Message from the Publisher
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his issue features a variety of subjects again starting with a practice profile for Palm Beach Equine Clinic in Wellington, FL. As we are based in South Florida, this was an easy project. PBEC serves as the premier clinic for the annual Winter Equine Festival. They care for horses brought in from around the world and around the country with an incredible staff of veterinarians and a world-class facility featuring a full operating room and nuclear scintigraphy. Read the article and be impressed. Although Dr. David Frederick is writing a book about his 40 years of treating laminitis, he continues to share his experience with us again in this issue. Dr. Geoff Tucker turns philosopher on us relating his experience while attending the annual AAEP convention held this year in Orlando, FL. He came away with strong feelings about the profession and the people who comprise it. What made them become equine veterinarians and was it the right career move for them? In our continuing effort to keep the lines of communication open between farriers and equine veterinarians, we feature Steve Kraus, CJF, Head of Farrier Services at Cornell University College of Veterinary Medicine. He tells us how poor fitting saddles can cause lameness, gait faults, shoeing problems, and even personality problems as well. Finally, we thank Jump Media for an excellent wrap-up on the Equine World Stem Cell Summit (EWSCS) which partnered with the North American Veterinary Regenerative Medicine Association on a ground-breaking event held recently in Palm Beach, FL. Stem cell therapies have been positively changing the face of modern medicine for decades, and equine regenerative medicine lies at the forefront of these groundbreaking advancements. We hope you enjoy this issue. G. Richard Booth Publisher
Table of Contents Palm Beach Equine Clinic Welcomes the World to Wellington
A new year means one thing in Wellington, Florida: horse show season. Home to Palm Beach International Equestrian Center’s (PBIEC) iconic Winter Equestrian Festival (WEF) and AdequanŽ Global Dressage Festival (AGDF). This practice profile describes how Palm Beach Equine Clinic cares for horses (and owners) from around the country as well as the world. Page 6
A 40 Year Clinical Trial Treating Acute Laminitis as Vaso-Compression, Never VasoConstriction 1200+ Cases (1974-2014) Dr. Dave Frederick gives us another chapter in his upcoming book on the challenges of treating laminitis during his 40-year career as an equine veterinarian. Page 12
People
Dr. Geoff Tucker had a rude awakening when he attended the recent AAEP Annual Meeting in Orlando. When he tried to engage many of the younger equine veterinarians in conversation, he had concerns about the level of care and professionalism looming in the profession. However, his story has a good ending. Page 18
Saddle Fitting and Farriery Steve Kraus, CJF, Head of Farrier Services, Cornell University College of Veterinary Medicine, tells us that many farriers and equine veterinarians do not realize that poor fitting saddles can cause lameness, gait faults, shoeing problems, and even personality problems as well. Understanding the general principles of saddle fitting will help farriers and vets either confirm or eliminate that as a problem. Page 23
Equine World Stem Cell Summit Brings Equine Regenerative Medicine to Global Stage We report on the Equine World Stem Cell Summit (EWSCS) which partnered with the North American Veterinary Regenerative Medicine Association recently in Palm Beach, FL. Page 27
The publisher of this magazine makes no representation and provides no warranty as to the accuracy of any advertising or article contained herein. The views expressed by all contributors are not necessarily those of the publisher. The publisher reserves the right to decline any advertising for any reason. Copyright 2016 by Boca Publishing, Inc., PO Box 970902, Coconut Creek, FL 33097 (954) 295-2154. Reproduction in part or whole of this publication is not permitted without written permission from Boca Publishing, Inc.
Practice Profile
Palm Beach Equine Clinic Welcomes the World to Wellington By Lindsay Brock/Jump Media
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new year means one thing in Wellington, Florida: horse show season. Home to Palm Beach International Equestrian Center’s (PBIEC) iconic Winter Equestrian Festival (WEF) and Adequan® Global Dressage Festival (AGDF), as well as the International Polo Club, Wellington transforms into a winter haven for thousands of competitive sport horses each winter. Traveling from all corners of the world, riders, trainers, and owners call Wellington home for several months out of the year with many uprooting their entire training programs and relocating to the warmer climate. This “on the road” mentality brings certain challenges, but thanks to Wellington’s own Palm Beach Equine Clinic, maintaining the highest level of horse care is not one of them. “The growth in how many horses compete in Wellington each year has been exponential. To see the health of the industry in South Florida is representative of how horse sport is growing around the world,” said Dr. Scott Swerdlin, President of Palm Beach Equine Clinic. “The competition is obviously impressive, but the winter season is also an 5
Dr. Natalia Novoa performs a chiropractic adjustment on a horse at Palm Beach Equine Clinic. Photo provided by Palm Beach Equine Clinic engaging and exciting time for Palm Beach Equine Clinic, its veterinarians, and staff in general.” PBEC proudly serves as the official veterinarians of the renowned WEF and AGDF events with state-of-the-art facilities and a world-class team of veterinarians just minutes from PBIEC. They also boast an annex location in the heart of the WEF show grounds with a convenient location at the wood barn for pharmacy pick-ups, exams, and initial emergency evaluations only steps from the stabling areas. “For us to play a role in the growth of horse sport in Wellington and beyond is a real honor,” said Swerdlin. “Through our work, we aim to serve the local equine community, as well The International Equine Veterinarian • Issue 6 • 2016
as the international contingent of equestrians who migrate to Wellington each year, with the best veterinary care available.” PBEC’s intimate knowledge of the multi-disciplinary mecca that Wellington becomes in the winter makes them a convenient and unmatched one-stop-shop for the quarantine, emergency, and routine horse health care.
Welcoming the World With some of the most talented show jumping, dressage, and polo horses landing in Wellington for top competition during each winter season, Palm Beach Equine is dedicated to ensuring their treatments and services are among the best in the world. “It is always an exciting time of year to see the horses return to Wellington each winter, and every year it seems like better and better horses are competing from all over the world,” said Swerdlin. “The quality of horses and the quality of competition always continues to improve, and to play a role in the care of these gifted athletes is something we take great pride in.”
