First Aid

First Aid / Emergency Care Articles

Protect Your Horse's Legs With Proper Bandaging Techniques Applying Hock Bandages Cold Therapy & Ice Bandages Leg Bandages - Bandaging Your Horse's Legs Cast Care Snakebite! Applying Pressure Bandages Applying Sweat Bandages To The Horse’s Leg Applying A Hoof And Lower Leg Bandage Emergency Chart WOUND MANAGEMENT & BANDAGING Emergency Care Tips Equine Exertional Rhabdomyolysis: Management of Sporadic Exertional

Rhabdomyolysis Heat Stroke WHEN MY HORSE IS IN A FIRE ..... Emergency Preparedness: Being Prepared During Times of Disaster.

Important Tips for Horse Owners Disaster Planning For Horse Farms Wounds in Horses Fracture Repair Guidelines to Follow During Equine Emergencies

Protect Your Horse's Legs With Proper Bandaging Techniques

The following article is provided as a courtesy and service to the horse industry by the American Association of Equine Practitioners.

There may be any number of occasions when you will need to bandage your horse’s legs. Bandaging can provide both protection and support for the horse while working, traveling, resting or recovering from an injury.

Regardless of the purpose, it is essential that you use proper leg bandaging techniques. Applied incorrectly, bandages may not only fail to do their job, but also may cause discomfort, restrict blood flow and potentially damage tendons and other tissue.

It is often said that it is better to leave a horse’s legs unbandaged than to bandage them incorrectly. Fortunately, there is nothing complicated about learning to apply bandages. It simply takes the right materials and a bit of practice. If you have never bandaged a horse’s legs, ask your veterinarian to demonstrate the proper techniques. Practice under his or her supervision before doing it on your own.

Follow these basic guidelines from the American Association of Equine Practitioners (AAEP) when bandaging a horse’s leg:

1. Start with clean, dry legs and bandages. If there is a wound, make sure it has been cleaned, rinsed and dressed according to your veterinarian’s recommendations.

2. Use a thickness of an inch or more of soft, clean padding to protect the leg beneath the bandage. Apply padding so it lies flat and wrinkle-free against the skin.

3. Start the wrap at the inside of the cannon bone above the fetlock joint. Do not begin or end over a joint, as movement will tend to loosen the bandage and cause it to unwrap.

4. Wrap the leg from front to back, outside to inside (counterclockwise on left legs, clockwise on right legs).

5. Wrap in a spiral pattern, working down the leg and up again, overlapping the preceding layer by 50 percent.

6. Use smooth, uniform pressure on the support bandage to compress the padding. Make sure no lumps or ridges form beneath the bandage.

7. Be careful not to wrap the legs too tightly, creating pressure points.

8. Avoid applying bandages too loosely. If loose bandages slip, they will not provide proper support and may endanger the horse.

9. Leg padding and bandages should extend below the coronet band of the hoof to protect the area (this is especially important when trailering).

10. Extend the bandages to within one-half inch of the padding at the top and bottom. If there is a potential problem with bedding or debris getting into the bandage, seal the openings with a loose wrap of flexible adhesive bandage.

For more information about bandaging techniques, ask your equine veterinarian for the “Leg Bandages” brochure, one in a series of eight bandaging brochures produced by the AAEP in partnership with 3M Animal Care Products. More bandaging information is also available on the AAEP’s horse health web site, www.myHorseMatters.com.

The American Association of Equine Practitioners, headquartered in Lexington, Kentucky, was founded in 1954 as a non-profit organization dedicated to the health and welfare of the horse. Currently, AAEP reaches more than 5 million horse owners through its 6,500 members worldwide and is actively involved in ethics issues, practice management, research and continuing education in the equine veterinary profession and horse industry.

posted: 9/3/2002. Last updated: 9/3/2002.

Applying Hock Bandages

A horse uses its hock in nearly everything it does-from stopping and standing to walking and galloping. Constant use and a prominently exposed point make hocks vulnerable to stress, fatigue and traumatic injury.

Your veterinarian may recommend a hock bandage in any number of situations, such as: following surgery; providing joint support for a weak foal; protecting a wound; or reducing heat and swelling in a strained joint.

Hock bandages are used to:- Prevent or reduce swelling and edema- Reduce motion in the joint- Provide support for a weak or injured joint- Protect a wound or surgical site from contamination or trauma- Aid in the healing of wounds- Absorb fluids (exudates)

The Challenge

Applying a hock bandage is not without its challenges. Because of the shape and motion of the joint, it requires special techniques to make the hock bandage safe, secure and effective.Horses also tend to react more to a hock bandage than a lower leg bandage, and may be inclined to kick, fight or fidget. Stay alert and be prepared to move out of harm’s way if the horse reacts adversely to its hock bandage.

As with any type of bandage, a hock bandage can be hazardous if applied incorrectly. There is always the risk of injury to circulation, and to the tendons and ligaments if the layers are not applied smoothly, evenly and with the right amount of tension.If you have never bandaged a horse’s legs before, ask your veterinarian or an experienced equine professional to demonstrate the proper techniques. Practice under his or her supervision before doing it on your own.

Bandaging Materials

Because of the bandage’s location, you will need materials that readily conform to the shape of the hock and permit movement without slipping or loosening. If the bandage will cover a wound or surgical site, the materials should also be sterile.

You will need:- Sterile, Non-Stick Gauze Pads or dressing to cover wounds- Sheet Cotton, Roll Cotton, or Combine Cotton for padding- Stretch Gauze or Bandaging Tape such as 3M Vetrap Bandaging Tape at least 2-3 inches wide for support.- Stretch Adhesive Tape such as Elastikon, to secure the bandage.

Hock Bandaging Guidelines

1) Cover the wound or surgical site with sterile, non-stick gauze or dressing.2) Surround the hock with soft, absorbent padding, such as roll or sheet cotton

or combine sheet at least two inches thick. Padding should extend 4-6 inches

above and below the point of the hock and lie flat and wrinkle-free against the skin.

3) Begin wrapping with support fabric well below the point of the hock (approximately one-half inch above the edge of the padding).

4) Wrap front to back, outside to inside, spiraling upward (clockwise in right legs, counterclockwise in left legs). Exert just enough pull to stretch the fabric to half its maximum extended length.

5) Overlap each preceding layer by 50 percent using smooth, uniform tension to compress the padding without forming lumps or ridges beneath the bandage.

6) Begin a figure 8 pattern just below the point of the hock by extending the bandage from inside the leg below the point of the hock to the outside of the leg above the point of the hock. Continue the wrap around the back of the leg and then extend it downward inside to outside.

7) Repeat this figure 8 pattern working up the leg until the bandage extends 4-6 inches above the point of the hock, covering the padding to one-half inch of the edge.

8) Depending on the nature and location of the injury, your veterinarian will advise you whether or not to cover the point of the hock with the support layer. (The horse may be more comfortable if the hock is not completely encased.)

9) When bandaging, use enough pressure to minimize swelling and keep the bandage in place, but never wrap so tightly that you cannot easily slip a finger between the top of the bandage and the tendon that runs up the back of the leg above the point of the hock.

10) Do not wrap too loosely as the bandage may slip or fail to do its job.

11) Secure the bandage at the top and bottom with an adhesive tape such as Elastikon.

12) If you have problems with the hock bandage slipping, begin by wrapping the lower leg from coronet band to several inches below the hock.* This provides a foundation for the hock bandage and will help keep it in place. This technique is especially useful in post-legged (straight-hocked) horses and is usually used when horses have edema or swelling below the hock as well as within the hock area.

Special Considerations

Because hocks are such vital structures, any injury to the joint or immediate area should be evaluated by a veterinarian.

If a hock bandage is required, do not be disappointed if your initial efforts are less than satisfactory. Even under the best of circumstances, the hock is a difficult place to secure a bandage. Work with you veterinarian, and, if necessary, employ him or her to change the bandage as needed.

Following are some additional considerations:

A horse with a condition requiring a hock bandage should be confined to a stall or small run unless otherwise directed by your veterinarian.

Check the bandage several times a day to make sure it has not shifted or loosened.

Make sure the bandage does not cut off circulation, pinch the tendon at the back of the leg, create pressure sores, or cause discomfort.

Monitor and evaluate the horse carefully. If swelling develops above the bandage or at the point of the hock, or lameness increases, contact your veterinarian.

If the horse has an elevated temperature, becomes depressed or irritable, or loses its appetite, consult your veterinarian.

Change the bandage at least every 2-3 days, or immediately if it becomes wet or soiled.

If you have any further questions or concerns about hock bandaging techniques, contact your local equine veterinarian.

This information was produced through a joint venture between 3M Animal Care Products and the American Association of Equine Practitioners.

Keyword: 3M Hock

keywords: 3M Hock. posted: 6/16/2002. Last updated: 6/16/2002.

Cold Therapy & Ice Bandages

When a horse injures a leg, many times the first - and best – course of action is to cool the area as quickly as possible using ice packs or very cold water. Your immediate goal is to try to reduce inflammation and swelling in order to minimize tissue damage and speed healing. Ice slows the inflammatory process while other treatments such as medications can begin to take effect.Care must be taken, however, whenever cold therapy is applied to a limb. Ice wraps used incorrectly or applied for too long can potentially damage the skin and underlying tissue.To maximize the therapeutic benefits of ice or cold therapy, follow your veterinarian’s instructions exactly and keep in mind the recommendations contained in this brochure.

How Cold or Ice Can Help

Applying ice or cold therapy can improve a variety of tendon, joint, muscle and other soft tissue injuries by decreasing blood flow to the damaged area and slowing the metabolism of the surrounding tissue so it is less likely to suffer damage from swelling and constriction. Cold therapy helps to:

- Reduce Inflammation- Reduce Swelling- Dissipate Heat- Alleviate Pain- Slow Bleeding

Applying Cold or Ice

The best method for applying ice or cold therapy will depend on the type and location of the injury, as well as the materials you have at your disposal.

Ice packs may be either rigid or flexible depending on their contents. You will need to determine what works best for the area you are treating.

You can make an ice pack using a resealable plastic bag to hold slab or crushed ice. Crushed ice releases its cooling properties more quickly and the pack will conform more readily to the shape of the limb. A bag of frozen vegetables (such as peas & corn) is also a convenient and ready-made ice pack. Chemical ice packs such as the "blue ice" commonly used in picnic coolers also work well. Commercial ice bandages designed for specific parts of the horse’s leg are also available.

There are also special chemical pouches that produce a rapid freezing reaction when activated. Chemical ice packs are especially useful additions to first aid kits.

Another option for lower limbs is to use a bucket or ice boot filled with ice water. Running cold water over the injury site with a hose is also a convenient way to reduce heat and swelling at the injury site.

General Recommendations

1) Contact your veterinarian and explain the symptoms and location of the injury.

2) Request immediate veterinary help if lameness is severe or the horse resists moving.

3) If cold therapy is recommended, begin the initial application as soon as possible. The first 24-48 hours are key.

4) Use proper leg bandage techniques so you can position the ice pack without constricting the blood supply to the leg or damaging tendons.

5) Apply ice for approximately 5 minutes at a time, but no more than 10-15 minutes. A rule of thumb is 5 minutes on, 15 minutes off until heat and swelling are perceptibly reduced.

6) Repeat cold therapy every 4-6 hours within the first day of treatment or as otherwise recommended by your veterinarian.

7) Use a damp cloth or sheet cotton as a buffer between the ice pack and the horse’s skin to protect the tissue and dissipate the cold.

8) Chemically activated cold packs may require more layers of fabric to buffer the skin and prevent frostbite.

9) Do not place ice directly against the skin if there is an open wound. Utilize several layers of cotton gauze to protect tissue and absorb fluids.

10) If possible, place a bandage on the area between treatments to prolong the benefits and help reduce swelling. Again, make sure to use proper leg bandaging techniques.

11) Get veterinary help if the lameness lasts longer than 1 day without significant improvement.

Bandaging Guidelines

When applying an ice bandage, although the bandage will be in place for only short period of time, it is still important to follow these safety guidelines.

Place a cloth between the ice pack and the skin.

Use gauze or a bandaging material such as 3M Vetrap Bandaging Tape that has enough strength, stretch and cohesion to conform to the leg and hold the ice pack in place.

Wrap in a spiral pattern, overlapping layers with smooth, uniform pressure. Be careful not to bandage the leg too tightly or create any pressure points. Some

veterinarians recommend wrapping from front to back, outside to inside-counterclockwise for left legs, clockwise for right legs-to prevent tendons from being pulled outward from the cannon bone and vessels, and to reduce the likelihood of constriction. While your horse is recovering, pay close attention to its progress. Contact your veterinarian immediately if you observe any of the following:

1) Increased pain or lameness.

2) Discharge from a wound that has a foul odor, unusual color or seems to be excessive.

3) Excessive swelling.

4) Increased warmth at the injury site.

5) Elevated body temperature (100F+ or –1 is considered normal.

6) Recumbency - horse spends an abnormal amount of time lying down.

7) Lack of appetite or depression.

Talk with Your Veterinarian

If you have questions or concerns, your equine veterinarian will be your greatest asset. Do not hesitate to call. He or she can address problems that need to be handled or alleviate any unnecessary worry. It is a health care partnership, with your horse’s well being at the heart of it.


Keyword: 3M Ice

keywords: 3M Ice. posted: 6/16/2002. Last updated: 6/16/2002.

Leg Bandages - Bandaging Your Horse's LegsThere may be any number of occasions when you will need or want to bandage your horse’s legs. Bandaging can provide both protection and support for the horse while working, traveling, resting or recovering from an injury.

For whatever purpose, it is essential that you use proper leg bandaging techniques. Applied incorrectly, bandages may not only fail to do their job, they can cause discomfort, restrict blood flow and potentially damage tendons and other tissue.

It is often said that it is better to leave a horse’s legs unbandaged than to bandage them incorrectly. Fortunately, there is nothing complicated about learning to do this. It simply takes the right materials and a bit of practice.

Reasons To Bandage

Leg bandages are beneficial for several reasons:

- Provide support for tendons and ligaments during strenuous workouts- Prevent or reduces swelling (edema) after exercise, injury or during stall rest

- Protect legs from concussion and impact

- Shield leg wounds from contamination and aid in healing.

