot weather and regular bathing to discourage skin disease.
For older horses maintained in a herd, careful observation of bullying or loss of interest in fighting for food
so that modifications can be done will minimize stress. Separation for feeding will give a horse more op-
portunity to eat the entire meal and to monitor feed intake. Thermoregulation is often altered in the older
horse from loss of fat cover, changes in hormonal temperature regulation, and decreased heat production
from fiber digestion. Shelter and/or blanketing in adverse weather and colder temperatures may be needed.
During cold weather, reduction in water intake can result in colic and subsequent impaction due to self-in-
duced dehydration. Careful observance of water intake can help to avoid problems. Feeding meals soaked
in warm water and/or adding salt to the meal might entice a horse to increase water intake.
Jarvis N. Clinical care of the geriatric horse. In Practice, Jan/Feb (2021) 35-44.
Argo CM. Nutritional Management of the Older Horse. Vet Clin Equine 32 (2016) 343–354.
Dr. Kathleen Crandell earned her MS in Equine Nutrition and Exercise Physiology and PhD in Equine Nutrition
and Reproduction from Virginia Polytechnic Institute and State University (Virginia Tech). Dr. Crandell was a
Superintendent of the Virginia Tech Middleburg Agricultural Research and Extension Center in Middleburg,
Virginia, where she ran an equine research and breeding program with over 100 Thoroughbred horses. For the
past 26 years, she has been an equine nutrition consultant for Kentucky Equine Research (KER), responsible
for support of the national and international feed mills associated with KER with feed formulation, advising on
issues of manufacturing and packaging of equine feeds and customer equine feeding recommendations. She
also provides recommendations for nutritional programs of individual horses or farms and equine publications,
and has consulted for some of the top equine competitors in the US. Dr. Crandell has presented nutritional
seminars for education of the general equine public and scientific community around the world. Dr. Crandell
has authored book chapters and articles in refereed journals. She also writes or is interviewed for articles on
specific topics in equine nutrition for KER publications, KER.com Equinews website and popular magazines.
In addition, Dr. Crandell is an Instructor for Equine Guelph, University of Guelph, Ontario, Canada, teaching an
equine nutrition course “Advanced Equine Health through Nutrition”, an in-depth study of nutritional related
diseases and disorders. Dr. Crandell has been awarded 3 John H. Daniels Fellowships by the National Sport-
ing Library in Middleburg, Virginia, to study historical perspectives on equine nutrition, supplementation and
laminitis. Having previously owned a small breeding farm and competed in endurance and competitive trail,
she is currently an avid trail rider with her Arabian and half-Arabian horses.
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Keys of Nutrition in Growing Horses

Nutrition is of paramount importance during the growth phase of horses, as it directly influences their de-
velopment, skeletal integrity, and overall health. The critical factors that underpin the nutritional needs of
growing horses include energy requirements, protein quality, mineral balance, and dietary management.
Understanding these keys to nutrition ensures that young horses achieve their full potential in terms of
structure and performance. The growth phase is a critical period in a horse’s life, determining its future
soundness, performance, and longevity. Proper nutrition during this stage is pivotal, as it provides the build-
ing blocks necessary for the development of strong bones, robust muscles, and a healthy immune system.
Energy is the cornerstone of growth, as it fuels cellular processes and supports anabolic activities. Young
horses require a consistent supply of energy to sustain growth, maintain bodily functions, and support their
increasing activity levels. The energy requirements are influenced by factors such as age, breed, size, and
activity level. Providing access to a high-quality forage is important for growing horses as it provides a
valuable source of energy from carbohydrates and fiber, along with providing other crucial nutrients such
as protein and the amino acids from which protein is comprised. High quality protein is essential for the
development of tissues, including muscles, tendons, ligaments, and organs. Growing horses have increased
protein requirements to support the rapid growth of these structures. The quality of protein, as determined
by its amino acid composition, is crucial. Essential amino acids like lysine, methionine, and threonine are
particularly important during growth. Ensuring that young horses receive a diet with balanced and di-
gestible protein sources promotes optimal muscle and skeletal development. Minerals are pivotal for the
formation and maintenance of bones, which are the foundation of a horse’s structural integrity. Calcium
and phosphorus are the primary minerals required for skeletal development. Great care should be taken
to ensure readily available dietary calcium exceeds phosphorus to avoid skeletal issues such as nutritional
secondary hyperparathyroidism. Imbalances or deficiencies of these and other minerals can lead to skeletal
abnormalities such as developmental orthopedic diseases. While growth is a natural process, rapid growth
rates can lead to developmental issues, particularly if deficiencies or imbalances of nutrients are present
in the diet. Overfeeding, especially in terms of energy, can result in excessive weight gain and stress on
developing joints. This is particularly relevant in large-breed horses prone to orthopedic problems. Careful
dietary management, including monitoring body condition, adjusting energy intake, and ensuring balanced
nutrition, helps mitigate these risks. Regular monitoring of a growing horse’s body condition, growth rate,
and overall health is crucial for assessing the effectiveness of its nutrition plan. Adjustments may be nec-
essary based on factors such as growth rate, activity level, and health status. Consulting with an equine
nutritionist or veterinarian trained in equine nutrition can provide valuable insights into refining the diet
as the young horse develops. The nutrition of growing horses is a multifaceted undertaking that requires
particular attention to energy, protein, minerals, and proper dietary management. Providing a balanced diet
that supports optimal growth and prevents developmental issues is key. By adhering to these nutritional
principles, horse owners can contribute to the healthy development and future success of their growing
equine companions.

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trainer in 1997.
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Nutrition for the pregnant and postpartum mare

Mariano Hernández Gil
MVZ MC
Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México.
Regarding horse soundness, Mexican equestrian traditional knowledge affirms that “horses are worth what
they are, and do, whilst foals are worth what they will be, and will do”; and there is enough solid, current sci-
entific evidence to confirm that, among other environmental factors, the nutrition of the broodmare during
pregnancy and early lactation affects phenotype of her offspring at both short and long term, especially
when nutritional disorders occur during critical periods of development.1, 2, 3, 4, 5, 6
A critical period is a point in the life of an organism in which a specific environmental factor is likely to exert
its greatest influence,7 just as it occurs in critical periods of development thru the prenatal and early post-
natal life, in which nutritional derangements, and the resulting metabolic disorders,8 have a major effect on
the anatomy, physiology, and behavior of the foal,9 then on its performance when adult.6
Since intrauterine growth is determined primarily by the supply of nutrients, both under- and overnutrition
of the mare during pregnancy, cause profound effects on the development of body systems that are essen-
tial to cope with the extrauterine environment and to perform later in life (e.g. musculoskeletal, cardiovas-
cular, gastrointestinal, nervous, metabolic and endocrine). 2,3,6 The mismatch between offspring phenotype
and the environment1 can be noticed just after birth, when assessing the health and soundness of the
newborn foal, or perceived later in life,10 at some point in growth, foundation, training or work, when physical
and mental effort is exerted. Whether physical or behavioral, the outcome has lifelong consequences for
horsemanship.4
Therefore, considering that nutrient availability, transport, and partitioning during critical periods affect cell
multiplication and differentiation, as well as tissue development and maturation, with the latter still during
early lactation, it seems sensible to approach the nutrition of the broodmare from the concept of fetal
programming;4,6,11,12 particularly when reproductive technologies are implemented,13 due to their effects on
fetoplacental and postnatal development. 2,3
Certainly, although the supply of nutrients and oxygen depends on both their availability in the mare and
the functional capacity of the placenta,4,12 through this lecture, the need of ensuring nutrient availability in
the mare is highlighted, leaving placental function for further review. 2,3,12
Concerning nutritional disorders, under- and overnutrition, as well as macro and trace elements deficien-
cies or excesses, are commonly found in the equine world, because nutritional requirements and nutritional
value of feedstuffs in horses are rarely estimated in practice. Undernutrition is the result of an inadequate
supply of nutrients, although it can also result from malabsorption, impaired metabolism, loss of nutrients,
or increased requirements due to disease or other environmental stresses.12 Overnutrition has become a
common condition in the horse industry as a result of excessive ingestion of nutrients, not only due to the
disproportionate addition of concentrates and supplements but also to the misinformed introduction of
some forages, whose contents of protein, minerals and non-structural carbohydrates may exceed horses
natural needs. Likewise, mineral deficiencies, excesses, and imbalances, result from the poor application of
available information on equine mineral nutriton.14
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Because dietary management of broodmares is essential for breeding and successfully raising healthy
foals,15 equine veterinary professionals16,17,18 play a key role in providing nutritional advice according to life
stage of individual equids, as well as in designing feeding programs to sustainably promote the health,
welfare, productivity and performance of equine populations. Fortunately, there are educational programs,19
innovating methods, 20 and progressive technology, 21 to enable veterinarians to clearly and confidently guide
the horse industry in the proper use of feeding resources and the implementation of nutritional strategies.
A One Welfare approach, 22 considering animal, human and environmental factors, facilitates the devel-
opment of effective, affordable and sustainable nutritional programs. Animal aspects include breed, age,
body weight, body condition, physiological state, and health status; whilst purposes of breeding, industry
requisites, type of system, and management practices, are some human influences. Among environmental
components, geography, climate, season, fauna, flora, diseases, resources, and facilities are most important.
The aim of a nutritional program is to guarantee that requirements for maintenance, fertility, pregnancy, and
lactation are met. Implications of nutrition during pregnancy have already been discussed, so it is oppor-
tune to mention that nutrition for lactation is crucial, primarily, because the immediate neonatal period is
a critical period of development,3,5 during which maturation of some tissues takes place and, furthermore,
because the mare has to reach her potential of milk production, with proper quality to feed a foal that, by
weaning, has to be around eighty percent of its adult height and fifty percent of the expected adult body
weight. Although other factors like age, parity and breed are involved, maternal nutrition influences colos-
trum quality, as well as milk yield and composition.5,27 As an ultimate reason to warrant nutrition during lac-
tation, it is the fact that most sectors of the horse breeding industry expect taking advantage of the natural
ability of the mare to become pregnant again shortly after parturition, in order to produce a foal by the same,
ecologically or economically, convenient season each year.
In view of that, the nutrition of the broodmare for pregnancy and lactation begins months before concep-
tion to extend longer than lactation, especially when she becomes pregnant at foal heat. The controlling
nutritional requirement is energy, 23 although protein, 24 amino acids, 24 fatty acids, 25 minerals,14 and vitamins26
must also be met, making sure not only that amounts are sufficient but also that ratios (e.g. DE:CP; Ca:P;
Zn:Cu) are balanced according to physiological state;27,28,29,30,31 namely maintenance (for cyclicity and fertil-
ity), pregnancy (initial, middle and final third) and lactation (first and second half).
Finally, from the plains to the breeding centers, guaranteeing the nutrition of the broodmare is as challeng-
ing as interesting; challenging because horses, breeds and equitation exist in a wide variety of conditions;
interesting because, whatever the form of equitation, nutrition for welfare and performance has to be ad-
dressed before conception. Therefore, making a sensible use of resources,32 besides applying concepts
of evolutionary veterinary science,1,33,34 will result in improvements in the management of animal health,
welfare, productivity and performance, to have a sound horse world.
1. Veit W and Browning H (2023) Developmental Programming, Evolution, and Animal Welfare: A
Case for Evolutionary Veterinary Science. Journal of Applied Animal Welfare Science 26(4): 552 –
564. DOI: 10.1080/10888705.2021.2014838
2. Chavatte-Palmer P, Derisoud E and Robles M (2022) Pregnancy and placental development in hors-
es: an update. Domestic Animal Endocrinology 79: 106692 DOI: 10.1016/j.domaniend.2021.106692
3. Fowden AL, Giussani DA and Forhead AJ (2020) Physiological development of the equine fetus
during late gestation. Equine Veterinary Journal 52 (2020) 165–173 DOI: 10.1111/evj.13206
4. Coverdale JA, Hammer CJ and Walter KW (2015) HORSE SPECIES SYMPOSIUM: Nutritional pro-
gramming and the impact on mare and foal performance. Journal of Animal Science 93(7): 3261
– 3267. DOI: 10.2527/jas.2015-9057
5. Becvarova I and Buechner-Maxwell V (2012) Feeding the foal for immediate and long-term health.
Equine Veterinary Journal 44, Suppl. 41 (2012) 149–156. DOI: 10.1111/j.2042-3306.2011.00522.x
6. Rossdale PD and Ousey JC (2003) Fetal programming for athletic performance in the horse:
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Potential effects of IUGR. Equine Veterinary Education 15(Suppl. 6): 24 – 37 DOI: 10.1111/j.2042-
3292.2003.tb01811.x
7. Gariépy JL, Bailey DB and Holochwost SJ (2020) Critical Periods. In: Benson JB (Ed.) Encyclope-
dia of Infant and Early Childhood Development (Second Edition). Elsevier. Pages 347-357. ISBN
9780128165119 DOI: 10.1016/B978-0-12-809324-5.23626-2.
8. Michońska I, Łuszczki E, Zielińska M, Oleksy Ł, Stolarczyk A and Dereń K (2022) Nutritional Pro-
gramming: History, Hypotheses, and the Role of Prenatal Factors in the Prevention of Metabolic
Diseases—A Narrative Review. Nutrients 14: 4422. DOI: 10.3390/nu14204422
9. Sutton EF, Gilmore LA, Dunger DB, Heijmans BT, Hivert MF, Ling C and Szyf M (2016). Devel-
opmental programming: State-of-the-science and future directions–Summary from a Pennington
Biomedical symposium. Obesity, 24(5), 1018–1026.
10. Ousey JC, Fowden AL, Wilsher S and Allen WR (2008) The effects of maternal health and body
condition on the endocrine responses of neonatal foals. Equine Veterinary Journal 40(7): 673 – 679.
DOI: 10.2746/042516408X322175
11. Stevenson K, Lillycrop KA and Silver MJ (2020) Fetal programming and epigenetics. Current Opin-
ion in Endocrine and Metabolic Research 13: 1 – 6 DOI: 10.1016/j.coemr.2020.07.005
12. Fowden AL, Jellyman JK, Valenzuela OA and Forhead AJ (2013) Nutritional Programming of Intra-
uterine Development: A Concept Applicable to the Horse? Journal of Equine Veterinary Science 33:
295 – 304 DOI: 10.1016/j.jevs.2013.03.005
13. Squires E (2020) Current Reproductive Technologies Impacting Equine Embryo Production. Jour-
nal of Equine Veterinary Science 89. 102981. DOI: 10.1016/j.jevs.2020.102981
14. Coenen M (2013) Macro and trace elements in equine nutrition. In: Geor RJ, Harris PA and Coenen
M (Eds) Equine Applied and Clinical Nutrition. 190 – 228. Saunders. ISBN 978-0-7020-3422-0
15. Morley SA and Murray JA. (2014) Effects of body condition score on the reproductive physiology
of the broodmare: A Review. Journal of Equine Veterinary Science 34: 842 – 853. DOI: 10.1016/j.
jevs.2014.04.001
16. Abood S (2008) Teaching and Assessing Nutrition Competence in a Changing Curricular Environ-
ment. Journal of Veterinary Medical Education 35(2): 281 – 287 DOI: 10.3138/jvme35.2.281
17. Matthew SM, Bok HGJ, Chaney KP, Read EK, Hodgson JL, Rush BR, May SA, Salisbury SK, Ilkiw JE,
Frost JS and Molgaard LK (2020) Collaborative Development of a Shared Framework for Compe-
tency-Based Veterinary Education. Journal of Veterinary Medical Education 47(5): 578 – 593 DOI:
10.3138/jvme.2019-0082
18. Nichols JL, Robinson JS, Hiney KM, Terry R and Ramsey JW (2023) An Investigation into Equine
Nutrition Knowledge and Educational Needs of Equine Veterinarians. Journal of Veterinary Medical
Education 50(2): 183 – 191 DOI: 10.3138/jvme-2021-0121
19. Harris P and Shepherd M (2021) What would be good for all veterinarians to know about equine
nutrition. In: Veterinary Clinics of North America: Equine Practice 37(1): 01 – 20. DOI: 10.1016/j.
cveq.2021.01.001
20. Muca E, Cavallini D, Raspa F, Bordin C, Bergero D and Valle E (2023) Integrating New Learning
Methods into Equine Nutrition Classrooms: The Importance of students’ perceptions. Journal of
Equine Veterinary Science 126: 104537 DOI: 10.1016/j.jevs.2023.104537
21. Tylutki TP (2011) Fancy: An equine nutrition and management model. Journal of Equine Veterinary
Science 31: 211 – 218. DOI: 10.1016/j.jevs.2011.03.021
22. Stallones L, McManus P and McGreevy P. Sustainability and the Thoroughbred Breeding and
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23. Ellis A (2013) Energy systems and requirements. In: Geor RJ, Harris PA and Coenen M (Eds) Equine
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24. Urschel KL and Lawrence LM (2013) Amino acids and protein. In: Geor RJ, Harris PA and Coenen
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25. Warren LK and Vineyard KR (2013) Fats and fatty acids. In: Geor RJ, Harris PA and Coenen M (Eds)
Equine Applied and Clinical Nutrition. 136 – 155. Saunders. ISBN 978-0-7020-3422-0
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and Clinical Nutrition. 168 – 189. Saunders. ISBN 978-0-7020-3422-0
27. Miraglia N and Martin-Rosset W (2006) Nutrition and feeding of the broodmare. EAAP publication
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30. Dunnett CE (2013) Ration evaluation and formulation. In: Geor RJ, Harris PA and Coenen M (Eds)
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32. Saastamoinen M, Fradinho MJ, Santos AS and Miraglia N (2012) Forages and grazing in horse
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33. Scaramuzzi RJ, Martin GB (2008) The importance of interactions among nutrition, seasonality and
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34. Dawkins MS (1998) Evolution and Animal Welfare. The Quarterly Review of Biology 73(3): 305 –
328. http://www.jstor.org/stable/3036918
Mariano Hernández-Gil
MVZ Cert. MC
Equine Welfare and Performance
National Autonomous University of Mexico
Enjoying equitation since childhood, Mariano qualified in Veterinary Medicine and Animal Science by the
National Autonomous University of México (UNAM) in 2000, and two years later obtained a Master’s Degree
in Animal Nutrition by the Autonomous University of Yucatán.
Certified in Equine Practice by the Mexican Council of Veterinary Certification, his professional development
has been committed to welfare where equids are essential; always promoting the good traditional knowledge,
whilst introducing science and technology to facilitate effective human-equid relationships.
Practicing in diverse equine contexts and interplaying with stakeholders with distinct backgrounds, his main
interests are in behavior, nutrition, soundness, locomotion and health, as well as in sustainable development
and veterinary education.
Mariano is a full-time Equine Professor at UNAM. As an educator with expertise in work, production, leisure
and sport equids, he balances agricultural and medical models of veterinary education, to promote compe-
tence for equine welfare, health and performance at every context.
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Management of Metabolic Diseases

Kathleen Crandell, MS, PhD
Equine Nutritionist
Kentucky Equine Research, Versailles Kentucky USA
Metabolic diseases are becoming increasingly more common in the modern equine. Equine metabolic
syndrome (EMS) is a term coined to describe a collection of metabolic risk factors, mainly insulin dysregu-
lation (ID), hyperinsulinemia-associated laminitis (HAL), and obesity. Insulin dysregulation is characterized
by high resting insulin, high postprandial insulin, or insulin resistance at the tissue level. The severity of ID
can vary greatly between individuals and is often seen in obese horses while less commonly in non-obese
horses. Hyperinsulinemia-associated laminitis, also known as pasture-associated laminitis, is thought to be
a result of chronically high insulin levels having adverse effects on laminar tissues, and causing mild to mod-
erate lameness which can progress to classical laminitis. Divergent hoof rings can be indicative of insidious
HAL and disruption of the internal structural changes in the hoof. Dietary sugar, starch and fructans can
be instigators of HAL in susceptible animals. Although the exact mechanism has not been completely elu-
cidated, the most popular theory is that hyperinsulinemia induces inappropriate stimulation of insulin-like
growth factor-1 receptors on lamellar epidermal cells. Obesity is a common characteristic of the EMS horse.
With the clinical signs of EMS in obese individuals, some or all the following may be present: weight loss
resistance, clinical laminitis, divergent hoof rings (subclinical laminitis), cresty neck, subcutaneous adipose
tissue deposits, preputial or mammary gland enlargement. Manifestation of EMS in non-obese individuals
commonly presents as clinical or subclinical laminitis. Many genetically at-risk non-obese EMS horses are
not obese because they are maintained in controlled environment and/or have been obese historically.
EMS may coexist with pituitary pars intermedia dysfunction (PPID) in older horses. More information on
PPID will be discussed in the accompanying abstract on Feeding Old Horses by this author.
While there are a number of tests currently used for diagnosing EMS and ID, the two recommended tests
are the Oral Sugar Test (OST) and Insulin Tolerance Test (ITT). Resting insulin and glucose blood levels can
be used alongside the dynamic tests as a two-step approach to ID testing. The combined glucose-insulin
test, frequently-sampled intravenous glucose tolerance test, and euglycemic-hyperinsulinemic clamp pro-
cedure are considered too complex and expensive for routine clinical use but can provide relevant informa-
tion in a research setting.
Management of EMS in obese individuals involves dietary changes and restrictions such as restricting or
eliminating grazing access, as well as elimination of treats, grain and most concentrate feeds (except a
ration balancer type feed). Hay fed should be low non-structural carbohydrate (NSC) content, preferably
< 10%. For weight loss, offer the equivalent of 1.2-1.5% BW in hay, on a dry matter basis, and avoid higher
calorie hays such as alfalfa. For hays with higher NSC content, soaking for 60 minutes can leach out some
of the sugar but the amount lost can be variable dependent on the hay and is not 100% reliable for sugar
reduction. For situations where lower NSC hay is not available, then up to 50% of the hay can be replaced
with good quality straw but needs to be introduced into the diet very gradually to avoid colic. To avoid
prolonged periods of fasting, slow feeder hay nets or small frequent meals can be used. If small amounts of
grazing are tolerated, then a grazing muzzle can be used to limit the amount of grass consumed. To balance
out the vitamin and mineral shortcomings of the hay/pasture, particularly if the hay is being soaked, the diet
should include either a low NSC ration balancer type concentrate feed for when the protein content of the
hay is low or questionable, or a vitamin mineral supplement when protein is adequate in the hay or horses
that are extremely sensitive to any concentrate. If desired weight loss is achieved, then amounts of hay and
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2023
pasture access can be gradually increased to a level that maintains the weight loss but does not cause
an increase in body condition. Supplements commonly recommended for ID are magnesium, chromium,
and resveratrol as well as some herbal blends. While minerals like magnesium are required in the diet, the
above-requirement supplementation has not been studied very well as treatment for ID. Off label use of
the following drugs are currently being used in the treatment of EMS: high dose levothyroxine, metformin
hydrochloride, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. As exercise is likely to be beneficial
for weight loss and maintenance of reduced body condition as well as improving insulin sensitivity, any
level of exercise tolerated is recommended unless laminitis is present. Ideally, horses should be maintained
in a low stress environment and housed with a companion if restricted to a drylot. Avoiding confinement
in a stall, if at all possible, except during laminitis treatment, is desirable. Conscientious hoof care is also
essential in the treatment of EMS.
Treatment of non-obese EMS horses is similar except weight loss is not desirable. The horses should still be
maintained on a low-glycemic diet, such as low NSC hay and a low NSC concentrate feed or ration balanc-
er. However, the non-obese EMS horse may be able to tolerate higher amounts of a low NSC, high fat, and
high-quality fiber concentrate feed such as one with beet pulp and soy hulls. Medication with metformin or
SGLT2 inhibitors can be used if dietary restrictions are not effective at controlling ID. Exercise and stress
management are equally important as long as the horse is not laminitic.
Frank N, Bailey S, Bertin F, Burns T, de Laat M, Durham A, Kritchevsky J, Menzies-Gow N. 2022 Recom-
mendations for the Diagnosis and Management of Equine Metabolic Syndrome. Equine Endocrinology
Group, https://sites.tufts.edu/equineendogroup/files/2022/10/EMS-EEG-Recommendations-2022.pdf.
Dr. Kathleen Crandell earned her MS in Equine Nutrition and Exercise Physiology and PhD in Equine Nu-
trition and Reproduction from Virginia Polytechnic Institute and State University (Virginia Tech). Dr. Crandell
was a Superintendent of the Virginia Tech Middleburg Agricultural Research and Extension Center in Middle-
burg, Virginia, where she ran an equine research and breeding program with over 100 Thoroughbred horses.
For the past 26 years, she has been an equine nutrition consultant for Kentucky Equine Research (KER),
responsible for support of the national and international feed mills associated with KER with feed formulation,
advising on issues of manufacturing and packaging of equine feeds and customer equine feeding recommen-
dations. She also provides recommendations for nutritional programs of individual horses or farms and equine
publications, and has consulted for some of the top equine competitors in the US. Dr. Crandell has presented
nutritional seminars for education of the general equine public and scientific community around the world.
Dr. Crandell has authored book chapters and articles in refereed journals. She also writes or is interviewed
for articles on specific topics in equine nutrition for KER publications, KER.com Equinews website and pop-
ular magazines. In addition, Dr. Crandell is an Instructor for Equine Guelph, University of Guelph, Ontario,
Canada, teaching an equine nutrition course “Advanced Equine Health through Nutrition”, an in-depth study
of nutritional related diseases and disorders. Dr. Crandell has been awarded 3 John H. Daniels Fellowships
by the National Sporting Library in Middleburg, Virginia, to study historical perspectives on equine nutrition,
supplementation and laminitis. Having previously owned a small breeding farm and competed in endurance
and competitive trail, she is currently an avid trail rider with her Arabian and half-Arabian horses.
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2023
Pain mitigation and welfare

FRCVS.
Senior Medical Director Lap of Love Veterinary Hospice, Lutz, Florida, USA and Courtesy Professor, Univer-
sity of Florida, Gainesville, Florida, USA.
In any species the presence of pain is a welfare issue. The prevention, recognition and treatment of pain in
horses involves ethical, welfare and medical knowledge. Most horses will experience acute and / or chronic
pain during their lifetime. Examples of acute pain include wounds, post-operative pain (e.g., after castration),
and “colic.” Examples of chronic (also referred to as maladaptive) pain include laminitis, tendon injuries and
musculoskeletal diseases such as osteoarthritis. However it should be noted that there is a “continuum”
where acute pain can evolve into chronic pain and some diseases may start as acute but become recurring
and affect the horse long term; one example is laminitis.
By the very nature of what we expect from horses, ranging from gentle pleasure riding to participation in
racing events or carrying heavy loads over long distances, it should be expected that injury resulting in pain
is an occupational hazard.1 Webster stated that it may be morally acceptable to expose horses to the risk of
injury through racing, but not to ignore the painful outcome of such injury. 2 Alleviation of pain is a welfare
issue and we have an obligation to treat animals in our care as we do not want them to suffer. However
treating pain is also good medicine. Pain has wide-reaching negative effects including but not limited to
promoting ileus with serious outcomes (e.g., impaction), immunosuppression, delayed healing, defensive
behaviors which make nursing care difficult and handling dangerous, catabolism, weight loss and adverse
cardiovascular effects (e.g., tachycardia and hypertension).
It is important to anticipate pain because preventive measures are beneficial; for example administering
analgesics before, during and after surgery which is referred to as preventive analgesia. We have a wide
variety of analgesic drugs and techniques at our disposal to treat pain in horses, but just using these does
not mean they have alleviated pain in an individual patient. To claim that pain has been treated effectively, it
must be measurable. If we ask, “what is the unit of pain?” the answer is “there is none.” Recognition, assess-
ment or measurement of pain is important as horses are unable to self-report. Recognition and assessment
of pain is based on understanding normal equine behaviour and documenting what changes after a painful
insult or onset of disease. This is an area where great strides have been made and we now have clinically
applicable pain assessment tools which all clinicians should be encouraged to use.3-5
Owners and veterinarians must be engaged in the prevention, recognition and treatment of pain in horses.
Education of all stakeholders, the continued development of assessment tools and effective analgesic drugs
and non-drug therapies are essential components of equine welfare.
References
1. Robertson S. The importance of assessing pain in horses and donkeys. Equine Vet J 2006;38:5-6.
2. Webster J. Animals for sport In: Kirkwood J, Hubrecht RC,Robertson EA, eds. Animal Welfare:
Limping Towards Eden. Oxford: Blackwell Publishing Ltd., 2005; 205-226.
3. Barreto da Rocha P, Driessen B, McDonnell SM, et al. A critical evaluation for validation of compos-
ite and unidimensional postoperative pain scales in horses. PLoS One 2021; 16:e0255618.
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4. Ladewig J, McLean A, Wilkins CL, et al. A review of The Ridden Horse pain Ethogram and its po-
tential to improve ridden horse welfare. Journal of Veterinary Behavior 2022; 54:54-61.
5. van Loon J, Macri L. Objective Assessment of Chronic Pain in Horses Using the Horse Chronic Pain
Scale (HCPS): A Scale-Construction Study. Animals (Basel) 2021; 11(6): 1826.
6.
7. Dr Sheilah A Robertson BVMS (Hons), PhD, DACVAA, DECVAA, DACAW, DECAWBM (WSEL),
CVA, MRCVS.
Colleges. She is the senior medical director of Lap of Love Veterinary Hospice, a large network of veterinarians
dedicated to end-of-life care. Dr Robertson is also a courtesy Professor at the College of Veterinary Medicine,
University of Florida, Gainesville, Florida.
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When is it time to quit?

Christopher Riggs
BVSc, PhD, DEO, DipECVS, FRCVS. The Hong Kong Jockey Club Equine Welfare Research Foundation.
Sha Tin Racecourse. Hong Kong SAR. CHINA
The repetitive, cyclical nature of loads on the musculoskeletal system associated with training for and
competition in equine athletic pursuits results in a relatively high incidence of fatigue-related injuries and
degenerative conditions in competition and race horses. The incidence and rate of onset of disease is relat-
ed to the magnitude of load each cycle, which is determined by the speed and nature of activity, together
with intrinsic (animal-related) and extrinsic (environment-related) factors. The ability to tolerate training and
competition with minimal damage to musculoskeletal tissues does, in part, appear to be animal-dependent
although the mechanisms behind such variation is not yet understood.
Common examples of repetitive stress injuries (RSI) in the racehorse include stress fractures and disease
of subchondral bone and whole joints. There is some evidence that injuries to the superficial digital flexor
tendon are also a manifestation of RSI.
The consequences of RSI are accumulative and there is often a point where associated pathology becomes
irreversible. Furthermore, focal pathology associated with RSI of the skeleton is a significant risk factor for
more serious injuries, such as complete fracture of long bones.
Anti-inflammatory and analgesic drugs are regularly used to manage the impact of RSIs in sports horses.
While this may be reasonable practice there is a danger that on occasions it masks the severity of underly-
ing pathology, thereby increasing the risk that disease progresses to a state where it becomes irreversible
or where pathology that risks acute, catastrophic injury goes undetected.
Clinicians have a responsibility to act as guardians of the horse. They should understand the pathobiology
behind musculoskeletal disease that is common in competition horses, appreciate the significance of ad-
ministering medications that mask the severity of disease and be prepared to acknowledge when risk of
continuing training, under the influence of medication, is against the best interests of the horse.
Dr Chris RIGGS
Leverhulme Equine Hospital, University of Liverpool, where he developed specialist skills in equine surgery.
He gained further clinical experience at several equine referral centres in the United Kingdom and Australia
before joining the Hong Kong Jockey Club as Head of Veterinary Clinical Services in 2003. He was appointed
to a new role in the Club as Director, HKJC Equine Welfare Research Foundation/ Chief Advisor, Mainland
Veterinary Engagement in 2019.
over 80 scientific papers about fatigue damage in bone and its role in racehorse fractures, among other top-
ics. He also cares deeply about helping to provide opportunities for young colleagues to further their clinical
skills, with a focus on Mainland China.
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at the College of Veterinary Medicine and Life Sciences, City University, Hong Kong, Special Professor at
the School of Veterinary Medicine and Science, University of Nottingham, UK, and Guest Professor at Inner
Mongolia Agricultural University.
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Biosecurity in Equestrian Activities

Lutz S. Goehring, DVM, MS, Ph.D., Dipl. ACVIM/ECEIM
Wright-Markey Professor of Equine Infectious Diseases
M.H. Gluck Equine Research Center -Dept. of Veterinary Science,
Martin-Gatton College of Agriculture, Food and Environment.
University of Kentucky, Lexington, Kentucky, USA
Equestrian events, gatherings or activities come with an inherent risk of contagious disease introduction
and its subsequent spread. Risk comes with any form of mixing and mingling, while risk increases with
event size, grounds and set-up, event duration, and stocking densities. There is an increased risk of trans-
mission during events with a focus on young stock because of an immunologically naïve population, and
last, but not least, there is a human factor to consider on either side of an event: organizers and participants.
Biosecurity measures reduce the risk of introduction and spread of contagious organisms. Biosecurity aims
to prevent any direct or indirect contact between horses coming from different backgrounds. Biosecurity
regulates static components like building structures, the set-up and size of boxes and aisles, ventilation,
the number of wash stalls and outdoor paddocks, cleaning & disinfection protocols, quarantine space,
but it also regulates dynamic aspects of an event: movement of horses on the premises, strategic occu-
pation of barn space, but also humans: participants (riders, grooms, supporters with access to horses and
facilities), the organizers and primary and secondary personnel. Biosecurity can only be of success if the
static components fulfill the requirements and if there is broad compliance and adherence to protocols and
procedures by the human component. Breeches most likely will occur on the dynamic side when there is
low to moderate compliance only due to a lack of information, lack of planning, distraction, detachment,
indifference, panic.
Biosecurity relies on early detection of a suspicious animal, and entry to the showgrounds is a very im-
portant filter station in the prevention of disease introduction, but it is not the first. Horses to be admitted
should travel with a current health certificate and up-to-date mandatory vaccinations. Sick animals should
not travel - should not attend an event. Horses should not travel from premises with undiagnosed cases of
acute cough, diarrhea, ataxia/recumbency, or abortion unless tested appropriately (and in seclusion) for rel-
evant contagious diseases. A check-in exam should be a routine part of admittance in case there is stabling
in a shared barn environment. This exam should include, but is not limited to findings like abnormal rectal
temperature, nasal discharge, coughing, mandibular lymph nodes, diarrhea, unexplained sudden ataxia/
recumbency, symmetrical limb/ventral edema, abortion, petechial hemorrhage.
Early recognition of a suspicious animal during competition is germane to spread prevention. However,
this requires reporting by the participants to the event management, which on their side requires a plan of
action.
Any contagious disease is of concern during an event. Many diseases spread through direct contact, albeit
via fecal – oral transmission or through nose-to-nose contact. Most of them can also be transmitted via
fomites. Simple measures ‘no contact’, ‘no touching’ unless barrier precautions (gloves, gowns, shoe cover)
are in place, will quite effectively prevent transmission. Airborne transmission, however, is ‘complicating
matter’, and several pathogens are capable of spread via airspace: Equine Influenza, Equid alphaherpes-
virus 1/ 4 (EHV-1, -4), Strep equi spp. equi and Equine Arteritis virus (EAV). Effective containment and
mitigation can only be achieved by increasing distance between horses, erecting barriers between horses,
but above all, transferring a shedding animal into a separate quarantine barn. Furthermore, many of the air-
borne pathogens can be shed by subclinically infected animals. Any pathogen on the list can be picked up
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at home and is travelling with the animals on the same transport. This highlights the importance of clinical
evaluation at home, the importance of an official health certificate, and the key function of an intake exam
at the event grounds which may be expanded to additional targeted testing in the (near) future. EHV-1 (and
EHV-4) is exceptionally different as it is present in many horses in its latent (silent, non-replicative) form.
Latent virus can be reactivated during times of transportation and stress. Reactivation is followed by repli-
cation in the respiratory tract, which will lead to shedding of infectious virus. However, several days will go
by until a horse starts to shed, and this infection is likely to bypass the travel precautions and intake exam
at the event grounds.
Conclusion: preparedness, compliance to protocols and early detection is key to outbreak prevention and
mitigation.
Lutz S Goehring
University of Kentucky, USA
I graduated as a veterinarian from Utrecht University, the Netherlands in 1993. Since then I became a
board-certified Equine Internal Medicine Specialist in 2 specialty colleges, ACVIM and ECEIM. I was a fac-
ulty member at Utrecht University (Netherlands), Colorado State University (USA) and Ludwig-Maximilians
University in Munich (Germany). Through all these years my research focused on Equid alphaherpesvirus 1
(EHV-1), on equine infectious diseases in general, and on neurological conditions and anomalies in horses.
My focus on EHV-1 brought me to Kentucky, where I am a faculty member now at the M.H. Gluck Equine Re-
search Center at the University of Kentucky in Lexington, Kentucky (USA). Here I can focus on my research
areas EHV-1 latency, acute disease pathogen-host interaction, transmission, epidemiology and vaccine/treat-
ment efficacy testing (gluck.ca.uky.edu/directory/lutz-goehring).
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Relevance of Equine Doping for Welfare

Christopher Riggs
BVSc, PhD, DEO, DipECVS, FRCVS. The Hong Kong Jockey Club Equine Welfare Research Foundation.
Sha Tin Racecourse. Hong Kong SAR. CHINA
Doping and doping control both have potential to significantly impact horse welfare in negative ways. The
former is, clearly, unregulated and unlikely to ever have the horse’s best interest at heart. Conversely, dop-
ing control, which is all about protecting the horse, must be balanced to achieve its objective while having
minimal impact on legitimate use of effective therapeutic medicines.
Doping of horses is undertaken to alter the performance of the animal with the intention of yielding mon-
etary or social reward for the culprit. Horses may be doped to enhance or supress their performance, the
latter where the reward from betting income exceeds that from prize money. An injured horse may be
cynically administered a legitimate therapeutic agent to disguise pathology from which it is suffering, in
order to circumvent regulatory checks or in an attempt to restore its normal performance. Drugs, such as
furosemide, may be used to mask the use of doping agents by increasing urine output and, thereby, dilution
of the illicit agent.
There are many different drugs that have been used to enhance performance over the years. Manipulation
of the horses’ genome to alter an animal’s physique, to increase production of endogenous agents that
impact metabolic processes or manipulate pain tolerance are increasingly relevant.
Performance enhancing drugs may stimulate a horse to perform beyond its natural physiological limit,
increasing the risk of injury and disease in the process. The drugs themselves may cause disease through
direct pharmacological effects. Use of analgesics and anti-inflammatory drugs used to mask disease or in-
jury increase the risk of catastrophic musculoskeletal injury and are likely to exacerbate existing pathology.
Drugs used to suppress performance may have direct negative effects and may also increase the risk of an
accident in competition, causing injury to the doped horse and those in close proximity
Gene doping is associated with a range of additional threats to horse welfare, especially in a totally unregu-
lated environment. Immune responses to vectors used to transfer genetic material and to transgene expres-
sion have been documented in humans and other animals. Vector integration, predisposing to cancerous
mutation, overexpression of transgenic proteins and severe side-effects have also been recorded. Further-
more, the integrity of the natural genome may be damaged if genes in germ line cells are interfered with.
The distinction between “doping” and the legitimate use of therapeutic agents to care for horse welfare
can be controversial. Many racing jurisdictions are full signatories to the guidelines documented in article
six of the International Agreement on Breeding, Racing and Wagering of the International Federation of
Horseracing Authorities, which requires zero tolerance towards presence of prohibited substances in hors-
es at the time of competition. However, some would argue that temporary cessation of administration of
drugs such as omeprazole, in order to comply with this rule may not be in the best interests of the horse.
Nevertheless, racing authorities and analytical laboratories in relevant countries go to lengths to establish
realistic screening limits for therapeutic medications, which set levels of detection (screening limits) at a
point that allows valid use of the medication as late as possible while ensuring that the therapeutic effect of
any residual drug at the time of competition is negligible.
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Dr Chris RIGGS
Leverhulme Equine Hospital, University of Liverpool, where he developed specialist skills in equine surgery.
He gained further clinical experience at several equine referral centres in the United Kingdom and Australia
before joining the Hong Kong Jockey Club as Head of Veterinary Clinical Services in 2003. He was appointed
to a new role in the Club as Director, HKJC Equine Welfare Research Foundation/ Chief Advisor, Mainland
Veterinary Engagement in 2019.
over 80 scientific papers about fatigue damage in bone and its role in racehorse fractures, among other top-
ics. He also cares deeply about helping to provide opportunities for young colleagues to further their clinical
skills, with a focus on Mainland China.
at the College of Veterinary Medicine and Life Sciences, City University, Hong Kong, Special Professor at
the School of Veterinary Medicine and Science, University of Nottingham, UK, and Guest Professor at Inner
Mongolia Agricultural University.
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Outbreak Management
Lutz S. Goehring, DVM, MS, Ph.D., Dipl. ACVIM/ECEIM
Wright-Markey Professor of Equine Infectious Diseases
M.H. Gluck Equine Research Center - Dept. of Veterinary Science,
Martin-Gatton College of Agriculture, Food and Environment.
University of Kentucky, Lexington, Kentucky, USA
The meaning of ‘outbreak’ is when 2 or more horses suffer from similar disease. Outbreak management
tries to mitigate the progression of an outbreak, while prevention should be our goal. While outbreaks also
can be caused by toxicants or deficiencies, we will focus in the following discussion on the management of
outbreaks caused by infectious and transmissible pathogens. However, regardless of the outbreak’s cause
clinical signs in combination with environment/season (what is common in this area, region, country), and/
or similar genetic background of affected needs to be taken into consideration for a diagnosis, which needs
to be confirmed by specific testing.
There are no winners with outbreaks. However, the ill-prepared will suffer most… Outbreak management
will differ between premises. It will depend on size, stabling type and on the organizational (management)
structure of the operation. It is fact, that premises that experienced an outbreak of a contagious disease
before will respond faster at an early stage to an outbreak than those without experience. ‘Never again’ is
the phrase that drives an immediate outbreak response. Outbreak prevention and mitigation strategies
should be tailored to individual premises and their needs. What helps in outbreak prevention and mitigation
is simple preparedness: i) a strategic plan in place; ii) regular communication of this strategic plan with all
stakeholders, ii) an emergency fund for diagnostics and mitigating adaptations; iii) routine sequestration
and testing of new additions to the herd or returning horses from an event of mixing and mingling prior to
joining the rest of the herd; iv) availability of (temporary) quarantine facilities; v) earliest recognition of an
infected/shedding animal.
In greater detail:
i) Procedures on paper on ‘who needs to do what and when’, assigning responsibilities and organizing
practice rounds with mandatory presence.
ii) Many horse owners are not willing to pay for diagnostic testing when their horse is apparently
healthy. A monthly contribution to an emergency fund during #healthy times’ will allow the testing that
is necessary, and funds can also be used for purchase of materials/products of transmission inhibition.
iii) protocol of sequestration (= no direct contact, 4+ m to the next horse, ideally a separate airspace)
and testing for any new addition(s) to the herd, or for returning horses from an event of mixing and
mingling. I recommend 10 days for ‘new additions’ and 3 - 5 days for the returners.
iv) availability of (temporary) quarantine facilities. ‘Temporary’ refers to the use of alternative space or
temporary stable rental.
v) 4x I of infection control
Identify a suspicious animal (fever, acute cough, nasal discharge, lymph node enlargement, petechial
hemorrhage, symmetrical limb edema/ ventral edema, ataxia/recumbency, abortion, diarrhea).
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Isolate/ sequester a suspicious animal immediately. During this time:

Investigate into the cause of the abnormal presentation (initiate testing).
Inform stakeholders (internal and external) as quickly as possible if a contagious cause has been iden-
tified. Check and start testing horses in the vicinity of the affected and other in-contact horses. ‘Inform’
also includes quarantine for the entire operation. No horses/animals in, and horses ‘off’ only under specific
circumstances.
Furthermore- Implementation of procedures (see item i) for outbreak scenario: Close the affected unit for
through traffic; relocate other shedding animals and create space (or barriers in case of airborne transmis-
sion) between the remainders. Mark vacated boxes as ‘unavailable for use’ until further notice. Implement
for all animals on the farm: twice daily temperature collection; written recording & report data to manage-
ment. All other horses are advised to avoid contacts with others (includes shared grooms & riders, feeding
and barn crew) as much as possible. Avoid bottlenecks and traffic jams; stop activities for 72 hours (hand
walking only and in an organized manner, ‘as previously discussed during mock outbreak exercises’), let go
of contact routines with others. Cancel farrier and routine veterinary appointments. Initiate treatments or
prophylaxis if indicated or appropriate. The duration of quarantine is variable and depends on the cause of
an outbreak. Negative testing prior to lifting quarantine is advised.
Conclusion: be prepared, be pro-active and follow the 4xIs.
Lutz S Goehring
University of Kentucky, USA
I graduated as a veterinarian from Utrecht University, the Netherlands in 1993. Since then I became a
board-certified Equine Internal Medicine Specialist in 2 specialty colleges, ACVIM and ECEIM. I was a fac-
ulty member at Utrecht University (Netherlands), Colorado State University (USA) and Ludwig-Maximilians
University in Munich (Germany). Through all these years my research focused on Equid alphaherpesvirus 1
(EHV-1), on equine infectious diseases in general, and on neurological conditions and anomalies in horses.
My focus on EHV-1 brought me to Kentucky, where I am a faculty member now at the M.H. Gluck Equine Re-
search Center at the University of Kentucky in Lexington, Kentucky (USA). Here I can focus on my research
areas EHV-1 latency, acute disease pathogen-host interaction, transmission, epidemiology and vaccine/treat-
ment efficacy testing (gluck.ca.uky.edu/directory/lutz-goehring).
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Challenges for Equine Veterinary Practice in India:

A Multidimensional Analysis Amidst Sporting
Aspirations
Dr. Phiroz Khambatta, M.V.Sc.,PG Cert(SAS)
Raintree Veterinary Clinic and Rehabilitation Centre, Pune, INDIA
In a nation of 1.42 billion, India’s equine sector, once pivotal, now faces a series of challenges. Recent statis-
tics show a sharp 46% decline in the equine population, dwindling to just 340,000 by 2019. This decline, set
against India’s rapid economic ascent, underscores deeper complexities for equine veterinarians.(https://
pib.gov.in)
Historically, the thoroughbred racing industry, with roots going back 250 years in India, was a primary pa-
tron of veterinary services. However, shifts in the political landscape, particularly the introduction of a 28%
GST on betting wagers, has notably impacted this sphere. With 3500 thoroughbred racehorses and an
additional 1314 mares and 70 stallions at stud, spread out across 62 stud farms and nine race tracks, many
now grapple with limited access to specialist veterinary attention.(NHBSI)
Concurrently, India is witnessing a surge in equestrian sport aspirations. The past decade has seen a 65%
increase in participation at national equestrian championships. Moreover, India’s participation in global
events like the Asian Games has spiked interest levels, resulting in the import of over 500 elite warmbloods
within just a few years and a surge in investments towards breeding indigenous warmbloods.
The Equestrian Federation of India, birthed in 1967, now boasts 4,220 members, with a roster of 3,700 hors-
es engaged in diverse sporting events, from dressage to showjumping. Polo, too, has been ascendant, with
33 registered clubs nationwide and an ever-growing spectator base.(efinf.org)
Despite this optimism, the diagnostic infrastructure, or lack thereof, remains a chronic concern. While In-
dia produces over 600 veterinary graduates yearly from its 54 registered colleges, the dearth of advanced
diagnostic tools such as MRI, CT, and scintigraphy machines critically hampers their ability to offer world-
class care. This situation is intensified by societal and legislative challenges that inhibit ultrasound usage,
primarily due to concerns around female foeticide.
Culturally, there’s renewed interest in indigenous breeds like the Marwari and Kathiawari, championed by
entities like the Indigenous Horse Society. However, the nuanced care these breeds require calls for more
specialized veterinary knowledge.
Most alarmingly, only about 200 veterinarians are dedicated to exclusive equine practices in the vast ex-
panse of India. The predominant number are mixed animal veterinarians, which, given the burgeoning
equine sectors and sporting aspirations, amplifies the gap in specialized care. This deficit has forced many
horse enthusiasts to rely on international veterinarians and farriers.
To encapsulate, the equine landscape in India is a complex tapestry of challenges and opportunities. The
way forward demands rejuvenated veterinary education, amplified infrastructure investment, and fostering
global collaborations. As equestrian sporting aspirations rise, there is an urgent need for India to elevate its
equine veterinary sector to global standards, ensuring the health and prosperity of its revered equines in a
dynamically shifting socio-economic backdrop.
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Dr Phiroz Khambatta BVSc ,MVSc, PG Cert.SAS,.

Dr Phiroz Khambatta graduated Nagpur Veterinary college in 1985 and completed his masters in Veterinary
Science, Surgery , in 1987. He has been a practicing veterinarian at the Mumbai race track from 1987 to date,
and has a Surgical and diagnostic facility there. He also runs a multi species veterinary hospital, the Raintree
Veterinary clinic , in Pune , India. In addition to being on the board of WEVA , he is Vice president of the Indian
Association of Equine practitioners, and on the board of many animal welfare organisations in India.
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What is normal in the newborn foal?

Siobhan McAuliffe
History
The first part of any neonatal examination is a thorough history. This is often acquired orally at the farm, over
the phone or in the form of a foaling record chart.
Important details include:

• Time of foaling,
• Duration of foaling,
• Any difficulties during foaling.
• Was the foaling observed, if not where was the foal in relation to the mare when it was found, alone
or nearby. Was the foal wet indicating a recent birth or was it dry?
• Has the foal met normal post-delivery milestones?
• Has the foal nursed? Did the mare drip milk before foaling?
• Was the colostrum quality tested?
The general history of the mare is also important:
• Did she carry to term?
• Is she multiparous or is she a maiden foaler?
• Has she had problems with previous pregnancies or foals?
• History or evidence of placentitis (examination of the placenta).
• Vaccination status of the mare.
• Was the placenta passed in an appropriate time frame (<3hours)
Normal developmental milestones and timeframes
Clinical examination of the newborn foal should always begin at a distance, with observation of behaviour,
respiratory rate and musculoskeletal abnormalities. Normal foals will nurse for short periods, multiple times
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each hour and will follow the mare closely. Changes in bahaviour, including loss of affinity for the dam or
abnormal nursing behaviour can be a sign of Hypoxic-Ischaemic encephalopathy (HIE) or sepsis. Respira-
tory rate and character should be assessed both when the foal is resting and when ambulating around the
stall. Signs of prematurity or dysmaturity should be evaluated including small size for breed and gestational
age, a domed forehead, floppy ears and a silky haircoat. Limb laxity can also be a sign of prematurity. Many
congenital abnormalities are also obvious from a distance while others may be suspected and required a
closer examination.
Clinical examination should be systematic and include all body systems.
Mucous membranes and sclera may show the presence of ecchymotic hemorrhages caused by the pres-
sure of passage through the birth canal and be mildly injected compared with adults. The capillary refill time
is similar to adults.
A normal cardiac sinus rhythm or sinus arrhythmia is auscultated. It is common to hear a systolic murmur
(point of maximum intensity at the left heart base) for a few days after birth. Murmurs that persist longer
should be evaluated further.
The normal foal’s respiratory rate and effort should decrease over the course of the first day of life, and its
heart rate should increase after a few minutes. Foals should urinate within the first 24 hours of life, and urine
should become progressively more dilute as they begin to consume a liquid diet.
Many normal foals are born with a mild degree of carpal and fetlock valgus in their front limbs and slight
varus in their hind fetlocks. This condition typically resolves as they grow.
Foals should pass meconium, the first faeces, within 12 to 24 hours. Meconium is dark brown to tan and may
be hard or pasty. Subsequent milk faeces are yellow tan and typically softer in consistency.
Neonates lack a menace response, as this is a learned behaviour that will develop at a few weeks of life.
Stimulation (auditory or visual) often results in exaggerated, jerky head movements. The neonatal foal’s
primary behaviour should be directed toward maintaining close contact with its dam.
Foals can be bradycardic at birth; the heart rate should increase relatively quickly to normal values. Per-
sistent bradycardia can be caused by hypoxia, hypoglycaemia, and hypothermia. Oxygen supplementation
should be instituted. A continuous intravenous (IV) infusion of dextrose is recommended (see section on
fluid therapy) if glucose monitoring is not available. Bolus therapy with glucose-containing fluids is not rec-
ommended, as hyperglycaemia has deleterious effects. If bolus therapy is unavoidable, dextrose should be
added to an isotonic crystalloid at a low percent (0.5% solution = 10 mL 50% glucose in 1-L crystalloids). If
a foal is mildly hypothermic, it is recommended to allow slow, passive warming (cover the foal and keep in a
dry, warm area out of the wind), as hypothermia is protective against hypoxic brain injury.1 With more severe
hypothermia, active warming is recommended and is best done by infusion of warmed IV fluids. The use of
external heat sources is controversial as the resultant peripheral vasodilation can cause a reflex drop in core
temperatures as cold blood flows centrally from the periphery.
The causes of tachycardia include pain, hypovolemia, anaemia, fever, and excitement. If pain, fever, anaemia,
and excitement are ruled out, fluid therapy is indicated to attempt to correct hypovolemia (see section on
IV fluid therapy).
As the foal clears fluid from its lungs, its respiratory rate and effort should decline. Prominent rib retraction
and the presence of an abdominal effort with paradoxic collapse of the chest wall during inspiration are
indicators of respiratory distress and suggest respiratory or cardiac dysfunction. The foal’s chest wall is
extremely compliant compared with the adult animal. Respiratory muscle contraction is needed to maintain
thoracic and lung volume and prevent alveolar collapse and atelectasis. Foals that are sick, weak, hypo-
glycaemic, or have underlying respiratory disease may develop respiratory muscle exhaustion, worsening
atelectasis, and pulmonary function.
During parturition, mucous membranes may appear grey or cyanotic; this should rapidly resolve once the
foal is delivered. Pale mucous membranes can be an indicator of anaemia or hypovolemic shock. Icteric
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mucous membranes can indicate haemolysis (neonatal isoerythrolysis), in utero placental dysfunction, or
liver dysfunction. Further evaluation including blood work (complete blood count and serum chemistry
analysis) and ultrasound examination looking for evidence of internal bleeding is recommended. Because
cyanosis requires between 2 and 5 g of deoxygenated haemoglobin per decilitre of blood, anaemic individ-
uals may not be cyanotic even in the presence of severe hypoxia. 2 Petechia on the mucous membranes or
ears can be an indicator of septicaemia or thrombocytopenia.
Examination of the eye may aid the clinician in determining a diagnosis as hypopyon, or hyphema may be
present in septic foals. Retinal haemorrhages may also be present in neonates born with equine herpesvi-
rus type 1 infection. Sick foals may have abnormal blink responses or tear production making them more
susceptible to corneal injury.
Dehydration and poor body fat stores can result in the development of entropion. If not recognized quickly,
corneal abrasion and ulceration can develop. Treatment should be directed at correcting the abnormal lid
position. This correction can be achieved by pulling the lid margin out to its normal position and placing
a skin staple or mattress suture below and perpendicular to the lid margin to hold the lid out. Temporary
correction can also be achieved by injecting 0.5 mL of procaine penicillin G subcutaneously approximately
5 mm below the lid margin. As the lid distends, the margin is rolled out and returned to its normal position.
This technique may need to be repeated as the solution dissipates over time. Entropion usually resolves
once the foal is rehydrated or gains weight.
Siobhan McAuliffe graduated from UCD in 1997. She worked in ambulatory equine practice in Ireland until
2001 when she took up a residency in Equine Internal Medicine at the then Hagyard, Davidson and McGee
in Lexington, Ky. Following completion of the residency she took up a role at the Stables of King Abdullah in
Saudi Arabia for 5 years. She then returned to Lexington for 2 years where she ran her own practice. In 2010,
she took up a medicine position at the newly constructed Kawell Equine Hospital in Buenos Aires where she
remained until returning to Ireland in 2017 to take up a medicine position at Fethard Equine hospital. She now
works as an internal medicine consultant in conjunction with a part-time pharmacovigilance role with MSD
AH Ire. Siobhan has numerous publications in both English and Spanish.
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Ultrasonography of the neonate

Siobhan McAuliffe
Ultrasonography has become a routine and important part of medical examination of the foal. The small
size of the foal, lack of muscle mass and body fat facilitate the exam. A variety of ultrasound machines and
transducers are available. For the detection of most disorders in neonates, extremely expensive equipment
is not required, and a linear rectal probe of variable frequency (5-13MHz) is sufficient for most exams. Al-
though we often separate disorders of the thorax and abdomen into distinct categories, both body cavities
are usually evaluated during the same ultrasound examination. The ultrasound examination is performed
in a cranial-to-caudal manner—passing the ultrasound probe along each intercostal space, scanning from
dorsal to ventral, and then sweeping the caudal and ventral abdomen behind and beneath the ribs.
Thorax
Clipping of the thorax is generally not required for routine examinations but may be needed where addition-
al detail and a clearer image is needed.
Disorders of the thorax in the neonatal foal include rib fractures, pneumonia, and effusions (septic, hemor-
rhagic, or other). Rib fractures are common in hospitalized neonatal foals, and ultrasound is considered a
more accurate method of detection compared with radiography and physical examination. Fractures are
most often located with 3cm of the costochondral junction and more commonly involve the first few ribs be-
hind the elbow. Fractures may be non-displaced to severely displaced and are categorised by the number
of mm separating the fracture fragments. Fractures may displace over time as the foal becomes more mo-
bile with the distal segment usually moving medially. There may be fluid or hemorrhage in the soft tissues
surrounding the fracture ends. Injury to the underlying pulmonary parenchyma can vary from mild bruising
with a few echogenic “comet tails” to progressively more involvement with parenchymal consolidation and
occasional hemothorax or pneumothorax. Serial evaluation of the degree of displacement is recommended
to determine if there is an indication to consider surgical stabilization versus conservative management of
restricted mobility in the stall. Ultrasound can also be useful in monitoring the fracture healing process—
determining when there is sufficient callus formation and fracture stability to allow more exercise. With
fracture of more caudal ribs, there may be injury to the diaphragm and possible diaphragmatic hernia with
intestinal structures within the pleural space. In cases where the intestine lies between the lung lobes and
cannot be directly visualized there is often and increase in free pleural fluid. This combined with an abnor-
mal respiratory rate of pattern would indicate the additional use of radiography.
Ultrasound has become a routine tool in the evaluation of pneumonia in the foal. Pneumonia can be a pri-
mary anatomic site of sepsis in the neonate. Patterns of changes on the ultrasound image can be helpful
in predicting the type of lung injury present. Scattered echogenic “comet tails” may be present in the early
stages of a variety of bacterial pneumonias, with ventral consolidation being evident with further progres-
sion or more serious pneumonia. Broad-based or diffuse echogenic shadowing is more consistent with
interstitial lung disease (pulmonary edema or interstitial pneumonia) and suggests a more serious disease
process. Serial ultrasonographic examination of the lung is useful in evaluating the progression of disease
and can be a component for evaluating response to medical therapy.
Abdominal ultrasound
Ultrasound examination of the abdomen of foals is often used in the evaluation of foals with signs of colic
and can be useful in differentiating causes of abdominal distention in foals with and without colic signs.
Ultrasound is useful in extremely useful in the evaluation of disorders of the umbilical structures and ab-
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normalities of the abdominal wall surrounding the umbilicus and the inguinal area (e.g., traumatic injury
acquired during delivery and congenital defects).
The approach to the ultrasound examination of the foal with signs of acute abdominal pain is similar to that
used for the adult equine patient. There are some special circumstances and lesions that may be unique
to the younger foal that must be evaluated. The use of a high-frequency (5 to 7.5 mHz or higher) probe—
whether linear or microconvex—is sufficient for imaging much of the abdominal cavity in the young foal
with good resolution of structures. This can be performed with the foal standing or in a recumbent position.
The ultrasound examination should proceed as with the adult patient by evaluating the ventral thorax and
abdomen by passing the ultrasound probe dorsal to ventral along each intercostal space beginning just
caudal to the triceps muscle on each side and progressing in a cranial to caudal fashion to the thigh. The
exam is completed by then sweeping the ventral aspect of the abdomen to evaluate the umbilical structures
and the urinary bladder.
Gastric distension can be evaluated in the foal in a manner similar to that seen in the adult. Causes of gas-
tric distension may include ileus with or without enteritis or small intestinal strangulation obstruction. Small
intestinal obstructive disorders such as volvulus or entrapment in scrotal hernias will appear similar to that
seen in the adult patient—with profoundly fluid-distended segments of small intestine occasionally with
sedimentation of particulate material to the ventral or dependent aspect. With the hernia, small intestinal
segments may also be evident within the vaginal tunic. Small intestinal disorders including enteritis can
be easily identified in the foal. The ultrasound finding of fluid distension of the small intestinal lumen along
with variable motility and variable thickening (2 to 3 mm) of the small intestinal wall concurrent with fever
and leucopenia is supportive of the clinical diagnosis of enteritis. The small intestinal wall may often be less
distinct with enteritis due to inflammatory cell infiltrates and variable edema of the wall.
Colic associated with small intestinal obstruction from intussusceptions occur more commonly in young
foals, often secondary to enteritis or dysmotility secondary to birth asphyxia. Serial ultrasound examinations
may be necessary to identify the intussusception, which is classically described as a “target lesion” with the
concentric rings of the intussuscepted intestinal wall. Occasionally, the acute onset of rotaviral enteritis will
result in variable signs of colic and inappetence, sometimes before the appearance of diarrhea. Abdominal
ultrasound can be useful in identifying liquid contents of both the small and large intestines, which may be
indicative of impending diarrhea.
The urogenital system of the foal represents a special system within the abdominal cavity of the foal for
ultrasound evaluation. Uroperitoneum secondary to rupture of the urinary bladder is the most common ab-
normality. Ultrasound imaging usually demonstrates variable volumes of variably echogenic to hypoechoic
peritoneal effusion with free-floating intestinal organs. There are some instances in which the peritoneal
fluid associated with uroperitoneum will appear quite echogenic and require differentiation from suppura-
tive exudate associated with septic peritonitis by abdominocentesis. In cases of uroperitoneum associated
with a ruptured urinary bladder, the bladder is usually collapsed and folded on itself. The actual rupture
site is usually located on the dorsal aspect of the bladder, although it may not be easily identified on the
ultrasound image. It is important to note that ruptures of the urinary tract may occur at sites other than the
urinary bladder, such as the urachus or ureters. Urachal ruptures often will have a periumbilical plaque of
edema associated with subcutaneous leakage of urine. In cases of uroperitoneum associated with a rup-
tured urinary bladder, the bladder is usually collapsed and folded on itself. The actual rupture site is usually
located on the dorsal aspect of the bladder, although it may not be easily identified on the ultrasound image.
It is important to note that ruptures of the urinary tract may occur at sites other than the urinary bladder,
such as the urachus or ureters.
Umbilical ultrasound frequently requires clipping of the area between the umbilicus and udder/prepuce.
The thickness and content of both umbilical arteries and the umbilical vein should be determined. Infection
of these are common and haematomas can also be identified.
In summary ultrasound imaging is a readily available diagnostic tool that is easily applied to evaluation of
the young foal, both in the hospital setting and in the field.
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Siobhan McAuliffe graduated from UCD in 1997. She worked in ambulatory equine practice in Ireland until
2001 when she took up a residency in Equine Internal Medicine at the then Hagyard, Davidson and McGee
in Lexington, Ky. Following completion of the residency she took up a role at the Stables of King Abdullah in
Saudi Arabia for 5 years. She then returned to Lexington for 2 years where she ran her own practice. In 2010,
she took up a medicine position at the newly constructed Kawell Equine Hospital in Buenos Aires where she
remained until returning to Ireland in 2017 to take up a medicine position at Fethard Equine hospital. She now
works as an internal medicine consultant in conjunction with a part-time pharmacovigilance role with MSD
AH Ire. Siobhan has numerous publications in both English and Spanish.
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Field Approach To Treating The Sick Neonatal Foal

Pamela A. Wilkins DVM
University of Illinois, Champaign IL USA
Equine NICUs have greatly improved our knowledge and understanding of the normal and abnormal phys-
iology of the equine neonate, resulting in an improvement in our ability to successfully treat the critically ill
equine neonate and save lives. The success rate has increased tremendously since the early 1980s from a
little over 50% to 80% or more for most facilities; some of best success has been in the treatment of ‘dummy
foals’ that have a greater than 80% rate of survival to discharge in most hospitals. We have also been able to
translate many treatments from the referral hospital to the field with good success for the practitioner. This
lecture provides information on how to translate many specific and supportive treatments from the NICU
to the field situation.
Neonatal Encephalopathy: The ‘Dummy’ Foal

