Regenerative Medicine Steps into the Future at Palm Beach Equine Clinic

Wellington, FL – As sport horses become faster and stronger, veterinary medicine is often challenged to break barriers to provide the best in diagnostic and maintenance care. Palm Beach Equine Clinic (PBEC), based in Wellington, FL, is consistently on the forefront of those advances, and employs a team of veterinarians equipped with the latest developments in regenerative medicine.

Two resources that have become increasingly popular to treat equine injuries are Platelet Rich Plasma (PRP) and Interleukin-1 Receptor Antagonist Protein (IRAP) to encourage regeneration of injured or degenerative tissue. Managing joint diseases and injuries using these methods is ground-breaking, but logical at their core. They essentially use naturally-occurring proteins, cells, and other natural processes originated from within the body of the horse to put the horse’s own biological mechanisms to work stimulating healing without the use of steroids or other drugs.

A PRP tendon injection taking place at Palm Beach Equine Clinic.

What is PRP?                                                 

Platelets are among the very first cells to accumulate at an injured site, making them very important when simulating 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. To treat a horse with PRP, the veterinarians at PBEC are able to take a sample of the horse’s blood and concentrate the platelets in a high-speed centrifuge onsite. The harvest and processing procedure takes approximately 30 minutes before the concentrated platelet rich sample is injected back into the horse at the specific area of injury using sterile techniques and guided by ultrasound.

PBEC’s Board-Certified Staff Surgeon, Dr. Weston Davis, explained PRP use in more detail: “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.”

What is IRAP?

IRAP is used to treat equine athletes that are susceptible to musculoskeletal injuries and osteoarthritis or degenerative joint disease. Joint trauma results in the release of inflammatory mediators such as Interleukin-1 (IL-1). IRAP uses a horse’s own anti-inflammatory protein found within the blood to counteract the destructive effects of IL-1 to slow the process of osteoarthritis. The process works by binding to the IL-1 receptors in the joint and blocking the continuation of damage and inflammation.

“We often see joint damage in sport horses because of the nature of their work, but we try to avoid overuse of steroids in joints because steroids can have long term effects on cartilage,” said PBEC veterinarian Dr. Samantha Miles. “This is a way we can manage joint disease and stop inflammation without having to consistently use steroids every time. Some of our clients will maintain their horses on IRAP alone for joint injections.”

An injection being administered by use of a guided ultrasound.

Introducing MediVet ACS

Dr. Bryan Dubynsky has been specializing in sport horse medicine at PBEC for 12 years and has added another option beyond PRP and IRAP to the clinic’s arsenal of treatments. MediVet Autologous Conditioned Serum (ACS) was developed by Medivet Equine, a leading manufacturer of preventative and regenerative equine therapies. It serves to block and terminate the inflammatory response that leads to tissue destruction, pain, and interruptions from training, competition, or a comfortable life.

Where IRAP makes use of IL-1ra, MediVet’s ACS utilizes both IL-1ra, IL-4,IL-10, IL-13 and it inhibits six pro-inflammatory cytokines and upregulates specific growth factors to stimulate regeneration and expedite healing.

“It’s the IRAP 2.0 if you will,” said Dr. Dubynsky, who started using MediVet ACS two years ago. “MediVet has found a way to get more interleukins involved. We have known there are a lot of interleukins working other than IL-1, but now we have proteins from more interleukins and are blocking more of the inflammatory mediators. It also gives us more volume. I will collect 400-500 milliliters of blood and 40-50 four-milliliter syringes come back to me ready to inject.”

The MediVet ACS collection kit contains everything needed to collect blood and ship it to the MediVet lab where the blood is processed and shipped back, all in less than 72 hours. The process includes the spinning out of unnecessary parts of the blood, patented, specially coated glass beads and the use of patented LED photobiostimulation technology (low-level light) to generate theACS.  Before the product leaves the lab, MediVet filters, checks for bacteria, and doses the finished ACS – when the ACS reaches the horse it is aseptic and ready to inject.

Dr. Dubynsky added, “Another benefit to these regenerative therapies is that you have a total dose limit of corticosteroid you can put in a joint. With MediVet ACS, you don’t. You can put it in as many joints as you want. You start to see improvement in 48 hours and I have seen the level of that improvement significantly higher with ACS over traditional IRAP.”

