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Author: Beth Lawler

6 Key Takeaways About EHV-1 from Dr. Peter Heidmann’s Noelle Floyd Instagram Takeover

On March 24, 2021, board-certified internal medicine specialist Dr. Peter Heidmann answered questions regarding Equine Herpesvirus (EHV) live on the Noelle Floyd Instagram page. Watch the video below or read these six main takeaways he discussed.

1. Equine Herpesvirus (EHV) can be present in any area where there are horses.

EHV can be found in horses in every country around the world. The virus can have varying consequences and not every horse may be symptomatic. The duration of their immunity, their capability to shed viral particles, and whether they continue to carry the virus are all variables unique to the individual horse.

2. There are multiple strains of EHV that lead to varying health defects.

Most horses, by two years old, have been exposed to EHV. Nearly every horse over five years old has had EHV in a mild respiratory form, in which they have likely suffered from symptoms such as a runny nose or cough. The disease becomes gravely serious when there is a neurological form of EHV-1 that is spreading rapidly among horses.

Over the last century, the primary focus of EHV disease control was related to reproduction.  EHV was a major cause of infectious abortions in mares.  Since the advent of effective vaccines that protect against EHV abortions, the concern has shifted to the rare but serious occurrences of neurologic disease caused by EHV-1.

Certain strains of EHV can have more propensity to cause neurological disease, while others do not. It is important to understand that both “neurologic” and “non-neurologic” strains can cause neuro symptoms, and that some horses infected with “non-neurologic” strains may also develop the neurologic form of the disease. Symptoms of mild neurologic disease can include ataxia or hind end weakness and irregular gaits. When horses suffer mild neurologic symptoms, most will make a full recovery. If they suffer from severe symptoms, it can be increasingly difficult to treat, and some cases can be fatal.

3. Vaccination is key.

work with your veterinarian to develop a vaccination program for your horse

There are currently no genetic explanations regarding whether a particular horse may be more likely to contract EHV-1. However, when a horse is stressed, whether it be from shipping, competing, or other causes, its immune system is more susceptible to illness. EHV-1 can live in the central nervous system, and during times of stress when endogenous corticoids are produced, the virus can start to replicate. This causes the horse to shed viral particles into the environment and explains why there are outbreaks of the disease. It does not take much for a stressed horse to start shedding viral particles into the environment and infecting non-stressed horses nearby.

Vaccinations can help horses generate additional antibodies and minimize the spread of disease. The vaccines available today are effective at preventing the respiratory and reproductive strains of EHV, but are not effective for the neurologic strain. It is just as important as ever to vaccinate because vaccines help to limit the spread of virus by decreasing the shedding of viral particles from each individual horse.

Immunization is recommended every six months at a minimum.  Most vaccine manufacturers suggest vaccinating against EHV as often as once every 90 days when travelling or competing.  It is recommended to work closely with your veterinarian to tailor a vaccination program for your horses’ specific requirements.

4. Surveillance is crucial to preventing a serious outbreak in the United States.

Due to the recent outbreak in Europe, medical surveillance has increased. There are now extra layers of protection in the process of importing horses. Imported horses have always been quarantined, but now horses are also receiving a nasal swab to look for the presence of EHV-1 in their nasal passages. There have been cases of EHV-1 in the U.S. recently. However, there is no evidence that these EHV-1 cases are related to the major outbreak in Europe, partially thanks to our increased level of surveillance on horses being brought into the country.

5. The handling of horses with fevers shifts dramatically when cases have been identified locally.

Veterinarians have significantly shifted how show horses with any symptoms are being handled. If a horse had presented with a fever or runny nose prior to the European EHV-1 outbreak in early 2021, it would typically have been treated by its own veterinarian and left to return to full health. What is happening now is that each horse with a fever becomes a possible candidate for being the index case of EHV-1. This changes veterinarians’ responsibilities everywhere because of the potential for the disease to spread among the population in respective local areas. Horses with fevers must therefore be strictly quarantined and tested.

The fastest and most accurate test in the world for diagnosing EHV-1 is a PCR test, which looks for the DNA of the infecting organism. The horse will test positive if it is actively shedding organisms. The biggest downside is that it typically takes 24 hours to produce results. Therefore, horses who have been tested are put under strict isolation until the test results come back. Often, by the time test results are ready, the horse’s symptoms have ceased. Yet that is the level of scrutiny necessary to prevent a serious outbreak.

palm beach equine clinic quarantine isolation stalls resized
PBEC offers on-site isolation facilities with individual air flow systems.

6. There are clusters of the disease reported all over the Unites States, although they are unrelated to the neurological strain of EHV-1 outbreak in Europe.

While this is routine from a veterinarian’s perspective, it is still serious and certainly worth our attention. A few isolated cases reported in the U.S. this March have been found to be due to the neurotropic form of the disease and some have been non-neurotropic. The concern is warranted, but cases are highly localized, mainly in areas with large equine populations. We see the disease cropping up because the virus may already be dormant in their bodies. To minimize the likelihood of outbreaks on the individual farm level, have a vaccination program with your veterinarian and if necessary take temperatures of horses twice daily to catch any viral infection early.


For up-to-date information on reported cases of EHV, horse owners can utilize the following resources:

Keeping Horses in the Game

Navigating Lameness Prevention and Treatment

Our responsibility with horses is to keep them healthy and sound. Horses are incredible athletes, and we ask a lot of them. It’s important that they are cared for as the elite athletes they are. Non-equestrians do not equate an equine athlete to a football player, marathon runner, or gymnast, but as horse owners we know that the same level of dedication is required to keep them in optimal health and fitness.

Daniel Bluman and Cachemire de Braize by Jump Media. Sport horse medicine at winter equestrian festival 2021
As the Official Veterinarian of the Winter Equestrian Festival, Palm Beach Equine Clinic has experience providing sport horses with top care. Pictured is Daniel Bluman and Cachemire de Braize, photo by Jump Media.