Materials

A proper leg bandage generally has two or more layers; an ample amount of padding secured by a support bandage and sometimes a protective outer layer. If a wound is involved, gauze pads or a sterile, absorbent dressing may be required as well.

Padding is essential for protecting limbs. At least an inch or more soft, cushioning material should be placed between the limb and the bandage to help disperse the pressure evenly and prevent blood flow from being restricted. Roll cotton, sheet cotton or leg quilts work well and are lightweight and comfortable.

Generally, the longer a bandage is to remain in place, the greater is the amount of padding needed.

There are many choices of bandaging materials, including track or polo wraps, cotton flannels, roll gauze or bandaging tapes such as 3M Vetrap Bandaging Tape, Elastikon and similar products.

The bandaging material should be at least two inches wide to avoid a tourniquet-like effect and allow for sufficient overlap as the leg is wrapped. Using stretch fabric makes joint bandaging easier, allows for movement, and is less apt to cut off circulation as long as it is not pulled too tightly.

General Guidelines

If you have never bandaged a horse’s legs before, ask your veterinarian or an experienced equine professional to demonstrate the proper techniques. Practice under his or her supervision before doing it on your own.

Follow these basic guidelines:

Remove dirt, debris, soap residue or moisture to prevent skin irritation and dermatitis. Start with clean, dry legs and bandages.

If there is a wound, make sure it has been properly cleaned, rinsed and dressed according to your veterinarian’s recommendations.

Use a thickness of an inch or more of soft, clean padding to protect the leg beneath the bandage.

Apply padding so it lies flat and wrinkle-free against the skin.

Start the wrap at the inside of the cannon bone above the fetlock joint. Do not begin or end over joints - as movement will tend to loosen the bandage and cause it to come unwrapped.

Wrap the leg from front to back, outside to inside (counterclockwise in left legs, clockwise in right legs).

Wrap in a spiral pattern, working down the leg and up again, overlapping the preceding layer by 50 percent.

Use smooth, uniform pressure on the support bandage to compress the padding. Make sure no lumps or ridges form beneath the bandage.

Be careful not to wrap the legs too tightly, creating pressure points.

Avoid applying bandages too loosely. If loose bandages slip, they will not provide proper support and may endanger the horse.

Leg padding and bandages should extend below the coronet band of the hoof to protect the area (especially important when trailering).

Extend the bandages to within one half inch of the padding at the top and bottom.

Check bandages daily to make sure they are securely in place and not cutting off circulation.

If there is a potential problem with bedding or debris getting into the bandage, seal the openings with a loose wrap of flexible adhesive bandage such as Elastikon adhesive tape.

Rewrap the legs every 1-2 days to minimize the chance of circulation problems caused by slippage, or skin irritation due to dirt or debris entering the bandages.

Before rewrapping take a few minutes to examine the legs for any signs of heat, swelling or irritation. Problem areas are usually wet with perspiration.

Allow the horse ample time to become accustomed to leg bandages before trailering, riding or leaving alone in a stall.

Talk With Your Veterinarian

If you have any further questions or concerns about bandaging techniques, do not hesitate to contact your veterinarian. As your animal health care partner, your equine practitioner has your horse’s well being at heart. He or she is always happy to explain and demonstrate sound health care practices.


Keyword: 3M Leg

keywords: 3M Leg . posted: 6/16/2002. Last updated: 8/2/2005.

Cast Care

Your horse has been fitted with a cast to give it the best possible chance of recovery. A cast provides both protection and support and thereby gives the horse’s injury a chance to heal.

Because you can’t actually see what’s happening beneath a cast, caring for a convalescent horse can seem a bit daunting. You can ease your mind and decrease the chances of complications by knowing what to watch for and what to do. You’ll also keep your horse more comfortable and help speed healing. Careful observation will be your best tool.

YOUR HORSE’S CAST

Casts are used for a variety of problems such as some bone fractures, tendon and ligament injuries, wounds, and abnormal growth and development.

Several important functions are:

- First Aid Tool- Immobilization of Limbs

- Overcoming Tension – keeping skin from pulling apart at wound sites

- Rigid Support – allows horse to stand and use limb during convalescence

- Protection and Reduced Concussion to Limb

- External Support – reinforcement for internal fixation devices such as plates or screws used in fracture repair

BETTER TECHNOLOGY

Fortunately for your horse, casting materials and techniques have greatly improved over the years. Today, casts are generally made of lightweight fiberglass or plaster. They conform well to the horse’s anatomy, set quickly, and are durable, strong and porous.

A well-constructed cast permits the skin to breathe, the wound to drain, and is comfortable for the horse. Horses normally adjust quickly to wearing a cast.

The type of cast will depend on the nature and location of the injury.

Full Cast – includes the foot and extends the length of the limb to just below the elbow or stifle.

Sleeve/Tube Cast – partial cast that generally covers only a portion of the limb but does not encase the foot (usually immobilizes the knee or hock).

Half Limb/Distal Limb Cast- extends from below the knee or hock down to include the foot.

Short Cast/Foot Cast – starts below the fetlock joint and covers the foot.

SYMPTOMS FOR CONCERN

While your horse is in a cast, you will need to pay extra close attention to it. Check your horse several times a day, paying special attention to the cast area. Contact your veterinarian immediately if you observe any of the following:

1) Increased pain or lameness2) Discharge (exudates) from the cast that has a foul odor, unusual color or seems

to be excessive

3) Swelling above or below the cast

4) Focal warmth (noticeable heat emitting from the cast)

5) Elevated body temperature (100F + or – 1 is considered normal)

6) Chewing at, or other apparent irritation with the cast

7) Recumbency – horse spends an abnormal amount of time lying down

8) Secondary Wounds – rub sites or pressure sores that develop where the cast contacts the skin

9) Cast damage or breakage

10) Lack of appetite or depression

DOCTOR’S ORDERS

While your horse is in a cast, follow your veterinarian’s instructions to the letter.

1. Prevent excessive movement by keeping your horse confined to a stall.2. Check the horse regularly.

3. Keep the horse’s environment scrupulously clean and dry to prevent contamination of the cast or wound.

4. Seal the cast openings with bandaging tape (not too tight) to prevent dirt and debris from entering it. Check and change as required.

5. If the cast becomes excessively dirty or wet, contact your veterinarian. Follow cleaning and drying instructions explicitly.

6. Give medications only as prescribed by your equine practitioner.

7. Do not provide drugs or pain relievers that could mask a horse’s condition – unless specifically directed to do so by your veterinarian.

8. Do not trailer your horse while in a cast without express permission and guidance from your veterinarian.

9. Stay in close communication with your equine practitioner for guidance in monitoring and evaluating your horse’s progress.

YOUR HEALTH CARE PARTNERSHIP

Be assured that your equine practitioner will do everything in his or her power to help you get your horse out of a cast and back to work as soon as possible. If you have questions or need more information on cast care management, contact your veterinarian.

This information was produced through a joint venture between 3M Animal Care Products and The American Association of Equine Practitioners.

Keyword: 3M Cast

keywords: 3M Cast . posted: 6/16/2002. Last updated: 6/16/2002.

Snakebite!

by Kenneth L. Marcella, DVM

Snakes commonly found in the United States can cause serious injury to a horse. Horses are at the top of the list of sensitivity to snakebites and are followed in order by sheep, cows, goats, dogs, pigs, and cats. However, because a lethal dose of venom is based on body weight, most horses and cows are simply too large for snakes to kill. Other factors that affect the severity of the bite are:

Type of venom. Some snakes are deadlier than others.Location of bite. Bites to the head, face, and other areas of major blood supply are far more serious than bites to limbs and the body. Fatalities in horses and cattle have been reported when the snakebite is on the muzzle, head, or neck.

Size and species of the victim and its age and general health and condition. Dogs are most commonly bitten because of their aggressive and inquisitive nature. Most dogs, like horses, are bitten on the muzzle face as they sniff to investigate. Given the relatively small size of the dog compared to that of the horse, many snakebites in dogs are fatal.

Poisonous snakes fall into two categories: the elapine snakes, which include the cobra, mamba and coral snake, and viperine, which include the pit vipers, such as rattlesnakes, copperheads, cottonmouths, and moccasins.

Elapine snakes have short fangs and tend to chew their victims. Their venom is mainly neurotoxic in that it affects the nervous system and kills its target by paralyzing the respiratory system.

Viperine snakes, located throughout the Americas, however, have long, hinged fangs that strike, penetrate, and withdraw. The venom of these snakes is mainly hemotoxic and causes massive damage to blood vessels and tissue loss even if the victim recovers. The main ingredients of snake venom consist of potent enzymes, peptides, and neurotoxins

Poisonous snakes can be differentiated from nonpoisonous snakes in some generally easy-to-remember ways. Poisonous snakes have an eliptical pupil, while the pupil of nonpoisonous snakes is round.

Nonpoisonous snakes have small teeth rather than fangs, and they will have a rounded head that is about the same size as their bodies. Poisonous snakes have a triangular head that is somewhat larger than their bodies and will have single scales under their tail and a pit or hole above the mouth and under the nose. Some time spent learning to recognize poisonous snakes will save some worry and may save a harmless snake’s life.

The most common snakes encountered in the U.S. are the copperhead and various types of rattlers. Rattlesnakes have both day and night vision and give birth to live, poisonous young. Most subspecies are relatively docile.

The Eastern diamondback rattler is the most dangerous American snake. It can grow up to eight feet long and weigh as much as 15 pounds. The fangs of this snake can be three-quarters of an inch long and capable of penetrating thick hides. The Western diamondback is a similar cousin but smaller in size. It is responsible for the majority of recorded deaths in the U.S. The prairie rattler and sidewinder are found in the Western states, and the timber or banded rattlesnake is a Northeastern snake often camouflaged in forested areas.

Rattlers are usually startled when they attack, such as when a horse steps over a log in the trail to find a snake dozing in the shade on the other side. Rattlers coil before striking with a strike distance of one-third to one-half of their overall length. The sound a rattler makes is caused by the clicking together of rattle segments when the tail is vibrated. The sound has been described as similar to the crackling sound of frying fat.

Perhaps the most interesting fact about snakes is that the decision to inject venom into a bite is a voluntary action and totally under the reptile’s control. Current theories are that the snake makes a decision whether the bite is protective, such as when a larger predator startles it, or whether it is aggressive and meant to kill its victim.

Many bites in horses are thought to be nonvenomous because the snake has to put a lot of biological work into making its poison and does not seek to waste it. Because the snake can sense the size of the horse, it bites only to get away. This is perhaps another reason why equine deaths from snakebites are not common.

If a horse is bitten, there are a few steps to take. If riding, prevent the horse from looking down and slowly back away. Most snakes will give larger animals a few seconds to get out of the way. The snake is trying to avoid confrontation, and you want to avoid further strikes. Try to confirm the bite and attempt to identify the snake—it may be important later in trying to determine the correct antiserum, but do not waste time looking for the snake. The primary concern is the horse.

Snakebites can be difficult to locate on the body because of hair, bleeding, or swelling, but a close examination should reveal fang marks. Viperine snake venom causes immediate swelling.

Horses bitten on the nose or muzzle can swell so much that their nostrils almost close and breathing can be difficult or impossible.

Seasoned trail riders and ranch hands carry two six-inch pieces of old garden hose that can be lubricated and inserted into the nostrils of a snakebitten horse; more than one animal has been saved with this simple procedure. The hose allows the horse to breathe until the swelling subsides with treatment.

Intense pain, nausea, muscular weakness, and shock follow a typical snakebite. If the horse has become excited or was exercising heavily prior to the bite, it is important to quiet him down. Increased heart rate causes higher blood flow and the dispersal of the poison to larger areas of the body.

A wide constricting band (handkerchief or shredded clothing) should be placed about two inches above the bite if it is on the leg. Obviously, tourniquets on the face are not indicated. The band should only be tight enough to compress the veins and lymphatic vessels and not the arteries. Your goal is to keep the venom in the bite area. This band should be as tight as the band a nurse applies when drawing blood.

Wash the bite with soap and water. If possible, trailer the horse to its stall. If you have to travel, walk the horse slowly to the nearest trailer. Do not cut the bite area. Recent research shows that this old practice actually may contribute to further damage. Also, never suck venom from a bite by mouth; you can use the rubber suction cup in a snakebite kit if one is available, but this rarely does much good and usually only serves to give you something to do until help arrives. Do not apply cold or hot compresses. Recent research positively show this to worsen the damage.

Antivenin has proved useful in horses even when given 24 hours after a head bite. There are some potential problems with antivenin, however, because it is produced in horses and therefore anaphylactic shock can occur. A veterinarian may use epinephrine to help lessen the threat of reactive shock to the serum. Corticosteroids and fluids may be necessary to counteract the effects of shock, and good management will be required to treat the tissue damage that may result.

If the owner has seen a horse bitten by a snake then the diagnosis is easy to make. Most times, however, the horse is found at pasture or in the stall with a severely swollen leg and exhibiting signs of shock. Bites by scorpions, spiders and the occasional Gila lizard must also be considered in these cases. Treatment for all of these injuries is generally similar with the use of antivenin being the biggest difference with snakebites. The appropriate antivenin must be used for individual snakes. Many states have Hot Line numbers in your area. Rural hospitals are your best bet for locating the antivenin you may need. Because of the anaphylactic response possibility be sure to have epinephrine available.

Shock is the most common problem following snakebites. The aims of treatment for snakebit horses focus on three areas—prevent or delay absorption of venom; neutralize any absorbed venom with the use of the appropriate antivenim; and fight the effects of the venom and maintain cardiorespiratory function. To this end, fluid therapy to maintain blood volume is tempered with the desire to limit the spread of venom through the body. Corticosteroids should be utilized to counter the shock and to minimize tissue destruction. Broad-spectrum antibiotics should be given and since many snakes’ mouths contain Pseudomonas bacteria, Gentacin and Penicillin are the drugs of choice. Intravenous fluids containing dextrose and DMSO (a potent antioxidant) can be given if needed.