The high-speed centrifuge that concentrates the platelets of a horse’s blood on-site at Palm Beach Equine Clinic.

The goal to better serve sports horses that continue to improve athletically is the driving force behind the development of an even more developed and precise techniques used in regenerative medicine. And, at PBEC, the work to break new ground is never finished.

“I believe we are learning more about these technologies with more advanced science behind what they do and how they do it,” said Miles. “These treatments are natural, drug free, and competition safe, and necessity drives the need for regenerative therapies in the sport horse world.”

Have further questions about the regenerative therapy programs available at PBEC? Call the clinic today at 561-793-1599 to learn more.

Breeding the Modern Way: Palm Beach Equine Clinic’s Own Dr. Katie Atwood Discusses a 21st Century Take on Equine Reproduction

Wellington, FL – The process of breeding sport horses is ever changing. Whether in an effort to produce the healthiest, most talented foals, to prolong the competition career of a mare, or make the most of a stallion’s longevity, reproductive science in horses has come a long way from the days of the traditional breeding shed.

Dr. Katie Atwood joined Palm Beach Equine Clinic, based in Wellington, FL, in June and brought her passion for reproductive work with her to the winter equestrian capital of the world.

I like the creating of life,” said Dr. Atwood, who is a Florida native and University of Florida graduate and currently pursuing steps to become a board-certified reproductive specialist. “Equine medicine is intriguing, but you’re dealing with sick, unhealthy animals. With reproduction, I am working with healthy animals and making their babies, which I love!”

Dr. Katie Atwood. Photo by Erin Gilmore

Embryo Transfer

The most popular wave of advancement that has hit the horse sport industry over the past several years is the process of embryo transfer.

How it works:

  1. A donor mare and stallion, who hold the genetics of the future foal, are bred.
  2. At seven or eight days of pregnancy, the embryo is flushed out.
  3. A catheter is placed through the vagina and cervix, and an inflatable cuff on the catheter provides a fluid-tight seal.
  4. A lavage fluid with surfactin (added to reduce the “stickiness” of the embryo and allow it to be extracted easily) passes down through a tubing system into the uterine lumen. As the fluid swirls throughout the lumen and drains back out through gravity, it collects the embryo, which is swept back out. The fluid and embryo pass out through the tubing system into and through an embryonic filter.
  5. When the embryo is identified under microscope, it is removed into a more enriched medium until the time of transfer.
  6. The embryo is shipped to a recipient farm where a young and healthy surrogate mare of decent size receives the embryo. That mare carries the foal to term, but it is genetically created from the donor mare and stallion.

While the process is fascinating, some may wonder why it’s necessary. According to Dr. Atwood, it relieves much of the concern owners have about breeding their sport horse mares.

“The gestation period for a horse is 11 months, so you’re only getting one foal per year when you breed traditionally,” she said. “This allows a mare to produce multiple foals per year, but it also allows that mare to remains in competition. This process can be done on younger mares with no interruptions to their competition and training schedules.”

Horses are now being bred at an ideal reproductive age while they are still in training, which is made even more valuable by the fact that advances in equine science has prolonged the longevity of horses. While 16 or 17 was once the age of an older horse, now it’s commonly seen as the age when horses are winning in the show ring. Thanks to embryo transfer, these horses can enjoy longer, healthy careers and still produce the talent of the future.

Embryo transfer can be done on younger mares with no interruptions to their competition and training schedules. Photo by Erin Gilmore.

Dr. Atwood has seen embryo transfers become popular in dressage and polo, but she has begun to see it span all disciplines, saying, “At the start of the season, I had one farm and a few mares, but now it has quickly grown to several farms with multiple mares at each. It is really taking off because people now realize it does not remove their mares from competition.”

The process not only keeps mares competing, but it allows stallions to cross continents. Frozen fertilized embryos from working polo ponies in the U.S. are now being shipped to Argentina where they are carried by mares and then trained by some of the best polo trainers in the world. On the flip side, semen can also be frozen and shipped to the U.S.

“Stallions are collected, the semen is placed with an extender and high nutrient base so the sperm has something to use for energy, and then cooled slowly until it is frozen in liquid nitrogen,” said Dr. Atwood. “Once frozen, it is theoretically good forever. Last year, I bred a mare with 1991 semen and she was successfully pregnant!”