Neonatal encephalopathy (NE) is one of the most common diseases of the equine neonate and is also
described as dummy foal syndrome and neonatal maladjustment syndrome (NMS). A wide spectrum of
clinical signs are associated with NE ranging from mild depression with loss of the suck reflex to grand mal
seizure activity. The majority of affected foals are normal at birth but show signs of central nervous system
(CNS) abnormalities within a few hours following birth although some will not show signs until 24 hours of
age. NE is the most common clinical presentation and management of foals presenting with signs consis-
tent with a diagnosis of NE requires complete examination of other body systems and provision of specific
and supportive therapies of all affected body systems. Although PAS is most clinically obvious as NE, the
gastrointestinal tract and kidneys are also frequently affected; complications associated with these systems
should be anticipated, in addition to cardiovascular, respiratory, and endocrine disorders.
Pathophysiology:
The underlying pathophysiologic details of PAS and NE in the foal are unknown and likely multifactorial
and equine neonatologists have long looked to human studies and models of the human disease for un-
derstanding of the syndrome in the equine neonate. NE is commonly associated with adverse peripartum
events, including dystocia and premature placental separation, but a fair number of foals have no known
peripartum period of hypoxia, suggesting that these foals result from unrecognized in utero hypoxia. Se-
vere maternal illness may also result in foals born with PAS. There is increasing evidence that cytokinemia,
resulting from placental infection or insult, is a major contributor to NE in infants, and probably foals, with
incidence of NE increased with the presence of maternal fever, something veterinarians have suspected for
the last decade or so.
Treatment:
Therapy for the various manifestations of PAS involves control of seizures, general cerebral support, cor-
rection of metabolic abnormalities, maintenance of normal arterial blood gas values, maintenance of tissue
perfusion, maintenance of renal function, treatment of gastrointestinal dysfunction, prevention/recognition/
early treatment of secondary infections and general supportive care.
It is important that seizures be controlled as cerebral oxygen consumption increases five-fold during
seizures. Diazepam and midazolam can be used for emergency control of seizures. If seizures are not
readily stopped with diazepam or midazolam, or more than two seizures are recognized, then diazepam
should be replaced with a midazolam constant rate infusion (CRI).
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Probably the most important therapeutic interventions are aimed at maintaining cerebral perfusion.
Thiamine and vitamin C supplementation in the intravenous fluids can be administered to support
metabolic processes. The author rarely uses DMSO, has not used it at for the last decade and has
not recognized any change in outcome by discontinuing its use. GABAergic agonists (gabapentin) are
being used by some practitioners in the managements of PAS/NE in foals, based on evidence showing
neuroprotection when used in ischemia, both alone and in combination with NMDA antagonists like
magnesium.
Foals suffering from PAS will also have frequent recurrent bouts of hypoxemia and occasional bouts
of hypercapnia. INO2 is generally needed in these cases both as a preventative therapy and as direct
treatment, as the appearance of the abnormalities can be sporadic and unpredictable. Additional respi-
ratory support, particularly in those foals with centrally mediated hypoventilation and periods of apnea
or abnormal breathing patterns, include caffeine (per os or per rectum) or doxapram CRI and finally
positive pressure ventilation.
Maintaining tissue perfusion and oxygen delivery to tissues is a cornerstone of therapy for PAS in order
to avoid additional injury. Oxygen carrying capacity of the blood should be maintained; some foals will
require transfusions to maintain a PCV > 20%. Adequate vascular volume is important, but care should
be taken to avoid fluid or sodium overloading. Early evidence of fluid overload is subtle accumulation of
ventral edema between the front legs and over the distal limbs. Perfusion is maintained by supporting
cardiac output and blood pressure by judicious use of intravenous fluid support and inotrope/pressor
support. We do not aim for any ‘magic’ systolic, mean or diastolic pressure. Instead we monitor urine
output, mentation, limb perfusion, gastrointestinal function and respiratory function as indicators that
perfusion is acceptable.
The Sick Foal

The kidney is a target for injury in these patients and it is not unusual for renal compromise to play a signif-
icant role in the demise of these foals. Clinical signs of renal disease are generally referable to disruption of
normal control of renal blood flow and tubular edema leading to tubular necrosis and renal failure. These
foals present with signs of fluid overload and generalized edema. The urine of normal newborn foals is quite
dilute, reflecting the large free water load they incur by their milk diet. Many antimicrobial agents used in the
management of these cases, most notably the aminoglycosides, depend on renal clearance. Aminoglyco-
side toxicity occurs in the equine neonate and will exacerbate or, at the least, complicate the management
of renal failure originally due to primary hemodynamic causes.
In general sick foals can suffer from a variety of problems associated with abnormalities within the gas-
trointestinal tract. Commonly they present with ileus, recurrent excessive gastric reflux and gas distention.
These problems are exacerbated by constant feeding in the face of continued dysfunction and continued
hypoxia. Frequently, enteral feeding cannot meet their nutritional requirements and partial (PPN) or total
parenteral nutrition (TPN) is required. Special attention should be paid to passive transfer of immunity
status and glucose homeostasis in these cases. Clinical signs of injury to the gastrointestinal tract can be
subtle and lag behind other abnormalities for days to weeks. Low grade colic, decreased gastrointestinal
motility, decreased fecal output and low weight gain are amongst the most common clinical signs of gas-
trointestinal dysfunction in these case, but more severe problems, including necrotizing enterocolitis and
intussussception, have been associated with these cases. The return to enteral feeding must be slow in
many of these cases.
Foals with PAS are also susceptible to secondary infection. Treatment of recognized infection is required
and antimicrobial treatment is almost always required and should be broad-spectrum. Repeat determina-
tion of IgG concentration should be made and additional intravenous plasma therapy may be required. Any
acute deterioration in the condition of a foal with PAS indicates a need for further evaluation for possible
sepsis.
The prognosis for foals with PAS is good to excellent when it is recognized early and aggressively treated in
term foals. More than 80% of these neonates survive and go on to lead productive and useful athletic lives.
Prognosis decreases with delayed or insufficient treatment and concurrent problems such as prematurity
and sepsis with evidence is accumulating that failure resolve hyperlactatemia within 48 hours of presenta-
tion in foals with PAS indicates a poorer prognosis for ultimate survival.
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Practical Solutions to Common Problems of the Foal

The equine practitioner may be faced with management of fairly ill neonatal foals without access to referral
facilities, either due to location or financial restriction placed by the owner. The following are some suggest-
ed solutions to problems that may be encountered by the practitioner under these conditions.
Long-term Intravenous Access:

Long-term intravenous access for fluid administration or antimicrobial administration may be necessary in
some cases. In these cases, placement of ‘over the wire catheters’ provides the best solution. The catheters
are generally made of non-thrombogenic materials and are more pliable, making them less likely to clot or
to break. Although this author uses catheters made by Mila for this purpose, Arrow also has a long-tem
catheter that is similar. Placement of these catheters is more challenging than over the needle catheters,
but with practice placement becomes straightforward.
Catheterization is performed most readily in recumbent foals but can be performed in standing foals. Hav-
ing sufficient help available is important, as good restraint of the patient is necessary. If help is not readily
available, small doses of diazepam (2-5 mg per foal, IV) can make the process easier. Xylazine should be
avoided in very young foals as it can cause transient hypertension. Acepromazine should not be used in
foals with potential for seizure activity, such as perinatal asphyxial syndrome foals (‘dummy’ foals) as it low-
ers the seizure threshold. Small doses of butorphanol (~3 mg/foal) are tolerated fairly well.
Catheterization should be performed under sterile conditions. The site should be clipped and surgically
prepped. Placing a rolled towel under the foal’s neck in the mid-cervical region elevates the neck and
makes catheter placement easier. Catheters should be sutured in place. This can be made easier by using
small blebs of lidocaine over the jugular vein where the catheter is to be places and in the skin where reten-
tion sutures are to be placed. All needed materials should be within arms reach once catheter placement
has commenced, including syringes for blood sampling, heprinzed saline for flushing and the injection cap.
Large volumes of flush are not required for these catheters and the catheter patency can usually be main-
tained by flushing with 5 ml heparinized saline after each use. These catheters should be flushed at least 4
times daily. There is generally no need to place a bandage or any other type of protection over the catheters.
Tube feeding:
Foals able to tolerate enteral feeding but too weak to suck properly from the mare, or any foal without the
ability to suck, may benefit from placement of a long-term enteral feeding tube. The tubes are well tolerated
by foals and they can learn to suck from a bottle or from the dam around them. They are small diameter
tubes that are placed as nasoesophogeal tubes. They can be purchased with enteral feeding bags that at-
tach to them and they have small, attached caps to prevent air aspiration into the esophagus.
Feeding should always be performed under gravity flow only. It is ideal to pass a large bore nasogastric tube
to check for reflux before placing these tubes as a foal with significant gastric fluid accumulation, or blood
tinged gastric fluid, should not be fed enterally until this is resolved.
The amount fed should be calculated on a daily basis. Feeding should initially aim at providing milk or milk
replaced at about 10% of the foals body weight per day. For examples, a 100 pound foal should have an
initial target of 10 pounds of milk. This is divided into 12 feedings given at 2 hour intervals. An approximate
feeding schedule would be 14 ounces every 2 hours. Once the feed is administered the tube should be
flushed with a small volume of water ad recapped. Foals should be standing or in sternal recumbency
during the feeding and should remain in that position for at least 5 minutes once feeding is completed. If the
foal tolerates feeding well, the amount fed can be gradually increased to 20% of the body weight per day.
Arterial blood gas analysis:

Arterial blood gas analysis has traditionally been performed primarily at large referral institutions. However,
the advent of stable and durable portable blood gas analysis units has expanded this ability t the private
practitioner. Units are available as either new units or refurbished units. Two popular units are the IRMA and
the I-STAT units. Information can be found on the internet regarding these units.
Fluid Therapy in the Field:

Fluid therapy in foals can be taken can be undertaken in the field, keeping in mind some differences between
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the neonate and the adult. The intravenous route should be used for initial resuscitation and administration
of glucose and plasma. Oral fluid supplementation is possible, but should only be done under gravity flow.
Because renal function and vascular physiology of the equine neonate is substantially different from the
adult, fluid therapy in the neonate cannot simply be scaled down from adult therapy. Fluid therapy should
be conservative during postpartum resuscitation, as the newborn foal is generally not volume depleted
unless excessive bleeding has occurred. Some compromised newborn foals are actually hypervolemic. If
intravenous fluids are required for resuscitation administration of 20 ml/kg of a non–glucose-containing
polyionic isotonic fluid over 20 minutes (about 1 L for a 50-kg foal), known commonly as a ‘shock bolus’, can
be effective. Non–glucose-containing polyionic intravenous fluids should be used because hyperglycemia,
but not hypoglycemia, immediately after fetal or neonatal asphyxia has been shown to interfere with the re-
covery of brain cell membrane function and energy metabolism in neonatal piglets. These findings suggest
that post–hypoxic-ischemic hyperglycemia is not beneficial and might even be harmful in neonatal hypox-
ic-ischemic encephalopathy. Indications for ‘shock bolus’ therapy include poor mentation, poorly palpable
peripheral pulses, and the development of cold distal extremities, compatible with hemodynamic and/or
hemorrhagic shock. The foal should be reassessed after the initial bolus and additional boluses adminis-
tered as necessary. These same indications should be used when administering ‘shock bolus’ treatment
to neonates with other conditions requiring fluid resuscitation, such as sepsis. For the practitioner, failure
to respond well to bolus therapy probably indicates a need for referral to a hospital where continuous fluid
therapy and, potentially, inopressor therapy, can be more safely and readily administered. If blood loss ap-
pears to be significant, referral should also be considered for administration of blood.
Glucose-containing fluids can be administered as a constant rate infusion (CRI) both after resuscitation
and for energy support in the sick neonatal foal at a rate of 4 to 8 mg/kg/min, particularly in the obviously
compromised foal. If the foal requires glucose during resuscitation, dextrose can be added to the bolus liters
as 0.25-1% dextrose (5-20 ml 50% dextrose) per liter. This will approximate 4-8 mg/kg/min. A rapid method
of calculating an appropriate rate in the field for administering 5% dextrose in water at 4 mg/kg/min is as
follows:
[(Body weight in pounds) x 2] + [(Body weight in pounds) x 20%] = #mls/hour
For a 100 lb foal, this becomes:

[(100) x 2] + [(100) x 10%] = 200 + 40 = 240 mls 5% dextrose in water/hour
* This can be “ballparked” at 250 mls per hour to most average (50 kg) foals!
If this rate is not sufficient to keep blood glucose concentration within a normal range (60-140 mg/dl) then
the rate can be doubled, or the same rate can be used by with a greater dextrose concentration, such as
10% dextrose. A fluid pump is a good idea to use for this and many can be found on the secondhand market
for very reasonable cost. Most pumps will require specific administration sets. Alternatively, buretrols can
be used to delive a set maximum amount each hour, even if the line is wide open no more than what is in
the chamber will be delivered. Hand-held glucometry units are commonly used to monitor glucose con-
centrations in the blood or plasma, but should be assessed for their accuracy in the specific conditions they
are used in, as they can be quite inaccurate.
CRI glucose therapy is indicated to help resolve metabolic acidosis, to support cardiac output because
myocardial glycogen stores likely have been depleted, and to prevent postasphyxial or sepsis associated
hypoglycemia. Under normal conditions, the fetal-to-maternal blood glucose concentration gradient is 50%
to 60% in the horse, and glucose is the predominant source of energy during fetal development. Glucose
transport across the placenta is facilitated by carrier receptors (glucose transporter [GLUT] receptors), and
a direct relationship exists between maternal and fetal blood glucose concentration when maternal glucose
is in the normal range.
At term, the net umbilical uptake of glucose is 4 to 8 mg/kg/min, with most of the glucose being used by the
brain and skeletal muscle. The fetus only develops gluconeogenesis under conditions of severe maternal
starvation. Fetal uptake of lactate across the placenta is about half that of glucose. The transition to gluco-
neogenesis, stimulated by increased circulating catecholamine concentration from birth and by stimulation
of glucagon release at the time the umbilical cord breaks takes 2 to 4 hours in the normal foal, and glycog-
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enolysis supplies needed glucose until feeding and glucose production are accomplished. In the challenged
foal, glycogen stores may have been depleted and gluconeogenesis delayed, so provision of glucose at
rates similar to what the liver would normally produce during this period is requisite.
The clinician managing critically ill neonates must recognize that intravenous fluid therapy simply cannot
be scaled down from adult management approaches. Fluid management of the ill neonate, particularly
over the first few days of life, must take into consideration that the neonate is undergoing a large transition
from the fetal to the neonatal state and that important physiologic changes are taking place. These tran-
sitions include shifts in renal handling of free water and sodium and increased insensible losses because
of evaporation from the body surface area and the respiratory tract. The newborn kidney has a limited
ability to excrete excess free water and sodium, and the barrier between the vascular and interstitial space
is more porous than that of adults. Water and sodium overload, particularly in the first few days of life, can
have disastrous long-term consequences for the neonate. In the equine neonate, excess fluid (and sodium)
administration frequently manifests as generalized edema formation and excessive weight gain, frequently
equivalent to the volume of excess fluid administered intravenously. In cases in which antidiuretic hormone
(ADH) secretion is inappropriate, as seen in some foals with PAS, generalized edema may not form and the
excess free water is maintained in the vascular space. This ‘syndrome of inappropriate anti diuretic hormone
secretion’ (SIADH) is recognized in the foal that gains excessive weight not manifested as edema generally,
with decreased urine output and electrolyte abnormalities such as hyponatremia and hypochloremia. The
foal manifests neurologic abnormalities associated with hyponatremia and this should be distinguished
from PAS. The serum creatinine concentration varies in these cases, but urine always is concentrated com-
pared with the normally dilute, copious amounts of urine produced by foals more than 24 hours of age on a
milk diet. The treatment for this disorder is fluid restriction until weight loss occurs, electrolyte abnormalities
normalize, and urine concentration decreases. If the clinician is unaware of this differential diagnosis, the
neonate can be assumed mistakenly to be in renal failure, and the condition can be exacerbated by exces-
sive intravenous fluid administration in an attempt to produce diuresis.
The problem of appropriate fluid management in critically ill human neonates has been recognized by med-
ical physicians for years and has resulted in changes in fluid management of these patients. The approach
taken has been one of fluid restriction, in particular sodium restriction but also free water restriction, and
has resulted in improved outcome and fewer complications, such as patent ductus arteriosus and necro-
tizing enterocolitis. The calculations used for ‘dry’ maintenance intravenous fluid support in these patients
takes into consideration the ratio of surface area to volume and partially compensates for insensible water
losses. The majority of maintenance fluids are then provided as 5% dextrose to limit sodium overload and
provide sufficient free water to restore intracellular and interstitial requirements. The calculation for mainte-
nance fluid administration is as follows:
First 10 kg body mass 100 ml/kg/day

Second 10 kg body mass 50 ml/kg/day
All additional kilograms 25 ml/kg/day
As an example, the average 50-kg foal would receive 1000 ml/day for the first 10 kg of body mass, 500 ml/
day for the next 10 kg of body mass, and 750 ml/day for the remaining 30 kg of body mass for a total of 2250
ml/day. This translates to an hourly fluid rate of about 94 ml/hr for maintenance. Most foals will generally
receive 1.5 to 2 times maintenance but the rate must be adjusted higher if there are large ongoing losses.
Potassium is generally supplied to the foal at 20 mEq/L of fluids administered, and then adjusted as needed.
Fluid and sodium requirements can be adjusted for ongoing losses exceeding the maintenance require-
ments. These losses can take the form of diarrheal losses and excessive urine output, such as those with
glucose diuresis and renal damage resulting in an increased fractional excretion of sodium. The normal
fractional excretion of sodium in neonatal foals is less than that of adult horses and normal foal urine (foals
on a milk diet that are more than 24 hours of age) is generally quite dilute with a specific gravity of 1.005 or
so. Remember that the first urine produced by foals is generally quite concentrated, with a specific gravity
in some cases of 1.050 or more. In the critically ill foal the sodium requirement can be met with as little as
140 mEq of sodium per day (1-3 mEq per kg/day for growth), about that administered in a single liter of iso-
tonic crystalloid fluids. One liter of commercially available equine plasma will have a sodium concentration
of ~170 mEq/L due to aniticoagulation with sodium citrate. One can address sodium deficits by separate
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infusion of sodium-containing fluids, although this may not be necessary if one considers the sodium being
administered in other forms, including drugs administered as sodium salts and any constant rate infusions
(pressors, inotropes, etc.) that are being provided as solutions made with 0.9% sodium chloride. The major-
ity of fluid should be delivered as 5% or greater dextrose in water.
The author has used this approach to fluid therapy in the NICU for many years and believes that the per-
centage of foals suffering from generalized edema, and related problems, has decreased. When using this
approach to fluid therapy, the foal should be weighed at least once daily, although this is frequently imprac-
tical in practice, and fluid intake and output should be monitored closely as practical.A normal neonatal foal
will gain 1-3 kg/day. Any larger than anticipated weight gains or losses should result in closer evaluation
of the foal. Urine output will probably not approach the reported normal of 300 ml/hr for a 50-kg foal on
a free choice milk diet because the free water administered is limited, unless the patient is experiencing
diuresis (glucosuria, resolution of the syndrome of inappropriate antidiuretic hormone secretion, resolution
of previous edematous state, renal disease). If possible, urine specific gravity should be measured several
times daily –and should be hyposthenuric after 24 hours, specific gravity < 1.010- and fractional excretion of
sodium measured if renal injury or dysfunction is suspected. If the volume of urine produced by the patient
is measured accurately, one can determine sodium losses accurately and can obtain creatinine clearance
values.
In practice, fluid boluses are frequently used as maintenance of intravenous lines can be challenging, par-
ticularly if the foal remains in a stall with the mare. This approach can be used safely, but the amount of fluid
need over the day needs to be carefully considered, particularly in foals with diarrhea where losses may be
larger than anticipated. The total amount of fluids needed should be calculated for the day and then divided
in to bolus administrations ranging from every 2 to every 6 hours, depending on the condition of the foal,
ideally bolus administration should be limited to 1-2 liters per bolus. Fluid choices should be dictated by
the needs of the foal, but generally the sodium load administered with this route will be greater than that of
constant rate infusion as dextrose should not be administered by bolus at large concentration, ie more than
1-2.5%. Potassium should not be added to fluids being administered as a bolus. This approach will result in
sodium overload but will work well in a foal that is nursing. Bolus fluids can also be given as 0.45% saline
and 2.5% dextrose if calories are needed, although this is less than ideal.
If the oral route is available for hydration, this can be used in foals that are not nursing but are able to tolerate
enteral feeding. Placement of an indwelling small feeding tube (Kangaroo tube) will facilitate this, but the
foal should be checked for the presence of reflux using a large diameter tube prior to placing the smaller
feeding tube. These tubes are generally placed in the espophagus at the mid thorax level and not in the
stomach. They also take some practice to learn to place, but once the technique is ‘conquered’ they are
easy to place and maintain. In general a foal with a healthy gastrointestinal tract will tolerate 10% of it body
weight in milk or milk replacer divided into every 2 hour feedings (12 times per day). For a 100 pound foal,
this would be:
100lb x .10= 10 lbs

10 lb / 12 = 0.83 lb per feeding
There are 16 ounces in a pound, therefore the feeding should be ~13-14 ounces per feeding. If the foal toler-
ates this well, it can be gradually increased to 15 to 20 percent of its body weight over a few days if the foal
continues to not nurse or drink from a bucket. If the foal shows evidence of colic or abdominal distention,
feeding should be discontinued for a few hours and reinstated slowly. Water can be substituted for milk for
rehydration purposes and milk or milk replacers can be diluted with water if needed for rehydration purpos-
es, but keep in mind that the caloric support of the foal will be less in these circumstances. All enteral fluids
should be administered under gravity flow only and the foal should be kept standing or in sternal recum-
bency at the least, for 5-10 minutes once the feeding is completed to prevent aspiration.
Nursing Care:
Nursing care is one of the most important aspects of treating recumbent foals. Foals should be kept warm
and dry. They should be turned at two-hour intervals if they are recumbent. Feeding recumbent and min-
imally responsive foals can be a challenge if gastrointestinal function is abnormal and total parenteral nu-
trition may be needed. If at all possible foals should be weighed daily and blood glucose levels monitored
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frequently. Some foals become persistently hyperglycemic on small glucose infusion rates. These foals may
benefit from constant rate low dose insulin infusions. Recumbent foals must be examined frequently for
decubital sore development, the appearance of corneal ulcers and for heat and swelling associated with
joints and physis.
Restraint of the Foal

Working quietly and gently with proper restraint will minimize stress and injury to both handler and foal.
Foals can be caught by using the mare to corner the foal or by creeping up on the foal with the handler’s
head height below that of the foals. The foal is caught and subsequently restrained. For longer procedures
the foal is “folded” and laid down in lateral recumbency. To stimulate a recumbent foal to stand, scratching
along the spine, often vigorously, will help wake the foal up. Ensure the frontlegs are out in front of the foal
and, if needed, lift using the sternum /elbows and pelvis; do not use the tail or put pressure on the abdomen.
Care of the Recumbent Foal
Bedding
The recumbent foal should be kept clean and dry to avoid urine and fecal scalding and decubital ulcers.
Urinary catheters can be used however there is an increased risk of ascending infections (McDonald et
al 1990). The foal is turned every 2 hours and the wet side is dried off with the use of towels and talcum
powder.
Respiratory Care
INO2 tubes need to be cleaned at least once a day. The most common complications with INO2 therapy
are nasal irritation and airway drying resulting in excessive discharge. Maintaining the foal in sternal recum-
bency and alternating sides of recumbency every 2 hours assists with improving oxygenation. Coupage,
nebulizing with saline and ensuring the foal is hydrated will assist with loosening secretions. When standing
the foal can be coupaged with its head lowered.
Umbilical Care
A chlorhexadine or dilute betadine solution is applied to the external stump twice daily for the first 3 days
after birth. Recumbent foals are at increased risk of developing patent urachus or umbilical infection.
Eye care
Recumbent foals are at increased risk of developing corneal ulcers. Artificial tears/lubricant/tribple antibiot-
ic ointment should be placed by placing the ointments on a gloved finger and applying to a rolled out lower
lid every 6 to 12 hours in foals with decreased eyelid tone and tear production. Corneas should be stained
every 24-48 hours in order to evaluate for ulcers. If entropion is present it should be corrected and eyes
treated as if ulcerated. If the foal is thrashing, protective foam helmets can be made to encircle and protect
the eye socket.
Temperature Control
Premature foals have poor thermoregulation. Hypothermic foals should be gradually warmed with a com-
bination of water bottles, blankets, heated water mats, air blankets, and heat lamps, ensuring scalding and
secondary burning of the underlying skin does not occur. Hyperthermic foals can be cooled with cold water
and alcohol baths, and fans. NEVER FEED A COLD FOAL!
Care of the Standing Foal

Deep dry bedding should be provided as pressure sores can develop with increased recumbency, muscle
weakness and struggling to stand. Straw is preferred over shavings. If the foal is nursing, the mare’s udder
should be checked frequently to ensure the foal is nursing well. The foal’s urine SG is monitored to ensure
it is maintaining hydration (SG < 1.008). Foals usually urinate just after standing or nursing. Foals with diar-
rhea need frequent cleaning and applications of emollients to prevent scalding of the perineum and vulva.
Feeding the foal

Foals which are nursing from the mare should have their nursing observed. Mares whose foals are not nurs-
ing are milked out every 2 hours; the milk is stored and frozen for future use. Foals with a functional GIT but
no suckle or swallow reflex are fed via an indwelling nasogastric tube. Complications which can occur with
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indwelling nasogastric tubes are pharyngeal and esophageal irritation (most common; oral sucralfate helps
with alleviating discomfort); aspiration pneumonia or an inflow of air into stomach through an uncapped
tube. The position of the tube should be felt prior to each feeding by feeling the tube in the esophagus above
the pharynx. The tube is check for reflux by applying gentle suction. Feeding is by gravity flow. Recumbent
foals should be sat sternal during and for 10 minutes after feeding (Fig 3). Standing foals are fed near the
mares to encourage bonding.
Maintain the Maternal Bond

It is very important to ensure the bond with the mare is maintained. Once the foal is being assisted to stand
the mare is brought over to the foal. Vigorously scratching the mare’s wither often starts grooming behavior
towards the foal. Taking the mare and foal outside on warm sunny days helps improve their (and everyone
else’s!) attitude. Warm compresses should be applied to the udder if swollen and edematous and to assist
with milk let down.
Prognosis:
The prognosis for foals with PAS is good to excellent when it is recognized early and aggressively treated in
term foals. Up to 80% of these neonates survive and go on to lead productive and useful athletic lives.Prog-
nosis decreases with delayed or insufficient treatment and concurrent problems such as prematurity and
sepsis and evidence is accumulating that failure resolve hyperlactatemia within 48 hours of presentation in
foals with PAS indicates a poorer prognosis for ultimate survival.
The Future:
Cooling of the head or whole body, Biomarkers such as early serum S100B, neuron-specific enolase (NSE)
and fibrillary acidic protein are associated with neuroradiographic and clinical evidence of brain injury in
newborns with encephalopathy and may prove to be good biomarkers of disease severity. Newer drugs,
reinvestigations of older drugs and newer imaging modalities are all under current investigation and may
reach a veterinarian near you soon
Table 1: Drugs and dosages used in the treatment of perinatal asphyxial syndrome/ neonatal encephalopthy.
Drug Indication Dose Potential complications
Diazepam Single or short term seizure 0.1-0.2 mg/kg Rapid administration IV may result in respi-
control ratory depression
(5-10 mg to a 50 kg foal IM or IV)
0.1-0.2 mg/kg
Single or short term seizure (5-10 mg to a 50 kg foal IM or IV) Rapid administration IV may result in respi-
Midazolam control ratory depression
NOT water soluble.
Longer term control for 3-6 mg/hr. Rapid administration IV may result in respi-
ratory depression
repetitive seizures. Midazolam is water soluble and CRI
Midazolam CRI
Mild sedation for hyper-re- is administered in isotonic crystalloidHigher doses may be used if necessary.
fluid using a 0.5 mg/ml concentra- Advantage is ability to titrate to effect and
sponsive or ‘jittery’ foals. tion. reversibility if needed.
2-5 mg/kg IV slowly over 20 minutes. Respiratory depression, hypothermia, hy-
Longer term seizure control Start with lower dose and monitor to potension and pharyngeal collapse partic-
Phenobarbital effect. Maximal effect expected after ularly at higher doses or in more severely
45 minutes. affected foals.
1-20 mg/kg q12 hr added to IV fluids
Thiamine Metabolic support None
(protect from light)
Dehydration. May result in significant
Mannitol Intercellular edema: osmotic 0.25-1.0 g/kg IV as a 20% solution hyperosmolarity with repeated administra-
diuretic rapidly over 15-20 minutes tion. May exacerbate cerebral bleeding.
Dimethylsulf- Anti-inflammatory, Intercel- 0.1-1 gm/kg IV as a 10%solution Odor; OSHA restrictions in some areas,
oxide lular edema: osmotic agent hemolysis; dehydration
Neuroprotection: GABA 10-15 mg/kg/day divided equally and None described: an uninvestigated drug in
Gabapentin receptor agonist. given orally 3 to 4 times a day equine neonates
*See below. Can precipitate other
Magnesium CRI Neuroprotection: NMDA infusates, test compatibility or dis- In very high doses (>10x) muscular weak-
receptor antagonist. continue when administering intra- ness can occur as can hypotension
venous antimicrobial drugs.
CRI: constant rate infusion
*Magnesium CRI: Remove 20 ml from 100 ml bag sterile isotonic saline (0.9%). Add 20 ml 50% MgSO4 for
a final volume of 100 ml. Administer loading dose at 25 ml/hr for a 50 kg foal for 1 hour, decrease infusion
to 12.5 ml/hr thereafter. This is approximately 50 mg/kg loading dose followed by 25 mg/kg maintenance
dose. Infusion can be maintained for 24-48 hours.
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Table 2: Commonly used antimicrobials in neonatal foals and their dosages. It is important to recognize that
many antimicrobials have different dosages and interval in the foal, especially the neonate, than those used
in adults
Drug Dose, Route, Frequency Comments
Acycolvir 16 mg/kg PO TID
Nephrotoxic
< 1wk old: 25-30 mg/kg IV SID TDM: 30 min peak > 45 μg/ml
Amikacin sulfate
2-4wk old: 20 – 25 mg/kg IV SID 8 hr trough: < 15 μg/ml
12 hr trough: < 5 μg/ml
Ampicillin sodium 50-100 mg/kg IV QID
Azithromycin 10 mg/kg PO SID for 5 days then EOD Hyperthermia, diarrhea in foal and mare
Cefazolin 25 mg/kg IM TID/QID 1st generation cephalosporin
Cephalexin 30 mg/kg PO TID 1st generation cephalosporin
30 mg/kg/day PO BID/QID
Cefuroxime 2nd generation cephalosporin
50-100 mg/kg/day IV TID/QID
Cefotaxime 50-100 mg/kg IV QID 3rd generation cephalosporin
Ceftazidime 40 mg/kg IV TID/QID 3rd generation cephalosporin
5 mg/kg IV BID 3rd generation cephalosporin

10 mg/kg IV QID No CNS penetration
Ceftiofur CRI: 1.5 mg/kg/hr Ideally given over 20 mins
Nebulized: 1 mg/kg as 25 mg/ml solution TID/ Higher doses: broader
BID gram-ve spectrum
Cefpodoxime 10 mg/kg PO BID/QID 3rd generation cephalosporin

Ceftriaxone 25 mg/kg IV BID 3rd generation cephalosporin
Cefepime 11 mg/kg IV/IM TID 4th generation cephalosporin
Chloramphenicol 50 mg/kg PO QID Public health/OHS concerns
Clarithromycin 7.5 mg/kg PO BID Hyperthermia, diarrhea in foal
Doxycycline 10 mg/kg PO BID
Enrofloxacin 5 mg/kg PO SID Chondropathy and arthropathy
Erythromycin stearate 25 mg/kg PO TID Hyperthermia, diarrhea in foal and mare
Fluconazole 8 mg/kg loading then 4 mg/kg PO BID
Nephrotoxic
< 7do: 11-13 mg/kg IV SID
TDM: 30 min peak > 25 μg/ml
Older foals: 6.6 mg/kg IV SID
Gentamicin sulfate
Nebulized: 2.2 mg/kg as 50 mg/ml solution 8 hr trough: < 5 μg/ml
SID
12 hr trough: < 2 μg/ml
Imipenem 10-20 mg/kg IV QID
Metronidazole 10-15 mg/kg PO or IV TID 10 mg/kg BID if increased GIT absorption may occur.
Oxytetracycline 10 mg/kg IV BID Nephrotoxic, give slowly
Na or K Penicillin 20,000 - 50,000 IU/kg IV QID Use upper dose in severe infections
Procaine penicillin 20,000 – 50,000 IU/kg IM BID
Rifampin 5 mg/kg PO BID Use with other antimicrobials
50 – 100 mg/kg IV QID
Ticarcillin and clavu-
lonic acid CRI: 2-4 mg/kg/hr
Trimethoprim -sulfon- 30 mg/kg PO/IM/IV BID Dose/kg is combined trimethoprim and sulfonamide
amide
Suggested Reading: Papers are listed in alphabetical order under areas of relevance.
Pathophysiology:
1. Andine P, Jacobson I, Hagberg H. 1992. Enhanced calcium uptake by CA1 pyramidal cell dendrites
in the postischemic phase despite subnormal evoked field potentials: excitatory amino acid recep-
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tor dependency and relationship to neuronal damage. Journal of Cerebral Blood Flow and Metab-
olism 12(5):773-783
2. Chernick V, Craig RJ. 1982. Naloxone reverses neonatal depression caused by fetal asphyxia. Sci-
ence 216(4551):1252-1253.
3. D’Souza SW, McConnell SE, Slater P et al. 1993. Glycine site of the excitatory amino acid N-meth-
yl-D-aspartate receptor in neonatal and adult brain. Archive of Diseases in Childood 69(2):212-215.
4. Evrard P. 2001. Pathophysiology of perinatal brain damage. Developmental Neuroscience 23(3):171-

174.
5. Filler G. 2001. Acute renal failure in children: aetiology and management. Paediatric Drugs 3(11):783-
792.
6. Goetzman BW, Itskovitz J, Rudolph AM. 1984. Fetal adaptations to spontaneous hypoxemia and
responses to maternal oxygen breathing. Biology of the Neonate 46(6):276-284.
7. Hayes BC, Cooley S, Donnelly J, Doherty E, Grehan A, Madigan C, McGarvey C, Mulvany S, Ryan
S, Gillian J, Geary MP, Matthews TG, King MD. The placenta in infants >36 weeks gestation with
neonatal encephalopathy: a case control study. Arch Dis Child Fetal Neonatal Ed. 2012 Jul 12. [Epub
ahead of print.
8. Kempski O. 2001. Cerebral edema. Seminars in Nephrology 21(3):303-307.
9. Kitchen H, Rossdale PD. 1975. Metabolic profiles of newborn foals. Journal of Reproduction and
Fertility Supplement 23:705-707.
10. Lyden PD, Lonzo L. 1994.Combination therapy protects ischemic brain in rats: a glutamate antag-
onist plus a gamma-aminobutyric acid agonist. Stroke 25(1):189-196.
11. Madden KP. 1994. Effect of gamma-aminobutyric acid modulation on neuronal ischemia in rabbits.
Stroke 25(11):2271-2274.
12. Martin-Ancel A, Garcia-Alix A, Gaya F et al. 1995. Multiple organ involvement in perinatal asphyxia.
Journal of Pediatrics 127(5):786-793.
13. Nelson KB, Willoughby RE. 2000.Infection, inflammation and the risk of cerebral palsy. Current
Opinion in Neurology 13(2):133-139.
14. Palmer AC, Rossdale PD. 1975. Neuropathology of the convulsive foal syndrome. Journal of Repro-
duction and Fertility Supplement 23:691-694.
15. Rossdale Peter D. 1969. Clinical studies on 4 newborn thoroughbred foals suffering from convul-
sions with special reference to blood gas chemistry and pulmonary ventilation. Research in Veter-
inary Science 10(3):279-91,
16. Sebastiao AM, de Mendonca A, Moreira T et al. 2001. Activation of synaptic NMDA receptors
by action potential-dependent release of transmitter during hypoxia impairs recovery of synaptic
transmission on reoxygenation. Journal of Neuroscience 21(21):8564-8571.
17. McGlothlin JA, Lester GD, Hansen PJ,et al. 2004 Alteration in uterine contractility in mares with
experimentally induced placentitis. Reproduction 127(1):57-66.
18. Tute AS, Wilkins PA, Gleed RD et al. 1996. Negative pressure pulmonary edema as a post-anes-
thetic complication associated with upper airway obstruction in a horse. Veterinary Surgery 25(6):
519-523.
19. Vexler ZS and Ferriero DM. 2001. Molecular and biochemical mechanisms of perinatal brain injury.
Seminars in Neonatology 6(2):99-108.
Treatments:
20. Ambalavanan N, Carlo WA. 2001. Hypocapnia and hypercapnia in respiratory management of new-
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born infants. Clinical Perinatology 28(3):517-531Giguère S, Sanchez LC, Shih A, et al. 2007. Com-
parison of the effects of caffeine and doxapram on respiratory and cardiovascular function in foals
with induced respiratory acidosis. American Journal of Veterinary Research 68(12):1407-16.
21. Chaudhari T, McGuire W. Allopurinol for preventing mortality and morbidity in newborn infants with
hypoxic-ischaemic encephalopathy. Cochrane Database Syst Rev. 2012 Jul 11;7:CD006817
22. Giguère S, Slade JK, Sanchez LC. 2008. Retrospective comparison of caffeine and doxapram for
the treatment of hypercapnia in foals with hypoxic-ischemic encephalopathy. Journal of Veterinary
Internal Medicine 22(2):401-5.
23. Kellum JA, M Decker J. 2001. Use of dopamine in acute renal failure: a meta-analysis. Critical Care
Medicine 29(8):1526-1531.
24. Maroszynska I, Sobolewska B, Gulczynska E et al. 1999.Can magnesium sulfate reduce the risk of
cerebral injury after perinatal asphyxia? Acta poloniae pharmaceutica 56(6):469-473.
25. Greenwood K, Cox P, Mehmet H et al. 2000. Magnesium sulfate treatment after transient hypox-
ia-ischemia in the newborn piglet does not protect against cerebral damage. Pediatric Research
48(3):346-345.
26. Rudis MI. 2001. Low-dose dopamine in the intensive care unit: DNR or DNRx? Critical Care Med-
icine 29(8):1638-1639.
27. Spehar AM, Hill MR, Mayhew IG et al. 1984. Preliminary study on the pharmacokinetics of pheno-
barbital in the neonatal foal, Equine Veterinary Journal 16(4):368-371.
28. Ting P, Pan Y. 1994. The effects of naloxone on the post-asphyxic cerebral pathophysiology of new-
born lambs. Neurological Research 16(5):359-364.
29. Watanabe I, Tomita T, Hung KS et al. 1981. Edematous necrosis in thiamine-deficient encephalopa-
thy of the mouse. Journal of Neuropathology Experimental Neurolology 40(4):454-471.
30. Whitelaw A. 2000. Systematic review of therapy after hypoxic-ischaemic brain injury in the perina-
tal period, Seminars in Neonatology 5(1):33-40,
31. Wilkins PA, Vaala WE, Zivotofsky D et al: A herd outbreak of equine leukoencephalomalacia, Cor-
nell Vet 84(1):53-59, 1994.
32. Young RS, Hessert TR, Pritchard GA et al. 1984. Naloxone exacerbates hypoxic-ischemic brain
injury in the neonatal rat, American Journal of Obstetrics and Gynecology 150(1):52-56.
Fluid Therapy:
33. Bell EF, Acarregui MJ: Restricted versus liberal water intake for preventing morbidity and mortality
in preterm infants. Cochrane Database Syst Rev 2:CD000503, 2000, and 3:CD000503, 2001 (up-
date).
34. Berry LM, Ikegami M, Woods E et al: Postnatal renal adaptation in preterm and term lambs. Reprod
Fertil Dev 1995;7:491-498.
35. Brewer BD, Clement SF, Lotz WS et al: Renal clearance, urinary excretion of endogenous substanc-
es, and urinary diagnostic indices in healthy neonatal foals. J Vet Intern Med 1991;5:28-33.
36. Brewer BD, Clement SF, Lotz WS et al: A comparison of inulin, para-aminohippuric acid, and en-
dogenous creatinine clearances as measures of renal function in neonatal foals. J Vet Intern Med
1990;4:301-305.
37. Cowett RM, Oh W, Pollak A et al: Glucose disposal of low birth weight infants: steady state hyper-
glycemia produced by constant intravenous glucose infusion. Pediatrics 1979;63:389-396.
38. Edwards DJ, Brownlow MA, Hutchins DR: Indices of renal function: values in eight normal foals
from birth to 56 days. Aust Vet J 1990;67:251-254.
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39. Fowden AL, Forhead AJ, White KL et al: Equine uteroplacental metabolism at mid- and late gesta-
tion. Exp Physiol 2000;85: 539-545.
40. Fowden AL, Silver M: Glucose and oxygen metabolism in the fetal foal during late gestation. Am J
Physiol 1995;269:R1455-R1461.
41. Kalhan SC, D’Angelo LJ, Savin SM et al: Glucose production in pregnant women at term gestation:
sources of glucose for human fetus. J Clin Invest 1979;63:388-394.
42. Kalhan SC, Bier DM, Savin SM et al: Estimation of glucose turnover and 13C recycling in the human
newborn by simultaneous [1-13C]glucose and [6,6-1H2]glucose tracers. J Clin Endocrinol Metab
1980;50:456-460.
43. Kawai Y, Arinze IJ: Activation of glycogenolysis in neonatal liver. J Biol Chem 1981;256:853-858.
44. Kavvadia V, Greenough A, Dimitriou G et al: Randomised trial of fluid restriction in ventilated very
low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2000;83:F91-F96.
45. Takata K, Hirano H: Mechanism of glucose transport across the human and rat placental barrier: a
review. Microsc Res Tech 1997;38:145-152.
46. Palmer JE. Fluid therapy in the neonate: not your mother’s fluid space.Vet Clin North Am Equine
Pract. 2004;20:63-75.
47. Park WS, Chang YS, Lee M: Effects of hyperglycemia or hypoglycemia on brain cell membrane
function and energy metabolism during the immediate reoxygenation-reperfusion period after
acute transient global hypoxia-ischemia in the newborn piglet, Brain Res 2001;901:102-108.
48. Russell C, Palmer JE, Boston RC, Wilkins PA. Agreement between point-of-care glucometry, blood
gas and laboratory based measurement of glucose in an equine neonatal intensive care unit. J Vet
Emerg Crit Care 2007;17:236-242.
49. Wilkins PA. Advantages and potential pitfalls of point of care (POC) glucose and lactate monitoring.
In Proceedings American Association of Equine Practitioners Meeting, 2007;53:356-359.
Prognosis:
50. Axon J, Palmer J, Wilkins PA. 1999. Short-term and long-term athletic outcome of neonatal intensive
care unit survivors. Proceedings of the American Association of Equine Practitioners 45:224-225.
51. Bain FT. 1998. Neurologic disorders in foals other than hypoxic-ischemic encephalopathy. Pro-
ceedings of the International Veterinary Emergency Critical Care Symposium, San Antonio, Tex,
pp 691-692.
52. Baker SM, Drummond WH, Lane TJ et al. 1986.Follow-up evaluation of horses after neonatal inten-
sive care. Journal of the American Veterinary Medical Association 189(11):1454-1457.
53. Freeman L, Paradis MR. 1992. Evaluating the effectiveness of equine neonatal intensive care. Vet-
erinary Medicine 87:921-926.
54. Henderson ISF, Franklin RP, Boston RC, Wilkins PA. Association of hyperlactataemia with age,
diagnosis and survival in equine neonates. Journal of Veterinary Emergency and Critical Care Ac-
cepted April 2008.
55. Borchers A, Wilkins PA, Marsh PM, Axon JE, Read J, Castagnetti C, Pantaleon L, Clark C, Qura’n
L, Belgrave R, Trachsel D, Levy M, Bedenice D, Saulez MN, Boston RC. Association of admission
L-lactate concentration in hospitalised equine neonates with presenting complaint, periparturient
events, clinical diagnosis and outcome: a prospective multicentre study. Equine Vet J Suppl. 2012
Feb;44 Suppl 41:57-63.
The Future:
1. Ennen CS, Huisman TA, Savage WJ, Northington FJ, Jennings JM, Everett AD, Graham EM. Glial
fibrillary acidic protein as a biomarker for neonatal hypoxic-ischemic encephalopathy treated with
whole-body cooling. Am J Obstet Gynecol. 2011 Sep;205(3):251
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2. Cheong JL, Coleman L, Hunt RW, Lee KJ, Doyle LW, Inder TE, Jacobs SE; for the Infant Cooling
Evaluation Collaboration. Prognostic Utility of Magnetic Resonance Imaging in Neonatal Hypox-
ic-Ischemic Encephalopathy: Substudy of a Randomized Trial MRI in Neonatal Hypoxic-Ischemic
Encephalopathy. Arch Pediatr Adolesc Med. 2012 Jul 1;166(7):634-640.
3. Guillet R, Edwards AD, Thoresen M, Ferriero DM, Gluckman PD, Whitelaw A, Gunn AJ; CoolCap
Trial Group. Seven- to eight-year follow-up of the CoolCap trial of head cooling for neonatal en-
cephalopathy.Pediatr Res. 2012 Feb;71(2):205-9.
4. Massaro AN, Chang T, Kadom N, Tsuchida T, Scafidi J, Glass P, McCarter R, Baumgart S, Vezina
G, Nelson. KB Biomarkers of Brain Injury in Neonatal Encephalopathy Treated with Hypothermia. J
Pediatr. 2012 Apr 10. [Epub ahead of print]
5. Shankaran S, Barnes PD, Hintz SR, Laptook AR, Zaterka-Baxter KM, McDonald SA, Ehrenkranz
RA, Walsh MC, Tyson JE, Donovan EF, Goldberg RN, Bara R, Das A, Finer NN, Sanchez PJ, Poin-
dexter BB, Van Meurs KP, Carlo WA, Stoll BJ, Duara S, Guillet R, Higgins RD; Brain injury following
trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy. for the Eunice Kennedy Shriv-
er National Institute of Child Health and Human Development Neonatal Research Network. Arch
Dis Child. 2012 Jul 17.
6. Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic
ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc
Med. 2012 Jun 1;166(6):558-66.
Dr. Pamela Wilkins Brief Biosketch 2023

Dr. Pamela Wilkins joined the faculty of the University of Illinois in 2008 after serving on the faculty at the Uni-
versity of Pennsylvania New Bolton Center from 1998 to 2008. She has authored or co-authored more than 90
peer-reviewed scientific articles, 140 scientific abstracts, 250 scientific and clinical meeting proceedings, and
140 book chapters, reviews and editorials. Dr. Wilkins has served as Principle Investigator or Co-Investigator
on more than 45 grants and contracts. She co-edited the textbook ‘Equine Emergency and Critical Care’,
published in 2015 and is currently co-editing ‘Equine Neonatology’ with an estimated publication date in 2023.
She is an Associate editor for Equine Veterinary Education and is Editor for Special Issue of Animals journal
on Equine Neonatology for publication in 2024. Dr. Wilkins has provided more than 350 continuing education
lectures in the United States, Canada, Brazil, England, Ireland, Scotland, Finland, Denmark, Sweden, Germany,
Austria, Italy, France, Czech Republic, Australia and South Africa. She had been honored with the IVECCS
2008 inaugural Equine Educator Award, the 2016 Ira Zaslow Award for Excellence in Service to VECCS, the
2018 World Equine Veterinary Association Boehringer Ingelheim Research Award and the 2019 the T. Douglas
Byars Equine Emergency & Critical Care Educator of the Year Award. Her current research interests include
biomarkers of disease and disease severity and Point-of-Care diagnostic tools.
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Intensive care management under field conditions;

what we really can do?
Pamela A Wilkins, DVM, MS, PhD, DACVIM, DACVECC
Professor Equine Internal Medicine and Emergency/Critical Care
University of Illinois, Champaign-Urbana IL USA
Equine NICUs have greatly improved our knowledge and understanding of the normal and abnormal phys-
iology of the equine neonate, resulting in an improvement in our ability to successfully treat the critically
ill equine neonate and save lives. We have also been able to translate many treatments from the referral
hospital to the field with good success for the practitioner.
The Sick Foal

The kidney is a target for injury in these patients and it is not unusual for renal compromise to play a sig-
nificant role in the demise of these foals. The urine of normal newborn foals is quite dilute, reflecting the
large free water load they incur by their milk diet. Aminoglycoside toxicity occurs in the equine neonate and
will exacerbate or, at the least, complicate the management of renal failure originally due to primary hemo-
dynamic causes. In general sick foals can suffer from a variety of problems associated with abnormalities
within the gastrointestinal tract. Foals with other ailments, peripartum adverse events or failure of passive
transfer of maternal immunity (FPT) are also susceptible to secondary infection. Treatment of recognized
infection is necessary and antimicrobial treatment should be broad-spectrum. Any acute deterioration in
the condition of a compromised foal indicates a need for further evaluation for possible sepsis.
Practical Solutions to Common Problems of the Foal

The equine practitioner may be faced with management of fairly ill neonatal foals without access to referral
facilities, either due to location or financial restriction placed by the owner. The following are some suggest-
ed solutions to problems that may be encountered by the practitioner under these conditions.
Long-term Intravenous Access:

In these cases, placement of ‘over the wire catheters’ provides the best solution. The catheters are generally
made of non-thrombogenic materials and are more pliable, making them less likely to clot or to break Place-
ment of these catheters is more challenging than over the needle catheters, but with practice placement
becomes straightforward.
Catheterization is performed most readily in recumbent foals but can be performed in standing foals. Hav-
ing sufficient help available is important, as good restraint of the patient is necessary. If help is not readily
available, small doses of diazepam (2-5 mg per foal, IV) can make the process easier. Xylazine should be
avoided in very young foals as it can cause transient hypertension. Catheters should be sutured in place.
These catheters should be flushed at least 4 times daily. There is generally no need to place a bandage or
any other type of protection over the catheters.
Tube feeding:
Foals able to tolerate enteral feeding but too weak to suck properly from the mare, or any foal without the
ability to suck, may benefit from placement of a long-term enteral feeding tube. The tubes are well tolerated
by foals and they can learn to suck from the dam around themFeeding should always be performed under
gravity flow only. It is ideal to pass a large bore nasogastric tube to check for reflux before placing these
tubes as a foal with significant gastric fluid accumulation, or blood tinged gastric fluid, should not be fed
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enterally until this is resolved. Feeding should initially aim at providing milk or milk replaced at about 10%
of the foal’s body weight per day. This is divided into 12 feedings given at 2 hour intervals. Once the feed is
administered the tube should be flushed with a small volume of water ad recapped. Foals should be stand-
ing or in sternal recumbency during the feeding and should remain in that position for at least 5 minutes
once feeding is completed.
Fluid Therapy in the Field:

Fluid therapy should be conservative during postpartum resuscitation, as the newborn foal is generally not
volume depleted unless excessive bleeding has occurred. If intravenous fluids are required for resuscitation
administration of 20 ml/kg of a non–glucose-containing polyionic isotonic fluid over 20 minutes (about 1 L
for a 50-kg foal), The foal should be reassessed after the initial bolus and additional boluses, up to 2, admin-
istered as necessary. These same indications should be used when administering ‘shock bolus’ treatment
to neonates with other conditions requiring fluid resuscitation, such as sepsis. In practice, fluid boluses are
frequently used as maintenance of intravenous lines can be challenging, particularly if the foal remains in a
stall with the mare.
Nursing Care:
Nursing care is one of the most important aspects of treating recumbent foals. Foals should be kept warm
and dry. They should be turned at two-hour intervals if they are recumbent. Feeding recumbent and min-
imally responsive foals can be a challenge if gastrointestinal function is abnormal and total parenteral nu-
trition may be needed. Recumbent foals must be examined frequently for decubital sore development, the
appearance of corneal ulcers and for heat and swelling associated with joints and physis.
Umbilical Care
A chlorhexadine or dilute betadine solution is applied to the external stump twice daily for the first 3 days
after birth. Recumbent foals are at increased risk of developing patent urachus or umbilical infection.
Eye care
Recumbent foals are at increased risk of developing corneal ulcers. Artificial tears/lubricant/triple antibiotic
ointment should be placed by placing the ointments on a gloved finger and applying to a rolled out lower
lid every 6 to 12 hours in foals with decreased eyelid tone and tear production.
Temperature Control
Premature foals have poor thermoregulation. Hypothermic foals should be gradually warmed with a com-
bination of water bottles, blankets, heated water mats, air blankets, and heat lamps, ensuring scalding and
secondary burning of the underlying skin does not occur. Hyperthermic foals can be cooled with cold water
and alcohol baths, and fans. NEVER FEED A COLD FOAL!
Prognosis:
The prognosis for most sick foals is good to excellent when it is recognized early and aggressively treated
in term foals.
References Available upon Request
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Foal pneumonia: Rhodococcus equi and more

Foals develop multiple forms of pneumonia. Differential diagnoses will vary based on clinical signs and age
of the foal. As with adult horses, culture and cytology of the tracheal fluid is required to obtain a definitive
diagnosis.
Clinical signs
Clinical signs of pneumonia may not be too prominent until disease is severe or may be masked by clinical
signs of the primary condition (i.e. sepsis). Fever, lethargy, tachypnea, nostril flaring, increased abdominal
respiratory effort, purulent bilateral nasal discharge and cough may be present. Sudden death is not un-
common with severe disease.
Young foals:
Pneumonia associated with sepsis

• The most common organisms isolated are Gram negative enteric bacteria (E. coli, Klebsiella spp,
Actinobacillus equuli, etc.) or Streptococcus zooepidemicus.
• Predisposing factors: Placentitis, failure of passive transfer, prematurity, etc.
• Severe disease develops rapidly.
• Route of infection may be vertical (in utero), hematogenous (umbilical infection, ingestion, and
absorption of bacteria) or respiratory.
• Treat the underlying disease. Systemic broad-spectrum antibiotics to treat sepsis. Adjust as soon
as sensitivity is available.
EHIV-1 pneumonia
• EHV-1 infection of a mare around foaling time may lead to the birth of a weak.
• The time of foal infection remains unknown.
• Foals develop severe, progressive pneumonia that may be complicated by secondary bacterial
infection.
• Foals typically die within 2 weeks in spite of critical care; thus prognosis is poor. There might be
a history of respiratory clinical signs in the farm or abortions associated with the birth of these
affected foals.
Pneumocystis carinii
• Affects immunosuppressed foals (co-infection with other organisms, malnutrition, etc.). Causes
interstitial pneumonia.
• Cytology definitive: Macrophage with P. carinii organism inside. Radiographs may show a distinct
military pattern.
• Treatment (based on humans) is trimethoprim sulfa (TMS). Correction of underlying cause of im-
munosuppression if possible.
Adenovirus
• Adenovirus can be present in horses and result in subclinical or mild upper respiratory tract dis-
ease that resolves uneventfully.
• It causes progressive, fatal bronchopneumonia in Arabian foals that have severe combined immu-
nodeficiency disease (SCID).
• The clinical sings are of those of pneumonia accompanied by lymphopenia (if SCID) and neutrope-
nia (immunosuppression). The virus replicates in the respiratory epithelium.
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Diagnosis
• Auscultation can be misleading: May be normal even if disease is severe.
• If patient is stable: transtracheal wash and submit fluid for culture/sensitivity and cytology.
• Thoracic radiographs: Helps with assessment of disease severity.
• Ultrasound: Widely available, easy to do. Limited to the surface of the lung unless consolidation/
abscessation is present.
• Hematology: Non-specific inflammatory findings
Treatment
• Varies with the condition (see above) but in many cases, treatment is instituted using broad spec-
trum antibiotics until results from culture-sensitivity are available.
• Intranasal oxygen: For critical patients.
• Anti-inflammatories: Ensure patient is hydrated before using.
• Bronchodilators: Evaluate case by case as it may cause a ventilation-perfusion mismatch.
• Rest
Pneumonia in older foals
Atypical interstitial pneumonia
• Sporadic, rapidly progressive bronchointersitial pneumonia that leads to respiratory failure and
death.
• Foals 1-6 months of age.
• The cause is unknown in most cases, but the thought is that is triggered by a pathogen.
• Clinical signs develop fast.
• Diagnosis depends on ruling out other conditions.
• Diagnostics are limited because of the degree of respiratory distress.
• Thoracic radiographs: Caudodorsal interstitial and bronchointerstitial pattern.
• If patient is stable, perform a TTW for culture/cytology.
• Combination of systemic and inhaled corticosteroids and bronchodilators. Broad spectrum anti-
biotics are recommended until diagnosis is confirmed. Intranasal oxygen is useful until the clinical
signs subside.
Rhodococcus equi
• Bacteria must carry the Virulence-associated plasmid gene (vapA) that encodes for the VapA pro-
tein to be pathogenic. VapA- strains are not pathogenic.
• Sporadic or endemic in farms.
• Present in normal adult’s horse feces (and other mammals).
• Affects young foals: Appear to be susceptible to infection first few weeks of life only.
• Affects adults if immunosuppressed.
• Risk of zoonosis if person immunosuppressed.
• Foals ingest R. equi and it replicates in the intestine: May also cause colitis and diarrhea.
• Inhaled into the lower airways. Bacteria replicates in the alveolar macrophage and leads to granu-
lomas and abscessation.
• Typically cause slow progressive disease but sudden death has been reported. Clinical signs seen
2-4 months of age.
• Definitive diagnosis is made by TTW. Perform only if foal is not in respiratory distress. Fluid sample
for cytology and culture. PCR for the vapA gene.
• Thoracic ultrasonography: Abscesses located on the surface of the lung, useful for presumptive
diagnosis.
• Radiographs: Pulmonary abscessation. Presumptive diagnosis.
• Hematology: Non-specific chronic infection: Mature neutrophilia, monocytosis, thrombocytosis,
mild anemia, increased fibrinogen, and globulins.
• Treatment: Combination of macrolide with rifampin.
• Rifampin (5mg PO q12h): Urine discoloration (orange) is common, warn the owner.
• Macrolides: Induce fatal hyperthermia because they prevent sweating: Keep foals inside in cool
area.
• Azithromycin (10mg/kg PO q24h for 5 days, thereafter eod) or clarithromycin (7.5mg/kg PO
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q12h) are the most used. Erythromycin old treatment (25mg/kg PO q6h). Clarithromycin re-
ported to be the best.
• A combination of doxycycline (10mg/kg PO q12h) and rifampin can be used in case of diarrhea.
• Intranasal oxygen if needed. Other supportive care and rest
Other bacterial pneumonia: Foals can be affected by the same bacteria than adult horses. Clinical
sings are those described above. Definitive diagnosis is made by cytology and culture of TTW sample.
Parasitic pneumonia:
• Parascaris equorum (“ascarids”).
• Parasite’s life cycle includes a migratory phase in the lung: Weanling and yearlings. Adult horses (>
18m) don’t develop pneumonia.
• Clinical sings are mild. Thick, bilateral purulent nasal discharge that improves as they age (and get
dewormed). Cough is not uncommon.
• Signs of parasitism, such as poor body condition, rough haircoat may also be present.
• Can affect multiple foals at once because of the timing of the parasite cycle.
• Cytological evaluation of TTW may reveal an eosinophilic reaction or larvae.
• No antibiotics are usually needed.
References
1. Reuss SM, Cohen ND. Update on bacterial pneumonia in the foal and weanling. Veterianry clinics:
equine practice, Volume 31(1), 2015
2. Bordin A, Huber L, Sanz MG, Cohen ND. Rhodococcus equi pneumonia: Update on epidemiology,
immunity, treatment, and prevention. Equine Veterinary Journal, 2022
3. Punsmann S, Hoppe J, Klopfleisch R, Venner M. Acute interstitial pneumonia in foals: A severe,
multifactorial syndrome with lung tissue recovery in surviving foals. Equine Veterinary Journal,
2021, 53:718-726
Animal Internal Medicine Residency and a Master’s of Science degree at Washington State University and she
is a Diplomate of the ACVIM College. She also completed a PhD in equine immunology at the Gluck Equine
Research Center; her research focuses in equine immunology and infectious diseases. She worked as a Se-
nior Lecturer in Equine Medicine at the Onderstepoort Veterinary School in South Africa for 3 years. Dr. Sanz
is an Associate Professor in Equine Medicine at Washington State University in the US.
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Gastrointestinal Disorders of Neonatal Foals

Pamela A Wilkins, DVM, MS, PhD, DACVIM, DACVECC
Professor Equine Internal Medicine and Emergency/Critical Care
University of Illinois, Champaign-Urbana IL USA
Colic in the foal can be difficult to diagnose accurately because one cannot perform an examination per rec-
tum. However, many diagnostic aids, most importantly ultrasonography, are available to help differentiate
medical from surgical causes of abdominal discomfort in the foal.
Obstruction
Intestinal accidents of all types described in adult horses, with the possible exception of enteroliths, occur
in foals. Intussusception, volvulus, displacement, diaphragmatic hernia, and intra- and extraluminal ob-
struction have been reported in foals.Abdominal ultrasonographic and radiographic evaluation greatly aids
diagnosis. Treatment is primarily surgical.
Meconium Retention/Impaction
Meconium retention or impaction is a common cause of abdominal discomfort in newborn foals. Most foals
defecate shortly after their first meal. The usual practice for most owners or veterinarians attending the birth
of a foal is to administer an enema to aid this process. The best enema is warm soapy water made with a
mild soap such as liquid Ivory soap that can be administered through soft rubber tubing using gravity flow.
Foals with significant meconium retention become colicky within the first few hours of life as gas accumu-
lates within the bowel. Additional diagnostics can include abdominal ultrasonography and radiography,
particularly if one must rule out other, more serious types of colic. One can treat persistent meconium
retention resulting in significant abdominal distention by muzzling the foal administering intravenous fluids.
Trocharization for the relief of gas can be quite effective and the author uses this approached commonly
in severe cases where pain management is difficult. Most cases resolve with medical management and
trocharization alone within 12 to 24 hours.
Z
Congenital Defects
Atresia within the gastrointestinal system of the foal occurs infrequently, but clinical signs are character-
istic. Acute colic occurs within the first few hours and is accompanied by abdominal distention similar to
meconium retention. Antemortem diagnosis of atresia, short of abdominal exploratory surgery, is aided
by the lack of meconium staining of the rectum or any administered enema fluids. Additional diagnostic
tests may include administration of a barium enema for a radiographic study, colonoscopy, and abdominal
ultrasonography. One can make affected foals more comfortable by muzzling them to prevent further milk
intake and by supplying them with fluids and nutrition intravenously. If one attempts surgical correction, one
first should initiate broad-spectrum antimicrobial therapy and determine passive transfer status. Frequently,
these foals are hypoxemic because of the abdominal distention, and oxygen supplementation is desirable.
Lethal White Syndrome

Solid white foals born to overo-overo mating of American Paint Horses may suffer from congential agan-
glionosis of the ileum, cecum, and colon. These foals present similarly to foals with meconium impaction or
atresia in that colic develops shortly after birth and involves progressive abdominal distention with feed-
ing. The inherited defect is in the endothelin receptor gene. No effective treatment exists, but the clinician
should be aware that not all white foals of this mating are affected, and some simply may have meconium
retention, so a short period of treatment may be warranted.
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Necrotizing Enterocolitis
Necrotizing enterocolitis is considered the most common acquired gastrointestinal emergency of human
infants.The clinical spectrum of necrotizing enterocolitis is multifactoral and ranges from temperature in-
stability, apnea, lethargy, abdominal distention, bilious residuals, septic shock, disseminated intravascular
coagulation, and death. In the neonatal foal, necrotizing enterocolitis is probably one of the most under-
recognized causes of gastrointestinal dysfunction and in the past has been attributed only to infection with
anaerobic organisms including Clostridium perfringens type C and C. difficile. Although a specific form of
enteritis in the foal is associated with intestinal infection by these organisms, most necrotizing enterocolitis
is associated with prematurity or PAS in the infant and the foal. One should suspect necrotizing enterocolitis
in any foal that is having difficulty tolerating oral feeding, demonstrating signs of ileus, or having episodes of
colic and in any foal with occult blood, digested blood or frank blood in the stool or reflux.
Gastric Ulcers
Gastric ulcer disease has been recognized in foals, and lesions vary in anatomic distribution, severity, and
cause. In clinically normal neonatal foals (<30 days of age), gastric ulcers and mucosal desquamation have
been documented. Because of these reports and other early reports of death following ruptured clinically
silent ulcers in neonatal foals, for years many clinicians felt it necessary to treat critically ill neonates with
antiulcer medication prophylactically. Few specific causes have been found for gastric ulcer disease in
foals. Excessive administration of nonsteroidal anti-inflammatory drugs can result in ulceration of the glan-
dular and squamous epithelium because of an inhibition of prostaglandin production, which leads to a
decrease in mucosal blood flow and an increase in acid production. Nonsteroidal anti-inflammatory drugs
also can impair the healing of lesions and rarely are indicated in neonatal equine medicine. In the sick neo-
natal foal (<7 days of age) a wide variability in the intragastric pH has been documented depending on the
type of disease, severity, and milk intake frequency and volume, suggesting that in the critically ill equine
neonate, ulcer prophylaxis using histamine antagonists or proton pump inhibitors is not only unnecessary
but unlikely to work.
Clinically significant gastric ulcers can occur in the squamous, glandular, or both portions of the stomach as
a primary problem or resulting from another problem. Clinical signs include diarrhea, abdominal pain, rest-
lessness, rolling, lying in dorsal recumbency, excessive salivation, and bruxism. In the neonatal foal the only
clinical signs present may be depression or partial anorexia until a more catastrophic event, such as perfo-
ration, occurs. The presence of a brown gastric reflux fluid may indicate the presence of bleeding ulcers or
necrotizing enterocolitis. Blood in the feces of the neonate is more consistent with a diagnosis of necrotizing
enterocolitis, which can be associated with gastric ulcers. Traditional therapy for gastric ulceration includes
mucosal adherents, histamine type 2 receptor antagonists, proton pump inhibitors, and antacids.
References Available Upon Request
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Session 16
Anesthesia in the field. What is possible?

