Owned by Barrie Padgham and bred by Rae-Dawn Arabians
By Michelle Delco, DVM Diplomate ACVS
What is IRAP?
IRAP is a treatment that decreases inflammation and promotes healing. Unlike traditional anti-inflammatory therapies like steroids or bute, IRAP is the horse’s natural anti-inflammatory – made by it’s own cells. To understand what IRAP is and how it works, we must talk a bit about inflammation. When your horse sustains an injury, the damaged tissues release signals to the body that cause inflammation – you recognize inflammation as heat, swelling and pain. One of the major signals for inflammation is a substance called IL-1. Think of IL-1 as a “key” that turns on inflammation. The “lock” that IL-1 fits into is called IL-1 receptor. To prevent inflammation from getting out of control, the body has a natural blocker of inflammation called IL-1 receptor antagonist protein, or IRAP.
How does IRAP work?
So IRAP is a protein produced by your horse’s own cells to block inflammation. Some very smart scientists figured out how to induce blood cells to increase the natural synthesis of these anti-inflammatory proteins. The system involves harvesting about 60 mls of your horse’s blood and incubating it with special glass beads for 24 hours. The blood cells produce large amounts of IRAP as well as other healing factors. The IRAP-rich serum is then separated from the blood, harvested, frozen and stored for later use. It can then be thawed and injected directly into a damaged or inflamed area (such as a joint) at any time. Early studies and the experience of veterinarians who use IRAP suggests that it is an extremely useful tool to treat injuries in horses. Again, because IRAP is derived from the horses’ own cells, we are able to avoid certain risks and negative effects of other “traditional” drugs.
What is PRP?
Like IRAP, Platelet Rich Plasma or PRP is another product derived from your horse’s own blood. PRP is loaded with natural healing proteins that accelerate tissue repair. So what is a platelet? Platelets are the component of blood that cause clotting. In addition to initiating clotting, platelets also act as factories and storage units for a myriad of growth and healing factors. When platelets are activated, they release these growth factors, which accelerate healing and improve the quality of healing. The aim is not just fast healing, but good quality repair, so that your horse is less likely to re-injure.
Unlike IRAP that requires 24 hours to process, PRP can be obtained in just a few minutes. Your horse’s blood is again drawn, and spun in a centrifuge. The process concentrates platelets into the plasma, and this platelet rich plasma is then separated from the rest of the blood. The PRP can then be directly injected in to injured tissue, such as a tendon tear. Often, this accomplished with ultrasound guidance.
Are one of these treatments right for your horse? The first important step in answering this question is obtaining a diagnosis. All injuries are not equal- they have different causes, different treatments and carry different prognoses. To know what treatment is best, first a veterinarian specializing in lameness diagnosis needs to perform a thorough evaluation- likely to include an orthopedic examination, diagnostic analgesia (joint or nerve blocks) and imaging such as radiographs, ultrasound or MRI. Once an accurate diagnosis has been made, your veterinary specialist can discuss the options and provide state of the art treatment options. The goal is to get your equine athlete back to soundness as quickly as possible and keep them sound for the long haul.
By Lisa Gift Krauter, DVM, DACVS, Pilchuck Veterinary Hospital
During the busy summer and early fall months, our horses are often required to perform at their maximum level, and, as such, a number of them develop lameness issues.
Any discussion of lameness in the horse has to begin with the front hoof region. Because the horse carries at least 20% more of his weight on his forelimbs than hind limbs, the front foot region is a common area to develop injuries. The front foot is a complex structure made up of bones and soft tissues (tendons and ligaments), in addition to blood vessels and nerves. The navicular bone and its associated structures, along with the deep digital flexor tendon, provide stability to the back of the foot, while the collateral ligaments of the coffin joint provide stability to the front part. All these structures are prone to injury in athletic horses because of the compressive, pulling and torque forces placed upon them. Diagnosis of these injuries can be challenging because radiographs reveal some bone injuries, but not all. The soft tissues cannot be evaluated with radiographs and, because most of them are located within the hoof capsule, are only partially visible with ultrasound evaluation. With the advent of MRI technology, it is now possible to diagnose injuries to the bones and tendons/ligaments of the front foot to allow for appropriate treatment and thus a better chance of the horse returning to competition.
