Ep. 61 – Strangles in Horses Part 2 Podcast

Welcome back to The Equine Vet Connect Podcast.

 

I’m Dan Carter here with Dr. Caroline Brown.

 

How are you this morning?

 

Doing great.

 

Good.

 

We’re back in the old studio this morning, recording in treatment room one here at Countryside Equine Hospital.

 

So as promised, Strangles round two.

 

Didn’t think we’d have to do two episodes of this, but it’s a beast of a topic.

 

I feel like we could do five.

 

We could go deep into it.

 

I think especially too, when we get into today’s topic, which is the treatment and the vaccination part.

 

Oh, man.

 

Which is there’s a lot of hot topics in there.

 

Yes, there is. I think there’s going to be some triggering here.

 

Isn’t that what your generation calls it?

 

Yes, some triggers.

 

I feel like our first episode was very, very factual and very like this is how it is, this is how it goes, all the things.

 

In this episode is where there’s going to be some facts, but there’s also a lot of opinions and a lot of controversial things and how we do decision-making and…

 

Well, I think that’s the one thing I’ve seen with close to 20 years now between vet school and being out in practice.

 

I got close to 20 years, which is scary to say.

 

You just showed your age there, Dan.

 

I did.

 

I was a late bloomer going to vet school.

 

I think the thing where this gets really confusing with the topics we’re going to hit on today is it has changed so many times as far as what the recommendations were.

 

It’s changed again, changed again.

 

I’ve seen it change back and then change again.

 

There’s science behind all of it.

 

That’s the thing is, it’s not that there isn’t science, there’s some science, but then we’re constantly tweaking, constantly learning.

 

There’s a lot of different schools of thought into, in an outbreak, what you’re supposed to do.

 

I think that all depends on your experience with it, and where you did get your education, and what you were taught.

 

It’s very situational dependent.

 

I feel like if you put 10 vets in a room and ask them how they’re going to deal with it, they might all have a different answer.

 

Yeah, that would be a really fun podcast.

 

10 vets and be like, Strangles, go.

 

Go, yes.

 

Do that with anything.

 

I think that would be fun.

 

I feel like at some point in time they’re probably boxing gloves and yeah.

 

Oh yeah, you go to some of these conferences and you start talking to some of these vets about things.

 

I went through an ophthalmology conference, and there’s a couple different schools of thought there, and they get talking about things, and there’s some words.

 

I mean, it can get intense.

 

It can get intense.

 

Yeah, for those of y’all listening, Vet Med is not for the faint of heart.

 

I mean, we’ll get pretty intense.

 

Like, it’s like nerds gone wild, I think.

 

And it’s a very small community, so everybody knows everybody, and…

 

Yeah.

 

If you ever get a chance, you should attend a vet conference.

 

Because it can get quite opinionated and wanting to throw blows.

 

Oh yeah.

 

It’s a lot of fun.

 

Like, sometimes you just want to poke the bear when you’re there.

 

So, like, I want to see if I can get these two people fired up.

 

But, you know, I think the cool thing about that is it tells you that our profession is just really passionate about what we do.

 

Yes.

 

And I think it comes from a place of wanting to do what’s right.

 

And that’s, I guess, that’s one thing I love about our profession is, you know, it just, we do care that much.

 

We do care that much.

 

And there’s a lot of ways to do the right thing.

 

Yes.

 

Yes.

 

There’s a lot of ways to do the wrong thing, but…

 

I mean, I’m still a firm believer there’s two ways to do anything, and that’s the wrong way in my way.

 

So…

 

That’s a bumper sticker.

 

Yeah.

 

Only two ways to do anything.

 

Dan’s way or the wrong way.

 

All right.

 

Well, let’s do a quick overview.

 

Talk about Strangles.

 

Talking about the bacterias, the bacterial infection.

 

Streptococcus equi subspecies equi.

 

Yes.

 

And so this is a very contagious little bacterium, and it has to enter the horse through the nose or the mouth.

 

It does not transverse through the skin, or come through mosquitos or animal bites, or any of the other crazy weird things you might hear on the Internet.

 

Can’t sprout wings and fly.

 

No.

 

I realize we should have said this to make our epidemiology professors proud.

 

It has a high morbidity.

 

Yes.

 

But a low mortality.

 

Yes.

 

Which basically means it affects a lot of individuals in a population, but the number of those individuals that are going to die from this, or from direct complications of this, is fairly low.

 

Yeah.

 

So a lot of people are always worried, “my horse has Strangles.

 

He’s not going to make it.”

 

And it’s like, he’s going to make it.

 

Let’s start there.

 

He’s going to come out better than ever.

 

Yeah.

 

Potentially.

 

Potentially.

 

Potentially.

 

But this little bacterium will enter the horse through the nose or the mouth.

 

It attaches to the lymphoid tissue in the pharynx area, and it primarily affects the lymph nodes.

 

These lymph nodes get so enlarged and inflamed that they eventually end up rupturing, and that is what causes the kind of stereotypical big draining abscesses that are coming off of their lymph nodes around their jaw.

 

If they rupture on the inside into their guttural pouch, you can see very profuse discharge from their nose.

 

Leading up to this, they’ll get a pretty severe fever, like 105, 106.

