Do you ever wonder what all those letters at the end of a veterinarian’s name actually mean? It is kind of like a secret language where they signify a variety of different veterinary qualifications. Palm Beach Equine Clinic explains how to crack the code of letters.
DVM
Doctorate of Veterinary Medicine: This qualification is given to graduates of veterinary colleges. Although this was once only for graduates of American veterinary colleges, the abbreviation is now given to graduates from several other universities around the world. The vast majority of the veterinarians at Palm Beach Equine Clinic are DVMs that earned their degrees at U.S. institutions.
DACVS
Diplomate of the American College of Veterinary Surgeons: Holders of this qualification are board-certified specialists in Surgery. Board-certified means that the veterinarian has a mastery of advanced knowledge and skills after completing required testing. At Palm Beach Equine Clinic, Dr. Robert Bruise, Dr. Jorge Gomez, Dr. Weston Davis, Dr. Liz Barrett, and Dr. Karen Beste are all specialist surgeons.
Photo by Jump Media
DACVIM
Diplomate of the American College of Veterinary Internal Medicine: This qualification means that the veterinarian is board-certified in Internal Medicine. Dr. Peter Heidmann and Dr. Fernando Marqués of Palm Beach Equine Clinic are both board-certified specialists in Internal Medicine.
DACVR
Diplomate of the American College of Veterinary Radiology: This qualification indicates the holder is a board-certified specialist in Radiology. Palm Beach Equine Clinic’s Dr. Sarah Puchalski is a DACVR.
DACVSMR
Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation: A relatively new specialty, this qualification indicates the veterinarian is a board-certified specialist in Sports Medicine and Rehabilitation. Both Dr. Christopher Elliott and Dr. Fernando Marqués of Palm Beach Equine Clinic have this qualification.
BVETMED
Bachelor of Veterinary Medicine: This distinction is given to veterinary graduates of the Royal Veterinary College (RVC) in London, which is the first and oldest English-speaking veterinary college in the world. Dr. Richard Wheeler and Dr. Charlie McColough of Palm Beach Equine Clinic are both graduates of the famous RVC.
BVM&S
Bachelor of Veterinary Medicine & Surgery: These letters indicate a graduate of The Royal (Dick) School of Veterinary Studies in Edinburgh, Scotland, which is Scotland’s oldest veterinary school. Palm Beach Equine Clinic’s Dr. Sarah Allendorf is a Dick Veterinary graduate.
BVMS
Bachelor of Veterinary Medicine & Surgery: This particular abbreviation is given to graduates of several British veterinary schools. At Palm Beach Equine Clinic, Dr. Janet Greenfield Davis and Dr. Tyler Davis both have this qualification as graduates of the Glasgow University School of Veterinary Medicine.
Photo by Jump Media
Photo by Jump Media
BVSc
Bachelor of Veterinary Science: These letters were typically associated with veterinary graduates from Commonwealth countries such as Australia and New Zealand. The qualification is now granted by numerous vet schools around the world. Within Palm Beach Equine Clinic, Dr. Christopher Elliott has this qualification from the University of Queensland School of Veterinary Science in Australia.
MVB
Bachelor of Veterinary Medicine: This renowned abbreviation indicates graduates of the University College Dublin School of Veterinary Medicine, which is Ireland’s only veterinary school. Dr. Laura Hutton of Palm Beach Equine Clinic is a University College Dublin School graduate.
MVZ
Medico Veterinario Zootecnista: This qualification is given by several Spanish-speaking veterinary schools. Palm Beach Equine Clinic’s Dr. Jorge Gomez has this qualification as a graduate of the University of Caldas in Colombia.
MRCVS
Member of the Royal College of Veterinary Surgeons: These celebrated letters indicate the holder as satisfying the stringent regulatory requirements to practice as a Veterinary Surgeon in the United Kingdom. At Palm Beach Equine Clinic, Dr. Richard Wheeler, Dr. Scott Swerdlin, Dr. Stephen O’Grady, Dr. Janet Greenfield Davis, Dr. Tyler Davis, Dr. Charlie McColough, Dr. Sarah Allendorf, and Dr. Christopher Elliott are all MRCVS.
MANZCVS
Member of the Australian and New Zealand College of Veterinary Scientists: These letters indicate the veterinarian has studied at the Australian and New Zealand College of Veterinary Scientists and is an advanced practitioner in a particular area of veterinary science. Dr. Christopher Elliott of Palm Beach Equine Clinic is a MANZCVS in Equine Sports Medicine and Rehabilitation.
