Tag: Dr. Ramey

I thought we'd start off 2023 talking about a product for osteoarthritis in horses, pentosan polysulfate sodium (we'll just call it pentosan from now on). A new, FDA-approved formulation has just been released in the United States, although it's been available in Australia and a few other places since the 1990s.

NOTE: You might have been giving your horse a pentosan product already. There have been compounded formulations of pentosan available for some time in the United States. Compounded drugs are not the same as FDA-approved drugs, although the horse drug market is flooded with compounded products. Compounded medications are the subject of another article, but suffice it to say that if you've been giving pentosan to your horse, depending on where you live, it's production may be more or less regulated, that is, you may be more or less sure that you're getting pentosan in your pentosan. If you want to try the new, FDA-approved product on your horse, you'll have to get it from your veterinarian.

WHAT IS PENTOSAN?

Pentosan is an ester (a chemical term) that's made up of a chain of sugars (known as polysaccharides). In this case, the sugars are called pentoses, that is, they contain five carbon atoms. None of this is particularly important to horse owners (or veterinarians, for that matter), unless you love chemistry, but at least you now know why it's called pentosan (from pentoses).

In its chemical action, pentosan is similar to a class of drugs known as low molecular weight heparins. In people, heparins are used to prevent blood clots, and to treat stroke and heart attacks. In horses, heparin was once tried for treatment of laminitis, but it didn't pan out. This is mostly relevant to you because heparin inhibits blood clotting, and bleeding is a side effect of pentosan (more on that in a bit).

HOW DOES PENTOSAN WORK?

Well, begging questions such as, “If” and “How Well” (more on that in a bit), frankly, it's still a bit of a mystery of pentosan might work for osteoarthritis. Oh sure, there are lots of entirely optimistic proposed mechanism, such as increasing production of hyaluronic acid (which is thought of as a sort of joint lubricant) and increasing production of cartilage components (known as glycosaminoglycans), and maybe it helps prevent enzyme destruction of cartilage, and perhaps it affects the production of cytokines (which are just substances secreted by some cells that have effects on other cells).

Heck, maybe it even sops up free radicals, those dreaded compounds that are said to damage about anything they come in contact with (in the simplistic way of looking at the compounds that seems to be pushed by Dr. Google). But the fact is, nobody really knows how pentosan works for the treatment of osteoarthritis, if in fact it does much at all. To me, this is annoying, because I like to have some idea of how something really works before I give it to a horse. Call me cranky.

WHAT IS PENTOSAN USED FOR?

There is a pentosan pill available for humans. In humans, pentosan may be prescribed to relieve the bladder pain that's caused by a condition known as interstitial cystitis. There, it apparently works by preventing bladder wall irritation. For what it's worth, interstitial cystitis is apparently not a big problem in horses, although it apparently does occur. I've never seen a case.

Of course, the big news in animals – especially insofar as advertising and sponsorship goes – is that it's yet another option for the treatment of osteoarthritis. Interestingly, in humans, pentosan is NOT approved for the treatment of osteoarthritis, in spite of some early evidence which concluded it was helpful (CLICK HERE) which, to me anyway, is curious, because if you want to make a lot of money for a successful treatment for arthritis, there's no better place to start than the human market. That fact is a bit of a red flag for me when it comes to pentosan for osteoarthritis in horses (and dogs, too).

NOTE: Apparently, there are now clinical trials being conducted on pentosan in humans. It will be very interesting to see the results of these trials.

WHAT'S THE CLINICAL EVIDENCE?

While it's been tried in humans – to no avail, apparently, insofar as getting drug approval, and in spite of a couple of studies that showed “promise” – pentosan has been occasionally tested on horses (and dogs, too). For example, it's been reported in an influential book on equine arthritis that a group of racing Thoroughbreds who had chronic osteoarthritis were given pentosan in the muscle once a week for four weeks and that signs of joint disease were “improved” but not eliminated.

In another study, nine horses that got pentosan in an experimental arthritis model had improvement in the quality of their joint cartilage (but we don't know if they got any better – CLICK HERE to see the study). Finally, in another study, a product containing pentosan and a couple of other things didn't do much of anything when administered to horses (CLICK HERE).

