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What is a Retained Placenta?

What is a Retained Placenta?

Jun 4, 2018 | Foaling

Tuesdays with Tony

   As I curled up in my usual spot on the seat of Dr. Vurgason’s truck Monday morning, I noticed a distinct, slightly unpleasant, yet oddly familiar odor. It was the scent of placenta. You see, Dr. Vurgason had been out the night before working on removing a retained placenta from a mare that had just given birth to an adorable foal. Curious, and slightly grossed out by the realization of what I was smelling, I started asking Dr. Vurgason all sorts of questions about mares and placentas.  Read on to learn why this is something you need to look out for during the immediate post-partum period.

When is a placenta “retained” and why does it matter?

    In normal mares, the placenta should pass on its own within 3 hours of the birth of the foal. This recommendation is based on the fact that at birth, the placenta begins to disintegrate almost immediately. That’s Springhill Equine Veterinary Clinicbecause the placenta begins to separate from the uterine lining right after birth, and blood flow through the placenta stops. When blood flow stops, a process called autolysis begins. The placenta becomes friable, turns a brownish-green color, and begins to smell quite unpleasant. In short, as soon as the foal is born, the placenta starts to die. Unfortunately, when you leave a dead, decaying, fluid-filled pile of placenta sitting in the uterus for several hours, you end up with a nasty infection.
   The mare’s post-partum uterus is basically a giant open wound. During this time, there is great opportunity for an infection within the uterus to enter the bloodstream and spread throughout the body. This is called septicemia, or sepsis. And, since horses will be horses, guess what septicemia leads to? You guessed it: laminitis. For this reason, mares with retained placentas will often be treated with broad-spectrum antibiotics, anti-inflammatory medications, and will need to wear ice boots until the threat of laminitis has passed.

Why does this happen?

   During a normal delivery, the weight of the foal will begin to pull on the placenta as the foal is born. The umbilical cord attaches to the foal on one end and to the placenta on the other. When the mare stands and the cord breaks, it also gives a good tug on the placenta at the same time. A normal delivery also includes uterine contractions after the foal is born in order to expel the rest of the placenta. This passing of the after-birth is actually considered Stage 3 of labor.
    A retained placenta usually happens for one of 2 reasons: either the mare’s uterus doesn’t contract enough, or it contracts too much. If the uterus doesn’t contract enough, or the uterine contractions aren’t strong enough to expel the heavy, blood-filled placenta, it will just sit there indefinitely. The other possibility is that the uterus contracted too much, and in the wrong places. A mare’s uterus is essentially Y-shaped. One arm of the Y would have been the pregnant horn of the uterus. The pregnant horn of the placenta is thin, stretched out, and covers a large surface area. The other arm of the Y would have been the non-pregnant horn of the uterus. The non-pregnant horn of the placenta is thick, narrow, and covers a relatively small surface area. Fun fact: the most common piece of placenta to be retained is the tip of the non-pregnant horn. Too much uterine contraction can actually cause the uterus to grab hold of the thick, narrow non-pregnant horn of the placenta, and refuse to let it go! You see, the attachment between the placenta and the uterus is kind of like Velcro. There are thousands of microscopic, finger-like projections called microvilli that hold the two layers together. Prolonged uterine contractions can in fact cause these microvilli to get stuck within the uterine lining, like a Chinese finger trap.

How do you get a retained placenta out? 