Photo courtesy of Dr. Christopher Elliott
CERPM
Certified in Equine Rehabilitation & Performance Medicine: This is a post-veterinary school qualification focusing on the early diagnosis of performance deficits, how to correct them, and rehabilitation after injury. Palm Beach Equine Clinic’s Dr. Janet Greenfield Davis holds this qualification.
CVA
Certified in Veterinary Acupuncture: Veterinarians with this post-veterinary school qualification have studied the fundamentals of equine acupuncture including points and techniques. This is a postgraduate qualification also held by Dr. Janet Greenfield Davis.
CVMMP
Certified Veterinary Medical Manipulation Practitioner: This is a post-veterinary school qualification where veterinarians are educated in how to perform medical manipulation to treat musculoskeletal problems. Dr. Ryan Lukens of Palm Beach Equine Clinic has this qualification.
Dr. Karen Beste joined the Palm Beach Equine Clinic team in January 2023. Dr. Beste is a board-certified large animal surgeon. Keep reading to learn more about Dr. Beste and her background as a veterinarian.
Where did you grow up and what is your background with horses?
I grew up in a small town in north Texas called Double Oak. My father loved horses. His parents had a small property with several horses and a Shetland pony that I learned to ride on. We were involved with the Lewisville Saddle Club and went to “playdays” together throughout my childhood where I learned how to barrel race and compete in speed events. During this time I started to train my own horse named Buck. I joined the Marcus Rodeo Team and competed in high school rodeo for four years with Buck who took me to the finals for pole bending my senior year. In college I switched gears and joined the Texas A&M University polo club my freshman year. I quickly fell in love with the game, and through a lot of hard work I made the polo team my sophomore year. During my senior year I went on to be the team captain.
When and why did you decide you wanted to become a veterinarian?
I decided I wanted to be a veterinarian at a very young age. When one of our horses became injured and ultimately had to be euthanized despite surgical intervention efforts I knew I wanted to be able to help horses as a career. In third grade I wrote a book describing how I wanted to go to Texas A&M University in order to become a veterinarian, and I followed my dream.
Photo courtesy of Dr. Karen Beste
What is some advice you would give someone who wants to become a veterinarian?
I would recommend they spend as much time as they can with a veterinarian. It is important to understand the commitment that is required and how rewarding it can be working on animals that people not only compete on but truly love as members of their family.
What aspects of equine medicine interest you most, and what types of cases do you find most rewarding?
As a surgeon, I am obviously interested in being in the operating room and helping horses in emergency situations or with routine surgery. I find the most joy in watching a horse I have been involved with have a good outcome in the show ring following surgical intervention.
What is something interesting people may not know about you?
The most exciting animal I have done surgery on was a baby bongo!
There’s nothing more exciting than buying a young horse with a lot of potential. When Margo Crowther of Fort Myers, FL, purchased three-year-old “Sissy” she was looking forward to the young mare’s future as a barrel racer.
In 2016, when Sissy was a four-year-old, Crowther, a professional barrel racer, took the mare to an event in South Carolina. The pair successfully made it to the top 30 in a barrel race competition to qualify for the final taking place the next day. Unfortunately, while making the turn around the first barrel in the final, Sissy slipped and fell down. Crowther came off, caught Sissy, and took her back to the stabling area to check her over.
Photo courtesy of Margo Crowther
“Once we reached the stalls, Sissy began to limp with her hind end,” explained Crowther. “After traveling home, I knew something wasn’t right. We immediately brought her to Dr. Weston Davis at Palm Beach Equine Clinic. Dr. Davis is the best, and he’s a good friend of mine. He was also the only vet that had worked on Sissy at that point.”
Dr. Davis examined Sissy when she arrived at Palm Beach Equine Clinic in Wellington, FL. She was lame at the walk but had no swelling or signs of where the injury was located.
Photo by Springer
“We ended up doing a bone scan to diagnose Sissy,” commented Dr. Davis. “She had a really hot bone scan at the hock. We decided to do several different special x-ray views and found she had a central tarsal bone fracture. This is a very uncommon source of lameness in equine athletes. It was an atypical slab fracture, which meant it spanned from one joint to the next.”
Dr. Davis and his team of veterinarians found the fracture on x-rays, but a standing magnetic resonance imaging (MRI) was performed to help accurately define the fracture configuration.
“We did our surgical planning on the MRI,” said Dr. Davis. “Then we put a screw across the fracture line. A lag screw stabilization promotes compression and primary healing of the bone and is considered the treatment of choice for this type of injury.”
Sissy stayed at Palm Beach Equine Clinic for a few days then returned home to Crowther’s farm where she remained on stall rest for four months. Her next step was a few weeks of daily hand walking, followed by a gradual return to working under saddle. Crowther made sure to take it slow with Sissy, especially in the beginning. Dr. Davis checked the mare on a monthly basis throughout the recovery period. At Sissy’s three-month check-in, Dr. Davis removed the screw.
