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Adding prebiotics and probiotics on a daily basis to an equine feeding program is an inexpensive insurance policy that lowers the risk of colic and other metabolic issues that can occur in horses. The life cycle of these microbes within the gut is around 15 minutes, and therefore, it’s easy to change the population very quickly, and that can be a recipe for disaster.

Almost every day in the domestic horse’s life, something occurs that causes the microbial population in the gut to shift in the wrong direction, which can increase the numbers of “bad” microbes and lower the number of “good” ones. The vet comes to vaccinate, the farrier has to dig out an abscess, a new load of hay arrives that is different from the last, a horse gets the wrong feed or has to travel to a show. All of these types of events cause digestive stress and disruption of the microbes in the hindgut. By adding the “good” microbes daily through supplementation, the odds of the “bad” ones having much effect are minimized.

Prebiotics and Probiotics:

Microbes in the equine hindgut (cecum and colon) are required to help break down and ferment the fibrous portion of hay and feed into products called volatile fatty acids that can then be used by the horse to produce energy, milk production and other bodily functions.

B vitamins and other nutrients essential to the health and well-being of the animal are also formed through the actions of the microbial populations. Because of the major role microbes play in digestion of feeds, it is essential that the microbial population of the hindgut be healthy and their numbers and ratios be at appropriate levels for proper digestion.

Many horse owners feed supplements or commercial feeds containing some of these essential microbes. The idea behind feeding these is to keep the hindgut stabilized.

Adding probiotics on a daily basis can be helpful. High-end feed manufacturers put these in most of their commercial feed products, and you can find them listed on the feed label.

Why Adding Them Daily to the Equine Diet is Important

The most beneficial probiotic for horses is a live, equine origin probiotic; one that contains organisms cultured from the equine digestive tract. Not all probiotics are created equal. Unless they complement what’s in the horse’s digestive tract (and not a cow’s digestive tract) and are alive, they don’t work. Prebiotics help to feed and maintain the health and sustain the life of the probiotics. The prebiotic is not actually part of the microbe population but is beneficial to enhance the quality of the microbe population that’s there.

Prebiotics are non-digestible foods that make their way through the digestive tract and help the good bacteria grow and flourish, keeping the good bacteria healthy.

Prebiotics that assist beneficial bacteria in the gut mostly come from carbohydrate fiber called oligosaccharides.

They are not digested, so the oligosaccharides remain in the digestive tract and stimulate growth of beneficial bacteria.

Sources of oligosaccharides include fruits, legumes and whole grains. For example, a prebiotic could contain part of the carbohydrate that’s in the wall of a yeast cell. This section of the yeast cell wall is called a mannan oligosaccharide.

Pre- and probiotics are very useful in helping to keep the equine digestive tract correctly populated with good microbes and functioning at an optimum level.

Dr. Amy M. Gill is an equine nutritionist based in Lexington, Kentucky and Boynton Beach, Florida. Dr. Gill specializes in nutritional therapeutic solutions for horses affected by exercise, growth, metabolic and immune-related disorders. She can be reached at 859-967-3307 or drgill@equiforce.com.

PPID DEFINEDPituitary Pars Intermedia Dysfunction (PPID), also known as Equine Cushing’s Disease, is the most common endocrine disorder in horses. An estimated 21% of horses and ponies over the age of 15 are affected by PPID, and the prevalence increases for each year of age.1 Although the pathophysiology differs from humans and dogs with Cushing’s, PPID is now the preferred scientific name as it specifies the exact area of the pituitary gland affected in the horse.