Martin Suarez DVM, MS
Assistant Professor Anesthesiology
College of Veterinary Medicine
Washington State University
Equine anesthesia has always been associated with greater patient risk compared to other common do-
mestic species. Understanding of the unique factors associated with equine anesthesia compared to other
species is the first step in improving patient safety. The risk of anesthetic mortality is greater in equine
species than other domestic animals. Studies have reported rates between 0.24% and 1.6% for horses
compared to dogs (0.05%) and cats (0.11%).
General considerations
Inducing recumbency in horses from the standing position can be dangerous. To minimize the risk, ap-
propriate sedation and muscle relaxation should be administered prior to induction. Size is a factor in
determining peripheral (skeletal muscle) perfusion. The risk of postanesthetic neuropathy and myopathy
is higher in equine patients, particularly draft and large warmblood breeds. The goal for most adult horses
should be to maintain a mean arterial blood pressure above 70–80 mmHg. Appropriate padding is always
recommended but not always possible during field anesthesia. Recumbency can also lead to Ventilation/
perfusion mismatch which is more remarkable on the equine patient.
Pre-operative considerations
Some factors like age, type of surgical procedure, drug choice, and duration of anesthesia can increase the
mortality risk of the anesthesia. To prevent complications during anesthesia, every patient should have a
complete physical exam performed prior to induction. The physical exam should be focused in the cardio-
vascular and respiratory systems. It is also important to obtain a complete medical history of each patient.
Whenever possible, pre-operative blood work should be submitted to evaluate overall health of the patient.
Fasting of solids for 8hr prior anesthesia has been suggested to prevent distension of the abdomen that
causes hypoxia. Another important point is to thoroughly flush the oral cavity of the horse prior to induction
to minimize the risk of bacterial contamination of the lower airway during the endotracheal tube placement.
Field anesthesia
Total intravenous anesthesia (TIVA) a technique of general anesthesia that is performed using a combina-
tion of agents given solely by the intravenous route. TIVA is probably the most practical way to anesthetize
horses on field conditions. A key point is the lack of need for an anesthetic machine which makes the use of
TIVA very applicable to field anesthesia. In general, there is better cardiovascular function and a smoother
recovery because horses undergoing TIVA anesthesia are not exposed to inhalant gases. Some potential
disadvantages of this technique include drug accumulation in the animal’s system and whenever prolonged
infusions are used, a build-up of active metabolites may occur. In addition, this technique is not suitable for
prolonged anesthesias.
The ideal drugs selected for TIVA should have pharmacokinetic properties that are not cumulative when
infused into horses for prolonged periods. Unfortunately, the ideal injectable anesthetic drug does not exist,
and a combination of multiple drugs is often necessary.
Usually, the are two methods of drug administration. Intermittent administration (top-ups) of injectable
anesthetics can lead to a variable depth of anesthesia due significant changes in the plasma concentration
being outside of the therapeutic range. The result is an inadequate depth of anesthesia.
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To minimize variation within plasma concentrations a continuous administration (CRI-constant rate infu-
sion) of a drug usually results in a more stable plasma concentration.
Common protocols for providing anesthesia to horses under field conditions include combinations of ket-
amine and an α2-adrenergic receptor agonist. The combination of guaifenesin, ketamine, and xylazine (of-
ten referred to as ‘triple drip’) has been described when intravenous maintenance of anesthesia is needed
for 1 hr approximately procedures. Commonly used TIVA protocols in equine practice.
Sedation dose (IV) Induction dose (IV) (mg/kg) Maintenance

(mg/kg)
α2 agonist Ketamine
Ketamine (2.0–2.5)
Re‐dosing:
±
Xylazine 1.0–1.5
Diazepam/midazolam ⅓‐½ of initial dose of xylazine and ketamine every 10 minutes.
(0.02–0.1)
Detomidine 0.01–0.02
Ketamine (2.0–2.5) Re‐dosing:
or
Romifidine ± ⅓‐½ of initial dose ketamine every 10 minutes.

0.08–0.12 Diazepam/midazolam (0.02–0.1 ⅓‐½ of initial dose α2 agonist every 15–20 minutes.
2 agonist + Ketamine + Guaifenesin (Triple Drip)
Xylazine 1.0–1.5
or
Guaifenesin (5%), 0.5–1 L. Ketamine (2 g).
Detomidine 0.01–0.02 Ketamine (2.2)
Xylazine (500 mg)/or Detomidine (20 mg)/or Romifidine (50 mg).
or ±
Infuse at a rate of ~2–3 mL/kg/hr.
Romifidine Diazepam/midazolam (0.02–0.1)
Dose rate needs to be adjusted to effect over time.
0.08–0.12
Monitoring
Intubation and availability of supplemental oxygen are prudent during triple drip anesthesia. Respiratory
depression and bradycardia may occur during administration of triple drip, hence respiration and heart rate
should be monitoring closely during anesthesia. Monitoring consciousness and the depth of anesthesia is
the key to a safe anesthetic practice. Monitoring depth of anesthesia, respiratory rate, mucous membrane
color and perfusion time, and arterial blood pressure is of particular importance. Monitoring of the pulse
should be performed at regular intervals. This is easily achieved by palpating the transverse facial artery
(located in proximity of the zygomatich arch) or the facial artery (as it turns around the mandibular bone).
Heart rate is easily determined with a stethoscope, but stroke volume is not easily obtained under field
conditions.
Non-invasive arterial blood pressure determination is easily accomplished in the field with the development
of hand-held pressure monitors. A better, more accurate method is the use of doppler-ultrasonic, also an
easy and practical method for the determination of blood pressure. The doppler crystal can be placed over
the coccygeal artery. A cuff is placed around an extremity of the tail. The cuff is inflated to a preset pressure
that excess the systolic arterial pressure and then slowly released. The pressure at which the audible flow
signal returns it is considered the systolic blood pressure. Normal systolic blood pressure values in an anes-
thetized horse range from 90-120 mmHg.
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Respiratory rate should be closely monitored in the anesthetized patient. The normal respiratory rate of a
anesthetized adult horses ranges between 5 and 15 breaths/min. Abnormalities such as obstruction, apnea
or an increase in rate should be corrected immediately. Signs of a light anesthesia plane include an increase
in respiratory rate and depth and increased activity of the eyeball. During a light anesthesia plane the effect
of the alpha two agonists may make not significant changes in heart rate.
Horses undergoing TIVA using ketamine will appear lightly anesthetized, often with a brisk palpebral reflex,
occasional nystagmus, swallowing, and lacrimation.
Recovery
The quality of the recovery is negatively correlated with the duration of anesthesia.Usually when TIVA last
less than 60 minutes the recovery is generally smooth and predictable. Prolonged infusions lead to accu-
mulation of drugs, longer times to recovery, and a less predictable course of achieving the standing position.
References
1: Lumb and Jones. Veterinary Anesthesia and Analgesia: Edition 5.
2: Muir and Hubell. Equine Anesthesia: Monitoring and Emergency Therapy, Edition 2.
3: Doherty. Manual of Equine Anesthesia and Analgesia, Edition 2.
Martín Suarez, DVM

Graduated in the year 2003 DVM, University of La Plata, College of Veterinary Medicine, Buenos Aires, Ar-
gentina.
Master’s of Science - University of Pretoria, South Africa. “ Total Intravenous Anesthesia”
Anesthesia Residency, College of Veterinary Medicine, University of Tennessee, USA.
CURRENT POSITION: Anesthesia clinical instructor, College of Veterinary Medicine, Washington State Uni-
versity.
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Balanced Anaesthesia
Luís Filipe Louro
EBVS® European Specialist in Veterinary Anaesthesia and Analgesia
RCVS Specialist in Veterinary Anaesthesia and Analgesia
DVM MSc PGCertVPS CertAVP(EL) CertAVP(VA) DipECVAA FHEA MRCVS
Veterinary Anaesthesia Consultancy Services
CVS UK Ltd
Liverpool, United Kingdom
In the context of maintenance of general anaesthesia using volatile anaesthetic agents, reducing their con-
centration in the anaesthetic circuit stands as a key principle to prevent and manage cardiopulmonary de-
pression. However, contemporary volatile anaesthetics lack analgesic properties, making it challenging to
decrease their concentration in the anaesthetic circuit during general anaesthesia maintenance, especially
in painful procedures. Insufficient intra-operative analgesia can lead to intra-operative nociception, poor
recovery quality from general anaesthesia and post-operative pain. To address this challenge, incorporat-
ing supplementary systemic anaesthetics/analgesics can effectively reduce the dependence on volatile
anaesthetics. This approach, known as balanced anaesthesia, not only mitigates the reliance on volatile
anaesthetics but may also improve cardiovascular function, quality of recovery from general anaesthesia
and intra- and post-operative pain management.
As already mention, balanced anaesthesia involves administering a combination of anaesthetic and analge-
sic agents to achieve the desired depth of anaesthesia and appropriate analgesia while minimising adverse
effects of individual drugs. This strategy aims to attain the anaesthesia triad: hypnosis, analgesia, and mus-
cle relaxation, all while ensuring that proper cardiorespiratory function is maintained (Bettschart-Wolfens-
berger & Larenza, 2007).
In the domain of equine anaesthesia, balanced anaesthesia protocols commonly entail the administration
of both volatile and injectable anaesthetics and/or analgesic agents during the maintenance phase. This is
also referred to as partial intravenous anaesthesia (PIVA). While balanced anaesthesia facilitates a lighter
plane of anaesthesia due to the analgesic and relaxation properties of injectable agents, it can potentially
increase the risk of awareness, a phenomenon hard to ascertain in veterinary patients.
PIVA has gained popularity among equine anaesthetists, as evidenced by the increasing number of related
publications. Preliminary findings from the latest Confidential Enquiry into Perioperative Equine Fatalities
(CEPEF-4) show a trend towards using volatile anaesthetics in combination with intravenous constant
rate infusions (CRI) for PIVA. Among 6,000 inhalant-based general anaesthetics, 3,718 utilised PIVA (62%),
compared to 2,282 (38%) using pure inhalation anaesthesia (Gozalo-Marcilla et al., 2021). Common drugs
administered during PIVA protocols in horses include lidocaine, ketamine, opioids, and α2-adrenoceptor
agonists (Gozalo-Marcilla et al., 2014, 2015).
Systemic lidocaine administration offers intraoperative analgesia and dose-dependent reduction in volatile
agent requirements. Noted adverse responses to monitor for include central nervous system (CNS) toxicity,
which can lead to ataxia during the recovery phase. Ketamine, administered at sub-anaesthetic intrave-
nous doses, provides analgesia and decreases anaesthetic requirements, albeit requiring caution to avoid
excitement during recovery due to accumulation of norketamine. Systemic full μ-opioids are justifiable for
analgesia, despite debates about their inconsistent minimum alveolar concentration reduction and poten-
tial side effects. These days, α2-adrenoceptor agonists have gained significant popularity across diverse
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clinical contexts and have largely supplanted lidocaine, ketamine and opioids in PIVA protocols used to
anaesthetise healthy patients undergoing routine surgical procedures. This shift can be credited to their
notable contribution to better recovery quality from general anaesthesia. While cardiovascular effects of
these agents raise concerns, appropriate CRI dose rates of short-acting drugs like xylazine, medetomidine,
and dexmedetomidine can mitigate risks.
This presentation aims to critically review existing literature, discussing the rationale and constraints of bal-
anced anaesthesia in horses, stimulating discussion on PIVA recommendations for equine patients.
Bibliography:
1. Bettschart-Wolfensberger, R., & Larenza, M. P. (2007). Balanced Anesthesia in the Equine. Clinical
Techniques in Equine Practice, 6(2), 104–110. https://doi.org/10.1053/j.ctep.2007.05.002
2. Gozalo-Marcilla, M., Bettschart-Wolfensberger, R., Johnston, M., Taylor, P. M., & Redondo, J. I. (2021).
Data collection for the fourth multicentre confidential enquiry of perioperative fatalities (Cepef4)
study: New technology and preliminary results. Animals, 11(9), 2549. https://doi.org/10.3390/
ANI11092549/S1
3. Gozalo-Marcilla, M., Gasthuys, F., & Schauvliege, S. (2014). Partial intravenous anaesthesia in the
horse: A review of intravenous agents used to supplement equine inhalation anaesthesia: Part 1:
Lidocaine and ketamine. In Veterinary Anaesthesia and Analgesia (Vol. 41, Issue 4, pp. 335–345).
Blackwell Publishing Ltd. https://doi.org/10.1111/vaa.12179
4. Gozalo-Marcilla, M., Gasthuys, F., & Schauvliege, S. (2015). Partial intravenous anaesthesia in the
horse: A review of intravenous agents used to supplement equine inhalation anaesthesia: Part 2:
Opioids and alpha-2 adrenoceptor agonists. Veterinary Anaesthesia and Analgesia, 42(1), 1–16.
https://doi.org/10.1111/vaa.12196
Luís Filipe Louro graduated from Vasco da Gama University in Portugal. After several years working in first
opinion and referral equine practice, Luís completed a 3-year residency programme in Veterinary Anaesthesia
and Analgesia at the University of Liverpool. Subsequently, Luís joined Rossdales Equine Hospital and in the
same year became a Diplomate of the European College of Anaesthesia and Analgesia. Currently, Luís works
for CVS Referrals Division and Veterinary Anaesthesia Consultancy Services providing Equine Anaesthesia
and Analgesia consultancy in various equine hospitals in the UK, Ireland and France. A keen clinical research-
er, Luís’ interests include foal anaesthesia, pain management and recovery quality in horses.
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Anesthetic management of foals during common

surgical procedures.
Martin Suarez DVM, MS
Assistant Professor Anesthesiology
College of Veterinary Medicine
Washington State University
The neonatal period is generally classified as the first four weeks of life and is a period of very rapid phys-
iologic change and adaptation, particularly in the cardiovascular, respiratory, immune, and neurologic sys-
tems. Foals younger than 1 month have an increased risk of anesthetic-related death (seven times higher
than that of an adult horse) and complications. At 1 to 4 months of age the risk level decrease but there
is still immature anatomy. Common procedures that require anesthesia include angular limb deformities,
abdominal surgery, endoscopy, umbilical hernia, ribs fractures, umbilical infections, etc. General anesthetic
considerations will be mentioned.
Respiratory system of the neonatal foal

Pulmonary changes occur during the first few hours but the most important changes to the adult circula-
tory system take 48–72 hours. Expansion of the lungs results in increased pulmonary blood flow, closure of
foramen ovale, and closure of the ductus arteriosus.
Foals have an increased respiratory rate in comparison with adult horses and the chest wall compliance is
greater too. PaO2 values are low (75 mmHg) by 4 h after birth. However, adult values are not achieved for
about 7 days. PaCO2 values are 50 mmHg in the first hour of life and decrease thereafter. Hypoxia (oxygen
saturation <95%), hypercapnia, and acidosis may be common in these patients under anesthesia. The ad-
ministration of oxygen is always recommended.
Cardiovascular system
Foals have a higher average heart rate and a lower MAP compared with adult horses. Contractility of the
heart ventricular compliance are limited. Adequate heart rate is important to maintain cardiac output and
blood pressure when a patient is under general anesthesia. The sympathetic system and baroreceptors are
also immature.
Thermoregulation
Neonatal foals are prone to heat loss under general anesthesia because of a lack of involuntary muscle
activity (e.g., shivering) caused by the anesthesia. The attempting to thermo-regulate also contribute to the
development of hypoglycemia and increase in oxygen consumption.
Fasting
It is unclear whether this is beneficial. In general, the neonatal foal should be allowed to suck up to the time
of anesthesia induction. Older foals, on solid food, may have food withheld from 4–6 hours.
Sedation
The mare and foal if possible, should be kept together as long as the foal is conscious to avoid fear. Mares
could also be sedated if necessary. Foals are very needle-shy and it is easy to accidentally hit the carotid ar-
tery while attempting jugular puncture. Intradermal or subcutaneous local anesthesia makes jugular cath-
eterization easier, and IM sedation in older foals can be useful. To prevent hypothermia and hypoglycemia,
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avoid keeping the neonatal foal sedated for long periods. Diazepam/midazolam 0.05–0.1 mg/kg, IV, can be
used. Alpha2 agonists should be used with caution (low doses to effect e.g., xylazine 0.2 – 0.5 mg/kg) in the
very young. If possible, avoid the use of alpha 2 agonists in foals less than a week of age.
Induction
Ketamine (2–3 mg/kg, IV) with diazepam/midazolam (0.1 - 0.2 mg/kg IV) given slowly to effect ± a low-dose
α2 agonist (depending on physical status and age).
Propofol (4 mg/kg, IV) given slowly to effect with or without prior sedation with a benzodiazepine.
Maintenance Agents
For short procedures (<30 minutes), maintenance of anesthesia may be provided with additional doses of
injectable anesthetics such as propofol. Oxygen/ventilatory support may be necessary due to the respi-
ratory depressant effects of the drugs combined with the foal’s physiologic immaturity. For major surgical
procedures or the need for prolonged anesthesia (>30 minutes), inhalant anesthetics isoflurane and sevo-
flurane are the mainstay. This requires tracheal intubation and the use of an anesthesia machine.
Analgesia
As part of a balanced anesthesia the administration of infusions or boluses of ketamine, lidocaine, α2 ago-
nists, and/or opioids as adjuncts to inhalational anesthesia, it is always appropriate. Butorphanol is the most
used opioid analgesic in horses. Foals, unlike adult horses, do not exhibit behavior effects when adminis-
tered butorphanol, and neonatal foals become sedate. For analgesia, foals seem to need higher doses of
butorphanol than do adults. In foals aged from 1 to 8 weeks, a butorphanol dose of 0.1 mg/kg, IV provided
150 minutes of analgesia in a thermal model of nociception. A dose of 0.05 mg/kg, IV was not associated
with analgesia. The pure mu agonists, morphine and methadone, may be used at adult doses; thus, it would
seem reasonable to assume that hydromorphone can also be used in foals at adult doses. However, PK/
PD data on these drugs are limited in foals. Morphine (0.05–0.1 mg/kg, IV, IM). Methadone (0.05–0.1 mg/kg,
IV, IM). Hydromorphone (0.02–0.04 mg/kg, IV, IM). NSAIDs dosing interval may be longer in foals than in
adults. Flunixin in neonatal foals, dosages of 1.1 mg/kg, IV q 24–36 hours seem to be safe. For meloxicam a
dose of 0.6 mg/kg, IV or orally q12–24 hours have been recommended.
Considerations for monitoring

• The electrocardiogram (ECG) should be displayed, and arterial blood pressure should be mea-
sured in all but the shortest anesthetic events. Blood pressure can be measured using non-invasive
or invasive methods; however, the latter are more desirable and give a beat-to-beat display.
• A lower mean blood pressure (50 mmHg) appears to be acceptable in the neonate.
• Cardiac output is heart-rate dependent in foals; therefore, bradycardia (<50 beats/min) is generally
unacceptable. Hypotension during anesthesia may be related to vasodilation, hypovolemia, brady-
cardia, and/or decreased contractility (decreased stroke volume). Treatment aimed at hypotension
should be directed at an identified underlying cause.
• Ensure an adequate PaO2.
• Maintain body temperature and normal blood glucose.
• Mechanical ventilation is commonly employed in anesthetized neonatal foals to maintain the

PECO2 in the normal range (35–45 mmHg). Tidal volumes are in the range 6–8 ml/kg. A respira-
tory rate of 12–25/minute is usually employed. The airway pressure should not exceed 12 cm H2O.
Recovery
Foals should be kept warm in recovery, and excess moisture on the foal’s coat should be removed (e.g. with
a hair dryer). Most foals can be hand recovered without problem. A portable SpO2 monitor applied to the
tongue can be used to monitor hemoglobin saturation with oxygen.
References
1: Lumb and Jones. Veterinary Anesthesia and Analgesia: Edition 5.
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2: Muir and Hubell. Equine Anesthesia: Monitoring and Emergency Therapy, Edition 2.
3: Doherty. Manual of Equine Anesthesia and Analgesia, Edition 2.
4: Equine Anesthesia and Co-Existing Disease – Edition 1.
Martín Suarez, DVM

Graduated in the year 2003 DVM, University of La Plata, College of Veterinary Medicine, Buenos Aires, Ar-
gentina.
Master’s of Science - University of Pretoria, South Africa. “ Total Intravenous Anesthesia”
Anesthesia Residency, College of Veterinary Medicine, University of Tennessee, USA.
CURRENT POSITION: Anesthesia clinical instructor, College of Veterinary Medicine, Washington State Uni-
versity.
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Post-operative analgesia
Luís Filipe Louro
CVS UK Ltd

In recent decades, significant advancements have taken place in modern equine anaesthesia, medicine
and surgery, leading to highly sophisticated treatments and surgical techniques. Despite these notable ad-
vances, including the adoption of balanced anaesthesia protocols, multimodal analgesia, standing surgery,
and minimally invasive techniques, specific surgical procedures unavoidably give rise to varying degrees
of moderate to severe pain. Minimising pain in the peri-operative period remains pivotal to ensure animal
welfare and promoting enhanced recovery, ultimately yielding improved treatment outcomes. However,
effectively mitigating pain requires the ability to accurately identify it, which can present a more significant
challenge (van Loon & Van Dierendonck, 2018).
The International Association for the Study of Pain (IASP) updated the definition of pain in 2020. The IASP
defines pain as an unpleasant sensory and emotional experience associated with, or resembling that asso-
ciated with, actual or potential tissue damage (Raja et al., 2020). Adding to this definition, six key notes were
introduced by the IASP. The most relevant to the study of pain in animals was the recognition that verbal
description is only one of several behaviours to express pain; inability to communicate does not negate the
possibility that a human or a nonhuman animal experiences pain (Raja et al., 2020).
Pain assessment in humans benefits from their capacity to convey pain-related attributes such as quality,
location, and intensity verbally. However, the utilisation of self-report is infeasible for pain assessment in
horses. As a result, the evaluation and quantification of pain in horses and other animals rely upon the
observer’s capacity in discerning potential pain-associated alterations in both behavioural patterns and
physiological parameters exhibited by the patient. In order to optimise the objectivity and consistency of
pain assessment, it becomes imperative to undertake the following steps:
• Determine the specific behaviours and physiological parameters that may be indicative of pain.
• Systematise the observation of these indicative signs.
• Delineate the degree of pain correlation with specific behavioural manifestations.
• Integrate these empirical observations into a quantitative metric, facilitating the estimation of pain
intensity over time.
This comprehensive approach aids in determining the potential requirement for analgesic intervention and
enables the detection of treatment efficacy. The drive for objective pain assessment prompted the develop-
ment of systematic evaluation through pain scales. These scoring systems must undergo validation tailored
to the specific type of pain, considering factors like condition and duration (e.g., acute post-abdominal
surgery).
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When a horse is identified as being in pain or likely to experience pain following a surgical procedure, a
well-structured pain management plan is essential. An effective analgesic plan includes a combination of
systematically administered drugs along with locoregional analgesic techniques when feasible. The key
lies in understanding the nature of potential pain, drug mechanisms, and their application to optimise pain
relief (Elvir-Lazo & White, 2010). This approach results in a multimodal therapeutic plan that combines ap-
propriate drugs and targets various aspects of the pain pathway. Common systemic administration routes
involve intravenous or intramuscular injections for short-term relief, while oral medication is employed for
more extended treatment periods. Although a combination of these routes is usually sufficient, alternative
methods of drug delivery, such as transdermal, oral-transmucosal, epidurally or intra-articular can enhance
analgesia for specific cases. When managing post-operative pain in horses, it is essential to formulate a
“pain ladder” approach. This entails creating an individualised pain management plan that remains adapt-
able and follows a continuous cycle of plan–treat–evaluate. Cautiously monitoring the patient’s response is
integral for a successful post-operative pain management protocol.
Supplementary therapies, such as pharmacological and non-pharmacological methods to reduce stress

during hospitalisation, along with practices like bandaging, attentive nursing, physiotherapy, farriery, and
specific surgical interventions, are essential contributors to attaining positive outcomes in post-operative
pain management.
The aim of this presentation is to present current evidence, examining both the benefits and obstacles of
utilising pain scales in horses. Additionally, I will explore various pharmacological and non-pharmacological
methods for pain management in horses during the post-operative period. The intent of this analysis is to
initiate a dialogue regarding the compelling requirement for enhanced pain relief in equine care.
Bibliography:
• Elvir-Lazo, O. L., & White, P. F. (2010). Postoperative Pain Management After Ambulatory Surgery:
Role of Multimodal Analgesia. Anesthesiology Clinics, 28(2), 217–224. https://doi.org/10.1016/j.an-
clin.2010.02.011
• Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ring-
kamp, M., Sluka, K. A., Song, X. J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K.
(2020). The Revised IASP definition of pain: concepts, challenges, and compromises. Pain, 161(9),
1976. https://doi.org/10.1097/J.PAIN.0000000000001939
• van Loon, J. P. A. M., & Van Dierendonck, M. C. (2018). Objective pain assessment in horses (2014–
2018). The Veterinary Journal, 242, 1–7. https://doi.org/10.1016/J.TVJL.2018.10.001
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Feeding and anaesthesia

FRCVS.
Senior Medical Director Lap of Love Veterinary Hospice, Lutz, Florida, USA and Courtesy Professor, Univer-
sity of Florida, Gainesville, Florida, USA.
Historically, fasting times of up to 14 hours have been recommended before general anaesthesia in horses.1
However, it is important to look at what lies behind those recommendations and ask if they are based on
evidence or opinion. Hypotension and hypoxaemia are frequently encountered in anaesthetised horses.
The theoretical benefits of fasting are reduced gastrointestinal contents which may enhance lung function
(reduced pressure on the diaphragm, less negative impact on Functional Residual Capacity and less hy-
poventilation) and cardiovascular function (decreased pressure on major abdominal vessels) when horses
are in dorsal recumbency but there is little evidence to support this. Dobromylskyj and colleagues reported
no statistically significant differences in arterial oxygen tension (PaO2) during anesthesia in horses that had
been kept off concentrate feed for an average of 16.6 hours and off hay for 10.6 hours compared to those
that had access to concentrate and hay until 3.8 and 0.8 hours respectively before anaesthesia. 2
In donkeys, a 5-hour fast showed no advantage over no fasting on arterial blood gas variables.3
Horses are browsers and may become stressed when fasted resulting in reduced gastrointestinal motility.
After 12 hours of fasting, the intensity of gastrointestinal sounds and motility were significantly decreased
(by up to 90%) in adult horses.4 Fasting decreases myoelectric activity in the equine colon and therefore re-
duces contractile activity.5 Decreased gastrointestinal motility is a risk factor of colic. Post-anaesthetic colic
is an adverse event that results in increased morbidity, cost, hospitalisation time and mortality. It has been
reported to occur in between 2.8 and 12% of horses that undergo general anaesthesia, and, in these studies,
most horses were fasted for a minimum of 6-12 hours, as part of their pre-operative preparation. Senior and
others reported a 5.2% prevalence of post anaesthetic colic in a multi-centre study.6 In their study there
was a trend for non-fasted horses to be more likely to develop colic after anaesthesia but the centre where
the procedure was performed, and the type of surgery were also linked to the likelihood of post-anaesthetic
colic occurring. The reasons for anaesthesia may play a role in the development of post-anaesthetic colic
as only 1.5% horses undergoing magnetic resonance imaging developed colic compared to 7.1% of horses
undergoing non-abdominal surgery.7 Surgery and pain stimulate the sympathetic nervous system which
results in decreased gastrointestinal motility but drugs given to horses undergoing surgery (e.g., antibiotics)
may also play a role.7 Bailey and others studied the incidence of post-anaesthetic colic in non-fasted horses
that underwent elective anaesthesia for non-abdominal procedures.8 In their study population the inci-
dence of post-operative colic was 2.5% and they proposed that providing food may help maintain normal
gastrointestinal motility and decrease the risk of post-anaesthetic colic.8 Another adverse effect of fasting
in horses is that their water intake will also decrease and reduced water intake is a risk factor for colic.9 The
role of stress should be considered in discussions because the use of muzzles (which most horses dislike)
to prevent ingestion of solid feed was associated with more cases of post-operative colic than just “not
feeding” horses before anaesthesia.10
An exception to allowing access to food before surgery is when the horse is scheduled for a laparoscopic
procedure.11 An empty or minimally distended gastrointestinal system allows for better visibility and less risk
of perforation. A so-called laparoscopic diet should produce little gas and have a short transit time. Long,
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stem-rich hay is recommended in the days before surgery, with a fasting period of 24-26 hours.11
The literature does not support the idea that pre-anaesthetic fasting improves cardiopulmonary function
in horses. The impact of fasting versus feeding before anesthesia on developing post-anaesthetic colic
has less clear as many studies included multiple confounding factors. However, perusal of multiple studies
along with clinical experience suggests that prolonged fasting is detrimental in horses. Access to hay (but
restriction of grain) and allowing normal browsing activity may help maintain gastrointestinal motility and
decrease post-anaesthetic colic and for most procedures this is now an acceptable strategy. Preparation
for laparoscopic surgery is different and food restriction is advised. With respect to post-anaesthetic colic
many other factors such as adequate pain control and decreasing stress must also be addressed.
References
1. Clarke KW, Trim CM, Hall LW. Veterinary Anaesthesia. 11th ed. Philadelphia, Pennsylvania: Saun-
ders Elsevier, 2014.
2. Dobromylskyj P, Taylor PM, Brearley JC, et al. Effect of pre-operative starvation on intra-operative
arterial oxygen tension in horses. J Vet Anaesth 1996; 23:75–77.
3. Maney J, Little E, Dzikiti T. Effect of a short pre-anesthetic fast on arterial blood gas values in iso-
flurane-anesthetized donkeys. Can Vet J 2019; 60:1057-1059.
4. Filippo PAD, Duarte BR, Albernaz AP, Quirino CR. Effects of feed deprivation on physical and blood
parameters of horses. Braz J Vet Med 2021; 43: e000321.
5. Naylor JM, Poirier KL, Hamilton DL, Dowling PM. The effects of feeding and fasting on gastrointes-
tinal sounds in adult horses. J Vet Intern Med 2006; 20:1408-1413.
6. Senior JM, Pinchbeck GL, Allister R, et al. Post anaesthetic colic in horses: a preventable complica-
tion? Equine Vet J 2006;38: 479-484.
7. Andersen MS, Clark L, Dyson SJ, Newton JR. Risk factors for colic in horses after general anaesthe-
sia for MRI or nonabdominal surgery: absence of evidence of effect from perianaesthetic morphine.
Equine Vet J 2006; 38:368-374.
8. Bailey PA, Hague BA, Davis M, et al. Incidence of post-anesthetic colic in non-fasted adult equine
patients. Can Vet J 2016; 57:1263-1266.
9. Archer DC, Proudman CJ. Epidemiological clues to preventing colic. Vet J 2006; 172:29-39.
10. Jones RS, Edwards GB, Brearley JC. Commentary on prolonged starvation as a factor associated
with post operative colic. Equine Vet Educ 1991; 3:16-18.
11. Zebeli Q, Keßner J, Kliseviciute V, Rijkenhuizen AM. Dietary Approaches to Optimize the Fasting
Period Before Laparoscopic Surgery in Horses: An Overview. Journal of Equine Veterinary Science
2015; 35:701-708.
Dr Sheilah A Robertson BVMS (Hons), PhD, DACVAA, DECVAA, DACAW, DECAWBM (WSEL), CVA,
MRCVS.
Colleges. She is the senior medical director of Lap of Love Veterinary Hospice, a large network of veterinarians
dedicated to end-of-life care. Dr Robertson is also a courtesy Professor at the College of Veterinary Medicine,
University of Florida, Gainesville, Florida.
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Locoregional anaesthesia for surgical procedures

Luís Filipe Louro
CVS UK Ltd
It is well-documented that the risk of anaesthesia-related mortality in horses is considerably higher com-
pared to dogs, cats, and humans. The preliminary findings from CEPEF-4 reported a mortality rate of 0.2%
related to standing sedation in horses, in comparison to a 1% mortality rate for horses undergoing general
anaesthesia (Gozalo-Marcilla et al., 2021). As anticipated, the occurrence of fatalities linked to standing se-
dation appears to be lower than that associated with general anaesthesia, highlighting the fact that stand-
ing sedation eliminates the mortality risk associated with recovery from general anaesthesia. As a result,
there’s a growing interest in performing surgery under standing sedation (Loomes & Louro, 2023) . This,
along with a stronger focus on improving pain management in horses, has sparked a greater enthusiasm for
exploring and thoughtfully assess a range of both pioneer and well-established techniques of locoregional
anaesthesia and analgesia techniques in equine anaesthesia.
However, the benefits of locoregional anaesthesia and analgesia extend beyond horses undergoing surgery
under standing sedation. These approaches also offer numerous advantages for horses undergoing surgi-
cal procedures under general anaesthesia, including pre-emptive analgesia, reduced general anaesthetic
requirements resulting in decreased drug side effects, improved recovery quality and post-operative pain
relief (Gaesser et al., 2020; Louro et al., 2020).
Traditional perineural blocks in equine veterinary medicine have historically been performed blindly guided
by anatomical landmarks. While this method can be effective through direct nerve palpation, its practicality
is limited to nerves located close to the skin’s surface. Recent years have witnessed a surge in research
in human and small animal anaesthesia due to the adoption of innovative approaches and technologies
to locate nerves situated deeper to the skin, such as peripheral nerve stimulation and ultrasound-guided
injections. These techniques have to potential to improve accuracy and precision, as well as reduce compli-
cations associated with regional anaesthesia and analgesia. The use of these objective methods for locore-
gional anaesthesia in equine patients has led to the development of various new techniques for targeting
different nerves and desensitising various anatomical areas, allowing for standing surgery as well as re-
duced intraoperative pain during surgery performed under general anaesthesia. To assess the advantages
and disadvantages of these objective methods in comparison to traditional blind locoregional anaesthetic
techniques, and to determine their impact on equine anaesthesia, analgesia, and surgery, further research
is necessary. Developing a thorough grasp of the effects of these objective methods of nerve location
has the potential to greatly facilitate the incorporation of such techniques into the day-to-day procedures
of equine veterinary surgeons. Consequently, this empowerment will equip clinicians to make informed
choices when selecting the most appropriate locoregional approaches for their equine patients, ultimately
resulting in better patient care standards and enhanced surgical results.
Various drugs are used to perform locoregional anaesthesia or analgesia in horses. Among these, local
anaesthetics are the prevailing choice, although additional drug categories such as opioids and alpha-2
adrenoceptor agonists can also be administered to achieve analgesia via locoregional methods. Recent
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advancements in pharmacology have endeavoured to influence the pharmacokinetics of local anaesthetics,

aiming to prolong the duration of action of the block. This has been pursued through techniques such as
encapsulating local anaesthetics within liposome molecular structures or introducing additives to tradition-
al local anaesthetics.
This presentation purposes to present existing literature, discussing the advantages and disadvantages of
performing locoregional anaesthesia and analgesia in horses undergoing surgical procedures either under
general anaesthesia or standing sedation. This analysis aims to stimulate discussion on the utility and po-
tential future of locoregional anaesthesia for equine patients.
Bibliography:
1. Gaesser, A. M., Varner, K. M., Douglas, H. F., Barr, C. A., Hopster, K., & Levine, D. G. (2020). The
effect of intra-articular mepivacaine administration prior to carpal arthroscopy on anesthesia man-
agement and recovery characteristics in horses. Veterinary Surgery, 49(7), 1343–1349. https://doi.
org/10.1111/vsu.13501
2. Gozalo-Marcilla, M., Bettschart-Wolfensberger, R., Johnston, M., Taylor, P. M., & Redondo, J. I. (2021).
Data collection for the fourth multicentre confidential enquiry of perioperative fatalities (Cepef4)
study: New technology and preliminary results. Animals, 11(9), 2549. https://doi.org/10.3390/
ANI11092549/S1
3. Loomes, K., & Louro, L. (2023). Is general anaesthesia avoidable for limb fracture repair in horses?
Equine Veterinary Education, 35(5), 240–243. https://doi.org/10.1111/EVE.13732
4. Louro, L. F., Milner, P. I., & Bardell, D. (2020). Epidural administration of opioid analgesics improves
quality of recovery in horses anaesthetised for treatment of hindlimb synovial sepsis. Equine Veter-
inary Journal, evj.13338. https://doi.org/10.1111/evj.13338
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Cervical Pain And Poor Performance

Jairo Jaramillo Cardenas
MV. MSC. PHD.
Alapile and Iselp Certified
Equarter Continuing Education
The cervical region is divided in 3 main segments: Cranial cervical segment, containing C1 and C2 (at-
las and axis with more specialized function like flexion/extension and rotation of the nucha respectively);
median cervical segment containing C3, C4 and C5 (all very similar vertebrae); caudal cervical segment
containing C6 and C7.
Each segment can have distinct lesions that can be correlated to the different biomechanics of the area,
trauma, or development pathologies. The clinical signs associated can vary from decreased performance,
lameness or neurologic disorders that can go from mild to severe.
Some pathologies that can lead to the clinical signs mentioned above have been described. Interverte-
bral discopathy, arthropathy of the cervical articular facets, reduction of the intervertebral foramina, com-
pression of the cervical nerves ventral roots C6, C7 and C8, cervico-thoraco-brachial syndrome, vertebral
fractures, cervical articular facets capsulitis/synovitis, large muscles tendinopathies, myopathies, Osteo-
chondritis dissecans, vertebral malformations (C6 and C7), agenesia and/or ankilosis, exostosis and malfor-
mation of the first ribs or arthropathy of the costovertebral joints are the most common pathologies found
in this body region.
The best way to understand how to manage these horses is to have a profound knowledge of the anatomy
of the cervical region and its biomechanics as well as good diagnostic imaging. With all these it´s possible
better understand the pathology and eventually, its neuromuscular consequences.
The treatment should aim not only the primary pathology but also the other structures that can be involved
in consequence of the primary lesion.
Some physical therapies to control de diffusion of pain like mesotherapy, acupuncture, laser therapy, mag-
netic field and more focal therapies like intra-articular and perineural infiltration of corticosteroids may be
associated with other pharmacological systemic therapies to control pain and discomfort. Some specific
cases like discopathies, wobbler syndrome or severe arthropathy with compression of the intervertebral
foramen may require a surgical procedure.

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Diagnosis of sub-performance due to lameness

Andrew P. Bathe MA VetMB DipECVS Dip ACVSMR DEO MRCVS
Rossdales Equine Hospital, Newmarket, Suffolk, England
Orthopaedic conditions are the most common cause of poor performance in sport horses and as such the
management of these is a critical part of optimising performance. It is important to ascertain if there is
actually poor performance or just an inherently low level of performance. The expectations on the horse
may be beyond those of the horse’s actual athletic capabilities or that of the rider. There are differences in
presentations for different levels of rider experience and competence. Many amateurs will present horses
as a poor performance case whereas professionals are more likely to present them as a lameness as they
are capable of riding the horse through many more painful and schooling issues.
Common causes of poor performance in sport horses is usually related to proximal suspensory desmitis
and sacroiliac region pain, joint pain and back pain. In young thoroughbred racehorses, fetlock and carpal
pain are more common.
An accurate diagnosis is essential to treat any cause of poor performance effectively. It is very easy to fall
into the trap of using random speculative medications at the request of the rider or trainer. Trial medication
can have a role in the assessment of subtle conditions, so that the response to can be assessed in normal
work over a period of time, but assessments need to be as objective as possible, as it is easy to fall prey to
a placebo effect.
Diagnosis relies on trying to obtain an accurate history in the first place. Many riders may just describe the
horse as “not quite right” or “not jumping right”. Others will provide an overly extensive of history of every
problem the horse may have had or is thought to have had. Try to summarise this down to a few bullet
points of the key problems. Beware riders trying to give a history that fulfils their preconceptions of what
the problem may be.
The clinical examination is very important but in the majority of subtle cases there are no significant clin-
ical findings. However, in some cases it is amazing how obvious findings can be missed in the desperate
search for something obscure, and riders are often confused about which leg the actual problem may be
affecting. A dynamic evaluation is very important and horses should be lunged on a hard and soft surface
as a differentiation between these two is often very helpful. Flexion tests can be helpful but I rarely rely on
them. Ridden evaluation is critical to try and accurately identify the problem as perceived by the rider in
more subtle cases. It is quite common for a horse to demonstrate a mild forelimb lameness when lunged
on a firm circle with the blocks to the feet but this may not be the actual cause of poor performance under
saddle. Thus riding the horse when blocked can be very helpful to see if it actually improves the perceived
problem. However, there can often be a placebo effect with the rider and thus I try and do this ridden
blocking with the rider not knowing which areas have been blocked. It may also be difficult for riders to feel
an improvement and thus having the horse also ridden by another experienced rider can be very helpful to
accurately interpret the results. A thorough and logical progression of diagnostic local analgesia should be
undertaken. High yield areas in cases of poor performance are the proximal suspensory ligaments, sacro-
iliac regions and stifles.
After accurate localisation of the problem then diagnostic imaging of the affected areas would be undertak-
en, predominantly with radiography and ultrasonography. MRI examination can be very helpful particularly
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for feet but also in other areas if there is a lack of significant findings on two dimensional imaging. I rarely
use gamma scintigraphy in poor performance cases in sport horses, although it is extremely helpful in sub-
tle problems in young thoroughbred flat horses with their active bone turn over.
Once a diagnosis has been made then a treatment plan can be constructed containing the horse’s athletic
targets and the severity of any pathology that has been identified. As mentioned earlier the response to
treatment can be very helpful in determining which of any abnormalities noted are the most significant.
There are often multiple concurrent sites of pain, and treating all of these in sequence, alongside a progres-
sive rehabilitation programme, will be most effective.
Andrew P. Bathe MA, VetMB, DEO, DipECVS, DipACVSMR, MRCVS

Andy qualified from Cambridge University Veterinary School and subsequently trained in surgery at the Uni-
versity of Bristol and then at Rossdales in Newmarket. After working as University Equine Surgeon at the
Queen’s Veterinary School Hospital, University of Cambridge he returned to Rossdales, where he became a
partner and, in 2021, a clinical director. Andy’s main areas of speciality lie in orthopaedic surgery and lame-
ness, especially related to competition horses. He has always been interested in the application of novel
diagnostic and therapeutic techniques to lameness problems and poor performance. He is a Diplomate of
the European College of Veterinary Surgeons and holds the Royal College of Veterinary Surgeons (RCVS)
Diploma in Equine Orthopaedics. He is recognised by the RCVS as a Specialist in Equine Surgery. He is team
vet to the Japanese Three Day Event Team. He has previously been team vet to the British Three Day Event
and British Pony Showjumping Teams; the Japanese Showjumping and Dressage Teams; the Hong Kong
Dressage Team; as well as working for numerous private competitors at competitions and championships.
He was an official treating vet for the 2012 Olympics in London. In 2015, Andy was awarded Diplomate status
by the American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR), which means that he
now holds diplomas in three separate areas of expertise (surgery, orthopaedics and equine sports medicine).
He is a Board Director of British Showjumping. He enjoys skiing, ski mountaineering and racing cycling in his
spare time.
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Pelvic Fractures In Sport Horses

Jairo Jaramillo Cardenas
MV. MSC. PHD.
Alapile and Iselp Certified
Equarter Continuing Education
The pelvis is one of the most important and complex areas of the horse in terms of anatomy and biome-
chanics. Blood vessels like the bifurcation of the aortic end into the iliac arteries, large gluteal and femoral
muscles, bone structures connected to the coxal bone, the sacrum, the proximal aspect of the femur, lumbar
vertebrae and important nerve trunks like lumbosacral plexus shows the complexity of this area.
Pelvic fractures have been described as a relevant and high frequency occurring group of pathologies on
the hind limb. Some anatomical areas such as ischiatic tuberosity, coxal tuberosity sacral tuberosity and
femur greater trochanters, are prominent bony structures that are exposed to trauma which may induce
fractures on the iliac wing, iliac neck, acetabulum, pubic bone, ischiatic bone and sacrum. Biomechanical
fractures can occur by the strong contraction of large muscles which press some bony regions in certain
movements like the explosion on the propulsion phase. An example of those biomechanical fractures is the
iliac wing fracture or the comminute fracture of the proximal third of the femur. The prognosis can be good,
reserved, or severe depending on the level of pain, soft tissues involvement and the type of fracture.
Clinical signs can vary as much as just decreased performance, as to such an intense pain that have to
end with euthanasia. A good evaluation of the anatomy of the region and biomechanics as well as a good
extra-abdominal and intra-rectal ultrasound examination are the basis for a quick diagnostic process to try
to establish the best management possible to each fracture and each horse.

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Diagnosis of sub-performance due to respiratory

disease.
Samantha Franklin BVSc., PhD., DipACVSMR. MANZCVS., FRCVS, University of Adelaide, South Australia.
Most equestrian disciplines rely on aerobic energy metabolism to power exercise. Oxygen delivery to the
exercising muscles is therefore a critical determinant of athletic performance. Horses are considered to be
elite athletes due to their high aerobic capacity, which exceeds that of other athletic species, and is largely
achieved through the enhanced ability of the cardiovascular system. The respiratory response to exercise
is achieved through an increase in both the breathing frequency and tidal volume, resulting in a dramatic
increase in minute ventilation from approx. 100L/min at rest to over 2000L/min during strenuous exercise.1
Yet it is widely acknowledged that the respiratory system is the limiting factor for athletic performance,
with healthy horses exhibiting hypoxaemia and hypercapnia during strenuous exercise.1 It is perhaps not
surprising therefore that respiratory disorders, even in mild forms, are potentially deleterious to athletic
performance.
Respiratory disease is common in equine athletes and may affect the upper airways, lower airways or a
combination of both. 2 In some instances, the diagnosis is challenging because conditions can be subclinical
at rest and become clinically relevant only during exercise. In such cases, an exercise test may be warranted
in the evaluation of the patient, especially for definitive diagnosis of upper airway collapse. Additional diag-
nostic techniques such as bronchoalveolar lavage are also required for diagnosis of subclinical lower airway
disorders that have the capacity to impair performance.
Horses are particularly prone to developing dynamic upper airway collapse because they are obligatory
nasal breathers and cannot avoid the high pressures, associated with nasal breathing, during exercise.
Modelling of the equine airways has identified that the most negative pressures and highest airflow turbu-
lence occur at the floor of the rostral aspect of the nasopharynx and within the larynx3, and these are the
most commonly affected regions. The nasopharyngeal region, which is not supported by osseous or carti-
laginous structures and relies on muscular activity to maintain stability and patency, is especially prone to
dynamic collapse resulting in palatal instability, dorsal displacement of the soft palate and pharyngeal wall
collapse. Laryngeal collapse is also common, resulting in collapse of one or both vocal folds, arytenoid car-
tilages and / or aryepiglottal folds. Whilst some conditions may be evident on a resting examination, most
forms of upper airway collapse can only be definitively diagnosed using exercising endoscopy.4
The prevalence of lower airway diseases, including mild to moderate equine asthma (mEA) and exercise
induced pulmonary haemorrhage (EIPH) is high in equine athletes across a range of disciplines. Equine
asthma is considered to be a disease of domestication, occurring as a result of exposure to particulate
matter in the forage and stable environment.5 It affects all groups of horses, although the degree to which
performance is impacted will be dependent on the intensity of exercise being performed, and the condition
may often go undetected. EIPH is a unique condition resulting in bleeding into the airways during strenu-
ous exercise, as a result of stress failure of the alveolar capillary walls in association with high transmural
pressures. It occurs most commonly in racehorse populations, where up to 100% of horses are affected to
a variable degree.6 The condition occurs less commonly in other disciplines and is largely dependent on
exercise intensity. Despite the high prevalence of lower airway disorders, these conditions may easily be
underestimated because most progress subclinically, and relevant diagnostic procedures are sometimes
difficult to implement routinely in the field. Endoscopic examination of the tracheobronchial tree will en-
able visualisation of tracheal mucus and or blood, whilst bronchoalveolar lavage is required for a definitive
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diagnosis of lower airway inflammation and can also indicate prior EIPH through the identification of red
blood cells and haemosiderophages, which may persist for several weeks following an episode of bleeding.
Studies of the effects of respiratory disease on respiratory function and exercise capacity have yielded
varying results. The impact of respiratory disease will depend not only on the nature and severity of the
disease but also on the equestrian discipline performed. 2 In horses exercising at maximal aerobic capacity,
even small changes in airflow and gas exchange may have an important impact on athletic performance,
whereas horses exercising less strenuously may not exhibit exercise intolerance until respiratory impair-
ment becomes more severe.
Bibliography:
1. Franklin, S.H., Van Erck-Westergren, E. and Bayly, W.M., 2012. Respiratory responses to exercise in
the horse. Equine Veterinary Journal, 44(6): 26-732.
2. Van Erck-Westergren, E., Franklin, S.H. and Bayly, W.M., 2013. Respiratory diseases and their ef-
fects on respiratory function and exercise capacity. Equine Veterinary Journal, 45(3): 376-387.
3. Rakesh, V., Ducharme, N.G., Datta, A.K., Cheetham, J. and Pease, A.P. (2008) Development of equine
upper airway fluid mechanics model for Thoroughbred racehorses. Equine Vet. J. 40: 272-279.
4. Franklin, S.H. and Allen, K.J., 2017. Assessment of dynamic upper respiratory tract function in the
equine athlete. Equine Veterinary Education, 29(2): 92-103.
5. Mazan, M.R., 2018. Lower airway disease in the athletic horse. Veterinary Clinics: Equine Prac-
tice, 34(2): 443-460.
6. Sullivan, S. and Hinchcliff, K., 2015. Update on exercise-induced pulmonary hemorrhage. Veterinary
Clinics: Equine Practice, 31(1): 187-198.
Samantha Franklin Bio

After graduating from the University of Bristol in 1995, Sam spent time in mixed practice in the UK before
returning to Bristol to undertake a PhD related to upper airway dysfunction in Thoroughbred racehorses.
Following her PhD, she remained at the University of Bristol as a lecturer in equine exercise physiology and
ran the Equine Sports Medicine Centre. She moved to the University of Adelaide, Australia in 2010, where
she is currently an Associate Professor in Veterinary Physiology. Sam combines teaching, clinical work and
research, with a focus on cardio-respiratory causes of poor performance in equine athletes. She is interna-
tionally renowned for her pioneering work on the development of overground endoscopy and has presented
and published widely on this subject and other aspects of equine sports medicine.
Sam is a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, an Austra-
lian and RCVS Recognised Specialist in Equine Medicine (Sports Medicine) and a founding member of the
Veterinary Sports Medicine and Rehabilitation Chapter of the Australian and New Zealand College of Veteri-
nary Scientists. She is currently the Chair of the International Committee for the International Conference on
Equine Exercise Physiology (ICEEP) and was recently awarded a Fellowship of the Royal College of Veterinary
Surgeons for meritorious contributions to clinical practice.
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Dynamic endoscopy of the upper airways.

Samantha Franklin BVSc., PhD., DipACVSMR., MANZCVS., FRCVS, University of Adelaide, South Australia.
Obstructive disorders of the upper airways have been recognised as important causes of abnormal respi-
ratory noise and poor performance in the equine athlete for many years. Resting endoscopy may be useful
to identify static forms of upper airway obstruction, such as subepiglottal cysts, epiglottal entrapment,
arytenoid chondritis, and laryngeal hemiplegia. However, exercising endoscopy is considered to be the
“gold standard” for making a definitive diagnosis of dynamic upper airway collapse in horses where resting
findings are frequently unreliable or absent. Through the use of exercising endoscopy, it has been possible
to identify the collapse of a range structures within the nasopharynx and / or larynx, with complex dynamic
collapse (whereby multiple structures are affected) occurring frequently.1 A number of systems are now
available commercially for performing dynamic endoscopy in the field and this technique has a number of
advantages over treadmill endoscopy because the horse can be examined in its normal environment and
the effects of the tack and rider can be accounted for.2
When performing exercising endoscopy, the type of exercise test performed is crucial in enabling an ac-
curate diagnosis of dynamic airway obstruction to be made. In cases where horses make obvious respira-
tory noise during training conditions, a diagnosis should be straightforward. However, for investigation of
those cases that make abnormal respiratory noise or perform poorly only during competition or racing it is
essential to replicate the conditions encountered during competition. If the clinical signs reported during
competition are not replicated, false negative findings may occur.3 For the examination of racehorses, it is
recommended that exercise testing be performed at an appropriate track where the distance and speeds
encountered during racing can be replicated. In many cases dynamic upper airway obstruction only occurs
or is at its most severe during peak exercise. This is because inspiratory airway pressures become more
negative at higher speeds and fatigue of the upper airway musculature may also be involved. However,
there are occasions when upper airway collapse appears more severe at slower speeds. In horses that are
involved in non-racing disciplines, factors other than exercise intensity such as head and neck position, tack
modifications and other rider interventions have been shown to induce or exacerbate dynamic airway col-
lapse and need to be considered.4-6 There is increasing evidence that these factors may also play a role in
the development of dynamic airway collapse in both harness and Thoroughbred racehorses. Furthermore,
many of these factors may occur concurrently, for example when pulling up at the end of the gallops the
horse will slow down and at the same time might show concurrent head-neck flexion and mouth opening,
making it difficult to separate the possible inciting causes.
It is important to note that whilst dynamic endoscopy enables visualisation of any dynamic airway collapse,
it does not enable quantification of the functional effects of an obstruction. In order to definitively assess
any respiratory limitation, it is necessary to measure upper airway mechanics. However, this is challenging
to perform in the field and is not commonly performed in clinical practice. Not all upper airway obstructive
conditions have the same impact on respiratory function, but they commonly create an increase in respira-
tory resistance along the upper respiratory tract, which may result in either reduced airflow or an increase in
the trans-upper airway pressures required to maintain airflow. This increase in airway resistance will lead to
an increase in respiratory workload, and where airflow is reduced, the resulting hypoventilation may lead to
decreased oxygen consumption, increased blood lactate concentration and exacerbation of arterial hypox-
aemia and hypercapnia.7 It should also be recognised that concurrent lower airway disease is also present
in many horses and may exacerbate the situation further.
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The impact of respiratory disease will not only depend on the nature and severity of the disease but also
on the equestrian discipline performed. In horses competing at maximal and supramaximal intensities (ie.
at or above speeds that elicit maximal oxygen consumption (VO2Max)), optimal efficiency of all body sys-
tems including the respiratory system is essential. Therefore, upper airway obstructions in racehorses will
more markedly impair their performances than those of horses exercising at less strenuous levels, such as
dressage horses or show jumpers. The oxygen consumption associated with these equestrian disciplines
is less than for racing and a smaller fraction of the total respiratory capacity is required. Nevertheless, sev-
eral studies have confirmed that upper airway obstruction is a cause of poor performance in sport horses.
Whilst effort perception cannot be measured in horses, it is plausible that the increased work of breathing
may affect the horse’s attitude and willingness to work.
In conclusion, athletic horses may be afflicted with a wide range of upper airway obstructions. The clinical
significance of this in any individual may be influenced by a number of factors, including the type and se-
verity of the obstruction as well as the level and type of activity being undertaken and rider / driver inter-
ventions. It is important to make a definitive diagnosis and take into consideration these other factors when
making decisions relating to treatment.
Bibliography:
• 1. Franklin, S.H. and Allen, K.J., 2017. Assessment of dynamic upper respiratory tract function in the
equine athlete. Equine Veterinary Education, 29(2), pp.92-103.
• 2. Kate Allen and Samantha H Franklin. 2015. Dynamic Endoscopy. In Robinson’s Current Therapy in
Equine Medicine (7th Edition). Elsevier. Chapter 51: 221-223.
• 3. Allen, K.J. and Franklin, S.H., 2010. Assessment of the exercise tests used during overground en-
doscopy in UK Thoroughbred racehorses and how these may affect the diagnosis of dynamic upper
respiratory tract obstructions. Equine Veterinary Journal, 42: 587-591.
• 4. Allen, K.J., Terron-Canedo, N., Hillyer, M.H. and Franklin, S.H., 2011. Equitation and exercise factors
affecting dynamic upper respiratory tract function: a review illustrated by case reports. Equine Veteri-
nary Education, 23(7): 361-368.
• 5. Van Erck, E., 2011. Dynamic respiratory videoendoscopy in ridden sport horses: effect of head flexion,
riding and airway inflammation in 129 cases. Equine Veterinary Journal, 43, pp.18-24.
• 6. Hackett, E.S. and Leise, B.S., 2019. Exercising upper respiratory videoendoscopic findings of 50 com-
petition draught horses with abnormal respiratory noise and/or poor performance. Equine veterinary
journal, 51(3): 370-374.
• 7. Van Erck-Westergren, E., Franklin, S.H. and Bayly, W.M., 2013. Respiratory diseases and their effects
on respiratory function and exercise capacity. Equine Veterinary Journal, 45(3): 376-387.
Samantha Franklin Bio

After graduating from the University of Bristol in 1995, Sam spent time in mixed practice in the UK before
returning to Bristol to undertake a PhD related to upper airway dysfunction in Thoroughbred racehorses.
Following her PhD, she remained at the University of Bristol as a lecturer in equine exercise physiology and
ran the Equine Sports Medicine Centre. She moved to the University of Adelaide, Australia in 2010, where
she is currently an Associate Professor in Veterinary Physiology. Sam combines teaching, clinical work and
research, with a focus on cardio-respiratory causes of poor performance in equine athletes. She is interna-
tionally renowned for her pioneering work on the development of overground endoscopy and has presented
and published widely on this subject and other aspects of equine sports medicine.
Sam is a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, an Austra-
lian and RCVS Recognised Specialist in Equine Medicine (Sports Medicine) and a founding member of the
Veterinary Sports Medicine and Rehabilitation Chapter of the Australian and New Zealand College of Veteri-
nary Scientists. She is currently the Chair of the International Committee for the International Conference on
Equine Exercise Physiology (ICEEP) and was recently awarded a Fellowship of the Royal College of Veterinary
Surgeons for meritorious contributions to clinical practice.
236
Proceedings
2023
Cardiac Limitations To Athletic Performance

Cris Navas, LV, PhD, Dip ACVIM
New Bolton Center, College of Veterinary Medicine
University of Pennsylvania, Kennett Square, PA, USA
Introduction
Cardiac disease is a cause of poor performance in equine athletes. The musculoskeletal and respiratory
systems, are the body systems more commonly involved in poor performance in horses participating in any
equestrian disciplines, followed by the cardiovascular system.
Mitral Valve Disease

Cardiac auscultation is often the first clue for the detection of valvular, arrhythmic or congenital disease that
can affect performance, safety or life expectancy. The most common physical examination findings that
alert clinicians about cardiovascular disease are murmurs and irregular rhythms. Careful description of the
cardiac auscultation may seem superfluous but is key to the diagnosis of heart disease in horses. Mitral
valve disease is. A left sided systolic murmur should be considered mitral regurgitation until proven other-
wise. The exception to this rule is the physiologic ejection (or flow) murmur. Auscultation is often sufficient
for the differentiation. A physiologic ejection murmur is usually 1-2/6 (sometimes 3/6) early to mid-systolic
blowing or coarse crescendo-decrescendo murmur with the point of maximal intensity over the pulmonic or
aortic valve areas. Ejection murmurs do not radiate and often vary in intensity with exercise or excitement.
Physiologic murmurs are common in horses and this leads to many horse owners to the false conclusion
that a cardiac murmur in a horse is never a problem. Mitral regurgitation murmurs are 1-6/6 holo- or mid- to
late systolic blowing, coarse, musical or honking band shaped or crescendo murmurs with the point of max-
imal intensity over the mitral or aortic valve areas. Murmurs of mitral regurgitation may or may not radiate
and usually do not vary in intensity unless they are caused by a prolapsed valve. Systolic murmurs that are
variable in intensity (with excitement, exercise sedation or pain) are frequent. Physiologic ejection murmurs
and murmurs of mitral valve prolapse are the common variable murmurs and the clue to their differentiation
is their timing and shape: physiologic ejection murmurs are early to mid-systolic crescendo-decrescendo
and mitral valve prolapse are mid to late crescendo.
Aortic Regurgitation
Aortic regurgitation is a common disease of teenage horses. Aortic valve disease is frequently an incidental
finding but some horses with aortic regurgitation can develop exercising arrhythmias, exercise intolerance
or heart failure. A diastolic murmur in a horse should be considered to be aortic regurgitation until proven
otherwise. The presence of a diastolic murmur, and the consequent suspicion of aortic regurgitation, should
prompt the clinician to feel the peripheral pulses. A horse with a diastolic murmur and strong or bounding
peripheral pulses likely has moderate or severe aortic regurgitation. Moderate to severe aortic regurgitation
predisposes horses to ventricular arrhythmias particularly during exercise. Aortic regurgitation and exercise
make the perfect arrhythmogenic cocktail; the ventricular enlargement and remodeling, the decreased cor-
onary perfusion caused by the aortic regurgitation, the shortened diastole caused by the increase in heart
rate, the increased oxygen demand and the increased sympathetic tone caused by the exercise create ideal
conditions for arrhythmias. Horses with moderate or severe aortic regurgitation that continue to exercise
should have an exercising electrocardiogram to investigate if exercising arrhythmias are present and an
echocardiogram to assess the cardiac structure and function.
Ventricular Septal Defect

Ventricular septal defect (VSD) is the most common congenital heart disease of horses. A VSD can be
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identified on cardiac auscultation by the presence of a characteristic combination of murmurs. The left to
right shunt causes a loud right sided systolic murmur. The second murmur is a systolic crescendo-decre-
scendo murmur with the point of maximal intensity over the pulmonic valve area that is less loud than the
one on the right. This second murmur is caused by the ejection of blood (increased due to the shunt) out of
the right ventricle and is called the murmur of ‘relative pulmonic stenosis’. Echocardiograms are needed to
determine the prognosis and level of exercise that will be tolerated by a horse with a VSD.
Atrial Fibrillation
Atrial fibrillation is the most common clinically relevant arrhythmia in humans and horses.Atrial fibrillation
affects performance in horses that practice high intensity exercise but many horses used for pleasure riding
or low intensity equestrian sports can do so while in atrial fibrillation. The decision to convert a horse to nor-
mal sinus rhythm is multifactorial. Duration of the arrhythmia, presence of previous episodes, presence of
underlying heart disease, economic factors, risk aversion of the owners and the use of the horse are some of
these factors. There is ongoing debate about the safety/risk for collapse in horses with AF. If a horse is not
going to be converted an echocardiogram and an exercising electrocardiogram are needed to determine if
it is safe for the horse to exercise. Current recommendations in horses with sustained atrial fibrillation are
that these horses should only be used by informed adult riders and exercise should be limited to a level
considered relatively safe based on the exercising ECG. Other cardiac diseases that can cause decreased
performance are myocarditis, poor myocardial function, aortocardiac fistulas, complex congenital heart
disease, 3rd degree AV block, sick sinus syndrome, severe pericarditis etc.
Exercising Arrhythmias
The field of exercising arrhythmias deserves special mention. The presence of arrhythmias is common in
normally and poorly performing horses. The influence of exercising arrhythmias on performance or toler-
ance to exercise is intuitive and extrapolated from basic physiologic studies documenting the associated
cardiovascular changes. However this influence is not proven and in many cases it is not possible to ascer-
tain if arrhythmias are incidental or the cause of poor performance. The fact that a malignant arrhythmia has
the potential of causing collapse or sudden cardiac death (SCD) complicates the decision making process-
es. Collapse and SCD can affect the health of horses, the public perception of welfare during equestrian
sports and most importantly the safety of riders. The incidence of malignant arrhythmias causing collapse
or SCD is fortunately low but likely 50-100 fold higher in horses than in analogous human athletes.
Cris Navas is a clinician and Penn Vet’s New Bolton Center. He received his veterinary degree from the
UCH-CEU University in Valencia, Spain, Phd from UAB, Barcelona, Spain and Masters Of Veterinary Clini-
cal Medicine from the University of Illinois. He completed a residency in Equine Internal Medicine (Universi-
ty of Illinois) and Fellowship in Cardiology and Ultrasound (University of Pennsylvania) and is a Diplomate of
the American College of Veterinary Internal Medicine since 2009. Before starting formal Internal Medicine
training worked in equine ambulatory practice. Dr Navas joined Texas A&M from 2015-2019 and returned
to PennVet in 2019. Dr Navas’ clinical activity and research focuses in equine cardiology and ultrasound. Dr
Navas’ ongoing projects are designed to prevent injuries and exercise assocaited deaths in equine athletes
and to promote veterinary health and education using telehealth.
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The use of echocardiography for cardiac disease in

the field setting
CRASH: A Point-Of-Care Ultrasound Protocol for
Cardiorespiratory Assessment
Cris Navas, LV, PhD, Dip ACVIM
New Bolton Center, College of Veterinary Medicine
University of Pennsylvania, Kennett Square, PA, USA
A POCUS protocol for the evaluation of the thorax is referred as TFAST. In the horse a similar protocol is
being developed and validated for the evaluation for the horse with cardiorespiratory disease as is some-
times referred to as CRASH- cardiorespiratory assessment with sonography of the horse. This is a POCUS
protocol to assess the cardiovascular and respiratory system of horses in a goal-oriented, time-sensitive ap-
proach. Echocardiographic windows described for this protocol are standard echocardiographic windows
as recently summarized by Schwartzwald.
This is the summary of the CRASH windows (Figure 1).

1 - Right parasternal long axis 4-chamber view (4C) - The transducer is positioned in the right fourth inter-
costal space at a level slightly above the olecranon, angled caudally, and rotated clockwise to the 1-o-clock
position. The ventricles, atrioventricular valves and atria are imaged. Imaging the left ventricular (LV) apex
is prioritized and the dorsal aspect of the atria may not be imaged in its entirety in all horses. This view is
used to assess the structures and dimensions of the LV and left atrium (LA).
2 - Right parasternal long axis view of the left ventricular outflow tract (LVOT) - Starting from a 4-chamber
view, the transducer is angled cranially, and rotated to the 2-o-clock position. It is used to assess the struc-
ture and dimensions of the aorta (Ao) and the pulmonary artery (PA). Specific attention is paid to the relative
size of the PA and the Ao as a marker for pulmonary hypertension.
3 - Right parasternal short axis view at the level of the chordal attachments (SACA, Image 3). This view is
obtained by rotating the transducer clockwise to the 3- to 4-o-clock position from a 4-chamber view. It is
used to assess ventricular size.
4 - Right parasternal short axis view at the level of the aorta (SAAo) -This view is obtained by moving the
transducer dorsally from the SACA and rotating the probe to the 5- to 6- o-clock position. The Aorta (Ao)
is seen centrally with the left atrium (LA) and left atrial appendage (LAa) visualized caudally toward the far
field. The size of the LA can be directly compared with the Ao similarly to the LA:Ao ratio described in small
animals.
5 - Caudoventral thoracic (CAV) window (right and left) - The caudo-ventral thorax from right side is viewed
in a longitudinal plane over the 7th intercostal space. A hyperchoic echo of lung, A lines and gliding respi-
ratory motions are the expected normal appearance. The diaphragm is viewed at the ventral aspect of the
window to ensure ventral position.
6 - Caudodorsal thoracic (CAD) window (right and left) - The caudo-dorsal thorax from right side is viewed
in a longitudinal plane over the 15th intercostal space. A hyperchoic echo of lung, A-lines and gliding respi-
ratory motions are the expected normal appearance.
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7 - Left parasternal long-axis 2-chamber view (2C) - The transducer is positioned in the 5th or 4th left
intercostal space slightly above the olecranon. The left ventricle (LV), left atrium (LA), and mitral valve are
viewed. Imaging of the LA is prioritized, and the apex of the LV may not be viewed. This view has tradition-
ally been used for assessment of LA dimensions.
The objectives of the examination are to answer the 8 specific questions below:
1. Is there increased pleural fluid?
Increased pleural fluid is seen as fluid in the pleural space. Fluid is considered relevant to report if
it is more than in the lateral aspect of the most ventral lung tip and more than approximately 1 cm
in depth.
2. Is there increased pericardial fluid?

Increased pericardial fluid is seen as fluid visible in the pericardial space that is more than a few
millimeters in depth
3. Is there moderate or severe lung pathology such as, consolidation, masses, abscesses and severe
or coalescing B-lines or comet tails. Consolidation is defined as hypoechoic area of lung with pres-
ent bronchial or vascular markings. Mass and abscesses are defined as well circumscribed areas
in the lung or pleural space that do not contain normal bronchial or vascular markings. Moderate
or severe B-lines or comet tails are defined as interruptions of the smooth and regular hyperechoic
echo of lung that merge or create patches.
4. Is there a pneumothorax?
Pneumothorax is the presence of air in the pleural space. This is visible as a hyperechoic echo of
gas free in the pleural space (outside of the lung) and therefore the hyperechoic echo of lung is not
seen sliding with respiratory motions
5. Is there evidence of moderate or severe pulmonary hypertension?

These are a pulmonary artery that is larger than the aorta’s sinotubular junction or shape of the
interventricular septum becoming concave right to left
6. Is there evidence of moderate to severe left side heart disease?

These are a left ventricular apex that is rounded and not cone shaped, the left ventricle is severely
enlarged and compressing the right ventricle, or the left atrium is moderately or severely enlarged
losing its rectangular shape and being disproportionate to the size of the right atrium.
7. Is there moderate or severe left ventricular hypertrophy or pseudohypertrophy?

The left ventricle is thicker in relationship to the left ventricular internal diameter. This corresponds
to RWT larger than 0.55.
8. Is there abnormal echogenicity of the myocardium or valves?

This is defined as the presence of hyperechoic, hypoechoic or nodular areas in the myocardium,
mitral, tricuspid, or aortic valves.
It is important to recognize that POCUS protocols that are not designed to substitute comprehensive so-
nograms or the work of specialists. This protocol has recently been published in peer reviewed literature
under the reference below that is an open access manuscript. For a digital version of these materials please
follow this link.
https://www.dropbox.com/scl/fi/il4eye8kte7oms74052zp/CRASH.pptx?rlkey=aan8krun6ohf7e4lax4yx-
42d3&dl=0
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WEVA CONGRESS
2023
Cris Navas is a clinician and Penn Vet’s New Bolton Center. He received his veterinary degree from the
UCH-CEU University in Valencia, Spain, Phd from UAB, Barcelona, Spain and Masters Of Veterinary Clini-
cal Medicine from the University of Illinois. He completed a residency in Equine Internal Medicine (Universi-
ty of Illinois) and Fellowship in Cardiology and Ultrasound (University of Pennsylvania) and is a Diplomate of
the American College of Veterinary Internal Medicine since 2009. Before starting formal Internal Medicine
training worked in equine ambulatory practice. Dr Navas joined Texas A&M from 2015-2019 and returned
to PennVet in 2019. Dr Navas’ clinical activity and research focuses in equine cardiology and ultrasound. Dr
Navas’ ongoing projects are designed to prevent injuries and exercise assocaited deaths in equine athletes
and to promote veterinary health and education using telehealth.
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2023
How ultrasound can be used to minimise the need for

big surgical incisions
Smith, R.K.W. MA VetMB PhD DEO FHEA DipECVSMR DipECVS FRCVS
Dept. of Clinical Sciences and Services
The Royal Veterinary College
London, U.K.
Introduction
Ultrasound lends itself well to intra-operative use because it provides real-time imaging, is portable, and
can be applied intraoperatively to image soft tissues but also the surface of bone. It can therefore be used
intra-operatively to facilitate minimally invasive surgical procedures.
Technique
Intra-operative use requires the transducer to be sterile. A small amount of ultrasound gel (which does
not need to be sterile) should be applied to the surface of the transducer. This should then be enclosed
by the gloved surgeon using a sterile covering such as an arthroscopic camera sleeve, sterile ultrasound
transducer sleeve, or, in some occasions, a sterile glove. A glove provides the least robust sterile barrier
and hence is only useful for standing procedures where the lead hangs down away from the surgical field.
In open surgical fields, there is usually sufficient blood for adequate contact, but this can be supplemented
with sterile saline (in open wounds), or surgical spirit (alcohol) when the transducer is applied to intact skin
within the sterile field. In most situations a linear high frequency (~10MHz) transducer is used because
most ultrasound guided surgery is superficial. Wireless transducers are also useful for intra-operative
use and have the advantage of lacking a lead which also needs to be enclosed in a sterile covering. Good
awareness by the theatre staff of ultrasound machine operation is helpful to optimise image quality and for
image storage during the procedure.
Indications
1. Pre-surgical planning
Ultrasound evaluation of the surgical area is helpful to optimise the surgical approach and hence mi-
nimise the size of any incision. This can be done prior to the induction of general anaesthesia or else
after the area has been prepared for aseptic surgery.
2. Identifying bony fragments and foreign bodies

Bony fragments or foreign bodies that require removal can be hard to locate within tissues or fibrinous
material inside a joint. Ultrasound can be used either pre-operatively, when the location of the foreign
body/bony fragment is marked on the skin, or intra-operatively to help guide instruments in real-time,
or locate them when they have moved or when they have not been visible (eg during arthroscopy).
3. Optimising instrument placement – examples will be given showing:

a. Introduction of the arthroscope in unfamiliar locations.
When the cavity being accessed is not one for which there are already established portals –
such as acquired synovial cavities or areas of fluid collection within tissues. Ultrasound can also
be helpful for less easily accessed synovial cavities – such as the caudal pouch of the medial
femorotibial joint.
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b. Distant debridement
Ultrasound can provide real-time guidance of instruments placed through small incisions to
guide them to a more distant site while avoiding important structures.
c. Improving fasciotomy techniques for proximal suspensory ligament surgery

The fasciotomy performed as part of the neurectomy and fasciotomy procedure for the man-
agement of proximal suspensory desmitis in the hindlimb requires the introduction of surgical
scissors or a fasciotome through the surgical incision and accurately placed at the proximal limit
of the metatarsal fascia. Iatrogenic damage to the suspensory ligament has been reported after
this procedure [1] and an experimental study suggested the fasciotome required, although did
not eliminate, the risk of this damage [2]. The use of concurrent ultrasound using a transverse-
ly orientated transducer immediately distal to the incision helps to reduce this risk further by
ensuring the instrument is cutting the plantar fascia without entering the adjacent suspensory
ligament.
d. Transection of tendons and ligaments

This can be achieved minimally invasively through a small incision with the help of intra-opera-
tive ultrasound – such as the accessory ligament of the deep digital flexor tendon [3], the palmar
annular ligament [4], medial patellar ligament, and tenotomy of the distal limb tendons (eg super-
ficial and deep digital flexor and extensor tendons).
e. Implant placement and removal

Drains and transphyseal screw placement can be performed minimally invasively with the con-
current use of ultrasound. Removal of bone screws can also be facilitated by identifying the
screw head ultrasonographically.
References
1. Dyson, S. and R. Murray, Management of hindlimb proximal suspensory desmopathy by neurecto-
my of the deep branch of the lateral plantar nerve and plantar fasciotomy: 155 horses (2003-2008).
Equine Vet J, 2012. 44(3): p. 361-7.
2. Sidhu, A.B.S., et al., Comparison of Metzenbaum scissors and Y-shaped fasciotome for deep meta-
tarsal fasciotomy for the treatment of proximal suspensory ligament desmopathy in horses. Vet
Surg, 2019. 48(1): p. 57-63.
3. White, N.A., 2nd, Ultrasound-guided transection of the accessory ligament of the deep digital flexor
muscle (distal check ligament desmotomy) in horses. Vet Surg, 1995. 24(5): p. 373-8.
4. De Gasperi, D., et al., Ex vivo evaluation of a percutaneous thread-transecting technique for des-
motomy of normal palmar/plantar annular ligaments in horses. Vet Surg, 2023. 52(3): p. 388-394.
Professor Roger K.W. Smith MA VetMB PhD FHEA DEO DipECVSMR DipECVS FRCVS
Large Animal Imaging Associate of the European College of Veterinary Diagnostic Imaging
Roger Smith is Professor of Equine Orthopaedics at the Royal Veterinary College (RVC) with particular inter-
ests in orthopaedic surgery, imaging, lameness, and tendon research. He qualified with a First from Cam-
bridge University in 1987. After 2 years in general practice, he undertook a residency in equine surgery at the
RVC and then a PhD on the extracellular matrix of equine tendons. He remained at the RVC and was appoint-
ed Professor in December 2003. He holds the Diploma of Equine Orthopaedics, is Diplomate of two European
Specialist Colleges (Veterinary Surgery (ECVS) and Veterinary Sports Medicine and Rehabilitation), and is a
Royal College of Veterinary Surgeon’s Specialist in Equine Surgery. He was awarded an RCVS Fellowship in
2016 and was ECVS President in 2017. He is currently President-Elect of British Equine Veterinary Association.
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Methods for screening racehorses for fracture risk

Prof Chris Whitton BVSc FANZCVS PhD, University of Melbourne
Fatal fractures in racehorses are an animal welfare issue that threaten the racing industry’s social licence.
As the majority of fractures that occur in racehorses develop over time due to the accumulation of bone
microdamage, there is an opportunity to develop screening methods that detect horses at risk of fracture
prior to catastrophic bone failure. Important considerations when developing screening methods include
determining the level of risk that is tolerable, how long the findings will be valid for, and will the method be
used on its own or in combination with other screening methods. It is also important to understand the
positive and negative predictive value of any screening method so that the number of false positive and
false negative results can be determined. The positive predictive value decreases for all screening tests
when the prevalence decreases meaning that false positives are more common for events that are rare.
This is an issue when applying screening to fracture risk because fractures in racehorses remain relatively
rare. Screening horses for fracture risk with advanced imaging is currently undertaken for the Melbourne
Spring Racing Carnival. Evidence for the use of imaging derives from postmortem studies where pre-exist-
ing pathology that could be detected with imaging modalities such as standing CT has been identified. The
monitoring of horses’ gait with wearable technology is a new methodology that shows some promise, but
more work is required before it can be effectively applied as a practical screening method.
Chris Whitton BVSc FANZVCS PhD

Specialist in Equine Surgery
Head of Equine Centre
Melbourne Veterinary School
Faculty of Science
University of Melbourne
Chris leads the Equine Limb Injury Prevention Program at the University of Melbourne Equine Centre a multi-
disciplinary research program funded by Racing Victoria, the Victorian State Government and the University
of Melbourne, combining microstructural analysis, histopathology, biomechanics, epidemiology and mathe-
matical modelling, dedicated to developing preventative training and management protocols for racehorses.
Chris trained as a specialist equine surgeon at the University of Sydney, Australia, gaining Fellowship of the
Australian and New Zealand College of Veterinary Scientists in Equine Surgery by examination in 1995. He
also completed a PhD in Carpal disease of racing horses at the University of Sydney in 1998 before moving
to work at the Animal Health Trust in Newmarket, England in 1996. From 1999 to 2004 he ran his own surgical
referral practice at the Newcastle Equine Centre in Australia and has worked at The University of Melbourne
since 2004 as a Specialist surgeon and researcher.
He has published over 70 peer reviewed papers and contributed to 12 book chapters. He has been awarded
over $13million in research grants. He regularly presents educational lectures on injury prevention to trainers
in Australia and has also presented to trainers and racing veterinarians in England, Ireland, Wales, Hong Kong,
Singapore, Korea, Brazil, and Uruguay.
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The Importance of Standing Computed Tomography in

Lameness and Orthopedics
Nicolas Ernst DVM, MS, DACVS
St. Paul, Minnesota, USA
The availability and utilization of computed tomography (CT) to aid lameness diagnosis and orthopedic
surgery predates magnetic resonance imaging (MRI) and has dramatically increased in the last 5 years.
In human orthopedics, CT is considered to be the best diagnostic modality for orthopedic problems and
fracture repair. For horses, CT has been a valuable aid in diagnosing lameness in the distal limb, offering
more information than radiographs. CT uses similar radiation to radiographs, but is faster, taking an average
of few minutes to image a region. This allows the imaging of a significant portion of the horse’s limbs from
distal radius/tibia to the foot. The new Standing CT systems for horses allows for imaging of both limbs
simultaneously whereas other diagnostic modalities require separate acquisition of the contralateral limb.
This facilitates a comparative evaluation of the anatomical area of interest and can help identify bilateral
causes of lameness.
Historically, CT in horses has been a limited due to the need for general anesthesia and the risks associated
with the anesthetic procedure. Now days, CT imaging in sedated, standing horses is now a possibility that
provides three dimensional (3D) information that improves the possibility of obtaining a definitive diagnosis
for orthopedic problems that cause lameness. Standing CT can provide more information regarding the
morphology of bone and some soft tissue injuries due to the possibility of obtaining cross-sectional images
in multiple planes. Musculoskeletal lesions (especially soft-tissue) can be further detected with the addition
of contrast material (iodine based) through intra-vascular, intra-articular or intra-thecal routes. Based on
the volume of information provided, it is essential that one understands anatomy in order to interpret all the
CT images.
Radiographs and ultrasound have low sensitivity and specificity for the detection of early bone changes.
In lameness cases, CT can provide valuable diagnostic information these other modalities often cannot
provide. This makes standing CT a tremendously valuable tool for clinicians when diagnosing lameness in
sport horses associated to the distal limb.
Imaging-assisted fracture repair is becoming part of the routine practice in orthopedic surgery. Fracture
configurations are complex making it hard to characterize them radiographically. CT is a superior 3D imag-
ing technique for pre-operative diagnosis and planning, intra-operative implant placement and post-oper-
ative evaluation of the repair. CT produces cross-sectional images with spatial separation of structures that
assists in recognizing and following the number and direction of fracture lines in a comminuted fracture,
facilitating a faster surgery and anesthesia time with less patient morbidity and minimal radiation exposure
to surgery personnel.
Cone-beam CT scanners have been used in horses; however, movement of the horse during acquisition
can affect the final image resulting in streaking artifacts, scatter and noise artifacts, and image distortion.
Helical CT systems developed for imaging of human patients are currently being used to scan distal limb in
horses. However, only one limb (non-weight-bearing) can be scanned at a time. A new multi-slice, helical,
fan beam CT scanner design specifically for horses (Equina system; Asto CT Inc.) has been developed with
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a sliding gantry that can be tilted from 0° to 90° for horizontal or vertical scanning. For distal limb scanning,
imaging from the distal portion of the radius or tibia, including the carpal or tarsal region, to the foot can be
performed on both limbs simultaneously. The Equina Standing CT by ASTO was first installed in the Uni-
versity of Minnesota Leatherdale Equine Center in 2019. Since that time, more than 600 horses have been
evaluated with this imaging modality in our hospital.
References:
1. Desbrosse FG, Vandeweerd J-MEF, Perrin RAR, et al. A technique for computed tomography (CT) of
the foot in the standing horse. Equine Vet Educ. 2008;20(2):93-98.
2. Puchalski SM. Computed tomography in equine practice. Equine Vet Educ. 2007;19(4):207-209.
3. Puchalski SM. Advances in equine computed tomography and use of contrast media. Vet Clin North
Am Equine Pract. 2012;28(3):563-581.
4. Porter EG, Werpy NM. New concepts in standing advanced diagnostic equine imaging. Vet Clin North
Am Equine Pract. 2014;30(1):239-268.
5. Mageed M. Standing computed tomography of the equine limb using a multi-slice helical scanner:
technique and feasibility study. Equine Vet Educ. 2022,34 (2) 77-83.
6. Pauwels FE, Van der Vekens E, Christan Y, et al. Feasibility, indications, and radiographically con-
firmed diagnoses of standing extremity cone beam computed tomography in the horse. Vet Surg.
2021;50(2):365-374.
7. Barrett M, Acutt E, Redding WR. Diagnostic Imaging. In: Baxter GM, ed. Adams and Stashak’s Lame-
ness in Horses. 7 ed. 2020;416.
Nicolas Ernst DVM, MS

Diplomate American College of Veterinary Surgeons
• Graduated from the University of Chile in 2000.
• Equine Rotating Internship (medicine, surgery, anesthesia and reproduction) at UC Davis in 2000.
• Equine Surgery Internship at Chino Valley Equine Hospital, Chino, California 2000-2001.
• Masters in Clinical Epidemiology at University of Florida 2001-2002.
• Equine Surgery Residency at University of Florida 2003-2006.
• Diplomate American College of Veterinary Surgeons 2007.
• Assistant Professor on Equine Surgery, Emergency and Critical Care at The Ohio State University 2006-2007
• Professor of Equine Surgery, Sports Medicine and Lameness at University of Minnesota 2007- present.
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Common complications in orthopaedic surgery

Luis M. Rubio-Martínez DVM DVSc PhD DipACVS DipECVS DipACVSMR MRCVS. Sussex Equine Hospi-
tal. Billingshurst Road, Ashington RH203BB, United Kingdom
Surgical complications are defined as ‘any undesirable, unintended, and direct result of an operation affect-
ing the patient that would not have occurred had the operation gone as well as could reasonably be hoped’
(Sokol and Wilson, 2008). Surgical complications can be categorised as intraoperative or postoperative,
depending if the complications occur during or after the surgical procedure. A postoperative complication
includes any event that occurs within a 30-day period after the surgery, either during or after hospitalisa-
tion (Jacobs er al 2007). Complications can also be categorised as patient-related and practitioner-related.
Practitioner-related complications are often a result of a surgical error; however, not all surgical errors end
up in surgical complications.
It remains key that errors and complications be recognised, identified and managed timely. The objective of
recognising these errors and complications is to be able to anticipate and implement measures to prevent
them as much as possible (Tseis et al 2014; Wooley et al 1993). A key strategy to decrease the risk of com-
plications is to ask the members of the team the questions: ‘Are we ready to respond?’.
Morbidity and mortality discussions provide analysis of failures and were first implemented in the early
1900s at Massachusetts General Hospital (USA). Implementation of Morbidity and Mortality discussions
have led to improved healthcare quality and patient safety (Kravet et al, 2006; Lecoanet et al, 2016; Tig-
nanelli et al, 2017). Professional practice evaluations by peer review of physician individuals and groups lead
to improved quality, protected patients from harm and improved patient outcome through implementation
of measures to identify and prevent operative complications. (Reines et al 2017; Tignanelli et al 2017).
Implementation of surgical safely checklists improved surgical safety of human patients, but reduced mor-
bidity, reduced hospitalisations, reduced mortality, whilst maintained operating room efficiently (Gawande
2007).
Unprofessional behaviour within the surgical theatre is associated with 14% higher surgical complication
rate (Tschan et al 2019) and disruptive doctors have a negative impact on the work of members of the sur-
gical team, with team members making more mistakes in the operating room.
Examples of surgical errors and complications in equine orthopaedic surgery will be reviewed in this lecture.
References:
1. Tschan F, Semmer NK, Timm-Holzer E, Zimmermann J, Candinas D, Demartines N, Hübner M,
Beldi G. Disruptive behavior” in the operating room: A prospective observational study of triggers
and effects of tense communication episodes in surgical teams. PLoS One. 2019; 14(12): e0226437.
2. Gawande A: The checklist: if something so simple can transform intensive care, what else can it
do? New Yorker 2007:86-101.
3. Jacbos JP, Jacbos ML, Mavrudis C, Maruszewski B, Tchervenkov CI, Lacour-Gayet FG, Clarke DR,
Yeh T, Walkers HL, Kurosawa H et al: What is Operative Morbidity? Defining Complications in a
Surgical Registry Database*. Ann Thorac Surg 2007, 84:1416-1421.
4. Kravet SJ, Howell E, Wright SM: Morbidity and mortality conference, grand rounds, and the AC-
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GME’s core competencies. J Gen Intern Med 2006, 21(11):1192-1194.
5. Lecoanet A, Vidal-Trecan G, Prate F, Quaranta JF, Sellier E, Guyomard A, Seigneurin A, Francois

P: Assessment of the contribution of morbidity and mortality conferences to quality and safety
improvement: a survey of participants’ perceptions. BMC Health Serv Res 2016, 16:176.
6. Reines HD, Trickey AW, Donovan J: Morbidity and mortality conference is not sufficient for surgical
quality control: Processes and outcomes of a successful attending Physician Peer Review commit-
tee. Am J Surg 2017.
7. Sokol DK, Wilson J: What is a surgical complication? World J Surg 2008, 32(6):942-944.
8. Tignanelli CJ, Embree GGR, Barzin A: House staff-led interdisciplinary morbidity and mortality con-
ference promotes systematic improvement. J Surg Res 2017, 214:124-130.
9. Tsesis I, Rosen E: Approach for prevention and management of surgical complications. In: Compli-
cations in endodontic surgery. edn. Edited by Tsesis I. Berlin: Springer-Verlag; 2014: 1-6.
10. Tsesis I, Rosen E: Introduction: an evidence-based approach for prevention and management of
surgical complications. . In: Complications in endodontic surgery: prevention, identification and
management. edn. Edited by Tsesis I. Berlin: Springer; 2014: 1-6.
11. Wooley CF, Boudoulas H: Clinician. Hellenic Journal of Cardiology 1993, 34:241-243.

University of Madrid (Spain). He then returned as an equine clinician to the University of Zaragoza, followed by
a surgical residency and a doctoral degree (DVSc) in subchondral bone disease in racehorses at the Ontario
Veterinary College (Canada). Luis has held faculty positions at the Universities of Guelph (Canada), Pretoria
(South Africa) and Liverpool (UK). In December 2017 Luis joined the Sussex Equine Hospital, where Luis is
currently a Clinical Director.
During his free time Luis enjoys attempting skiing, running, swimming and spending time with his wife and 2
kids.
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Understanding barefoot methodology: advantages

and limitations
Authors address: Virginia Therapeutic Farriery, 833 Zion Hill Rd, Keswick, VA 22947; e-mail: sogrady@look.
net
Introduction
The equine foot with healthy structures is superior in its natural or barefoot state as opposed to
being shod with regards to accepting the weight of the horse, shock absorption and dissipating
the energy of impact 1,2,3. Furthermore, the structures of the foot have an inherent ability to change
shape, strengthen and improve over time through the process of adaptation1,3. With the decline in
working horses and the rise in popularity of equestrian sports performed on deformable synthetic surfaces,
shoeing should no longer be regarded as a necessity. Indeed, at the 2020 Tokyo Olympics, the Swedish
team won the gold medal in show jumping. The fact that sport horses can perform at the highest levels
without shoes challenges traditional practice that regards a shod foot as the normal state.
The author does not infer that traditional farriery using horseshoes should be abandoned but that barefoot
methodology presents another viable option in equine foot care. Horseshoes provide protection when
wear on the solar surface of the foot exceeds growth at the coronet, they maintain or enhance
functionality by providing traction and lastly, therapeutic shoes are used to improve compromised
structures of the foot and treat disease/lameness. However, there are some negative consequences
of a horse being shod. The shoe replaces the single interface between the hoof capsule and the
ground with two interfaces7,8 The abrupt transitions from hoof wall to shoe and shoe to ground, to-
gether with the material properties of the shoe alter concussion and dampening by the foot and
lower limb, ultimately increasing impact intensity on the hoof 8.9,10. Furthermore, applying a stan-
dard horseshoe to the horse’s foot increases the force exerted on the navicular bone by the deep
digital flexor tendon by up to 14%8,12.
There is rivalry between traditional farriers and barefoot trimmers. Certainly, traditional farriery using horse-
shoes can be performed in a physiological manner with minimal damage to the horse’s foot 4,5,6 but a suc-
cessful outcome in transitioning a horse to barefoot methodology requires a different approach. This paper
will distance itself from the conventional trim and outline a simple and easy method of ‘shaping’ the foot for
a barefoot lifestyle based on basic farriery principles5,6.
Indications for Barefoot

In equine practice, a permanent or temporary transition to barefoot should be considered for horses that:
• Have good quality hooves and are not required to perform a large amount of exercise on abrasive
surfaces. These horses can transition from shod to barefoot and be maintained permanently
in the barefoot state.
• Will be out of work for a period, i.E., While being rehabilitated from an injury.
• Have poor limb conformation leading to hoof capsule deformation.
• Have chronic foot lameness associated with farriery.
• Have chronic foot lameness with an unexplained cause.
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• Have a low heel ‘bull nose’ conformation in the hind feet.
• Have abnormal gait associated with forging, interfering, and overreaching.
• Are rehabilitating hoof tissues such as
• Hoof capsule distortions involving compromised heel structures in the palmar/plantar foot.
• Sheared heels.
• Frogs that are either recessed or prolapsed relative to the ground surface of the foot.
Benefits of Barefoot
Maintaining horses in a barefoot condition should not be regarded as a fad that is rooted in minimalist ideas
of equine management nor should it be regarded as a cure-all. There are, however, many aspects of going
barefoot that pose a feasible and practical option to traditional farriery with practical and functional
benefits to the horse and owner.
• In comparison with being shod, the barefoot hoof shows a superior ability to absorb shock, dissi-
pate energy and accept the weight of the horse1,2,3.
• The structures of the foot have an inherent ability to change shape, strengthen and im-
prove over time through the process of adaptation when not confined by a rigid shoe1,3.
• A shoe elevates the hoof off the ground and loads it peripherally which places the bulk of the
load on the hoof wall whereas a barefoot horse loads the entire foot, and this affects the wear
pattern due to friction between the hoof and the ground.
• Allows natural movement and physiological function of the foot including greater heel expansion
and vertical movement of the heels in the unshod hoof 10,11.
• Hoof growth and wear often allow the barefoot horse to maintain the shape of its feet by
friction and wear between the entire solar surface of the foot and the ground.
• When a horse is shod, friction/wear is localized between the heel of the hoof capsule and the shoe,
which induces greater wear at the heel than the toe and changes the conformation of the foot be-
tween shoeing cycles 8,11.
The Barefoot Trim

The preparation of a foot that will remain barefoot, either temporarily or permanently, differs from the prepa-
ration of a foot prior to being shod. When the horse is shod, the foot is ‘trimmed’ and when the horse is
barefoot, the foot is ‘shaped’.
• The biggest differences in preparing the barefoot hoof are:
• The horny sole remains intact.
• The heels are placed in a load sharing state.
• The hoof wall is left 3–5 mm longer to provide maximal protection 6, 13.
•
A thick bevel is created around the perimeter of the hoof wall.
• The transition from being shod to remaining barefoot.
• The prerequisites for transitioning a horse to barefoot are:
• An adequate transition period to allow the feet to adapt.
• Good foot structures or foot structures that will improve.
• A change in farriery (‘shaping’ vs. trimming)
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Removing the horse’s shoes without a transition period will seldom be successful. After removing the shoes,
all the foot structures are involved in weight acceptance and these structures adapt to withstand changes
in the biomechanical forces/load now placed on the foot 8. . The length of the transition time depends on
the quality of the hoof capsule structures when the shoes are removed. The feet are shaped at 3–4-week
intervals as outlined in the trim protocol above, ensuring the hoof wall at the heels and the frog remain on
the same plane to ensure that the palmar/plantar section of the foot ‘shares the weight ‘.
Characteristics of horses that transitioned successfully from shoes to barefoot:

• Foot develops a hard hoof wall, possibly because moisture or urine were not being retained under
the shoe.
• A thick sole callus formed at the sole-wall junction of the toe.
• The hoof wall-bar junction became stronger.
• The frog became thicker and wider.
• The foot changes shape by developing an increased depth (cup/concavity)
Conclusions
Success in transitioning horses from shod to barefoot is based on the veterinarian, farrier, trainer, and owner
understanding and being willing to adhere to the entire transitional process. The author has had consistent
success in transitioning horses to barefoot primarily due to the cooperation of all parties involved. Trainers/
riders state that stride kinematics change when the horse is barefoot, and they show greater clearance over
the jumps. Based on the records of 70 horses, 50 of which were actively competing, only two horses that
met the prerequisites could not be transitioned from wearing shoes to barefoot.
References
1. Clayton HM, Gray S, Kaiser LJ, Bowker RM. Effects of barefoot trimming on hoof morphology. Aust
Vet J. 2011 Aug;89(8):305-11.
2. O’Grady SE. Various aspects of barefoot Methodology relevant to equine veterinary practice.
Equine Vet Edu 2016 28(6):321-326.
3. Davies, H.M. (2007) Biomechanics of the equine foot. In: Equine Podiatry, Eds: A.E. Floyd and R.A.
Mansman, Elsevier, St. Louis. pp 42-56.
4. O’Grady, S.E. and Poupard, D.E. (2003) Proper physiologic horseshoeing. Vet. Clin. N. Am. 19, 333-
351.n
5. O’Grady, S.E. (2009) Guidelines for trimming the equine foot: a review. Proc. Am. Ass. Equine Pract.
55, 215-225.
6. O’Grady, S.E. Principles of trimming and shoeing. In: Baxter GM, ed. Adams and Stashak’s Lame-
ness in Horses 7th ed. Ames, IA: Wiley-Blackwell, 2020;1112-1133.
7. Parks, A.H. (2011) The practice of shoeing. In: Lameness in the Horse, 2nd edn., Eds: M.W. Ross and
S.J. Dyson, Elsevier, St. Louis. pp 301- 303.
8. Eliashar, E. (2012) The biomechanics of the equine foot as it pertains to biomechanics. Vet. Clin. N.
Am.: Equine Pract. 28, 284-291.
9. Benoit, P., Barney, E., Renault, J.C. and Brochette, J.L. (1993) Comparison effect of dampening effect
of different shoeing by the measurement of hoof acceleration. Acta Anat. 146, 109-113.
10. Roepstorff, L., Johnston, C. and Drevemo, S. (1999) The effects of shoeing on kinetics and kinemat-
ics during the stance phase. Equine Vet. J. 31, Suppl. 30, 279-285.
11. Roepstorff, L., Johnston, C. and Drevemo, S. (2001) In vivo and in vitro heel expansion in relation to
shoeing and frog pressure. Equine Vet. J. 33, Suppl. 33, 54-57.
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12. Willemen MA, Savelberg HH, Barneveld A. The effect of orthopaedic shoeing on the force exerted
by the deep digital flexor tendon on the navicular bone in horses. Equine Vet J 2004; 36:431-435.
13. Castelijns, H. (2012) The basics of farriery as a prelude to therapeutic farriery. Vet. Clin. N. Am.:
Equine Pract. 28, 314.
Stephen E. O’Grady, DVM
The first title ‘Managing hoof wall defects’ is perfect. The second title ‘Radical hoof surgery for laminitis’ pres-
ents a problem. I am not familiar with any radical hoof surgery other than the resections that were performed
years ago, nor do I practice any radical procedures in my own practice. I have an extensive podiatry practice
and the only surgery I do for laminitis is an occasional DDF tenotomy.
As an alternative, I would like to suggest ‘Understanding barefoot methodology: advantages and limitations. I
have always used barefoot methodology as an option to rehabilitate hoof capsule distortions with great suc-
cess. I published a paper on this topic in 2015 in EVE. Since the Olympics in Japan where the gold and silver
medal winners in the jumpers were barefoot, there has been a renewed interest in competing horses without
shoes. This has become popular in Europe and currently, there is a study going on in Sweden. Allowing the
horse to compete barefoot for many varied reasons is a viable option to traditional farriery. However, there is
a process…determining if the hoof has the structural integrity or can the current structures be improved to
remain barefoot, an adaption period that is required, and the hoof care needs to be modified…all of which
would be described in the paper. I currently have over seventy upper-level competition horses competing
barefoot. To summarize, the paper would describe both using barefoot methodology to rehabilitate problem
feet and why/how it can be used in competition horses.
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Surgical treatment of laminitis-is there a place for i?

Several surgical procedures have been recommended for the treatment of laminitis. These procedures are
the following:
Inferior check desmotomy. The purpose is to relieve stress on the deep digital flexor tendon. The procedure
is very effective for flexural limb deformity. The procedure is effective in releasing tension on the deep digital
flexor tendon but may be too little to make a significant impact on laminitis (depending on the severity).
Deep digital flexor tenotomy. Deep digital flexor tenotomy is a surgical alternative that transects the deep
digital flexor tendon in either the mid-cannon bone region or mid-pastern region. Transection removes one
of the main forces responsible for rotation of the coffin bone in laminitis. In one retrospective study, Sev-
enty-seven percent of the horses that had the operation were still alive after six months, and 60% survived
at least two years. This was considered substantial considering the presurgical conditions of the horses.
Transfixation pin casts. This is an external fixation device that uses large pins placed within the metacarpus
and sidebar, the apparatus incorporates the foot and transfixation pins. The procedure reduces weight on
the hoof and reduces the strain on the deep flexor tendon. There are no studies looking at outcomes relative
to laminitis but there are individual cases where it has been effective. There are long-term issues associated
with the pin holes.
Lag screw fixation of hoof capsule to the coffin bone. Investigations have been underway to test the possi-
bility of preventing coffin bone rotation in cases of acute laminitis by placing a single screw through the hoof
wall and into the bone. After 48 to 72 hours or once the initial inflammation has subsided the screw can be
removed. While effective and relatively non-painful in non-laminitic horses, the procedure has so far been
disappointing in its initial results with laminitic horses.
Hoof wall resection. Performing a resection is the removal of part or all of the hoof wall can relieve the
pressure on the laminae and thereby allow the critical blood circulation to be restored. With meticulous
aftercare, the foot’s underlying tissues can then repair. Twenty years ago is quite popular but has since lost
popularity.
1. Burba JB, Hubert JD, Beadle R: How to perform a mid-metacarpal deep digital flexor tenotomy on
a standing horse. In Proceedings An Assoc Eq Practnr, 52; 2006: 547-550.
2. Hunt RJ, Allen D, Baxter GM, et al. Mid-metacarpal deep digital flexor tenotomy in the management
of refractory laminitis in horses. Vet Surg 1991;20:15–20.
3. Joyce J, Baxter GM, Sarrafian TL, et al: Use of transfixation pin casts to treat adult horses with com-
minuted phalangeal fractures: 20cases. JAVMA 2006:229:725-730.
4. Carmalt KP, Carmalt JL: Novel technique for prevention of rotation of the distal phalanx relative to
the hoof wall in horses with acute laminitis. AJVR 2019:80:943-948.
5. Rucker A: Chronic laminitis: strategic hoof wall resection. Vet Clin North Am Equine
Pract. 2010:26:197-205.
253
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2023
Tracy Turner began his professional career as a farrier and used those skills to help finance his education. He
received his DVM degree from Colorado State University in 1978. He completed an internship at the University
of Georgia and a surgical residency as well as a Master of Science degree at Purdue University in 1981. His
Master’s thesis was “Thermography of the Lower Limb of the Horse.” He served on the faculty of the Univer-
sities of Illinois, Florida and Minnesota. At Minnesota, he was Head of Large Animal Surgery and attained the
rank of full Professor before leaving academics to join Anoka Equine Clinic in 2004. In 2016, he started his own
practice dedicated to Sports Medicine and Surgery.
back issues in horses, rehabilitation and thermography. His podiatry research has evaluated the radiographic
and morphologic characteristics of hoof imbalance, as well as the differential diagnosis of palmar foot pain
(PFP) and the development of PFP treatment strategies. Turner has researched the use of diagnostic imaging
techniques for evaluation of equine back problems (including saddle fit) and developed epidemiological data
on overriding spinous processes in horses. He pioneered the use of thermography as a diagnostic aid in lame-
ness evaluation, as well as its use in horse welfare regulation. Turner has extensively published on these topics
and been invited to lecture nationally and internationally. In 2004, Turner was inducted into the International
Equine Veterinarian’s Hall of Fame.
possible.
254
Proceedings
Oral Presentations WEVA CONGRESS
2023
#25 - Effect Of Altrenogest On Endogenous

Progesterone During Early Pregnancy in Recipient
Mares
Authors
Crabtree, James1 ; Mouncey, Rebecca2 ; Wilsher, Sandra3
Affiliation
1Equine Reproductive Services (UK) Ltd, Director, Malton, Reino Unido (RU) ; 2Royal Veterinary College,
Department of Pathobiology and Population Sciences, London, Reino Unido (RU) ; 3Sharjah Equine Hos-
pital, Reproduction, Sharjah, Emiratos Árabes Unidos
Introduction: Altrenogest is commonly utilised for hormonal pregnancysupport with undefined effects.
We investigated effects of altrenogest on endogenous progesterone (P4) in embryo recipient mares (RM)
during early pregnancy by cross-sectional study.
Materials And Methods: Thirty RM received 150mg depot altrenogest from transfer, at 7-day intervals,
through to 42 days (ALT), a further 31 RM received no altrenogest (CON). P4 assayed by amplified ELISA
at 7-day intervals, starting 7 days after transfer. Data analysed by total (tP4, ng/ml) and corrected (cP4) by
number of corpora lutea (CL). Statistical comparisons by Kruskal-Wallis ANOVA and Friedman repeated
measures; values presented as median and 95%CI. Odds ratios (OR) calculated to evaluate associations.
Results: In ALT, cP4 was lower on days 21, 28 and 35 compared to days 14 and 42 (p<0.01). In CON, com-
pared to day 14, cP4 was lower on days 21, 28, 35 (p<0.01) and day 42 (p=0.026). Secondary CL occurred in
17.24% CON and 26.67% ALT (OR 1.55; 0.45-5.28, p=0.487); tP4 was lower in ALT 4.8 (3.9-6.3), compared
with CON 6.0 (5.4-7.3, p=0.04), and in ALT 4.7 (3.9-5.3), compared with CON 5.7 (5.1-7.4, p=0.02) at 21 and
28 days respectively. This held true for cP4 at 21 (ALT 3.7; 2.8-4.3 versus CON 4.7; 3.7-6.6, p=0.03) and 28
days (ALT 3.4; 2.5-4.3 versus CON 5.0; 4.0-5.8, p=0.005) where effect of multiple ovulations was nullified.
In 40% of ALT, tP4 was <3.0 at 1 time-point compared to 3.2% in CON. The odds of a mare having a tP4
concentration <3.0 at any time-point was greater
for ALT (OR 11.2; 1.37-91.83, p=0.024). CONCLUSIONS: Altrenogest led to suppressed endogenous P4 pro-
duction with greatest magnitude at 28 days of gestation; we hypothesise that this is mediated via negative
feedback of altrenogest on pituitary LH release and effective reduction of its luteotrophic influence.
255
Proceedings
2023
#29 - Putting The Cart Before The Horse: Mixed-

Methods Participatory Investigation Of Working Equid
Harnessing Practices In Ethiopia
Authors
Merridale-Punter S., Mathilde1 ; Elias, Belay2 ; Legesse, Abel3 ; Hitchens L., Peta4
Affiliation
1University of Melbourne, Melbourne Veterinary School, Faculty of Science, Melbourne, Australia ; 2Hawas-
sa University, Faculty of Veterinary Medicine, Hawassa, Etiopía ; 3Addis Ababa University, College of Veter-
inary Medicine and Agriculture, Addis Ababa, Etiopía; 4University of Melbourne, Equine Centre, Melbourne
Veterinary School, Melbourne, Australia
Background: Millions of working equids support the functioning of low-income communities worldwide.
With the prevalence of harnessrelated wounds reported as high as 80%, this study aims to describe the
equipment used by working equids in three Ethiopian locations, and the attitudes and practices of equid
stakeholders regarding work equipment.
Methods: This mixed-methods study consists of cross-sectional surveying of working equids used for taxi,
transport of goods or water, as well as structured interviews with cart-drivers and focus group discussions
(FGD) with working equid stakeholders. Focus group discussions included participatory ranking of equip-
ment attributes and equipment drawing exercises. Indicators of equipment design and assembly, as well as
cart-driver attitudes and practices were described quantitatively. Associations between equipment char-
acteristics and species, work-type and cart-driver indicators were investigated through univariable logistic
regression models, whereas focus group discussions were transcribed and analysed thematically.
Results: In total, 368 working equids and cart-drivers were surveyed and 88 participants took part in
nine FGD. Equipment characteristics differed considerably from those described in the literature, with only
saddles and breast collars present in all equipment. Donkey harnesses had fewer components than those
of horses, such as swingle-trees (OR 0.02; 95% CI 0.01-0.06; p<0.001) or girths (OR 0.09; 95%CI 0.02-0.4;
p=0.002). Horse equipment was more likely to have functional elements such as breeching (OR 7.8; 95% CI
2.9-20.9; p<0.001). Of all equipment attributes, FGD participants ranked cost, design and animal wellbeing
highest. Thematic analysis identified lack of training, awareness and direct or indirect access as barriers to
quality equipment, which participants indicate
compromises the welfare of equids and the broader community.
Conclusions: Various deficiencies of design, assembly and use of equid work equipment were identified.
Promoting behavioural change through awareness and training could lead to a sustainable improvement of
work equipment quality, access and prevention of equipment-related problems.
256
Proceedings
2023
#111 - Evaluation Of The Concentration And Molecular

Weight Of Hyaluronic Acid In Synovial Fluid Before
And After Arthroscopic Irrigation In Horses With Intra-
Articular Osteochondral Fragmentation
Authors
Oliveira Cota, Leticia1 ; Fulber, Joice1 ; Valero Fiorin, Eliti1 ; Lopes Correia Silva, Luis Claudio1
Affiliation
1University of São Paulo, Department of Surgery, São Paulo, Brasil
Introduction
Joint irrigation fluids replace synovial fluid (SF) during arthroscopy. It is known that only after 24 hours
hyaluronic acid (HA) concentrations return to baseline levels. However, we have poor information of the
immediate effects of arthroscopy on SF replacement. Therefore, the objective of the study was to evaluate
the concentration and molecular weight of HA in the SF of horses in the first hour after arthroscopy.
Materials and methods

Horses with osteochondral fragmentation undergoing arthroscopy of two or more joints were included. A
prospective study of the first joints accessed was carried out. Arthroscopy was performed with irrigation of
lactated Ringer’s solution and SF was collected from the same joint at the beginning of the first procedure
and at the end of the last arthroscopy (average ± standard deviation of 61 ± 23 minutes). HA was identified
by agarose gel electrophoresis and its concentration and molecular weight were quantified by densitome-
try. The HA concentration was corrected by the urea concentration. Data were evaluated using the paired
T and Wilcoxon test (Jamovi 2.3).
Results
Concentration (baseline: 0.97 ± 0.36 mgHA/mgU; post-arthroscopy: 0.61 - 0.36 mgHA/mgU; p<0.001;
d=1.16) and weight (baseline: 7,767 ± 987 kDa; post-arthroscopy: 4,134 ± 596 kDa; p<0.001; d=1) of the HA
of the SF after arthroscopy was significantly lower, despite being present and measurable.
Discussion/conclusions
In the first hour after arthroscopy, despite being significantly lower, the SF presents levels greater than 50%
in the concentration and molecular weight of HA, compared to baseline values. The study therefore demon-
strates a process of early reestablishment of HA production in SF after arthroscopic irrigation, providing
protection to the joint surface in the immediate postoperative period, even during anesthetic recovery.
257
Proceedings
2023
#149 - Equine Viral Infections In Argentina: A Ten-Year

Overview Based on Laboratory Results
Authors
VISSANI, MARIA ALDANA1 ; Tordoya, Maria Silvia2 ; Alamos, Florencia2 ; Barrandeguy, Maria Edith3
Affiliation
11-Instituto Nacional de Tecnología Agropecuaria (INTA); 2-Facultad de Ciencias Agrarias y Veterinarias,
Universidad del Salvador, 1- Instituto de Virología, CICVyA, 2-Instituto de Investigación en Veterinar, Cas-
telar, Argentina ; 2Instituto Nacional de Tecnología Agropecuaria (INTA), Instituto de Virología, CICVyA,
Castelar, Argentina ; 3Facultad de Ciencias Agrarias y Veterinarias, Universidad del Salvador, Instituto de
Investigación en Veterinaria, Pilar, Argentina
Introduction
Viral infections are a threat to the equine industry(1,2). In this work, we summarized the information on viral
diseases of horses in Argentina in 2013-2023.
Materials and Methods

Samples of 687 abortions, 172 neurological cases, 76 outbreaks of respiratory disease and 95 cases of di-
arrhea in foals; and 1874 nasopharyngeal swabs (NS) from horses in the pre-export quarantine; plus 547
semen from the pre-import quarantine, were submitted for virological studies. Serum for Equine Arteritis
Virus (EAV; n: 44853) and West Nile Virus (WNV; n: 9867) serology were submitted from pre-import/export
quarantine and surveillance programs. Virological diagnosis was performed by virus isolation and PCR,
while seroneutralization and ELISA were used for EAV and WNV serology, respectively. Tests were con-
ducted following the recommendations of the World Organization for Animal Health(3).
Results
Equid herpesvirus 1 was detected in 5% (33/687) of the abortions and in 2% (4/172) of the neurological
cases. Rabies virus (antigenic variant 3) and Equine Infectious Anemia were the etiology of two other neu-
rological cases. For respiratory disease, Equid herpesvirus 4 was registered in 17% (13/76) of the cases, and
Influenza virus (EIV), only in 2018, in relation to the outbreak in Argentina. Abortions and NS from respirato-
ry cases resulted negative for EAV. Rotavirus A was detected in 38% (36/95) of the diarrhea cases. All NS
from pre-export horses resulted negative to EIV. EAV was only detected in one semen straw (0.2%) from
the pre-import quarantine. As for serology, 2% (782/44853) of the samples resulted positive for EAV, being
these horses either related with the 2010 EAV outbreak in Argentina, or vaccinated, or imported as vacci-
nated. No new EAV positive horses were detected after August 2010. No samples tested positive for WNV.
Conclusions
This data emphasize the importance of etiological diagnosis to implement control measures and the ben-
efits of surveillance programs.
References
1. Timoney P. Infectious diseases and international movement of horses. In: Sellon D, Long M, editors.
Equine Infectious Diseases. 2nd ed. St. Louis, MO, USA: Saunders Elsevier; 2014. p. 544–50.
2. Sellon D, Long MT. Viral Diseases. In: Sellon D, Long MT, editors. Equine Infectious Diseases. Sec-
ond. 2017. p. 132–256.
3. World Organization for Animal Health. WOAH Listed Diseases and Other Diseases of Importance.
In: Manual of diagnostic tests and vaccines for terrestrial animals [Internet]. 2023. Available from:
https://www.woah.org/es/que-hacemos/normas/codigos-ymanuales/acceso-en-linea-al-manu-
al-terrestre/
258
Proceedings
2023
#8 - Common clinical findings identified in working

equids in low- and middle-income countries from 2005
to 2021
Authors
Merridale-Punter, Mathilde1 ; Patrick, Cameron2 ; El-Hage, Charles1 ; Wiethoelter, Anke1
Affiliation
1University of Melbourne, School of Veterinary Medicine, Melbourne, Australia ; 2University of Melbourne,
Statistical Consulting Centre, School of Mathematics and Statistics, Melbourne, Australia
Despite several millions of working equids worldwide[1, 2], there are few studies regarding the epidemiolo-
gy of their health and welfare. Data collected by non-governmental organisations (NGOs) operating in the
working equid sphere therefore have important epidemiological value and could be used towards animal
health surveillance.
The aim of this study was to identify common clinical findings and mortality patterns of working equids
in low- and middle-income countries and investigate their epidemiology using data collected from an in-
ternational NGO. A retrospective analysis was conducted to determine the proportion of clinical findings
and mortality risk by equid species, year and region. Negative binomial regression models were generated
to investigate differences in mortality risk and proportion of key clinical findings between equid species,
hemispheres and calendar month.
A total of 4,313,606 presentations were reported from 14 countries between January 2005 and March 2021
(mean 263,957; SD ± 63,898 per year). Wounds were the most reported clinical finding for all equid species
(mean proportion 35%; SD ±0.19 of all findings). A higher proportion of wounds (mean proportion 41.7%;
SD±0.2) was recorded in donkeys than mules or horses (P<0.001). Mules had higher reported mortality
risk (1.2%; 95% CI 0.94-1.46%) than horses (0.4%; 95% CI 0.36-0.55%; p<0.001) or donkeys (0.2%; 95% CI
0.14-0.22%).
Work-related wounds were the predominant finding in all working equids, particularly so in donkeys. Pre-
vention strategies should focus on improvements to work equipment and practices for all equids. Future
investigations required include refinement of diagnostic approaches for donkeys and investigation of risk
factors to understand the higher mortality in mules. Routine monitoring of clinical findings reported by inter-
national NGOs could be included in animal health surveillance strategies, although standardisation of data
for this purpose is critical so that changes in prevalence following implementation of prevention strategies
can be monitored.
References
1. FAO. FAOSTAT, Production Data, Live Animals. Food and agriculture data for over 245 countries
and territories. Food and Agriculture Organization of the United Nations2019.
2. Norris SL, Little HA, Ryding J, Raw Z. Global donkey and mule populations: Figures and trends.
Plos one. 2021;16(2):e0247830.
259
Proceedings
2023
#86 - A new option for pain relief in donkeys: a

pharmacokinetic pilot study comparing transdermal
Flunixin Meglumine to oral and intravenous forms
Authors
MCLEAN, AMY1 ; Felt, Tara1 ; Gonzalez Navas, Francisco Javier2 ; Kynch, Heather3
Affiliation
1UNIVERSITY OF CALIFORNIA DAVIS, Animal Science, Davis, Estados Unidos (EEUU) ; 2University of
Cordoba, Vet Genetics, Cordoba, España ; 3University of California, Clinical Veterinary Pharmacology, Da-
vis, Estados Unidos (EEUU)
Introduction
Donkeys are stoic animals who may endure pain without the display of feelings and complaints. Due to this
behavior, a donkey may ultimately mask pain with behaviors, such as sham eating or by only showing slight
indications of pain. These subtle behaviors may go unnoticed, thus concealing illness/injury. There is a lack
of analgesic drugs with marketing authorization for administration to donkeys and a lack of information
on dosing rates and intervals when analgesia is provided. Donkeys differ from horses behaviorally, phys-
iologically, and pharmacologically1. Recent approval and effectiveness of transdermal flunixin meglumine
(Banamine®) in cattle has opened the door for the drug’s potential application in other species. Hypothesis
was transdermal flunixin meglumine will have similar pharmacokinetics and effects on biomarkers of in-
flammation in donkeys compared to oral and injectable.
Materials And Methods

Oral, injectable, and transdermal flunixin meglumine (Banamine®, Merck Animal Health) were administered
to six healthy donkeys dosed at 1.1 mg/kg BW for oral, intravenous and (per label) 3.3 mg/kg transdermal in
a three-way crossover design. The study was carried out in Davis, California, U.S.A under IACUC #22018.
Whole blood samples were collected over 96 hours to measure concentrations of flunixin, 5OH flunixin, and
eicosanoids using LC-MS/MS and pharmacokinetic parameters determined.
Results
Both flunixin and 5OH flunixin reached detectable levels in blood collected during the transdermal trial.
Drug elimination was slower following transdermal compared to IV and oral forms. Transdermal signifi-
cantly decreased TXB2 1 to 96 hours post-administration, IV and oral resulted in TXB2 reduced 1 to 8 hours
(P<0.001). Significant reduction in PGF2 alpha was seen 1 hour later in oral and IV but transdermal resulted
in gradual decline 1 to 24 hours.
Discussion
This study suggested therapeutic doses for flunixin are 1.1mg/kg for oral and IV and 3.3 mg/kg off label use
of transdermal are effective.
References
1. Ciofalo VB, Latranyi MB, Patel JB, et al. Flunixin meglumine: a non-narcotic analgesic. Pharmacol. Exp.
Ther. 1977, 200(3), 501-507.
260
Proceedings
2023
#153 - Colitis Caused By Multidrug-Resistant

Klebsiella Pneumoniae Infection In 6 Horses in South-
East Germany: Case Series
Authors
Blaszczyk, Klaudia Zofia1 ; Barsnick, Rosa2
Affiliation
1Altano Germany GmbH, Equine Veterinary Center Kirchheim, Establishment Empfingen, 72186 Empfingen,
Alemania ; 2Altano Germany GmbH, Equine Veterinary Center Kirchheim, 73230 Kirchheim unter Teck,
Alemania
Introduction: Clinical diseases affecting the respiratory and reproductive tract caused by the gram-neg-
ative bacterium Klebsiella pneumoniae have been reported in horses. Klebsiella pneumoniae can cause
diarrhea in humans and other species such as dogs and cattle. Thus far, this facultative anaerobe has been
isolated in the feces of healthy horses and in horses with diarrhea as a finding of coinfection with other
colitis pathogens. This case series describes new information pertaining to Klebsiella pneumoniae as a sole
pathogen in equine (entero-) colitis.
Clinical history: Retrospective case series of five horses and one foal hospitalized in 2022/2023.
Relevant clinical findings: All cases presented with typical clinical signs of (entero-) colitis of varying sever-
ity, to include dehydration, diarrhea, hypoproteinemia, and intestinal wall thickening.
Evidence-based diagnosis: A positive fecal bacterial culture for Klebsiella pneumoniae as the sole in-
testinal pathogen was obtained in all six cases, including one foal. Comprehensive testing for other viral,
bacterial and parasitic pathogen co-infection was negative. All adult horses with colitis were confirmed with
multidrug-resistant strains of Klebsiella pneumoniae.
Treatment and management: Cases received individualized supportive treatment for colitis. All patients
were additionally treated with antimicrobials guided by available susceptibility testing for Klebsiella pneu-
moniae.
Evolution: Five out of six cases recovered. One horse was euthanized due to severity of disease; post mor-
tem examination was not performed.
Discussion: This cases series newly highlights the importance of multidrug-resistant strains of Klebsiella
pneumoniae as a sole pathogen in cases of equine intestinal disease, similar to which is observed in other
species. The close proximity between humans and horses increases the risk for transmission of zoonotic
diseases and requires that proper biosecurity and use of antimicrobial treatment is instituted.
References
1. Ribeiro M G, et al. Klebsiellainduced infections in domestic species: a caseseries study in 697 animals
(1997–2019). Brazilian Journal of Microbiology; 2022. 53:455–464.
2. Loncaric I, et al. Broad-Spectrum Cephalosporin-Resistant Klebsiella spp. Isolated from Diseased
Horses in Austria. Animals; 2020. 10, 332.
3. Estell K E, et al. Pneumonia Caused by Klebsiella spp. in 46 Horses. J Vet Intern Med; 2016. 30:314–321.
4. Özgür N Y, A. Bagcigil A F, Ikiz S. Isolation of Klebsiella pneumoniae from Mares with Metritis and
Stallions, Detection of Biotypes and Capsule Types. Turk J Vet Anim Sci; 27; 2003. 241-247.
5. Valkova I, Barton A K, Briese B, Kershaw O, Gehlen H. Klebsiella pneumoniae causing colitis and
terminal sepsis in a horse. Pferdeheilkunde – Equine Medicine 39; 2023. 325–331 p.
261
Proceedings
2023
#26 - The Hypothalamic-Pituitary-Adrenal Axis

Response to Vasopressin Stimulation Test in Healthy
and Critically ill Foals
Authors
Dembek, Katarzyna1 ; Elder, Erin1 ; Wong, David2
Affiliation
1North Carolina State University, College of Veterinary Medicine, Raleigh, Estados Unidos (EEUU) ; 2Iowa
State University, College of Veterinary Medicine, Ames, Estados Unidos (EEUU)
Introduction: Sepsis remains the leading cause of death in foals. The hypothalamic-pituitary-adrenal gland
axis (HPAA) dysfunction is a common complication of sepsis, resulting in decreased survival. HPAA dys-
function can be diagnosed with arginine vasopressin (AVP) stimulation test in other species. The goal of
this study was to evaluate HPAA response to AVP stimulation in healthy and hospitalized foals. We hy-
pothesized that AVP would stimulate a rise in ACTH and cortisol in healthy foals. We also proposed that
cortisol and ACTH response would be decreased in critically ill foals compared to healthy foals, and that the
diminished response would be associated with
disease severity and outcome.
Materials and Methods: HPAA function was assessed in 12 healthy and 18 hospitalized foals <7-days
old on admission to a referral hospital in USA, utilizing 2 doses of AVP (2.5, 5 IU). Cortisol and ACTH were
measured at 0 (baseline), 15, 30, 60, and 90 minutes after AVP administration with immunoassays. A fold
increase 15 and 30 minutes from baseline was calculated for cortisol and ACTH concentrations.
Results: All doses of AVP resulted in a significant increase in cortisol concentration and a dose-dependent
increase in ACTH concentration over time in both groups. ACTH and cortisol concentration increased 15
and 30 minutes after both doses of AVP compared to baseline in healthy and hospitalized foals (P<0.01).
Cortisol and ACTH response to AVP administration (2.5 and 5 IU) at 30 and 15 minutes was lower in criti-
cally ill foals compared to healthy foals suggesting HPAA dysfunction (P<0.05).
Discussion: Administration of AVP is safe and results in a significant rise in ACTH and cortisol in both
healthy and hospitalized foals. A stimulation test with 2.5 and 5 IU of AVP can be considered for HPAA
assessment in critically ill foals.
References
1. Johnson K, Peterson J, Kopper J, et al. The hypothalamicpituitaryadrenal axis response to ovine
corticotropinreleasinghormone stimulation tests in healthy and hospitalized foals. J Vet Intern Med
2023;37:292-301.
2. Dembek KA, Johnson LM, Timko KJ, et al. Multiple adrenocortical steroid response to administration
of exogenous adrenocorticotropic hormone to hospitalized foals. J Vet Intern Med 2019;33:1766-
1774.
3. Hart KA, Slovis NM, Barton MH. Hypothalamic-pituitary-adrenal axis dysfunction in hospitalized
neonatal foals. J Vet Intern Med 2009;23:901-912.
4. Dembek KA, Hurcombe SD, Stewart AJ, et al. Association of aldosterone and arginine vasopressin
concentrations and clinical markers of hypoperfusion in neonatal foals. Equine Vet J 2014;48:176-
181.
5. Dembek KA, Timko KJ, Johnson LM, et al. Steroids, steroid precursors, and neuroactive steroids in
critically ill equine neonates.Vet J 2017;225:42-49
262
Proceedings
2023
#70 - Endobronchial Biopsy Scores Reflect The Severity

Of Naturally Occurring Equine Asthma
Authors
Höglund, Nina1 ; Rossi, Heini1 ; Javela, Hanna-Maaria1 ; Mykkänen, Anna1
Affiliation
1UNIVERSITY OF HELSINKI, Department Of Equine And Small Animal Medicine, Helsinki, Finlandia
Introduction:
Equine asthma (EA) is a common inflammatory airway disease, where persistent inflammation provokes the
airways to undergo unfavorable structural changes. The aim was to investigate the association of naturally
occurring EA disease severity and airway remodeling.
Materials and Methods:

Control horses (n = 15) and horses with mild/moderate EA (MMEA, n = 10) or severe EA (SEA, n = 5) were
examined in a prospective clinical case-control study. Clinical examination, arterial blood oxygen content
(PaO2), endoscopy, and airway cytology from tracheal wash (TW) and bronchoalveolar lavage (BAL) were
performed. Endobronchial biopsies (EBB) were obtained 25cm distally from the main carina, stained for
routine histology and scored with a system using 14 maximum points1. The results were analyzed with
ANOVA and Pearson correlation coefficient.
Results:
Mean (±SD) EBB score for control horses was 6.9 (±2.2), for MMEA horses 7.3 (±2.0) and for SEA horses
9.2 (±1.3). The EBB score was different between control and SEA horses (p=0.033), but not between con-
trol and MMEA horses (p=0.601), or MMEA and SEA horses (p=0.095). EBB score correlated positively
with BAL neutrophil-% (r=0.409, p=0.025) and negatively with PaO2 (r=–0.457, p=0.011). PaO2 was differ-
ent between control and SEA horses (p=0.041). BAL neutrophil-% for control horses was 1.9% (±0.9), for
MMEA horses 11.3% (±4.7) and for SEA horses 39.1% (±12.9). Differences between groups were observed
in BAL neutrophil-%, BAL macrophage-%, TW neutrophil-% (p<0.001), and BAL lymphocyte-% (p=0.013).
Conclusion:
In this spontaneous asthma model, airway remodeling was associated with SEA, while EBB could not dif-
ferentiate horses with MMEA from control horses. Remodeling and severe neutrophilic airway inflammation
reflected impaired oxygen transfer from the alveoli into blood.
References:
1. Bullone, M., Hélie, P., Joubert, P. and Lavoie, J.-P. (2016), Development of a Semiquantitative Histo-
logical Score for the Diagnosis of Heaves Using Endobronchial Biopsy Specimens in Horses. J Vet
Intern Med, 30: 1739-1746.
263
Proceedings
ABSTRACTS WEVA CONGRESS
2023
#2 - Systemic Inflammation Index And Platelet-To-

Lymphocyte as Effort Markers in Endurance Horses
Competing in Different Distances
Authors
Farinelli Siqueira, Renata1 ; Roberto Fernandes, Wilson2
Affiliation
1Universidade Federal de Santa Maria, Departamento de Clínica de Grandes Animais, Santa Maria, Brasil ;
2Universidade de São Paulo, FMVZ, São Paulo, Brasil
Introduction
The integrative cellular markers neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR)
and systemic immune inflammation index (SII) have been emerging in human medicine as an inflammation
marker in many types of cancer and vascular disease, however, few studies have assessed this potential
value in the context of exercise.
The aims of this study were to verify the immune response to different distances in endurance riding and
evaluate if the immune inflammation indexes could be used an effort marker.