After a successful recovery, Crowther and Sissy made their return to the show ring exactly seven months after the injury happened. The duo competed in the Fort Smith Derby in Fort Smith, AR, where the pair won $26,000.
“It was a huge accomplishment and even more so since it was her first run back from her injury,” explained Crowther. “We were all shocked, to say the least.”
Sissy is now 11 years old and continues to be Crowther’s main competition horse. In 2022, Crowther and Sissy competed at the National Finals Rodeo, known as the “super bowl of rodeo,” where the pair won $86,000 in prize money. Sissy’s lifetime earnings have topped $450,000.
“Sissy is a family member to my husband and me as well as our kids,” Crowther said of the mare. “She means the world to all of us. My kids joke that if I could build her a stall in the house I would. She is the kindest horse, and she loves her job. She is one in a million.”
Thanks to the team of top veterinarians at Palm Beach Equine Clinic, Sissy was able to have a successful career as a barrel racer. Crowther and Sissy will continue to compete and look forward to more top-place finishes.
Thanks to the team of top veterinarians at Palm Beach Equine Clinic, Sissy was able to have a successful career as a barrel racer. Crowther and Sissy will continue to compete and look forward to more top-place finishes.
Morgan Barbançon (FRA) piloted her own Habana Libre A to the top of the podium in the Grand Prix Special CDI4* presented by Palm Beach Equine Clinic at the Adequan® Global Dressage Festival (AGDF) in Wellington, FL, on Saturday, January 28, 2023.
Barbançon and the 11-year-old Dutch Warmblood gelding received an unbeatable score of 74.404%. The victory was special to Barbançon who has had Habana Libre A since he was four years old.
Photo by Susan J. Stickle Photography
“When I came out and saw the score, I started crying because he has come a long way,” commented Barbançon. “Today I had such a floaty and fluid ride, and I didn’t push. My goal was to give him confidence in the ring and have a fault-free test. That was my goal, and that’s what I had. There were a few hiccups here and there, and there are things that can get better, but it felt like such a nice ride.”
Barbançon is looking forward to continuing her success during the rest of the AGDF season with Habana Libre A.
“I’m looking at the five-star with him,” explained Barbançon. “He’s going to tell me when he’s ready, and I’ll just take it week by week. I’m here until the end of March so there is no rush and no pressure. I’m here to compete as much as I can. I want to give him the confidence in the ring, where he really wants to go and really wants to do it.”
Photo by Susan J. Stickle Photography
Anna-Christina Abbelen (GER) and Sam Donnerhall, owned by Abbelen and Silke Abbelen-Mooren, finished in second place with a score of 71.234%. Pablo Gómez Molina (ESP) and Ulises de Ymas, owned by Javier Bacariza, Cristina Danguillecourt, and Yeguada de Ymas S.L., rounded out the podium after receiving a score of 69.915%.
The FEI Young Horse 7 Year Old Preliminary and FEI Young Horse 7 Year Old Final presented by Palm Beach Equine Clinic took place on Saturday, January 28, and Sunday, January 29. Juan Francisco Fernandez Muñoz (ESP) took top honors in both classes aboard Fraggle Rock, owned by Precision Sport Horses. Muñoz and the seven-year-old gelding received a score of 72.482% on Saturday and a 72.643% on Sunday.
Palm Beach Equine Clinic is the Official Veterinarian of the Adequan® Global Dressage Festival in Wellington, FL. The third week featured the Grand Prix Special CDI4*, the FEI Young Horse 7 Year Old Preliminary, and the FEI Young Horse 7 Year Old Final presented by Palm Beach Equine Clinic. View results, live stream replays, and more at gdf.coth.com.
Palm Beach Equine Clinic is the Official Veterinarian of the Adequan® Global Dressage Festival in Wellington, FL. The third week featured the Grand Prix Special CDI4*, the FEI Young Horse 7 Year Old Preliminary, and the FEI Young Horse 7 Year Old Final presented by Palm Beach Equine Clinic. View results, live stream replays, and more at gdf.coth.com.
The $50,000 Palm Beach Equine Clinic National Grand Prix took place under the lights in the International Arena on Saturday, January 21, 2023, at Wellington International in Wellington, FL, during the third week of the Winter Equestrian Festival (WEF). Kent Farrington (USA) piloted Greya, owned by Kent Farrington LLC, to top honors in the competitive class.
Farrington and Greya went 17th in the starting order of 45 riders and were the first pair to produce a fault-free round over the technical course designed by Catsy Cruz (MEX). Six more horse-and-rider combinations produced clear rounds to join Farrington in the jump-off including Ben Maher (GBR), Jos Verlooy (BEL), Sam Walker (CAN), Bertram Allen (IRL), Michael Murphy (USA), and Mimi Gochman (USA).