   I’m so glad you asked, because the technique I’m going to tell you about is super awesome! First of all, the one thing you DON’T want to do is pull on the placenta. In addition, nothing heavier than the weight of the placenta itself should ever be tied to the end of the hanging-out bits. Putting too much traction on the placenta can cause tearing, which leaves fragments of the placenta stuck inside. Even worse, pulling on the placenta can cause uterine prolapse or uterine artery tears, which are definitely life-threatening.
   The first thing to try is a single dose of oxytocin. Oxytocin induces strong, rhythmic uterine contractions for a short duration, aimed at pushing the placenta out from within. This takes care of those placentas that are retained because of the first scenario described above: the uterus didn’t contract enough. I’d say about 50% of the time, this works. The mare says, “oh yeah, I forgot about that part!” And out it plops. However, often when the mare has failed to pass her placenta after we gave her 3 hours to do so, there is a reason for it.
   So the next step is to call our docs, of course. But you already knew that. One of the methods they might employ to get that stubborn placenta out of there is called the Dutch Technique. In this procedure, the vet makes a small incision in the umbilical vein, just above where it broke away from the foal. Then, a tube is inserted into the vein headed toward the stuck placenta. The other end of this tube is attached to a water hose or pump, and water is steadily pumped into the blood vessel. What this does is distend the vessels throughout the placenta, causing it to separate from the lining of the uterus. After infusing several liters of water, we patiently wait 5 minutes. This part is hard…cats are not particularly patient. After 5 minutes, gentle traction is applied to the placenta. Then, if all goes well, out it plops! It is seriously the coolest thing to watch, trust me.
    Well, I hope you learned something from this wise old cat today! Now remember folks, don’t try this at home. Just call one of my docs the moment you suspect there may be a problem.
Until next week,
Tony

Tuesdays with Tony is the official blog of Tony the Office Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

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Pregnant Mare Care

Pregnant Mare Care

May 29, 2018 | Breeding

Tuesdays with Tony

Pregnant Mare Care 

Congratulations! You’ve got a bouncy baby horse coming in about 11 months! In my experience watching the humans around here, it’s a very long 11 months. There are important things to do during that time to make sure the baby arrives happy and healthy. In my experience, humans are really good at getting the heartbeat ultrasound check at 30 days, but not so good at the rest of it. Read on for Tony’s words of equine wisdom regarding pregnant mare care.

Ultrasounds

These are just so freakin cool! You get to see that baby go from a black dot on the screen at 2 weeks to having a heart beat at 30 days. At the 60 day ultrasound there are legs and something resembling a head! They grow so fast. My Docs are checking way more than just the baby when they’re ultrasounding, though. They are also checking the entire uterus and ovaries to make sure they’re doing what they should.

The most important thing they are checking is where the cervix and placenta meets. This is where the outside world meets the uterus, and it’s where problems often start. My Docs will check to be sure the placenta is tight up against the cervix, along with measurements to be sure it’s not too thick. A thick placenta can be an indication of infection. If infection is spotted early, it can be easily treated with antibiotics. On young mares who don’t have a lot of exposure to other horses, ultrasounds should be done at 5, 7, and 9 months to check for infection. On older mares (over 12 years), problem mares, or mares who see lots of other horses all the time, the Docs recommend ultrasounds at 3, 5, 7, and 9 months.

Vaccinations

Rhinopneumonitis vaccines are super, super, super important for pregnant mares. Most humans call this a Pneumobort shot. Rhinopneumonitis is a Herpes virus. Herpes viruses are nasty little buggers. Once a horse has the virus, they’ve got it for life, and most horses are infected in their first year of life. The virus spends most of its time hibernating, but stress (I hear pregnancy is definitely stressful) can make it wake up. Frequent vaccinations keep the immune system on high alert for this virus. This means that if it does wake up, the immune system is right there to tackle it.

Rhinopneumonitis vaccines follow the same rules as ultrasounds. If your mare doesn’t meet new horses often, she can get a vaccine at 5, 7, and 9 months. If she is a social butterfly, she should get vaccinated an additional time at 3 months. This vaccine can be what my Docs call hot (horses often get a mild to moderate vaccine reaction from it). The Docs recommend some Bute beforehand to help reduce the reaction if you’re worried.

At around 10 months of pregnancy, your mare will need all her “regular” vaccines. For most mares this is Eastern and Western Encephalitis, Tetanus, Influenza, West Nile Virus, and Rabies. This makes sure the baby has great protection against these viruses when it gets here.

