Dr. Rahal's Qualifications
Dr. Cheryl Rahal received her doctorate in Veterinary Medicine from Washington State University in Pullman, WA in May 1994, and earned Board Certification from the American College of Veterinary Internal Medicine in August 1999 after completing a 3 year residency program in Large Animal Internal Medicine, with an Equine focus, at the Veterinary Medical Teaching Hospital of University of California-Davis.
 
Dr. Rahal is a member of the American Association of Equine Practitioners -  http://www.aaep.org/index.php  and the American College of Veterinary Internal Medicine -  http://www.acvim.org/websites/acvim/index.php?p=61.  For more see Staff Bio.
 
Dr. Rahal has been practicing in Phoenix since January 2002, as an Internist in Equine Medicine.  She has also spent some time practicing small animal emergency and critical care, as well as general practice with the typical Desert Hills farm animals such as goats, pot bellied pigs and horses. 
 
Dr. Rahal’s primary interests and specialty are Equine Medicine, with her subspecialties including Perinatology, Exercise Physiology, Geriatrics and Nutrition.  
 
Perinatology involves monitoring the pregnant mare throughout  gestation,  assuring the foal stays healthy in that neonatal period and has a healthy birth.  
 
Exercise Physiology medicine involves dealing with any medical problem that affects the performance of your horse.  The heart, lungs, liver, kidneys, intestinal tract, and muscle system must function at maximum efficiency for peak performance. 
 
Equine Geriatrics is developing into a new field of medicine as our equine friends continue to age, the oldies have special medical needs.  Finally, optimal nutrition provides optimal health.

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Equine Perinatal Care
 
You’ve Got her Bred, Now What?
1) Proper Nutrition throughout gestation is important.  Gestational length is about 11.5 months.  1st trimester - 1-4 mos - feed as usual.  2nd Trimester - 5-8 mos - increas feed/roughage as the fetus begins to demand increased energy from your mare.

At 9 months, the 3rd Trimester begins in which the fetus has exponential growth and Dietary Energy Demand is at its greatest.   However, your mare has decreased digestive capacity and needs to be fed with more concentrates/grains.

2) Choosing the Birth Place - This depends on the time of year.  You should select a place that is warm & dry - ideally a draft-free stall 12x24, but at least 12x12.  Bed the stall with straw and shavings/grindings.

Move the mare to the birthplace at the beginning of her 3rd trimester to be sure she feels comfortable in her new location.  If you don't have a stall, place your mare in a clean, dry pasture with a safe fence.
 
3) Deworming and Immunizations - Deworm every 4 months.  Use a product that is labeled safe for use in pregnant mares - Eqvalan, Zimectrin, Panacur or use a daily dewormer such as Strongid C throughout gestation.

Immunizations -  Rhinommune or Pnuemobort at 5,7,9 months of gestation aids in preventing abortion due to a Herpesvirus.  4-Way (Eastern/Western Sleeping Sickness, Tetanus, and Flu) and West Nile Virus Vaccine given at 11th month will insure high levels of antibodies in colostrum.     
    
Vitamin E and Selenium Injection (E-Se)  (in regions of Se deficiency or unsupplemented mares) given at 11th month of gestation will prevent White Muscle Disease.

What do I do if my Mare does abort?
    1)  Save the Fetus
    2)  Save the Placenta and Amnion
    3)  Call your Vet

It is not uncommon for a Mare to have a Difficult Delivery (Dystocia) with a Late Term Abortion.

Causes of Abortion: Infections, Bacteria cause Placentitis (or infection of the Placenta), Viral causes like Rhino, EVA, Placental Insufficiencies, Older mares, Twins, Fetal Death due to a Genetic Defect.
*Viral causes like Rhino are the only diseases we can control with vaccination.

When is Her Due Date?
Gestation Length in Horses is extremely variable  -  320 - 365 days - on the average 340 days.  Take the last breeding date and subtract 25 days - that equals Her Due Date
ex. May 27th - 25 = May 2nd
Breeding history is helpful as mares are typically consistent with gestation length.

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The rest of this is under construction.
 
What do I need to Get Ready for this Birth?
 