 

They’ll feel pretty crummy for a couple days.

 

Once these little lymph nodes rupture though, then they’re usually on the up and up at that point.

 

They usually feel a lot better, and it’s a matter of that point of just waiting until they have stopped shedding the disease, and then they’re usually good to go.

 

We talked about it before, the best way to prevent is isolation, isolate the affected individuals, because as we’re going to reiterate again, it can’t sprout wings and fly.

 

Correct.

 

It does not grow legs and walk.

 

It can’t just magically translocate from one barn to another.

 

It does require that nose to nose contact.

 

That being said, we talked about it, quarantine, isolation.

 

That’s the best route to go down when you first see this pop up.

 

So that being said, let’s just dive into it.

 

Let’s get the internet fired up this morning.

 

Let’s talk about treatment.

 

Treatment of Strangles.

 

So where this becomes controversial is the use of antibiotics.

 

Because Strangles, as we said, is a bacterium and bacterium do typically respond to antibiotics.

 

The issue that comes into this is there is some thought that if you have a horse that has been exposed to Strangles, whether they’re starting to show fever or they’re not, but they have the bacterium in their body, if you start antibiotics on these horses, you are actually going to prolong the duration that they are infected with Strangles, versus if you just let them run the course with no antibiotics.

 

I think that comes from, in order for an antibiotic to work, that antibiotic has to reach the bacterium.

 

Yes.

 

If it’s in the lymph node, that antibiotic can get there.

 

If it is free floating in the guttural pouch, antibiotics aren’t going to get there.

 

Correct.

 

Not systemic.

 

Yes.

 

We’ll talk about some other ways we can get antibiotics there.

 

I think that’s where the controversy comes from, we can kill a few, but not all.

 

But yeah, antibiotics.

 

The two antibiotics, I think, that mostly get talked about with this one, it’s important to understand the spectrum is gram positive bacterium.

 

We’re typically going to reach for something in the penicillin family.

 

Love penicillin.

 

Like PPG, which I don’t think actually exists anymore.

 

That was the one you could get at Tractor Supply for a while.

 

Now, I know we can’t get it.

 

It’s on the back order right now.

 

I mean, it may come back, but PPG or Procane Penicillin, there’s an IV version, K-Pen.

 

Do not confuse the two.

 

If you give PPG IV, you don’t even want to know what that looks like.

 

But there is a K-Pen or Potassium Penicillin.

 

So there’s K-Pen.

 

Then the other one that we’ve actually got a label for now is Exceed.

 

Is it really?

 

Has a label for the treatment of a streptococcus.

 

Interesting.

 

I mean, it makes sense.

 

It’s a ceftiofur antibiotic.

 

So it’s kind of one of our other first lines that we use for a lot of things.

 

But yeah, that’s good.

 

Yeah.

 

So those are the two we mostly think of is Naxcel, which Exceed just the long-acting version of Naxcel.

 

But those are our two antibiotics of choice.

 

I’m going to be honest, I’m riding the fence on this one.

 

I think it’s a case-by-case basis.

 

Yes.

 

It’s, I think, my judge is, where I look at is how early in infection are we?

 

Correct.

 

Like if we’re early, like beginning, like just the beginning of clinical signs, or just usually, and when I say clinical signs, usually just that fever.

 

Because if we talk about that, fever will spike before the shedding of bacteria.

 

Which is where a lot of our, you know, a lot of our, you know, kind of method into doing the quarantine comes into because we are checking all these horses for a fever.

 

And once they start showing that fever, we say, okay, you’ve got something going on.

 

And that gives us some time to kind of figure things out.

 

But the idea is, is that if you start these guys on antibiotics, you know, are you just going to prolong it?

 

Maybe they’re not getting that shedding happening within two days, maybe now it’s not happening for a week.

 

Right.

 

Because you’ve slowed down the progression of that disease.

 

That’s the theory behind it.

 

Well, and I can remember, like, this is where things have changed.

 

I can remember when I was in school, my generation used to talk about chicken pox, right?

 

Your generation doesn’t get chicken pox because there’s a vaccine for it.

 

But we used to get chicken pox.

 

And the whole thing was, is like, when somebody in your class popped up with chicken pox, everybody went over and played with the kid with chicken pox because parents were like, this is a rite of passage, you got to get chicken pox, go ahead and get this done.

 

And once you get that, you get lifelong immunity and everything’s great.

 

So we used to think like Strangles is almost like a rite of passage for young horses.

 

Like, you know, you get a Strangles outbreak, let it run its course, get everybody infected, get this over and done with because you’re supposedly going to get this lifelong immunity.

 

We know now that that’s a yes and no kind of situation.

 

And there was one theory too that said that if you are giving these horses antibiotics while they’re actively dealing with Strangles, they won’t develop that immunity or they won’t develop as strong of an immunity, which I was like, that is interesting because again, that kind of negates one of the big, you know, theories behind Strangles.

 

Again, just throw the horses all together, let them run its course.

 

Right.

 

And we’ll talk about a little bit on vaccines.

 

You know, the immunity, I don’t, it’s odd to get that good of an immunity against a bacterium.

 

Usually we don’t, horses don’t amount that good of an immune response against a bacterium, like they do a virus.

 

Right.

