Equine VetThe Modern

Vol 2 Issue 6 2013www.modernequinevet.com

Coming to termERAV more common than thoughtCompounding, rabies,Technician Update and more

Punky?It may be lepto

2 Issue 6/2013 | ModernEquineVet.com

TAblE of ConTEnTs

RepRoducTIVe MedIcIneHelping horses come to term ............................................................ 7

InfecTIous dIseases"common cold" common problem ...............................................10

TecHnIcIan updaTeali fernandez: expect the unexpected ........................................15

news

aVMa: new compounding policies ..............................................9one health helps for burn victim ...............................................12equine rabies .....................................................................................17

To conTacT us, eMaIl MaRIe RosenTHal

LEGAL DISCLAIMER: The content in this digital issue is for general informational purposes only. PercyBo Publishing Media LLC makes no representations or warranties of any kind about the completeness, accuracy, timeliness, reliability or suitability of any of the information, including content or advertisements, contained in any of its digital content and expressly disclaims liability of any errors or omissions that may be presented within its content. PercyBo Publishing Media LLC reserves the right to alter or correct any content without any obligations. Furthermore, PercyBo disclaims any and all liability for any direct, indirect, or other damages arising from the use or misuse of the information presented in its digital content. The views expressed in its digital content are those of sources and authors and do not necessarily reflect the opinion or policy of PercyBo. The content is for veterinary professionals. ALL RIGHTS RESERVED. Reproduction in whole or in part without permission is prohibited.

punky? It might be lepto

coVeR sToRy: 4

Cover photo by Dhoxax/shutterstock

Thank you for emailing me The Modern Equine Vet. However, advertisements such as the MRI topic in the last issue should be more clearly identified as ads. Standing MRI's do not replace a high-field magnet exam under general anesthesia for detecting some lesions.

They also rely on well behaved horses who do not move. If the topic is presented as an article the downsides of standing MRI should be discussed along with the benefits. — Dr. M. Lunney

Thanks for writing. The article was not a paid advertisement, but it was put together from company materials. — MeV

REAdER CoMMEnT

Equine VetThe Modern

advertise Today! contact | Marie Rosenthal • Executive Editor

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Leptospirosis is more com-mon in horses than previously thought, so it makes sense to keep it in the differential when evalu-ating a horse that is just a little punky. You just might catch an acute infection before more seri-ous signs of disease occur.

“The dogma was that leptospi-rosis in horses was less prevalent than in other domestic species. However, at least in some coun-tries, it is clearly much more com-mon than we thought,” said Ben Adler, PhD, of the Australian Re-search Council who recently wrote

a review of the disease with folks from Ross University and the Uni-versity of Kentucky.

Adler did not know the inci-dence in the United States, but an analysis of aborting mares in North America published in 2011 found that 20 out of 21 were se-rovar positive for leptospirosis. Some countries in Europe and South America that are looking actively for the disease have found a seropositive rate of 50% to 75% in horses.

Unfortunately, early indica-tions of equine leptospirosis infec-

tion are pretty vague — low-grade fever, listlessness and anorexia — and can signal many different problems.

differential diagnosis“The acute signs are definitely

not unique and could reflect pretty much any febrile illness or any ill-ness with liver or kidney involve-ment,” said Adler.

More severe forms present with a range of signs, including con-junctival suffusion, jaundice, ane-mia, petechial hemorrhages on the mucosa and general depression,

4 Issue 5/2013 | ModernEquineVet.com

Horse a little punky?

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It might be leptoLeptospirosis more prevalent in horses than previously thought.

ModernEquineVet.com | Issue 6/2013 5

renal failure and spontaneous abortion, according to Adler.

Aborted fetuses will have his-topathologic lesions and silver-staining organisms consistent with Leptospira, but the organism has not been recovered in culture from aborted fetuses.

Fortunately, the pulmonary hemorrhages seen in some hu-man leptospirosis infection is not common in horses, according to the article, which was published in Veterinary Microbiology.

Recurrent uveitis or moon blindness is one of the hallmarks of the more severe form of the dis-ease in horses. Experts think that the uveitis is an immune-mediate response to the antigenic cross-

reactivity between proteins in the Leptospira organism and the equine cornea. Although other species can suffer moon blindness, the condition is more common among equids.

pcR vs. cultureThe gold standard for diagnos-

ing leptospirosis is still culture, but PCR also can be used and might be more convenient for treating veterinarians.

“Acute infection can be treat-ed with antibiotics,” Adler said. However, the regimens have been extrapolated from other spe-cies without good data in horses. Common antibiotics used are streptomycin and/or penicillin, al-

CoVER sToRy

Recurrent uveitis or moon blindnessPhotos courtesy of Dr. Dennis Brooks, http://largeanimal.vethospitals.ufl.edu/services/ophthalmology

6 Issue 6/2013 | ModernEquineVet.com

though many veterinarians do not give horses streptomycin because of potential toxicities. Tetracycline also can be used.

