In a settlement with the medical board, Blea agreed to continuing education classes in record keeping, a remittance to the VMB of $131,464 for the investigation costs, and a three-year probationary period.

Those believing the return of Blea to his prior role would bring an end to the veterinary medical board's regulatory inroads into the state's racing industry would be sorely mistaken.

The medical board has ongoing cases against at least nine other backstretch veterinarians in California, and the nature of some of the accusations–often identical in nature to those leveled against Blea–reveal a yawning schism between the veterinary board and the CHRB concerning approaches to standard equine veterinary care.

Until these differences are rectified, the legal ramifications hang like a Sword of Damocles over not just the state's racetrack practitioners but the performance horse veterinary community in general.

“It's been very unusual,” says David Foley, executive director of the American Association of Equine Practitioners (AAEP), about the nature of the complaints against Blea and some of the other backstretch veterinarians.

“If the veterinary medical board is going to interpret the rules in a companion animal manner towards equine practitioners, nobody's going to want to practice in California,” Foley says.

Areas of Conflict

The main areas of disconnect with the medical board–at least where the CHRB is concerned–surrounds the use of what the VMB terms misbranded drugs like Thyro-L, non-FDA approved compounded drugs and the correct nature of the veterinarian-patient-client relationship. More broadly, the disconnect also ensnares the prophylactic use of medications and record keeping differences between small and large animal veterinarians.

In the process, these areas highlight often conflicting sets of rules between these separate state agencies throwing the work of backstretch practitioners into confusion and possible professional jeopardy.

In short, some of the veterinarians with pending cases face a conundrum should they settle with the VMB and return to work under probation: If they then continue to practice under the CHRB's standard of equine veterinary care-but against the VMB's interpretation of the rules-they could face stark professional consequences.

The VMB deems Thyro-L, or thyroxine, misbranded under the Federal Food, Drug, and Cosmetic Act. And in laying out its accusations against some of the veterinarians, the medical board argues that the use of such misbranded drugs is prohibited through statutes written into the California Health and Safety Code.

Specifically, the code states that it is “unlawful for any person to receive in commerce any drug or device that is misbranded or to deliver or proffer for delivery any drug or device.”

Sarah Andrew

Essentially, a drug is misbranded if its labeling proves false or misleading in any particular situation, says attorney Mike Casey, who represented Blea in his case against the veterinary board. This could mean that the drug has been proven effective in the treatment of ailments for which it hasn't been labeled, says Casey, or vice versa.

But confusingly, Thyro-L is labeled for use in horses to treat hypothyroidism–a relatively rare equine condition–if dispensed by a licensed veterinarian.

Furthermore, many equine veterinarians routinely use it to treat a variety of conditions, including insulin resistance, for which there's a body of research.

“Veterinarians have a wide authority to prescribe medications,” says David Ramey, president of the Los Angeles Equine Advisory Committee, who says the VMB's stance on Thyro-L runs “absolutely contrary to regular medical practice.”

Most pertinent for backstretch veterinarians operating in California within the last decade is how the CHRB has issued advisories outlining thyroxine use in racehorses.

The first such advisory came in 2014 following an agency investigation into a series of sudden deaths among Bob Baffert-trainees, which found that the uniform use of thyroxine among the horses in question is “concerning in horses with suspected cardiac failure.”

The CHRB's much tightened rules surrounding thyroxine use went into effect earlier this year.

“If the VMB truly believed that Thyro-L was prohibited in use by the FDA as misbranded, why didn't they simply pick up the phone and call the CHRB,” says Casey. “They've been aware of the concerns surrounding Thyro-L since 2013.”

As a non-FDA approved drug, thyroxine overlaps another key area of conflict between the two agencies-the use of non-FDA approved compounded medications, which is permitted in veterinary practice in California.

So, where does the conflict arise?

Look no further than the CHRB's own Rule 1867 (b) which states that “the possession and/or use on the premises of a facility under the jurisdiction of the Board of any drug, substance or medication that has not been approved by the United States Food and Drug Administration (FDA) for use in the United States.”

The veterinary medical board appears to interpret that rule categorically, stating in complaints against several backstretch veterinarians how no compounded drugs are FDA approved, even if compounded from FDA approved parent drugs.

The list of drugs the CHRB prohibits–at least according to the veterinary board–includes commonly used compounded medications like dantrolene, used on horses that tie-up, and naquasone, which ameliorates swelling.

Crucially, the CHRB's own interpretation of its rules follows existing state law, leaving the door open to backstretch practitioners using compounded medications so long as they contain FDA-approved parent drugs.