While serving as a state-of-the-art quarantine facility, a full-service surgical center, and intensive care hospital, as well as providing trusted routine care, PBEC’s team of 28 veterinarians look forward to the winter season because it is the perfect opportunity for collaboration. Veterinarians from around the world often follow their equine patients to Wellington, giving PBEC the opportunity to be part of a pool of knowledge not found anywhere else in the world. As the winter circuits in all disciplines grow each year, more and more veterinarians are following an ever-expanding number of horses to Wellington. To meet the needs of these traveling veterinarians, PBEC has a large referral veterinary program that works closely with individual veterinarians to provide a full-service clinic spanning the running of blood work to advanced diag-
nostic imaging and surgery procedures. PBEC veterinarians welcome the team approach and embrace the opportunity to support the traveling veterinarians in better serving their clients on the road while also learning from their cases. From the sport horse requiring an arthroscopic surgery or the racehorse requiring a condylar fracture repair, PBEC offers an array of support services to meet their needs. “It is a privilege for the team at PBEC to work together with many of the best veterinarians from all over the world as they travel to Wellington with their clients,” continued Swerdlin. “Collaborating with outside vets is a very valuable opportunity for our staff.” Ribbons and world ranking points may be the top priority for many of the horses and riders who ascend on Wellington, but for PBEC, seeing healthy horses arrive and leave Florida and the U.S. is the goal. Aside from general and emergency veterinary care, PBEC is uniquely positioned to help owners navigate through the ever-changing import, export, and quarantine regulations when traveling to Wellington from other countries. With their close proximity to Miami, one of the largest agricultural import locations in the country, Palm Beach Equine Clinic veterinarians stay abreast of current regulations of both import 8
and export countries and ensure they are upheld to rule out the presence of any threatening diseases. Such diseases routinely ruled out include equine infectious anaemia (EIA) or coggins, piroplasmosis, glanders, and dourine. Palm Beach Equine Clinic’s facility is also perfectly equipped to accommodate any contagious disease outbreaks. PBEC has expanded its facilities to include three climate controlled isolation stalls, each equipped with a separate dressing room and washing area to effectively follow strict biosecurity protocols in place to ensure cases are properly contained. Coupled with highly trained veterinarians and technicians, isolation cases are provided with exceptional care. “Palm Beach Equine Clinic is superbly prepared, both by location and expertise, to combat any unforeseen outbreaks of diseases during the show season,” said Dr. Swerdlin. “Such outbreaks are something our vets work tirelessly to prevent by encouraging proper biosecurity measures, but if an instance does occur, PBEC works with state veterinarians, show organizers, and horse owners to quarantine, prevent, and treat as necessary.”
World-Class Care at Palm Beach Equine Clinic The annex facility at PBIEC is a supplement to their renowned full-service facility located just minutes from the show grounds. PBEC takes pride in being able to accommodate diagnosis, treatment, and recovery of some of the world’s most valued sport horses. Through innovative technology and world-class veterinarians specializing in all areas of equine medicine, Swerdlin equates PBEC to some of the highest ranked human-treating hospitals in the U.S. That fact is one that gives horsemen and women local to Wellington peace of mind in knowing that the most advanced methods of veterinary medicine are at their disposal. The PBEC facility houses the most advanced imaging technologies available, including a standing Magnetic Resonance The International Equine Veterinarian • Issue 6 • 2016
Imaging (MRI), Nuclear Scintigraphy (Bone Scan), Ultrasonography, Digital Radiography, and Endoscopy to scan all disciplines and lameness origins. PBEC is unique in that a Board-Certified Radiologist is on-site to interpret images and assist with diagnosis for rapid results. PBEC’s on-site, full-service laboratory equipped with hematology, chemistry, and microbiology equipment provides veterinarians with the ability to quickly evaluate blood tests for critical cases. Whether it’s a pre-season screening scan to make sure the sound horse can remain healthy for a long season, or provide further diagnostic imaging for the acutely lame or chronically lame horse, in-depth performance evaluations and treatments thanks to PBEC’s veterinary technology help maintain horses performing at their best. Coupled with the most advanced equipment and veterinary technology, PBEC is home to board-certified surgeons, primary care veterinarians, and hospital technicians who are scheduled for emergency on-call assistance 24 hours a day, 365 days a year to treat, monitor, and care for critical cases. According to Dr. Swerdlin, the latest in diagnostic and treatment equipment drives the success of Palm Beach Equine Clinic within the horse sport world. It is his goal to have PBEC be equipped for
Palm Beach Equine Clinic’s Nuclear Scintigraphy equipment. Photo by Jack Mancini
any injury that may result from competition, but also be the most advanced referral center in the country. With that goal in mind, he took a giant leap into the future by investing in equipment that will aid in diagnosing injuries unique to the competition horse on any level, be it a child’s pony or Olympic hopeful. Swerdlin’s “build it and they will come” approach was a huge success as leading technology in turn attracted top talent. “The equipment came first, and it helped us to get some of the most talented specialists in the world,” he said. “With that said, it is a valuable experience for us to showcase our facility and equipment to outside vets who spend their winters in Wellington while following clients. These vets are the 1%, and we are fortunate to have the best in the world collaborating on our patients. You may only see one vet, but I guarantee three or four were involved in the decision-making process.”
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When winter arrives in Florida, the stakes climb higher for PBEC as horses with significant value settle in Wellington for competition. “With the value of these horses, it’s important that we have the most thorough vet and technological support,” added Dr. Swerdlin. “We don’t want to think we know what the problem is; we want to know the problem and what the solution is.”