The goals of equine Sports Medicine are to keep horses feeling and performing at their best, to detect subtle changes and appropriately address underlying issues, and to correctly diagnose and treat injuries to get horses back to optimum health. Despite being powerful and strong animals, horses are quite fragile, as most horse owners have come to learn. One day they are competing in perfect form, the next they might walk out of their stall lame. Thus begins the process of addressing the issue and determining a treatment plan.

Lameness can manifest itself in different ways, from subtle decreases in performance to severe and obvious signs of pain. Lameness, however, is not a diagnosis or disease; it’s the symptom of an underlying issue, which Palm Beach Equine Clinic veterinarians specializing in Sports Medicine are skilled at diagnosing and treating. Pinpointing the underlying issue is a crucial step in proper rehabilitation.

Prior to rehabilitation comes the constant practice of proactive prevention. Understandably, it is important to do what we can to prevent serious incidents such as falling, missteps, and accidents with other horses. Key to preventative efforts is detecting signs of lameness as early as possible so underlying issues do not exacerbate or cause longer-term lameness. Prevention techniques combined with proper training and rest, high-quality nutrition, and correct and balanced farrier work, help reduce normal wear-and-tear injuries.

Keys to Catching Lameness Early

Early recognition of the signs of lameness may help prevent more serious injuries from occurring that could shorten a performance horse’s career. Having a firm understanding of what your horse’s “normal” is will be crucial to identifying subtle changes in behaviors, movement, or body conditions:

  • Do a daily hands-on leg check, comparing opposite legs to detect heat, swelling, or sensitivity
  • Watch for shortened strides, decreased performance, reduced stamina, changes in attitude
  • Give the horse a few days off if you suspect a problem; if the signs return when they go back to work, ask your veterinarian to examine them
  • Remember that a mild problem can blossom into a career limiting condition if left untreated
Dr. Marilyn Connor soundness exam palm beach equine clinic sport horse veterinarian in Wellington, Florida

Schedule routine performance evaluations by your veterinarian. A thorough evaluation will often consist of:

  • History from rider/trainer, covering the how, what, when, and why of the perceived lameness
  • Physical examination and limb palpation to detect swelling or soreness
  • Lameness or motion examination, both in hand and under tack, to see how the horse moves and may be compensating
  • Flexion testing to narrow down the problem area
  • Diagnostic analgesia (a.k.a. nerve blocks) to pinpoint the specific area causing pain
  • Isolation and confirmation of the problem area
  • Imaging – Radiograph (X-Ray), Ultrasound, Nuclear Scintigraphy (Bone Scan), Magnetic Resonance Imagining (MRI), Computed Tomography (CT) – to diagnose underlying issues
  • Specific identification of the lameness or performance problem

Treatment Options

Though preventative care is crucial, we cannot avoid all injuries. Therefore, it is important to work with your veterinarian to develop the best treatment plan before an injury occurs. There are traditional treatment methods such as conservative treatment (rest, ice, compression), medical management (NSAIDS, steroids), intra-articular medication (joint injections), soft tissue (self-derived biologic therapies such as stem cells or pro-stride and shockwave, laser, and ultrasound), and as a last resort, surgery.

Sabine Schut-Kery and Sanceo by Jump Media.
Also the official veterinarian of the Adequan Global Dressage Festival, PBEC has expertise in a variety of sport horse disciplines. Pictured is Sabine Schut-Kery and Sanceo, photo by Jump Media.

Palm Beach Equine Clinic also offers comprehensive Alternative Therapy options for when traditional sports medicine is not your choice. Veterinarians create treatment and rehabilitation programs using traditional and non-traditional therapies, laser, therapeutic ultrasound, acupuncture and Chinese medicine, and shockwave therapy. Palm Beach Equine Clinic can help advise when an alternative method may be the appropriate or adjunct treatment.

There are many non-intuitive causes of lameness that horsemen alone cannot diagnose without the watchful eye of an experienced Sport Horse Veterinarian. At Palm Beach Equine Clinic, the goal is to get horses “back in the game” and keep them safe throughout their athletic careers. PBEC veterinarians know how frustrating injuries can be for horse owners who have personally dedicated years of constant effort and resources to the maintenance of high caliber sport horses. PBEC veterinarians strive to be a part of each winning team’s successes and have been committed to delivering comprehensive care. Contact your Palm Beach Equine Clinic veterinarian today to make sure your horse is in their optimum health.

What to Expect BEFORE Your Mare is Expecting

Considerations for Breeding the Sport Horse Mare

Newborn foal Felix Hope out of Becky Blue, owned by Meg McDermott and bred by Dr. Katie Atwood.
Newborn foal Felix Hope out of Becky Blue, owned by Meg McDermott and bred by Dr. Katie Atwood.

Breeding is not typically on the forefront of owners’ minds when it comes to their high-performance sport horse mare. The focus is mostly on keeping those mares at their best, in terms of health, athleticism, and performance. Prospects for them being bred are usually reserved for well after their competition schedule winds down.

Often when sport horse mares are injured and their careers are either put on hold or cut short altogether, breeding may become the next best option for the owner to consider. Depending on the injury sustained and their overall health and age, breeding can be a great alternative for the out-of-work mare. However, modern reproduction techniques have made breeding the sport horse mare not only an option reserved for after their careers have come to a close. Through embryo transfer, mares can produce multiple foals during the same season all while continuing their training and competition schedules.

With the possibility of breeding comes a significant number of unknowns, so we asked Palm Beach Equine Clinic veterinarian Dr. Katie Atwood to guide us through the process of examining a mares’ reproductive health and the different options for creating a foal.


Start with a vision for the future foal

The first step when embarking on the breeding process is to choose the stallion. This decision hinges entirely on what the owner’s vision and end goal may be for the future foal.

“The owner will need to know what they want that future foal’s purpose to be before choosing a stallion,” Dr. Atwood explained. “Owners should already be in the process of choosing a stallion or have already decided before examining the mare.”