1) Dry, Draft free Birthplace 
    Ideal bedding is Shavings topped with Straw
    Clean the stall at least twice daily

2) Thoroughly Groom or Bath the Mare 
    Wash her perineum and udder with warm soapy water

3) Prepare a Birthday Box
    Scissors
    Clamp
    Towels
    Suction bulb
    Thermometer
    Naval Dip
    Baby bottle
    A Clean 4 cup Tupperware container
    Non-Phosphate Enema
    (optional) Stethoscope
    Camera
    Watch/Clock
 
 
Okay, She’s 320days along, Now how do I know?
    1) Restlessness, Inappetence, Behavior changes
    2) Waxing Up - production of early colostrum and relaxation of teat canals
    3) Shifting of weight in abdomen

Time to Prep your mare, wash her perineum and udder again and wrap her tail.
Mares usually foal between 12am and 4am. 

Do I have to stay up every night for potentially 45 days?
 
Predicting Birth by evaluating Milk Electrolytes
    FoalWatch by CheMetrics Inc. 1-800-356-3072 (or www.chemetric.com)
    Test kit costs $25 and includes 20 tests 
    98% probability that the Mare will Foal within 72 hours when milk Calcium reaches or exceeds 200ppm
    Water Hardness Test Strips can be used - have a lower predictability
 
Foaling Monitors
Foal Alert - A transmitter attaches to vulva, when separated alerts by pager/alarm
Foalert, Inc. 1-800-237-8861 or www.foalert.com
 
Breeder Alert - A monitor that attaches to mare’s Halter, alerts when mare lies down by a pager/alarm.
Allsman Enterprises 1-415-883-3218
  
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Stages of Labor
 
Stage One
    Mild Uterine Contractions, Foal is getting to delivery position
    30minutes to 4 hours but is reversible
    Restless, lying down and getting up, appears uncomfortable
    Sweating
    Laxity of perineum, Swelling of Vulva
    Intervention is not indicated at this time.
    Allow privacy (remember it’s reversible)

Stage Two   
    Active Labor and Delivery
    Delivery Should occur in 20 minutes (look at your watch)
    Water breaks  -  White balloon is the chorioallantois membrane, when it ruptures the amnionic fluid is expelled
    Mares usually lie down and will have strong abdominal contractions
    Forelegs are presented first with one foot in front of the other, may be covered with white amniotic membrane
    Nose should present at level of fetlock.
 
At this point you may intervene, slowly approaching mare, we don’t want her to get up.  Rupture the amnion membrane, grasp the fetlocks, and pull only on a contraction.
Once the shoulders have cleared the mare’s pelvis, Mares frequently take a short (3minutes) break before resuming delivery.
 
If 10 minutes of Active Labor does Not produce 2 feet and a nose - Call Your Veterinarian
At any time if strenuous contractions fail to advance the foal, attempt to get the mare up and walk her until the veterinarian arrives.
 
Umbilical Cord Rupture  -  Once delivery is complete, the mare will sit up, looking for her baby.  At this time the foal is still receiving blood from the mare, so don’t disturb them.  This time is variable 3-7 minutes.  When the mare stands she automatically ruptures the umbilical cord.  Nervous mares may stand early, rupturing the cord prematurely, use your clamps on the foal’s umbilical stump to prevent hemorrhage.  Dip the foals umbilical stump or naval in a 2% Nolvasan Solution every 6 hours for 24 hours.
 
Mothering  -  Allow the Mare to lick her foal and or the amniotic fluids, this stimulates important hormones (like oxytocin) that will assistant in Stage 3 of Labor and Milk Let Down
 
Stage 3 of Labor   
    Expulsion of the AfterBirth or Placenta
    Usually occurs in the First Hour after delivery.
    If she has not passed her Placenta in 2 hours, call your Veterinarian
    Retained Placenta (retained greater than 3 hours) can become a Medical Emergency
    Some mares will lie down again, strong uterine contractions occur and mares become uncomfortable.
    Save the Placenta for inspection by your Veterinarian

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Common Complications with Delivery
Dystocia (difficult birth) due to Malposition - The foal is not positioned correctly and will not fit through the Mare’s pelvic canal.
 
‘Red Bag’ or Premature Placental Separation - Cut the bag with scissors and put the foal as quickly as possible.
 
Uterine Artery Rupture - Internal bleeding, mare may be too weak to rise, very pale oral membranes.  Blood transfusion is required. 
 