High doses of penicillin should be given to pregnant mares with

high titers to prevent spontaneous abortion.

No leptospirosis vaccine is in-dicated for equine use, although some people do use the cattle vac-cine off label. However, Adler et al.

recommends against doing so be-cause some of the antigens in the cattle vaccine may actually prime the horses for the development of uveitis and blindness. Adler did recommend vaccinating any ani-mals for which there is a labeled vaccine.

“Because there is no equine vaccine, prevention would involve eliminating rodents or reducing their populations as much as pos-sible, and restricting contact with any infected horse, or any other animal species for that matter,” he said.

Good biosecurity is essential to prevent the spread of this infec-tion. Clean up garbage and trash that attract rodents and isolate any infected animals. MeV

Moon blindnessOne of the most striking signs of equine leptospirosis is recurrent

uveitis, or moon blindness. The condition is painful and recurrent, according to Dr. Ben Adler, of the Australian Research Council, and is considered an immune mediated disease that is characterized by alternating periods of severe and low inflammation. Researchers believe that there is cross-reactivity between leptospiral and ocular proteins that contribute to the immunopathogenesis.

The ocular manifestations can develop months after a systemic infection. Early signs include miosis, blepharospasm, lacrimation, photophobia, edema of the eyelid and cornea, and swollen conjunctiva. Aqueous flare and hypopyon may also be seen in progressive disease. The repeated bouts of inflammation eventually can lead to cataract, anterior or posterior attachment of the iris, lens luxation, vitreous exudates and retinal detachment.

The best outcome depends on early diagnosis and treatment, which is aimed at reducing the inflammatory response. An intraocular device containing cyclosporine A has been effective.

Recurrent uveitis appears to be an immune-me-diate response to the antigenic cross-reactivity between proteins in the Leptospira organism and the equine cornea.

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for more information: Verma A, Stevenson B, Adler B. Leptospirosis in horses. Vet Microbiol. 2013 Apr 16. pii: S0378-1135(13)00215-0. doi: 10.1016/j.vetmic.2013.04.012. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/23647816

Leptospira are spirochete bacteria, which are characteristically long, helically coiled (spiral-shaped) cells.

ModernEquineVet.com | Issue 6/2013 7

For women, the first trimes-ter is the most risky time: many expectant women are reluctant to inform their friends or colleagues that they are pregnant until after this period has passed.

Horses suffer from similar problems, with a considerable number of pregnancies failing to progress beyond the first five weeks. Researchers do not know why the birth rate of horses is low with many pregnancies fail-ing within the first few weeks after conception.

self defense?The reason is still unclear but

may relate to a problem with the mare’s immune system, accord-ing to the latest work in the group of Christine Aurich, DVM, PhD, DECAR, at the University of Vet-erinary Medicine, Vienna (Vetme-duni) the Center for Artificial In-semination and Embryo Transfer.

The problem might be related to a particular class of blood cells, according to a online paper in the journal Reproduction, Fertility and Development.

The fertilized egg, or concep-tus, obviously contains contribu-tions from the mare and the stal-lion, which means it must avoid being recognized and attacked by the mare’s immune system as for-

eign material. Horse breeders talk about maternal tolerance of the conceptus and horses have a vari-ety of mechanisms to enable fertil-ization and a successful pregnan-cy. Maternal tolerance probably depends on wide-ranging changes to the maternal immune response. But what makes some mares better than others at adapting their im-mune systems?

There are indications from work in humans and mice that a particular class of immune cell, the so-called regulatory T cells or Tregs (pronounced “tea regs”), might somehow be important in

maternal tolerance. Aurich and her colleagues have now developed a highly sensitive assay to measure the proportion of Tregs in the blood of horses. They used their new technique to investigate more than 100 mares that were presented for artificial insemination, correlat-ing the results with the outcome of the resulting pregnancies.

Of course, not all of the animals conceived. The scientists could find no association between the level of Tregs in the mares’ blood with the success of the insemina-tion procedure. However, they did observe lower numbers of Tregs

Helping horses

REpRodUCTiVE MEdiCinE

come to termImmune system might affect birth rate of mares.

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8 Issue 6/2013 | ModernEquineVet.com

for more information:

Aurich C, Weber J, Nagel C, et al. Low levels of naturally occurring regulatory T lymphocytes in blood of mares with early pregnancy loss Reproduction, Fertility and Development. http://dx.doi.org/10.1071/RD13012

in the blood of horses that suf-fered an early loss of pregnancy compared with those that either aborted much later (for what-ever reason) or gave birth to live foals.

The results suggest that high numbers of Tregs might somehow be required to suppress the mare’s natural immune reaction against the conceptus. In other words, low levels of Treg cells in mares might cause pregnancy loss in the five weeks after fertilization.