Dr. Katie Atwood - Palm Beach Equine Clinic sperm analysis procedure reproduction

“There are countless breeding stallions across all different breeds and disciplines, and it all comes down to the owner’s opinion and preferences. If I have personally met the stallion, I can comment on their disposition, but I do not make recommendations on one stallion versus another. As the veterinarian, I pay attention to their health and fertility versus the external qualities that do not play a role in reproduction. I let the professionals – owners, riders, and trainers – make those decisions,” said Dr. Atwood. 

Evaluating the mare’s reproductive soundness

After assessing the mare’s overall health and taking into account her breeding history, Dr. Atwood will begin with the reproductive soundness exam. This usually includes a rectal ultrasound and palpation of the uterus, ovaries, and cervix. Dr. Atwood also typically performs a vaginal speculum exam to examine the quality of the mare’s cervix. All the information that Dr. Atwood gathers during this step helps to determine what stage the mare is at in her estrous cycle, identify any potential issues, and establish the next steps.

“When performing that first ultrasound, I look for endometrial cysts, fluid or air, and mucus in the uterus,” said Dr. Atwood. “I examine both ovaries to make sure they appear normal and are cycling normally. There are a lot of elements that can change depending on the time of year and where the mare may be in her cycle. But if we are examining her during breeding season, then I can evaluate whether or not there are any abnormalities.”

During the ultrasound, Dr. Atwood will look for signs of Endometritis, an inflammation and infection of the most superficial layer of the uterus and a big reason why mares can’t get pregnant. It is important to identify issues such as this before taking any further steps.

breeding mare ultrasound exam by reproduction equine veterinarian Dr. Katie Atwood
breeding mare ultrasound exam by reproduction equine veterinarian Dr. Katie Atwood

Age can bring about changes to the uterus, as can any previous pregnancies, so a uterine biopsy is also recommended for older mares (generally over 14 years old) before being bred. Some of those changes, such as fibrosis, are irreversible, which is also crucial to know before you proceed further with breeding.

Maiden mares can also have their own challenges if being bred for the first time at a later stage in their life. “When a middle-aged or older mare has not had a foal before, her cervix does not relax. This means that they more easily maintain fluid in their uterus and that can present its own complications,” commented Dr. Atwood. Dr. Atwood also notes that the conformation of the mare’s external genitalia needs to be taken into consideration. If the mare’s anatomy predisposes her to uterine infections, there will likely be complications throughout the pregnancy.

Getting the timing right

Since many sport horses will travel frequently over far distances and through different climates, its important to consider the mare’s natural estrous cycle and her best time for ovulation. “Here in south Florida, a lot of clients will want to breed their horse when they arrive for the winter season,” said Dr. Atwood. “Their mare may have been in New York for the last 8 months, so her uterus is still influx with New York seasons and she is anestrous, meaning that she is not cycling.”

When the mare is in her seasonal anestrous, her uterus is flaccid and her ovaries are not producing follicles. The veterinarian can administer a hormonal therapy to help trigger ovulation, however, Dr. Atwood tries to go the natural route whenever possible. In these situations where the owner wants to breed the mare and are traveling from up north, Dr. Atwood has a simple yet effective trick.

“I usually recommend putting the mare under lights starting in the beginning of December and lasting until they are bred. This is a very simple, economic way we can naturally stimulate the mare to cycle. The mare only needs to be under lights from 4 p.m. until 11 p.m. and the brightness test is that you’ll need to be able to read a newspaper in the darkest corner of the stall,” said Dr. Atwood.

embryo transfer breeding mare Dr. Katie Atwood

Considering a surrogate mare

Using a surrogate mare is one of the most popular routes for breeding sport horse mares. This process requires an embryo transfer, meaning that an embryo from the donor mare will be transferred to a surrogate, or recipient, mare to carry the foal to term. Embryo transfer has become a leading method for breeding as it relieves many of the owner’s concerns regarding the mare’s health and carrying the foal. It also allows the mare to be bred at an ideal reproductive age without any interruptions to their training and competition schedules.

“The average gestation period for a horse is 11 months and you’re only producing one foal per year with traditional breeding. Embryo transfer allows the mare to produce multiple foals per year while remaining in their normal routine,” commented Dr. Atwood.

What the surrogate mare process entails

Dr. Atwood cautions that a one-to-one ratio is not a good plan for a surrogate mare. In other words, she advises that you do not choose one single mare you’d like to be the surrogate, but rather go through a commercial recipient herd.

Embryo transfer surrogate mare giving birth at Palm Beach Equine Clinic
A surrogate mare giving birth at Palm Beach Equine Clinic.

“I advise clients to not just rely on another one of their mares as a surrogate,” said Dr. Atwood. “In a perfect world, I would line up three recipient mares for every donor mare. The donor and recipient mares have to be on the same cycle because if you are going to take an embryo out, you have to put it in a uterus that’s ready for that embryo.”

Though the deposit to reserve a mare in a commercial herd can be costly and often nonrefundable, it guarantees that there will be a mare in the herd on any given day that is ready to receive the embryo. When it comes time for the embryo transfer, the mare whose uterus is the best quality on that day will receive the embryo. Prior to the embryo transfer, the donor mare will still undergo an ultrasound and palpation exam to determine her reproductive health.

Genetically, the recipient mare has no contribution to the genetic makeup of the foal if breeding through embryo transfer. The foal will be with that recipient mare from birth to weanling (six months), so there is a possibility that some of her personality traits could rub off but that is often not the case. “The recipient mare is usually under the age of eight, an appropriate size, and has a nice, calm disposition,” commented Dr. Atwood. “Some owners do have the recipient mare shipped to their personal barn during the last stages of the pregnancy because they want to be part of the foaling process or have their own team and veterinarian there for that process.”

Speak with a veterinarian about your mare’s breeding options

sport horse breeding at palm beach equine clinic
Newborn foal “Lady” owned by Ponies and Palms Show Stables and bred through an embryo transfer.

