Global Study – Equine Cushings Disease (PPID) Around The World

This article was published October 16th in American Veterinarian,  based off of a study originally published in The Canadian Journal of Veterinary Research (attribution to Natalie Stilwell, DVM, MS, PhD):

“Pituitary pars intermedia dysfunction (PPID), also known as equine Cushing disease, typically occurs in horses over age 18. Current diagnostic tools for PPID include detection of suggestive clinical signs, such as hirsutism, and measurement of endogenous adrenocorticotropic hormone (ACTH).

Results of a global study recently published in The Canadian Journal of Veterinary Research outline the estimated prevalence, diagnosis, and treatment of PPID.

Study Design
The investigators approached equine veterinarians with an online survey, made available through international veterinary groups and organizations, to evaluate recent experience with PPID cases. A paper survey was distributed to attendees at the 2012 American Association of Equine Practitioners annual meeting.

Linear regression analyses were used to compare answers by practice type and geographic region, including North America, South America, Europe, Australasia, the Middle East, and Africa.  

Results
A total of 426 veterinarians from 20 countries completed the survey. Most respondents were from the United States and Canada. Most respondents worked in equine specialty practice (31.0%), followed by general mixed (15.3%), large animal (12.2%), and combined small animal and equine (11.0%) practice. Eighty-five percent of respondents reported seeing at least 1 PPID case, and the median number of cases was 5 per veterinarian and 1% of the equine caseload.

Horses diagnosed with PPID averaged 20 years of age. While 67% of cases were managed medically, 33% were treated in alternate ways or not at all. The drug of choice for PPID treatment was almost exclusively commercially available or compounded pergolide mesylate, while cyproheptadine, trilostane, and bromocriptine were chosen rarely. Alternative treatments included dietary management, herbal therapy, exercise, acupuncture, immunomodulation, and parasite management. Reported reasons for foregoing treatment included client limitations, lack of available drugs, or because treatment was “not warranted.”

Seventy-one percent of respondents believed that PPID was an important equine disease, and 54% expressed the need for a new approach to managing the disease.

The authors limited certain statistical analyses to data from North American and European veterinarians, due to the relatively low response from practitioners from other geographic regions. On these 2 continents, veterinarians working in equine specialty practices reported a greater number of PPID cases than did other veterinarians. Twenty-seven percent of respondents used the presence of clinical signs as the only diagnostic test for PPID, whereas the most common adjunct test performed was ACTH measurement. None of the examined factors, including geographic location, was associated with the decision to treat or not to treat PPID cases.   

What We Know
In this study, most veterinarians who treated horses encountered cases of PPID. Many respondents, especially those in Europe, used the presence of clinical signs rather than a specific test to diagnose PPID. Suggestive clinical signs do have high documented diagnostic sensitivity and specificity values for PPID, and there is no consensus on a definitive diagnostic test for PPID in its early stages. Thus, the authors indicated a global need for increased research on PPID detection and long-term management.”

 

Dr. Judith Samson-French Discusses Live Export of Horses on Alberta Primetime

Dr Judith Samson French at studioJudith Samson-French, MSc, DVM,  recently appeared on Alberta Primetime,  a feature program of CTV Alberta.  The program focused on the live export of horses to Japan and was presented as a debate over horse treatment between Dr. Samson-French and horse slaughter promoter Bill desBarres.

In the 8 minute program, which is viewable here, Dr. Samson-French outlined the major concerns:

  • Horses over 14.1 HH are not universally segregated
  • Horses are not trained or exposed to transportation
  • Horses have been not been able to hold their heads in their natural upright position
  • Repeated branding is a welfare issue – pain cannot be alleviated using drugs since that would taint the meat
  • In Canada the limit is 36 hours, compared to 24 hours in the EU and 28 in the US. Science has shown us that after 24 hours without water,  horses become compromised.  The business model of transporting horses is not easily accomplished within the 36 hour limit unless those limits are reset/bypassed entirely.

Dr. Samson-French concluded her presentation by offering that Canada was relegated to the position of “janitor” – cleaning up all the unwanted horses in North America, with no traceability of horsemeat.

