At 10 a.m. on a mild Friday morning, four giant Ford pick-up trucks head out from Haymarket Veterinary Service, going in different directions like the spokes of a wheel. In each was an equine veterinarian, her assistant, an assortment of medications and veterinary equipment, and all the makings of a tiny mobile office—including a working printer on the floor in the backseat.
And, in the backseat of one of the trucks, was me, an editorial assistant at EQUUS magazine. I’d been warned—we’d be making lots of stops at the end of long winding roads in the hills of Virginia. If I needed Dramamine or a seat up front, I’d better speak up.
We spent the morning making routine visits to administer fall vaccines, check on healing wounds and discuss the possibilities of equine seasonal allergies. Approximately 10 stops were scheduled for the day, all within a reasonable distance from the office and from each other.
Melinda Freckleton, DVM, maneuvered the truck while taking bites of her to-go breakfast. Freckleton has been practicing equine veterinary medicine in Virginia since her graduation from Cornell University in 2002. A lifelong rider, she has dabbled in a range of disciples, but has been hooked on dressage since before she started veterinary school. Freckleton and her fiancé own five horses, one of which is patiently teaching their young daughter to ride.
Alissa Graham, Freckleton’s assistant of 12 years, announced where our next destination would be as we went. Essentially Freckleton’s right-hand woman, Graham helped handle horses while they received treatment, assisted Freckleton with procedures and kept tabs on the truck’s medical supplies.
One of the first visits served as a reminder of the risk of laminitis in the fall.
A chubby bay gelding got a pat on the neck and smile from Freckleton. “Not missing any groceries are you?” she said. He was one of many horses we saw that day who was deemed a little on the heavy side, a condition that needs to be taken seriously, especially in the fall and spring.
Freckleton explained that two factors contribute to the autumn surge in laminitis. “One is the change in the grass as it gets stressed with the change of season,” she said. “The other is the endocrine changes within the horse that happen normally to prepare him for winter.”
Many horse owners are aware of the danger, but Freckleton says autumn is a great time of year to remind her clients to take steps to prevent laminitis.
For more information from Freckleton on fall laminitis, watch this video.
We got a break from the road around lunchtime. We ate our packed lunches on the go, but the route to one farm took us past a beloved local ice cream shop. Luckily, we’d be coming back the same way again after our next appointment and we unanimously agreed to stop for a quick scoop.
Interspersed with late afternoon appointments were medication deliveries, for those clients that didn’t live too far off the scheduled route. Freckleton took a moment to chat if the horse owner was at home, catching a status report on old issues or discussing new concerns. If no one was home, the trick to dropping off medication was finding a “dog safe” place to leave it at the house or the barn.
One of our final stops was a follow up call for a horse Freckleton had just seen only a month before. A Quarter Horse cross stood waiting at the end of the driveway when we arrived, grazing at the end of a lead rope next to her owner.
Freckleton told me that Aruba, the 22-year old mare, had always been a bit overweight. But during last month’s visit a subtle difference in her appearance caught Freckleton’s attention.
“You could see she had a little hint of a bump of crest in addition to all the regional fat pads,” explained Freckleton. “And while she’s always been a little portly, she’d never had that before this fall’s first visit.”
Freckleton drew blood during last month’s visit to test Aruba for Cushing’s disease, technically known as pituitary pars intermedia dysfunction (PPID). The ACTH test for Cushing’s measures the level of adrenocorticotropic hormone, a pituitary hormone that regulates the release of cortisol by the adrenal glands. The test showed that Aruba’s ACTH levels were through the roof.
During most of the year, the normal range for the hormone is around 35 and it increases as much as three times in a normal horse in the fall, to around 105. The result of Aruba’s test showed a level of 705. Freckleton started the mare on Prascend, the medication most commonly used to treat PPID in horses, and today she was returning to see how Aruba was doing.
“Today we’re drawing blood to test if the current dosage is controlling her Cushing’s,” said Freckleton. “This test is usually done once a year, but because her number was so high, we are retesting already.”
Luckily, Aruba is not shy about needles and stood quietly as Freckleton drew blood for the second test.
Back on the road, Freckleton explained that years ago there was no point in testing horses for PPID in the fall because ACTH levels rise at that time of year as the body prepares for winter. But recent research into how ACTH levels fluctuate in the fall has changed all of that.
“Before that research was completed, we didn’t test in the fall because we didn’t think the numbers were any good, because normal horses were going outside of what we called the normal range,” Freckleton explained, “So now the normal range is essentially two-track—there’s a fall normal and there’s a rest-of-the-year normal.”
This is a major advance because PPID horses are especially at risk for laminitis at this time of year. “In normal horses ACTH rises one or two fold and in Cushing’s horses ACTH raises more than three fold in the fall,” said Freckleton. “In Cushing’s horses, therefore, their risk for laminitis goes sky-high.”
Watch this video for more information about warning signs of Cushing’s disease from Freckleton.
