Equine Medicine and Surgery Palm Beach Gardens
Category: Surgery
A New Lease on Life with Surgical Intervention
Palm Beach Equine Clinic is one of the foremost equine surgical centers in the world with three board-certified surgeons on staff, led by Dr. Weston Davis. As a busy surgeon, Dr. Davis has seen many horses with the dreaded "kissing spines" diagnosis come across his table. Two of his most interesting success stories featured horses competing in the disciplines of barrel racing and dressage.
Flossy's Story
The words "your horse needs surgery" are ones that no horse owner wants to hear, but to Sara and Kathi Milstead, it was music to their ears. In 2016, Sara – who was 17 years old at the time and based in Loxahatchee, Florida – had been working for more than a year to find a solution to her horse's extreme behavioral issues and chronic back pain that could not be managed. Her horse Two Blondes On Fire, a then-eight-year-old Quarter Horse mare known as "Flossy" in the barn, came into Sara's life as a competitive barrel racer. But shortly after purchasing Flossy, Sara knew that something wasn't right.
"We tried to do everything we could," said Sara. "She was extremely back sore, she wasn't holding weight, and she would try to kick your head off. We tried Regu-Mate, hormone therapy, magna wave therapy, injections, and nothing helped her. We felt that surgery was the best option instead of trying to continue injections."
At the time, Sara and her primary veterinarian, Dr. Jordan Lewis of Palm Beach Equine Clinic (PBEC), brought Flossy to PBEC for thorough diagnostics. They determined Flossy had kissing spines.
Kissing Spines Explained
In technical terms, kissing spines are known as overriding or impinging dorsal spinous processes. The dorsal spinous process is a portion of bone extending dorsally from each vertebra. Ideally, the spinous processes are evenly spaced, allowing the horse to comfortably flex and extend its back through normal positions. With kissing spines, two or more vertebrae get too close, touch, or even overlap in places. This condition can lead to restrictions in mobility as well as severe pain, which ultimately can lead to back soreness and performance problems.
"The symptoms can be extremely broad," acknowledged Dr. Davis. "[With] some of the horses, people will detect sensitivity when brushing over the topline. A lot of these horses get spasms in their regional musculature alongside the spinous processes." A significant red flag is intermittent, severe bad behavior, such as kicking out, bucking, and an overall negative work attitude, something that exactly described Flossy.
Lakota's Story
With dressage horse Lakota owned by Heidi Degele, there were minimal behavior issues, but Degele knew there had to be something more she could do to ease Lakota's pain.
"As his age kicked in, it was like you were sitting on a two-by-four," Heidi said of her horse's condition. "I knew his back bothered him the most because with shockwave he felt like a different horse; he felt so supple and he had this swing in his trot, so I knew that's what truly bothered him." Though she could sense the stiffness and soreness as he worked, he was not one to rear, pin his ears, or refuse to work because of the pain he was feeling.
Heidi turned to Dr. Davis, who recommended a surgical route, an option he only suggests if medical treatment and physical therapy fail to improve the horse's condition. "Not because the surgery is fraught with complications or [tends to be] unsuccessful," he said, "but for a significant portion of these horses, if you're really on top of the conservative measures, you may not have to opt for surgery.
"That being said, surgical interventions for kissing spines have very good success rates," added Dr. Davis. In fact, studies have shown anywhere from 72 to 95 percent of horses return to full work after kissing spines surgery.
After Lakota made a successful recovery from his surgery in 2017, he has required no maintenance above what a typical high-level performance horse may need. Heidi attributes his success post-surgery to proper riding, including ground poles that allow him to correctly use his back, carrot stretches, and use of a massage blanket, which she has put into practice with all the horses at her farm. Dr. Davis notes that proper stretching and riding may also prolong positive effects of injections while helping horses stay more sound and supple for athletic activities.
Lakota, who went from Training Level all the way up through Grand Prix, is now used by top working students to earn medals in the Prix St. Georges, allowing them to show off their skills and earn the qualifications they need to advance their careers.
Flossy's Turnaround
Flossy was found to have dorsal spinous process impingement at four sites in the lower thoracic vertebrae. Dr. Davis performed the surgery under general anesthesia and guided by radiographs, did a partial resection of the affected dorsal spinous processes (DSPs) to widen the spaces between adjacent DSPs and eliminate impingement.
Sara took her time bringing Flossy back to full work. Within days of the surgery, Sara saw changes in Flossy, but within six months, she was a new horse.
"Surgery was a big success," said Sara. "Flossy went from a horse that we used to dread riding to the favorite in the barn. It broke my heart; she was just miserable. I didn't know kissing spines existed before her diagnosis. It's sad to think she went through that pain. She's very much a princess, and all of her behavioral problems were because of pain. Now my three-year-old niece rides her around."
Sara and Flossy have returned to barrel racing competition as well, now that Sara graduated from nursing school, and have placed in the money regularly including two top ten finishes out of more than 150 competitors.
"I can't even count the number of people that I have recommended Palm Beach Equine Clinic to," said Sara. "Everyone was really great and there was excellent communication with me through every step of her surgery and recovery."
By finding a diagnosis for Flossy and a way to ease her pain, Sara was able to discover her diamond in the rough and go back to the competition arena with her partner for years to come.
A Horse Owner's Guide to Colic Surgery Recovery
What To Expect After the Unexpected Strikes
Featured on Horse Network
Every owner dreads having to decide whether or not to send their horse onto the surgical table for colic surgery. For a fully-informed decision, it is important that the horse's owner or caretaker understands what to expect throughout the recovery process.
