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Endoparasites;  the gut-wrenching villains that terrorise our horses from their tums to their bums, but how big an issue are they for the average horse? Which worms do we need to be aware of? Is wormer resistance really that big an issue? So many questions, so many drug names.

What is a worm?

A worm, or an endoparasite, is an organism that lives inside of your horse, to your horse's detriment. We have all seen the adverts for ‘good bacteria'; this is known as a synergistic relationship, where both host and occupier benefit. With parasites, only the parasite gains.

1. Cyathostomes. Why did the cyathostome always get what he wanted? Because he was so encystant… Excuse my awful jokes; it’s been a long day. Cyathostomes are a type of nematode, or round worm, known as small encysted redworm.  The adults, when in the large intestine, produce eggs that the horse will excrete onto their pastures; the eggs then hatch, and the larvae are eaten by the horse. It is also the larvae that are capable of encysting (hiding) in the walls of the large intestine. So the saying really is true, don't eat where you… These nasty critters can encyst in the mucosal lining of the large intestine of horses; the larvae are capable of ‘hypobiosis’; they stay in a state of arrested development (a bit like hibernation).  It is when they emerge that they can cause potentially fatal damage and diarrhoea, known as larval cyathostomosis.
2. Strongyles (large redworms). These nematodes are detrimental to your horse in a different way than their smaller namesakes. Eggs in the pasture have a moult phase, referred to as Larval stage 1, L1, and moult to form, logically, L2. The L3 are consumed by an unwitting grazer; it is the L4 stage that migrate from the gut to the arterial supply of the intestine (the cranial mesenteric artery if you are curious). This can cause a compromised blood supply to the large intestine with inflammation of the arteries known as verminous arteritis, and can cause the dreaded colic.
3. Parascaris Equorum (ascarids); another nematode. Are you the owner of a young horse? This one is for you (sorry!).  Thankfully, our equid amigos develop a resistance to these worms; however, young-stock in the 6 month – 2-year old bracket are highly susceptible. The eggs are passed out in excrement, and moult to L1 and then L2; unlike large redworms, it is the second larval stage that is ingested. They, too, have a damaging migratory pathway; from the intestines, they migrate through the liver and moult to L3, before progressing to the lungs.  From here, they can be coughed up, swallowed, and moult to L4 and then adulthood in the small intestine before starting the whole cycle again. Liver and lungs may be damaged, but impacted colic from a heavy worm burden, along with ill-thrift and a pot-belly, are common signs.
4. Dictyocaulus arnfieldi (lungworm) is another nematode. To my horror, it is donkeys that are particularly affected by lungworm, and carry it, as the life cycle is not actually completed in the horse.  These larvae are ingested, and burrow out of the intestinal wall into the bloodstream, where they penetrate the lungs. They will cause reactive changes in the respiratory system, such as coughing, increased mucus production and irritation of the bronchi. Chronic pneumonia, secondary infections and pulmonary oedema (fluid on the lungs) may be other features in heavy burdens.
5. Anoplocephala (tapeworms); a cestode, not a nematode. It requires an intermediate host to develop to a larva from an egg, and it finds a host in the oribatid (harvest) mite. When the horse eats the mite with the parasite, the adult tapeworms can then settle in the caecum (the huge fermentation chamber of the horse gut) and small intestine. Tapeworms pose a real threat to your horse by associations with spasmodic colic; it can cause food impaction and intussusception, when the colon ‘telescopes’, folding in on itself. Inception may be about a dream within a dream, so think of intussusception as a colon within a colon.

Other parasites include Oxyurius equi (pinworms, causing itching and irritation around the anus) and Gasterophilus (bots; actually a fly larva, and not known to cause many problems despite settling in the stomach).

What can we do about worms?