Photo by Jump Media
“It was Greya’s first time jumping under the lights,” said Farrington of the nine-year-old Oldenburg mare (Colestus x Contender). “My plan was to just work out of her normal gallop, which is already pretty quick. Luckily, it worked out tonight.”
Farrington and Greya were the first pair to return for the jump-off and set the pace with a quick time of 37.756 seconds. Although the remaining competitors tried to beat the duo’s time, Farrington and Greya proved to be uncatchable.
“I thought she was incredible,” said Farrington of his mount. “I think it is a very special horse. I thought she jumped great tonight. I think she has a promising future so I’m looking forward to that.
Photo by Jump Media
“She is a very opinionated mare,” continued Farrington. “She has her own ideas, and those types are sort of my favorite horses. I think in the end when you can train the horse to work with you and use all of their energy to go in the right direction they can be great.”
Maher and Enjeu de Grisien, a nine-year-old Selle Français gelding owned by Charlotte Rossetter and Pamela Wright, claimed second-place honors with a time of 38.835 seconds. Verlooy and Nixon Van’t Meulenhof, a 10-year-old Belgian Warmblood stallion owned by Eurohorse BVBA, rounded out the podium after stopping the timers at 39.767 seconds.
Palm Beach Equine Clinic is the Official Veterinarian of the Winter Equestrian Festival in Wellington, FL. Week 2 of the 13-week series featured competition sponsored by Palm Beach Equine Clinic. View results, live stream replays, and more at WellingtonInternational.com.
Palm Beach Equine Clinic is the Official Veterinarian of the Winter Equestrian Festival in Wellington, FL. Week 2 of the 13-week series featured competition sponsored by Palm Beach Equine Clinic. View results, live stream replays, and more at WellingtonInternational.com.
Sarah Panico has been a part of the Palm Beach Equine Clinic team for the past seven years. Panico is one of the Hospital Technicians and is an integral member of our Hospital Management team.
Panico grew up riding horses, and by age 14 she was the assistant manager of a private stable in Coconut Creek, FL. She later began teaching lessons, running summer camps, training horses, and more. Panico started competing and traveling on the show jumping circuit in New York, Kentucky, and Canada. In 2015, at the age of 19 she decided she was ready for a change and applied for a position at Palm Beach Equine Clinic. The rest was history, and Panico found her true passion as a Hospital Technician.
Photo courtesy of Sarah Panico
“I absolutely love spending time with my patients and pouring every ounce of my abilities into the care of these amazing equine athletes,” commented Panico. “It’s such a great feeling being able to help them. There’s no greater feeling than watching a patient you’ve spent so much time caring for and rooting for improve and get to go home. On the other hand, there are days when sad moments occur too. Having the opportunity to be the person who is with these horses, providing them with love and compassion in their final moments, is certainly difficult but honorable at the same time.”
A typical day for Panico at Palm Beach Equine Clinic starts with doing early morning treatments, running blood work, placing catheters, performing physical exams, and admitting patients for elective surgeries or procedures. If there is a patient that is in a more critical condition, the majority of her time is dedicated to that patient. Being part of the Hospital Management team means that she handles the more critical cases and assigns the other patients accordingly.
Photo courtesy of Sarah Panico
“There are days we have multiple emergencies come to the clinic at all different times, and sometimes there are multiple emergencies at the same time,” explained Panico. “Some end up going into emergency surgery right away. Time management, communication, and delegation are vital in this profession. You never know what is in store for the day, and honestly that’s probably my favorite part. I enjoy the unknown as to what my day will be like, the fast-paced environment, caring for critical patients, aiding the doctors, and the unique cases that come in.”
Photo courtesy of Sarah Panico
Outside of Palm Beach Equine Clinic, Panico can be seen driving her drift car. Although it is something she does for fun, she is looking forward to being able to compete next year. She also enjoys traveling, boating, fishing, going to the gun range, and spending time with her German Shepherd, Layla.
The team at Palm Beach Equine Clinic is excited to welcome Dr. Christopher Elliott. Dr. Elliott was born and raised in Brisbane, Australia, and graduated from the University of Queensland’s School of Veterinary Science in 2007 with First-class Honors. Since then, he has become board-certified in Sports Medicine and Rehabilitation. Dr. Elliott has experience working at Fédération Équestre Internationale (FEI) equestrian events in more than 20 countries. As well as being a dedicated FEI Veterinarian, Dr. Elliott has been a Private Athlete Veterinarian, Team Veterinarian, Permitted Treating Veterinarian, and Official Veterinarian. Dr. Elliott is the Veterinary Services Manager for FEI Competition at Wellington International for the 2023 Winter Equestrian Festival. Keep reading to learn more about Dr. Elliott and his role as a veterinarian at Palm Beach Equine Clinic.