Palm Beach Equine Clinic (PBEC) veterinarian Weston Davis, DVM, DACVS, assisted by Sidney Chanutin, DVM, has an impressive success rate when it comes to colic surgeries, and the PBEC team is diligent about counseling patients' owners on how to care for their horse post-colic surgery.
"After we determine that the patient is a strong surgical candidate, the first portion of the surgery is exploratory so we can accurately define the severity of the case," explained Dr. Davis. "That moment is when we decide if the conditions are positive enough for us to proceed with surgery. It's always my goal to not make a horse suffer through undue hardship if they have a poor prognosis."
Once Dr. Davis gives the green light for surgical repair, the surgery is performed, and recovery begins immediately.
"The time period for the patient waking up in the recovery room to them standing should ideally be about 30 minutes," continued Dr. Davis. "At PBEC, we do our best to contribute to this swift return by using a consistent anesthesia technique. Our team controls the anesthesia as lightly as we can and constantly monitors blood pressure. We administer antibiotic, anti-inflammatory, anti-endotoxic drugs, and plasma to help combat the toxins that the horse releases during colic. Our intention in the operating room is to make sure colic surgeries are completed successfully, but also in the most time-efficient manner."
Colic surgery recovery often depends on the type and severity of the colic. At the most basic level, colic cases can be divided into two types – large intestine colic and small intestine colic – that influence the recovery procedures and outlook.
Large intestinal colic or impaction colic is characterized by the intestine folding upon itself with several changes of direction (flexures) and diameter changes. These flexures and diameter shifts can be sites for impactions, where a firm mass of feed or foreign material blocks the intestine. Impactions can be caused by coarse feeds, dehydration, or an accumulation of foreign materials such as sand.
Small intestinal colic or displacement colic can result from gas or fluid distension that results in the intestines being buoyant and subject to movement within the gut, an obstruction of the small intestine, or twisting of the gut. In general, small intestinal colics can be more difficult than large intestinal colics when it comes to recovery from surgery.
"Many people do assume that after the colic surgery is successfully completed their horse is in the clear," said Dr. Chanutin. "However, during the first 24 to 48 hours after colic surgery, there are many factors that have to be closely monitored.
"We battle many serious endotoxic effects," continued Dr. Chanutin. "When the colon isn't functioning properly, microbial toxins are released inside the body. These microbials that would normally stay in the gastrointestinal tract then cause tissue damage to other bodily systems. We also need to be cognizant of the possibility of the patient developing laminitis, a disseminated intervascular coagulation (overactive clotting of the blood), or reflux, where a blockage causes fluids to back up into the stomach."
Stages after surgery
Immediately Post-Surgery
While 30 minutes from recumbent to standing is the best-case scenario, Dr. Davis acknowledges that once that time period passes, the surgical team must intervene by encouraging the horse to get back on its feet.
Once a horse returns to its stall in the Equine Hospital at PBEC, careful monitoring begins, including physical health evaluations, bloodwork, and often, advanced imaging. According to Dr. Davis, physical exams will be conducted at least four times per day to evaluate the incision and check for any signs of fever, laminitis, lethargy, and to ensure good hydration status. An abdominal ultrasound may be done several times per day to check the health of the gut, and a tube may be passed into the stomach to check for reflux and accumulating fluid in the stomach.
"The horse must regularly be passing manure before they can be discharged," said Dr. Chanutin. "We work toward the horse returning to a semi-normal diet before leaving PBEC. Once they are at that point, we can be fairly confident that they will not need additional monitoring or immediate attention from us."
Returning Home
Drs. Davis and Chanutin often recommend the use of an elastic belly band to support the horse's incision site during transport from the clinic and while recovering at home. Different types of belly bands offer varying levels of support. Some simply provide skin protection, while others are able to support the healing of the abdominal wall.
Two Weeks Post-Surgery
At the 12-to-14-day benchmark, the sutures will be removed from the horse's incision site. The incision site is continuously checked for signs of swelling, small hernias, and infection.
At-Home Recovery
Once the horse is home, the priority is to continue monitoring the incision and return them to a normal diet if that has not already been accomplished.
The first two weeks of recovery after the horse has returned home is spent on stall rest with free-choice water and hand grazing. After this period, the horse can spend a month being turned out in a small paddock or kept in a turn-out stall. They can eventually return to full turnout during the third month. Hand-walking and grazing is permittable during all stages of the at-home recovery process. After the horse has been home for three months, the horse is likely to be approved for riding.
Generally, when a horse reaches the six-month mark in their recovery, the risk of adverse internal complications is very low, and the horse can return to full training under saddle.
When to Call the Vet?
Decreased water intake, abnormal manure output, fever, pain, or discomfort are all signals in a horse recovering from colic surgery when a veterinarian should be consulted immediately.
Long-Term Care
Dr. Davis notes that in a large number of colic surgery cases, patients that properly progress in the first two weeks after surgery will go on to make a full recovery and successfully return to their previous level of training and competition.
Depending on the specifics of the colic, however, some considerations need to be made for long-term care. For example, if the horse had sand colic, the owner would be counseled to avoid sand and offer the horse a selenium supplement to prevent a possible relapse. In large intestinal colic cases, dietary restrictions may be recommended as a prophylactic measure. Also, horses that crib can be predisposed to epiploic foramen entrapment, which is when the bowel becomes stuck in a defect in the abdomen. This could result in another colic incident, so cribbing prevention is key.
Generally, a horse that has fully recovered from colic surgery is no less healthy than it was before the colic episode. While no one wants their horse to go through colic surgery, owners can rest easy knowing that.
