Monthly Archives: February 2017

Palm Beach Equine Clinic: Leading the Way in Rapid Response for Emergency Colic Care

Wellington, FL – Palm Beach Equine Clinic (PBEC) 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 PBEC 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, PBEC 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 PBEC 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.”

Board-Certified Surgeon Dr. Weston Davis performs colic surgery with the
large colon exteriorized. Photo courtesy of Palm Beach Equine Clinic

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.”

Colic from a partially strangulated small intestine. Quick intervention yielded a good
 recovery without resection. Photo courtesy of Palm Beach Equine Clinic

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 PBEC 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.”

Tumor of the intestines, removed at surgery. Photo courtesy of Palm Beach Equine Clinic​​

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, PBEC 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.

Unparalleled Excellence in Equine Sports Medicine and Surgery

Twenty-Five Dollars Could Save a Horse’s Life

Several regions across the U.S. have reached the peak of the winter show season, and with the increase in equine travel, as well as large populations of horses in close contact with one another, proper vaccination protocols are as important as ever.

Dr. Kathleen Timmins of Palm Beach Equine Clinic in Wellington, FL, is often asked why proper equine vaccination protocols are imperative for all horses, and her answer voices directly to the welfare of the horse.

“You could save your horse’s life!” she said. “It is really important from an infectious disease standpoint, but also for mosquito-born diseases or rabies; these are diseases that are life-threatening for lack of a $25 vaccine.”

Vaccinations: When, What, and How
According to Dr. Timmins, recommended vaccination protocols vary by vaccine and by the location of the horse, but the core group of vaccines is relatively standardized. As a rule, horses should receive vaccines to prevent against mosquito-born diseases like Eastern Equine Encephalitis (EEE), Western Equine Encephalitis (WEE), and West Nile Virus twice a year. Equine Encephalitis is characterized by the swelling of the brain in an infected horse, while West Nile Virus infects the central nervous system and may cause signs of Encephalitis, including those ranging from fever to weakness and paralysis of the hind limbs.

East and West Equine Encephalitis, West Nile, and Flu/Rhino can all be administered as a
combination vaccine requiring only one injection. Photo courtesy of Palm Beach Equine Clinic

 

“Vaccinations against mosquito-born diseases become very important in south Florida because we have mosquitoes year-round,” said Dr. Timmins. “As you go further north, owners may sometimes choose to only vaccinate against those once a year.”

Included in the twice-a-year vaccination program is a Flu/Rhino dose. The Flu vaccination prevents the illness in horses much the same way it does in humans, while the Rhino vaccine is key in helping to prevent the Equine Herpesvirus (Rhinopneumonitis). Equine herpesvirus type 1 (EHV-1) and Equine herpesvirus type 4 (EHV-4) most commonly result in respiratory disease in horses and can progress to neurological disease.

East and West Equine Encephalitis, West Nile, and Flu/Rhino can all be administered as a combination vaccine requiring only one injection.

In addition to vaccinations given twice a year, annual vaccinations include those to prevent Potomac horse fever, a potentially-fatal illness that affects the digestive system and is caused by the intracellular bacterium Neorickettsia risticii; Strangles, a bacterial infection of the upper respiratory tract; and Tetanus, an acute, often fatal disease caused by the bacteria Clostridium tetani found in soil.

Much like the vaccinations administered to humans, the companies that produce the vaccines are in constant transition, adapting each vaccine to the most common strains to ensure the most accurate prevention of disease.

The Role of the Horse Show
To combat the rise of infectious disease outbreaks, many horse show organizers have taken a proactive step to reduce the spread of disease by developing vaccination requirements for the show grounds. This is a step towards preventing disease as an organized community, according to Dr. Timmins.

“No one wants sick horses,” she said. “All horse show organizers can do is put the requirements out there and hope that people comply and that they understand why vaccinations are so important.

“When a horse pops with a fever at a show everyone is alarmed,” continued Dr. Timmins. “If proper vaccination protocols are followed, it is easier for us to figure out why that horse has a fever and treat them quickly and appropriately.”

