July 2013 

Fiddler: A Thoroughbred Foal
MRI Scheduling
Its not JUST a ranch horse
Farrier Care at Montana Equine
Evidence-Based Medicine

This edition includes a case report, some news updates, and answers to a few of your questions. If you have any ideas for article topics, please email us at info@montanaequine.com. You can also browse old newsletters on our website: Montana Equine.  Your feedback is ALWAYS welcome.

Whether you are a horse owner, trainer or referring veterinarian, Montana Equine is dedicated to promoting equine heath care.  Thanks for your continued support!  
We're hoping that Summer is going really well for you and your herd!  

Fiddler the Running Horse: A case report


It happens over and over again at Montana Equine.  While every patient is special, sometimes one case in particular can tear at our heartstrings, and provide inspiration.  Sometimes horses seem so fragile, and othertimes, extraordinarily resilient.  This year, a colt named Fiddler with a HUGE will to live captured our imagination, and captured our hearts. 


During the first half of every year, we see lots of our youngest patients, and of course  we fall in love with all of them to a certain degree.  Some foals are just accompanying the mare while she visits the clinic to be bred.  Some foals arrive to have medical, or even surgical care to help straighten crooked limbs.   And they are all amazing and adorable.  But sometimes the foal arrives as a very sick patient, needing serious intensive care.   Of course, foals can be more fragile than our adult patients, so early intervention can really stave-off more severe illness.  


Fortunately, Fiddler arrived within just a few hours of birth.  But he was already really really sick.  Bred as a racing thoroughbred, Fiddler was born only 10 days early, but even such mild pre-maturity can present a very

 severe combination of problems in foals.   He had been delivered at the same time as his placenta, strongly suggesting separation of the placenta from the lining of the uterus prior to delivery, a so-called "red bag" delivery.  There had been little warning of any problem prior to his early arrival, as is often the case.  Very often, uterine infections can go undetected and result in problems.  Sometimes the only clue is milk running from the mare's udder - this is definitely abnormal and warrants a call to your vet! 


Likely secondary to this type of smoldering uterine infection in the latter stages of pregnancy, Fiddler had signs of septicemia (blood-borne infection),low blood oxygen concentration due to pneumonia, and decreased mental status secondary to his low oxygen levels.  His prematurity also meant that the small bones in his knees were not fully mineralized or "calcified", so he needed special care to minimize risk of damage to his legs.  On top of all this, we soon discovered that his pancreas was not working properly - a blood sugar measurment of 475 (over 3 times the normal concentration!!) was checked and rechecked.  We soon determined that Fiddler had juvenile diabetes.


Diabetes is extremely rare in foals, but can be due to a variety of causes.  In Fiddler's case, it seemed most likely that his pancreas, which like the brain,

kidneys, and heart can be very sensitive to low blood oxygen levels, had suffered from low oxygen levels around the time of delivery.  His subsequent pneumonia wasn't helping anything!

Fiddler was treated with intravenous antibiotics, specialized fluid therapy and hyperimmune plama, as well as continuous oxygen, and began to make spectacular progress.   And just like a person with diabetes, his bloodsugar was closely monitored so we could provide just the right amount of insulin for him around the clock. 




Just before going home from the clinic in Late March, 2013
April, 2013.


Foals in particular have such an amazing ability to heal, and over a couple weeks of hospitalization Fiddler made amazing progress.  He was weaned off of the oxygen therapy as his lungs improved, and he was switched to oral antibiotics as his infection subsided.   More importantly, his pancreas began to heal!  After all, its one thing to supply insulin around the clock for a little while during foal-hood, but obviously not practical to do that throughout a horse's lifetime!  Soon, Fiddler didn't need ANY supplemental insulin and he went home mostly cured.  Over the following weeks and months, Fiddler has done amazingly well.  He is growing fast, and his family has high hopes for his racing career. 


With his goat buddy, June, 2013.
He is growing up fast!

Every year, we treat many foals with varying problems, most of which are much less severe than Fiddler's.  With a little help, fragile youngsters can get back onto the right track with just a little veterinary care.  


Too often, sick foals arrive after their problems begin to compound upon themselves.  There is SO much we can do to stabilize and treat sick foals, from basic care to fancier treatments like oxygen therapy, blood pressure medications, or continuous infusions...cases that arrive sooner tend to GO HOME sooner, and often with a better prognosis and a lower vet bill!   With our special expertise in equine internal medicine, we are often called upon to offer second opinions or other input on some of these cases.  So call us or your local veterinarian right away if you have concerns about your youngster.  