"A lot of people still have a negative association with colic surgery, in particular the horse's ability to return to its intended use after surgery," said Dr. Davis. "It's a common old-school mentality that after a horse undergoes colic surgery, they are never going to be useful again. For us, that situation is very much the exception rather than the rule. Most, if not all, recovered colic surgery patients we treat are fortunate to return to jumping, racing, or their intended discipline."
Surprise – It's a Boy: A Friesian's Journey to Becoming a Gelding
When Debbie Cruz imported her 2012 Friesian from Europe, she was excited to welcome the gelding into her life. However, the mount she purchased as a gelding from The Netherlands still had a lot of stallion left in him. Literally.
Marquis, Cruz's hopeful dressage mount, arrived safe and sound to her home in Miami, FL, in early 2020. When he started to display quintessential stallion-like behavior, she called her veterinarian, Dr. Joseph Zerilli, to help her determine the cause of this very "un-gelding like" behavior.
"I was told that he had been gelded while in The Netherlands, but when he came home, he was acting exactly like a stud rather than the sweet gelding I thought would be arriving," said Cruz. "I wasn't sure what the cause could have been, but I knew something wasn't right."
Dr. Zerilli performed a blood test as part of his exam, which revealed very high levels of testosterone for a horse that was supposed to be a gelding. The level of testosterone present was a solid marker for a retained testis, one that would require surgery to remove. Marquis was referred to Dr. Weston Davis, a board-certified surgeon at Palm Beach Equine Clinic in Wellington, FL.
Dr. Davis used a hCG stimulation test and abdominal ultrasound to determine if testicular tissue was present and the source of Marquis' testosterone levels were confirmed: he was a cryptorchid. Also known as a "rig" or "ridgling," a cryptorchid horse has one or both testes that are not fully descended into the scrotum. In Marquis' case, he had a retained left testis within the abdomen.
In a normal stallion, the testes gradually descended from just below the kidneys, through the inguinal canal, and into the scrotum. This happens either in utero or during the first few weeks of life. Occasionally, either one or both testes fail to descend for reasons that are still not fully understood by veterinarians. A cryptorchid stallion can be further classified as either inguinal when the testis is in the inguinal canal, or abdominal when the testis remains in the abdominal cavity, which was the case for Marquis.
"During surgery, the horse was placed under general anesthesia and we used the laparoscopic camera inserted into the abdomen to examine the retained testis," said Dr. Davis.
A laparoscopy is an endoscopic procedure where a fiberoptic video camera and surgical instruments are introduced into the abdomen through a small incision. This permits the observation of the inside of the abdomen and allows abdominal surgeries to be performed without a large incision into the abdominal cavity.
"We could see that there was torsion, which indicates restricted blood flow and often pain, as well as severe enlargement," said Dr. Davis. "The testis, which had become quite large, was then exteriorized through an enlarged paramedian incision. Marquis recovered from anesthesia without complication and with an excellent prognosis."
"The biggest victory in this rather rare case is that the horse was relieved of pretty severe discomfort and the owner could enjoy the gelding disposition she was expecting."
Dr. Davis
Aside from pain from the torsion and subsequent enlargement within the body, Marquis' risk of developing malignant (cancerous) tumors was increased with the testis left inside his body. Prompt diagnosis and surgery likely prevented more critical problems in the future for Marquis.
After recovering from surgery at Palm Beach Equine Clinic's onsite hospital, Marquis was returned home to Cruz without his retained testis and a new attitude.
"I am very grateful to have had my horse seen by Dr. Weston Davis and his staff. I am not only happy that he was able to get his surgery with one of the best surgeons in the country, but also that it was such a success."
Debbie Cruz
Marquis' recovery progressed quickly after he returned to his home barn, and he is now back in the tack with Cruz. "I am looking forward to a long journey with him," she said. "I am thankful to everyone at Palm Beach Equine Clinic for the care they provided Marquis. I couldn't see myself going anywhere else."
When the Bone Breaks
Palm Beach Equine Clinic is Changing the Prognosis for Condylar Fracture Injuries
Palm Beach Equine Clinic is changing the prognosis for condylar fracture injuries in race and sport horses. Advances in diagnostic imaging, surgical skillset, and the facilities necessary to quickly diagnose, treat, repair, and rehabilitate horses with condylar fractures have improved dramatically in recent years.
Photo by Jump Media
Most commonly seen in Thoroughbred racehorses and polo ponies, a condylar fracture was once considered a career-ending injury. Today, however, many horses fully recover and return to competing in their respective disciplines.
What is a Condylar Fracture?
A condylar fracture is a repetitive concussive injury that results in a fracture to the cannon bone above the fetlock due to large loads transmitted over the cannon bone during high-speed exercise. On a radiograph, a condylar fracture appears as a crack that goes laterally up the cannon from the fetlock joint and out the side of the bone, essentially breaking off a corner of the cannon bone, sometimes up to six inches long.
"A condylar fracture is a disease of speed," said Dr. Robert Brusie, a surgeon at Palm Beach Equine Clinic who estimates that he repairs between 30 and 50 condylar fractures per year. "A fracture to the left lateral forelimb is most common in racehorses as they turn around the track on a weakened bone and increased loading."
Condylar fractures are further categorized into incomplete and non-displaced (the bone fragment hasn't broken away from the cannon bone and is still in its original position), or complete and displaced (the fragment has moved away from the cannon bone itself and can often be visible under the skin).
Additionally, condylar fractures can occur laterally or medially. According to fellow Palm Beach Equine Clinic surgeon Dr. Weston Davis, most condylar fractures tend to be lateral on the outside condyle (a rounded projection on a bone, usually for articulation with another bone similar to a knuckle or joint).
