Monthly Archives: January 2017

Palm Beach Equine Clinic Sets the Bar in Regenerative Sport Horse Medicine

Learn About Stem Cell and PRP Therapies

Wellington, FL – Palm Beach Equine Clinic (PBEC) of Wellington, FL, is consistently on the forefront of advances in sport horse medicine. Two resources that have become increasingly popular to treat equine injuries are the use of stems cells or Platelet Rich Plasma (PRP) to encourage regeneration of injured tissue. Read on to learn more about regenerative sport horse medicine and what is offered at Palm Beach Equine Clinic.

What Are Stem Cells?

Stem cell therapy can be used for many soft tissue and intra-articular problems, including severe cartilage damage, meniscal disease, tendon/ligament pathology, or any injury where the veterinarian would want to encourage a regenerative response. Stem cells can decrease re-injury rates in tendon bows, yield improved outcome in horses with meniscal tears, and may also have benefit when used in regional profusions for laminitic horses. Stem cells help to orchestrate an improved repair process in the site of injection and have anti-inflammatory properties.

Stem cells help to orchestrate an improved repair process in the site of injection
and have anti-inflammatory properties.

 

How Can You Collect Stem Cells?

There are three different ways to collect stem cells from the horse. The first comes from bone marrow origin, where a collection of bone marrow from the sternum in a standing procedure. The bone marrow is sent to the lab for processing and expansion, which expands the cells up to a predetermined number (generally between 10 to 20 million cells).

Stem cells can be procured from harvesting fat. The veterinarian may extract a significant quantity of fat from around the tail head and gluteal region of the horse. The fat will be processed in the lab, stem cells in the fat are concentrated, and the cells are re-injected into the injury site.

The third option is to acquire allogenic stem cells, meaning stem cells from another animal of the same species. University programs offer commercially available stem cell lines where anywhere from 10 to 30 million stem cells are shipped for use the next day.

PBEC’s Board-Certified Staff Surgeon, Dr. Weston Davis, is one of the top surgeons that has made clinical advances in stem cell therapy. Remarking on the three methods of obtaining stem cells, Dr. Davis detailed, “I think the advantage of the bone marrow cells is that they are the most researched version of stem cells. The nice thing about the fat cells is that you can basically harvest the fat, process it, and inject it back on the same day. The allogenics are noninvasive to the horse that you are performing the procedure on. You don’t have to do a pre-surgical procedure to get your cells; you just call up and have your cells the next day to implant. One of the unique properties of stem cells is that they do not have immunologic markers, so if you inject the cell into another horse, that horse does not recognize that it is foreign. So generally speaking, there is no immune reaction to implanting the cells into another horse.”

An ultrasound guided technique is often used to inject stem cells
into an injured area.

 

There are also different methods of implanting the stem cells into the horse at specific areas of interest. Dr. Davis explained, “If we were treating a meniscal injury or cartilage damage in a joint, implantation would be as simple as a joint injection technique. If you are going to implant cells into an injured tendon or ligament, then we will most often do an ultrasound guided technique where we watch and direct the needle precisely into the lesion so we can put these regenerative cells right into the damaged area.”

How Does Platelet Rich Plasma Work?        

Another therapy that can be applied on its own or in conjunction with stem cell therapy is the use of Platelet Rich Plasma (PRP). Platelets are very small blood cells that are a crucial part of the body and play an integral part in the blood clotting process to stop hemorrhaging from any wound. Because platelets are among the very first cells to accumulate at an injured site, they are very important orchestrators and stimulators in the repair process. Platelets contain granules filled with growth factors (the elements that aid in healing) and stimulate specified tissue to heal at an increased rate.

In order to treat a horse with Platelet Rich Plasma, the veterinarians at PBEC are able to take a sample of the horse’s blood and concentrate the platelets in a high-speed centrifuge on-site.

 

In order to treat a horse with Platelet Rich Plasma, the veterinarians at PBEC are able to take a sample of the horse’s blood and concentrate the platelets in a high-speed centrifuge on-site. This harvest and processing procedure takes approximately 30 minutes. The concentrated platelet rich sample is injected back into the horse at the specific area of injury using sterile technique and guided by ultrasound.