Deworming

Don’t. Ha! That was easy. Seriously though, see my numerous blogs on deworming. Watch an entire presentation by my Docs about deworming here: Deworming Seminar  Fecal egg counts and targeted deworming is the way to go. Don’t go deworming all willy nilly like you humans are prone to doing.

Nutrition

Don’t go crazy. Again, easy! Have your mare on a good feed. If she gets skinny easily, then a mare and foal feed may be necessary. If she’s an easy keeper, then good quality hay and a ration balancer may be all she needs. This is not the time to get her fat. It won’t make foaling easier on you or her.

Exercise

Yes. Of course they tell me that too, but I don’t like exercise, so I don’t. Pregnant mares can go out and do what they did before they were pregnant with a few guidelines in place.

  1. Don’t do more than you did before she was pregnant. If you went for 5 mile trail rides, great. Don’t sign up for the 50 mile endurance ride.
  2. Watch how hot she gets in the early stages of her pregnancy. Being really hot can be really, really bad for embryos younger than 90 days.
  3. Listen to your mare. At some point, later in her gestation, she’s going to tell you she doesn’t want to work anymore. Respect that.

Before you know it, 11 months will have flown by and you will be anxiously awaiting your foal. Spend the time wisely by thinking up perfect baby names, and keeping your mare up to date on all her prenatal care! Bring her into the Clinic for her happy mom check ups and I’ll even throw in a free CAT scan by yours truly.

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Springhill Equine Veterinary Clinic

Tuesdays with Tony is the official blog of Tony the Office Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

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Horse Injuries, and How To Prevent Them

Horse Injuries, and How To Prevent Them

May 21, 2018 | Exercise, Injuries

Tuesdays with Tony

Horse Injuries

It rained around here a lot over the last week. It’s Florida, and almost summer. It’s what we do here. For the record, I’m going to state that I don’t like rain. Wet paws are not something I enjoy, but that’s not what I’m here to talk about. While it was raining here, I was watching (or attempting to watch) Justify run in the Preakness. Wow, was it raining!!! Also, while it was raining here, Dr. Lacher was showing her horses down in Venice, Florida, where it was also raining. Her event wasn’t nationally televised, so I couldn’t watch it (seems unreasonable, but she said it’s not nearly as exciting as the Preakness). However, she said she had some tough decisions to make about riding because of the rain, and the potential for horse injuries. That got me wondering: do horses hurt themselves in all that mud and slop? I mean, horses hurt themselves on sunny days, when the temperature is a lovely 72, and the wind is out of the east at 4 miles per hour. How can they not hurt themselves in the rain??

Springhill Equine Veterinary ClinicThe Short Answer: It Depends

Ah, that most-human of answers. Racehorses are running at top speeds, pushing the limits of how fast the equine skeleton was designed to go. However, they are running in mostly straight lines, and big curves. The tracks are also meticulously maintained, especially for a race as big as the Preakness. What that means is, yes, the horses may have to put in a bit more effort to overcome the wet track. Overall, though, you probably would have found the track to be quite good to run across, even in the chosen human running gear of sneakers and inappropriate shorts.

Events which require quick turns and changes of speed, like the jumping Dr. Lacher does, may have a different answer. The other major difference in pretty much any horse sport but racing is that the horses are going to be going over the same spot repeatedly. There should be serious thought put into how the footing will handle that, and if it can. If you are the last one to go before they drag the ring, what kind of damage has been done to the footing around the barrel, or the jump, or the obstacle? Horse factors should be considered as well. If your horse is young, or working on confidence, asking them to handle footing that is even a little challenging can be hard on the brain, if not the body.

Eventers are crazy and don’t even realize it’s raining, so we won’t talk about them. (Just kidding, eventers!) Same as everyone else who isn’t racing in the Preakness, I recommend you evaluate the track, and decide if it’s going to be OK. You humans have enormous brains. You should put them to good use.