The differences in the levels of Tregs between horses in the “successful pregnancy” and the “unsuccessful” groups were too small to predict whether an in-dividual mare is likely to suffer early pregnancy failure. Nev-ertheless, the results may help breeders solve the problem.

There is evidence from hu-man medicine that estradiol

may enhance the function of Tregs during pregnancy. Treat-ment with this hormone could

possibly benefit mares prone to losing the conceptus. Another possible course would be to ex-pose mares to the stallion’s se-men before implantation, which might increase the number of Tregs in the blood and the ani-mal’s tolerance to the conceptus, thereby, helping to avoid early pregnancy losses.

“A number of reasons have been proposed to account for early pregnancy failure in the horse but our work suggests that a low level of Tregs may actually be among the most important factors. It can only be a matter of time before we find out how to solve the problem,” Aurich said.

The work was undertaken in collaboration with staff at Certa-gen GmbH in Rheinbach, Ger-many and at Epiontis GmbH in Berlin, Germany. MeV

Many reasons have

been proposed for

early pregnancy

failure, but new work

suggests that a low

level of regulatory T

cells (Tregs), might be

an important factor.

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ModernEquineVet.com | Issue 6/2013 9

The American Veterinary Medical Association’s (AVMA) executive board recently approved three new policies to provide guidance on compounding to veterinarians and legislators.

“These policies are important to our members and the animals they treat because veterinarians need compounded preparations to provide treatments to animals when drugs approved by the Food and Drug Administration (FDA) cannot be used,” said Douglas G. Aspros, DVM, president of the AVMA.

“Our staff in Washington is meeting with members of Congress to ensure that compounded preparations are available to our patients when they need them. These policies will help in that educational process, not only by providing guidance to legislators considering compounding issues and legislation, but by informing our members on what is currently legal.”

Compounded preparations are common in veteri-nary practices and include mixing two injectable drugs, preparing an oral paste or suspension from crushed tablets, or adding flavoring to a drug to get a patient to accept the medication. These compounds can be cre-ated at the veterinary practices or through a prescrip-tion by a pharmacist.

non-food vs. food animalsHowever, there is clear differentiation between

compounding that is medically necessary in non-food patients and the very limited compounding that is used in food animal patients.

The executive board passed one new general policy about veterinary compounding and two about compounding from bulk unapproved raw active ingredients. The new, general policy on veteri-nary compounding advocates for additional uses of compounded drugs, but offers recommendations for compounding in a way that minimizes the risk for adverse events.

For example, the new policy recommends al-lowing veterinarians to maintain compounds in

their office stock of drugs for urgent and emergent needs.

The other two policies, which address compounding from bulk unapproved substances, state that there are certain circumstances when bulk compounded drugs are useful and necessary. The policies establish clear differentiation be-tween medically necessary compound-ing needs in non-food animals from the very limited compounding in food animals.

The FDA and federal courts have held that compounding from bulk unapproved raw active ingredients is prohibited under federal drug law. The

AVMA’s two new policies on bulk compounding suggest how bulk compounding could be useful for veterinarians:

• Compounding from Unapproved (Bulk) Substances in Non-Food Animals states that compounding from bulk is medically neces-sary in certain situations and should be allowed when the approved product is not commercially available (for example, during a drug shortage); when the approved product cannot be used to make the needed compound (for example, if the patient is allergic to the FDA-approved drug); or when there is no approved product from which to compound the needed prepara-tion (for example, cisapride used for megacolon therapy in cats).

• Compounding from Unapproved (Bulk) Substances in Food Animals states that com-pounding from bulk should be allowed specifi-cally for and limited to euthanasia, depopula-tion and poison-antidote compounding. If adequate scientific information is not available to determine a clearance time it takes for a drug to adequately clear an animal’s system, the com-pound cannot be used in a food animal or the treated animal cannot enter the food supply.

The new AVMA policies replace previous guid-ance on compounding. MeV

AVMA: new policies on drug compounding

nEwsnoTEs

for more information:

AVMA policies, please visit http://www.avma.org/KB/Policies/Pages/default.aspx, and for more information about veterinary compounding, visit http://www.avma.org/KB/Resources/Reference/Pages/Compounding.aspx.

Douglas G. Aspros, DVM

10 Issue 6/2013 | ModernEquineVet.com

‘Common cold’When researchers started doing titers to see how much equine influenza there was, they found pretty high titers of rhino-viruses, which cause the common cold in people.

At a prevalence of around 75%, equine rhinitis A and B (ERA, ERB) are more prevalent in horses than anyone thought, according to Laurent Viel, DVM, MSc, PhD, professor of large animal inter-nal medicine at the University of Guelph Ontario Veterinary Col-lege in Canada.