Negative Reactions
There are occasional cases of horses reacting negatively to certain vaccinations, making a regular schedule difficult. After receiving a vaccine intramuscularly, some horses experience local muscular swelling and soreness or signs including fever, anorexia, and lethargy. Severe reactions such as anaphylaxis can also occur in rare, extreme cases.

There are procedures in place to help keep horses that suffer reactions on a systematic vaccination plan without threatening their health or competition schedules. Photo by Jump Media

 

According to Dr. Timmins, there are procedures in place to help keep horses that suffer reactions on a systematic vaccination plan without threatening their health or competition schedules.

“What I will do first is break up the vaccinations so we can figure out which one is bothering the horse,” said Dr. Timmins. “Then sometimes all it takes is a change in the vaccine company because the particular horse is reacting to their preservative or their carrier. Veterinarians can also pretreat with a nonsteroidal anti-inflammatory drug to avoid really bad reactions. Finally, there is always an option to administer intranasal vaccines rather than using an injectable.

“Very few horses have severe reactions to vaccines and for the most part, the horses traveling to shows are part of a young and healthy populations,” continued Dr. Timmins.

As the winter horse show season continues throughout the U.S., horse health must be a priority and vaccinations are a simple way for the equine community to do their part.

“Vaccinations are an easy and relatively inexpensive way to prevent infectious disease outbreaks, and keep our horses healthy and safe,” she said. “There’s just no reason not to vaccinate.”

“There is just no reason not to vaccinate,” says PBEC’s Dr. Kathleen Timmins. Photo by James Wooster

 

More About Dr. Timmins

Dr. Kathleen A. Timmins is a 1993 graduate of the Ohio State University School of Veterinary Medicine. She completed her internship in equine medicine and surgery at the Illinois Equine Hospital near Chicago. Prior to coming to Florida, Dr. Timmins practiced in Aiken, South Carolina, where she met her husband, John, who plays polo professionally. Growing up in Central Ohio, Dr. Timmins began her relationship with horses as a child on the hunter/jumper circuit. She continues to ride and show as much as possible. She and her husband are enjoying parenthood with their daughter Schuyler.

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!

Learn About Palm Beach Equine Clinic’s Dr. Robert Brusie

Wellington, FL – Palm Beach Equine Clinic (PBEC) of Wellington, FL, has a team of 30 skilled veterinarians, including three Board-Certified Surgeons, one of the world’s only Board-Certified equine Radiologists, and numerous other experts in their fields. PBEC’s surgical team leader, Dr. Robert Brusie, is a nationally renowned Board-Certified surgeon whose surgical specialties include orthopedic, arthroscopic, and emergency cases. Dr. Brusie has been the head surgeon with PBEC for the past 20 years and is a beloved part of the team.

PBEC’s surgical team leader, Dr. Robert Brusie, is a nationally
renowned Board-Certified surgeon. Photo by Eques Solutions

Dr. Brusie graduated from Michigan State University College of Veterinary Medicine. He completed his surgical residency at the Marion DuPont Scott Equine Center in 1989 and has been in private practice ever since. He became a Diplomate of the American College of Veterinary Surgeons in 1994. Dr. Brusie joined Palm Beach Equine Clinic (PBEC) in 1996.

Dr. Brusie is a Board-Certified Surgeon who is recognized for his expertise in colic surgery, as well as for his skill in arthroscopic surgery. His surgical experience expands the clinic’s progressive care in both emergency and elective procedures. He has published articles on numerous topics, including the equine intestinal tract and septic arthritis in horses. Dr. Brusie is married and has three daughters. Read on to find out more!

What was your background with horses growing up?

I grew up on a farm in Michigan. We had usually between 200-600 head of cattle and always between four to six horses. Our horses were cow ponies or driving horses. My dad loved horses and had to have them around. My family has owned our farm for six generations – it pretty much occupied all of our time besides sports and school. Needless to say, we didn’t have much time to show horses.

When and why did you decide to become a veterinarian? Did you know you wanted to be a surgeon from the start?

