In This Chapter
- Understanding lameness issues
- Recognizing digestive disorders
- Exploring skin, eye, respiratory, and other common problems
Considering how big, strong, and powerful horses are, it’s amazing how prone they are to illness. Some people (like your authors, for example) believe that many of these problems are related to the way that humans manage horses in captivity. Wild horses don’t suffer from most of these issues, in large part because they live the way nature intended horses to live.
In this chapter, we help you get
a handle on some of the problems your domestic horse may unfortunately
encounter. You find out about soundness and digestive troubles, which are the
two most prevalent health issues for horses. You also discover illnesses
affecting the horse’s skin, eyes, respiration, and metabolism. Hopefully, when
you finish perusing this chapter, you’ll have a good handle on the kinds of
conditions that your horse may be prone to.
Getting a Leg Up on Soundness Issues
One of the most widespread health
issues in the horse world concerns soundness. Soundness refers to a
horse’s ability to move freely and without pain, at all the natural gaits
(walking, trotting, and cantering), and to be free of any disease.
Unfortunately, many horses become unsound at some point in their lives, and
some become so permanently.
Recognizing unsoundness in your
horse and understanding the various causes make it easier for you to help your
veterinarian give your horse the help that he needs.
Arthritis
Arthritis is the most common
cause of soundness problems in horses. Basically, arthritis is an inflammation
of the joints. Horses tend to develop arthritis in their knees, hocks, and
fetlocks (see Chapter Introducing
the Anatomy of a Horse for an illustration of these parts of the horse). The
joints become painful, and the condition tends to worsen over time.
Veterinarians recognize four different
types of arthritis:
- Degenerative joint disease (DJD). The most common form of arthritis, degenerative joint disease develops as horses age. Horses who have been worked hard are most likely to develop this type of arthritis.
Most cases of DJD affect the hocks. The knees are the next most commonly affected joint, followed by the fetlocks and stifles. Horses with poor conformation and those who have worked hard in their lives are most susceptible to this condition.
Symptoms of DJD can include chronic stiffness and swelling around a joint, inability to perform activities that used to be easy, and bumps or swellings on the legs.
Your veterinarian has a few different treatment options available to tackle DJD. The goal with each is to stop the cycle of inflammation in the joint. Stopping the cycle may include injection of the joint with hylauronic acid. Other treatments may include corticosteroids, non-steroidal anti-inflammatories, and oral joint supplements containing glucosamine, chondroitant, and MSM. Alternative therapies, particularly acupuncture and Traditional Chinese Veterinary Medicine, have also proven helpful. (See Chapter Checking Out Complementary and Alternative Therapiesfor details about alternative therapies for horses.)
Tip
DJD can’t always be prevented, but you can help minimize the likelihood that this debilitating condition will cripple your horse. Keeping your horse’s feet trimmed properly (see Chapter Getting Up to Speed on Routine Care for details), riding him on surfaces that provide good footing (such as a well-maintained riding arena or flat, rock-free trails), and not working him too hard, especially when he’s not properly conditioned, can help stave off DJD.
- Septic joint arthritis. Septic arthritis occurs when the horse has an infection of the joint and the by-products of the infection and accompanying inflammation cause degradation of the cartilage. This degradation causes a change in the biomechanical properties of the cartilage.
An infected joint in an adult horse can be the result of direct trauma with an accompanying bacterial or fungal contamination. The most common causes of joint infections are puncture wounds, infection secondary to joint injections, and surgery followed by a generalized bacterial infection. Heat, pain, and severe lameness are signs of septic arthritis.
Remember
If your horse ever suffers a joint injury, call your veterinarian right away. Septic arthritis can be not only career-ending, but also life-ending.
Your veterinarian will treat this condition with antibiotics or another drug, depending on the type of organism affecting the joint. Arthroscopic surgery may also be necessary to treat the joint.
To help prevent septic arthritis, have your horse seen immediately if he experiences a joint injury.
- Immune-mediated arthritis. This type of arthritis is actually quite rare in horses. Experts suspect that immune-mediated arthritis is secondary to lupus erythematosis, an immune-mediated disease that causes the immune system to go haywire and destroy normal tissue. Although considered rare, coauthor Dr. Kate suspects that veterinarians may be diagnosing this illness more in the future because its existence is becoming more well-known.
Symptoms can include joint pain, lameness, lack of appetite, and fever. Treatment includes anti-inflammatory medications and chemotherapy drugs. Veterinarians don’t know how to prevent immune-mediated arthritis.
- Traumatic arthritis. Traumatic arthritis is common and caused by repetitive injury or sometimes an isolated trauma to the joint. Horses who are worked too much and too hard can suffer from this type of arthritis. It’s similar to DJD (see the earlier bullet), and viewed as the same by some veterinarians. It’s usually treated with the same remedies.
Hoof problems
Issues that arise because of some
insult to the hoof can cause problems for your horse. The good news is that
these problems are fixable, and they’re often preventable with good care.
Hoof cracks
Hoof cracks are just what they sound like: cracks in the hoof. They can begin from the coronet band and extend downward, or begin at the toe and go upward. Cracks that extend from the bottom up are most common, and may be due to poor hoof care. In these cases, the hooves become overly long, brittle, and dehydrated. (Chapter Getting
Up to Speed on Routine Care has tips on good hoof care so that your horse can be clear of cracks.) Some cracks are secondary to a condition called seedy toe, where the hoof wall separates from the sensitive laminae — not a good thing!
The major types of cracks include
the following:
- Hoof cracks that start from the bottom up may not be a big problem, but if your horse develops one of these, you need to determine why it occurred. Also, if the crack progresses and extends into the deeper structures of the foot, it can lead to a hoof abscess (see the next section for more information).
- Cracks that are consistently found at the quarters and heels of the hoof are a concern. The horse needs to be evaluated for poor conformation or poor shoeing or trimming practices.
- Hoof cracks that start at the coronet band and go down are usually caused by an injury or trauma, and result in a lack or unusual growth of horn at the injured site. You’ve likely seen a similar crack in people who have had an injury to their fingernail bed and forever after have a deformed nail.
Remember
Your veterinarian should treat any trauma to your horse’s coronet band immediately. Deep infections or trauma to this part of the hoof can cause severe and permanent problems.
Common and simple hoof cracks
often can be easily treated by a good farrier. A special shoe may be applied,
and the horse may be limited to stall rest or only very light exercise while
the crack grows out.