Indeed, just last month–seemingly with this interpretive discord in mind–the agency issued an advisory to its relevant stakeholders stating that while compounded medications are not FDA approved, the CHRB's “longstanding interpretation” of rule 1867 “is that lawfully prescribed, compounded medications which are manufactured according to Federal and State guidelines do not violate this regulation.”

The advisory continues: “The CHRB recognizes that compounded medications are necessary for the safe and effective treatment of horses. These medications contain approved Federal Food and Drug Administration (F.D.A.) substances, which have been compounded to achieve proper dosages for safe and effective equine treatment and are necessary for equine veterinarians to effectively treat various medical conditions.”

Furthermore, the CHRB has never filed a complaint for violation of 1867 (b), according to CHRB spokesperson, Mike Marten.

Which leads to the final area of tension-how to define the proper veterinarian-client-patient relationship on a racetrack backstretch.

As the veterinary medical board sees it, no veterinarian can prescribe, dispense or administer a medication without first performing three main tasks: examining the patient and documenting the findings, establishing and documenting a diagnosis, then communicating the best course of treatment with the client.

Among the list of common medications that backstretch practitioners allegedly issued without first performing these tasks includes acepromazine, a tranquilizer used routinely to keep horses calm, and GarstroGard, used to treat stomach ulcers.

But backstretch practitioners and performance horse veterinarians voice frustration with what they see as the VMB's narrow interpretation of this relationship.

The problem arises, says Ramey, because the Veterinary Medicine Practice Act-the overarching rules by which all licensed veterinarians must comport their business-is almost entirely geared around small animal practice.

“The practice act doesn't really address herd health,” says Ramey, who added the American Veterinary Medicine Association (AVMA) is currently reviewing its model practice act to possibly address this. “In herd health, animals aren't always treated individually every time.”

Indeed, California's current laws are “far easier to understand and follow for small animal practitioners (who typically see individual animal patients in a brick-and-mortar context) than they are for veterinarians who treat herds, such as equine or livestock veterinarians,” wrote Dan Baxter, executive director of the California Veterinary Medical Association (CVMA), in an emailed response to questions.

Another wrinkle in the picture, say experts, concerns the currently routine prophylactic use of certain medications in performance horses to avoid injury and the onset of common training-driven ailments.

A prime example in racehorses would be the use of acepromazine-or ace, for short-used ubiquitously during morning training to keep fractious horses calm and to minimize the risk of harm to themselves and others.

“They're saying you can't give GastroGard without listening to their gut sounds and without taking their temp' and what-not on every horse every time. But not every medication requires that degree of [daily diagnosis],” says John Madigan, professor emeritus at the UC Davis school of Veterinary Medicine, calling the VMB's recent actions “horrifically wrong,” due to what he sees as those unfamiliar with equine practice leading complaint investigations.

Who Wields the Stick?

One of the main questions that arise is this: To whose rules should backstretch practitioners adhere?

The CHRB strikes the note that neither agency appears to have “primacy” of authority when it comes to regulating backstretch veterinarians. “And that's the problem because in certain areas there seems to be a disagreement about interpretation,” says CHRB executive director, Scott Chaney.

Veterinary medical board spokesperson, Monica Vargas, equivocated, writing that while the VMB “cannot advise on CHRB enforcement of laws applicable to their licensees,” the VMB has jurisdiction over the practice of veterinary medicine in California “unless otherwise pre-empted.”

Legal pre-emption, in this case, appears to come in the form of the federal Horseracing Integrity and Safety Act's (HISA) racetrack safety rules, which went into effect July 1 and provides guidelines for record keeping and appropriate veterinary-patient-client relationships.

Scott Chaney | CHRB

Indeed, “federal authority does pre-empt state law and state reg's,” says Chaney.

A HISA spokesperson told the TDN that the agency has not yet involved itself with the differences that have arisen between the VMB and CHRB.

For backstretch practitioners with cases from prior years open against them, however-along with the state's broad contingent of performance horse practitioners-HISA pre-emption is a moot point.

That's why California's equine veterinarians and leading equine veterinary bodies have been publicly sounding the alarm about the potential pitfalls of this schism since at least the January veterinary board meeting.

After that January meeting, the CVMA and other stakeholder groups asked the VMB if they could submit a presentation at the following April board meeting about their concerns. The board pulled that presentation prior to the meeting, however.

