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.
Rileigh Tibbott and Charley. Photo by Jacquie Porcaro
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.
Rileigh Tibbott and Charley. Photo by SportFot.
“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.”
Photo by Andrew Ryback Photography
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.”
A few of Palm Beach Equine Clinic’s veterinarians traveled to the “Big Apple” and traded in palm tree views for the city’s skyline at the 2022 Longines Global Champions Tour New York (LGCT). Palm Beach Equine Clinic served as the competition’s Official Veterinarian, and Dr. Richard Wheeler, Dr. Bryan Dubynsky, and Dr. Christopher Elliott were on-site supporting the horses and riders at the competition. We spoke with Dr. Chris Elliott about his experience at the penultimate event of the LGCT.
1. This is Palm Beach Equine’s second time being the Official Treating Vet at a Longines Global Champions Tour show. How are these shows different from other equestrian competitions?
The Longines Global Champions Tour (LGCT) is really unique because they’ve been able to take equestrian competitions to iconic locations all over the world. They’ve figured out how to set up a temporary set of stables and arenas anywhere, and that’s one of the main things that sets LGCT apart from other equestrian competitions.
2. What do your tasks and responsibilities include?
We’re here not only as the Official U.S. Department of Agriculture-accredited Veterinarian but also as the Official Treating Veterinarian, so our responsibilities start at the beginning of quarantine. We work with the U.S. Department of Agriculture and their team of veterinarians to ensure that all the appropriate importation of the European horses is correct by their quarantine standards, and we ensure that those quarantine standards are maintained throughout the competition. As the Official Treating Veterinarian, we see any horse that requires veterinary attention in and out of the ring. We also work alongside the Official Shipping Agent to get all the horses’ health certificates and ensure they’re fit to travel and can go home or wherever their next destination may be.
3. What’s a typical day at the show like?
Our days start really early here! The first horse warm up is at 6 a.m., so we wake up before the sun rises to take the ferry from Manhattan to the show grounds on Governors Island. One of us is primarily in the stables to look after the horses and provide support to the riders and grooms, while the other is next to the ring to act swiftly if any accident occurs. Our day goes until it’s all done, so they’re long days, but we enjoy what we do. The final days here are a bit longer because the ferry is also the transport system for getting all of the horses off the island, and it can’t take a large number of horse trucks.
5. What did you enjoy most about your time at LGCT New York?
The competition is fantastic, the quality of horses is amazing, and the location is absolutely stunning! Being at an equestrian competition against the backdrop of the Manhattan skyline and the Statue of Liberty is unique, and something very few veterinarians experience. For me, another big highlight was seeing the President of the United States fly in and out of the city on Marine One. It was pretty cool to see that in person.
The phrase “It takes a village” is commonly heard in the equestrian world. From the groom and barn manager to the professional rider, there are multiple individuals who help a horse reach its full potential and continue performing at its best. Although many people may think a veterinarian is who you call only when tragedy strikes, Palm Beach Equine Clinic’s team of veterinarians pride themselves on being an integral part of a horse and rider’s success. For Megan McDermott, a young show-jumping professional, Palm Beach Equine Clinic’s team of professionals has been there every step of the way.
McDermott, who started riding at the age of seven, originally planned to have a career in the film industry after graduating college and continue riding as an amateur. However, after a fateful meeting with Daniel Bluman and months under his mentorship and coaching, McDermott began spending more time in the saddle and eventually made a full career switch. “I remember my first Saturday Night Light class was a three-star grand prix at the Winter Equestrian Festival, and at the time, I had just turned pro so I didn’t have a trainer,” shared McDermott. “Dr. Richard Wheeler was the last person to speak to me before I went into the ring and the first person I saw when I came out.
