February 20, 2015
Any horse can get a tendon injury, but our equine athletes are at a greater risk for soft tissue injures due to the additional strains and forces applied during and in preparation for competition. In the past, certain tendon injuries meant the end of a horse’s career or the start of a long and frustrating period of rest; but thanks to the advances in the field of regenerative medicine we are seeing improvement in quality of healing, reduced re-injury rates and less time until return to work. But let’s be honest: It doesn’t make desmitis—inflammation due to an injury to a ligament–any less frustrating because controlled rehabilitation programs are still the most important (and patience-testing) aspect of recovery.
As a budding veterinarian it is important to me to use my time at Hagyard not only to read and be exposed to current research surrounding regenerative therapies like stem cells, Platelet Rich Plasma (PRP), etc., but to pick the brains of experts and hear their opinions formed from years of experience and training. Call me a nerd, but to me that’s the best part of veterinary medicine: We are always learning and changing for the better of our profession.
In Thermal we are lucky enough to have access to the latest and greatest equipment and Dr. Liz Barrett’s expertise to offer and apply regenerative therapies to appropriate cases. Recently we had a horse who presented with a significant left front lameness–what we would grade a 3/5 lameness baseline at the trot. Our examination started with palpation and flexions, and then we began isolating the lameness. Because our patients can’t “point to where it hurts,” we target specific nerves with subcutaneous anesthetic to locally block regions of the limb. Once we had identified the general location of the problem, it was time to image the fetlock with radiographs and ultrasound the suspensory branches and the attachments. The pathology that was discovered at the conclusion of our exam lead to a discussion of therapeutic options to make our new pal sound.
After discussing the available options for this injury, pricing and side effects, one of the therapies chosen was Platelet Rich Plasma. But what exactly is PRP, where does it come from and why is it going to be helpful? PRP is a biological product consisting of concentrated platelets. It is prepared by collecting the patient’s own blood and then processing the sample in a centrifuge-like machine specific for producing PRP. Unlike stem cells, which can take weeks to be cultured, PRP is ready to be injected directly into the lesion in less than an hour. We know that platelets are important in the clotting process, but how do they help tendon fibers heal? The big challenge with tendon injury is that once the fibers have become disrupted the body doesn’t replace them with the same type of connective tissue previous to the injury. This makes the tendon predisposed to future tears and injury because the fibers have less elasticity and strength. Platelets contain growth factors that, when released, aid in the healing process. The theory is that these growth factors produce less scar tissue and a larger percentage of new fibers closer to the strength of the original. With this particular case we injected the PRP into the medial suspensory branch and expect that this will be the only injection needed. However the number of injections varies depending on what is being treated and the horse’s healing response.
That was another glimpse in my life as a HEMI intern and some of the cases I am seeing out here in Thermal, California. Now back to working and melting in the desert!
February 13, 2015
The first was the inaugural Wellington Eventing Showcase. As an eventer, I have been eagerly awaiting this. The entire event was held at the Palm Beach International Equestrian Center’s dressage complex. It was lovely being able to watch eventing dressage with palm trees in the background. The real fun came on Saturday: Show jumping was held in the dressage arena, which made for a more intimate setting than many other show-jumping events. Cross country was held that afternoon, and the riders went in reverse order of placing, which made for a great atmosphere as the class went along. For many of the horses, this was their first run of the year, and you could feel their excitement! The course was shorter than a typical Advanced-level course, and the speeds were decreased due to the arena being quite small. With that being said, the organizers did a fabulous job of setting up most of the typical cross-country obstacles: corners, skinnies, a small water complex, ditch and wall, banks, gallop fences, etc. The jumps themselves–created especially for the event–were beautiful. As a spectator, it was so fun to be able to sit in one location and see more than 90% of the course. The crowds were phenomenal, especially considering that many of the people probably had little exposure to the sport; by the end there was lots of cheering and many congratulations. I hope they continue this event for years to come!
The other fun event that was held recently was the Great Charity Challenge. Usually on Saturday evenings the International Arena hosts large Grand Prix classes, but this last Saturday many of the riders changed out their show coats for capes and became superheroes for the night. The evening is all about charities–$1.5 million was distributed among 34 local charities. Teams of juniors, amateurs and professional riders competed in a relay fashion. Jumps were set at different heights and one horse and rider jumped all those at one height before the next rider took off to do his or her set. The highlight wasn’t necessarily the jumping but instead watching costumed horses and riders fly around the ring as you imagine superheroes would! All the caped crusaders from Batman (or in many cases Batgirl) and Robin to the Incredibles were represented. My favorite team of superheroes may have been Captain Canada, who was represented by Ian Millar–they proudly wore Canadian flags as capes and their horses were adorned with letters spelling out “Captain Canada”. All the riders looked to be having the times of their lives and the horses loved the atmosphere!
Wellington definitely has some interesting and fun events that you would not normally see at an average horse show. It has been such a pleasure to be able to go and watch these extraordinary classes.