MRI Scans being performed Friday, August 30th

Montana Equine Medical & Surgical Center continues to host a travelling MRI (Magnetic Resonance Imaging) trailer at our clinic.  The next visit is scheduled for the end of August (Friday August 30th) so we are currently accepting appointments and/or referrals from veterinarians for horses, dogs and cats.  

MRI is an imaging modality that provides the gold-standard of highly detailed images of body structrues, especially soft-tissue structures.  In equine veterinary care, we most often use MRI to create images of tendons and ligaments, especially inside the horse's foot.  No other tool is as effective for imaging soft tissues.  The same tool can also be used to create images of small animals.

MREquine at MTEQ

This particular MRI machine, one of three being operated nationwide by MR Equine, utilizes a large-size magnet, so the images of various body systems are very high quality.  

It is important to know that genereal anesthesia is required to obtain all the MR images, so patients will be fully asleep for the procedure.

General Anesthesia before the scan

Montana Equine is fully equipped to provide all aspects of general anesthesia (including induction and recovery) for patient and referred horses, and will partner with our small animal colleagues around the region to provide excellent anesthesia and patient care to small animal patients.

Most equine cases will cost $2500 for a complete imaging scan and interpretation of the images.  This fee includes the cost of anesthesia as well as one night's hospitalization at the Montana Equine clinic, if necessary.  Fees for small animal cases vary, but we've arranged lower charges: a typical MRI for a dog is now $1100-1500 including anesthesia costs.

The MRI trailer from MR Equine is scheduled for regular visits to Montana Equine, servicing the Gallatin Valley and our entire region.  Whether you are a veterinarian, horse-owner, pet-owner, or just curious about the arrival of this exciting tool in Gallatin County, please feel free to contact the clinic at 406-285-0123 or info@montanaequine.com.  

You can also contact MREQuine directly at 1-877-MRE-4MRI or on their website at www.MREquine.com.
As many of you know the WPRA has developed a guidelines for drug and medication use at WPRA aproved rodeos.  While these rules are new to the WPRA many equine events are goverened by drug and medication guidelines.  The rules outlined by the WPRS closely follow the rules outlined by the United State Equistrian Federation.  While these rules will change the management of lameness and illness associated with barrel horses, it does provide for the use of many of the standard practices of treatment.  Please refer  http://www.wpra.com/equine_drugs.asp for more information.  If you have any questions please contact your veterinarian. 
Its not just a ranch horse...

One of the real joys about our practice at Montana Equine is that we get to see a wide variety of different types of horses.  We see more Western performance horses than anything else, from reiners and cutters to barrel-horses and athletes who compete in other rodeo sports, but we also work with many types of English sport horses, including dressage and jumping and three-day eventers, not to mention endurance horses and some trail/pleasure horses. Some patients are pasture pets, and some are working ranch horses. Not too long ago, I heard that a staff member had off-handedly asked the owner, "What does he do, or is he just a ranch horse?"  The owner took a little offense, and rightly so!


Too often, young veterinarians, vets-in-training, or technicians have been led to believe that the "best" horses are those with a fanciest pedigree or price-tag.   This view is sometimes reinforced by the owners and trainers of horses who perform in specialized events; many of these horses are legitimately considered among the best in their chosen discipline.   And which proud horse-owner doesn't feel that their horse is "the best"! As horsemen and horsewomen, we are all prone to being a bit blinded by our love for our magnificent equine friends and partners.



Outside the dressage ring, the rodeo ground or the reining arena, ranch horses are performing their vital roles with incredible heart and physicality.   And it doesn't take anything away from incredible skill-sets and performances of the jumper, the cutting horse, or the reiner to take a moment to acknowledge the talents and importance of working ranch horses throughout our region and beyond.   In some contrast to the stylized events of Western and English competition, working ranch horses also perform at the highest levels, with a combination of intelligence, athleticism, and expertise.   Some would say that ranch horses are actually the epitome of equine athletes, performing a vital role in ranch stewardship and husbandry, and keeping their riders safe while working with their human partners to manage difficult situations in hostile environments.   Its not just a ranch horse!




Grass that is ... With the warm weather and hope for frequent precipitation, it is time to watch out for the green grass. The burst of cool season grasses can wreak havoc on those horses prone to metabolic disease and laminitis (founder). Horses that are prone to these problems or those not used to green grass should be carefully managed.


1) Slow transition to grass, usually over 2 weeks.


2) Night turn out - The risky sugars ("fructans") in grass are less concentrated in the wee hours of the morning, because fructan production dwindles after nightfall.  