“Not only is he a fantastic veterinarian, but he also acts as an advocate and understands that you’re doing this because you love horses and that there’s a business aspect to it as well,” she continued. “He’s able to give phenomenal advice and really understands the rider’s perspective. He also understands the trajectory of the horses’ careers and at what point they need to peak and is very conscious of your money, your time, and of course, your horses’ careers. He’s more than just a veterinarian, and I think all his clients feel that their wins are his wins.”
During the summer, McDermott spends a lot of her time traveling to different shows in the Northeast, sometimes making it difficult for her horses to be seen by their primary veterinarian. “If Richard can’t see me where I am during the summer, he’s extremely willing to collaborate with other veterinarians,” she noted.
McDermott recalled when her horse Tizimin LS sustained a severe injury while competing at HITS Saugerties in 2018. “Tizi was my first FEI horse, and we shared a really special bond,” she commented. “We were competing in a big jumper class and going clear, and then at the last jump, something happened, and his hind end just gave out. At the time, people thought he was going to have to be put down in the ring. It was horrible.”
She continued, “Dr. Sarah Allendorf was there at the ring when it happened. Richard wasn’t there, but he had dealt with something similar before, and he was the only person who told me Tizi would be able to recover. We sent Tizi to Rhinebeck [Animal Hospital], and Richard was there for me every step of the way. He was constantly talking to all the veterinarians there and so invested in helping me get him back into the ring.” Tizi stayed at Rhinebeck for three months before getting the green light to return home, where he continued to recover and returned to the FEI ring in 2020.
Although Dr. Wheeler is McDermott’s primary veterinarian, she shared that her success is thanks to a collaborative effort with other veterinarians at Palm Beach Equine Clinic.
McDermott explained, “All of the veterinarians there are extremely collaborative. Most veterinarians get very possessive in a way that makes them single-minded, but I think it’s really important to be open to different perspectives and be creative, and all of the veterinarians at Palm Beach Equine have been like that for me. Although Richard is my primary veterinarian, Dr. Sarah Allendorf, Dr. Laura Hutton, and Dr. Selina Watt have also done a lot for me and my horses. Managing sport horses is a bit of an art form, and I think they all understand sport horses a lot more than most veterinarians do.”
Equine ulcers have long been a common concern for horse owners. Our understanding of ulcers has dramatically improved over time through medical advancement, and there is currently more nuance to the diagnostics, treatment, and management of horses suffering from these internal sores. Gastroscopy and ultrasound have become more readily available, and their increased accessibility have allowed non-specialty practitioners more experience and a greater comfort level with these tools. These developments throughout the industry have led to more animals being correctly diagnosed and appropriately treated.
Jordan Lewis, DVM of Palm Beach Equine Clinic (PBEC) sees a variety of equine ulcer cases. She breaks them down into three categories: gastric ulcer disease of the squamous mucosa, gastric ulceration of the glandular mucosa, and colon ulcers of the right dorsal colon.
Equine gastric ulcer disease of the squamous mucosa refers to the ulcers found on the stomach’s inner lining closer to the esophagus. They are primarily caused by exposure to stomach acid and vary in severity depending on the amount of time the stomach’s lining has been in contact with the stomach acid.
“We often see this increased stomach acid exposure with the squamous mucosa in performance horses due to the mechanical aspects of exercise and abdominal pressure,” Dr. Lewis described. “The increase in acid production and contact time can also be seen in fasting animals and animals with delayed gastric emptying or slowed motility.”
Glandular mucosa describes the stomach lining around the pyloric region closer to the intestines. Ulcers found here are typically caused by a decrease in mucosal blood-flow as well as a decrease in mucus production, which normally serves as a protective barrier for the stomach lining. Stress and non-steroidal anti-inflammatory drugs (NSAIDS) such as phenylbutazone (“bute”) or flunixin meglumine (“Banamine®”) are the usual culprits in this case.
Similarly, ulcers found in the colon are also usually caused by stress and NSAID administration, leading to a decrease in the mucosal wall protection resulting in ulceration and inflammation.
“In some cases with colon ulcers of the right dorsal colon, we see minimal thickening noted on the right abdominal wall, but other times it can be more severe thickening with more ominous clinical signs of colic, fever, hypoalbuminemia (protein loss), ventral and limb edema, and diarrhea,” detailed Dr. Lewis.
The tricky thing about ulcers is that they do not always present with the same symptoms in every horse. It can be difficult to know when it’s time to be a little more invasive in order to take a closer look at a horse’s digestive system. At a minimum, persistent symptoms warrant a veterinarian consultation.
“The range of symptoms can vary from mild to severe,” Dr. Lewis explained. “The horse might be being a picky eater, or they might exhibit moderate to severe colic symptoms like signs of abdominal discomfort such as pawing or rolling. Even still, some horses present with the only outward sign being poor performance.”
Dr. Lewis uses varying diagnostic tools for a complete understanding of the affliction. Sometimes she will perform the Succeed test, which is a fecal test that generally helps indicate the presence of ulcers. Another option is to perform a gastroscopy with a three-meter endoscope to see the stomach where both forms of gastric ulcers are found. Ultrasound is the primary diagnostic tool to look for thickening of the right dorsal colon wall indicating ulceration in the colon. Basic bloodwork to determine total albumin, a protein made by the liver, also helps indicate more severe cases of colon ulcers.
Once a horse has been diagnosed with ulcers of any variety it’s important to begin treatment, especially since horses suffering from ulcers are predisposed to colic. Because each type of ulcer disease has a different underlying cause, the treatment protocol and medications are also different.
Though omeprazole paste used to be thought of as the cure-all, today we know that it is only part of the puzzle. Dr. Lewis recommends an omeprazole paste for at least a four-week period and uses other medications in conjunction with this depending on what type of ulcer she is treating. For horses that have ulcers of the squamous mucosa experiencing more severe, colic-like symptoms, Dr. Lewis adds a dose of sucralfate before meals to the protocol. If she finds ulcers in the glandular and pyloric region of the stomach, misoprostol and prostaglandin analog is used. For ulcers of the right dorsal colon, sucralfate is used as a coating agent while misoprostol is used as a treatment.
In addition to medication, some lifestyle adjustments can aid in maintaining an ulcer-free digestive tract. “It’s helpful if we can provide a more natural, less stressful environment for these horses with continuous grazing on pasture or hay as well as more turnout,” stated Dr. Lewis.
She continued, “Horses with gastric ulcers do well on adding alfalfa hay as a buffering agent before a grain meal, while horses with colon ulcers do well on a low-bulk diet, meaning less forage and a more complete feed-based pellet. Adding a psyllium-based supplement can be helpful for these horses too.”
Even with the best curative efforts, some horses can continue to suffer from ulcers, underscoring the importance of monitoring your horse for any changes even after treatment. Because sport horses have an increased likelihood of developing gastric ulcers due to exercise, their constant work also increases the odds of them have recurring ulcers. Personality and demeanor also play a part.
“Horses that have recurrent ulcer disease tend to be horses that internalize more and are stressed easily,” said Dr. Lewis.
She highlighted some additional measures that can be taken to help continuously protect the stomach’s lining, noting the importance of a regulated diet and more opportunity to relax, as well as treatment with a prophylactic dose of omeprazole paste.
If you think your horse feels a little off from their normal behavior, it might be time to discuss different diagnostic options with your veterinarian. Trust your gut – it might just help your horse’s too.
Vinceremos Therapeutic Riding Center hosted area first responders at its facility in Loxahatchee, FL, on December 6, 2021. The annual event provides training by veterinarians from PBEC for first responders in handling horses during an emergency. The Winter Equestrian Festival season sees the influx of thousands of horses each winter. These sessions have successfully educated area first responders in equine care during a crisis to create a safer community for the horses.
Dr. Janet Greenfield-Davis giving the demonstration to the area first responders. Photos courtesy of Vinceremos Therapeutic Riding Center.