If you are considering breeding your mare, keep in mind the time of year, whether you’d like to use a surrogate, and what you want the final result to be. The breeding process can be a bit overwhelming, especially for those who are new to it, but Palm Beach Equine Clinic veterinarians are here to assist and guide you in the process whenever help is needed. At the end of the day, for Dr. Atwood, the reproductive process is her passion, so she is always eager to meet new patients and help plan for a new foal.

“I love the creation of life,” Dr. Atwood remarked. “Equine medicine is intriguing, but you’re usually handling sick, unhealthy animals. With reproduction, I am working with healthy animals and making their babies, which I love.”


Contact the Palm Beach Equine Clinic Reproduction Department:
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Notice Regarding European Outbreak of Equine Herpesvirus

10:30 a.m. on March 4, 2021 – Equine Herpesvirus (EHV) is a highly infectious DNA virus found all over the world. Currently, there is an outbreak of the neurological form of EHV-1 in Europe, which originated in Spain. This has resulted in outbreaks in at least three other European countries and the cancellation of FEI competitions through the month of March.

EHV-1 is contagious and spread by direct horse-to-horse contact via the respiratory tract through nasal secretions or indirectly through surfaces that have been contaminated with the virus.

In Wellington, Florida, we currently have no reported cases of affected horses. Our location in the Winter Equestrian Capital of the World poses its own risk factors with large numbers of horses in close quarters and under the stresses of competition and travel. This heightens our shared responsibility to take specific measures that will help keep each horse safe from the virus. We can work towards this by implementing two strategies: biosecurity and vaccination protocols.

1. Biosecurity

Implementing thorough hygiene and biosecurity protocols is important at all times, even when an outbreak has not occurred. Biosecurity and preventing the spread of disease is fresh in our minds due to the COVID-19 pandemic, and owners must now implement specific protocols at their barns for the safety of their horses. Some biosecurity steps to prevent the spread of EHV-1 include:

  • Limit direct contact of your horse with others whenever possible – think equine “social distancing.” Do not use communal water buckets and avoid mixing of horses wherever possible.  
  • Take your horse’s temperature twice daily and report any horse with a temperature above 101.5 degrees Fahrenheit to your veterinarian immediately.
  • Pay close attention for signs of respiratory or neurological disease. Clinical signs of neurologic disease may include incoordination, hind limb weakness, lethargy, head tilt, inability to get up after laying down, and inability to maintain balance. Clinical signs of respiratory disease often include discharge from the nostrils or eyes or swelling in the throatlatch area.
  • Do not share buckets, halters, leads, bridles, or other tack between horses to prevent possible cross contamination. Clearly label your equipment, and if you must share, make sure to scrub and thoroughly clean equipment with detergent before using with another horse.
  • Prevent people in your barn from potentially transferring the virus by washing your hands between handling different horses. Bring a change of clothes and shoes incase a horse is suspected of being infected. 
  • If you suspect your horse may be infected or has a high temperature, immediately isolate them from the other horses at your barn and contact your veterinarian. Ideally, a potentially sick horse should be moved into a separate building or paddock, or to an isolation facility. Palm Beach Equine Clinic is equipped with a USDA-approved quarantine center and is readily available to initiate the laboratory diagnostics required for diagnosing EHV-1.
Palm-Beach-Equine-Clinic-Isolation-Stalls
Isolation stall at Palm Beach Equine Clinic.

2. Vaccinate

Making sure your horse is up to date on all their vaccines will help strengthen their immune system against potential viruses. There are vaccines available to protect against the respiratory disease and abortion-causing EHV (Rhinopneumonitis vaccine), however, there is no vaccine available for protection against the neurologic form. Some EHV vaccines can reduce nasal shedding of the disease, therefore potentially reducing transmission. Please contact your veterinarian for any questions regarding vaccinating your horse.

What To Do Next

If you have recently imported a horse or are planning for the arrival of a horse from any country in mainland Europe, please take extra precaution by calling your veterinarian. In addition to implementing biosecurity measures in the barn, Palm Beach Equine Clinic veterinarians recommend that your imported horse receive a nasal swab and blood sample to detect the virus by PCR (polymerase chain reaction), which will identify the DNA of the virus.


EHV is a normally occurring virus in the equine population, but by following vaccination and biosecurity protocols, outbreaks can be minimized and contained. Early identification and reporting of the virus is key to tracing and preventing further spread. If you have any questions or concerns about your horse horse’s health, please contact Palm Beach Equine Clinic at 561-793-1599 to speak with a veterinarian.

Florida’s Reportable Equine Disease Map. For the most up-to-date interactive map, go to www.fdacs.gov.
Florida’s Reportable Equine Disease Map. For the most up-to-date interactive map, go to www.fdacs.gov.

Additional Resources:

Master of Manipulation

Veterinary Medical Manipulation Case Study

Palm Beach Equine Clinic Veterinarian Dr. Ryan Lukens Veterinary Chiropractic Adjustment Manipulation vertebrae

When the “chiropractor” visits the barn to adjust your horse, what’s really being done is called veterinary medical manipulation, which Dr. Ryan Lukens, DVM, CVMMP, of Palm Beach Equine Clinic defines as the art of improving motion at segmental levels, including bones, the supporting soft tissue structure, and nerves. The ultimate goal of veterinary medical manipulation is to allow free movement throughout the horse’s body by restoring normal range of motion.

The way Dr. Lukens determines what specific segments to manipulate is by motion palpation, or by examining for a decrease in motion. Not only does this have the ability to relieve pain and soreness, but it also reduces the chance of horses having to physically compensate for an area of their body that may not be functioning properly. This act of compensating for being off balance is a frequent cause of sport horse injuries. Regular adjustments by a certified veterinary medical manipulation practitioner helps the horse to maintain their natural balance and full range of motion to perform at the best of their ability.  

Medical manipulation can benefit every horse, from miniature pasture pets to grand prix equine athletes. In addition to improving their range of motion, adjustments can help calm nerves associated with the “fight or flight” instinct.  This can lead to calming effects across various bodily systems such as neutralizing stomach acids, lowering blood pressure and cortisol, and strengthening the immune system.

