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Month: July 2020

A Healthy Mouth is a Supple Mouth

Healthcare Reminder: Equine Dentistry

equine dentistry dr. tyler davis palm beach equine clinic
Dr. Tyler Davis performing a tooth extraction.

The general goals of equine dentistry may appear straight-forward but include a complex system of evaluations that in turn affect the entire body and well-being of a horse. At its core, equine dentistry encompasses the objectives of maintaining even tooth wear, treating infection or disease, allowing for proper digestion, and promoting longevity. Dr. Tyler Davis of Palm Beach Equine Clinic says that routine and thorough dental exams can help prevent many issues from ever becoming problems.

Why do horses require dental care?

Horses grind their food into a finely masticated bolus before swallowing. The combination of a horse’s upper jaw being larger than the lower jaw, and the fact that a horse chews by moving their jaws from side to side results in uneven wear of the teeth. This uneven wear may cause sharp edges to form, which hinder efficient chewing and may ulcerate or tear the cheeks and tongue. Uneven wear can also cause the horse to swallow food that isn’t properly chewed and can lead to more daunting problems such as colic.

Dentistry supple mouth equine clinic

No horse is exempt from needing their teeth cared for by a veterinarian. For sport horses, however, dental care becomes even more crucial. Much of the connection between horse and rider comes by way of the horse’s mouth, and depending on the discipline, the horse may always have pressure in their mouth. If there are problems or discomfort within the mouth, it can become evident in the horse’s performance and disposition under saddle.

According to Dr. Davis, having a horse’s teeth in perfect shape allows one to immediately rule out dental issues when trying to troubleshoot a performance problem. A “sound mouth” also allows the best condition for supple, soft, and accurate connections between horse and rider through the bridle.

What is floating?

On a basic level, most horses require a routine float. Floating is the term for rasping or filing a horse’s teeth to ensure an even, properly aligned bite plane. While floating is the physical process, the scope of equine dentistry is much broader and examines the horse’s overall health as influenced by the mouth.

“A proper dental exam using a lightweight speculum, a very good light source, and a dental mirror allows me to see any possible problems and prevent those problems from becoming painful and affecting a horse’s performance and overall health,” said Dr. Davis.

How often should you have a veterinarian perform a routine dental exam on your horse?

Dr. Davis recommends an exam every 12 months at a minimum. For many sport horses, the demands of their competition schedule may require bi-yearly exams to prevent any problems that could sideline them from training or events. Lastly, any horse with a history of dental problems may require exams every three to four months. Without routine dental exams by a veterinarian, uneven wear can escalate to a serious health problem.

The most common signs of dental discomfort in horses include:

  • head-tilting and tossing
  • difficulty chewing
  • bit-chewing and tongue lolling
  • tail-wringing, bucking and other behavioral issues
  • drooling and bad breath
  • (sometimes) weight loss and spillage of grain
palm beach equine clinic preventative medicine

Technological Advances

While it is the owner’s responsibility to develop a diligent care routine, the veterinary community has done its part by continuously improving evaluation and diagnostic technology. Advances in instruments, such as the speculum and imaging technologies, allow veterinarians to better understand and examine the equine mouth. In turn, they are able to diagnose and treat dental problems more effectively.

Equine dental health is far more involved than simply evaluation the outward appearance of the teeth. While trained eyes can see external problems, and educated hands can feel for abnormalities, assessing internal issues can be done through diagnostic imaging. Improved imaging technology has greatly expanded Dr. Davis’ ability to find and analyze unseen problems in the mouth.

Diagnostic Imaging - Computed Tomography
Diagnostic Imaging – Standing Computed Tomography

Portable imaging technology, such as digital radiography (x-rays) allows him to conveniently understand dental pathology better for his patients in the field. While Standing Computed Tomography (CT) allows Dr. Davis to capture a comprehensive, multiplanar profile of all the structures within the horse’s head, with the horse only lightly sedated.

“Having these advanced imaging modalities available for my patients allows us to thoroughly identify an issue and then intervene as early as possible to treat the issue, relieve discomfort, or prevent tooth loss,” commented Dr. Davis.

Contact your veterinarian at Palm Beach Equine Clinic for more information on equine dentistry, or to schedule a dental exam, at 561-793-1599.

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Bella Ciao: Back Out Front

Maurizio Sano, Bella Ciao, and groom Angel Mijangos at Gulfstream Park West. Photo courtesy of Alessandro Sano
Maurizio Sano, Bella Ciao, and groom Angel Mijangos at Gulfstream Park West. Photo courtesy of Alessandro Sano

Racehorse Bella Ciao Undergoes Surgical Repair

Trainers Alessandro and Antonio Sano reviewed a daunting x-ray on the morning of April 19, 2019. Their three-year-old Thoroughbred filly Bella Ciao, owned by Cairoli Racing Stable and Magic Stables LLC, had just finished a breeze in 49 seconds flat when she suffered a fracture in her right front leg.

She exited the track at Gulfstream Park West, her home racecourse in Miami Gardens, FL, with her racing fate hanging in the balance.