I decided to become a veterinarian at an early age. I think I was seven or eight years old when I pulled my first calf. One of my dad’s hired men called me ‘doc’ when I was about that age. When I went to college, my plan was to become a large animal veterinarian and live in my hometown and continue to farm part-time with my three brothers. All of that changed when I was in Veterinary school at Michigan State University. Dr. Ed Scott was one of the five surgeons at MSU. He was a gifted surgeon and a great teacher. He kind of steered me into an equine internship at Auburn University. It was one of those things that the more you did, the more you wanted to do to improve yourself. I operated my first colic by myself when I was three weeks out of vet school (32 years ago).

Dr. Brusie is recognized for his expertise in colic surgery, as well as
for his skill in arthroscopic surgery. Photo by Jump Media

 

How did you first start working at PBEC?

I was a surgeon at a clinic in Atlanta. In 1996 I had performed a surgery for a client of Dr. Paul Wollenman’s. He had started this practice in 1975. He asked me if I needed a job. I was planning on staying in Atlanta for the rest of my career. I received phone calls from the other two partners over the next nine months, and eventually with encouragement from my fiancé, now wife Melissa, I took the job.

What do you love most about working at PBEC?

We have an exceptional group of veterinarians and staff here. The depth and scope of our veterinarians is amazing due to the large caseload. On any individual case, there may be two to three doctors that have input on the case to ensure no stone is left unturned.

Additionally, we are so privileged to work on some of the best show, race, and polo horses in the world. It is truly an honor.

What sets the surgical services at PBEC apart?

Between Drs. Gomez, Davis, and myself, we perform just about every soft tissue and orthopedic surgeries that are done in our field.

Personally, my greatest sense of success is when I see a horse back after surgery going as good or better than it was prior to surgery.

What are the biggest changes you have seen in sport horse medicine over the years?

Currently, the most exciting thing we see going on in medicine is regenerative therapy. Twelve to 15 years ago, we were harvesting bone marrow from the sternum and injecting it into lesions in tendons and ligaments. Now we manipulate the bone marrow or other sources of stem cells to promote more rapid and more functional healing of some of these injuries. I can assure you that in 10-20 years what we are doing now will seem stone-aged by then. There are some very clever minds performing some serious research in this field.

Between Dr. Robert Brusie, Dr. Jorge Gomez, and Dr. Weston Davis,
PBEC’s three Board-Certified Surgeons perform just about every soft tissue
and orthopedic surgery that is done in their field. Photo by Jump Media​

How do you stay up-to-date on new medical advances?

Every veterinarian at PBEC tries to attend as many meetings as time allows. We also do weekly journal club at our clinic to discuss recently published papers in veterinary and human medicine and surgery.

What is the most interesting or challenging surgery that you have done?

Dr. Gomez and I had a three-year-old racehorse that had split his P1 (long pastern bone) and cannon bone in the same leg in a race. We were able to piece together both bones perfectly and the horse recovered brilliantly. He probably could have returned to racing, however, the owners elected to retire him to life as a breeding sire.

How do you spend your free time when you are not working?

When I’m not doing something with my family, I really enjoy woodworking. My current project is building a kitchen table for Sarah, my assistant of 12 years. In the summer, I get roped into helping on my brother’s farm.

What is something interesting that people may not know about you?

I have three daughters who I am very proud of and tend to brag on maybe a little too much. My oldest, who was a nationally ranked swimmer, is now an anesthesiologist in human medicine. My middle one is either number four or five (depending on the week) in the nation in debate, and my youngest will probably run the free world (you will have to ask her if she wants to).

How else is the family involved in horses?

My wife (Melissa) and youngest daughter (Kayla) are horse nuts in the true sense of the word. Anything to do with horses (especially show hunters) they are dialed in. Melissa loves riding, and Kayla shows in hunters and equitation.

Dr. Brusie and daughter Kayla at U.S. Pony Finals in 2015.
Photo by Shawn McMillen Photography

What makes PBEC a special place for you?

I am blessed to have three good men as business partners. They are my good friends and great people. We are very lucky to have 20-plus veterinarians working with us who are very knowledgeable and caring individuals. We feel like a little practice, but with a lot of people who just get the job done.

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!