In both the front and hind limb, injury to the suspensory ligament is a common source of lameness for all types of equine athletes. The suspensory ligament functions to prevent excessive extension of the fetlock joint and thus undergoes extraordinary pulling forces. The lameness associated with the suspensory ligament may initially be mild, and the horse may “wear out of the lameness” with continued light exercise. With suspensory injuries in the rear limb, the rider often initially just feels that the horse has a reduced amount of push. With continued stress, however, these mild strains can progress to ligament tears resulting in a definitive lameness. Because there is often no swelling of the leg, injuries to the suspensory ligaments are usually diagnosed by ultrasound examination following localization of the lameness by local anesthesia (nerve blocks). Treatment often involves some form of regenerative therapy such as platelet-rich plasma or stem cell treatments, shockwave therapy, and a rest/rehabilitation program.
The hock and stifles are common sources of lameness in the rear limbs of equine athletes. The hock is prone to developing bone/joint pain associated with the bottom two of the four joints that make up the hock. Radiographs of these joints often reveal some degree of arthritic change, and treatment often involves the use of intramuscular Adequan or Pentosan injection or injections of anti-inflammatory agents into the affected joints. Pain associated with the stifle can involve either the bones, meniscus separating the bones, or internal ligaments. Diagnosis of which structures are affected may require arthroscopic surgery in addition to radiographs and ultrasonography due to the limited visibility of some of the structures. Treatment may involve the use of intra-articular medications, or in the case of traumatic injury, arthroscopic surgery and regenerative therapy followed by a rest and rehabilitation program.
By James E. Bryant, DVM, DACVS,
Pilchuck’s Equine Department Head, Staff Surgeon and Lameness Specialist
Noticing a change in your horse’s gait is a worrisome experience. Because lameness can be caused by pain from just about any part of a horse’s body, proper treatment relies on accurately sourcing the problem. Fortunately, our understanding of lameness and the availability of new technologies to facilitate a diagnosis have increased significantly in the last 10 years.
Lameness exam: The first step toward a definitive diagnosis is a lameness exam. Because horses can’t tell us where it hurts, we must systematically determine the source of pain. When there is obvious swelling, heat and pain, the cause is usually easily identifiable. More commonly, there are no outside signs.
First, the veterinarian runs his or her hands over the horse to identify sources of heat, pain or swelling. Next, the horse is evaluated in hand, and the affected limb is identified. Flexion tests and trotting in circles are used to further localize the source of pain.
Next, diagnostic nerve blocks are used. We place local anesthetics over the nerves, starting from the bottom of the limb and working our way up until the pain has gone away. When the horse travels sound, we know the source of pain is between the last and current nerve blocks. Now, we move to diagnostic imaging for an accurate diagnosis, treatment plan and prognosis.
Diagnostic imaging: In simple terms, radiographs (X-rays) are used for evaluating bone, ultrasound for soft tissue structures, and magnetic resonance imaging (MRI) for either soft tissue or bone.
Digital radiology allows for rapid, on-site evaluation of arthritis, fractures, bone degeneration, OCD lesions, tendon or ligament attachment problems, and sites of soft tissue swelling or infection. Limitations include difficulty in reaching the hip or back, bone contusions (which cannot be seen with radiographs), and knowing the findings are clinically significant.
Ultrasound allows for good visualization of tendons, ligaments, joint capsules, cartilage and bone surfaces. While convenient (often portable and used stall-side), limitations include not being able to penetrate the hoof capsule or deep structures such as the pelvis, and lack of sensitivity for some deep structures (e.g., suspensory ligament).