Palm Beach Equine Clinic Leading the Way
Palm Beach Equine’s own Dr. Richard Wheeler flexing a horse at the clinic. Photo provided by Palm Beach Equine Clinic
Over the past 30 years, PBEC bought the first ultrasound for equine practice in South Florida, installed the first gamma ray camera to perform bone scans (Nuclear Scintigraphy), and developed Computed Radiography (CR) for horses. Currently, PBEC’s services offer the most advanced state-of-the-art surgical and diagnostic imaging equipment available, but they also have veterinarians leading the way in alternative therapies that can optimize a horse’s health and increase the longevity of their career. Considering the concentration of horses in Wellington during the winter, many PBEC veterinarians encounter symptoms that don’t respond to traditional or commonly accepted methods. For these sensitive cases, several PBEC veterinarians are well versed in chiropractic manipulation, acupuncture, and Chinese herbal medicines. These are three proven and effective alternatives to the standard medical treatments offered at PBEC. Chiropractic and acupuncture therapies are complementary treatments for lameness problems and other issues, and while they do not always replace conventional veterinary medicine or surgery, they are very useful in maintaining top performance levels or treating injuries and illnesses in horses.
The world-renowned Magnetic Resonance Imaging (MRI) machine located at Palm Beach Equine Clinic. Photo by Jack Mancini 10
PBEC was also one of the first clinics to respond to new 2017 regulations within show jumping that require all United States Equestrian Federation (USEF) and United States Hunter Jumper Association (USHJA) registered horses to be microchipped in order to accumulate points towards their showing record. The International Equine Veterinarian • Issue 6 • 2016
PBEC offers microchipping services onsite at PBIEC in order to conveniently aid owners and trainers in complying with the new rules. Whether collaborating with out-of-state or out-of-country veterinarians, assuming medical care of horses that do not have traveling veterinarians, or diagnosing and treating common lameness and injuries of competitive jumper, dressage, and polo mounts, PBEC continues to evolve each winter.
is also an opportunity for our vets to continue learning and advancing their methods,” concluded Dr. Swerdlin. “Our responsibilities are two-fold: to treat the world’s best horses with the most advanced knowledge and services available, and to collaborate with and learn from fellow veterinarians from around the globe. It is not an opportunity that every veterinarian can say they get in their career, and we make the most of every moment during the winter season because of that.” For more information on Palm Beach Equine Clinic and all the services they provide, please visit www.equineclinic.com or call 561-793-1599.
“It is our responsibility to the industry to be on top form during the influx of horses during the winter season, but it
Photo by G. Richard Booth The International Equine Veterinarian • Issue 6 • 2016
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A 40 Year Clinical Trial Treating Acute Laminitis as Vaso-Compression, Never Vaso-Constriction 1200+ Cases (1974-2014) Dr. David Frederick • drdfrederick@yahoo.com
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he author, having seen severe acute laminitis treated simply, quickly, and dramatically in 1968 prior to entering veterinary school, has held a minority theory on the pathogenesis and effective treatment of acute laminitis his entire career (1974-2014) in the same private solo equine field practice northwest of Chicago, Illinois. The author absolutely disagrees with the statement: “From the outset it must be understood that a therapeutic regime, using biological or chemotherapeutic agents able to arrest or block the triggering of laminitis, does not exist.” The same researcher has also written that “Some fortunate horses experience the foot pain of acute laminitis, but do not develop distal phalanx displacement and appear to make a complete recovery.”(1) This author has about 1080 anecdotes, not analyzed for this paper, who have made very simple, but complete recoveries from the pain and lameness of acute laminitis.
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A 31 yr old eventer/fox hunter (ret.) who was fully cured of acute laminitis 8 times over 33 years. He jumped the full sized picnic table every year to celebrate his birthday from age 30 to 34! His acute laminitis was always caught very early, by a very sensitive rider. He never needed more than 3 days of bute, and very temporary feed restrictions.
Materials and Methods From 1974 to 1992 all, or complicated or severe acute Grade IV laminitis cases were recorded retrospectively (starting in 1984, following Burney Chapman’s address to the AAEP on radical hoof resections and heart bar shoes as a salvage procedure.(2)) A medical record search, the author’s, and his client’s memories were used in 1984 to reconstruct all serious cases of laminitis seen the first 10 years of practice. All severe or complicated cases analyzed were treated by the author with an attempt to restore optimum circulation as soon
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as possible by treating the vaso-compression of compartment syndrome inflammation and edema within the hard hoof capsule. None of the author’s patients were ever given a vasodilator by the author, which he has always believed would be contraindicated. Also, the author always asked for as much turn out time as possible for acute laminitis—never stall confinement. Ideally, that turn out would be a sand arena 24/7 whenever available. From 1985 to 1992 all severe cases were recorded in real time, however there were too few cases to develop a significant database. Starting in 1993, a particularly bad year for acute laminitis (33 personally treated cases), every cases, mild and severe were recorded in real time. A significant number of these same horses were treated differently by other veterinarians prior to becoming the author’s patients. Others were treated for subsequent relapses after their owners had moved out of state with very different vasoconstriction laminitis theories. Too often there were vastly different outcomes due to the different treatment theories. A serious effort was made by the author to identify and tabulate what he believes to be the causes and mistakes which led to all complicated cases and the most dramatic recoveries.
A 1500# retired Warm Blood mare who survived Grade IV Acute Pasture Laminitis with 3 months of daily Bute and zero clinical damage to her hoofs. The 120 worst or most severe cases were analyzed (out of approximately 1200 total cases, since mild cases and quickly resolved cases were not traced prior to 1993) The other approximately 1080 cases recovered very quickly and could be considered routine, BUT it is precisely those types of cases which are too often ignored by the owners during the “window of opportunity”. The author believes every laminitis case has such a window to reverse the disease and prevent damage, if diagnosed early and treated logically, rather than symptomatically. Far too often the mild cases, when treated symptomatically by other vets, become severe cases.