Twenty Arabian horses were studied in an endurance race competing in 160 km, 120 km, and 80 km. Sam-
ple times were in rest (T0), right after and 3 h after the final vet check (T1 and T2). Laboratory analyses con-
sisted of leukocyte count and differential, platelets count, T lymphocyte immunophenotyping, cortisol, and
interleukins (IL-1, IL-2, IL-4, IL-10, TNF and IFN) level determination. Data was analyzed by one-way ANOVA
and Tukey’s test (p<0.05 considered significant).
Results
All horses showed a cortisol increasing in T1 and decreasing in T2. Neutrophils count increased up to T2
and lymphocyte count decreased. LTCD4+/CD8+ showed a shift in Th1 and Th2 response in 120 km and
80 km horses. The pro-inflammatory cytokine’s changes were more pronounced in 80km horses and the
anti-inflammatory cytokines levels increased in in all horses. NLR remained increased in T2 and both PLR
and SII were increased in T1 and decreased in T2.
Discussion and Conclusions

The endurance exercise resulted in a cellular immune disturbance up to and including 3 hours post-race,
higher in the less experienced horses.
SII and PLR may represent a promisor method to routinely examine (anti-)inflammatory responses. How-
ever, to enable regular assessment, resting values for athletes’ horses and the kinetics in more prolonged
recovery periods have to be established.
References
1. Shaw DM, Merien F, Braakhuis A, Dulson D. T-cells and their cytokines production: The anti-in-
flammatory and immunosuppressive effects of strenuous exercise. Cytokine 2018;104:136-142.
2. Walzik D, Joinsten N, Zacher J, Zimmer P. Transferring clinically established immune inflammation
markers into exercise physiology: focus on neutrophiltolymphocyte ratio, platelettolymphocyte ra-
tio, and systemic immuneinflammation index. Eur J Appl Physiol 2021; 121:1803–1814.
3. Yang R, Chang Q, Meng X et al. Prognostic value of systemic immune-inflammation index in can-
cer: a meta-analysis. J Cancer 2020;9:3295–3302.
4. Yang YL, Wu CH, Hsu PF et al. Systemic immune-inflammation index (SII) predicted clinical out-
come in patients with coronary artery disease. Eur J Clin Invest 2020;50:e13230.
264
Proceedings
2023
#3 - Development of an Ultrasound-Guided Proximo-

Medial Approach for Injection of The Carpal Sheath in
Horses
Authors
Dörner Santa María, Cristóbal1 ; Vargas Aravena, Valentina2
Affiliation
1Universidad Andres BellO, Escuela de Medicina Veterinaria, Quillota, Chile ; 2Equestria Centro Medico
Equino,Lameness center, Quillota, Chile
Introduction
Equine clinicians have embraced the use of ultrasonography over the past decade and it that has been
used routinely as an interventional tool. Several studies have demonstrated the efficacy of the use of ultra-
sound-guided techniques for different applications within the locomotor apparatus. Intratechal access to
the equine carpal sheath is challenging and without a guaranteed efficacy because is commonly performed
using the ‘blind’ technique. To our knowledge, an ultrasound-guided approach to access the carpal sheath
has yet to be published, so our objective was to develop an easy and reliable ultrasound-guided technique
to access the carpal sheath.
Material And Methods

The ultrasound-guided proximo-medial approach technique was firstly developed on 5 cadaver specimens.
10mL of undiluted ionic iodinated contrast medium (Iohexol) was used. Accuracy of the procedure was
verified by contrasted radiographic studies. Afterwards, the technique was validated in 5 healthy mature
horses. With the horses bearing weight, the skin was clipped, cleaned, and blocked. Horses were sedated
with xylazine 10% and restrained with a nose twitch. Landmarks for the ultrasound-guided technique were
established and the point of entry was confirmed sonographically. A 21-gauge 1½-inch needle was guided
sonographically between the adius and cephalic vein until the proximal pouch on the carpal sheath was
entered.
Results
Using the ultrasound-guided technique we achieved a 100% accuracy which was confirmed by contrasted
radiographs. No adverse effects were observed during the procedure.
Discussion/Conclusions
Multiples etiologies have been identified to cause carpal sheath effusion and lameness, nonetheless, a
reliable and efficient technique to access the carpal sheath for diagnostic and therapeutic purposes need-
ed to be developed. The ultrasound-guided proximo-medial approach for injection of the carpal sheath is
accurate and technically easy to perform. This approach should be considered to access the carpal sheath,
particularly in horses with no evident effusion.
References
1. 1. Tnibar M a. Ultrasound-aided tendon and ligament surgery in the horse. Equine Vet Edu.
2002;14:39–50.
2. 2. Fürr A. Diagnostic Anesthesia. In: Auer J, Stick J, editors. Equine Surgery. 4th ed. St. Louis: Else-
vier Saunders; 2012. p.998–1014.
3. 3. Minshall GJ, Wright IM. Tenosynovitis of the carpal sheath of the digital flexor tendons associat-
ed with tears of the radial head of the deep digital flexor: Observations in 11 horses. Equine Vet J.
2012;44(1):76–80.
4. 4. Nixon AJ, Schachter BL, Pool RR. Exostoses of the caudal perimeter of the radial physis as a
cause of carpal synovial sheath tenosynovitis and lameness in horses: 10 Cases (1999-2003). J Am
Vet Med Assoc. 2004;224(2):264–70.
5. 5. Jorgensen JS, Genovese RL, Döpfer D, Stewart MC. Musculoskeletal lesions and lameness
in 121 horses with carpal sheath effusion (1999-2010). Veterinary Radiology and Ultrasound.
2015;56(3):307–16.
265
Proceedings
2023
#4 - Morphometry as an Assessment Tool for

Overweight/Obesity in Raza Chilena Stallions
Authors
Werner Becker, Marianne1 ; Bustamante Díaz, Hedie2 ; Carmona Lespai, Germán2
Affiliation
1UNIVERSIDAD AUSTRAL DE CHILE, Instituto de Ciencia Animal, Valdivia, Chile ; 2Universidad Austral de
Chile, Instituto de Ciencias Clínicas Veterinarias, Valdivia, Chile
Introduction
Obesity/overweight is an abnormal/excessive fat accumulation representing a health risk that affects hu-
mans and domestic animals. In horses and ponies prevalence ranges from 23-70%, and up to 79.6% in
Raza Chilena horses (Wyse et al 2008; Robin et al 2015; Jensen et al 2016; Potter et al 2016). The aim of
this study was to determine the effect of overweight/obesity over some morphologic parameters in Raza
Chilena stallions.

Twenty-nine Raza Chilena stallions (5-21 years), weighting 404±14,01kg, and mean height (H) of 139,8±1,3cm,
were included. Body condition score (BCS, Henneke et al 1983), cresty neck score (CNS, Carter et al 2009),
body and neck measurements were obtained, and some ratios were calculated. Stallions were allocated
into three groups: Control (C): BCS<6,5 (n=8), Overweight (O): BCS>7 (n=12), Equine Metabolic Syndrome
(EMS) positive glucose test (n=9).
Results
Abdominal perimeter (AP) was larger in EMS and O groups compared to C and medium neck circumfer-
ence (MNC) was larger in EMS stallions (p<0.05). Neck crest was higher in O and EMS stallions compared
to C (p<0,05). AP:H ratio was higher in EMS and O stallions compared to C. MNC:neck length and MNC:H
ratios were larger in EMS stallions compared to O and C groups. C stallions showed lower values of Girth:H
ratio compared to O and EMS. CNS was 2,86, 3,08 and 3,26 for C, EMS, and O groups, respectively.
Easier methods to identify horses at obesity risk and metabolic problems could improve health/welfare.
EMS status had an effect over AP, therefore could be a useful measurement to obtain, like MNC. G:H ratio
>1,21 could indicate overweight/obesity (Jensen et al 2016), observed in this study. AP:H could be an ade-
quate ratio to assess adiposity in stallions (Carter et al 2009).
References
Acknowledgement to Morris Animal Foundation funding (D20EQ-801).
References
1. Carter RA, Geor RJ, Burton Staniar W, Cubitt TA, Harris PA. 2009. Apparent adiposity assessed by
standardized scoring systems and morphometric measurements in horses and ponies. Vet J. 179,
204-210.
2. Jensen R, Danielsen S, Tauson A. 2016. Body condition score, morphometric measurements, and
estimation of body weight in mature Icelandic horses in Denmark. Acta Vet Scand 58, 59. DOI:
10.1186/s13028-016-0240-5.
3. Potter S., Bamford N., Harris P., Bailey S. 2016. Prevalence of obesity and owners´ perception of
body condition in pleasure horses and ponies in south-eastern Australia. Aust Vet J 94, 427-432.
4. Robin C, Ireland J, Wylie C, Collins S, Verheyen K y col. 2015. Prevalence of and risk factors for
equine obesity in Great Britain based on owner-reported body condition scores. Equine Vet J 47,
196-201.
5. Wyse C, McNie K, Tannahil V, Murray J, Love S. 2008. Prevalence of obesity in riding horses in
Scotland. Vet Rec 162, 590-591.
266
Proceedings
2023
#6 - Imaging Findings of the Temporal Mandibular

Joint (Tmj) in Sport Horses: “A Silent Enemy”
Authors
Dörner Santa María, Cristóbal1
Affiliation
1UNIVERSIDAD ANDRES BELLO, Equestria Centro Medico Equino, Viña del Mar, Chile
Introduction
The TMJ is an incongruous and complex joint which can be associated with decrease performances and
clinical signs when affected. Clinical signs displayed by horses with TMJ disease include difficulties with
mastication, pain when opening the mouth, effusion, headshaking, and refusal to accept a bit when being
ridden. The objective of this study was to describe the imaging findings of the TMJ in healthy horses and to
evaluate potential differences between equestrian disciplines and age.
Material And Methods

50 clinically normal horses were evaluated in this study (n=100 joints). They were allocated in five groups:
control I (<5 years); control II (>24 years-old); III (dressage), IV (jumpers), V (polo). All horses were evaluated
clinically by mouth movement and signs of pain, TMJ effusion or inflammation. Subsequently, both TMJ
joints were evaluated with radiographs (70º tangential view) and ultrasonography. Shapiro Wilks normal-
ity test and Barlett homoscedasticity test were used to analyze the data. For quantitative data two-way
ANOVA and Tukey post-hoc test were run. For qualitative data Pearson chi-square test was performed.
Significance was set at 5%.
Results
44.5% of the horses showed one or more imaging finding. When the diameter of the joint was compared
between imaging modality no statistical difference was observed. No differences were observed between
left and right side or between gender. Nonetheless, statistically significant differences were observed when
imaging findings were analyzed by discipline being polo horses the most affected.
An important number of horses have imaging alterations in the TMJ. Radiographs and ultrasonography are
readily available, and both can be used to get a proper assessment of the TMJ. The Polo, is a highly de-
manding discipline that demands sudden accelerations, turns and stops at high-speed forcing the raiders
to be rough with the reins and bits probably predisposing to TMJ changes.
References
1. Ramzan PH, Marr C, Meehan J,Thompson A. Novel oblique radiographic projection of the temporo-
mandibular articulation of horses. Vet Record. 2008; 162(22):714-716.
2. Rodriguez M, Agut A, Gil F, Latorre R. Anatomy of the equine temporomandibular joint: study by
gross dissection, vascular injection and section. Equine Vet J. 2006; 38(2):143-147.
3. Rodriguez M, Soler M, Latorre R, Gil F, Agut A. Ultrasonographic anatomy of the temporomandibu-

lar joint in healthy purebred Spanish horses. Vet Radiol Ultrasound. 2007; 48(2):149-154
4. Townsend N, Cotton J, Barakzai S. Tangential Radiographic projection for investigation of the

equine temporomandibular joint. Vet Surg. 2009; 38(5):601-606.
267
Proceedings
2023
#7 - Volunteering as means to acquire equine

veterinary practice associated competitions based
on The American Association of Equine Practitioners
Authors
Tobar Montanares, Florencia1 ; Velasquez, Javier1 ; Tadich Gallo, Tamara1 ; Gajardo Aedo, Gonzalo2
Affiliation
1universidad Austral De Chile, Ciencia Animal, Valdivia, Chile ; 2universidad Catolica De Chile, Medicina
Veterinaria, Valdivia, Chile
Introduction: There are minimum skills associated to equine management that are expected from recently
graduated veterinarians. Students can acquire these skills through the “formal” route, during their classes,
or through de “informal” route, for example through volunteering. The purpose of this study was to demon-
strate that volunteering in a University equine breeding farm can facilitate the acquisition of basic equine
management skills.
Materials and methods: The equine breeding farm has 5 mares, of which 3 were pregnant during 2022.
Around 15 volunteers, from different levels of the career, participate in it by doing husbandry activities, with
more experienced students helping those less experienced. After a semester, what was learned during
these activities was compared with the basic skills proposed by the AAEP.
Results: Volunteers had the opportunity to put in practice skills associated to “Medical knowledge” such as
estimating weight, recognizing pain, estimating the degree of dehydration, analyzing the basic components
of a feed ration and making general recommendations based on caloric needs. Skills associated to exam-
ination such as performing a physical examination in foals and adults, auscultating and interpreting respi-
ratory and gastrointestinal sounds, performing a neonatal examination, administration of oral medications
and jugular vein puncture. In relation to the “Reproductive issues skills” they learned to place a tail bandage,
palpate and discuss aspects of a failed reproductive cycle. From the “Daily management” skills they learned
how to approach, capture and place a halter, lift and examine fore and hind limbs, tie a quick release knot
and contention of a foal. Finally, for the “Locomotor system” they were able to carry out a musculoskeletal
examination, perform a lameness examination and identify the affected limb, and identify angular limb/
flexion deformities in foals.
Conclusion: Informal activities such as volunteering allows the acquisition of competencies established by
the AAEP.
References: American Association of Equine Practitioners (AAEP). 2022. Basic competencies for new
graduates of the veterinary school. Available at: https://aaep.org/core-competencies
268
Proceedings
2023
#9 - Evolution of Height at Withers in the Chilean Horse

Population
Authors
Muñoz, Lisandro1 ; Oliveras, Karen2 ; Briones, Mario3
Affiliation
1Universidad de Concepción, Facultad de Ciencias Veterinarias, Concepción, Chile ; 2Universidad de Con-
cepción, Facultad de Ciencias Veterinarias, Concepción, Chile ; 3Universidad de Concepción, Facultad de
Ciencias Veterinarias, Chillán, Chile
Introduction: Chilean Horse Studbook established in 1921 limits of height at withers as 1.38 to 1.5 m. In 1978
and 2002 limits were refined as 1.38 to 1.48 m (ideal 1.42 m) for males, and 1.36 to 1.46 m (ideal 1.40 m) for
females. Currently, different values are observed in the breed. Evolution of height at withers of Chilean horse
was analyzed since the definition of its first standard.
Materials And Methods: Height at withers were analyzed in 1,637 adult Chilean horses (1,068 males, 569
females), clasified in three periods: 1 (horses born since 1958 to 1978), 2 (horses born since 1979 to 2002),
and 3 (horses born since 2003 to 2016). ANOVA was performed to determine differences between periods
and sexes.
Results: Average (± standard deviation) of height at withers in period 1 was 1.426±0.016 m (males 1.43±0.027
m, females 1.422±0.023 m), period 2 was 1.397±0.024 m (males 1.400±0.028 m, females 1.394±0.029 m), and
period 3 was 1.397±0.055 m (males 1.399±0.028, females 1.394±0.024). A significant difference was ob-
served for period 1 compared to 2 and 3 (p<0.05), but no difference was observed between periods 2 and 3.
A significant difference was observed between sexes (p<0.01). A 2%, 18% and 18%, of males of the periods
1, 2 and 3 presented values below the limit of the period. In females, values below the limit where in a 1%,
26% and 5% in periods 1, 2 and 3. In males, the upper limit of the standard was exceeded in period 1 and 2
by 1% of the horses, and by 1% of females in period 2.
Discussion/Conclusion: Currently, male average height at withers is lower than standard ideal for Chilean
horses.
References
Caballo y Rodeo [Internet]. Federación de Criadores: Federación Criadores de Caballos Raza Chilena;
2011. Reglamento de exposiciones [update 2019]. Available from: http_p11.ivn.cl_portal_rodeo_site_ar-
tic_20110805_asocfile_20110805130140_reglamento_exposiciones_corregido_ y _aprobado_en_conse-
jo_2019(1).pdf
Porte FE. Standard del caballo chileno. Rev Fed Rodeo Chileno Asoc Criadores Caballares Chilenos
1978;30:14-9.
Porte FE. Evaluación técnica del caballo criollo chileno 1893-1993. Santiago: Universidad de Chile, Facultad
de Ciencias Agrarias y Forestales; 1993.383 p.
Porte FE. Fundamantación técnica del caballo criollo chileno. An Fed Criadores Caballos Chilenos
2002;54:48-9.
Sociedad Nacional de Agricultura. Stud Book de la raza chilena. Santiago: Sociedad Nacional de Agricul-
tura; 1937.243 p.
269
Proceedings
2023
#14 - Hospitalization Causes a Transient Adverse

Impact on Horse Resting Pattern
Authors
Oliveira Marcelo, Tiago1 ; Zanotto Miranda, Gustavo2 ; Trindade Henrique Esteves, Pedro3 ; Baccarin
Yvonne Arantes, Raquel1
Affiliation
1UNIVERSITY OF SÃO PAULO, Departament of Internal Medicine, São Paulo, Brasil ; 2Texas A&M Uni-
versity, College of Veterinary Medicine & Biomedical Sciences, Bryan, Estados Unidos (EEUU) ; 3North
Carolina State University, College of Veterinary Medicine, Raleigh, Estados Unidos (EEUU)
Introduction: The influence of different environments on resting patterns is very investigated in humans,
but it is not completely understood in horses. This study aimed to identify differences in resting patterns of
athletic horses subjected to the hospital environment. Materials and Methods: Eight Quarter Horses from
the Equestrian Team of Texas A&M University were recorded by cameras for 3 days in their stalls to deter-
mine the normal resting pattern, for 5 days in the Teaching Hospital of the University, more 3 days following
their return. Despite hospitalization, the horses did not undergo any procedures at the hospital.
Results: The mean times of sternal and lateral recumbency, and the number of times the horses were
in sternal and lateral recumbency decreased by up to 90% on days when the horses were hospitalized
(p<0.05), but the average time spent in each recumbency position did not differ between the days in the
hospital. Baseline values were reached on the first night of returning to their stalls.
Discussion/Conclusion: Hospitalization for 5 days can adversely affect resting patterns in horses. All pa-
rameters returned to baseline values on the first night of their return to the normal environment. The factors
that may have contributed to this negative impact were the smaller stall size, the presence of light, and less
physical activity of the animal. Although not statistically significant, an 18% increase in lateral recumbency
time was observed on the first day of return to the horse’s normal environment. This increase in lateral
recumbency could characterize a “rebound effect”, to compensate for the restricted rest in the previous
5 days. In conclusion, the hospital environment decreases the resting times of horses transiently and the
return to normality was only observed with the return to their
environment.
References
1. Costa J, Figueiredo PY, Nakamura F, Brito J. The Importance of Sleep in Athletes. Exercise Physiol-
ogy [Internet]. 2022 Feb 7. Available from: https://www.intechopen.com/chapters/80371
2. Greening L, Mcbride S. A Review of Equine Sleep: Implications for Equine Welfare. Frontiers in
Veterinary Science, v. 9, August, p. 1–22, 2022. Available from: https://www.frontiersin.org/arti-
cles/10.3389/fvets.2022.916737/full
3. Greening L, Downing J, Amiouny D, Lekang L, McBride S. The Effect of Altering Routine Husband-
ry Factors on Sleep Duration and Memory Consolidation in the Horse. Applied Animal Behaviour
Science. 2021 Jan;105229. Available from: https://www.sciencedirect.com/science/article/abs/pii/
S0168159121000162
4. Hartman N, Greening LM. A Preliminary Study Investigating the Influence of Auditory Stimula-
tion on the Occurrence of Nocturnal Equine Sleep-Related Behavior in Stabled Horses. Journal of
Equine Veterinary Science. 2019 Jul;102782. Available from: https://www.sciencedirect.com/sci-
ence/article/abs/pii/S0737080619303934?via%3Dihub
5. 5.Oliveira T, Santos A, Silva J, Trindade P, Yamada A, Jaramillo F, Silva L, Baccarin R. Hospitalisation

and disease severity alter the resting pattern of horses. J. Equine Vet. Sci. 2022 110:103832. Avail-
able from: 10.1016/j.jevs.2021.103832.
270
Proceedings
2023
#15 - Use of Bacuri Butter (Platonia Insignis Mart.) And

Onion Biofilm (Allium Cepa L.), Washed And Unwashed,
In Wound Healing In Equines
Authors
Resende Menezes, André1 ; Miranda Alves, Beatriz1 ; Miranda Pereira da Rocha, Rachel1 ; Campebell de
Cássia, Rita1
Affiliation
1UNB - UNIVERSITY OF BRASÍLIA, Faculty of Agronomy and Veterinary Medicine (FAV), Brasília, Brasil
Introduction: Wounds are frequent in horses. The “bacuri butter” is widely used as a healing agent. The
onion has been used in the production of bioplastics through the hydrothermal treatment of its pulp. The
objective of this study was to search for treatments that enable proper healing while causing minimal harm
to the environment. This study was conducted at the University of Brasília/Brazil and approved by CEUA-
UnB, n° 23106.064222/2021-19, to evaluate the macroscopic and histopathological aspects of skin healing
by second intention of wounds in 6 horses.
Materials And Methods: Wounds surgically induced were topically treated with bacuri butter (GMB),
washed onion biofilm (GBCL), unwashed onion biofilm (GBCNL), and ringer lactate (GC). Four wounds
were made on each side of the lumbar region, one side for macroscopic evaluation with photos and mea-
surement of the area and contraction rate and the other side for histopathological evaluation. The right side
was used for clinical evaluation of the wound in three horses and the left side for microscopic evaluation,
and in the other three, the opposite procedure was performed. The lesions were treated daily, and clinical
and histopathological evaluations were performed on days 0, 3, 7, 14, 21 and 28.
Results: The GMB had a smaller wound area and a higher percentage of contraction on days 21 and 28.
At 28 days the average contraction rate was 95.95%, 93.93%, 86.54% and 92.61% for GMB, GC, GBCL and
GBCNL respectively.
Discussion/Conclusions: Clinical and histopathological analysis revealed the potential use of biopolymers
as occlusive dressings for wounds, with beneficial characteristics for healing, providing a barrier against
bacterial invasion. Although there was no statistically significant difference between the groups, clinical
evaluations showed a greater healing and anti-inflammatory effect in the GMB, making safe, effective, and
low-cost-effective option, favoring the re-epithelialization of the wounds.
References:
1. Barreto MR, Aleixo NA, Silvestre RB, Fregonezi NF, Barud HS, Dias DS, Ribeiro CA, Resende FA.
Genotoxicological safety assessment of puree-only edible films from onion bulb (Allium cepa L.) for
use in food packaging-related applications. Journal of Food Science 2020; 85:201-208.
2. Campanati A, Savelli A, Sandroni L, Marconi B, Giuliano A, Giuliodori K, Ganzetti G, Offidani A.
Effect of allium
3. cepaallantoinpentaglycan gel on skin hypertrophic scars: clinical and videocapillaroscopic results
of an openlabel, controlled, nonrandomized clinical trial. Dermatologic Surgery 2010; 36(9):1439-
1444.
4. Dias DS, Otoni CG, Silva RR, Meneguin AB, Mattoso LHC, Barud HS, Ribeiro CA. Large scale
manufacturing of puree-only edible films from onion bulb (Allium cepa L.): Probing production and
structure–processing–property correlations. Industrial Crops and Products 2019; 145.
5. Lustosa AKMF, Coelho AG, Santos AA, Barros YSO, Rodrigues KAF, Amorim LV, Alves MMM,
Carvalho ALM, Mendes AN, Carvalho FAA, Arcanjo DDR, Citó AMGL. Topical formulations based
on seeds butter from Platonia insignis Mart. for the treatment of injuries related to experimental
cutaneous leishmaniasis. Research, Society and Development 2021; 10(4):e52310413665.
6. Santos Júnior RQ, Soares LC, Maia Filho ALM, Araujo KS, Santos IMSP, Costa Junior JS, Saffi J.
Estudo histológico da cicatrização de feridas cutâneas utilizando a manteiga de bacuri (Platonia
insignis Mart.). ConScientiae Saúde 2010; 9(4):575-581.
271
Proceedings
2023
#16 - A New Option for Pain Relief in Donkeys: A

Pharmcokinetic Pilot Study Comparing Transdermal
Flunixin Meglumine to Oral and Intravenous Forms
Authors
Mclean, Amy1 ; Falt, Tara1 ; Abdelfattah, Essam2 ; Middlebrooks, Brittany3
Affiliation
1
university Of California Davis, Animal Science, Davis, Estados Unidos (Eeuu) ; 2university Of California,
Vet Med, Tulare, Estados Unidos (Eeuu) ; 3colorado State University, Vet Med, Fort Collins, Estados Unidos
(Eeuu)
Introduction
Donkeys are stoic animals who may endure pain without displaying feelings and complaints. Due to this
behavior, donkeys may ultimately mask pain with behaviors, such as sham eating or by only showing slight
indications of pain. These subtle behaviors may go unnoticed, thus concealing illness/injury. There’s a lack
of analgesic drugs with marketing authorization for administration to donkeys and lack of information on
dosing rates and intervals when analgesia is provided. Donkeys differ from horses behaviorally, physio-
logically, and pharmacologically1. Recent approval and effectiveness of transdermal flunixin meglumine in
cattle has opened the door for the drug’s potential application in other species. Hypothesis was transdermal
flunixin meglumine will have similar pharmacokinetics and effects on biomarkers of inflammation in don-
keys compared to oral and injectable.

Oral, injectable, and transdermal flunixin meglumine (Banamine®, Merck Animal Health) were administered
to six healthy donkeys dosed at 1.1 mg/kg BW for oral, intravenous and (per label) 3.3 mg/kg transdermal in
a three-way crossover design. The study was carried out in Davis, California, U.S.A IACUC #22018. Whole
blood samples were collected over 96 hours to measure concentrations of flunixin, 5OH flunixin, and eico-
sanoids using LC-MS/MS and pharmacokinetic parameters determined.
Results
Both flunixin and 5OH flunixin reached detectable levels in blood collected during transdermal trial. Drug
elimination was slower following transdermal compared to IV and oral forms. Transdermal significantly de-
creased TXB2 1 to 96 hours post-administration, IV and oral resulted in TXB2 reduced 1 to 8 hours (P<0.001).
Significant reduction in PGF2 alpha was seen 1 hour later in oral and IV but transdermal resulted in gradual
decline 1 to 24 hours.
Discussion
This study suggested therapeutic doses for flunixin are 1.1mg/kg for oral and IV and 3.3 mg/kg off label use
of transdermal are effective.
References
1. Ciofalo VB, Latranyi MB, Patel JB, et al. Flunixin meglumine: a non-narcotic analgesic. Pharmacol. Exp.
Ther. 1977, 200(3), 501-507.
272
Proceedings
2023
#17 - The Relationship Between Hoof Conformation

and Racing History In Thoroughbred Horses Using
Computed Tomography
Authors
Mosquera Jaramillo, Fernando1 ; Arantes Baccarin, Raquel Yvonne2 ; Hitchens, Peta L.1 ; Whitton, R. Chris1
Affiliation
1
university Of Melbourne, Equine Centre, Melbourne Veterinary School, Faculty of Science, Melbourne,
Australia ; 2 University Of Sao Paulo, Department of Internal Medicine, School of Veterinary Medicine and
Animal, São Paulo, Brasil
Introduction. International Thoroughbred racehorses traveling to Australia to compete have a higher in-
cidence of musculoskeletal injuries (MSI) when compared to horses that compete in Australia only (local
horses). The fetlock is the most commonly affected joint in these horses and previously we have shown
that hoof conformation was associated with loads generated in the fetlock joint during locomotion and with
scintigraphic evidence of fetlock bone injury (1, 2). To investigate whether hoof conformation contributes to
this higher incidence of MSI in international horses, we measured the hoof angles of local and international
racehorses. We hypothesized that international horses have lower dorsal hoof wall angle (DHWA), palmar
angle (PA) and hoof pastern angle (HPA) compared to local horses. Materials and Methods. The distal
forelimbs and hindlimbs of 84 Thoroughbred racehorses that were competing without evidence of lame-
ness were scanned standing, under sedation with a dedicated equine fan-beam CT system (Asto Equina®
CT). All measurements were made using the angle tool in dicom viewer software (RadiAnt®). Analysis was
performed using multivariable general linear models to enable adjustment for horse factors such as age,
bodyweight and racing history. Results. The DHWA of international horses was lower than that of local
horses (46.6±2.3° vs. 49.4±1.9°, P<0.001), for PA there was no difference between local and international
horses (P=0.083), and for HPA international horses had a lower angle than local horses (163.4±4.9° vs.
166.0±4.9°, P=0.004). Discussion/Conclusion. Hoof conformation differed between local and international
racehorses. Further
investigations should explore whether hoof conformation contributes to the higher incidence of MSI in
international horses competing in Australia, and whether these conformation differences result from differ-
ences in local and international racetrack surfaces.
References
1. Harrison SM, Whitton RC, Kawcak CE, Stover SM, Pandy MG. Evaluation of a subject-specific
finite-element model of the equine metacarpophalangeal joint under physiological load. Journal of
Biomechanics. 2014;47(1):65-73.
2. Walmsley EA, Jackson M, Wells-Smith L, Whitton RC. Solar angle of the distal phalanx is associat-
ed with scintigraphic evidence of subchondral bone injury in the palmar/plantar aspect of the third
metacarpal/tarsal condyles in Thoroughbred racehorses. Equine Vet J. 2019;51(6):720-6.
273
Proceedings
2023
#24 - Successful Removal of J-Guide Wire Guidance

Lost During Jugular Vein Catheterization in an Arabian
Mare
Authors
Faria, Thalita1 ; Drahonovska, Anna2 ; Verhoeven, Gregory3 ; Berreta, Ana4
Affiliation
1The Equine Hospital, Jockey Club of Saudi Arabia, Riyadh, Saudi Arabia., Medicine, Riyadh, Brasil ; 2The
Equine Hospital, Jockey Club of Saudi Arabia, Riyadh, Saudi Arabia., Surgery, Riyadh, República Checa ;
3The Equine Hospital, Jockey Club of Saudi Arabia, Riyadh, Saudi Arabia., Surgery, Riyadh, Francia ; 4The
Equine Hospital, Jockey Club of Saudi Arabia, Riyadh, Saudi Arabia., Internal Medicine, Ryadh, Brasil
Introduction
Guidewire venous catheterization complications have been sparsely reported in equine medicine.
Clinical History / Treatment and Management

A 10 year-old Arabian mare was being hospitalized and needed her venous access replaced. The mare was
prepared for placement of a 15 cm x 16 gauge MILA® over-the-wire Seldinger intravenous catheter. An
18-gauge catheter was inserted in the proximal left jugular vein and a 45 cm flexible braided stainless guide
wire was passed through it. The operator failed to retain the guidewire, which then slipped into the left jug-
ular vein. Transcutaneous ultrasonography and radiographs revealed that the guidewire was positioned at
the caudal cervical third of the left jugular vein. The removal was performed transcutaneously, under stand-
ing sedation with detomidine and butorphanol. The left jugular vein was surgically prepared, the procedure
was guided by ultrasonography, the blood flow was reduced by a cranial transcutaneous compression of
the vein with a Kelly forceps. A 2 cm long longitudinal skin incision was performed over the vein at the level
of the cranial tip of the wire, the muscles were retracted by a Weitlaner retractor, and the jugular vein was
isolated, the tip of the guidewire was gently held by forceps through the vessel and a 2 mm long venotomy
was then made and the wire extracted. The adventitia of the vein and subcutaneous tissues were sutured
with Vicryl® 2.0 and the skin with Ethilon® 1. The time from wire loss
to wire removal was approximately 45 minutes.
Evolution
During the following days, the mare was closely monitored and a few days later was discharged from the
hospital without complications. No swelling or hematoma formation was observed.
Discussion
The surgical removal trough small venotomy was a time-efficient option that prevented cardiac arrhythmias,
vascular damage, thrombosis and led to a successful outcome.
References
1. Ames TR, Hunter DW, Caywood DD. Percutaneous transvenous removal of a broken jug-
ular catheter from the right ventricle of a foal. Equine Veterinary Journal. 1991;23(5):392–3.
doi:10.1111/j.2042-3306.1991.tb03745.x
2. Hardy JM, Lansdowne JL, Himsel CA, Freer SR. Surgical retrieval of a guide wire lost during central
venous catheterization in a dog. Journal of Veterinary Emergency and Critical Care. 2017;27(3):342–
7. doi:10.1111/vec.12587
3. McGee DC, Gould MK. Preventing complications of central venous catheterization. New England
Journal of Medicine. 2003;348(12):1123–33. doi:10.1056/nejmra011883
4. Nannarone S, Falchero V, Gialletti R, Beccati F, Pepe M. Successful removal of a guidewire from the
jugular vein of a mature horse. Equine Veterinary Education. 2012;25(4):173–6. doi:10.1111/j.2042-
3292.2012.00397.x
274
Proceedings
2023
#31 - Sleep Pattern Interference in Dressage Horses

Authors
Barbosa Perrone, Ângela1 ; Oliveira Marcelo, Tiago1 ; Roncati Vanderlei, Neimar2 ; Baccarin Yvonne Ar-
antes, Raquel1
Affiliation
1FMVZ-USP, Departamento de Clínica Médica, São Paulo, Brasil ; 2Grupo de Educação UNIEDUK, Gestor,
São Paulo, Brasil
Introduction
Horses adapted their polyphasic sleep pattern by dividing it into small fragments and alternating between
REM phase (Rapid Eyes Movement) and NREM phase (Non-rapid Eyes Movement). REM sleep only occurs
when the horse is in recumbency. Few studies present possible impairments when REM sleep is restricted.

In Brazil, ten Lusitano Pure Breed horses, age from 3 to 7, all Dressage athletes, were used in this random-
ized crossover experiment. REM sleep deprivation was accomplished by an observer not letting the horses
enter in sternal or lateral recumbency for 72 hours. Horse grimace scale (HGS) was measured twice a day
and heart rate variability (HRV) once a day and after the test competition. After 72 hours, horses partici-
pated in a test competition, with scores from three judges, two FEI certified and one veterinary doctor FEI
certified. Riders and judges were blind to the experiment condition. This work was approved by the Ethics
Committee on Animal Use (CEUA/FMVZ).
Results
Regarding HGS there were no alterations in score between control (not sleep deprived) and sleep depri-
vation groups. There was no difference between groups for seven HRV parameters evaluated. Three HRV
parameters presented difference between 0h and after test competition for both groups. There is a signifi-
cant statistical difference (p<0,05) between three judges.
Discussion/Conclusion
HGS can be a valuable tool to measure acute pain but cannot predict sleep deprivation on horses. Also,
REM sleep deprivation does not cause pain facial expression. HRV did not appear to chance in regards
of sleep deprivation in this specific population. Exercise changed HRV to a sympathetic regulation. Judge
scores in dressage competitions seems to have weak to poor reliability and could not predict sleep deprived
horses. 72 hours of REM sleep deprivation did not influence facial expression, HRV and performance in
dressage horses.
References
1. Dalla Costa, E., Minero, M., Lebelt, D., Stucke, D., Canali, E., & Leach, M. C.L. Development of the
Horse Grimace Scale (HGS) as a pain assessment tool in horses undergoing routine castration.
PLoS one; 2014. v. 9, n. 3, p. e92281.
2. Hartman, N. Greening, L. A preliminary study investigating the influence of auditory stimulation
on the occurrence of nocturnal equine sleep-related behavior in stabled horses. Journal of equine
veterinary science; 2019. v. 82, p. 102782.
3. Greening, L., Mcbride, S. A review of equine sleep: Implications for equine welfare. Frontiers in
veterinary science; 2022. v. 9, p. 916737.
4. Janczarek, I., Kdzierski, W., Wilk, I., Wnuk–Pawlak, E., & Rakowska, A. Comparison of daily heart
rate variability in old and young horses: A preliminary study. Journal of veterinary behavior; 2020 v.
38, p. 1-7.
5. Oliveira, T., Santos, A., Silva, J., Trindade, P., Yamada, A., Jaramillo, F, Silva, L.C.L.C., Baccarin, R.
Hospitalization and disease severity alter the resting pattern of horses. Journal of Equine Veterinary
Science; 2022. v. 110, p. 103832.
275
Proceedings
2023
#32 - Effect of Incubation of Thawed Equine

Spermatozoa Under Different Capacitating
Conditions and Binding to the Zona Pellucida
of Mare Oocytes.
Authors
Cabrera Herreros, Paulina1 ; Aguila Paredes, Luis2 ; Castro Paredes, Macarena1 ; Felmer Dörner, Ricardo1
Affiliation
1universidad De La Frontera, Laboratory of Reproduction, Centre of Reproductive Biotechnology, Temuco,
Chile ; 2 Universidad De La Frontera, Laboratory of Reproduction, Centre of Reproductive Biotechnology
(Cebior-B, Temuco, Chile
Introduction: Eyaculated mammalian sperm accuire their ability to fertilize an oocyte during transit through
the female reproductive tract, a process known as sperm capacitation. Induction of capacitation in vitro can
be achieved by incubating spermatozoa with bicarbonate, calcium and albumin. However, in the equine
species, in vitro sperm capacitation is not efficient. The aim of this study was to evaluate the effect of incu-
bating thawed equine spermatozoa in SP-TALP medium with different capacitation inducers and assess the
binding to the zona pellucida of these spermatozoa in mares oocytes. MATERIALS AND METHODS:Sper-
matozoa were incuvated for 120 minutes at 38,50 C in SP-TALP base medium supplemented with MßCD,
IBMX, dbAMPc. SP-TALP without bicarbonate and albumin was used as non-capacitating control. Acro-
some reaction (PNA FITC), membrane fluidity (MC540) and intracellular Ca+2 ( Fluo-3) were analyzed by
flow cytrometry. Capacitated sperm (1x 10 6 per ml) were taken and deposited with the oocytes for one hour,
and then fixed stained to count the numbre bound sperm.
Results: Incubation of spermatozoa in capacitating conditions showed no differences in the acrosome

reaction, howevwe, greater membrane fluidity and intracellular Ca+2 levels was observed in the treatments
with capacitation inducers compared to the control. Additionally, a higher binding of spermatozoa to the
zona pellucida was observed
whith MßCD treatment.
Conclusions: Addition of capacitation inducers to the SP-TALP medium imporved the membrane fluidity
and intracellular Ca+2 levels, without compromising the integrity of the plasma membrane, wich is a con-
sistent with an increase in the capacitation of equine spermatozoa under these conditions. Additionally,
binding to the zon pellucida of capacitated spermatozoa is higher in these capacitating conditions. Future
research wil focus on analyzing the efect of these treatments on ICSI or IVF.
References
Maintan et al. Henning H. Bicarbonate-Stumulated Membrane Reorganization in Stallion Spermatozoa.
Front Cell Boil Vol 9 772254. 2021.
276
Proceedings
2023
#34 - In Vitro Action of Melaleuca Alternifolia Oil

Against Bacteria and Fungi Isolated From Semen and
Urethral Fossa of Stallion
Authors
Viana Alves, Julia1 ; Molinari Donatele, Dirlei2 ; Berbari Neto, Felipe2 ; Braga MARTINS, Carla3
Affiliation
1RH Ranch, Veterinary Medicine, Campos dos Goytacazes - RJ, Brasil ; 2UFES, Veterinary Medicine, Alegre
- ES, Brasil ; 3 Universidade Federal do Espírito Santo - UFES, Veterinary Medicine, Alegre - ES, Brasil
Introduction: The action of essential oils has been explored in an attempt to overcome antimicrobial re-
sistance. Tea tree essential oil (Melaleuca alternifolia) is considered excellent ally in microbial control due
to its antibacterial, antiviral and antifungal properties. Given the scarcity of studies on its effects in the
treatment of genital infections in stallions, this study proposed to evaluate the antimicrobial activity of tea
tree essential oil in vitro, compared to the action of commonly used antibiotics and antifungals, against mi-
croorganisms isolated from semen and urethral fossa of stallions. Material and Methods: Samples collected
from the urethral fossa and semen of a stallion were submitted to microbiological culture. Antibiogram was
performed with ceftiofur, ampicillin, enrofloxacin, ketoconazole and itraconazole. Susceptibility to antimicro-
bials and tea tree essential oil was determined by the qualitative method of minimum inhibitory concentra-
tion established by CLSI (2019). Results: Bacterial colonies suggestive of Bacillus cereus, Staphylococcus
and Micrococcus spp. and fungal colonies were isolated. The isolated strains were resistant to enrofloxacin,
ketoconazole and itraconazole, showing senility only to ceftiofur and ampicillin. Regarding the bactericidal
power of the oil, the inhibitory halo at concentrations of 100% and 50% was 10 mm, similar to the halo gen-
erated by ceftiofur, and higher than that of enrofloxacin, showing a satisfactory effect against the isolated
bacteria. Concentrations of 25%, 12.5% and 6.25% did not demonstrate antimicrobial action. Regarding the
fungicidal action, a more satisfactory result was obtained at a concentration of 100%, whose halo of 27 mm,
demonstrated antifungal effect higher than standard established (CLSI, 2019). Discussion/Conclusion: Tea
tree essential oil presented as a promising antimicrobial agent, constituting an efficient alternative in the
treatment of pathogens isolated from the genital system of stallions. These results corroborate with Neves
et al. (2018), who observed the efficacy of oil against the same microorganisms.
References
1. CLSI - Clinical and laboratory standards institute. Manual de Antibiograma. Laborclin Produtos
para Laboratórios Ltda. Rev 16 –03/2019.
2. Neves R et al. In vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infec-
tions in dogs. Pesquisa Veterinária Brasileira, v. 38, n. 8, p. 1597- 1607, 2018.
3. The present study was approved by the Ethics Committee on the Use of Animals of the Federal
University of Espírito Santo, under number 011/2022.
277
Proceedings
2023
#35 - Contributions of Working Equids to Community

Resilience in The Dry Corridor of Nicaragua
Authors
VALDIVIA FLORES, FREDRED1
Affiliation
1THE BROOKE, Regional Director, Managua, Nicaragua
Introduction
The effects of climate change have strike the productivity and food security in the Dry Corridor of Nicara-
gua, an area highly vulnerable to extreme climate events such as long periods of drought, followed by heavy
rains, disturbing the livelihoods of families who depend mostly on working equids for their season-base
subsistence agriculture. Working equids, often play a crucial role in the immediate and long-term aftermath
of disaster as they also offers opportunities to build more robust livelihoods assets, but the management of
animal welfare is not habitually part of the local preparedness, and response plans. This research aims to
highlight the role of working equids to people´s resilience in sudden-onset, and low-onset disasters, as well
as their welfare needs, acknowledging that equine welfare increases the ability of communities to restore,
and upgrade their livelihood.

Semi-structure interviews took place with 201 equid´s owners, 31 member of the Municipal Disaster Preven-
tion Committees from the Dry Corridor, six focus group were held with 38 people, and the welfare of 249
working equids was assessed using animal-base indicators.
Results
Findings reveal that working equids are important in pre-disaster, response and post-disaster, while trans-
porting water, food, humanitarian aid, and restoring the interconnectivity of communities in the Dry Corri-
dor. Despite their contributions to community resilience, 94% of households acknowledged that their needs
are not considered in emergency plans, and 13% of assessed equids are in acceptable welfare conditions.
Working equids are key assets for the livelihoods of rural families, especially those expose to climate change,
as they can provide independence, protect food security and reduce vulnerability to future disaster events.
Yet, their needs are not visible in coping mechanisms, for which it is important to include working equids in
welfare initiatives to build more resilient communities.
References
1. Thornton, P. et al. Vulnerability, Climate change and Livestock – Research Opportunities and Cha-
llenges for Poverty Alleviation. SAT eJournal 4, 1–23 (2007).
2. Bank, W. Pooling Catastrophe Risk to Protect against Natural Hazards: Nicaragua’s Experience
in Disaster Risk Management and Finance. https://www. worldbank.org/en/results/2021/11/01/
pooling-catastrophe-risk-to-protect-against-natural-hazards-nicaragua-sexperience-in-disas-
ter-risk-management-and-finan
3. Clancy, C., Watson, T. & Raw, Z. Resilience and the role of equids in humanitarian crises. Disasters
46, 1075–1097 (2022).
4. FAOSTAT. FAO Statistical Year Book. Food and Agricultural Organization of the United Nations.
http://www.fao.org/faostat/en/#home (2019).
5. Mellor, D. J. et al. The 2020 Five Domains Model: Including Human–Animal Interactions in Assess-
ments of Animal Welfare. Anim. 2020, Vol. 10, Page 1870 10, 1870 (2020).
278
Proceedings
2023
#37 - Computer Vision Applied to Behavior

Identification for Horses
Authors
Yvonne Arantes Baccarin, Raquel1 ; Oliveira, Tiago1 ; Mosquera Jaramillo, Fernando1 ; Vieira de Sousa, Rafael2
Affiliation
1
University of São Paulo, Internal Medicine, São Paulo, Brasil ; 2University of São Paulo, Biosystems Engi-
neering, Pirassununga, Brasil
Introduction: The evaluation by video monitoring allows the identification of horse behaviors in a non-in-
vasive and low-cost way. Materials and Methods: Horses were housed in stalls with high image resolution
cameras with infrared capabilities. Recordings were conducted in 5 consecutive 24-hour periods, captur-
ing different conditions (standing, eating, lying, handling). A Convolutional Neural Network (CNN) based
tool was applied to develop a behavior classifier model using TensorFlow from the Keras 2.0.6 library. The
labeled images were partitioned for training, validation and testing, and subjected to a cross-validation
methodology. Results: The final CNN-based model observed is composed of 3 convolution layers, each
containing 64 kernels of size 5x5 and polling layer of size 2x2 (activation by Rectified Linear Unit). The con-
vergence threshold was obtained in 10 epochs and the computational model tested with 569 frames (10%)
obtained a general accuracy of 97.5%. Discussion/Conclusion: Although the ‘standing’ class showed the
highest number of incorrectly classified frames, in percentage terms in relation to the total frames of each
class, the CNN-based model shows better performance for this class (precision of 98.4%). The precision
(mean = 94.2%) and recall (mean = 94.7%) exhibited a more distinct outcome for the ‘eating’ class (83.3%
and 87.7%, respectively) in comparison to the other classes. This indicates the smaller number of frames
examples in the mentioned class influenced the model’s learning. The lower F1-Score value for the ‘eating’
class (0.85) compared to the other classes further supports this assertion. Less learning ability was identi-
fied to distinguish a horse standing close to the feeder region and a horse feeding, indicating that in the next
stage of the work it is essential to expand the image database. In general, the results show the potential of
the approach to compose a computer vision system for the studied application.
References
1. Greening, L., Downing, J., Amiouny, D., Lekang, L., McBride, S., 2021. The effect of altering routine
husbandry factors on sleep duration and memory consolidation in the horse. Applied Animal Be-
haviour Science. https://doi.org/10.1016/j.applanim.2021.105229
2. Oliveira, T., Santos A., Silva J., Trindade P., Yamada A., Jaramillo F., Silva L., and Baccarin R.. . 2022.
Hospitalisation and disease severity alter the resting pattern of horses. J. Equine Vet. Sci. 110:103832.
doi: 10.1016/j.jevs.2021.103832.
3. Valletta, J.J., Torney, C., Kings, M., Thornton, A., Madden, J., 2017. Applications of machine lear-
ning in animal behaviour studies. Animal Behaviour 124, 203–220. https://doi.org/10.1016/j.anbe-
hav.2016.12.005
279
Proceedings
2023
#38 - Effect of Tea Tree Essential Oil (Melaleuca

Alternifolia) on the Control of Bacteria Isolated From
The Uterus of a Mare With Endometritis
Authors
Machado Sobreira, Juliana1 ; Câmara Almeida, Italo1 ; Molinari Donatele, Dirlei1 ; Braga Martins, Carla2
Affiliation
1UFES, Veterinary Medicine, Alegre - ES, Brasil ; 2Universidade Federal do Espírito Santo - UFES, Veteri-
nary Medicine, Alegre, Brasil
Introduction: Endometritis are considered the main causes of subfertility and infertility in the equine spe-
cies.
The use of antimicrobials is essential for the successful treatment of the condition. However, indiscriminate
use has resulted in the development of microbial resistance. Melaleuca essential oil (Melaleuca alternifolia)
has proven effectiveness in microbial control due to its antibacterial, antiviral and antifungal properties.
Faced with the need to seek new treatment alternatives and the scarcity of studies on the action of tea tree
oil against pathogens that cause endometritis, the present study aimed to evaluate the antimicrobial effect
of tea tree essential oil in vitro in the control of bacteria isolated from the uterus of a mare with endometritis,
comparing the action of antibiotics commonly used as treatment.
Material and methods: Samples collected from the endometrium of a mare with endometritis were sub-
mitted to microbiological culture. Susceptibility to antimicrobials and oil was determined by the qualitative
method of minimum inhibitory concentration established by CLSI (2019). An antibiogram was performed
with gentamicin, enrofloxacin and ceftiofur, and tea tree oil at 100% concentrations; 50%; 25%; 12.5%;
6.75%; 3.37%; 1.68% and 0.84%.
Results and Discussion: The strains found were consistent with Bacillus cereus and Staphylococcus
aureus. The diameters of the inhibitory halos obtained were: negative control (DMSO and saline solution)
absent, gentamicin (16mm), enrofloxacin (21mm) and ceftiofur (22mm) consistent with the values imposed
by NCCLS (2003). In the group treated with oil there was an inhibitory halo only at concentrations of 100%
(20mm), 50% (11mm) and 25% (8mm). In the other concentrations there was resistance of the strains. Petry
et al. (2021), evaluating the antimicrobial action of the same oil, considered sensitivity of strains in halos
from 8mm.
Conclusion: Melaleuca essential oil in a concentration greater than 25% showed an antimicrobial effect
against strains that cause endometritis.
References
1. CLSI - Clinical and laboratory standards institute. Manual de Antibiograma. Laborclin Produtos
para Laboratórios Ltda. Rev 16 – 03/2019.
2. NCCLS. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard -
Eighth Edition. NCCLS document M2-A8 (ISBN 1-56238-485-6). NCCLS, 940 West Valley Road,
Suite 1400, Wayne, Pennsylvania 19087-1898 USA, 2003.
3. Petry T F et al. Atividade antimicrobiana de biofilme de quitosana associado ao óleo essencial de

citrus reticulata. Mostra de Extensão, Ciência e Tecnologia da Unisc, n. 2, p. 184, 2021.
4. *The present study was approved by the Ethics Committee on the Use of Animals of the Federal
University of Espírito Santo, under number 011/2022.
280
Proceedings
2023
#41 - Investigating The Impact of Clodronate

Disodium on Bone Metabolism Using a Juvenile,
Exercising Sheep Model for Juvenile Horses
Authors
Vergara-Hernandez, Fernando1 ; Nielsen, Brian2 ; Popovich Jr., John3 ; Colbath, Aimee4
Affiliation
1
Michigan State University, College of Agriculture and Natural Resources, Department of Animal Sciences,
East Lansing, MI, USA, Chile ; 2Michigan State University, College of Agriculture and Natural Resources,
Department of Animal Sciences, East Lansing, MI, USA, Estados Unidos (EEUU) ; 3Michigan State Univer-
sity, College of Osteopathic Medicine, Center for Neuromusculoskeletal Clinical R, East Lansing, MI, USA,
Estados Unidos (EEUU) ; 4Cornell University, College of Veterinary Medicine, Department of Large Animal
Clinical Science, Ithaca, NY, USA, Estados Unidos (EEUU)
Introduction: Bisphosphonates are used in juvenile, exercising horses;1 their effects on bone metabolism
in these animals are unknown. Sheep have been used in bisphosphonate research2 and as a model for ex-
ercising horses.3 A clodronate disodium (CLO) dose of 0.6mg/kg IM in sheep has similar pharmacokinetics
to horses.2 This study aimed to determine the effects of CLO on serum bone biomarkers (SBB), bone min-
eral density (BMD), bone microstructure, biomechanical testing (BMT), and bone healing in juvenile sheep
under forced exercise.
Materials And Methods: Forty juvenile sheep (253±6d old) were divided into four groups (n=10/group):
Control group (saline), T0 (0.6mg/kg CLO, day 0), T84 (0.6mg/kg CLO, day 84), and T0+84 (0.6mg/kg CLO,
day 0 and day 84). Sheep were exercised 4 days/week. Outcome measures included physical and lameness
examinations (PE) every 14 days; serum was harvested every 28 days for SBB until euthanasia at 165 days.
Micro-CT was used to evaluate BMD, bone microstructure, and bone healing of tuber coxae (TC) biopsies
(day 84 and day 165). The fused metacarpus and fourth lumbar vertebrae underwent BMT. Data were an-
alyzed using PROC MIXED in SAS.
Results: Sheep PE, SBB, BMD, microstructure, BMT and bone healing results did not differ between groups.
SBB showed an increase in bone formation (P0.03) and a decrease in some bone resorption markers over
time (P0.03). TC biopsies showed an increase in bone volume fraction, trabecular spacing and thickness,
and reduced trabecular number at day 165 compared to day 84 (P0.04).
Discussion/Conclusion: CLO had no measurable skeletal effects. The lack of treatment effects may be
due to the lower CLO dose used in large animals versus humans. Previous research has shown clinical
improvement in lameness without changes in bone turnover markers.4,5 Therefore, further research could
focus on the analgesic effects of CLO in large animals.
References
1. Vergara-Hernandez FB, Nielsen BD, Colbath AC. Is the use of bisphosphonates putting horses at
risk? An osteoclast perspective. Animals. 2022;12:1722. doi:10.3390/ani12131722.
2. Vergara-Hernandez FB, Nielsen BD, Kottwitz JJ, Panek CL, Robison CI, Paris BL, Welsh TH Jr, Bra-
dbery AN, Leatherwood JL, Colbath AC. Pharmacokinetics and plasma protein binding of a single
dose of clodronate disodium are similar for juvenile sheep and horses. Am J Vet Res. 2023;84(8):1-7.
doi:10.2460/ajvr.23.03.0051.
3. Vernon KL, Riggs L, Coverdale J, Bodine AB, Gibbons J. The effects of forced exercise on collagen
type II fragments, lysyl oxidase concentrations, and total protein concentrations in sera and syno-
vial fluid of lambs. J Equine Vet Sci. 2010;30:266-74. doi:10.1016/J.JEVS.2010.03.001.
4. Richbourg HA, Mitchell CF, Gillett AN, McNulty MA. Tiludronate and clodronate do not affect
bone structure or remodeling kinetics over a 60 day randomized trial. BMC Vet Res. 2018;14:1-11.
doi:10.1186/s12917-018-1423-2.
5. Mitchell A, Wright G, Sampson SN, Martin M, Cummings K, Gaddy D, Watts AE. Clodronate im-
proves lameness in horses without changing bone turnover markers. Equine Vet J. 2019;51:356-63.
doi:10.1111/EVJ.13011.
281
Proceedings
2023
#42 - Case Report of Transient Neonatal Diabetes in a

Foal
Authors
Frezza, Mariel1 ; Kehoe, Patricio1 ; Tuemmers, Christian2 ; Muriel, Marcos1
Affiliation
1Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Cátedra de Medicina Equina, La Pla-
ta, Argentina ; 2Universidad Católica de Temuco, Departamento de Ciencias Veterinarias y Salud Pública,
Temuco, Chile
Introduction
Transient neonatal diabetes mellitus (TNDM) is described in human medicine but reports in equine medi-
cine are scarce. The objective of this work is to describe a case of transient neonatal diabetes in a foal.
Clinical History
Male foal, small crossbreed, 15 kg, 12 days old. History of weakness and restricted intrauterine growth at
birth as a consequence of fetal stress (mother with very low body condition and severe injuries), treated
with antibiotic therapy and plasma transfusion. The hematology and blood biochemistry (including glyce-
mia) at 12 hours after birth yielded results within normal values.
Relevant Clinical Findings

The patient presented weakness and depression with response to stimuli, mild hyperthermia, dehydration,
weak metatarsal pulse, hyperglycemia, white colored serum and the owner commented that the stools were
also whitish.
Evidence-Based Diagnosis
Hematology and blood biochemistry showed leukopenia with a left shift, a slight increase in total protein
and fibrinogen, an increase in urea, a marked increase in triglycerides, and low levels of pancreatic enzymes
(amylase 2 U/l), lipase 13 IU/l). Cortisol measured 1.9 g/dl and insulin <1.6 uU/ml.
treatment and management

Medical treatment included fluid therapy, broad-spectrum antibiotics, NSAIDs, gastric protector, heparin
(due to hyperlipidemia) and hypoglycemic drugs.
Evolution
The foal had a favorable response to treatment, lowering blood glucose when administered exogenous
insulin. After 7 weeks he began regulating his blood glucose without insulin, so from day 55 medication
began to be withdrawn.
Discussion
TNDM is defined as persistent hyperglycemia for more than 2 weeks with low insulin levels that requires
exogenous insulin in patients less than 180 days of life, described in neonates from one month of life. In this
case, insulin-dependent hyperglycemia began at 15 days of life, with exogenous pancreatic insufficiency
(also seen in human neonatal patients with this pathology), hyperlipidemia and hypercholesterolemia.
References
1. Beltrand J, Busiah K, Vaivre-Douret L, Fauret AL, Berdugo M, Cavé H, Polak M. Neonatal diabetes
mellitus. Frontiers in Pediatrics. 2020:602.
2. Navas de Solis C, Foreman JH. Transient diabetes mellitus in a neonatal Thoroughbred foal. Journal
of Veterinary Emergency and Critical Care. 2010 Dec;20(6):611-5.
3. Naylor RN, Greeley SA, Bell GI, Philipson LH. Genetics and pathophysiology of neonatal diabetes
mellitus. Journal of Diabetes Investigation. 2011 Jun;2(3):158-69.
4. Rajadhyaksha SB, Agarwal N, Desai LS. Neonatal diabetes mellitus with severe hypertriglyceride-
mia. Journal of Pediatric Endocrinology and Metabolism. 1996 May 1;9(3):435-8.
282
Proceedings
2023
#43 - Comparative Cytology of Bronchoalveolar

Lavage Fluid from Asymptomatic Horses After Being
Moved From Pasture to a Stabled Management
Regimen
Authors
Frezza, Mariel1 ; Picco, Sebastían2 ; Tuemmers, Christian3 ; Muriel, Marcos1
Affiliation
ta, Argentina ; 2Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Instituto de Genética
Veterinaria Ing. Fernando Noel Dulout (IGEVET), La Plata, Argentina ; 3Universidad Católica de Temuco,
Departamento de Ciencias Veterinarias y Salud Pública, Temuco, Chile
Introduction: Stabling has been identified as a risk factor for equine asthma. The objective of this study
was to analyze bronchoalveolar lavage (BAL) cytology in horses without signs of lower respiratory disease,
before and after being subjected to a 30-day stabled regimen at the Hospital Escuela, Facultad de Ciencias
Veterinarias, UNLP.
Materials And Methods: 5 male equines, age range 7-17 years, of different breeds were used. The regimen
consisted of daytime paddock turnout and night stabling in boxes with wood shavings bedding. They were
fed alfalfa hay and grains. Two samples were taken, the first BAL was performed 24 hours after admission
(they had been at pasture for 90 days), and the second BAL was repeated a month later. Cytology reference
values were based on the latest consensus on inflammatory airway disease of the American College of
Veterinary Internal Medicine.
Results: In the first BAL, 4 animals presented a slight increase in the number of neutrophils and/or mast
cells. One horse was diagnosed as subclinical asthmatic due to presenting more than 5% of mast cells and
maintained high levels after 30 days. Although all of the animals remained asymptomatic, there was a vari-
able increase in the proportion of active macrophages, neutrophils and mast cells. Eosinophils were absent
in the first sample and then present in all horses (above the reference value in 3 horses). After the second
BAL, two other cases of mild subclinical asthma were diagnosed, one due to an increase in eosinophils and
the other in mast cells.
Discussion/Conclusions: This study demonstrated that BAL is an effective method for the early detection
of pulmonary inflammation and allowed to associate housing with an increase in macrophage activity and
mild inflammation, showing the heterogeneity in the inflammatory response of the lower airways in horses
with identical exposure.
References
1. Couëtil LL, Cardwell JM, Gerber V, Lavoie JP, Léguillette R, Richard EA. Inflammatory airway di-
sease of horses—revised consensus statement. Journal of Veterinary Internal Medicine. 2016
Mar;30(2):503-15.
2. de Patologia PD, Xavier de Alencar N, Viscardi V, Fernanda de Mello Costa M, Maria Hess T, Au-
gusto Barroso Lessa D. Cytology profile and age influence in the equine bronchoalveolar lavage in
healthy and asymptomatic inflammatory airway disease. Ci. Rural. 2013.
3. Hansen S, Klintoe K, Austevoll M, Baptiste KE, Fjeldborg J. Equine airway inflammation in loose-
housing management compared with pasture and conventional stabling. Veterinary Record. 2019
May;184(19):590-.
4. Ivester KM, Couëtil LL, Moore GE, Zimmerman NJ, Raskin RE. Environmental exposures and
airway inflammation in young thoroughbred horses. Journal of Veterinary Internal Medicine. 2014
May;28(3):918-24.
5. Riihimäki M, Raine A, Elfman L, Pringle J. Markers of respiratory inflammation in horses in relation
to seasonal changes in air quality in a conventional racing stable. Canadian Journal of Veterinary
Research. 2008 Oct;72(5):432.
283
Proceedings
2023
#44 - A Homemade Manual Cytocentrifuge for the