Hoof cracks are best prevented
with good hoof care. Make certain that your farrier knows what he or she is
doing. (For details on how to find a good farrier, see Horses For Dummies, 2nd
Edition, by coauthor Audrey with Janice Posnikoff, DVM [Wiley].)
Hoof abscesses
A hoof may seem like a weird
place for an abscess, but horses get them all the time. Hoof abscesses can
cause severe lameness. Often, they start at the bottom of the hoof at the white
line and work their way up into the laminae. They eventually break open at the
coronary band and drain out. The subsolar abscess is usually caused by a
puncture wound on the bottom of the hoof that becomes infected. Abscesses can
cause sudden and severe lameness.
Veterinarians diagnose hoof
abscesses by observing clinical symptoms and examining the limb. If the
lameness is sudden and on only one leg, and if an increased digital pulse is
present, an abscess is likely. Sensitivity to hoof testers may also point to an
abscess.
To treat an abscess, your
veterinarian may open it up on the sole of the hoof by using a hoof knife. By
opening the abscess, the veterinarian enables it to drain out with the help of
gravity. He or she then soaks the hoof in Epsom
The prognosis for hoof abscesses
is usually very good. Most horses recover fully in three to five days. (Figure
11-1 shows the treatment of an abscess.)
Tip
To avoid having your horse go through this unpleasant ordeal, keep your pastures free of nails and other debris that your horse can step on. Examine your horse’s feet daily for nails and puncture wounds. If you find anything, contact your veterinarian immediately, even if your horse isn’t showing signs of lameness.
Figure 11-1: To soak a hoof
for treatment of an abscess, ask the horse to stand in a pan of water and Epsom
salts. (Bob Langrish)
Laminitis
One of the strangest soundness
problems that affects horses is laminitis. Also known as founder, this
condition results when the lamina in the hoof are severely inflamed. This
inflammation can lead to disruption in the attachment of the coffin bone to the
hoof, allowing the coffin bone to rotate out of its normal alignment. The
consequence of this rotation is tremendous pain in the affected leg. Figure
11-2 shows a normally aligned coffin bone, and Figure 11-3 shows laminitis.
Figure 11-2: A normal coffin
bone maintains the same angles as the horse’s hoof.
Figure 11-3: Laminitis causes
the coffin bone to change angles within the hoof.
The causes
Laminitis occurs when the blood
supply to the horse’s legs is compromised. The tissue that lines the coffin
bone, called the laminae, degenerates rapidly and the coffin bone slips out of
its normal position.
Warning!
A number of factors can cause the blood supply to the legs to short circuit. One of these factors is diet. Abrupt changes in feed or a sudden substantial increase in carbohydrates can lead to an imbalance of microorganisms in the horse’s digestive system. Toxins are released from the digestive tract into the bloodstream, wreaking havoc in the horse’s body.
Other causes of laminitis
include:
- High doses or prolonged use of corticosteroids
- Obesity
- Bedding with black walnut shavings
- Severe colic (which we cover later in this chapter)
- Improper shoeing
- Retained placenta in mares after foaling
- Excessive exercise on hard surfaces (called road founder)
- Grazing on a lush pasture without gradual introduction (grass founder)
- Trailering long distances
- Any primary foot disease (any disease that affects the function of the hoof, such as an abscess)
- Any illness with high fever
- Any metabolic problem, such as Cushing’s disease (we discuss these types of problems later in this chapter)
- Laminitis is a complicated disease. At this time, researchers need more pieces to solve the puzzle. This condition is extremely serious and excruciatingly painful for the horse. To help manage this terrible disease, you need immediate attention from your equine veterinarian.
Warning!
Certain equines are more prone to developing laminitis than others. Ponies and draft horses seem more likely to have problems with this illness than other horses. Also, horses who have foundered in the past are more likely to suffer a recurrence of the condition.
Diagnosis, treatment, and prevention
Veterinarians initially diagnose
laminitis by observing the clinical signs of the disease. These signs include
lameness, a painful stance (where the horse leans back on his heels while
standing), increased digital pulses in the feet, and heat in the foot. X-rays
can confirm coffin bone rotation and the degree to which it has occurred.
Because coffin bone rotation may occur days to weeks after the initial onset of
laminitis, X-rays on day one may show no rotation, while X-rays taken one week
later may show significant rotation.
Treatment for laminitis may
include anti-inflammatory drugs like phenylbutazone (bute), drugs to help
dilate blood vessels, drugs to help thin the blood, antibiotics, and placing a
special shoe on the affected leg or legs. Pain medication is important, too,
because laminitis is excruciating for the horse. Acupuncture has also been
shown to help in many cases.
The prognosis for a horse who’s
suffering from laminitis depends on the degree of rotation of the coffin bone.
Many horses can recover from laminitis, although the damaged tissue in the hoof
may take almost a year to grow out. In very severe cases, horses with laminitis
are euthanized.
Horses recovering from laminitis
need soft bedding or sand to help relieve their pain and pressure on their
hooves. This soft bedding or sand is not only easier on the hooves, but also
encourages the horse to lie down.
Because most cases of laminitis
are diet related, this condition often is preventable with good nutrition. Pay
close attention to what you feed your horse, and keep his weight down to a
healthy level. (See Chapter Your
Hungry Horse: Feeding Fundamentals for information on how to feed your horse, and
Chapter Sizing
Up a Healthy Horse for details about determining the proper body weight for your horse.)
Remember
If you even suspect that your horse has eaten too much of any good thing (he’s gotten into the grain bin, for example), call your veterinarian immediately. Don’t wait to see whether your horse develops symptoms of laminitis. Your vet can take preventative measures to try to prevent the development of laminitis.
Tip
To get a jump on laminitis, feel your horse’s feet frequently so that you know his normal hoof temperature. Plus, ask your veterinarian to show you how to measure your horse’s digital pulse so that you can check it yourself if you suspect laminitis.
Navicular syndrome
A small bone in the horse’s hoof
called the navicular bone is involved in various ways in navicular syndrome,
which can render a horse unsound in his front legs (see Figure 11-4).
Researchers believe that one cause of navicular syndrome is the degeneration of
the navicular bone as a result of decreased blood supply. A more current theory
on the condition suggests that it occurs as a result of excessive force on the
navicular bone, causing abnormal bone remodeling. No one is sure how the
problem arises, although many veterinarians suspect a genetic link because some
types of lower leg conformation seem to be prevalent in horses with this
condition.