Photo courtesy of Dr. Christopher Elliott
When and why did you decide you wanted to become a veterinarian?
Like most young boys I knew, I had illusions of grandeur that I was going to be playing cricket or rugby for Australia. As I got older, I decided I needed to knuckle down on my studies and veterinary medicine made sense. I decided this around the age of 15 and, since then there was nothing else I could possibly imagine I ever wanted to do. My background in horses from my father’s side and my love of animals from my mother’s side led me to veterinary medicine as the perfect career and lifestyle choice for me.
What advice would you give someone who wants to become a veterinarian?
Young people considering a career in veterinary medicine should spend as much time as possible working in practices in order to fully understand what makes it a challenging career choice. Aspiring veterinarians should take the time to truly understand what the profession is really about. I love being a veterinarian and it is all I could possibly imagine ever doing, but some people have a job that pays for their lifestyle and other people have a job that is their lifestyle. Young people who would like to become a veterinarian should be positive that it is the career they want and enjoy before committing to it.
What aspects of equine medicine interest you most, and what types of cases do you find most rewarding?
My chosen specialties are Sports Medicine and Rehabilitation. Ever since I became a veterinarian, the unique challenges of keeping equine athletes fit, sound, and competing at the highest level have always appealed to me. I enjoy performance management, investigating lameness, and helping my clients achieve their equine athletic goals. Regardless of the competition level, each combination of horse and rider has specific aspirations, and it gives me great satisfaction to help achieve those goals. Whether it be in the pony ring, at the grand prix level, or Olympic level, they all pose their unique challenges and are equally enjoyable.
Photo courtesy of Dr. Christopher Elliott
What is your role as the new Veterinary Services Manager for FEI Competition at Wellington International?
My job as the Veterinary Services Manager is to provide veterinarian services during each week of FEI competition. Tasks range from coordinating our Palm Beach Equine Clinic treating veterinarians on the showgrounds to assisting during the arrival exams and horse inspections. I am also the Attending Veterinarian ringside for each night class and FEI class. I have been working within the FEI all over the world for close to 15 years, and I look forward to working at this prestigious venue this year.
What are some of your other hobbies or interests?
I love traveling with my wife, Kjersten Lance, and going on fun adventures around the world. I enjoy all things sports related as well. I love watching team sports, especially live at the stadium. Coming from Australia, I played cricket and rugby and still follow them closely. A little-known fun fact about me is that I collect stamps.
Palm Beach Equine Clinic (PBEC) returns as the Official Veterinarian of the Winter Equestrian Festival (WEF) and Adequan® Global Dressage Festival (AGDF) for the 2023 show season. The veterinarians of Palm Beach Equine Clinic will be on-site to provide excellent care to all of the competing sport horses as well as those in the surrounding Wellington area.
Although we all hope emergencies will never occur, owners and riders can rest easy knowing that top sport horse veterinarians will be immediately available to help resolve equine medical emergencies. Palm Beach Equine Clinic veterinarians will provide veterinary services at the Annex Office located on the Wellington International showgrounds. Dr. Christopher Elliott, board certified in Sport Horse Medicine and Rehabilitation, will be the lead veterinarian at the showgrounds. Veterinarians will be available at the show to provide diagnostic evaluations, treatment, emergency care, and regular veterinary needs. At AGDF showgrounds at Equestrian Village, PBEC vets are on-site to help with any problems that arise during competition days.
Photo by Jump Media
At its main facility, Palm Beach Equine Clinic has an extensive team of more than 30 veterinarians offering a wide variety of services and remedies including internal medicine, emergency care, reproduction and fertility, alternative medicine, regenerative medicine, dentistry, podiatry, and more. From sport horse evaluations to non-traditional alternative medicine therapies such as equine medical manipulation and acupuncture, Palm Beach Equine Clinic veterinarians think outside of the box to prevent and treat injuries.
Photo by Erin Gilmore
Offering exceptional knowledge, capabilities, and commitment, the team at Palm Beach Equine Clinic is thrilled to be part of equine athletes’ success during the Wellington winter show season and beyond.
What Does Palm Beach Equine Clinic Offer?
Cutting-Edge Technology
The modern medical imaging modalities at Palm Beach Equine Clinic allow veterinarians to gather all the information they need to make a timely diagnosis and are available for all equine patients, even if their primary veterinarian is not at Palm Beach Equine Clinic.
