Vaccinations, Yes!

 

This afternoon, a client asked me “ What are your thoughts on vaccination?” Without blinking I said “ Yes, do it!” She stared at me for a moment, and said “ well, but, vaccinations have lots of down sides..” I said to her, and say to you “ No, they don’t. Vaccines are one of the most meaningful medical advancements of all time. The only reason we demonize them is because we live in a country and an age where most of the serious diseases we vaccinate for are completely or mostly eradicated. Ask someone in a country where childhood polio is still a serious disease threat about the “down sides” of vaccines.” See what answer you get.

 

Now, before they have even gotten this far in the post, some of you will be saying “ Well of course she promotes vaccines. Vets make tons of money off vaccines.” Let’s clear something up right now. I don’t care WHO you pay to do vaccines, or if you do them yourself. I do not make much money off of them, especially when you consider the cost of carrying inventory for the spring vaccine season before I am actually paid for them. I DO sincerely HATE watching animals die of diseases that are easy to prevent. End of story. You can order your vaccines from an online retailer and give them yourself if you want( though I wish you would tell me so I can give you some epinephrine to keep on hand and tell you how to use it). I don’t care. I just want them vaccinated so that I don’t have to watch horses die from preventable diseases.

 

The term “vaccinosis” has been thrown around in blog posts , magazine articles, and websites to indicate disease caused by “over-vaccination”. “Vaccinosis” is a term that was invented by a natural health practitioner over a hundred years ago. In the intervening time, not one study has been able to prove that vaccination causes disease of any kind. On the contrary, the advancement of vaccine science has made both animals and humans healthier. Many times you will hear that the vaccines overload the immune system, or “wear it out”. However, this effect can not be shown scientifically in anyway. There is no actual proven connection between vaccines and any type of autoimmune or other disease. In human children the vaccinations they get are estimated to use no more than about .01% of their immune system. Even if horses used .01% of their immune system every year for yearly vaccination, considering 30 years is a long life for a horse, that would mean only 3% of their immune system has ever been used or taxed in any way. Given this , it seem impossible that we are “wearing out” their immune systems . It is true that vaccination will sometimes cause swelling, low-grade fever, or in rare cases anaphylaxis. However problems such as malaise and muscle swelling are short lived and not life-threatening. Anaphylaxis, while life threatening, is rare and can be combated by the timely administration of epinephrine. Remember that those who try to convince you vaccines are bad for your horse are often trying to sell your something too.

 

In contrast to the small risk posed by vaccines, let us consider some of the diseases we vaccinate for in horses. I have been unfortunate enough to see horses die of West Nile virus, Eastern Encephalitis, tetanus, and Potomac Horse Fever. Having previously worked in Amish country, where vaccination is rare, I got to see up close that not vaccinating puts horses at risk of disease. These are horrible diseases and the horse that dies from them suffers tremendously.

 

Tetanus is up to 80% fatal in horses, who are among the most susceptible of domestic animals to disease. The disease begins with fever and malaise, progressing to muscle spasms, and finally severe muscle tetany so that the animals muscles are stiff and unmovable. The animal may die of suffocation as they become unable to breathe due to muscle tetany. It is a horrible way to die. Treatment is extremely expensive and often unsuccessful by the time symptoms are obvious. The tetanus vaccine is extremely effective and offers nearly 100% protection from the disease.

 

The encephalitis viruses ( Eastern, Western and Venezuelan Encephalitis) vary in fatality rates. Western and Venezuelan Encephalitis are fatal in 40-70% of cases, while Eastern Encephalitis ( the most common in Michigan) has a 90% fatality rate. The disease causes swelling of the brain and a colloquial term for it is “sleeping sickness”. Horses develop fevers. They will then show various signs consistent with the brain swelling. This can include blindness, head tile, inability to walk or stand, inability to eat, seizures, or other issues. It is very difficult and expensive to treat in the rare cases where the horse survives as intensive care must be directed at keeping food and water in the horse who can not eat or drink on its own, protecting them from muscle damage do to not being able to stand, and protecting them from head trauma caused by seizures or other abnormal behavior. Again the vaccines for the these diseases are very effective, preventing disease in almost all cases.

 

West Nile virus is also an encephalitis. The fatality rate in affected horses is up to 70%. Symptoms are very similar to those of Eastern, western, and Venezuelan encephalitis. Again, we have effective vaccines for it.