Skin and tissue loss is managed as it would be in any other traumatic case, but the actions taken in the first hour following a snakebite will ultimately do more for the outcome than almost anything

else. A compression wrap will limit the venom to the immediate area. Reducing activity will slow down the pumping of the horse’s heart and limit the spread of the venom. Tetanus protection should be given as well. Wrapping a severely swollen leg will also limit the edema that develops after a bite and may actually reduce the amount of fibrous tissue formed in the leg.Additional snake information is available at: www.acnatsci.org/exhibits/snakes/snakebite.html www.ecis.com/~whl/saf/snakes.html

Editor’s note: This article includes excerpts reprinted with permission from an article by Dr. Kenneth L. Marcella in the July 10, 1999, issue of Thoroughbred Times. Dr. Marcella is an AAEP member and partner at Chattahoochee Equine in Canton, GA.


Applying Pressure Bandages

When a horse sustains a serious leg injury, it is sometimes necessary tostabilize the limb and control bleeding and swelling until your veterinarianarrives. A pressure bandage is an effective first aid tool that can be used toaccomplish this task.

Keep in mind, however, that any leg injury serious enough to require apressure bandage is serious enough to require immediate professional attention.You should also recognize that pressure bandages can be potentially harmful ifnot applied correctly. If you know how to correctly apply a pressure bandage,you can come to the horse’s aid without causing further damage.

PURPOSE

The purpose of the pressure bandage is to protect the injured area and controlbleeding without constricting normal circulation.

Pressure bandages are used to:

- Control Bleeding- Minimize swelling

- Provide support for an injured limb

- Absorb fluids (exudates) from a wound

- Protect a wound from contamination or additional trauma

WOUND CARE

The severity or type of injury will determine the best course of action. Ifthere is an open wound with profuse bleeding-or it appears that a major bloodvessel has been cut (blood appears to spur not trickle) – your primary concernwill be to stop the bleeding. You will probably need to forego cleaning andapply pressure to the wound immediately.

If the bleeding is light to moderate, it maybe best to cleanse the wound usingcool running water from a hose prior to bandaging. Avoid prolonged hosing (notmore than 10-12 minutes) as it may increase swelling.

A commercially available sterile saline solution or a solution of 2tablespoons plain table salt to one gallon of water can also be used.

Ideally, the saline solution should be applied with pressure to loosen andflush dirt and debris from the wound. Avoid scrubbing as this may further damagetissue, increase bleeding, or drive dirt and debris deeper into the wound.

An antibacterial soap can be used to wash the surrounding area, but careshould be taken to avoid getting soap into the wound itself.

Stress or traumatic injuries, such as bowed tendons, will benefit from beinghosed or iced for 5-10 minutes prior to applying a pressure bandage.

PRESSURE BANDAGING MATERIALS

If an open wound is involved, gauze pads, a clean cotton washcloth, sanitarypads or other sterile, non-stick dressing should be placed over the wound.

Do not use sheet or roll cotton directly against a wound. While cotton isabsorbent and provides excellent padding, the fibers will stick to the tissueand contaminate the wound.

Once the wound is covered, you should use roll cotton, sheet cotton or legquilts to pad the bandage.

Adequate padding is essential to distribute pressure evenly around the limb.

Padding should be at least 2 inches thick. This will allow you to applysufficient tension to the support bandage to control bleeding and swelling. Theextra padding will also absorb drainage from the wound.

Generally, the longer a bandage is to remain in place, the greater the amountof padding needed.

Track or polo wraps, cotton flannels, roll gauze, 3M Vetrap Bandaging Tape,

Elastikon, Ace bandages or even duct tape can be used for the external(pressure) layer.

Bandaging material should be at least 2-3 inches wide. This will help preventa tourniquet effect and allow for sufficient overlap of the layers.

Using stretch fabric makes bandaging easier, allows for movement, and is lessapt to restrict circulation as long as it is not pulled too tightly.

GENERAL GUIDELINES

If you have never bandaged a horse’s legs, ask your veterinarian or anexperienced equine professional to demonstrate the proper techniques. Practiceunder his or her supervision before doing it on your own.


1. If blood loss does not appear excessive, clean the wound, removing as muchdirt, hair and debris as possible prior to bandaging.

2. Cover open wounds with sterile, non-stick gauze or dressing. Do not applysprays or chemicals to wounds that may need to be repaired. Water-solubleointments can always be used; petroleum based ointments should not be used insurgically repairable injuries.

3. Apply soft, absorbent padding, such as roll cotton, at least 2 inches thickaround the injured limb. Make sure it lies flat and wrinkle-free against theskin.

4. To prevent slippage, begin the support bandage at the foot, covering the heelbulb and coronary band (where hoof meets hair) and work up the leg.

5. Extend the pressure bandage 4-6 inches above the injury site. If the injuryis in the lower leg, always bandage to the knee or hock.

6. Wrap the leg front to back, outside to inside (counterclockwise on left legs,clockwise on right legs).

7. Spiral support fabric upward, overlapping each proceeding layer by 50percent.

8. Use smooth, uniform tension on the bandage to compress the padding withoutforming lumps or ridges beneath the bandage.

9. Apply sufficient pressure to control the bleeding, but do not wrap so tightlythat you cannot slip a pinky finger inside the bandage.

10. Do not wrap too loosely as the pressure bandage will not doits job.

SPECIAL CONSIDERATIONS

A pressure bandage should be left in place until the veterinarianarrives.

Point out the exact location of the injury so the veterinarian canavoid disturbing it when removing the bandage.

If blood soaks through the bandage, place a second bandage over it asbefore. Do not remove it, as this could disturb any blood clots that may beforming and encourage more bleeding.

Monitor and evaluate the horse frequently. Remember, pressure bandagescan be dangerous. If swelling develops above the bandage or lameness increases,check to see that the bandage is not cutting off the circulation and seek yourveterinarian’s advice.

Watch for other problems. If the horse loses its appetite or there isan elevation in body temperature, contact your veterinarian. If the bandageappears to be too tight, cut through the support layers, leave them in place,and wrap the new bandage around the first one more loosely.

Extreme emergencies include injuries that do not stop bleeding within15-20 minutes, lacerations that extend into joints and tendons, and severebreakdowns or injuries in which the horse is unable or unwilling to walk. In anyof these situations, get veterinary assistance immediately.

If you have any further questions or concerns about pressure bandagingtechniques, contact your equine veterinarian.

This information was produced through a joint venture between 3M Animal CareProducts and the American Association of Equine Practitioners.

Keyword: 3M Pressure

keywords: 3M Pressure. posted: 6/16/2002. Last updated: 6/16/2002.

Applying Sweat Bandages To The Horse’s LegWhen your horse suffers a strain, sprain or traumatic injury, or is stallbound for extended periods, its legs may swell and become warm to the touch.Because inflammation and swelling can damage tissues and cause discomfort, yourveterinarian may prescribe a “sweat” bandage as an aid in reducing fluidbuild-up in the legs.

Although sweat bandages are effective, the science of how and why they workstill isn’t precisely understood. The purpose of the sweat bandage is togenerate heat (which may help dilate vessels and increase blood flow), addpressure and provide support.

Whatever the mechanism, the combined effect seems to help the body dissipateexcess fluid from the injury site and reduce inflammation.

While sweat bandages are useful in reducing swelling, they are generally notrecommended for recent injuries or those that include open wounds. Be sure toconsult with your veterinarian before applying one.

The Sweat Bandage

What sets a sweat bandage apart from other wraps is that a “sweating”preparation or poultice is generally applied to the leg, covered withlightweight plastic wrap, and then bandaged.

There are a variety of commercial and homemade preparations that can beused to sweat legs. The formulation your veterinarian recommends will depend onthe type of injury and his or her personal preference. Some of these may contain“osmotic” agents that actively help pull fluid from the cells.

Common ingredients used in sweat preparations include:

- DMSO (dimethylsulfoxide)- Nitrofurazone Ointment- Mineral Oil- Petroleum Jelly- Epsom Salts- Glycerin or Glycerol

Proper Bandaging Techniques

It is essential to use proper techniques when applying a sweat bandage.

Applied incorrectly, the bandage will not only fail to do its job, it can causediscomfort, restrict blood flow and potentially damage tendons and other tissue.(It is often said that it is better to leave a horse’s legs unbandaged than towrap them incorrectly.)

Remember, padding is essential for protecting limbs. At least an inch ormore of soft, cushioning material should be placed between the limb and the

support bandage to distribute the pressure evenly and prevent blood flow frombeing restricted.

MaterialsMaterials needed for the sweat bandage include:

- Sweating compound (preparation)- Lightweight plastic wrap (kitchen varieties work well)

- Sheet cotton, roll cotton, combine cotton, or leg quilts for padding

- Flannels, stretch gauze, stable wraps or stretch bandaging tape such as3M Vetrap Bandaging Tape at least 2-3 inches wide for support

- Stretch adhesive tape such as Elastikon Elastic Adhesive Tape toprotect, seal and secure the bandage

Note: Commercial poultices are available.

General Guidelines

If you have never bandaged a horse’s legs before, ask your veterinarian oran experienced equine professional to demonstrate the proper techniques.Practice under his or her supervision before doing it on your own.


1. Start with clean, dry legs and bandages.2. Applying sweating preparation liberally to the entire segment of the leg to

be bandaged.

3. Surround the leg completely with plastic wrap, keeping the layers as smoothas possible.

4. Apply padding over the plastic wrap, encircling the leg with an inch or moreof cotton or quilting. Make sure that it lies flat and wrinkle-free against theskin.

5. Wrap the leg with support bandaging fabric at least 2-3’ wide, working fromfront to back, outside to inside (counterclockwise in left legs, clockwise inright legs).

6. Wrap in a spiral pattern, beginning at midpoint and working down the leg andup again.

7. Overlap each preceding layer by 50 percent, exerting just enough pull tostretch the fabric to half its maximum extended length.

8. Use smooth, uniform tension to compress the padding without forming lumps orridges beneath the bandage.

9. Use enough pressure to minimize swelling and keep the bandage in place, butnever wrap so tightly that you cannot easily slip finger between the bandage andleg.

10. Avoid applying bandages too loosely. Loose bandages are ineffective andmayendanger the horse.

11. Extend the support fabric to within a half-inch of the padding at thetop and bottom.

12. Check bandage periodically to make sure it is secure yet notinterrupting circulation.

13. If there is a potential problem with bedding or debris getting into thebandage, seal the top and bottom of the bandage with a flexible adhesive bandaging tape such as Elastikon tape.

Special Considerations

- Do not leave the sweat bandage on for more than 12 hours. After 12hours, remove the wrap, allow the leg to “rest” for 12 hours, and reapply thesweat bandage if necessary.

- After unwrapping, take a few minutes to examine the leg. It should benoticeably improved. If there are signs of increased heat, swelling, drainage orskin irritation due to the sweat, consult your veterinarian.

- A horse with a condition requiring a sweat bandage should be confinedto a stall or small run unless otherwise directed by your veterinarian.

- If DMSO is an ingredient in the sweating compound, make sure thehorse’s skin is dry before applying it to reduce the chance of skin irritation.Wear gloves to protect your hands.

- Check the bandage several times a day to make sure it has nottightened, loosened or slipped out of place.

- Make sure the bandage does not cut off circulation, compress tendons,create pressure sores or cause skin irritation, redness or discomfort.

- Monitor and evaluate the horse carefully. If swelling develops above orbelow the bandage, lameness increases, or the horse becomes distressed or beginsto bite, paw or rub the bandaged site, check the leg and contact yourveterinarian.

- Watch for any other signs of ill health. If the horse becomesdepressed, irritable, loses its appetite or has an elevated temperature, consultyour veterinarian.

- If you have any further questions or concerns about sweat bandaging,contact your veterinarian.

This information was produced through a joint venture between 3M Animal CareProducts and the American Association of Equine Practitioners.

Keyword: 3M Sweat

keywords: 3M Sweat . posted: 6/16/2002. Last updated: 6/16/2002.

Applying A Hoof And Lower Leg Bandage

Caring for a hoof or lower leg injury can be very labor intensive. Even under the most ideal management conditions, the horse’s lower extremities are regularly exposed to dirt, debris, moisture and manure. Without a properly applied bandage, it will be difficult-if not impossible-to heal many types of foot and lower leg injuries.

How Bandaging Helps

Hoof bandages may be used to:

- Protect wounds, cracks, abscesses or surgical sites from contamination or trauma- Apply medication

- Prevent or reduce swelling and edema

- Immobilize injured tissues and/or reduce motion in the joints

- Aid in the healing of wounds

- Absorb fluids (exudates)

- Provide support for structures such as tendons, ligaments, and even bone as in cases of laminitis.

Apply With Care

It is especially important to know the proper way to apply a hoof and/or lower leg bandage. The horse’s feet and legs depend on a steady and abundant supply of blood. Tendons, ligaments, joints and nerves are also vulnerable to damage from an improperly applied bandage, as there is minimal overlying tissue to protect them.

The bandage must be applied smoothly, evenly and with the right amount of tension so as not to interfere with circulation or put undue pressure on vital structures.

If you have ever bandaged a horse’s foot or lower limb before, ask your veterinarian or an experienced equine professional to demonstrate the proper techniques. Practice under his or her supervision before doing it on your own. Because a bandage covering the lower leg and especially the hoof will require frequent changing, you will get plenty of practice.

Bandaging Materials

Because of the bandage’s location and the stresses it will have to withstand, choose bandaging materials that:

- Readily conform to the shape of the hoof and lower leg- Permit use of the foot/leg without slipping or loosening

- Adhere well to the hoof wall or leg

- Are extremely durable

- Are water resistant

- Are sterile (if in contact with a wound or surgical site)

Supply List:

- Sterile, non-stick gauze pads or wound dressing- Sheet cotton, roll cotton, combine cotton, or disposable diapers.

- Stretch bandaging tape such as 3M Vetrap Bandaging Tape at least 2-3 inches wide

- Adhesive bandaging tape such as Elastikon Elastic Adhesive Tape

- Duct tape

Bandaging Guidelines

The location and type of injury will determine how high the bandage should extend. A sole abscess might require that just the bottom and lower half of the hoof be protected. A heel bulb, coronary band, or lower leg injury might require that the bandage extend to cover the pastern.

