Q - With nearly 15-years experience
system disorders including arthritic condiyou have a deep understanding of tions of the cervical, thoracic, or lumbar sports medicine and imaging as it spine, as well as infectious diseases such Cave Creek Equine Sports Medicine & Surgery relates to horses. Now with the new as EPM to neuromuscular issues such as Standing MRI from Hallmarq, you Equine Motor Neuron Disease (EMND). have the state-of-the-art technology at your fingertips. How does These can be very challenging conditions to sort out and can mimic that make you feel? many other conditions, therefore it is always something that I take into consideration, particularly in difficult clinical cases. Additionally, A - In a word- It makes me feel ‘equipped’! I feel this allows us to these conditions have huge implications on rider safety and equally offer clients and patients the highest standard of care. MRI is conas much as I care about my patients, I care about my clients. I sidered in most instances the ‘gold standard’ of diagnostic imaging need to know that not only are they riding a sound horse but a for orthopedic injuries as it relates to both equine and human sports SAFE horse. medicine. With the ability to perform an MRI in a standing, sedated horse, we can get a diagnosis in a way that allows the horse to Q - What are a few tips for people to keep their horse’s sound? come and go on an outpatient basis. Especially when combined with our other diagnostic imaging capabilities including radiography, A - The most poignant tip I can give my clients about keeping their ultrasonography and nuclear scintigraphy we have the ability to get horses sound is ‘go with your gut’. If you feel like there is somethe most accurate diagnosis and treat injuries thing wrong (or even if you just want to make sure effectively and efficiently. there ISN’T something wrong), don’t wait to seek help! We are always here to help ensure that the horse is sound, comfortable and at its peak abilQ - Dive deep in sharing with our readers what ity to perform. Regular and routine performance this Standing MRI machine can really do, it’s evaluations are a great way to get ahead of a effectiveness for imaging and cost benefit comproblem that may be brewing. If there’s something parison to alternative MRI processes? telling you it might be time to see the vet but you A - There are several options when it comes to just can’t put your finger on it… you are probably ‘types’ of MRI machines characterized by field right!! If there is a change in the horse’s behavior strength (low-field vs. high-field). Simply putand willingness to perform, the answer may not be there is no one machine that is THE BEST… ‘more leg’, a ‘longer whip’ or ‘longer spurs’- a horse but there is the best option for every situation. doesn’t have to be limping to have a problem. When it comes to standing MRI (which is a lowfield magnet) there are several advantages. The Q - Is the Standing MRI a tool used in lameness sMRI allows for diagnostic imaging without the exams? need for anesthesia- oftentimes translating to a lower cost for the client, allows other necessary A - Yes, but rather it is a compliment to a comprefunctions of the clinic to continue without interhensive lameness examination. After a thorough ruption and the patient can come and go on the same day without history, physical examination and moving/dynamic examination in the need for a hospital stay. According to a study in January ’20 hand and even under saddle an MRI may be indicated to help idenpublished in the “Equine Veterinary Journal” they concluded: ‘Field tify what structure(s) are involved in the lameness and the degree strength is a more important influencer of image quality than anesof the pathology. In other words, an MRI without a complete lamethesia for magnetic resonance imaging of the equine foot in clinical ness examination is meaningless as it must be related to the clinipatients. This means that in the equine foot, provided the operator cal presentation. and handlers are skilled in maintaining an appropriately positioned and sedated horse, there is not a significant difference in the image Q - Stem cell treatment is a reality in treating horses. You’re quite quality (or effectiveness) between a standing and anesthetized lowknowledgable in that field. Can you share five-areas of treatment field MRI scan. At Cave Creek Equine, we are fortunate enough to that stem cells are being used on horses today? have the ability to perform an MRI standing but if for some reason A - Soft tissue injuries, particularly tendon and ligament injuries that is not a feasible option due to patient constraints or the loca(above and beyond the most common place stem cells are indicattion of the injury (such as the stifle) we can easily anesthetize the ed and used) Laminitis Conditions of the podotrochlear apparatus horse and perform the MRI to get the necessary information for a (‘navicular disease’) Intra-articular joint therapies (arthritis, postdiagnosis. The cost of the anesthetized MRI is slightly more, howoperative, etc…) Neurological conditions ever the information that is gained by performing an MRI in any circumstance is invaluable. High-field MRI machines are primarily Q - How do you feel on the effectiveness of the stem cell treatonly seen in university settings and do incur a much higher cost for ments? operation and therefore a higher cost for the client, as well as a trip A - Completely depends on the condition you are attempting to out of state as there are no high field equine MRI machines in the treat and what the definition of effective is. At this point in time, we state of Arizona. can’t really say that stem-cells SPEED healing but we have quite a bit of evidence to suggest that the QUALITY of healing is improved Q - Lameness examinations is a specialty field of yours. What seri- and the likelihood for reinjury is reduced. This (biologic and regeneraous lameness issues you are seeing more of? tive medicine) is still such a relatively new area of veterinary medicine that we are still figuring things out. Trying to wade through the types of A - There are so many issues that are important that it is hard to stem-cell products is challenging- where to put them, how often to put pin down just one, but I would have to say that neurological issues them there, what adjunctive therapies to combine them with, etc. are all are perhaps one of the most serious and prevalent issues we are questions that we are still trying to find good answers to. I think the efencountering over the last several years. The term ‘neurological’ fectiveness of some of these treatments really depends as much on the can be associated with a very wide variety of orthopedic or nervous 14
Dr. Lea Walker - Interview
stem-cells as it does on an accurate and comprehensive diagnosis.
JULY 2021
