Internal Medicine: What’s it all about?

Palm Beach Equine Clinic President Dr. Scott Swerdlin often says, “If you want to attract equine veterinary specialists, you have to have impressive facilities and technology in place.” Palm Beach Equine Clinic is one of the few veterinary clinics in the country to offer clients the talents of board-certified specialists in nearly every branch of equine veterinary medicine. One such specialist is Peter Heidmann, DVM, DACVIM, a graduate of Tufts University School of Veterinary Medicine, who joined Palm Beach Equine Clinic in 2016.

Dr. Heidmann specializes in the treatment of internal medicine cases at Palm Beach Equine Clinic.

What attracted him? The facilities! In the heart of South Florida’s horse country and at the center of the busiest winter competition schedule in the world, Palm Beach Equine Clinic boasts an internal medicine and infectious disease center at its Wellington-based clinic.

The crown jewel of the center is the ability to stop airborne disease dead in its tracks with the U.S. Department of Agriculture (USDA) approved isolation stalls that completely enclose horses in their own environment with individual filtered airflow systems that do not reach other horses. On top of secure isolation and individual airflow systems in their internal medicine facilities, Palm Beach Equine Clinic 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 and wearing personal protective equipment such as Tyvek suits, gowns, and face masks to provide multiple layers of protection against spreading disease. In some cases, a specific team of doctor, technician, and intern is assigned to a patient and won’t touch another horse for the duration of the treatment.

Accurately Diagnosing Internal Medicine Cases

Diagnostics is not a guessing game at Palm Beach Equine Clinic. With advanced imaging equipment, including a computed tomography (CT) machine, standing magnetic resonance imaging (MRI), and nuclear scintigraphy camera (bone scan), as well as radiography (x-ray) and ultrasonography capabilities, Palm Beach Equine Clinic is armed and ready to quickly and accurately diagnose internal medicine cases.

Dr. Heidmann refers to the facilities and his work at Palm Beach Equine Clinic 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 Palm Beach Equine Clinic we have the tools that we need.”

Understanding Internal Medicine

To understand how diagnostic tools are most effective, one must understand what exactly internal medicine is. In an effort 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,” he continued. “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
• respiratory diseases.

Gastro-Intestinal Problems in Horses

“When it comes to GI issues, I usually see horses in two categories,” said Dr. Heidmann. “Number one are the horses that may need to go to colic surgery and the horses that just had colic surgery. The other is horses with intestinal infections, often colitis in which they have heavy diarrhea.”

According to Dr. Heidmann, all of the treatments for colitis tend to boil down to the same thing: replacing their ongoing losses and letting the intestine heal itself. It doesn’t matter if it’s colostrum, salmonella, Potomac Horse Fever, or any other kind of infection.

Equine Neurologic System

The nervous system in a horse is made up of the brain, spinal cord, and several different kinds of nerves that are found throughout the body. These create complex circuits through which animals experience and respond to sensations. Unfortunately, many different types of diseases can affect the nervous system, including birth defects, infections, inflammatory conditions, poisoning, metabolic disorders, nutritional disorders, injuries, degenerative diseases, or cancer.

“Palm Beach Equine Clinic has an incredible ability to do advanced imaging and diagnostics on neurologic conditions,” said Dr. Heidmann. “With equipment like the standing CT, we can do scans of the head and neck with contrast – a CT myelogram – which really increases our ability to diagnosis a condition.”

Palm Beach Equine Clinic is able to locate problems not only on 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.

“That’s part of the satisfaction of the job that I do; It’s not just ‘here is my experience and here is what I guess is going on.’ I have all of these options at my fingertips for diagnostics and tests. We can confidently confirm our clinical suspicions and then do treatment based on that.”

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: