Nocardioform placentitis is a frustrating and sometimes devastating diagnosis in broodmares. In this episode of StallSide, Theriogenologists, Dr. Maria Schnobrich and Dr. Karen Von Dollen take a closer look at how this condition develops, what makes it different from other forms of placentitis, and why early detection is important. They explain how expanding the definition to focal mucoid placentitis better describes this condition, then explore the clinical presentation, diagnostic tools, treatment strategies, and what current research and field experience suggests about prognosis and outcomes. Whether you're managing mares on the farm or supporting breeding operations, this episode offers practical, experience-driven insight into navigating high-risk late-term pregnancies. @roodandriddle
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Today's episode of the Stall Side Podcast is brought to you by Rood and Riddle Veterinary Pharmacy.
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Bart,
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how are you doing today?
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Nice day,
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foals are coming,
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hitting the ground.
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And,
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you know,
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we're going to talk a little bit about that today.
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Yeah,
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actually,
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we're going to talk about a really important syndrome,
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focal mucoid placentitis,
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which is colloquially known as no-cardia form.
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Yep,
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and there's some talk about it.
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There's a little bit of an uptick this year.
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So,
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what is it?
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Where do we...
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How do we treat it?
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What's the outcome?
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So,
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we have a couple of our experts from the hospital to talk to us about this.
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Yeah,
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we're very lucky today to have both Drs.
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Schnobrich and Von Dolan from the Theraginologist Service talking about this.
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And it's a very complicated syndrome.
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It's like very insidious onset,
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can be difficult to diagnose.
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There's really no systemic way that we can diagnose this condition in mares.
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We have to actually,
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like,
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ultrasound the mare to have a look at it.
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And it's a condition that nobody really knows what makes it occur in some mares.
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Can be sporadic,
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can occur in outbreaks.
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And so it's very complicated but potentially economically devastating.
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Yeah,
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it has some devastating effects.
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So let's get these two in here and talk to them about it.
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Yeah,
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okay.
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And so it's also this week we have Drs.
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Miraj Schnobrich and Karen Von Dolan from the Rudin-Riddle Theraginology Service talking about focal mucoid placentitis.
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You may know it as nocardia form.
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Snodrick and Von Dolan,
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welcome back to Storysite.
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Hi guys!
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It's a party today!
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Thank you for coming.
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Thanks for having us.
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Yeah,
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that's great.
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So,
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pretty interesting topic we're going to talk about today,
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and it's very timely.
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Nocardiform placentitis.
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So,
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would between the two of you like to describe what this syndrome is and how it's actually important reproductively to the mare?
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I would first like to,
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point of order,
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just move away from nocardiform placentitis and more broadly describe as focal-mucoid placentitis.
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Ah,
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that's right.
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Well,
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yes.
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Yes.
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So,
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do you want to explain why?
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Well,
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as recently shown by our colleague Pouyadini,
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it is not just nocardiform organisms that are present or can cause this classic presentation of this mucus present at the interface of the uterus and placenta.
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And so,
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you know,
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by limiting ourselves to nocardiform,
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we're pinning it into a narrow box that it doesn't deserve.
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And I think that's a really good point because,
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for a long time,
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people have thought about this as a very narrow syndrome.
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And actually,
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by expanding that out,
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maybe it's going to help us think about it a little bit differently.
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Because the problem with this syndrome is we can't reproduce it experimentally.
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We really are a little bit lost when it comes to the pathogenesis of it.
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But we're all pretty sure about what the effects are.
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So,
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would you like to describe what you will see in the pregnant mare when they're affected by this mucoid placentitis?
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Sure.
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Yeah,
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I can describe,
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basically,
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what we do know.
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And then we can kind of yo-yo...
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I'll correct you,
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like I did with Dr.
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Morrissey.
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Yeah,
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she's here to keep me on task.
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Keep me in.
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I have a low memory.
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Yeah?
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Good.
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She's tough.
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I love it.
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So,
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basically,
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what we do understand is that something is happening,
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not at the cervical start,
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which is where we see ascending placentitis.
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Usually,
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your vets are doing transrectal ultrasounds,
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and they'll see thickening of the placenta and bacteria coming from the vagina cranially,
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and causing a very severe inflammatory process that can end in abortion.
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This is really different,
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and we do think there's a local...
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We have a higher incidence here in Kentucky,
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but it's been found all over at this point.
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It's been reported in California,
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Pennsylvania,
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Maryland.
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So it's not just a Kentucky problem.
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We've had two kind of outbreak series around 2011 and 2020.
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And what it is,
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is when the mare delivers the foal and the fetal membranes,
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you'll see these brown peanut butter lesions at the base of the horns.
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And when they try to isolate the bacteria from those,
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they've traditionally been in this group that we call myocardioform.
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And what it is,
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is a slow...
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We don't know why or how it happens,
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but basically there's a loss of the connection between the fetal side and the maternal side.
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And then this purulent material kind of mucoid stuff develops there.
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It's really tricky,
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because with our traditional scanning and looking for it,
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a lot of times we don't find it until we have a mare either abort,
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or she has premature udder development,
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or bags up early.
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And then we know there's a problem.
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it doesn't always cause changes on ultrasound that we recognize.
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And it can go and progress to very large lesions before you actually have a problem.
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So it's a tricky disease for us to deal with.
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And as practitioners working in repro and trying to identify this,
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it is definitely challenging.
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It is thought to have less inflammation than the ascending placentitis,
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which results in kind of a tricky outcome when we talk about,
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if you identify it,
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is the fold definitely going to be small and dismature?
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Because we get such variability in the outcome.
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They can abort,
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they can have big lesions and abort a normal...
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or deliver a normal fold.
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There's so much variation depending...
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and why would you say that is?
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You're talking about,
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like,
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the uterus and growth restriction,
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or...
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Oh,
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I couldn't say for sure,
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but I think part of it is just the need for the growing fetus to have all of that placental surface area exchanging nutrients.
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And when you deprive them of a small area or a large area,
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then you're limiting the amount of groceries they can get from the dam.
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And so that's likely contributing to what we see clinically when they then are delivered.
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Yeah,
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yep,
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I would agree,
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yeah.
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And I think that's a good point to make,
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too,
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because they really do need all of that real estate,
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because essentially the uterus is maxed out,
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And especially late in gestation.
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That's why we start to see the problems those last month or two.
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Yeah,
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yeah.
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So,
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any sort of situations weather-wise,
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any situations farm-wise,
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anything that tends to be a pattern with the occurrence of this condition?
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You want to take that one?
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Sure,
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yeah.
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Well,
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it's been shown that there typically is an increase in cases after these long,
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dry summer drought conditions.
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It's the most consistent feature of these years where we have these big spikes in cases.
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But aside from that,
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we don't know a whole lot about how it happens,
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why it happens.
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And until we know that,
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preventing it and diagnosing it early are both going to be really challenging.
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And I was impressed with how much that they've done to try and figure out where it comes from,
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introducing it,
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breeding in the middle of their pregnancies,
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and just can't reproduce it.
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Yeah,
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they've given it intravenously,
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orally,
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like when we had MRLS.
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They found that by basically intubating with the setae from the caterpillars,
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it reproduced those signs.
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Well,
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they tried this with the bacteria that they were isolating from,
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the placentas that displayed the signs.
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They just couldn't get it.
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And Dr.
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Caniso did a lot of work on that with Dr.
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Ball.
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And that's been continued by some great researchers who are working on it now,
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and really trying to make some advances.
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And Dr.
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Fedorka did a great study here in Kentucky,
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looking at all these cases and trying to get information.
