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Researchers, Veterinarians Still Learning About The Capabilities Of Sensors To Detect Injury In Racehorses

In recent years it has become clear to veterinarians and researchers studying injury rates in racehorses that serious injuries probably don't happen out of the blue. Major injuries are now commonly believed to be the result of minor injuries going undetected until they accumulate or worsen. One of the reasons those minor issues can easily go unseen is that the first defense for soundness monitoring for most horses is still a visual exam from a trainer or veterinarian or an assessment from a seasoned rider. Horses are very good at compensating for minor problems however, and small changes in their movement can often be imperceptible to the human eye.

Some experts are hopeful that sensor systems may help pick up what the human eye cannot. At a special virtual edition of the annual Tex Cauthen Memorial Seminar held on Jan. 24, several veterinarians provided updates on research into the use of data from systems like the Lameness Locator and StrideMASTER on the racetrack.

So far, the consensus seems to be that both systems provide veterinarians useful information but they're still learning how to contextualize that information.

Dr. Abigail Haffner presented data from a recently-concluded study at Thistledown Race Course which is still being analyzed. Researchers placed Lameness Locator sensors on horses and watching them jog about 25 strides in hand. The Lameness Locator uses sensors on the horse's head, pelvis, and right front pastern which contain accelerometers and gyroscopes. Together, the sensors develop a sense of the horse's “gait signature” or its normal way of going.

The study measured 73 horses weekly over several weeks, with a total of 1,663 exams performed. The horses were selected based on voluntary participation of their trainers, which also meant that horses dropped out of the study for reasons that weren't always known to the study team – like whether the horse had left the barn because it was claimed, or because it had developed an injury and been sent for lay-up or retirement.

None of the horses in the study suffered fatal injuries.

What Haffner and her team learned was that the process of using the system in a practical, racetrack setting is pretty easy – each reading takes three to four minutes and the sensors were simple to apply correctly.

She is hopeful the data may tell her more about how good the system is at noticing changes that were indicative of impending injury. Due to conformational differences, horses may not always move in a perfectly symmetrical way without an injury actually being present, which can sometimes complicate lameness exams.

Dr. Kevin Keegan, professor of veterinary medicine and surgery at the University of Missouri, said he's hopeful for the system's potential to help horses, but does admit it has limitations.

When used for these repeated measurements over time, the Lameness Locator is best at showing existing asymmetries of movement and changes to the horse's movement — but it can't tell you why those asymmetries exist.

“We are measuring a clinical sign, not a disease,” said Keegan “You can define lameness as a movement that's different from normal … lameness may have many causes, but the cause we're most interested in is physical pain.”

If it's put on a horse who already has mild underlying lameness, it will show areas where the horse's body travels asymmetrically but the interpreter won't know if that's a horse's pain-free, normal way of going or if there's an underlying problem.

A horse demonstrates the bonnet portion of the Lameness Locator, which has a sensor at the poll to detect head movement

Bilateral lameness, or lameness occurring in two legs at a time, is even more difficult to capture with the human eye than lameness in a single leg. Keegan says it's possible for the Lameness Locator to detect this, although it is more challenging. Many people assume that a horse will swap weight evenly between the left and right limbs in a bilateral lameness to avoid pain, but it's usually not that precise. Keegan said that sooner or later, the sensors are going to pick up changes in the head and pelvic movements that will point to that swapping.

The process of studying systems like this one has also shown veterinarians that the current way of doing pre-race lameness exams can be less than ideal. Horses are walked or jogged without a rider on board, and can often be fractious, which interferes with their movement. Keegan pointed to Mongolian Groom as a classic example of the variability you could have between multiple exams conducted at the barn versus on the track. He believes a sensor on the ill-fated colt during a jog on the track may have provided a different set of information than the vet checks the horse passed at the barn before the 2019 Breeders' Cup Classic.

Dr. Bronte Forbes, veterinarian with the Singapore Turf Club, said the Lameness Locator has been used in that country to assess poor performers post-race, helping officials flag which ones need further assessment.

“If you're going to consider using this technology as a regulatory tool, everyone has to buy into it,” Forbes said.

Horsemen really believed in the technology in Singapore, Forbes said, and would sometimes request a reading if they had a horse they were worried about.

Still, Forbes said, he has concerns about the best way to work the technology into a regulatory system. He worries that a pre-race use of the technology could lead to a liability issue if it records asymmetry that the trainer or veterinarian believes is just a horse's gait signature, and the horse subsequently breaks down. Likewise, if a horse breaks down in a jurisdiction where the technology is used post-race, many people may have legitimate questions as to why it wasn't used as a screening tool.

Also, Forbes agreed with Keegan, the sensors provide information, but not context, and veterinarians must be aware of the difference.

“It's a measure of asymmetry, and there is no line in the sand currently that determines whether that horse is lame or whether that horse is going to sustain an injury or not – and that's especially true for a one-off assessment of the horse,” he said. “We've all seen very sound horses injure themselves and lame horses not injure themselves. I think we'll establish a welfare level of 'It's not acceptable to send this horse out there.'”

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Gluck Professor Assisted With FDA Approval Of COVID-19 Testing Device

Dr. Ted Kalbfleisch, an associate professor at the University of Kentucky in the Gluck Equine Research Center, was a member of a research team that sought emergency FDA approval for a veterinary device to be used to help test for COVID-19.

Veterinarians have had the ability to run real-time assays in the field for years. One of the commonly used devices was developed by MatMaCorp out of Lincoln, NE. The self-contained unit is about the size of a laptop; it can provide results to vets in one to two hours, without requiring the horse to be brought to an equine hospital.

It was quickly realized that this technology, which is familiar to veterinarians, could play a vital role in the fight against COVID-19 in humans. Kalbfleisch and other members of the team were able to get the unit approved by the FDA; the COVID assay it tests for has now been approved for use in CLIA-approved laboratories. Future research will focus on a device that can be utilized in the field for COVID-19 testing.

Sesamoid Bones: They Take A Lot Of Pressure And Raise A Lot Of Questions For Researchers

As racing continues its quest to reduce injury rates, one key area of interest for many experts is the proximal sesamoid bones.

Most racing fans who have heard of sesamoid bones know about the two small, triangular bones held inside the suspensory ligament that form the back of the equine ankle, but horses (and humans) actually have other sets of sesamoids in the body. The two that form each ankle are called the proximal sesamoid bones. The human kneecap or patella is present in the horse as a component of the stifle and is also considered a type of sesamoid bone. The navicular bone in the internal structures of the hoof is also a type of sesamoid. Sesamoids exist because they reduce friction on joints by gliding over the joint's surface, helping to pull the limb back and forth.

The proximal sesamoid bones are part of the ankle or fetlock, which drops down toward the racing surface to absorb the horse's weight during a footfall. The joint flexes farther down the harder the foot falls. The elastic tendons and ligaments (particularly the suspensory ligament) are crucial during this shock absorption procedure, and the proximal sesamoids are hard at work in this moment too – which may mean it's not surprising that they're a common source of injury.

Existing research suggests that sesamoid fractures or suspensory apparatus failures are associated with 30 to 50 percent of fatal injuries in Thoroughbred racehorses. At a recent virtual session of the University of Kentucky's annual Equine Showcase, researchers said that makes them a crucial area of study – but we have to start from the beginning.

Scientists would like to know how the structure of the proximal sesamoids changes in response to intense exercise like racing. We know bones change their shape and structure in proportion to the amount and types of forces placed on them through exercise in a process called bone remodeling. (You can learn more about bone development and remodeling here.) It would be helpful to know if somewhere in that process, sesamoid bones undergo abnormal changes that could signal or predispose an upcoming fracture.

According to Dr. James MacLeod, researcher and faculty member at the Gluck Equine Research Center, scientists first need the answers to more basic questions about proximal sesamoids. In order for researchers to know what is considered an abnormal structural change, they have to know what's normal for these particular bones – what size, shape, and internal structure is typical? How do they develop? When do they develop? How much variation is there in size, shape and structure between individuals, between breeds and between sports?

Unfortunately, MacLeod said, existing science is somewhat light on the answers to these questions.

“It turns out that in the horse, very little information was published about proximal sesamoid bone development and maturation in a normal sense,” he said.