What does a typical day look like for you at Palm Beach Equine Clinic? My work is mainly sports medicine oriented. I do a lot of performance evaluations to make sure riders get the most out of their equine athletes every time they enter the ring. Also, pre-purchase exams are a large part of what I do, but every day is different. You never know what is going to come up on a daily basis. It’s what makes the job so great. There’s always something to learn from both the horses and their riders.
What aspects of equine medicine interest you most, and what types of cases do you find most rewarding? What I really love is diagnosing and treating performance problems. Sometimes very subtle problems can lead to more rails and lower results. The process of putting together all the pieces of the puzzle by really listening to the rider, taking a careful history, examining the horse, and then treating the horse, is so rewarding. Knowing you are part of the team that makes the horse and rider successful is very special.
Currently, I’ve been spending a lot of time diagnosing and treating neck and poll issues. The more we look in these areas, the more we are finding performance-related issues such as head tossing, head tilt, one-sided rein resistance, rooting, and lots of other symptoms we haven’t necessarily thought about in the past as being related to poll and neck discomfort.
Dr. Bryan Dubynsky
Photo courtesy of Jump Media
What do you enjoy most about working with performance horses?
The most enjoyable part would be when you see horses that you have treated and made better do well in competition. There’s nothing more satisfying than being part of the team and having a rider say, “He’s/she’s never felt so good!”
What has been one of your favorite moments while working for Palm Beach Equine Clinic? There have been so many great moments at PBEC. It is so special when the entire team, from ambulatory vets, to surgeons, and everyone in between pulls together and turns challenging cases into successful outcomes. One particular case was when a horse had a full thickness abdominal laceration from a jump cup and his intestines were falling out. The attending horse show vet did perfect emergency first aid, the horse came to the clinic, and the whole team medicated and prepped for surgery. The surgeon patched him all up and the horse was competing again a few weeks later. That case really illustrated what a whole team effort looks like in achieving great outcomes.
When and why did you decide that you wanted to become a veterinarian?
My father is a physician, and I always had an interest in medicine. Choosing to become a veterinarian seemed to be a natural fit combining my love for horses and medicine.
Dr. Dubynsky performing a hind flexion test.
Photo courtesy of PBEC
What is some advice that you would give someone who wants to become a veterinarian? Pick out the top people in the industry and work with them. Learn as much as you possibly can from the people who have been practicing for a long time.
What is something interesting that people may not know about you?|
I love to do woodworking projects like building tables.
Palm Beach Equine Clinic’s Dr. Weston Davis performing kissing spines surgery.
Palm Beach Equine Clinic is one of the foremost equine surgical centers in the world with three board-certified surgeons on staff, led by Dr. Weston Davis. As a busy surgeon, Dr. Davis has seen many horses with the dreaded “kissing spines” diagnosis come across his table. Two of his most interesting success stories featured horses competing in the disciplines of barrel racing and dressage.
Flossy’s Story
The words “your horse needs surgery” are ones that no horse owner wants to hear, but to Sara and Kathi Milstead, it was music to their ears. In 2016, Sara – who was 17 years old at the time and based in Loxahatchee, Florida – had been working for more than a year to find a solution to her horse’s extreme behavioral issues and chronic back pain that could not be managed. Her horse Two Blondes On Fire, a then-eight-year-old Quarter Horse mare known as “Flossy” in the barn, came into Sara’s life as a competitive barrel racer. But shortly after purchasing Flossy, Sara knew that something wasn’t right.
“We tried to do everything we could,” said Sara. “She was extremely back sore, she wasn’t holding weight, and she would try to kick your head off. We tried Regu-Mate, hormone therapy, magna wave therapy, injections, and nothing helped her. We felt that surgery was the best option instead of trying to continue injections.”