Mr. desBarres provided little rebuttal to these very specific issues,  other than to say that the regulations are fine the way they are, and that we had no right to interfere with the democratic process of a commercial business, provided that the process is “regulated and enforced by the scientific authorities.”  If Mr. desBarres were attentive to the issues Dr. Samson-French had brought up,  he would realize that the 36 hour transport timeline is not scientifically supported,  and other regulations are not being adhered to.  Furthermore,  the conditions horses experience are regulated by rules that are decades old.

In this study, horses transported for “only” 24 hours showed “changes in muscle metabolism, stress indices, dehydration and immune parameters, and body weight.”

(https://www.ncbi.nlm.nih.gov/pubmed/10875627)

 

 

Critique of Horse Slaughter Industry by Dr. Maureen Harper Published in Canadian Veterinary Journal

The October 2017 Issue of the Canadian Veterinary Journal features an article written by  Maureen Harper,  DVM, MSc (Epidemiology),  discussing the transport of slaughter-bound horses.

Dr. Harper approaches the problematic issues with the CFIA governance over the horse slaughter industry in Canada from an analytical point of view – citing examples of substandard treatment of horses, inhumane slaughter and transport, and the many procedural violations of Canada’s antiquated 40+ year-old Health of Animals Regulations.

“Canada is a major international supplier of horse meat in the world. In 2016, over 54 000 horses were slaughtered in this country. It is estimated that 65% to 70% of the horses slaughtered in Canada originate from the United States. This is because horse slaughter ceased in the United States in 2007. Also, according to Agriculture and Agri-Food Canada, 5839 live horses were shipped to Japan for slaughter in 2016.

Horse slaughter in Canada has become a contentious issue in recent years. There have been numerous undercover recordings showing the improper stunning of horses.”

Please read more here: (scroll to page 1117)

maureen harper veterinary ethical question

British Columbia’s Chief Veterinarian Clashes With College Of Veterinarians Over Reporting Of Animal Abuse

Originally Published August 9th in Abby News,  by Tyler Olsen

The College of Veterinarians of British Columbia send out a directive to their 8025748_web1_copy_jane-pritchard-gpsmembership in July, advising that veterinarians should only report animal abuse if they have “unequivocal evidence” of wrongdoing by clients.  B.C.’s Chief Veterinary Officer Jane Pritchard disagrees with this position.

“And she took the CVBC to task for emphasizing client confidentiality above reporting abuse in an email the organization sent to members in June.

That memo states that reporting a client “should be reserved for circumstances where there is clear and unequivocal evidence of an animal being in distress as a direct result of the actions of the veterinarian’s client. Threatening to report or reporting on circumstantial evidence will leave veterinarians open to criticism for breaching client trust and confidentiality … Veterinarians will best serve their patients when clients can rely on them to make patient treatment a priority, while simultaneously meeting client confidentiality obligations.”

The Prevention of Cruelty Act (PCA) states that veterinarians “must promptly report” what they know if they think a client is “likely” abusing an animal. The CVBC position, which cites the need for “unequivocal evidence,” would require a vet to know for certain that abuse is happening before reporting it to authorities.

In opposing the CVBC memo, Pritchard cited provincial law, an oath taken by vets to protect animal health and welfare, and several high-profile animal abuse cases in the Fraser Valley over the last year.

“The emphasis on protecting client confidentiality to defend not reporting animal cruelty seems to me to be less than professional within the context of our oath and the requirements of the PCA.”

Pritchard wrote that the “CVBC memo focused on the role for veterinarians to protect client confidentiality in face of possible animal abuse.”

She wrote: “In B.C. we have witnessed high-profile media coverage and public outrage on extreme acts of cruelty against farm animals in recent months and years. The public often questions what the role of the veterinarian is in these circumstances, and if we do not speak up, take an interest, ask questions and become engaged in this area, I fear we, as veterinarians, will be seen as irrelevant in protecting animal welfare. I feel that veterinarians need to remain relevant in animal welfare that we should actively continue to strive to promote animal health and welfare, relieve animal suffering.”

Thank you Dr. Pritchard!

The rest of the article can be read here.

 

Research – How Does Transport Impact Senior Horse Immune Function?

Original article – The Horse – written by Erica Larson, July 25, 2017

Transporting horses is stressful,  particularly so for the senior horse,  who may experience a compromised immune response, elevated stress hormones, and decreased body weight.  Weakened immune responses as a result of transporting the senior horse may explain the frequency of respiratory illnesses in feedlots etc.  These findings are yet another reason why senior horses should not be transported for the “humane end of life option” of slaughter.