To diagnose navicular, your
veterinarian uses visible symptoms rather than X-rays. These symptoms include
consistent reluctance to stand with weight on a particular leg and intermittent
lameness. Nerve blocks and hoof testers can help your vet rule out other issues
and make a diagnosis of navicular syndrome.
Navicular syndrome doesn’t have a
cure, but it can often be managed with special shoeing, drugs to help increase
the blood flow to the navicular bone, intra-articular injections, and
anti-inflammatory drugs. Some horses who suffer severely from navicular
syndrome may be helped by cutting the nerves to the heel portion of the hoof.
The horse can no longer feel the pain in the caudal portion of his hoof after
this procedure.
You can help prevent your horse
from developing navicular by providing him with good farrier care.
Figure 11-4: A tiny bone called
the navicular is responsible for a disease of the same name.
Osteochondritis Dissecans (OCD)
Osteochondritis dissecans is a
mouthful, so most people call this condition OCD. A type of degenerative bone
disease, OCD is basically a problem at the cartilage’s cellular level, and
starts when a horse is young and growing. The cartilage in the young horse’s
bones fails to ossify like it’s supposed to — that is, it fails to turn into
bone. So, instead of growing up like good cartilage cells should, they remain
as cartilage. This happens at the growth centers of the horse’s bones, so as
the horse matures, this abnormal cartilage gets thicker and can separate from
the underlying bone. It can also die, or wrinkle up and become flaps and little
loose pieces of cartilage floating around in the joint capsule. (Coauthor Dr.
Kate says that vets like to call these particles “joint mice.”) These floating
pieces of cartilage can make the joint very painful and cause lameness.
OCD is believed to have several
causes. It’s considered a developmental orthopedic disease (DOD for short), and
can be caused by rapid growth in young horses, which is often caused by
incorrect diet. Young horses who grow too fast because they’re fed high-energy
foods or have overweight mothers who produce overly rich milk can develop OCD,
as well as other DODs. Genetics can also play a part in OCD, and some lines of
horses show a greater tendency toward this condition.
Underfed young horses can also
develop OCD. Poor-quality and low-quantity foods can lead to decreased bone
growth, which puts additional stress on bones. Both lack of food and too much
food can cause a mineral imbalance, which is believed to be behind OCD.
You can’t always tell whether
your horse has OCD. Although some horses display swelling of the affected area,
others show no signs of it at all. Sometimes they become lame and sometimes
they don’t. The only definitive way to diagnose OCD is with the use of X-rays.
If the OCD is giving the horse trouble, your vet may prescribe joint injections
with anti-inflammatory drugs or simply prolonged rest. In cases that don’t
respond to conservative treatment, surgery may be in order.
The prognosis is good for some horses
with OCD, especially after surgery in some cases. After the offending OCD is
removed, the horse can often live a normal, active life.
Ringbone
An insidious lameness problem by
the name of ringbone (technically known as phalangeal exostosis) is often
diagnosed in horses. Ringbone is the development of extra bone in or around the
joint and affects the pastern and coffin joints, usually in the forelegs. Low
ringbone affects the coffin joint. High ringbone affects the pastern joint.
High ringbone is worse than low ringbone because it causes more pain and
lameness in the horse.
Ringbone often starts out slow
and shows itself as mild lameness. Eventually more of the joint becomes
involved with the disease, and the lameness becomes worse.
No one is completely sure why
ringbone develops in some horses and not others, although certain factors seem
to be involved. Those factors include the following:
- Genetics. When horses with ringbone are bred, their offspring have a tendency to develop the condition as well.
- Conformation. Horses who have very upright leg angles are more prone to the condition.
- Poor hoof trimming. Uneven trimming causes trauma to the joint.
One of the most common forms of
treatment for ringbone is therapeutic shoeing. This involves special trimming
and shoeing techniques that promote balance in the horse’s feet.
Anti-inflammatory drugs (taken orally or injected directly into the joint) can
also help manage this condition, but can’t cure it. Nutraceuticals designed to
support the joints, acupuncture, and Traditional Chinese Medicine have also
been shown to help.
Surgical treatment for ringbone
calls for arthrodesing, which involves “freezing” (or fusing) the joint
to make it nonfunctional while still allowing the horse to use the leg.
Depending on the severity of the ringbone, this method may produce a good
outcome, especially if the problem is in the hind limbs.
Unfortunately, when extensive bone
growth with joint involvement has occurred, arthrodesing may be the only
option. Even with this procedure, many horses still have some lameness.
Tip
The best way to help protect your horse from ringbone is to make sure that he gets proper hoof care from a reputable farrier. See Chapter Getting Up to Speed on Routine Care for more details.
Tendonitis
Tendonitis, or bowed tendon, is a
common problem in hard-working horses. In fact, experts estimate that 30 to 40
percent of all performance horses have some degree of tendonitis.
Tendonitis is a condition that
affects the lower foreleg. Some cases are acute, while others are chronic.
Sometimes, tendonitis is a precursor to a fracture, back pain, or joint
problems. It occurs when the tendons at the back of the leg (the flexor
tendons) are strained or torn. Jumping and galloping, especially in deep
footing, can cause a horse to develop tendonitis.
Tendonitis may be easy to spot.
The horse acts lame, and the back of his leg may be swollen and hot to the
touch. The condition and its relative severity can also be diagnosed by a
veterinarian who’s using ultrasound.
Veterinarians treat tendonitis by
trying to reduce the inflammation. This treatment involves icing the leg,
giving oral anti-inflammatory drugs, and resting the horse. A tendon takes a
long time to heal, and horses who suffer from severe tendonitis often need six
months to a year in order to recuperate. Stem cell therapy is being used to
combat this condition, and so is shock wave therapy. Acupuncture and
Traditional Chinese Veterinary Medicine have also been shown to help.
Remember
Whatever form of treatment you choose to treat your horse’s tendonitis, it’s imperative that the affected horse receive an ultrasound examination before returning to work. Ultrasound helps to tell the veterinarian whether the tendon has healed sufficiently enough to likely withstand the rigors of a normal exercise routine.
Tip
Bowed tendons can sometimes be prevented by following these guidelines:
- Make certain that your horse is receiving good hoof care from a qualified farrier (see Chapter Getting Up to Speed on Routine Care).
- Ride your horse in footing that’s not too deep, slippery, or muddy. (If you must ride in these conditions, keep your horse at a walk.)