Asked why, Vargas responded that the presentation went beyond the scope of the request and included, among other things, discussion regarding pending disciplinary matters. “The Administrative Procedure Act prohibits the Board from receiving communications regarding the merits of any issue in a pending disciplinary proceeding,” wrote Vargas.

Interestingly, in a subsequent statement to its constituents, the CVMA took issue with that interpretation, writing that the VMB routinely holds policy discussions concerning the Veterinary Medical Practice Act, including while enforcement cases are simultaneously being conducted.

“If it were the case that the VMB could never talk about problematic regulations or statutes due to a risk of infringing on current disciplinary cases, then the VMB would not be able to function as a rulemaking body at all,” wrote the CVMA.

After that aborted presentation, the VMB assembled a two-person Equine Practice Subcommittee tasked with researching the equine practice regulations and statutes, taking “input” from relevant stakeholders, then “returning to the Board with particular recommendations,” wrote Vargas.

The VMB failed to answer other questions about specific goals of the subcommittee, including those about timelines and about whether the subcommittee's work could lead to amendments to the California Veterinary Medicine Practice Act.

Vargas did write, however, that at the upcoming Multidisciplinary Advisory Committee meeting this Tuesday, the Equine Practice Subcommittee will provide an “update on the issues the Board has directed the Subcommittee to research.”

One of these key stakeholders is the CVMA, which has already approached the VMB several times requesting an “in-depth look be taken at the aforementioned laws,” wrote Baxter.

“The CVMA will continue to engage the VMB in dialogue about the regulations and will strongly advocate for the veterinary profession,” Baxter added.

According to Chaney, the CHRB met with the subcommittee some two weeks ago.

The CHRB's goal for these ongoing negotiations, Chaney says, is “clarity” for licenced backstretch practitioner. “All racing veterinarians that I've spoken with want to comply with CHRB rules and vet' med' board rules, they just don't know what they are right now,” he says.

This “clarity” could come the way of changes to the California Veterinary Medicine Practice Act or to the CHRB's own regulations, says Chaney. But changes to these state rule books can be a glacially slow process.

In the meantime, backstretch practitioners with open cases against them face a Catch-22.

On the one hand, they're incentivized to settle their cases swiftly or even to defend themselves due to the VMB's right, if it prevails on any finding, to seek cost recovery, says Casey.

For Blea, that was a six-figure sum.

However, if the veterinarians settle with the VMB before these practical differences have been smoothed over, they face potentially serious consequences if they then return to active practice under a probationary period.

The VMB is “aware of that potential,” responded Chaney, when asked about this conundrum. But he was unable to elaborate on whether the VMB has proposed any timeline for resolving the agencies' differences.

Investigatory integrity

Which leads to concerns among certain stakeholders about the manner in which the VMB is conducting its investigations into California's backstretch practitioners.

According to both Casey and Blea, neither Blea nor the clients relevant to his case were interviewed as part of the investigatory process.

“At no point did anyone ever ask Jeff [Blea] what was the purpose of administering acepromazine. What was the purpose of administering aspirin powder. He was never asked at any point during the quote, investigation, end quote about anything in his medical record. Not once,” says Casey.

A busy backstretch | Sarah Andrew

“Neither were the trainers, the owners, the grooms,” Casey added. “No one.”

The TDN asked the veterinary medical board about these claims-including about standard investigatory procedures when a practitioner's veterinarian-patient-client relationship is in question-but the agency offered no response.

Other prominent figures in equine practice question the VMB's impartiality in these matters.

As someone frequently called upon to provide expert testimony in cases involving equine practice, Ramey responded to the veterinary medical board's open call for experts in Blea's case, he says.

Ramey told the TDN that when he saw the accusations against Blea, however, he spent an hour and a half explaining to two VMB attorneys that the accusations against Blea amounted to typical standards of care in horses facing rigorous training programs.

“These horses are at risk of developing certain problems, and you're trying to help mitigate that risk,” says Ramey, describing his version of the conversation with the VMB's attorneys.

“The next day they let me know that they did not need my services as an expert witness,” says Ramey, who added that he is “firmly convinced” that the VMB had a “pre-determined outcome that they were looking for.”

It should be noted that Ramey considers himself Blea's professional and personal acquaintance.

“I think it's important that the public is protected against poor veterinary practice,” he responded, when asked about how this relationship might color his opinions. “But [Blea's case] wasn't that.”

When asked about Ramey's claims, Vargas wrote that “As the adjudicator in administrative disciplinary actions, the Board does not participate in prosecutorial activity leading up to an administrative hearing. As such, the Board has no knowledge of expert witness preparation discussions for administrative hearings.”