Dr. Marty Whitehouse
February 6, 2015
Hello from Southern California! I am Dr. Magda Stewart, a Hagyard Sport Horse intern who is getting to experience practicing veterinary medicine not only Hagyard- style but on the other side of the country at the HITS Desert Horse Park in Thermal. Our technician Rachel Blum and I road tripped across the United States in my trustful steed “The Silver Bullet”– a gas-guzzling Tahoe packed high with equipment. We made a quick detour through Red Rock Park in Arizona for some scenic views and to acquire some extra earth energy from the famous vortexes in preparation for nine weeks of horse show fun!
Now I am here with the Hagyard HITS team and I am finding not only how different equine management is in California but also the challenges the environment presents. I know that I should not be complaining about my inevitable farmer’s tan while the East Coast prepares for blizzards, but the desert conditions are keeping us very busy, especially in the evenings when we are often called out to treat emergency colics.
Here in the desert the temperatures vary greatly over a 24-hour period–hot and sunny during the day and then dropping down into the 40s overnight. Temperature swings can cause a horse to drink less water, which when combined with a hard day in the show ring can lead to dehydration as well as gastrointestinal disturbances. I am lucky to have the guidance of a boarded surgeon, Dr. Liz Barrett, who is skilled at performing abdominal ultrasound as well as thorough colic examinations. Abdominal ultrasound provides a window into the abdomen to evaluate stomach size and small intestinal motility, locate the kidney to rule out nephrosplenic entrapment (when the large colon becomes trapped between the left kidney, the spleen, and the ligament that runs between them) and measure colon wall thickness and cecum status. With Dr. Barrett’s guidance I am learning this important skill that helps to make game-time decisions such as whether to trailer to the nearest referral clinic, three hours away. I find abdominal ultrasound to be such an important skill, particularly because in the jumper world it is common for the colon microflora to become unbalanced from the stresses surrounding showing and for a gas-filled colon to be moved into an abnormal location from the motion of jumping. Being able to identify these displacements is important because it alters your treatment of choice and the likeliness of referral.
This doesn’t mean that we refer everything, in fact at this point our team has been able to treat all of our colics either stall-side or by bringing them to our veterinary building here on the grounds, which is equipped with stalls for hanging fluids and hospitalizing patients overnight for observation. A fluids shortage is making it very difficult to obtain 5-liter bags of Plasmalyte. Having only single 1-liter bags and a USEF rule requiring a minimum of 10 liters run to any horse has required us to get creative. Thankfully we are ambulatory vets, so along with some help from Hagyard Pharmacy, our skilled technician Rachel Blum and some MacGyver-like skills, we have come up with a solution to run multiple liters of fluids efficiently into our patients.
All of our patients have done well and it is exciting to see them returning to the show rings. That is a small glimpse of the official show vet day, or more accurately nights, here in California. I look forward to sharing more of my intern adventures next week!
February 4, 2015
Hi again from Wellington!
This last week has been another fun and exciting week in the life of a sport horse intern. The main draw of doing an internship for me was the opportunity to continue my education after graduation from veterinary school in specific avenues, such as improving my techniques in ultrasonography.
This last week Dr. Courtney Wittich and I have had a couple of cases that required the imaging modality of ultrasound and we also found a couple of normal horses for me to practice ultrasounding different lower limb areas.
Typically, Dr. Wittich will scan the horse first and we will discuss areas with lesions or strains. Then it is my turn- we spend time making sure I am able to get good quality images of all important structures within the specific area we are examining. Another part to the learning are the discussions we have with owners and trainers after the ultrasound exam. We are able to formulate the best treatment schedules and training plans based on the findings.
It has been great to learn so much from both the cases and “practice” horses. Stay tuned for another update next week!
Dr. Marty Whitehouse
Hello from Wellington! I am Dr. Marty Whitehouse, the lucky sport horse intern, who was sent down along with Dr. Courtney Wittich, to serve as the Hagyard Sport Horse team in the Wellington community for the winter of 2015. This first week has been a whirl-wind of both work and fun, but I am going to elaborate on some of the special events of this week. We arrived in time for the first week of showing at both the Winter Equestrian Festival and Global Dressage Festival. These locations are hosting world class competitions with some of the top horse and rider combinations from around the world over the next three months. This past Friday night we went to Friday Night Stars, which was an FEI Grand Prix Freestyle class. The musical freestyles were fun and breathtaking to watch, with the music ranging from today’s hits to several fun Disney themed ones! Saturday was filled with jumper classes in the international ring, but at night a different tension could be felt as it was the Battle of the Sexes night. The two teams competed in three different jumper classes- Speed round, Head to head round, and a Six Bar competition. Points were awarded throughout the events to determine the winners- it turned out to be a tie between the men and the women. The packed stadium lead to the atmosphere being electric! Though the speed and head to head rounds were fun, it was the six bar that really tested the athleticism of the horses. Alison Robitaille was the only person to clear the final vertical which was 1.80 meter (5’9”!)- talk about having to have your horse at the top of it’s game! On Sunday we returned to watch the Grand Prix in the afternoon which had 55 horses entered in the event. As always the jump off was where all the action was- the speed, accuracy, and shear power shown by each equine athlete was awe inspiring. Todd Minikus won riding a horse he had only been partnered up with for a couple of weeks! At the end of the day it is always fun to watch each rider come out of the ring with their special equine partners and dote on them for a job well done, even if the result was not being the winner. Until next time, everyone in colder environments, stay warm and continue to look for more posts from sunny Florida!