Analysis Of Bronchoalveolar Lavage Fluid in Horses
Authors
Frezza, Mariel1 ; Picco, Sebastían2 ; Tuemmers, Christian3 ; Muriel, Marcos1
Affiliation
ta, Argentina ; 2Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Instituto de Genética
Veterinaria Ing. Fernando Noel Dulout (IGEVET), La Plata, Argentina ; 3Universidad Católica de Temuco,
Departamento de Ciencias Veterinarias y Salud Pública, Temuco, Chile
Introduction: Homemade cytocentrifuges have been described for other samples, however, its use for
equine BALF cytology has not yet been described. The objective of this study was to evaluate the perfor-
mance of a manual cytocentrifuge for the processing of equine BALF.
Materials And Methods: Fifteen equine BALF samples were processed in a commercial cytospin and
a manual cytocentrifuge. The latter was adapted from a salad spinner using the disposable devices from
commercial cytocentrifuges. The slides obtained by both methods were analyzed considering their cellular-
ity, proportion of ruptured cells and differential cell count.
Results: Results obtained were expressed in mean ± SD. We found a decrease in the number of cells in
the manual cytocentrifuge compared to the cytospin (50.615 ± 21.668 cytospin vs. 20.323 ± 14.227 manual,
p0.01) and also an increase in the proportion of ruptured cells (4.346 ± 3.092 vs. 7.061 ± 6.122, p=0.083
respectively). The differential cell count for inflammatory cells didn’t differ significantly allowing to reach the
same cytological diagnosis (neutrophils: 5.44 ± 6.1 cytospin vs. 5.4 ± 5.15 manual, p= 0.47, R=0.971; mast
cells 3.34 ± 3.26 vs. 3.54 ± 3.23, p= 0.435, R= 0.915; eosinophils 0.346 ± 0.938 vs. 0.366 ± 0.677, p= 0.473,
R= 0.714 respectively). However statistical difference was found with macrophages (44.066 ± 15.128 cyto-
spin vs. 54.306 ± 14.216 manual, p=0.033, R= 0.143) and lymphocytes (47.113 ± 13.983 vs. 36.52 ± 13.108,
p= 0.02, R= 0.038).
Discussion/Conclusions: The predictive value of the differential cell count was adequate for the more rel-
evant cells for the diagnosis of equine asthma. However, further improvement in the technique is needed. It
has the advantage of being low cost, easy to operate and transport, and since it does not require electricity,
it can be used in rural areas.
References
1. Brown J, Theis L, Kerr L, Zakhidova N, O’Connor K, Uthman M, Maria Oden Z, Richards-Kortum
R. A hand-powered, portable, low-cost centrifuge for diagnosing anemia in low-resource settings.
American Journal of Tropical Medicine and Hygiene. 2011 Aug 1;85(2):327.
2. Marcos R, Santos M, Marrinhas C, CorreiaGomes C, Caniatti M. Cytocentrifuge preparation in
veterinary cytology: a quick, simple, and affordable manual method to concentrate low cellularity
fluids. 2016 Dec.
3. Marcos R, Ribeiro T, Santos M, Correia-Gomes C, Macedo S, Guimarães T, Blielbernicht M, Caniatti
M, Rocha A. The advantages of using cytospins of uterine lavage fluid for the diagnosis of equine
endometritis. Theriogenology. 2020 Sep 15;154:143-51.
4. Morán P, Galindo J. A practical homemade microcentrifuge for teaching purposes. Biochemistry
and Molecular Biology Education. 2011 Jul;39(4):298-9.
5. Pickles K, Pirie RS, Rhind S, Dixon PM, McGorum BC. Cytological analysis of equine bronchoalveo-
lar lavage fluid. Part 2: comparison of smear and cytocentrifuged preparations. Equine veterinary
journal. 2002 May;34(3):292-6.
284
Proceedings
2023
#45 - Diagnostic Option for Suspected Equine Motor

Neuron Disease
Authors
Terziotti, Horacio1 ; Frezza, Mariel1 ; Tuemmers, Christian2 ; Muriel, Marcos1
Affiliation
1Facultad de Ciencias Veterinarias- Universidad Nacional de La Plata, Cátedra de Medicina Equina, La Pla-
ta, Argentina ; 2Universidad Católica de Temuco, Depto. de Ciencias Veterinarias y Salud Pública, Temuco,
Chile
Introduction: Equine motor neuron disease (EMND) is a neurodegenerative disorder caused by increased
oxidative damage in the nervous system, associated with a vitamin E deficiency. Describe the alternative
diagnostic methodology for suspected EMND.
Clinical history and relevant clinical findigs: During the 2022-2023 period, three patients were exam-
ined that presented signs of weakness and muscle atrophy, proprioception alteration, chronic weight loss,
dysphagia, and one of them also had the “circus elephant” stance (‘elephant on a ball’), which suggested
EMND as the presumptive diagnosis.
The suggested diagnostic protocol is based on vitamin E measurements, electromyography, histopathology

of the coccygeal and masseter muscles, eye fundus abnormalities, and enzyme measurements. Due to the
lack of access to certain complementary diagnostic tests in these cases, histopathology of the coccygeus
muscle, fundus examination and measurement of creatine kinase (CK) and aspartate aminotransferase
(AST) enzymes was performed.
Evidence- based diagnosis: In none of the cases was there evidence of lipofuscin deposits in the fundus.
In all three cases, CK was slightly increased and AST was normal whilst histopathology identified angulated
atrophic muscle fibers compatible with EMND.
Discussion: Although vitamin E deficiency is suggested as the cause of this disease, its blood levels are
often not representative, in addition to the fact that its measurement is not accessible. On the other hand,
the equipment required for electromyography is usually very expensive and difficult to access, therefore, it
is necessary to rely on other diagnostic techniques. Based on our results, which agree with other authors,
it is extremely important to perform histopathology of the coccygeus muscle and eye fundus examination,
since alterations detected in these ancillary tests, added to the history and clinical signs, allow us to reach
a diagnosis of EMND.
References
1. -Bedford HE, Valberg SJ, Firshman AM, Lucio M, Boyce MK, Trumble TN. Histopathologic findings
in the sacrocaudalis dorsalis medialis muscle of horses with vitamin E-responsive muscle atrophy
and weakness. J Am Vet Med Assoc. 2013 Apr 15;242(8):1127-37. doi: 10.2460/javma.242.8.1127.
PMID: 23547678.
2. -Divers TJ et al: Equine motor neuron disease. Proc Am Coll Vet Intern Med 13:918–921, 1995.
3. -Divers, T; Mohammed, H; and Cummings, J DVM. Equine motor neuron disease Veterinary clinics
of North America: equine practice (1997). Volume 13, number 1.
4. -Husulak, M; Lohmann, K; Gabadage, K; Wojnarowicz, C and Marqués, F. Equine motor neuron
disease in 2 horses from Saskatchewan. Can Vet J. 2016 Jul; 57(7): 771–776.
5. -Kyles KW et al: Electromyography under caudal epidural anaesthesia as an aid to the diagnosis of
equine motor neuron disease, Vet Rec 148:536– 538, 2001.
285
Proceedings
2023
#47 - IMPORTANCE OF THE OPHTHALMOLOGICAL

EXAMINATION IN CASE OF SUSPICION OF EQUINE
MOTOR NEURON DISEASE. Description of 2 cases.
Authors
Zapata, Gustavo1 ; Meana, Virginia1 ; Tuemmers, Christian2 ; Terziotti, Horacio1
Affiliation
1Facultad de Ciencias Veterinarias- Universidad Nacional de La Plata, Cátedra de Medicina Equina- Servi-
cio de Oftalmología Comparada, La Plata, Argentina ; 2Universidad Católica de Temuco, Depto. de Ciencias
Veterinarias y Salud Pública, Temuco, Chile
Introduction: Equine motor neuron disease (EMND) is a degenerative neurological condition caused by
an imbalance between oxidative stress and antioxidant agents, associated with a vitamin E deficiency. To
describe the importance of the ophthalmological examination in case of suspicion of EMND.
Clinical history: Two patients with recurrent esophageal obstruction who also presented generalized mus-
cular atrophy and progressive weight loss were evaluated, being EMND considered as the presumptive
diagnosis. For this reason, a fundus examination was performed.
Relevant clinical findings: No alterations in visual function were observed, but brownish-black deposits
with a mosaic distribution pattern deposited in the tapetal and peripapillary area were observed in the fun-
dus, compatible with lipofuscin deposits.
Evidence- Based diagnosis: To confirm the definitive diagnosis, clinical history and ophthalmological
findings were complemented with histopathology of the coccygeal muscles. In both patients, angular atro-
phic muscle fibers were evident, consistent with EMND.
Discussion: Most authors agree that the presence of lipofuscin deposits in the retina is a pathognomonic
sign of the disease. This is due to the fact that the appearance of these accumulations is the result of in-
creased phagocytosis of the photoreceptors’ outer segments by the retinal pigment epithelium and a failure
in lysosomal degradation associated with damage due to oxidative stress.
It is worth emphasizing the importance of ophthalmoscopy as a diagnostic method in cases of suspected

EMND since it is a fast and non-invasive study and, even though lipofuscin deposits are not constant find-
ings (30-50% of cases), it becomes an accurate diagnostic method if lipofuscin deposits are evident.
References
1. -Finno, C; Kaese,H; Miller, A; Gianino,G; Divers, T and Valberg, S. Pigment retinopathy in warm-
blood horses with equine degenerative myeloencephalopathy and equine motor neuron disease.
Vet Ophthalmol. 2017 Jul; 20(4): 304–309.
2. -Gilger, B. Equine Ophthalmology 2nd Edition. Elsevier (2011). Chapter 13, page 445.
3. -Husulak, M; Lohmann, K; Gabadage, K; Wojnarowicz, C and Marqués, F. Equine motor neuron
disease in 2 horses from Saskatchewan. Can Vet J. 2016 Jul; 57(7): 771–776.
4. -Riis, R; Jackson, C; Rebhun, W; Katz, M; Loew, E; Summers, B; Cummings, J; De Lahunta, A; Di-
vers, A and Mohammed, H. Ocular manifestations of equine motor neuron disease. Equine Vet J.
1999 Mar;31(2):99-110.
5. -Verhulst, D; Barnett, KC and Mayhew, G. Equine motor neuron disease and retinal degeneration:
case report. Equine veterinary education (2001) 13 (2) 59-61.
286
Proceedings
2023
#51 - Fibroscopic Evaluation of the Upper Airways

in Thoroughbreds, Post Competition at the La Plata
Racetrack, Buenos Aires, Argentina. Between 2019 –
2022.
Authors
LÓPEZ, RAMÓN ANDRÉS1 ; FREZZA, MARIEL SUSANA1 ; TUEMMERS, CHRISTIAN2 ; MURIEL, MAR-
COS GERMÁN1
Affiliation
1FACULTAD DE CIENCIAS VETERINARIAS UNIVERSIDAD NACIONAL DE LA PLATA, CÁTEDRA ME-
DICINA EQUINA, LA PLATA, Argentina ; 2Universidad Católica de Temuco, Depto. de Ciencias Veterinarias
y Salud Pública, TEMUCO, Chile
Introduction: The horse is an obligate nasal breather, so upper airway obstructions (UAO) cause poor
performance. Pharynx and larynx affections are the most frequent and present with clinical signs such as
choking, respiratory noises and poor performance.
Objective: to evaluate the prevalence of static UAO in Thoroughbred horses that competed and requested
a post-competition endoscopy at the La Plata racetrack.
Materials and methods: The post-race endoscopic examination was performed at the racetrack in the city
of La Plata, Argentina, to all those horses that requested the study. A total of 898 Thoroughbred horses were
endoscopically evaluated immediately after the end of the competition using an Olympus GIF fiberscope.
Results: Out of the total number of equines evaluated, 792 did not show alterations, 106 presented one or
more alterations, of which 100 had only one condition and 6 more than one. The UAO observed were Dor-
sal Displacement of the Soft Palate (DDSP) (n=74), Epiglottic Entrapment (EE) (n=19), Recurrent Laryngeal
Neuropathy (RLN) (n=12) and others (n=4). The presentation between females and males was 53 animals
per category. Regarding the age of the horses, 2 years (n=11), 3 years (n=22), 4 years (n=36) and 5 years
and older (n=37).
Discussion/Conclusion: We can conclude that 11.8% of the horses that requested endoscopies presented
alterations in the upper airways, of which 94.3% presented a single UAO condition and 5.6% more than one.
The prevalence of the disorders in the upper airways was 69.8% DDSP, 17.9% EE, 11.3% RLN, and the others
were of very low incidence. In this study, there was no difference between sexes. And it was determined that
the affections of the upper airways occurred to a greater extent when the age was higher.
References
1. Barakzai SZ, Dixon PM. Correlation of resting and exercising endoscopic findings for horses with
dynamic laryngeal collapse and palatal dysfunction. Equine Veterinary Journal. 2011 Jan;43(1):18-23.
2. Lane JG, Ellis DR, Greet TR. Observations on the examination of Thoroughbred yearlings for idio-
pathic laryngeal hemiplegia. Equine veterinary journal. 1987 Nov;19(6):531-6.
3. Stick JA, Peloso JG, Morehead JP, Lloyd J, Eberhart S, Padungtod P, Derksen FJ. Endoscopic as-
sessment of airway function as a predictor of racing performance in Thoroughbred yearlings: 427
cases (1997–2000). Journal of the American Veterinary Medical Association. 2001 Oct 1;219(7):962-
7.
287
Proceedings
2023
#56 - Do Sport Horse Owners in Chile Consider their

Horses’ Behavioural Needs in their Management
Practices?
(Friends, Forage, Freedom): A Survey
Authors
Montero Artaza, Beatriz1 ; Tadich Gallo, Tamara2 ; Watson, Wendy3
Affiliation
1The University of Edinburgh, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, San-
tiago, Chile, Chile ; 2 Universidad Austral de Chile, Facultad de Ciencias Veterinarias, Instituto de Ciencia
Animal, Valdivia, Chile, Chile ; 3The University of Edinburgh, The Royal (Dick) School of Veterinary Studies
and The Roslin Institute, Edinburgh, Scotland, Reino Unido (RU)
Introduction: Fulfilling horses’ primary behavioural needs, known as the “3F’s” (Forage, Friends, and Free-
dom), significantly impacts their welfare, presenting a global challenge for horse owners. In South America,
evidence underscores inadequate housing conditions for sport horses, with limited unrestricted movement,
social contact, and forage access. The aim of this study was to investigate the management practices of
Chilean sport horse owners towards their horse’s primary behavioural needs.
Material and Methods: For this an online, semi-quantitative, and anonymous survey with 19 multi-
ple-choice closed-ended questions was conducted. Participants were recruited via social media and sport
horse stakeholders, requiring horse management/ownership, age over 18, and Chilean residency. Respons-
es were analyzed with descriptive statistics and a Chi-Square test. A P-value of >0.05 was considered
significant.
Results: Descriptive analyses indicated that most horse owners (80.5%) made all decisions for their hors-
es. Concerning freedom, 79.18% of horses were individually housed, 57.9% had less than eight hours of daily
turnout, and 56% fell short of the recommended 500m² area. Socially, 71% lacked physical contact from
their boxes, and turnout interactions were scarce. Regarding forage, 45% had less than 12 hours of access,
with half turned out in soil paddocks. Chi-Square analyses revealed that the most prevalent associations
among forage, companionship, and freedom were linked primarily to demographic and educational factors.
Notably, a significant association emerged between freedom duration and forage access (P < 0.001). This
manifested as nearly half of the horses having less than eight hours of daily freedom in an area smaller than
100m², without access to grazing.
Discussion: Our findings suggest that Chilean sport horse owners may inadequately address their horses’
freedom and social needs, despite some attention being given to forage. These results will inform interven-
tions targeting human behavior to effectively fulfill sport horses’ primary behavioral needs.
Ethical Approval: HERC 769_21
288
Proceedings
2023
#59 - Evaluation of The Slap Test Using

Ultrasonography
Authors
Ferreira, Violeta ; Hernández, Hugo ; Tuemmers, Christian ; Muriel, Marcos1
1 1 2
Affiliation
1
Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Cátedra de Medicina Equina, La Pla-
ta, Argentina ; 2Universidad Católica de Temuco, Departamento de Ciencias Veterinarias y Salud Pública,
Temuco, Chile
Introduction
Laryngeal hemiplegia (LH) or recurrent laryngeal neuropathy (RLN) is an idiopathic distal axonopathy that
prevents maximum laryngeal dilatation, there is a failure in the abduction of the arytenoid cartilage due
to the absence or motor decrease of the dorsal cricoarytenoid muscle, the narrowing of the rima glottidis
decreases the air intake to the lungs and may limit athletic performance. The slap test (ST) induces the
thoraco-laryngeal adductor reflex, this is currently widely used in the physical and endoscopic examination
for the diagnosis of this condition. Ultrasound is a portable, fast, non-invasive, innocuous, and accessible
method by means of which we can visualize the movement of the vocal cords.
Objective: Evaluation of the slap test under ultrasonographic visualization. Materials and Methods
The evaluation of ST was performed in the physical, endoscopic and ultrasonographic examination of 20
equines. Prior to the ultrasound study a tricotomy of the ventral aspect of the laryngeal region was per-
formed, was used Sonoscape E2 ultrasound with a linear transducer at a frequency of 7.5MHZ. The trans-
ducer was placed perpendicular to the mandibular branches. The thoracolaryngeal adductor reflex was
induced by performing a slap on the caudal angle of the scapula on both sides.
Results
In 16 equines the ST evaluation was positive, and movement of both arytenoid and vocal cords could be de-
tected by physical, endoscopic and ultrasound examination. In 4 of the equines the ST evaluation by phys-
ical, endoscopic and ultrasound examination was negative on the left side and positive on the right side.
Conclusion
Currently endoscopy is the most widely used complementary method to evaluate laryngeal functionality in
the equine, however, ultrasonography represents a faster, safer and non-invasive diagnostic method that
allows visualization of the vocal folds movement at the time of performing the ST, being a very useful, ob-
jective, accessible and uncomplicated tool for the diagnosis of LH.
References
1. Curtis RA, Hahn CN, Evans DL, Williams T, Begg L. Thoracolaryngeal reflex latencies in Thorou-
ghbred horses with recurrent laryngeal neuropathy. The Veterinary Journal. 2005 Jul 1;170(1):67-76.
2. De Clercq E, Rossignol F, Martens A. Laryngeal hemiplegia in the horse: an update. Vlaams Dier-
geneeskundig Tijdschrift. 2018;87(5):283-94.
3. Greet TR, Jeffcott LB, WHITWELL KE, Cook WR. The slap test for laryngeal adductory function in
horses with suspected cervical spinal cord damage. Equine veterinary journal. 1980 Jul;12(3):127-31.
4. NewtonClarke MJ, Divers TJ, Delahunta A, Mohammed HO. Evaluation of the thoracolaryngeal
reflex (‘slap test’) as an aid to the diagnosis of cervical spinal cord and brainstem disease in horses.
Equine veterinary journal. 1994 Sep;26(5):358-61.
289
Proceedings
2023
#60 - Diagnóstico de Desplazamiento Dorsal de

Paladar Blando Mediante Endoscopia Dinámica:
¿Es Útil el Lenguero para Mejorar el Rendimiento
Deportivo de Equinos con esta Patología?
Authors
Rodríguez Jorquera, Patricia ; Molina Martínez, Claudia
1 2
Affiliation
1
universidad Mayor, Hospital Docente Veterinario Universidad Mayor Hipódromo Chile, Santiago, Chile;
2
universidad Mayor, Escuela de Medicina Veterinaria, Santiago, Chile
Introducción
En la hípica usan lenguero para mejorar la respiración del equino atleta.
Autores aseguran sirve usarlo en caballos Fina Sangre de Carreras (FSC) con Desplazamiento Dorsal de
Paladar Blando (DDPB) intermitente 2
.
Este estudio de endoscopía dinámica, analizó si usar lenguero en equinos FSC, evitaba el DDPB, mejoran-
do su rendimiento deportivo (hipótesis/objetivo).
Material y Método
Estudio realizado en Hospital Veterinario Universidad Mayor (diciembre 2022 - junio 2023), evaluando a 11
FSC en entrenamiento (2 hembras, 4 castrados y 5 machos), con problemas respiratorios y baja de ren-
dimiento, sometidos a endoscopía dinámica, en ejercicio intenso, con y sin lenguero.
Imágenes observadas para determinar si existió o no DDPB, intermitente o permanente.
Se realizaron mediciones del diámetro de laringe y faringe (software gráfico ImageJ) y analizaron con Infos-
tat, t-students. Resultados
De 11 ejemplares (100%), 3 presentaron DDPB (27,27%) mientras usaban lenguero, en trabajo intenso. Dos
tuvieron desplazamiento intermitente. Solo uno manifestó DDPB permanente, con y sin usar lenguero.
Discusión
En equinos FSC, el DDPB se presenta con prevalencia del 10 al 20% . En este estudio obtuvo como prev-
1
alencia, 27,27% (3 casos de 11).
El lenguero, es usado para evitar el DDPB, impidiendo que retraiga la lengua, inhibiendo el desplazamiento
laríngeo caudal y aumentando el diámetro de la laringe y faringe 1. En este estudio, se observó el DDPB en
3 ejemplares, durante ejercicio intenso, usando lenguero.
Nos dimos cuenta como el uso del lenguero restringe el movimiento natural de la faringe y laringe, reduc-
iendo su diámetro, coincidiendo con estudios que hacen referencia a lo mismo y no tendría relación con
evitar el DDPB 5,1.
Conclusión
Usar “lenguero” no evita el DDPB (intermitente ni permanente), en algunos casos produjo la patología men-
cionada. Restringe la apertura de faringe y laringe, forzándolas. en ejercicio intenso, bajando el rendimiento
deportivo del equino.
290
Proceedings
2023
References
1. Barton, A. K., Troppenz, A., Klaus, D., Lindenberg, I., Merle, R., & Gehlen, H. (2022). Tongue ties
do not widen the upper airways in racehorses, Equine Veterinary Journal. https://doi.org/10.1111/
evj.13867
2. Barakzai, S. Z.,Finnegan, C., & Boden, L. A, (2009). Effect of “tongue tie” use on racing performance
of Thoroughbreds in the United Kingdom. Equine VeterinaryJournal, 42 (8), 812-816. https://doi.
org/10.2746/042516409x434134
3. Courouce-Malblanc, A., Deniau, V., Rossignol, F., Corde. R., Leleu, C., Maillard, K., Pitel,P. -H., Pro-
nost, S., & Fortier, G. (2010). Physiological measurements and prevalence of lower airway disea-
ses in Trotters with dorsal displacement of the soft palate: Lower airways diseases in Trotters
with DDSP. Equine Veterinary Journal. Supplement, 42(38), 246-255. https://doi.org/10.1111/j.2042-
3306.2010.00276.x
4. Franklin, S. H., y Allen, K. J. (2015). Assessment of dynamic upper respiratory tract funtion in the
equine athlete. Equine Veterinary Education, 29(2), 92-103. https://doi.org/10.1111/eve.12432
5. Weller, D., Franklin, S., White, P., Shea, G., Fenner, K., Wilson, B., Wilkins, C., & McGreevy, P. (2021).
The reported use of tongue- ties and nosebands in Thoroughbred and Standardbred horse ra-
cing-A pilot study. Animals: An Open Access Journal from MDPI,11(3), 622. https://doi.org/10.3390/
ani11030622
291
Proceedings
2023
#62 - Use of Fecal Microbiota Transplantation as an

Adjuvant to the Post-Surgical Treatment of Equines
Undergoing Enterotomy of The Large Colon: Partial
Results
Authors
de Matos Curvelo de Barros, Aline ; Martins de Camargo, Maristela ; Bargi Belli, Carla
1 2 1
Affiliation
1
University of São Paulo - School of Veterinary Medicine and Animal Science, Internal Medicine, São Paulo,
Brasil ; 2University of São Paulo - Institute of Biomedical Sciences, Immunology, São Paulo, Brasil
Introduction
As the large colon enterotomy can lead to dysbiosis, the goals of this study are to evaluate the intestinal
microbiota after surgery and to verify if the Fecal Microbiota Transplantation (FMT) helps in the return to
eubiosis.

The experiment occurs in Brazil, with 20 horses divided into two groups, control and treatment. The FMT
was performed with feces of four healthy horses, 1.5Kg diluted in 2L of saline, 24h after surgery. Feces, col-
lected in 4 moments (the first from the colon), were subjected to bacterial DNA extraction and amplification
of the V4 region of the 16SrRNA gene. Alpha and beta diversity were analyzed, and statistical analysis by
Kruskall-Wallis and PERMANOVA tests.
Results
At this time, six horses controls have been evaluated and four in the treatment. When collection moments
are not considered there was a difference in alpha diversity between the total samples collected from the
control and donors (p=0.003868), and in beta diversity (p=0.034). It was inferred that at the phylum level
there was an increase in Proteobacteria after surgery regardless of the group with a decrease at the last
moment.
Discussion And Conclusion

Results are partial and it is still not possible to verify whether FMT helps in the return to eubiosis, but the
increase in Proteobacteria in the postoperative in both groups suggests dysbiosis. Reduction of this phylum
at the last moment of collection suggests a recovery or adaptation of the microbiota. The differences in
alpha and beta diversity between donors and controls consolidate the knowledge that there is a difference
in the microbiota between healthy and animals subjected to intestinal insult. It is concluded that the micro-
biota probably undergoes changes due to colic and/or surgery, and that changes in bacterial phyla may be
related to the adaptations to return to eubiosis.
References
1. Arnold CE; Pilla, R. What Is the Microbiota and What Is Its Role in Colic? Veterinary Clinics: Equine
Practice; 2012.
2. Di Pietro R; Arroyo LG; Mathilde, L; Costa, M. Effects of concentrated fecal microbiota transplant
on the equine fecal microbiota after antibiotic-induced dysbiosis. Canadian Journal of Veterinary
Research 2023; 10 (4):85-96.
3. Tuniyazi M; Wenqing W; Naisheng Z. Systematic Review of Current Applications of Fecal Microbio-
ta Transplantation in Horses. Veterinary Sciences 2023; 10 (4):290.
292
Proceedings
2023
#63 - Abdominal Metastatic Melanoma in a Horse

Authors
Queiroz Junqueira, DANIELA ; Souza Coelho, Adriana ; Silva Rodrigues, Ketherson ; Bariani-Junior, Antô-
1 1 1
1
nio Fernando
Affiliation
1Centro Universitário Barão De Mauá, Veterinary Hospital, Ribeirão Preto, Brasil
Introduction: Melanoma is a malignant neoplasm that especially affects gray-haired animals. The predi-
lection sites are tail and perineum, but may also occur in genitals and ocular, auricular and parotid regions.
Clinical History: A 20-year-old mixed breed horse, brown-haired, was referred for treatment with funicu-
litis resulting from an orchiectomy performed 20 days ago. It was reported that had lost weight since the
orchiectomy and had an acute abdomen that resolved with clinical treatment.
Relevant clinical findings: The prepuce and inguino-scrotal regions were edematous and the surgical
wound showed purulent exudate. Transrectal palpation revealed a firm mass on the pelvic cavity extending
into the abdominal cavity. Hemogram showed anemia and leukopenia with left shift.
Treatment And Management: Local treatment was instituted with hydrogen peroxide and 2% iodine solu-
tion, and systemic treatment with dipyrone and penicillins.
Evolution: After seven days treatment anemia and leukopenia were resolved. The horse was alert, with
appetite, and volume increase in the inguinal region had disappeared, but the weight loss persisted. Two
weeks after admission the horse manifested abdominal pain and died.
Post-Mortem Findings: A mass was found in the abdominal cavity extending to the pelvic cavity (46x36x24
cm/ 25.85 kg). It was attached to the mesentery of the small colon. There were also brownish nodules in
abdominal cavity and omentum lymph nodes, as well as in the peritoneum. Histopathological examination
revealed atypical mitosis, cells with vacuolated cytoplasm and large number of tumor cells with brownish
pigment inside, positive for Fontana Masson staining special for melanin.
Discussion: it was not possible to establish the site, since the cutaneous tumor was probably surgically
removed and not identified. Melanoma is a neoplasm that occurs not only in grey-haired horses and that
can cause metastases. Abdominal neoplasms must be considered as differential diagnosis in progressive
weight loss in elderly horses.
References
1. Melotti VD, Souza RG, Moscaridini ARC, Saquetti CHC, Ferreira RF. Estudo retrospectivo de der-
matopatias nodulares em equinos atendidos no centro de medicina veterinária da PMDF no perío-
do de 2011 a 2018. Revista Ciência e Saúde Animal. 2020;2(2):19-33.
2. Monteverde AC, Passos LFP, Roldão CH, Silva MA. Melanoma maligno metastático disseminado
pela cavidade abdominal em equino tordilho. Revista Acadêmica de Ciência Animal. 2017;15(1):307-
308.
3. Ucheaga EM, Emmanuel ER, Wayuta MP. A. case of colic due to metastatic melanoma in a 23-year-
old mare. Animal Research Internacional. 2022;19(3):4643-4647.
293
Proceedings
2023
#64 - Cross-Sectional Study of the Occurrence of

Ultrasonographic Findings in the Cervical Articular
Process Joints of Showjumping and Dressage Horses
Authors
Tokawa, Paula Keiko Anadão1 ; Vendruscolo, Cynthia do Prado2 ; Agreste, Fernanda Rodrigues1 ; Baccarin,
Raquel Yvonne Arantes1
Affiliation
1FMVZ-USP, Department of Internal Medicine, São Paulo, Brasil ; 2Autonomous, Equine practitioner, São
Paulo, Brasil
Introduction: Cervical articular process joints (APJ) have been increase focus of attention for changes
that could affect equine performance and welfare. Ultrasonographic (US) examination is employed by vet-
erinarians in the field to aid in diagnosis of diseases of APJs along with radiographic assessment. Studies
investigating and characterizing the radiographic findings of APJ are common but for US examination are
currently scarce. This prospective cross-sectional study aims to identify the occurrence of US findings of
APJs of normally performing showjumping and dressage horses. The authors also investigated if there was
higher prevalence of each finding for the different APJ levels and if their presence is associated to sports
modality or correlated with age.
Methods: Horses were US screened in a systematic manner by the same operator throughout the study.
Transverse and longitudinal views were collected from C2-C3 to C7-T1 APJs of all horses. Findings were
classified as present/absent by two evaluators in agreement. Association of US findings and sport modality
and age was also investigated.
Results: A hundred and fifty horses were included and 1794 APJs were evaluated in the transverse view,
while 1445 were successfully acquired for evaluation in the longitudinal view, being this, more difficult to
perform. Irregularities in peri-articular bone margins, effusion and echogenic foci were more present than
hyperechogenic floating spots. Prevalence of US findings varied according to APJ level. Analysis did not
found association between US findings and sports modalities or age.
Discussion/Conclusion: Knowledge of occurrence and prevalence of findings in normally performing

populations may help clinicians to better understand significance of findings. US findings investigated in
this study were distributed along the cervical APJs and clinicians should bear in mind that their presence
may not be associate with an active disorder, therefore, their relevance should be assessed along with
clinical findings.
References
1. Berg LC, Nielsen JV, Thoefner MB, & Thomsen PD. Ultrasonography of the equine cervical region:
a descriptive study in eight horses. Equine Vet J. 2003;35(7):647–655.
2. Story MR, Haussler KK, Nout-Lomas YS, Aboellail TA, Kawcak CE, Barrett MF, Frisbie DD, McI-
lwraith CW. Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment. Animals.
2021;11(2):422.
3. Donati B, Coudry V, Denoix JM, Ohlert S, Dittmann M, Richter H, Weishaupt M, Sanchez-Andrade
JS. Findings and interobserver agreement in radiography and ultrasonography of the vertebral
column of a large population of normally performing horses. Pferdeheilkunde. 2022. 38:500-514.
4. Haussler KK, Pool RR, Clayton HM. Characterization of bony changes localized to the cervical arti-
cular processes in a mixed population of horses. PLoS One. 2019. 14(9):e0222989.
294
Proceedings
2023
#65 - Prospective Study Investigating the Association

Between Ultrasonographic Findings of the Cervical
Articular Process Joints And Clinical Examination of
The Neck Of 150 Horses
Authors
Tokawa, Paula Keiko Anadão1 ; Rodrigues, Nubia Nayara Pereira1 ; Fonseca, Brunna Patricia Almeida2 ;
Baccarin, Raquel Yvonne Arantes1
Affiliation
1
FMVZ-USP, Department of Internal Medicine, São Paulo, Brasil ; 2Autonomous, Axial Vet, Indaiatuba, Brasil
Introduction: Pathologic changes involving the articular process joints (APJ) of the cervical spine have
potential serious implications to horse’s welfare and performance. This study aims to prospectively investi-
gate the association between ultrasonographic findings of cervical APJs and changes identified in clinical
examination of the neck of horses.
Material And Methods: A population of performing horses was investigated for changes in clinical and ul-
trasonographic examinations. Exams were performed by blinded evaluators in a systematic manner. Asso-
ciation of findings of clinical assessment (muscle hypotrophy, positive palpation of the neck and decreased
neck mobility) and ultrasonographic examination of APJs (bone margin irregularities, effusion, echogenic
foci or hyperechogenic floating spots) was investigated. Owners were asked about complaints when riding
investigated horses and these were also investigated for association to US findings.
Results: A hundred and fifty horses were included in this study. Data analysis showed a significant as-
sociation between higher scores of irregularities within bone margins of APJs found on ultrasonographic
examination and owners report of poor performance, presence of muscle hypotrophy and positive response
for palpation (p < 0.05). In addition, presence of hyperechogenic floating spots on US were associated with
muscle hypotrophy (p <0.001). No associations were found between the other US findings of APJs, and
changes detected on clinical examination.
Discussion/Conclusion: Ultrasonographic examination is an important complementary diagnostic tool

for musculoskeletal changes in horses. For neck conditions, this tool is mainly reported as a guide for in-
tra-articular injections of APJs. This study highlights that some changes found on ultrasound examination
are associated to common clinical signs of neck disorders. Despite this may be a mere causality, these
results warrant further studies in the area, and brings attention to this diagnostic modality which lacks in
clear description – mainly regarding disorders – in the current literature.
References
1. Story MR, Haussler KK, Nout-Lomas YS, Aboellail TA, Kawcak CE, Barrett MF, Frisbie DD, McI-
lwraith CW. Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment. Animals.
2021;11(2):422.
2. Haussler KK, Pool RR, Clayton HM. Characterization of bony changes localized to the cervical arti-
cular processes in a mixed population of horses. PLoS One. 2019. 14(9):e0222989.
3. Crijns CP, Broeckx BJG. Evaluation of cervical radiographs in Dutch Warmblood horses, using a
novel radiographic grading system for the cervical articular process joints. Equine Vet Edu. 2021.
33(11):593-601.
4. Koenig JB, Westlund A, Nykamp S, Kenney DG, Melville L, Cribb N, Oberbichler D. Case-control
comparison of cervical spine radiographs from horses with a clinical diagnosis of cervical facet
disease with normal horses. J Equine Vet Sci. 2020. 92:103176.
295
Proceedings
2023
#66 - Cerebellar Abiotrophy in an Arabian Foal In Saudi

Arabia
Authors
Faria R, Thalita T ; Almuhanna, Mohammed ; Berreta, Ana
1 2 3
Affiliation
1
The Equine Hospital of Jockey Club-Saudi Arabia, Equine Hospital Veterinary, Riyadh, Arabia Saudita ;
2
The Equine Hospital of Jockey Club of Saudi Arabia, Equine Hospital Veterinary, Riyadh, Arabia Saudita ;
3
The Equine Hospital of Jockey Club of Saudi Arabia, Equine Internal Medicine Specialist, Riyadh, Arabia
Saudita
Introduction
Cerebellar abiotrophy (CA) is a rare but significant disease in Arabian horses caused by progressive death
of the Purkinje cells resulting in cerebellar ataxia.
Clinical History / Management

A 4-month-old Arabian filly was presented to The Equine Hospital for evaluation of a head tremor noticed
three days prior to presentation. On admission, the filly was bright and alert. Physical examination and
complete bloodwork were within normal limits. The filly did not have any painful response to palpation of
the head or neck. A complete neurological exam revealed grade 1 ataxia (Mayhew scale) and dysmetria of
all four limbs, decreased menace bilaterally and no other cranial nerve deficits. She had a head tremor that
was worsened when she moved her head. Her neurological deficits were very consistent with CA, and hair
samples of the filly as well as from its mare and stallion were submitted for genetic testing. The test evalu-
ated the presence of the mutation genes, a single nucleotide polymorphism (CA allele) has been identified
in the horse TOE1 gene which is associated with CA in Arabian horses. According to the test, the mare and
stallion were carriers of CA, with 1 copy of the mutation, and the foal was affected, with 2 copies of the mu-
tation. The filly was sent home with recommendations of a small paddock turnout with the mare or box rest
with multiple daily walks. She was also started on d-alpha-tocopherol (vitamin E), which is an antioxidant
and could help slow down the progression of the disease.
Evolution
At a five-month follow up, the filly’s clinical signs were unchanged.
Discussion
The are no therapeutic options for horses that suffer from CA. The importance on CA diagnosis is to avoid
breeding CA carrier and affected horses.
References
1. Blanco A, Moyano R, Vivo J, Flores-Acuña R, Molina A, Blanco C, Monterde JG. Purkinje cell
apoptosis in Arabian horses with cerebellar abiotrophy.J. Vet. Med. A Physiol. Pathol. Clin.
Med.2006;53:286–287.
2. Brault LS, Famula TR, Penedo MC. Inheritance of equine cerebellar abiotrophy in Arabians.Am. J.
Vet. Res.2011b;72(7):940–944.
3. De Lahunta A. Abiotrophy in domestic animals: a review.Can J. Vet. Res.1990;54(1):65–76.
296
Proceedings
2023
#67 - Case Report: Resolution Of Esophageal Stricture

By Foley Catheter Guided By Video Endoscopy In A
3-Month-Old Filly
Authors
Rivera Vasquez, Gonzalo1 ; Muñoz Alonzo, Lisandro2 ; Ortiz Ramirez, Reinaldo1 ; Bustamante Serrano, Felipe1
Affiliation
1
Universidad De Concepcion, Ciencias Clinicas, Chillán, Chile ; 2universidad De Concepcion, Ciencias Clin-
icas, Concepción, Chile
roduction
Esophageal disorders are uncommon and mainly in adult horses, the most common being esophageal ob-
struction, which can present as a complication with esophageal stricture, which are normally acquired by
external or internal trauma(1). However, they are not common in foals(2).
Clinic History
A 3-month-old filly was presented to the Clinica Veterinaria Equina Patagonia Spa, Chillán, who 10 days
before had had milk reflux from both nostrils, being treated for esophageal obstruction with a nasogastric
tube. Treatment with temporary effect and recurrence in 3 times. In addition, it had respiratory distress and
weakness.
Relevant Clinical Signs
Bilateral nasal reflux, pneumonia, and body condition 3/9, heart rate: 100 beast/minute, respiratory rate: 60
breaths/minute and temperature 39,5º Celsius.
Evidence
Aspiration pneumonia and fever.
Esophageal stricture in the proximal third with ulcerative lesion, without contraction, and gastric ulcer of the
glandular mucosa, diagnosed by video endoscopy.
Contrast radiograph shows a narrowing of the lumen in the proximal third of the esophagus.
Treatment And Management
Under general anesthesia, the esophagus was dilated by insufflation of a 14G Foley catheter. The Foley
catheter was directed to the stenosed site by means of video endoscopy and insufflated with 5 ml of water
for 90 seconds. Repeated procedure for 5 consecutive days. Ulcers were treated with sucralfate (Mulcatel-
TM 20 mg/kg, BID, oral) and omeprazole (EquigastrimTM 2 mg/kg/d, oral) and aspiration pneumonia with
ceftiofur (CobactamTM mg/kg every 24 hours for 10 days). The resolution was successful and without
recurrence up to 30 months of age.
Discussion
The ulcer was caused by the nasogastric probing. There is only one record of successful resolution of
esophageal stricture by Foley catheter dilation in foals, a low-cost alternative, with much greater success
than with esophagostomy and with fewer complications(3, 4).
References
1. Bezdekova B, Janalik P. Oesophageal disorders in horses: retrospective study of 39 cases, Equine
Vet Educ. 2018; 30(2):94-9.
2. Nijdam P, Elmas C, Fugazzola MC. Treatment of an esophageal stricture in a 1-month-old miniature
Shetland colt, Case Rep Vet Med. 2017;3069419.
3. Chidlow HB, Robbins EG, Slovis NM. Balloon dilation to treat oesophageal strictures in five foals,
Equine Vet Educ. 2017; 29(11):609-16.
4. Mira J, Posada S, Castillo C, Velez M. Dilation of a proximal esophageal stricture by endoscopically
and radiologically guided balloon in a Falabella foal, Rev Med Vet. 2015;(31):85-95.
297
Proceedings
2023
#68 - Case Report: Dentigerous Cyst in the Temporal

Region of a Chilean Breed Horse
Authors
Rivera Vasquez, Gonzalo1 ; Muñoz Alonzo, Lisandro1 ; Ortiz Ramirez, Reinaldo1
Affiliation
1
Universidad De Concepcion, Ciencias Clinicas, Chillán, Chile
Introduction
Dentigerous cysts are congenital defects of the closure of the first aortic arch(1). They are characterized by
containing dental structures of different degrees of development, in some cases they are only segments and
in others they may be ectopic teeth(2).
Clinical History
A stallion, Chilean breed horse, 2 years old, presented to the Hospital Clínico Veterinario, Universidad de
Concepción, Chillán, with a right temporal area fistula, with purulent and bad-smelling exudate. It had been
treated for 3 months with drains and local and systemic antibiotics, without positive results.

Right temporal area fistula with purulent bad-smelling exudate. Normal physiological constants.
Ectopic tooth in the right temporal area, evidenced by radiography. Abscess and fistula around the cyst
diagnosed by ultrasound.

Surgery was performed under general anesthesia to removal the dentigerous cyst. Post-surgery was admin-
istrated trimethoprim- sulphadoxine (GorbanTM, 30 mg/kg every 48 hours for 5 applications) and NSAIDs
were administered flunixin meglumine (FebrectalTM, 1,1 mg/kg every 24 hours for 5 days).
Evolution
No post-surgical complications, outcome 10 days after surgery and no recurrences.
Discussion
Dentigerous cysts must be differentiated from other pathologies of the temporal area such as bone se-
questrations, abscesses, foreign bodies or neoplasia(3). For its diagnosis a good clinical examination and
radiography are needed(2). Surgical removal is the definitive treatment for the pathology. Depending on the
area covered, there may be complications such as severe nerve trauma or temporomandibular joint disease,
mild complications such as damage to auricular muscles or scutiform cartilage are also described(3). In the
current case, no complications occurred. All the reports so far describe that its presentation is unilateral,
such in this case. But may be bilateral(1).
References
1. Heun FAS, Hansmann F, Bienert-Zeit A, Hellige M. Dentigerous cysts with exostosis of the tempo-
ral bone in horses – A new variant diagnosed by computed tomography, Equine Vet Educ. 2022;
34(5):e181-e6.
2. Gutzmer C, Nijdam P. Maxillary dentigerous cyst with double wolf teeth in a 3-year-old quarter
horse mare, Case Rep Vet Med. 2021; 55:322-36.
3. Ruby JL, Scrivani PV, Thompson MS. What is your diagnosis? Dentigerous cyst. J Am Vet Med
Assoc. 2015; 247(10):1097-9.
298
Proceedings
2023
#71 - Evaluation of the back of dressage lusitano horses

and the respective saddle fitting using thermography
Authors
Nascimento, Carolina ; Santos, Maria2 ; Farinelli SIQUEIRA, Renata3 ; Simões Coelho, Clarisse1
1
Affiliation
1Lusofona University, Veterinary Medicine, Lisbon, Portugal ; 2Evora University, Mediterranean Institute
for Agriculture, Environment and Development, Lisbon, Portugal ; 3Universidade Federal de Santa Maria,
Large Animal Clinic, Santa Maria, Brasil
Introduction: Studying the interaction between horse–rider–saddle is complex, but a saddle that does not
fit correctly for both horse and rider has long-term health consequences for both. This work aims to study
the positioning of a single saddle and its interaction with the back of four dressage Lusitano horses using
thermography analysis.
Material and Methods: Four horses, 5-16 years-old, ~542 kg, were evaluated before (M1) and after (M2) 30
minutes of a routine sequence of dressage exercises. The intensity of effort was moderate, with increased
intensity depending on the level of physical condition of each horse. All animals used the same saddle and
were ridden by the same rider. In M1 and M2, thermographic images of the thoracolumbar spine and the
respective saddle were obtained, using markers at specific points (T7; T12/T13; T18; L3/L4) to identify the
superficial muscle groups in 7 regions of interesting (ROI). The images were processed using FLIR Tools
and ImageJ. Variables were analyzed by ANOVA and t-test with P<0.05 to denote significancy.
Results: Significant increases were registered in all ROI (P<0.05) after the practice of the dressage
exercise, with emphasis on the most caudal ones (6 and 7), referring to the gluteus medius muscle. Regard-
ing the contact surface, only two animals showed a fit close to the ideal (between 69.3-75.6%), with the
others indicating a bad fit, oscillating between 12.9 and 17.2%.
Discussion/Conclusion: Thermography proved to be a practical and useful tool in assessing saddle ad-
justments and spinal pressure points in dressage horses. Through the results, it was possible to conclude
about the importance of saddle fitting in dressage, even when the animals are ridden by the same rider, in
order to obtain a better contact surface of the horizontal panels with the back, preventing the appearance
of injuries.
References
1. Masko, M., Krajewska, A., Zdrojkowski, L., Domino, M., & Gajewski, Z. (2019). An application of tem-
perature mapping of horse’s back for leisure horse-rider-matching. Animal Science Journal, 90(10),
1396–1406. https://doi.org/10.1111/asj.13282
2. Soroko, M., Zaborski, D., Dudek, K., Yarnell, K., Górniak, W., & Vardasca, R. (2019). Evaluation of
thermal pattern distributions in racehorse saddles using infrared thermography. PLoS ONE, 14(8).
https://doi.org/10.1371/journal.pone.0221622
299
Proceedings
2023
#72 - Dyslipidemia In Hospitalized Horses

Authors
Queiroz Junqueira, DANIELA ; Mogno, Julia1 ; Carvalho, Laura1 ; Jesus, Juliana1
1
Affiliation
1
Centro Universitário Barão De Mauá, Veterinary Hospital, Ribeirão Preto, Brasil
Introduction: Poor diet or reduced food intake, especially associated with high energy requirements, may
result in hyperlipidemia and hyperlipemia, syndromes related to triglyceride increase. The aim of this study
was to evaluate triglyceride concentrations to determine the development of dyslipidemia in hospitalized
horses with different clinical and surgical conditions.
Materials And Methods: 51 horses hospitalized at the veterinary hospital of CBM, in Ribeirão Preto/ SP
– Brazil, were included in the study. 21 of them had clinical conditions excluding acute abdomen, 10 under-
went non-emergency surgical procedures and 20 had an acute abdomen, of which 10 underwent celiotomy.
Blood was collected from the external jugular vein with a 30X10 needle, in 10 ml syringes, daily during the
hospitalization period. Blood samples were sent immediately after collection to the laboratory to separate
blood serum. Next, the serum samples were placed in eppendorf tubes in a freezer for later analysis in an
Automatic Biochemical Analyzer using commercial kits.
Results: 14 of the 51 animals showed increased serum triglycerides (triglycerides above 100 mg/dL) at
some point during hospitalization. Among the horses with clinical conditions, 4 had dyslipidemia with tri-
glycerides ranging between 106 and 241 mg/dL. Of the animals submitted to non-emergency surgical pro-
cedures, 2 out of 10 presented triglycerides between 153 and 477 mg/dL and, among the animals with acute
abdomen, 3 clinically treated developed dyslipidemia (triglycerides between 109.5 and 377.5 mg/dL) and 5
of those who underwent celiotomy (triglycerides between 107.5 and 822 mg/dL).
Discussion/ Conclusions: Syndromes related to increased serum levels of triglycerides predominantly

affect ponies, donkeys and mini horses, but can also occur in horses, as observed in the present study
(27.45% of the animals developed dyslipidemia). Among the animals monitored, the incidence of dyslipid-
emia was higher among animals with acute abdomen, especially those submitted to celiotomy.
References
1. Berryhil EH, Magdesian KG, Kass PH, Edman JE. Triglyceride concentrations in neonatal foals: Se-
rial measurement and effects of age and illness. The Veterinary Journal. 2017;227:23-29.
2. Durham AE, Thiemann AK. Nutritional management of hyperlipaemia. The Veterinary Journal.
2015;27(9):482-488. Mckenzie III, HC. Equine hyperlipidemias. Veterinary Clinics North American
Equine Practice. 2011;27:59-72.
3. Paixão PP, Barbosa TS, Brasileiro PP, Watanabe MJ, Yonezawa LA, Paixão MVS. Triglicerídeos
séricos em equinos suplementados com vitamina E submetidos a exercício de longa duração em
esteira. Revista de Medicina Veterinária. 2020;1(41):115-122.
300
Proceedings
2023
#74 - Association of Imaging Findings of The Poll and

Clinical Examination in Performing Horses
Authors
Soares Locoselli, Leonardo1 ; Fernando De Souza, Anderson1 ; Mosquera Jaramilo, Fernando1 ; Yvonne Ar-
antes Baccarin, Raquel1
Affiliation
1
College of Veterinary Medicine and Zootechny, University of São Paulo, Medical Clinic Department, São
Paulo, Brasil
Introduction: Injuries originating from the poll can lead to poor performance and, insertional desmopathy
of the nuchal ligament (NL) as well as of the semispinatus capitis tendon (SCT) has been reported among
possible causes. This study aims to investigate possible associations between diagnostic imaging findings
of the poll and riders’ complaints or changes identified on clinical examination.
Material And Methods: For this study, 150 showjumping/dressage performing horses were evaluated.
Clinical and imaging evaluators were blinded. Data such as excessive head movement and resistance to
the bit when riding was collected. Clinical examination was performed to identify muscle atrophy, pain on
palpation or discomfort on poll flexion. Horses were also submitted to radiographic and ultrasonographic
examinations of the poll.
Results: Bone remodeling/proliferation in the caudal border of the occipital was present in 43.4% horses,
and irregularities of bone margins within the enthesis of the NL were identified by ultrasound (US) in 56.9%
of them, with 25.3% presenting changes within the SCT insertion. The presence of bone proliferation seen
in radiographs was associated with irregularities of NL insertion or with at least one side of the SCT seen on
US (P= 0.00004; P=0.00002). Analysis also showed an association between hypertrophy of caudal oblique
capitis muscle and presence of NL insertion irregularities observed on US (P=0.028). No associations were
found between imaging findings and investigated complaints or other clinical features.
Conclusion: Ultrasonography of the poll seems to be more sensitive for the diagnosis of insertional des-
mopathy/tendinopathy of NL or SCT when compared to radiographs. Presence of changes within the in-
sertion of the NL, diagnosed by US, was associated with hypertrophy of the cranial oblique muscle and this
warrants further investigations. Regarding other possible symptoms, no associations were found, suggest-
ing that imaging findings of this region might not me associated to symptoms.
References
1. Butler, Janet A., et al. Clinical radiology of the horse. John Wiley & Sons, 2017.
2. Gellman, K. S., and J. E. A. Bertram. “The equine nuchal ligament 1: structural and material proper-
ties.” Veterinary and Comparative Orthopaedics and Traumatology 15.01 (2002): 01-06.
3. Lazarczyk, Miriam Joanna, Katarzyna Maria Michlik-Polczynska, and Darilisz Jan Skarzynski. “In-
sertional desmopathies of the cranial attachment of the nuchal ligament in horses–A review.” Ve-
terinární medicína 65.8 (2020): 327-335.
4. Ross, Michael W., and Sue J. Dyson. Diagnosis and Management of Lameness in the Horse. Else-
vier Health Sciences, 2010.
301
Proceedings
2023
#76 - Comparison of Tracheal Wash and

Bronchoalveolar Lavage For Cytological Diagnosis of
Exercise-induced Pulmonary Haemorrhage in Horses
Authors
Barbazanges,Pauline1 ; Richard, Eric2 ; toquet, Marie-Pierre2 ; Couroucé, Anne1
Affiliation
1
Oniris, Internal Medicine, Nantes, Francia ; 2Labéo, Labeo, Caen, Francia
Introduction: Various methods are reported for diagnosis of exercise-induced pulmonary haemorrhage
(EIPH). Cytological evaluation of airway samples is a sensitive method, but the correlation between tracheal
wash (TW) and bronchoalveolar lavage fluid (BALF) findings for diagnosis of EIPH is unknown.
The objective was to determine whether diagnosis of EIPH, using haemosiderophages/macrophages (H/M)
ratio, differs when based on samples from TW and BALF collected concomitantly from the same racehorse.
Methods: Prospective cross-sectional study on 102 Standardbred horses in active training. TW and BALF
from each lung separately were collected from all horses at rest. Smears were stained with May-Grün-
wald-Giemsa (MGG) and H/M ratio calculated. Diagnostic cut- off values were set at 17% for individual (left
and right) BALF and 9% for pooled BALF. H/M ratio in TW samples were scored as none (0%), occasional
(<10%), small (10-25%), moderate (25-50%) or large proportions (>50%).
Results: In BALF, 21 horses met the cytological inclusion criteria for EIPH diagnosis from individual and/or
pooled samples. In TW, 20 horses had occasional proportions of haemosiderophages, and respectively 9,
1 and 3 horses had small, moderate and large proportions. Poor correlations between TW and respectively
pooled, left and right BALF were found for H/M ratio. Among the 13 horses with at least small proportions
of haemosiderophages in TW, 8 (61.5%) had no cytological evidence of EIPH in any BALF.
Conclusion and clinical relevance: No association between TW and BALF was found for the cytological
diagnosis of EIPH. A large number of horses has cytological evidence of pulmonary bleeding in BALF with
none or occasional proportions of haemosiderophages in TW. In addition, finding small to large proportions
of haemosiderophages in TW is mostly not associated with evidence of pulmonary haemorrhage in BALF.
Based on H/M ratio, BALF remains the sample of choice for cytological diagnosis of EIPH.
302
Proceedings
2023
#77 - Association Between Fungal Detection and

Diagnosis of Moderate Equine Asthma (Mea)
According to Sampling Site and Methodology
Authors
Barbazanges, Pauline1 ; Couroucé, Anne1 ; Cardwell, Jacky2 ; Richard, Eric3
Affiliation
1ONIRIS, Internal Medicine, NANTES, Francia ; 2Royal Veterinary College, Department of Pathobiology and
Population Sciences, Hertfordshire, Reino Unido (RU) ; 3LABÉO, Biologie, CAEN, Francia
Introduction: Poor agreements were previously described between tracheal wash (TW) and bronchoal-
veolar lavage fluid (BALF), as well as fungal detection by cytology and mycology culture. The link between
moderate equine asthma (mEA) and detection of fungal elements in the airways remains controversial.
Objectives: To determine the prevalence of fungal detection in TW and BALF and its association with
diagnosis of mEA.
Methods: Prospective study on 120 horses in active training or referred for respiratory disease. Horses
were classified as “control” or “mEA” based on clinical examination, airway endoscopy and BALF. A sample
was considered positive if at least one colony was identified by culture or at least one fungal element was
observed on cytology.
Results: Respectively, 35 and 85 horses were classified as “control” and “mEA”. No significant difference
was observed between groups for fungal detection by cytology, regardless the sampling site. Prevalence
of positive mycology culture was significantly higher for TW (89.4%) and BALF (31.8%) of mEA horses
compared to controls (respectively 68,6%and 8.6%). Diagnosis of mEA was significantly associated with
positive mycology culture on both TW (OR = 3.9) and BALF (OR = 5.0) Mycology culture on BALF exhibited
high specificity (0.90) and high positive predictive value (0.91), unlike mycology culture on TW (respectively
0.76 and 0.31).
Conclusion and clinical importance: Despite a significant association with asthma diagnosis, the high
prevalence of fungal detection in TW of control horses precludes its clinical relevance. However, positive
mycology culture on BALF represents a significant risk-factor of suffering mEA.
303
Proceedings
2023
#82 - Non-Surgical Treatment of Pythiose in a

Mangalarga Marchador Mare: Case Report
Authors
Bernardo Lima, Laura Cecília ; Bertonha Bertonha, Candice Mara
1 1
Affiliation
1Federal Institute Of Minas Gerais, Agricultural Science Department, Bambuí, Brasil
Introduction: Cutaneous pythiosis is a common fungal disease in horses with previous lesions in flood-
ed environments. The pharmacological treatment for Pythium insudiosum is challenging because it is an
oomycete and doesn´t have the main target of antifungals at the plasmatic membrane, ergosterol.
Clinical History: A Mangalarga Marchador mare kept in flooded area was attended with a history of a
persistent wound in ventral region and progressive weight loss.
Relevant clinical findings: An extensive granulomatous ulcerative lesion (25x20 cm) was observed on
clinical examination. There were also kunkers, exudation of bloody mucous, intense itching and fetid odor.
Diagnosis: Pythiosis diagnosis was based on clinical and epidemiological factors and confirmed by histo-
pathology.
Treatment and management: Intramuscular injections of 20 mg of triamcinolone acetonide was adminis-

tered weekly for 3 weeks. Additionally, oral potassium iodide compounded in vanilla flavor by a specialized
pharmacy was administered twice a day during 45 days (dose of 55 mg/kg, totaling 20 grams per day).
During all treatment, wound was washed with neutral soap and repellent was applied around it.
Evolution: Weekly measures of the wound were performed and there was a complete recovery after 50
days of treatment. Granulation tissue showed total regression, extensive scarring disappeared and the ani-
mal´s clinical condition improved significantly.
Discussion: Due to the absence of specific drugs, surgical removal of the affected tissue is the main choice
for pythiosis treatment. However, the invasive characteristics of the surgical procedure and risks enrolled,
the search for effective pharmacological treatments is extremely necessary as an alternative conduct. The
successful clinical treatment for this case is of great relevance for future studies and conducts.
References
1. Ubiali DG, Pereira AHB, Boabaid FM, Dutra V, Nakazato L, Campos CG, et al. Successful potassium
iodide treatment for rhinofacial pythiosis in sheep. Journal of Medical Mycology [Internet]. 2022
Mar 1 [cited 2023 May 29];32(1):101233. Available from: https://www.sciencedirect.com/science/
article/abs/pii/S1156523321001244
2. H. Elkhenany, Shady Nabil, H. Abu-ahmed, Mahmoud HS, Korritum A, Khalifa H. Treatment
and outcome of horses with cutaneous pythiosis, and meta-analysis of similar reports [Inter-
net]. SLOVENIAN VETERINARY RESEARCH. 2019 [cited 2023 May 29]. Available from: https://
www.semanticscholar.org/paper/TREATMENT-AND-OUTCOME-OF-HORSES-WITH- CUTA-
NEOUS-AND-Elkhenany-Nabil/4536c1febf6a45fa5ec075c253cf41885aef1958
3. Cardona-Álvarez J, Vargas-Vilória M, Patarroyo-Salcedo J. Cutaneous pythiosis in horses treated
with triamcinolone acetonide. Part 1. Clinical Characterization. MVZ Cordoba Magazine. 2016 Sep
1;5511–24.
4. Cardona-Álvarez J, Vargas-Vilória M, Patarroyo-Salcedo J. Cutaneous pythiosis in horses treated
with triamcinolone acetonide. Part 2. Histological and histochemical description. MVZ Cordoba
Magazine. 2017 Jan 3;22(1):5638–52.
5. Carvalho A de M, Munhoz TCP, Toma HS, Santos JPV dos, Oliveira LGS de, Boabaid FM, et al. Use
of flucozanol associated with surgical excision in the treatment of equine cutaneous pythiosis. Se-
minar: Agricultural Sciences. 2019 Sep 30;40(6Suppl2):3079.
304
Proceedings
2023
#83 - Exertional Heat Illness In Thoroughbred

Racehorses In Argentina
Authors
Zubia, Candelaria1 ; Muriel, Marcos1 ; Tuemmers Apablaza, Christian2 ; López, Ramón1
Affiliation
1Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Cátedra de Medicina Equina, La
Plata, Argentina ; 2Facultad de Recursos Naturales, Universidad Católica de Temuco, 2 Departamento de
Ciencias Veterinarias y Salud Pública, Temuco, Chile
Introduction: Exertional heat illness (EHI) has been described associated with physical exertion in hu-
mans, horses, and other species. It occurs when an individual cannot adequately dissipate the metabolic
heat produced by physical exertion and the subsequent elevation in body temperature causes a complex
physiopathological cascade with damage to multiple organs and potentially lethal consequences. The clin-
ical manifestation is divided into 4 levels ranging from irritability, sweating and hyperthermia, continuous or
intermittent spasmodic kicks, to altered mental status and significant levels of ataxia. The objective of this
work is to report the diagnosis of EHI in Thoroughbred racehorses in Argentina.
Materials And Methods: Three Thoroughbred horses examined after competing in different 1100 mt races
at the La Plata racetrack in Buenos Aires, Argentina are reported.
Results: Horse 1: 3-year-old female, ambient temperature (T°) 15°C, humidity (H°) 56%, signs of sweating,
body temperature (BT)
40.5 °C, kicking intermittently, irritability. Horse 2: 2-year-old female, T° 24°C, H° 68%, sweating, BT 42 °C,
kicks to the abdomen continuously while walking, irritability. Horse 3: 4-year-old female, T° 18°C, H° 75%,
marked sweating, BT 43.5 °C, kicks to the abdomen continuously while walking, irritability, ataxia and re-
cumbency.
Discussion/Conclusions: Diagnosis was made based on the clinical signs with different levels of severity,
level 3 for the first two cases and level 4 for the last one. Although this disease is described in many coun-
tries, it had not been reported in Argentina.
Environmental conditions, workload, and individual susceptibility may be risk factors for developing EHI. To
ensure the well-being of racehorses it is imperative that veterinarians working at racetracks can recognize
early clinical signs, understand the mechanism of action and the rationale for practical treatment options.
References
1. Brownlow, M. A., Dart, A. J., & Jeffcott, L. B. Exertional heat illness: a review of the syndrome affec-
ting racing Thoroughbreds in hot and humid climates. Australian Veterinary Journal (2016) 94(7),
240-247. https://doi.org/10.1111/avj.12454
2. Brownlow, M., & Mizzi, J. X. An overview of exertional heat illness in thoroughbred racehor-
ses: Pathophysiology, diagnosis, and treatment rationale. Animals (2023) 13(4), 610. https://doi.
org/10.3390/ani13040610
3. Kang, H., Zsoldos R., SoleGuitart A., Narayan E., CawdellSmith A., & Gaughan J. Heat stress in
horses: a literature review. International Journal of Biometeorology (2023) 67:957–973. https://doi.
org/10.1007/s00484-023-02467-7
4. Trigg, L.E., Lyons, S. & Mullan, S. Risk factors for, and prediction of, exertional heat illness in Thorou-
ghbred racehorses at British racecourses. Sci Rep 13, 3063 (2023). https://doi.org/10.1038/s41598-
023-27892-x
305
Proceedings
2023
#84 - Post Breeding Endometrial Inflammatory

Response In Jennies
Authors
Chapero, Luisina1 ; Rossetto, Liliana2 ; Bilbao, María Guillermina1 ; Losinno, Luis3
Affiliation
1
CONICET - Universidad Nacional de La Pampa, Facultad de Ciencias Veterinarias, General Pico, Argentina
; 2Universidad Nacional de La Pampa, Facultad de Ciencias Veterinarias, General Pico, Argentina ; 3Univer-
sidad Nacional de Río Cuarto, Laboratorio de Producción Equina, Río Cuarto, Argentina.
Introduction
Studies conducted on mares shows that post-mating endometrial inflammation resolves 48 hours after
covering or artificial insemination (AI), but in jennies (Equus africanus asinus) few data are published. This
study aims to evaluate the uterine inflammatory response in jennies following natural mating.