In speaking with nearly a dozen equine practitioners or leading figures within prominent veterinary organizations, it's clear the ongoing philosophical and practical discord in equine practice has rattled the veterinary community in California.

Some veterinarians have already begun to question their professional futures in the state, says Madigan. “Unfortunately,” he adds, “a lot of veterinarians are thinking 'I just hope it doesn't happen to me.'”

The post “Horrifically Wrong”: California VMB and Equine Practitioners at Odds appeared first on TDN | Thoroughbred Daily News | Horse Racing News, Results and Video | Thoroughbred Breeding and Auctions.

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We've all heard a lot in the last year about the way vaccines work. What's the mechanism of action for most equine vaccines? (Killed virus vs mRNA, etc.)

Dr. Earl Gaughan: The simple way a vaccine works is to mimic a natural exposure to an infectious organism that can cause disease, and to stimulate an animal or human to develop an immune response such that infection and disease are prevented. The normal mammalian immune system has several ways it responds to these kinds of exposures and threats of disease. The immune system's “goals” are to rid the body of the infectious organism and/or to reduce any potential life-threatening results such that the body can survive.

Among the responses of the immune system are humoral (antibodies) and innate (chemical and cellular) mechanisms. Infectious organisms present antigens which are usually proteins that stimulate these immune responses. Antibodies are the immune system proteins that bind or block these outside antigens to reduce the number and threat these organisms can present. This response takes the body hours to days to reach effective levels. Cellular and chemical production to fight infectious organisms develop rapidly and can be the quick, first responses after exposure to these threats.

“Killed virus” vaccines are just that – a product that contains killed organisms or proteins that typically stimulate humoral antibody responses. “Modified-live” vaccines perform similarly to killed vaccines but utilize a similar organism to the targeted infection that has been altered such that it will stimulate an immune response but not disease. These vaccine products are most commonly administered to a horse by injection deep into muscle tissue. At least one modified-live vaccine can be administered up the nose of a horse (intra-nasal) such that the vaccine itself is placed on the lining of the nasal passage. This stimulates what is known as innate or mucosal immune responses. This is a rapid (minutes to hours) response based on release of chemical and cellular mediators of the immune defense.

Currently, we do not have mRNA vaccines for horses. These vaccines work by entering body cells and stimulating protein production that can reduce invading viral reproduction and entry into host body cells. Long term repercussions of these products are unknown at this time.

Do equine vaccines vary year to year like the human flu shot?

Equine vaccines do not vary year to year. The AAEP-recommended core vaccines against rabies, tetanus, Eastern Equine Encephalomyelitis/Western Equine Encephalomyelitis (EEE/WEE) and West Nile virus remain very effective and should be administered to every horse in every location in North America. These diseases are typically lethal and the vaccines are successful at preventing disease with very few negative effects.

The reason human flu vaccines change each year is the rapid ability of influenza to undergo what is called “antigenic drift” or mutation of the virus to make it more able to infect a host (human). Antigenic drift in horses occurs, but at a much slower pace than what is seen in people. Equine flu vaccines are changed to keep up with evolving strain development, but again, we are fortunate this does not happen at the rate seen in humans. The rate of equine flu strain and therefore vaccine change is more in a five to ten-year window vs. annual. To date, influenza appears to be the only viral pathogen where annual change is monitored in horses. The strains of equine herpesvirus appear to be stable or more slowly changing, although more strains of herpesvirus are being discovered with more sophisticated diagnostic methods, so additional vaccines may be on the horizon for horses. The same can probably be said for some of the other, less commonly seen, risk-based vaccines.

Some horse owners are skeptical of the efficacy of equine vaccines; how well do they really work? 

Skepticism is rational and informed questions are welcomed by equine veterinarians. The vaccines available for horse diseases like rabies, tetanus, Eastern and Western Equine Encephalomyelitis (EEE/WEE) and West Nile virus work very well to prevent these diseases in horses. These vaccines are considered core or essential for a horse's well-being, as they help prevent diseases that are typically lethal. While there is never an absolute guarantee, it is interesting to note that when these diseases are diagnosed in horses, they are most commonly seen in horses that have not been vaccinated or are far past the appropriate date for booster vaccines.