PRP treatment has had great success in tendon and suspensory ligament injuries and increasingly used in the treatment of intra-articular joint injuries. It can also be used following surgery in the joint to encourage a faster healing response.

Platelet Rich Plasma is injected into an injured area to encourage a more
robust healing response.

Dr. Davis spoke of PRP use in more detail, stating, “We harvest a large quantity of blood, anywhere from 60 to180 milliliters, and we process that to concentrate the segment that is very rich in platelets. We get a high concentration of platelets – we are hoping for five to eight times the concentration that you would get from normal blood – then we take that platelet rich extract and inject it back into an injured area to encourage a more robust healing response. Whenever you have an injury, platelets are one of the first cells that get there. They will aggregate, clump, and de-granulate. They release these granules, which are very rich in growth factors, and signal the body to start the healing process.”

Cost is one thing that dictates the difference in the use of stems cells versus PRP for many owners. PRP tends to be more economically affordable, while stem cells can be a more expensive and aggressive therapy.

What New Technologies Are Available?

Both stem cell and PRP therapy are cutting-edge in the horse world right now, as veterinary medicine researches how to further use the body’s own healing mechanisms to repair injuries. These regenerative therapies are part of a continually advancing field that has made exciting developments in both human and equine sports medicine.

“There is constantly new research,” Dr. Davis pointed out. “They have done some of the initial studies looking at the efficacy of both. Right now they are working on ways to refine their use. We want to get higher platelet yields out of our PRP, and we are tweaking the properties of the PRP to modify the number of white and red cells for particular injuries. For stem cells, they are researching different matrixes to apply them with, so that the cells integrate better at the injection site. Then they are working on triggering the stem cells, and trying to put in signaling cytokines or chemicals to make them differentiate to the specific cell type that you want. Actually directing the stem cells to become the exact type of cells you want is definitely still in its infancy, but it is on the horizon.”

In December, several of the veterinarians at PBEC took part in the12th annual World Stem Cell Summit (WSCS), which welcomed the equestrian community to a special conference, held at the Palm Beach County Convention Center in West Palm Beach, FL.

The Equine World Stem Cell Summit 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.

As part of the opportunity to bridge both the equine and human applications of stem cell therapies, vets of Palm Beach Equine Clinic, including Dr. Robert Brusie, Dr. Jorge Gomez, and Dr. Richard Wheeler, hosted a question and answer session addressing how regenerative medicine is changing and benefiting Palm Beach Equine Clinic’s clients. Attending the session were fellow veterinarians, human and equine researchers, biochemists, and others who were able to actively engage in beneficial conversation on numerous facets of regenerative medicine.

Brandon Ames, CEO of AniCell BioTech, with Dr. Scott Swerdlin, Dr. Robert Brusie, Dr. Richard Wheeler, and Dr. Jorge Gomez, all of Palm Beach Equine Clinic at the Equine World Stem Cell Summit.

 

Every regenerative therapy program is different and it is important to consult a veterinarian and understand the options and specific applications for each treatment. To find out more about stem cell therapy or PRP treatment, please visit Palm Beach Equine Clinic at www.EquineClinic.com or call 561-793-1599.

 

 

 

Palm Beach Equine Clinic Saves Horse Owners Time and Money Through Early Diagnosis

Palm Beach Equine Clinic (PBEC) in Wellington, FL, has the most advanced state-of-the-art surgical and diagnostic imaging equipment available. With board-certified Radiologist Dr. Sarah Puchalski, PBEC uses their Equine Standing MRI (Magnetic Resonance Imaging) and a Nuclear Scintigraphy camera to quickly and accurately diagnose injuries for their clients.

Every horse owner dreads seeing signs of lameness or discomfort in any horse, whether it is a backyard companion or a top-caliber sport horse. For performance horses, however, one of the first questions many owners ask upon contacting a veterinarian about a problem is, ‘Can the horse safely and comfortably return to work?’ Using PBEC’s cutting-edge technology, Dr. Puchalski can quickly and accurately answer that question.

The Equine Standing MRI produces highly detailed images in several different planes to capture a complete image of a desired area. An MRI is best used to further define a specific area of both bony or soft tissue that has been pinpointed as the origin of lameness. The process can be completed while the horse is in a standing position and requires only light sedation.