 

It does seem to be mostly those younger, immunonaïve horses that get this.

 

Yes.

 

As far as treatment, like I said, I am with systemic antibiotics.

 

We’ll talk about some other things, but I’m really on the fence here.

 

I think I look at it on case by case and even horse by horse basis.

 

Yeah.

 

What’s your?

 

I mean, we’ve talked about that.

 

It’s also, there’s a practicality to it as well.

 

So if we’re dealing in an outbreak and say, we only have two or three horses, I say, okay, maybe let’s put them on some prophylactic antibiotics.

 

Now, if you go to a barn and there’s 50 horses, putting them all on antibiotics just is not feasible.

 

That’s a lot.

 

Now, we’re dealing with the whole responsible use of antibiotics and all of that.

 

So again, I think it is very much a case by case basis.

 

I think it’s one of those.

 

I know I had one scare where we were suspecting of strangles.

 

It didn’t end up being strangles, but we had a pregnant mare that was nearby, and I put her on antibiotics immediately.

 

I don’t think she had had any direct contact with these horses, but I said, I don’t care.

 

You have precious cargo on board.

 

Yeah.

 

You’re getting antibiotics.

 

Well, we know in a two-week-old pregnant mare, we know strips.

 

One of the causes of a lot of the placentitis is out there, so yeah.

 

Right.

 

And so I’m like, okay, this horse is at a little bit more increased of a risk.

 

We’re going to take care of her, but every other horse in this barn was not super young horses, but they were all healthy.

 

Nobody had any immunocompromised.

 

Nobody was super old or geriatric.

 

We didn’t have any super, super young horses.

 

So I’m like, you know what?

 

Everybody else here is pretty healthy.

 

We’ll let them ride the course out and see what happens.

 

Well, I think the other thing I look at too is deadlines.

 

Yes.

 

If I’m dealing with a barn that sells yearlings, thoroughbred, standardbred, quarter horse, some type of a sale situation.

 

We’ve got a deadline that these horses sell like November 11th, and all of a sudden this pops up and we’ve got to get ahead of it.

 

We miss that window to sell, that’s a huge income loss for that farm.

 

And also in the show situation, where you get one that comes into a show barn, especially if I know I’ve got older horses, there happens to be a young horse and a few young horses that happen to have this.

 

I will use antibiotics in those.

 

And my theory and my thought is I will monitor the temps.

 

And the ones that spike the temp, as soon as they spike that temp, I will start the administration of antibiotics.

 

I’ll also still quarantine those horses.

 

They go to the yellow light barn.

 

And I will monitor those horses, almost like their own little yellow light.

 

Right.

 

But I will start those horses on an antibiotic.

 

Because I’m trying to get this controlled in a rapid time because of a deadline, either a big horse show or a sales type situation.

 

And so again, I think kind of circling back at all, it’s all very case by case.

 

It’s very dependent on the barn and the timing of it, and what types of horses we have here.

 

And I think that’s part of it.

 

And the disease process as well, they say that horses that already have big abscesses developed, at that point, there’s not really a need for the antibiotics because-

 

I agree.

 

It’s going to potentially stop them from even rupturing at that point.

 

Yeah, if you have true clinical signs, the big abscess lymph nodes, that’s a no-go because like you said, you’ll kill some of those bacterium, but the minute you stop, it’s going to blow back up.

 

Yeah.

 

We’re going to go through this whole process again.

 

Again, right.

 

So let it run its course.

 

So when we get these horses that have these big abscesses, at this point, we’re saying, hey, let’s do some nursing care.

 

We put some warm compresses on there.

 

We do our best to try to get these things to rupture.

 

I don’t typically go and puncture them just because I’m not about that.

 

The only times I’ve done that is if I literally, I’ve had a couple that were in or having respiratory issues because of the size.

 

I will go in and open and drain those just because we are dealing with a respiratory situation.

 

And so those I will go in and rupture.

 

But I need to look at them on an ultrasound and have a very clear spot to hit and know that I can get where I’m going.

 

There’s a lot of important structures running through those areas.

 

There’s a lot of stuff around there.

 

Yes.

 

But again, a lot of times once these guys have ruptured, they’re feeling a heck of a lot better.

 

They’re feeling so much better.

 

So, you know, we always tell people once they’ve ruptured, usually those ones on the outside, we’re saying, hey, flush them out with some Betadine solution.

 

Just try to keep it clean.

 

Just get all of that crap out of there because that’s going to be what keeps it.

 

My favorite thing is a lot of these will rupture into the guttural pouch and you’ll have this copious discharge.

 

So I’m a big proponent of flushing the guttural pouches.

 

You do love a guttural pouch flush.

 

I do.

 

So I’m going to drive a scope in there.

 

Or use an AI rod.

 

I think I showed y’all the cool technique with AI rod.

 

Yep, you did.

 

I learned that from you.

 

That was back in the day before we had video scopes.

 

We had these old school ones.

 

Hey, it works.

 

Showing my age, but it works really well.

 

And it still works.

 

It still works.

 

But basically, what we’re doing there, these things have abscessed into the guttural pouch where the lymph node has ruptured into the guttural pouch instead of out into the wide open.

 

And we have one of my favorite words, an empyema.

 

Empyema.