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And from the farms were great,
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they contributed blood samples,
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and of course that was a year that we didn't have a ton of it.
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So...
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But it's been...
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It is challenging.
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And hopefully,
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as we get some more assays to identify it,
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potentially in blood markers or things like that,
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we may learn more about the disease process.
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The organisms themselves,
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right?
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There tends to be a bit of a range.
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What is unique about these organisms,
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or what about their growth characteristics,
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lend themselves to turn up in this location,
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causing this problem?
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They live in the soil,
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and they go to this ventral part of the uterus,
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and they grow very,
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very slowly.
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They're branching ectomyces.
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Yep.
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Just kind of...
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They are...
00:08:23.000 - 00:08:23.170
Yeah,
00:08:23.170 - 00:08:23.500
as a group,
00:08:23.500 - 00:08:25.500
they're gram-positive,
00:08:25.500 - 00:08:27.500
usually found in the soil.
00:08:27.500 - 00:08:30.500
And in terms of saying why they grow in that area,
00:08:30.500 - 00:08:37.500
I think Huyadini did some good work looking at the DNA that was present in these placentas,
00:08:37.500 - 00:08:40.500
and what organisms were there,
00:08:40.500 - 00:08:49.500
and actually found a couple different things that sort of suggested we have a lot of bacteria and things that are present in the uterus,
00:08:49.500 - 00:08:50.500
even in normal pregnancies.
00:08:50.500 - 00:08:53.500
So what causes them to then proliferate,
00:08:53.500 - 00:08:54.500
we're trying to figure out.
00:08:54.500 - 00:09:09.500
And there is some new work suggesting that certain strains of the nocardioform-associated organisms might produce certain antimicrobial effects or things that inhibit the immune system.
00:09:09.500 - 00:09:11.500
So it may be something like that's that,
00:09:11.500 - 00:09:12.500
but honestly,
00:09:12.500 - 00:09:13.500
I have no idea.
00:09:13.500 - 00:09:15.500
I think we're still trying to figure that out.
00:09:15.500 - 00:09:18.500
But it is different a lot of times with our ascending placentas.
00:09:18.500 - 00:09:20.500
You have a beta strep infection,
00:09:20.500 - 00:09:23.500
and that is a very inflammatory process.
00:09:23.500 - 00:09:25.500
This really isn't.
00:09:25.500 - 00:09:25.809
I mean,
00:09:25.809 - 00:09:26.029
Dr.
00:09:26.029 - 00:09:30.110
Vondel has got some beautiful images that show if you went quickly over this lesion,
00:09:30.110 - 00:09:31.500
you wouldn't even notice it.
00:09:31.500 - 00:09:32.500
There's not a lot of edema.
00:09:32.500 - 00:09:35.500
It doesn't change the fetal fluids that much.
00:09:35.500 - 00:09:38.500
And we'll show you guys some of those images.
00:09:38.500 - 00:09:38.740
Yeah,
00:09:38.740 - 00:09:39.500
let's look at them.
00:09:39.500 - 00:09:39.950
Yeah,
00:09:39.950 - 00:09:40.500
yeah.
00:09:40.500 - 00:09:41.500
Whereas in ascending placentas,
00:09:41.500 - 00:09:43.500
the fluids change.
00:09:43.500 - 00:09:44.539
They get brighter,
00:09:44.539 - 00:09:46.500
which might suggest more protein.
00:09:46.500 - 00:09:49.500
And we don't see that as much with this.
00:09:49.500 - 00:09:49.799
All right,
00:09:49.799 - 00:09:50.070
go ahead,
00:09:50.070 - 00:09:50.220
Dr.
00:09:50.220 - 00:09:50.500
Vondel.
00:09:50.500 - 00:09:51.500
You got it?
00:09:51.500 - 00:09:54.500
So here's an ultrasound image trans-abdominally,
00:09:54.500 - 00:10:00.500
and you can see here that there is diffuse thickening of this C-tub region.
00:10:00.500 - 00:10:02.570
The fetus is deep to the screen,
00:10:02.570 - 00:10:04.500
and then the mare's body wall is close to the screen.
00:10:04.500 - 00:10:10.500
So this is almost 20 millimeters of depth of that abnormal C-tub.
00:10:10.500 - 00:10:11.840
And then here again,
00:10:11.840 - 00:10:13.470
a little bit more narrow,
00:10:13.470 - 00:10:14.500
just 13.
00:10:14.500 - 00:10:15.100
But again,
00:10:15.100 - 00:10:16.500
if you were going quickly,
00:10:16.500 - 00:10:21.500
it doesn't really jump out at you until when you're scanning,
00:10:21.500 - 00:10:23.500
you can just see the C-tub coming together here,
00:10:23.500 - 00:10:25.500
how it comes together,
00:10:25.500 - 00:10:26.500
and that exudate's not separating,
00:10:26.500 - 00:10:28.500
and then here it balloons out,
00:10:28.500 - 00:10:32.500
and then coming together again.
00:10:32.500 - 00:10:37.500
And so it can be easy to miss on trans-abdominal ultrasound.
00:10:37.500 - 00:10:43.500
And then the other really challenging thing about diagnosing these is just if you think about how large the uterus is,
00:10:43.500 - 00:10:54.500
and how limited we are in what we're able to actually visualize when we compare our little ultrasound probe and the mare's enormous abdomen.
00:10:54.500 - 00:10:59.500
And so it can be really hard to identify these lesions.
00:10:59.500 - 00:11:06.500
Here's a bit more of a dramatic bulge of the mucoid lesion,
00:11:06.500 - 00:11:13.500
where it really bulges here and is quite a larger abnormal region.
00:11:13.500 - 00:11:18.500
And this is all the same mare that I followed along during her disease progress.
00:11:18.500 - 00:11:19.129
And again,
00:11:19.129 - 00:11:20.500
this is all fetus here.
00:11:20.500 - 00:11:21.980
So here's some umbilical cord,
00:11:21.980 - 00:11:23.500
a little more umbilical cord,
00:11:23.500 - 00:11:24.500
fetal body here.
00:11:24.500 - 00:11:27.500
And this is our abnormal region.
00:11:27.500 - 00:11:32.820
And that's over four centimeters of separation of this thick,
00:11:32.820 - 00:11:34.500
tenacious exudate.
00:11:34.500 - 00:11:35.190
Again,
00:11:35.190 - 00:11:37.500
just illustrating that.
00:11:37.500 - 00:11:39.500
And here's another video of that,
00:11:39.500 - 00:11:43.500
how it comes together and then kind of...
00:11:43.500 - 00:11:45.500
And then it's really exciting,
00:11:45.500 - 00:11:46.710
because if you hold it,
00:11:46.710 - 00:11:48.580
you can see it swirl,
00:11:48.580 - 00:11:49.500
which is pretty gross.
00:11:49.500 - 00:11:50.210
It makes,
00:11:50.210 - 00:11:51.500
you know...
00:11:51.500 - 00:11:51.809
Well,
00:11:51.809 - 00:11:52.639
which is amazing,
00:11:52.639 - 00:11:54.500
because when you get it out physically,
00:11:54.500 - 00:11:55.500
there's no swirling there.
00:11:55.500 - 00:11:56.009
Right,
00:11:56.009 - 00:11:57.500
it's just this thick.
00:11:57.500 - 00:11:58.500
It's so thick.
00:11:58.500 - 00:11:59.059
And then,
00:11:59.059 - 00:12:01.080
the other thing that's interesting,
00:12:01.080 - 00:12:02.450
if you have a vet like Dr.