Since, sadly, there's not really much robust clinical evidence for the effectiveness of pentosan (after, oh, nearly 30 years), perhaps it might be instructive to ask veterinarians who have been using the stuff what they think. Or, maybe not. I've asked a couple of friends who practice(d) in Australia and one thinks it's wonderful, while the other things it's akin to pouring water on their back. But rather than just rely on two conflicting opinions, in 2014, a survey of 76 Australian veterinarians was published (CLICK HERE) Here's a summary of results

1. Pentosan was most commonly used as prophylactic therapy prior to competition (80.3%). NOTE: That's right along the lines of the rationale typically used for a bunch of horse products intended to help joints. That is, “We don't know if it will do anything, but it might help.”
2. Pentosan was considered by 48.2% of respondents to have high efficacy. NOTE: That also means that 51.8% of respondents thought that the product didn't do much, which is right along the opinions of the two people that I asked.
3. The most common dose regimen for prevention and treatment of OA was 3 mg/kg, intramuscularly, once weekly for four weeks followed by monthly injections. NOTE: That's a combination of the manufacturer's recommendation plus some unknown dosing schedule, which, again, is just like what's used for many other products. First, the products are dosed according to the label, and then, they're given on some other schedule that's often dictated by how much the medication costs. Otherwise stated, you don't really know what you're doing, but at least you're doing something, if you can afford it.
4. Most respondents (78%) combined PPS with other drugs for treatment of OA. NOTE: That's not much of a ringing endorsement for the effectiveness of the product.
5. For treating OA, 83% of respondents considered a combination product was more efficacious than pentosan alone. NOTE: This was a curious finding, especially since the research that I previously cited showed exactly the opposite (CLICK HERE).
6. The most common reason not to use this combination was cost. NOTE: That makes a good deal of sense, actually. It's fine to spend money on your horse but if it doesn't seem to do much, why bother?

SO, WHAT ABOUT THE EVIDENCE THAT GOT THE DRUG APPROVED?

In spite of the previous (underwhelming) evidence, the fact of the matter is that pentosan did get approved by the US Food and Drug Administration, so the evidence had to show something. This is where you have to dig into the evidence a little bit. I did, and here's what I see, based on the drug summary, which you can see if you CLICK HERE.

The manufacturer of the new product did a field study, that is, they were using horses at barns, stables, etc. They ended up with 109 horses that got a shot of pentosan in the muscle once a week for four weeks, and 113 horses that got an injection of saline once a week for the same period (that's according to the recommended dosing regimen).

All of the evaluated horses were lame, and they were graded by the lameness scale developed by the American Association of Equine Practitioners:

• 0: Lameness not perceptible under any circumstances.
• 1: Lameness is difficult to observe and is not consistently apparent, regardless of circumstances (e.g., under saddle, circling, inclines, hard surface, etc.).
• 2: Lameness is difficult to observe at a walk or when trotting in a straight line but consistently apparent under certain circumstances (e.g., weight-carrying, circling, inclines, hard surface, etc.).
• 3: Lameness is consistently observable at a trot under all circumstances.
• 4: Lameness is obvious at a walk.
• 5: Lameness produces minimal weight bearing in motion and/or at rest or a complete inability to move.

So, what were they measuring? The metric for improvement was a change of one level on the AAEP scale. For example, perhaps a horse was lame at the walk initially (grade 4) but after the medication, he was only lame all the time at the trot (grade 3). I guess that's something, but it's not much, in my opinion. In fact, I rarely hear clients congratulate me, saying, “Great doc, after treatment, now he's less bad!” Plus, add that to the fact that the measurement was subjective (“Is he a bit better?”) and the relatively small number of horses (relative to the large trials often conducted in human medicine, that is), and there's some reason to wonder how meaningful the metric really is.

But how about the results? Well, according to the study, 57% of the horses that received pentosan improved. Of course, 36% of the horses that got saline also improved. That's a difference that is statistically significant, that is, it's somewhat less likely (although not impossible) that the results occurred purely by chance.

But there are larger questions that can't really be answered by this study. In fact, you're probably the best person to answer them. Specifically:

1. Is the relatively modest possibility of mild improvement worth the cost?
2. Do the results, even if true, really mean anything (that is, are they clinically relevant – I don't think that they're likely to be, but I'm pretty conservative)?
3. Are the possible side effects worth the risk (more on that, below)?

