Archive for August 2018
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Monday 29th October 2018
Venue: University of Surrey, Vet School Main Building(VSM), Daphne Jackson Road, Guildford, GU2 7AL
Doors open 7pm / Prompt 7.30pm start
A review of recent advances in Standing Surgery – The story so far!
Tom Hughes MA VetMB CertES (Orth) DECVS MRCVS is a Clinical Director and Surgeon at Liphook Equine Hospital and is an RCVS and European Specialist in Equine Surgery
A complete guide to Equine Gastric Ulcers – Signs,pathophysiology and treatment
Andy Durham BSc BVSc CertEP DEIM DipECEIM MRCVS is a Clinical Director and Head of the Medicine Referral team at Liphook Equine Hospital and is an RCVS and European Specialist in Equine Internal Medicine
With guest speaker International Showjumper : TREVOR BREEN
Trevor Breen has had a great deal of success to date both competing on the National and International circuit as well as sourcing, producing and selling some top international horses. He has been a regular member of the Irish International team since 2007 and on the Olympic long list for the London 2012 and Rio 2016 games
To book your FREE place, please contact our reception team on: 01428 723594, or via email to email@example.com
Kindly supported by Equitop Myoplast
There is no doubt that molecular biologic technologies such as PCR testing have dramatically increased the sensitivity of diagnostic tests designed to detect the presence of several infectious pathogens including Streptococcus equi subsp. equi (Strep equi), Salmonella sp., CEMO and Dermatophytosis. Following on from an outbreak of strangles it is important to establish freedom from infection in all affected animals before “a line is drawn” under the outbreak and horses are free to mix and attend shows. Evidence suggests that guttural pouches are the only logical target for post-outbreak sampling with latest research indicating a greater than 50 times chance of detecting the presence of Strep equi in the guttural pouches of carriers compared to their nasopharynx (Boyle and others 2017). Furthermore, recent studies indicate that around 40% of culture-negative strangles submissions may be positive by PCR (Boyle and others 2017; Pusterla and others 2018).
However, the main drawback to reliance on PCR testing is that the technique simply detects the presence or absence of the DNA or RNA of the organism in question, whether or not that material is present in live or dead organisms. Indeed one recent study indicated that less than 20% of PCR positive and culture negative samples contained viable organisms (Pusterla and others 2018). It has been suggested that the lack of mucociliary clearance mechanisms in the guttural pouch could facilitate retention of DNA from dead Strep equi organisms leading to positive PCR results that do not actually indicate any risk of contagion.
A new PCR assay has been developed at Liphook which can distinguish live from dead Strep equi organisms. Use of this PCR will enable much greater confidence in the clinical relevance of positive PCR results. Results from examination of 10 washes, 5 of which had been boiled to kill the organisms, is shown in the graph below. The PCR was able to distinguish the live from dead organisms. Further validation in greater numbers of samples is ongoing.
In order to avoid the possible confounding effect of death of organisms between sampling and testing, it is important that samples are shipped in chilled saline (ACTH chiller packs for example), as previous evidence indicates that viability of Strep equi is excellent in cold and wet conditions (Durham and others 2018).
BOYLE, A. G., STEFANOVSKI, D. & RANKIN, S. C. (2017) Comparison of nasopharyngeal and guttural pouch specimens to determine the optimal sampling site to detect Streptococcus equi subsp equi carriers by DNA amplification. BMC Vet Res 13, 75
DURHAM, A. E., HALL, Y. S., KULP, L. & UNDERWOOD, C. (2018) A study of the environmental survival of Streptococcus equi subspecies equi. Equine Vet J
PUSTERLA, N., LEUTENEGGER, C. M., BARNUM, S. M. & BYRNE, B. A. (2018) Use of quantitative real-time PCR to determine viability of Streptococcus equi subspecies equi in respiratory secretions from horses with strangles. Equine Vet J 50, 697-700
We are seeking to employ an additional, hardworking and enthusiastic individual to work within our state-of-the-art equine hospital based in Liphook, Hampshire. You will be responsible for providing first class care for horses, ponies and donkeys. Applicants must have a proven record of excellent horse handling, horse care and top class stable management, plus experience of working in a professional yard. We require reliable, conscientious, self-motivated applicants with extremely high standards. Nursing skills are not required.
The candidate will be required to work every weekend from 7am until 1pm, Saturday & Sunday. Additional hours may be available, based on zero hours contract.
Please apply to the Yard Manager enclosing your CV and the names of at least two referees. Please include details of your notice period and current salary package.
Applications should be sent either by mail to Liphook Equine Hospital, Forest Mere, Liphook, GU30 7JG or by email to firstname.lastname@example.org
We are pleased to announce that on the 8th August 2018 Liphook Equine Hospital has joined forces with Vet Partners, one of the leading veterinary groups. Joining the group positions LEH to take the business forwards and, with the backing of an experienced partner, we will be able to develop the practice and continue to invest in the facilities and services that enable us to remain at the forefront of equine veterinary care. The entire team of directors, veterinary surgeons, nursing and support staff remain unchanged and our clients will see no change in the day to day interaction with the practice and the care that we provide to your horses. The relationship offers great opportunities for the excellent team at LEH giving them even more opportunity for development and career progression. Vet Partners has a base of small animal practices across England, Scotland and Wales, and moved into equine and mixed practices earlier this year. These are exciting times for the practice and we look forward to new developments and to continuing to provide the very best care possible for you and your horses.