"Most lateral condylar fractures are successfully repaired," said Dr. Davis. "Medial condylar fractures tend to be more complicated configurations because they often spiral up the leg. Those require more advanced imaging and more advanced techniques to fix."
What is the Treatment?
The first step in effectively treating a condylar fracture through surgery is to accurately and quickly identify the problem. Board-certified radiologist Dr. Sarah Puchalski utilizes the advanced imaging services at Palm Beach Equine Clinic to accomplish exactly this.
"Stress remodeling can be detected early and easily on nuclear scintigraphy before the horse goes lame or develops a fracture," said Dr. Puchalski. "Early diagnosis of stress remodeling allows the horse to be removed from active race training and then return to full function earlier. Early diagnosis of an actual fracture allows for repair while the fracture is small and hopefully non-displaced."
Photo by Jump Media
Once the injury is identified as a condylar fracture, Palm Beach Equine Clinic surgeons step in to repair the fracture and start the horse on the road to recovery. Depending on surgeon preference, condylar fracture repairs can be performed with the horse under general anesthesia, or while standing under local anesthesia. During either process, surgical leg screws are used to reconnect the fractured condyle with the cannon bone.
"For a small non-displaced fracture, we would just put in one to two screws across the fracture," explains Dr. Davis. "The technical term is to do it in 'lag fashion,' such that we tighten the screws down heavily and really compress the fracture line. A lot of times the fracture line is no longer visible in x-rays after it is surgically compressed. When you get that degree of compression, the fractures heal very quickly and nicely."
More complicated fractures, or fractures that are fully displaced, may require additional screws to align the parts of the bone. For the most severe cases of condylar fractures, a locking compression plate with screws is used to stabilize and repair the bone.
Palm Beach Equine Clinic surgeon Dr. Jorge Gomez approaches a non-displaced condylar fracture while the horse is standing, which does not require general anesthesia.
"I will just sedate the horse and block above the site of the fracture," said Dr. Gomez. "Amazingly, horses tolerate it really well. Our goal is always to have the best result for the horse, trainers, and us as veterinarians."
According to Dr. Gomez, the recovery time required after a standing condylar fracture repair is only 90 days. This is made even easier thanks to a state-of-the-art standing surgical suite at Palm Beach Equine Clinic. The four-and-a-half-foot recessed area allows doctors to perform surgeries anywhere ventral of the carpus on front legs and hocks on hind legs from a standing position. Horses can forgo general anesthesia for a mild sedative and local nerve blocks, greatly improving surgical recovery.
"A condylar fracture was once considered the death of racehorses, and as time and science progressed, it was considered career-ending," concluded Dr. Brusie. "Currently, veterinary medical sciences are so advanced that we have had great success with condylar fracture patients returning to full work. Luckily, with today's advanced rehabilitation services, time, and help from mother nature, many horses can come back from an injury like this."
Condylar Fracture: Your Horse's Career Isn't Over!
Palm Beach Equine Clinic (PBEC) is changing the prognosis for condylar fracture injuries among sport horses. Advances in imaging, surgical talent, and the facilities necessary to quickly diagnose, treat, repair, and rehabilitate horses with condylar fractures have recently improved immensely.
Most commonly seen in Thoroughbred racehorses and occasionally polo ponies, a condylar fracture was once considered a career-ending injury. Today, however, odds are in favor of a full recovery with horses regularly returning to competition in their respective disciplines.
What is a Condylar Fracture?
A condylar fracture is a repetitive strain injury that results in a fracture to the cannon bone above the fetlock due to large loads transmitted over the cannon bone during high-speed exercise. On a radiograph, a condylar fracture appears as a crack that goes laterally up the cannon from the fetlock joint and out the side of the bone, essentially breaking off a corner of the cannon bone, sometimes up to six inches long.
"A condylar fracture is a disease of speed," said Dr. Robert Brusie, a surgeon at PBEC who estimates that he repairs between 30 and 50 condylar fractures per year. "A fracture to the left lateral forelimb is most common in racehorses as they turn around the track on a weakened bone and increased loading."
Condylar fractures are further categorized into incomplete and non-displaced (the bone fragment hasn't broken away from the cannon bone and is still in its original position), or complete and displaced (the fragment has moved away from the cannon bone itself and can often be visible under the skin).
Additionally, condylar fractures can occur laterally or medially. According to fellow PBEC surgeon Dr. Weston Davis, most condylar fractures tend to be lateral on the outside condyle (a rounded projection on a bone, usually for articulation with another bone similar to a knuckle or joint).
"Most lateral condylar fractures are fairly simple for us to fix," said Dr. Davis. "Medial condylar fractures tend to be more complicated configurations because they often spiral up the leg. Those require more advanced imaging and more advanced techniques to fix."
What is the Treatment?
The first step in effectively treating a condylar fracture through surgery is to accurately and quickly identify the problem. PBEC's board-certified radiologist Dr. Sarah Puchalski utilizes the advanced imaging services at PBEC to accomplish exactly this.
"Stress remodeling can be detected early and easily on nuclear scintigraphy before the horse goes lame or develops a fracture," said Dr. Puchalski. "Early diagnosis of stress remodeling allows the horse to be removed from active race training and then return to full function earlier. Early diagnosis of an actual fracture allows for repair while the fracture is small and hopefully non-displaced."
Once the injury is identified as a condylar fracture, PBEC surgeons step in to repair the fracture and start the horse on the road to recovery. Depending on surgeon preference, condylar fracture repairs can be performed with the horse under general anesthesia, or while standing under local anesthesia. During either process, surgical leg screws are used to reconnect the fractured condyle with the cannon bone.