This study was performed from March - April 2023 in Argentina. Five healthy jennies were subjected to nat-
ural mating when signs of estrus, endometrial edema, and a pre-ovulatory follicle of 35 mm were detected.
A jack of proven fertility was used for mating. Uterine cytology samples were obtained using guarded swabs
at 0, 6, 24, and 48 hours post-mating. Cytology smears were stained with a panoptic staining (Biopur SRL);
200 cells were counted under optical microscope (Nikon Eclipse™ NI-U) and the percentage of polymor-
phonuclear neutrophils (% PMN) was calculated. A marginal mix model with a continuous autoregressive
covariance matrix of order 1 was used to study repeated measures, with time and 0 h (baseline value) as
fixed effects, and individual as a random effect, according to AIC criterion. Values are expressed as mean ±
SEM. Differences were considered if P < 0.05.
Results
The % PMN at 0, 6, 24, and 48 hours post-mating was: 0, 68.7 ± 6.16, 41 ± 9.14, and 13.1 ± 6.16 respectively.
We observed a marked time effect (P < 0.0001).
+These findings are consistent with previous studies on post-AI endometritis using frozen donkey se-
men, indicating comparable PMN percentages at 6, 24, and 48 hours. In mares, inflammation was fully
resolved within 48 hours, whereas in jennies, complete resolution was not observed. This study shows that
post-breeding physiological endometritis pattern in jennies is similar with natural mating and AI with frozen
semen.
References
1. Chapero L., Rossetto L., Sánchez J., Bilbao M. G., Losinno L. (2023). Dexamethasone’s effect on en-
dometrial inflammatory response in jennies after artificial insemination with frozen donkey semen.
Journal of Equine Veterinary Science, 125, 104701. https://doi.org/10.1016/j.jevs.2023.104701
2. Costa L. M. L., Sancler-Silva Y. F. R., Albino M. V., Fontes C. S., Teixeira C. S., Freitas M. S., Kladt L.
V., Schultz E. B. (2023). Does the uterine inflammatory response differ between mares and donkey
jennies inseminated with frozen donkey semen? Journal of Equine Veterinary Science, 125, 104703.
https://doi.org/10.1016/j.jevs.2023.104703
3. Katila T. (2012). Post-mating Inflammatory Responses of the Uterus: Post-Mating Inflammation.
Reproduction in Domestic Animals, 47, 31–41. https://doi.org/10.1111/j.1439-0531.2012.02120.x
4. Rodriguez A., Boeta M., Zarco L. (2023). Endometrial inflammatory response to insemination in jen-
nies. Journal of Equine Veterinary Science, 125, 104740. https://doi.org/10.1016/j.jevs.2023.104740
5. Woodward E. M., & Troedsson M. H. T. (2015). Inflammatory mechanisms of endometritis: Mecha-
nisms of endometritis. Equine Veterinary Journal, 47(4), 384–389. https://doi.org/10.1111/evj.12403
306
Proceedings
2023
#85 - Investigation of Pathogenic Protozoans and Their

Impacts on Mule Health
Authors
Khan Ullah, Raja Zabeeh1 ; Abdelfattah Mahmoud, Essam2 ; Smith, Woutrina3 ; MCLEAN, AMY4
Affiliation
1
University of California Davis, Animal Biology, Davis, Estados Unidos (EEUU) ; 2University of California Da-
vis, Department of Animal Hygiene and Veterinary Management, Tulare, Estados Unidos (EEUU) ; 3Univer-
sity of California Davis, OneHealth, Davis, Estados Unidos (EEUU) ; 4University Of California Davis, Animal
Science, Davis, Estados Unidos (EEUU)
Introduction
Equine protozoal myeloencephalitis (EPM) is one of the most common neurologic diseases of horses and
can be caused by protozoans such as Sarcocystis neurona, to a lesser extent by Neospora hughesi [1], and
possibly by Toxoplasma gondii [2]. EPM has seldom been reported in mules.

Blood was collected cross-sectionally from the jugular vein of 75 mules, (n= 33 females, 42 males) ranging
from ages 6 to 23 from a farm in Texas, U.S. Clinical signs associated with behavioral, physical and neuro-
logical disorders were recorded. Serum was tested for antibodies specific to S. neurona, N. hughesi and T.
gondii detected by indirect fluorescence antibody test (IFAT). Statistical analysis tested correlation between
clinical signs, seropositivity, sex and age.
Results
Interestingly, 26 (34.7%) mules were seropositive for S. neurona, 18 (24%) for N. hughesi, and 30 (40%) for
T. gondii. Further findings show seropositivity and type of clinical signs varied widely. Overall, 51(68%) of
mules were clinically healthy, 9 (12%) had neurologic deficits, 4 (5.33%) had behavioral anomalies, and 11
(14.67%) showed physical signs of disease including weight loss, lethargy, and dull coat. Significant differ-
ences were only observed for mule age (p = 0.02), for S. neurona.
Discussion
This warrants future serologic testing of seropositive healthy mules to assess their most recent health sta-
tus, changes in titers, and seasonal influences on serological values. This will provide vital information on
how the pathogenicity of these parasites varies and progresses in the mules and whether seasonal chang-
es have an effect on health status and serological titers. These are important missing links to explore the
true impact of EPM on mules, and to consider mule medicine, welfare, and husbandry care in a time when
mules are becoming increasingly popular in recreational, performance, and working equid industries.
References
1. Borges AMCM, Yeargan MR, Silva LG, Taques ÍIGG, Howe D, Aguiar DM. Antibodies Against Sar-
cocystis neurona, Neospora spp., and Toxoplasma gondii in Horses and Mules From the Northern
Pantanal Wetland of Brazil. J Equine Vet Sci 2017;56:19–25. https://doi.org/10.1016/j.jevs.2017.04.007.
2. James KE, Smith WA, Packham AE, Conrad PA, Pusterla N. Toxoplasma gondii seroprevalence and
association with equine protozoal myeloencephalitis: A case–control study of Californian horses.
Veterinary Journal 2017;224:38–43. https://doi.org/10.1016/j.tvjl.2017.05.008.
307
Proceedings
2023
#87 - Comparison of Energy Expenditure of Horses

Used in Show Jumping and Bullfighting Simulation
Tests
Authors
Simões Coelho, Clarisse ; Cavaca, Patricia ; Oliveira, Manuel ; Farinelli de Siqueira, Renata ; Prazeres,
1 1 1 2
José1 ; Souza, Vinícius1 ; Cordeiro Manso Filho, Helio3 ; Simões, Joana1
Affiliation
1
Lusofona University, Faculty of Veterinary Medicine, Lisboa, Portugal ; 2Universidade federal de santa ma-
ria, Large Animals Clinic, Santa Maria, Brasil ; 3Universidade Federal Rural de Pernambuco, Departamento
de Zootecnia, Recife, Brasil
Introduction: Heart rates (HR) have been used to quantify the cost of transport (COT), and metabolic power
(Pmet), defining energy expenditure (EE) in horses used in different equestrian sports. Differences between
equine athletes must be well documented to properly manage training and nutritional programs. The aim
of this study was to quantify and compare energy expenditure (EE), cost of transport (COT) and metabolic
power (Pmet) of jumping horses and bullfighting horses in simulation tests.
Material and Methods: Five 9.8-year-old Lusitano horses, executed a bullfighting simulation exercise
(BST), and other thirteen 11.5-year- old horses, performed a jumping simulation test (JST), both for ~5
minutes. During the exercise all animals used an integrated heart rate and GPS monitoring system (Polar
M430/H10) and from these data, EE , COT and Pmet were calculated using matematical formulas. A de-
scriptive data analysis was done for the comparison between equestrian disciplines.
Results: For BST it was recorded 127.9 bpm for HR, 128.24 J/min for EE, 114.06 bpm/kg/m.103 for COT and
4,958.66 bpm/kg for Pmet. Bullfighting horses reached Vmed of 3.8 m/s, HRmed of 99.0±29.2 bpm and
HRpeak of 150.6±45.6 bpm. These results were higher than those observed during the JST. In this last one,
it was recorded 90.3 bpm for HR, 67.15 J/min for EE, 88.79 bpm/kg/m.103 for COT and 719.00 bpm/kg for
Pmet. Jumping horses reached Vmed of 11.6 m/s, HRmed of 85.6±20.9 bpm and HRpeak of 109.5±34.4 bpm.
Discussion/Conclusion: Comparison between show jumping exercise and bullfighting showed that the
last one is a more intense exercise, although it is performed with a lower speed. Further, effort was more
intense due to the relentless search for the bull, with constant and sudden changes in direction.
References
1. Coelho CS, Sodre TDRP, Sousa LN, Siqueira RF, Manso Filho, HC, Aragona F, Fazio F. How much
energy vaquejada horses spend in a field simulation test? Animals 2021;11:3421.
2. Piccione G, Messina V, Bazzano M, Giannetto C, Fazio F. Heart rate, net cost of transport, and
metabolic power in horse subjected to different physical exercises. J Eq Vet Sci 2013;33: 586–589.
308
Proceedings
2023
#89 - Acute Responses of Iron Indices in Young

Lusitano Horses During a Dressage Simulation Test
Authors
Simões Coelho, Clarisse1 ; Martins, João1 ; Farinelli de Siqueira, Renata2 ; Prazeres, José1 ; Souza, Vinícius1 ;
Simões, Joana1
Affiliation
1
Lusofona University, Faculty of Veterinary Medicine, Lisboa, Portugal ; 2Universidade Federal De Santa
Maria, Large Animal Clinic, Santa Maria, Brasil
Introduction: Dressage is an Olympic equestrian discipline that requires special characteristics such as
a precise interaction between the rider and the horse. Studies evaluating the iron profile are necessary to
elucidate this trace mineral requirements and its role in exercises such as dressage. The aim of this study
was to evaluate the influence of a dressage simulation test on serum iron profile of young Lusitano horses.
Material and Methods: Eight 4-year-old Lusitano horses, 474.8±46.9 kg, executed a dressage simulation
exercise (DST) for ~5 minutes, after a warming period of 35 minutes. The DST was performed in a 30x15m
indoor riding arena demarcated by letters in accordance with FEI regulations. During the exercise all ani-
mals used a Polar M430/H10 heart monitor. Horses were examined before (T0) and after (T1) DST, and at
240 min (T2) during the recovery period. Blood samples were taken to determine hemoglobin concentration
(Hb), serum iron (SI), total iron-binding capacity (TIBC) and transferrin saturation (TSAT). All variables were
analyzed by ANOVA and Tukey test with P<0.05 to denote significancy.
Results: The exercise led to significant decrease only for SI (166.0 mg/dL in T0 to 153.3 mg/dL in T2,
P=0.0380). For all other biomarkers, no changes were observed due DST (P>0.05). During DST, animals
reached Vmed of 2.31±0.70 m/s and HRmed of 108.6±24.5 beats/min in a 220 m distance.
Discussion/Conclusion: Significant changes occurred in the circulating serum iron concentration in

young Lusitano Horses during the dressage simulation exercise. The reduction in SI concentration after
DST can be attributed to an exercise-induced inflammatory response, urinary excretion and/or relative
slowness of absorption from gastrointestinal tract.. Such changes must be well understood for an optimum
level of iron availability in the athletic performance of such animals.
References
1. Abramovitc G, Parra AC, Fernandes WR. Variações de níveis séricos de ferro, da capacidade total
de ligação do ferro e da saturação de transferrina em equinos de corrida, antes e após exercício
físico. Rev Bras Med Vet 2014;36: 289-293.
2. Coelho CS, Cappi Neto M, Binda MB, Teixeira FA, Carvalho RS, Macedo LP, Manso Filho, HC. Acu-
te responses of iron indices in Quarter Horses during a 3-barrel racing exercise. Acta Vet BRNO
2018; 87:109–114.
3. Kristensen L, Buhl R, Nostell K, Bak L, Petersen E, Lindholm M, Jacobsen S. Acute exercise doe
not induce an acute phase response (APR) in Standardbred trotters. Can J Vet Res 2014;78: 97-102.
309
Proceedings
2023
#90 - Thyroid Hormones Response to Dressage

Simulation Test In Young Lusitano Horses
Authors
Simões Coelho, Clarisse1 ; Farinelli de Siqueira, Renata2 ; Nabais, Maria1 ; Prazeres, José1 ; Souza, Vinícius1 ;
Cordeiro Manso Filho, Helio3 ; Simões, Joana1.
Affiliation
1
Lusofona University, Faculty of Veterinary Medicine, Lisboa, Portugal ; 2Universidade Federal De Santa
Maria, Large Animal Clinic, , Brasil ; 3Universidade Federal Rural de Pernambuco, Departamento de Zoo-
tecnia, Recife, Brasil.
Introduction: Dressage is an Olympic equestrian discipline that requires special characteristics such as a
precise interaction between the rider and the horse. The comprehension of such a level of effort is import-
ant and tracking the exercise-related responses of the horses represents a way to monitor performance and
the wellbeing of such athletic animals. The aim of this study was to evaluate thyroid hormones response to a
dressage simulation test by measuring serum concentration of total (TT4) and free thyroxine (FT4) and total
(TT3) and free triiodothyronine (FT3) in young Lusitano horses.
Material and Methods: Eight 4-year-old Lusitano horses, 474.8±46.9 kg, executed a dressage simulation
exercise (DST) for ~5 minutes, after a warming period. The DST was performed in a 30x15m indoor arena
demarcated by letters in accordance with FEI regulations.
During the exercise all animals used a Polar M430/H10 heart monitor. Horses were examined before (T0)
and after (T1) DST, and at 240 min (T2) during the recovery period. Blood samples were taken to determine
TT3, FT3, TT4 and FT4. All variables were analyzed by ANOVA and Tukey test with P<0.05 to denote sig-
nificancy.
Results: The exercise led to significant increases for TT3 (38.7 to 61.6 ng/dL, P=0.0243), that remained
high (59.1 ng/dL) even after 4 hours of recovery. Further, both TT4 and FT4 significantly increased during
the recovery period (TT4- 31.2 to 34.2 nmol/L, P=0.0019: FT4- 15.1 to 20.6 pmol/L, P=0.0022). During DST,
animals reached Vmed of 2.31±0.70 m/s and HRmed of 108.6±24.5 beats/min in a 220 m distance.
Discussion/Conclusion: Results demonstrated that circulating concentration of TT3, TT4 and FT4 in
horses increased in response to dressage exercise. Exercise-induced changes have already been described
previously, however results are inconsistent. These data are important to consider when evaluating young
Lusitano horses used for dressage.
References
1. Coelho CS, Folador JC, Drumond B, Souza VRC. Thyroid hormone response to marcha gait in
Mangalarga Marchador horses. Rev Bras Ci Vet 2015; 22(1):19–22.
2. Graves EA, Schott HC, Marteniuk JV, Refsal KR, Nachreiner RF. Thyroid hormone responses to
endurance exercise. Eq Vet J 2010; 36(Suppl.):32–36.
310
Proceedings
2023
#91 - Effects of a 7-Week Training Protocol Using a

Water Treadmill on Biomarkers of Jumping Horses
Authors
Nascimento, Carolina1 ; Afonso, Vera1 ; Silvestre, Filipa1 ; Farinelli de Siqueira, Renata2 ; Prazeres, José1 ; Borg-
es, João1 ; Simões, Joana1 ; Simões Coelho, Clarisse1
Affiliation
1
Lusofona University, Faculty of Veterinary Medicine, Lisbon, Portugal ; 2Universidade Federal De Santa
Maria, Large Animal Clinic, Santa Maria, Brasil.
Introduction: Water treadmill (WT) represents a good form of physical conditioning for equestrian sports
such as jumping, since it generates greater impulsion, improves straightness and longer strides. However,
there is no consensus regarding its use in training protocols, with discrepancies related to water height,
speed, time and frequency of use. Thus, the objectives were to study the effects of a training program using
WT on biomarkers that indicate performance and well-being.
Material and Methods: Four horses, ~17.3 years-old, ~614 kg, were evaluated before (M1) and seven weeks
after (M2) the new training routine that included the WT (20min, twice/week, water height at the carpus).
On both occasions animals were examined through a jumping simulation test (JST) and blood samples
were collected before (T0), after (T1) exercise and at 30 min (T2) and 240 min (T3) of recovery. Animals
used a Polar M430/H10 heart monitor. Heart rate (HR), respiratory rate (RR), body temperature (BT), eryth-
rogram, lactate and glucose, serum proteins, albumin, AST and CK values were recorded, and data was
analyzed using ANOVA and Tukey tests (P<0.05).
Results: Although JST in M1 and M2 produced significant changes (P<0.05) in HR, RR, lactate and eryth-
rogram, with higher values in T1, training didn’t modify these biomarkers. Further, glucose (P<0.0001) and
BT (P=0.0450) were higher in M2. No changes were observed for speed of work during the JST; however,
there was a significant increase (P<0.05) in HRpeak (114.5 to 161.0 beat/min) and HRmean (96.0 to 128.5
beat/min) Biomarkers returned to basal levels 30 minutes post DST on both M1 and M2.
Discussion/Conclusion: An initial evaluation of results suggests that the training regimen didn’t improve
the athletic conditioning of the jumping horses; however, further research is necessary to identify useful
markers for that can be adequately used in the assessment of exercise in water.
References
1. Muñoz A, Becero M, Saitua A, Arguelles D, Medina AS, Castejón-Riber C. Exercise in the wa-
ter: should we incorporate it into training and rehabilitation programs for the sport horse? APMB
2019;107(2):SD3(1-11).
2. Vincze A, Szabo C, Szabo V, Veres S, Uto D, Hevesi A. The Effect of Deep Water Aqua Treadmill
Training on the Plasma Biochemical Parameters of Show Jumpers. Agr Consp Scie 2013;78(3):289-
293.
311
Proceedings
2023
#93 - Equine Cheek Tooth Extracorporeal

Apicoectomy, Retrograde Endodontic Treatment
and Replantation: Case Report
Authors
Matheus Martinez, Murillo1 ; Bittar José, Maurício1 ; Moore Nicholas, Nicholas2 ; Corrêa Romero, Rodrigo3
Affiliation
1
Clínica Bittarvet De Odontologia Equina, Surgery, Rio Claro, Brasil ; 2Moore Equine Dentistry, Surgery, ,
Estados Unidos (EEUU) ; 3Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo,
Pirassununga, Surgery, Pirassununga, Brasil.
Introduction: The practice of endodontics therapy is concerned primarily with the removal of necrotic
dental pulp and damaged dentine and their replacement with filling material. The endodontic techniques
currently available are the orthograde technique, paraendodontic surgery and extracorporeal apicoectomy/
replantation.
Clinical History: A 4-year-old showjumping horse gelding was referred with left mandibular ramus swell-
ing and dysmastication. Relevant Clinical Findings: Intraoral examination revealed a periodontal fistula in
buccal side of tooth 307. Clinical crown was intact and there were no signs of pulp exposure.
Evidence-Based Diagnosis: Radiographs showed mesial periodontal space enlargement, radiolucent

halo in mesial root of 307 and thickening of mandibular cortex.
Treatment And Management: The tooth was extracted by intraoral technique using only thin interdental
spreaders and forceps. The roots were cut out using an irrigated diamond disc, necrotic pulp material was
removed with endodontic files and pulp cavity was filled with calcium hydroxide based resinous cement
and the tooth was replanted. After reimplantation the occlusal equilibration was performed to avoid prema-
ture occlusal contact on tooth 207 during early postoperative period.
Evolution: The horse was reevaluated within 15, 45, 90, 180 and 360 days and presented neither clinical
or radiographic signs of periodontal disease or bone infection. The dysmastication was completely solved
and the horse improved body condition score. Radiographs showed complete bone filling in the removed
apical region.
Discussion: During endodontic treatment, once necrotic pulp is removed, the tooth or part of it is consid-
ered dead or inert, although the periodontium is generally still vital and functioning. The main reason that
leads to this technique’s choice were secondary occlusal dentine integrity and signs of mandibular cortex
enlargement. This approach is indicated only for teeth with long reserve crown and healthy adjacent teeth.
References
1. Simhofer H, Camil S, Karl Z. A long-term study of apicoectomy and endodontic treatment of apica-
lly infected cheek teeth in 12 horses. The Veterinary Journal. 2008; 178(3): 411-418.
2. Stoll, M. Replantation of extracorporal treated cheek teeth in the horse. In: Proceedings of the Ve-
terinary Dental Forum. 2014 Nov 13- 16; Atlanta, United States.
3. Pierce CJ, Lundstrom T. Endodontic treatment of equine cheek teeth. In: Easley J, Dixon P, Toit N.
Equine dentistry and maxillofacial surgery. Newcastle: Cambrige Schoolars Publishing; 2022. p.
730-52.
312
Proceedings
2023
#94 - Clinical, Radiographic, Tomographic,

Macroscopic and Histological Characterization Of
Concrescence In Equine Cheek Tooth
Authors
Martinez Matheus, Murillo1 ; Bittar José, Maurício1 ; Staszyk, Carsten2 ; Corrêa Romero, Rodrigo3
Affiliation
1
Clínica Odontológica Bittarvet, Surgery, Rio Claro, Brasil ; 2Faculty of Veterinary Medicine Justus-Lieb-
ig-University Giessen, Anatomy, Histology and Embriology, Giessen, Alemania ; 3Faculdade de Medicina
Veterinária e Zootecnia da Univesidade de São Paulo, Surgery, Pirasununga, Brasil
Introduction: Concrescence is a developmental anomaly showing union of adjacent teeth by cementum.

The concrescence leads to a loss of gingival architecture leading to the development of funnels, which may
cause plaque accumulation thus, resulting in periodontal tissue destruction.
Clinical History: A 8-years-old Mangalarga Paulista mare was referred with complaint of bit behavioral
signs during riding.
Relevant Clinical Findings: Presence of supernumerary tooth (S1) distal to 211. The tooth 211 was rotated
and there was palatal gingival retraction and valve diastema between 210 and 211.
Evidence-Based Diagnosis: Radiography showed the presence of a supernumerary tooth distal to 211,
increased periodontal space in distal side of 210 and mesial side of 211, osteolysis of alveolar crestal bone
from the reserve crown to the root and specific signs of apical infection of 211. The dorsoventral offset pro-
jection showed absence of alveolar crest between 211 and S1, due to dental fusion.
Treatment and Management: The fused tooth (211 and S1) was extracted using the standard intraoral
technique associated with the use of a set of supporters for elevators and spreaders.
Evolution: After extraction, alveolar dressings were applied every 07 days. After 10 days the mare was rid-
den and did not present any behavioral signs related to the bit.
Post Extraction Findings: After extraction, macroscopic, histological and tomographic evaluations were
performed, which confirmed the clinical suspicion.
Discussion: A “true fusion” of teeth is a developmental abnormality in which two adjacent tooth germs
merge. Another type of dental fusion is the concrescence. This condition is characterized by teeth featuring
separated formations of dentine and enamel but showing a complete or partial connection by a mass of
cementum. In the present case, the largest areas were connected by dental cementum and only a small part
was connected by fused dentine and enamel.
References
1. Venugopal S, Smitha BV, Saurabh SP. Paramolar concrescence and periodontitis. Journal of Indian
Society of Periodontology. 2013 May;17(3):383.
2. Mohan B. Hypercementosis and concrescence of maxillary second molar with third molar: a case
report and review of literature. Oral Health and Dental Management. 2014 Jun 1;13(2):558-61.
3. Henry TJ, Young AC. Diagnostic Imaging in Veterinary Dental Practice. Journal of the American
Veterinary Medical Association. 2014 Sep 1;245(5):493-6.
313
Proceedings
2023
#95 - Chondroitin Sulfate Urinary Excretion

Following Chondroitin Sulfate and Glucosamine
Oral Supplementation in Horses With Induced
Osteoarthritis
Authors
Pereira Rodrigues, Nubia Nayara1 ; Miluzzi Yamada, Ana Lúcia2 ; Arantes Baccarin, Raquel Yvonne1 ; Keiko
Anadao Tokawa, Paula1
Affiliation
1university Of Sao Paulo, Vcm, São Paulo, Brasil ; 2university Of Sao Paulo, Vci, São Paulo, Brasil.
Introduction: Progression of osteoarthritis can be assessed through monitoring changes in urinary chon-
droitin sulfate (CS) levels. The increase in excretion may be related to a higher turnover rate of the extra-
cellular matrix, due to increased chondral metabolic activity.This study investigated urinary CS excretion in
horses supplemented with CS and glucosamine (GlcN).
Materials And Methods: Metacarpophalangeal osteoarthritis was surgically induced in sixteen Warm-
bloods. The horses were divided into a control group (CG) and treated group (TG). The TG received a 10g
oral supplement (1,9g CS; 4g GlcN) twice daily, starting from the day of the OA induction, and continued
for more than 120 days. Urine samples were collected by spontaneous urination at 9 predetermined time
points. CS concentration was identified by 0.5% agarose gel electrophoresis in 1,3-diaminopropane acetate
buffer followed by densitometry. Creatinine (Crea) concentration was used as a correction factor for CS
excretion.
Results: Despite addition of exogenous CS, decreases in the rate of urinary excretion of CS was observed
at some times in TG (P=0.03), which did not occur in the CG. However, when the rate is corrected for uri-
nary creatinine (g), the TG animals presented no differences in CS/Crea ratio between time points. Animals
treated with oral CS and glucosamine had urinary CS/Crea excretion similar to the control group (P=0.08).
Discussion/Conclusions: Exogenous CS supplementation didn’t significantly change the urinary CS/

Crea excretion rate between groups. Although orally administered CS and GlcN are absorbed, the bioavail-
ability may be variable and consequently influence the excretion rate. The increase in CS excretion may
be related to a higher turnover rate of the extracellular matrix in horses, due to a high metabolic chondral
activity. Based on the doses used in this study after 120 days with CS and GlcN did not significantly affect
CS excretion in horse urine.
References
1. Baccarin RYA, Machado TSL, Lopes-Moraes AP, Vieira FAC, Michelacci YM. Urinary glycosami-
noglycans in horse osteoarthritis. Effects of chondroitin sulfate and glucosamine. Res Vet Sci. 2012
Aug;93(1):88–96.
2. Contino EK. Management and Rehabilitation of Joint Disease in Sport Horses. Vol. 34, Veterinary
Clinics of North America - Equine Practice. W.B. Saunders; 2018. p. 345–58.
3. Fiorin V, Rodrigues NNP, Cota LO, Seidel SRT, Barbosa P, Tokawa PKA, et al. Clinical study of chon-
droitin sulfate urinary excretion following intramuscular application of the chondroitin sulfate and
glucosamine association in horses. Arq Bras Med Vet Zootec. 2023;75(2):355–9.
4. Michelacci YM, Glashan RQ, Schor N. Urinary excretion of glycosaminoglycans in normal and sto-
ne forming subjects. Vol. 36, Kidney International. 1989.
5. ira FAC, Baccarin RYA, Aguiar JAK, Michelacci YM. Urinary Excretion of Glycosaminoglycans in
Horses: Changes With Age, Training, and Osteoarthritis. J Equine Vet Sci. 2005;25(9):384–6.
314
Proceedings
2023
#99 - Non-Theratoid Medulloepithelioma In Mare

Authors
Espinoza Freitas, MARCIO1 ; Silva Rodrigues, Ketherson1 ; Mogno Jesus, Julia2 ; Queiroz Junqueira, Daniela1
Affiliation
1Centro Universitário Barão De Mauá, Hospital Veterinário Barão de Mauá, Ribeirão Preto/SP, Brasil ; 2Cen-
tro Universitário Barão de Mauá, Hospital Veterinário Barão de Mauá, Ribeirão Preto, Brasil
Introduction: Non-teradoid medulloepithelioma is an intraocular neoplasm, originating from the embry-

onic neural tissue. With relatively slow growing, it can be congenital or acquired, developing from non-pig-
mented ciliary cells. Distant metastases are not common, but it is aggressive in the origin site.
Clinical history: A 15-year-old Mangalarga Marchador mare, presented a spot in her left eye about a
month ago. Treatment with ointments and eye drops were performed, however the mass grew to cover
about 50% of the eyeball.
Relevant Clinical Findings: The animal´s left eye showed a reddish, granulomatous, rapidly growing mass
that compromised the animal´s vision. The left ocular mucosa was hypercolored, with engorged blood
vessels.
Treatment And Management: Due to the size and neoplastic characteristics, transpalpebral enucleation
was performed, under general inhalation anesthesia with isoflurane. The removed material was sent for
histopathology examination.
Evolution: After surgery, the animal was medicated with flunixin meglumine (1.1mg/Kg) for 3 days, benza-
thine penicillin (20,000ui/Kg) for 5 days and local dressing with aqueous chlorhexidine. On the 10th day the
stitches were removed and the animal was discharged.
Histopatological: Microscopic finding consisted of round neoplastic cells, well differentiated and hyper-
chromatic, forming solid areas organized like rosettes with central cavity showing little figures of mitosis
and apoptosis.
Discussion/ Conclusion: Medulloepitheliomas are reported more frenquently in humans, and with a few
reports in other animal species. In horses, the highest occurrence is in adults, and enucleation is the most
accepted corrective option. Although rare, it should be a differential diagnosis in cases of primary ocular
neoplasms.
References
1. BROUGHTON, W. L.; ZIMMERMAN, L. E. A clinicopathologic study of 56 cases of intraocular me-

dulloepitheliomas. American J. Ophthalmology, v. 85, p. 407-418, 1978.
2. DINELI BRAS, I.; GEMENSKY-METZLER, A. J.; KUSEWITT, D. F.; COLITZ, C. M. H.; WILKIE, D. A.
Immunohistochemical
3. characterization of a malignant intraocular teratoid medulloepithelioma in a cockatiel. Veterinary
Ophthalmology, v. 8, p. 59-65, 2005.
4. KIVELA, T.; TARKKANEN, A. Recurrent medulloepithelioma of the ciliary body. Ophthalmology, v.
95, p. 1565-1575, 1988.
5. KNOTTENBELT, D. C. et al. Primary intraocular primitive neuroectodermal tumor (retinoblastoma)
causing unilateral blindness in a gelding. Veterinary Ophthalmology, v.10, n.6, p.348-356, 2007.
315
Proceedings
2023
#104 - Adipogenesis In Equine Synovial Membrane-

Derived Mesenchymal Stem Cells Submitted To
Culture With Platelet Lysate And Serum
Authors
Kneipp, Maria Luiza1 ; Rosa, Gustavo2 ; Alves, Ana Liz2 ; Carvalho, Armando1
Affiliation
1Universidade Federal de Minas Gerais (UFMG), Equinova Research Group, Belo Horizonte, Brasil ; 2Uni-
versidade Estadual Paulista (UNESP), Cirurgia Veterinária e Reprodução Animal, Botucatu, Brasil
Introduction: Stem cell therapy for tissue regeneration has gained prominence as the preferred treat-
ment for equine orthopedic injuries. Fetal bovine serum (FBS) serves as a commonly used supplement for
mesenchymal stem cell (MSC) culture but has raised ethical, scientific, and safety concerns. To address
potential shortcomings of FBS as a nutrient source for the clinical expansion of MSCs, researchers have
shifted their attention towards equine blood products as viable alternatives. This study aims to compare the
effectiveness of FBS with equine platelet lysate (PL) and equine serum (ES) as supplements in the culture
medium for equine synovial membrane-derived MSCs (SMMSCs).
Materials And Methods: Equine SMMSCs used were from an animal biobank and evaluated in culture
(FBS medium, equine PL medium and ES medium) for cell morphology; adherence to plastic; ability to
tri-lineage differentiation (adipogenic, osteogenic and chondrogenic); immunophenotypic characterization;
expansion capacity by cell proliferation rate and cell population doubling time; and cellular metabolism by
the MTT assay. The protocol was approved by the ethics committee for animal experimentation of the uni-
versity (number: 0049/2021).
Results: All groups presented, among the evaluated parameters, the expected characteristics of SMMSCs,
with some differences in rates among the groups of supplements used. Tri-lineage differentiation was pos-
itive in all groups, with emphasis on spontaneous adipogenesis by the PL and ES groups.
Discussion/Conclusions: The results of the study allowed us to affirm that the SMMSCs cultivated with
PL and ES were able to maintain the essential characteristics to be identified as MSC. However, the spon-
taneous adipogenesis by the cells of the groups with equine blood components stands out, which justifies
in-depth studies so that the clinical application of MSCs therapy is not impaired by the early and unexpect-
ed behavior of the cells.
316
Proceedings
2023
#105 - Relationship 0f Morpho-Echogenicity 0f the

Corpus Luteum With Uterine Characteristics and
Progesterone Levels on D5 Post- Ovulation in Mares
Authors
Mocha, Adriana1 ; Rojas, Paola1 ; Serrano-Recalde, Elena Carolina1
Affiliation
1Universidad Nacional de Loja, College of Veterinary Medicine, Loja, Ecuador
Introduction: The corpus luteum (CL) with different morphology or anechoic cavities may affect progester-
one (P4) blood levels. Therefore, the aim of this study was to relate CL morpho-echogenicity with P4 blood
levels and uterine characteristics on D5 post- ovulation. Materials and Methods: The study was carried out
in Loja, Ecuador, with 10 cyclic mares. Ovulation was monitored until 12 cavitary and 12 non-cavitary CL
were obtained. On day 5 after ovulation, ultrasonographic images (Mindray DP–50 Vet®) from four sec-
tions, left and right, of the base and tip of uterine horns were taken. Videos of the CL were performed, and
three images of the larger diameter were selected to be analyzed by histogram on the ImageJ program to
measure echogenicity by gray pixel scale. Statistical analysis was performed by a Mixed model (SAS, 2023).
Results: Cavitary CL had larger (p0.05) total area, cavitary area and perimeter (7.29cm2; 2.37cm2; 10.35cm)
than non-cavitary CL (5.70cm2; 0cm2; 9.25cm). Furthermore, non-cavitary CL showed higher (p=0.02)
mode of pixels (65.75±8.01) than cavitary CL (38.32±7.54), even though, no differences were observed in
the mean, minimum and máximun values of pixels. An effect of side was observed, left CL presented larger
(p0.05) perimeter (10.40cm) and diameter (3.31cm) than right CL (9.20cm; 2.95cm). An interaction of mor-
phology and side (p0.05) showed that left non-cavitary CLs had larger compact area (6.77cm2) and right
non-cavitary CLs had smaller perimeter (8.04cm) and diameter (2.60cm). However, no differences were
observed on P4 blood levels. Mares with non-cavitary CL had higher (p<0.001) uterine tone (2.58±0.11) than
mares with cavitary CL (2.00±0.11), still, no differences on uterine pixels, cervix tone or edema were found.
Conclusion: On D5 post-ovulation, morpho- echogenicity of the CL in mares does not interfere on P4 blood
levels, nevertheless, affects uterine tone.
References
1. Rosa, L. C., Dias, E. C. S., Melo, R. S., Pereira, F. L. C., Chung, L. B. P., Junior, F. D. J. M., & de Macêdo
Chaves, R. (2021). Características de morfoecogenicidade uterina e de corpo lúteo e suas relações
com os níveis de plasmáticos de progesterona em éguas “baixadeiro”. Veterinária e Zootecnia, 28,
1-12.
2. Sales FABM, Azevedo MV, Souza NM, Ferreira-Silva JC, Chaves MS, Junior VR, Rocha JM, dos San-
tos Filho JP, Freitas VJF, Oliveira MAL. 2021. Correlations of corpus luteum blood flow with fertility
and progesterone in embryo recipient mares. Tropical Animal Health and Production 53(280): 1-7.
317
Proceedings
2023
#106 - Effect Of Weaning On Distal Radius Physeal

Closure, Serum Cortisol and Growth Rate in
Thoroughbred Foals
Authors
Mondino ., Mariela Ayalen1 ; Bilbao, María Guillermina2 ; Rossetto, Liliana1 ; Giliberti, Sergio Nicolás3 ; Uberti,
Benjamin4
Affiliation
1Universidad Nacional De La Pampa, Facultad de ciencias veterinaria, General Pico, Argentina ; 2Universi-
dad Nacional De La Pampa-Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facul-
tad de ciencias veterinaria, General Pico, Argentina ; 3private, activity, Buenos Aires, Argentina ; 4Universi-
dad Austral de Chile, Instituto de Ciencias Clínicas Veterinarias, Facultad de Ciencias Veterina, Doha, Qatar
Introduction
Radiological evaluation of growth epiphyseal growth cartilages is important before starting training in
young horses. It is an indicator of bone maturity and supports ridden exercise while avoiding often irrevers-
ible lesions. The objective of this study is to determine variation of growth markers and stress indicators
generated by weaning between males and females. We hypothesized that stress induced by weaning im-
pacts on long bone growth cartilage closure differently between genders.
This observational study was carried out on thirty Thoroughbred male and female foals raised in north-
western La Pampa province, Argentina. Individual weights were recorded monthly from birth to weaning (at
6-8 months of age), and height at the withers was recorded at birth and weaning. Two blood samples were
obtained from each subject, 7 days before and 2 days after weaning, to determine serum cortisol. Distal
radius dorsocaudal radiographs were obtained from each subject at 18 months of age to determine growth
plate closure.
results
Weight gain increased proportionally to time, as expected. There was no difference between genders from
birth to weaning, neither in weight gain (P=0.405) nor in height (P=0.369). Serum cortisol values were
higher in females than in males at both sampling times (P=0.004). Within each gender, there was no differ-
ence in serum cortisol between sampling times (P=0.778). There was no gender-time interaction (P=0.962).
There was no relationship between growth plate closure and age (P=0.134). Growth plate closure tended
to be more frequent in females than in males at the time of sampling (P=0.067).
Thoroughbred female yearlings seem to have earlier distal radius growth plate closure times than males,
according to our observations. This suggests that females have a higher growth rate than males and might
support an earlier start of training providing growth plate closure is monitored.
References
1. Arfuso, F., Assenza, A., Tosto, F., Giannetto, C., Interlandi, C., Piccione, G., & Liotta, L. (2022). Serum
bone metabolism biomarkers in healthy fillies and colts from weaning until one year of age. Re-
search in Veterinary Science, 150, 156–163. https://doi.org/10.1016/j.rvsc.2022.06.018
2. Baxter, G. M. (Ed.). (2020). Adams and Stashak’s lameness in horses. John Wiley & Sons.
3. Bruschetta, G., Fazio, E., Cravana, C., & Ferlazzo, A. M. (2017). Effects of partial versus complete se-
paration after weaning on plasma serotonin, tryptophan and pituitary-adrenal pattern of Anglo-Ara-
bian foals. Livestock Science, 198(May 2016), 157–161. https://doi.org/10.1016/j.livsci.2017.02.025
4. Hoffman, R. M., Kronfeld, D. S., Holland, J. L., & Greiwe-Crandell, K. M. (1995). Preweaning diet and
stall weaning method influences on stress response in foals. Journal of Animal Science, 73(10),
2922–2930. https://doi.org/10.2527/1995.73102922x
5. Malinowski, K., Hallquist, N. A., Helyar, L., Sherman, A. R., & Scanes, C. G. (1990). Effect of diffe-
rent separation protocols between mares and foals on plasma cortisol and cell-mediated immune
response. Journal of Equine Veterinary Science, 10(5), 363–368. https://doi.org/10.1016/S0737-
0806(06)80098-5
318
Proceedings
2023
#107 - Relationship of Morpho-Echogenicity of the

Corpus Luteum With Uterine Characteristics and
P4 Levels in Mares On Day 7 Post- Ovulation
Authors
Rojas, Paola1 ; Mocha-Brito, Adriana1 ; Serrano-Recalde, Elena Carolina1
Affiliation
Introduction: A detailed analysis of echogenicity and morphological features of the corpus luteum (CL) as-
sociated to progesterone (P4) blood levels brings information of its functionality, which is crucial to prevent
embryo losses and optimize reproductive index. Therefore, the aim of this study was to relate luteal mor-
pho-echogenicity with P4 blood levels and uterine characteristics on day 7 post-ovulation. Materials and
Methods: The study was carried out in Loja, Ecuador. Ten cyclic mares were used, follicular development
was monitored until 12 compact (non-cavitary) and 12 cavitary CL were obtained. On day 7 post-ovulation,
three ultrasonographic (Mindray DP–50 Vet®) videos of the CL were performed, from which three images
of the larger diameter were selected. Also, images from four sections, both left and right of the base and tip
of the uterine horns were taken, to be analyzed by histograms on the ImageJ program in order to measure
echogenicity by gray pixel scale. P4 blood levels were measured. Statistical analysis was performed by a
Mixed model (SAS, 2023). Results: Cavitary CL had larger (p=0.01) total area (6,29 cm2) and cavitary area
(1,31 cm2) than non-cavitary CL (4,88 cm2 and 0 cm2) respectively. No significant differences (p<0,05) were
found on area of compact tissue or mean, mode and minimum pixel values of the CL. However, cavitary CL
presented a higher (p=0,018) maximum value of pixels (173,25±8,18) than non-cavitary CL (140,43±8,64).
Mean, minimum, maximum and mode values of pixels of the four regions of the uterus did not differ. More-
over, uterine and cervical tone, absence of edema and P4 blood levels were similar between mares with
cavitary or non-cavitary CL.
Conclusion: On day 7 post-ovulation, different luteal morpho-echogenicity does not interfere on P4 blood
levels or uterine characteristics, which are within the normal parameters of diestrus in mares.
References
1. Plaza, J. P., Arraztoa, C. C., Gambini, A., Gambarotta, M., Miragaya, M. H., & Neild, D. M. (2023). Ul-
trasonographic and Doppler characteristics of corpus luteum luteogenesis in Remonta Argentino
jennies. Journal of Equine Veterinary Science, 125, 104738.
319
Proceedings
2023
#109 - Effect of Antioxidant Application on Oxidative

Stress During Short-Term Intense Exercise
Authors
Castillo-Ramón, Bryan Alexander1 ; Valdivieso, Jéssica1 ; Serrano-Recalde, Elena Carolina1
Affiliation
Introduction: High intensity physical activity causes an increase in cellular metabolism which produces
reactive oxygen species (ROS) and generates oxidative stress in a deficit of antioxidants. The aim of this
study was to analyze the effect of antioxidant solution in polo horses before, during and after short-term in-
tense exercise assessing physiological constants, hematological values, lactate dehydrogenase (LDH) and
glucose levels. Materials and Methods: Healthy horses (n=8), aged between 9 to 14 years, were assigned
in a crossover design to receive either 100mL of ringer’s lactate or antioxidant based on Se, Mg, Ca and
K (TopRace, Richmod®, Argentina) before exercise. Physical exercise was performed in a distance of 6.75
km for 1 hour at 12 km/h and altitude between 2100 to 2279 masl. All animals underwent both treatments.
Heart and respiratory rate were measured by stethoscope, temperature by thermometer, blood pressure
by sphygmomanometer and capillary refill time was observed. Blood biometry, erythrocytes, hemoglobin
and haematocrit were determined by hematology analyser (RT-7600, RAYTO®, China), LDH and glucose
by spectrophotometry (cobas c311, Roche®, Japan). Statistical analysis was performed using a mixed model
(SAS, 2023). Results: There was no treatment effect (P> 0.05), however there was a time effect (P < 0.05)
with an increase of heart and respiratory rate, LDH and a decrease in glucose levels during and post-exer-
cise. In addition, there was an increase in temperature, red blood cells and hemoglobin post-exercise.
Conclusion: The use of antioxidants is recommended to improve physical condition and decrease oxida-
tion in the muscle prior to high intensity exercise, however in the present study it is concluded that there
was no effect of the treatment, with the doses used in equines performing this type of activity.
References
1. Sánchez-Valle, V., & Méndez-Sánchez, N. (2013). Estrés oxidativo, antioxidantes y enfermedad. Rev
Invest Med Sur Mex, Julio- Septiembre, 20(3), 161–168.
2. Izurieta Barzola, J. L., Luna Narváez, D. F., Cedeño Prócel, Y. M., & Chacha Vega, S. R. (2017). De-
terminación de los valores de referencia en el hemograma de caballos nacidos o criados a más
de 3000 msnm en la sierra centro norte ecuatoriana. LA GRANJA. Revista de Ciencias de la Vida,
25(1), 62-70.
320
Proceedings
2023
#110 - Elimination of Patogenic Microoganisms in

Equine Bedding Through a Composting System
Authors
Teixeira NETO, Antonio Raphael1 ; Carvalho Rodrigues Nascimento, Ana Gabriela2 ; Monteiro de Paula,
Alessandra3 ; Perecmanis, Simone1
Affiliation
1
UNIVERSITY OF BRASILIA, FAV/VTH, Brasília, Brasil ; 2University of Brasilia, FAV/VTH, Brasilia, Brasil ;
3
University of Brasilia, FAV, Brasília, Brasil
On equine industry, there are multiple problems related to waste management. Constant and direct con-
tact can lead to human and animal health problems.and contribute to unhealthy conditions on facilities.
Composting is a sustainable solution that is becoming very useful on biomass treatment. The aim of the
present research was to check if higher temperature achieved in a composting system using saturated
equine bedding, was sufficient for pathogenic microrganisms elimination. A composting system with 6 piles
(1,80x1,90x2,10m) was done. Throughout the hole process (90 days) the temperature was daily monitored.
For pathogenic bacteria analysis, total coliforms, termotolerants coliforms was determined by more prob-
able number (NMP.g-1) (Kornacki & Johnson, 2001), and Salmonella sp detected by Andrews & Hammack
(2007), method. Peak temperature (56,3oC) was reached in all piles at day 4, and remained elevated until
day 18. At the beginning, termotolerants and total coliforms quantification was higher than 1,6 x103 NMP.g-1.
At the end of composting process total coliforms results was lower than 0.53x103 NMP.g-1 and fecal coli-
forms lower than 1x103 NMP.g-1. These results are in accordance with Brazilian environmental normative
instructions. Samonella sp isolates were not found in this experiment. In conclusion, equine bedding com-
posting revealed to be a reasonable way of microbiologic control on farms.
References
1. Kornacki, J.L., Johnson, J. L.Enterobacteriaceae, coliforms and Escherichia coli quality and safety
indicators. In:Vanderzant, C., Splittstoesser, D.F. Compendium of methods for microbiological exa-
mination of foods. 4 ed. Washington: American Public Health Association, 2001, cap 8, p.62-82.
2. Andrews, H., Hammack, T.S. Bacteriological analytical manual. 8 ed. New Hampshire: FDA, 2007.
Available from: https://www.fda.gov/food/laboratory-methods-food/bam-chapter-1-food-sam-
plingpreparation-sample-homogenate. Accessed on: August 1, 2023.
3. Souza, H. D., Oliveira, E. L., Faccioli-Martins, P. Y., Santiago, L., Primo, A. A., Melo, M. D., & Pereira,
G. A. C. Características físicas e microbiológicas de compostagem de resíduos animais. Arquivo
Brasileiro de Medicina Veterinária e Zootecnia, 2019,71, 291-302.
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#112 - A Blinded Randomized Trial Of The Efficacy Of

The Combined
Chondroitin Sulphate and Glucosamine as a Treatment for Experimentally In-
duced Osteoarthritis in Horses
Authors
Valero Fiorin, Eliti ; Miluzzi Yamada, Ana Lucia ; Arantes Baccarin, Raquel Yvonne ; Lopes Correia Silva,
1 1 1
Luis Claudio 2
Affiliation
1
University of São Paulo, Department of Surgery, São Paulo, Brasil ; 2University of São Paulo, Department
of São Paulo, São Paulo, Brasil
Introduction
Chondroitin sulphate (CS) and glucosamine (GlcN) demonstrated to be beneficial for osteoarthritis (OA)
treatment, decreasing inflammation and cartilage degradation. This study aims to evaluate the efficacy of
the intra-muscular (IM) injection of the combined CS/GlcN as treatment for experimentally induced OA in
horses.

Fetlock joints of 16 horses were subjected to linear chondral lesions through arthroscopy and these were
assigned to treated (TG) or control groups (CG). Eight horses of TG were treated with a total of seven IM
injections of CS/GlcN at a 2mL/100kg dose, 5-days intervals. Clinical, laboratorial, and diagnostic imaging
examinations were performed before OA-induction, and each 5 days at D6, D11, D16, D21, D26, D31 e D36.
Lameness was evaluated subjectively (AAEP scale) and objectively (Lameness Locator®). Joint perimetry,
flexion angle, radiographic and ultrasonographic examination were also performed besides measurements
of synovial biomarkers CTX- II and PGE2.
Results
At D11 (p=0,033) and D21 (p=0,055) there was a significant decrease of lameness grades in TG, as well as
reduction of joint circumference at D21 (p=0,009) and D36 (p=0,015). The blinded ultrasonographic evalua-
tion yielded lower scores for the TG at D26 (p=0,038) and concentrations of CTX-II were significantly lower
at D31 (p=0,05) when compared to CG.
Conclusion
In such context, the treatment was able to modulate the inflammatory response in TG, providing symptoms
reduction and benefits to joint metabolism in triggering surgically induced OA. The association of CS/GlcN,
when administered intramuscularly, has the potential to attenuate the signs of experimental OA in horses.
References
1. Baccarin RY, Machado TS, Lopes-Moraes AP, Vieira FA, Michelacci YM. Urinary glycosamino-
glycans in horse osteoarthritis. Effects of chondroitin sulfate and glucosamine. Res Vet Sci [In-
ternet]. 2012 Aug [cited 2023 Aug 5]; 93 (1): 88-96. Available from: https://pubmed.ncbi.nlm.nih.
gov/21925689 doi: 10.1016/j.rvsc.2011.08.009
2. Maninchedda U, Lepage OM, Gangl M, Hilairet S, Remandet B, Meot F, Penarier G, Segard E,
Cortez P, Jorgensen C, Steinberg R. Development of an equine groove model to induce metacar-
pophalangeal osteoarthritis: a pilot study on 6 horses. PLoS One [Internet]. 2015 Feb [cited 2023
Aug 8]; 13;10 (2): e0115089. Available from: https://pubmed.ncbi.nlm.nih.gov/25680102 doi: 10.1371/
journal.pone.0115089
3. Silva MM, Hagen SCF, Vendruscolo CP, Baccarin RYA, Spagnolo JD, Yamada ALM, Stievani FC,
Correia da Silva, LCL. The correlation between score-based protocol for equine joint assessment
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2023
and subsequent arthroscopic intervention outcomes. Braz J Vet Res Anim Sci [Internet]. 2020 Jan
[cited 2023 Aug 8]; 56 (4): e158072. Available from: https://www.revistas.usp.br/bjvras/article/
view/158072 doi: 10.11606/issn.1678-4456.bjvras.2019.158072
4. Yamada ALM, do Prado Vendruscolo C, Marsiglia MF, Sotelo EDP, Agreste FR, Seidel SRT, Fülber
J, Baccarin RYA, da Silva LCLC. Effects of oral treatment with chondroitin sulfate and glucosa-
mine in an experimental model of metacarpophalangeal osteoarthritis in horses. BMC Vet Res
[Internet]. 2022 Jun [cited 2023 Sept 13]; 9;18 (1): 215. Available from: https://pubmed.ncbi.nlm.nih.
gov/35681208 doi: 10.1186/s12917-022-03323-3
323
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2023
#113 - Enviromental Parasites Control Through

Composting System Of Equine Bedding
Authors
Teixeira NETO, Antonio Raphael ; Jaramillo Gracia, Laura ; Carvalho Nascimento, Ana Gabriela ; Chaves
1 2 2
Rocha, Gino 2
Affiliation
1
UNIVERSITY OF BRASILIA, FAV/VTH, Brasília, Brasil ; 2University of Brasilia, FAV/VTH, Brasilia, Brasil
The amount of waste produced by horse establishments and lack of space for its disposal are serious prob-
lems faced by everyone who deal with horses. Another problem is related to the enviroment, specially soil
and underwater contamination, flies multiplication and pasture reinfection.
The aim of this work was to verify composting efficacy on equine gastrointestinal parasites elimination.
Six horses were kept in individual stables with wood straw bedding, during 15 days. The saturated bed with
feces and urine was collected daily and after this period six piles (1,80x0,90x2,10mts) was built. An aerobic
fermentation system, in a slow decomposition process was held during 90 days. Humidity was maintained
between 40 to 60% and temperature was monitored daily. 30 grams of compost were collected on day 1,
day 5 (begining of the termophilic phase, with higher temperatures), day 30 (mesophilic phase) and day 90
(end of composting process). All sample were transported to Parasitology Lab for analysis.
Mean temperature of piles reached 55oC on day 7. On day 30, mean temperature of 40oC was a charac-
teristic of mesophilic phase. After that, temperature remained stable (30 to 35oC), until day 90. More than
50 eggs per gram was found at the beginng of the process (days 1 to 3), and after that, no egg was found.
Strongylus spp larvae revealed a peak count on the fifth day (1 larva/gram) showing significant reduction
until the end of process.
Helmints eggs disapeared in the first few days due to eclosion, with ideal conditions, for larvae develop-
ment. Larvae were detected in the begining of composting process and were also eliminated.
Composting of equine bedding revealed to be an easy and efficient method to eliminate eggs and larvae
of equine gastrointestinal worms. It is very important for horse welfare and also important for enviromental
protection and equine industry sustainability.
References
1. Fujii Keila Youko, Dittrich João Ricardo, de Castro Edilene Alcântara, da Silveira Emanuel Orestes.
Treatment procedures for stable waste and reduction or elimination of infective eggs and larvae
of the genus Strongylus spp. Arquivos do Instituto Biológico [Internet]. 2014 DOI 10.1590/1808-
1657000482012. Available from: https://www.scielo.br/j/aib/a/5BqZWd5PkzTvxrJb4jYnrdb/?lan-
g=pt
2. Hutchinson G.W, ABBA S.A, Mfitilodze M.W. Seasonal Translation of Equine Strongyle Infective Lar-
vae to Herbage in Tropical Australia. Veterinary Parasitology [Internet]. 1989 [cited 2023 Aug 10];:251-
263. Available from: https://www.sciencedirect.com/science/article/pii/0304401789901350
3. Quinelato Simone, Couto Melissa C.M, Ribeiro Bruno C., Santos Cláudia N., de Souza Luciene S.,
dos Anjos Débora H.S, Sampaio Ivan B.M, Rodrigues Lurdes M.A. The ecology of horse cyathosto-
min infective larvae (Nematoda-Cyathostominae) in tropical southeast Brazil. Veterinary Parasito-
logy [Internet]. 2008 [cited 2023 Aug 10];:100-107. Available from: https://www.sciencedirect.com/
science/article/pii/S0304401708000435
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#114 - Correlation Between Lameness and Properties

Of Synovial
Fluid In Horses With Intra-Articular Fragmentation
Authors
Oliveira Cota, Leticia ; Fulber, Joice ; Valero Fiorin, Eliti ; Lopes Correia Silva, Luis Claudio
1 1 1 1
Affiliation
1University of São Paulo, Department of Surgery, São Paulo, Brasil
Introduction
Presence of osteochondral fragments usually change viscolubrication of synovial fluid (SF) and can trigger
osteoarthritis. The objective of this study was to analyze the correlation between lameness due to osteo-
chondral fragmentation and properties of the SF in horses.

Data from the physical examination and SF collected before arthroscopy of 27 horses, referred for removal
of an intra-articular (IA) osteochondral fragment, were used. Lameness was graded 0-5 (AAEP). Hyaluronic
acid (HA) was identified by agarose gel electrophoresis and quantified by densitometry. The viscosity of
the SF was determined by the length of the thread formed, in centimeters. Data were analyzed using the
Spearman correlation test (Jamovi 2.3).
RESULTS
The minimum-maximum score of lameness, concentration and molecular weight of HA and viscosity of SF
were 0-4; 126.16-660.44 g/mL; 4340-7613 kDA and 7-29 cm, respectively. Correlations of HA concentration
were observed with the lameness score (r=0.420, p=0.029), with the molecular weight of HA (r=-0.472,
p=0.013) and with the viscosity of the SF (r=-0.503, p=0.008). Positive correlation was found between HA
molecular weight and SF viscosity (r=0.576, p=0.002).
The higher the lameness score, the higher the concentration of HA in the SF of horses with IA osteochon-
dral fragment; however, the lower the weight of this molecule and the lower the viscosity of the SF. The find-
ings demonstrate that horses with IA fragmentation have lower SF quality and that basic parameters, such
as lameness score and SF viscosity, can help in understanding the joint disease and establishing therapy to
recover the HA quality into the joint.
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Proceedings
2023
#117 - Cryosurgery, Homeopathy and Ozone Therapy in

The Treatment of Squamous Cell Carcinoma in a Horse
Authors
FREITAS ESPINOZA, MARCIO1 ; Nunes Rodrigues, Bianca2 ; Rubanya Anjos, Gabrielle1 ; Junqueira Que-
iroz, Daniela1
Affiliation
1
Centro Universitário Barão de Mauá, Hospital Veterinário Barão de Mauá, Ribeirão Preto/SP, Brasil ; 2Cen-
tro Universitário Barão de Mauá, Hospital Veterinário Barão de Mauá, Ribeirão Preto, Brasil
Introduction: Squamous cell carcinoma is a malignant and invasive skin tumor, with a predisposition to
appear in areas with little hair cover and less pigmentation of the skin.
Clinical History: A 12-year-old Paint Horse mare was referred with a wound in the right nasolabial region,
with clinical evolution of approximately six months, with worsening in the last 20 days.
Relevant Clinical Findings: A fragment of the wound was collected and sent for histopathological exam-
ination. The results of the examination indicated that it was squamous cell carcinoma.
Treatment And Management: Cryosurgery was performed with liquid nitrogen followed by homeopathic
treatment with Sulfur 30ch + Cina 30ch (1 ml per day for 60 days) and Viscum album D3 (from Monday to
Friday in the first month and on alternate days for the following 3 months). Minor autohemotherapy was also
performed with 50 mg of ozone in 10 ml of blood, once a week, for four weeks.
Evolution: The wound regressed considerably after the second week of treatment, and at the time this
report was written it was completely closed.
Discussion/ Conclusion: The gold standard treatment would be surgical excision, however, due to the
location of the lesion, it would not be possible to remove it with a safety margin. The treatment of choice,
despite being little used, brought very satisfactory results.
References
1. Rabbers AS, Rabelo RE, Vulcani VAS, Sant’ana FJF, Lima CRO, Silva LAF. Diagnóstico clínico, labo-
ratorial e tratamento cirúrgico do carcinoma de células escamosas no genital de equinos machos:
relatos de dois casos. Revista Brasileira de Ciência Veterinária [Internet]. 2014 Fev 28 [cited 2023
Set 13];21(1):12-18. Available from: http://dx.doi.org/10.4322/rbcv.2014.020
2. Valle ACV. Viscum album in Veterinary Medicine. International Journal of Science and Research.
2021; 10(8):1-8.
326
Proceedings
2023
#118 - Equine Multinodular Pulmonary Fibrosis (Empf)

Associated With Equine Herpesvirus-5 (Ehv-5): First
Report In Chile
Authors
Bustos Mansilla, Carla ; Monje, Josue ; Durán, María Carolina
1 1 1
Affiliation
1
Universidad Austral de Chile, Equine Hospital, Inst. of Clinical Sciences, Faculty of Veterinary Sciences,
Valdivia, Chile.
Introduction
EHV-5 is considered ubiquitous in horses and is commonly associated with fatal EMPF.
Clinical History
A 5-year-old QH gelding was referred to the Equine Hospital for treatment of sarcoids on his neck and face.
Treatment consisted in surgical resection and electrochemotherapy, repeated every 3-4 weeks.On month 3
of hospitalization, the patient started with weight loss, lethargy and respiratory distress.