- Rinse your horse’s legs with cold water after a workout. (Coauthor Dr. Kate does this for all her horses to help keep their tendons healthy.)
- Make sure that splint boots, polo bandages, and leg wraps are properly put on. The wrong application of leg protection can actually cause tendonitis.
Trying to Stomach Digestive Problems
Horses are eating machines,
designed by nature to spend most of their lives ingesting and digesting. Put
them in an artificial environment where they’re given foods that they wouldn’t
find in the wild, and then limit the time during which they can eat, and you
have a recipe for trouble.
Digestive problems are one of the
biggest veterinary issues in the horse world. The equine digestive tract
doesn’t always function well in the confines of domesticity. The result is a
host of conditions that both horse owners and veterinarians face on a regular
basis. (Flip to Chapter Introducing
the Anatomy of a Horse for general information about a horse’s digestive
system.)
Diarrhea
Recognizing diarrhea in your
horse is easy. Loose, liquid feces are a sure sign of it.
Diarrhea can be caused by any
number of things, including an infectious agent (such as salmonella or
clostridium bacterial diseases), Potomac Horse Fever (a bacterial disease),
antibiotics, non-steroidal anti-inflammatory medication, blister beetle ingestion,
poisonous plants, and a heavy parasite burden. Bowel strangulation or
obstruction, peritonitis, and liver disease can also bring on diarrhea.
Before even trying to find the
cause of the diarrhea, your veterinarian treats the condition to prevent
dehydration and electrolyte imbalance. He or she also gives aggressive
supportive care to help prevent your horse from going into shock or developing
laminitis. In severe cases, your horse may have to be admitted to a hospital,
placed in intensive care, and possibly put in isolation.
A condition called chronic
diarrhea is any diarrhea episode that lasts longer than two to three weeks,
with stool that’s wet and unformed, but not completely liquid. The cause of
this type of diarrhea is the same as the cause of acute diarrhea: parasites,
internal issues (such as liver disease), salmonella infection, chronic
peritonitis, inflammatory bowel disease, and unfortunately, cancer. Sometimes,
nonspecific chronic diarrhea responds to a change in diet to grass hay.
Getting a specific diagnosis on chronic diarrhea can be challenging for your veterinarian, but it’s important to ultimately get one. Hit-or-miss treatments may prolong the problem or, at best, be a temporary fix that may seriously delay resolution of the problem.
Warning!
If your horse develops diarrhea, don’t wait to call your vet, especially if your horse exhibits pain, fever, weakness, or lethargy. Diarrhea is a serious problem that should be immediately addressed.
Enteroliths
Imagine having a giant rock
growing in your intestines. Horses who suffer from enteroliths have just that
problem. A rock is literally growing inside them.
Enteroliths, also called
“stones,” form inside horses as a result of something that they may have eaten.
Accidentally ingesting sand, hay bale twine, or a piece of wood starts the
process. If the body fails to expel the foreign object, it becomes a nidus —
essentially, it’s like the pearl in an oyster. The horse’s body tries to get
rid of it while protecting itself, so it deposits mucous, minerals, and food
around the object. That process, along with the normal peristaltic movements of
the gut, turns the mass into a hard, rocklike ball.
Enteroliths are usually round,
but they can assume other interesting shapes as well. Horses can pass very
small enteroliths in their feces, or the stones can float around in the GI
tract and cause impactions that can lead to fatal colic. (We discuss impactions
later in this chapter.)
Some enteroliths can be seen on
X-rays or felt by your veterinarian on rectal palpation. Most often, they’re
found with exploratory surgery. The enterolith must be surgically removed if
the horse has any chance at surviving the impaction.
Warning!
Horses living anywhere in the U.S. can develop enteroliths, but this problem is most often seen in the Southwestern states. California in particular has a very high incidence of enteroliths. Some experts believe that alfalfa hay, which is often fed to horses in California, combined with the high magnesium content of the state’s water, contributes to the condition.
Because veterinarians aren’t
completely sure why enteroliths form, no one can say for certain how to prevent
them. Some horse owners don’t give their horses alfalfa for fear that stones
may develop.
Gas colic
With all the fiber horses eat,
it’s not surprising to find out that they can sometimes suffer from gas. Colic
can result when excessive gas production causes gas to become trapped in the
cecum and large colon. This can be extremely painful to the horse. After all,
just think about how you feel when you have severe gas pains. It’s not fun.
Most cases of gas colic are
simply the result of gas not being passed the way that it should. In other
situations, gas colic can be a sign of an intestinal blockage or a twisted intestine.
A gas-filled bowel can even rupture if the problem isn’t rectified.
Horses with gas colic may paw the
ground, roll repeatedly and kick at their bellies (see Figure 11-5 for a horse
who’s exhibiting some of these symptoms).
Figure 11-5: Horses express
abdominal pain in a number of ways, including
rolling on the ground. (Bob Langrish)
Veterinarians treat gas colic by
giving the horse an IV-painkiller. Vets recommend that you hand-walk your horse
to help her pass the gas that’s causing the problem. If this doesn’t do the
trick, your vet may opt to give your horse mineral oil or a laxative via a
stomach tube. This can help stimulate movement of the bowel and allow the
offending gas to pass.
Remember
If your horse is showing signs of colic pain, contact your veterinarian right away. It could be just a bit of gas, but it could also be something more serious. To help prevent gas colic, make diet changes gradually in your horse.
Impactions
When a horse is impacted, dry
manure has clogged up her intestines and stopped her from being able to
defecate. Impactions are very serious in horses, and can be fatal if they’re
not treated quickly.
Impactions occur most often when
a horse is fed tough, dry, forage with a lot of stems and not provided with
enough water. Occurrences of impaction increase in the colder months because
horses don’t like to drink cold water — a good reason to keep your horse’s
water warm in the winter. Long stall rest or a long trailer ride can also be a
contributing factor to impaction, because a horse’s bowels work better with
exercise.
A horse suffering from an
impaction may show signs of colic, including pawing the ground, rolling
repeatedly, or kicking at her belly. She may also be unable to produce manure.
Impactions are treated with large
amounts of mineral oil passed into the horse’s stomach through a tube in the
nose. If this treatment doesn’t make the impaction pass, the vet may give oral
or intravenous hydration to the horse to help moisten the impaction and make it
passable. If this tactic fails, surgery may be the only option for removal of
the impaction.