I have been on many yards with rigid worming routines as a means of prevention as much as treatment: this is called interval dosing. Is it necessary? If I had to fall in a strict ‘yes’ or ‘no’ camp, I would be in the latter. Wormers, known as "anthelmintics", are becoming less efficacious; that is to say, anthelminthic resistance is becoming a real problem. The more that worms are exposed to wormers, the more the wormer becomes a selection pressure; some worms will have innate features which allow them to survive despite these chemicals specifically designed to kill them – pesky mutants. The more that we use wormers when we may not need to, the stronger this selection pressure is; we kill the worms which are susceptible to the wormers, allowing the few worms which can survive to reproduce in an environment with less competition. Thus, new wormers need to be developed all the time; a laborious and long task. How can we slow or stop this resistance developing? By being responsible owners and avoiding ‘over-worming’ - saving our horses and wallets in the process! Moving away from wormers, we need to look to management. As we can see in the life-cycles, it is the output of eggs in faeces that are responsible for providing a suitable environment for parasites. Poo-picking fields is one of our biggest weapons in the battle of the bugs; deploy it often! Quarantining new horses prior to turn-out can help to minimise worms on a busy yard; moxidectin and praziquantel can be used 24 hours prior to turn-out. What wormers are available? There are macrocyclic lactones (ivermectin and moxidectin), tetrahydropyrimidines (pyrantel) and benzimidazoles (fenbendazoles) and pyrazinoisoquinolines (praziquantel). We must treat with what is most efficacious for the type of worm, and also only when it is needed. Faecal egg counts (FECs) give a picture of what worm eggs are being put out in your horse’s faeces; when the FEC exceeds 200 eggs per gram, it may be justification for worming. If that sounds a lot, we need to get our heads around the fact that horses will always have worms; whilst this is not a pleasant idea, unfortunately our horses will never have a totally worm-free body, and we shouldn’t strive for that in our worming regimes. Further to this, we want to keep a certain worm population ‘in refugia’; this means we want to keep some worms unexposed to wormers, because then we are not selecting for worms resistant to the wormers. It is only when worm burdens get too high and will damage our horses’ well-beings that we should use wormers. FECs can reduce the selection pressure that help those resistant worms to thrive, as well as being a cost-effective means of targeting the individual horses who need it most.

Is there an ideal worming regime?

Perhaps not. FECs will not give an accurate representation of encysted populations, and are not deemed specific enough for tapeworm counts. Fecal egg flotation or ELISA (enzyme-linked immunosorbent assay) blood tests can be used for tapeworms, but are more expensive. Furthermore, an ELISA detects the antigen (the immune response to a parasite) level, thus the burden may appear high as antibodies are still circulating against the old burden, even if the worms are now dead. However, there are means of interval dosing that do not require administration of a wormer, regardless of whether the horse needs it. We must focus on what burdens are of concern and when… SPRING: Performing a faecal egg count (FEC) for strongyles; ivermectin or single dose pyrantel can be utilised if there are over 200 eggs per gram. Stronglyes were previously a huge concern for causing colic, but thanks to ivermectin, they have become less of a menace, hence the need to protect the efficacy of this wormer by responsible use. Additionally, treatment for tapeworms in the form of praziquantel or double dose pyrantel may be used in spring. SUMMER: FEC for Strongyles and treatment when the FEC indicates, again with ivermectin or pyrantel. AUTUMN: we must treat for any encysted cyathostomes. Remember the larval cyathostomosis? Commonly these larvae will encyst, and emergence can occur in late winter/early spring. Treatment of a heavy burden is advisable; a five day course of fenbendazole, or a single dose of moxidectin are licensed for encysted cyathostomes. However, a large amount of dead worms and a huge inflammatory reaction can spell out a disaster in the form of colic, so if there's a heavy burden your vet may recommend using the older (and less potent) but "gentler" course of fenbendazole first, and then following up with moxidectin 4-6 weeks later to "mop up" any survivors. Tapeworms can be treated with praziquantel or double dose pyrantel again at this time of year. WINTER: The same treatment (or not!) for strongyles when indicated; if bot flies were a problem over the summer, ivermectin or moxidectin will kill the larvae in the stomach. From all of us here from VetHelpDirect, we hope your horses have a wonderfully worm-free year ahead! There is nothing so good for the inside of a man as the outside of a horse. ~John Lubbock