00:12:02.450 - 00:12:05.500
Von Dolan who's going to catch these early,
00:12:05.500 - 00:12:07.500
if you start treatment,
00:12:07.500 - 00:12:11.500
what's fascinating is a lot of times the fetal membranes that come out are just bald.
00:12:11.500 - 00:12:13.500
There's no slime.
00:12:13.500 - 00:12:14.029
So people say,
00:12:14.029 - 00:12:14.230
"Oh,
00:12:14.230 - 00:12:18.500
she didn't have nicardia form". But it may be that you treated it effectively,
00:12:18.500 - 00:12:20.500
but you've lost some of those microvilli.
00:12:20.500 - 00:12:21.009
So anyway,
00:12:21.009 - 00:12:22.500
that's another great picture.
00:12:22.500 - 00:12:24.100
If you're wondering what it looks like,
00:12:24.100 - 00:12:25.500
she's got some great pictures.
00:12:25.500 - 00:12:25.960
Well,
00:12:25.960 - 00:12:30.500
this was the same case that actually ended up falling out of the clinic.
00:12:30.500 - 00:12:33.490
And so this is that really...
00:12:33.490 - 00:12:43.500
just a lot of this classic thick pus that we're dealing with that's very classic for the disease process.
00:12:43.500 - 00:12:45.419
This foal was living,
00:12:45.419 - 00:12:50.620
but did not have adequate ossification of her carpal bones,
00:12:50.620 - 00:12:52.500
and so was humanely euthanized.
00:12:52.500 - 00:12:57.500
But illustrating the extent of this disease process.
00:12:57.500 - 00:12:57.899
Yeah,
00:12:57.899 - 00:12:59.500
it's pretty impressive.
00:12:59.500 - 00:13:00.500
And that's...
00:13:00.500 - 00:13:00.750
yeah,
00:13:00.750 - 00:13:02.500
I was sort of picking up on what you said before.
00:13:02.500 - 00:13:02.919
I mean,
00:13:02.919 - 00:13:06.500
like a strep ascending placentitis is a strep ascending placentitis,
00:13:06.500 - 00:13:08.139
but this group of organisms,
00:13:08.139 - 00:13:09.500
like being in the soil,
00:13:09.500 - 00:13:14.070
sort of going to favor those things in the grown-to-grown regions that maybe don't have so much oxygen,
00:13:14.070 - 00:13:14.500
right?
00:13:14.500 - 00:13:17.500
And so this is quite a unique location.
00:13:17.500 - 00:13:18.309
And another point,
00:13:18.309 - 00:13:19.769
people think the uterus is sterile,
00:13:19.769 - 00:13:20.500
but it's not.
00:13:20.500 - 00:13:22.500
And so they're sitting there,
00:13:22.500 - 00:13:26.500
and the way it sort of separates the membranes is sort of unique.
00:13:26.500 - 00:13:26.950
It is,
00:13:26.950 - 00:13:27.500
yeah.
00:13:27.500 - 00:13:28.500
And without...
00:13:28.500 - 00:13:30.500
as shown in her images,
00:13:30.500 - 00:13:31.320
very...
00:13:31.320 - 00:13:33.500
it just sort of slowly separates them,
00:13:33.500 - 00:13:35.500
but you don't see thickening over,
00:13:35.500 - 00:13:36.500
which is...
00:13:36.500 - 00:13:39.500
we think of thickening of the chorioallantois,
00:13:39.500 - 00:13:41.210
or the fetal portion,
00:13:41.210 - 00:13:43.500
as edema and inflammation.
00:13:43.500 - 00:13:44.940
And sometimes you don't see any of it,
00:13:44.940 - 00:13:45.500
so...
00:13:45.500 - 00:13:45.929
Yeah,
00:13:45.929 - 00:13:47.100
and that...
00:13:47.100 - 00:13:51.500
you mentioned some of the recent work by the group out of California and Belgium,
00:13:51.500 - 00:13:51.919
you know,
00:13:51.919 - 00:13:52.340
with Dr.
00:13:52.340 - 00:13:52.940
Deeney there,
00:13:52.940 - 00:13:55.500
is that when they're looking at some of the transcripts there,
00:13:55.500 - 00:13:58.500
the inflammatory response is not that high,
00:13:58.500 - 00:14:05.500
but there's actually also a down-regulation of the compounds that are involved in creating new blood vessels.
00:14:05.500 - 00:14:10.659
So you start to think it's creating this environment which is not very oxygen-rich,
00:14:10.659 - 00:14:13.500
but is pretty well nutrient-supplied.
00:14:13.500 - 00:14:15.500
So they're pretty sneaky bacteria to do this.
00:14:15.500 - 00:14:15.950
Yeah,
00:14:15.950 - 00:14:17.500
there's some...
00:14:17.500 - 00:14:18.250
and there is...
00:14:18.250 - 00:14:19.230
I think you had mentioned,
00:14:19.230 - 00:14:19.500
Bart,
00:14:19.500 - 00:14:26.500
we see it in that last month and there was a farm that I had followed every 30 days that had quite a bit of it,
00:14:26.500 - 00:14:32.500
and what I noticed is they really didn't develop lesions until 270 or later.
00:14:32.500 - 00:14:32.950
I mean,
00:14:32.950 - 00:14:37.500
sometimes the really bad cases from around 250 days you might see something,
00:14:37.500 - 00:14:38.750
but they would be fine,
00:14:38.750 - 00:14:39.120
boom,
00:14:39.120 - 00:14:39.490
boom,
00:14:39.490 - 00:14:39.860
boom,
00:14:39.860 - 00:14:42.500
and then all of a sudden you would see a lesion.
00:14:42.500 - 00:14:43.480
So it's interesting,
00:14:43.480 - 00:14:45.500
it's almost like the conditions are optimal.
00:14:45.500 - 00:14:47.500
And that's just us hypothesizing.
00:14:47.500 - 00:14:47.840
I mean,
00:14:47.840 - 00:14:48.500
it's...
00:14:48.500 - 00:14:48.840
Yeah,
00:14:48.840 - 00:14:51.500
it's not like we're seeing abortions at 180 days.
00:14:51.500 - 00:14:52.159
Right,
00:14:52.159 - 00:14:53.500
that's right.
00:14:53.500 - 00:14:54.350
It's all very,
00:14:54.350 - 00:14:55.000
very late,
00:14:55.000 - 00:14:56.500
last month type things.
00:14:56.500 - 00:14:57.500
Yeah.
00:14:57.500 - 00:15:01.590
So abortions is one potential outcome,
00:15:01.590 - 00:15:07.500
but you can have a foal that goes to term and then those foals are not born in a week.
00:15:07.500 - 00:15:07.820
So Peter,
00:15:07.820 - 00:15:09.500
why don't you take us through that just a little bit.
00:15:09.500 - 00:15:10.549
Because some of these,
00:15:10.549 - 00:15:11.500
when you find them,
00:15:11.500 - 00:15:13.500
they actually have a placental lesion,
00:15:13.500 - 00:15:14.500
they have this mucoid material,
00:15:14.500 - 00:15:16.500
but the foal is perfectly fine,
00:15:16.500 - 00:15:20.500
because then it comes down to how much of the real estate of the uterus has actually been involved,
00:15:20.500 - 00:15:23.500
and also whenabouts in that foal's development this came about.