“Researchers have long known that transportation can be stressful for horses—not only for their minds but also for their bodies. Still, scientists haven’t yet zeroed in on all the ways travel impacts horses’ body systems. They have proven that transport negatively impacts the immune function of other species, including cattle and swine, but little is known about the horse, and there’s no work investigating the impact on senior horses.

…the team hypothesized that, following short-distance transportation:

  • Stress hormone (cortisol) levels would increase;
  • Cell-mediated immune responses (which protect the body against intracellular organisms, such as viruses, using special white blood cells called T-cells; the T-cells recognize when a cell has been infected by a pathogen and act to eliminate it before the pathogen can replicate) would decrease; and
  • Inflammatory cytokine production would increase.

The team used 16 senior horses with an average age of 25 years. They collected baseline blood samples and evaluated clinical parameters a week before a 1.5-hour trip. They gathered the same samples and data 15 minutes before the trip, 15 minutes after, and on Days 3, 7, 14, and 21 after transport.

Some of the team’s key findings included:

  • Horses had decreased INF-γ (interferon-gamma, an inflammatory mediator produced by lymphocytes) production starting 15 minutes after travel and through Day 21;
  • After transport, lymphocyte gene expression showed reduced INF-γ, TNF-α (tumor necrosis factor alpha, a cytokine involved in mediating systemic inflammation), and IL-10 (interleukin-10, another anti-inflammatory cytokine) levels;
  • Cortisol levels were increased 15 minutes after travel;
  • There were no differences in whole blood gene expression before and after transportation; and
  • Horses’ body weights decreased on Day 3 post-transport.”

Please read more here.

Researchers Use Conceptual Models To Improve Equine Welfare In Veterinary Teaching

Veterinary students often lack previous experience in handling horses and other large animals. This article discusses the challenges of using horses for veterinary teaching purposes and the potential consequences for equine welfare. The article proposes a conceptual model to optimize equine welfare using equine similators during practical handling classes.

Written by:  By Christa Lesté-Lasserre, MA, originally published – The Horse

“Horses used for veterinary teaching programs often experience repeated handling and treatment techniques by students who have had relatively little exposure to horses. Unfortunately, that’s becoming more common now than in the past.

A team of researchers from Massey University, in New Zealand, said statistics suggest fewer veterinary students than in the past have prior experience with horses before entering their degree programs. And that, the team said, could have welfare implications for the horses they’re learning from, as well as increased safety risks for the students themselves.

As a result, the researchers recently reviewed the challenges of working with horses in veterinary teaching programs and the potential consequences for human safety and equine welfare. They’ve also proposed a model for improvement.

Veterinary program administrators must realize “that most students are now from an urban environment and that there is a need to formally teach what was previously assumed to be prior animal handling knowledge,” said Gabriella Gronqvist, PhD, MSc, a postdoctoral fellow in equine science at Massey University’s Institute of Vet, Animal, and Biomedical Sciences.

Long-term, she added, the team hopes to “identify parameters which we can measure, such as how many times can you repeat a procedure, given that different activities or procedures all have varying levels of (welfare) cost to the horse. With these metrics, guidelines for horse use can be put in place to assist with the management and the rotation of the teaching horses with the different teaching activities in order to optimize welfare.”

In their study, the team proposed a conceptual model to optimize teaching horse welfare. Gronqvist and colleagues suggested veterinary students receive basic training in equine learning theory and ethology (animal behavior) very early in their education, before being exposed to teaching horses. Notably, they should recall the social needs of horses and understand that keeping a familiar horse nearby during a consultation can reduce stress as well as injury risk.

“A focus on this would be a great first step and would provide the most significant improvement in animal welfare in relation to the time and resources required,” she said.

Meanwhile, computer simulators could help teach students to recognize equine communication signals and learning behavior, Gronqvist said. However, no such equine-specific software exists currently.

Other simulators and dummies—such as Breeding Bonnie, the jugular vein puncture simulator, and the joint injection simulator—can allow students to practice their skills without compromising teaching horse welfare, she said. But after the students have mastered their skills on simulators, they will have to practice on live horses, where their handling techniques will be paramount.

“The model proposed in the study is only a first step toward better understanding the welfare needs of teaching horses in veterinary schools,” she said.

