Monthly Archives: December 2017

Internal Medicine at Palm Beach Equine

Equine internal medicine by definition is focused on treating diseases of the internal systems of the horse, but for Board Certified Large Animal Internist Dr. Peter Heidmann, DVM, MPH, it boils down to an analytical way of thinking and approaching any equine health concerns.

“What you’ll see on the American College of Veterinary Internal Medicine (ACVIM) website is an emphasis on organ systems and organ system problems – respiratory disease, gastrointestinal disease, and neurologic disease being three of the most prevalent,” said Dr. Heidmann, who is both a part of the team at Palm Beach Equine Clinic (PBEC) and the owner and hospital director of Montana Equine Clinic & Surgical Center. “What it really entails is a way of analyzing problems specific to the organ systems. It can be all over the map, and that’s part of what makes the specialty so fun and interesting.”

Dr. Peter Heidmann (right).

Since the winter of 2016, Dr. Heidmann has brought his analytical approach to PBEC for the Winter Equestrian Festival (WEF) seasons, and he returns this winter to again add his skill-set to an already impressive line-up of talented veterinarians and specialists.

“Palm Beach Equine is well-equipped for these types of cases. We now have Dr. Heidmann, who is an internal medicine specialist; we have an amazing staff, and we have top-notch facilities providing great care,” said Dr. Jordan Lewis, who has been a part of the PBEC staff for more than 12 years and has dedicated several of her years at PBEC to hospitalized, internal medicine cases. “We have three U.S. Department of Agriculture (USDA) approved isolation stalls; our main hospital is brand new, and we have ten stalls equipped for ICU patients. We have a whole team that works together, including Dr. Heidmann as an internist, three boarded surgeons, a boarded radiologist, and access to other specialists.”

Dr. Jordan Lewis

Among the most common internal medicine cases that require the attention of the PBEC team of veterinarians are those horses with gastrointestinal (GI) problems.

“When it comes to GI issues, I usually see horses in two buckets or categories,” explained Dr. Heidmann. “Bucket number one are the horses that may need to go to colic surgery and the horses that just had colic surgery. The other bucket is horses with intestinal infections, often colitis in which they have heavy diarrhea. All of the treatments for colitis kind of boil down to the same thing: replacing their ongoing losses and letting the intestine heal itself. It doesn’t matter if it’s colostrum or salmonella or Potomac Horse Fever or any other kind of infection.”

Colitis case receiving fluids.

What each of those types of colitis cases also have in common is the need for the aforementioned isolation stalls. These USDA approved stalls can also become necessary in the second most common type of internal medicine cases seen at PBEC: respiratory diseases.

“Isolation is important for any infectious disease, and the two big ones that are the most common are colitis and respiratory problems – things like influenza,” explained Dr. Heidmann. “If there were ever to be an influenza outbreak, we have the ability to isolate horses in their own air supply. They’re breathing fresh air. You can have them just a stall or two away from each other, but they’re breathing their own air; it’s not cross-contaminated. That’s something extremely important we’re able to offer.”

Veterinarians exploring inside a patient with a scope.

The third most frequently seen disease pertaining to internal medicine are those of the neurological system, an area in which PBEC has recently become even better equipped to offer correct diagnosis and treatment options.

“We have an incredible ability to do advanced imaging and diagnostics on neurologic conditions,” said Dr. Heidmann. “Most vets even in the field can do neck x-rays, but we can do neck x-rays with contrast, so myelograms. More importantly, with the new standing CT, we can do CT scans of the head and neck, and CTs of the head and neck with contrast, so basically, a CT myelogram. It really ups our ability to diagnosis a condition.”

With the acquisition of a new standing CT scanner, PBEC is able to locate problems on not only the top or bottom of a horse’s neck, but also on the sides of the neck – an area previously inaccessible to view even from myelograms under anesthesia.

“Being able to go around and around with the CT, allows us to see things that are not just up and down, but it allows us to see things that are left and right on an image. It ups our ability to diagnosis problems substantially,” said Dr. Heidmann. “That’s part of the satisfaction of the job that I do. It’s not just ‘here is my experience. Here is what I guess is going on.’ I use that, but then I have at my fingertips all of these options for diagnostics and tests. We can confirm our clinical suspicions and then do treatment based on that.”

Meet PBEC Internal Medicine Specialist Dr. Peter Heidmann

One of the characteristics that is repeatedly praised and recognized as one of Palm Beach Equine Clinic’s greatest strengths is the great pool of talented professionals from all specialties that make up the clinic’s large team. In 2016, Dr. Peter Heidmann, DVM, MPH, began working with PBEC for the winter season, and this year, the accomplished internal medicine specialist is returning to work with PBEC for the duration of the 2018 winter season.

Dr. Heidmann graduated from Tufts University with his veterinary degree in 2000 before beginning a one-year internship in equine medicine and surgery at Arizona Equine, followed by a one-year surgical fellowship at Oregon State University, followed by a residency for internal medicine at the University of California, Davis, which he completed from 2002 to 2005. In 2005, Dr. Heidmann joined a private equine practice in Montana, and today he is the owner and hospital director of Montana Equine. 

Q: What prompted you to pursue equine veterinary medicine in particular?

I grew up on my family’s farm and orchard with draft horses, but I honestly thought that I would be a cow vet for most of vet school. Instead, I found that to be really frustrating academically and intellectually. In most dairy and beef cattle medicine, you have about eight drugs that you can use; you throw five of them at every sick animal, and they either get better or they don’t. I find a lot of reward in the process of getting to a diagnosis and treating a problem that’s more complicated and allows for more of a one-to-one relationship, rather than a herd type of relationship.