Case Study

One notable case Dr. Lukens recalls involved a nine-year-old Dutch Warmblood gelding was training at Third Level dressage. The horse was roughly 300 pounds overweight and was too head shy to even have a fly mask put on. Under work, it presented with right front limb lameness and stiffness on the left while traveling left. Balance is essential for dressage, and this horse struggled with its natural balance.

Aerial view showing the spines of both scapula bones clearly visible because of the lack of musculature. Dr. Ryan Lukens Palm Beach Equine Clinic
Aerial view showing the spines of both scapula bones clearly visible because of the lack of musculature.

The horse showed severe cavitation of the muscling in its neck at the first evaluation. The divots seen in the neck indicate the atrophy of the paracervical muscles which is not normal. Though circumstances like this are seen often, it can be a sign that the horse’s nerves are not functioning properly, and that the muscles are suffering. When adjusting the horse, Dr. Lukens found that the horse had restricted movement at the poll and cervical vertebrae 5, 6, and 7 to the left, which essentially covers the whole lower neck on that side, and the sixth cervical vertebrae on the right side.

Atrophied paracervical muscles, shown as divots in the neck, improved after just two sessions and four weeks of training. Dr. Ryan Lukens Palm Beach Equine Clinic
Atrophied paracervical muscles, shown as divots in the neck, improved after just two sessions and four weeks of training.

The horse tolerated the adjustments and was more welcoming to hands on the neck, face, and ears after the manipulations Dr. Lukens performed. Four weeks later, after just two sessions, the muscles appeared more filled out in the neck, signaling improvement. On the left side of the neck, the muscle mass became very convex, signifying proper muscle tone. Dr. Lukens adjusted only the head and neck while treating the horse to see what changed and how the horse performed before making further adjustments. The horse lost about 100 pounds of fat with training, and the right front lameness improved without any other treatment or medical manipulation.

Convex musculature of the neck showing a significant improvement after manipulation sessions. Dr. Ryan Lukens Palm Beach Equine Clinic
Convex musculature of the neck showing a significant improvement after manipulation sessions.

“The diagonal lameness that this horse presented could have been the result of lower cervical pain,” said Dr. Lukens. “The underdevelopment of the muscles of the cervical region that support the scapula was a large clue to the primary problem of this horse’s lameness.”

“Restrictions in the cervical region can cause the horse to keep its head in an extended position and decrease the range of motion within the facet joints of the vertebrae. This decrease, along with local inflammation and the overall restricted range of motion, causes a decrease in the frequency of nerve firings. Nerves that are not firing properly can lead to cartilage degeneration, adhesions, and decreased circulation,” he continued.

Often issues a horse presents physically can be tied back to its inability to access its full range of motion. It is important to have horses routinely examined by a certified veterinary medical manipulation practitioner to ensure proper range of motion, especially if they have demanding jobs that could exacerbate minor injuries with continued work. Dr. Lukens believes that a veterinarian trained in medical manipulation is the safest choice for the horse.

“A veterinarian’s extensive knowledge of anatomy and understanding of when not to adjust a horse is key. Medical manipulation is a safe treatment if performed by the correct practitioner under the correct circumstances. A veterinarian can use a whole-body approach to treating lameness or enhancing performance while ensuring the horse’s safety and well-being.”

Dr. Lukens

To learn more about veterinary medical manipulation or to schedule an evaluation for your horse, contact Palm Beach Equine Clinic by calling 561-793-1599.


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Surprise – It’s a Boy: A Friesian’s Journey to Becoming a Gelding

When Debbie Cruz imported her 2012 Friesian from Europe, she was excited to welcome the gelding into her life. However, the mount she purchased as a gelding from The Netherlands still had a lot of stallion left in him. Literally.

Marquis, Cruz’s hopeful dressage mount, arrived safe and sound to her home in Miami, FL, in early 2020. When he started to display quintessential stallion-like behavior, she called her veterinarian, Dr. Joseph Zerilli, to help her determine the cause of this very “un-gelding like” behavior.

“I was told that he had been gelded while in The Netherlands, but when he came home, he was acting exactly like a stud rather than the sweet gelding I thought would be arriving,” said Cruz. “I wasn’t sure what the cause could have been, but I knew something wasn’t right.”

Dr. Zerilli performed a blood test as part of his exam, which revealed very high levels of testosterone for a horse that was supposed to be a gelding. The level of testosterone present was a solid marker for a retained testis, one that would require surgery to remove. Marquis was referred to Dr. Weston Davis, a board-certified surgeon at Palm Beach Equine Clinic in Wellington, FL.

Dr. Davis used a hCG stimulation test and abdominal ultrasound to determine if testicular tissue was present and the source of Marquis’ testosterone levels were confirmed: he was a cryptorchid. Also known as a “rig” or “ridgling,” a cryptorchid horse has one or both testes that are not fully descended into the scrotum. In Marquis’ case, he had a retained left testis within the abdomen.

In a normal stallion, the testes gradually descended from just below the kidneys, through the inguinal canal, and into the scrotum. This happens either in utero or during the first few weeks of life. Occasionally, either one or both testes fail to descend for reasons that are still not fully understood by veterinarians. A cryptorchid stallion can be further classified as either inguinal when the testis is in the inguinal canal, or abdominal when the testis remains in the abdominal cavity, which was the case for Marquis.

cryptorchid marquis surgery laparoscopy Dr. Weston Davis Palm Beach Equine Clinic

“During surgery, the horse was placed under general anesthesia and we used the laparoscopic camera inserted into the abdomen to examine the retained testis,” said Dr. Davis.

A laparoscopy is an endoscopic procedure where a fiberoptic video camera and surgical instruments are introduced into the abdomen through a small incision. This permits the observation of the inside of the abdomen and allows abdominal surgeries to be performed without a large incision into the abdominal cavity.

“We could see that there was torsion, which indicates restricted blood flow and often pain, as well as severe enlargement,” said Dr. Davis. “The testis, which had become quite large, was then exteriorized through an enlarged paramedian incision. Marquis recovered from anesthesia without complication and with an excellent prognosis.”