The study, “The Challenges of Using Horses for Practical Teaching Purposes in Veterinary Programmes,” including details on the proposed conceptual model for improvement, was published in Animals.”

The Veterinarian’s Role in Equine Abuse Investigations

By Alexandra Beckstett, The Horse Managing Editor

The following article is reproduced from “The Horse,”  January 19, 2017

How a veterinarian goes about examining and treating allegedly abused horses can mean the difference between a successful or unsuccessful case against the owner. He or she must know how to properly document all findings and avoid destroying evidence while still putting the horse’s welfare first.

Nicole Eller, DVM, a Minnesota-based field shelter veterinarian with the American Society for the Prevention of Cruelty to Animals’ Field Investigations and Response team, described the veterinarian’s unique role in animal crime scene investigations during her presentation at the 2016 American Association of Equine Practitioners Convention, held Dec. 3-7 in Orlando, Florida.

First, she reviewed the basics of evidence identification, collection, and preservation. “Evidence is generally defined as anything that can demonstrate or disprove a fact in contention,” said Eller. In equine abuse investigations, this can include anything from photos of a horse’s injuries or body condition to the moldy hay in his feeder.

Veterinarians must view these cases through the lens of someone looking for and collecting evidence. As the equine expert, the veterinarian will recognize key pieces of evidence that other investigators might overlook.

Eller then described the four phases of processing an animal crime scene.

Phase 1: Document the condition of the facility or farm upon arrival

The area will most likely have already been secured by law enforcement and documented via photos and video by the time the veterinarian arrives on the scene.

Phase 2: Document each animal and its environment

The veterinarian will conduct what Eller called “critical triage” during the initial walk-through of the property.

“Critical triage is a rapid visual sorting of animals for treatment priority,” she said. “It’s done to identify animals in immediate need of medical care.”

The practitioner should classify horses needing immediate care as “red animals.” Eller said this might include horses with open fractures, seizures, hemorrhaging, etc.

“Document everything as fast as possible before treating, because the live animal is evidence, and treatment alters evidence,” she said.

After caring for the red animals, Eller said the veterinarian should perform a second walk-through and color-code the remaining animals as yellow (in need of treatment before transport), green (ready for transport), or blue (exhibiting signs of infectious disease).

“Given how horses are typically housed, if one has infectious disease, they may all have it,” said Eller. “But if a few are obviously infectious, you would want to handle them last and have an isolation area set up at the clinic or place where the horses are being transported.”

Once the horses have been documented and tended to, then it’s time to document their living conditions and environment. “Demonstrate how that environment may have directly affected the animal,” she said, including taking photographs or directing the person who is. Any dead horses, carcasses, or skeletal remains on the property must also be catalogued as physical evidence.

Once all horses have been removed from the property, the veterinarian should perform a more thorough documentation of the living space. Note the dimensions of each enclosure or shelter as well as how many horses shared each space, said Eller. Take mid-range and close-up photos of “any receptacles, presence or lack of good and water, quality of food and water, shelter and fence construction and possible hazards, feces, and urine,” she added.

Phase 3: Nonanimal evidence

Veterinarians also play an important role identifying nonanimal evidence. “This could include items such as medications, supplements, surgical supplies, emasculators, and caustic substances,” said Eller. “Some items of evidence may be overlooked by law enforcement officers who are not familiar with the particular crime type.”

Phase 4: Document the condition of the scene upon exit

This final phase involves a thorough physical exam and detailed photos of each horse. “Photos are a fundamental component of a forensic examination,” said Eller. She suggests treating the horse like a cube and getting photos of all six sides, with close-ups of any findings, such as lesions, abscesses, or wounds, and placing a forensic ruler next to these findings for measurement purposes.

And above all, never delete any photos—even the blurry or unintentional ones. “They will be found, and you will be questioned,” said Eller.

The veterinarian’s role in an animal abuse case doesn’t end after the crime scene has been documented, evidence collected, and horses treated. He or she must provide a final report on the facts of the case, known as a forensic veterinary statement. This will help the judge and jury understand the evidence. When putting together a forensic veterinary statement, write for a lay audience, and remain impartial, said Eller. It is not the veterinarian’s job to determine guilt or innocence, but to present the medical facts of the case.