Why rain matters less than you think

There are two kinds of injuries horses get: the wrong step/trip and something-tears kind, and the low-level repetitive strain kind. Guess which horse injury is more common? And guess which one is sometimes really disguised as the other? That’s right, repetitive strain is the real bad guy. Lots of times there’s a weak spot created by that repetitive strain that breaks when there’s a bad step or trip, so I’m counting that as a repetitive-use injury, too.

How to avoid injuries

Appropriate fitness is the answer. Just like people, horses need to be fit to do the job asked of them. Just like people, horses can get bored, bored, bored with the same old stuff. Know why CrossFit became a thing? Bo Jackson (if you’re under 40 you may need to Google him) got bored doing the same drills, and his injuries kept getting worse from doing those same drills over and over. He started incorporating strength and coordination exercises of all different types to keep him fit enough for baseball and football without the repetition. You can CrossFit your horse, too! It’s called dressage with your jumper, or jumping for your dressage horse. Team pen with your barrel horse. Take your reining horse to an obstacle challenge. The absolute best thing you can do for them is trail riding. I don’t mean the cat version of trail riding: a slow meander involving lots of naps. I mean a ride across terrain with a purpose. Ask them to collect downhill, push uphill, bend around trees. Take advantage of any training opportunity the terrain provides. While you’re busy enjoying nature, your horse will be working on coordination, strength, and balance without even realizing it. As an added bonus, the next time conditions are a little sloppy, your horse will be ready to deal with it.

Fitness is hard. Need help with a plan? Ask Dr. Lacher. She’s rehabbed not only client horses, but her own horses as well. Dr. Lacher seriously knows her stuff when it comes to fitness for equine athletes.

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Until next week,

~ Tony

Springhill Equine Veterinary Clinic

Tuesdays with Tony is the official blog of Tony the Office Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

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Warmblood Fragile Foal Syndrome

Warmblood Fragile Foal Syndrome

May 14, 2018 | Breeding, Warmblood Fragile Foal Syndrome

Tuesdays with Tony

This week we’re going to talk about a tough topic: Warmblood Fragile Foal Syndrome. I apologize to those who enjoy my feline brand of sarcasm, but it will be largely missing this week. Even a cat can’t be snarky when it involves death, and Warmblood Fragile Foal Syndrome causes foals to die soon after birth, which is even worse.

What is Warmblood Fragile Foal Syndrome?

Springhill Equine Veterinary ClinicWarmblood Fragile Foal Syndrome (WFFS) is a point mutation in the PLOD1 gene. I’m going to get a wee bit nerdy here because I can’t help myself.  A point mutation means that in the DNA for this gene where a Guanine should be, there’s an Adenine. PLOD1 is responsible for helping raw collagen turn into something that can support all the stresses skin, tendon, ligaments, and blood vessels undergo every day. That single change from a G to an A means the skin can’t handle shear forces. That’s it: one letter. It can also be a cause of abortions in pregnant mares because of umbilical cord ruptures. The umbilical cord grows from the foal side of things, so if the foal has WFFS, the umbilical cord will be made with defective collagen. You know those bubbles you see in a water hose before it bursts? That’s what blood vessels made with defective collagen do. And once the umbilical cord bursts, the foal can’t survive.

I tell you, the more I learn, the more amazed I am that life even happens. There are so many places where one tiny little error makes the whole system fail.

How does my foal get it?

WFFS is an inherited genetic mutation, and specifically an autosomal recessive condition. Every foal gets one copy of genes from the sire, and one copy from the dam. For an autosomal recessive condition to cause problems, the foal has to get two copies of the gene. This is a good news/bad news scenario. It means that most foals won’t be affected with the syndrome. However, autosomal recessive is a great way to have a gene silently make its way into a population.  For example, let’s say we cross a mare that is A/G (this means she’s a carrier) with a stallion that is A/G (so he’s a carrier too). With this cross, there is a 25% chance we get a G/G foal (not a carrier and normal), 50% we get an A/G foal (normal but a carrier), and a 25% chance we get an A/A foal (fully affected). This means it is very, very important to know the status of your mare and stallion if you are breeding!

