Update for Equine DVMs: SERUM AMYLOID TESTING at PVH

Following is an update re: Serum Amyloid Testing for our veterinary colleagues:

Pilchuck Veterinary Hospital (PVH) is pleased to announce the availability of a test for Serum Amyloid A (SAA). SAA is an acute phase reactant that is present in mammalian species. It is present in serum at a low (often undetectable) level in healthy animals. But the levels increase rapidly (within 4 hours) of the onset of an inflammatory reaction, and will continue to rise as long as the inflammation is present with peak levels 36-48 hours after the inflammatory insult. The half-life of this protein is short (30 minutes to 2 hours) so that values will fall rapidly after the inflammation subsides. SAA has been studied most extensively in horses but can also be used in dogs and cats to identify acute inflammation.  The SAA increases are apparent prior to increases in fibrinogen (by 36-48 hrs) and may also be apparent 2-4 hours before iron levels decline. This test can be run on serum/heparinized plasma/or body fluids. This test is run daily as the results decline by as much as 20% over 48 hours of storage. The reference interval is 0 -18ug/ml in horses.  

References:

  1. Jacobsen S; Kjelgaard-Hansen M, Peterson H et al; Evaluation of a commercially available human serum amyloid A (SAA) turbidometric immunoassay for determination of equine SAA concentrations. Vet Journal 2006; 172, 315-319.
  2. Christensen M, Jacobsen S, Ichiyanagi et al; Evaluation of an automated assay basedon monoclonal anti-huma serum amyloid A (SAA) antibodies for measurement of canine, feline and equine SAA. Vet Journal 2012; 194: 332-337.

ACTH LEVELS

PVH runs plasma ACTH levels on a daily basis and can guarantee results Monday to Friday within 4 hours of receipt of the sample as long as the samples (EDTA plasma) are in the laboratory by 3pm. Plasma ACTH levels run along with Insulin levels (serum or heparinized plasma) and a panel of chemistries that include triglyceride (metabolic panel) can be helpful in identifying various forms of the metabolic syndromes that exist in horses.

Please call us at 360.568.3111 for details and pricing information.

 

When MRI May Be Helpful in Equine Lameness: Three Case Examples

This is the second part of Dr. Greg Haines' article on MRI for horses. Read part one of the article.

Magnetic resonance imaging (MRI) may be indicated when a lameness has been localized to a specific region, generally through diagnostic nerve or joint blocks. Through limitations, other imaging modalities (X-rays, ultrasound, bone scan) may have failed to determine a specific diagnosis.

MRI has greatly advanced our diagnostic capabilities particularly within the equine foot. Common injuries within the foot that have been diagnosed with MRI include deep digital flexor tendon (DDFT) injuries and navicular bone degeneration. Below are specific examples when MRI was helpful diagnostically. The first two deal with the foot, the third with the proximal metatarsus (Mt3) – cannon bone/hock.

Case #1

A mare presented with a seven-week history of forelimb lameness that failed to improve. There were no obvious clinical findings and no response to solar hoof tester placement. The lameness was worsened when the mare trotted in a circle. She showed minimal improvement to a palmar digital nerve block (blocks the heel area and sole of the foot) and was essentially sound after an abaxial sesamoid nerve block (blocks from the fetlock to the foot). X-rays failed to identify any specific abnormalities. Given the chronicity and lack of improvement, an MRI was undertaken. A marked DDFT lesion was diagnosed by MRI.

Case #2

This horse had only a two-week history of forelimb lameness that was also worsened by trotting in a circle. Again, specific abnormalities on initial examination were not noted. The lameness essentially resolved after a palmar digital nerve block and radiographs failed to provide a specific diagnosis. MRI evaluation revealed marked navicular degeneration characterized by a flexor cortex erosion.