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Horses will shake their heads for a range of reasons, but vets recognise that some of the time the headshaking signs are associated with diseases and nerve problems in their heads, causing discomfort and resulting in characteristic pattern of headshaking signs.
Headshaking horses show a pattern of signs that can include some or all of the following:
– Vertical (up and down), horizontal (side to side) or rotationary (round and round) flicking of the head
– Nostril twitching or grimacing
– Nose twitching and lip smacking
– Scrubbing the nose on the floor, against their legs, on the rider’s feet, or stable walls
– Snorting (obviously all horses can snort, but where this is exaggerated it could be signs of headshaking)
– Sometimes it appears very dramatically and the horse behaves as if an insect has flown into the ear or up their nose
These headshaking signs are sometimes caused by infections, cysts, growths, and inflammation in the head that damage the trigeminal nerve that is responsible for communicating facial sensation to the brain. More often though, the signs are related to a problem with the function of the nerve itself and we call these cases “trigeminal-mediated headshakers”.
Horses usually develop the condition between the ages of 5 and 12 years. It can start rapidly and severely, or it can begin with very mild signs and gradually get worse over months and years. Some horses only show signs during the spring and summer, and others have signs that persist all year.
The use of computed tomography (CT) has revolutionised our ability to investigate headshaking cases. It enables us to rule out other diseases, and make a confident and accurate diagnosis of trigeminal-mediated headshaking. If you suspect your horse is showing headshaking signs, your vets are likely to recommend this important step in the investigation of headshaking signs.
There is an evidence-based non-invasive treatment option for trigeminal-mediated headshaking cases called PENS therapy. This PENS treatment has a good success rate in returning horses back to their previous athletic activities and (other than the sedation used during the procedure) has no withdrawal time prior to affiliated competition.
More information on PENS can be found here: https://liphookequinehospital.co.uk/…/Trigeminal-mediated-h…
Victoria South and Jamie Prutton, two of our equine internal medicine specialists, have a wealth of experience in managing headshaking cases, and are involved in international research projects in this area. They would be delighted to talk through the diagnostic steps and treatment options, so if you have a suspected headshaker case and would like to find out more then please contact the Hospital for more information on 01428 723594 or via email at firstname.lastname@example.org.
How does the seasonal influence on the pituitary gland influence the diagnosis of PPID at this time of the year? And how does it impact follow-up blood samples in cases that were previously under control? What happens if you try to start pergolide treatment in July or August?
Let us take the stress out of managing your PPID cases – download our latest (free) podcast with Victoria South and Andy Durham who discuss what happens to our basal ACTH reference intervals at this time of the year, and chat through some common case scenarios that are affected by the pituitary hyperactivity observed at this time of the year – Seasonal PPID Podcast
We have upgraded our Endocrinology Analysers and are proud to introduce the Immulite 2000 xpi System.
Our driving ethos at Liphook has always been to stay ahead of the game and offer the latest and best to all of our laboratory users. Thus, we have recently purchased two Siemens Immulite 2000 xpi analysers, the newest and most proficient chemiluminescent immunoassay system available in this format which supersedes the older Immulite 1000 system used by most other labs. These new analysers allow greater precision, accuracy and throughput and, given that we have duplicate machines, this means that we can guarantee uninterrupted output of results even in the unlikely event of a machine malfunction.
It is well recognised that different assays and analysers generally return different results, and even the change from Immulite 1000 to Immulite 2000 xpi is no different in this respect. We have spent the past 6 months validating the new analysers and re-establishing appropriate cutoffs for diagnostic use and so you will see slight differences on forthcoming laboratory reports.
We apologise as I’m sure we’d all prefer to stay with our previous familiar values, but this change not only improves test reliability, but will in time be inevitable as the old Immulite 1000 system is withdrawn. We felt that as reference intervals (for ACTH at least) are about to change with the season in any case, this was the best time to implement this change. Should you require any assistance with interpretation or comparison with previous results then don’t hesitate to contact us to discuss.
Effects on ACTH reporting
As a general guideline the newly generated ACTH values will be slightly lower than previously (by around -10%) meaning lower cutoffs. In general terms this means a cutoff between 23-26 pg/mL for most of the year, rising slowly from July to a peak of 50 pg/mL in late September and returning to baseline by mid-November. Liphook Equine hospital remains the only laboratory internationally with valid ACTH reference ranges available for every week of the year, allowing greater accuracy of interpretation.
Effects on Insulin reporting
As a general guideline the newly generated insulin values will be higher than previously (by around +30%) meaning higher cutoffs. Resting insulin values in normal horses are expected to be no higher than 30-50 mU/L depending on the diet, and the response to 0.45 mL/kg Karo Light Corn Syrup should be no higher than 63 mU/L between 60-90 mins post-dosing.