“The biggest victory in this rather rare case is that the horse was relieved of pretty severe discomfort and the owner could enjoy the gelding disposition she was expecting.”

Dr. Davis

Aside from pain from the torsion and subsequent enlargement within the body, Marquis’ risk of developing malignant (cancerous) tumors was increased with the testis left inside his body. Prompt diagnosis and surgery likely prevented more critical problems in the future for Marquis.

After recovering from surgery at Palm Beach Equine Clinic’s onsite hospital, Marquis was returned home to Cruz without his retained testis and a new attitude.

“I am very grateful to have had my horse seen by Dr. Weston Davis and his staff. I am not only happy that he was able to get his surgery with one of the best surgeons in the country, but also that it was such a success.”

Debbie Cruz
Marquis owned by Debbie Cruz - cryptorchid success story by veterinary surgeon Dr. Weston Davis
Marquis owned by Debbie Cruz

Marquis’ recovery progressed quickly after he returned to his home barn, and he is now back in the tack with Cruz. “I am looking forward to a long journey with him,” she said. “I am thankful to everyone at Palm Beach Equine Clinic for the care they provided Marquis. I couldn’t see myself going anywhere else.”

Good Vs. Bad Bugs: How Environment Affects Horses’ Gut Health

Dr. Peter Heidmann internal medicine veterinarian equine gut microbiome health abdominal ultrasound
Dr. Peter Heidmann evaluating a patient through an abdominal ultrasound.

Anyone who has experience with horses is aware of the very real threat of losing a horse to colic or other gastrointestinal disease. But looking back on the history of equine death causes, colic still holds the same percentage as it did 20 years ago, standing firm as the second highest cause of death behind natural causes. Why hasn’t modern medicine decreased the chance of losing horses to colic? Why do we all still share the common fear of our horses colicking out of the blue, with little warning and minimal reliable strategies to prevent problems?

The answers to these questions remain a work-in-progress, but over the past 10 years, veterinarians and researchers have learned a lot about the role of the equine gut microbiome on all sorts of health outcomes, including colic, maldigestion, dysbiosis, and a myriad of other health problems.

The organisms that cause diarrhea are mostly bacteria –Salmonella and Clostridium difficile are among the most common

The equine gut microbiome is an ecosystem composed of quadrillions of microbes, including bacteria, fungi, and even viruses, which interact and coexist in the gastrointestinal tract and contribute to overall gut health and well-being. In equines, when the microbiome is disrupted in such a way that populations of beneficial bacteria and yeast have declined and/or populations of harmful pathogenic bacteria and yeast have increased, it is not unusual to see issues such as colic and colitis, laminitis, among other serious conditions.

Like each individual horse, each microbiome is unique; regional, dietary, and even breed and genetic differences can create diverse microbiomes, and varying degrees of digestive health. Even within one horse’s microbiome, the “top end” of the colon can be drastically different from the “bottom end” in terms of the population and diversity of microbes. The way all the organisms perform and act within the microbiome determines the functionality of the gut as a whole. Board-certified internal medicine specialist Dr. Peter Heidmann leads the Internal Medicine department at Palm Beach Equine Clinic and takes us on a deeper dive into the equine gut microbiome.

Microbiome and Nutrition

“When we’re working to improve overall GI health, we are basically trying to increase the population of ‘good bugs’ and crowd out the ‘bad bugs,” Dr. Heidmann remarked.  The combination of probiotics, prebiotics, and diet are all key factors that influence what happens on the inside of a horse’s gut. According to Dr. Heidmann, a well-balanced diet is most important, but the sources of nutrients also play a huge role in promoting gastrointestinal health.

“Probiotics can limit lactic acid production and prevent huge swings in pH in the cecum. This happens through many pathways, but largely by encouraging fiber fermenters over bacteria that like to gobble sugars and produce lactic acid,” he said. “Prebiotics provide additional, non-starch nutrients and are meant to support healthy flora, or microbes. Prebiotics also limit the likelihood and severity of dysbiosis, or microbial imbalance, when the diet changes, like what can happen following sudden exposure to too much starch-rich feed.”

Excessive amounts of starch-rich grains can reduce populations of healthy flora, decrease the types of bacteria that are present in the colon, and also promote overgrowth of unhealthy flora. In turn, overly homogenous populations limit a horse’s resilience to stress, dietary changes, and other unpredictable changes such as those in weather.

Oats and other starch-rich grains cause increases in propionic acid-producing bacteria, while hay-only diets increase acetic acid-producing flora, and therefore promote more diverse and stable populations of beneficial bacteria and yeasts. On the flipside, feeding hay and no grain means the nutrients are being digested much more slowly and will promote more diversity and stability of flora populations.

“At the same time, some ‘good’ bugs are also decreased when a hay-only diet is fed, especially ones that rely on easy-to-digest starchy grains,” noted Dr. Heidmann. “One type of organism, the Lachnospiraceae, is among the most prevalent type present in a healthy horse’s hindgut, and its population also diminishes when grain is not being fed.”

Ultimately, some easily digestible concentrate feeds promote healthy bacterial populations and release lots of energy quickly, yet it is fairly easy and risky to over-do the easily digestible feed. Not only do abrupt changes in diet increase the risk of upsetting a horse’s healthy microbiome, but feeds that are high in carbohydrates can also promote gas formation, lactic acidosis, and other types of colic. “Simply put, garbage in equals garbage out,” Dr. Heidmann explained.

Other Stressors to the Microbiome

Aside from what goes into the horse, there are other factors that determine the behavior of the microbiome and the overall functionality of the gut. Genetic makeup almost certainly plays a role in the way organisms manage the nutrients going in and, in turn, impacts the horse. Stress is another significant factor that definitely has a relationship with the gut, though it remains difficult to draw clear lines of “cause and effect” when studying all the ways that stress affects a horse’s gut health.