“In early 2,000, we were asked to look at respiratory outbreaks in

Canada and let the World Health Organization know when equine influenza appeared,” Viel ex-plained. “People just weren’t vacci-nating their horses. But we found not only influenza was prevalent, but so was rhinovirus A. We found that when you challenge a horse, it gets a substantial respiratory in-fection. Some of these outbreaks that people thought were influen-za were actually rhinitis.”

Rhinovirus is a respiratory vi-rus that causes flu-like symptoms in a variety of species, including people and horses.

“It is not a horse-specific vi-

B y M a r i e R o s e n t h a l , M s

Vaccinate to protect horses against

equine rhinitis

common problem in horses

Nasal secretions in a horse with ERAV. Photo courtesy of Dr. Viel.

ModernEquineVet.com | Issue 6/2013 11

rus,” explained Nicola Pusterla, DrMedVeT, MedVet, professor of medicine and epidemiology at the University of California, Da-vis, School of Veterinary Medi-cine. “But it has been associated with outbreaks of the upper re-spiratory tract among horses. In-fections occur generally in young horses, and there is a very good report from Canada that shows that it is one of the most common respiratory viruses associated with outbreaks at the race tracks.”

Rhinovirus is a fairly “new” vi-rus in horses in that it was only recently recognized as causing substantial disease in equids, be-cause people often attribute the clinical signs to herpesvirus or influenza, Pusterla said.

“You usually don’t die from a rhinitis virus, but it can cause significant respiratory illness,” added Viel. “We just don’t know a lot about the virus in horses.”

Young horses are at higher risk than older adults, but older horses can also be susceptible, although they usually have some partial immunity. Once infected, a horse does develop some natu-ral immunity, but no one knows how long it lasts.

During the initial examination, a veterinarian would not be able to differentiate among the various respiratory diseases, so the gold standard for testing is serology and PCR rather than culture.

Young horses usually develop fever with a temperature of about 102° to 104° F and mild depres-sion. They will develop nasal se-cretions that start out thin and eventually become thick and pu-rulent, but they generally do not cough as much as they do with influenza. Their lymph nodes are usually swollen.

It is costly when the disease occurs in racehorses, because these horses must be kept from competition until they recover, and it can take months before

they are racing, again. “There are no specific antiviral

drugs to treat ERV A or B, so you must treat it symptomatically,” said Pusterla. “Treatment is the same as for other respiratory infections: address the fever, rest the horse, and confine the affected horse to prevent spreading the virus.

“You should not race or exer-cise any horse that is affected to prevent any secondary complica-tions, such as bacterial broncho-pneumonia,” he said.

Because there is no antivirals available for treatment, vaccination is the best course, they both said.

Regular vaccination with the new Equine Rhinitis A Vaccine (Boeh-ringer Ingelheim Vetmedica) will prevent disease and minimize the shedding.

“The reality is that when we have outbreaks, we can find the cause in about 30-50% of out-breaks. The vaccine is a tremen-dous step in the right direction in improving the area of preven-tion for respiratory diseases in the equine field.

“You want to vaccinate before the show season, before horses get comingled, maybe even ear-lier in the winter when animals go to sales and training facilities,”

said Pusterla. Viel believes that many horses

show mild signs with substantial viral shedding before horses show more apparent clinical signs, which makes it a difficult virus to contain at tracks and on large farms, which is why he recom-mends vaccinating against ERA.

“It is probably spread more from droplets and nasal secretions than from airborne spray and shared equipment fomites,” Viel said.

And can also be excreted from the urine, which will also make it harder to contain, according to Pusterla.

“There are no good experi-mental studies or a lot of longi-tudinal surveys of the disease. If you compare it to flu or equine herpesvirus, we need to assume that by the time the animal is fe-brile, it is almost at the peak of its shedding and the shedding can be variable, 6 to 10 days.

“In healthy horses you can find ERA in the urine for weeks. The question is when does this virus transition from the respiratory tract to the urinary tract epithe-lium and how long does it stay in the urinary tract. I don’t think there are good studies to answer these questions.”. MeV

Electron microscopy of ERAV Photos courtesy of Dr. Viel.

infECTioUs disEAsEs

12 Issue 6/2013 | ModernEquineVet.com

By Emily Caldwell The Ohio State University

Pairing an equine veterinarian and a burn surgeon is providing a second chance for a horse that was doused in flammable liquid and set on fire late last summer.

No suspect has been identified in the case, but Pennsylvania law enforcement is pursuing this case.

The Ohio State University doc-tors and their teams have part-nered to perform two skin grafts on Northstar, an American Paint, which suffered severe burns to almost half of his body.

The same instruments used for a human burn victim were used for the horse’s grafting procedures. The clinicians removed ultrathin sheets of skin from Northstar’s chest and expanded them with a meshing tool before placing the grafts across an enormous wound spanning the horse’s back.