1. Thoroughly cleanse the injury site as prescribed by your veterinarian.

2. Cover the wound or surgical site with sterile, non-stick gauze or dressing.

3. Utilize padding as needed. Apply to sole of foot in case of abscess or laminitis, or surround the hoof wall, heel bulb and ankle for other types of injuries. A disposable diaper also works well. Padding should lie flat and wrinkle-free where it contacts the skin.

4. Secure the padding by encircling the hoof wall and lower leg with stretch or adhesive bandaging tape.

5. Cover the sole using a figure-8 bandaging pattern, cris-crossing the fabric over the bottom of the foot and extending it up around the sides of the hoof and pastern until the padding is completely covered.

6. Work top to bottom or bottom to top, conforming the bandage to the hourglass shape of the hoof and lower leg. Exert just enough pull to stretch the fabric to half its maximum extended length, being especially careful not to constrict the area around the coronary band.

7. Overlap each preceding layer by 50 percent using smooth, uniform tension to compress the padding without forming lumps or ridges beneath the bandage.

8. Secure the bandaging tape with adhesive to keep it in place.

9. Create a strong, durable surface by applying duct tape to the bottom and sides of the foot. Use strips that extend across the bottom and up the sides of the hoof walls.

10. Overlap the edges of the duct tape, then add a second, cross-hatched layer to create a watertight seal.

11. Secure the edges along the hoof wall by encircling the foot with additional duct tape.

12. Seal the top opening of the bandage with an adhesive tape such as Elastikon Tape to prevent dirt or debris from getting in.

Special Consideration

Because the foot and lower leg are the site of so many vital structures, any injury to the hoof, heel, coronary band or pastern should be evaluated by a veterinarian.

Other considerations include:

A horse with a condition requiring a hoof bandage should be confined to a stall or small run unless otherwise directed by your veterinarian.

Hoof and lower leg injuries may bleed excessively because the area is highly vascular. Pressure may be applied directly to the wound to control bleeding. However, a pressure bandage should not be left in place for more than an hour or two.

When bandaging, use enough pressure to keep the bandage securely in place, but never wrap so tightly that you cannot easily slip a finger between the top of the bandage and the leg.

Check the hoof bandage several times a day to make sure it is not cutting off circulation, constricting the coronary band or leg, creating pressure sores, or causing discomfort.

Monitor and evaluate the horse carefully. If swelling develops above the bandage, lameness increases, or the horse begins to chew at the bandage, check the bandage and contact your veterinarian.

If the horse has an elevated temperature, becomes depressed or irritable, or loses its appetite, consult your veterinarian.

For hoof injuries that require continuous soaking or medication, a foot bandage can be lined with a heavy plastic bag, inner tubing, or latex rubber folded around the hoof to contain fluids. Ask your veterinarian for special instructions.

A properly fitted hoof boot may be used over the bandage to aid in extending wear and water resistance of the bandage.

Change the hoof bandage at the intervals specified by your veterinarian or immediately if it becomes wet or soiled.

Casting

In some cases, your veterinarian may recommend that the foot be cast rather than bandaged. A cast, used short term, can speed healing by immobilizing and protecting delicate tissues, often reducing recovery times from months to weeks.

If you have any further questions or concerns about hoof or lower leg bandaging techniques, contact your local veterinarian.


Keyword: 3M Hoof

keywords: 3M Hoof. posted: 6/16/2002. Last updated: 6/16/2002.

WOUND MANAGEMENT & BANDAGING

by Erin Denney-Jones, DVM

Florida Equine Veterinary Services, IncClermont, Florida

When to call the vet is the most frequently asked question by a new horse owner. Knowing what is or is not an emergency, especially when it comes to wounds, is also a common concern. Not all wounds can be or should be sutured. Good disinfecting and bandaging may be all that is needed. But for those cuts, lacerations and wounds you are unsure about whether you should make the call, here are a few questions you need to ask yourself:

Does the bleeding stop with direct pressure? Is the horse lame? Does the wound involve a bone, tendon or joint? Is it a puncture wound? Are there signs of infection? Is an eye involved? Is there a nail in the sole?

After you have called the vet, what should you do while you are waiting for that return call or their arrival? Here are some suggestions that will help the situation:

Keep the patient quiet and confined Apply pressure to stop bleeding- bandages help! Wash dirt from affected area with sterile water Do not attempt to flush a puncture wound Bandage wound and provide limb support Do not remove the nail from the foot

The vet has come, and now you are doing daily treatments and bandaging. Some problems may still arise. The following are signs to watch for:

Signs of infection: heat, swelling, pain/lame, pus, foul smell Wound is not closing Proud flesh

Bandaging a horse limb may be necessary in some circumstances. First, let us start with some suggested items to have for your first aid kit to use for bandaging.

Topical antibiotic ointments (Neosporin, Nolvasan ointment) Sterile gauze pad and gauze bandage (primary/contact layer) Quilt or cotton roll for padding (secondary/intermediate layer) Standing wrap, Vetrap, Elastikon, standing support bandage (tertiary/outer layer)

The key to bandaging is to make it smooth and tight. It is difficult to wrap over joints due to the curves of the limb, but practice and the right materials will make this task easier. In order to avoid constriction on the limb the cotton roll or quilt is necessary to use under your snug Vetrap, Elastikon or standing wrap. This allows you to apply pressure with the outer layer on a badly bleeding wound or swollen leg. Even with a stalled horse a bandage will loosen in 24-36 hours. Changing a bandage every day is necessary to treat wounds, check suture lines for infection and re-apply pressure to decrease swelling.

To place a bandage, first cover your wound with a sterile gauze pad with or without antibiotic ointment and keep in place with roll gauze.

Now place your quilt or cotton over this making the wound the center of the bandage.

For your tertiary layer, begin wrapping either at the top of the bandage or bottom and overlap by _ as you go around the limb to avoid pinching or constricting parts of the leg. A good suggestion is

to not end the bandage over a moving joint area, because the movement of the horse will continue to weaken the bandage and come apart.

A portion of the quilt or cotton must be seen above and below a bandage placed on a horse limb.

Bandaging wounds by the knee or hock in a horse requires a stacking bandage. This keeps the bandage from sliding down the leg as well as keeping swelling out of the lower limb. Bony prominences will require holes to be made in the cotton quilt and avoidance by the tertiary level.

Bandaging of the hoof is difficult and requires practice. I recommend a thin layer of roll cotton placed on the bottom of the hoof and up the wall to the fetlock. Then begin wrapping your Vetrap over the bottom and around the top, but leave some cotton sticking out of the top of the bandage. This protects the coronet band.

Summary

There may be any number of occasions when you will need to bandage your horse’s legs. Bandaging can provide both protection and support for the horse while working, traveling, resting or recovering from an injury. Here are some key points to keep in mind:

1) Start with clean, dry legs and bandages. If there is a wound, make sure it has been cleaned, rinsed and dressed according to your veterinarian’s recommendations.

2) Use a thickness of an inch or more of soft, clean padding to protect the leg beneath the bandage. Apply padding so it lies flat and wrinkle-free against the skin.

3) Start the wrap at the inside of the cannon bone above the fetlock joint. Do not begin or end over a joint, as movement will tend to loosen the bandage and cause it to unwrap.

4) Wrap the leg from front to back, outside to inside (counterclockwise on left legs, clockwise on right legs).

5) Wrap in a spiral pattern, working down the leg and up again, overlapping the preceding layer by 50 percent.

6) Use smooth, uniform pressure on the support bandage to compress the padding. Make sure no lumps or ridges form beneath the bandage.

7) Be careful not to wrap the legs too tightly, creating pressure points.

8) Avoid applying bandages too loosely. If loose bandages slip, they will not provide proper support and may endanger the horse. \

9) Leg padding and bandages should extend below the coronet band of the hoof to protect the area (this is especially important when trailering).

10) Extend the bandages to within one-half inch of the padding at the top and bottom. If there is a potential problem with bedding or debris getting into the bandage, seal the openings with a loose wrap of flexible adhesive bandage.

Regardless of the purpose, it is essential that you use proper leg bandaging techniques. Applied incorrectly, bandages may not only fail to do their job, but also may cause discomfort, restrict blood flow and potentially damage tendons and other tissue.

It is often said that it is better to leave a horse’s legs unbandaged than to bandage them incorrectly. Fortunately, there is nothing complicated about learning to apply bandages. It simply takes the right materials and a bit of practice. If you have never bandaged a horse’s legs, ask your veterinarian to demonstrate the proper techniques. Practice under his or her supervision before doing it on your own.

For more information about bandaging techniques, consult your equine veterinarian.

posted by rose posted: 2/17/2006. Last updated: 2/17/2006.

Emergency Care Tips

The following article is provided as a courtesy and service to the horse industry by the American Association of Equine Practitioners

If you own horses long enough, sooner or later you are likely to confront a medical emergency. From lacerations to colic to foaling difficulties, there are many emergencies that a horse owner may encounter. You must know how to recognize serious problems and respond promptly, taking appropriate action while awaiting the arrival of your veterinarian.

Preparation is vital when confronted with a medical emergency. No matter the situation you may face, mentally rehearse the steps you will take to avoid letting panic take control. Follow these guidelines from the American Association of Equine Practitioners (AAEP) to help you prepare for an equine emergency:

1) Keep your veterinarian’s number by each phone, including how the practitioner can be reached after hours.

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

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

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

5) Prepare a first aid kit and store it in a clean, dry, readily accessible place. Make sure that family members and other barn users know where the kit is. Also keep a first aid kit in your horse trailer or towing vehicle, and a pared-down version to carry on the trail.

First aid kits can be simple or elaborate. Here is a short list of essential items:

o · Cotton roll o · Cling wrap

o · Gauze pads, in assorted sizes

o · Sharp scissors

o · Cup or container

o · Rectal thermometer with string and clip attached

o · Surgical scrub and antiseptic solution

o · Latex gloves

o · Saline solution

o · Stethoscope

o · Clippers

Many accidents can be prevented by taking the time to evaluate your horse’s environment and removing potential hazards. Mentally rehearse your emergency action plan. In an emergency, time is critical. Don’t be concerned with overreacting or annoying your veterinarian. By acting quickly and promptly, you can minimize the consequences of an injury or illness. For more information about emergency care, ask your equine veterinarian for the “Emergency Care” brochure, provided by the AAEP in partnership with Bayer Corporation, Animal Health. More information can also be obtained by visiting the AAEP’s horse health web site, www.myHorseMatters.com.

The American Association of Equine Practitioners, headquartered in Lexington, Kentucky, was founded in 1954 as a non-profit organization dedicated to the health and welfare of the horse. Currently, AAEP reaches more than 5 million horse owners through its 6,500 members worldwide and is actively involved in ethics issues, practice management, research and continuing education in the equine veterinary profession and horse industry.


Equine Exertional Rhabdomyolysis: Management of Sporadic Exertional Rhabdomyolysis

by Stephanie Valberg, DVM, PhD, Associate Professor, University of Minnesota, College of Veterinary Medicine

Summary: Exertional rhabdomyolysis (ER) has been recognized in horses for more than 100 years as a syndrome of muscle pain and cramping associated with exercise. Recently it has been recognized that this syndrome has numerous possible causes. Sporadic forms of ER are due to over-training and muscle strain, dietary deficiencies of electrolytes, vitamin E and selenium or exercise in conjunction with herpes or influenza virus infections. Chronic forms are due to specific inherited abnormalities such as polysaccharide storage myopathy (PSSM) in Quarter Horses, Warmbloods and Draft breeds or recurrent exertional rhabdomyolysis (RER) in Thoroughbreds, Standardbreds and Arabians. PSSM, a glycogen storage disorder, can effectively be managed by providing regular daily exercise and a high fiber diet with minimal starch and sugar and provision of a fat supplement. RER appears to be a disorder of intracellular calcium regulation that is triggered by excitement. Changing management to provide horses with a calm environment and training schedule and substitution of fat for grains in high caloric rations are helpful means to manage this condition.

Exertional rhabdomyolysis continues to be a performance-limiting or career-ending disorder for many equine athletes. In the last 15 years, research advances have provided greater insight into this syndrome. Of greatest importance is the realization that exertional rhabdomyolysis comprises several myopathies that, despite similarities in clinical presentation, differ considerably in regards to pathogenesis (cellular events, reactions, and other pathologic mechanisms occurring in the development of disease). In addition, new knowledge regarding effective management of horses with exertional rhabdomyolysis, particularly with regard to diet, have significantly reduced the severity ER in many horses.

Clinical Signs of ER: Clinical signs of exertional rhabdomyolysis usually occur shortly after the beginning of exercise. The most common sign is firm and painful muscles over the lumbar (loin) and sacral (croup) regions of the topline, including the large gluteal muscles. Excessive sweating, quick, shallow breathing, rapid heart rate, and muscle tremors are also noticed. In extreme cases, horses may be reluctant or refuse to move and may produce discolored urine due to the release of myoglobin from damaged muscle tissue. Episodes of ER vary from subclinical to severe in which massive muscle necrosis and renal failure from myoglobinuria occurs.

Diagnosis of Exertional Rhabdomyolysis: In order to confirm a diagnosis of ER blood samples should be obtained to determine that serum creatine kinase (CK) and aspartate transaminase (AST) activity are elevated. When muscle cells are damaged, CK and AST are released into the bloodstream within hours. AST activity may be heightened in asymptomatic horses with chronic exertional rhabdomyolysis.

Muscle biopsies are helpful in distinguishing various forms of chronic tying-up. Biopsies taken at our veterinary hospital are from the middle gluteal muscle using a 6 mm modified Bergstrom biopsy needle and frozen immediately. Biopsies shipped by referring veterinarians to our laboratory are of the semimembranosus/ semitendinosus muscles performed by an open surgical technique. Muscle biopsies are stained with a battery of histochemical and tinctorial stains and examined under the microscope to look for specific types of exertional rhabodmyolysis.