Equine MRI by Jump Media-4536The Equine Standing MRI produces highly detailed images in several different planes
to capture a complete image of a desired area. Photo by Jump Media

Equine MRI by Jump Media-4521An MRI is best used to further define a specific area of both bony or soft tissue
 that has been pinpointed as the origin of lameness. Photo by Jump Media

Similarly, the process of a Nuclear Scintigraphy is a bone scan that begins with the injection of a radioactive isotope, specifically named Technetium 99. The isotope attaches to the phosphorous proteins localized within the bone and is absorbed over a few hours’ time. A specialized nuclear isotope gamma ray camera is used to capture images of the skeletal anatomy with a 360-degree view. Points of interest “light up” on the image to indicate increased metabolic activity and the site of injury.

Lameness or performance problems are most frequently approached through routine x-rays and ultrasounds, which can appear normal. Thus, it is difficult to diagnose subtle problems because the most common tools are not sensitive enough to diagnose in every case. At PBEC, the Equine Standing MRI and Nuclear Scintigraphy equip veterinarians with an advantage when troubleshooting a lameness issue and helps them to determine a correct diagnosis in a timely manner.

Nuclear Scintigraphy Scan by Jump Media-4743The process of a Nuclear Scintigraphy is a bone scan that begins
with the injection of a radioactive isotope. Photo by Jump Media

Nuclear Scintigraphy Imaging by Jump Media-4775A specialized nuclear isotope gamma ray camera is used to capture
images of the skeletal anatomy with a 360-degree view. Photo by Jump Media

Coupled with advanced technology, PBEC is also one of very few equine practices in the U.S. with a Board Certified Radiologist on staff, and thanks to Dr. Puchalski, hundreds of MRI and bone scans are read each year at PBEC. In addition to being state-of-the art diagnostic tools, the technology also affords economic benefits to owners.

“MRIs can give a definitive diagnosis, and that saves time and money in the long run,” said Dr. Puchalski. “For example, if a horse goes lame and is examined and treated empirically, which is a diagnosis based on likely problems through common diagnostic procedures, it either stays sound or it becomes lame again or even non-functional in three to six months. This method sets back the commencement of the appropriate therapy.

“What the MRI does is allow the horse to be treated early and correctly,” continued Dr. Puchalski. “Otherwise, you may not be treating the correct issue, and the horse could end up lame again very soon.”

Board Radiologist Dr. Sarah PuchalskiCoupled with advanced technology, PBEC is also one of very few equine practices in the U.S.
with a Board Certified Radiologist on staff, and thanks to Dr. Sarah Puchalski, hundreds of MRI
and bone scans are read each year at PBEC. Photo by Eques Solutions

Nuclear Scintigraphy does not produce a scan that is as specific, but it gives Dr. Puchalski the opportunity to procure a concrete diagnosis, as well as evaluate the whole horse for secondary problems.

“Oftentimes the primary problem in one place is making a horse sore in other places,” she said. “Owners like to know the root problem, but to also quickly diagnose secondary problems so the entire horse can be treated at once.”

As the official veterinary hospital of the Winter Equestrian Festival (WEF) and the Adequan® Global Dressage Festival (AGDF), PBEC sees a high concentration of sport horses in need of care. In turn, owners of those horses are eager to see their horses quickly and happily return to competition.

“The biggest benefit to PBEC and the Wellington community as a result of these MRI and Nuclear Scintigraphy scans is accessibility,” concluded Puchalski. “Anyone can call from the horse show to the clinic, get a scan scheduled quickly- in and out, get results fast, and then their training program can be changed immediately.”

About Dr. Sarah Puchalski

Dr. Puchalski is from Davis, CA, where she was an associate professor at the University of California in their Department of Surgical and Radiological Sciences. In 1995, she received her BS in biology from Simon Fraser University in British Columbia, and in 1999 earned her Doctor of Veterinary Medicine from the University of Saskatchewan in Saskatoon, where she received the ACVS Outstanding Large Animal Surgery Student award that same year. Dr. Puchalski interned in Field Service and Sports Medicine at New Bolton Center at the University of Pennsylvania in 2001, and completed her residency in radiology at UC Davis in 2005.

Dr. Puchalski has devoted her career to teaching and improving equine health through the development and refinement of diagnostic techniques. In 2011, she contributed to two books on the topic of equine lameness. Her recent contributions include chapters in “Diagnosis and Management of Lameness in the Horse,” edited by Ross and Dyson, as well as in “Veterinary Computed Tomography and the Clinical Veterinary Advisor: The Horse, Equine Colic and Veterinary Clinics of North America.” She also has contributed close to 50 scientific articles concerning the diagnosis of equine lameness to many periodic journals, including Veterinary Radiology & Ultrasound: the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association; Veterinary Pathology; Equine Veterinary Journal; the American Journal of Veterinary Research; Equine Veterinary Education; Journal of the American Veterinary Medical Association; and Journal of Veterinary Internal Medicine.

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!

Premier Medical Services Draw Equestrians of the World to Palm Beach Equine Clinic

Wellington, FL – Palm Beach Equine Clinic (PBEC) is proud to serve as the local headquarters for emergency services and equine diagnostics during the winter show season in Wellington, FL. As the official veterinary hospital of the Winter Equestrian Festival (WEF) and the Adequan® Global Dressage Festival (AGDF), PBEC has been the premier surgical facility in Wellington for over three decades.

While competing in South Florida, horses and riders from around the globe have access to Palm Beach Equine Clinic’s state-of-the-art hospital for all of their sport horse needs. PBEC has a team of 30 veterinarians, which includes three Board-Certified Surgeons, a Board-Certified equine Radiologist, and numerous other experts in their fields. All competitors and their traveling veterinarians are welcome for the support of services and collaboration throughout the season.

Horse in surgery by Jump Media-4824At PBEC, the advanced imaging and surgical technology is unmatched. Photo by Jump Media

The referring relationship between veterinarians is most commonly seen in the specialty departments of surgery, internal medicine, ophthalmology, and advanced diagnostic imaging. At PBEC, the advanced imaging and surgical technology is unmatched, and the three Board-Certified Surgeons are skilled in many procedures that require high levels of expertise and advanced current equipment. As a result, many veterinarians refer their clients to the facility for specialty services.

Weston Davis surgery by Eques Solutions

Dr. Weston Davis, one of three Board-Certified Surgeons on the staff at
PBEC, works with many referral cases. Photo by Eques Solutions

Dr. Weston Davis, one of the Board-Certified Surgeons on the staff at PBEC, works with many referral cases. Throughout the year, veterinarians from all over Florida frequently refer their clients to PBEC for surgical procedures and advanced diagnostic imaging. The referring veterinarians may range anywhere from general practitioners to other surgeons that do not have access to surgical facilities or the most modern imaging modalities while on the road.

“As a rule, we are friendly with referring doctors and take care of their clients with as much high-level care and professionalism as possible,” Dr. Davis stated. “It is important to us to maintain good relationships with the veterinarians that refer into us for specialty work. We always try to facilitate whatever level of involvement they desire. If they want to come and be there for the surgical procedure, we make that happen, and if they just want to send the case and not be as involved, we can do that as well. However, we also always collaborate with the referring veterinarian and the client as a team. If they send a horse in for a surgical procedure, we are going to do the procedure and then connect the client with the referring physician for the follow up.”

Repairing fracture by Jump Media-4877
Among the hospital’s features, the latest in surgical technology enables less invasive
operations that result in faster recovery times for the horse. Photo by Jump Media

The cutting-edge services available at PBEC are made possible by the expertise of the hospital’s talented surgeons, along with the assistance of state-of-the-art imaging and comprehensive surgical and medical resources. The combination brings many of the best veterinarians in the world to Palm Beach Equine Clinic for assistance with their most complex cases.

Among the hospital’s features, the latest in surgical technology enables less invasive operations that result in faster recovery times for the horse. Dr. Davis explained how imaging is used during surgery to help guide procedures and assure the best possible result.

“Magnetic Resonance Imaging (MRI) and other advanced imaging modalities can often be used for three-dimensional mapping to help enhance the surgical technique,” he noted. “There are some fractures in particular where the surgeon can map out the exact configuration of the fracture off of the MRI scan. We are then able to place markers with the MRI to guide a more exact, refined surgery.