00:15:23.500 - 00:15:25.500
So they can actually get through that,
00:15:25.500 - 00:15:26.500
and sometimes it's an incidental finding,
00:15:26.500 - 00:15:26.950
because,
00:15:26.950 - 00:15:27.399
you know,
00:15:27.399 - 00:15:29.500
we'll talk a little bit more about detecting this,
00:15:29.500 - 00:15:32.590
but sometimes it's exceptionally difficult to detect it,
00:15:32.590 - 00:15:35.500
because of its location and the fact that you may not necessarily be looking for it,
00:15:35.500 - 00:15:38.500
because the mare's not giving you the cues that she has a problem.
00:15:38.500 - 00:15:39.759
But some of the foals,
00:15:39.759 - 00:15:43.500
if this happens early enough in that period of late fetal development,
00:15:43.500 - 00:15:45.500
like the last six to eight weeks or so,
00:15:45.500 - 00:15:46.500
they are doubling in size in there.
00:15:46.500 - 00:15:49.610
And so their nutrient requirements,
00:15:49.610 - 00:15:52.500
and metabolically things are actually very,
00:15:52.500 - 00:15:53.500
very active.
00:15:53.500 - 00:15:59.500
So that fetus is grabbing every nutrient it can from the placental unit.
00:15:59.500 - 00:16:02.500
And so it's very unfortunate,
00:16:02.500 - 00:16:05.500
but some of these are very compromised late in the piece,
00:16:05.500 - 00:16:07.259
and if they are delivered early,
00:16:07.259 - 00:16:11.500
they seem to have had the stress response where they actually get pulmonary development.
00:16:11.500 - 00:16:13.500
So they are actually viable,
00:16:13.500 - 00:16:20.500
but from an athlete they're not viable because the ossification of the cubital bones especially is not accelerated by that stress response.
00:16:20.500 - 00:16:26.500
So you'll have foals that actually are perfectly viable from a life standpoint,
00:16:26.500 - 00:16:29.500
but they're actually not viable from an athletic standpoint.
00:16:29.500 - 00:16:31.500
And those are really the unfortunate ones.
00:16:31.500 - 00:16:33.950
And they can get to like early 320,
00:16:33.950 - 00:16:42.559
sometimes mid 320 days of gestation and we have that scenario and then you suddenly start to realise how important it is that they get all the nutrition that they need,
00:16:42.559 - 00:16:51.500
that their uterine environment is perfect and they get as long as they need and their residence in utero is not shortened by this condition.
00:16:51.500 - 00:16:56.500
So it's difficult from that standpoint in that sometimes you don't know this is going on,
00:16:56.500 - 00:16:58.620
but backing up a little bit,
00:16:58.620 - 00:17:00.500
how do we detect this in the mare?
00:17:00.500 - 00:17:00.940
You know,
00:17:00.940 - 00:17:01.769
what is available,
00:17:01.769 - 00:17:02.500
what's coming,
00:17:02.500 - 00:17:07.500
but in a field situation you guys are faced with where you see maybe a little bit of precocious mammary development,
00:17:07.500 - 00:17:12.500
what's your thought process going through for how you're actually going to detect this condition?
00:17:12.500 - 00:17:12.950
Yeah,
00:17:12.950 - 00:17:16.500
and maybe you can go through the screening that we do.
00:17:16.500 - 00:17:19.500
One thing that I would like to answer,
00:17:19.500 - 00:17:21.500
because we see such variability in the foals,
00:17:21.500 - 00:17:23.579
a lot of times you'll hear the argument,
00:17:23.579 - 00:17:25.500
if the mare is precocious at her development,
00:17:25.500 - 00:17:26.630
there's no point in treating her,
00:17:26.630 - 00:17:27.500
you're already too far,
00:17:27.500 - 00:17:29.500
you're not going to get a good foal.
00:17:29.500 - 00:17:37.500
And I think with this disease it's really important to understand that you still can get a viable foal with treatment and resolution.
00:17:37.500 - 00:17:43.500
You're not going to get the placenta or the fetal membranes to reattach to the dam's uterus,
00:17:43.500 - 00:17:49.500
but there are mares that we've looked at that you look at lesions and say we're in big trouble,
00:17:49.500 - 00:17:50.500
and they get a healthy foal.
00:17:50.500 - 00:17:51.720
So don't give up,
00:17:51.720 - 00:17:52.500
I guess.
00:17:52.500 - 00:17:54.500
It's important to understand that the foals are born,
00:17:54.500 - 00:17:54.980
they're not septic,
00:17:54.980 - 00:17:56.500
they're not affected by the bacteria,
00:17:56.500 - 00:17:59.599
it's stuck in between that layer between the placenta and the uterus,
00:17:59.599 - 00:18:01.500
and it's not getting to the foals.
00:18:01.500 - 00:18:03.500
They just weren't getting enough to eat.
00:18:03.500 - 00:18:05.500
And if you can keep them in there,
00:18:05.500 - 00:18:07.500
I've been pleasantly surprised how well some of these will come out.
00:18:07.500 - 00:18:07.769
Yes,
00:18:07.769 - 00:18:08.500
absolutely.
00:18:08.500 - 00:18:09.500
And you're right.
00:18:09.500 - 00:18:11.500
And you look at the placenta and you're talking about the avilis nature of the placenta,
00:18:11.500 - 00:18:13.170
and you look at it and say,
00:18:13.170 - 00:18:13.550
wow,
00:18:13.549 - 00:18:15.579
this was a significant lesion,
00:18:15.579 - 00:18:18.500
or we've seen the pictures like have been shown previously,
00:18:18.500 - 00:18:20.500
of all this detachment,
00:18:20.500 - 00:18:22.500
and they actually manage to get through that if you treat them.
00:18:22.500 - 00:18:24.630
So let's talk a little bit about detection,
00:18:24.630 - 00:18:26.500
and then let's move to treatment.
00:18:26.500 - 00:18:29.500
I thought each of you just raised really good points,
00:18:29.500 - 00:18:35.119
and yours with the rapid increase in the metabolic requirement that I hadn't previously thought of,
00:18:35.119 - 00:18:36.500
but that's such a good point.
00:18:36.500 - 00:18:38.500
And then to highlight the lack of sepsis in the foal,
00:18:38.500 - 00:18:40.500
that's also critical to remember,
00:18:40.500 - 00:18:43.500
because it's very different from our ascending placentatus cases,
00:18:43.500 - 00:18:45.500
where those foals can be so sick.
00:18:45.500 - 00:18:47.710
But in terms of screening,
00:18:47.710 - 00:18:48.279
yeah,
00:18:48.279 - 00:18:52.500
keeping regular serial monitoring transrectally,
00:18:52.500 - 00:18:54.500
and then as you get into later gestation,
00:18:54.500 - 00:18:55.599
transabdominally,
00:18:55.599 - 00:18:59.779
is going to allow you to catch these before they become externally apparent,
00:18:59.779 - 00:19:02.500
where you are playing a little bit of catch-up.
00:19:02.500 - 00:19:04.319
So if you can catch it beforehand,
00:19:04.319 - 00:19:06.500
get that mare on appropriate treatment,
00:19:06.500 - 00:19:09.500
based on seeing something on ultrasound,
00:19:09.500 - 00:19:12.500
then we can do a lot of good with these cases.
00:19:12.500 - 00:19:15.690
And it is an investment to do this,
00:19:15.690 - 00:19:18.500
from both time and finances,
00:19:18.500 - 00:19:21.500
but can be really well worth it if it means saving the foal.
00:19:21.500 - 00:19:22.130
Yeah,
00:19:22.130 - 00:19:23.500
absolutely.
00:19:23.500 - 00:19:24.500
And I think some people,
00:19:24.500 - 00:19:26.500
we know what the treatment is for placentitis,
00:19:26.500 - 00:19:30.500
so the temptation is just to maybe treat everything,
00:19:30.500 - 00:19:32.500
and that may hold...