Classification: Exertional rhabdomyolysis can be subdivided into one of two distinct forms—sporadic and chronic. Horses that experience a single episode or infrequent episodes of muscle necrosis with exercise are categorized as having sporadic exertional rhabdomyolysis, whereas horses that have repeated episodes of exertional rhabdomyolysis accompanied by increased muscle enzyme activity, even with mild exertion, are classified as having chronic exertional rhabdomyolysis.

Sporadic Exertional Rhabdomyolysis

Sporadic exertional rhabdomyolysis occurs most commonly in horses that are exercised in excess of their level of conditioning. This happens frequently when a training program is accelerated too abruptly, particularly after an idle period of a few days, weeks, or months. Endurance competitions held on hot, humid days may elicit sporadic exertional rhabdomyolysis in susceptible horses because of high body temperatures, loss of fluid and electrolytes in sweat, and depletion of muscle energy stores. These metabolic imbalances can lead to muscle dysfunction and damage. In some instances, horses seem more prone to exertional rhabdomyolysis following respiratory infections. Therefore, horses should not be exercised if they have a fever, cough, nasal discharge, or other signs of respiratory compromise.

Nutritional Management of Sporadic Exertional Rhabdomyolysis:

A well-designed exercise program and a nutritionally balanced diet with appropriate caloric intake and adequate vitamins and minerals are the core elements of treating exertional rhabdomyolysis. In some cases, deficiencies of vitamins, minerals or electrolytes may cause sings of muscle pain and stiffness in horses. Suggested deficiencies include:

Vitamin E and selenium. Adequate amounts of vitamin E and selenium prevent the detrimental interaction of peroxides with lipid membranes of the muscle cell. Most horses with chronic rhabdomyolysis have adequate or more than adequate concentrations of vitamin E and selenium, and further supplementation has not been found to have protective effects on muscle integrity in exercising horses. Many feeds, particularly those designed for horses with rhabdomyolysis, provide adequate selenium supplementation and caution should be taken not to provide

excessive selenium in the diet. Likewise, sufficient vitamin E is provided in most diets by green grasses, well-cured hay, and rice bran.

Electrolytes and minerals. Horses performing in hot weather often develop electrolyte imbalances, particularly if exercise continues for several hours. Free-choice access to loose salt or a salt block should be provided to these horses, or alternatively, one to four ounces of salt can be added to the feed daily. Extreme climatic conditions may necessitate the use of commercial electrolyte mixtures containing a 2:1:4 ratio of sodium:potassium:chloride. Fresh water should be available to horses at all times, especially if they are being supplemented with electrolytes.

Dietary imbalances of electrolytes, particularly deficiencies of sodium, potassium, and calcium, have been implicated in exertional rhabdomyolysis. Correction of imbalances may be crucial in the management of some exertional rhabdomyolysis cases.

Chromium. Supplementation with oral chromium (5 mg/day) has been suggested to calm horses and improve their responses to exercise possibly by affecting glucose and glycogen metabolism, possibly by potentiating the action of insulin. The purported calming effect of chromium may be beneficial in horses with recurrent exertional rhabdomyolysis because it appears that stress is a critical precipitator of this disorder. However, because PSSM horses display abnormal sensitivity to insulin, chromium supplementation may be counterproductive in these animals.

Chronic Exertional Rhabdomyolysis

Chronic exertional rhabdomyolysis arises frequently from heritable myopathies such as polysaccharide storage myopathy (PSSM) or recurrent exertional rhabdomyolysis (RER). Other causes of chronic exertional rhabdomyolysis are probable; however, their etiopathologies remain unknown.

Part II: Management of Recurrent Exertional Rhabdomyolysis

Recurrent Exertional Rhabdomyolysis (RER)

Recurrent exertional rhabdomyolysis commonly afflicts Thoroughbreds and likely Standardbreds and Arabians. During a racing season, 5-10 % of Thoroughbreds often exhibit signs of RER and of those 2 and 3 year-old horses with RER, up to 15% may not be able to train sufficiently to race at all that season. Interestingly, if horses that experience RER can race, there is no difference between their performances and those of matched control horses. In one investigation of heritability, a farm had 18 horses tie-up repeatedly over three years. Fourteen of the broodmares on this farm were bred to a particular stallion; all of the offspring experienced tying-up. When the same mares were bred to another stallion, only two of the offspring tied-up. On a different farm, one mare prone to tying-up produced six offspring with the disorder. A breeding trial conducted at the University of Minnesota as well as pedigree studies from a variety of farms now suggest that susceptibility to RER is inherited as an autosomal dominant trait.

The most severely affected horses are nervous young (two-year-old) fillies in race training at tracks. The sex predilection for females, however, is not obvious in older horses with RER. Episodes of RER occur most often when horses are restrained during exercise, and incidences of RER may become more frequent as level of fitness increases. Clinical expression of RER is often stress-induced, and horses with RER are typically described as having nervous or very nervous

temperaments. Older horses with RER may have muscle stiffness and soreness but only show overt evidence of tying-up after Steeplechase or cross-country phases of a 3-day event.

A specific cause for RER in Thoroughbreds has recently been identified. It appears that the mechanism by which muscle contraction is regulated can be disrupted by excitement and exercise in some susceptible horses. This discovery was based on the observation that intercostal muscle biopsies from RER horses readily develop contractures when exposed to agents (halothane and caffeine) that increase intramuscular calcium release. The threshold for developing a contracture is much lower for RER horses compared to normal horses similar to a muscle disease in people and swine called malignant hyperthermia. Every time a muscle contracts, calcium is released from muscle storage sites and then taken back up into storage sites for muscle relaxation. The altered contraction and relaxation of muscle suggests that abnormal intracellular calcium regulation is the cause of this form of RER. These intramuscular calcium concentrations are extremely small compared to the amount of calcium in the rest of the body and are completely independent of dietary calcium concentrations.

Diet manipulation is becoming the method of choice in controlling RER, particularly in equine athletes that are closely monitored for pharmacological substances. A well-designed exercise program and a nutritionally balanced diet with appropriate caloric intake and adequate vitamins and minerals are the core elements of treating RER.

Effect of Modulation of Dietary Fat and Starch: Increasing dietary fat supplementation and decreasing dietary starch have resulted in beneficial effects to horses with RER, however, the mechanism for this is not clearly understood. Fat supplementation is only beneficial to RER horses when total dietary caloric intake is high. The beneficial effects of fat supplementation in RER horses may be due to the exclusion of dietary starch rather than specific protective effects of high dietary fat. Given the close relationship between nervousness and tying-up in horses with RER, assuaging anxiety and excitability by reducing dietary starch and increasing dietary fat may decrease predisposition to RER by making these horses calmer prior to exercise.

Controlled and field studies have shown that feeding 2 to 5 pounds of rice bran or rice bran-based products (Re-Leve by Hallway Feeds, Lexington, KY) to both PSSM and RER horses has resulted in significant improvement in disease.

Recommended Diets for Horses with RER: As with any horse, feeding forage at a rate of 1.5-2% of body weight is a fundamental part of the diet. RER horses seem to benefit from fat supplementation only when they require high caloric intakes. Once caloric needs are assessed, a diet should be designed with an appropriate amount of fat and starch. Thoroughbred horses with frequent episodes of rhabdomyolysis are usually being fed 5-15 pounds of sweet feed per day. The incidence of subclinical rhabdomyolysis is low in Thoroughbreds being fed a moderate caloric intake whether it is in the form of sweet feed or rice bran. However, when calories are increased by the addition of more sweet feed, the incidence of subclinical and clinical rhabdomyolysis is much greater. One way to lower serum CK after exercise when a high caloric intake is required is to feed a low-starch, high-fat ration. For RER horses, the recommendation is to feed no greater than 20% of daily DE as nonstructural carbohydrate and to supply 20-25% of daily DE from fat. The diet should contain no more than five pounds of sweet feed, 600 ml of vegetable oil, and five pounds of rice bran per day. For horses undergoing intense exercise, the combination of sweet feed and oil or sweet feed and rice bran does not achieve an adequate DE without feeding amounts of cereal grains that have been shown to elicit rhabdomyolysis in susceptible horses.

A specialized diet, Re-Leve, (www.Re-Leve.com) has been designed for intensely exercised horses with chronic exertional rhabdomyolysis. Re-Leve contains 13% fat by weight (rice bran and corn oil) or 20% DE as fat and only 9% DE as starch. This type of high-energy diet for RER horses might be provided through a combination of other commercially available grains, several

fat supplements, and highly fermentable fiber sources (soy hulls, beet pulp). Other commercially available concentrates contain moderate amounts of fat (6-10%) and have lower NSC values (17–30 % by weight). However, they cannot be fed in the quantities necessary to achieve the calories required to sustain intense exercise in RER horses without exceeding recommended NSC limits for these horses. They should therefore be combined with a fat supplement.

All supplemental feeds should be reduced in amount on days when energy requirements are not as high, particularly if the horse is at risk of weight gain. Other management strategies may help to decrease the intensity of the postprandial glycemic response, and include feeding small meals, providing at least 1.5-2.0% body weight per day in forage, and feeding a forage source either two hours before or concurrently with any grain. Avoiding high starch supplements such as molasses is also important.

Surprisingly, recent studies in RER horses show that significant reductions or normalization of post-exercise serum CK activity occurs within a week of commencing a diet providing 20% DE as fat and 9% DE as starch. This low serum CK activity compared to the high CK activity observed in the same horses on an isocaloric diet where 40% DE was starch was not the result of any measurable change in muscle glycogen or metabolism during exercise. Potentially, the rapid response to decreasing starch and increasing fat was a result of neurohormonal changes that resulted in a calmer demeanor, lower pre-exercise heart rates, and a decreased incidence of stress-induced rhabdomyolysis. Avoiding prolonged stall rest in fit Thoroughbreds with RER is also important since post-exercise CK activity is higher following two days of rest compared to values taken later in the week when performing consecutive days of the same amount of submaximal exercise. It is quite possible that exercise exerts beneficial effects on horses with chronic exertional rhabdomyolysis that are separate from the impact of reduction in dietary starch and/or fat supplementation. Failure to implement an appropriate exercise routine will likely lead to failure to control rhabdomyolysis.

Additional management strategies for chronic exertional rhabdomyolysis. RER horses are often very fit when they develop rhabdomyolysis and require only a few days off before commencing a reduced amount of training. Stall confinement should be kept to less than 24 hours if possible. Since RER appears to be a stress-related disorder, management strategies to reduce stress and excitability in these horses are important. These include turn-out, exercising or feeding these horses before other horses, providing compatible equine company, and the judicious use of low-dose tranquilizers during training. Anecdotal reports of increased nervousness have been received when selenium is supplemented at higher than the recommended levels. Feeds designed for RER should be evaluated for their selenium concentrations and should not be supplemented in addition if adequate levels are provided in the feed.

Dantrolene (4mg/kg PO) given 1 hour before exercise to horses that are not fed their morning feed is effective in preventing RER. However, little absorption of dantrolene occurs in horses that have been on full feed at the time of administration. Dantrolene is used to prevent malignant hyperthermia in humans and swine by decreasing the release of calcium from the calcium release channel. Phenytoin (1.4-2.7 mg/kg PO BID), has also been advocated as a treatment for horses with RER (Beech 1988). Therapeutic levels vary, so oral doses are adjusted by monitoring serum levels to achieve 8 ug/ml and not exceed 12 ug/ml. Phenytoin acts on a number of ion channels within muscle and nerves including sodium and calcium channels. Unfortunately long-term treatment with dantrolene or phenytoin is expensive.

References

Beech J, Lindborg S, Fletcher JE et al.: Caffeine contractures, twitch characteristics and the threshold for Ca2+-induced Ca2+ release in skeletal muscle from horses with chronic intermittent rhabdomyolysis. Res Vet Sci 54:110, 1993.

Beech J, Fletcher JE, Lizzo F, et al: Effect of phenytoin on the clinical signs and in vitro muscle twitch characteristics in horses with chronic intermittent rhabdomyolysis and myotonia, Am J Vet Res 49(12):2130-2133, 1988.

Beech, J. 1994. Treating and preventing chronic intermittent rhabdomyolysis. Vet. Med. 458-461.

Collinder E, Lindholm A, Rasmuson M. Genetic markers in standardbred trotters susceptible to the rhabdomyolysis syndrome. Equine Vet J. 1997;29(2):117-20.

Lentz LR, Valberg SJ, Balog E, Mickelson JR and Gallant EM. Abnormal regulation of contraction in equine recurrent exertional rhabdomyolysis. Am J Vet Res 1999:60:992-999.

MacLeay JM, Sorum SA, Valberg SJ, Marsh W and Sorum M. Epidemiological factors influencing exertional rhabdomyolysis in Thoroughbred racehorses. Am J Vet Res 1999a;60(12) 1562-1566.

MacLeay JM, Valberg SJ, Geyer CJ., Sorum SA and Sorum MD. Heritable basis for recurrent exertional rhabdomyolysis in thoroughbred racehorses. Am J Vet Res 1999b;60:250-256.

MacLeay JM, Valberg SJ, Pagan J, Billstrom JA, and Roberts J. Effect of diet and exercise intensity on serum CK activity in Thoroughbreds with recurrent exertional rhabdomyolysis. Am J Vet Res 2000;61:1390-1395.

McKenzie EM, Valberg SJ, Pagan J. Nutritional management of exertional rhabdomyolysis. In: ed. NE Robinson. Current Therapy in Equine Veterinary Medicine 5. Saunders St Louis MO 2003, pp727-734.

McKenzie EC, Valberg SJ, Godden S, Pagan JD, MacLeay JM, Geor RJ, Carlson GP. Effect of dietary starch, fat and bicarbonate content on exercise responses and serum creatine kinase activity in equine recurrent exertional rhabdomyolysis J Vet Int Med 2003;17:693-701

McKenzie EC, Valberg SJ, Godden SM and Finno CJ. The effect of oral dantrolene sodium on post-exercise serum creatine kinase activity in thoroughbred horses with recurrent exertional rhabdomyolysis. Am J Vet Res 2004;65(1):74-9.