“Intra-operatively, x-rays are taken to view progress, particularly for fracture repairs,” Dr. Davis continued. “The digital radiographs allows us to view the fracture in two planes to ensure optimal screw placement and fracture repair. Ultrasound is also frequently used in surgery for some of the more delicate procedures, specifically with soft tissue.”

Surgeons looking at radiograph by Jump Media-4838

Advanced imaging is used during surgery to help guide procedures
and assure the best possible result. Photo by Jump Media

Radiograph of fracture repair by Jump Media-4902

Intra-operatively, x-rays may be taken to view progress, particularly for fracture repairs.
Shown here, digital radiographs allow the surgeons to view a fracture in two planes to
ensure optimal screw placement. Photo by Jump Media

Other surgical procedures may be guided with Arthroscopy, which aids in visualization of a joint;
Laparoscopy, which uses a camera inserted into the abdomen; or Endoscopy, which is used in upper airway procedures. With the most advanced imaging technology onsite, PBEC is the go-to hospital for equine owners and referral veterinarians from around the world during the winter season in Wellington.

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! To find out more, please visit www.equineclinic.com or call 561-793-1599.

Palm Beach Equine Clinic Leads the Industry in Veterinary Referrals and Sport Horse Care

2015-wef-approved-logogdf-adequan-2017_no-year

Palm Beach Equine Clinic (PBEC), of Wellington, FL, is located in the epicenter of the world’s leading winter equestrian destination. With horses and riders traveling from around the globe to compete in various disciplines, the top equestrians need look no further than PBEC’s state-of-the-art hospital for all of their sport horse needs. PBEC has been the premier surgical facility in Wellington for over three decades and continues to expand!

PBEC serves as the official veterinary hospital of the Winter Equestrian Festival (WEF) and the Adequan® Global Dressage Festival (AGDF) in Wellington, and is proud to serve as the local headquarters for emergency services and equine diagnostics.

During the 2015-2016 season, PBEC added a support Annex Veterinary Office located on the show grounds at the Winter Equestrian Festival. The wooden barn located at the beginning of the north grounds entrance offers an on-site office space, a pharmacy for supplies and medication pick up, as well as examination areas. Veterinarians from PBEC are always on the grounds when competition is underway, and are always available for daily lameness evaluations, pre-purchase examinations, medical assessments, or any other needs.
pbec-wef-annex-rs

The Referral Relationship

Palm Beach Equine Clinic has a team of 30 veterinarians, which includes three Board-Certified Surgeons, one of the world’s only Board-Certified equine Radiologists, and numerous other experts in their fields. All competitors and their traveling veterinarians are welcome for consultations and other services throughout the season.

Dr. Richard Wheeler and many of the vets from PBEC travel around the country and the world to provide support services for clientele throughout the year. While abroad, PBEC veterinarians consult with various veterinarians and utilize the support services from their home base clinics. As the veterinarians of the world have shown generous hospitality for PBEC into their home locales, PBEC reciprocates the hospitality to all visiting veterinarians in Wellington.

richard-wheeler-by-jump-media-4650

“In our travels, we work with veterinarians around the world,” Dr. Wheeler explained. “We may share clients with people who spend their summers in Europe or the northeast, some of which we will fly to take care of throughout the year. We often consult with other veterinarians, and it is always interesting and rewarding to share views on different cases. We get to meet people from different countries with different opinions and techniques. I think it is always beneficial for all of us to broaden our horizons a bit by working together with people in different areas of the world. We are able to glean expertise from them and hopefully help them out with their clients as well.

“At PBEC we welcome a lot of team veterinarians and veterinarians from around the country, and we work alongside them with their clients,” Dr. Wheeler continued. “We reciprocate what we do over the summer. The equine vet world is pretty small, so we know most of these veterinarians pretty well and have worked with them a lot. It is a good relationship that goes both ways.”

The referring relationship between veterinarians is most commonly seen in the specialty departments of surgery, internal medicine, ophthalmology, and radiology or diagnostic imaging. At PBEC, the advanced imaging and surgical technology is unmatched, and the three Board-Certified Surgeons are skilled in many procedures that require high levels of expertise and advanced equipment. Therefore, many veterinarians refer their clients to the facility for specialty services.