Surgical Center
Palm Beach Equine Clinic’s 24/7 emergency services are led by three board-certified surgeons, who perform some of the most advanced and least invasive surgeries in the world. Head of surgery Dr. Robert Brusie, as well as Dr. Weston Davis and Dr. Jorge Gomez, make up the team of surgeons who are adept in many procedures from colic cases to injuries that require high levels of expertise and advanced equipment.
Photo by Jump Media
Internal Medicine
Understanding why a talented prospect may be coming up short makes Palm Beach Equine Clinic veterinarians determined to find the answers and develop solutions. PBEC proudly offers internal medicine services led by board-certified internal medicine specialist Dr. Peter Heidmann. Going beyond standard veterinary care, the staff at Palm Beach Equine Clinic can identify the root of subtle changes in a horse’s health or performance with internal medicine evaluations and diagnostic procedures. Comprehensive internal medicine offerings include respiratory, cardiac, gastrointestinal, and neuromuscular evaluations.
Alternative Medicine
Employing a holistic approach to treating patients, Palm Beach Equine Clinic considers all the available avenues for health care. Alternative medicine therapies are often used in conjunction with traditional medicine and can be uniquely tailored to enhance a horse’s performance and overall health. Alternative medicine offerings include acupuncture, equine medical manipulation adjustments, Chinese herbal medicine, laser therapy (photobiomodulation), and extracorporeal shockwave.
Photo by Jump Media
Reproduction and Fertility
Palm Beach Equine Clinic offers a broad array of reproductive and fertility services for stallions and mares, available at the equine hospital or in the barn. With expert care and advanced practices, PBEC maximizes the likelihood of a successful pregnancy. As the process of breeding sport horses is ever changing, Palm Beach Equine Clinic proudly offers clients modern reproductive services to produce the talent of the future.
Palm Beach Equine Clinic is partnered with Hagyard Equine Medical Institute (HEMI), one of the leading equine medical centers in advanced reproductive medicine. Through the partnership, equine reproductive specialists work collaboratively with Palm Beach Equine Clinic to expand upon the traditional reproductive services currently being offered.
Palm Beach Equine Clinic has provided the highest quality of equine health care for 41 years. With a world-class facility, state-of-the-art technology, and great compassion for the horses, Palm Beach Equine Clinic is committed to providing the best possible service for both patients and owners.
6:30 a.m. – 7:30 a.m.: Family Time/Morning Ritual
I like to start my morning with my two boys who are four and six years old. We get up and play a little before breakfast. We then all load into the car to head to school.
8:00 a.m. – 9:15 a.m.: Hospital Rounds
When I arrive at Palm Beach Equine Clinic, I convene with the hospital staff to discuss the hospitalized patients. There are about 15 horses currently hospitalized with us, though some of them are only here for MRI and bone scans or other outpatient procedures. During rounds, the hospital’s patient-care team of veterinarians and technicians make a plan for each patient and debate the best treatment strategies. This is an opportunity to make sure everyone is on the same page with the specific rationale for each treatment plan, and also an opportunity to quiz some of our younger veterinarians on the relevant science.
Photo by Jump Media
Today, I got into a good conversation with another senior clinician regarding the ideal choice of blood thinners to limit the risk of clotting in a sick patient. Although we did not totally agree, our diverging opinions provided some perspective to the young veterinarians during rounds. Honestly, even without complete consensus on any given topic, this kind of dialogue challenges us to remain abreast of the medical literature, helps us provide articulate and succinct presentations, and ultimately, promotes optimum patient care.
Photo by Jump Media
We also discussed modifying the treatment strategies for a six-year-old stallion who had colic surgery about 18 hours earlier. He was experiencing the all-too-common problem of “post-operative ileus” where the small intestine was not returning to normal motility as quickly as we would like. We increased the regimen of prokinetic drugs, which are IV medications that can help increase the contractions of that sluggish small intestine. We also discussed the possibility of increasing his hand-walking, which can improve his motility.
As we made our way through the barn, we talked about rechecking the current insulin levels of a 15-year-old Hanovarian mare who has been fighting founder for more than a week. If the insulin remains high, we may need to modify her treatment regime, including increasing her dose of metformin, a medication that can help modify the concentration of insulin in her bloodstream. Thankfully, it came back as normal when we checked it with the handy patient-side test called Wellness Ready.
Other notable cases included a mare who is hospitalized with us on foal-watch since her pregnancy is nearly full-term, a polo pony with a corneal ulcer (eye trauma), and an almost totally better horse that had presented to the hospital with a fever of unknown origin. After the fever had abated on its own within hours of hospitalization, he was set to remain boarded until his PCR tests confirm that he wasn’t shedding any infectious diseases and he could safely return to his home barn.