How do I test my horse?

First, if your horse is a gelding there is no reason to test unless you are curious. WFFS carrier status will NOT affect performance.

Ok, now that that’s out of the way. UC Davis and Etalon Diagnostics are the two places my Docs recommend. Many, many warmblood breeders are testing aggressively right now. This means there may be a wait to get your results, but both labs are trying to get results out as fast as they can. Both labs have submission forms on their websites. You will need to pull about 25 hairs, being sure to get the roots, and mail them in along with the submission form. That’s it.  

And if my horse is a carrier?

That depends on you. Responsible breeding would mean removing carrier horses from the gene pool by not breeding them. I do understand that’s easier said than done. At the very least, avoid breeding two carrier horses. As I said, many stallion owners are trying to determine the status of their horses. Hilltop Farm has done an excellent job getting information to mare owners. They have also said any mares bred to carrier stallions must have proof of non-carrier genetic status. This is a great start. It gives me hope for you humans.

Now be a good human: scroll down just a smidge further and subscribe. It’s the only way to be sure you see all the wisdom I have to offer delivered directly to your Inbox.

Until next week,

Tony

Springhill Equine Veterinary Clinic

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Tuesdays with Tony is the official blog of Tony the Clinic Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. If you liked this blog, please subscribe below, and share it with your friends on social media! For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

Navicular Disease

Navicular Disease

May 7, 2018 | Lameness, navicular disease

Tuesdays with Tony

It’s definitely busy season here at the clinic! All the breeding work and new foal checks on top of my usual bread & butter makes for one exhausted office cat. But I’d hate to disappoint my adoring fans, so I will postpone my cat nap long enough to shower you all with some new information on an old problem called Navicular disease.

 

What is a “navicular”?

     Kinda sounds like one of the pieces you make sure you take out of your Thanksgiving turkey before eating it, right? Well, in fact, the navicular is a small bone in your horse’s foot at the back of the coffin joint. It is technically a sesamoid bone, meaning it is not one of the main weight-bearing bones in a joint. Despite this, navicular bones play a huge role in the physiology of how a horse’s foot bears weight.
      Navicular disease syndrome describes a problem with the navicular bone plus or minus any of the structures it connects to. You see, the location of the navicular bone smack in the middle of the hoof makes this tiny bone extremely significant. The navicular bone is in contact with the coffin joint, the navicular bursa, the coffin bone, the short pastern bone, the navicular impar ligament, the deep digital flexor tendon, and the digital cushion. This is why navicular disease can go south so quickly!

How is Navicular disease diagnosed?

      Navicular disease usually manifests itself as forelimb lameness. The lameness may be mild or intermittent at first, and it may be difficult to tell which front foot is lame. The classic feature of navicular disease is that it is almost always bilateral (affecting both front feet). If your horse’s lame foot is blocked (numbed with local anesthesia), and the lameness switches to the other foot, a diagnosis of navicular disease is high on the list.
     X-rays of the front feet are needed to confirm this diagnosis and to get an idea of the severity of your horse’s condition. This is when I get to sit back and watch the docs and techs try to make your horse do circus tricks in order to get some fancy X-ray views. First, they need the horse to put both front feet up on these little wooden blocks. Next, they get the horse to stand on a tunnel with the X-ray plate in it. Then they ask the horse to stand with one leg forward and one leg back while they crouch under the horse’s belly and point the machine at the horse’s heel. Let me tell you, it looks absolutely ridiculous, and is hilarious to watch.
    While X-rays can give the docs a lot of information about the navicular bone itself, MRI is required to fully evaluate the soft tissue structures involved. If it’s in the budget, we would strongly recommend an MRI if your horse is diagnosed with Navicular disease.

Can Navicular disease be treated? 

