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Horses In North Carolina Dying From Mystery Illness

New Hope Stables in North Carolina has had four horses die from a mystery illness that veterinarians cannot isolate or explain. Treasure, an 18-year-old rescue horse used in the stable's lesson program, was the first horse afflicted and was originally suspected to be colicking when barn workers found him down on September 23.

When the veterinarian arrived, however, it was apparent that Treasure was not colicking, but the horse was experiencing gastrointestinal irritation. The gelding was sent to Woodside Equine Clinic in Richmond, VA, where he deteriorated and was euthanized.

On Sept. 28, several other horses at the farm became ill and three died. Three horses remain in the clinic and nearly half of the farm's stable is on intravenous fluids.

Treating veterinarian Dr. Shanna Edwards has asked colleagues all over the United States for opinions; thus far no conclusive diagnosis has been reached, even after a necropsy of one of the horses.

Affected horses have diarrhea, colic and fever, and become bloated and lethargic. Edwards suspects a toxin may be in the horse's hay, grain or water as every horse in the farm is affected, which doesn't typically happen with an infectious disease. The farm has stopped using their well water and has brought in new hay and grain.

A GoFundMePage has raised nearly $30,000 of the $20,000 goal.

Ring Ring: New Resources For Vet Clinics Taking After-Hours Colic Calls

Telephone triage is a critical part of modern patient care in both humans and horses. A British study explored how suspected colic cases called into a veterinarian's office were handled; from there the research team created resources to support decision making.

Drs. Katie Lightfoot, John Burford, Gary England, Mark Bowen and Sarah Freeman created an online survey targeting veterinary practices that took calls from horse owners outside of normal work hours. The team used 116 responses in their analysis: half were from veterinary surgeons, a quarter of responders were members of client care teams, 18 percent were management staff and 4 percent were veterinary nurses.

Of the group, management and client care staff felt less confident offering advice to owners and recognizing critical colic indicators, though they were the ones most likely to answer after-hours emergency colic calls. People in these roles often would not offer advice to horse owners who called the clinic, stating that it was not their role to provide suggestions. Often, information that could affect the speediness of treatment were not asked, like those dealing with equine insurance or transportation to a clinic.

The research team then created evidence-based materials that provide current information about colic and support decision-making made by those taking the calls. The materials included a form for recording information from clients and a flow chat for decision making.

Client care teams were then recruited to employ the new resources and provide feedback. The four teams used worked for East Midlands veterinary practices; they were interviewed before they used the resources and six months after their implementation. All teams reported that the information and resources were helpful, and that they had increased confidence in recognizing critical colic cases and offering owners advice.

The success of the standardization of call response led the researchers to suggest that more should be done to ensure veterinary team members were supported for after-hours emergency calls, including by implementing formal training and standardized protocols. They also acknowledged that some barriers to implementation would include the use of computerized booking systems, practice protocol and owner familiarity may be barriers to implementation.

The resources are available for free through the British Equine Veterinary Association website; they can be used in their current form or adapted to suit other requirements.

Read the full study here.

When Digging For A Diagnosis Becomes Harmful

Equine and pediatric medicine has many parallels, notes Dr. David Ramey in an article for Horse Network, including a propensity for overdiagnosis.

Ramey draws multiple similarities between the two, including that both horses and children are reliant upon adults to make medical decisions for them. Additionally, neither small children nor horses can talk, so diagnoses must be made on observation and testing.

Ramey says that a horse may have an issue where a diagnosis is warranted, but determining an exact diagnosis can be difficult—and in some cases harmful–to the horse. An ultrasound can be a helpful tool to use if a horse is colicking and a diagnosis on whether surgery is needed is imperative. However, sometimes a precise diagnosis isn't needed. If a horse is older and sore, using every diagnostic tool to determine where it is unsound may not change the treatment or the outcome—it simply adds to the owner's expense. In Ramey's words, “'Overdiagnosis' describes a situation when an abnormality is found, but detection of that abnormality doesn't actually benefit the patient.”

Though vets have multiple diagnostic tools at their disposal, their use doesn't always behoove the horse or the owner. Using every tool available to find a diagnosis might physically harm the horse: It's imperative that the owner and vet agree that the benefit outweighs the possible risk of the test or procedure.

Psychologically, naming the issue may change the perception of what a horse can do. Some owners then become focuses on “fixing” the problem, adding in supplements and other treatments that the horse may not need. Finally, the financial strain on owners who choose to offer treatments to horses that may not garner long-term improvement can be immense.

Ramey offers some thoughts on why veterinarians may seek to over diagnose the equines in their care:

Industry influence
Defensiveness
Incentives

Owners may attempt to seek out concrete diagnoses for their own peace of mind; uncertainty is not well tolerated by most people.

The benefit—to both horse and owner–of performing a test or procedure should be discussed before an owner agrees to pay for it. Many equine conditions improve on their own, so immediately throwing every test and procedure at the horse may result in the same diagnosis as waiting and not doing additional tests.

Equine Enteroliths: A Difficult Diagnosis

A horse that ingests a foreign object like a pebble, baling twine or metal may not colic immediately upon eating the inedible item. Instead, his body may hold onto the object and coat it with minerals that form a flat, round or triangular stone inside the bowel. Called enteroliths, these are generally found in the large colon, where they can remain for years before potentially causing an issue.

Though it isn't clear why some horses develop enteroliths, breed disposition, management practices and certain diets (like those high in magnesium and protein) may contribute to enterolith formation. Geography does seem to play a role, with more cases in California and Florida than elsewhere in the United States. Though these stones can occur in all breeds, Morgans, Saddlebreds, Arabians and Arabian crosses are often affected.

Enterolith formation is believed to be affected by gut pH and motility, as well as by the availability of certain minerals. Horses can form both large and small stones; the small stones may be excreted with manure, but the large stones may create an obstruction that leads to colic.

Horses with enteroliths will present differently depending on how many enteroliths there are and where they are located. A horse with a big enterolith in the large colon may have chronic colic symptoms. Horses with smaller stones that move around may show signs of acute colic when something is obstructed. Before the horse exhibits any colic signs, he may have loose manure, weight loss, be reluctant to move or have an attitude change.

Diagnosing enteroliths can be challenging as many of the signs are not specific. X-rays are often used, but they are not always able to definitively diagnose stones not located in the large colon. Early diagnosis is important so that complete obstruction doesn't occur. The only treatment for horses that colic from enteroliths is surgery to remove the stones. Horses that have enteroliths removed should not have any alfalfa in their diets.

Enteroliths can be prevented by offering as much grazing time as possible, increasing the number of meals fed each day, exercising consistently and supplementing with psyllium.