 What’s Next at PBEC

PBEC underwent significant facility renovations over the last year, which included improvements to their onsite breeding shed. Now covered from the heat and inclement weather like an indoor arena, the shed boasts a hydraulic phantom mare.

“We can raise a lower our phantom with the push of a button so it can be the appropriate for the stallion,” said Dr. Atwood. “Previously, we had to bring a tractor in to raise and lower the phantom.”

Additionally, PBEC recently incorporated the use of a SCA® CASA (computer assisted sperm analyzer) system into their reproduction work. An excellent way to improve quality control of a stallion’s sperm, the system evaluates sperm motility (velocity and type of movement), concentration (sperm count), morphology (sperm shape), DNA fragmentation (counting of fragmented sperm), vitality (live and dead count) and acrosome reaction, which is what ultimately allows the sperm to penetrate the egg.

From onsite experience to computer technology, PBEC offers Dr. Atwood the opportunity to be at the forefront of equine reproduction, a place she has always strived to be.

“I wanted to come into a practice that had a developed program in place, but what is even more important to me is mentoring and teaching my technicians and clients about reproduction,” she said. “It is so important to make sure these techniques are shared and promoted for the continued success of veterinarians, owners, and most of all horses.”

Learn more about Dr. Katie Atwood at here.

Have further questions about equine reproduction and the options available at PBEC? Call the clinic today at 561-793-1599 to learn more.

Getting to Know PBEC Veterinarian Dr. Santiago Demierre

At first glance, Dr. Santiago Demierre appears to be a young veterinarian making a name for himself in the field of equine medicine. A closer look, however, reveals that he is not only that, but also an exceptional example of diligence; working to become an extraordinary veterinarian while speaking a second language all in a country that is 5,000 miles from his home.

Born in San Antonio de Areco, a small town in the countryside of Buenos Aires, Argentina, Dr. Demierre is now a 32-year-old veterinarian working with some of the most cutting-edge medical technology in the industry at Palm Beach Equine Clinic (PBEC) in Wellington, FL. He attended vet school at Universidad de Buenos Aires and graduated as Medico Veterinario in 2012 before setting a goal to validate his degree in the U.S. While mastering the English language, he enrolled in a program called The Educational Commission for Foreign Veterinary Graduates (ECFVG) through the American Veterinary Medicine Association and officially validated his degree in the U.S. in January of 2017.

Palm Beach Equine Clinic veterinarian Dr. Santiago Demierre.
Photo by Erin Gilmore

Today, Dr. Demierre is one of 40 veterinarians on staff at PBEC, which includes six boarded specialists and over 80 technicians and staff members, making it one of the largest sport horse practices in the world.

Three things you may not know about Dr. Santiago Demierre:

1. Horses are in his blood.

Dr. Demierre: My father was a racehorse breeder and trainer, so while I was growing up I spent hours with him and the horses at the farm. I was always very interested in animals in general, not only horses, so even as a little kid I had the idea and the dream that I would be a veterinarian in order to be able to spend as much time with animals as I could. Now, I enjoy so many things about this work, but what really motivates me is the satisfaction I feel when I have a successful outcome on a case.

2.  When the opportunity came to study veterinary medicine, he picked up and moved across the world.  

Dr. Demierre: A fellow veterinarian who is a friend of mine named Dr. Eduardo Beccar Varela contacted me with his nephew Dr. Axel Beccar Varela, who is a board-certified surgeon and they offered me an externship at the clinic he was practicing at in Florida. I took that opportunity and began working in the U.S.

While here, a friend of mine, Gringo Colombres, introduced me to Dr. Scott Swerdlin, president of PBEC.  He offered me an internship at PBEC in Wellington and I am now in my fourth season there.

The team at Palm Beach Equine Clinic is made up of great veterinarians and now great friends. There is always somebody from whom you can learn something new every day. Also, it is awesome to be in contact with the world’s top equine athletes. That is what I enjoy most about being part of the team at PBEC, working on performance horse cases. Most specifically, preventing and treating lameness in sport horses.

3.  True to his Argentinian roots, he does some riding himself.

Dr. Demierre: I love being outdoors. When I am not treating patients or at the clinic, you can probably find me riding polo ponies. If I’m not there, I am either fishing, hunting, or enjoying some time off with my girlfriend.