Retained Placenta - The placenta releases toxins into the Mare’s blood, producing Endotoxic Shock.  She may sweat, have muscle tremors, have injected oral membranes, and develop a fever.  A common sequela of retained placenta is Laminitis or Founder.

Neonatal Vital Signs
    Rectal Temperature 99-101.5o F
    Heart Rate 80-130 bpm
    Respiratory Rate 60-80 bpm in first 30 minutes, 30-40bpm thereafter

Neonatal Respiratory Resuscitation
    Initial Stimulus - straw up the nose
    Thoracic Copage - slap chest with a cupped palm
    Suction of fluid from Nares
    Finally mouth to nares resuscitation  -  hold foals mouth and one nares closed, next gently blow into other 
    nares, watching for expansion of the foal’s chest, count to 5 and repeat.
 
Neonatal Time Line
    1-2 minutes  -  sitting sternal
    2-20 minutes  -  suckle reflex
    1 hour  -  Begin attempting to Stand
    2 hours  -  Time to be standing
    Less than 3 hours  -  Time to successfully nurse the Mare
    6 hours for colts, 10 hours for fillies  -Time to Urination
    by 12 hours  -  passage of meconium, first defecation
    by 2 days vision is fully developed
 
Signs of Prematurity/Immaturity/Dysmaturity
    Important to Identify, these foals are at Increased Risk for Developing Disease
    Low birth weight  -  ribs prominent, pointy hips, low body fat
    Short, silky hair coat
    Domed head
    Floppy Ears
    Joint Laxity, extreme flexibility
    Generalized Weakness
    Delayed Timeline

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Colostrum, What the heck is it and Why is it so important?
Colostrum or Mare’s first milk is concentrated with Immunoglobulins or very large proteins called antibodies.  All mammals are born with an immature immune system, lacking the ability to recognize non-self and make their own antibodies.  Antibodies bind non-self substances, like bacteria, and aid the immune cells in clearing the contagion.  Horses are one of the number species that do Not receive antibodies across the placenta, and therefore must receive it all in the Colostrum.  A mare will produce Colostrum for up to 24 hours.
  
These immunoglobulins can only be absorbed by the foal’s intestine in the first 18-24 hours of life.  During this time the foals gut is considered to be ‘Open’, capable of absorbing large particles or proteins.  Once the gut closes, Immunoglobulins can no longer cross the gut.  The absorption of immunoglobulins is referred to as Passive Immune Transfer.
  
The quality of the Mare’s colostrum can be tested, and should be if she has had a sick foal in the past, or if she is an Older Mare (>10 yrs).  Colostrum is tested based on its specific gravity with a Colostrometer (Lane Manufacturing or Biogenics 541-268-4730).  Good quality colostrum is considered to have a specific gravity greater than 1.060.
  
A foal should receive 1 liter (32 oz) of colostrum in the first 8 hours of life.
 
Colostrum Banks - Only Good quality Colostrum is worth storing.  Colostrum is good frozen for up to 2 years.  After the foal has suckled for 2 hours, milk out 8-16 ounces, strain, and freeze in a tightly sealed plastic bottle.

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Failure of Passive Transfer (FPT)
Every foal should have its Passive Immunity Assessed.  Your veterinarian will perform this test on a blood sample drawn 12-18 hours after birth.  The immunoglobulin assessed is referred to IgG (there are many types, IgA, IgE, IgM), and is the immunoglobulin in highest concentration in colostrum.  
                
    FPT is IgG <200mg/dl
    Partial FPT is an IgG 200-400mg/dl
    Adequate is an IgG >400mg/dl
    If all goes perfectly your foal will likely have an IgG >800mg/dl
 
Common Causes of FPT
    1) Poor Quality Colostrum
    2) Delayed Time to Suckling
    3) Gastrointestinal Problems causing Malabsorption
    4) Overwhelming Infections
 
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Consequences of Failure of Passive Transfer (FPT)  -  Neonatal Septicemia
In that first 18-24 hours when the gut is ‘Open’, immunoglobulins are not the only thing that can cross the intestinal wall, bacteria can also cross.  Bacteria gain entrance to the gut during udder seeking, and thus the importance of a clean mare and stall.  When bacteria are in the bloodstream it is call Septicemia.
 