Tip
If your horse must be confined for a period of time, ask your veterinarian for suggestions on how to prevent impactions in your horse. Soaking your horse’s hay is one way to help decrease the likelihood of your horse becoming impacted.
Sand colic
If you ate your food off the
ground, you’d probably end up with a belly full of sand. Well, that’s what
often happens to horses who live in areas with sandy soil. As they graze or
munch on their hay, they accidentally ingest particles of sand.
The Southwestern states are most
known for sand colic, which occurs when a significant amount of sand
builds up in the horse’s large intestine. It erodes the lining of the gut and
can cause extreme pain, diarrhea, depression, weight loss, and decreased
appetite.
Tip
Prevention is worth a pound of cure when it comes to sand. Here are some tips:
- If you live in an area with sandy soil, avoid feeding your horse directly off the ground. Use a feed bin, and put a stall mat underneath it. If some of the food spills out, your horse isn’t eating directly off the ground.
- As a preventative for sand colic, give your horse 1 cup of dry psyllium every day for a week, mixed with a complete feed, oats, or another kind of grain mixture. This combination helps clear out any sand that may be lurking in your horse’s gut before it becomes a problem.
Ulcers
Horses don’t have long commutes or sales quotas to make, but they still get ulcers. In fact, 90 percent of all performance horses and horses in training have some degree of stomach ulcers. These gastric ulcers are caused by stress, frequent dosing of phenylbutazone or other non-steroidal anti-inflammatories, and certain diets, such as those lacking in adequate roughage.
Even baby horses can get ulcers,
possibly indicating a bacterial link in some cases. Foals affected with ulcers
grind their teeth, salivate excessively, have a decreased appetite, show pain
after eating, and lie down more frequently than unaffected foals.
Adult horses with ulcers often
show no signs of illness, although some are clearly uncomfortable. Frequent
colic episodes may be a sign of possible ulcers. The gold standard to confirm
the presence of a gastric ulcer in horses involves placing an instrument called
an endoscope into the horse’s esophagus and down to the stomach. By the time an
ulcer is visible by endoscope, it’s already causing the horse considerable
discomfort because ulcers begin forming and are painful before they can even be
seen with endoscopy.
Treatment for ulcers requires
that the horse’s stress be reduced, if possible. If the horse is being given
phenylobutazone for a medical condition, alfalfa hay should be fed to help
protect the stomach. Ulcer medication is also given to a horse suffering from
ulcers. Drugs by the name of cimetidine or famotidine and omeprazole can help,
and so can stomach ulcer protectors. Coauthor Dr. Kate also uses Traditional
Chinese Veterinary Medicine to treat ulcers and has great success with it.
To help prevent gastric ulcers in
your horse, feed her a diet high in roughage. If your veterinarian prescribes a
regimen of phenylobutazone for a health issue, ask him or her about medication
that can be given to your horse to help prevent ulcers.
Saving Your Horse’s Skin: Examining Skin Disorders
Horses are big animals, so they
have a lot of skin. They’re also prone to a number of skin disorders. These
problems are usually pretty obvious to the astute horse owner, and can
sometimes be alarming. The good news is that, in most cases, skin problems
aren’t fatal.
Allergies
Horses get allergies just like
people do, and sometimes symptoms take the form of hives, or urticaria. These
hives usually appear as either small or large wheals (anywhere from half an
inch to a few inches in diameter) that may or may not be itchy (see Figure
11-6).
Figure 11-6: Skin allergies
in horses present themselves as hives. (Dr. Janice Sojka, Purdue University)
Hives are usually brought on by
hypersensitivity to drugs, feeds, insects, chemicals, molds, dust, pollens, or
any number of other substances. With so many causative agents, finding the
inciting culprit can be tricky. Your vet may want to do skin or other allergy
testing, or even a food trial to attempt to find out exactly what’s causing
your horse’s allergies.
The usual treatment is
corticosteroids, either injected or oral. Determining and eliminating the
causative agent is also part of the prescription.
Bacterial infections
Bacterial skin problems in horses
are usually secondary to other problems that disrupt the protective barrier of
the skin. These secondary problems can include trauma or injury, warm and humid
weather, a dirty environment, and poor hygiene. Figure 11-7 shows a typical
bacterial infection.
Figure 11-7: An example of
a bacterial infection on a horse’s skin. (Dr. Janice Sojka, Purdue University)
A common bacterial skin problem
in horses is called greasy heel, scratches, or pastern dermatitis, and is a
condition involving the underside of the pastern or fetlock area. Like other
bacterial skin problems, a predisposing factor — such as moisture or an
abrasion — is usually to blame. Horses with white legs are most commonly affected.
In some cases of pastern dermatitis, a fungus or mite is involved. Whatever the
cause, your vet needs to make an accurate diagnosis for proper treatment and
future prevention. (Treatment depends on the source of the problem.)
Another, similar problem in
horses with white legs results when urine hits the ground and splashes onto the
front of the hind legs. If it’s not cleaned or rinsed often, it may also lead
to a secondary bacterial infection that must be treated with antibiotics.
Fungal infections
Fungal infections can be more
than itchy and painful to your horse, causing him to be irritable. Your
veterinarian can use a Woods Light test to detect some fungal species, but a
fungal culture or microscopic exam may be needed for diagnosis.
The most common fungal skin
problem in horses is ringworm, which isn’t actually a worm but a fungal
infection that’s highly contagious to other horses and humans. Called
“ringworm” because the lesions often begin as small, round areas of hair loss —
sometimes with raised edges — this infection relies on the presence of the
fungal spores and skin abrasions to take hold (see Figure 11-8). It’s most
common during damp seasons, or when horses are kept in damp, dark conditions
with poor hygiene.
Figure 11-8: Ringworm starts
as small areas of hair loss. (Dr. Janice Sojka, Purdue University)
Most problems occur at the girth
and saddle blanket areas, or the shoulders and neck — areas where horses sweat
the most. Ringworm can also be spread by using dirty brushes, blankets, and
other equipment on multiple horses.
Tip
Treatment for any kind of fungal infection is to avoid sharing grooming tools between horses and to clean all tools thoroughly in anti-fungal cleansers. Tack should be kept clean, especially girths and blankets. Horses affected by ringworm should be bathed with an anti-fungal shampoo recommended by your veterinarian. Vets may also give topical prescription medication to put on your horse.