PPID is a chronic progressive disease. PPID causes multiple health problems for the horse, including laminitis and recurrent infections. Ponies and Morgans are overrepresented, but all breeds and types of equids may be affected.2 Horses with a history of

Equine Metabolic Syndrome (EMS) are thought to be at higher risk of developing the disease at a younger age.2

PATHOPHYSIOLOGYThe equine pituitary is divided into three regions: the pars distalis (anterior pituitary), the pars intermedia (intermediate lobe), and the pars tuberalis (posterior pituitary). Dopaminergic neurons originating from the hypothalamus innervate and inhibit the secretory activity of the melanotrophs of the pars intermedia. Dopaminergic inhibition to the pars intermedia normally decreases with aging. However, degeneration of dopaminergic neurons occurs at an accelerated rate in PPID. The exact cause of this degeneration is poorly understood, but is thought to result from chronic oxidative damage.3 As degeneration occurs, melanotrophs of the pars intermedia become hyperplastic, increasing secretion of proopiomelanocortin (POMC) peptides such as α-MSH, β-endorphin, CLIP, and now ACTH, which is not normally produced in significant amounts from this region. Elevated ACTH from the intermediate lobe acts on the adrenal glands to produce excessive cortisol which, along with multiple other hormones, results in the unique, individual clinical

presentation of PPID. With hyperplasia of the pars intermedia, functional pituitary adenomas develop over time.

CLINICAL SIGNSHypertrichosis (previously termed hirsutism) and muscle atrophy are commonly recognized in PPID. However, a variety of non-specific clinical signs have been associated with early or advanced disease:

New Developments in an Old Problem: Pituitary Pars Intermedia Dysfunction (PPID)

Early signs of PPID may include:• Regional hypertrichosis or haircoat abnormalities

• Metabolism shift; from an “easy keeper” to lean body condition

• Regional adiposity; cresty neck, tailhead, supraorbital region

• Poor performance; attitude/behavioral changes, dullness, docility

• Reproductive problems; subfertility, pseudolactation

• Lameness; unexplained laminitis episodes, foot soreness

Advanced signs of PPID may include:• Generalized hypertrichosis; long, curly, dull haircoat that fails to shed despite change in season

• Muscle atrophy with regional adiposity; loss of topline, pot-bellied appearance

• Polyuria/polydipsia

• Recurrent infections; white line disease, subsolar abscesses, scratches, periodontal disease, sinusitis

• Inappropriate sweating; hyperhidrosis or anhidrosis

• Chronic laminitis

• Neurologic disorders; blindness, seizure, ataxia

Signs of PPID may be discounted to the normal aging process, but it is important to recognize that this disease develops very slowly over time, making early detection difficult. Owners should record when their horse sheds its winter haircoat and compare this time with herdmates to detect delayed shedding.2 Regional alterations in length, or subtle changes in color, texture, or thickness of hair may indicate early PPID. Generalized hypertrichosis (persistence of hair follicles in anagen) is easily recognized and considered pathognomonic for PPID.4 The presence of this retained haircoat is considered advanced disease and efforts at detection of PPID should begin long before this textbook sign is observed. Chronic, recurrent infections that fail to respond appropriately to treatment may occur due to immunosuppression. In some cases, diagnosis of PPID may be missed altogether due to focus on treatment of the obvious infection and lack of other overt signs of PPID. Another indicator common to early and advanced PPID is lameness or “foot soreness” associated with insidious onset laminitis which progresses to debilitating laminitis over time. Laminitis may be the only presenting sign, and may be difficult to recognize unless the horse is examined on a hard surface. Laminitis has been associated with the presence of hyperinsulinemia and suggests a poorer prognosis for long-term management of PPID.1

by Marian G. Little, DVM, Field Equine Professional Services, Boehringer Ingelheim