Part III: Management of Polysaccharide Storage Myopathy (PSSM)

Polysaccharide Storage Myopathy (PSSM)

Polysaccharide storage myopathy affects primarily Quarter Horses and horses with Quarter Horse bloodlines such as Paints and Appaloosa. In addition, Warmbloods as well as Morgans have been diagnosed with this disorder. Horses with PSSM typically have calm dispositions and are in good body condition. A change in exercise routine often triggers an episode of rhabdomyolysis. This change need not be profound; something as subtle and seemingly harmless as unaccustomed stall confinement may provoke an episode. Signs of PSSM include sweating, stretching out as if posturing to urinate, muscle fasciculations, and rolling or pawing following exercise. Severe cases may display stiffness and hesitance to move within minutes of starting exercise, and extreme cases may result in the horse being unable to stand and in discomfort even when lying down. Serum creatine kinase (CK) activity may be persistently elevated despite an extended period of rest.

The muscle biopsy is very useful for identifying PSSM. PSSM is a glycogen storage disorder characterized by the accumulation of glycogen and abnormal polysaccharide complexes in 1-40% of skeletal muscle fibers. Muscle glycogen concentrations in affected horses are 1.5 to 4 times

greater than in normal horses. In humans, glycogen storage diseases commonly result from impaired utilization and breakdown of glycogen by tissues. No limitations in the ability of skeletal muscle to metabolize glycogen have been identified in PSSM horses and in fact, PSSM horses have higher glycogen utilization rates than healthy horses during anaerobic exercise. As such the metabolic defect responsible for marked glycogen accumulation appears to involve abnormal regulation of glycogen synthesis rather than a defect in utilization. We have found that horses with PSSM clear glucose from the bloodstream after an IV bolus, or oral meal much faster than normal horses. It appears they do this because of increased insulin sensitivity. When insulin is given to PSSM horses it causes a profound drop in blood sugar, which lasts for twice as long relative to normal horses. Thus it appears that one of the abnormalities in PSSM is that when fed a starch meal, these horses, store a higher proportion of the absorbed glucose in their muscle compared to normal horses. The mechanism of glucose transport into muscles of PSSM does not appear to be regulated in the same fashion as healthy horses. Why this in itself causes muscle cells to become damaged with exercise is not clear at this time. Accumulation of polysaccaride occurs gradually over time and may not be apparent until 2 yrs of age even though rhabdomyolysis may occur in young foals. Breeding trials support an autosomal dominant mode of inheritance for PSSM. Although the specific cause of PSSM in horses remains unknown, it can naively be seen as the opposite of type 2 Diabetes.

A glycogen storage disorder with similar histological characteristics occurs in draft breeds. Belgian and Percheron horses appear to have about a 25% prevalence of EPSM in the population. This syndrome is referred to as equine polysaccharide storage myopathy (EPSM). While similarities exist between PSSM and EPSM, draft horses with EPSM often exhibit signs not indicative of PSSM, including normal serum creatine kinase, difficulty backing and holding up limbs, a shivers-like gait, and loss of muscle mass. Some drafts afflicted with EPSM also show recumbency and weakness with only slight increases in serum CK and AST, and this combination of signs is not seen in Quarter horses with PSSM.

Prevention of Rhabdomyolysis with PSSM

Training: Horses with PSSM will not improve if the only change made is the addition of dietary fat. Prevention of further episodes of rhabdomyolysis requires a very gradual increase in the amount of daily exercise horses experience. Minimizing stress, providing regular routines and daily exercise are highly beneficial. Turn-out each day with other horses in as large an area as possible will keep the horse active and is in my experience the single most important thing that can benefit these horses. If there has been a recent severe episode of tying-up I recommend turning the horse out for 2 weeks on the diet recommended below. After switching your horse's diet for 2 weeks, horses can begin longing once a day for 5 minutes at a walk and trot. Gradually increase the time by 2 minutes a day. If the horse seems stiff, stand the horse still for 1 minute and see if the stiffness persists when walking. If stiffness is present, stop there, if not continue after a 2 minutes walk. When the horse can do 15 minutes provide a 5-minute break at a walk and gradually increase walking and trotting after this. Once the horse has reached 30 minutes of trotting on a lunge-line (with a break at 15 min) then I would begin to ride for 20 to 30 minutes and gradually increase the length and intensity of exercise. It should take at least 3 weeks before the horse is ridden. Keeping horses with PSSM fit increases oxidative metabolism, increases glycogen utilization and this seems the best prevention against further episodes of tying-up.

Dietary management of PSSM: As with any horse, feeding forage at a rate of 1.5-2% of body weight is a fundamental part of the diet. Once caloric needs are assessed, a diet should be designed with an appropriate amount of fat and starch. The amount of fat supplied to horses with PSSM is controversial. If PSSM horses are exercised regularly, many respond to low-calorie, low-starch diets that are only lightly supplemented with fat. Although recommended in the lay-press, not all horses with exertional rhabdomyolysis require diets in which 25% of daily caloric intake is supplied by fat. In fact, such a diet is not always appropriate, is difficult to achieve in the face of high-calorie requirements, and may result in problems with weight gain and unpalatable diets.

Fat Sources: Animal- and vegetable-based fats are the major sources of fat available for equine consumption. Examples of vegetable oils used for supplementation include corn, soy, peanut, coconut, safflower, linseed, flaxseed, and canola. Corn and soy oils are the most palatable. Vegetable oils are highly digestible (90-100%) and energy dense. While it can be messy to dole out, unpalatable to some horses, prone to rancidity in warm weather, and difficult to feed in large amounts, oil is an effective way to boost daily energy intake and may be the most economical way of providing fat to horses that do not require large amounts of supplementation. Horses receiving large amounts of oil may need vitamin E supplementation. Animal fat varies in digestibility (75-90%). Because animal fat is more saturated, it tends to be solid at room temperature and would need to be melted before being top-dressed on feed. Most horses find animal-based fats less palatable than vegetable-based fats. Rice bran contains about 20% fat as well as a considerable amount of vitamin E. Products containing rice bran are readily accepted by most horses. Commercial rice bran products are usually in powder or pellet form and are considerably more stable than animal fat and vegetable oils. Many rice bran-based products are balanced for calcium and phosphorus or are concurrently fed with a mineral supplement to offset the naturally high phosphorus content. Recently commercial diets have been developed for horses with exertional rhabdomyolysis. To be effective these diets need to be low in starch as well as high in fat.

Recommended diets for PSSM horses: In Quarter Horse-related breeds, PSSM can usually be managed with grass hay or mixed hay and a fat supplement that is balanced for vitamins and minerals. Starch should be decreased to less than 10% of daily digestible energy (DE) intake by eliminating grain and molasses. Rice bran can be gradually introduced into the diet as powder or as a pelleted feed. Some horses that will not eat powder will consume pelleted forms of rice bran (Re-Leve, Hallway Feeds, Lexington, KY). It is important for owners to understand that if horses eat the rice bran at a slower rate than sweet feed this can be beneficial as it reduces rapid absorption of starch. Depending on the caloric requirements of the horse, 1-5 pounds of rice bran can be fed but must be combined with a reduction in dietary starch to less than 10% of DE. Interestingly, rice bran oil is now being used as a means to manage human beings with type I and type II diabetes as it significantly lowers daily blood glucose concentrations (measured as glycosylated hemoglobin). Horse with severe forms of PSSM respond with lower serum CK activity when fed ReLeve compared to other rice bran products, likely due to the lower starch content of ReLeve compared to rice bran.

An alternative source of fat is corn oil added to alfalfa pellets. An upper limit of 600 ml of oil per day is recommended, and additional vitamin E should be added to the diet. It is not possible to achieve the high caloric requirements for intense exercise using oil supplementation of alfalfa pellets, sweet feed, or rice bran without exceeding recommended maximum amounts of these products. To achieve the appropriate caloric intake for PSSM horses performing intense exercise, high fat, low-starch pelleted feeds designed for PSSM horses in intense exercise are recommended (Table 1). Supplying fat at 6-10% by weight (or 15-20% of DE) of the entire ration to PSSM Quarter Horses (unless a higher energy intake is required for exercise) is likely quite sufficient for managing PSSM and further benefit from more fat has not been demonstrated in controlled trials. Note, however, that none of these diets will result in clinical improvement of muscle stiffness and exercise tolerance without gradually increasing the amount of daily exercise and maximizing access to turnout.

Expectations of fat supplementation. The time required for improvement in signs of exertional rhabdomyolysis is controversial. It has been suggested that a minimum of four months of supplementation is required and that relapses are associated primarily with disruption of supplementation. However, in the author’s experience clinical improvement with PSSM is more dependent on the amount of daily exercise and turnout than on the length or amount of dietary fat supplementation. For example, when serum CK was monitored daily post-exercise, levels were almost within the normal range after four weeks of daily exercise, without fat supplementation. In addition, when PSSM horses were turned out 24 hours a day on grass, post-exercise serum CK

was normal compared to high activities during the same exercise test with stall-kept horses on a hay diet. Thus, it seems that consistent fat supplementation without implementing a structured daily exercise regime in PSSM horses is highly likely to result in failure and confinement, while consuming high levels of fat is likely to lead to obesity.

Supplemental Readings

Annandale EJ, Valberg SJ, Mickelson JR and Seaquist ER. Insulin sensitivity and skeletal muscle glucose transport in Equine Polysaccharide Storage Myopathy. Neuromusc Disorders 2004;14(10):666-674.

De La Corte FD, Valberg SJ, Williamson S, MacLeay JM and Mickelson JR. Enhanced glucose uptake in horses with polysaccharide storage myopathy (PSSM). Am J Vet Res 1999a;60;458-462.

De La Corte FD, Valberg SJ, MacLeay JM and Mickelson JR. The effect of feeding a fat supplement to horses with polysaccharide storage myopathy. Journal World Equine Health 1999b;4,2:12-19.

DeLaCorte FD, Valberg SJ, MacLeay JM and Mickelson JR. Developmental onset of polysaccharide storage myopathy in 4 Quarter Horse foals. J Vet Int Med 2002;16:581-587.

Firshman AM, Valberg SJ, Bender J, Finno C. Epidemiologic characteristics and management of polysaccharide storage myopathy in Quarter Horses. Am J Vet Res 2003;64:1319-1327.

Pagan, J.D. Carbohydrates in equine nutrition. 1997. In: Proc. 7th Equine Nutr. Conf. Feed Manufacturers. Kentucky Equine Research Inc., Lexington, KY, p. 45-50.

Ribeiro W, Valberg SJ, Pagan JD and Essen Gustavsson B. The effect of varying dietary starch and fat content on creatine kinase activity and substrate availability in equine polysaccharide storage myopathy 2004;18:887-894.

Valberg S, Cardinet III, GH, Carlson GP and DiMauro S. Polysaccharide storage myopathy associated with exertional rhabdomyolysis in the horse. Neuromusc Disorders 2:351-359, 1992.

Valberg SJ, Geyer C, Sorum SA and Cardinet III GH.; Familial basis for exertional rhabdomyolysis in Quarter Horse-related breeds. Amer J Vet Res 57:286-290, 1996.

Valberg SJ, MacLeay JM and Mickelson JR. Polysaccharide storage myopathy associated with exertional rhabdomyolysis in horses. Comp Cont Educ 1997;19(9)10:1077-1086.

Valberg SJ, MacLeay JM, Billstrom JA, Hower-Moritz MA and Mickelson JR. Skeletal muscle metabolic response to exercise in horses with polysaccharide storage myopathy. Equine Vet J, 1999a.31:43-47.

Valberg SJ, Mickelson JR, Gallant EM, MacLeay JM, Lentz L and De La Corte FD. Exertional rhabdomyolysis in Quarter Horses and Thoroughbreds; one syndrome, multiple etiologies. International Conference on Equine Exercise Physiology Equine Vet J Suppl. 1999b;30: 533-538.

Valentine BA, Hintz HF, Freels KM et al. Dietary control of exertional rhabdomyolysis in horses J Am Vet Med Assoc 1998b;212:1588-1593.

Valentine, B.A., Van Saun, R.J., Thompson, K.N., et al. 2001. Role of dietary carbohydrate and fat in horses with equine polysaccharide storage myopathy. J. Am. Vet. Med. Assn. 219:1537-1544.

keywords: tying-up, pssm, polysaccharide storage myopathy . posted: 2/27/2003. Last updated: 9/2/2005.

Heat Stroke

by Steven M. Haugen, DVM

The body maintains its normal temperature in hot weather by moving heat through the muscles and out through the skin. Blood also removes heat as it circulates through the body and releases it through lung tissue, skin and expanding blood vessels. This is why our own vessels and the horse’s blood vessels may appear larger and more distended during hot weather. This serves to cool the skin as it evaporates. Horses that cannot sweat will usually overheat very rapidly, even in cooler weather with a small amount of exercise.

Other factors may increase heat in the body other than just outside temperature. A major source of body heat is exercise. The more a horse exercises, the more heat is produced. Another source is feed. All feed releases heat as it is digested. Approximately 50% of the energy in oats is released as heat.

When the sum of outside temperature plus the relative humidity is below 130 (e.g., 70 F with 50% humidity), most horses can keep their body cool. The exception will be very muscular or fat horses. When the sum temperature and humidity exceeds 150 (e.g., 85 F and 90% humidity), it is hard for a horse to keep cool. If the humidity contributes over half of the 150, it compromises the horse’s ability to sweat – a major cooling mechanism. When the combination of temperature and humidity exceeds 180 (e.g., 95 F and 90% humidity), the horse’s cooling system is almost ineffectual. At this stage, exercise can only be maintained for a short time without the animal’s body temperature— especially in the muscles— rising to dangerous levels. Very little cooling takes place even if the horse is sweating profusely. When the horse’s body temperature reached 105 F, the blood supply to the muscles begin to shut down. After this occurs, the blood supply to the intestines and kidneys also shut down. The blood supply to the brain and heart are spared until last, but severe and permanent damage may have already taken place.