 

Potomac Horse Fever is a disease that causes fever, diarrhea and laminitis in affected horses. The death rate can be up to 30% in affected horses. The vaccine for Potomac Horse Fever is not as effective as some others due to the nature of the organism that causes it. It will not always prevent disease. However, many practitioners, myself included, believe that vaccinated horses have shorter, milder courses of the disease. In 13 year of practice I have never seen a horse who was vaccinated for Potomac Horse Fever die from it, whereas I have seen at least 30 unvaccinated horses who died from Potomac Horse Fever.

 

This does not include all the diseases we vaccinate for , but it includes some of the worst. Watching horses die from these diseases is heart wrenching, not the least of all because they are preventable. Always, the animals suffer greatly before they die.

 

Some horse people view “nosodes” or homeopathic vaccines as alternatives to traditional vaccines. Nosodes are created by diluting pus, blood, mucous, or feces from a sick animal in order to create a tincture that supposedly will prevent the disease. First for those who view this as a better alternative than the chemicals in vaccines, let me repeat that :pus, blood, mucous, or feces from a sick animal. While in various places on the internet you will see statements such as “nosodes are as effective or even more effective than traditional vaccines”, this is blatantly false. For a vaccine to be approved the manufacturer must perform what is called a “challenge study”. Horses are vaccinated with the vaccine, and then exposed to the disease the vaccine is supposed to prevent. To be approved the vaccine must be shown to be effective in preventing the disease. There have been few challenge studies with nosodes . However, a notable one involved parvovirus in dogs. The traditionally vaccinated puppies were challenged with parvovirus. 9 out of 10 puppies who were vaccinated survived. The puppies vaccinated with a nosode protocol fared very differently . Only 10% of those puppies survived. 90% of the nosode vaccinated puppies died of parvovirus. In addition, studies done to evaluate antibody production after nosode administration noted that nosodes did NOT result in the body creating antibodies to disease. Nosodes at this point have been proven to be ineffective in preventing disease.

 

Another issue is people bring up repeatedly in vaccination frequency. Since we vaccinate school children and then stop vaccinating once they are older. We get tetanus vaccinations only every 7 years. First of all, susceptibility and the amount of protection offered by vaccines differ in between species. In horses, there have been documented cases of tetanus in horses who were vaccinated more than 1 year but less than 3 years previously. So obviously the 7 year rule of tetanus does not apply to horses because as a species horses are more susceptible than humans. This is only one example, but on the whole, the horse’s immune system is somewhat fragile. One trailer ride can significantly alter their ability to fight off a disease. These species differences mean we can not extrapolate human experience to horses.

 

In humans and dogs we sometimes pull what are called titers, which is a test that will measure the amount of antibodies you have to a particular disease. The problem with titers in horses is we have no idea what antibody level the horse needs to be protected against a disease. So at best we would be guessing at whether the horse needs to be revaccinated or not. In addition titers end up being many times more expensive than vaccinations. So while titers are a good idea and could become useful as more research in done on what titers will protect a horse from contracting various diseases, right now they are a waste of money.

 

There is no single “right” vaccine schedule for a horse. The correct vaccine schedule depends on how much risk the horse has of being exposed to various diseases, how old they are, what their prior vaccination history is, how much they travel, and other variables. Horses who have systemic problems such as Cushing’s disease or a history of bad reactions to vaccines may need a program tailored to them.

 

However, in the end, vaccines still provide the single greatest “bang for your buck” in terms of disease prevention. They are the safest and most reliable way to prevent the diseases we can vaccinate for. Vaccines have revolutionized the health of humans and animals across the globe. So my thoughts on vaccination are simple. Yes. Vaccinate.

On Love and Loss

 

This has been one of those weeks that haunt me. One of those weeks that remind me that however hard I work, however much I care, however thoroughly I research, there are times when our beloved horses can not be saved. This is a hard thing to be reminded of, and worse now that my own once-in-a-lifetime horse is struggling with chronic health problems. I know that one day it might be him, and however much I love him, however hard I try, it may not be enough. Every horse I lose takes a sliver of my soul with them when they go. But when Brennir leaves me, he will take a big chunk of my heart and soul with him.

 

I sit here with my laptop on a warm June evening, and he is grazing beside me, cropping grass, happy and healthy again for now. For how long, I don’t know. The vet in me knows that I can’t by the will of my heart keep him here. He is on ulcer medication, Succeed, supplements, probiotics. Still, everything we can do isn’t always enough. These huge creatures we give our hearts to are incredibly, achingly fragile.