WHAT ABOUT SIDE EFFECTS?

I'm glad you asked. If you want to give your horse pentosan, there are some side effects you should be aware of. In fact, the study documented several of them, including:

• Increase in measures of blood clotting (which you'd probably expect in a heparin-like product)
• Lethargy
• Behavior changes
• Colic
• Stiffness

The effect on blood clotting is real. As a result, I'd probably avoid giving it immediately before your horse is going to do something potentially traumatic (like run, jump, or spin). I'd probably also avoid giving it to a horse that might need surgery. Oh, and, just in case you have blood clotting problems yourself, and since pentosan is an anti-coagulant, if you take an anti-coagulant, you should take care not to inject yourself, or maybe even have someone else do it.

WHAT'S THE BOTTOM LINE?

Frankly, I'm not very impressed. To be fair, I'm pretty conservative, so I'm rarely an early adopter. That said, first of all, this really isn't a new drug – it just finally got approved in the US after being available for nearly 30 years in other countries. Experimental reports – including the one that got the drug improved – aren't particularly robust, that is, you shouldn't expect to see a great improvement, if you see improvement at all. In addition, pentosan is also NOT a pain-relieving medication. The idea that the product might prevent arthritis is mostly just naïve optimism, although, as with other products, and as per the Australian survey, it's probably the number one reason that people will use pentosan.

You'll probably see lots of advertising coming up in the next few months – perhaps you'll even see sponsorships show up at horse shows. Hopefully, I've given you plenty of information with which you can start to make up your own mind.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey's website, doctorramey.com and is reprinted here with permission.

The post Ramey: A New Pentosan Drug For Horses Was Just FDA-Approved; What Does It Mean For You? appeared first on Horse Racing News | Paulick Report.

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It's kind of cool, being a veterinarian. Most people have a general appreciation for what you do. I mean, taking care of animals (in my case horses) really is a pretty great thing, and most people seem to appreciate you for it. However, most people don't know much about veterinary medicine – and particularly horse medicine. So, upon meeting me, and in starting up a conversation, they often want to jump in with a question of what-would-seem-to-be mutual interest.

So, when learning that I'm a veterinarian who takes care of horses, there's one question that seems to crop up all of the time as an icebreaker. People always ask, “Why do you have to put a horse to sleep if it breaks its leg?”

Still, even if they haven't been around horses, people are aware of them as, say, arguably the most important animal in human history. They've seen them; in old Westerns, on TV, in old pictures, and in various urban settings where horses happily take blanket-covered couples on evening tours. People care about horses! Thus, the question comes from a combination of unfamiliarity, a bit of compassion, and a bit of curiosity as to why fractures – which are generally handled rather routinely in most other species, seem to be such a big problem in horses.

Putting horses to sleep seems to also have been a pretty well-accepted solution to the majority of horse health problems. People apparently think that working on horses can be a pretty hopeless endeavor, especially when it comes to their legs. Such despair seems to be pretty ingrained. You know, in the movies, the horse gives his all to save the hero, breaks his leg in the process, and gets shot for his efforts. Racehorses break their legs, and sometimes have to get put to sleep (for various and sundry reasons that we'll get into). Heck, the cartoonist Gary Larson even got his two cents in.

Yet, the fact is, that you don't always have to put a horse to sleep when he breaks his leg, although, sometimes, you may not have any choice. Still, the answer to the question is complicated. And, unfortunately, in my experience, the nuances of this discussion cause the people who asked it to almost immediately regret having done so, but since you're here, and have made it this far, here we go.

1. What kind of break are we taking about? In a way, to say that a horse broke his leg is sort of like saying that a person has cancer. For people, cancer can be everything from a little spot on the end of the nose that the dermatologist shaves off in a quick office visit, to the chilly realization that your affairs had better be in order.

   Some “breaks” really aren't that big a deal. For example, I've seen a couple of horses that cracked the big bone above the knee, in the forearm (the radius). The horses were very lame. The leg was, in fact, broken. Looked just horrible on X-rays. And, after a couple of months in the stall, the leg healed. The bones didn't displace. The horses were fine. Uncommon fracture, to be sure, but not dead as a result, either.