Other disease-causing organisms do not lend themselves to as complete vaccine protection as the vaccines for the infectious neurologic disorders mentioned above. However, these are also far less lethal infections cause by influenza, herpesviruses, and others. Vaccinating for these diseases is considered “risk-based” and is encouraged for horses that may encounter infectious agents at home or during travel. Vaccinating for these concerns is performed to help reduce infections, reduce severity of clinical disease, and reduce spread of the virus, or other organisms. These vaccines can be very helpful and are recommended for most horses in consultation with a veterinarian. 

Why is it important for a horse who doesn't leave home to still get regular vaccinations?

While a horse at home would appear unlikely to encounter disease-causing organisms, these infectious agents can often come to the horse. For instance, rabies is usually the result of a bite from a skunk, raccoon or other carrier; EEE, WEE, and West Nile can be delivered by mosquitos and the tetanus organism is found in soil everywhere. Vaccinating the horse at home is important to prevent these highly lethal diseases.

Vaccinating horses that do not travel for things like influenza and herpes should be done in consultation with a veterinarian. If other horses do travel and come home, or if horses from varied places mix at all, these infections can be transmitted and are typically very contagious. Other, less common, disease entities may not require vaccination unless presence of the diseases occurs locally or regionally, putting the horse at home at risk. Even trail rides with neighbors can expose horses to infectious organisms not necessarily present at home. Again, discussion with your veterinarian is a great place to get the best answers. 

What are some common reasons horse owners give for not vaccinating their horses? 

Sound medical reasons for not vaccinating:

1. The horse has reacted severely with past vaccine administration
2. The horse has recently recovered from the targeted disease
3. Known or potential adverse events/reactions to a vaccine product

The post A Closer Look At: The Whats And Whys Of Equine Vaccines appeared first on Horse Racing News | Paulick Report.

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Dr. Read joined Ohio State in 2018 after 11 years on the veterinary faculty at the University of Calgary, which included stints as chair of the Clinical Skills Program, associate dean academic, and interim dean. She previously taught at the Ontario Veterinary College and worked for a private specialty referral practice in Alberta.

While in Calgary, Dr. Read worked with national and international equine athletes and riders as part of the treatment team at Spruce Meadows showjumping facility. She also helped develop and validate several simulator models that were later commercialized by Veterinary Simulator Industries.

“AAEP has been like an old close friend from the day I joined as a student to where I am now in my career,” said Dr. Read. “AAEP is my social circle and a source of connection to the wider industry. I am grateful to this organization for all it has given me, and I want to give back to others, especially those new to their career. I look at our current issues with retaining new graduates and really want to help that situation so others have the opportunity to make the most of a career in this field and feel like they belong in a welcoming inclusive profession with a bright future.”

Dr. Read earned her veterinary degree from the Western College of Veterinary Medicine in 1998 and became board certified in veterinary surgery in 2004. She currently serves on the AAEP's Educational Programs Committee. Dr. Read previously served on the board of directors from 2011-2013, as chair of the Student Programs Task Force, and as a member of the Member Engagement, Nominating and Student Relations committees.

In addition, Dr. Read serves on the Competency Based Veterinary Education working group and the Council for International Veterinary Medical Education for the Association of American Veterinary Medical Colleges.

Read more here.

The post Ohio State Associate Dean Dr. Emma Read Takes Reins As AAEP’s 2022 President  appeared first on Horse Racing News | Paulick Report.

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The “Beyond the Call” Award is named in honor of its first recipient, the late Wayne O. “Sage” Kester, DVM, and recognizes a current or former AAEP member who has made significant and long-lasting contributions to equine veterinary medicine and the community. Dr. Bramlage received the award during the December 7 President's Luncheon at the AAEP's 67th Annual Convention in Nashville, Tenn.

A partner at Rood & Riddle Equine Hospital in Lexington, Ky., Dr. Bramlage has advanced the diagnostics and treatment options for horses with orthopedic disease and injury through groundbreaking research and application into clinical practice. He has shared his extensive knowledge and expertise through numerous peer-reviewed publications, provision of continuing education for veterinary surgeons and other practitioners, and training and mentorship of countless students, interns and residents.

His four decades of distinguished service to the AAEP include a term as president in 2004; participation on 28 different councils, committees and task forces, including chair of the Educational Program Committee in the mid-1990s; and establishment of the popular Kester News Hour session at the annual convention. In 2014, the AAEP presented its Distinguished Service Award to Dr. Bramlage and fellow orthopedic surgeon Dr. C. Wayne McIlwraith for their pivotal contributions over 23 years to the development and growth of the AAEP's award-winning “On Call” program that provides veterinary expertise in support of televised horseracing broadcasts.