When trying to answer the basic question of when these bones develop, MacLeod and his colleagues dug up two publications in textbooks suggesting that these particular bones don't begin to form in a developing equine fetus until very late in gestation, between Day 290 and 330 in what's typically a 340-day gestation. The end of ossification (hardening) for the bones was, according to these textbooks, complete at around month three or four of the foal's life.

“We had evidence right away that there was much more to know about the development of proximal sesamoid bones,” he said.

Soon after the research team began their inquiries, Dr. Emma Adam, assistant professor at Gluck, used advanced imaging to discover that the very beginnings of cartilage (which would eventually transition to bone) were beginning to form in what would become the fetlock at Day 46 of gestation. At that point the fetus was only three centimeters long, with a tiny forming limb only three millimeters long.

Currently, MacLeod and his colleagues are in the process of learning more about the variability of the bones in adults, assembling lots of samples from horses who have died for reasons independent of development or injury to the sesamoid bones. Researchers want to study them grossly (recording observations detectable without a microscope) as well as at a microscopic level. They're looking at elements like bone volume, which refers to the amount of a bone that is minerals. Researchers already know that sesamoid bone volume increases with age as an animal matures and the bone itself grows. Next, MacLeod said, we need to learn how bone volume may change when the horse grows old enough to begin exercise.

Another element that could be important in microscopic bone changes is the trabeculae, which are the bands or thin rods of tissue that together make up the hard structural elements of the bone. MacLeod hopes researchers will learn more about the orientation of these little beam-like supports – are they isotropic, meaning their orientation creates a look of sameness throughout a sample, or are they anisotropic, meaning many of them lie in a single, similar orientation? This matters because it impacts how easy a substance is to break. If you think about chopping an anisotropic piece of wood, he points out, it's easy to do with the grain because all the strands of the block's interior structure are pointing more or less the same direction. If you chop against that grain, it suddenly becomes tougher. With an isotropic substance like metal, its components are oriented in all different directions at a cellular level, making it equally difficult to cut or split no matter how you approach it — there's no area or angle of weakness on a microscopic level.

The initial step to understanding these elements of the bone's structure is to get as many samples as possible from a wide cross section of ages and breeds. Those breed differences could be really important, too — it won't help racehorses if the team develop their sense of normal sesamoid bones from Shetland ponies.

“You'd certainly expect [to see differences],” he said. “The skeletal system in general matures differently between different breeds. Small horses and ponies actually mature faster than larger horses.”

There could also be important differences in what's “normal” between male and female animals, as well as large, heavy-bodied and fine-boned horses within the same breed.

For now, MacLeod said his team has more questions than answers, but he is hopeful that soon – maybe even by next year's annual equine research showcase – he can provide some.

“I think as we ask the questions, as we generate quality data sets, as we advance imaging technologies, I think we will be able to answer those questions,” he said.

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Ask Your Veterinarian Presented By Kentucky Performance Products: What We Know About This Year’s Placentitis Cases

Veterinarians at Rood and Riddle Equine Hospital answer your questions about sales and healthcare of Thoroughbred auction yearlings, weanlings, 2-year-olds and breeding stock. If you have a question for a veterinarian, email us info at paulickreport.com .

QUESTION: We saw an increased number of nocardioform placentitis in the 2020 foaling season. Why are some years worse for placentitis than others?

DR. MARIA SCHNOBRICH: In the 2020 foaling season in Central Kentucky saw an increase in the incidence of Nocardioform placentitis. The University of Kentucky Veterinary Diagnostic Laboratory reported that this was the second worst year for Nocardioform placentitis behind 2011, when they had 328 confirmed cases. In 2020 there were 207 cases confirmed. Likely these numbers represent an underrepresentation, as not all cases are submitted for evaluation.

Nocardioform placentitis is a type of placentitis that is associated with isolation of a slow-growing, gram-positive family of bacteria that are found in the placenta after delivery or abortion. These bacteria (Crosiella, Amycolytopsis, Actinomycetes) are thought to originate from the soil, but frustratingly we do not know at this time how the disease process starts or what is the reason it develops in some mares and not others. This type of placentitis usually causes well-demarcated lesions in the placenta where a mucoid plaque develops and causes the placenta to be disrupted, and may limit or severely compromise fetal development. The outcome of mares affected with this type of placentitis can range from abortion to normal foals and does not always correlate to the severity of the lesions.