00:19:32.500 - 00:19:38.500
It probably does do positive things in some cases,
00:19:38.500 - 00:19:40.650
but if you don't know how big the lesion is,
00:19:40.650 - 00:19:41.500
initially,
00:19:41.500 - 00:19:43.500
it's hard to gauge if you're...
00:19:43.500 - 00:19:46.500
Because sometimes the antibiotics you're using may not be appropriate,
00:19:46.500 - 00:19:48.529
so the screening is really helpful,
00:19:48.529 - 00:19:51.500
because we can initially see how big is the lesion.
00:19:51.500 - 00:19:54.500
Is it getting better or worse with our treatment?
00:19:54.500 - 00:19:56.500
Because we may need to modify treatment.
00:19:56.500 - 00:19:58.500
So there really is...
00:19:58.500 - 00:20:03.500
I know a lot of farms that have pretty good success with kind of the blanket treatment one week a month.
00:20:03.500 - 00:20:05.500
We're really trying to get away from that,
00:20:05.500 - 00:20:07.500
for a couple of reasons.
00:20:07.500 - 00:20:12.500
But it's a decision that the farm manager has to make based on finances and things like that.
00:20:12.500 - 00:20:14.500
And there are also...
00:20:14.500 - 00:20:19.849
Another thing that's frustrating about this disease is a lot of the blood tests that you might think would help,
00:20:19.849 - 00:20:23.500
such as serum amyloid A or some of the inflammatory markers,
00:20:23.500 - 00:20:26.220
are really not helpful in these chronic,
00:20:26.220 - 00:20:28.500
slow-growing disease processes.
00:20:28.500 - 00:20:32.500
And even the total estrogens and progestogens...
00:20:32.500 - 00:20:42.500
And there was a recent study that said that the progestogen ratios and albumin is very sensitive for ascending placentitis.
00:20:42.500 - 00:20:44.500
We don't have something like that.
00:20:44.500 - 00:20:45.500
A blood test at the moment...
00:20:45.500 - 00:20:46.500
There are some in the works,
00:20:46.500 - 00:20:49.500
but at the moment we don't have something that's a slam-dunk.
00:20:49.500 - 00:20:49.990
Well,
00:20:49.990 - 00:20:54.500
that gets back to the way this disease occurs and its location.
00:20:54.500 - 00:20:55.500
It's sort of actually quite local,
00:20:55.500 - 00:20:56.500
right?
00:20:56.500 - 00:21:02.500
And so for that mare to systemically notice that something's going on between all of those layers,
00:21:02.500 - 00:21:07.500
between where the mucoid material is and the bloodstream,
00:21:07.500 - 00:21:08.500
I mean,
00:21:08.500 - 00:21:10.500
it's very difficult to detect that.
00:21:10.500 - 00:21:12.500
And if you were looking for inflammatory markers,
00:21:12.500 - 00:21:13.500
you mentioned SAA.
00:21:13.500 - 00:21:13.720
Well,
00:21:13.720 - 00:21:15.500
that was going to be the great saviour for everything,
00:21:15.500 - 00:21:16.500
and especially in this situation.
00:21:16.500 - 00:21:17.500
But you're right.
00:21:17.500 - 00:21:21.500
It's been and gone by the time that this condition becomes a problem.
00:21:21.500 - 00:21:25.960
And how do we have anything that's going on in there that's actually going to be systemically recognised by the mare,
00:21:25.960 - 00:21:26.500
number one.
00:21:26.500 - 00:21:27.500
Number two,
00:21:27.500 - 00:21:32.500
there's so many other processes going on in the mare where all of these markers may be involved.
00:21:32.500 - 00:21:33.500
How do you actually get the signal from the noise?
00:21:33.500 - 00:21:36.500
So it's really going to come down to you guys with the ultrasound.
00:21:36.500 - 00:21:38.240
And it's not easy always to find,
00:21:38.240 - 00:21:39.500
with the ultrasound,
00:21:39.500 - 00:21:40.500
to just serially monitor.
00:21:40.500 - 00:21:42.500
And I think that's something to hammer home,
00:21:42.500 - 00:21:44.500
is you must look and you must serially monitor these mares.
00:21:44.500 - 00:21:48.500
Because sometimes we have dystocia come into the hospital as an incidental finding.
00:21:48.500 - 00:21:49.279
She's termed,
00:21:49.279 - 00:21:50.299
the foal is normal,
00:21:50.299 - 00:21:51.609
the placenta comes out,
00:21:51.609 - 00:21:55.500
and all of a sudden we've got this mucoid plaque.
00:21:55.500 - 00:21:58.500
Or routine foal watchers come in for another reason.
00:21:58.500 - 00:22:00.500
Say she has an orthopedic issue and we're scanning them.
00:22:00.500 - 00:22:01.599
And it sort of says,
00:22:01.599 - 00:22:01.990
"Hey,
00:22:01.990 - 00:22:07.579
why have one problem when you can have two?" But even the problem with serial scans is,
00:22:07.579 - 00:22:09.900
it doesn't do you any good to start looking at eight,
00:22:09.900 - 00:22:10.500
nine months.
00:22:10.500 - 00:22:11.500
You're not going to find it.
00:22:11.500 - 00:22:15.500
You're not going to see it until so much later.
00:22:15.500 - 00:22:19.500
It has an advantage on us because we can't find it until it's fairly well advanced.
00:22:19.500 - 00:22:20.160
I agree.
00:22:20.160 - 00:22:20.809
I agree.
00:22:20.809 - 00:22:23.250
And I do think screening's important,
00:22:23.250 - 00:22:25.500
but I think it's in this later stage.
00:22:25.500 - 00:22:33.500
And hopefully there's some very smart people working on blood tests that are going to be useful for us to limit the screening that we do.
00:22:33.500 - 00:22:34.269
So ideally,
00:22:34.269 - 00:22:35.809
you could do a blood test,
00:22:35.809 - 00:22:38.650
identify animals that have markers for this,
00:22:38.650 - 00:22:40.500
and then use the ultrasound.
00:22:40.500 - 00:22:42.500
So that you're not having to screen the whole group.
00:22:42.500 - 00:22:44.230
But I truly believe now,
00:22:44.230 - 00:22:47.910
the best way to find it is doing the trans-abdominal,
00:22:47.910 - 00:22:49.500
not the trans-rectal.
00:22:49.500 - 00:22:50.730
Because the trans-rectal,
00:22:50.730 - 00:22:51.390
a lot of times,
00:22:51.390 - 00:22:53.500
you won't find it unless it's very advanced.
00:22:53.500 - 00:22:53.990
Yeah.
00:22:53.990 - 00:22:56.500
Price of freedom is eternal vigilance.
00:22:56.500 - 00:22:57.500
Anxiety.
00:22:57.500 - 00:22:59.069
That's one of your American favorite things,
00:22:59.069 - 00:22:59.500
isn't it?
00:22:59.500 - 00:22:59.809
Yeah,
00:22:59.809 - 00:23:00.500
there you go.
00:23:00.500 - 00:23:02.259
So now we've actually found this lesion,
00:23:02.259 - 00:23:03.500
no matter what size it is.
00:23:03.500 - 00:23:06.500
How are you guys going to have the conversation with your client?
00:23:06.500 - 00:23:09.059
This is how we need to treat,
00:23:09.059 - 00:23:11.500
and this is the duration,
00:23:11.500 - 00:23:13.500
and how do we move stepwise through the drugs that we have,
00:23:13.500 - 00:23:15.500
depending on the severity that you find.