 

In the past week or so, we lost several patients. All of them had autopsies done at MSU. All of them had severe, unpredictable problems that were not fixable. One of them was a horse dear to my heart, a tough, spunky older horse full of what I call “pony power”, that indomitable spirit some small horses seem to have. He overcame incredible odds, beating severe colic, EPM, and a meniscal tear in his stifle over the past few years. To the end, he did things his way, and continued to go on rides with his owner in the sunshine, doing what he loved until he couldn’t anymore. No horse could have been more well loved, or had better care. On visits to the barn I would find his owner breaking alfalfa cubes into little flakes for him. He had dental problems that prevented him from eating hay, and the cubes were too big for him to chew easily, but he did not like pellets or mashes. So the owner would sit in the barn and break the cubes he liked into pieces small enough for him to handle, day in and day out.

 

We gave all we could to save him, but in the end his dental problems resulted in him accidentally aspirating feed into his lungs. Tough as he was, he did not show he was sick until the infection was very advanced. Despite IV medications and fluids, 24 hour care, and much devotion, he ultimately lost the fight. The owner was alone when he laid down and passed. She called me and I stayed on the phone with her, knowing he was dying, unwilling to let her face that grief all alone, when I from my battles with Brennir, know the hugeness of that grief.

 

The other horses I knew less well. One of them was a POA who became acutely, horribly ill. I did not know it as we tried desperately to save him that his intestines had ruptured, in a freak accident no one could have predicted. Feces and bacteria had already poured into his abdominal cavity, and he was dying of toxic shock. One of the staff at the barn asked me, while he was trembling and feverish and we were running boluses of iv fluids and banamine and muscle relaxants into his shaking body, “ Will he make it?”

 

The truth is, until they take their last breath, I have to believe the horse will make it. Until the last I try to keep my grip on them, holding them here with everything in me. When I lay out cold hard facts and statistics as I try to help owners decide what to do, as I had to for the third horse, who clearly had a small intestinal obstruction, and whose owners decided surgery was not a possibility, I try to guide people towards the best and most humane decision for them and their horse. Yet I never stop wanting to save them. I am sure I sound at times like the world’s worst pessimist, but until the end, I want to save them, even when I know they can not be saved. Even when, as for the horse with the small intestinal twist, who’s autopsy would reveal his stomach had already ruptured from the pressure built up from the obstruction, I know as I give the shot of euthanasia solution that I am lifting the horse from unimaginable suffering.

 

 

All this suffering was made worse by the illness of my own dear horse. The scientist in me knows the facts. He has had two trips to MSU for small intestinal problems in the last year. The odds are against us. Yet through his illnesses I have held him here, with all the strength within me. Every minute I have left with him is a gift. These cases remind me.

 

Even with the autopsy results telling me I could do no more than I did, the guilt is intense at times. Each horse in my care, I feel an elemental responsibility for. When I lose them, it is a failure so deep and personal it is hard to describe. At times, I feel I would give anything at all, to save all of them. But I can’t. So while I am with them I love them. I give them cookies, and kiss their noses, and tell them they are beautiful, even if I look like a fool, or as one irate client once said “ A goddamn pony kisser”. So be it. I will kiss them while they are here with me. You should too.

The Horse Always Knows

I can’t remember now who it was, long ago in vet school, or maybe before, who told me “ the horse always knows what is wrong”, but it has always been the guiding mantra of how I detect lameness. The horse knows where he hurts. The horse can tell me. He speaks a different language, so I have to learn to understand it. But the horse knows, and the horse can tell me what is wrong. Body language, tension in muscles, the movement of a leg, the swishing of a tail, this is how they speak. We who profess to love them ought to learn to listen.

Yesterday I had the experience of examining a horse who was almost euthanized as a “dangerous bucker”. Initially she was a good riding horse for her prior owner, who had her for several years . One day though, she started showing bad behavior under saddle. Eventually She bucked off the owner, the owner’s daughter, and the trainer paid to sort the horse out. They decided she was unfixable and wanted to euthanize her. Fortunately, another horse person in the barn felt they were making a mistake. She took the horse, and gave her some time off. Then, she decided to have her examined for something that might have caused the bucking.

When they led the horse out of the barn, I recognized the tense expression on her face. Horses repeatedly asked to work through significant pain often undergo a personality change They may become withdrawn, tense, anxious, or cranky . She had that look about her. I am a veterinarian, and a scientist, but that look tears at my heart in a way that has nothing to do with science. Throughout history the horse has suffered for us, and they suffer still. Its painful to watch that quiet, confused suffering.

A 15 year old Thoroughbred mare, bay without a speck of white, she lashed her tail back and forth as she came out onto the drive. Her hind end was stiff, the “posty” walk horse people talk about. As she walked on the gravel drive her toes dragged and kicked up stones. She didn’t limp, which is typical of horses with problems like hock arthritis that tend to occur in both legs at the same time. Often, these lamenesses are missed by owners and sometimes trainers until they are very bad, because both hind legs move in an abnormal fashion. Asked to trot, she pinned her ears and flatly refused, then kicked out when someone tried to encourage her. When I tried to flex her hind legs, she held them stiff, fighting my every movement, though she lifted her foot and gave it to me like a horse well trained.

It was quite clear to me she was suffering from hock pain. She moved as much as possible without flexing them at all, and resisted my attempts to manipulate them. She has the cranky demeanor of a horse in chronic pain. Also, bucking is a common owner complaint in horses with hock pain . Unable to tell us they hurt, they speak in the ways they can: bucking, rearing, refusing transitions, balking at jumps, getting girthy, refusing to be caught. The careful reader will note that many of these signs of pain are things a lot of horse people write off as disobedience, poor training, or lack of respect. Indeed I have seen a number of horses with very painful physical ailments who have been hauled from trainer to trainer, with the same poor results until the good trainer gets the horse and says” there is something wrong. Your horse needs to see the vet”.

Xrays confirmed my suspicions. She had distal hock arthritis. The joint spaces in both hocks were narrowed and filled with bony overgrowth. Movement would create bone-on-bone rubbing that would be very painful for the horse All her bad behavior was a way of communicating her pain, and she was almost put to sleep for it when what she needed was medical treatment.

While as a lameness vet I certainly believe there is no substitute for a lameness exam by a qualified professional you CAN be an advocate for your horse’s well being by learning to recognize the signs of lameness. Here is a rule to remember. When a good horse suddenly goes bad, don’t blame the horse until you have made sure the horse isn’t just asking you for help. Behavior problems like bucking, rearing, girthiness, etc are common complaints from owners of horses with back or hock problems.

Particularly in addition to hock pain, kissing spines in the back can cause this type of behavior. The horse’s back vertebrae have large dorsal spines, like a skinny version of a shark fin. Sometimes, these spines will grow so that they overlap each other. The result is pain, particularly when there is pressure of any kind placed over the back, by for example a saddle and rider. One striking case involved a half Arab gelding who after being a dressage mount for some time, began biting when girthed. The biting progressed to refusal to be caught for rides, and finally to bucking and complete refusal of anything but a walk under saddle. The trainer was insightful enough to realize something had to be going on.

During the exam , I palpated along the dorsal spines of the back vertebrae, and the horse ducked painfully, pinned his ears, and cow-kicked at me. Clearly there was pain present. On the lunge line he looked content and smooth without a saddle, but once the saddle was on he began to drag himself with the front end, losing the collected grace he’d previously showed. After several circuits, he charged the owner with pinned ears and refused to go forward again for several minutes. The owner attempted to do a riding demo but we aborted it because the horse’s behavior was so extreme and dangerous.

For these cases I will often inject local anesthetic between the vertebral spines, where the bone contact is. If the spine is the cause of the problem, it will resolve as the area numbs similar to when a dentist gives a Novocaine shot. In this case, the change was stunning. After 15 minutes with the local anesthetic block, he trotted off obediently with the saddle on , moving on the lunge line as lightly as he had without. The owner mounted, and he moved off quietly, a completely different horse than we had seen just a few minutes before.

Following back injections with steroids and pain relievers, this horse was again a cooperative and sound mount. His bucking and refusal was only an attempt to communicate how badly his back hurt.

While it takes years of study of both normal and abnormal horses to really develop an eye for lameness, any horse owner can take the step of pursuing an exam if their horse starts showing unusual behavior. Don’t be too quick to write off behavior problems as dominance or disrespect. The horse will tell us what is wrong. We only have to listen.