“She is a tough filly with a lot of heart, and she walked herself back to the barn where we had x-rays taken,” said Alessandro, who met with the track veterinarian right away to identify the problem. “When we saw it, we were nervous that she was headed to the breeding shed, and her career was over.”

Alessandro and his father, however, were not willing to give up on their special filly. They entrust Palm Beach Equine Clinic’s board-certified surgeon, Dr. Robert Brusie, with care of their entire string of racehorses, and quickly decided to send the x-rays for his review. Dr. Brusie quickly identified a condylar fracture and advised a surgical repair. Immediately after her diagnosis was confirmed, Bella Ciao made her way to the Hospital at Palm Beach Equine Clinic.

Identifying a Condylar Fracture

A condylar fracture is a repetitive strain injury that results in a fracture to the cannon bone above the fetlock. The fracture is a result of excessive strain and weight carried over the cannon bone during high-speed exercise. It emerges from the fetlock joint running laterally up or medially out the side of the cannon bone, essentially breaking off a corner of the bone.

“A condylar fracture is a disease of speed,” said Dr. Brusie. “A condylar fracture was once considered the death of racehorses. As time and science progressed, it came to be considered merely career-ending. Currently, veterinary medical sciences are so advanced that we have had great success with condylar fracture patients returning to full work.

“Luckily, with today’s advanced rehabilitation services, time, and help from mother nature, many horses can come back from an injury like this. My prognosis for Bella Ciao after surgery was very good,” said Dr. Brusie.


Dr. Brusie performed Bella Ciao’s surgery and inserted five screws to repair the fracture.

Digital radiographs show a condylar fracture to the right front leg, and the five screws that completed the surgery.

Digital radiographs show a condylar fracture to the right front leg, and the five screws that completed the surgery.

From left to right: Digital radiographs show the condylar fracture to the right front leg, and the five screws that completed the surgery.


“He does an excellent job with all of our horses. We wanted to give it a shot for Bella Ciao, and it paid off,” said Alessandro. He and his father, Antonio, have worked with Dr. Brusie on many horses, including a past Kentucky Derby runner and horses winning in excess of million-dollar purses. “He told us that she would be back to the track, so we followed his instructions perfectly.”

Back On Track

Dr. Brusie prescribed stall rest and hand walking for the first several months of Bella Ciao’s recovery. She slowly began jogging, and then breezing.

On October 27, 2019, she returned to the track in a $45,000 Allowance race. With Leonel Reyes up in the irons, Bella Ciao made her comeback in storybook fashion by winning that race and coming out fit, sound, and healthy. Now a four-year-old, Bella Ciao won again on April 30, 2020, and most recently placed third in a $60,000 race on June 27.

“While treatable, a condylar fracture is not an easy injury to come back from, but Dr. Brusie is one of the best surgeons in the country, and we trusted him,” said Alessandro, who has been working with Dr. Brusie since he and his father moved their business from Venezuela to the U.S. in 2010. “She recovered brilliantly, and we could not be happier with how she is going now. She is a special filly, and we are thrilled that we took this chance on her.”

Removing the “Guess” from Lameness Evaluations

A Look at Palm Beach Equine Clinic’s Advanced Imaging Technology

Dr. Sarah Puchalski reviewing a CT scan at PBEC.
Photo by Jump Media

Palm Beach Equine Clinic takes pride in being a world-class facility for the diagnosis, treatment, and recovery of some of the industry’s most valued sport horses, as well as backyard companions. A vital area of the Equine Hospital that helps veterinarians to diagnose subtle or acute lameness is the Advanced Imaging Department.

Producing thousands of scans a year across all modalities, the Palm Beach Equine Clinic Imaging Department offers an on-staff, board-certified radiologist, and equipment that elevates the effectiveness of lameness diagnostics. Lameness is no longer a guessing game as PBEC veterinarians have an arsenal of imaging technologies to capture inside the horse.

Tour the PBEC Imaging Department:


Palm Beach Equine Clinic bone scan nuclear scintigraphy diagnostic imaging

Nuclear Scintigraphy (Bone Scan)

Nuclear scintigraphy begins with the injection of a radioactive isotope called Technetium 99 that is bound to a phosphate analogue. The isotope – phosphate molecule attaches to the mineral matrix of the bone in areas where bone is active. A gamma camera is then used to capture images of the skeletal anatomy. Points that “light up” on the image indicate increased metabolic activity as a possible site of injury.

Standing Magnetic Resonance Imaging (MRI)

The standing MRI produces highly detailed, cross-sectional images of bone and soft tissue in multiple different planes to fully image a desired region. The standing MRI requires sedation (not anesthesia) and is best used to further define a specific area that has already been pinpointed as the origin of lameness.

Computed Tomography (CT)

Similar to its use in humans, CT allows veterinarians the unique opportunity to conveniently explore areas of a horse’s body that were previously inaccessible. The machine produces 360 degree images of a horse’s neck, spine, and head and can be conducted while a horse is standing and under only light sedation.