Septicemia is the Leading Cause of Illness in Foals hospitalized in NICU. Foals are at greatest risk for the First Week of Life
 
Signs of Septicemia  
    Sleeping a lot - normal foals suckle 4 times per hour
    Weakness, difficulty getting up; due to hypoglycemia, or low blood sugar
    Blood-shot Eyes 
    Wandering, not identifying with Mare
    Fever - rectal temperature >102 degrees F
    Call your veterinarian immediately, these disease progresses very rapidly
 
 
Other Neonatal Diseases are identified early when attention is paid to the Timeline
    Dummy Foals or Neonatal Maladjustment Syndrome
    Angular Limb Deformities
    White Muscle Disease
    Patent Urachus or Ruptured Bladder
    Omphalophlebitis - Naval Ill
    Meconium Impactions leading to Colic
 
So, Everything Went PERFECTLY, you have a healthy Mare and Foal, Now What?? Have FUN!!!
 
Other Management Tips:
Turn the Mare and Foal out on day 2 in a in Paddock with Safe Fencing.  They should not be turned out with Geldings or other Non-Broodmares.

Feed your Mare as much forage as she wants, lactation is a great Energy Demand.  The foal will begin to forage at about a week, and you may begin creep feeding as soon as you note some independence.

You can’t begin too early on halter training your foal.  They are cute and loveable, but a spoiled child will soon grow to be 1000lbs.  Make sure that they respect your space.  Whisker pulling is a good remedy to biting and will prevent head shying.

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Your Foal - Protecting your Investment
 
Last spring you invested your time, veterinary bills, and breeding/stud fees all into getting your mare(s) pregnant.  You fed high quality feeds all winter long, and at $14-18 a bale and $18-23 a bag of grain that’s a significant investment.  Now what?  The hard part is done, right? You sit back and let the mare do her thing and pop out your investment?  Maybe not.  The goal of this article is to outline things you should be considering, thinking about, and learning more about--- all to protect that precious investment.
 
What we want – a healthy foal, that can grow up beautifully and sound, which doesn’t cost, or call for more investment.
 
What we fear – a sick foal, a poor doing or developing foal, or neonatal death from sepsis (bacterial infection of the blood), neonatal asphyxia (not enough oxygen to the brain  or dummy foals) and colic to name only a few.  We fear a weanling with crooked legs and lameness.  All of which create a huge loss in our investment and a sad heart.
 
What we do – fuel ourselves with knowledge.  Preventative medicine or early detection of disease is the key to protecting our investments.
 
First, the foaling needs to be attended and report to your veterinarian as soon as you notice something out of the ordinary.  The key to early detection of many neonatal problems is all in the timing.  Events of the birthing process should adhere to the following timeline, so make sure you look at your watch, and frequently.  Sitting sternal by 1-2 minutes ; suckle reflex, sucks on your figure by 2-20 minutes ; Begin attempting to Stand by 1 hour; standing unassisted by 2 hours; successfully nursing the mare in 3 hours;  Urination  by  6 hours for colts, 10 hours for fillies; passage of meconium or first black feces by 12hrs.  The experienced breeder may think these times seem prolonged, and really many foals are up and suckling within minutes, but it’s a signal that something is wrong when these times are exceeded.
 
Second, assure your foal as had adequate passive transfer, or has gotten enough good quality colostrum to provide a competent immune system to fight infection and disease.  Your veterinarian will need to perform a simple blood test.  Dipping the umbilicus in chlorhexidine antiseptic every 4 hrs for the first 24hrs is another must in prevention of infection and neonatal illness.
 
Third, provide a safe, clean environment.  A no-brainer, right?  An important fact to keep in mind while preparing:  a foal’s vision is not completely developed until 2 days of age.
 
Finally, some remarks on soundness.  If a foal is born with tendon contracture or laxity, this issue needs to be addressed by your veterinarian with in the first 12hrs, particularly if the timeline is prolonged.  Foals with angular limb deformities should be evaluated by your veterinarian within the first 2 days to develop a plan which will prevent long term deformities or lameness.
Protect your investment with knowledge.  Discuss preparations for foaling or neonatal concerns with your veterinarian. 
 