   Other breaks, however, are an enormous problem. That's because of the forces generated on the horse's legs when they are running. A horse is pretty much built to the limit of its tolerance – with its muscular body, and relatively skinny legs, it really can't be much bigger than it is. As such, when a horse is running, turning, jumping, pivoting, or otherwise exercising, it's putting stresses on its limbs that are right up to the maximum of what they can take.

   When those stresses exceed what the horses limb can take – BOOM! – an explosion goes off in the horse's leg.  As such, the bone not only fractures into a bunch of pieces, but blood vessels can tear, tendons can rupture, and ligaments can shear off the bone. Under such circumstances, there's not really anything left to fix. The limb of a person who had sustained such an injury would usually be amputated – that's something that's rarely done in horses. But even under such catastrophic circumstances, people sometimes try to fix fractures; thus, the story of Barbaro, the 2006 Kentucky Derby winner who, despite the best efforts of the best surgeons, was unable to recover from his fractured leg.

2. Where's the break? A crack in the middle of a long bone can sometimes heal with rest. But a crack that's into a joint will ultimately destroy the joint. If that joint is a joint that doesn't move a lot, a fracture may not be a big deal. So, for example, a horse with a broken pastern can sometimes be saved by screwing the broken bones together and fusing the joint – turning two bones into one, as it were. Horses can move pretty normally – even perform – with a fused pastern. But it's a lot harder for horses to get around if their fetlock joint has been destroyed.

   The higher up the leg you go, the harder it gets. Once you start dealing with fractures of the upper leg, repairs are pretty much impossible. For one reason, that's because they're so hard to get to. If you wanted to try to fix a horse's femur (in the hind leg), or its humerus (in the front leg), you'd have to dissect through so much tissue trying to get to the fracture that you we're trying to fix that you'd essentially be destroying the leg anyway. And the forces placed on the implants in such areas are almost unimaginable – the muscles of the horse's legs can pull apart the repaired tissues, bending metal screws and plates as if they were pieces of licorice.

3. How bad is the fracture? The worse the fracture, the harder it is to deal with. Some fractures are described as a “bag of glass.” In such fractures, there are so many pieces of bone that they can't be put back together. Others, such as the ones in the radius that I described, are pretty simple – just a crack that has to heal. Even the best surgeon can't fix the worst fractures – there's not really anything left to fix.
4. What's the horse used for? Sometimes, you might be able to fix a fracture, but you'd end up with a pasture ornament. So, for example, if you had a horse that fractured its fetlock, while it might be possible to fuse the fetlock, and save the life of the horse, you'd also have a horse that you couldn't really ride (I'm sure there may be an exception somewhere), but it would certainly be a horse that would always walk around with a limp. In the case of a valuable breeding stallion, the cost might be worth it. But the fact is that if, say, a 5-year-old barrel horse is rendered unusable as a result of a fracture, many people may not feel that the cost of keeping the horse for the next 20 years is worth the price of the repair.
5. How much is fixing the break going to cost? Fixing a horse's broken leg isn't cheap. Even under the best of circumstances, a successful fracture repair is going to cost many, many thousands of dollars (those screws and plates that you see in the X-rays aren't cheap!). As such, the decision of whether to try to repair a horse's fracture often comes down to a single question: “Do you want this horse, or do you want a horse?” If you're being asked to spend $20,000 to fix your horse's broken leg, and you'll end up with a lame horse, well, to be simply factual, you can buy a really nice replacement horse – a horse that won't be lame – for the same money. Plus, there's no guarantee of the outcome, even under the best of circumstances.

The fact is that limb fractures in horses can have terrible outcomes. But there can also be some wonderful success stories, ending with sound horses, or even lame horses that live happy and long lives as pets and companions. The decision as to whether to try to fix a horse's broken leg is usually complicated – but you sure don't always have to put them to sleep!

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey's website, doctorramey.com and is reprinted here with permission.

The post Ramey: Why Some Horses’ Leg Fractures Are Fatal And Others Aren’t appeared first on Horse Racing News | Paulick Report.

