Dr. Lea Walker - Interview Cave Creek Equine Sports Medicine & Surgery

Q - With nearly 15-years experience you have a deep understanding of sports medicine and imaging as it relates to horses. Now with the new Standing MRI from Hallmarq, you have the state-of-the-art technology at your fingertips. How does that make you feel?

A - In a word- It makes me feel ‘equipped’! I feel this allows us to offer clients and patients the highest standard of care. MRI is considered in most instances the ‘gold standard’ of diagnostic imaging for orthopedic injuries as it relates to both equine and human sports 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 come and go on an outpatient basis. Especially when combined with our other diagnostic imaging capabilities including radiography, ultrasonography and nuclear scintigraphy we have the ability to get the most accurate diagnosis and treat injuries effectively and efficiently.

Q - Dive deep in sharing with our readers what this Standing MRI machine can really do, it’s effectiveness for imaging and cost benefit comparison to alternative MRI processes?

A - There are several options when it comes to ‘types’ of MRI machines characterized by field strength (low-field vs. high-field). Simply putthere is no one machine that is THE BEST… but there is the best option for every situation. When it comes to standing MRI (which is a lowfield magnet) there are several advantages. The sMRI allows for diagnostic imaging without the need for anesthesia- oftentimes translating to a lower cost for the client, allows other necessary functions of the clinic to continue without interruption and the patient can come and go on the same day without the need for a hospital stay. According to a study in January ’20 published in the “Equine Veterinary Journal” they concluded: ‘Field strength is a more important influencer of image quality than anesthesia for magnetic resonance imaging of the equine foot in clinical patients. This means that in the equine foot, provided the operator and handlers are skilled in maintaining an appropriately positioned and sedated horse, there is not a significant difference in the image quality (or effectiveness) between a standing and anesthetized lowfield MRI scan. At Cave Creek Equine, we are fortunate enough to have the ability to perform an MRI standing but if for some reason that is not a feasible option due to patient constraints or the location of the injury (such as the stifle) we can easily anesthetize the horse and perform the MRI to get the necessary information for a diagnosis. The cost of the anesthetized MRI is slightly more, however the information that is gained by performing an MRI in any circumstance is invaluable. High-field MRI machines are primarily only seen in university settings and do incur a much higher cost for operation and therefore a higher cost for the client, as well as a trip out of state as there are no high field equine MRI machines in the state of Arizona.

Q - Lameness examinations is a specialty field of yours. What serious lameness issues you are seeing more of?

A - There are so many issues that are important that it is hard to pin down just one, but I would have to say that neurological issues are perhaps one of the most serious and prevalent issues we are encountering over the last several years. The term ‘neurological’ can be associated with a very wide variety of orthopedic or nervous system disorders including arthritic conditions of the cervical, thoracic, or lumbar spine, as well as infectious diseases such as EPM to neuromuscular issues such as Equine Motor Neuron Disease (EMND). These can be very challenging conditions to sort out and can mimic many other conditions, therefore it is always something that I take into consideration, particularly in difficult clinical cases. Additionally, these conditions have huge implications on rider safety and equally as much as I care about my patients, I care about my clients. I need to know that not only are they riding a sound horse but a SAFE horse.

Q - What are a few tips for people to keep their horse’s sound?

A - The most poignant tip I can give my clients about keeping their horses sound is ‘go with your gut’. If you feel like there is something wrong (or even if you just want to make sure 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 ability to perform. Regular and routine performance evaluations are a great way to get ahead of a problem that may be brewing. If there’s something telling you it might be time to see the vet but you just can’t put your finger on it… you are probably right!! If there is a change in the horse’s behavior and willingness to perform, the answer may not be ‘more leg’, a ‘longer whip’ or ‘longer spurs’- a horse doesn’t have to be limping to have a problem.

Q - Is the Standing MRI a tool used in lameness exams?

A - Yes, but rather it is a compliment to a comprehensive lameness examination. After a thorough history, physical examination and moving/dynamic examination in hand and even under saddle an MRI may be indicated to help identify what structure(s) are involved in the lameness and the degree of the pathology. In other words, an MRI without a complete lameness examination is meaningless as it must be related to the clinical presentation.

Q - Stem cell treatment is a reality in treating horses. You’re quite knowledgable in that field. Can you share five-areas of treatment that stem cells are being used on horses today?

A - Soft tissue injuries, particularly tendon and ligament injuries (above and beyond the most common place stem cells are indicated and used) Laminitis Conditions of the podotrochlear apparatus (‘navicular disease’) Intra-articular joint therapies (arthritis, postoperative, etc…) Neurological conditions

Q - How do you feel on the effectiveness of the stem cell treatments?

A - Completely depends on the condition you are attempting to treat and what the definition of effective is. At this point in time, we 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 and the likelihood for reinjury is reduced. This (biologic and regenerative 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 stem-cell products is challenging- where to put them, how often to put them there, what adjunctive therapies to combine them with, etc. are all questions that we are still trying to find good answers to. I think the effectiveness of some of these treatments really depends as much on the stem-cells as it does on an accurate and comprehensive diagnosis.