At the time, Sara and her primary veterinarian, Dr. Jordan Lewis of Palm Beach Equine Clinic (PBEC), brought Flossy to PBEC for thorough diagnostics. They determined Flossy had kissing spines.
Kissing Spines Explained
In technical terms, kissing spines are known as overriding or impinging dorsal spinous processes. The dorsal spinous process is a portion of bone extending dorsally from each vertebra. Ideally, the spinous processes are evenly spaced, allowing the horse to comfortably flex and extend its back through normal positions. With kissing spines, two or more vertebrae get too close, touch, or even overlap in places. This condition can lead to restrictions in mobility as well as severe pain, which ultimately can lead to back soreness and performance problems.
“The symptoms can be extremely broad,” acknowledged Dr. Davis. “[With] some of the horses, people will detect sensitivity when brushing over the topline. A lot of these horses get spasms in their regional musculature alongside the spinous processes.” A significant red flag is intermittent, severe bad behavior, such as kicking out, bucking, and an overall negative work attitude, something that exactly described Flossy.
A radiograph of a PBEC patient with kissing spines before surgery showing the marked surgical incision sites of the mid to caudal thoracic vertebrae. A radiograph of the same PBEC patient after kissing spines surgery.
Lakota’s Story
With dressage horse Lakota owned by Heidi Degele, there were minimal behavior issues, but Degele knew there had to be something more she could do to ease Lakota’s pain.
“As his age kicked in, it was like you were sitting on a two-by-four,” Heidi said of her horse’s condition. “I knew his back bothered him the most because with shockwave he felt like a different horse; he felt so supple and he had this swing in his trot, so I knew that’s what truly bothered him.” Though she could sense the stiffness and soreness as he worked, he was not one to rear, pin his ears, or refuse to work because of the pain he was feeling.
Heidi turned to Dr. Davis, who recommended a surgical route, an option he only suggests if medical treatment and physical therapy fail to improve the horse’s condition. “Not because the surgery is fraught with complications or [tends to be] unsuccessful,” he said, “but for a significant portion of these horses, if you’re really on top of the conservative measures, you may not have to opt for surgery.
“That being said, surgical interventions for kissing spines have very good success rates,” added Dr. Davis. In fact, studies have shown anywhere from 72 to 95 percent of horses return to full work after kissing spines surgery.
After Lakota made a successful recovery from his surgery in 2017, he has required no maintenance above what a typical high-level performance horse may need. Heidi attributes his success post-surgery to proper riding, including ground poles that allow him to correctly use his back, carrot stretches, and use of a massage blanket, which she has put into practice with all the horses at her farm. Dr. Davis notes that proper stretching and riding may also prolong positive effects of injections while helping horses stay more sound and supple for athletic activities.
Lakota, who went from Training Level all the way up through Grand Prix, is now used by top working students to earn medals in the Prix St. Georges, allowing them to show off their skills and earn the qualifications they need to advance their careers.
Flossy’s Turnaround
Flossy was found to have dorsal spinous process impingement at four sites in the lower thoracic vertebrae. Dr. Davis performed the surgery under general anesthesia and guided by radiographs, did a partial resection of the affected dorsal spinous processes (DSPs) to widen the spaces between adjacent DSPs and eliminate impingement.
Sara took her time bringing Flossy back to full work. Within days of the surgery, Sara saw changes in Flossy, but within six months, she was a new horse.
“Surgery was a big success,” said Sara. “Flossy went from a horse that we used to dread riding to the favorite in the barn. It broke my heart; she was just miserable. I didn’t know kissing spines existed before her diagnosis. It’s sad to think she went through that pain. She’s very much a princess, and all of her behavioral problems were because of pain. Now my three-year-old niece rides her around.”
Sara and Flossy have returned to barrel racing competition as well, now that Sara graduated from nursing school, and have placed in the money regularly including two top ten finishes out of more than 150 competitors.
“I can’t even count the number of people that I have recommended Palm Beach Equine Clinic to,” said Sara. “Everyone was really great and there was excellent communication with me through every step of her surgery and recovery.”