Beyond the AAEP, Dr. Bramlage has been active in the American College of Veterinary Surgeons, serving as president in 2007 and on the board of regents and other committees. He also serves on the board of Grayson-Jockey Club Research Foundation and is a past chair of its Research Advisory Committee. Elected to membership in The Jockey Club in 2002, Dr. Bramlage currently serves as a steward of the organization and member of its Thoroughbred Safety Committee.

Among his many honors are the 1994 Jockey Club Medal for his contributions to Thoroughbred racing; the 1997 Tierklink Hochmoor Prize for his pioneering work concerning internal fixation of fractures; the British Equine Veterinary Association Special Award of Merit in 2000; AAEP Distinguished Life Member recognition in 2008; and the 2010 American College of Veterinary Surgeons Foundation Legends Award for his development of the fetlock arthrodesis procedure for horses.

A 1975 graduate of Kansas State University College of Veterinary Medicine, Dr. Bramlage served as an associate professor of equine surgery at The Ohio State University prior to joining Rood & Riddle in 1989. In addition to his considerable industry contributions, Dr. Bramlage is a strong advocate for the needs of neglected and abused children through his support of CASA of Lexington; and he has served on many committees within his church and helped establish its stewardship mission.

Read more here.

The post Dr. Larry Bramlage Receives Coveted AAEP Sage Kester Award appeared first on Horse Racing News | Paulick Report.

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Summarizing the strengths and work styles of each generation currently in the workforce, Johnson said:

Baby Boomers (born between 1946-1964) understand the importance of teamwork as the first generation for whom education became an expectation.

Generation X (1965-1980), as the offspring of parents who both worked outside the home, tend to be fiercely independent. They want to be given a task and the necessary tools, then be left alone to accomplish the task.

Millennials (1981-1996) tend to be interested in building their corporate “lattice” instead of climbing the corporate ladder. They value collaboration and want to know their manager is participating in their career development. Beyond feedback, they crave a sense of purpose: more than 85% of millennials who have remained with their employer for at least 5 years were happy with their sense of purpose at work.

Generation Z (1997-2012) is the first digital generation and by far the most diverse. They are values-driven and want to see diversity reflected in leadership. Nearly 60% of Gen Z job seekers rank their organization's social media presence as the reason they accepted the job. In light of that, Johnson recommends practices examine their website and social media to introduce their team, highlight success stories, share letters from clients, post about charity events and more.

Johnson also suggests practice's consider instituting monthly 15-minute conversations with younger employees to help advance skills, improve learning curves and facilitate satisfaction. The conversations should be built around four questions:

1. What's something you're better at now than you were last month?
2. What things would you like to get better at this month?
3. What is your plan for developing these skills?
4. What resources can I help you with?

Similarly, Johnson advises practices to consider replacing an employee's traditional annual review with periodic stay interviews to help ensure their professional growth and satisfaction, discover what they value and would like to improve, and identify any potential impediments that otherwise wouldn't be discovered until the employee's exit interview.

Finally, Johnson stresses the importance of young equine veterinarians feeling as impassioned as practice owners, who can expedite this process by not summarily dismissing ideas and suggestions from associates and new practitioners. Rather, practice owners should first explore how the ideas affect cost, quality, safety and service before making a determination.

The post AAEP: Keynote Speaker Urges Veterinarians To Think About, Embrace Generational Differences appeared first on Horse Racing News | Paulick Report.

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Spike-Pierce presented some unsettling statistics at the clinic's annual client education seminar last month and shared her thoughts on why equine practice is in particular trouble. She cited a study by the American Veterinary Medical Association that found only about 1 percent of veterinary students are planning to go into equine practice – down from 4 percent in the mid-2000s. In the population of existing veterinarians, equine vets make up 5.6 percent of the total. Spike-Pierce also said that within five years post-graduate, 50 percent of equine veterinarians will leave equine practice.

There are lots of reasons for this, but they all boil down to burnout. Spike-Pierce said that veterinarians surveyed by the American Association for Equine Practitioners (AAEP) report their physical health as pretty good – impressive, considering how physical their jobs often are. They self-reported their mental health as much less favorable, with 18% of male equine veterinarians classifying their mental health as fair to poor, and 25% of female equine veterinarians saying the same.

The Paulick Report ran an open letter from Dr. Rebecca Mears about the mental health of veterinarians earlier this year, specifically focusing on the “Not One More Vet” or NOMV movement aimed at preventing veterinary suicide.

(You can read that letter here.)