"For a very simple and small non-displaced fracture, we would just put in one to two screws across the fracture," explains Dr. Davis. "The technical term is to do it in 'lag fashion,' such that we tighten the screws down heavily and really compress the fracture line. A lot of times the fracture line is no longer visible in x-rays after it is surgically compressed. When you get that good compression, the fractures heal very quickly and nicely."
More complicated fractures, or fractures that are fully displaced, may require more screws to align the parts of the bone. For the most severe cases of condylar fractures, a locking compression plate with screws is used to stabilize and repair the bone.
PBEC surgeon Dr. Jorge Gomez, approaches a simpler non-displaced condylar fracture while the horse is standing, which helps to aid in a faster recovery and more successful surgical outcome.
"I will just sedate the horse and block above the site of the fracture," said Dr. Gomez. "Amazingly, horses tolerate it really well. Our goal is always to have the best result for the horse, trainers, and us as veterinarians."
According to Dr. Gomez, the recovery time required after a standing condylar fracture repair is only 90 days. This is made even easier thanks to a state-of-the-art surgery pit installed at PBEC. The four-and-a-half-foot recessed area allows doctors to perform surgeries on anything from a horse's hock and below from a standing position. Horses can forgo the risks of general anesthesia for a mild sedative and local nerve blocks, greatly improving outcomes.
"A condylar fracture was once considered the death of racehorses, and as time and science progressed, it was considered career-ending," concluded Dr. Brusie. "Currently, veterinary medical sciences are so advanced that we have had great success with condylar fracture patients returning to full work. Luckily, with today's advanced rehabilitation services, time, and help from mother nature, many horses can come back from an injury like this."
Palm Beach Equine Clinic Provides the Best in Emergency Colic Care
Fear of colic is in the back of many horse owners' minds, but with the expert care of Palm Beach Equine Clinic, owners can rest easy knowing that they have some of the world's best surgeons and veterinarians at their disposal in the event of an emergency.
Colic 101
Characterized by abdominal pain or problems with the gastrointestinal tract, colic is something that often arises unexpectedly and from many different origins. Spoiled feed, abrupt changes in feed, parasite infestation, sand ingestion, lack of water consumption, and even excess stress or changes in the weather are among the numerous causes generally related to colic.
Colic Symptoms
Whatever the cause may be, the most important step any owner can take is to recognize the symptoms as early as possible and immediately call their veterinarian. Pawing, rolling, looking at abdomen, sweating, loss of interest in food and water, and absence of gut sounds in any of the four abdominal quadrants are some of the telltale signs of colic development. Unfortunately, colic can be fatal, but the proper knowledge and care may save your horse's life. The sooner your veterinarian gets involved in treatment, the better your horse's chance of survival.
Emergency Colic Care
In the event of an emergency, the veterinarians and surgeons of Palm Beach Equine Clinic are available 24/7 to offer the very best care for your equine partner. Palm Beach Equine Clinic is renowned for its referral full-service surgical center and intensive care hospital located in the heart of Wellington, Florida. Board-Certified surgeons, primary care veterinarians, and skilled hospital technicians are available to treat, monitor, and care for critical cases. With world-class veterinarians and a full staff of highly trained technicians, both clients and patients of Palm Beach Equine Clinic are in the best hands possible.
Surgical Capabilities
Palm Beach Equine Clinic offers the latest in technology as the surgical techniques are less invasive and result in faster recovery times for your horse. The surgical team leader, Dr. Robert Brusie, is a nationally renowned, Board-Certified surgeon. Dr. Brusie's surgical specialties include orthopedic, arthroscopic, and emergency cases. Dr. Brusie has been the head surgeon with PBEC for the past 20 years.
"In the last ten years, colic surgery has come a long, remarkable way," Dr. Brusie stated. "With our clients, if the horse needs to go to surgery, we get an approximately 95% success rate. We attribute that to the client's excellent care of their horses, as well as their knowledge to contact us immediately. That being said, colic surgery is always the last resort. We try to help all horses improve medically first."
Palm Beach Equine's surgical suite and staff is prepared to handle all types of emergencies, day and night. The large team of 40 veterinarians includes three Board-Certified Surgeons who rotate on-call duties so every day is covered. This aids Palm Beach Equine Clinic veterinarians and all of Southeast Florida with the ability to treat their emergencies requiring surgical assistance as quickly as possible. The state-of-the-art intensive care hospital is equipped with top-of-the-line medical equipment, including digital video cameras for the clinicians to easily monitor their patients from any location, at any time.
Need Emergency Colic Care?
For more information on the Palm Beach Equine Clinic facility or in case of an emergency, please call (561) 793-1599 to contact an on-call veterinarian.
Early Response to Equine Joint Disease Improves Career Longevity
At Palm Beach Equine Clinic in Wellington, FL, the team of Board-Certified surgeons are experts in minimally invasive surgical techniques, aiming to reduce joint disease, resolve lameness, and improve the longevity of sport horse careers.
Arthroscopy (or arthroscopic surgery) is a minimally invasive surgical technique that can be performed on an injured joint or synovial structure to accurately explore and treat pathology. The surgery generally involves two very small (8mm) keyhole incisions. The first incision is where the surgeon will insert the arthroscope, which is an instrument with a small surgical grade camera installed that allows a complete, clear view of the interior joint surface. The second small incision is created to insert the surgical instrument to perform the procedure.
Arthroscopy is used to treat a broad range of injuries inside of a joint. Chip fracture removal is a procedure that is particularly commonly in both young Warmblood horses with developmental disease and in racehorses travelling at high speeds. A small chip fracture can cause persistent irritation in the joint as well as arthritis if left untreated. It is best removed immediately so that no further damage is created. The surgeon can go into the joint, remove the chip, and clean up the surrounding cartilage. Most horses recovery quickly and return to their normal athletic activity.