MRI is the latest tool in our armamentarium and allows for visualization of bone and soft tissue like never before. We can accurately diagnose tears in the deep tendon in the foot, reassess our diagnosis of navicular disease, and look at collateral ligaments of the coffin joint, to cover just a few. With the MRI at Pilchuck, we can visualize any body part from the carpus (knee) in the front limb to the hock in the rear limb, along with the head and parts of the neck.
In summary, veterinarians are now able to more accurately pinpoint the pain causing lameness and treat more effectively – with a better outcome for you and your horse.
For more information, contact Pilchuck’s equine services department at 360.568.3111 or visit www.pilchuckvet.com.
Sourece: www.PilchuckVet.com/articles/advances-in-diagnosing-equine-lameness
By Brandi Holohan, DVM
You’ve waited 11 long months … and your mare has just delivered her foal. Now what? The foal and mare are lying on the stall floor, staring at each other and trying to figure out what just happened. The first few hours of the relationship between mare and foal are extremely important for bonding and functioning as a maternal offspring pair.
The mare generally stands within 15 minutes of delivery, and the tension on the umbilical cord will cause it to tear about 1 inch from the foal’s abdomen. The vessels in the cord are stretched, resulting in contraction and clotting. The placenta is sometimes passed immediately but more commonly will hang from the mare’s vulva for a short time. The umbilical stump on the foal’s belly should be dipped in antiseptic, dilute chlorhexidine, three times the first day, twice the second and once the third. If the umbilicus does not stop bleeding within a few minutes, or if it doesn’t break away from the placenta, tie it with dental floss or a clean shoe lace about 1 inch from the abdomen. Cut off any excess, leaving half an inch to an inch on the opposite side of the tie, and consult your veterinarian.
My general rule of thumb is 1-2-3: The foal should stand within one hour and nurse within two hours, and the mare should pass her placenta within three hours. Set the placenta aside for the veterinarian to inspect for completeness and any abnormalities. A retained placenta is an emergency.
Maiden mares often have a more difficult time adjusting to a nursing foal. The mare may require you to offer reassurance that the foal is OK and restrain her to allow the foal to nurse. If the mare was dripping milk for more than one hour prior to foaling, consult your vet. The foal needs to consume the colostrum/first milk from the mare in order to absorb the antibodies that are essential for survival. If the mare loses the colostrum prior to nursing, or the foal does not consume an adequate amount within the first six to eight hours, it may be at risk of life-threatening infection. Your veterinarian typically draws a blood sample when the foal is 18 to 24 hours of age to assess this antibody level, the IgG level. This test gives you the peace of mind that the level is adequate and the foal does not require a plasma transfusion.
Look over your new foal for any physical signs of concern. Start at the nose and work your way to the tail. The nostrils should be clear of debris. If you notice milk coming from the nostrils, call your vet. This may indicate a problem with the foal’s palate or ability to swallow correctly. Part the foal’s lips: The upper and lower jaw should be in good alignment, and the gums should be pink (not red). Look at the foal’s eyes. A new foal may have suffered some blood vessel rupture in the white part of the eye during the foaling process from pressure, and the eyes may look red around the edges. Discharge from the eyes, cloudiness, swelling and holding the eyes closed are causes for concern. Ears should be upright and alert. Legs should be strong and without angular deformities. The umbilicus should be checked for a hernia, swelling, any continued bleeding or urine drainage.
The foal should pass a blackish stool called meconium within the first 12 to 18 hours of life. Contact your veterinarian if the foal appears to be in discomfort or has not passed meconium. An enema to soften this stool and allow it to pass more easily may be needed.
Foals should be full of energy and curiosity, and nurse with vigor and frequency. If your foal seems dull or lethargic, it is an emergency and may indicate serious illness.
Your veterinarian will perform a mare and foal exam. The mare will be examined for foaling complications, vulvar or reproductive tract injuries, udder health, and post-foaling comfort. The foal will have a full physical exam and should have a blood sample taken for an IgG (antibody level), as previously discussed. As always, contact your veterinarian with questions or concerns. He or she can offer support as you and your mare welcome this new life into the world.