Weight loss, hyperthermia, weakness, anorexia, dyspnea, distended nostrils.
Complete respiratory exam was performed.Thoracic radiographs revealed a diffuse nodular pulmonary pat-
tern, neutrophilia and hyperfibrinogenemia at blood work, increased tracheal mucus with high cellularity
and intracellular bacteria.Differential diagnosis included bacterial pneumonia, exacerbated chronic asthma,
pulmonary fibrosis or neoplasia.Pulmonary fibrosis was considered the working diagnosis.
TREATMENT AND MANAGEMENT

Anti-inflammatory drugs (corticosteroids, NSAIDs), bronchodilators, systemic antibiotics and supportive
care.
Evolution
The horse failed to respond to treatment and died 5 days after initiating therapy.
Post-Mortem Findings
Post-mortem examination confirmed the diagnosis of EMPF, showing diffuse loss of functional pulmo-
nary parenchyma due to extensive nodular interstitial fibrosis with reactive and enlarged pulmonary lymph
nodes.Tissue samples were PCR positive to EHV-5.
Discussion
This is the first case of EMPF associated with EHV-5 reported in Chile, detected by PCR in lung tissue sam-
ples.EMPF and EHV-5 infection has been reported in North America and Europe.
The pathogenesis remains unclear, but gammaherpesviruses, have been implicated as co-factors for ini-
tiating, promoting or exacerbating pulmonary fibrosis[1-3]. EHV-5 has been detected in nasal secretions
and peripheral blood mononuclear cells of asymptomatic horses, but all horses with EMPF are positive to
EHV-5[2].
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2023
In Chile the prevalence of EHV-5 infection in horses is unknown but needs to be studied.In conclusion,
EHV-5 infection and EMPF should be considered as differential diagnosis in patients with fever, weight loss
and respiratory problems.
References
1. Davis, E. Disorders of the Respiratory System. En S. M. Reed, W. M. Bayly, & D. C. Sellon, Equine
Internal Medicine. St Louis, Missouri: Elsevier; 2018. p. 339-343.
2. Easton-Jones, CA, Cissell, DD, Mohr, FC., Chigerwe, M. and Pusterla, N. Prognostic indicators and
long-term survival in 14 horses with equine multinodular pulmonary fibrosis. Equine Vet Educ 2020;
32: 41-46.
3. Wilkins, PA. Equine multinodular pulmonary fibrosis: Diagnosis and treatment. AAEP College of
Veterinary Medicine.
328
Proceedings
2023
#123 - Morphological Parameters in High Performance

Raza Chilena
BREED HORSES
Authors
Carmona, Germán1 ; Bustamante, Hedie2 ; Werner Becker, Marianne1
Affiliation
1Universidad Austral de Chile, Instituto de Ciencia Animal, Valdivia, Chile ; 2Universidad Austral de Chile,
Instituto de Ciencias Clínicas Veterinarias, Valdivia, Chile
Introduction
Morphometry is important for breed standards, estimate liveweight, evaluate physical conditions, and pos-
sible relationships to metabolic disorders. In Raza Chilena, height (H), girth (G) and metacarpal perimeter
(MP) are morphologic measurements considered. For better characterization of the breed and genetic
improvement strategies, more parameters should be obtained. Aim was to determine some morphologic
parameters in Raza Chilena horses.
Materials/Methods
Measurements from 28 mares, 35 stallions, and 58 geldings participants of 73° Rodeo Chileno Champion
(2022) were obtained: H, G, MP, length (L), and neck circumference (NC25%, NC50%, NC75%). Compari-
son between categories was performed using one-way ANOVA and Tukey post hoc test (normally distrib-
uted variables) and Kruskal Wallis and Dunn’s post hoc (non-normal variables).
Results
Table 1. Mean and standard deviation of measurements (centimeters).
Mares Stallions Geldings
Height 139,8 (2,36) 143,0 (2,64) 140,7 (3,34)
Length 153,6 (5,09) 151,9 (4,68) 152,0 (4,09)
Girth 167,2 (4,47)ab 165,4 (4,05)a 167,7 (4,34)b
MP 17,7 (0,60)a 18,3 (0,56)b 18,1 (0,57)b
NC25% 68,0 (4,11)a 73,3 (3,97)b 69,5 (3,37)a
NC50% 89,0 (4,73)a 98,1 (3,63)b 91,9 (5,63)c
NC75% 110,8 (5,27)a 117,3 (4,56)b 112,4 (4,81)a
*Different letters show statistically significant differences between groups (p<0,05).
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2023
Height, G and MP were within breed standards, but not ideal for H and MP (Porte 1993). Length should
not exceed more than 10 cm H, because longer animals have less dorsolumbar resistance (Pinochet 1980),
observed only in stallions. Neck measurements were higher in stallions, especially compared to mares.
NC50% has been shown to be a possible good indicator of risk for metabolic conditions, therefore it should
be considered. Results contribute with more data for better characterization of Raza Chilena horses and
add information that can be used for studying risk factors associated to some disorders.
References
1. Federación Criadores de Caballos Raza Chilena. XXXX. Anexo 1. Del Prototipo del Caballo de Raza
Chilena. Reglamento del registro genealógico del Caballo de Raza Chilena.
2. Mohr J. 2016. La Morfología Explicada. Guía de la conformación del Caballo Chileno y su relación
con el desempeño funcional. 1a ed. Mages ediciones, Osorno, Chile.
3. Muñoz L, Briones M, Saavedra MJ. 2021. Relationship between the body condition index and the
modified Henneke body condition score in Chilean horses. Chilean J Agric Anim Sci 37, 74–80.
4. Pinochet JL. 1980. Estudio hipométrico y morfológico del caballo Raza Criolla Chilena y su posi-
ble cambio tipológico. Memoria de Título, Facultad de Ciencias Veterinaria, Universidad de Chile,
Santiago, Chile.
5. Porte E. 1993. Evaluación técnica del caballo criollo chileno. 1a ed. Facultad de Ciencias Agrarias y
Forestales, Universidad de Chile.
330
Proceedings
2023
#124 - Influence of Surgical Procedure on Resting

Patterns In Horses
Authors
Oliveira, Tiago Marcelo1 ; Tartarini, Leticia Victoria2 ; Chiacchio Fernandes, Guilherme De La Penha2 ; Ar-
antes Baccarin, Raquel Yvonne1
Affiliation
1University Of São Paulo, Departament of Internal Medicine, São Paulo, Brasil ; 2Cruzeiro do Sul University,
Veterinary Medicine, São Paulo, Brasil
Introduction: Surgery and the post-surgery period may change the behavioral parameters in horses. The
aim of this research was to quantify this influence on the resting time of horses that were submitted to ar-
throscopy procedures.
Materials and Methods: Eight horses were recorded in their stalls in three different moments: Four pe-
riods of 24 hours in the stalls before the first arthroscopy procedure (control), four periods of 24 hours
immediately after the first arthroscopy procedure (experimental arthroscopy to induce Osteoarthritis in the
fetlock) and four periods of 24 hours immediately after the second arthroscopy procedure (experimental
arthroscopy to inspect the same fetlock).
Results: The average resting pattern in the control moment was 249 min (Sternal recumbency) and 25 min
(lateral recumbency). On the first day after the first surgery, the horses adopted the sternal recumbency for
62 min and the lateral recumbency for 13 min. On the first day after the second surgery, the horses adopt-
ed sternal recumbency for 73 min and lateral recumbency for 14 min. In both post- surgical moments, the
horses returned to the basal resting times on the third day in the sternal recumbency and on the second
day in the lateral recumbency.
Discussion/Conclusion: The resting pattern of horses is affected by the surgical procedure. However, the
return of the horses to their stalls may contribute to them achieving the normal resting pattern as soon as
possible. It was shown that environmental changes could have a greater influence on the resting pattern
than the performance of a surgical procedure. It’s an attention point to monitor the resting time of horses
in the post-surgery period because this decline in the lying down time could induce impairments in the
horse’s recovery. More studies are necessary to show the relationship between the lack of resting time and
post-surgery complications.
References
1. ALEMAN, M.; COLETTE WILLIAMS, D.; HOLLIDAY , T. Sleep and Sleep Disorders in Horses. In:
AAEP Proceedings, Anais..., 2008.
2. GREENING, L.; MCBRIDE, S. A Review of Equine Sleep: Implications for Equine Welfare. Frontiers
in Veterinary Science, Frontiers Media S.A.,17 ago. 2022.
3. KELEMEN, Z. et al. Recumbency as an equine welfare indicator in geriatric horses and horses with
chronic orthopaedic disease. Animals, v. 11, n. 11, 1 nov. 2021.
4. OLIVEIRA, T. et al. Hospitalisation and Disease Severity Alter the Resting Pattern of Horses. Journal
of Equine Veterinary Science, v. 110, 1 mar. 2022.
5. VAN LOON, J. P. A. M. et al. Intra-articular opioid analgesia is effective in reducing pain and inflam-
mation in an equine LPS induced synovitis model. Equine Veterinary Journal, v. 42, n. 5, p. 412–419,
jul. 2010.
331
Proceedings
2023
#125 - Clinical Findings and Risk Factors of Periodontal

Disease in Chilean Horses
Authors
PELLERANO FRANCIA, JOAQUIN1 ; Guerra Diaz, Sebastian2
Affiliation
1
UNAB, HCV Equinos, viña del mar, Chile ; 2UNAB, HCV Equinos, Santiago, Chile
Backgorund: Periodontal disease (PD) is a prevalent issue in equine dentistry, significantly impacting horse
health and performance. However, limited reports exist on its prevalence and correlated risk factors, par-
ticularly in Chilean pure breed horses. Objectives: This study aims to characterize and classify PD lesions
in horses of different breeds in Chile, estimate risk factors (diet, breed, age), and the correlated presence of
dental malocclusions. Methods: A total of 89 horses of four different breeds were subjected to dental exam-
inations (Chilean pure breed: 36; Arabians: 7; Jumpers: 39; and Thoroughbreds: 7). They were divided into
two groups based on PD presence (46 Healthy; 43 PD group). Variables registered in the PD group included
periodontal pocket depth and width, diastema location, peripheral cementum appearance, gingival clinical
aspect, periodontal disease grades, and other dental issues. Data analysis involved central tendency statis-
tics and logistic regression (OR). Results: A significant correlation of 78% was found between the presence
of diastema and PD. The distribution of diastema location and associated PD was observed in mandibular
arcade triadan 310/309. The most prevalent classification was PD Grade 1 (56%), with periodontal pockets
ranging from 5 to 9 mm. Gingival inflammation (gingivitis) and peripheral cementum staining were signif-
icant clinical findings, observed in 80% and 78% of cases, respectively. Furthermore, 84% of horses with
PD had type 1 dental malocclusions. Regarding the risk factors, diet did not exhibit a statistically significant
relationship with periodontal disease (p=0.23). Age showed statistical significance (OR=1.47; p=0.00010),
as did the horse’s breed, suggesting a potentially higher risk for Chilean purebred horses compared to other
breeds. Conclusions: Chilean pure breed horses demonstrate similar clinical PD findings to other latitudes.
Identified risk factors include age and breed, with probably higher risk of Chilean pure breed horse than
other breed studied.
References
1. Guerra S, Pineda M, De Negri L, et al. Frequency of dental disorders in Chilean Rodeo Horses be-
tween 2010 and 2013, Sustainability, Agri, Food and Environmental Research (SAFER) 2016; 4(3),
37-43 ISSN: 0719-3726
2. Lee L, Reardon R, Dixon P. A post-mortem study on the prevalence of peripheral dental caries in
Scottish horses. Equine Vet. Educ. 2019; 31, 96–101
3. Nuttall H, Ravenhill P. Prevalence and analysis of equine periodontal disease, diastemata, and peri-
pheral caries in a first-opinion horse population in the UK. The Veterinary Journal 2019; 246, 98–102
4. Kennedy R, Dixon P. The aetiopathogenesis of equine periodontal disease – a fresh perspective.
Equine vet. Educ. 2018; 30 (3) 161- 168
5. Kennedy R, Lappin D, Dixon P et al. The microbiome associated with equine periodontitis and oral
health. Vet Res 2016; 47:49
6. Chinkangsadarn T, GJ Wilson, RM Greer et al. An abattoir survey of equine dental abnormalities in
Queensland, Australia. Australian Veterinary Journal 2015; 93; 189;194
7. Pearce C. ‘What’s new in treatment for diastema in cheek teeth’. Paper presented at: Toothfest
2015, Coffs Harbour, NSW, Australia, March 2-6, 2015
8. Jackson K, Weber L, Tennant M. A Retrospective Study of the Effectiveness of Four Different Treat-
ments of Periodontal Disease in Equine Cheek Teeth. Journal of Veterinary Dentistry 2016;33(2),
83-89
9. Leite CT, Duarte CA, Mozzaquatro FD, Mistieri ML, Machado IR, Porciuncula ML, Leon IS, Dowich
G, Goss GC, Santini AP, Pereira EP. Survey of dental diseases in crioulo breed horses reared in an
extensive farming system. Arq. Bras. Med. Vet. Zootec. v.71, n.1, p.21-27, 2019.
10. Jackson K, Kelty E, Stazsyk C, Tennant M., 2019. Peripheral caries and diseases of the periodontium
in Western Australian horses: An epidemiological, anatomical and histopathological assesment.
Equine Vet Journal. 51, 617-624
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2023
#129 - Behavioral Response to a Controlled Simulated

Competitive
Enviroment
Authors
Urbaneja, Ana Paula1 ; Bogossian, Paulo2
Affiliation
1
University Of Anhanguera, Veterinary Medicine, Sao Bernardo Do Campo, Brasil ; 2Municipal University Of
Sao Caetano Do Sul, Veterinary Medicine, Sao Caetano Do Sul, Brasil
INTRODUCTION
There is limited information on how horses perceive working and competitive environments and whether
these perceptions may drive horses’ physiology and behavior. We hypothesized that horses are capable to
increase power output and attention behavior in the presence of another horse exercising ahead. The aim
of this is study was to compare physiological, biochemical, functional, and behavioral responses of horses
exercising freely with and without sensory stimuli to compete.

Seven healthy mixed-breed horses were recruited to a crossover trial, following a brief familiarization. They
were asked to exercise freely in a rectangular sand track (38x22m) either with (test) and without (control)
a ridden horse trotting ahead (“guide horse”). The protocol comprised 90 seconds of free exercise without
stops longer than 5 seconds. The horses were left free to either stop briefly, increase the speed, or overtake
the guide, which in turn started the test on trot and adjusted the speed to keep ahead of the experimental
element. Biochemical (plasma lactate and glucose levels), behavioral (ethogram) and functional variables
(time to cover initial 58 and 116 meters), as well as heart rate were evaluated during the tests.
Results
There was a significant association between the behavior of “snorting” and the experimental condition (P =
0.004), whereby when exercising behind the guide, horses were less likely to present snorts (14.25%) than
when exercising alone (100.00%). No significant difference was observed between experimental conditions
for the biochemical and functional variables.
The presence of a guide horse triggered behavioral but not biochemical and functional responses. Despite
the absence of rider, saddle and bit, horses showed more constraint behavior when a controlled competi-
tive environment was simulated. This finding may support the development of riding techniques aiming to
improve attention and concentration without artificial constraints.
References
1. Stomp M, Leroux M, Cellier M, Henry S, Lemasson A, Hausberger M. An unexpected acoustic in-
dicator of positive emotions in horses. PLoS One. 2018;13(7):e0197898.
2. Stomp M, Masson A, Henry S, Hausberger M, Lesimple C. Could snorts inform us on how horses
perceive riding? Behav Processes. 2020;172:104041.
3. Munsters CC, van Iwaarden A, van Weeren R, Sloet van Oldruitenborgh-Oosterbaan MM. Exercise
testing in Warmblood sport horses under field conditions. Vet J. 2014;202(1):11-9.
4. Rorvang MV, Nielsen BL, McLean AN. Sensory Abilities of Horses and Their Importance for Equi-
tation Science. Front Vet Sci. 2020;7:633.
5. Stomp M, Leroux M, Cellier M, Henry S, Hausberger M, Lemasson A. Snort acoustic structure co-
des for positive emotions in horses. Naturwissenschaften. 2018;105(9-10):57.
333
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2023
#130 - Mechanical Nociceptive Threshold In The Hooves

Of Healthy
Horses Subjected To Epidural Analgesia With Methadone Alone Or Coadmin-
istered With Dexmedetomidine
Authors
Camila Angela, Marques1 ; Júlia da Penha Piccoli, Rangel1 ; Rafael, Faleiros2 ; Oliveira de Paula Lage, Alvaro3
Affiliation
1
Universidade Vila Velha, Departamento De Medicina Veterinária / Cirurgia De Animais De Grande Porte,
Vila Velha, Brasil ; 2 Universidade Federal De Minas Gerais, Departamento De Medicina Veterinária / Clínica
E Cirurgia Veterinárias, Belo Horizonte, Brasil ; 3universidade Vila Velha, Department Of Veterinary Medi-
cine / Large Animal Surgery, Vila Velga, Brasil
introduction: This study aimed to investigate the effects of coadministering dexmedetomidine and meth-
adone via caudal epidural route on the mechanical nociceptive threshold (MNT) in the distal regions of
thoracic and pelvic limbs in healthy horses and assess their adverse effects.
Materials and methods: A crossover design was used with four Mangalarga Marchador mares, averaging
386 ± 8 kg in weight, 11.2 ± 1.7 years old, and with a body condition score of 7.5 ± 0.5. Group 1 received a 0.1
mg/kg methadone (MET) bolus via caudal epidural, while group 2 received 0.1 mg/kg methadone + 3 g/kg
dexmedetomidine (METDEX). Both treatments were diluted in 0.9% NaCl at 0.018 mL/kg. The MNT was
evaluated using a portable dynamometer in the dorsal laminar region of the hoof (LD), lateral bulb (Blat),
and medial bulb (Bmed) of the thoracic and pelvic limbs. Sedation level was assessed using the numerical
rating scale (NRS), intestinal motility through transabdominal ultrasonography (MI), and vital signs (heart
rate, respiratory rate, rectal temperature). RESULTS: Both treatments significantly increased MNT up to 120
minutes in Bmed, Blat, and LD regions of thoracic and pelvic limbs (p<0.05). However, METDEX treatment
didn’t enhance analgesia, led to hypomotility, and caused sedation.
Discussion/Conclusion: In conclusion, methadone via epidural route provides viable analgesia in distal
thoracic and pelvic limb regions in horses, while adding dexmedetomidine as an adjuvant did not improve
analgesia and resulted in adverse effects.
References
1. Ibrahim, Hussam M. M., et al. “Comparative Effect of Epidural Administration of Xylazine or Dexme-
detomidine on Echocardiographic Dimensions and Cardiac Indices in Clinically Healthy Donkeys
(Equus Asinus).” Journal of Equine Veterinary Science, vol. 85, 1 Feb. 2020, p. 102882, pubmed.ncbi.
nlm.nih.gov/31952632/, https://doi.org/10.1016/j.jevs.2019.102882.
2. Malacarne, Bruno D., et al. “Mechanical Nociceptive Assessment of the Equine Hoof Following
Distal Interphalangeal Joint Intra- Articular Anesthesia.” PeerJ, vol. 8, 2020, p. e9469, pubmed.ncbi.
nlm.nih.gov/32864201/, https://doi.org/10.7717/peerj.9469.
3. Paz, C.F.R., et al. “Mechanical Nociceptive Thresholds of Dorsal Laminae in Horses after Local
Anaesthesia of the Palmar Digital Nerves or Dorsal Branches of the Digital Nerve.” The Veterinary
Journal, vol. 214, Aug. 2016, pp. 102–108, https://doi.org/10.1016/j.tvjl.2016.05.005.
4. Valadares, Rodrigo C., et al. “Neostigmine Combined or Not with Lidocaine for Epidural Anesthesia
in Mares.” Journal of Equine Veterinary Science, vol. 57, 1 Oct. 2017, pp. 18–23, www.sciencedirect.
com/science/article/pii/S0737080617301077, https://doi.org/10.1016/j.jevs.2017.06.001.
5. VanderBroek, A. R., et al. “Assessing Gastrointestinal Motility in Healthy Horses Comparing Aus-
cultation, Ultrasonography and an Acoustic Gastrointestinal Surveillance Biosensor: A Randomi-
sed, Blinded, Controlled Crossover Proof of Principle Study.” Equine Veterinary Journal, vol. 51, no.
2, 6 Aug. 2018, pp. 246–251, https://doi.org/10.1111/evj.12990.
334
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2023
#132 - Anti-Inflammatory Effects of Different

Hemocomponents in an Equine Co-Culture System of
Synovial Cells and Cartilage Explants
Authors
Seidel Torquato, Sarah Raphaela1 ; Fülber, Joice2 ; Agreste, Fernanda Rodrigues1 ; Baccarin Arantes, Raquel
Yvonne1
Affiliation
1FMVZ-USP, Department of Internal Medicine, São Paulo, Brasil ; 2FMVZ-USP, Department of Surgery, SÃO
PAULO, Brasil
Introduction: Hemocomponents, such as Platelet-Rich Plasma (PRP), are widely used among equine vet-
erinarians to treat several musculoskeletal conditions. PRP can also have different presentations, as freeze-
dried PRP (FD-PRP) and Platelet Lysate (PL), allowing larger volume production and storage for further use.
The objective of this study was evaluated the anti-inflammatory response of an in vitro co-culture system
with cartilage explants (CE) and synovial membrane derived cells (SMDC) treated with PRP, FD-PRP and
PL.
Materials and methods: Two healthy donors were used to produce the hemocomponents, at a single mo-
ment, avoiding variations throughout the treatments. Six horses, euthanasied for reasons not related to this
study and with no visual signs of articular disease, were used as articular tissue donors. SMDC were plated
on 8 wells, and each well received 5 CE in an insert. 4 wells were stimulated with LPS (100ng/mL/1h), and
then each well (stimulated and unstimulated) received the following treatments: culture medium (DMEM),
PRP, FD-PRP and PL. The supernatant was collected and replenished with new treatment every 48h, total-
ing 3 times. PGE was quantified in all supernatants through ELISA methodology.
2
Results: All hemocomponents were able to reduce the initial concentrations of PGE2 comparing to DMEM
group, regardless stimulated or not. Considering the stimulated wells, PL presented the major reduction
on PGE2 concentrations, followed by PRP and FD-PRP. On unstimulated wells, the sequence of the major
decreasing was FD-PRP, PL and PRP.
Discussion/Conclusions: A transient inflammation is commonly attributed to the PRP treatment, which

is beneficial in some conditions. In this study, we demonstrated that all hemocomponents were capable of
decrease PGE2 concentrations in all moments evaluated. PL showed a major anti-inflammatory potential
in comparison to PRP, while FD-PRP had the most complex response and need more investigation to elu-
cidate its action mechanism.
References
1. Seidel SRT, Vendruscolo CP, Moreira JJ, Fülber J, Ottaiano TF, Oliva MLV, et al. Does Double Centri-
fugation Lead to Premature Platelet Aggregation and Decreased TGF-1 Concentrations in Equine
Platelet-Rich Plasma? Veterinary Sciences. 2019 Aug 21;6(3):68.
2. Katrin Agnes Muenzebrock, Kersten V, Alblas J, Garcia JP, Creemers LB. The Added Value of the
“Co” in Co-Culture Systems in Research on Osteoarthritis Pathology and Treatment Development.
Frontiers in Bioengineering and Biotechnology. 2022 Mar 3;10.
335
Proceedings
2023
#136 - Electromyographic Patterns of Equine Limb

Muscles During
Walk and Trot on Treadmill
Authors
1
Heck Daiane Oldiges, Daiane Oldiges Heck ; Tomaini Matheus Crawford, Matheus Crawford Tomaini1 ;
Marson Runer Augusto, Runer Augusto Marson2 ; Almeida Fernando Queiroz de, Fernando Queiroz de
Almeida1
Affiliation
1Federal Rural University of Rio de Janeiro, Veterinary Graduate Program, Rio de Janeiro, Brasil ; 2Brazilian
Army, Brazilian Army Research Institute of Physical Fitness, Rio de Janeiro, Brasil
Introduction: Surface electromyography (sEMG) detect muscular electrical activity through surface elec-
trodes, making it possible to characterize muscle activity during locomotion without any damage. The pres-
ent study was carried out to evaluate through sEMG the behavior of four muscles in horses walking and
trotting on a treadmill.
Materials / Methods: Eleven Brazilian Sport horses from the Brazilian Army Riding School were used.
Research was conducted in a laboratory within referred institution. Animals were trained and adapted to
the high-speed treadmill prior experiment. Muscle activity was investigated during walk and trot (1 min walk
1.8m/s, 1 min trot 4.0m/s, 1 min walk 1,8m/s). sEMG signals were recorded (Miotool - Miotec) from Extensor
Carpi Radialis, Flexor Carpi Ulnaris, Tensor Fasciae Latae and Biceps Femoris muscles, bilaterally. Bipolar
Ag/AgCl adesivated electrodes were placed on muscle belly of each muscle. Before placing the electrodes,
trichotomy and cleaning were performed. Twenty seconds of electromyographic signals in each velocity
were used for integral calculation. Statistical analysis was made using a one-way analysis of variance with
Kruskall-Wallis and Mann-Whitney tests.
Results: Horses were fully adapted to treadmill after six training sessions. All selected muscles were acti-
vated during both gaits. Higher activity was detected in trot in comparison to walk except to Tensor Fasciae
Latae, and comparing contralateral muscles, results didn’t show significant differences.
Discussion/Conclusions: The sEMG technology has the potential to open up a wide range of possibil-
ities for veterinarians to evaluate pathological gait through a quantitative analysis. The lack of difference
between contralateral muscles was already expected as all horses healthy without lameness alterations.
This study provides new knowledge of the electromyographic patterns of lower limb muscles during walk
and trot. It can be concluded that all the selected muscles are directly involved in the locomotion of horses
at walk and trot.
336
Proceedings
2023
#137 - MULTIMODAL THERAPY FOR TREATMENT OF

EQUINE CUTANEOUS
PYTHIOSIS
Authors
Dias, Lucas1 ; Cavalcante, Marina1 ; Azevedo, Maria isabel2 ; Carvalho, Armando1
Affiliation
1Universidade Federal de Minas Gerais (UFMG), Equinova Research Group, Belo Horizonte, Brasil ; 2Uni-
versidade Federal de Minas Gerais (UFMG), Department of Preventive Veterinary Medicine, Veterinary
School, Belo Horizonte, Brasil
Introduction: Multimodal therapy (MT) for equine cutaneous pythiosis (ECP) involves using a combination
of different treatment approaches to effectively manage the disease. Since ECP can be challenging to treat,
combining various strategies can increase the chances of successful outcomes. In this report, we highlight
the association of surgical debridement with fluconazole (1) and triamcinolone (2).
Clinical History: 25-years-old Lusitano horse was admitted to the UFMG Veterinary Hospital Brazil, pre-
senting an ulcerated wound on the right hindlimb, with dimensions of 15cm x 20cm and intense pruritus.
The owner reported that the animal lived freely in the pasture and had access to a pond/lake.
Relevant Clnical Findings: The wound showed the presence of necrotic tissue and kunkers. The blood
analysis revealed mild anemia (Hematocrit 29%), reduced hemoglobin count (10.5g/dL), fibrinogen levels of
600mg/dL, leukocytosis (25050cells/µL).
Evidence-Based Diagnosis: ECP was confirmed after in vitro isolation.
Treatment And Management: A MT was performed, involving surgical excision followed by thermal cau-
terization, Fluconazole (initial dose 10 mg/kg after surgery and subsequent doses of 5 mg/kg for 20 days,
PO), Triamcinolone Acetonide (50 mg, IM, three applications with 7-day intervals). The wound was cleaned
daily with 0.9% NaCl solution.
Evoltution: The wound showed good progress in the immediate postoperative period, and the animal did
not exhibit pruritus. At 90 days, complete healing of the wound occurred without recurrence.
Discussion: The successful clinical resolution ECP case highlights the benefits of employing a MT ap-
proach for this condition. Surgical debridement notably facilitated the elimination of the granulomatous
lesion containing the kunkers, while fluconazole contributed to the effective in vivo control of the oomycete,
and triamcinolone played a role in modulating the inflammatory process. Controlled clinical studies need to
be conducted to establish the effectiveness and safety of this therapeutic combination.
References
1. Carvalho AM, Munhoz TCP, Toma HS, Santos JPV, Oliveira LGS, Boabaid FM, Xavier ABS, Kom-
mers GD. The use of fluconazole associated with surgical excision in the treatment of equine cuta-
neous pythiosis. Semina: Ciências Agrárias. 2019;40(6Supl2):3079–3088.
2. Cardona-Álvarez J, Vargas-Vilória M, Patarroyo-Salcedo J. Pythiosis cutánea en equinos tra-

tados con acetonida de triamcinolona. Parte 1. Caracterización clínica. Revista MVZ Córdoba.
2016;21(3):5511-5524.
337
Proceedings
2023
#140 - Familial Men (Multiple Endocrine Neoplasia)

Type 1 With
Pituitary Dysfunction And Primary Hyperparathyroidism In Two Welsh A Pony
Mares
Schwarz, Bianca1 ; Moeller, Svenja2
Affiliation
1Pferdeinternist - Dr. Bianca C. Schwarz, DipECEIM, -, Saarlouis, Alemania ; 2Laboklin Veterinary Labora-
tory, -, Bad Kissingen, Alemania
Introduction: MEN (multiple endocrine neoplasia) has been reported to occur in horses, primarily affecting
older horses, but no familial forms of MEN type 1 – as reported in humans - have been described so far.
Clinical History And Relevant Clinical Findings: Two related Welsh A pony mares aged 25 (mother) and
19 years (daughter) were presented with hypertrichosis, laminitis and an equine metabolic syndrome phe-
notype. Clinicopathological abnormalities included elevated ACTH as well as hypercalcaemia, hypophos-
phatemia, and increased parathyroid hormone (PTH). Other causes of hypercalcaemia, like renal disease,
were ruled out.
Evidence-Based Diagnosis: Both mares were diagnosed with primary hyperparathyroidism (PHPT), pitu-
itary dysfunction (PD), and insulin dysregulation (ID), meeting the diagnostic criteria for familial MEN type
1 (in humans).
Discussion: In humans, MEN type 1 is based on familial and clinical criteria and clinical practice guidelines
help diagnosing MEN. Extrapolating those to equine medicine, familial MEN type 1 can be diagnosed in
these two mares due to the appearance of two MEN type 1-associated tumours (PHPT and PD) and the
development of a minimum of one MEN type 1-associated tumour in a first degree relative. An additional
third, enteropancreatic, neoplasia could neither be proven nor ruled out in these two mares but could be
connected to ID. The presentation of these two mares shows striking similarities to the clinical course of
disease in human MEN type 1, with PHPT usually being diagnosed incidentally by testing. Genetic analysis
of members of this horse family leading to discovery of a genetic mutation, could potentially result in an
earlier diagnosis of the disease. In addition, it would be beneficial to know if horses with elevated ACTH
suffer from PPID or pituitary adenoma as part of MEN, which might not respond to pergolide treatment due
to its different aetiopathogenesis.
References
1. Ellenberger C, et al. Tumours of the endocrine system in the horse – clinical pathology. Pferdehei-
lkunde 2010;26:764-774.
2. Kamilaris CDC, Stratakis CA. Multiple endocrine neoplaise type 1 (MEN1): An update and the signi-
ficance of early genetic and clinical diagnosis. Frontiers in Endocrinology 2019;10:339.
3. Perez-Ecija A, Toribio RE, Mendoza FJ. Endocrine tumours in equids. Equine Vet Edu 2018;30:664-
670.
There is no conflict of interest.
This work follows international guidelines for humane animal treatment and complies with relevant legisla-
tion in Germany and ethical approval according to the WEVA abstract guidelines.
Funding was not received.
338
Proceedings
2023
#143 - Equine Diffuse Eosinophilic And

Lymphoplasmocytic Enteritis: Case Report
Authors
Lima Brasil Dutra, Natália1 ; Acosta Duarte, Claudia1 ; Alberto Machado, Guilherme2
Affiliation
1
Federal University of Pampa, Equine Clinic and Surgery, Uruguaiana, Rio Grande do Sul, Brasil, Brasil ;
2
Guadalupe Veterinary Clinic, Equine Clinic and Surgery, Nova Santa Rita, Rio Grande do Sul, Brasil, Brasil
Introduction
Inflammatory intestinal diseases are conditions that may be related to surgical colics. This work reports a
case of equine eosinophilic and lymphoplasmacytic enteritis.
Clinical History
An 11-year-old Brazilian Equestrian adult animal, a castrated male, was treated, presenting abdominal dis-
comfort with a history of recurrent colic (five episodes of abdominal pain in two years).

The most relevant findings were pain unresponsive to analgesia, hypomotility, reduced defecation and ul-
trasound image compatible with distension and edema of the small intestine.
The presumptive diagnosis was based on the history and macroscopic appearance of the small intestine
(edematous and with purplish patches) during the celiotomy. A intraoperative biopsy of this segment was
performed for definitive diagnosis. Thus, through histopathological examination, eosinophilic and lymphop-
lasmacytic erosive enteritis was evidenced with the presence of edema and lymphangiectasia.

In the post-operative period, the patient presented intestinal stasis and gastric reflux (87 liters in 72 hours).
Ultrasonography was compatible with distended and edematous small intestine, responding well to treat-
ment. The patient was discharged on the 10th postoperative day and returned for emergency care on the
13th day with discomfort and presenting the same ultrasound image described previously. Clinical treat-
ment was performed with dexamethasone and dimethyl sulfoxide. The animal responded favorably. Subse-
quently, a long-term protocol with predinisolone was instituted.
Evolution
Unfortunately, this horse died 43 days later surgery.
Discussion
Inflammatory intestinal diseases can cause chronic abdominal pain and complete obstruction, as observed
in the present report, and can also cause weight loss. The disease can manifest itself diffusely, as in the
present case, or focally, with complementary tests being essential for diagnosis. Treatment will depend on
the manifestation and may include the use of corticosteroids, resection and anastomosis and changes in
management, with a guarded prognosis for chronic cases with diffuse presentation.
References
1. Archer CD. Obstruction of equine small intestine associated with focal idiopathic eosinophilic en-
teritis: An emerging disease? The veterinary jornal, v.171; 2006;504-512 p.
2. Kalck AK; Inflamatory Bowel Disease in Horses. Veterinary Clinic Equine, v.25; 2009; 303-315 p.
3. Southwood L. Digestive system and peritoneal disease. In: SOUTHWOOD, L. L.; WILKINS, A, P.
Equine Emergency and Critical Care Medicine; 2015; 93-95 p.
339
Proceedings
2023
#147 - Digestive Responses in Eventing Horses fed a

Complete Extruded Diet
Authors
Marín Ada Morgana Soares, Marín, Ada Morgana Soares1 ; Silva Vinicius Pimentel, Vinicius Pimentel Silva1;
Almeida Fernando Queiroz de, Fernando Queiroz de Almeida1
Affiliation
1
Federal Rural University of Rio de Janeiro, Animal Science Program, Rio de Janeiro, Brasil
Introduction: The complete extruded diet is a concentrated food that in its composition has the minimum
amount of roughage for equine consumption, therefore, it is supplied as a single food.
Objectives: The study was carried out to evaluate the intake and digestion of nutrients from the complete
extruded diet, as well as body weight (BW), body fat percentage (%BF) in eventing horses.
Material And Methods: Thirteen Brazilian Sport horses were used in a completely randomized design,
with three diets: First diet (control) - pelleted feed and coastcross hay (n = 5). Second diet - complete ex-
truded diet (Foragge Horse Energy - NUTRATTA®) (n = 4). Third diet - complete extruded diet added with
coastcross hay, supplied through a slow feeder hay bag (EQUILIBRE®) (n = 4). The eventing horses were
performed daily training activity for nine months. Body weight and body fat percentage were evaluated
throughout the three phases of training cycle, initial, intermediate and final. Voluntary intake of dry matter
only from concentrates and, intake rate of diets was evaluated. Digestibility coefficients were estimated.
The results were subjected to analysis of variance using SAS® using PROC MIXED with 5% significance.
Results: There was no difference between the diets for BW and BF%, which remained stable during train-
ing. The concentrate intake rate was lower in the complete extruded diet with a value of 19.8 g DM/Minute
than the Control and complete extruded + hay in a slow feeder bag, with average values of 59.3 g and 48.9
g DM /Minute, respectively. Digestibility coefficients was higher for all nutrients evaluated in horses fed
complete extruded feed compared to those fed Control diet.
Discussion/Conclusions: The complete extruded diet presented higher digestibility coefficients values
compared to other diets, except for cellulose digestibility, and maintained good body conditions in eventing
horses during training.
340
Proceedings
2023
#155 - Utilization of Frog Skin and Tilapia Skin for

Wound Healing Evalution In Horses
Authors
MIRANDA PEREIRA DA ROCHA, RACHEL1 ; de Miranda Alves, Beatriz1 ; Aranha Borges, Andressa1 ; Cam-
pebell de Cássia, Rita1
Affiliation
1
UNB - University Of Brasília, FAV/UnB, Brasília, Brasil
Introduction:
Injuries are common in horses due to their behavioral characteristics. Frog skin (Rana catesbeiana) and
tilapia skin (Oreochromis niloticus) sterilized with gamma rays or frozen tilapia skin are presented as bi-
ological material for wound treatments. Thermography as a non-invasive method is potential option for
inflammation assessment, aiding in monitoring and contributing to determining the best treatment alterna-
tive. The objective of this study, conducted at the University of Brasília/Brazil and approved by CEUA-UnB,
23106.027371/2022-70, was to assess wound healing in the dorsal region of horses using frog skin and
tilapia skin, in conjunction with infrared thermography evaluation.
Materials And Methods:

Wounds surgically induced were topically treated with frozen tilapia skin (GPTC), sterilized tilapia skin
(GPTE), frog skin (GPR), and ringer lactate (GC). Four wounds were made on each side of the thoraco-lum-
bar region. One side was used for clinical evaluation, thermography, photos, measurement of the area and
contraction rate. The other side for histopathological evaluation by biopsy. The sides were chosen randomly
to avoid partiality. The lesions were treated daily, and thermography, clinical and histopathological evalua-
tions were performed on days 0, 3, 7, 14, 21 and 28.
Results:
The GPTC had statistically a higher wound area on day 14 and a smaller percentage of contraction on days
14 and 21 compared to the other groups. At 28 days the average contraction rate was 77,85%; 90%, 91,26%
and 94,98% for GPTC, GPR, GPTE and GC respectively.
Discussion/Conclusions:
Although there was no statistical difference between the groups, clinical evaluations revealed a more pro-
nounced wound healing and anti-inflammatory effect in the sterilized tilapia and frog skins on days 3 and 7,
making it a safe, effective, and cost-effective option to regeneration of wounds, even though frozen tilapia
skin delayed the healing process.
References
1. Adorno J. Avaliação histológica e imunohistoquímica de cicatrização com curativo de pele de rã
(Rana catesbeiana) em pacientes vítimas de queimaduras. 2005. 73p. Dissertação (Mestrado em
Ciências Médicas) - Universidade de Brasília. Brasília, Distrito Federal.
2. Alves APNN, Verde MEQL, Ferreira Júnior AEC, Silva PGB, Feitosa VP, Lima Júnior EM, Miranda
MJBM, Moraes Filho MO. Avaliação microscópica, estudo histoquímico e análise de propriedades
tensiométricas da pele de tilápia do Nilo. Revista Brasileira de Queimaduras, v.14, n.3, p.203-210,
2015.
3. Costa BO, Lima Júnior EM, Fechine FV, Alves APNN, Melo MMO, Ribeiro WLC, Siqueira JP, Moraes
Filho M.O. Utilização da pele de tilápia-do-Nilo (Oreochromis niloticus) como xenoenxerto em um
equino com ferimento traumático. Acta Scientiae Veterinariae, v.48, Suppl 1, p.506, 2020.
4. Redaelli V, Bergero D, Zucca E, Ferrucci F, Costa LN, Crosta L, Luzi F. Use of thermography techni-
ques in equines: principles and applications. Journal of Equine Veterinary Science, v.34, p.345-350.
2014.
5. Silva SC, Ríspoli VFP, Graner C., Sá RLM, Belli C.B., De Zoppa ALV. Using tilapia skin (Oreochromis
niloticus) as an occlusive biological curative in equine wounds: short communication. Brazilian
Journal of Veterinary Research and Animal Science, v.56, n.4, p.1-5, 2019.
341
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2023
#157 - “Medial Femoral Condylar Subchondral

Cysts In Chilean Horses Breed: Prevalence And
Characteristics”
Authors
1
Suazo, Macarena
Affiliation
1
Hospital Clinico Veterinario Unidad Equino UN, Unidad Equinos, Santiago, Chile
Introduction
Subchondral bone cysts (SBC) can originate from trauma or during development due to failure in endo-
chondral ossification, potentially causing poor performance and lameness [1].
To the authors knowledge there are no prevalence studies in the Chilean horse breed. The aim of this study
is to determine the prevalence of SBC on the medial femoral condyle (MFC-SBC) on Chilean horse breed.

Stifle radiographs (LM, CdCr and Cd60L-CrMO) were obtained from 200 Chilean horses, aged 2-12 years.
SBCs were classified using the scale described by Santschi et. al. [1].
Results
This study found a prevalence of MFC-SBC of 22.5%. Within affected horses,19% were classified as grade
1, 0.5% as grade 2, 1% as grade 4, 2% as grade 6 and no affected horses were found with grade 3 and 5.
Discussion/Conclusion
The prevalence of MFC-SBC in this study was 22.5%, which was higher than the previous 3.8%, 2% and
5.6% reported in Thoroughbreds [2-3]. However, it is lower than the 41.4% reported in Quarter horses [4].
Comparison among the studies have to be done carefully due to the difference in classification criteria used
in other studies.
In this study, within the prevalence of 22,4% of SCBC in Chilean horse breed, 19% were classified as MFC
flattening. If we not consider MFC flattening in our study, we would have a total prevalence of 3.5%, and
this result would be closer than previous reports in Thoroughbred [2,3]. However, if MFC flattening were
not considered in the Quarter Horse study, they would have a prevalence of 19.8% [4], remaining above our
results.
This study represents the first step toward describing the prevalence in SCBC in Chilean horse breed. Ref-
erences
1. Santschi EM, Williams JM, Morgan JW, Johnson CR, Bertone AL, Juzwiak JS. Preliminary investi-
gation of the treatment of equine medial femoral condylar subchondral cystic lesions with a trans-
condylar screw. Vet Surg. 2015;44(3):281-288. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1532-
950X.2014.12199.x
2. Castle K. Investigating the Genetic and Genomic Basis of Osteochondrosis in Thoroughbred Hor-
ses from Australia and New Zealand [Tesis doctoral]. University of Sydney; 2012. https://ses.library.
usyd.edu.au/bitstream/handle/2123/9369/2012_K_Castle_Thesis.pdf?sequence=1&isAllowed=y
Russell J, Matika O, Russell T, Reardon RJM. Heritability and prevalence of selected osteochondro-
sis lesions in yearling Thoroughbred horses. Equine Vet J. 2017;49(3):282-287. https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC5412687/
3. Contino EK, Park RD, Mc Ilwraith CW. Prevalence of radiographic changes in yearling and 2yearold
Quarter Horses intended for cutting. Equine Vet J. 2012;44(2):185-195. https://pubmed.ncbi.nlm.nih.
gov/21815932/
342
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2023
#158 - Concentrations of Crosslinked C-Telopeptide

Fragments of Type II Collagen after Serial
Administration of Allogeneic Stem Cells Derived From
Synovial Fluid in Equine Osteoarthritis Model
Authors
Pereira Rodrigues, Nubia Nayara1 ; Valero Fiorin, Éliti2 ; Miluzzi Yamada, Ana Lúcia2 ; Arantes Baccarin,
Raquel Yvonne3
Affiliation
1
university Of Sao Paulo, Vcm, , Brasil ; 2university Of Sao Paulo, Vci, São Paulo, Brasil ; 3university Of Sao
Paulo, Vcm, São Paulo, Brasil
Introduction: Several studies have demonstrated beneficial effects of the application of mesenchymal
stem cells (MSCs) in osteoarthritis (OA) and many biomarkers are utilized for monitoring the degeneration
of cartilage. Hence, crosslinked c-telopeptide fragments of type II collagen (CTX-II) showed consistent cor-
relation with OA. The aim of this study is to monitor the CTX-II levels in the synovial fluid (SF) of surgically
OA induced joints treated with three intra-articular applications of allogeneic MSCs derived from SF.
Materials And Methods: Twelve animals with experimentally induced OA were randomized to receive
intra-articular applications of allogeneic MSCs (three doses of 107 MSCs administered at day 0, day 15 and
day 45) in the treated group (TG). The control group (CG) received three applications of Ringer’s lactate
solution at the same time points. The study was continued for another 135 days, with animals evaluated at
six different times. Samples of SF collected were analyzed for CTX-II by ELISA.
Results: During an observation period of 175 days post joint injury, both groups had the same mean CTX-II
(568 pg/ml - mean diff. - 0.06) in SF before treatment or sham treatment. However, after the first treatment
the concentrations were lower in the TG at all time points, but significantly lower at the last time point
(P=0.04).
Discussion/Conclusions: Several studies have shown that cartilage degradation increases as OA pro-
gresses, and monitoring CTX-II levels can provide insight into the extent of cartilage degradation and help
assess disease progression.Throughout the study, TG had lower CTX-II levels, although only at the final time
point was statistically significant. Our results suggest that treatment with three intra-articular applications
of allogeneic MSCs was able to slow the degradation of type II collagen, which is a major component of
cartilage. Further studies should investigate the potential of MSCs for reducing cartilage degradation.
References
1. Lohmander LS, Atley LM, Pietka TA, Eyre DR. The Release of Crosslinked Peptides From Type II
Collagen Into Human Synovial Fluid Is Increased Soon After Joint Injury and in Osteoarthritis. Ar-
thritis Rheum. 2003 Nov;48(11):3130–9.
2. Broeckx SY, Seys B, Suls M, Vandenberghe A, Mariën T, Adriaensen E, et al. Equine Allogeneic
Chondrogenic Induced Mesenchymal Stem Cells Are an Effective Treatment for Degenerative Joint
Disease in Horses. Stem Cells Dev. 2019 Mar 15;28(6):410–22.
3. Cleary OB, Trumble TN, Merritt KA, Brown MP. Effect of exercise and osteochondral injury on sy-
novial fluid and serum concentrations of carboxy-terminal telopeptide fragments of type II collagen
in racehorses AbbreviAtions BAP Bone alkaline phosphatase CTX-II Carboxy-terminal telopeptide
fragments of type II collagen MC Middle carpal MCP Metacarpophalangeal OCI Osteochondral
injury RC Radiocarpal SF Synovial fluid. Vol. 71, AJVR. 2010.
4. Oestergaard S, Chouinard L, Doyle N, Karsdal MA, Smith SY, Qvist P, et al. The utility of measuring
C-terminal telopeptides of collagen type II (CTX-II) in serum and synovial fluid samples for estima-
tion of articular cartilage status in experimental models of destructive joint diseases. Osteoarthritis
Cartilage. 2006 Jul;14(7):670–9.
5. Yamada ALM, do Prado Vendruscolo C, Marsiglia MF, Sotelo EDP, Agreste FR, Seidel SRT, et al.
Effects of oral treatment with chondroitin sulfate and glucosamine in an experimental model of
metacarpophalangeal osteoarthritis in horses. BMC Vet Res. 2022 Dec 1;18(1).
343
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2023
#162 - Wedge Closing Osteotomy for Treatment of

Severe Angular Limb Deformity in a Mangalarga
Marchador Neonate
Authors
Oliveira de Paula Lage, Alvaro1 ; Marques Angela, Camila1 ; Rangel da Penha Piccoli, Júlia2 ; Andrade Ribeiro
de, Caroline3
Affiliation
1
Universidade Vila Velha, Medicina Veterinária/Cirurgia de Animais de Grande Porte, Vila Velha, Brasil ;
2
Universidade Vila Velha, Medicina Veterinária/ Anestesiologia, Vila Velha, Brasil ; 3Universidade Vila Velha,
Medicina Veterinária/ Cirurgia de Animais de Pequeno Porte, Vila Velha, Brasil
Introduction: Angular deformities in the musculoskeletal system, classified as valgus or varus, can result
from various factors such as genetics, perinatal issues, incomplete ossification, periarticular laxity, overload,
trauma, infection, or fracture non-union in equids.
Corrective surgical treatments include osteotomy, ostectomy in sagittal/frontal planes, and closing wedge
ostectomy. We report a case of closing wedge ostectomy for distal tibial valgus in a 1-day-old Mangalarga
Marchador male foal weighing 48 kg.
Clinical History: The foal presented with severe right tibial malformation, bearing weight on the limb but
with moderate lameness in the right pelvic limb.
Evidence-Based Diagnosis: Radiographic and tomographic evaluation revealed frontal plane deformity
resulting in distal tibial valgus.
Relevant clinical findings: The foal was bearing weight on the limb, capable of walking and trotting, but
exhibited moderate mechanical lameness of the right pelvic limb.
Treatment And Management: For correction, the cutting plane was calculated following Paley (2003).
Post ostectomy, the tibia was stabilized using three LC-DCP plates (one 4.5 mm and two 3.5 mm) and two
crossed Steiman pins. Postoperative drug therapy included ceftiofur, gentamicin, metronidazole, phenylbu-
tazone, meloxicam, firocoxib, DMSO, morphine, omeprazole, and local wound care.
Evolution: The foal fully weight-bore on the limb for up to 15 days postoperatively, with uncomplicated
wound healing. Subsequently, the foal developed moderate limb lameness due to bacterial osteomyelitis
and non-union at the ostectomy site, despite antibiotic treatment, leading to euthanasia.
Discussion/Conclusion: This case highlights the importance of preoperative planning and surgical tech-
nique selection for success and concerns about postoperative infection and bacterial resistance.
References
1. Auer JA, Lischer C, Haab M. Displacement osteotomies/ostectomies in the horse. Equine Veteri-
nary Education. 2021 May 4;34(6):291–8.
2. Radtke A, Morello S, Muir P, Arnoldy C, Bleedorn J. Application of computed tomography and ste-
reolithography to correct a complex angular and torsional limb deformity in a donkey. Veterinary
Surgery. 2017 Oct 12;46(8):1131–8.
3. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sa-
gittal plane corrective osteotomies. The Orthopedic Clinics of North America [Internet]. 1994 Jul
1;25(3):425–65. Available from: https://pubmed.ncbi.nlm.nih.gov/8028886/
344
Proceedings
2023
#164 - Identification Of Iatrogenic Lung Injury, Induced

by General Anesthesia in Horses Kept in Dorsal and
Lateral Recumbency, by Using Microbubble Contrast
Echocardiography
Authors
Favero, Maria Luiza1 ; Canola, Paulo Aléscio2 ; Moslavacz de Sá, Julia3
Affiliation
1
Faculty of Agricultural and Veterinary Sciences- UNESP, Veterinary Hospital / Large Animal Medicine and
Surgery, Jaboticabal, SP, Brasil ; 2Faculty of Agricultural and Veterinary Sciences- UNESP, Department of
Veterinary Medicine and Surgery, Jaboticabal, SP, Brasil ; 3Faculty of Agricultural and Veterinary Sciences-
UNESP, FCAV, Jaboticabal, SP, Brasil
Introduction: Respiratory changes are common during inhalation anestesia. Horses are also susceptible
to the depressant effects of inhalational anesthetics, which are exacerbated by recumbency and directly
interfere with gas exchange, with the potential for lung injury. In men, the presence of an intrapulmonary
shunt secondary to intrapulmonary vascular dilatation, commonly observed in hepatopulmonary syndrome
(HPS), is readily diagnosed by transthoracic echocardiography contrasted with microbubbles. We sought
to verify the potential use of this test in the diagnosis of intrapulmonary shunts in horses, possibly caused
by inhalation anesthesia.
Materials and methods: We evaluated 19 animals in need of surgical treatment that were treated at the
UNESP/FCAV Veterinary Hospital (Jaboticabal, São Paulo, Brazil), which were subjected to the microbub-
ble test during the anesthetic procedure. Evaluations were performed at 20-minute intervals and continued
until the end of anesthesia. For this purpose, 60 mâ„“ of contrasting microbubble solution was injected into
the patients’ external jugular vein. At the same time, echocardiography was used to assess the potential
passage of contrast from the right to the left ventricle.
Results: In the animals evaluated, it was possible to visualize the passage of contrast in the left ventricle of
only one patient, who underwent important hemodynamic changes during the anesthetic period.
Discussion/Conclusions: Patients who did not experience hemodynamic changes did not present a pos-
itive test on contrast echocardiography, not demonstrating the presence of an intrapulmonary shunt that
could be identified by the proposed diagnostic method. However, it proved to be effective in identifying the
passage of microbubbles from the right to the left ventricle, with potential for identifying pulmonary lesions
in this species.
Ethical approval: #2115/21
References
1. Favero ML, Canola PA. Estudo exploratório do teste de ecocardiografia contrastada por microbol-
has para identificação de lesão pulmonar decorrente de inflamação sistêmica em cavalos: ade-
quação, execução e viabilidade diagnóstica. SIMCAV 2021 [Internet]; 26- 30 abr 2021: Even3; 2021
[cited 2021 May 10]. Doi: 10.29327/SIMCAV2021.330462
2. Klemm M, Alvarenga J, Fantoni DT, Silva LCLC, Auler JO. Estudo comparativo dos efeitos da ven-
tilação mecânica controlada (VMC) com ou sem o emprego da pressão positiva no final da expi-
ração (PEEP) sobre a variação da pressão interpleural em anestesia eqüina. Brazilian Journal of
Veterinary Research and Animal Science [Internet]. 1998 [cited 2021 May 10];35(6). Doi: 10.1590/
S1413- 95961998000600006
3. Koch DG, Fallon MB. Hepatopulmonary Syndrome. Clinics in Liver Disease. 2014 May;18(2):407–20.
4. Nacif LS, Andraus W, Pinheiro RS, Ducatti L, Haddad LB, D’Albuquerque LC. The hepatopulmo-
nary syndrome. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2014 Jun;27(2):145–7.
345
Proceedings
2023
#166 - Equine Proliferative Enteropathy (Epe) Caused

By Lawsonia Intracellularis in Chile
Authors
Palma Espinoza, Paula1 ; Bustos Mansilla, Carla1 ; Navarro, Mauricio2 ; Restrepo, Juan Manuel1 ; Uberti, Ben-
jamin1 ; Durán Graeff, María Carolina1
Affiliation
1Universidad Austral De Chile, Equine Hospital, Inst. of Clinical Sciences, Faculty of Veterinary Sciences,
Valdivia, Chile ; 2Universidad Austral De Chile, Institute of Animal Pathology, Faculty of Veterinary Sciences,
Valdivia, Chile
Introduction
Lawsonia intracellularis causes EPE in foals, which causes ventral edema, diarrhea, fever and weight loss1.
The disease is prevalent in North America, but rarely reported in South America2.
Clinical History
An 8-month-old-Thoroughbred-foal presented with acute diarrhea.The last month, this foal and two other
ones were showing reduced weight gain.Four days prior presentation the foal showed hyperthermia, mild
dehydration and lethargy.Treatment administered was moxidectin, NSAIDs and IV-fluids.

Poor general condition, taquicardia, hyperthermia (39°C), dehydration, ventral edema, anorexy, dullness,
profuse diarrhea, mild colic signs.
Blood work, abdominal ultrasound, and fecal analysis were performed.Results showed anemia, leucopenia,
neutrophilia, hiperfibrinogenemia, azotemia, hypochloremia, hyponatremia, hypokalemia, hypoproteinemia,
hypoalbuminemia. Diffuse thickening in small intestinal walls was detected on ultrasound. In feces, adult
small strongyles and tenias were detected. Fecal culture was negative for Salmonella, positive PCR for L.
intracellularis. The feces of the 2 foals at the farm, with similar but milder signs, also tested positive for L.
intracellularis.

fluids (isotonic, plasma), antibiotics (TMS, oxytetracycline), NSAIDs, antihelmintic drugs. On day 7 added
corticosteroids, diuretics, synthetic colloids, and lower limb bandages.
Evolution
Initially the patient was stabilized, appetite and attitude improved. Nevertheless, after 1-week of treatment
slowly and steady clinical signs worsen, serum protein kept falling and ventral edema increasing. Due to his
poor prognosis humane euthanasia was performed.
Diffuse and severe thickening of jejunum and ileum, with thickened ileal mucosa and hypertrophy of the
muscularis mucosa. Positive PCR of the ileum for L. intracellularis.
Discussion
This is the first report of EPE caused by L. intracellullaris in Chile. The infection should be considered as
differential diagnosis in foals with fever, reduced weight gain and diarrhea. Early detection programs are
needed to establish prevalence, distribution, and economic impact of the disease in Chile.
References
1. Pusterla N, Gebhart C. Equine proliferative enteropathy caused by Lawsonia intracellularis. Equine
Veterinary Education. 2009 Aug;21(8):415-419. doi: 10.2746/095777309X453119
2. Guttmann P de M, Viscardi V, Lessa DAB, Guedes RMC. Equine Proliferative Enteropathy Caused
by Lawsonia intracellularis in a Foal in Brazil. J Equine Vet Sci [Internet]. 2014;34(5):701–3. Available
from: https://www.sciencedirect.com/science/article/pii/S0737080613008836
346
Proceedings
2023
#167 - Equine Sarcoids Treated With Intravenous

Chemotherapy And Local Electrochemotherapy (Ect)
Authors
1
Contreras Delgado, Javiera
Affiliation
1
UNIVERSIDAD AUSTRAL DE CHILE, Student, Valdvia, Chile
Introduction
Equine-sarcoid is a common skin neoplasia [1]. ECT is a newer treatment that generally involves intratumor-
al injection of chemotherapeutic-drugs followed by repeated electrical current [2]. Typically, 1-3 treatments,
2-4 weeks apart are required. More treatments (6-12) are needed with chronic/severe presentations [per-
sonal-experience].
Clinical history
Two equids (Case1: 7yo anglo-arab pleasure riding mare; Case2: 8yo Chilean exposition stallion), presented
with aggressive-chronic tumoral masses for treatment at our Equine Hospital.

C1 presented with several fleshy-ulcerated-masses on neck and base of one ear. Blood-work showed mod-
erated-anemia, hyperfibrinogenemia, mild-neutrophilia. C2 had two-well circumscribed-circular-swellings
on one upper eyelid. No abnormalities were detected on blood work.
Final-diagnosis of equine sarcoid was reached with histopathology-analysis in both cases.

Chemotherapy with 90UI of bleomycin was administered IV, 8-10min later, intratumorally cisplatin (0.5mg/
cm2) and ECT with biphasic- electrical-pulses was applied (700volts, 200ms, 5KHz; VETCP 125-electro-
porator).
The first-treatment was preceded by surgical resection of ulcerated-bulging-masses. Flunixin meglumine

(1.1mg/Kg SID, PO/IV) was administered just before treatment and for 2-following-days.
Evolution
Both cases remained clinically healthy, treated areas showed local inflammation which resolved within 10-
14d. CBCs performed for 7d after treatment showed mild leucopenia and neutropenia 3-4d after treatment.
Treatment was repeated every 3-4w, as needed. A total of 4 and 2-treatments were applied in C1 and 2,
respectively.
Discussion
Intravenous-chemotherapy in conjunction with local-ECT was well tolerated and successful in treating
aggressive-chronic-fibroblastic- equine-sarcoids after 2-4 treatment-sessions.
IV-bleomycin is generally used in small-animals, as it reaches adequate distribution and concentration in

tumors/margins and contributes to a local immune response [3]. In horses, this IV-route is costly, little ev-
idence about its safety is available, and it should be avoided in animals destined for human consumption.
347
Proceedings
2023
References
Sciences
2. Bastrup, F. 2022. Electrochemotherapy for metastatic cutaneous melanoma. Acta oncologica. vol
61(5).
3. Calvet CY, Famin D, André FM, Mir LM. 2014. Electrochemotherapy with bleomycin induces hall-
marks of immunogenic cell death in murine colon cancer cells. Oncoimmunology. 3:e28131. 10.4161/
onci.28131
348
Proceedings
2023
#170 - Equine Sarcoids Treated With Intravenous

Chemotherapy and Local Electrochemotherapy
Authors
Contreras Delgado, Javiera1 ; Sirguiado, Romina2 ; Duran, Carolina3 ; Ojeda, Javier3
Affiliation
1
Universidad Austral de Chile, Students, Valdivia, Chile ; 2univerdidad Austral de Chile, Students, Valdivia,
Chile ; 3univerdidad Austral De Chile, Institute of Clinical Sciences, Valdivia, Chile.
Introduction
Equine-sarcoid is a common skin neoplasia [1]. ECT is a newer treatment that generally involves intratumor-
al injection of chemotherapeutic-drugs followed by repeated electrical current [2]. Typically, 1-3 treatments,
2-4 weeks apart are required. More treatments (6-12) are needed with chronic/severe presentations [per-
sonal-experience].
Clinical History
Two equids (Case1: 7yo anglo-arab pleasure riding mare; Case2: 8yo Chilean exposition stallion), presented
with aggressive-chronic tumoral masses for treatment at our Equine Hospital.
Relevant clinical findings

C1 presented with several fleshy-ulcerated-masses on neck and base of one ear. Blood-work showed mod-
erated-anemia, hyperfibrinogenemia, mild-neutrophilia. C2 had two-well circumscribed-circular-swellings
on one upper eyelid. No abnormalities were detected on blood work.
Final-diagnosis of equine sarcoid was reached with histopathology-analysis in both cases.

Chemotherapy with 90UI of bleomycin was administered IV, 8-10min later, intratumorally cisplatin (0.5mg/
cm2) and ECT with biphasic- electrical-pulses was applied (700volts, 200ms, 5KHz; VETCP 125-electro-
porator).
The first-treatment was preceded by surgical resection of ulcerated-bulging-masses. Flunixin meglumine

(1.1mg/Kg SID, PO/IV) was administered just before treatment and for 2-following-days.
Evolution
Both cases remained clinically healthy, treated areas showed local inflammation which resolved within 10-
14d. CBCs performed for 7d after treatment showed mild leucopenia and neutropenia 3-4d after treatment.
Treatment was repeated every 3-4w, as needed. A total of 4 and 2-treatments were applied in C1 and 2,
respectively.
Discussion
Intravenous-chemotherapy in conjunction with local-ECT was well tolerated and successful in treating
aggressive-chronic-fibroblastic- equine-sarcoids after 2-4 treatment-sessions.
IV-bleomycin is generally used in small-animals, as it reaches adequate distribution and concentration in

tumors/margins and contributes to a local immune response [3]. In horses, this IV-route is costly, little ev-
idence about its safety is available, and it should be avoided in animals destined for human consumption.
349
Proceedings
2023
Although this treatment is costly and must be performed under general anesthesia, increased treatment-ef-
ficacy implies less treatment- sessions, especially with large-aggressive-tumors.
References
Sciences
2. Bastrup, F. 2022. Electrochemotherapy for metastatic cutaneous melanoma. Acta oncologica. vol
61(5).
3. Calvet CY, Famin D, André FM, Mir LM. 2014. Electrochemotherapy with bleomycin induces hall-
marks of immunogenic cell death in murine colon cancer cells. Oncoimmunology. 3:e28131. 10.4161/
onci.28131
350
Proceedings
2023
#171 - Efectiveness of Prazicuantel against

Anoplocephala spp in Andean horses in Ecuador.
Authors
Martinez, Alegria1 ; Flores, Nicole2 ; Galecio Naranjo, Juan Sebastian1
Affiliation
1Universidad San Francisco de Quito, Escuela de Medicina Veterinaria, Quito, Ecuador ; 2Universidad San
Francisco de Quito, Laboratorio de Patología Clínica, Quito, Ecuador
Introduction
Anoplocephala perfoliata is an internal parasite that resides in the equine small intestine, leading to various
clinical manifestations, including intermittent colic, diarrhea, weight loss, lethargy, and, in severe cases,
intestinal intussusception. Preventive treatment relies on specific anthelmintic medications, such as prazi-
quantel, known for its efficacy in eradicating equine tapeworms. Ecuador has diverse climate and environ-
mental conditions across regions, creating favorable conditions for the parasite life cycle. This study aims to
evaluate the efficacy of praziquantel against Anoplocephala spp. in Andean horses in Ecuador.

The study was conducted at the Bombolí mountain (-0.34597444781572567, -78.71152509258572), situated
3500 meters above sea level in the Ecuadorian Andes (55 km SW from Quito). Fecal samples were col-
lected from 17 adult horses, with only seven testing horses positive for Anoplocephala spp. These horses
received oral praziquantel treatment (2.5 mg/kg) on day 0. Post-treatment fecal samples were collected at
14- and 28-day intervals to determine the presence or absence of Anoplocephala spp eggs in feces.
Furthermore, fecal samples were analyzed using the modified McMaster technique to quantify the number
of Anoplocephala spp. eggs per gram (EPG) of feces.
Results
Anoplocephala spp. were detected in the fecal samples of seven horses, with a mean excretion of 108.3±20.4
EPG of feces on day 0. Following treatment with praziquantel, there was no evidence of Anoplocephala spp
EPG excretion at days 14 and 28.
Conclusion
The administration of praziquantel at a dose of 2.5 mg/kg proved effectiveness against gastrointestinal
infections caused by Anoplocephala spp in Andean horses in Ecuador.
351
Proceedings
2023
#173 - White Muscle Disease in Three Adult Pure Chilean

Breed Horses
Authors
SANDOVAL ALVARADO, ANDREA1 ; MUÑOZ, NICOLAS1 ; NAVARRO, MAURICIO2 ; DURAN, M. CARO-
LINA1
Affiliation
1Universidad Austral De Chile, Equine Hospital, Institute of Clinical Sciences, Faculty of Veterinary Scie,
VALDIVIA, Chile ; 2Universidad Austral De Chile, Institute of Animal Pathology, Faculty of Veterinary Sci-
ences, VALDIVIA, Chile
Introduction
White muscle disease (WMD) is more frequently described in neonatal animals. Selenium-and/or vita-
min-E-deficient diets cause acute degeneration of skeletal muscles [1].
Clinical history
Three adult Pure-Chilean-Breed Horses from the same farm in southern Chile were referred to the Equine
Hospital 2-days apart with acute signs of rhabdomyolysis. Case 1 (C1: 1,5yo yearling) arrived dead, C2 (3,5yo
colt) and C3 (3,8yo colt) on day-3, alive. They were kept on pasture without supplementation, regularly de-
wormed, not vaccinated.

C2+C3 were dehydrated, showed muscle soreness/weakness, lameness and pigmenturia, C2 tachycardia
with arrhythmia.
On blood work, the horses had increased serum muscle enzymes (C1: AST 2,500U/L, CK 1,500,000U/L;
C2: AST 22,450U/L, CK 5,600,000U/L), and liver enzymes, as well as azotemia. Glutathione peroxidase was
very low (average GPx 36 U/g Hb)(serum-vitE was not measured). ECG-analysis on C2 was not-performed.

Aggressive fluid therapy, flunixin meglumine (1,1mg/kg/IV/SID), methocarbamol (5mg/kg/IV/SID), selenium
(IV/Na2SeO3/26mg of total- Se), calcium/magnesium (60mg calcium gluconate, 15mg magnesium chlo-
ride; IV), vitE (50U/Kg/PO).
Evolution
C2+C3 were stabilized, over the following hours, C2 started with more pain, muscle fasciculations, poor ap-
petite, prolonged recumbency, and died 24h after referral. C3 recovered and was discharged after 3-days.
C1+C2 showed pale-muscle-color of several skeletal muscles and dark-red-urine in bladder. Histologically,
myocytes showed severe- degeneration and necrosis with mineralization and occasional regeneration.
Discussion
WMD in adult-horses is rarely described, but Se-deficiency is frequently reported in southern-Chile. In
foals, WMD is generally restricted to areas with low-Se-content or high soil-acidity and increasing intensive
plant production. However, not all foals or adults with low- serum-Se/vitE develop disease. Nevertheless,
selenium should be supplemented in deficient areas and regularly tested.
352
Proceedings
2023
References
1. Reed, S. M., Bayly, W. M., & Sellon, D. C. (2018). Equine Internal Medicine. Saunders.561-562 p.
2. Streeter, R. M., Divers, T. J., Mittel, L., Korn, A. E., & Wakshlag, J. J. (2012). Selenium deficiency as-
sociations with gender, breed, serum vitamin E and creatine kinase, clinical signs and diagnoses in
horses of different age groups: A retrospective examination 1996-2011: Retrospective examination
of equine selenium deficiency. Equine Veterinary Journal, 44, 31–35. https://doi.org/10.1111/j.2042-
3306.2012.00643.x
3. Urschel, K. L., & McKenzie, E. C. (2021). Nutritional influences on skeletal muscle and muscular
disease. The Veterinary Clinics of North America. Equine Practice, 37(1), 139–175. https://doi.or-
g/10.1016/j.cveq.2020.12.005
353
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2023

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Biofilm: is it real and how do we manage it in equine

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16 mls sterile fluid 10 mls of 8.4% sodium

Ceftiofur (1 gram re- 10 mls sterile fluid

Ciprofloxacin (10 mg/ Split between two syrin-

H2O2- 1% final concentration in the syringe

Antibiotic Drug Amount H2O2 QS Final volume Notes:

26 mls sterile fluid 10 mls of 8.4% sodium

Ciprofloxacin (10 mg/

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Ceftiofur (1 gram re- 20 mls sterile fluid

Ciprofloxacin (10 mg/

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Marco Antonio Alvarenga

What’s new for embryo transfer?

Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia (Spain)

Juan Cuervo-Arango MSc, PhD, DVM, Dipl. ECAR (Equine)

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Juan Cuervo-Arango MSc, PhD, DVM, Dipl. ECAR (Equine)

Real World Approaches to ART in Practice

How to recognize and manage the high-risk pregnancy

Conditions causing the risk of the mare or the fetus

Juan C. Samper, DVM, MSc, PhD, Diplomate ACT

Anti-inflammatories used consists of Flunixin Meglamine and Firocoxib. A combination of Firocoxib,

Karen Wolfsdorf DVM, Dipl. ACT

Field solutions for dystocia management

Assisted vaginal delivery

Controlled vaginal delivery

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2. Sertich PL. Periparturient Emergencies. Vet. Clinics North America. 1994;10:19-36.

Karen Wolfsdorf DVM, Dipl. ACT

Beyond retained fetal membranes: Managing

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How to manage the anovulatory mare during breeding

Conditions that interfere with regular cyclicity

Juan C. Samper, DVM, MSc, PhD, Diplomate ACT

Achieving a definitive diagnosis of pain in the foot in

History and clinical examination

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Dr Ellen Singer BA DVM, DVSc., Diplomate ACVS/ECVS, FRCVS

Managing hoof wall defects

Pathophysiology of Quarter Cracks and Toe Cracks

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