UPDATES IN PPID DIAGNOSISRoutine CBC may reveal a neutrophilia and hyperfibrinogenemia. Chemistry is usually unremarkable with exception of hyperglycemia present in diabetes mellitus.2 Diagnosis of PPID can be challenging in early stages, as no gold standard exists for detection of early disease. Some horses in early stages of disease may test negative due to inability of these tests to detect subtle pituitary changes. There have been a variety of tests suggested historically for diagnosis of PPID. Long thought to be the “gold standard” for PPID diagnosis, the Overnight Dexamethasone Suppression Test (ODST) has not proven superior in sensitivity or specificity; and it is now suggested practitioners choose either of the following Tier 1/Tier 2 tests for diagnosis of PPID. As of this writing, a field diagnosis of PPID focuses on one Tier 1 Screening test: Plasma ACTH, and one Tier 2 Dynamic test; Thyrotropin-releasing hormone (TRH) stimulation measuring ACTH. Plasma ACTH can be interpreted year-round and is easy to perform in the field as a single blood draw. TRH stimulation measuring ACTH at baseline, 10 or 30 minutes is currently advocated as a more sensitive test for detection of earlier PPID.5 TRH simulation measuring ACTH may also be used when resting ACTH is equivocal, or to confirm a positive or negative result. TRH is available as protirelin or synthetic TRH and is now available to practitioners.

Both tests are affected by normal hormonal processes that increase in the fall, when the body is triggered to prepare for winter. Both normal and PPID horses experience this seasonal rise in ACTH and other hormones, generally August-October, with PPID horses exhibiting a more profound hormonal rise. Thus, positive test results obtained in the fall should be interpreted carefully and laboratory seasonally-adjusted reference ranges used. As laboratory ACTH assays can vary significantly, it is also important to standardize sampling times, be consistent with the laboratory used, and confirm the laboratory’s familiarity with equine endocrine samples and updated testing recommendations.6 Test results should be interpreted alongside clinical signs. It is recommended that prior to initiating medical treatment, baseline test results (Day 0) be obtained via Tier 1 tests in order to accurately judge clinical response to drug. Follow-up testing at Day 30 is recommended with dose titration (if necessary, based on clinical response and results) and the horse placed on a 6-month recheck schedule with one appointment occurring August-October.2

Detection of early PPID remains difficult, although this is the time period in which medical intervention can be most satisfying. In horses with negative or equivocal test results, tests should be repeated in 6 months or alternatively, another Tier 1 test used. If test results remain negative in the presence of clinical signs, a 6-month treatment trial with pergolide (Prascend®) can be considered. In

COMPLICATING FACTORSHyperinsulinemia and insulin resistance/IR now collectively referred to as insulin dysregulation2 is a common finding in approximately 30% of horses with PPID.1 Insulin resistance/IR is defined as decreased tissue response to insulin, or decreased uptake of insulin. In IR, the pancreas continues to secrete more insulin to compensate for the decreased tissue response, thus blood insulin levels will be elevated when IR occurs. As the condition worsens, the pancreas can fail to secrete enough insulin, which may lead to a true uncompensated diabetic state. The concern with insulin dysregulation is that with decreased tissue response to insulin, tissues can be deprived of proper nutrients. Laminar tissue is extremely sensitive to alterations in nutrient supply, and horses with a history of insulin dysregulation usually suffer from laminitis. Insulin dysregulation occurs in a minority of horses with PPID, but is a defining

component of Equine Metabolic Syndrome (EMS).

advanced disease, the most accurate diagnostic “test” is the observation of generalized hypertrichosis. This classic haircoat remains the most sensitive indicator of an abnormally functioning pituitary, although with end-stage disease, medical treatment is palliative.

It is important to note that horses can exhibit concurrent history and clinical signs consistent with both EMS and PPID. It is highly recommended that when screening for PPID, insulin parameters be evaluated, and when screening for EMS, diagnostics for PPID be included. As the relationship between EMS and PPID is emerging, a complete diagnostic evaluation should include comprehensive testing parameters for both. Proper nutritional management of the PPID horse must include knowledge of insulin status, and hence laminitis risk. A panel consisting of the dynamic OST (oral sugar test), leptin and triglycerides are helpful components for thorough assessment of the PPID horse.7 The author wishes to thank the Equine Endocrine Working Group for their ongoing contributions to diagnostic updates. http://sites.tufts.edu/equineendogroup/