I knew I wanted to be a vet for a long time, but I didn’t know that I wanted to practice more individually focused medicine until I was going through vet school. It wasn’t until my fourth year, where you’re actually starting to work with patients, that I made that realization. I started moving in that direction, and I had some faculty that saw the same for me and encouraged me to do the horse stuff.  I always loved working with horses, but up until that time, I thought my background was too agricultural to do high-end sport horse work.  But their encouragement helped me realize that wasn’t true.   Then, I decided as a result of that realization and thought process, that I wanted to do an internship and residency to become specialized in internal medicine.

Q: What led you to Montana, and how has your role and practice evolved from when you started there in 2015 to today where you’re now the owner and hospital director of Montana Equine?

When I finished my residency at Davis in 2005, I wanted to be in the west. I wanted to be somewhere where there was nobody with my skill set – meaning internal medicine. I wanted to be in a small mountain town basically. Somewhere that I could practice the kind of medicine that I was trained to do but not in big metropolis. So, I narrowed it down to a practice in New Mexico and a practice in Montana. I went to work for a practice in Bozeman, MT, in July of 2005 and six months later my predecessor, Dr. Dave Catlin, passed away in a car crash. It was really sad. He had three kids, left a widow, and it was his dream to start an equine only specialty vet hospital, which he had done in 1999.

When he died, the conventional wisdom around Bozeman was, ‘Well this can’t be done. Dave had a dream, and it’s not a realizable dream now. There aren’t enough people here. Montana residents won’t understand specialized medicine and they won’t pay for it.’ I was faced with this proposition of leaving the practice after just arriving there, but I knew that was where I really wanted to be. I basically picked up the pieces of Dr. Catlin’s practice and formed Montana Equine in February of 2006.

Now we have a 7,500 square foot hospital with a surgery site at Bozeman, and I have a partner there, an associate, and two interns. We have two satellite locations: an ambulatory-only satellite in Helena, MT, and have nearly completed satellite clinic building in Billings, MT, which is the largest community in Montana.

Dr. Heidmann participated as one of the founding veterinarians in Montana State University’s bioregions program to Mongolia in 2014.

Q: You began working with PBEC during the 2016 Winter Equestrian Festival (WEF) season, but you’re out in Montana and have your own practice there. How did that relationship come about, and what does it look like today?

There are various aspects to that. We’re very quiet in Montana from basically Thanksgiving through March, and it’s not really my personality to sit around. That’s one aspect, and another is from a business perspective, it allows me to bring more vets on and keep them year-round. A third element is the desire to do more high-end medicine, and a fourth element that led me to Wellington, is my wife, Allison, who is a professional jumper rider. Two years ago, during the winter of 2015, Allison had a girlfriend who had just had a baby and asked Allison to run her business for her here at WEF. I thought that was an interesting idea and started talking to PBEC and found that there might be a need for a internal medicine specialist in their group. So that’s when I started coming. At that point, I was in Wellington for four or five days and then home for ten days, back and forth and back and forth. Then last year, I was more of a week here and a week at home. We had our first child, so Allison and Oliver, who was brand new then, were here straight through, but I went back home to Montana as well. The need is there and the relationship is great. So, this year, I’m in Wellington full-time for the WEF.

Q: What do you enjoy most about having the opportunity to practice with PBEC?

It’s a huge group of people, so there are a lot of personalities. When you have a lot of different personalities, you have a lot of different perspectives on treatments, and that’s interesting and fun. It means that every year when I’m here, it’s pretty dynamic. Back in Bozeman, I have a great team, but I’m the leader of the team. I’m the oldest and the most experienced. That’s good, and that’s not to say that those guys don’t definitely come with new ideas, but being here, there are so many ways of doing things that I end up picking up new tricks or new ideas even though I’ve been practicing for most of two decades. So here at PBEC, I’m picking up new strategies and new techniques separate from new stuff coming out in the world – just different ways of doing things, and different experienced veterinarians to bounce ideas off of. That’s really refreshing and stimulating.

From a vet’s perspective, with the Wellington demographic there is sometimes less of a limitation on budget and expense, so we’re really able to set that factor and worry aside and instead focus solely on what is best for the patient. The limitation isn’t financial; the limitation is just medicine and what we are able to do, which is exciting and allows us to see great results.

Q: Have you had any favorite cases or standout moments during your time with PBEC thus far?

I won’t name any in particular, but what I really enjoy are the challenging medical cases, the internal medicine cases that tend to be really sick and that you’re able to fix. The most common ones that we see are probably sickness after colic surgery, horses with really bad diarrhea, so colitis cases, followed by foals. Those cases generally all have a lot of things going on in a lot of different organ systems. So, there are a lot of factors to balance. Internal medicine people like me are kind of inherently nerdy, and we really get into what’s happening with the acid base status, and electrolytes, and blood gases, and fluid volumes, and other technical aspects of sick horse medicine.

Q: What do you enjoy doing outside of work?

In South Florida, we’re basically working all the time this time of year, so not as much here except trying to get exercise and be fit. I like to ride a bike or go for a run. At home, the Gallatin Valley – which is where Bozeman is – is surrounded all around by mountains. The valley floor at Bozeman is at about 5,000 feet, and the peaks are at 8,500, so you can do a lot of really serious hiking. Our son is only 18 months old, but he loves it. I’ve had dogs in the past where their whole personality changes when you get out of town, and that’s what Oliver is like too. It’s almost like his whole face is a different face when he’s out there.