Case #3

This horse had a two-month history of right rear lameness that was localized to the area of the proximal metatarsus (Mt3) – cannon bone/hock. The horse displayed a mild improvement to a lateral plantar nerve block (blocked the area of the proximal cannon bone – suspensory ligament), but a significant improvement was noted after a tibial peroneal nerve block (blocked the area of the hock). Radiographs failed to identify any significant abnormalities. An ultrasound evaluation of proximal Mt3 demonstrated proximal suspensory ligament enlargement. A bone scan of the rear limbs was considered normal. The horse was rested and had extracorporeal shock wave therapy performed to the area of the proximal suspensory ligament without any clinical improvement. An MRI evaluation revealed enlargement of the origin of the suspensory ligament with disruption of the medial bundle. The area of the hock was ruled out as a potential source of lameness.

In each instance, a specific treatment plan was initiated and a more accurate long-term prognosis for soundness was provided. It is important to remember that MRI is not a survey technique or a substitute for a thorough clinical investigation, including conventional imaging modalities. The interpretation of MRI findings is greatly enhanced by the information obtained from these evaluations. It is clearly not indicated in all situations, but may be considered in selected cases through consultation with your veterinarian.


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Article written by Greg Haines, DVM, DACVS

Pilchuck Veterinary Hospital offers comprehensive diagnostic imaging options, including MRI, video endoscopy, high-resolution ultrasound and more. Please call 360.568.3111 for more information.

Magnetic Resonance Imaging in the Horse

Magnetic resonance imaging (MRI) uses a strong magnetic field and radio waves to produce detailed, various plane, cross-sectional images. It allows a simultaneous examination of both bone and soft-tissue structures and can identify injuries to tendons and ligaments as well as bones and joints. Generally, MRI is limited to the lower part of the limbs, meaning up to and including the carpus, or knee, and hock.

MRI was first performed on live horses in 1997 at Washington State University. As its availability has become more commonplace, MRI has increasingly become the gold standard for the diagnosis of musculoskeletal injuries of the distal limb. It has become especially helpful in the equine foot, a particularly common site of lameness where other imaging techniques are sometimes limited. 

MRI is indicated when a lameness problem has been localized to a specific anatomic area, generally through diagnostic nerve or joint blocks. Through limitations, other imaging modalities (X-rays, ultrasound, bone scan) may have failed to provide a specific diagnosis. MRI is also useful in interpreting the significance of findings that were previously identified, particularly those that have responded poorly to treatment. It is not a survey technique or a substitute for a thorough clinical investigation, including conventional imaging modalities. The interpretation of MRI findings is enhanced by the information obtained from these previous clinical examinations.

Front and/or rear shoes need to be removed prior to the exam depending on which limb/limbs are being imaged. Metal produces MRI image artifacts, significantly affecting image quality. If an examination of the feet is being performed, the feet are generally radiographed prior to the exam. This confirms that any metal from a nail has not been left behind in the hoof. If present, its removal is facilitated by this finding.

MRI examinations may be performed in a standing (low-field MRI) or recumbent (high-field MRI) position. Standard protocols result in the generation of hundreds of very detailed images that require time and specialized training for interpretation. Horses placed in lateral recumbency (down) require general anesthesia. Examinations take approximately an hour and a half. Those performed under general anesthesia generally image both the clinical and the opposite (“normal”) limb for comparison purposes. Time constraints with respect to sedation and keeping the horse still make this much more difficult in the standing individual. Younger or fractious individuals may not be able to be kept quiet enough to perform this procedure standing. Individuals undergoing general anesthesia are generally dropped off the day prior to the procedure for preanesthetic blood work and nail check radiographs, if required. Horses typically spend the night of the exam under observation before being discharged the following day. 

The main disadvantages of MRI involve cost, its somewhat limited availability, the limited accessibility to areas above the distal limbs (head, neck, stifle), and the need for general anesthesia in high-field magnets. The accurate evaluation of cartilage lesions using MRI in the distal limbs of horses remains difficult. 

MRI has greatly advanced our diagnostic capabilities and has enabled us to prescribe more focused treatments and more accurate prognosis. It is certainly not indicated in all situations, but may be considered in selected cases through consultation with your veterinarian.

Stay tuned: Dr. Haines is writing a follow-up post with MRI case study examples. 


Article written by Greg Haines, DVM, DACVS

Pilchuck Veterinary Hospital offers comprehensive diagnostic imaging options, including MRI, video endoscopy, high-resolution ultrasound and more. Please call 360.568.3111 for more information.