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The most likely causes of the laminitis in the 120 horses and ponies analyzed were identified in every case—usually between 2 and 5 causes for every case. It is extremely important to identify and correct all causes.
A Shetland pony who has had a grade IV flare-up the past 8 years in Aug and Sept due to pasture and hypersensitivity to falling Walnut leaves. He runs and bucks the other 10 months. The Belgian mare represents 5 of the 120 cases selected which were Belgian mares with retained placentas.
Results The breeds in the 120 cases analyzed included: 24 AQHA 4 Standardbreds 13 Arabs 5 Belgians 8 Tenn. Walkers 3 Warm Bloods 7 Thoroughbreds 2 Morgans 7 Am. Saddlebreds 2 Andalusians 5 Paints 1 Percheron 4 Paso Finos 1 Friesian 1 Appaloosa
10 Shetland ponies 5 Welsh ponies 1 Hackney pony 1 Connemara pony 1 POA 3 Minis 1 Mini. Donkey
26 of the 1200 cases were eventually euthanized due to permanent lameness.
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74 Alfalfa hay 60 Excessive grain 59 Lush pasture 41 Clover 41 Excessive stall time 33 “Easy Keepers” 26 PPID signs and symptoms 15 Equine Metabolic Syndrome or obesity 6 Wild Cherry tree leaves or bark 6 Retained placenta 3 Road concussion 2 Corn 2 Walnut leaves and bark 2 Abscesses 2 Dexamethazone 1 West Nile Virus 1 Vit K-3 Kidney failure 1 Oak leaves 1 Colic Human errors contributed to virtually all of the failures analyzed. 58 times the owner made serious errors. 14 times the author made mistakes -- usually not recognizing very mild laminitis, allowing some of the ponies to be overdosed with bute, and using acute treatments too far into chronic, unstable cases. 30 times a previous vet made serious errors, and the horses were well into
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the chronic stage before the author saw them. 11 times a subsequent vet treated vasoconstriction with poor results. 6 times a trainer made errors. And just 2 farriers failed to recognize acute laminitis, and 2 other farriers used inappropriate treatments.
Discussion It is most unfortunate for horses that there is no more consensus on effective treatment of acute laminitis today than there was 100 years ago. In 1903, Dr. Dennis Magner wrote “The first or acute stage can be invariably cured which is not is not at all difficult to do; the second, or chronic, stage is not curable, but may be palliated to a limited extent.”(3) Caulton Reeks, a British professor and Fellow of the Royal College of Veterinary Surgeons, had frustratingly different opinions on laminitis treatment in his classic 1906 book, Diseases of the Horse’s Foot. (4) Next, in 1907, the USDA offered no specific treatment at all in their 17 page description of the signs, symptoms, and causes of laminitis.(5) In the 1907 USDA report on Diseases of the Horse there was simply one sentence on treatment of laminitis: “The treatment of laminitis is probably more varied than in any other disease, and yet a large number of cases recover for even the poorest practitioner.” The 1942 revision of the USDA report warned that “Bleeding, both general and local, should be guarded against.” (6) But the same year, the 1942 Yearbook of Agri-
A very special 20 year old TB who still holds Arlington Park’s track record for a 3 year old mile on the turf. His very mild acute laminitis was misdiagnosed as “foot soreness” (with digital radiographs). He lost a 14 month battle to grow new soles. culture, also published by the USDA, stated that acute laminitis was still “one of the few ailments which may be improved by bleeding…” (7) In 1986 and 1988, Dr. Ric Redden twice stated at the AAEP Convention that 20% of all laminitis cases become complicated “regardless of therapy” and 80% remain non-complicated “with or without treatment.” (8,9) The author of this report absolutely does not agree that any percentage of acute laminitis cases are doomed to fail due to “the mysterious nature of the disease”. Practicing medicine is very much like professional sports, insofar as the need to improve our skill by analyzing and correcting our mistakes. We can learn far more from our failures than from our successes. There is far too much peer pressure to not discuss mistakes for fear of litigation. The silence might be good business for veterinarians, but it hurts the horses we need to help.
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The author’s basic belief that the swelling and edema of inflammation within a confined space is what causes the lack of circulation to the laminae has never changed. The author has believed since veterinary school that the increased digital pulse pressure seen with laminitis is the horse’s sympathetic response to anoxia in the laminae. The horse must have “Acute, Oxygen-Sensing Mechanisms” in the laminae similar to the human oxygen-sensing mechanisms described by Weir in the New England Journal of Medicine in 2005. (10) The author believes this sympathetic attempt to restore adequate circulation to the laminae should NOT be interfered with by veterinarians with vasodilators, stall confinement, and therapeutic shoes in the ACUTE stage of laminitis. Time is critical depending on the severity of the inflammation. Horses with mild inflammation, allowed to roam, and good hoof conformation may heal themselves if the cause is removed, but severe inflammation has a very short window of opportunity for correct treatment.