Dr. Demierre conducting an x-ray at Palm Beach Equine Clinic.
Photo by Erin Gilmore

Even after treating patients in both Argentina and North America, Dr. Demierre’s trans-continental bucket list is far from fulfilled. Next, he hopes to take the skills he has mastered at PBEC and validate his degree in Europe as well.

Want to learn more about the veterinarians of PBEC and what they have to offer your equine athlete or backyard companion horse? Visit, or call the clinic today at 561-793-1599 to learn more.

“No Hoof, No Horse”: Three Aspects of Correct Farriery

Many a seasoned horseman will admit that success in any discipline of horse sport is dependent on healthy hooves. Palm Beach Equine Clinic (PBEC), based in Wellington, FL, proudly offers the most advanced equine podiatry services to referring veterinarians and clients.

As the winter show season reaches its peak in South Florida, hoof care is paramount and the importance of good quality hoof care in the competition horse can’t be denied. The equine hoof is unique, as it is comprised of a group of biological structures that follow the laws of biomechanics. To that end, the farrier is a major asset during the show season as he or she can be proactive in maintaining the health of a horse’s foot and help to prevent lameness.

Illustration shows the bilogicial structures of the hoof and the biomechanical focus (red circle).

There are three very important aspects of farriery science that the farrier will use to keep any horse sound:

  1. The Trim: Trimming the foot in conjunction with the size and placement of the horseshoe. Typically, a farriery session will begin with an evaluation of the conformation of each hoof from the front, side, and behind to observe the height of the heels. Next, the farrier should observe the horse in motion to see whether the horse’s foot lands heel first, flat or toe first. Regarding the trim, many farriers no longer use the term ‘balance the foot’ – which has no meaning – and have begun to use guidelines or landmarks when approaching the trim. 

    The guidelines used are:
    – Trimming to achieve a straight hoof-pastern axis
    – Using the widest part of the foot which correlates to the center of rotation
    – Trimming the palmar foot (heels) to the base of the frog or to the same plane as the frog

    A closer look at these three guidelines, which are all interrelated, will help to show their importance. If the dorsal (front) surface of the pastern and the dorsal surface of the hoof are parallel or form a straight line, then the bones of the digit (P1, P2, P3) are in a straight line, and the force from the weight of the horse will go through the middle of the joint. Furthermore, and equally important, if the hoof-pastern axis is straight, the weight will be distributed evenly on the bottom of the foot.

    Left: Yellow dotted line shows the bony alignment of the digit. Red line shows the straight hoof-pastern axis. Right: Black line is the widest part of the foot and the yellow dotted line shows the heels trimmed to the base of the frog.

  2. Center of rotation (COR): As the COR is located a few millimeters behind the widest part of each foot, it allows the farrier to apply appropriate biomechanics to each foot. The foot is trimmed in approximate proportions on either side of the widest part of the foot, which provides biomechanical efficiency.
  3. The Heel: One should trim the palmar section of the foot to the base of the frog or trim such that the heels of the hoof capsule and the frog are on the same plane. Adherence to this guideline keeps the soft tissue structures (frog, digital cushion, ungula cartilages) within the hoof capsule, which are necessary to absorb concussion and dissipate the energy of impact.We must remember that heels do not grow tall, they grow forward. If we allow the heels to migrate forward, the soft tissue structures will be forced backward out of the hoof capsule. Furthermore, as the heels migrate forward, the weight is placed on the bone and lamellae, thus bypassing the soft tissue structures of the foot. Allowing the heels to migrate forward also decreases the ground surface of the foot.

Left: Foot where heels have migrated forward and red circle shows the soft tissue structures displaced out of the hoof capsule and thickened. Right: Shows the same foot after the heels have been trimmed and a larger shoe has been applied.

These three guidelines can be applied to any foot and they serve as a basis for maintaining a healthy foot, as well as a basic starting point for applying farriery to a horse with poor foot conformation or one with a distorted hoof capsule.

Left: Foot shows the three guidelines applied to the foot. Note the proportions on either side of the widest part (black line) of the foot. Right: Shows the length of the shoe and the wide expanse of the shoe creating a platform under the foot.

Have further questions about podiatry and farriery consultations available at PBEC? Call the clinic today at 561-793-1599 to learn more.