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Vaccination is certainly one of the most important interventions in health (human, animal, fish, etc.) that has ever been invented. But not all vaccines for horses are equally effective. Before the time comes for spring shots, I thought I'd give you some information about individual vaccines, and how well they are likely to work.*  And by “work,” I mean, how likely they are to actually prevent the disease that they are supposed to prevent.

DISCLAIMER:  By no means should you read this article and then go our and ignore the advice of your veterinarian.  He or she may be aware of some individual circumstances that might make certain vaccines more or less useful in your area.  But with the information below, if nothing else, you can have a good discussion.

FIRST THING:  Vaccination is the process whereby a horse can be made somewhat resistant to a particular disease.

SECOND THING:  Vaccines are not an iron-clad guarantee that your horse won't ever get sick with that disease.

Vaccines have enabled veterinarians to control and prevent many awful diseases, especially in the pet and livestock industries.  However, while I know your horse is important to you, economically speaking horses are not as important as livestock or pets.  That's perhaps one reason why there hasn't been a strong reason (read: return on investment) to spend a lot of time on developing and testing vaccines. So, in many respects, the equine vaccine field has lagged behind other that of other species.

It's actually pretty hard to determine how well – or even if – many equine vaccines work. That's because, when compared to most every other species, there's not much published data put out before vaccines are released, and not much data gets accumulated after the vaccines are out there. Otherwise stated, nobody really keeps track once the vaccines are released. That means that the sort of information you'd need to make a fully informed decision (effectiveness, rate of reactions, etc.) for your horse just isn't available. In fact, such aftermarket oversight isn't even required.

The rationale behind vaccination is pretty simple — you vaccinate your horse, you prevent a disease, right? To be perfectly honest, that's not always the case (and not necessarily through any fault of the vaccine).

Many vaccines simply claim to be an aid in the management of the disease, which can be quite a shock when your vaccinated horse still gets sick.  The fact of the matter is that no vaccine is perfect. Using vaccinations to prevent disease should be just one part of an overall strategy to control disease in horses, a strategy that might also include such things as:

• Isolation of sick animals
• Keeping shared environments clean
• Quarantine of new animals brought onto a premise

There's a lot more that can be said, of course, about the type of evidence that's (not) available and such, but let's get to the bottom line: which vaccines appear likely to be effective, based on the evidence we have.

EQUINE INFLUENZA (FLU)

In experiments, flu vaccines tend do pretty well at preventing disease caused when horses are challenged with a particular strain of virus. However, most horses don't live in laboratories, at least not the ones I take care of  Unfortunately, field data – that is, how well the vaccines prevent the flu in barns, stables, and pastures – is extremely limited, and field trials have not shown the vaccine to be particularly effective at preventing the spread of influenza. In fact, if you consider that horses are pretty widely vaccinated against the flu (except in Australia, where, with the exception of one outbreak a number of years back, the disease doesn't occur), and that flu is still a very common problem, you might be drawn to conclude that the vaccine hasn't been very effective. In general, vaccinated horses will still get infected with flu virus, and even though they may show milder clinical signs of disease, they will still shed virus and so be a source of infection for other susceptible horses.

PLEASE NOTE:  If you show your horse, there are many competitions and show organizations that have requirements for flu vaccines – make sure you're aware of them. This fact is independent of vaccine effectiveness.

EQUINE HERPES VIRUS (EHV, Rhinopneumonitis, Infectious Abortion, etc.)

There are three scenarios where your horse may be affected by a herpes virus.

1.  Pregnancy.  EHV (you don't want me to have to spell it each time, do you?) causes mares to abort their fetuses. And, happily, there is some evidence that EHV 1-4 vaccines (the numbers indicate a vaccine strain) do reduce the likelihood of abortion. However, the vaccines may not work very well if horses exposed to a high dose of the virus, and the rationale behind the five, seven, and nine month vaccine schedule is not at all clear. You'll probably do it if you have pregnant mares, because you'd feel terrible if your mare aborted from the virus, and you didn't vaccinate.

2.  Respiratory Disease. EHV-4 can cause respiratory disease that is pretty much indistinguishable from the flu. There's some evidence that vaccination can reduce the severity and duration of respiratory disease after an experimental challenge, but it probably doesn't do anything to stop the spread of the disease, and particularly since many horses are exposed to the virus when they are very young.