Northstar was burned down to the bone at the base of the neck

when he arrived in Columbus on Sept. 5, 2012, and his progno-sis was not good. Skin damage extended from his neck to the base of his tail and along both of his sides.

“There’s been a lot of trial and error with the challenges of how to bandage him, what the most ap-propriate antiseptic is for cleaning the wound bed, and the biology of burned tissue in a horse,” said Samuel Hurcombe, BSc, BVMS, MS, SACVIM, DACVECC, as-

sistant professor of veterinary clinical sciences and the leader of Northstar’s care team.

Veterinary experts got the healing off to a good start with relentless wound management, a series of smaller skin grafts and the implantation of cell cultures in the wound bed. These procedures were performed to bring top-layer skin tissue to the central area of the expansive wound bed on North-star’s neck and shoulders, where all his skin had burned away.

To address the large wound across the horse’s back, Hurcombe consulted Larry Jones, MD, director of the burn center at Ohio State’s Wexner Medical Center. The two observed one another’s surgeries and studied human- and veterinary-medicine journal ar-ticles before teaming to accelerate Northstar’s care.

GraftingThe thickness of the graft is

different for a horse than a person,

nEws noTEs

one Health: working to save equine burn victim

Dr. Samuel Hurcombe and NorthstarDr. Samuel Hurcombe, BVMS from The Ohio State University Veterinary Medical Center comforts Northstar before surgery. The horse underwent two surgeries to repair burn wounds to his back.

Doctors who collaborated on surgeryDr. Samuel Hurcombe (left) from The Ohio State University Veterinary Medical Center and Dr. Larry Jones (right) from The Ohio State University Wexner Medi-cal Center collaborated on the historic surgery for Northstar.

Veterinarian and

burn specialist apply

human burn medicine

techniques to rescue

American paint.

ModernEquineVet.com | Issue 6/2013 13

according to Jones, who led the two larger skin graft procedures.

“We want to take the top layer of skin but we also need a portion of the second layer, the dermis,” he said. “I knew I had to take a graft that’s about twice as thick as one I would take if I were operating on a human.”

The team then ran the graft through a mesher that cut holes in the graft skin and allowed for expansion of the graft to about four times its original size. “When the graft takes, the holes will fill in from skin cells growing from the edges,” Jones said.

They dressed the wounds with bandages containing medical-grade silver, which functions as an antibiotic, to speed healing of the grafts and the donor sites.

At this stage of the horse’s recovery, more than half of the initial wound is healed, with the repair resulting from both the various skin grafting proce-dures and normal closure along the edges of the damaged skin. Just as human burn victims do,

Northstar will likely undergo a series of graft surgeries before he is healed completely.

“It’s a slow process but even in the time we’ve been caring for him, he has made remark-able progress,” said Hurcombe, a specialist in equine emergency and critical care. “From a welfare standpoint, his psychology is great and after what he’s gone through, the fact that he is still so trusting of people is pretty amazing.”

no dark horseWhile he initially appeared

to be a dark horse for recovery, Northstar persevered through weeks of daily cleansing and removal of dead and infected tis-sue followed by the application of antiseptics, honey, aloe and silver sulfadiazine cream, a common human burn treatment, to his damaged tissue.

In yet another application of human medicine, the team has treated Northstar with gabapentin (Neurontin, Pfizer), a medication used for human neuropathic pain,

to treat the severe itching and nerve-related pain that is typical in burn patients as they recover.

Northstar, who turned 7 in January, is a “young, naughty boy” and would love nothing more than to toss himself to the ground and roll on his back to scratch that persistent itch, Hurcombe said. So the horse is gently tethered to keep him standing, and he wears a cradle that immobilizes his neck several hours throughout the day. He is also covered in bandages and wears a full-body “sleazy.”

The road ahead is a long one, both physicians acknowledge, but they hope Northstar has a complete layer of skin coverage by his eighth birthday. The location of his back wound is tricky to treat because the horse anatomy is such that Northstar’s every movement disturbs the grafted areas even with secure bandages from his neck to his tail.

Northstar’s owners live in northwestern Pennsylvania, where police have investigated the burn-ing incident as a criminal case.MeV

Northstar recovers from burn woundsDoctors from The Ohio State University Veterinary Medical Center are currently treating Northstar with methods commonly used on human burn victims.

Preparations before surgeryThe teams at The Ohio State University Wexner Medical Center and The Ohio State University Galbreath Equine Center work together to prep the horse for surgery. Northstar received skin grafts across his back in a historic surgery.