While the sun's glorious rays may leave us jumping for joy, and our saddles, we must be vigilant about ensuring our horses' well-being. Here are some top tips to avoid the dreaded heat stroke, and ensure our four-legged friends have as much fun in the sun as we do! What is heat stroke? Heat exhaustion is characterised by: 1. An elevated body temperature (hyperthermia; a temperature exceeding 41oC/105 F); 2. An elevated heart rate (tachycardia; the normal heart rate of a horse is 36 – 42 beats per minute, although this may be higher in smaller ponies) 3. An elevated respiratory rate (tachypnoea – exceeding the normal 8 – 12 breaths per minute); 4. A tired, unresponsive horse; 5. The horse's gums will feel dry and tacky; if you press on them, the area under pressure will turn white, and the time to return to normal colour will be longer than in a non-thermally stressed horse. Vets may describe this as a capillary refill time in excess of 3 seconds. If there is no intervention, the condition may escalate to heat stroke where the horse may stagger, appear depressed or, in extreme cases with central nervous system damage, collapse and have convulsions. This is a serious medical emergency that we have the ability to prevent. [caption id="attachment_4392" align="aligncenter" width="350"] Keep them cool![/caption] So how do I keep my horse cool in summer? 1. Water, water, everywhere! Often, people believe the old wives' tale that they should not allow a hot horse to drink water; however water is essential to maintain adequate hydration status. Horses sweat to lose excess body heat; the heat of their body then evaporates this water, leaving their skin colder. Excessive sweating without enough water to drink leads to dehydration, which can be very dangerous, causing a drop in blood pressure and an increased heart rate. Thus cool, clean water must be provided at all times, especially in outdoor grazers, to ensure they can replenish their hydration states. 2. Elect to keep your horse cool. When horses sweat, they lose essential salts from their body, known as electrolytes. Notably, horses lose proportionally more potassium in sweat than other mammals. Offering water with added electrolytes or a salt lick may be advisable. Salt stimulates thirst receptors in the horse's brain, so may have an added effect of encouraging them to drink. If providing electrolyte-infused water, ensure that there is ample fresh water available, as some horses dislike the taste (have you ever had Dioralyte? I can't say I blame them!). 3. Shady characters Horses in the wild and our domesticated critters will seek shade when turned out. Natural shade such as trees can be a great advantage. Bear in mind that the position of the sun changes throughout the day; ensure that your horse has protection from all angles of the sun, whatever the time. 4. Cool runnings Anyone who has been running in the searing midday heat has experienced the unpleasant (and in my case, unattractive) phenomenon of being sweaty, red-faced and exhausted. Horses' huge muscles will generate enormous amounts of heat. Try to time your rides for cooler times of the day, such as early mornings or evenings. If you are lucky enough to have access to beaches or woodlands, these cooler areas can be ideal for summer strolls. 5. Lose a coat like it's going out of fashion! Horses wear their beautiful coats all year round, but generally have a much lighter summer coat. However, some ponies, for example native breeds, will naturally have a heavier summer coat. Additionally, horses and ponies suffering from Cushing's syndrome may have hirsutism – failure to shed their winter coat. In such cases, clipping may be advisable, to ensure they are not excessively insulated. 6. Mystical creatures Misting your horse with cool water will help your horse to lose heat from the skin by evaporative cooling. 7. Splash about For many horses, a tepid bath can be most enjoyable. Be sure to use a sweat-scraper to remove excess water. If you choose to wash post-exercise, walking your horse gently in a cooler will prevent a sudden drop in temperature and aid in an effective cool down. 8. Ice queen Adding ice to water can be refreshing for your horse, though excessively cold water may put him off drinking it. Ice packs are frequently applied to horses' legs after intensive exercise, and there is no reason why this should not continue to be practiced throughout summer. 9. Be your horse's biggest fan American-barn style stables often have excellent ventilation. If it is safe (i.e. without trip, electrical or fire risks), using a fan in a stable with no air flow can help to keep your horse comfortable. 10. Always wear sunscreen Baz Luhrmann may not have been targetting horse-owners, but the 1999 hit rings true; animals with pale areas of skin are particularly susceptible to sun-burn. Think especially of cremellos, pink noses, white socks, pink sheaths and pink anuses – areas under the tail are more susceptible than you may think when your horse deploys his best fly-swatter while grazing in summer! Some owners elect to use specific horse suncreams which are available, and some will use high SPF human suncreams. Whichever you decide, be sure to ensure that your horse is not allergic to any of the ingredients before applying liberally. All of us here at VetDirect wish you and your horses a very happy, healthy summer! “Horses make a landscape look beautiful” - Alice Walker. Rachael McKinney