 

Empyema.

 

That’s what it’s called when you got a guttural pouch full of pus.

 

And dilution solution to pollution.

 

Yes.

 

So we’ll flush the heck out of that thing, lavage all that stuff out, remove those bacteria.

 

And then this is where I will use some antibiotics in the guttural pouch.

 

Directly into the guttural pouch.

 

Directly into the guttural pouch.

 

Because I think we’ve talked about the guttural pouch on this podcast before, but the guttural pouch is probably…

 

I’m sure it has a use, but its only purpose in my book is just getting stuff stuck into it.

 

I would agree.

 

And causing a problem.

 

We think it’s some sort of extension of their inner ear network.

 

Sure.

 

And we don’t know, but there’s a lot of vessels that run through there.

 

There’s a lot of nerves that run through there.

 

There’s a lot of hyoid bones run through there.

 

So there’s a lot of little things that can get infected living in there.

 

And so you get bacteria or fungi or whatever in there.

 

You got a lot of problems.

 

Yeah.

 

So I’ll lavage all those things out a couple of days in a row.

 

And then I’ll actually.

 

So there’s two different ways.

 

Do they teach you about the old K pen and gelatin?

 

No.

 

What is that?

 

Okay.

 

Oh God.

 

So you basically, it’s plain Jell-O, plain gelatin, not Jell-O, not watermelon gelatin, not the strawberry flavored gelatin, Jell-O.

 

This is gelatin.

 

This is what actually makes Jell-O Jell-O.

 

No flavors, no sugar, no additives.

 

We need the pure organic gelatin.

 

You mix up some gelatin and you add K-Pen to it.

 

Okay.

 

And then you put that into the guttural pouch, all right, after you’ve lavaged it.

 

Well, what happens is as that gelatin breaks down in the guttural pouch, it’s a slow release antibiotic.

 

Ah, okay.

 

So the other thing I’ll use is there’s a compound called pleuronics, and this is where physics gets defied, because you actually put it in the refrigerator and make it cold, it becomes a liquid, but at room temperature, it’s a solid.

 

I don’t like that.

 

Yeah, that’s just not supposed to work that way.

 

No, that’s not how that goes.

 

But it works great because we can add things like Naxel to it or K-Pen, have it sitting there really, really cold, put it into the guttural pouch.

 

As soon as it gets in the guttural pouch, it turns into a solid.

 

It breaks down over time, about three to five days, slow releasing an antibiotic directly into the guttural pouch.

 

Okay, and then you don’t have to go in there every single day and?

 

We’ll still get one or two flushes on it, but I can put this in and it prevents, what we’re going to talk about this, prevents the PIs, the persistently infected, which is going to be our next topic anyway.

 

Interesting.

 

I didn’t know the gelatin thing.

 

What crazy vet did that first?

 

I have no idea.

 

Like what was going through their mind when they said, y’all, I got something crazy here.

 

I mean, my guess is they probably sitting up at the cafeteria, saw that little jello with the whipped cream on top and was like, Wait a minute.

 

I have an idea.

 

Who gets that anyway?

 

Do you remember the old school cafeterias and they had like little jello?

 

I don’t think I’ve ever gotten jello on purpose other than for a jello shot.

 

But like-

 

I mean, who’s up there like, because I remember they’d have the jello, they’d have pudding, and they’d have cake.

 

It’s like, who’s like, I want the jello.

 

I don’t even know who eats jello.

 

My mom went through a weird phase where she tried to make her own jello and was putting stuff in jello and we’re like, mom, you got to stop this.

 

This has got to be some midlife crisis.

 

Sorry, Cathy, I’m talking bad about you on the podcast.

 

I don’t know if she listens or not, but she’s going to call me and be like, what the heck, man?

 

I’m a big pudding fan.

 

I love pudding, instant pudding, big fan.

 

Just not jello.

 

But in this case, yeah, jello.

 

Jello.

 

Okay, cool.

 

So, you know, cause what we’re trying to, your next step when you’re, when you’re talking about treatment, is it’s not just treating to that moment, but you’re trying to prevent what we call the persistently infected animal.

 

Yes.

 

Or the PI.

 

Yes.

 

This is where the infection harbors.

 

Yes.

 

It didn’t harbor on your fence rail.

 

It didn’t harbor in that bit that your granddad used to use.

 

It wasn’t hanging around in the horse trailer.

 

Like I said, didn’t blow in on the wind or show up because it grew legs and walked.

 

It’s a persistently infected animal.

 

And this is an animal that has the bacteria in their guttural pouch.

 

They’re not showing clinical signs, but they’re able to harbor this bacteria in their guttural pouch and not show clinical signs.

 

Right.

 

So this is where we get one of my favorite words, it’s inspissated, inspissated puss, is basically hard little balls of puss that are just sitting in the guttural pouch, like little rocks.

 

Well we call them a chondroid.

 

Kasey, throw a picture of a chondroid out there.

 

A chondroid, yes.

 

Throw a picture of some chondroids.

 

They’ll sit there.

 

They can also exist as what’s called a biofilm on some of the mucosal surfaces.

 

And a biofilm is every veterinarian’s worst nightmare because it’s just this ecosystem that…

 

Protective goo is what I like to call it.