AAEVT MembershipAAEVT* membership is open to US and international equine veterinary technicians, assistants, practice managers, and support staff employed in the veterinary industry. It is also open to students of AVMA/CVMA accredited programs

AAEVT MembershipBi-Annual NewsletterWeekly “HoofBeats” email NEwsblastFull access to www.aaevt.org, including the Career Center and the LibraryUp-to-date information on the AAEVTDiscounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT ConventionNTRA, Working Advantage and Platinum Performance BenefitsThe opportunity to participate in the AAEVT Online Certification Program or to become a member of the AEVNT Academy-Specialty in Equine Veterinary Nursing Scholarship opportunities. AAEVT’s Equine Manual for Veterinary Technicians (Blackwell Publishing 20% discount on purchase price)Subscription to THE HORSE Magazine, compliments of Intervet Schering/Plough Opportunity to attend Purina’s Annual Equine Veterinary Technician Conference - All Expenses paid!

••••••••

••

•

AAEVT ObjectivesProvide opportunities for CE, training, communication, and networkingEducate the equine veterinary community and the public about our professionInform Members of issues affecting our professionAssist in providing the best medical care to improve the health and welfare of the horse

••••

AAEVT Online Equine Certification Program

For more information visit www.aaevt.org*American Association of Equine Veterinary Technicians and Assistants

AAEVT Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.

A three course, 10 module, equine-only online program offered through ACTGeared toward Credentialed Veterinary Technicians, Assistants, Support staff, & StudentsAreas of study include: equine medical terminology, anatomy and physiology, parasitology, laboratory, diagnostics, equine basics (breeds, wellness, husbandry,) diagnostic procedures, emergency medicine, restraint, pharmacology, surgical assistance and anesthesia, equine office proceduresA certificate of completion is awarded to those who: Successfully complete required courses Complete the list of required skills (per a supervising DVM who is an AAEP member) Attend an AAEVT regional CE symposium and participate in the we labsThose individuals who successfully complete the programs will be recognized as AAEVT Certified Equine Veterinary Technicians / AAEVT Certified Equine Veterinary Assistants depending on their current designation. The certificate is recognized by the AAEVT and the AAEP but does not grant the credentialed status by the AVMAFor more information go to www.aaevt.4act.com or call 800-357-3182

•••

•

•

•

AAEVT MembershipAAEVT* membership is open to US and international equine veterinary technicians, assistants, practice managers, and support staff employed in the veterinary industry. It is also open to students of AVMA/CVMA accredited programs

AAEVT MembershipBi-Annual NewsletterWeekly “HoofBeats” email NEwsblastFull access to www.aaevt.org, including the Career Center and the LibraryUp-to-date information on the AAEVTDiscounted registration for AAEVT Regional Meetings and the annual AAEP/AAEVT ConventionNTRA, Working Advantage and Platinum Performance BenefitsThe opportunity to participate in the AAEVT Online Certification Program or to become a member of the AEVNT Academy-Specialty in Equine Veterinary Nursing Scholarship opportunities. AAEVT’s Equine Manual for Veterinary Technicians (Blackwell Publishing 20% discount on purchase price)Subscription to THE HORSE Magazine, compliments of Intervet Schering/Plough Opportunity to attend Purina’s Annual Equine Veterinary Technician Conference - All Expenses paid!

••••••••

••

•

AAEVT ObjectivesProvide opportunities for CE, training, communication, and networkingEducate the equine veterinary community and the public about our professionInform Members of issues affecting our professionAssist in providing the best medical care to improve the health and welfare of the horse

••••

AAEVT Online Equine Certification Program

For more information visit www.aaevt.org*American Association of Equine Veterinary Technicians and Assistants

AAEVT Mission Statement: To promote the health and welfare of the horse through the education and professional enrichment of the equine veterinary technician and assistant.

A three course, 10 module, equine-only online program offered through ACTGeared toward Credentialed Veterinary Technicians, Assistants, Support staff, & StudentsAreas of study include: equine medical terminology, anatomy and physiology, parasitology, laboratory, diagnostics, equine basics (breeds, wellness, husbandry,) diagnostic procedures, emergency medicine, restraint, pharmacology, surgical assistance and anesthesia, equine office proceduresA certificate of completion is awarded to those who: Successfully complete required courses Complete the list of required skills (per a supervising DVM who is an AAEP member) Attend an AAEVT regional CE symposium and participate in the we labsThose individuals who successfully complete the programs will be recognized as AAEVT Certified Equine Veterinary Technicians / AAEVT Certified Equine Veterinary Assistants depending on their current designation. The certificate is recognized by the AAEVT and the AAEP but does not grant the credentialed status by the AVMAFor more information go to www.aaevt.4act.com or call 800-357-3182

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ModernEquineVet.com | Issue 5/2013 15

By Ali Fernandez, BS

Whether it be a routine ran-dom inspection or as a re-sponse to a complaint, your clinic can be inspected by nu-merous agencies at any time.

During the inspection, a licensed veterinarian or registered veterinary tech-nician in good standing may request, and must be granted, access to all areas of your practice.