There are few professions that can carry such a range of emotions, than that of working with and caring for animals. Almost all animal charities will tell you of the amazing successes they have with cases, for animals of varying species. They can also tell you of the heart breaking decisions they have to make, on a daily basis. Recently Vet Help Direct supported one such organisation, The Brooke Animal Hospital, with a cash donation. The Brooke is the UK’s leading overseas equine welfare charity and helps improve the lives of horses, donkeys and mules in some of the poorest parts of the world. Sometimes the team of vets and animal health workers at the Brooke face the harsh reality that some animals cannot be helped, despite their best efforts. Here is a touching story from the charity, discussing how bringing a peaceful and dignified end to a hardworking life, can alleviate suffering in our equine friends. Click here for the full story...

This year, 5th November is on a Tuesday - and that means we're not expecting a Fireworks Night so much as a Fireworks Week! As prey animals, horses are by their very nature predisposed to panic at loud noises, especially in the dark. Bright flashes of light don't help either! And panicked horses are rather inclined to run into things and hurt themselves (I've spent many hours stitching up horses who have lost arguments with fences, hedges, gates and stable walls). There are three important elements to keeping horses safe when there are fireworks in the air: 1) Help them to avoid injury 2) Distract them 3) Keep them calm To avoid injury, I generally recommend that horses be stabled when fireworks are expected. That probably means dusk to dawn for the next fortnight or so, but if possible, find out when displays are expected in your area. You can then focus on those dates and times (but don't forget that many people will set off a few rockets for themselves and their families). Inside their stables, horses can still become frightened, but they're not surrounded by the scary noises, and they can't bolt and get up so much speed, so they're less likely to cause themselves serious injuries. It can also be helpful to leave the stable light on overnight - more light inside the stable means flashes outside are less visible, but make sure your horse copes OK with the lights on overnight first! If you don't have stables, first of all, see if you can borrow one for a few nights, especially if you have a really spooky or nervous horse. If not, the next best thing is to "accident-proof" the field you're planning to turn them out in as far as possible - make sure the fencing is safe, remove any wire, fill in potholes, etc. Also, consider tying white or pale feed sacks to fencing, to make it more visible in poor light - tie them tightly, though, so they don't flap and cause a stampede themselves. Distraction just means keep them busy so they're less interested in what's going on outside. This generally means a well filled hay rack, and any toys your horse likes. Turnips on a rope are good, and horse balls filled with food or treats are a favourite with my two, who'll spend hours chasing the balls round the stable for a mouthful of pasture nuts! Finally, calming. For a herd animal like a horse, the most reassuring thing is having stable mates within sight/sound/smell - this is vital, and if they can touch noses or groom each other, its even better. However, it may not be enough on its own, especially for very nervous individuals. If your horse is particularly panicky, you should contact your vet (as soon as possible now), as they may need prescription medicines to help them cope. If possible, its best to avoid sedation, as it may lead to the horse becoming more nervous next year (as with dogs and cats), but unfortunately, horses are so big and powerful it may be necessary for their safety and yours. Your vet will be able to advise you on the best strategy for your horses. There is increasingly, however, a middle road, as there are a wide variety of calmers on the market. Most are based on magnesium or amino acid combinations; these can be good to take the edge off, but usually need long term use. Others (e.g. Calmex powder) are designed to work immediately, although there is often little scientific proof of their effectiveness. Another fairly new product on the market is Zylkene Equine. This is based on the milk protein casein, which studies suggest is broken down in the body into a benzodiazepine-like molecule. This has a similar effect to Valium to reduce anxiety and stress. As usual, I'd advise you to discuss with your vet the exact product you're thinking of using, as they'll be able to give you impartial advice as to how effective a product is likely to be. This is especially important if your horse is on any other medication: just because a product is natural or herbal doesn't mean it won't interact or interfere with another medicine. That said, not every horse needs anything extra - I'll never forget going to one yard on bonfire night evening and seeing a row of horses lined up at the fence watching the fireworks display two fields off with every sign of enjoyment... The bottom line is that you need to find out what works best for your horse: every horse is an individual, and they need to be managed as such. We may enjoy the fireworks - but not all of our horses do!