When Rescues Go Bad, Veterinarians Should Be Ready To Help

Here’s a good article by Natalie Voss from the Paulick Report, on the importance for veterinarians to recognize and act upon neglect in horse rescues. Veterinarians are in a position to observe occasions of animal abuse and have a moral obligation to report suspected cases.  That obligation has increased with the recognized link between abuse in animals and abuse in people and the recognition in some provinces (Quebec) of animal sentience. The rapid increase in the number of equine rescues and the number of horses under their control also means that increased vigilance and scrutiny must be made.

For Canadian veterinarians,  there is a Canada-specific resource produced by the CVMA that can be used for reference purposes.  Please click here to read the Microsoft Word document.

From the Paulick Report:

“As social media brings together more animal lovers and homeless horses than ever, authorities across the country are seeing an increase in the number of rescue situations gone bad. At the recent American Association of Equine Practitioners convention in Orlando, Fla., a panel of experts devoted an entire afternoon to helping veterinarians understand the legal and ethical implications involved in reporting cruelty cases and helping investigators document them.

There is no centralized authority keeping track of the numbers of horses reported neglected by owners each year, but the American Society for the Prevention of Cruelty to Animals suggests the number is growing. ASPCA is often called in large-scale neglect cases of all species to provide volunteer manpower and veterinary expertise.

It’s also becoming more common than ever to receive reports of large-scale neglect from farms operating as non-profit horse rescues. Dr. Jennifer Williams, president and co-founder of Blue Bonnet Equine Humane Society, pointed out the number of rescues has grown with the number of unwanted horses. When she began working in horse rescue 18 years ago, she was one of very few in that role in the state of Texas.

“Now you can’t hardly walk down the road without stumbling into a rescue. They’re everywhere,” said Williams, who noted there are now more than 400 organizations listed with the Internal Revenue Service as being a “horse” or “equine” rescue/humane society.

It’s only logical that some of those organizations will be ill-equipped to handle the unending need for their services, the panel agreed.

This means veterinarians need to be aware of the laws governing animal cruelty and neglect in their state and county and have an idea of who to call before they need to report a case. Some vets hesitate to report cases because they assume if the owner is ordering medical care for an animal, they can’t be considered to be abusing the animal. Others may believe they have to know who is responsible for abuse or neglect before reporting it (they don’t), or feel uncomfortable reporting a case in which the animals belong to someone who’s not a client. It’s also important for veterinarians to know the language of their state’s animal welfare laws, and the difference in “cruelty” (an act of commission, like beating an animal) versus “neglect” (an act of omission, like withholding feed).
 

“Just because you or I may feel something constitutes abuse, doesn’t mean the law recognizes it as such,” said Dr. Rachel Touroo, director of veterinary forensics at the ASPCA. “Therefore, you need to familiarize yourself with these laws to form an opinion of what constitutes cruelty or neglect.”

In fact, the non-reporting of a potential abuse case can pose a legal problem for veterinarians; some 11 states require them to report suspicions of abuse. (Kentucky, Florida, and New York have no such requirement; California does.)

Touroo indicated neglect is seen more often in horses than outright abuse and can be attributed to a variety of factors. Some owners (or rescues) run out of funding, others don’t have the necessary education to understand how to feed or care for animals. Others could experience depression or other emotional issues related to caregiver stress. Still others, Touroo said, have physical or mental health issues limiting their capacity to provide care. Mental health issues often manifest in the form of hoarding both animals and objects. In Touroo’s experience, people involved in these cases have lost touch with reality, and insist their crowded, starving, or ill animals are happy and healthy, even if it’s obvious they are not.

“They often will remain vigilant with this defense, all the way through court, even if they’re found guilty,” said Touroo. “They will insist they were providing the best care for these animals and no one else could care for these animals like they do.”

Despite this odd defense, people with overcrowded farms can also be aware enough of the horse’s physical appearance to hide the worst-looking animals on the back of the property, so veterinarians are encouraged to keep their eyes open. People operating rescues with this issue are sometimes known to refuse visitors to the facility, seem to focus on acquiring more animals rather than adopting out from their herd, and may insist upon accepting donated horses at a remote location.

Once a case has been identified and reported, veterinarians were encouraged to volunteer their support to local law enforcement. Some areas have dedicated animal control officers who may have training in identifying symptoms of malnourishment or untreated disease, but others are completely unprepared.

