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.”