Endoscopy

An endoscope is an instrument that allows veterinarians to look inside the body by being inserted through a natural opening or incision. A tiny camera on the instrument allows an in-depth view of internal structures such as the upper and lower respiratory track, gastrointestinal and urinary tracts, as well as the cervix and uterus of mares.

Palm Beach Equine Clinic Sport Horse Medicine Radiography

Digital Radiography

Used routinely, radiographs are traditional x-rays that are made available within seconds for digital viewing and evaluation.

Ultrasonography

An ultrasound machine generates high-frequency sound waves, which echo an image back to the machine where bone appears white, fluid appears black, and all other structures are on a grayscale. An ultrasound is non-invasive, usually does not require sedation, does not use radiation or require injecting radioactive isotopes, and provides real-time images.


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

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

Brittany Riddle, manager of PBEC’s Nuclear Scintigraphy Department, is fascinated by the structure of the horse’s body and helps to produce hundreds of bone scans per year.

“I’ve always had a strong interest in the anatomy of horses,” said Riddle, who spends her workday keeping patients comfortable and calm while operating a gamma ray camera housed in its own suite at Palm Beach Equine Clinic. “The horses are under light sedation for standing scans and these usually take from one to four hours depending on the type of scan. Usually during the winter competition season, we have anywhere from two to three horses being scanned daily.

“The variety of patients we treat is always interesting,” continued Riddle. “We see patients from all aspects of the industry. From racehorses to polo ponies, western performance, dressage, top show jumpers and hunters.”

According to Palm Beach Equine Clinic President Dr. Scott Swerdlin, having the latest in diagnostic capabilities drives the success of the Clinic.

“Many years ago, we committed to establishing Palm Beach Equine Clinic as an all-inclusive hospital and making it the most advanced referral center in the country,” said Dr. Swerdlin. “By investing in the very best personnel and equipment, we are able to provide the very best care we can for our patients.”

Meet The Team: Dr. Laura Hutton

Dr. Laura Hutton grew up immersed in equestrian culture in Enniskillen, Northern Ireland. She can’t recall a time when she wasn’t dreamily gazing at horses in a field or fantasizing about the day when she would pilot a show jumper in the competition ring. She knew at an early age that she wanted to be an equine veterinarian, and she stuck to that goal.

When not caring for horses, Dr. Hutton can be spotted competing in the adult jumper ranks on her jet-black Dutch Warmblood mare, Brimara. She even competes against one of her mentors, Dr. Jorge Gomez.

Dr. Hutton is currently spending her summer in New York with ambitions to compete at HITS Saugerties and Great Lakes Equestrian Festival in Traverse City, MI.

What brought you to the U.S. and then to Florida?

After I completed high school, I took a year off and was a working student at a show jumping yard in Ireland. When I went back to school, I studied at the University College Dublin’s School of Veterinary Medicine. The day after I graduated from veterinary school, I moved to the USA and completed a surgery internship at Hagyard Equine Medical Institute in Lexington, KY. 

In 2016, I headed south and accepted a position at Palm Beach Equine Clinic and have been there ever since. I love Ireland, but I found so many opportunities here in the States that I could not pass up. For example, after completing an acupuncture course, I now work with some of the most successful show jumping horses in the world right in my backyard in Wellington. I always wanted to work with sport horses and I really couldn’t be in a better place to do that; the volume and quality of horses that come through the clinic is incredible. The Florida sunshine is pretty sweet, too.

What are your day-to-day responsibilities at Palm Beach Equine Clinic and what branch of equine medicine do you consider to be your specialty?

Palm Beach Equine Clinic handles all kinds of treatments and I am an ambulatory vet, which means that my cases vary from lameness issues, medical cases, emergencies, and everything in between. I see so many unique cases, but the best ones are those that end with a pleased client. I remember I had a horse come in with a severe laceration that took six months to heal. When that horse was fully recovered, the owner was extremely grateful and that’s the best outcome we can hope for.

I love the variety of ambulatory work, but I enjoy diagnosing and treating lameness the most. It’s like solving a puzzle, with the end goal being that I am able to help an equine athlete perform to the best of its ability.

What do you enjoy most about treating horses and being a part of the Palm Beach Equine Clinic Team? 

The best part about being an equine veterinarian, for me, is being around the horses all day. They’re amazing animals and it’s a very rewarding responsibility to have a sick or lame horse in your care, treat it, watch it recover, and then see it doing well in the future.

Palm Beach Equine Clinic is made up of a really talented group of people with years of experience. I am able to consult with veterinarians who have decades of experience in the industry – like Palm Beach Equine Clinic board-certified surgeon Dr. Jorge Gomez – and learn so much from them. Also, we are lucky to have the latest and most advanced treatments, technology, and medications right at our fingertips at Palm Beach Equine Clinic.

What can we find you doing when you are not working?

Dr. Laura Hutton competing in the show jumping ring.
Photo courtesy of Laura Hutton.

You can still find me riding and competing, but it’s never enough. Other than horses, I am always trying to stay fit and I have run in a couple marathons. But mostly, I enjoy being here in Florida with friends, having the craic!

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