00:23:15.500 - 00:23:16.480
You want to field that,
00:23:16.480 - 00:23:17.500
whatever you tell me.
00:23:17.500 - 00:23:17.839
I'll start,
00:23:17.839 - 00:23:18.500
and then you fill in.
00:23:18.500 - 00:23:18.789
Okay,
00:23:18.789 - 00:23:19.500
sounds great.
00:23:19.500 - 00:23:19.950
Okay,
00:23:19.950 - 00:23:20.500
okay.
00:23:20.500 - 00:23:21.500
There'll be a lot and nothing with someone.
00:23:21.500 - 00:23:22.500
Go for it.
00:23:22.500 - 00:23:22.869
Also,
00:23:22.869 - 00:23:24.500
if we see a definitive lesion,
00:23:24.500 - 00:23:28.500
then antibiotics are obviously going to have to be part of our treatment protocol.
00:23:28.500 - 00:23:33.500
Another challenge of these is that we can't go in and just get a sample of that for culture and cytology.
00:23:33.500 - 00:23:34.549
That would tell us,
00:23:34.549 - 00:23:36.920
"Here's what drug we use for this". And so,
00:23:36.920 - 00:23:45.500
we're treating empirically based on what we know about the behavior of the majority of these bugs in lab conditions.
00:23:45.500 - 00:23:46.170
And so,
00:23:46.170 - 00:23:51.500
we have some broad-spectrum antibiotics that we can reach for.
00:23:51.500 - 00:23:53.210
Sulfas and genomicin,
00:23:53.210 - 00:23:54.470
or doxycycline,
00:23:54.470 - 00:23:58.500
have been typically the ones that we'll start with.
00:23:58.500 - 00:24:00.690
If I start a mare on one of those,
00:24:00.690 - 00:24:02.500
and I'm monitoring her,
00:24:02.500 - 00:24:05.500
and I'm not pleased with the progression of the visible lesion,
00:24:05.500 - 00:24:08.500
then I'll typically have a brief washout period,
00:24:08.500 - 00:24:10.500
make sure she's on a probiotic,
00:24:10.500 - 00:24:14.500
and then flip-flop antibiotics to see if the other one is going to have a greater effect.
00:24:14.500 - 00:24:15.240
And then,
00:24:15.240 - 00:24:18.500
as a mainstay of all these placentitis cases,
00:24:18.500 - 00:24:21.500
also having these on anti-inflammatories,
00:24:21.500 - 00:24:25.579
progestin support to promote myometrial quiescence,
00:24:25.579 - 00:24:28.500
and anti-inflammatories,
00:24:28.500 - 00:24:31.500
and then anything we can do to improve blood flow through these compromised regions of the placenta.
00:24:31.500 - 00:24:33.500
Do you have a preference for anti-inflammatories?
00:24:33.500 - 00:24:34.130
Yeah.
00:24:34.130 - 00:24:34.490
So,
00:24:34.490 - 00:24:35.390
actually,
00:24:35.390 - 00:24:37.500
thanks to Mariah's input,
00:24:37.500 - 00:24:43.500
I have started using Flunix and Meglumin at the start of when I diagnosed a case of these,
00:24:43.500 - 00:24:46.700
and then switching around to Firacoxib,
00:24:46.700 - 00:24:53.500
and have been really impressed with how quickly the bandamine really can take down the inflammation,
00:24:53.500 - 00:24:56.500
and especially if they have premature mammary development,
00:24:56.500 - 00:24:58.500
it can have some pretty rapid resolution there.
00:24:58.500 - 00:25:04.500
And then keeping her on Firacoxib with less side effects for more long-term maintenance.
00:25:04.500 - 00:25:14.500
And then keeping your point about how you're never going to get that placenta to re-fuse where that abnormal region is,
00:25:14.500 - 00:25:19.500
and so keeping her on some supportive meds out of consideration for that.
00:25:19.500 - 00:25:20.500
Okay.
00:25:20.500 - 00:25:21.500
You mentioned blood flow to the uterus,
00:25:21.500 - 00:25:22.710
so the classic one's aspirin,
00:25:22.710 - 00:25:23.500
pentoxifilin?
00:25:23.500 - 00:25:23.769
Yep,
00:25:23.769 - 00:25:24.500
absolutely.
00:25:24.500 - 00:25:24.950
Okay,
00:25:24.950 - 00:25:25.500
both.
00:25:25.500 - 00:25:27.779
And it goes without saying,
00:25:27.779 - 00:25:29.970
if you start some of these,
00:25:29.970 - 00:25:31.109
for example,
00:25:31.109 - 00:25:33.500
if you have them on aspirin,
00:25:33.500 - 00:25:35.500
banamine,
00:25:35.500 - 00:25:37.559
pentoxifilin,
00:25:37.559 - 00:25:38.500
genomicin,
00:25:38.500 - 00:25:40.329
it's good to also screen the effects,
00:25:40.329 - 00:25:43.500
because some of these can be very hard on the gut and the kidney,
00:25:43.500 - 00:25:48.500
so you can do certain things like gastrogard to try to prevent ulcers,
00:25:48.500 - 00:25:50.500
just thinking about the whole horse.
00:25:50.500 - 00:25:52.259
And I think you asked the question,
00:25:52.259 - 00:25:56.500
"How long are you on?" It really depends on how big the lesion is and how it responds.
00:25:56.500 - 00:26:03.500
So there is a possibility of taking them off quite a bit of the medication if you see enough improvement.
00:26:03.500 - 00:26:09.500
And I've seen mares go from 4-centimeter pockets one week to gone.
00:26:09.500 - 00:26:11.500
You can't see it,
00:26:11.500 - 00:26:14.500
but you can tell there's something different in that interface.
00:26:14.500 - 00:26:18.500
So it's pretty impressive.
00:26:18.500 - 00:26:19.000
And also it's interesting,
00:26:19.000 - 00:26:19.500
we can monitor...
00:26:19.500 - 00:26:20.500
We've used this,
00:26:20.500 - 00:26:21.369
you've used this too,
00:26:21.369 - 00:26:21.500
Peter,
00:26:21.500 - 00:26:23.099
is the total estrogens,
00:26:23.099 - 00:26:27.500
which is a marker of fetal viability and also placental function.
00:26:27.500 - 00:26:28.980
And a lot of times when we take this,
00:26:28.980 - 00:26:30.500
if they're before 300 days,
00:26:30.500 - 00:26:32.500
we see it can be very low,
00:26:32.500 - 00:26:34.500
which would suggest it's very compromised.
00:26:34.500 - 00:26:35.849
And with treatment,
00:26:35.849 - 00:26:37.650
that will actually rise up,
00:26:37.650 - 00:26:41.500
which would suggest you're having some positive effect.
00:26:41.500 - 00:26:42.279
A lot of it's,
00:26:42.279 - 00:26:42.880
you know,
00:26:42.880 - 00:26:44.500
you're hypothesizing it,
00:26:44.500 - 00:26:46.500
but we do see improvement of clinical signs,
00:26:46.500 - 00:26:48.500
improvement of outcome.
00:26:48.500 - 00:26:49.779
You can't save them all,
00:26:49.779 - 00:26:50.930
but if you want to try,
00:26:50.930 - 00:26:52.500
I think it's worth trying.
00:26:52.500 - 00:26:53.819
And to talk to the client,
00:26:53.819 - 00:26:54.900
if it's a big lesion,
00:26:54.900 - 00:26:57.500
they're going to probably be on these medications,
00:26:57.500 - 00:27:00.500
because you're just trying to stop its progression.