Dr. Peter Heidmann palm beach equine clinic veterinarian internal medicine wellington horse abdominal ultrasound

It is common knowledge among trainers that horses with anxious, “stressed-out” personalities seem prone to developing stomach ulcers. Separate from stress caused by riding, changes in surroundings, or even changing stablemates can make a difference in the organisms in a horse’s gut.  Even when the feeding program remains consistent, a change in workload or their neighboring stall-mate invites stress and can promote ulcers.

“There is reason to believe that colon ulcers indicate problems in the gut microbiome,” said Dr. Heidmann. “Organisms, both healthy and not, vary between different barns, even in the same region or town, and those differences are also associated with differences in a horse’s microbiome. Even if horses are on the exact same food, with the same hay and turnout schedule, the flora is going to be different due to varying exposure to new microorganisms.” But this doesn’t mean we shouldn’t subject our horses to change. Many competition horses are accustomed to changes in environment and can perform without major gastrointestinal issues. The primary goal is to maintain as much consistency as possible when horses go through geographical changes that may disrupt their gut health.

“The relationship between stress and gut health isn’t as simple as a cause-and-effect relationship, where stress leads to a direct change in the behavior of the bugs, or where a change in flora directly increases a horse’s stress levels. It is a complex, dynamic interaction; it’s a constant feedback loop.”

Dr. Heidmann

It is difficult enough to separate cause from effect when looking at the relationships between gastrointestinal flora and factors like diet, exercise, pre- and probiotics, or supplemental digestive enzymes.  But explaining the relationship between horse’s behavior and their GI flora is inherently subjective, and therefore even more difficult to confirm. 

“It may seem far-fetched to think that a horse’s behavior might be affected by the balance of flora in their GI tract, but some microbes appear to have developed mechanisms that encourage certain behaviors by producing compounds that mimic the horse’s own neurotransmitters,” reflected Dr. Heidmann. “This can translate into increasing hunger signals or stimulating cravings for certain foods.  Some microbes can enhance taste sensation, and others can co-opt a horse’s normal signaling pathways to enhance mood or increase discomfort by slowing gastrointestinal motility.  Any or all of these mechanisms may be up or down regulated during changes in the balance of GI flora.”

Still More to Learn

Veterinary science and research still have a long way to go to draw firm associations between illness and the microbiome. According to Dr. Heidmann, “it’s not known yet if the disease is the cause of the change in microbiome flora or if it is the result of a change in the flora, but for sure there is a strong relationship between these things.  For now, we don’t yet know if the horse has an unusual balance of organisms because of its problems with chronic colic, or if it is the reverse: that the colic is rooted in an unusual balance of GI organisms.”

With today’s modern scientific tools and research methods, we are closer than we’ve ever been to understanding the dynamics between microbiome and overall health. Comprehensive understanding of the interplay between diet and digestion, between the microbiome and behavior, and between food and flora remains a work-in-progress, but ongoing studies promise to shed light on our current understanding.

In the interim, a consistent regime of diet and exercise, with workload tailored to each horse’s skillset and stage of training, remain the best ways to minimize risk and promote healthy GI flora. “Prebiotics and probiotics and other micronutrients are sometimes necessary,” said Dr. Heidmann, “but the most important things remain hay and sunshine, water and exercise, and consistency most of all.”


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Easy Breathing for Dickens

A performance evaluation led to uncovering a paranasal sinus cyst obstructing airflow through the horse’s right sinus.

Respiratory health can easily be overlooked. Unlike with a horse’s gaits, owners and riders do not typically pay close attention to a horse’s breathing for subtle irregularities or inconsistencies. Yet, respiratory function must be up to par for an equine athlete to pump the voluminous amounts of air in and out of their lungs required during exercise. When the horse’s respiratory system is not functioning up to par, the horse could have labored breathing, exercise intolerance, and prolonged recovery after exercise.

As rider Madison Aguilar was bringing Dickens – a 14-year-old Quarter Horse – back into a training program, she noticed some performance issues under saddle. She scheduled a performance evaluation with Dr. Meredith Mitchell to assess Dickens before moving forward with training and increasing his workload. As Dr. Mitchell was watching Dickens being ridden, she saw his breathing was exacerbated after only light work. She went up to him, simply held her hands over his nostrils, and noticed that there was no airflow coming out of his right nostril.

After taking digital radiographs (x-rays) of the horse’s head, Dr. Mitchell identified a paranasal sinus cyst responsible for Dickens’ breathing troubles.

Dickens Before Surgery radiography
Radiograph of Dickens used to identify a paranasal cyst.

To relieve Dickens, they scheduled surgery to remove the paranasal sinus cyst with board-certified equine surgeon Dr. Weston Davis. Once at the Equine Hospital, Dr. Davis used an endoscope to examine inside the horse’s nasal passages. They found two cystic structures in his right maxillary sinus and then proceeded with a standing maxillary flap surgery to remove the cysts.

Dickens surgery palm beach equine clinic paranasal sinus cysts

“We sent the cysts for pathology tests and luckily the results showed they were benign,” said Dr. Mitchell. “Reoccurrence of the cysts is unlikely, but we will follow up with radiographs six months post-surgery to make sure Dickens is still healthy, happy, and able to breathe easy.”

“I am so thankful to my vet for being the best at her job and the whole crew at Palm Beach Equine Clinic for making sure this boy was comfortable and recovering well during his time in the hospital.”

Madison Aguilar
Dickens success story post surgery

Dickens is now home and on the road to recovery with full, unobstructed breathing. Subtle and gradual changes in a horse’s health, behavior, and performance can be difficult to pinpoint. Routine performance exams and wellness checkups can be key to uncovering these subtle issues and taking action to address problems early on.

Whenever there is a question involving the health and well-being of your horse, do not hesitate to call your Palm Beach Equine veterinarian at 561-793-1599.