Another common fungal infection
of the skin is rain scalds, sometimes called rain rot. Technically
called dermatophilosis, rain scalds are caused by a genetic anomaly that
has properties of both a fungus and a bacterium. The organism responsible for
rain scalds becomes active in damp weather and causes the most trouble in rainy
seasons or in warm, humid climates.
The organism responsible for rain
scalds enters the skin at a break. A bug bite or scratch is all that the
organism needs to gain entry. Symptoms include areas of matted hair with crusty
scabs on your horse’s coat that look like paintbrush strokes. These areas show
up primarily on the back, hindquarters, and thighs.
Tip
The best way to prevent rain scalds is to keep your horse dry in wet weather. Provide him with shelter to escape from the rain, and provide a waterproof blanket to wear during rainstorms. More severe cases may need veterinary treatment.
Sarcoids
Sarcoids are benign tumors of the
skin. The most common of all equine tumors, sarcoids occur in horses of all
ages but are most often seen in horses older than 7 years of age.
Most sarcoid tumors occur on the
head, neck, limbs, and ventral abdominal area. The tumors can be solitary or
occur in clusters, and they can be raised or flat in appearance. They can also
look like warts, or large, firm skin masses, and usually come in one of two
forms: flat and proliferative. (Figure 11-9 shows sarcoid tumors.) Some
researchers believe that sarcoids are the result of a virus, although no
conclusive evidence exists to prove this theory.
Figure 11-9: Sarcoid tumors have a
distinct appearance that sets them apart from other skin disorders. (Dr. Janice
Sojka, Purdue University)
Sarcoids don’t spread
(metastasize) through the body the way that cancerous tumors do (we discuss
skin cancers later in this chapter), but they can send out tentacles that
spread into the immediate area, making some of them very difficult to
eradicate. They can also be very persistent and locally invasive. Depending
upon the location and size of the tumor, surgical removal is an option, but
recurrence is common, even with very wide skin margins.
Warning!
Sarcoids aren’t usually life threatening except when they develop in areas of the body where normal function is affected. Sarcoids that develop on the anal area can be a particular hazard because they can grow large enough to prevent the horse from being able to defecate. Sarcoids around and in the eyes can also be dangerous. If they become large or invasive, the eye may have to be removed. That’s why lumps or bumps near your horse’s eyes warrant a visit with your veterinarian. When sarcoids occur in areas that come into contact with the saddle, girth, or other pieces of tack, surgical removal is often warranted.
Treatments for sarcoids include
cryotherapy, immunotherapy, laser therapy, radiation therapy, and topical
chemotherapy.
Seborrhea
Have you ever seen a horse with
crusty skin on the front of his hind legs between the hoof and the hock? This
condition can be maddening if you have a horse who suffers from it. No matter
how much you wash his legs, you just can’t get rid of the ugly crusts.
The technical term for these
crusts is seborrhea. In most cases, seborrhea is secondary to another
problem. (Primary seborrhea, caused by a genetic problem, is extremely rare in
horses.) Also called cannon keratosis, secondary seborrhea may be the skin’s
response to the insult of bacteria, the contact of urine (in geldings, it
splashes up and hits the legs), or even too much sun. The skin at the effected
area may react by producing a greasy substance (see Figure 11-10).
You can buy over-the-counter shampoos
to treat secondary seborrhea. These shampoos are labeled for such use, and can
contain tar and sulfur, emollients, or mild sulfur-salicylic acid. The shampoo
that you choose should be determined by which type of seborrhea your horse is
experiencing. Treat seborrhea oleosa with a tar and sulfur shampoo. Seborrhea
sicca may respond to emollient shampoos or mild keratolytic sulfur-salicylic
acid shampoos. Your veterinarian may be able to tell you which type of
seborrhea you’re dealing with by taking a biopsy of the affected area.
To help prevent secondary
seborrhea, keep your horse’s hind legs clean by washing them every few days. If
your horse has pink skin on his hind legs, consider putting sunscreen on them
during the summertime.
Figure 11-10: Secondary seborrhea
causes crusty skin. (Bob Langrish)
Skin cancer
Every species of mammal seems to
be prone to cancer, and horses are no exception. Unlike in humans, cancer of
the lungs, liver, kidney, and other vital organs is uncommon in horses.
However, horses are prone to skin cancers, which can cause a lot of problems,
including death.
Remember
If you see a growth on your horse’s skin that doesn’t go away after a week or so, contact your veterinarian.
Melanoma
Especially common in older gray
horses, melanoma is most often seen in Arabians and Percherons because of the
large number of gray horses in these breeds. Three-quarters of these tumors are
malignant, and they most often occur in the skin. They usually show up on the perineum
(the area between the anus and the genitals), underside of the tail, around the
eyes, and on the limbs. One form of melanoma occurs in young horses who are
less than 2 years of age. This melanoma is usually benign, and usually is
different from the melanomas of older horses.
Melanomas are usually under the
skin and are black in color. Not all melanomas are black, however. The only way
to know for sure whether a tumor is melanoma is through a biopsy.
Melanomas are most manageable
when they’re diagnosed and treated early. Removing these tumors surgically is
the best way to prevent them from spreading further, but some veterinarians
prefer to use cryosurgery. In some cases, vets opt to treat the tumor orally
with a drug called cimetidine, which can bring about partial to even full
regression.
Squamous cell carcinoma
This malignant tumor originates
in the epidermal cells of the skin. It tends to develop in areas of the body in
which some horses don’t have pigment. These areas include the eyelids, nose,
vulva, and penis. Chronic sun exposure is a primary culprit.
Squamous cell carcinoma may
initially appear as warts or granulation tissue, and grows into raised, crusty
lesions that don’t heal. This cancer doesn’t usually spread to the entire body,
but it can be very locally invasive, especially in the eye, where it can spread
into the tear duct or sinuses. Because this type of cancer can initially look
like scar tissue, sarcoids, bacterial granuloma, or fungal granuloma, only a
veterinarian can determine its true nature with a biopsy.
Squamous cell carcinoma can be
treated with cryotherapy, radiation therapy, surgery, and various implants.
Watching Out for Eye Problems
The eyes are the window to the
soul, and this statement is especially true of horses. Few things are sadder
than a horse with eye problems. These conditions often are not only painful,
but also very troubling to the horse. Because horses are prey animals, they
depend a lot on their sight to feel safe.