This article is designed to help you assess your preparedness for an inspection from The Board, as well as address other key issues to keep your practice in good standing. Please note that these are general guidelines. Check with your state and local agencies for specific regulations and acceptable types of com-pliance.

overview of the processAn inspection can take from 1 hour to all day. In-

spectors will examine your physical facility and will commonly ask for access to pharmacies, medical re-cords, etc.

When an inspection is complaint driven, the in-spector may be accompanied by members of a task force or other government agency and may interview employees. They may also focus on a particular as-pect of the clinic. The person who files the complaint, as well of the details of the complaint remain anony-mous and no specifics will be disclosed to the staff. After the inspection is completed, the examiner will go over his/her findings and point out any deficien-cies with the practice owner and/or an appropriate representative. Inspectors will forward their infor-mation to The Board, who will then determine what, if any, actions need to occur to address any correc-tion to meet minimum standards of operations.

GeneralYour facilities must be clean and organized. Your

office and/or waiting room should be separate from any examination areas. Food for human consump-tion should be kept in a separate refrigerator from vaccines and refrigerated medications and should never be brought into an exam area.

Have your exit ways clearly marked and always have an appropriate amount of fire extinguishers ser-viced and ready for use.

signageMake sure that all mandatory notices are easily

accessible to your clients. This will include a veteri-nary and/or premise permit, as well as the registra-tion for your radiology equipment. If your clinic is not open to clients 24 hours, you must make sure that clients seeking services after hours are directed to a facility that can assist them. This information must be both on your answering machine and in writing at your clinic's entrance.

RadiologyRemember to have the appropriate signage at

the entrance of your radiology room/area. Minors and women who may be pregnant should not be exposed to any radiation. Staff members perform-ing radiology should have both the proper personal safety equipment and a personal radiation monitor-ing badge. Many states also require that any non-registered staff be properly trained and the training record be sent to the state prior to participating in radiology. All training documentation and radiol-ogy registration and information must be properly maintained and available for viewing.

Mobile unitsMobile veterinarians and their vehicles have be-

come a hot topic. Although the type of vehicle is not regulated, as a minimum, it must contain hot and cold water as well as have access to 110-volt power. The Drug Enforcement Administration currently prohibits veterinarians from transporting, using or distributing any controlled substance from a loca-tion other than the physical address on their DEA license. Although there is a bill aimed at amending the Controlled Substances Act, it is important to re-member that your veterinarian can still be cited for having these items in the vehicle.

surgeryIf your facility performs surgery, it must have its

own distinct area within the clinic. It should be as aseptic as possible, and have no windows, doors, etc. leading directly to the outside. It should have proper ventilation and heating to ensure the com-fort of both the staff and their patients. Emergency/back up power and lighting should also be available for this area.

Make sure that your equipment is cleaned after

Expect the unexpected — How to prepare your clinic for an inspection

TECHniCiAn UpdATE

16 Issue 5/2013 | ModernEquineVet.com

TECHniCiAn UpdATE

each use. Proper anesthetic monitoring equipment should be available at all times during surgery. All of your surgical tools should be kept sterile. Although there is no expiration date for sterility of a packaged product, many inspectors will ask about a protocol for monitoring and/or re-sterilizing tools.

controlled substancesMany of the drugs used daily are classified as a

controlled substance. Substances are classified on their likelihood to be abused. Because of this, con-trolled substances, such as butorphanol, ketamine and diazepam, should be closely monitored. The substances should be kept in a double-locked area only available to the staff. Their use should be prop-erly recorded, including ID number/address, pa-tient, directing veterinarian, recording staff mem-ber, amount used/wasted and a total of the drug on hand. The on hand amount should relate to a total within the open bottle so your zeroed tally should correlate with an empty bottle. Any new shipments entered into your records should also include the name and address of the distributor.

Record KeepingProper record keeping is key in any business.

Medical records should include any possible de-tails regarding your clients, patients and their care. Drugs, dosages, routes of administration, etc. are all important details to remember. Most states have a minimum time frame for keeping records (i.e. three years, seven years, etc.), although it can be in your interest to keep them longer. Although the records and diagnostic images are the property of the veteri-nary clinic, the information contained in them must be made readily available to clients if requested.

Msds sheetsAny chemicals used in your business should have

an associated Material Safety Data Sheet. These sheets must be available to staff at all times. A re-cently adopted policy requires that new MSDS con-form to an international format. These new sheets will be required to be in use by the year 2016.

MedicationsIt is important to monitor your drug inventory

regularly. Any expired medications should prompt-ly be removed from the main pharmacy area and marked as expired. There are a number of ways to properly dispose of these medications such as re-verse distribution, destruction programs, etc.