is usually interpreted incorrectly. The author used Pollitt’s photomicrographs and corrosion casts 15 years ago to explain laminar edema causing vasocompression within the hoof and the horse compensating with vasoconstriction outside the hoof. Sadly, Pollitt, the leading laminitis researcher the past 40 years (not a practitioner), still does not agree, and too many horses continue to die.(11)
References
1. Pollitt, Chris, Equine Laminitis, RIRDC, 2001. 2. Chapman, Burney; Platt, George in Proceedings Am Assoc Equine Pract, 1984:30:99. 3. Magner, D.Magner’s Standard Horse and Stock Book, 1905:409,492. 4. Reeks, Caulton, Diseases of the The author has seen this simple treatment work in some very Horse’s Foot, 1906. 5. Holcombe,AA, Special Report sick horses while they were dying of peritonitis, kidney failon Diseases of the Horse, USDA, ure, and West Nile disease. The author believes the reason 1907:414-430. there is a much higher fatality rate for laminitis in hospitals 6. Holcombe, AA, Special Report on is mainly due to stall confinement in the ACUTE stage and Diseases of the Horse, USDA, revised 1942 by Giltner,LT. 426. the tendency to use more vasodilators, and IV fluids; but less 7. Mott, LO, et. al. Yearbook of Agriculphenylbutazone and lasix in hospitals. ture, USDA, 1942:456. 8. Redden,R. in Proceedings Am Assoc The author believes laminitis should be treated as an emerEquine Pract, 1986:32:648. 9. Redden, R in Proceedings Am Assoc gency more like human strokes and heart attacks. Restoring the circulation as soon as possible can make all the difference Equine Pract, 1988:34:312. 10. Weir, E. Kenneth, MD, Acute Oxybetween success and failure. Locking a horse with ACUTE gen-Sensing Mechanisms, New England laminitis in a stall and waiting to see what will happen due to Journal of Medicine, Nov. 10, 2005, 353:19; Mar. 2, 2006, 354:9, letters. the “mysterious nature of the disease” is unacceptable. 11. Frederick, David in American Farri ers Journal, Sept/Oct 1997. Horses cannot wait for unethical and inhumane “double blind trials” for laminitis. We need to recognize what works, and try to understand why it works. There has already been an abundance of incredibly good research published, but it The International Equine Veterinarian • Issue 6 • 2016
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People by Geoff Tucker, DVM www.theequinepractice.com There are some equine veterinarians who think the world of equine veterinary care is doing well. I’m not one of them. Maybe it’s because I am getting older and I’m seeing it differently but after attending this year’s AAEP meeting in Orlando Florida I walked away really concerned. But I think I’ve finally figured it out. Before I go there, let me get you to the point where I am.
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want to assure you that this has a good ending. If you are one of the many equine vets who believe we are doing well, I might agree with some of your points, but not all of them. This is because I travel in my unique practice from Florida to Louisiana to Washington to Tennessee to the states of New England and back down the east coast. I get to hear what horse owners say about veterinary care and it honestly runs the gamut from poor to exceptional. With the assumption that we all graduated from an accredited veterinary college, our abilities should be within a standard deviation. This started last January when I met a veterinarian in charge of the large and small animal hospital of a veterinary school and when asked how many good horse vets would be graduating in the spring he said “Out of 119 students, two and maybe with a lot of extra work, another two.” I wrote an article in this publication titled “Houston, We Have A Problem.” I suggested that because of
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the decreasing horse population, the increased cost of providing veterinary services and the increased cost of obtaining a degree, the financial rewards of becoming an equine veterinarian were being restricted to the horse dense areas increasing the competition between vets and reducing the choices for horse owners in rural areas. Then I started to ponder the question of what makes a good horse vet. I spent two months canvassing my clients and came up with two qualities above all else: passion for the profession and the ability to work with the horse. Third down the list was knowledge. This became a simple concept that a well trained veterinarian who was good with horses should become successful earning an income that kept him or her from becoming depressed and losing their passion. But I became stuck because I didn’t have a solution to how to create, in the mind of our clients, more “good” horse vets. Making it worse was talking to older and seasoned vets as well as vet students. Simply put, the older vets think the new graduates are very smart but are unsure of what they are doing or are confused. Some older vets won’t hire a new grad because they have worked hard to cultivate their clientele and don’t want to risk losing business by sending a new grad. Others don’t worry but rather send the new grad out as disposable help to do the grunt work. There are a few good vets that hire on and mentor new grads investing their time and The International Equine Veterinarian • Issue 6 • 2016
money building a relationship with the young vet, but these stories are not as common as the vet mills On the other hand, I asked many vet students at the meeting a simple question. “Why do you want to be a horse vet?” With one exception, all answered with one of the following: “I don’t know.” or “I like horses.” or “I wonder where Sally is? She was supposed to meet us here.” or “text, text, text.” Really? A seasoned veterinarian drops in for some conversation about being a horse vet and asking if they have any questions and no one steps up with a serious conversation? I admit that I can be intimidating. I admit that I ambushed them. But in business, we all need an elevator pitch. A one or two sentence description of what our business is about. These kids had nothing. To those who said they like horses, I reminded them that I had never had a horse write me a check. That they had better like people.
ant to talk (loudly) with a client about their horse. If the best part of being at a convention of 5000 equine veterinarians is networking, meeting new like minded people and exchanging ideas, then how is this possible when over half the people are afraid to stick out their hand and say something like, “You know of anyone doing such and such procedure? or such and such product? or anyone with a different approach to a difficult horse?” I got a few talking. Both were older vets and both very willing to offer advice on different subjects. That was fun. But when the last day came, I was more perplexed than ever. I headed out to the parking lot for the last time going through the elevated passageway with glass walls overlooking the now empty exhibitor hall with scattered garbage and beautiful displays nowhere in sight. Coming towards me was a tall young vet with a big Arizona smile who looked right at me and said, “Sure doesn’t look the same.” I was delighted to find a young vet not afraid to talk with a colleague she didn’t know and I thanked her for restoring my faith. She said it was no problem and she understood. But I still didn’t understand. Not until the next day on a 3 hour flight and a long conversation with Jerry Miller.
But it got worse. I walked the hallways for three days tipping my hat, smiling, saying “Howdy” to almost everyone willing to have eye contact with me. Ah, it was true that well over half couldn’t even have that. Those that did often looked like they had been cornered and blurted out a “Hi!” and continued walking. Of course there was a bunch texting but look at all the older Jerry Miller is a 4th generation West Point graduate. If that isn’t enough to qualify him in a discussion of military acadevets who thought it was more importThe International Equine Veterinarian • Issue 6 • 2016
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mies, he let me know that 2 of his 4 daughters now represent the 5th generation of Army graduates from West Point and are serving this country as we speak. He was joining his wife to share baby sitting duties of his one daughter serving in Afghanistan. One of the things my new friend does is interview high school students applying for admittance to West Point. He described most of these kids as motivated but missing in the one quality they look for - a desire to serve. I was intrigued as I was reflecting on the students I had talked with only days before at the AAEP meeting.
with people or horses, they wander the hallways of the convention never connecting with unknown colleagues but high-fiving those they do know, like a Top Gun pilot. They have no interest in driving the boat so to say of the association. They are only there because of the required credits needed for licensure.