Signs of heatstroke may include the following:

1) Temperature as high as 105 to 107 F 2) Rapid breathing, rapid pulse

3) Stumbling, weakness, depression

4) Refusal to eat or work

5) Dry skin and dehydration

6) In severe cases, a horse may collapse or go into convulsions or a coma

Treatment

When possible, place the animal in shade. A breeze can be added with a fan. In order to cool the body, ice the major blood vessels. The vessels that should be iced are the jugular veins, the major veins that run down both sides of the neck; the veins on the inside of the front of the legs and the large veins on the inside of the back of the legs. Ice packs or cold water from a hose will cool down the blood as it circulates through the body. It acts as the “antifreeze” and cooling system as it circulates. Avoid icing the large major muscles of the loin and hind end. These muscles are already lacking blood circulation it and may make the condition worse. You may ice the forehead since the brain contains the temperature control center for the body, and this will help to cool the horse. Small amounts of water should be provided to re-hydrate the horse. Electrolytes may also be given orally. In severe cases intravenous fluid therapy is necessary to treat dehydration, electrolyte loss and shock.

Remember that signs of heat stroke may range from mild to severe and life-threatening. Foals usually cannot take as much heat as adult horses. A mare may be fine, but her foal may be getting sick from being out on a hot day. Horses with heavy muscling or excess fat or in poor condition will have more problems. Keep in mind that strenuous exercise on a hot, humid day can lead to problems in a short period of time for even the best-conditioned horse.

keywords: heat, heat stroke, . posted: 9/24/2003. Last updated: 9/24/2003.

WHEN MY HORSE IS IN A FIRE .....

by Janyce L. Seahorn, DVM, MS, Diplomate ACVA, ACVIM and Thomas L. Seahorn, DVM, MS, Diplomate ACVIM

While a barn fire is uncommon, there is nothing more devastating—with more complicated consequences—than when a horse becomes a burn victim. But it does happen. The first steps when confronted with a barn fire are obvious—remove the animals from the structure if possible. Once the horse is away from imminent danger, call your veterinarian. He or she can advise you on what to do (and what not to do) before they arrive.

For example, you may be instructed to remove any coverings, including halters and blankets, as these items can retain heat and promote continued heat damage. Adhered fabric should be cut at the margin of the adhered area because forceful removal will cause even more tissue damage. Although cooling the skin with room temperature water or saline is recommended for human patients (and applies to horses as well), burns result in a reduced ability to regulate body temperature. Thus, attempts should be made to keep the patient warm once the burning process has been stopped because heat loss can be significant, especially during cold weather and in smaller equine patients.

In addition to the skin damage, the most immediate considerations are the lungs and the kidneys. Burns to the airway or inhalation of hot gases can cause the airway to swell, which may require placement of a tube directly into the trachea. Damage to the lungs can result in constriction of bronchi and fluid collection (pulmonary edema) requiring such supportive measures as

bronchodilators, diuretic agents and oxygen therapy. If these early complications are not rapidly treated, they can be fatal. Additionally, since the lungs are susceptible to secondary bacterial infection following smoke and heat exposure, broad-spectrum antibiotic therapy may be indicated.

Because of the massive tissue damage resulting from burns, the kidneys can be overwhelmed with the by-products of this damage. Early supportive therapy in the form of intravenous fluids and agents which promote diuresis are essential for maintaining kidney function and minimizing damage.

Another serious side effect of burns is damage to the eye. The cornea is vulnerable to damage from the heat, from trauma associated with escape from the burning building and from deposits of burning particles onto the surface. Immediate cleansing of the cornea by your veterinarian and application of protective ointments will help to minimize the development of irreversible eye damage.

A critical aspect of treatment during the initial days, along with lung and kidney support, is pain management. Burns are painful and dealing with the extreme discomfort can interfere with normal behavior and body function including eating, drinking and bowel movements. Some agents, such as the nonsteroidal anti-inflammatory agents, can unfortunately worsen kidney malfunction and may not provide adequate pain relief. These agents, while useful, should only be used once kidney function appears to be adequate based on ongoing laboratory testing. Opioids (ie. narcotics) are beneficial in the first days after the burn occurs. One opioid is now available in a transdermal (through-the-skin) slow release form which may provide adequate pain control for one to two days without the need for frequent repeated intramuscular or intravenous injections.

Another potential complication of burns is laminitis, commonly known as founder. Laminitis is a complicated disease with many potential causes and can develop in varying degrees of severity. Stress, secondary infection and the massive tissue damage associated with burns can contribute to this potentially life-threatening complication. Although there is no specific prevention for or treatment of laminitis, conservative use of nonsteroidal anti-inflammatory agents, hoof support, hydrotherapy to encourage blood flow to the foot and intravenous fluids to assure hydration may help to minimize the risk of laminitis.

Once the acute complications of massive burns in horses have been managed, the skin lesions become a major part of treatment. Daily hydrotherapy to remove the dead tissue combined with local therapy to protect the underlying new skin is imperative. Ointments which moisturize and help prevent secondary infection are ideal. Burn wounds should be treated until a healthy granulating tissue bed is established in the injured areas. Once healing begins, critical evaluation of the wounds by your veterinarian to assess the need for skin grafting is indicated. Skin grafting may be necessary when the burn area is massive or located in an area that can interfere with normal motion when the scar tissue begins to shrink. Depending on where you live, such specialized care may only be offered by a primary care facility such as a university teaching hospital or private referral practice.

Burn injury in horses can result in many serious and even life-threatening complications including respiratory failure, kidney failure, permanent eye damage, laminitis and skin damage (which can lead to lost range of motion). If your horse becomes a burn victim, seek immediate veterinary care to increase his chances of survival and return to full function. Remember that recovery will be slow and will take a long-term commitment.

keywords: fire safety, burns, equine burns. posted: 1/20/2004. Last updated: 1/20/2004.

Emergency Preparedness: Being Prepared During Times of Disaster. Important Tips for Horse Owners

by Written by the AAEP

In the event of a disaster, your veterinarian knows how important it is for you as a horse owner to have pre-planned actions and proper information to make rapid decisions that may save your horse’s and even your own life.

ASSESS YOUR RISKS

What are the most likely disasters in your area? (flood, fire, tornado, hurricane, nuclear accident, disease threat, chemical spill, ice storm, etc.)

For each type disaster, check:

What are your major vulnerabilities? What can you do to minimize the damage?

What plans do you have in place?

Who do you need to contact?

BEFORE THE EVENT

Take a careful look at your property and identify the best place for your animals in each type of disaster you consider.

Prepare for the possibility you might want to evacuate.

Check with your local veterinarian, law enforcement, animal control, or Ag extension agent for routes and recommendations.

Find several alternative locations and check the entry requirements for each. Be sure to have agreements arranged for your animals in advance.

Prepare and ID packet for each horse: age, sex, breed, color, registrations, unique ID’s, photos, microchip numbers, etc.

Write down any special feeding instructions; list any medications with dosage; record the name and phone number of your prescribing veterinarian.

Be sure all vaccinations and medical records are in writing and up to date. Have current Coggins Test records. Consult your veterinarian for other recommended immunizations or tests.

Take records with you. Records left at home may be damaged or destroyed during a disaster.

Check for alternate water sources. Have fresh water and hay available for 48-72 hours.

Keep trailers and vans well maintained and full of fuel.

Keep insurance coverage current and adequate.

Consider an event where you might by unable to save/evacuate all your animals. Make a priority list. Familiarize family and farm personnel with the list in case you are not there when the disaster occurs.

Prepare an emergency kit for a minimum of 72-hour care:

Plastic trash barrel with lid Tarpaulins

Water buckets

First aid items

o Betadine or Nolvasan solutions

o Antibiotic ointment

o Gauze squares and bandages

o Ichthammol ointment (feet)

o Tranquilizer injections (optional)

o Eye ointment

Portable radio, flashlight and extra batteries

Fire resistant, non-nylon leads and halters

Knife, scissors, wire cutters

Duct tape

Livestock markers or paint

Leg wraps

Lime and bleach/disinfectant

DEVELOP A BUDDY SYSTEM

Talk with a neighbor or friend; make arrangements to check on each other after a disaster. Tell one another if you are evacuating and to where, so authorities will know. Buddies may agree to pool resources, such as generators, water tanks, trailers, etc.

Permanently identify each horse by tattoo, microchip, brand, tag, photographs (front, rear, left and right side) and/or drawing. If disaster strikes before you can do this, paint or etch hooves, use neck or pastern bands, or paint your telephone number or last four digits of SSN on the side of the animal.

PRACTICE YOUR PLAN

When disaster strikes remain calm and follow your plan! Remember it is vital to be able to leave early in any mandatory evacuation to avoid getting stalled in traffic and create unnecessary hardships.

AFTER AN EVENT

Notify family, friends and officials that you are OK, whether you stayed or evacuated. Use phones, radios, Internet, signs, or word of mouth.

Inspect your premises carefully before turning our horses. Look for foreign materials (tin, glass, nails) and downed fences or power lines.

Be careful leaving your animals unattended outside. Familiar scents and landmarks may be altered, and your horses could easily become confused and lost.

Check with your veterinarian or State Veterinarian’s office for information of any disease threats that may exist because of the situation.

If you find other horses, use extreme caution in handling, and work in pairs if possible. Keep the horse contained and isolated, and notify authorities as soon as possible.

If any horses are lost, contact local authorities. BE PREPARED TO IDENTIFY AND DOCUMENT OWNERSHIP WHEN CLAIMING LOST HORSES.

Listen to the emergency alert system (EAS) for information about locating lost animals.

keywords: emergency preparedness, disaster, emergency disaster, emergency . posted: 3/3/2004. Last updated: 5/17/2006.

Disaster Planning For Horse Farms

by Dana N. Zimmel, DVM, Diplomate ACVIM, ABVP (Equine Practice), University of Florida College of Veterinary Medicine

Hurricanes, tornadoes, flooding and fire are the most common natural disasters in the state of Florida. The leading cause of death in large animals during Hurricane Andrew in 1992 included animals killed in collapsed barns, electrocution, kidney failure secondary to dehydration and animals hit and killed on roadways or tangled in barbed wire after escaping from their pasture. Each farm should have a written disaster plan to optimize safety and survival of all animals.

Before the Storm

Horses

· Vaccination: All horses should have a tetanus toxoid vaccine within the last year. Due to the increase in mosquitoes after massive rainfall, all horses should receive West Nile virus and Eastern / Western Encephalitis vaccinations at the beginning of hurricane season.

· Coggins test: A negative Coggins test is necessary if the horse needs to be evacuated to a community shelter or cross the state line.

· Health Certificate: A health certificate is required to cross the state line. This may be necessary for evacuation of coastal areas.

· Identification: Each horse should be identified with at least one, if not all of the following:

o A leather halter with name/farm information in a zip lock bag secured to the halter with duct tape.

o A luggage tag with the horse/farm name and phone number braided into tail. (Make sure this is water proof).

o Photos of each horse as proof of ownership highlighting obvious identifying marks.

· Evacuation: Evacuation of flood planes and coastal areas is recommended. Evacuation must occur 48 hours before hurricane force winds occur in the area. Transportation of horses when wind gusts exceed 40 mph is dangerous.

o Contact the Emergency Evacuation Relocation List at www.SSHC.org/evac or The Sunshine State Horse Council, Inc. (941) 731-2999 for more information.

· Should horses be left in the pasture or placed in the barn? If the pasture has good fencing and limited trees, it is probably best to leave the horses outside. Well constructed pole-barns or concrete block barns may provide safety from flying debris, but the horses may become trapped if the wind collapses the building.

o Electrical lines: Keep horses out of pastures with power lines.

o Trees with shallow roots will fall easily under hurricane force winds and can injure the horse or destroy the fencing.

o Fencing: Do not keep horses in barbed wire or electric fencing during a storm.

o Fire Ants and snakes will search for high ground during flooding. Carefully look over the premises and feed for these potential dangers.

Farm

· Water

o Each horse should have 12-20 gallons per day stored.

o Fill garbage cans with plastic liners and fill all water troughs.

o Have a generator to run the well if you have large numbers of horses.

o Keep chlorine bleach on hand to add to contaminated water if necessary. To purify water add 2 drops of chlorine bleach per quart of water and let stand for 30 minutes.

· Feed storage

o Store a minimum of 72 hours of feed and hay (7 days is best). It is very possible that roads will be closed because of down power lines and trees, limiting access to feed stores. Cover hay with water proof tarps and place it on palates. Keep grain in water tight containers.

· Secure all movable objects

o Remove all items from hallways.

o Jumps and lawn furniture should be secured in a safe place.

o Place large vehicles/ tractors/ trailers in an open field where trees cannot fall on them.

· Turn off electrical power to barn

· Emergency First Aid Kit

o Bandages (leg wraps and quilts)

o Antiseptics

o Scissors/Knife

o Topical antibiotic ointments

o Tranquilizers

o Pain Relievers (phenylbutazone or Banamine®)

o Flashlight and extra batteries

o Extra halters/lead ropes

o Clean towels

o Fly spray

· Emergency Tools

o Chain saw / fuel

o Hammer/nails

o Fence repair materials

o Wire cutters / tool box / pry bar

o Fire Extinguisher

o Duct tape

After the Storm

· Carefully inspect each horse for injury to eyes and limbs.

· Walk the pasture to remove debris. Make sure that no Red Maple tree braches fell in the pasture. Just a few wilted leaves are very toxic to horses. Clinical signs of Red Maple toxicity are dark chocolate colored gums, anorexia and red urine.

· Inspect the property for down power lines.

· Take pictures of storm damage.

· If your horse is missing, contact the local animal control or disaster response team.

· For more information regarding general emergency management in the state of Florida contact http://www.floridadisaster.org

keywords: hurricane safety, storm safety, natural disasters. posted: 9/15/2004. Last updated: 9/15/2004.

Wounds in Horses

by Written by: Spencer Barber, DVM, DACVS

Despite owners providing excellent facilities, wounds are common in all types of horses. An owner should have an excellent working relationship with his/her veterinarian to provide optimal care. While waiting for your veterinarian, there are a number of things a horse owner should not do. Placing fingers in the wound can contaminate it, as can hair from clipping around the wound. Do not apply medication to the wound as many antiseptics, detergents, greasy ointments and powders interfere with healing. Direct pressure can be applied to the wound to stop bleeding using a thick bandage, but a tourniquet is almost never applied, and in those rare cases when it is needed, should only be applied by a veterinarian.