Board-Certified Surgeon Dr. Weston Davis performs many arthroscopic surgeries at Palm Beach Equine Clinic alongside fellow surgeons Dr. Robert Brusie and Dr. Jorge Gomez.
"In many horses, we consider arthroscopy as a prophylactic measure, intervening after injury, but before the development of a generalized degenerative arthritic cycle ensues," Dr. Davis stated. "Arthroscopy is definitely something that you want to do early in the game if you feel like the horse has joint disease, or a chip, or cartilage disease, or an undefined injury that is not responding appropriately to medical therapy. Arthroscopy can be curative for some of these horses. But if you do not intervene early on in the course of the disease and there is already advanced arthritis, then you have missed your window.
"Arthroscopy is a preferred treatment because it is minimally invasive so most horses can go right back to work," Dr. Davis continued. "In a typical scenario, we thoroughly explore the joint with the arthroscopic camera, we remove a chip or repair a lesion, and the horse is not lame after the surgery. Because of the small incisions, there is minimal aftercare and horses are often able to go back to work quickly."
Other common indications for arthroscopic surgery are meniscal disease in the stifle, subchondral cystic lesions, primary cartilage lesions, and debridement of damaged tendinous/ligamentous tissue (such as deep digital flexor tendon tears in the navicular bursa). The surgeons at Palm Beach Equine Clinic can perform arthroscopy on virtually any joint in the horse. Anything from the Temporomandibular Joint (TMJ) of the head to the navicular bursa within the hoof capsule can be explored and treated with this minimally invasive approach.
Almost all arthroscopies are performed under general anesthesia with the horse on its back. New renovations at Palm Beach Equine Clinic include a set of stocks of adjustable height adjacent to a surgeon's pit, allowing the surgeons to have eye-level access to the joint they are working on, enabling many new procedures on the legs of standing horses.
Minimally invasive surgery allows for a simple and quick recovery for the horse. The traditional horse would be on stall rest with a bandage on until the sutures come out at two weeks, and then start doing some light hand walking and physical therapy. Barring severe damage in the joint or associated tendon/ligament disruption, most cases will undergo a six-week rest and rehabilitation protocol, then return to normal work.
As always, the advanced diagnostic imaging at Palm Beach Equine Clinic permits the surgeons to get a complete evaluation of an injury involving a joint to ensure the best possible outcome. Depending on the injury type, digital radiographs, ultrasound, MRI, and Nuclear Scintigraphy, or a combination thereof, may be used for pre-operative diagnosis and planning. Ultrasound and digital radiography are available for intra-operative use. Intra-operative CT scanning will also be available in the future with the new additions at Palm Beach Equine Clinic.
"When you are inside the joint with an arthroscopic camera, you have the most complete picture of the surface and health of that joint," Dr. Davis noted.
Condylar Fractures: No Longer A Career Ending Injury
Palm Beach Equine Clinic (PBEC), located in Wellington, FL, offers advanced diagnostic imaging, world-renowned surgical talent, and state-of-the-art facilities necessary to quickly diagnose, treat, and repair horses with condylar fractures, making PBEC one of the leading facilities in the U.S. for condylar fracture repairs.
With thanks to the technology required for early diagnosis and experienced surgeons on staff, horses that are admitted to PBEC for condylar fracture repairs are more likely to return to training quickly. Most commonly seen in Thoroughbred racehorses and occasionally polo ponies or eventing horses, a condylar fracture was once considered a career-ending injury. Today, however, advances in technology aid in a full recovery with horses regularly returning to competition in their respective divisions.
What is a Condylar Fracture?
A condylar fracture is a repetitive strain injury that results in a fracture to the cannon bone above the fetlock due to large loads transmitted during high-speed exercise. On a radiograph, a condylar fracture appears as a crack that goes from the fetlock joint up the cannon bone. Lateral fractures many times exit the bone usually one-third of the way up the bone. Medial fractures will oftentimes spiral up to the hock or knee. Medial fractures are much more common in the hindlimb than the forelimb. It is the spiral fractures that are more difficult, due to the fact that the extent of the spiral cannot be identified radiographically. If the surgeon cannot identify the fracture, then that part of the fracture cannot be repaired.
"A condylar fracture is a disease of speed," said Dr. Robert Brusie, a surgeon at PBEC who estimates that he repairs between 30 and 50 condylar fractures per year. "A fracture to the left lateral forelimb is most common in racehorses as they turn the track on a weakened bone and increased loading on the lateral condyle."
Condylar fractures are further categorized into two classes. An incomplete and non-displaced fracture means that the bone fragment is not separated from the cannon and is still intact with its original position. A complete and displaced fracture means the fragment has detached from the cannon bone and this fracture can often be visible under the skin. Displaced condylar fractures have a somewhat lower prognosis due to the fact that soft tissue structures, such as the joint capsule, become torn. When these structures heal, they are thicker, which makes the joint less flexible.
"Most lateral condylar fractures are fairly simple for us to fix," said PBEC surgeon Dr. Weston Davis. "Medial condylar fractures tend to be more complicated configurations because they often spiral up the leg. Those require more advanced imaging and more advanced techniques to fix."
What is the Treatment?
The first step to effectively treating a condylar fracture through surgery is to accurately and quickly identify the problem. PBEC's Board-Certified Radiologist Dr. Sarah Puchalski utilizes the advanced imaging services at PBEC to assist in the diagnosis.