Cheryl Rahal, DVM ACVIM - Published in Bridle & Bit - 2/24
 
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Spring Grass in The Valley of the Sun?
With all the rain we’ve had these last few months, our desert is looking pretty green.  Horses are typically discriminating eaters, and ingestion of toxic plants is not usually a worry.  However, horses raised in the desert don’t get a whole lot of fresh greens in the diet, and become much less discriminating over the green stuff. 

There are a few toxic plants that grow in our desert you should be aware of; Fiddleneck (Amsinckia), Bitter Rubberweed (Hymenoxys), Riddell groundsel (Senecio).  There are many other desert toxic plants, but these are the most common in the Valley. 

Fiddleneck is close to the ground and looks like a grass with a wide fuzzy blade, which later produces a stem with multiple small yellow flowers arranged in the shape of a neck of a fiddle.  Whole plant is hairy, leaves alternate. Flowers are orange to yellow and grow only on outside of fiddleneck.  All parts of the plant are toxic.
                   


The Rubberweed and Groundsel are the short shrubs that produce the daisy-like yellow flowers that turn our hills yellow in the spring.  
  
 
 


All three of these plants are toxic to the liver.  Your horse would need to eat these in high quantity before seeing acute signs of liver disease.  But do remember,  damage to the liver is accumulative over time and causes cirrhosis or scaring in the liver.  

The acute signs are typically low grade intermittent colic, and photosensitivity.  The photosensitivity is usually the tip off to the ingestion of this type of toxic plant, as the liver cannot completely detoxify the principal agent and the skin becomes sensitive to the sun and burns easily.  You may first notice a blistered muzzle or raised scabs in the white skin haired areas, like on the legs. 


Should you notice these signs in your horse, talk with your veterinarian.  Finally there are many other ornamental plants that are extremely toxic to horses, the most common being Oleander.  In many of these ornamental plants, the leaves remain toxic when dried, so take care to clean up any leaves that blow in your pasture from your yard or your neighbors. 

Link to poisonous plant and other toxin information: http://www.aspca.org/pet-care/poison-control.

Cheryl Rahal, DVM ACVIM - Published in Bridle & Bit, http://www.bridleandbit.com/ - 2/24.
 
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Spring Vaccines
Spring, Summer, Winter, Fall, 4-way, 5-way, tetanus, Flu, what was it again that I need to vaccinate my horse?
There are a lot of different vaccines available and it’s hard to keep it all straight. But there are two basic categories of vaccines---Core vaccines and Risk-based vaccines. If you want to review the nitty-gritty of equine vaccines as recommended by the American Association of Equine Practitioners - see the website www.AAEP.org.

Core vaccines are something that all horses should have at least yearly because the risk of disease is significant, the disease may be of public health significance, or even required by law.  AAEP includes vaccination for Tetanus, EEE/WEE or east and western equine encephalitis (a neurologic or spinal and brain disease), West Nile, and Rabies as part of the Core recommendations.  Rabies is the newest addition to the Core category, as of February 2009. In Arizona, there have been more reported cases of rabies in wildlife, domestic species and humans than ever before in our recorded rabies history. Rabies vaccines have been labeled for use in horses for many years, are one of the safest vaccines, and should be added to your Core vaccination program for your horse.

All the core vaccines come as separate vaccines or grouped together, hence the 3-4-5-way. The Tetanus, EEE/WEE and Rabies vaccines need yearly boosters. The West Nile vaccine, in low-risk regions is also yearly, and preferably in the spring when the chance of mosquitoes is most likely.  In higher risk regions, West Nile vaccine should be given every 6 months. In Arizona, it's best to include WN vaccine in your spring protocol, and in a particularly wet and humid monsoon season, a second booster for the year is warranted.

Risk-based vaccines are those vaccines that are given when a risk-benefit-cost analysis has been reviewed. This analysis should result as a conversation with your veterinarian, and include your horse’s age and what your horse does for living (backyard, trail, show, rodeo, community living).

The vaccines that should be considered in Arizona are Influenza, Equine Herpes Virus or EHV 1&4, and Strangles (Strep.equi). The vaccines for these diseases are offered as injectable or intranasal, and single or combined, and are given dependant upon risk, or at least yearly. A discussion with your veterinarian regarding your horse’s health risks will lead to the correct vaccine program for your horse.

Cheryl Rahal, DVM ACVIM - Published in Bridle & Bit  http://www.bridleandbit.com/ - 3/17