MANAGEMENT OF PPIDPPID is a chronic, lifelong condition for which there is no cure. Treatment of PPID focuses on administration of pergolide and attention to concurrent issues impacting the horse’s health, such as laminitis, dental disease and maintenance of proper diet. Pergolide is the gold standard for treatment of PPID. Pergolide, an ergot alkaloid dopamine receptor agonist, binds to D2 receptors of melanotrophs of the intermediate lobe, inhibiting the production of excessive POMC hormones, namely αMSH and ACTH. Until 2011, only compounded pergolide was available. Compounded pergolide products have been shown to be highly susceptible to light and temperature, and have also been associated with rapid declines in stability over time. In one 2010 study, initial concentrations of all formulations were highly variable, with many well below the label claim. In the same study, a high degree of variation was observed in “between two containers of same product ordered from same pharmacy on the same date.”8 Unpublished 2012 data on 21 additional compounded pergolide formulations supports previous findings.9 In September 2011, the FDA approved an equine pergolide formulation, Prascend® (www.prascend.com). Prascend® is now the standard of care for PPID with a starting dose of 2µg/kg PO q 24hrs.10 Owners should expect significant improvement in their horse’s clinical signs and test results when adequately controlled. Photographs taken at initiation of treatment and at 6-month intervals are recommended to document physical changes and provide motivation for clients to continue treatment. In refractory PPID where daily pergolide dose has reached 6µg/kg/day, horses may require the addition of cyproheptadine (Periactin®) a serotonin antagonist, at a dose of 0.25-0.5 mg/kg PO q12h.2, 11 It should be expected that like human Parkinson’s, PPID will progress over time. At the time of this writing, pergolide has not been definitively shown to improve insulin parameters, thus management of laminitis due to insulin dysregulation should be primarily addressed with diet, exercise, +/- medical therapies. Although PPID is primarily managed medically, body clipping, farrier care, regular deworming and routine dentistry are important. Additional water should be provided if the horse drinks and urinates excessively. Twice yearly re-assessment of haircoat, body condition and endocrine test results is recommended for ongoing monitoring of disease progression.

AUTHORMarian G. Little, DVM, Field Equine Professional Services, Boehringer Ingelheim, Paris, Kentucky. Marian.little@boehringer-ingelheim.com

REFERENCES1 McGowan TW, Pinchbeck GP, McGowan CM. Prevalence, risk factors and clinical signs predictive for equine pituitary pars intermedia dysfunction in aged horses. Equine Vet J 2012;45:74-79.2 Frank N. Pituitary pars intermedia dysfunction. Current Therapy 2013. 3 McFarlane D, Cribb AE. Systemic and pituitary pars intermedia antioxidant capacity associated with pars intermedia oxidative stress and dysfunction in horses. Am J Vet Res 2005;66:2065-2072.4Innera M, et al. Veterinary Dermatology. In press. 2013. 5 Goodale L, Hermida P, Oench SD, Frank N. Assessment of compounded thyrotropin releasing hormone for diagnosis of pituitary pars intermedia dysfunction. ACVIM abstract, 2013.6 Schott HC, et al. Comparison of assay kits for measurement of plasma Adrenocorticotropin Concentration. ACVIM abstract, Seattle, WA. 2013.7 Frank N. Oral sugar test used to diagnose insulin resistance in horses. AAEP Proceedings 2012; 58: 576.8 Stanley SD, Knych HD. DVM, Ph.D. Comparison of pharmaceutical equivalence for compounded preparations of pergolide mesylate. AAEP Proceedings 2012; 56: 274-276.9 Davidson G, Davis J. Potency and stability of compounded pergolide formulations for use in the horse. Unpublished. 2012.10 PRASCEND® (pergolide mesylate) [Freedom of Information Summary]. St. Joseph, MO: Boehringer Ingelheim Vetmedica, Inc.; 2011.11 Schott HC. Medical management of PPID. 2012.