Remember
All eye problems require immediate veterinarian attention. Most eye problems are quite painful, so your vet may perform a nerve block and/or sedate your horse before examining her eyes. The vet also may use topical anesthetic eye drops to lessen pain.
Coauthor Audrey lost her beloved
Appaloosa mare Rosie to eye disease several years ago, and knows all too well
how insidious eye problems can be.
Blocked tear ducts
Horses live in dusty,
plant-filled environments, and sometimes their tear ducts become blocked as a
result. Blocked tear ducts (technically called the nasolacrimal ducts) can make
your horse’s eye tear excessively, leaving her with a constantly wet face. It
happens because dust or pollen plugs up the ducts, causes swelling, and keeps
the tears from draining normally through the sinuses
Bacteria can feed on the excess
tears and cause itching and irritation. The itching and irritation, in turn,
cause your horse to rub her face and possibly damage her eyes. This is why it’s
important to have your vet examine your horse if her tear ducts appear to be
blocked. Your vet can clear the ducts, and also check to make sure that no
other, more serious issues are at play.
If your horse develops blocked
tear ducts, your vet may put a tube into the tear ducts by going through your
horse’s nose. He or she then flushes the ducts with solution to clear the
blockage.
To prevent blocked tear ducts,
try to minimize the dust in your horse’s environment. If your hay is very
dusty, soak it in water before feeding it to your horse. Water arenas and dusty
paddocks during dry times of year.
Cataracts
Horses get cataracts just like
people do. In horses, however, the condition can not only develop with age, but
also be present at birth. If your horse has a large and diffuse cataract, you
may easily see it. It presents itself as a gray colored pupil.
Congenital cataracts, which are
present in newborn foals, may be removed by a veterinary ophthalmologist with
the greatest likelihood of a successful surgical outcome. Acquired cataracts
usually are secondary to another eye problem like ERU (which we discuss later
in this chapter), but they may be the result of old age.
Cataracts can be present in one
or both of a horse’s eyes. They can affect your horse’s vision because they
prevent light from getting through to the retina. The maturity of the cataract
determines how much vision the horse loses.
Technical Stuff
Several years ago, coauthor Dr. Kate’s husband bought a 21-year-old gelding to be his first cutting horse. The horse had to be retired only two years later because of cataracts. He had trouble seeing at night, and couldn’t be ridden in the evening unless a full moon was in the sky. Eventually, he became unsafe to ride at night at all.
Corneal ulcers
Corneal ulcers or abrasions are
injuries to the surface of the cornea that result from injuries to the eye.
Trauma, burns, chemicals, and even dirt or debris can cause corneal ulcers.
This condition is extremely
painful, as are most eye problems. Untreated corneal ulcers can lead to other
eye problems and loss of vision or the eye itself if untreated.
Veterinarians use a stain to
determine the extent of the ulcer, and may manage the problem with ophthalmic
antibiotics and ophthalmic atropine if bacteria are involved. Your vet may culture
the ulcer to see what kind of bacterial or fungal agents may be destroying the
cornea. Deep corneal ulcers that don’t respond to medication may require
surgical intervention.
Corneal ulcers are difficult to
prevent, but they can be treated successfully if you catch them early. Pay
close attention to your horse’s eyes, and don’t hesitate to call the vet if
your horse is squinting, tearing, or rubbing her eye.
Equine recurrent uveitis (ERU)
Also called moonblindness or
periodic ophthalmia, equine recurrent uveitis (ERU) is the most common cause of
equine blindness. The condition comes and goes, and is primarily a problem in
the acute phase.
Uveitits, which means
inflammation of the anterior chamber of the eye, may be caused by trauma, a
septic infection, certain bacterial or parasitic infections, or an
immune-mediated disease. Some researchers believe that a genetic component may
be involved as well.
In the acute phase, uveitis causes
considerable pain, excessive tearing, and sensitivity to light (see Figure
11-11). The condition is treated symptomatically with anti-inflammatories and
pain medications that may be administered topically, orally, and by injection.
Acupuncture and Traditional Chinese Veterinary Medicine has also proven to be
helpful.
If your horse is diagnosed with uveitis, you can manage the condition by keeping a close watch for symptoms, and instituting treatment immediately when the problem recurs. You want to initiate treatment immediately, because each episode may cause some degree of permanent damage to the eye. Good management of this condition often helps minimize the speed of progression of the disease.
Figure 11-11: Equine recurrent
uveitis causes painful tearing and inflammation of the eye. (Bob Langrish)
A Common Respiratory Problem: Chronic Obstructive Pulmonary Disease
Because horses are such athletic
creatures, equine respiratory problems can create huge issues. Riding your
horse in a show, competition, or even just on the trail is hard if he’s having
trouble breathing.
One of the most common
respiratory diseases that’s seen mainly in the older horse is COPD. Chronic
obstructive pulmonary disease (COPD) is the equine version of asthma, and it
causes a horse to have difficulty breathing in, and even more difficulty
breathing out. COPD is also called recurrent airway obstruction (RAO) or
heaves. This illness causes inflammation and spasms within the lungs. It’s
usually triggered by airborne allergies to mold, dust, and pollen, or by poor
air quality.
Horses with COPD have shortness
of breath during exercise, chronic coughing, and wheezing. They also often may
develop a heave line, which is a line of developed muscle along the
belly. It forms as a result of the horse’s struggle to push air out of his
lungs.
Tip
Just like some humans are born with a predisposition to asthma, some horses are born with a predisposition to COPD. To keep it from showing up in your horse, you can take a few precautions. These precautions include providing good ventilation in your horse’s stall or keeping him in a pasture with shelter, giving your horse hay and bedding that’s low in dust, and feeding your horse from a ground feeder to help him clear his nasal passages as he eats.
If your horse is diagnosed with
COPD, your veterinarian may treat him with bronchodilators and/or
corticosteroids. He or she may also suggest that you soak your horse’s hay in
water before feeding, or switch to pellets or hay cubes. Most horses with COPD
do better when housed outdoors, because barn environments can be very dusty.
Surveying Other Systemic Problems
Issues that affect your horse’s
entire system are scary. Discovering that your horse is suffering from a
systemic problem can be a frightening realization. Fortunately, veterinary
science has made great inroads into diagnosing and treating these issues in the
past 10 years, making it easier on affected horses and their owners.
Anhidrosis
“No sweat!” is generally
something you like to hear — unless it applies to your horse. Some horses can
develop a metabolic problem called anhidrosis, which is the inability to
produce normal amounts of sweat.
