Dr. Santiago Demierre has been an integral part of the Palm Beach Equine Clinic team of veterinarians for the past 10 years. Dr. Demierre primarily focuses on equine performance medicine and is passionate about the prevention and treatment of lameness in sport horses. Keep reading to learn more about Dr. Demierre’s backgroundand his role at Palm Beach Equine Clinic.

Dr. Demierre was raised in San Antonio de Areco, a small town in the countryside outside Buenos Aires, Argentina. He grew up immersed in the equine industry as his father was a racehorse breeder and trainer. Dr. Demierre completed his veterinary medicine degree from the Universidad de Buenos Aires in 2012.

He began his career at Palm Beach Equine Clinic as an intern and then went on to become an ambulatory veterinarian before focusing on sport horse medicine. Dr. Demierre currently cares for some of the country’s top polo, jumper, and dressage horses.

“We have worked with Dr. Demierre several times now, and we love his determination and patience when it comes to the welfare of our horses,” said U.S. show jumping athlete Ali Boone. “He is the first one there in any urgent care we have needed, and he not only puts the animals’ needs above all else, but he also takes the time to explain and talk through any diagnosis and situation that needs special attention.”

At Palm Beach Equine Clinic, Dr. Demierre enjoys being surrounded by a diverse group of exceptional veterinarians who are always available to advise on a case. Dr. Jorge Gomez, Dr. Robert Brusie, and Dr. Scott Swerdlin have all played influential roles in Dr. Demierre’s career by providing guidance on managing cases and clients.

In his free time, Dr. Demierre stays busy riding polo ponies, fishing, hunting, hiking, and enjoying time outdoors.

The $25,000 Palm Beach Equine Clinic Grand Prix took place on Sunday, September 3, 2023, at Equestrian Village in Wellington, FL. The class served as the highlight event to close out the ESP Labor Day show. Sharn Wordley (NZL) and Valentine Car, owned by Fernando Cardenas, bested a field of 27 entries to take home the top prize.

Héctor Loyola (PUR) designed a technical track for the starting field of horse-and-rider combinations. Wordley and Valentine Car went toward the end of the order and produced a fault-free effort. In the end, 10 pairs managed a clear first round to advance to the jump-off.

“I thought the course was great,” shared Wordley. “The time was a bit fast for younger horses, but there were already 10 clear, and if the time had been slower there would have been 13 or 14 in the jump-off. For riders, where there’s a tight time on the first round, that’s where you must make your best judgment as to the pace you feel that your own horse is comfortable with.”

Wordley and Valentine Car were the second to last pair to return for the jump-off. The duo stopped the clock at 41.798 seconds to take first place. Wordley has been partnered with Valentine Car for the past two years, and they have earned many top placings together.

“He’s very quick-footed,” said Wordley of the 14-year-old Warmblood gelding. “Even in a fast jump-off like the one today it’s hard to beat him. He just skims over the jumps. I think we’ll do one more of these shows this summer, and then we’ll start doing FEI classes in the fall. The shows here are great for younger and older horses to help prepare them for bigger classes, so I want to bring them down here once more this year.”

Gabriel de Matos Machado (BRA) and Evabellie W, owned by Emily Wood, claimed second place with a time of 42.866 seconds. Dylan Daly (IRL) and Cinderella Z, owned by Jacqueline Steffens Daly, secured third place after stopping the clock at 44.280

Palm Beach Equine Clinic is the Official Veterinarian of the Wellington International Summer Series in Wellington, FL. Veterinarians are available on-site to provide exceptional care to competing horses as well as those in the surrounding Wellington area. View results, live stream replays, and more at WellingtonInternational.com. For more information about Palm Beach Equine Clinic, visit EquineClinic.com.

Sharn Wordley and Valentine Car
Sharn Wordley and Valentine Car
Photo by Wellington International/Cassidy Klein
Sharn Wordley and Valentine Car in their winning presentation for the $25,000 Palm Beach Equine Clinic Grand Prix.
Sharn Wordley and Valentine Car in their winning presentation for the $25,000
Palm Beach Equine Clinic Grand Prix.
Photo by Wellington International/Cassidy Klein

As elevated temperatures continue to prevail throughout the country, it is important that horse owners never underestimate how heat and humidity can affect equines. Even during the winter months, it is crucial to monitor how your horse is reacting to variations in temperature, especially when traveling to and from or relocating to Florida and other southern regions for the season.

Many problems can arise when temperatures climb, so as a starting point horse owners should pay attention to the amount of sweat their horse is producing. Anhidrosis, or the inability to sweat normally, can be a common challenge, particularly in hot, humid climates.