With the new financial year, and the recent bad weather, everyone involved in and working with horses is trying to make money go a bit further. Among other issues, the cost of medicines is rising every month (many drugs have seen their manufacturers put the price up 10 or 15% in the last few months), and feed bills are rising due to poor cereal harvests. As a result, I've put together a list of "top tips" for saving money in the coming year. Firstly, 5 things to do... 1) Make sure you worm smart - which doesn't necessarily mean often! Many owners still worm religiously every 6-8 weeks; however, recent studies have shown about that 80% of the worms are in 20% of the horses. If your horse doesn't have a high worm burden, it may be a waste of money pouring expensive wormers down him every other month. In addition, the more wormers we use, the higher the risk of worm resistance - there has been recognised round- or redworm resistance to every active ingredient available in the UK, so the less we use them, the longer they'll be effective. The way I like to recommend people go forward is to use Worm Egg Counts - your vet will be able to do these, or will have a lab they send them away to. The test simply takes a faeces sample and counts the worm eggs in it, giving you a good estimate of the number of worms in the horse. Remember, this test can only be done in the warmer months (the worms don't lay eggs in the winter!), and it only tests for nematodes (round and redworms). To test for tapeworms, your vet will need to take a blood sample, but this usually only needs doing once or at most twice a year. Depending on the test results, your vet will be able to advise you on the best worming strategy, and if you've got a low burden, it may not be necessary to worm at all, as long as your pasture management (poo-picking etc) is decent. I've seen horses wormed every month come back with such low counts that we stopped worming completely and, because they weren't mixing with lots of other horses, they were still worm free a year later. That said, I've also seen horses that really do need that regular dose, so it does depend on the yard, the herd and the individual horse. 2) Consider warming up with unaffiliated competitions - and beware direct debits! Skip past this one if you're not competing - but if you are, it may be possible to affiliate part way through the season, saving money by starting with cheaper unaffiliated events. How much you save depends on your sport, and your area (down here in Devon and Cornwall, unaffiliated events are are usually perhaps half to three quarters as much as an affiliated event), but at the very least you save the up-front cost of affiliation and membership. That said, you can't decide to cancel your affiliation if you've got a Direct Debit set up to automatcally renew it (as my brother found out this year, when he accidentally rejoined BE...!) 3) Buy medicines online. This is a fairly new area, and can be controversial. However, without any doubt you can save money on prescription drugs if you buy them from a reputable online pharmacy or dispensary. If your horse needs a prescription medicine, your vet is legally obliged to give you a written prescription if you ask for it (although they will normally charge an administration fee). In general, you can get the same medicines online for about half to two thirds the price. However, its important to make sure you deal with a reputable company: as a rule of thumb, if they don't ask for a prescription, or they're not based in the UK, don't touch them. In addition, you should check to see who is in charge of dispensing the medicines at that company - if they're legit, they'll be able to tell you the name and registration number of the pharmacist or vet who is responsible. Having worked in this sector, there are four companies I've dealt with who I would consider safe and reliable to buy from (AniMed Direct, MedicAnimal, MyVetMeds and VioVet), but that doesn't mean that there aren't other good ones out there. Bear in mind as well that a few companies change their prices through the day, and also make sure that the price includes VAT - if in doubt, phone them up and ask! Although it seems like a hassle, for long-term medication (like bute or Prascend) or really expensive drugs (like Gastrogard), you can make a massive saving buying online. 4) Shop around for insurance... It may be you can get a better deal from a different company! However, before you change, make sure that your level of cover won't be affected, and remember that you are legally obliged to disclose any relevant medical history. There are a couple of very bad insurers out there, and some fantastic ones, so do your research before changing - a company with a really cheap premium but who won't pay out when needed are a false economy. The other option is to cancel your insurance, and then set aside some money each month in a separate acount to cover vets bills. Do your sums first, but if you've got several horses it can save money to do it this way, and there's no worry about exclusions or wondering if they're going to pay out. 5) Does your horse NEED all those vaccines? Tetanus is a genuine life-saver. However, not every horse