Dr. James Bryant Earns ACVSMR-Equine Certification

The time has come to add a few more letters after Dr. James Bryant’s name! Dr. Bryant recently traveled to Orlando to take his exams for certification by the American College of Veterinary Sports Medicine and Rehabilitation. And (surprise, surprise) ... he passed! So we’ll be updating Dr. Bryant’s business cards to: James Bryant, DVM, DACVS, DACVSMR.

We want to give BIG congratulations to Dr. Bryant for his new ACVSMR-Equine diplomate status. (There are separate specialties for equine and canine.) It is quite a lot of time and work to prepare for and take these exams and meet the other certifying requirements. Dr. Bryant is now “double-boarded,” adding this certification to his existing one from the American College of Veterinary Surgeons. [2.17.16 update: As of this update, Dr. Bryant is the only ACVSMR-Equine diplomate in the state of Washington.]

What exactly is the ACVSMR?

An AVMA-recognized specialty organization, this group promotes “expertise in the structural, physiological, medical and surgical needs of athletic animals and the restoration of normal form and function after injury or illness.” You can read more at vsmr.org.

At Pilchuck Veterinary Hospital, our veterinarians and staff are passionate about providing the best possible care to our patients. Certifications such as this, along with continuing education, strong working relationships with our clients, and collaboration among colleagues, allow us to do just that. Thank you for entrusting us with your animal friends’ veterinary care needs!

Congratulations, Dr. Bryant!

PVHer Profile: Stacey Sikorski

Introducing our PVHer Profiles series! This series of posts allows clients and friends to learn a little more about the veterinarians and staff at Pilchuck Veterinary Hospital. If you have any suggestions or questions, just let us know!  To kick us off, we turn to ... Stacey!

Name: Stacey Sikorski

Position: Referral coordinator for the equine hospital, equine sponsorship and events coordinator

When did you join PVH? September 2002

Favorite part(s) of your job? Job is never the same day after day.

Hometown: Moodus, Connecticut

Education: B.S., genetics and cell biology, WSU

Tell us a little about your work background: I’ve been working with horses since the age of 14. I started working with Arabians at age 16, thought I wanted to be a veterinarian but really what I wanted was to be a trainer. I finished college and got the opportunity to work for Meadow Wood Farms as a show groom. Eventually I was promoted to head show groom, barn manager where I learned most of my skills. When the farm closed down, I found my way to PVH and "retired" from the horse show industry but still dabbled a little on the side working for Jeff Lee and Company, who eventually lured me back to the show world on a part-time basis.

What does your work day entail (no pun intended!)? At PVH, my day can include reviewing equine billing, scheduling for the surgical team, sponsorships, and just about anything else thrown my way.

A favorite patient success story? Magic’s. Magic had a compound fracture of a hind leg, went to surgery twice and has since healed and returned to active competition.

Your work-related super power? The ability to keep calm no matter what ER walks in the door

Any animal companions of your own?

  • High Spirrits, 23-year-old Arabian Gelding
  • OKW Annika, 8-year-old half-Arabian mare
  • MacKenzie, 8-year-old female Scottie
  • Angus, 8-year-old male Scottie 
Stacey and High Spirrits

Stacey and High Spirrits

Showing OKW Annika at Donida Farm

Showing OKW Annika at Donida Farm

MacKenzie (L) and Angus (R)

MacKenzie (L) and Angus (R)

What do you enjoy doing outside work? Watching baseball (huge Seattle Mariners fan), horseback riding, car shows, running my businesses 

I not only work at PVH and for Jeff Lee and Company, but I also run two other businesses on the side. I have a small boarding facility at home, and I run Equine Clipping Services, which is a mobile body clipping and show clipping service. I don't sit still well to say the least. 

Clipping a client's horse

Clipping a client's horse

Favorite animal-related activity in the Snohomish area/PNW? Horse shows of course!

What book is on your nightstand? No time to read – last book was by Stephen King, Doctor Sleep.

What’s in your music rotation right now? Aerosmith, Hinder, Volbeat, Five Finger Death Punch – I lean toward the harder side of rock.