 

Protective goo, yes, that just lives on the surface of the mucosum.

 

And it’s basically the bacterium and all of the things around it that help keep it alive and nourished and make it impossible for you to break it down.

 

Yeah, and it helps to evade detection.

 

The immune system can’t get to it.

 

Antibiotics don’t really get to it very well without having to go in with some chemicals and really try to break it down.

 

So, they say about 10% of horses that are infected with Strangles end up becoming some sort of a chronic shedder of this.

 

And these horses can, like you said, they can be very difficult to identify, but they won’t show the clinical signs necessarily.

 

Sometimes they went through the infection course, you know, they drained, they had the fever, they did all the things, and now they’re acting totally fine, but you keep having horses popping up on your farm with Strangles.

 

That means, somebody there is persistently infected.

 

Somebody there, yes.

 

And like I said, it’s very common to have the chondroids or that biofilm.

 

I think it’s easier if they have the chondroid.

 

Yes.

 

Because you’re able to, because I’ve been in situations where we’re like, okay, we have a persistent carrier.

 

We have a persistent carrier.

 

It’s a fairly closed system.

 

Somebody’s shedding this bacterium.

 

And so we go through and start scoping guttural pouches.

 

While we’re doing that, we’re going to flush these.

 

We’re going to get cultures from the guttural pouch, or PCRs, and we’re looking for this animal.

 

And it’s always very satisfying when you pop in that guttural pouch and like, there’s some rocks.

 

There’s some rocks.

 

And they literally look like rocks.

 

They do.

 

It looks like little tiny rocks in the guttural pouch.

 

And it’s like, there’s our carrier.

 

Which you get to do the coolest thing in the world.

 

We have this special instrument that goes in.

 

It’s like this little retractable basket.

 

And you basically lasso the chondroid and you pull it out.

 

Favorite thing.

 

That’s your dopamine?

 

I mean, you can sit there forever just pulling rocks out of a guttural pouch through an endoscope.

 

It’s pretty awesome.

 

It’s satisfying.

 

It is very satisfying.

 

Knock on wood, I haven’t had to do one yet.

 

So I’m like, I’ve seen them, but.

 

I’ve done a couple.

 

You know, some of them are bad enough and have so many.

 

You actually have to go in and make an incision under the jaw.

 

Access the guttural pouch and clean them out that way.

 

The ones that I’ve seen, that’s where they end up eventually having to do.

 

Or they’re just so large that you can’t get them.

 

Right.

 

So I mean, these things can get big.

 

Like, I mean, they can get like a quarter bigger.

 

Yes.

 

Like.

 

I’m lucky.

 

I’ve gotten to lasso a bunch of them and it is so much fun.

 

But yeah, we end up, you know, to get rid of those persistently infected animals, we’ve got to get the chondroids out.

 

Or if we have that biofilm, we’ve got to use things to get the biofilm out.

 

And lavage is your biggest key.

 

Yeah.

 

Lavage, lavage, lavage.

 

And then once you treat it, you wait a couple of weeks, you go back, you do a second PCR test.

 

You’re making sure you’ve gotten rid of this.

 

Yes.

 

And once you can clean up that animal, life’s good.

 

Yeah.

 

They’re usually good to go.

 

That was kind of one of the things that we, you know, kind of glossed on.

 

But they say that about 75% of horses after infection with Strangles do have some persistent immunity for life with that, which is great.

 

And that’s where a lot of that kind of old school philosophy comes in of, you know, just let them get the Strangles when they’re young and they’ll do that.

 

And we’ve kind of learned that there are some different strains of the bacterium.

 

And so, you know, Kentucky Strangles may not be the same as Florida Strangles or the same as California Strangles.

 

So, there is some changes with that.

 

But we know that mares will also pass that immunity on to their nursing foals, which is nice.

 

So, that kind of gives the little, little guys some protection.

 

You don’t typically hear about Strangles in nursing foals.

 

It really doesn’t start too much until they get older.

 

It’s usually kind of that like yearling age, I feel like, where it starts.

 

That’s where I typically see it, the yearlings.

 

Because for whatever reason, like right before sales time.

 

Right, yeah.

 

That’s what it likes to show.

 

But we think it’s because those mares have probably experienced some sort of Strangles at some point in their life, and they’re giving some of that immunity to their foals.

 

Which is really good, because like I said, most time bacterium do not develop.

 

Horses don’t develop a great human immunity to bacteria.

 

But yeah, and then unfortunately, 10% of those horses or 10% of the horses that get it will become persistently infected.

 

Right.

 

So if you’ve got chronic issues with this, give your vet a call, go through the process, clean this up.

 

Right, right.

 

Clean this up.

 

And then again, the biggest issue with Strangles is not the fact that, it’s not the disease itself, it’s just the persistence of this disease and how quickly this thing travels and how easily it seems to travel between the population.

 

And so, you know, the actual disease is not the problem.

 

It’s trying to stop it and prevent it from coming back.

 

Yep.

 

Get this over with.

 

Yes.

 

It’s worth it.

 

So on that note, I think it’s a great time to segue into vaccination.

 

Oh, wow.

 

Yeah, let’s get this to go.

 

Oh, my goodness.

 

Oh, you can tell just going into this that we have thoughts.