When repackaging a medication, such as break-ing down a bulk order for individual clients, be sure

to check with your local agencies regarding proper re-labeling. Compounded medications can be used when there is no FDA approved formulation for that client's need. If you need to dispense a compounded medication, you may only give the client an amount equal to no greater than three days of treatment. If a larger amount is needed, the client should be direct-ed to order from the compounding pharmacy with a prescription for the medication. When dispensing any kind of medication, it is important to maintain a veterinary-client-patient relationship.

additional Helpful HintsThere have been numerous reports of businesses

being targeted for violations of the Americans with Disabilities Act, and the veterinary world is no ex-ception. It is important to have proper signage in and around your facility. An accessible route in and out of the office, exam area, bathroom and any other public area must be properly marked and maintained. An accessible parking space and loading zone must also be marked with specific colors, wording and signage. Check with your local government's building depart-ment for regulations regarding specific requirements for accessible spaces. Although this may require some renovation of your practice, it can more than pay for itself in the long run.

employee RecordsDocumenting employee training and job de-

scriptions can be very useful to protect the liability of the practice. Most states have specific regulations relating to the approved jobs and duties for differ-ent classifications of staff. It is important to prop-erly document any employee performance reviews, or any disciplinary actions taken against them. It is an unfortunate truth that employee fraud is becom-ing increasingly common in the work place. It can be helpful to create a system of checks-and-balances between employees. This can be as easy as having records available for viewing by any employee, or having multiple employees working on a shared project." MeV

about the authorAli Fernandez graduated in 2009 from the Univer-sity of California at Davis with a BS in Animal Sci-ence, with an equine emphasis. In 2011, she joined Los Caballos Equine Practice in Galt, Calif., and has been working there as a veterinary assistant and of-fice manager. In addition, she volunteers her time to the American Association of Equine Veterinary Technicians and Assistants as a Pacific area Regional Contact.

ModernEquineVet.com | Issue 6/2013 17

With 12 cases of equine rabies already confirmed in 2013, veterinarians should be vigilant about mak-ing sure owners vaccinate their horses against this fatal zoonotic disease.

Although the incidence of equine rabies is low, it has considerable public health significance. Therefore, the AAEP recommends that rabies vaccine be a core vaccine for all equids.

The equine cases are among the hundreds of cases discovered this year in other species, including bats, cats, dogs, cows, foxes, raccoons and skunks.

“In 2011, which is the last year for which we have complete data, there were 44 confirmed cases of ra-bies in horses. But what really should be a concern for horse owners is the number of cases in wildlife as most horses are kept in areas near wildlife habitats,” said Megan Green, DVM, equine specialist in large animal veterinary services at Merial Ltd, which makes IMRAB rabies vaccine for horses.

“I’m sure every barn owner has seen skunks, foxes, raccoons and the occasional bat in and around their barns.”

Mammals contract rabies through exposure to infected secretions, usually through a bite from an infected animal, typically a wildlife source, such as raccoon, fox, skunk, or bat. Bites to horses occur most often on the muzzle, face and lower limbs. The virus migrates via nerves to the brain where it initiates rap-idly progressive, invariably fatal, encephalitis.

Clinical signs include, but are not limited to go-ing off feed, depression, excessive salivation, difficulty swallowing, lack of coordination, aggressive behavior, hyperexcitability, colic, convulsions or paralysis. These

signs are similar to other diseases affecting the horse’s nervous system, but in the case of rabies, become so severe, the horse is euthanized or dies within days.

There is no way to diagnose rabies in live animals, and veterinarians who suspect rabies must send the horse’s brain to a diagnostic laboratory where it is ex-amined for the presence of characteristic lesions.

Because it is zoonotic and just as lethal to people, any person who came in contact with the infected equid would require rabies prophylaxis.

“Horse owners have significant emotional and fi-nancial resources invested in their horses over long periods of time and consider their horses to be family,” said Green. “Their vision for the animal’s end of life tends toward retired days grazing in green pastures – not convulsions, paralysis and a painful death. MeV

Equine rabies confirmed

nEws noTEs

staying informed with oubreak AlertVeterinarians can use Merial’s Outbreak Alert program, launched in June

2011, to find out which infectious disease are occur and where. It is a good tool for evaluating risk, especially when traveling.

The program features a website with maps indicating the presence of con-firmed cases in all species, including the carriers of rabies, West Nile Virus, East-ern Equine Encephalitis, Western Equine Encephalitis, Influenza, Potomac Horse Fever and Equine Herpes Virus. Free, printable information about each of the diseases, their clinical signs and treatments, is also available on the site. MeV

2009 – 6,6942010 – 6,1552011 – 6,037

Besides the cases in horses, in the past several years, there have been

with

thousands ofincidents of animals

confirmed rabies, 92% of which were in wildlife:

Animal Rabies Cases, U.s.

Reach your veterinarians where ever they are, whenever they want.

foR adVeRTIsInG RaTes and InfoRMaTIon, eMaIlMarie Rosenthal, MS

Equine VetThe Modern