"Stress remodeling can be detected early and easily on Nuclear Scintigraphy before the horse goes lame or even develops a fracture," said Dr. Puchalski. "Early diagnosis of stress remodeling allows the horse to be removed from active race training and then return to full function earlier. Early diagnosis of an actual fracture allows for repair while the fracture is small and hopefully non-displaced."
Once identified as a condylar fracture, PBEC surgeons step in to repair the fracture and start the horse on the road to recovery. Depending on surgeon preference, condylar fracture repairs can be performed with the horse under general anesthesia, or while standing under local anesthesia and sedation. During either process, surgical lag screws are used to reconnect the fractured condyle with the cannon bone.
"For a very simple and small non-displaced fracture, we would just put in one to two screws across the fracture," explains Dr. Davis. "The technical term is to do it in 'lag fashion', such that we tighten the screws down heavily and compress the fracture line. Many times the fracture line is no longer visible in x-rays after it is surgically compressed. When you achieve good compression, the fractures heal very quickly and nicely."
More complicated fractures, or fractures that are fully displaced, may require more screws to align parts of the bone. For the most severe cases of condylar fractures, a locking compression plate with screws is used to stabilize and repair the bone.
Severe condylar fractures often require general anesthesia, but for PBEC surgeon Dr. Jorge Gomez, approaching a simpler non-displaced condylar fracture while the horse is standing helps to aid in a faster recovery and successful surgical outcome.
"I think it takes the risk of anesthesia away and is a faster surgery from the time the horse comes in to the time the horse recovers," said Dr. Gomez. "I will just sedate the horse and block above the site of the fracture. Amazingly, horses tolerate it really well, and it is very convenient for medial condylar fractures. In these cases, the fracture can spiral all the way up through the cannon bone, and they have a tendency to develop complete catastrophic fractures that can happen at any time after the injury. That risk can be significantly increased by the recovery from general anesthesia. Our goal is always to have the best result for the horse, trainers, and us, as veterinarians."
According to Dr. Gomez, the recovery time required after a standing condylar fracture repair is only 90 days.
While Dr. Brusie, Dr. Davis, and Dr. Gomez are all seasoned in quickly and effectively repairing condylar fractures, PBEC is helping them to stay on the cutting edge of surgical techniques. PBEC is currently renovating its facility with plans to give surgeons a new approach to fix condylar fracture repairs. A set of stocks and surgeon's pit have been added with the ability to give the surgeon eye-level access to the fracture with the patient standing and subsequently simplifying the procedure by reducing the risk from recumbent recovery.
What is the Prognosis?
One of the most common questions regarding an equine injury is, "Will the horse return to work?" Thanks to advanced imaging and surgical techniques, the answer to that question when involving a condylar fracture is most likely, "Yes." At PBEC, a condylar fracture diagnosis rarely results in the end of a racehorse's career.
Diagnostic imaging plays a major role in assisting to diagnose, surgically map, and follow up on condylar fractures. After primary use to diagnose a condylar fracture, digital radiographs are also used after surgery to ensure that a fracture repair was completely successful. According to Dr. Davis, scanning two planes during and after surgery gives a full view of the fracture and repair techniques, immediately indicating the success of the procedure before moving the horse on to recovery.
"A condylar fracture was once considered the death of racehorses, and as time and science progressed, it was considered career-ending," said Dr. Brusie. "Currently, veterinary medical sciences are so advanced that we have had great success with condylar fracture patients returning to full work. Luckily, with today's advanced rehabilitation services, time, and help from mother nature, many horses will come back from an injury like this."
Palm Beach Equine Clinic provides experience, knowledge, availability, and the very best care for its clients. Make Palm Beach Equine Clinic a part of your team!
Palm Beach Equine Clinic: Leading the Way in Rapid Response for Emergency Colic Care
Palm Beach Equine Clinic of Wellington, FL, is a worldwide leader in sport horse medicine and emergency colic care. While symptoms of colic should be treated medically first, surgical intervention can be necessary, and the team at Palm Beach Equine Clinic is prepared for every situation.
With three Board-Certified Surgeons on staff, as well as a state-of-the-art hospital and the most advanced surgical equipment, Palm Beach Equine Clinic has a very high success rate in saving horses from life-threatening colic. The veterinarians take pride in their equine clients returning to full intended use and continuing to perform at their highest levels.
Causes and Symptoms
Colic is defined as any source of abdominal discomfort in the horse. Abdominal pain or problems within the gastrointestinal tract can arise unexpectedly from many different origins, including but not limited to: spoiled feed, abrupt changes in feed, parasite infestation, sand ingestion, lack of water consumption, excess stress, or changes in the weather. Many times there is not a well-defined inciting cause.
The most important step any owner can take is to recognize the symptoms as early as possible and immediately call their veterinarian. Pawing, rolling, looking at the abdomen, sweating, loss of interest in food and water, and absence of gut sounds in any of the four quadrants are common symptoms. The sooner the veterinarian gets involved in treatment, the better the horse's chance of survival.
In the event of an emergency, the surgeons and veterinarians of Palm Beach Equine Clinic are available 24/7. When an equine patient is admitted to the hospital, every step is taken to quickly diagnose the problem and correct it immediately.
Tests and Diagnosis
Board-Certified Surgeon Dr. Weston Davis explained that one of the biggest challenges in the sport horse population is determining surgical versus non-surgical colic cases.
"We do not want to put a non-surgical case through the risk of anesthesia and the months of healing time, so we try to spare that at all costs and determine the surgical cases as accurately as we can," Dr. Davis detailed. "On the split side of that, we try to operate as quickly as possible on any horse that needs surgery and not miss any surgical lesion types."