 

I think you can, there’s a few topics in the world that you can separate veterinarians down the middle.

 

Like, there’s nobody that rides the fence on this one.

 

Vaccinate, not vaccinate.

 

Yeah.

 

So per the AAEP, which is the American Association of Equine Practitioners, they specifically said “we recommend the strangles vaccine on premises where strangles is a persistent endemic problem or for horses that are expected to be at high risk for exposure”.

 

There’s not really any details on that.

 

That’s all kind of subject to interpretation.

 

In other words, if you have a PI on your farm, you can either clean it up or vaccinate.

 

Yes.

 

So there’s two main vaccines that we’re working with, that we have available to us.

 

There’s the live vaccine, the brand is called Pinnacle.

 

It’s an intranasal vaccine.

 

So this is the fun one where you see us with the long little tube and we try to shove it up their nose and they rear up and hate us.

 

True.

 

So there, and then we have the intramuscular vaccine, which is an extract of the SEM protein.

 

So there’s different things with each one.

 

So the, I’d say we reach for the live vaccine much more frequently.

 

That one is kind of shown to have the best kind of protective immunity because it gives them both a systemic response and a direct mucosal response.

 

Well, if you listen to our podcast on vaccines, you know that sometimes getting that mucosal response prevents these diseases from ever setting up shop.

 

Correct.

 

So with systemic, they have to get the disease, it has to get into the body, and then the body mounts the immune response.

 

These internasal vaccines with this mucosal immunity, they’re like little gatekeepers.

 

They’re like the ninja out there with the sword, like you can’t come in.

 

They’re just like, no.

 

Right.

 

So I think that’s why we like it so much.

 

Yes.

 

So that’s the one we reach for.

 

The intramuscular vaccine, I don’t think I’ve ever even administered one of those.

 

I have years ago before I got educated.

 

Yeah.

 

So the issue with this one is it is a killed vaccine.

 

So you’re not giving them the live antibiotic.

 

You never are, excuse me, you’re never giving them the live bacterium in a vaccine.

 

You do not want to inject that into a muscle.

 

That is a very quick way to get an abscess on a horse.

 

So when we’re injecting this protein extract, the idea is that you’re starting more of that systemic response.

 

The studies say that this reduces the incidence of disease by about 50 percent in a population.

 

But you also should not give them this vaccine if they’ve had Strangles within the last year.

 

Right, because it’s that SEM protein and the antibody to that that increases our risk of purpura.

 

Yes.

 

And so there’s been, I think, one of the biggest criticisms of this vaccine is that when it has been administered to horses that have already very high protein titers, they are almost guaranteed to get this purpura, which is what we talked about in the first episode where they just get this kind of whole body, very painful edema that is not fun.

 

And actually, the American College of Internal Medicine, when their consensus statement on this, they actually said before you gave this vaccine, you should actually pull titers on the SEM.

 

Yes.

 

If they’re above a certain level, it’s not recommended.

 

Yeah.

 

So, and I think that’s why a lot of people don’t use it is because we got to go out, pull titers.

 

And then also we can give a vaccine that is less efficient at preventing disease.

 

Right.

 

And it requires more steps for a product that’s not as good.

 

Right.

 

Versus with the intranasal vaccine, which that is a live vaccine.

 

We are giving them a modified version of this bacterium.

 

So basically the virulence has been removed.

 

Yes.

 

But whenever you’re giving a live thing, you are potentially, they’re going to have some side effects from it.

 

They can have some nasal discharge.

 

They can get some lymphadenopathy from it.

 

There’s been reports of horses getting bastard strangles or purpura.

 

There was even a couple of studies where they thought that they were able to basically isolate that bacterium as the cause of a outbreak that happened on that property later on because a horse had come in that had been recently vaccinated with the strangles vaccine.

 

It has its pros and cons.

 

Here in our recommended vaccines that we do, we have our core vaccines which we recommend for all horses, regardless of where you live, if the horse travels or not, how old they are.

 

Then we have our risk-based vaccines for horses that need certain extra things.

 

Maybe they’re traveling a lot, maybe they have some sort of immunocompromised, maybe they’re going to certain places where there are certain problems.

 

I personally don’t ever really recommend the strangles vaccine for any of my traveling clients because in my experience, I’ve seen that unless everybody in the barn is vaccinated for strangles, it’s not really going to help that horse in the event of a major outbreak, if that makes sense.

 

It does.

 

I’m the same way.

 

We were going to vaccinate about 3,000 horses a year.

 

I think we go through about 30 doses of the strangles vaccine.

 

Yes, and it’s usually because somebody’s requested it specifically because their horse is going to a place where they know there’s going to be strangles, or they’ve specifically had a bad experience with it, and they’re like, listen, I just want it on board.

 

I’m like, I got you.

 

Because when I look at the risk versus reward, the risk in our population of horses, which is mostly older horses, the risk of getting strangles is very low.

 

The risk of having a vaccine reaction or having the vaccine cause an issue is higher than the risk of you getting it.

 

Yes.

 

And it’s not all that protective.

 

No.

 

It’s not that great, it’s not that protective.

 

Interesting enough, there was a time early in my career where they actually recommended vaccinating with the intranasal vaccine during an outbreak.