“Anhidrosis can develop acutely but generally develops gradually,” explained Dr. Natalia Novoa of Palm Beach Equine Clinic. “Horses lose 65-70% of their body heat through sweating, so the inability to sweat can be a potentially dangerous condition for them.”

Dr. Natalia Novoa
Photo by Jump Media

In addition to lack of sweat, signs of Anhidrosis can include increased respiratory rate, elevated body temperature, areas of hair loss, or dry and flaky skin.

There are several treatment options for Anhidrosis including supplements, lifestyle changes, and alternative medicine practices.

“Electrolyte supplements and access to salt blocks are important to replenish chloride, sodium, and potassium,” said Dr. Novoa. “A Vitamin E supplement can also be beneficial because it is an antioxidant that helps with the oxidative damage due to environmental heat stress.”

In addition to supplements, it is important to keep the horse in a shaded and well-ventilated area if possible. It can also be helpful to keep the horse’s body clipped during the summer season.

Another treatment option is adding one serving of dark beer a day to the horse’s feed. The alcohol in beer is a vasodilator so it helps open capillaries allowing heat to pass through more rapidly to stimulate sweat.

Alternative medicine therapies such as acupuncture can also help decrease symptoms of Anhidrosis. “Acupuncture is very effective at clearing heat,” explained Dr. Novoa. “The normal functions of sweat glands and sweating are regulated by the heart, the lungs, and the triple heater. Heat and humidity can block the Qi flow of those meridians, which are pathways connecting acupuncture points, leading to Anhidrosis.

Furst Filou, owned by Maura Weis, demonstrating acupuncture points for Anhidrosis.

Photo courtesy of Dr. Natalia Novoa

“Acupuncture treatment strategies are designed to clear the summer heat, nourish the Yin, and promote body fluids,” continued Dr. Novoa. “Opening up certain points where the heat tends to collect will help release neurotransmitters that affect the flow of blood and lymph.”

According to Dr. Novoa, there are three areas to work on during the acupuncture process:

1. Heart: Helps with blood supply

2. Lung: Controls Wei Qi, which dominates the opening and closing mechanisms of the sweat glands

3. Triple Heater: Controls pathways of body fluids

“It requires a few acupuncture sessions to see a change,” said Dr. Novoa. “The process is different for each horse. It can also help with symptoms like exercise intolerance, tachypnea, and fatigue.”

New Xiang Ru San powder promotes heat and fluid disbursement through healthy sweating and clears Summer-Heat.

Photo courtesy of Dr. Natalia Novoa

Another alternative treatment option is Chinese herbal medicine. New Xiang Ru San powder has proven to be a clinically effective aid for non-sweaters as it promotes heat and fluid disbursement through healthy sweating and clears Summer-Heat. New Xiang Ru San is a blend of the Chinese herbs Bian Dou (hyacinth bean), Xiang Ru (mosla), Hou Po (magnolia bark), Lian Qiao (forsythia), and Jin Yin Hua (honeysuckle flower). Bian Dou eliminates Damp, Xiang Ru clears Summer-Heat, Hou Po moves Qi and eliminates Damp, Lian Qiao clears Heat and opens the Exterior, and Jin Yin Hua clears Heat Toxin, detoxifies, and releases Exterior.

Overall, it is important to manage a horse with Anhidrosis carefully. In addition to considering the techniques described earlier, try to exercise them when temperatures are lower in the early morning or late evening. Also, make sure to allow plenty of cool-down time after exercise and monitor their respiration rate.

Anhidrosis is one of many significant issues to be aware of during temperature increases. Contact Palm Beach Equine Clinic to learn more about precautions that can be taken to keep horses happy and healthy throughout the summer season.


Keeping Horses in the Game

Navigating Lameness Prevention and Treatment

Owners and riders have the responsibility of making sure their horses are healthy and sound. Horses are incredible athletes both in and out of the show ring, so it is important that they are cared for like any elite athlete. Non-equestrians do not equate performance horses to football players, marathon runners, or gymnasts, but horse owners and veterinarians know the same level of commitment is required to keep equine athletes in optimal health and fitness.

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

Palm Beach Equine Clinic has a team of veterinarians who specialize in Sport Horse Medicine to keep equine athletes performing at their best.
Photo by Jump Media

Lameness can manifest itself in different ways, from subtle decreases in performance to severe and obvious signs of pain. Lameness is not a diagnosis or disease; it is the symptom of an underlying issue. Palm Beach Equine Clinic in Wellington, FL, has a team of veterinarians who specialize in Sport Horse Medicine and are skilled at diagnosing and treating the root causes of lameness. Pinpointing the underlying issue is the crucial first step in proper rehabilitation.