3) The use of a grazing muzzle limits feed intake.


4) Feed a small amount of hay prior to turn out. This will decrease the amount of intake and reduce the risk of grass overload.


In the past testing for metabolic disease and insulin resistance had been difficult. One-time testing of insulin and glucose concentrations are inaccurate in horses. Until now accurate measurement required measurement of blood insulin and glucose at multiple time points following an overnight fast.


Now however, Dr. Nick Frank, an internal medicine and endocrinology specialist at the Tufts University vet school, has developed a quick, easy and inexpensive protocol for identifying horses with insulin resistance. This test is called the Oral Glucose Tolerance Test (OGTT). If you would like to discuss this test please contact our head of internal medicine (and board-certified internal medicine specialist) Dr. Peter Heidmann. 


 ***Please note - Previous versions of this article mentioned night-time turnout.  It is true that fructan concentration begins to drop after nightfall, but the fructan concentration may actually decrease overnight, so the last hours before dawn may actually be safest in terms of dangerous fructans.   

A local farrier, Tom Peterson, will be at Montana Equine by appointment on Wednesdays through October 15th. Farriery, including corrective shoeing, can promote a sound performance season. Corrective shoeing is the foundation to many lameness issues and sometimes can be the only therapeutic treatment required to achieve soundness. Montana Equine is dedicated to working with all farriers from around the region to help your horse achieve its full potential.
Evidence-Based Medicine:
Evidence-based medicine means the reliance on scientific literature to form a solid basis for accurate testing and safe and effective treatment.  This is the true Gold-Standard, and at Montana Equine, we aim to constantly practice this type of medicine.

While its nice to know someone's opinion, a testimonial from the world's most famous trainer (or rider, or breeder, or farrier, or veterinarian) -- no matter how well intentioned -- isn't nearly as important as peer-reviewed medical literature. There is such a plethora of information and equine supplements and medications available on-line and elsewhere in the marketplace, how do you know who to believe?  


Indeed, there has been amazing progress in veterinary medicine, and this evidence provides the basis for good medicine.  There are some highly informative sites associated with referral clinics and teaching hospitals, and also places like PubMed that provide searchable databases of decades and decades of veterinary and human medical literature.   


A little research helps you be a better advocate for the health of your animals and your family.  God forbid an unproven or off-the-market treatment is ultimately found to be unsafe...Not worth it at any price! You have have read news reports, notably one from Florida a few years back, where mis-compounded or mis-prescribed medications caused the death of a number of horses.  


Here at Montana Equine, we ALWAYS rely on the medical literature to help guide you through the process of treatment for your animal. That way, based on the evidence, we can help you get an accurate diagnosis and a comprehensive list of treatment options.  Indeed, we are always open to new treatments and receptive to new research when it is well-documented with good studies.  In fact, Montana Equine believes SO MUCH in veterinary research that we make frequent contributions to ongoing research initiatives through the highly respected Morris Animal Foundation, which has many important equine projects underway all the time. 


One of the unfortunate realities of specialty equine practice is that clients sometimes assume that treatment and care for their talented or otherwise beloved horses might be prohibitively expensive. Here at Montana Equine, we work very hard to offer a wide range of progressive treatment alternatives, from basic to advanced, from holistic to highly targeted, from tried-and-true to cutting-edge.  But all will have a solid scientific basis.  For all of our patients.   All the time. 


So when you come to Montana Equine, you will be given the opportunity to "drive the bus" in terms of diagnostic and treatment options, and to determine a plan that suits your goals for the patient.  Under any scenario, our clients can count on us to offer progressive care, and first and foremost, to ensure that our treatments are based on solid evidence of safety and efficacy.   Our patients' lives, and our clients' expenses are just too important to be trusted to unproven remedies or undocumented conditions.   That extends to all our patients, whether they perform in the show ring, the ranch, the trail or backyard, or in a therapeutic riding program...they are all equally special, and are always going to be treated that way by the veterinarians and staff at Montana Equine.   BIllboard

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We hope you have a great Summer and early Fall.  Whether you are just getting started this season or you have a bunch of rides under your belt, Montana Equine Medical and Surgical Center is here to help with any Emergent or routine care for your horse.
The Team at Montana Equine 
American College of Veterinary Surgeons
25$ Discount on Lameness Exams 
Just make not of this voucher when scheduling any lameness exam through September 15, 2013, and you'll receive a discounted exam - $25 OFF!!!
Offer Expires: 9.15.13
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Montana Equine | 3934 Frontage Rd | Three Forks | MT | 59752