 

Really?

 

So you would actually go through, tempt the horses, anybody that did not have a fever, you would actually vaccinate them for strangles with the intranasal strangles.

 

You would actually give them the intranasal vaccine.

 

Okay.

 

The thought was if we could boost that mucosal immunity, we could shut down the shedding of the virus.

 

These had to be asymptomatic, so no nasal discharge and no fever.

 

So again, being able to use that thing about the fever spiking before clinical signs, the thought was we could get ahead of it.

 

So I have done this.

 

Now, later they’ve suggested, hey, let’s don’t do that because of the risk of bastard strangles secondary to it.

 

But I mean, I have done it and I do feel like it, again, I felt like it helped in the handful of times I’ve done it.

 

But I don’t do it anymore.

 

Right.

 

Again, if we put 10 veterinarians in here and we ask them all, what’s your protocol with vaccinating for strangles?

 

They’re probably all going to have a different answer.

 

Well, a lot of it can depend on the population of horses.

 

Yes.

 

If you’re out in Texas and you’re dealing with a lot of these breeding operations, these mare motels, and you’ve got hundreds of foals on the ground, and you’ve got a huge young horse population, two and three year old horses that are traveling, a lot of young horses, their take on this vaccine, in their case, a lot of times the risk is worth a reward.

 

Right.

 

When I worked on the racetracks, everybody got vaccinated for strangles.

 

Yeah.

 

Everybody.

 

Because again, you’ve got horses that are two to three to four years old, and that’s your key population of horses that are getting this, and they’re coming from all over the country, and they’re there for a few weeks and then they’re somewhere else, and there’s a lot of interaction in there, so a very high-risk population, but that made sense.

 

Also, to have an outbreak in some of these training centers, we’re dealing with as many as two and three hundred horses, the implications are high.

 

Exactly.

 

So again, I think this is why it’s such an individualized case-by-case situation on vaccination and treatment, and I think that’s why you get such strong opinions when you step back and look at where somebody’s coming from.

 

I like to say this is home with like the seven-year-old-plus population.

 

Yes.

 

I mean, that’s, if you look at, if you look at most of Georgia, we’re like, that’s seven-year-old-plus.

 

There’s a little bit of breeding here, but nothing like you go to Texas, and I mean…

 

I mean, they’ve got babies on the ground multiple times a day.

 

Yes.

 

I mean, they’ve got, I mean, it’s no different than Lexington, Kentucky.

 

Right.

 

Lexington, I mean, that’s, they’re going to have thousands of foals.

 

Yes.

 

I mean, they’re going to have thousands of foals in like Bourbon County.

 

Yes.

 

And we don’t have a thousand foals a year, I bet, more than Georgia.

 

And so I think this is why there’s such strong feelings, and people get in arguments, and no different than life.

 

Two people argue, but they’ll never take the time to see where the other person is coming from and understand their situation.

 

And so, strangles like life, you need to understand where the other person is coming from, and understand their thought process.

 

Right, exactly, exactly.

 

So, that was deep.

 

That was deep.

 

Who knew we could relate strangles to life?

 

I told you, I mean, I’m like, I didn’t expect we could do two full episodes on strangles, but here we are.

 

A lot of important lessons to be learned here.

 

Yes.

 

So, I really think, if there was ever a thing to talk to your veterinarian about, as far as the disease, like some of these things are pretty concrete, right?

 

Yeah.

 

Eastern, Western, West Nile, tetanus, rabies.

 

Vaccinate for that.

 

Vaccinate.

 

No, just vaccinate for it.

 

Just vaccinate.

 

At the moment, my horse doesn’t travel, no.

 

Mosquitoes do.

 

Bats do.

 

Rabies bad.

 

Rabies bad.

 

Vaccinate.

 

Tetanus all over.

 

Yes, everywhere.

 

It’s on your feet.

 

It’s on your shoes.

 

But Strangles, that’s, yeah.

 

It’s a conversation.

 

It is.

 

It is a conversation.

 

And it’s, again, it’s a pros and cons, and we’re going to weigh the pros and cons and make a decision from there.

 

I even have, I have very strong feelings about it just because the population of the horses I deal with, I mean, don’t vaccinate.

 

But at the same time, I still look at every barn, every situation, every case as an individual, even though I’m very strong, no vaccine to Strangles.

 

Right.

 

But I still look at each individual horse population because, you know, when I had some guys that were breeding and selling race horses, yes, I’m anti-vaccine on Strangles.

 

Those horses were vaccinated for Strangles because they had a higher risk.

 

Correct.

 

So, yeah.

 

Opinions.

 

Opinions.

 

Yes.

 

This is our Hot Topic Podcast today.

 

So, and so I mean, yeah, we just threw a lot of information at you guys.

 

So, you know, it’s if you have questions, please reach out to your veterinarian, you know, ask them, get their perspective.

 

They’re going to have the best idea of what is your horse’s risk for this.

 

They’re also going to have a handle on what’s going on.

 

Yes.

 

In states like Georgia, this is a reportable disease.

 

So, we can actually go on a website, we can look up where there could be a potential outbreak.

 

Yes.

 

We get notified of these outbreaks.

 

Now, if your state’s not one that requires it to be reported, you don’t have that information.