By finding a diagnosis for Flossy and a way to ease her pain, Sara was able to discover her diamond in the rough and go back to the competition arena with her partner for years to come.
Dr. Santiago Demierre mainly focuses on equine performance medicine and specializes in the prevention and treatment of lameness in sport horses. Originally from Argentina, Dr. Demierre completed a certification program called the Educational Commission for Foreign Veterinary Graduates (ECFVG) through the American Veterinary Medicine Association to validate his degree in the United States. Dr. Demierre completed an internship at PBEC and went on to become a staff veterinarian.
What is your background with horses?
When I was little my father used to have racehorses and train them. I would spend hours with him and the horses at the farm. Later on, I had friends who worked with cows, and I also played a little polo.
Where are you originally from, and where did you complete your undergraduate degree? I am from San Antonio de Areco, which is a small town in Argentina. I went to vet school at Universidad de Buenos Aires.
Dr. Santiago Demierre
Photo courtesy of PBEC
What inspired you to become an equine veterinarian?
I am not sure what exactly inspired me. I was always very interested in animals in general, not only horses. I have had the idea of becoming a veterinarian since I was five or six years old. I wanted to be able to spend as much time with animals as I could. I never thought of any alternative careers.
What advice would you give someone who wants to become an equine veterinarian? I would tell them it is a great career, but to be aware that there is a lot of work and continuous studying ahead.
What does a typical day look like for you at PBEC?
I drive from barn to barn all day and look at lameness and performance horse cases mostly.
Dr. Santiago Demierre taking an x-ray.
Photo by Erin Gilmore Photography
What do you enjoy most about working at PBEC?
The team at PBEC is made up of great veterinarians and great friends. There is always somebody from whom you can learn something new every day. Also, it is awesome to be in contact with the world’s top equine athletes. That is what I enjoy most about being part of the team at PBEC—working on performance horse cases. More specifically, I really like preventing and treating lameness in sport horses.
When not at PBEC, what do you enjoy doing or where can we find you?
I love outdoor activities like fishing, hunting, and running as a workout. I also love cooking and red wine.
In order for a racehorse to successfully speed down the track, a jumper to navigate a quick and clear round, or a dressage horse to perform a picture-perfect test, the horse must have a healthy respiratory system.
Regardless of discipline or level of training, it is key to ensure a horse is breathing properly for its overall wellbeing.
If a horse is having respiratory problems, there are several ways that a veterinarian can investigate the issue. One of the most effective tools is a dynamic endoscope, a video recording device that can be worn by the horse during exercise to observe the respiratory system while they are active.
Respiratory Specialist, Dr. David Priest of Palm Beach Equine Clinic (PBEC), focuses on upper airway diagnosis and surgery for equine athletes and often uses a dynamic endoscope to evaluate his patients.
The equine respiratory system is responsible for bringing large amounts of oxygen in and out of the lungs, where it is then used to fuel complex bodily processes. It comprises two sections, the upper and lower airways. The upper airway begins with the nostrils and extends through the larynx and into the trachea. The lower airway is made up of the lungs, which rest behind the shoulder, extend up the back, and reach toward the end of the ribcage.
Dr. David Priest
Photo by Jump Media
“Even a small decrease in lung capacity or impingement on airflow can have dramatic effects on overall health and performance,” described Dr. Priest. “Problems affecting the upper and lower airways may overlap but can include coughing or odd noises, exercise intolerance, nasal discharge, or labored breathing at rest.”
During exercise, the amount of air moved in and out of the horse increases proportionately to how hard the horse is working. The more demanding the work, the more oxygen must be used. A horse at rest inhales approximately 3.5 liters of air per second (L/s), and increases exponentially to 70 L/s at maximum exertion, according to Dr. Priest.