     Yes! While navicular disease is a degenerative condition, this diagnosis is certainly not a death sentence for your horse when it is identified in its early stages. Certain breeds, such as Quarter horses and Paints, are more likely to develop the condition than others. If you own one of these horses and notice any forelimb lameness, or if your farrier tells you that your horse is painful across his heels, have him evaluated by a vet ASAP!
     Corrective shoeing is the cornerstone of treatment for navicular disease. Wedge pads will take some pressure off the heels, where the navicular structures are, and redistribute the weight to his toe. Any decent farrier should be able to handle applying wedge pads, but make sure he or she gets a chance to look at your horse’s X-rays to determine what degree of wedge your horse needs. If you have a stellar farrier who is adept at corrective shoeing projects, he may try a therapeutic shoe with a built-in wedge (bars that are thicker at the heel than at the toe), and/or other modifications to suit your horse’s individual needs.
     The corrective farriery is essential to managing a horse with navicular disease, but it’s not always enough by itself. Your vet may prescribe anti-inflammatory medications to give your horse long-term in order to maintain his comfort. Equioxx is commonly employed in these cases because it boasts far fewer negative GI side effects compared to Bute or Banamine. Joint injections are another way to decrease the inflammation associated with navicular disease. Going back to our anatomy lesson from earlier, injections into either the coffin joint or the navicular bursa may help your horse, as the navicular bone borders both of these structures.

A word about OsPhos

    The new kid on the block as far as treating navicular disease goes is a drug called OsPhos. This medication is definitely in vogue right now, especially in the Quarter Horse world, but does it really work? Well, lucky for you, I like to be a well-educated cat, so I did some research on the subject.
     OsPhos has been shown in vitro (that means in a Petri dish in the lab) to reduce osteoclast activity. Osteoclasts are cells that break down bone. One of the primary features of navicular disease is that the navicular bone essentially disintegrates over time (a severely diseased navicular bone will look like a slice of Swiss cheese). Ok, so this sounds like a no-brainer, right? The navicular bone is breaking down, so let’s give a drug that inhibits bone breakdown to stop progression of the disease.
    Well, there are 2 little problems with OsPhos. Remember that whole Petri dish thing? Well, just because we know a drug works in a lab means nada when it comes to how that drug will work when injected into a horse’s body. The medication has been approved by the FDA so we know it is relatively safe for horses, but how well it works at actually treating navicular disease is anybody’s guess.
    The second problem is a recently-recognized side-effect, which we all should have expected when you think about it. It has been suggested (by some very smart veterinarians) that OsPhos inhibits bone healing. This makes sense, because in addition to eating away at diseased navicular bones, osteoclasts actually have an important role in bone healing in a healthy horse. If your horse were to fracture a bone, osteoclasts would get to work right away cleaning up the shattered fragments and making way for osteoblasts (bone-making cells) to lay down new bone. Well, if your horse is in work, and his bones are under stress, they are essentially sustaining millions of micro-fractures all the time. In a normal horse, this would be no big deal. Osteoclasts would swoop in, clean up the damaged bone, and it would be replaced by new bone, which would be even stronger than before. But, in a horse that has been treated with OsPhos, those osteoclasts are inhibited, the damaged bone doesn’t get cleaned up, the new bone can’t be laid down, and the bone is left weaker than before.
     If you’ve followed my cat-splaining this long, good for you! If not, don’t worry, just trust my vets. Here’s their two cents: OsPhos is worth a try in horses with a definitive diagnosis of navicular disease. However, if one treatment doesn’t do the trick, it’s probably not a good idea to give this medication repeatedly. OsPhos is definitely not a lameness cure-all, and it doesn’t make sense to use it in horses to treat anything other than navicular disease.
   Well, I sure hope I still have time to get my nap in! Tomorrow’s another day full of foals, mares, and stallions. I need to be alert to manage my minions as they run around like chickens with their heads cut off.
    See you next week!
           -Tony

Tuesdays with Tony is the official blog of Tony the Office Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

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