9:15 a.m. – 10:15 a.m.: Updating Clients
After hospital rounds, I spend a little bit of time returning calls and updating clients and owners on their hospitalized patients. I also document patient updates and client conversations in the medical record for each horse.
10:30 a.m. – 11:30 a.m.: Farm Call ¬– Follow-Up Gastroscopy
I arrive at a local farm along with one of our young veterinarians to do a recheck gastric scope to see how well a nine-year-old gelding has responded to 27 days of treatment for gastric ulcers. Our exam a month ago showed moderate gastric ulcers (Grade 2 out of 4 in severity) in the upper stomach (the “margo plicatus,” where the squamous stomach lining meets the portion that produces acid). There was also thickening around the pylorus, the outflow tract (“exit door”) at the bottom of the stomach. It’s good to see that the horse is acting much better, gained some weight, and has a healthier hair coat since we started treatment with Gastrogard omeprazole last month. We need to see how he has responded to a combination of medications, and hopefully, discontinue the anti-ulcer medications if possible. After a round of light sedation, we pass the endoscope into the stomach. The Grade 2/4 gastric ulcers are totally resolved, which is great news. The pyloric outflow tract is only a little bit better. Although it requires treatment twice a day, we recommend the addition of misoprostol, which is a medication that is often considered more likely to help resolve problems at the pylorus. We also discuss a plan to make sure that the horse has continuous access to grass hay and/or fresh grass in turnout. This can help prevent ulceration and, in some cases, promote healing without the necessity of additional medication. We write the prescriptions and make a plan to repeat the stomach scoping in another three to four weeks.
11:45 a.m. – 1:15 a.m.: Farm Call – Respiratory Evaluation
We continue to a second local farm to follow up on a case of suspected respiratory problems in a nine-year-old chestnut jumper mare. Earlier in the week, the mare’s regular veterinarian, who works with us at Palm Beach Equine Clinic, had been asked to evaluate her for shortness of breath and occasional coughing during and after work. The mare had been performing well, but had been a bit sluggish for the past three months. Recently, her symptoms had become much more obvious, especially after the mare finished training or competition. This raised the trainer’s concerns about asthma or possibly, Exercise-Induced Pulmonary Hemorrhage (EIPH).
Her physical exam is normal, including the “re-breathing exam”, where we ask the mare to breathe deeply by placing a medium trash bag over her nostrils. This test is the equine equivalent of when your doctor asks you to breathe deeply so they can hear your lungs. Her re-breathing is pretty normal, but it sounds like there might be a little bit of airway-narrowing in her caudo-dorsal lung fields, which is near where the back of the saddle would sit. We take a look at the lung surfaces using ultrasound, and there are no abnormalities there.
Next, in order to obtain a better understanding of what kinds of factors might be affecting her breathing, we scope her upper airways under light sedation. There are no significant abnormalities in the nasal passages, nasopharynx, larynx, guttural pouches, or the top of the windpipe. Based on this news, I recommend collecting a sample from the lower lung fields, which is called a bronchoalveolar lavage (BAL). A microscopic analysis of this sample will help us better determine if there is asthma, bleeding, or any sign of bacterial or fungal infection.
With a little bit of local anesthesia in the nasal passages, and a bit more in the windpipe and lower bronchi to minimize discomfort and coughing, we flush 240 milliliters of saline into her lungs, and aspirate it right back out. I can tell from the foaminess that we got a good sample. The good news is that while there is a little mucous, the sample is clear, so at least there hasn’t been any lung bleeding very recently. We discuss a plan to limit exposure to environmental dust and use nebulized bronchodilators and herbal medications while awaiting the results of the BAL fluid analysis. The results should be available in 24 to 48 hours.
1:14 p.m. – 2:30 p.m.: Prepare Prescriptions and Process Samples
We finalize and prepare prescriptions for the horse with stomach ulcers, including organizing the fat supplement they had requested. We also process samples from the respiratory case, and prepare to ship it out to the lab that specializes exclusively in reading BAL samples. I document the respective case details. I am almost done with these projects when one of the young veterinarians asks me to come out to the hospital barn to help assess how the stallion with post-operative ileus has responded to his prokinetic meds.
2:30 p.m. – 3:15 p.m.: Check In on the Stallion
I repeat the ultrasound exam on the stallion who, at this point, is about 24 hours post-operation for small intestinal colic surgery. The fact that our surgery team didn’t have to remove any compromised bowel bodes well for him, but we didn’t like the small intestinal distension this morning, especially so soon after his surgery. The good news is that the bowel is already moving a lot better than it was earlier in the day. Whether this represents a response to the prokinetic medications we recently started, or he is benefitting from a little more distance from the time of surgery, or both, we are happy with this improvement. We update the orders to continue with the current low dose of prokinetic drugs overnight.