“If a horse is showing signs of difficulties in its respiratory health, veterinarians may use radiography or ultrasound to image the lungs,” explained Dr. Priest. “Going beyond greyscale images [such as radiographs], the veterinarian may also evaluate the upper respiratory tract through the use of an endoscope. An endoscope is a medical device with a small lens on the end that can be inserted through the horse’s nostril to view the horse’s pharynx.”
A dynamic endoscope on a harness race horse.
Photo courtesy of PBEC
If a horse is having trouble breathing only while working, it is necessary for a veterinarian to be able to evaluate them while they are active. To perform that assessment, a dynamic endoscope is used. This allows veterinarians to examine the horse’s pharynx, epiglottis, and trachea in motion. The dynamic endoscope will detect throat abnormalities and provide more information on respiratory issues or problems that are not seen when the horse is resting.
“The soft tissue structures of the horse’s upper airway experience a significant amount of force when the horse is exercising,” remarked Dr. Priest. “There is also a significant difference in resting and exercising forces, and this causes the upper airway tissues to appear anatomically normal at rest, even if they are functioning abnormally during exercise.”
A dynamic endoscope is often used with horses that have recurrent laryngeal neuropathy, commonly known as “roaring.” Recurrent laryngeal neuropathy restricts the amount of air able to reach the lungs through the horse’s upper respiratory system. This is a useful tool to diagnose the problem and also to evaluate the effectiveness of the surgery.
Respiratory difficulties during exercise can have a significant negative impact on a horse’s health and performance. A dynamic endoscope is a valuable and informative tool in Equine Sports Medicine. Once the issue is identified, there are several treatment or surgical options to address specific respiratory illness. If your horse is making an abnormal noise during exercise, or if you suspect breathing problems, contact your veterinarian to make sure your horse is performing at its best.
Where are you originally from, and where did you complete your undergraduate degree? I am originally from Prince Edward Island, Canada. I completed my undergraduate degree and veterinary school there. I then did my surgery residency at Auburn University in Auburn, AL.
What does a typical day look like for you at Palm Beach Equine Clinic? Most of my time at Palm Beach Equine Clinic is spent splitting the surgery on-call with Dr. Weston Davis and Dr. Robert Brusie. When I am there, you are most likely to see me doing colic surgery. Outside of those responsibilities, I work for Shane Sweetnam at Sweet Oak Farm as a staff veterinarian. I oversee all aspects of those horses’ routines and preventative care spending time at their farm and at the Winter Equestrian Festival (WEF). I also enjoy the challenge of performance evaluations.
Dr. Liz Barrett Photo courtesy of Liz Barrett
What aspects of equine medicine interest you most, and what types of cases do you find most rewarding? I really enjoy performance horse issues. The cases that interest me the most are those dealing with horses that are competing at the top level of their sport. I like helping maintain the horses so they are able to compete at that high level comfortably. On the flip side, it’s also extremely rewarding to be able to take a colicky horse that is in pain and fix them by performing the surgery they needed to survive.
What is one of the most interesting cases you have worked on? I recently had a case where the patient was brought in for evaluation of a wound on their side, and that led to discovering a retained testicle. I also get excited when I work with any horses that I have been fangirling over in the show ring.
What is one of your favorite things about working at Palm Beach Equine Clinic? My favorite thing about PBEC is the camaraderie and team atmosphere. I like that there are plenty of specialists to consult with, and everyone really works together well. We have a great group of intern veterinarians who make working up cases enjoyable and after-hours emergencies run smoothly.
Dr. Liz Barrett competing at WEF. Photo by Bridget Ness Photography
Liz Barrett performing surgery. Photo courtesy of Liz Barrett.
What advice would you give someone who wants to become an equine veterinarian? Only do it if you can’t imagine yourself doing anything else.
What is something interesting that people may not know about you? I am a decent juggler, I hate bananas, and I have my own 13-year-old gelding that I compete in the adult jumper division when I am feeling brave enough to venture into the show ring.