Many factors must be taken into account to determine the best treatment choice. When there is excessive tension, motion, contamination or tissue loss, suturing might not be successful and could lead to increased costs of treatment and risks of complications. Some wounds can be sutured a few days after swelling and contamination is reduced, while excessive tissue loss dictates some wounds must heal without suturing. Typically, open wounds on the body heal faster and with fewer complications than leg wounds.

Bandages help protect wounds from further contamination and trauma, and they provide a warm, moist environment that promotes rapid wound repair. However, bandaging body wounds is difficult, and often impossible. Therefore, veterinarians frequently recommend hydrotherapy (hosing) to cleanse the wound, increase wound circulation and stimulate healing. An ointment may be applied afterward to the wound to prevent desiccation (drying out). Bandages stimulate proud flesh production on leg wounds, so numerous methods are used to control or prevent proud flesh, including the daily application of a topical corticosteroid cream. Severe wounds in areas of excessive motion often require a cast to facilitate healing.

Puncture wounds can result in devastating infections if bacteria are carried into a joint or tendon sheath. These cavities need to be flushed – usually using an arthroscope under general anesthesia – and regional perfusion (pumping of fluid and antibiotics into the area) performed. Then a high concentration of antibiotics administered to the distal limb through a vein or a hole drilled into the cannon bone while a tourniquet is temporarily applied. The regional perfusion is usually repeated daily for two to four days with the horse standing.

Punctures of the soles of the foot can cause abscessation, but respond well to draining and have an excellent prognosis. Punctures of the frog or lateral sulci of the foot can result in infection of either the navicular bursa and/or coffin joint. Both have a guarded prognosis for survival, especially if not identified immediately and treated aggressively.

Laceration of tendons certainly is a frightening thought for owners. If the extensor tendons are severed, the leg will knuckle forward at the fetlock. Rarely is it possible (or necessary) to suture the tendon ends. The fetlock should be maintained in a normal position with a bandage and splint for three to four weeks for the ends of the tendons to scar down, and to prevent secondary contraction of the flexor tendons. There is an excellent prognosis for return to normal activity. The flexor tendons are very important for maintaining normal angulation of the fetlock during weight bearing and to keep the foot flat on the ground. When they are lacerated, they must be sutured

and a cast applied. The prognosis for survival is guarded and the likelihood of a return to athletic activity is poor.

Wood, often from fences or trees, can be forced deep into the chest or thigh. If not removed, the wound fails to drain, or it breaks open later and has large volumes of purulent exudates. Since wood cannot be seen on an X-ray, special imaging techniques – such as contrast radiography or ultrasound – are required to locate the foreign body before it can be removed. Many serious wounds can be successfully treated if they are identified early and receive veterinary attention.

Article Provided Courtesy of The Horse

keywords: wounds, cuts, lacertaion, healing. posted: 9/30/2004. Last updated: 9/30/2004.

Fracture Repair

by Dwight Bennett, DVM, Ph.D.

Equine fractures are more difficult to repair and heal more slowly than human or small animal fractures. As recently as 30 years ago, most horses with severe fractures were euthanized or, at best, retired, largely because you couldn’t ask a horse to stay in bed or use crutches to keep his weight off of a fracture while it healed.

Today, internal fixation, using screws and bone plates, permits a horse to stand on a broken leg while it heals, often making previously life-threatening fractures treatable. Additionally, new anesthetics and methods of bringing a horse out of anesthesia greatly reduce the probability of developing new fractures and refractures during recovery. However, it’s still an anxious time when a horse whose fracture has just been repaired gets to his feet.

Due to increasing competitive intensity, fractured legs in performance horses are more common than ever. The chance of a successful repair often depends largely on how the horse is handled before he gets to the operating table. If a horse is forced to walk on the broken bone or if he’s transported to the hospital without a proper splint, what began as a relatively simple fracture might be irreparable.

Fracture Types

An incomplete fracture, sometimes called a stress or “green stick” fracture, occurs when the bone splits or cracks but doesn’t break into separate pieces. Such a fracture is caused by long-term, repeated stress that weakens the bone, as opposed to a single traumatic event that breaks the bone. Incomplete fractures are fairly common in performance horses.

A complete fracture separates the bone into pieces. A simple complete fracture means the bone breaks into two pieces, neither of which penetrates the skin. A fracture in which the bone breaks into more than two pieces is called a comminuted fracture. Complete fractures commonly occur during intense exercise (e.g. when a racehorse breaks down), or result from a kick or severe accident.

A compound fracture means the end of a broken bone penetrates the skin. Equine skin is thin and easily penetrated by sharp bone fragments.

Diagnosing Fractures

Most complete fractures are fairly obvious. The fracture sight generally swells quickly, and the horse shows immediate distress. The leg might hang crookedly or an end of a bone might penetrate the skin. A horse with a complete fracture often attempts to move on three legs.

Incomplete fractures, however, can be difficult to detect, because they usually cause only mild lameness. Early diagnosis is critical, because an incomplete fracture can lead to a complete fracture. The possibility of an incomplete fracture is one reason that it’s important to have your veterinarian promptly examine any lame horse. A stress fracture can be difficult to detect even on x-rays. Nuclear scintigraphy (the use of nuclear scanners to detect radioactive materials that, when injected intravenously, accumulate in diseased or traumatized areas of the body) is a highly useful technique a veterinarian can use to detect a hidden fracture. If detected in time, an incomplete fracture seldom requires splinting and generally heals with stall rest alone.

Complete-Fracture First Aid

Horses, unlike smaller quadrupeds, don’t move well on three legs. The inability to use his broken leg, along with the attendant pain, can cause considerable anxiety for a horse with a fracture. Frantic attempts to use his broken leg or to regain balance can cause the horse to damage his leg beyond repair. A horse can turn a simple fracture into a comminuted or compound fracture. Movement of the broken bones’ jagged edges can irreparably damage muscles and nerves. Arteries can stretch and be damaged to the point that the blood flow, which carries factors necessary for healing, to the fracture site is impaired. Fortunately, severe bleeding is unusual even with compound fractures.

Complete-fracture first aid requires prompt stabilization to reduce the horse’s anxiety, thus avoiding further damage. Stabilizing or splinting the fractured limb reduces the horse’s anxiety, because it allows him to regain control of the leg even though he can’t put any weight on it. Once the limb is stabilized, most horses will rest the leg rather than try to use it for support.

Whenever possible, a veterinarian should apply a splint to a horse’s fractured leg. He’ll generally stabilize the leg even before taking x-rays or performing any other diagnostic procedures. In some cases it might be necessary for the veterinarian to sedate the horse to relax him for sufficient splinting.

However, if the veterinarian can’t come immediately, or if you must transport the horse to the veterinarian, you may have to splint the leg yourself. You will need at least one assistant who’s a competent horseman to help restrain and calm the horse. Follow these steps to safely splint the horse’s leg.

1. Apply the bandage. Never place wood or other stiff splinting material directly against the horse’s skin. Instead, place a bandage under the entire length of the rigid splint.

For a fracture at the fetlock or below, apply a single layer of roll cotton over the skin. Wrap gauze smoothly and tightly over the cotton, then wrap it with elastic tape.

A fracture that lies from mid-cannon-bone upward requires several layers of cotton bandage, each layer being no more than an inch thick. Individually cover each layer with gauze and elastic tape. If the layer of the padding is too thick, or if several layers of cotton are tightened with just

one layer of gauze and tape, the padding will shift and bunch rather than lie smoothly. The total bandage diameter should be approximately three times the limb’s diameter. Such a thick, layered bandage is called a Robert Jones bandage.

2. Apply the splint. Any lightweight, relatively strong, rigid material, such as wood or PVC pipe split lengthwise, makes an effective splint. Place the rigid material over the bandage and tape it in place with nonelastic adhesive tape. (Elastic tape allows the splint to shift its position.)

A splint isn’t meant to align the bones’ broken ends. It severs to take weight off the broken bones and hold in a straight line any joints whose movement might cause further damage. The bones’ fractured ends grind against each other when weight is placed on the leg or when the leg is flexed and extended, thus the rigid materials must extend across all joints immediately above and below the fracture.

For example, if the fracture is near the fetlock or pastern, the front surfaces of the cannon and pastern bones should be held in a straight line by splints extending from just below the knee or hock down to the foot. If the fracture is in the area of the knee or in the cannon bone, the knee and fetlock must be held straight. A fracture of the mid-to-upper forearm (radius) must be splinted to keep the elbow and knee from bending, and prevent the horse from raising his leg to the side.

A splint requires two boards or two pieces of PVC tubing that must be placed 90 degrees apart, never 180 degrees. In other words, one board should lie along the outside of the leg and the other should lie along the front or the back of the leg. Placing one board along the inside and the other along the outside of the leg is ineffective, because it doesn’t prevent the leg from bending.

Nothing prevent the stifle from bending, hence hind-leg fractures from the hock above are difficult to splint, because the horse’s reciprocal apparatus causes the hock to bend whenever the stifle bends and to straighten whenever the stifle straightens. However, a lateral splint applied over a thick, tight Robert Jones bandage and taped tightly across the hock and stifle angles helps support a leg that has such a fracture.

Treatment Methods

The first step when treating complete fractures is to maneuver the bone fragments into proper alignment. The horse is usually placed under general anesthesia to perform the adjustment, and specialized equipment might be required to pull large bones into position.

Once the bone fragments are properly aligned, they’re fixed in position with casts, pins, screws or plates until the fracture heals.

Some simple leg fractures heal with nothing but a fiberglass cast holding the bones in place. Such treatment is usually less expensive than surgical correction. However, the necessity for frequent cast changes under general anesthesia can lead to considerable expense. A cast might be changed as frequently as every 10 days for a foal, or as infrequently as every six weeks for an older horse. The duration depends on how healing progresses and how the horse’s skin and muscle react to the cast. A cast provides less precise alignment and bone fixation than surgical methods of fracture treatment.

External fixation involves pins passed through bone above or both above and below the fracture and incorporated in a cast. The pins allow the intact bones above the fracture to bear most of the horse’s weight. External fixation is more commonly used in humans and small animals than in horses, because pins strong enough to bear a horse’s weight often require drilling excessively large holes in the bones.

Internal fixation requires the fragments to be compressed together by screws or bone plates applied from the outside of the bones or, less commonly, by various types of pins and other devices placed lengthwise inside the bones. In some cases, the plates or screws are permanently left in place. In others, they’re eventually removed. Although expensive, internal fixation has many advantages. A fracture, repaired under compression, heals more quickly and doesn’t form a bony callus, which could interfere with tendons sliding over the bone. A horse with an internally fixed fracture can bear weight on the injured leg and return to work more quickly than a horse whose fracture is repaired with a cast or external fixation. In addition, internal fixation avoids the complications casts pose, such as pressure sores.

When a plate rigidly immobilizes a human or small-animal bone, the bone tends to lose density because most of the weight previously borne by the bone is transferred to the plate. A less-dense bone is prone to refracture after the plate is removed. In horses, however, density rarely reduces (even in foals), because no bone plate available is strong enough to take more than a fraction of a horse’s weight off the bone. Equine surgeons constantly look for stronger, more rigid bone plates.

keywords: fractures, fracture repair, broken bones . posted: 11/16/2004. Last updated: 11/23/2004.

Guidelines to Follow During Equine Emergencies

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

RECOGNIZING SIGNS OF DISTRESS

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

WHAT'S NORMAL?

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

Pulse rate: 30-42 beats per minute. Respiratory rate: 12-20 breaths per minute. Rectal temperature: 99.5' to 101.5' F. If the horse's temperature exceeds

102.5' F., contact your veterinarian immediately. Temperatures of over 103' F indicate a serious disorder.

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

Other observations you should note:

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

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

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

Signs of distress, anxiety or discomfort. Lethargy, depression or a horse that's "off-feed." Presence or absence of gut sounds. Evidence of lameness such as head-bobbing, reluctance to move, odd stance,

pain, unwillingness to rise. Bleeding, swelling, evidence of pain. Seizures, paralysis, or "tying up" (form of muscle cramps that ranges in

severity from mild stiffness to life-threatening illness).

ACTION PLAN

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

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

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

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

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

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

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

FIRST AID KITS

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

*Cotton roll *Contact bandage *Cling wrap *Gauze pads, assorted sizes *Gauze wrap Adhesive wrap and adhesive tape Leg wraps Sharp scissors Hemostats Steel cup or container Rectal thermometer with string and clip attached Surgical scrub and antiseptic solution Latex gloves Flashlight and spare batteries Permanent marker pen Pliers (to pull nails) 6" diameter PVC tubing cut in half the long way (like a gutter) into lengths of

1-1 /2 to 2 feet (for emergency splinting)

EMERGENCY WOUND CARE

The sight of blood may unnerve you, but maintaining your presence of mind can save your horse's life. The initial steps you take to treat a wound can prevent further damage and speed healing. How you proceed will depend on your individual circumstances, and you must exercise good judgment. The following should be viewed as guidelines:

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

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

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

A. There appears to be excessive bleeding. B. The entire skin thickness has been penetrated. C. The wound occurs near or over a joint. D. Any structures underlying the skin are visible. E. A puncture has occurred. F. A severe wound has occurred in the lower leg at or below knee or hock

level. G. The wound is severely contaminated.

4. Consult with your veterinarian regarding a recommendation before you attempt to clean the wound or remove debris or penetrating objects, as you

may precipitate uncontrollable bleeding or do further damage to the wound. Large objects should be stabilized to avoid damaging movement if possible. Don't put anything on the wound except a compress or cold water.

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

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

7. If the eye is injured, do not attempt to treat. Await your veterinarian. 8. If a horse steps on a nail or other sharp object and it remains embedded in the

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

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

OTHER EMERGENCIES

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

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

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

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

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

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

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

SUMMARY

Many accidents can be prevented by taking the time to evaluate your horse's environment and removing potential hazards. Also, assess your management routines to make them safer. Mentally rehearse your emergency action plan. Preparation will help you stay calm in the event of a real emergency. Keep your veterinarian's phone number and your first aid kit handy. In an emergency, time is

critical. Don't be concerned with overreacting or annoying your veterinarian. By acting quickly and promptly, you can minimize the consequences of an injury or illness. Your horse's health and well-being depend on it.


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