In fact, latent (inactive) EHV-1 infection is quite common in horse populations worldwide. It has been estimated that inactive infections exist in something like 90% of the horses in some areas. Otherwise stated, EHV-1 vaccines probably don't do much good because horses are already infected in the same way that people with cold sores are carriers of the herpesvirus. Vaccination doesn't help when you've already got the disease.

3.  Neurological Disease.  No EHV-1 vaccine has been shown to prevent the neurologic form of the disease that periodically captures equine health headlines, and no vaccine claims that it can prevent the neurologic form of the disease. Period.

WEST NILE VIRUS

There is good evidence that vaccination against West Nile Virus is effective against preventing clinical disease and death in horses. You should follow the manufacturer's recommendations, but in some areas, those areas where there are lots of mosquitoes, more frequent boosting may be recommended in order to maximize the protective immunity. Ask your veterinarian for his or her recommendations if you're in an area where West Nile Virus is a particular problem.

POTOMAC HORSE FEVER (PHF)

PHF is more of a regional disease, mostly seen in the eastern United States. When the disease first came out, a vaccine was rapidly made available, and the early experimental data, which was based on challenge with a selected strain of the disease, was very good.

Unfortunately, there's not much data pertaining to use of the vaccine in the field, and what is there suggests that the vaccine doesn't work very well.  That's probably because there are many strains of the disease (as I recall, it's at least nine), but only a couple of strains are in the vaccine. Bottom line is that the PHF vaccine is not likely to provide much protection against disease.

ENCEPHALITIS (Eastern, Western, Venezuelan)

Viral encephalitis is an uncommon, but regularly seen problem that mostly occurs in the eastern United States (VEE doesn't occur in the US, but it's occasionally crosses the southern border with Mexico). If your horse gets encephalitis, he simply isn't going to get better, so vaccination is your best strategy to prevent the disease. Ask your veterinarian for the best vaccination schedule in your area. The vaccine is very effective.

STRANGLES

Frankly, there's very little evidence to suggest that strangles vaccines work. In fact, most of the world doesn't vaccinate against strangles. In addition, strangles vaccinations have among the higher incidences of vaccine reactions. If you're using the intranasal vaccine, it's also possible for your horse to get sick from the vaccine strain of the bacterium. There are some newer vaccines that sound promising, but they're not here yet.

I don't recommend that my own clients use the strangles vaccine. And as I said at the start of this article, the vaccine is certainly not a substitute for hygiene, quarantine, and control measures.  CLICK HERE for the 2018 position paper on strangles from the American College of Veterinary Internal Medicine (which does not advocate vaccination).

TETANUS

It works. Vaccinated horses survive tetanus infections, and non-immune horses die. We're not sure how long the vaccines last, but evidence from other species suggests that it's measured in years. Your horse is going to get plenty of opportunities to be vaccinated against tetanus if you, like most people, use a combination products (e.g., “Four-Way”) and there's no evidence that it will hurt him if he gets vaccinated against tetanus every year.

EQUINE VIRAL ARTERITIS (EVA)

EVA is another annoying viral disease, and vaccines are used in distinct regions of the world. These regions generally not include the US; they're not allowed to be used in the UK. That said, it does seem that the vaccine is effective at preventing the carrier state in vaccinated colts. However, safety concerns about the vaccine exist, the safety of vaccinating pregnant mares is up in the air, and there are some worries about vaccine-caused disease.  It's also pretty much impossible to tell if a horse has been vaccinated, or if it's been exposed to disease:  this can be a concern if you're planning on shipping a stallion internationally.

RABIES

In some parts of the United States, those with high rabies activity, it's advisable to vaccinate your horse. Plus, in some states, it's the law. The available vaccines are effective, and in areas where there is rabies in the wild population, it's important. Plus, you can get rabies from a horse. Why take that chance?