As Mears explained, recent veterinary school graduates begin their careers under a mountain of debt, often taking low-paying jobs in their first years out of school as they work to get established. Those who go into mobile practice for themselves (like many equine veterinarians) have even greater start-up debt.

Veterinary practices of all sorts have taken to social media in recent months, expressing that they are dealing with shorter tempers than normal from clients, combined with smaller staffs to help manage nursing care and caseloads. Social media has also enabled a dissatisfied client to put a practice on blast, whether or not their criticisms feel true or fair to the veterinarian. After a long day dealing with sick animals and angst-ridden clients, finding a negative review on social media can often feel like the last straw.

Equine practice can be even more demanding, since as Spike-Pierce points out, it doesn't have set hours the way a dog or cat clinic would.

“We are seeing these same issues in equine practice as we are seeing in general veterinary practice, but we're also seeing people leave equine practice and go to small animal practice,” said Spike-Pierce.

Oftentimes, she said she hears people dismiss these issues by saying that equine practice is “a lifestyle” – which she agrees is true.

“It is a lifestyle,” she said. “Actually it's one I pretty much enjoyed. What I loved about equine practice was feeling like I could take my kids with me. I went on calls with my dad growing up. The equine industry as a whole is very open to having kids be there. Oftentimes I think the reason we're working with horses is because we were there when our parents were.”

But not everyone wants to buy into having that round-the-clock lifestyle for most of their lives, and telling young veterinarians that they should work seven days a week or get out of the business seems to result in many choosing the latter. Spike-Pierce said the culture around horses is your job is 24/7 because horses need care 24/7 – but that care doesn't always have to come from the same person.

One reason equine veterinarians may make the switch to small animal practice is that dog and cat clinics often share emergency duty, or allow clinicians to work a smaller number of longer days each week so they get some predictable off time. Spike-Pierce said there's some degree of client education involved in a set-up like that for horse veterinarians — clients need to know who's on duty for after-hours calls on a particular night, or they need to be ok with having their call forwarded to a different doctor sometimes. She has seen some smaller practices experiment with this, with some success.

“Our younger veterinarians are asking for time,” she said. “They want to have time away from work, but they're able and willing to work extra hard when they are working. They want that separation.”

Splitting up duties, especially emergency duties, by geographic region can be a game changer for veterinarians' stress levels, too —  and it can reduce the wait for a client who's dealing with an animal in distress.

“If you all have ideas, that's welcome,” Spike-Pierce told the audience. “It's something we're going to need to address in the future to be able to continue to serve animals.

“If you look at the numbers, it just doesn't work if it continues on the same trend. So please, thank your veterinarian, and please work with them to give them the time they need.”

The post Why One Veterinarian Says There May Soon Be A Shortage Of Equine Practitioners — And How You Can Help appeared first on Horse Racing News | Paulick Report.

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Six outbreaks of CEM have occurred in the U.S. in the past 15 years, including a significant outbreak in 2008 to 2010 in which over 1,000 exposed horses in 48 states were required to be tested, resulting in 23 contaminated stallions and five infected mares ultimately identified and treated.

“Outbreaks in the U.S. have demonstrated the risk of incursions and the need for surveillance in the active breeding population to identify cases early and limit disease spread,” said guidelines co-author Dr. Abby Sage, Richmond staff veterinarian for the Virginia Department of Agriculture and Consumer Services. “Several of these outbreaks also demonstrated significant stallion-to-stallion spread of Taylor equigenitalis via fomites and inadequate biosecurity during semen collection and stallion handling.”

Dr. Sage and co-author Dr. Peter Timoney, the Frederick Van Lennep Chair in Equine Veterinary Science at the University of Kentucky's Gluck Equine Research Center, advise equine practitioners and stallion owners/managers to follow stringent biosecurity protocols when collecting and handling stallions and consider implementation of annual testing of active breeding stallions prior to breeding season as ongoing assurance of disease freedom.

CEM is an internationally reportable disease. When the carrier status of a stallion or infection of a mare is suspected, practitioners should contact their state and/or federal animal health official, who will provide current collection and response procedures for suspect cases.

The CEM Guidelines were reviewed and approved by the AAEP's Infectious Disease Committee and board of directors. View the guidelines or save them to your mobile device for future reference here.

Besides CEM, AAEP guidelines for 22 additional equine infectious diseases are available here.

Read more here.

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Read more about bisphosphonates in our archives here and here.

Dr. Heather Knych, renowned equine pharmacologist at the University of California-Davis, gave an overview of current research on bisphosphonates at the most recent, virtual convention of the American Association of Equine Practitioners (AAEP).