The condition has a range of
seriousness, from the extreme of a horse who has no ability to sweat, to a
horse who simply produces less sweat than she should at certain temperatures
and levels of exercise. The problem can be seasonal; some horses with this
problem do fine in the cooler seasons, but have trouble when the weather heats
up and humidity elevates.
Warning!
Your horse depends heavily on sweating to regulate her body temperature. Sweat is critical so that evaporation can cool her down and keep her body temperature from becoming dangerously high. When a horse stops sweating, she tries to cool herself through an elevated respiratory rate or even panting, which isn’t very effective. And the body temperature of a horse who can’t sweat may elevate as high as 103 degrees Fahrenheit. (The normal body temperature for a horse is between 99 and 101.5.) Add exercise to the equation, and the horse’s body temperature can go as high as 108 degrees. Brain damage is highly likely when body temperature exceeds 106 degrees.
Veterinarians believe that anhidrosis may result from a malfunction in the physiological or neural pathways involved in sweating. One theory is that the constant stimulation of sweat gland receptors wears them out, so to speak, and they quit responding. The problem is most common in the southern U.S., and especially in areas of higher humidity, but it can show up anywhere given the right conditions. Even horses who sweat normally can have episodes of anhidrosis, given the right set of circumstances of weather conditions, workload, and stress.
Remember
Your horse should normally cool off within 30 minutes after exercise. If your horse doesn’t seem to be cooling off, check her rectal temperature. If it’s above normal, and your horse is also breathing rapidly, has decreased energy, lethargy, and a lack of sweating, contact your veterinarian.
If your vet suspects anhidrosis,
he or she may choose to test your horse to see whether the sweat glands are
functioning properly. Anhidrosis has no proven treatments, but environmental
adjustment (moving the horse from a hot, humid climate to a drier, cooler area
of the country) tends to provide the best results. Some horses may be managed
with misting fans, stall air conditioning, or by choosing to exercise them in
the coolest part of the day. Horses with milder cases may respond to dietary
supplements containing a combination of cobalt, vitamin C, L-tyrosine, and
niacin. Some horses may benefit from methyl dopa and/or electrolytes. Other
horses respond to acupuncture and Traditional Chinese Veterinary Medicine.
Treatment isn’t 100 percent
effective in all cases of this no-sweat conundrum. In cases where horses don’t
respond to treatment, house them in cool environments on hot days, making sure
that they have plenty of shade and ventilation. They should be worked only at
cool times of the day or at night during hot weather.
Exertional rhabdomyolysis (tying up)
Exertional rhabdomyolysis — more
commonly known as “tying up” or azoturia — happens to some horses, often after
extreme exercise following several days without much exercise, and while fed
grain, especially high carbohydrate feeds. It may occur when a horse is
overexerted when she’s not fit to perform the work being asked of her. It can
also occur when a horse is experiencing an electrolyte imbalance, heat
exhaustion, or possibly a vitamin E deficiency.
The signs of exertional
rhabdomyolysis include sudden hind limb stiffness or lameness, muscle cramping,
refusal to move, and other distress, such as increased heart and respiration
rates, sweating, and acting colicky. Veterinarians diagnose exertional
rhabdomyolysis based on your horse’s behavior, and through a blood test for
elevated muscle enzyme levels. If your horse’s creatine kinase levels are
moderately elevated, the prognosis for recovery is good and the damaged muscle
tissue will heal in a few months. In severe cases, horses can have a guarded
prognosis for healing and future competition.
Remember
The possibility of exertional rhabdomyolysis makes it very important to carefully warm up your horse before exercise, and to gradually get her in condition for hard work.
Tip
Diet is extremely important for horses prone to exertional rhabdomyolysis. Limit starch in the diet, and avoid feeds that produce a grain high. (See Chapter Your Hungry Horse: Feeding Fundamentals for more on how to feed your horse.) Diets developed specifically for horses with exertional rhabdomyolisis can be a huge help.
Metabolic problems
Horses are prone to several
different metabolic problems. Each of these problems has a different origin,
yet all are closely related. Diagnosis can be tricky, but finding out which one
of these problems may be affecting your horse is important.
Remember
Although the solution to metabolic problems may be as simple as changing your horse’s diet, any hormonal metabolic problem becomes more difficult to treat the longer it progresses. If you suspect any of the problems described in this section, have your veterinarian test your horse for a metabolic condition.
The following conditions are
often difficult to differentiate, and ongoing research is constantly changing
the equine veterinarian’s understanding of these syndromes, diagnostic testing,
and management:
- Equine Metabolic Syndrome (EMS) has, in the past, been called peripheral Cushings disease. Many horses who suffer from EMS are insulin resistant. Symptoms often appear in the form of fat deposits at the base of the tail and crest of the neck (see Figure 11-12). These animals are often prone to developing laminitis. Current recommended management of EMS consists of regular exercise and a low-carbohydrate diet (no pasture, a grass hay diet, little or no low carbohydrate grain, and balanced vitamin and mineral supplementation). If your horse isn’t on pasture, she may need vitamin E supplementation.
- Cushings syndrome is more accurately referred to as pituitary pars intermediary dysfunction (PPID). Because a portion of the pituitary gland becomes unable to function properly, ACTH (a hormone) and blood cortisol levels are chronically too high. Horses who suffer from Cushings syndrome may also be insulin resistant, and they often have a long, curly haircoat (so they’re often sweaty because they’re hot). They’re prone to developing laminitis, chronic infections, and loss of muscle mass (producing a pot-bellied appearance), and they may have increased water intake and urine output. This condition can’t be cured, but many horses can be managed with drugs such as pergolide or cyprohepadine. Because much research is currently being done on this condition, your equine veterinarian may have newer, better information for diagnosing and treating this condition in the future.
- Primary hypothyroidism was once thought to cause many adult horses and ponies to develop cresty necks and excess fat at the tail head. Although many horses with this condition do have lower than normal blood thyroid hormone levels, many experts now think that this is a result of their overweight condition rather than a cause of it. Researchers found that horses who had their thyroid glands removed didn’t develop this classic appearance. In addition to primary hypothyroidism, a congenital form of hypothyroidism is occasionally seen in foals.
Figure 11-12: A fatty
crest on the neck can be a sign of metabolic disease. (Dr. Janice Sojka, Purdue
University)
by Audrey Pavia with Kate Gentry-Running,DVM,CVA
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