One equine professional that PBEC works with closely is Dr. Kit Miller, of Miller & Associates, based in Brewster, NY. Dr. Miller travels to Wellington each winter to work with his many clients that are there to compete, and he maintains a great relationship with PBEC. Alternately, when the veterinarians of PBEC are in New York, they are always welcomed to the support of Miller & Associates.

“I have worked with PBEC since I started going to Wellington in the early 90s. They are a valuable resource; they are good friends and good colleagues,” Dr. Miller stated. “Mainly, we refer horses in for imaging and for surgeries. PBEC has been very progressive in getting some of the best imaging equipment available. It helps our practice provide better care for our clients in terms of the quality of the diagnostics, and also just the resources in terms of veterinarians there.”

pbec-mri-horse-by-jump-media-4539

Dr. Miller added, “We have a facility in New York, and we do make it available to any of PBEC’s veterinarians when they are in the area. Ours is not a full hospital, so it is really more of an outpatient facility, but just as PBEC’s doors are open for us in Wellington, our doors are open for them when they are up here. We collaborate well. If we have clients that are in locations that we are not, then we routinely call on PBEC vets. If they are available, then we are happy and comfortable to have them taking care of any of our clients, and vice-versa.”

Sport Horse Maintenance

Top international competitors are happy to have the amazing resources of PBEC at their fingertips while competing in Wellington.

Top professional show jumper Georgina Bloomberg uses Palm Beach Equine Clinic to keep her horses in the best shape for the Wellington winter season and year-round.

“Palm Beach Equine Clinic is incredibly helpful in keeping our horses healthy and sound. We work very hard to make sure they feel good and are happy in their jobs, but if any lameness or issue does come up, they are always there to get a quick diagnosis and a plan to treat them. Proper preventative maintenance is key for our equine athletes,” she said.

In addition to her equine athletes, Palm Beach Equine Clinic also cares for the rescue pig and goat that Bloomberg has at her Wellington and New York farms.

Australian top professional dressage rider Kelly Layne moved to Wellington in 2009 and stables her horses at the Palm Beach Equine Sports Complex at PBEC. From the central location, Layne has easy access to both the clinic and the show grounds of the Adequan® Global Dressage Festival.

“It is such a luxury to have all of their services available,” Layne stated. “If I have an ill horse at 5 p.m. on a Saturday afternoon, I just walk it over to the clinic, and I know that the horse will be taken care of amazingly. There is always someone available. You’re not staying up all night worrying and checking on the horses. That is just such a nice service that they have, and it is definitely one of the advantages of being in this location.”

Layne continued, “Palm Beach Equine has amazing equipment for completing MRI, bone scans, and of course they have Dr. Sarah Puchalski, who is absolutely one of the best in the world for Radiology. To have her here during the season is incredible. She is a very knowledgeable horse person because she rides high level show jumping horses herself. We are so spoiled to have everything in one location. In the summer, I went to Germany for three months and we were so isolated. I would have to travel to get an MRI or I would have to travel to a certain vet that maybe had a shock wave machine. You couldn’t get everything in one location.”

kelly-layne-udon-p-by-jump-media-4605

Layne also appreciates the many experienced veterinarians that PBEC has to choose from, with various specialties and areas of expertise.

“I think it is just amazing to have so many great minds all in one place,” she acknowledged. “One of the reasons I moved to Wellington is because the resources are amazing. At Palm Beach Equine Clinic, you have a lot of veterinarians to choose from. You have a vet for every different specialty. I use a lot of different vets at the clinic – a certain vet for lameness, another vet for internal health, and it is nice to have that variety.”

Among the extensive list of services offered by PBEC, on-call veterinarians are available for 24-hour emergency coverage and intensive care, 365 days a year. The state-of-the-art hospital features comprehensive surgical and medical resources, including the latest in surgical technology for less invasive operations that result in faster recovery times for the horse. The advanced on-site diagnostic imaging resources are also unparalleled, including a standing MRI unit, a Nuclear Scintigraphy gamma ray camera, ultrasonography, radiography, and a bevy of additional equipment.

dr-robert-brusie-surgery-by-jump-media-4832

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! To find out more, please visit www.equineclinic.com or call 561-793-1599.

photos by Jump Media