3:15 p.m. – 5:30 p.m.: Finish Documenting and Reviewing Literature
I complete the documentation and records from our earlier farm calls. I also review the recent literature on a new prokinetic medication that can be given orally. Additionally, I review a recently revised consensus statement regarding Cushing’s disease. After that, I call a few clients in advance of farm calls that I will do tomorrow.
5:45 p.m. – 6:15 p.m.: Hospital Rounds
I wind down my day with evening hospital rounds to coordinate with the young veterinarians. We double-check the doctors’ orders on each patient, confirm plans and contingencies for overnight care, including feeding, medications, fluid therapy, and other treatments. We organize which member of our team will update horse owners, trainers, and also the referring veterinarians involved in every hospital case. We finish by briefly discussing the anticipated schedule of events for tomorrow’s planned procedures.
6:35 p.m.: I arrive home and enjoy dinner with my family.
One of the greatest fears for a rider is that their once-in-a-lifetime horse will become injured. In 2019, this worry turned into a reality for Rileigh Tibbott who was thinking about retiring her heart horse, Charley. Before making that difficult decision, Tibbott decided to take Charley to Dr. Bryan Dubynsky of Palm Beach Equine Clinic (PBEC) in Wellington, FL, for another opinion. Although it took more than a year, the decision to trust PBEC with Charley’s care ended up changing the outcome of his career as a performance horse.
Tibbott and her show jumping mount Charley, a now 14-year-old Warmblood gelding by Numero Uno, competed together in the Under 25 division and at the FEI three-star level. At the time, the main cause of Charley’s lameness was soreness in his front feet. After meeting with Tibbott and examining Charley, Dr. Dubynsky felt that he could work with Charley’s farrier to help the gelding.
“Instead of doing MRIs or any other diagnostic work I focused on working with Rileigh and the farrier as a team to get him shod properly,” explained Dr. Dubynsky. “My pitch to Rileigh was to fix the foundation on the horse. He was foot sore but I thought most of the issue was due to being improperly trimmed. There was a lot of excess foot on him, and a lot of foot imbalance. He also had some coffin joint compression areas that needed to be alleviated.”
Once Dr. Dubynsky began working with Rileigh’s farrier, the team found success almost immediately and Charley was able to return to the show ring.
Unfortunately, since Charley had gone so long with poor foot balance, he had also developed sidebones, a condition that results in the ossification of the collateral cartilages of the foot. The condition causes the collateral cartilages, which are found on the inside and outside of the foot, to become a harder and less flexible bone. Normally it is not problematic unless the sidebones become excessive. If that happens, a horse can more easily hit themselves in that area and fracture the sidebones causing lameness. At the beginning of 2020, Charley’s sidebones became an issue when he was competing on the grass derby field during the Winter Equestrian Festival in Wellington, FL.
“Charley overstepped taking off to a jump and his hind studs tore through and cut one of his sidebones,” recalled Tibbott. “Unfortunately, after getting stitched up Charley developed an infection. This extended his recovery time and we spent months trying to get him sound again. Charley does not do well with time off so while trying to bring him back from that injury he managed to keep re-injuring himself. The most difficult injury was a suspensory issue in his left hind in April 2020.
“We tried multiple times for many months to start him back but every time it seemed as though jumping would not be an option for him again,” continued Tibbott of Charley’s recovery process. “Dr. Dubynsky knew how much this horse meant to me and really thought outside the box while trying to treat him. I had a few other veterinarians tell me that he needed to be retired but Dr. Dubynsky really fought to get him back in the ring for me.”
Dr. Dubynsky recommended a plan to bring him back slowly rather than giving up. The regimen included frequent check-ups and a close partnership with both the farrier and Tibbott. Dr. Dubynsky also injected areas he felt would help make Charley more comfortable and aid in his recovery.
“We injected his coffin joints and around the sidebones,” commented Dr. Dubynsky. “Most importantly, every several months we would repeat foot x-rays and make sure we were getting a proper balance trim. I always emphasize the trim, not being shod. For me, it’s 90% how you trim the foot and then 10% what you are putting on the bottom of it. The relationship between the vet and farrier was critical during Charley’s recovery process.”
After a total of 19 months, Charley made a full recovery and was able to successfully return to the show ring. Although Charley is now back competing, Dr. Dubynsky continues to check in on Charley regularly and work closely with the farrier to ensure Charley is performing at his best.
“My goal is to have him back in the grand prix ring,” said Tibbott of her plans for Charley. “Without Dr. Dubynsky and our access to such a world-class facility at PBEC, I think Charley’s outcome would have been very different.”