Ulcer Prevention for the Competitive Sport Horse from Palm Beach Equine Clinic

Today’s competitive sport horses are asked to perform at their absolute best at the most prestigious competitions all over the world. Travel and life at the show grounds can be extremely stressful for horses. Ulcers can affect any horse, but competitive sport horses with the extra stressors from a life of work and travel are especially prone. The veterinarians at Palm Beach Equine Clinic (PBEC) strive to ensure that horses under their care remain healthy and ulcer-free. There are many precautions that can be taken to prevent ulcers from developing, but if a horse does suffer from ulcers, PBEC is there to assist with treatment.

What are ulcers?
There are two different kinds of ulcers – gastric ulcers and hindgut ulcers. Horses can develop one or the other, or both in combination, but gastric ulcers are most common. Gastric ulcers develop in the stomach, which is comprised of two different halves. The lower half of the stomach secretes acid and digestive enzymes to properly digest food. If the acid splashes up to the upper half of the stomach, there is minimal protection and causes painful erosion of the stomach lining.

Changes in environment and abnormal sleep patterns can cause added stress and possibly contribute to ulcer problems. Photo by Erin Gilmore

Increased acidity in the stomach heightens the chance that acid will come in contact with the larger, unprotected portion, resulting in damage to the stomach lining. There are many different factors that can change the environment of the stomach and cause increased acid production, ultimately resulting in ulcers. The most common factors are drastic changes in feeding times or types of feed, undue stress, and corrosive medications.

For the competitive equine, the stress of traveling and showing, as well as any change in environment or increased work, can increase the chances of ulcers forming. Abnormal sleep patterns at shows can cause added stress. It is important to ensure that the horse has ample bedding and space to feel comfortable enough to lay down to rest. Joint pain or other physical pain can also cause unnecessary stress to the horse’s system. Joint supplements, routine injections, and alternative therapies such as chiropractic and acupuncture can be used to keep the horse comfortable and stress-free.

Another major cause of gastric ulcers is chronic administration of phenybutazone (bute), banamine, or other nonsteroidal anti-inflammatory drugs (NSAIDs) as these medications can be corrosive to the stomach lining.

How are they diagnosed?
Ulcers can be difficult to diagnose as early signs can easily be confused with colic. Many times, horses with ulcers show mild, chronic, colic-like symptoms that resolve fairly quickly. Owners and trainers may notice that the horse seems sore after eating, denies feed entirely, or has colic-like symptoms such as upper lip movement, biting at its side, or pawing. If the ulcer is undiagnosed and the horse is given banamine to treat the colic symptoms, ulcers can actually be exacerbated.

For the competitive equine, the stress of traveling and showing can increase the chances of ulcers forming.

There are several ways to diagnose ulcers. First, if ulcers get severe enough, they can cause the stomach to bleed, and can be tested in a quick blood test to check for a low red blood cell count or anemia. A small amount of dark blood present in the stool can detect bleeding gastric ulcers or the right dorsal colon, but usually it is a microscopic amount and it can be difficult to visualize. A fecal test to test for blood in the stool can be performed but it is not the most specific or reliable method.

The most definitive way to diagnose gastric ulcers is the use of a gastroscope to provide an internal scan. A small camera is inserted down the esophagus and into the stomach, which allows for a clear picture of the separation between the glandular bottom portion and the upper unprotected portion of the stomach. On the gastroscope, ulcers with ranging severity can appear to be a minor red irritation or actual holes, which are depressions of the lining of the stomach. With the gastroscope, a veterinarian can also visualize the beginning of the small intestine, which is another common area for erosions to occur.

Hindgut ulcers can easily be identified by a non-invasive ultrasound of the colon.  With an ultrasound, the veterinarian is able to determine if a specific area of the colon wall is thickened.  Thickening of the wall is abnormal and is a primary sign of colonic ulcers. The drugs to treat hind gut ulcers differ from gastric ulcers but the treatment period is still four weeks or more.

PBEC veterinarians evaluate a horse using a scope.

Treatment and Prevention Tips
If ulcers are diagnosed to be present, they are graded as to their location and severity. A treatment plan is determined according to these factors.

  1. The gold standard treatment is Omeprazole for four weeks – one tube a day for 28 days. The most common Omeprazole treatment is Gastrogard. Oral supplements, such as calcium, which help to neutralize the stomach acids and act as a buffer to protect the stomach lining, are also sometimes recommended.
  2. If your horse is diagnosed with ulcers, it is important to avoid bute and banamine, if possible. Also, maintaining a consistent feeding schedule is important to avoid causing any major increases in acid production in the stomach.
  3. Keep the pH of the stomach neutral by adding one flake of alfalfa to the horse’s hay per day. It helps to lower the acidity of the stomach. Changes to a horse’s diet should always be discussed with a veterinarian.
  4. A proven way to prevent ulcers is to prophylactically give Omeprazole a day or two before a stressor. If you know the horse is traveling or going to a show, start administering Omeprazole three to four days prior. Gastric medications can be given every day during the stressor time period, at the show, and then a day or two following the show.

Have further questions about equine ulcers and how PBEC can help prevent them? Call the clinic today at 561-793-1599 to learn more.

Palm Beach Equine Leads the Way in Internal Medicine Services

Dr. Peter Heidmann talks respiratory disease in horses

Palm Beach Equine Clinic (PBEC), based in Wellington, FL, is one of the few veterinary clinics in the country to offer their clients the talents of board-certified specialists in nearly every branch of equine veterinary medicine. One such specialist is Dr. Peter Heidmann, a graduate of Tufts University School of Veterinary Medicine who joined the PBEC three years ago, and splits his time between Wellington, FL, and his own Montana Equine Clinic & Surgical Center practice based in Bozeman, MT.

Dr. Heidmann, DVM, MPH, is a board-certified specialist in internal medicine and sees these types of cases at PBEC, which recently underwent significant facility upgrades, including the addition of a dedicated internal medicine and infectious disease center.

Palm Beach Equine Clinic’s isolation area located at their Wellington-based facility. Photo by Erin Gilmore

To define internal medicine, Dr. Heidmann, noted, “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.

“What it really entails is a way of analyzing problems specific to the organ systems,” continued Dr. Heidmann, who is based at PBEC through April to help with internal medicine cases that may arise during the height of dressage, show jumping, and polo seasons in South Florida. “It can be all over the map, and that’s part of what makes the specialty so fun and interesting.”

The most common internal medicine cases can be split into three categories: gastrointestinal (GI) problems, neurological system issues, and respiratory diseases.

Dr. Peter Heidmann, board-certified internal medicine specialist. Photo courtesy of PBEC

Respiratory disease in horses
As common as a cold for a human or acute in nature, Dr. Heidmann further breaks down the different kinds of common respiratory disease in horses into three categories.

Equine Asthma “Heaves”
The majority of the horses competing in Florida during the winter season are impeccably cared for, which reduces the occurrences of chronic respiratory conditions or significant lung conditions. As a result, what is most commonly seen is equine asthma, or heaves.

“Very similar to asthma in humans, the small airway can constrict with inflammation and restrict air flow as a reaction to things in the environment,” said Dr. Heidmann. “As a result, you can have a top athlete one minute and an hour or a day or a week later have real exercise limitations. In South Florida, the moist air, dander, dust, and pollen are things that horses can react to, making heaves by far one of the most common respiratory problems in horses, but also one of the most treatable.”

According to Dr. Heidmann, equine asthma is treatable through a combination of nebulized medications, oral medications, or injections. These methods serve to quiet the inflammatory response much like how an inhaler helps relieve a human with asthma problems.

Acute Infections
Viral cases of respiratory disease include flu and Rhinopneumonitis, or rhino, caused by one of two types of equine herpesviruses; EHV-1 and EHV-4. While vaccinations are the easiest method to prevent cases of flu and rhino, these problems are a big concern because they spread so readily. While proper biosecurity protocols go hand in hand with vaccinations, isolation is key when it comes to infectious diseases affecting the respiratory system, according to Dr. Heidmann.

“At PBEC, our new isolation stalls completely enclose horses in their own environment with individually isolated and filtered air flow systems so that germs cannot reach other horses,” he said. “But, more importantly is the personnel. The staff that I work with at PBEC is highly trained with a lot of experience. They make transmission a non-factor between patients and also between the animals and those treating them.”

Shipping Fever
The most severe kind of respiratory disease found in horses is shipping fever, which is an infection that takes advantage of a horse’s stress while traveling.