HOMEOPATHIC NOSODES

You may not have heard of these things, and they aren't common, but they're out there. Nosodes (which are not, in fact, homeopathic), are prepared from high dilutions of infectious agents, material such as vomitus, discharges, or fecal matter, or infected tissues. Curiously, the founder of homeopathy, Samuel Hahnemann, decried the use of such preparations and was even a supporter of smallpox vaccination.  There is no evidence at all to suggest that homeopathic nosodes have any effectiveness. To the contrary, there is one case reported in the human literature where a patient followed her homeopath's advice and took a homeopathic immunization against malaria before traveling to an endemic area. The patient promptly got malaria. Nosodes have also failed to protect puppies against parvovirus.

I think that it is of note that the British Faculty of Homoeopathy acknowledges the effectiveness of vaccines and recommends their use in humans.  Seriously, just don't bother with them.

Heck, don't bother with homeopathy, either – CLICK HERE to see why.

A QUICK NOTE ABOUT TITERS – In some circles, people are trying to decide whether or not to vaccinate their horses based on a measure of immunity in the blood. Those measures are called titers. It sounds like a good idea, but there's actually no information in horses to suggest that a certain titer equals disease prevention. Seems like a good idea, but, in reality, nobody really knows what a particular titer means for a horse.

Oh, one more thing — don't fall for all of the negative stuff that some people say about vaccines. They aren't 100% effective at preventing disease, but they don't cause widespread harm, either. There are a lot of dopey things said about vaccines – CLICK HERE to read about some of them.

So there. The bottom line is that some vaccines are likely to help your horse(s) – others, not so much – and that nobody really keeps track. That's why it's important to work with your veterinarian to establish the ideal schedule for your horse – he or she should have a good idea of particular problems in your neck of the woods.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey's website, doctorramey.com and is reprinted here with permission.

The post Ramey: Which Vaccinations Are Worth A Shot For Your Horse? appeared first on Horse Racing News | Paulick Report.

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I don't know if you've noticed, but when it comes to dietary supplements for hoof growth, you have a whole bunch of choices (I can be a master of understatement). In fact, it seems like every day or two there's a new product out there to “support” or “improve” or do something otherwise wonderful for your horse's hooves (as well as for just about every other part of his body's systems).

Clearly, manufacturing hoof supplement represents something of an economic opportunity. The more important question (for you), of course, is whether hoof supplements are really an opportunity for you to do anything more than spend money. Unfortunately, due to the fact that hoof supplement products are essentially unregulated, and that follow-up is rarely conducted to see if such products really do anything useful for the horse, it's pretty much impossible to be confident in the true effectiveness and safety of any hoof supplement – heck, of any dietary supplement for horses (that's another article).

Regardless, I've got some secret inside information to share with you. The single most important nutritional factor for the normal growth and health of the horse – including the hoof – is a good diet. Otherwise stated, if you're feeding your horse a good diet, it's likely that he's getting all of the nutritional stuff that he needs to grow as good a quality of hoof as is possible. A “good” diet is one that provides and adequate amount of protein, carbohydrates, vitamins, and minerals, and such. Happily – for both you and the horse – in nearly all situations the horse is set up (physiologically speaking) to obtain all of those things from his normal diet.

You can get a pretty good idea when everything's OK without too much effort, too. Here's how. If your horse is at a good body weight (can't see the ribs, but can feel them easily), and he's feeling good, then it's pretty unlikely that anything else is wrong. It's not like horses are delicately balanced on the edge of some nutritional cliff, waiting for the lack of a nanogram of aluminum to push them over the edge. If they look good, and they feel good, it's usually because things are, well, good.

Of course, there are all sorts of nutritional problems that can affect the horse's hoof. Here are just a few:

1. Selenium toxicity
2. Carbohydrate overload (your horse breaks into the feed room and eats 25 pounds of grain, or he eats lush spring grass for hours on end)
3. Insulin dysregulation (more commonly known as insulin resistance or metabolic syndrome)
4. Obesity (one of the biggest nutritional problems for horses)

These are certainly things that you should be aware of and do your best to prevent. However, there's very little evidence to suggest that giving nutritional supplements to horses will prevent any of these things, and giving supplements to horses on good diets doesn't do anything to benefit their hooves.

There are occasions where a particular supplement may be helpful. So, for example, if you live in an area where the ground is deficient in the mineral selenium – part of the Northwest, Northeast, the Atlantic coastal area, Florida, and regions surrounding the Great Lakes – supplementation with some selenium may be of benefit. Even here, you have to be a little careful, because too much selenium is arguably worse than not enough (and too much selenium causes hoof problems, too).