The West Point Academy develops students to become leaders. At 22 years Jerry described for me the differences between West Point and of age they are second lieutenants in charge of a platoon of 15 to 30 people the other academies (Air Force, Navy and Coast Guard). The walking down the streets of Fallujah in following are the summaries of his words. Iraq. Only one mistake and all could be dead. These graduates are trained The Naval Academy develops students to drive a boat. They graduate with a skill that is applied in driving a boat and they to lead by interacting with people close to them, resolving conflicts and comwork through the ranks. After about 20 years they are finalpleting the mission. They stand up to ly given a boat to drive. Doesn’t this sound like the elders the challenges and succeed or, as Jerry in the AAEP who start as a new member, work through the says it, “They are toast.” Fear is not an ranks becoming members of committees, chair a committee, option. Over time, those electing to hold an office and finally become president of the AAEP? remain in the Army can end up piloting The Naval Academy develops boat drivers but few become admirals. The rest become glorified technicians good at their the ship and become President of the job. However remember that it was one of those well trained United States, but most become leaders admirals in the Pacific Fleet in 1942 who, when told the Japa- in almost ANY field. For example, Jerry leads in the health insurance field. nese were flying planes towards Pearl Harbor, dismissed it as nonsense. Jerry went on to further explain what it is recruiters are looking for in high The Air Force Academy develops students to fly a plane. school students for West Point. It is Only graduates with the skill in flying a plane are allowed to simply the desire to serve. They look fly and they do so piloting a very expensive piece of equipfor this one quality above all else. He ment at 22 years of age. These pilots work autonomously required it of his children and all of without really knowing the people of his maintenance team, them have done this to some capacity. the air traffic controllers, and the service personnel needUpon this desire to serve is a thick layer ed to fly their plane. They are basically well qualified but of leadership and experience. Most of work alone. Doesn’t this sound like most of the rest of the this is natural talent but the remainder veterinarians working on horses? Never taught to interact 20
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comes from coaching and mentorship from wiser people. Every second lieutenant in charge of a platoon has also a coach and mentor in their sergeant who, while having 20 years experience is still subordinate in rank. But he helps glue together the new lieutenant when he sees uncertainty and fear by offering advice and guidance. He won’t let the men of the platoon get killed. And so the proverbial lightening bolt struck me. Veterinary students are selected for intelligence and all fit some standard set up by the admission boards of all the schools. The result is a group of vets destined to drive a boat or fly a plane or do something with horses technically. The group is made up of four personalities which develop as time goes on. What is missing is the ability to work WITH people and not for people. Just imagine you are in charge of 15 to 30 people with their lives depending on your decisions. Could you work under that pressure? Most of us wouldn’t do well. We are great OB specialists or ultrasonographers or dentists or surgeons or lameness detectives, but how many could go up to each of us and effectively lead us? I think this is where the breakdown is occurring and preventing most of us from becoming “good horse vets.” It is our training to become good veterinarians that has prevented us from becoming good at people skills. After all, isn’t that really why we wanted to become a horse vet? To help horses but more importantly to help people through their horses. It works for me. We all want to become successful in our practices (fly a plane). Some of us want to become successful leading our profession (drive a boat). Horse owners tell me something else. They want a vet who connects with them and their horses. This seems to be a skill not taught or even selected for - the desire to serve the horse community. I had a chance to express this with the dean of Cornell at the alumni reception. I suggested that we needed to look at a way to make vet students better at communicating with clients and their horses. I didn’t get the impression that his school thought it
was important. But it is. The following day I was talking with a client who’s father is a 75 year old physician who has developed a new business of coaching physicians. Presently he is working with the cardiology unit of a local major hospital where the four cardiologists hate each other and won’t even speak with each other. If our human colleagues are having trouble communicating with each other (and the nurses tell me they have difficulty communicating with the nurses and clients) then where are we? My conclusion from the post convention analysis is that we, as a group of people equally trained and very dedicated to horses, need to work on our people skills. It is the missing ingredient in what I think makes every horse vet a “good horse vet.” It needs to start today in the selection process to find students who place a willingness to serve the horse owners and the horse industry above their like of horses. We need older mentors who have learned this to set the example for the new not just in the schools but in the practices and even in the way we treat the young client, for they are the next generation of students. While we still need plane flyers and boat drivers, we also need leaders of people.
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Farrier’s Corner
Saddle Fitting and Farriery Steve Kraus, CJF, Head of Farrier Services, Cornell University College of Veterinary Medicine
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s farriers we are aware that poor fitting horseshoes can cause discomfort and lameness in horses. Unfortunately, many farriers do not realize that poor fitting saddles can cause lameness, gait faults, shoeing problems, and even personality problems as well. Unless farriers have the opportunity to see the horses that they are shoeing, while being ridden, they will be blind to the problems that ill-fitting saddles cause. Being a master saddle fitter is not necessary to determine that a saddle doesn’t fit properly. However, understanding the general principles of saddle fitting will help farriers either confirm or eliminate that as a problem. This determination is important to avoid unnecessarily changing shoeing and trimming to fix a problem not caused by that. Many times farriers are blamed for lameness or movement problems that are being caused by a poor fitting saddle. These problems are: • Lack of forward impulsion • Actual lameness and injury • Unwilling to turn in tight circles • Refusing to jump • Failure to do extended gaits
An improperly fit saddle can also put the rider in an unbalanced position, which can cause movement problems and lameness. For example, a saddle that pitches the rider backward will eventually cause back problems, which will change the hind end stance.