“The sickest of these horses can’t be saved by any amount of dollars or expertise, so those are the ones we really worry about,” said Dr. Heidmann. “Whether a horse gets sick in transit or inadvertently aspirates food into their trachea, the result can be a deep bacterial infection.”

While treatable, these infections require two to three or more months on antibiotics that transition from injectable to oral, according to Dr. Heidmann.

Vaccinations play a pivotal role in preventing some respiratory problems and infectious diseases in horses. Photo courtesy of PBEC

How PBEC Can Help
On top of secure isolation and individual air flow systems in their new internal medicine facilities, PBEC also constructed areas for each stall where medications are prepared, equipment is stored, and dirty bedding is handled. To further mitigate risk, veterinarians, technicians, and staff take every available precaution, including foot baths before entering the stalls, Tyvek suits, gowns, and masks, providing multiple layers of protection. In some cases, a doctor/technician/intern team is assigned to a patient and won’t touch another horse for the duration of the treatment.

Dr. Heidmann refers to the facilities and his work at PBEC as a luxury, saying, “I’ve managed many cases in various facilities going all the way back through internship, fellowship, and residency, but this is as nice as any place I have ever worked. It makes the risk to the horses so much lower, but also removes the anxiety for myself because I’m able to look a client in the eye and tell them that there is no risk. I don’t have a concern about disease spreading from one patient to another because at PBEC we have the tools that we need.”

Call Palm Beach Equine Clinic today at 561-793-1599 to learn more about their internal medicine capabilities.

Want to know more about Dr. Heidmann? Click here!

Dr. Richard Wheeler Talks Equine Pre-Purchase Exams

Palm Beach Equine Clinic’s (PBEC) Dr. Richard Wheeler recently shared the basic steps he takes in performing an equine pre-purchase exam. Dr. Wheeler and PBEC’s 40 veterinarians, including Board Certified surgeons, internal medicine specialists, and radiologists, are considered some of the most experienced in the disciplines of show jumping, dressage, polo, and beyond. All of the doctors enjoy the opportunity to work with many of the top horses in the world in all disciplines featured in PBEC’s home base of Wellington, FL.

With thousands of horses competing in Wellington at events such as the Winter Equestrian Festival and the Adequan® Global Dressage Festival, equine sales are a big part of the business for many equestrians throughout the winter season. PBEC’s pre-purchase examination services are always available to assist in making the best decision on your purchase.

Palm Beach Equine veterinarian Dr. Richard Wheeler.
Photo by Erin Gilmore

No matter what the breed or discipline, pre-purchase exams include several basic initial steps. First, an overall health evaluation of the horse is completed, including previous health history, general condition, and conformation, as well as specific examination of the body systems including eyes, cardiovascular system, and respiratory system. Next, a lameness assessment is completed, including flexion tests, soft tissue structure palpation, and movement evaluation. Additional diagnostic imaging such as radiographs (x-rays), ultrasound, endoscopy, magnetic resonance imaging (MRI), nuclear scintigraphy (bone scans), or computed tomography (CT) scans may be requested for additional information.

PBEC recently underwent significant facility upgrades, including the addition of a state-of-the-art CT scan machine. The CT scan gives PBEC veterinarians the unique opportunity to conveniently explore areas of a horse’s body that they were not otherwise able to see.

A horse in the all-new CT scan machine at Palm Beach Equine Clinic.
Photo courtesy of Dr. Richard Wheeler

The purpose for the veterinarian to perform an examination of the horse is to assess its current state of health and soundness at the time of the examination, as well as gather information that may help to predict a level of risk for the future use of the horse. Dr. Wheeler explained the steps that he takes when evaluating a horse for sale, as follows:

  • “The first thing I do is talk to the potential buyer and trainer to gather their expectations and any concerns that have arisen during the trial of the horse. Next I discuss the horse with the current owner and/or trainer to determine what level of training or competition it is in, and if it has any previous issues that they are dealing with.”
  • “Then we look at the horse in a static exam in the stall. We do a physical exam, looking at the whole body from front to back. Key points are the eyes, heart, and lungs and we palpate from the head and neck, to the back, and down the limbs. We are looking for signs of old injuries or areas that may have issues; conformation comes into play here as well.”
  • “We want to look at the horse in a dynamic exam. We usually look at it on the lead line and on a lunge line, or trotting in a circle on hard and soft surfaces, and then also under saddle as well. I like to see all of my horses go under saddle because we can observe the interaction of horse and rider, which is very important. During this stage we will perform flexion tests and ask the horse to perform specific movements depending on the discipline.”
  • Blood tests are often taken and normally will include CBC, Chemistry, Coggins test, and a drug screen. Depending on the age or type of horse other tests may be performed.
  • “Finally, there are some auxiliary tests, which may include radiographs, ultrasound exams, and endoscopy of the upper airways. These days, if there are certain issues, we will also include further diagnostic tests such as MRIs, CT scans, or bone scans. That depends on what is found in other parts of the exam. If there is something suspicious on a radiograph, the buyer might want to do more advanced imaging. Or sometimes, depending on the value of the horse, they might want to do that anyway.”

Dr. Wheeler pointed out that it is not the intention of a pre-purchase exam to recommend the horse for purchase or for sale. The exam is performed to provide information about the level of risk and educate the client of that risk. The client will make the decision on whether they want to buy the horse or not based on the information the veterinarian has provided as well as information from their trainer.

Dr. Richard Wheeler at Palm Beach Euiqne Clinic’s Sports Medicine Center in Wellington, FL.
Photo by Jump Media

“What might be acceptable for you may not be for me, or vice versa, depending on what I want the horse for or the value of the horse,” Dr. Wheeler noted. “It is not a pass/fail situation. We are just describing the horse, doing our best to state whether the issues that it has can be maintained or can be useful for the horse’s given profession, and what is expected of it, and this is where experience is so important. If the horse is being purchased as a low level children’s show horse, the stresses on it are going to be less than if it is being asked to go to the Olympics.”

Every exam is different, but the basic steps of evaluating a horse for any discipline or level of competition are fairly standard. It is important to have a veterinarian who is experienced and knowledgeable with the specific discipline to provide accurate guidance on the horse’s condition for the expected job. For the clientele of Palm Beach Equine Clinic, the veterinarians are all well schooled in the different disciplines, and many have additional expertise in specific areas.

Call Palm Beach Equine Clinic today at 561-793-1599 to schedule your pre-purchase exam.

About Dr. Richard Wheeler
Dr. Wheeler graduated from the Royal Veterinary College in London in 2002. He spent his first two years of practice as an intern at Greenwood, Ellis and Partners in Newmarket, England, where he worked in a referral center specializing in the treatment of Thoroughbred racehorses and Sport Horses. Dr. Wheeler moved to Palm Beach Equine Clinic in 2005 and became a partner in 2009.  Dr. Wheeler’s clients include Jumpers, Dressage and Polo and he is licensed to practice in FL, KY, NC and NY and also the UK and Europe.

Cold Fronts: Effects on the Horses of Wellington

Each year, many people relocate to Wellington for the winter show season. This allows escape from the brutal winters in the northern US, Canada, and Europe. However, cold-fronts do periodically pass through South Florida. Horses who have acclimated to the warm temperatures of Wellington and the surrounding areas are at risk when the cold weather arrives.

Most horses are very resilient, but when there are rapid changes in temperature, they can be susceptible.  Any change of 20 degrees or more from typical should prompt consideration of ways to minimize risk.

  • Blanketing horses when there is a 20+ degree temperature change over a period of 24 hours or less will keep them more comfortable and likely to maintain normal water intake
  • Take care when using heaters to ensure air quality remains clear, and that no dust or hay chaff will be burnt in unused heaters.  Ensure adequate ventilation – carbon monoxide is colorless and odorless!

Many horses will refuse to drink cold water. This can lead to firmer fecal material and impactions which cause signs of colic, or abdominal discomfort.

There are several different methods owners may use to encourage their horses to drink water when the temperature drops:

  • Keeping access to hot water in the barn and topping off the water buckets with hot water to help keep the water at a warmer temperature
  • Adding a second water bucket with salt, electrolyte, or Gatorade added can help horses feel thirsty which in turn increases water intake
  • Soak hay with warm water and feed a sloppy, warm mash

As always, call your veterinarian to discuss management strategies to minimize risk for your horses. The vets and staff at Palm Beach Equine are here to help any time.

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.