 

Correct.

 

But we’re able to look up and see if there’s Strangles outbreaks going on in Georgia.

 

The other thing is we have our boots on the ground.

 

I mean, we look around and we’re like, oh crap, there’s an outbreak.

 

And if somebody starts hearing rumors like, call your vet and they can guide you through this.

 

Yes.

 

So I think that’s the moral of the story here is, from quarantine to prevention to treatment, talk to your vet.

 

Yes.

 

Talk to your vet because as we’ve talked about, there’s a lot of ways to kind of go about this.

 

It is not a, it’s not a scary disease, but-

 

Most, very rare, they’re gonna die.

 

Yes.

 

It is, it’s, again, I think we kind of said this in the last episode.

 

This is not something that you should be absolutely terrified of, but you need to be aware of it because it can become a nuisance if you’re dealing with it.

 

It’s an inconvenience.

 

It is a major inconvenience, yes.

 

It’s an inconvenience.

 

Yes, and there are, there’s a lot of things that we can do to try to prevent this.

 

There’s a lot of things that we can do if it, unfortunately, does happen at your facility, that we can do to try to slow it down and put it to a stop, but we have to work together on that.

 

Right.

 

And we don’t want to take away, like there are some, because I know the Internet’s going to blow up, people are going to be like, oh, my horse died from Strangles.

 

Yes, it does happen.

 

It does, yes.

 

But, I mean, horses die from foot abscesses, too.

 

It’s just, it’s not likely.

 

Correct.

 

That’s all we’re trying to say is don’t go off the deep end here, because your horse has Strangles.

 

Don’t go to the interweb and go down that rabbit hole and think your horse is never going to make it because it’s got Strangles.

 

It’s probably going to pull through.

 

Yes.

 

I’m not worried about it.

 

It’s more of all the after effects that we are more worried about, if they become a persistent infected horse, if they develop some bastard Strangles, if they go on to spread it to another horse on your property or nearby your property, and it becomes an outbreak.

 

That’s where the concern comes in, and that’s where we want to jump in and try to help.

 

I’ll tell you what, we’re going to wrap up Strangles here.

 

Been a great podcast, a lot of information thrown out there.

 

Yes.

 

Let’s just do a quick rundown.

 

If you had your key takeaways, if this is the only thing they heard in the whole podcast, these three takeaways, I better quit doing this, people can just fast forward to the end.

 

I know, right?

 

It’s like, yeah, that’s how we lose viewership.

 

So we talked about the treatment of it and how a lot of these horses do very well with just some supportive care.

 

So monitoring for that fever, antibiotics are going to be in the moment decision, depending on what’s going on with your horse, in that situation.

 

Again, back to isolating, quarantine, being clean, everything, watching out for our horses that have these persistent infections.

 

So if you’re just finished up with an outbreak and now you’ve got another one getting your vet on board and getting everybody involved and trying to figure out who’s the problem, then we can get that taken care of.

 

And then, vaccines, just talk to your vet.

 

Figure it out.

 

There’s options if we need to take them.

 

If you are wanting to vaccinate your horse, we are happy to do that.

 

But if you want to have a conversation and figure out if your horse is at risk for this, if this is something that we need to do, your vet is the best person to give you that answer.

 

I think everything you said is perfect.

 

I would probably summarize the whole thing and call your vet.

 

Call your vet.

 

Because this is definitely a choose your own adventure book.

 

Yes.

 

So call your vet and get a plan put together.

 

Don’t ask Facebook.

 

No, don’t ask Facebook.

 

Don’t ask Reddit.

 

No, don’t YouTube this.

 

Don’t ask all the other adult amateurs at your barn.

 

Yes.

 

If a guy drives a UPS truck, it’s not making a veterinarian.

 

Is that a thing?

 

I don’t know.

 

It just seems like…

 

It’s like he’s out here at a UPS truck posting his vet.

 

It just seems like people will ask anybody anything like, oh, he delivered that medicine, so he must know what he’s doing.

 

He must know what he’s doing.

 

Just call your vet.

 

I think that sums it all up.

 

Call your vet and then we’ll put together a choose your own adventure situation.

 

And even call your vet before.

 

If you’ve got a larger facility, call your vet or if you get show plans, like call your vet and land a plan before this is ever an issue.

 

Yes.

 

Go ahead and have that plan in place, contingency plan.

 

Yes.

 

So.

 

It’s like COVID where everything shut down and we forgot how to function as a society.

 

Just wash your hands.

 

Wash your hands, which is just good, good life advice from grandma.

 

When in doubt, wash your hands.

 

All right.

 

Well, thanks everybody for tuning in.

 

We really appreciate it.

 

If you like hearing these podcasts, no matter what channel you’re watching on, please like and subscribe, hit that bell.

 

We appreciate all the help from all our viewers and listeners out there helping us put this on by sending in such great questions.

 

If you got questions, send them to us.

 

We’ll get it covered.

 

Other topics you want to see us do, send it in.

 

We’re happy to do them.

 

Again, thank you, Kasey, for doing all the editing.

 

April, thanks for recording this whole thing.

 

Thanks again for all the wonderful people here at Countryside Equine to make this possible.

 

Thank you all and y’all have a great day.

 

Bye.