00:27:00.500 - 00:27:02.500
Hopefully you can get the bacteria to regress,
00:27:02.500 - 00:27:10.500
but the biggest thing is making sure that that separation and loss of interface doesn't continue to expand,
00:27:10.500 - 00:27:12.500
so that you really don't get enough nutrients.
00:27:12.500 - 00:27:12.750
Well,
00:27:12.750 - 00:27:13.500
that's the thing.
00:27:13.500 - 00:27:15.500
You can't restore that placental function,
00:27:15.500 - 00:27:17.500
but at least you can stop the deterioration.
00:27:17.500 - 00:27:17.750
Now,
00:27:17.750 - 00:27:19.660
you mentioned a couple of antibacterials,
00:27:19.660 - 00:27:20.690
potentiated sulfurs,
00:27:20.690 - 00:27:21.500
doxycycline.
00:27:21.500 - 00:27:24.500
Is there anything that is really not effective in this situation?
00:27:24.500 - 00:27:24.910
Because,
00:27:24.910 - 00:27:25.319
you know,
00:27:25.319 - 00:27:27.500
we are limited in choices we have in equine medicine.
00:27:27.500 - 00:27:28.500
Yeah.
00:27:28.500 - 00:27:32.500
But is there anything out there that's sort of been tried and really hasn't done in your hands,
00:27:32.500 - 00:27:33.500
your experience?
00:27:33.500 - 00:27:34.500
Ceftivir.
00:27:34.500 - 00:27:34.839
Yeah,
00:27:34.839 - 00:27:35.500
Ceftivir.
00:27:35.500 - 00:27:35.769
I mean,
00:27:35.769 - 00:27:37.500
I think when we think about treating placentitis,
00:27:37.500 - 00:27:46.500
one of the things that we look for are medications that can travel from the maternal blood into the fetal fluids.
00:27:46.500 - 00:27:47.029
And so,
00:27:47.029 - 00:27:47.640
really,
00:27:47.640 - 00:27:56.500
there are antibiotics that have been tested and do reach reasonable concentrations that they should kill the bacteria that we see.
00:27:56.500 - 00:27:57.069
Again,
00:27:57.069 - 00:27:58.500
this is debatable,
00:27:58.500 - 00:27:59.500
but that would be penicillin,
00:27:59.500 - 00:28:00.500
genomicin,
00:28:00.500 - 00:28:02.500
doxycycline,
00:28:02.500 - 00:28:03.849
enrofloxacin,
00:28:03.849 - 00:28:06.500
and the sulfas.
00:28:06.500 - 00:28:07.220
And then,
00:28:07.220 - 00:28:13.500
Ceftivir Exceed is unfortunately not one that we see that gets across the fetal membrane.
00:28:13.500 - 00:28:13.690
So,
00:28:13.690 - 00:28:14.410
in this disease,
00:28:14.410 - 00:28:15.630
it would be questionable,
00:28:15.630 - 00:28:18.500
because you could be treating the endometrium,
00:28:18.500 - 00:28:20.500
which it reaches good.
00:28:20.500 - 00:28:24.500
But I would probably be wanting to go with something that crosses the membranes,
00:28:24.500 - 00:28:25.500
just so you get the best.
00:28:25.500 - 00:28:25.750
Well,
00:28:25.750 - 00:28:27.500
the other thing is a compliance issue as well.
00:28:27.500 - 00:28:30.500
Because if you're in a situation where you're repeatedly injecting this mare,
00:28:30.500 - 00:28:33.380
if you're using a depo Ceftivir preparation,
00:28:33.380 - 00:28:37.500
she ain't going to want to be injected every three to five days.
00:28:37.500 - 00:28:38.500
That's right.
00:28:38.500 - 00:28:43.500
And it's not great if you get a colitis and you still have them on a long-acting antibiotic.
00:28:43.500 - 00:28:43.890
So,
00:28:43.890 - 00:28:45.660
in any placentitis,
00:28:45.660 - 00:28:47.589
it is really tricky,
00:28:47.589 - 00:28:51.500
because you have them on so many medications that if the foal dies,
00:28:51.500 - 00:28:57.500
there's a high likelihood that she will just retain the dead conceptus in the membrane.
00:28:57.500 - 00:28:57.759
So,
00:28:57.759 - 00:29:01.500
making sure that that fetus is still viable is really important.
00:29:01.500 - 00:29:03.500
You can't just put them on the meds and say,
00:29:03.500 - 00:29:05.759
"I'll see you in two months". You need to keep checking,
00:29:05.759 - 00:29:07.500
because she could develop...
00:29:07.500 - 00:29:09.119
The fetus could die and just sit in there,
00:29:09.119 - 00:29:10.500
and then she could get very sick,
00:29:10.500 - 00:29:12.500
just like a retained membrane.
00:29:12.500 - 00:29:12.799
So,
00:29:12.799 - 00:29:15.500
that's another kind of consideration.
00:29:15.500 - 00:29:15.930
Yeah,
00:29:15.930 - 00:29:16.210
so,
00:29:16.210 - 00:29:17.950
the question's going to be,
00:29:17.950 - 00:29:18.740
my mare has,
00:29:18.740 - 00:29:19.500
you know,
00:29:19.500 - 00:29:21.500
mucoid placentitis this year.
00:29:21.500 - 00:29:23.500
Is she going to do it again?
00:29:23.500 - 00:29:23.920
Oh,
00:29:23.920 - 00:29:25.500
good question.
00:29:25.500 - 00:29:27.849
Karen knows the answer to this,
00:29:27.849 - 00:29:29.500
so I'll let her know.
00:29:29.500 - 00:29:30.609
Fortunately,
00:29:30.609 - 00:29:34.500
no evidence that it is more likely to recur in mares.
00:29:34.500 - 00:29:36.500
We know that it's over-represented in older mares,
00:29:36.500 - 00:29:37.849
but that's the one,
00:29:37.849 - 00:29:38.339
like,
00:29:38.339 - 00:29:40.589
mare factor that has been shown,
00:29:40.589 - 00:29:43.500
but doesn't affect her future fertility,
00:29:43.500 - 00:29:45.500
even in that same season.
00:29:45.500 - 00:29:50.809
Very few mares will even culture these dicardiform-type organisms on,
00:29:50.809 - 00:29:54.500
if you were to lavage them after delivery of a dicardiform-type fetus.
00:29:54.500 - 00:29:55.559
So that's wonderful.
00:29:55.559 - 00:29:56.650
That's good news for us,
00:29:56.650 - 00:29:58.500
that it doesn't persist and linger.
00:29:58.500 - 00:29:58.930
Yeah,
00:29:58.930 - 00:30:00.750
that's a really good point.
00:30:00.750 - 00:30:01.619
They're not,
00:30:01.619 - 00:30:02.269
you know,
00:30:02.269 - 00:30:03.950
the next breeding season,
00:30:03.950 - 00:30:06.640
if the mare had a dicardiform abortion,
00:30:06.640 - 00:30:08.500
or you saw it on the placenta,
00:30:08.500 - 00:30:09.829
you're not concerned,
00:30:09.829 - 00:30:10.420
you know,
00:30:10.420 - 00:30:14.500
I'm not concerned with that mare going into the next breeding season.
00:30:14.500 - 00:30:15.259
It doesn't mean that,
00:30:15.259 - 00:30:15.619
you know,
00:30:15.619 - 00:30:17.500
whereas if she had high drops or something like that,
00:30:17.500 - 00:30:19.500
there can be some really negative...