Meet MRI Manager Cami Glaff

MRI Manager Cami Glaff Palm Beach Equine Clinic

Magnetic Resonance Imaging Manager Cami Glaff

Modern veterinary diagnostic technologies allow doctors to capture highly detailed images which can make a difference in having the most accurate diagnosis and determining the best course of treatment. Capturing these images, however, is another feat in itself. Imaging Technicians work to create a clear and comprehensive diagnostic profile by operating advanced technologies while keeping the patient still, calm, and comfortable. Spearheading management of all Palm Beach Equine Clinic patients for Magnetic Resonance Imaging (MRI) is Camille “Cami” Glaff.  A Jupiter, Florida, native, Cami has been an essential team member of PBEC since March of 2016.

Get to know PBEC MRI Manager Cami Glaff


MRI Manager Cami Glaff Palm Beach Equine Clinic

What is your background with horses?

I have been riding horses since the time I learned how to walk. I grew up trail riding and began competing on the hunter/jumper circuits when I was around 10 years old. I pursued a career with horses by studying Business Management with a specialization in Equine Science at St. Andrews University in North Carolina. I represented my school in the saddle by competing on their Intercollegiate Horse Show Association (IHSA) team throughout my four years there. I spent my first year after graduation as a groom and rider traveling to shows on the circuit. However, I discovered that I was more interested in the medical aspect of the horse industry, and I have been with PBEC ever since.

Have you always worked in the Imaging Department?

I joined Palm Beach Equine Clinic as the MRI Technician and quickly advanced to be the Manager of this department. I have also cross trained in other aspects of our imaging modalities so that I am able to properly operate our Nuclear Scintigraphy and Computed Tomography (CT) technologies as well. When I am not with an MRI or Imaging patient, I try to lend a hand by helping in other departments as needed.

What does a typical day as the MRI Manager entail?

When a horse is dropped off at the Clinic for an MRI, I perform a brief exam to note their vitals, place an intravenous catheter, and pull their shoes off. Once we are ready to begin the MRI, it is my responsibility to make sure we acquire the best images possible for our radiologist, Dr. Sarah Puchalski, to examine. The MRI is extremely sensitive to motion, and because of that I have to ensure that the patient is properly sedated, calm and comfortable so that we can obtain sharp images.

Once the horse is settled into position for whichever site is being scanned, I make slight adjustments to the unit’s magnet to make sure it is in the precise location needed. Depending on the site being scanned, such as the fetlock or suspensory origin, and the patient’s compliance, it may take anywhere from one to two hours to completely image the area. Once the scans are completed and are up to our standards, they are sent directly to our radiologist, Dr. Sarah Puchalski, who generates a complete MRI Report for the client typically within 24 to 48 hours. The hospital staff and I monitor the patient to make sure any sedation is properly wearing off to make sure they are safe to return home. It is always a team effort to make sure everyone is happy and that the horse is receiving the best possible care!

What aspects of your job do you most enjoy?

I enjoy being able to work with different horses each day. Every horse has its own unique reaction to being in a new place and being asked to stand very still throughout the scan. Being able to accurately read and handle each horse is a challenge that I appreciate.

I also find it rewarding to be a part of making a difference in a horse’s treatment plan. Acquiring the best possible images that may have the answers a veterinarian needs to make the most effective treatment plan.

When not at PBEC, what do you enjoy doing or where can we find you?

In my free time, I can usually be found outdoors. Whether I am going hiking with my dog Ryder, exploring new biking trails, or relaxing on the beach, I am always happiest outside.

Meet the PBEC Team: Dr. Gretchen Syburg

Gretchen Syburg Palm Beach Equine Clinic veterinarian

Servicing clients in Ocala, Florida, throughout the winter season, Dr. Gretchen Syburg is the newest addition to the Palm Beach Equine Clinic Team. Get to know a little about Dr. Syburg by reading on!

What is your background with horses?

I grew up on a farm in southeastern Wisconsin and have had horses since before I can remember. I have ridden in many disciplines but have been part of the hunter/jumper community for the past 15 to 20 years. I am definitely a “horse person” through and through, and I knew from a very young age that I wanted to be an equine veterinarian.

I completed my undergraduate degree at Carroll University in Waukesha, Wisconsin, then obtained my degree in veterinary medicine from the University of Guelph in Ontario, Canada. Upon graduating, I completed an internship at a large referral hospital in California.  In California I was able to gain extensive experience in all aspects of equine medicine, especially in complex orthopedic and sports medicine cases. After that, I worked for a practice where I spent my summers in the Northeast, mainly following the show circuits, then winters in Florida before joining Palm Beach Equine Clinic.

Why did you want to become an equine veterinarian?

Growing up on a farm, animals have always been a huge part of my life. My love for animals was evident at a young age, when I would spend my free time in the barn with our variety of animals. I caught the horse bug when I was five, and from then on it was clear my path was to pursue veterinary school.  I knew that the equine veterinary industry was where my interest would lie due to the complex and interesting cases I had seen come through our farm. 

What area do you specialize in?

I am on the road year-round, spending my summers in southeastern Wisconsin, servicing clients throughout the Midwest. During the winter months, I am in Ocala, Florida, providing care to patients at both HITS and WEC horse shows.  Being an ambulatory veterinarian, I offer a very broad range of services to cover the needs of my patients and clients. I focus primarily on sports medicine and the performance horse, but emergency medicine and basic internal medicine cases are another part of my caseload.

What do you enjoy most about your job?

I cherish the relationships that I build, not only with my equine patients, but also with clients. Being a horse person, I really understand the deep connections that my clients have with their horses. Having owned horses myself, I can relate to the trials and tribulations of horse ownership.

I appreciate being able to see all our collective efforts come to fruition when my clients are able to compete their horses or achieve their goals. I admire the moments when clients are grateful for their horse’s health above all else; it truly is a team effort and I love being able to see the reward of a horse in optimal health.

When not treating patients, what do you enjoy doing or where can we find you?

Gretchen Syburg and Nike - ESI Photography
Dr. Gretchen Syburg with her horse Nike. Photo by ESI Photography.

I enjoy spending as much time as possible outside, riding my horse Nike or hiking with my dog Luna. Most of the time you will find me in the barn or enjoying the occasional horse show. I am grateful for the time during the summer with my family in Wisconsin, we still have a small farm and now

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