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A saddle that fits well should not have any negative influence on how a horse moves. It should not leave any rub marks or uneven sweat patterns. It also should keep the rider in a balanced position. A saddle that needs a gel pad, riser pad, or any other extra pad, other than a normal saddle pad, does not fit properly. However, it is common to use these extra items when optimum fit can’t be achieved.
Another version of the adjustable tree is a system inside the tree that can be opened or closed with a tool provided by the manufacturer. There are also treeless saddles that mold themselves to the horse’s back. All of the above have advantages and disadvantages.
Due to the fact that owning many different saddles may be unaffordable to some horse owners that change horses often, there are some creative ways to assure a reasonable saddle fit. One is the adjustable tree. The saddle tree is the ridged part of the saddle that fits over the horse’s withers and rests on the shoulders. One system is the replaceable gullet. This gullet is an arch shaped piece of steel that comes in different widths, which fit inside a non-ridged tree. Just select the proper gullet width that matches the horse’s withers and install into the saddle.
Many high quality dressage and jumping saddles have an older method of adjusting them for proper fit. The under panels are stuffed with wool which can be manipulated to provide a precise fit and saddle balance. This process is known as “flocking”. Flocking is usually done by a professional saddle fitter. Recognizing an improper saddle fit is the key to knowing if there is a problem. There are some fitting errors that can
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easily be seen if you are aware of what constitutes a proper saddle fit. Further manual inspection can also give indications of fitting problems. To determine if a saddle fits properly, here are some guidelines to follow: • Saddle position - too far forward pinches the withers and restricts the shoulders, resulting in the horse not moving its front end out of the way (over reaching and forging). If you can see the horse right after it has been ridden, look for where there is no sweat under the saddle. That would indicate too much pressure in those areas. Too far back puts weight where it can hurt the horse’s back
• Pommel to cantle relationship - Depending on the type of saddle, the cantle should be higher than the pommel. How much higher depends on saddle type. If the cantle is lower, the saddle does not fit, which pitches the rider backwards causing back strains. • Level seat - the seat should be parallel to the ground which places the rider squarely on the horse’s back. An un-balanced rider causes gait problems and injury at speed. • Channel clearance and gullet width - the channel is the long groove down the center of the saddle. This should be completely clear of the horse’s spine. The saddle should only rest on the long back muscles. Pressure on the spine will cause dramatic movement problems. There should not be any sweat along the horse’s spine if the saddle fits well due to air flow through the channel.
• Wither clearance (saddle points too narrow or too wide) - the points are the front of the tree shaped like a fork. Too narrow digs into the shoulder muscles, restricting forward movement. Too wide lets the saddle rest on the withers causing soreness and rubs. If you see white hairs on the withers, it a sure sign that the saddle has been chronically sitting to low there. • Panel pressure and contact - by placing your hand, palm up, you can feel under the saddle if it is bridging or rocking. There should be even pressure on the underside of the saddle. If not, back problems can occur resulting in altered stance and gait.
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• Saddle stability with rider - due to individual conformational differences of horse’s backs, a well fitted saddle my shift with a rider at speed, jumping, or quick turns like used in polo or cutting. An unbalanced rider can cause interference problems and create sore spots. A breast collar, over girth, or a belly strap may help this problem. • Seat length - a saddle should never extend past the last rib which corresponds to the 18th thoracic vertebrae. Behind this are the lumbar vertebrae which are the weakest, non-weight bearing structures of the back. A saddle that is too long for the horse’s back can cause hind end problems will be misinterpreted as shoeing problems. • Horse response - Even watching a horse’s behavior while being saddled can give clues to an improper fit. If the horse twitches or puts its ears back when approached with a saddle, it is likely the saddle may be causing discomfort. Whenever a horse owner reports a problem to the farrier, the natural response is to judge our own work, looking for something we missed or can improve upon. Certainly, farriers should check on what is in their control, but observing outside influences is valuable to correctly diagnose problems.
Knowing how saddles should fit properly could take some of the frustration out of dealing with gait faults, stance changes, obscure lameness, and lack of forward impulsion. By doing this, farriers can move into the realm of professional horseman and horsewomen, not just horse shoe installers. When horses are trained, for various sports and work, there are many factors that will influence an individual horse’s ability to perform the best way possible. Farriers tend to focus on the shoeing aspects that are in their sphere of influence. However, to be able to understand the whole picture it is vital to be able to recognize problems and how to best handle them. Appropriate, skillful shoeing needs to be in concert not only with saddlery, but biting, dental care, nutrition, and training methods as well.
Equine World Stem Cell Summit Brings Equine Regenerative Medicine to Global Stage
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tem cell therapies have been positively changing the face of modern medicine for decades, and equine regenerative medicine lies at the forefront of these groundbreaking advancements. The utilization of equine stem cell therapies and regenerative applications have not only allowed for increased success in general veterinary medicine, the equine-model – scalable to humans – has provided numerous positive implications for human pre-clinical predictions. It was with this in mind that the World Stem Cell Summit decided to add a new, dedicated track to their 12th annual conference, produced by the non-profit Regenerative Medicine Foundation. This track, the inaugural Equine World Stem Cell Summit, held December 7-9, 2016, in West Palm Beach, FL, presented an exciting opportunity for an array of researchers, veterinarians, and equestrians to actively engage in the single largest conference uniting the global stem cell community. “We’re hearing more and more about the positive implications that regenera-
Dr. Alan Nixon, Director of Comparative Orthopaedics Laboratory, Professor, Department of Clinical Sciences, Cornell University, and the Chair of the Board of Directors at the North American Veterinary Regenerative Medicine Association (NAVRMA)
tive medicine is having on veterinary practice and veterinary success rates, and the research findings coming from the equine field – and the direct correlations that those findings have on human medicine – are particularly impressive,” said Bernie Siegel, Founder and Chair of the World Stem Cell Summit. “The Equine World Stem Cell Summit presented the perfect opportunity to bring equine medicine onto the global stem cell stage and to bring together leading veterinarians, researchers, and institutions from across all realms of regenerative medicine,” Siegel continued. The decision, fueled by Siegel, to add the equine track to the World Stem Cell Summit was one highly-praised by all in attendance.
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“It’s a great opportunity to get together with some of the scientists who are in the lab looking at this from the opposite level,” said Dr. Richard Wheeler of Palm Beach Equine Clinic, a sponsor of the 2016 Equine World Stem Cell Summit. Wheeler and fellow Palm Beach Equine Clinic colleagues, Dr. Robert Brusie and Dr. Jorge Gomez, were among the actively practicing veterinarians who spoke on the impact that regenerative medicine is having on equine medicine. Other practicing equine veterinarians sharing insights into the efficacy of specific cases, the utilization of amnion, stromal vascular fraction and platelet rich plasma in equines, the orthopedic and neurological applications of regenerative medicine, and more included Priscilla Ortiz Poras, DVM, of Innova Celulas Madre in Costa Rica and Dr. Rogerio Martins Amorim, DVM, MSc, PhD, Faculty of Veterinary and Animal Science, Veterinary Clinic Department, Veterinary Neurology Service of São Paulo, Brazil. “[The Summit] has been very, very good and very productive as far as as alternatives to palliative therapy,” said attendee Dr. Kevin Brophy of Victory Vet in Wellington, FL. “I do think regenerative medicine is certainly the way of the future for my practice.” Brophy continued, “I recommend [the Equine World Stem Cell Summit] to both small animal and equine veterinarians for sure. It’s not just for orthopedic or musculoskeletal issues either. We had a great talk on neurology, and there was a case today of a very productive outcome for equine protozoal myeloencephalitis (EPM).” Among those sharing findings from clinical trials and research were Dori Borjesson, BA, DVM, MPVM, PhD, Professor and Researcher, Pathology, Microbiology & Immunology, of University of California, Davis; Graham Parker, PhD, Wayne State University; Jeanne Loring, Scripps Research Institute; Dr. 28
Mathieu Spriet, DVM, MS, Diplomate American College of Veterinary Radiology, Associate Professor, Department of Surgical & Radiological Sciences, of University of California, Davis; track keynote speaker Arnold Caplan, PhD, Professor Biology and Director, Skeletal Research Center, of Case Western Reserve University; and Steven C. Ghivizzani, PhD, of University of Florida College of Medicine. For many of the researchers, including Ghivizzani, the introduction of the Equine World Stem Cell Summit to the larger World Stem Cell Summit has allowed them to share the findings that are proving relevant across both equine and human medicine and to learn more from practitioners and researchers on both sides. “I’m not a veterinarian, so for me, working with veterinarians gave us the chance to take our experimental therapies and try them on a large scale – on a human scale,” said Ghivizzani. “I just think the benefits are tremendous. Those who are in human medicine really need to work more closely with those certainly in equine medicine [and] the opportunities to really look at your therapies and see what they do on a large scale – and again with the same diagnostics. All of those things are the same so you really get a sense of what’s happening and what’s going on there. I can’t understand why people don’t do it more!”
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Brandon Ames, Dr. Scott Swerdlin, Dr. Robert Brusie, Dr. Richard Wheeler and Dr. Jorge Gomez. Photo courtesy of Jump Media.
Dr. Rogerio Martins Amorim. Photo courtesy of Jump Media.
Ghivizzani’s sentiments were echoed by Karl Nobert of Recellerate, a manufacturer of stem cell therapeutic preparations for veterinary and medical purposes.
The Equine World Stem Cell Summit was also proud to welcome Dr. Alan Nixon, Director of Comparative Orthopaedics Laboratory, Professor, Department of Clinical Sciences, Cornell University, and the Chair of the Board of Directors at the North American Veterinary Regenerative Medicine Association (NAVRMA).
“I think it’s important because it’s the development process for everything else that’s being talked about here,” Nobert said. “It’s the foundation; it’s the pre-clinical data that supports the human drug therapy. Everything that they’re talking about on the human side today will be supported by animal data – the horse, the dog, the cat.” Nobert spoke throughout the summit on the regulatory challenges associated with regenerative medicine and stem cell therapies and on working with the Food and Drug Administration (FDA) to develop equine regenerative medicine products. Also representing regenerative medical companies were Brandon Ames, CEO of AniCell BioTech and highly-respected regenerative medicine researcher and CEO of VetStem Biopharma, Inc., Dr. Robert Harman, DVM, MPMVM.
NAVRMA partnered with the Equine Stem Cell Summit in the event’s inaugural year, and Nixon looks forward to continuing the partnership in years to come. “The advantages of having those sorts of talks exposed at this sort of broad summit are multi-disciplinary,” Nixon said. “They impact practitioners as well as researchers and university environments. It makes a good melting pot to exchange ideas.
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“It’s beneficial to us [at NAVRMA] as a small group. It’s too small to be able to give the whole audience a big exposure to other people doing similar work or collaborations that they could form. You get fairly broad number of talks – from companion animal to equine tracks – but you’re talking to the same group,” Nixon continued. “What I’m hoping is that the association alliance will allow us to broaden our talks, but also allow us to get more involved with other people that are talking here afterward either as research collaborations or marketing collaborations or the pipeline system for approvals through the FDA. Those things are going to come out of this environment.”
UC Davis exhibit. Courtesy of Jump Media.
Following the great success of the 2016 Equine World Stem Cell Summit, plans are already in the works to expand the event for 2017, with details to be announced. To learn more about the World Stem Cell Summit and the Equine World Stem Cell Summit please visit www.worldstemcellsummit.com/ equine.
Karl Norbert, Steven Ghivizzani, Dori Borjesson and Alan Nixon. Photo courtesy of Jump Media.
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