Understandably, practicing proactive prevention is the best approach to avoiding incidents of lameness. It is important to do what we can to prevent serious incidents such as falling, missteps, and accidents with other horses. Key to these 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 usual wear-and-tear injuries.

Catching Lameness Early
Early recognition of the signs of lameness may help prevent more serious injuries from occurring. A firm understanding of what is “normal” for your horse is crucial to identifying subtle changes in behaviors, movement, or body conditions.

Once a day, do a hands-on leg check. During this exam, compare opposite legs to detect signs of heat, swelling, or sensitivity. While exercising the horse make sure you are aware of a shortness of stride, decrease in performance, reduced stamina, or changes in attitude. If you suspect a problem, give the horse a few days off. If the signs return when work is resumed ask your veterinarian to examine them. Remember that a mild problem can turn into a career-limiting condition if left untreated.

Scheduling routine performance evaluations with your veterinarian can also help catch signs of lameness early. Thorough evaluations often consist of:

• History from rider and 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 (nerve blocks) to pinpoint the specific area causing pain
• Isolation and confirmation of the problem area
• Diagnosing underlying issues through imaging such as a radiograph (x-ray), ultrasound, nuclear scintigraphy (bone scan), magnetic resonance imagining (MRI), or computed tomography (CT)
• Specific identification of the lameness or performance problem

Treatment Options
Even with preventative care, we cannot avoid all injuries. Therefore, it is important to work with your veterinarian to develop the best treatment plan for when an injury occurs. There are a wide range of traditional treatment methods including conservative treatment (rest, ice, compression), medical management (non-steroidal anti-inflammatory drugs, steroids), intra-articular medication (joint injections), soft tissue treatment (self-derived biologic therapies such as stem cells or pro-stride and shockwave, laser, and ultrasound), and as a last resort, surgery.

Veterinary practices like Palm Beach Equine Clinic also offer a holistic treatment approach through the use of Alternative Therapies. Often used in conjunction with traditional medicine, these therapies can be uniquely tailored to enhance a horse’s performance and overall health. Alternative Therapies include acupuncture and electro-acupuncture, veterinary medical manipulation (chiropractic adjustments), laser therapy, shockwave treatments, and Chinese herbal medicine.

Many causes of lameness are not intuitive, which makes them difficult to diagnose without the knowledgeable eye of an experienced Sport Horse Medicine veterinarian. At Palm Beach Equine Clinic, the goal is to get horses “back in the game” and keep them safe throughout their athletic careers.

Palm Beach Equine Clinic veterinarians and staff strive to be a vital part of the equine athlete’s support team and are committed to delivering comprehensive care specialized to the individual horse’s career, discipline, performance level, and training demands. Contact Palm Beach Equine Clinic today to make sure your horse is in optimal health.

As winter winds down and everyone looks ahead to the exciting spring and summer show season, there are preparations that can be taken in your horse’s care to ensure you get off on the right hoof. Close communication with your veterinarian can help you stay on track and ensure everything is properly addressed. Vaccinations, deworming, therapies and treatments, as well as shipping care and paperwork are all important to think about. At Palm Beach Equine Clinic in Wellington, FL, Dr. Elizabeth Barrett works with her clients to stay organized for the upcoming show season.

Dr. Elizabeth Barrett competing in Wellington, FL.
Photo by Bridget Ness Photography


Horses are generally vaccinated twice per year in the fall and spring. If you and your horse are traveling to a new area for the spring and summer season, it is important to think about the requirements of that area or diseases more commonly found there. As an example, Dr. Barrett notes that the Potomac Fever vaccine is not always administered in Florida but can be important for horses traveling to the northeastern part of the country.

Vaccinations also need to be administered with enough time prior to shipping or competing, making scheduling considerations more crucial. Dr. Barrett maintains consistent communication with her clients to find the most optimal day to vaccinate such that it coincides with the horse’s existing schedule. While horse owners and barn managers help organize timing, Dr. Barrett stays prepared on her end by counting her patients and ordering enough vaccines for them.

“The responsibility goes both ways,” said Dr. Barrett. “Usually, the farm manager will let me know that they have some time off from showing, so it’s a good time for spring vaccines. I might also remind them that it’s getting to be time to do that so they can work it into their schedules.”

Dr. Elizabeth Barrett.
Photo courtesy of Dr. Elizabeth Barrett


Springtime is also a good opportunity to deworm. When horses have traveled from one area to another, it is more crucial. While Dr. Barrett recommends worming twice annually, she explained that it is necessary to pay attention to each individual horse. Examining the horse and knowing the horse’s situation should guide the worming program. Horses that show clinical signs of worms, such as issues with weight and coat, should have a fecal egg count performed no matter what time of year.