A few takeaways:

• Bisphosphonates may be new to the horse world, where they are FDA-approved for the management of navicular syndrome in older horses, but the drug class has actually been in use in different settings for a couple of centuries. Knych explained that the substance was first used in the detergent industry in the 1800s as a water softener, anti-corrosive or anti-scaling agent. Their action on calcium carbonate made them effective in these settings. They were adapted as therapeutic drugs for human bone conditions in the 1970s.
• While we've most often heard of bisphosphoantes in humans as part of osteoporosis treatment, they've also been used in metastatic bone disorders, and multiple myeloma.
• We know that after an administration, bisphosphonates disappear from blood fairly quickly – their half life is one to two hours in plasma, but they can linger on bone surfaces for months or years.
• Bisphosphonates seem to prefer settling in trabecular bone – bones like skulls and ribs that take less mechanical stress – over cortical bone, like the long bones in limbs. It withdraws from bones based on the amount of turnover in that bone, which can vary depending on age, exercise, and trauma.
• Concentrations of bisphosphonates continues to increase as concentrations of it elsewhere decreases. It can also release from bone back into blood in small amounts and move into other bone surfaces, though we don't know a lot about why and when it does that.
• Knych presented the results of a two-part study led by researchers across multiple universities to learn more about how long bisphosphonates linger in the skeleton. The first part of the project required administration of the two FDA-approved bisphosphonates – Osphos and Tildren – to a total of four horses in university research programs who were already slated for euthanasia for unrelated reasons. Bone samples were taken after euthanasia, which came four days or 30 days after administration in each drug group. Samples from the radial bones showed detectable amounts of both drugs four days after administration, with levels of Tildren being higher in both samples. Thirty days after administration, both drugs could be found in all bones sampled, even right and left molars. Concentrations of both drugs were highest in the tuber coxae (hips).
• In the second phase of the study, researchers tested blood and fluid samples from four horses euthanized due to on-track injuries in California – three whose connections said they'd never had bisphosphonates, and one who had a treatment 18 months prior. The team could find no evidence of bisphosphonates in the three horses with no treatment history. The horse who had been treated 18 months before had no detectable amounts of the drug in serum, urine, or synovial fluid, but did have a detectable level in a sample from the radial bone.
• These results suggest, in line with what veterinarians had expected based on human data, that the drug does linger on the surfaces of bone for considerable periods of time, and lives on different bones in different ways.
• Knych acknowledged that both parts of the study came from extremely small sample sizes, as is often true in academic research with horses, and that further study is needed to better understand how bisphosphonates work in the equine body.

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The low inventory wasn't reported immediately; veterinarians began to have trouble obtaining pentobarbital when their orders were backordered or unavailable because of supply chain issues. It was added to the U.S. Food and Drug Administration's list of animal drug shortages in May.

To combat the dwindling supply, the American Veterinary Medical Association, American Association of Equine Practitioners, the Companion Animal Euthanasia Training Academy and other animal care organizations are urging vets to adhere strictly to dosing guidelines and to consider alternative euthanasia methods.

In anticipation of a potential continued shortage, the AAEP has published guidelines for preferred humane euthanasia methods, including gunshot, captive bolt or combinations of other drugs. The organization notes that right now they have not received calls from members about the issue and that the alternative methods are humane when done by a trained veterinarian.

It is unclear when the pentobarbital shortage will be resolved.

Read more at Chronicle of the Horse.

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Register in advance for this meeting here. Registration deadline is noon EST on Wednesday, May 26.

Ashley Harkins, Program Director for the United Horse Coalition will demonstrate the UHC Equine Resource Database, explore safety net programs available nationwide to help owners in need of assistance, share the UHC's COVID Resource site, and reveal new initiatives planned for 2021.

The mission of the UHC is to advocate responsible ownership through education. One of the many facets of this mission is to inform owners about assistance options, not only during the pandemic, but in any type of hardship.

Included in the discussion will be Emily Stearns, Program Manager of the Equine Welfare Data Collective (EWDC). The EWDC is a program of the UHC to collect, analyze, and report data on at-risk equines, those in transition, and the multitude of equine welfare organizations working diligently to help those in need.

The webinar will conclude with updates coming from UHC Members A Home For Every Horse (AHFEH), the ASPCA/Right Horse Initiative, and the American Association of Equine Practitioners (AAEP) about some of the programs and initiatives they have been working on to help owners, at-risk horses, and horses in transition.

Read more here.

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