Due to the increased incidence of this disease last year, many involved with the broodmare management, including veterinarians, farm managers, owners and researchers worked together to collect and compare data. The UK Gluck Equine Research Center's Dr. Barry Ball is currently compiling data from this past year and will be making his team's findings available to the public.

Dr. Maria Schnobrich

Frustratingly, despite many attempts to reproduce the disease, we do not know what causes or initiates Nocardioform placentitis in the mare. While researchers continue to work on this, we have learned several things which I will summarize below.

The incidence of Nocardioform placentitis seems to be associated with weather. When conditions are hot and dry (as they were in the late summer and early fall of 2019), there is an increase in disease. When conditions are wet and cold, we see a decrease in this type of placentitis, while other diseases like leptospirosis may increase.
Evaluations of soil samples from 2019 are pending and may help give us insight on whether this bacteria was more common. Previously the bacteria found in affected placentas could not be found in the soil from the affected farms when the soil was cultured much later in the year. The new data from 2019-20, when the soil was cultured closer to the time of possible infection, may be helpful in identifying why we had an increase.

Nocardioform placentitis does not occur only in Kentucky, as might have been previously thought. There are cases reported and diagnosed in animals that have never been in Kentucky, though we in Kentucky at the moment seem to have the highest incidence.
Natural cover is not required to produce the disease. Confirmed cases of Nocardioform placentitis occurred in mares bred by artificial insemination and even embryo transfer recipients.
Screening for the disease remains problematic as we have no sure way of identifying the issue. Diagnostic tools that may aid the owner and veterinarian in identifying affected patients include:

Clinical signs such as premature udder development, and rarely vulvar discharge.
Transabdominal and transrectal ultrasound which may identify lesions before they become advanced. The downside of ultrasound in the pregnant mare is that the entire placenta can't be visualized, so some cases may be missed. The advantage is this may allow you to identify an issue earlier in the course of the disease and implement treatment then.
Evaluation of hormones to assess pregnancy (estrogens and progesterone). Screening may result in identifying cases with significant pathology or compromise. In cases that were presented to a referral clinic, all animals had abnormalities in these values, though this needs further research to determine how useful a screening tool it may be.

This image shows the ultrasound image generated from a transabdominal screen of a pregnant mare. The blue arrow is pointing to an area where the uterus has separated from the fetal membranes and placental disruption is caused by a dense fluid. This area correlates to our findings of thick mucoid debris caused in areas affected by Nocardioform placentitis.

There seems to be little resistance to commonly used antibiotics when isolates from the disease were tested for susceptibility in vitro. Doxycycline (81-96% sensitivity) and TMS/SMZ (80%-95%) were incredibly effective when isolates from 2020 placentitis cases were tested in the lab.
The data regarding which treatment for this type of placentitis is most effective is confusing. Research by Gluck's Dr. Carleigh Fedorka demonstrated that cases that were treated actually had a worse outcome than untreated cases. Additionally, the only treatment which seemed to have a positive effect on pregnancy outcome was Firocoxib (Equioxx), an anti-inflammatory. We have to remember though that this data reflects animals that were treated because they were identified as having an issue, and so likely had more severe disease than those untreated animals. There are few situations in which an animal identified with disease would have been left untreated, as this usually results in a poor outcome.

This picture shows the brown discoloration caused from Nocardioform placentitis that can be found on the fetal membranes after delivery. Often there is thick, viscous debris that has been described as similar to “peanut butter” in consistency.

In summary, Nocardioform placentitis continues to be a sporadic but significant issue for the Thoroughbred industry. While it may affect us worse in certain years it has highlighted our need for vigilant monitoring of the pregnant mare and a continued effort to identify early markers of pregnancy compromise. As we now have seen trends related to weather this may give us an idea as to which years will be worse, but discussion with your veterinarian and farm manager about screening and treatment is recommended as it is a complicated issue without a clear recipe for management.

Dr. Maria Schnobrich grew up in Boston where visits to her grandparents' farm and riding lessons at a young age sparked her interest in horses and large animals. Dr. Schnobrich graduated Magna Cum Laude at Brown University followed by attending veterinary school at the University of Pennsylvania. She is a Diplomate of the American College of Theriogenology.

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