00:30:19.500 - 00:30:19.809
Yeah,
00:30:19.809 - 00:30:20.809
or a cervical defect,
00:30:20.809 - 00:30:22.500
and you've got to send a placenta.
00:30:22.500 - 00:30:22.900
Right,
00:30:22.900 - 00:30:23.500
exactly.
00:30:23.500 - 00:30:24.440
But at the same time,
00:30:24.440 - 00:30:26.019
they're not developing immunity,
00:30:26.019 - 00:30:26.500
right?
00:30:26.500 - 00:30:31.500
So they're not immune from it the next year.
00:30:31.500 - 00:30:32.500
That's exactly right.
00:30:32.500 - 00:30:33.500
Which is too bad.
00:30:33.500 - 00:30:38.619
Which really makes you sort of think it's like a set of conditions in that uterus,
00:30:38.619 - 00:30:42.500
and maybe some environmental impact that actually creates environment.
00:30:42.500 - 00:30:44.900
And it's so remote from the mare's immune system anyway,
00:30:44.900 - 00:30:45.299
really,
00:30:45.299 - 00:30:46.500
when you think about it.
00:30:46.500 - 00:30:46.759
So,
00:30:46.759 - 00:30:49.079
you mentioned it occurs in other places,
00:30:49.079 - 00:30:51.500
this is taking things back a little bit.
00:30:51.500 - 00:30:55.500
Are there any areas which it occurs more often than others?
00:30:55.500 - 00:30:55.890
Oh,
00:30:55.890 - 00:30:58.500
necartiform specifically?
00:30:58.500 - 00:30:59.500
Yeah.
00:30:59.500 - 00:31:02.500
In the United States?
00:31:02.500 - 00:31:02.720
Yeah,
00:31:02.720 - 00:31:03.500
in the United States.
00:31:03.500 - 00:31:03.859
Oh,
00:31:03.859 - 00:31:04.500
okay.
00:31:04.500 - 00:31:04.990
Yeah,
00:31:04.990 - 00:31:07.500
I would say Kentucky is a hot spot.
00:31:07.500 - 00:31:10.500
I know that it's reported...
00:31:10.500 - 00:31:15.500
I know around this region is a big issue.
00:31:15.500 - 00:31:16.500
Yeah.
00:31:16.500 - 00:31:21.220
And there are also horses that have shipped from New York or wherever,
00:31:21.220 - 00:31:23.500
and they will develop it later.
00:31:23.500 - 00:31:23.789
So,
00:31:23.789 - 00:31:25.500
we see all sorts of variations of it.
00:31:25.500 - 00:31:31.500
Horses that have been in Kentucky and get shipped north in areas that it's not endemic or not an issue,
00:31:31.500 - 00:31:36.500
and that year they'll have mares that were on the farm and shipped in that have the lesions.
00:31:36.500 - 00:31:36.960
So,
00:31:36.960 - 00:31:41.500
it is very confusing in terms of where it is.
00:31:41.500 - 00:31:44.500
But I would say we get it the most here.
00:31:44.500 - 00:31:45.500
Absolutely.
00:31:45.500 - 00:31:46.500
By far the most.
00:31:46.500 - 00:31:48.700
And sporadic case reports of other ones that pop up,
00:31:48.700 - 00:31:49.160
you know,
00:31:49.160 - 00:31:51.500
in a career forum reported in the state or whatever.
00:31:51.500 - 00:31:52.500
Yeah.
00:31:52.500 - 00:31:52.660
So,
00:31:52.660 - 00:31:56.500
that really does get back to the environmental thing when you mentioned about the season leading into this.
00:31:56.500 - 00:31:58.630
And maybe there's management things,
00:31:58.630 - 00:32:04.500
maybe there is unique environmental things pasture things to this area that we just haven't worked out yet.
00:32:04.500 - 00:32:06.579
Because this is an extremely frustrating condition,
00:32:06.579 - 00:32:08.500
because people live in fear of this condition.
00:32:08.500 - 00:32:10.039
They'll start to talk,
00:32:10.039 - 00:32:15.500
"Have you heard about this?" And then all of a sudden it bubbles up and then these cases start to appear.
00:32:15.500 - 00:32:16.000
And so,
00:32:16.000 - 00:32:20.500
it is something that really causes a lot of fear amongst the industry.
00:32:20.500 - 00:32:21.069
Yeah,
00:32:21.069 - 00:32:22.500
rightfully so.
00:32:22.500 - 00:32:22.990
Well,
00:32:22.990 - 00:32:27.500
this has been a fascinating tour through mucoid placentitis.
00:32:27.500 - 00:32:28.500
We all know...
00:32:28.500 - 00:32:30.250
We were going to bring live samples,
00:32:30.250 - 00:32:31.500
but these guys said no.
00:32:31.500 - 00:32:31.950
Yeah,
00:32:31.950 - 00:32:32.920
fair enough.
00:32:32.920 - 00:32:35.839
But if you want to go to your peanut butter jar,
00:32:35.839 - 00:32:38.500
you'll probably see exactly what it is.
00:32:38.500 - 00:32:40.089
Because everything has a food analogy,
00:32:40.089 - 00:32:40.500
right?
00:32:40.500 - 00:32:41.309
Yeah,
00:32:41.309 - 00:32:43.500
unfortunately.
00:32:43.500 - 00:32:43.759
So,
00:32:43.759 - 00:32:45.500
any questions for our guest?
00:32:45.500 - 00:32:45.740
No,
00:32:45.740 - 00:32:47.500
I think you guys did a great job.
00:32:47.500 - 00:32:49.500
I appreciate you running us through that.
00:32:49.500 - 00:32:50.569
Like you said,
00:32:50.569 - 00:32:52.500
it's a concern for people,
00:32:52.500 - 00:32:57.500
and it does have a devastating economic impact on our industry.
00:32:57.500 - 00:32:58.319
So it's a concern,
00:32:58.319 - 00:32:59.160
but like you said,
00:32:59.160 - 00:33:01.500
there's some really smart people working on it.
00:33:01.500 - 00:33:03.089
I have no doubts they'll work it out,
00:33:03.089 - 00:33:04.500
hopefully sooner than later,
00:33:04.500 - 00:33:06.500
and we'll have an answer for it.
00:33:06.500 - 00:33:06.730
Yeah,
00:33:06.730 - 00:33:07.809
and it's heartening to see that,
00:33:07.809 - 00:33:09.500
with so much pressure being put on this condition,
00:33:09.500 - 00:33:15.500
that there is actually some really good information coming about what is actually going on at the site of the lesion.
00:33:15.500 - 00:33:16.349
My concern is,
00:33:16.349 - 00:33:18.640
it's so remote from the rest of the mare,
00:33:18.640 - 00:33:20.500
developing some sort of screen,
00:33:20.500 - 00:33:23.660
other than what you guys are doing every day,
00:33:23.660 - 00:33:26.500
by ultrasounding the target region.
00:33:26.500 - 00:33:30.589
It's going to be really hard to see how we can easily find a systemic marker,
00:33:30.589 - 00:33:31.500
because that would be the key.
00:33:31.500 - 00:33:31.920
And,
00:33:31.920 - 00:33:32.589
as I say,
00:33:32.589 - 00:33:34.279
SAA was the great hope,
00:33:34.279 - 00:33:36.500
but it just didn't work out.
00:33:36.500 - 00:33:38.500
So that was Stallside for this week.
00:33:38.500 - 00:33:40.049
We've been talking to Drs.
00:33:40.049 - 00:33:45.500
Schnobrich and von Dolan from the Rudin-Riddle Therogenology Service on mucoid placentitis.
00:33:45.500 - 00:33:47.500
See you next time.