There are several methods for differentiating surgical cases. Simple physical exam findings, such as the color of the gums, heart rate, gut sounds, and level of pain can all be supportive of surgical necessity. A variety of tests may also include abdominal ultrasounds and rectal exams.
An Abdominocentesis (or belly tap) is performed on every questionable colic case, where fluid is collected from around the intestines and analyzed for color and character. A variety of other laboratory tests will be run on the fluid as well, with the aim of quickly determining if the horse's bowel is compromised.
Surgical Procedures
If surgery is necessary, there are a few different approaches that may be performed depending on the specific case.
For chronic colic cases, such horses with longstanding, intermittent colic, an abdominal exploratory procedure may be done with laparoscopy. This option can be done with the horse standing and is a minimally invasive way to examine the full abdomen.
In most acute cases, further steps must be taken. If the veterinarian determines that the horse is a surgical candidate, the patient will go under general anesthesia. The surgeons try to make as small of an incision as they can to perform the needed surgical correction.
"If we intervene early, we can take a strangulating or compromised lesion – one that most people understand as a twist – and we can go into the abdomen and correct the twist, reposition everything appropriately, explore the remainder of the abdomen to make sure nothing else is going on, and then close them up," Dr. Davis explained. "Some of these surgeries can be as quick as 30 minutes and require just an untwisting, repositioning, and closure. The ones that are bad are the usually the cases that have a more severe twist or have been going on longer."
In more severe or long-standing cases, the surgery can require a resection and an anastomosis procedure to excise a compromised or devitalized segment of the intestine. The surgeon then joins the healthy ends back together.
"Even more advanced procedures would be like a re-plumbing of the intestines," Dr. Davis noted. "One of the most common examples of this would be a patient with damage to the end of the small intestine, near or involving its junction with the cecum. In a case like this, we would perform a 'jejunocestomy' where we join another part of the small intestine to a different position on the cecum."
Post-Operative Recovery
After any surgery, there is a process of recovery, which Palm Beach Equine Clinic makes as easy as possible for its clients. In the traditional recovery, most horses will remain in the hospital for a few days. In the post-operative period, they generally receive fluids until they are ready to eat and drink, 3-5 days of antibiotics, and 5-7 days of anti-inflammatories.
"The recovery process is highly dependent upon how sick they are after surgery," Dr. Davis stated. "Some horses will bounce back and be home 48 hours later, but a very sick horse could potentially spend seven to ten days in the hospital until they are healthy enough to get off fluids and go home."
After leaving the hospital, the horse is usually placed on one month of stall rest, followed by another month of turnout in a small paddock. In between eight to 12 weeks, the horse will usually be fully recovered and ready to start back to work.
Physical Therapy
With the sport horse in mind, PBEC pays special attention to the health of the abdomen following surgery. The health of the abdominal incision and prevention of infection or hernias is very important. In most cases, the surgeon will recommend physical therapy and special exercises to re-strengthen the horse's abdominal muscles so that it can get back to work quickly and have a strong abdominal musculature when it does.
"Making the horse walk backwards is one thing that will make them tighten and work their abdominal musculature," Dr. Davis shared. "Pinching or tickling around their tail head is another common exercise to make them do something similar to a stomach crunch."
As one of the top equine emergency care centers in the world, Palm Beach Equine Clinic is prepared to handle any case, 24 hours a day, seven days a week, and 365 days a year.
"With the combination of quick surgical intervention, excellent surgical care, and specialized post-operative measures, Palm Beach Equine Clinic has a very high rate of return to athletic performance for all of our colic cases," Dr. Davis concluded.
Palm Beach Equine Clinic provides experience, knowledge, availability, and the very best care for its clients. To find out more, please visit www.equineclinic.com or call 561-793-1599.
PBEC Offers the Best in 24-Hour Equine Emergency Care
Best in Class Veterinary Team
Palm Beach Equine Clinic is renowned for its full-service surgical center and intensive care hospital located in the heart of Wellington, Florida. Board-certified surgeons, primary care veterinarians and hospital technicians are scheduled 24 hours a day, 365 days a year to treat, monitor and care for critical cases. With world-class veterinarians and a full staff of highly trained technicians, both clients and patients of Palm Beach Equine Clinic are in the best hands possible for equine emergency care and beyond.
Surgical Facilities for Equine Emergency Care and Beyond
Palm Beach Equine's surgical suite and staff is prepared for all kinds of 24-hour equine emergency care. The large team of 24 veterinarians includes three board-certified surgeons who rotate on-call duties for all equine emergency care. This aids Palm Beach Equine Clinic veterinarians and all of Southeast Florida with the ability to quickly treat equine emergencies requiring surgical assistance. The state of the art intensive care hospital is equipped with digital video cameras for the clinicians to easily monitor their patients from any location, at any time.
Laboratory and Diagnostic Capabilities
Palm Beach Equine Clinic has the most advanced imaging technologies available on-site, including Magnetic Resonance Imaging (MRI), Nuclear Scintigraphy (Bone Scan), Ultrasonography, Digital Radiography and Endoscopy. Palm Beach Equine Clinic has a board-certified radiologist on-site to interpret images and assist in precise diagnosis. Palm Beach Equin Clinic is equipped with a full-service laboratory with hematology, chemistry, and microbiology equipment to quickly help with the evaluation of each case.
For more information on Palm Beach Equine Clinic or in case of an equine emergency, please call (561) 793-1599 to contact an on-call veterinarian.
Source: https://equineclinic.com/category/medical/surgery-medical/
0 Response to "Equine Medicine and Surgery Palm Beach Gardens"
Post a Comment