When it comes to, oh, just about anything in horse medicine, people tend to follow the “bigger hammer” theory. This goes for nutrients for their horses, as well. According to this line of thinking, if you're trying to build a healthy horse, more is usually better. Want a healthy hoof? Feed them more of the stuff that's in hooves! But that's not how the horse's body works. If you give nutrients in excess, the body tends to do one of three things. It gets rid of them, it metabolizes them, or it stores them (which is why horses that get too much to eat for too long get fat – they just store the extra calories).

When it comes to nutrition and your horse's hooves, you don't need a bigger hammer, you need the right hammer for the right job. In the case of your horse, a horse that's being fed well will usually look good and feel good, and his hooves will be in good shape, too. That's as good as it gets. There's really no support at all for the idea that additional vitamins, protein, amino acids, or trace minerals will benefit the hooves of otherwise healthy horses.

BIOTIN

Essentially every hoof supplement known to man (and horse) has biotin in it. Curiously, a biotin deficiency has never been identified in horses. In fact, given that the intestinal bacteria make all of the biotin that any horse could ever possibly want, the idea that hoof problems are a result of a lack of biotin is a pretty big stretch.

There has only been a little bit of scientific investigation done on biotin supplementation for hooves; most of it is pretty old. Some studies from the 1990s did conclude that there was some benefit of giving biotin supplements to horses with poor quality hooves. The hooves of other species – like pigs – have benefited from additional biotin, but no matter what you think of your horse's eating habits, pigs and horses are different, so it's hard to make a direct extrapolation.

All that said, biotin is pretty harmless – it's a water-soluble vitamin that, in excess, just makes for expensive horse urine. Beneficial effects have only been shown with higher doses: along the lines of 15–20 mg/day for a 500 kg horse. You also have to be patient, because it takes several months of supplementation before any effect might be seen; the biotin would get incorporated into the growing hoof, and the hoof slowly grows down from the hairline. And, of course, don't be TOO optimistic, because biotin is certainly not a hoof panacea. Not all hoof problems respond to biotin supplementation.

ZINC AND COPPER

While they are often included in hoof supplements, neither zinc nor copper supplementation have been shown to promote hoof health in the few investigations that have looked at such things.

There's no question that they are both needed in the horse's diet (copper, for example, has been shown to be important for orthopedic health in growing horses), but it's far more likely that horses will get exposed to too much copper or zinc than it is that they will get too little. Fortunately, horses seem to tolerate zinc and copper pretty well, so you probably won't hurt them with the stuff unless you really give it some effort. But don't expect it to do much under any circumstances.

AMINO ACIDS

Many hoof supplements contain amino acids. Amino acids are the “building blocks” that make protein, and hooves have a lot of protein in them. According to the bigger hammer theory, since hooves contain protein (keratin), feeding them more stuff to help them make protein will make their hooves bigger/better/stronger. As a result, hoof supplements may have amino acids such as cysteine, methionine, lysine, proline, and tyrosine: amino acids all. But again, more isn't necessarily better. For example, additional methionine – the sulfur-containing amino acid often included in hoof supplements due to its existence in hoof tissue – hasn't been shown to benefit horses. In fact, poor hoof quality has been related to higher methionine levels in the horn of the sole.

Perhaps even more troubling, proteins and amino acids can also stimulate insulin production in some circumstances, which is exactly what you DON'T want if you're worried about things like laminitis (which, in general, is something to at least be aware of, if not consumed with worry). The bottom line is that feeding a bunch of amino acids to your horse isn't likely to help his hooves.

BOTTOM LINE?

The bottom line is that for most horses fed a good, healthy diet, feeding them some nutritional supplement is not likely to help them very much. Of course, good hoof quality is not only about nutrition – you also have to make sure that your horse gets good hoof care, and that he's not perpetually standing around in mud puddles or on hard, rocky, dry surfaces, and such. Good hoof care does require a bit of attention on other fronts besides nutrition. If you pay attention to the important stuff, you can usually just walk right on by all of the buckets and bags in the hoof supplement aisle.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey's website, doctorramey.com and is reprinted here with permission.

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