needs every other vaccine. If they're not competing, not mixing with other horses much and aren't on a big yard, its worth talking to your vet about flu vaccine, and if they're not breeding stock either, herpes vaccine probably isn't worth it. 6) If you have any health concerns about your horse - phone your vet! Most practice do not charge for a phonecall, and your vet will be able to advise you as to whether you need a visit, and if there's any treatment or first aid you can give. Beware of consulting "Dr Google" - its an easy way to scare yourself, because for some reason, Google always lists the most serious and rare diseases first. If you do want to check out your horse's symptoms online before calling your vet, I'd advise you to use the VetHelpDirect Symptom Checker - but talking to your vet is likely to be even more reliable! I once had a client call to arrange a visit for us to "sew up her mare after foaling". We thought that she meant the mare had torn a bit, but it turned out that she thought the foal was going to come bursting out of the mare's side like a alien parasite, and she was delighted when we were able to tell her that she didn't need to spend the £50 for an evening visit as long as the foaling went well... So, thats your things to do, now five things to watch out for: 1) DON'T skimp on Preventative Health. Tetanus vaccination is a genuine life-saver, and regular, routine dental care will save money in the long run. I once had to spend five hours basically repairing an 11 year old stallion's mouth because he'd never had any teeth rasped and the hooks had overgrown so much that one day he couldn't open his mouth enough to chew. For the previous six months the owners had been pouring expensive concentrates into this pony to try and get the weight back on, but it was due to his inability to chew properly. If they'd kept up to date with routine dental care, it would have saved them a lot of money, effort and time! 2) Be cautious with cheap paraprofessionals. There are a lot of horse dentists, chiropracters, massagers, physios and assorted back people out there. Many of them are very good, some aren't, and a few are downright dangerous. However, it isn't immediately obvious which is which... There are a couple of things to bear in mind when you're calling someone out. Firstly, it is a criminal offence for anyone who isn't a vet to diagnose a medical problem in a horse (with limited exceptions in the case of farriers dealing with a hoof problem, and BAEDT qualified dentists dealing with dental overgrowths). This means that your insurance policy will be invalidated if they make a diagnosis and act on it; it also means that in law you have no comeback if something goes wrong. In addition, if you allow anyone except a vet to prescribe or dispense a prescription only medicine to your horse (e.g. a dentist giving sedatives), you're both breaking the law. Remember too, even qualified physios technically need a referral from your vet before they're permitted to work on your horse. Secondly, it isn't necessarily a money saving technique to call in a paraprofessional. I remember seeing one client who had spent nearly a thousand pounds on physios, back people, chiropracters and alternative therapists, all of whom had given her a different diagnosis of her poorly performing pony. When my colleague was called out, she realised immediately that the horse was lame, and dug out an abscess from her nearside hind hoof. The horse was right as rain two days later - all for the princely sum of £48 plus a packet of animalintex. Thats not to say there isn't a place for paraprofessionals - BAEDT dentists, farriers, qualified physios and some other practtioners can be great to work with and bring a horse right again, but it needs to be a team exercise, as we all bring our different skills and expertise to the case. 3) DON'T buy ultra-cheap feed and fodder. Cheap, poor quality hay and haylage are never a good place to save money - if you're lucky, you're horse will need to eat more to maintain condition, and if you're unlucky, they'll suffer lung and sinus problems from spores, and possibly even listeria infection from bad haylage. 4) Be cautious about chopping and changing vets - many people use one vet for vaccines and another for out-of-hours and emergencies, or stud work. Sometimes this can save you money, but it can also lead to problems - a client of mine (who also used two other local vets) nearly lost one of her broodmares to a bad reaction to penicillin. It turned out that one of the vets had noted that the horse had reacted once before, but because they didn't know she was using the other practices, they didn't know to tell us. Fortunately in this case the mare survived, but it just goes to highlight the necessity for good communication. If you are going to use more than one practice, make sure that everyone knows who's involved and who's doing what, so that we can share notes if needed. Better still, make up your mind who you want to treat your horses, so they can provide continuity of care. Keeping horses is, by its very nature, expensive. However, with care and forethought, you can make the money stretch a bit further, even as the prices are going up.