If veterinarians are brought in to help with an investigation, ASPCA has a suggested protocol for getting neglected horses treated without disrupting the legal case. Vets should take photographs of each horse throughout the treatment process from all angles, and establish identification numbers and descriptions of animals early on. Horses with contagious diseases should be quarantined and those diseases reported to the state’s animal health department if required. Medical records belong to the veterinarian and cannot legally be released without a subpoena (or permission from the animal’s owner), but should be maintained extensively for use in prosecution. This includes notes on normal findings or on vital signs and even means veterinarians shouldn’t delete blurry or out-of-focus photos from their phones. Dr. Nicole Eller, field shelter veterinarian, noted this causes gaps in metadata which could provide a defense lawyer a line of questioning in court.

Law enforcement should be tipped to any unusual equipment on the property such as veterinary drugs or surgical supplies. Possession of these items could constitute additional charges and could help identify accomplices.

Vets should also not refrain from billing the appropriate party for their treatment of the animals, since this demonstrates to the court the financial impact of restoring animals to health (though they shouldn’t expect speedy payment, either).

Ultimately, veterinarians’ role is to provide clarity, and hopefully in turn, justice and safety for the animal.

“We are advocates, in these cases, for the truth,” said Eller. “We as vets are used to being advocate for the animal, and in a lot of cases it should probably be the same thing. You don’t need to describe guilt or innocence; you just need to describe your findings.”

University of Saskatchewan Develops Endoscopy Capsule (Camera Pill) For Horses

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Julia Montgomery, from the University of Saskatchewan’s Western College of Veterinary Medicine, holds up an endoscopy capsule designed for humans but tested on the thoroughbred horse, Mama. The camera in a pill is able to take pictures for nine hours throughout the horse’s abdomen. | William DeKay

Endoscopy capsules are already available for human patients,  and aid in the diagnoses of inflammatory bowel and other conditions.  The capsule is the size and shape of a large pill and contains a tiny wireless camera.  After a patient swallows the capsule, it takes pictures of the inside of the gastrointestinal tract. 

The University of Saskatchewan has developed a prototype capsule for horses based on the capsule already in use for humans.  The capsule will be inserted via stomach tube and will contain lenses that send digital colour images attached to a receiver located in a belt wrapped around the horse’s rib cage.

Please read more here:

Ontario Equestrienne Receives Award For Exemplary Horse Health Care From McKee-Pownall Equine Services

jen-sweetIn an email blast dated October 20, 2016, McKee-Pownall Equine Services announced that they have selected Ontario equestrienne Jen Sweet to receive a welfare award based on her horse-health care philosophy.  We also congratulate Jen for her accomplishments! This is the second of an annual Horse Health and Welfare Award offered by McKee-Pownall.

“This award is valued at $1000 and is based upon:

  • Incorporating veterinary care as part of the overall training routine of horses in their care.
  • Putting the best interests of the horse’s health first over competition and training schedules.
  • Educating their clients about horse health care.

1074 votes were cast in a very close race!

We would also like to acknowledge runners up for this year’s award; Jesse Cassidy-Skof and Claire Hunter as well as all of the trainers nominated for this award.

Here are some words about Jen Sweet from those who nominated her for this award.
Jen is 100% dedicated to the health and well-being of the horses in her care. She has a dedicated daily and annual herd health program that incorporates a holistic healthcare professional approach, including vets, farriers, nutritionists, chiropractors and certified saddle fitters, all ensuring that her horses are well cared for.  Jen has used this approach to rescue and rehabilitate many horses to allow them to return to the equine community.

Jen passes her immeasurable knowledge on to her students and boarders at every opportunity, using the barn mailing list to inform her clients on herd health updates and education opportunities. She offers seminars and clinics to her students and engages the juniors in her barn in horse health clinics and horse care lessons. Jen is very aware of her horse’s behaviours and quickly picks up on problems and will put horse health above ribbons and prizes. She is engaged in a horse’s life from the moment they enter the barn to the moment they leave. She has an amazing ability to care for horses in their advanced years and is always able to make difficult decisions in the end stages with the best interests of the horse in mind, even when it is not easy. 

Presentation of this award to Jen Sweet will be made on the first Saturday evening performance at the Royal Winter Fair Horse Show 2016. Thank you to everyone who has taken the time to nominate and vote for these trainers.”