Pituitary Pars Intermedia Dysfunction (PPID) continued

The most common allergic skin disease in horses is Insect Bite Hypersensitivity (IBH). It is the leading cause of pruritus in the horse. Most commonly, IBH is caused by the bite of the Culicoides species. Less commonly it can be attributed to the bite of other insects. These include Blackflies, Stable flies, Horn flies, Mosquitoes, Deerflies, and Horseflies. The type of insect varies on their feeding location and the time of feeding. For example, Culicoides usually feed dorsally at mane and tail and on the abdomen. In contrast, Blackflies feed on the ears, face, and ventral abdomen in morning and evening. The exact cause of the allergy is a hypersensitivity to the salivary antigens of the insects. The disorder represents a type I and type IV hypersensitivity.

Clinically, IBH is the number one cause of the allergic and pruritic horse. Its distribution is worldwide and can be seen in any breed, all ages and any sex. Genetic predisposition to the disease can be seen most commonly in the following breeds: Icelandic, German Shire, Shetland Ponies, Quarter Horses, and Thoroughbreds. Clinical signs are typically seasonal; most commonly seen in the spring, summer and fall. Normally, the condition worsens with age and clinical signs are more evident morning and evening when the insects normally feed. Dorsal distribution of lesions is the most common manifestation in the horse. It starts with itching usually beginning at the mane, croup, and base of tail. It is typically referred to as a “buzzed mane” and/or “rat tail.” It can extend to other areas of the body. Itching and chronicity leads to erosions, ulcers, variable hair loss, and pigmentary changes.

Diagnosis of IBH is usually based on history. The combination of seasonality with the distribution pattern of the skin lesions and the presence of the insect breeding ground in the horse’s environment is typically enough to make a diagnosis of IBH. In some cases, intradermal skin testing (IDST) can be used to detect which insect or group of insects that the horse is most allergic. The treatment of Insect Bite Hypersensitivity involves control of the insect causing the disease and addressing the skin lesions associated with it. Controlling the insects involves applying long-lasting insect repellents. Likewise, the owner can stable the horse during times of high insect activity. Depending on the severity of the skin lesions, treatment may involve systemic as well as topical treatments. Specifically, antibiotics and corticosteroids can be given to treat skin infections and to decrease the immune reaction.

Kinetic Vet has launched a product that encompasses each area for the topical treatment of Insect Bite Hypersensitivity. EquiShield® IBH Salve is the only product available specifically formulated to address IBH in horses. It is an antiseptic (chlorhexidine), anti-inflammatory (hydrocortisone), anti-itch (pramoxine) and insect repellent (citronella) in one formulation. It also contains colloidal oatmeal and lanolin to soothe skin.

Insect hypersensitivity can be a very difficult disease to manage. Every effort should be made to identify the insect causing the hypersensitivity and to reduce the exposure. Successful treatment of the skin may involve both systemic and topical therapies.

Insect Bite Hypersensitivity (IBH)by Stuart L. Pierce, DVM

AUTHORStuart L. Pierce, DVM received his Doctor of Veterinary Medicine degree in 1992 from the University of Missouri College of Veterinary Medicine and currently owns a multi-doctor practice with its offices in Lexington. He is a member of the American Veterinary Medical Association, American Association of Bovine Practitioners and the Kentucky Veterinary Medical Association.

VaccineComparison Chart

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SupplementEqui-DexElectrolytesRed CellEveryday Gold

Thyroid TreatmentEquine Thyroid SupplementThyro-LThyrozine PowderThyro-Kare

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VaccinesNeogenBotVax BBoehringerCalvenzaCephalovacEqui-FluStrepvax IITetguardVeteraRabvac

MerckEncevacFlu-Avert I.N.EquirabPrestigePreveNileProdigy

ZoetisArvacEquiloid InnovatorFluvac InnovatorPinnacle I.N.Pneumabort-K + 1BPotomacGuardRotavirusTetanus AntitoxinTetanus ToxoidWest Nile Innovator

MerialImrabPotomavacRecombitek

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