Therapies and Treatments

Many horses are completing busy winter show schedules and heading into a break before ramping back up again. This downtime is a great window of opportunity to help address any issues that may have emerged. Dr. Barrett suggests having your horse treated at the beginning of a break to allow more time for the treatment to settle in. Some joint injections and therapies require longer recovery times, so that needs to be planned accordingly.

“After the winter show circuit, I go over all the horses completely to see if there are any issues,” detailed Dr. Barrett. “If there is any lameness or any maintenance we need to do, we try to time it so that the horse has at least a small break before they ship to their next show. Sometimes the horse just needs downtime, and during the spring is often the time they can get that rest. It’s also a good time for different training routines, such as a water treadmill or hill work to change up the program a little bit.”


Spring and summer showing and shipping go hand in hand. Remembering all the paperwork that needs to be completed ahead of time is key to avoiding a last-minute scramble. Health certificates and Coggins papers are necessary documents for horses to travel both domestically and internationally. Dr. Barrett notes that it takes at least two days for a vet to complete this paperwork for national travel, so it is essential to keep that in mind when arranging an interstate trip. International travel health certificates take longer to prepare and have more requirements, necessitating additional forethought.

Once the logistics are handled, the horse must be physically prepared to ship. The longer the trip, the more stress it can put on the horse. Even trips as few as three hours can increase health concerns. Stomach ulcers are always a risk, so Dr. Barrett suggests administering preventative omeprazole paste to help keep your horse comfortable. Again, Dr. Barrett stresses that each horse needs to be considered individually, so a horse more prone to ulceration might also benefit from sucralfate when shipping.

“I would scope the stomach of any horse we are worried about that is clinically showing signs that they could have ulcers,” shared Dr. Barrett. “When they ship, it helps to try to feed them a little bit at a time with a steady supply of hay throughout the trip so that their stomach is full.”

Shipping fever and colic are other common issues. Taking your horse’s temperature and monitoring their behavior can help detect the problem sooner. Dr. Barrett also offers a couple of tricks to keep your horse hydrated and feeling comfortable in travel. Feeding a wet mash with mineral oil before the journey helps prevent impaction. Getting your horse accustomed to an electrolyte-flavored water beforehand allows you to produce the same familiar flavor on the road to encourage even the most stubborn drinker.

Additional precautions can be made to prevent other injuries. Considering the horse and weather will guide the best plan. For example, in warmer weather a horse that travels well might do better without wraps, but a horse that is more self-destructive could still need extra protection. Certain halters can cause rubs in warmer weather too. Dr. Barrett cautions that injury can also be caused by a travel buddy.

“It is really important to pay attention to what horses are next to each other,” emphasized Dr. Barrett. “I’ve seen plenty of injuries where one horse is picking on another and causing trouble. I’ve seen more injuries from that than self-inflicted horse wounds, but both can happen. You have to be careful.”

It helps to have cameras on the horses during longer trips to ensure there are no issues. Since the driver usually stops for gas every four hours or so, that is a good time to check on the horses and offer water. For trips of more than 10 hours, it can help to stop and unload the horses to give them a break. Many commercial shippers will drive directly, so in those cases, the health preparations you make are even more significant.

In all of your organization for spring, the most important thing is to stay in contact with your veterinarian. They will be able to inform your decisions, help with timing issues, and make the best possible plan for you and your horse.

The importance of good quality hoof care in competition horses cannot be denied. Farriery can be a major asset during the show season and beyond. The farrier can be proactive in keeping the horse’s feet healthy and thus preventing lameness. Learn more as Dr. Stephen O’Grady of Palm Beach Equine Clinic in Wellington, FL, explains the philosophy behind correct basic farriery in sport horses.

The Hoof
The equine hoof is unique as it is comprised of a group of biological structures (anatomy) that follow the laws of biomechanics. Therefore, if the veterinarian and farrier know the anatomy of the equine foot combined with an understanding of the biomechanics and good basic farriery principles, proper physiological farriery can be consistently applied (see Figure 1A and 1B). There are three important aspects of farriery used to keep the horse sound, beginning with the appropriate foot trim, along with the correct size and placement of the horseshoe.

Fig. 1A – Illustration shows the biological structures of the hoof and the biomechanical focus.
Fig. 1B – Biomechanical properties of the foot. (Black arrow is COR). Note the moments on either side of the COR.

The farrier session begins with an evaluation of the conformation of each foot. This means viewing the foot from the front, the side, and behind to observe the height of the heel bulbs (see Figure 2). It is important for the clinician to observe the horse in motion to see whether the horse’s foot lands flat or slightly heel first, which is desired. If the horse lands markedly heel first with a toe flip, it is a sign the heels have migrated dorsally (toward the front), decreasing the ground surface in the palmar section of the foot, or the size of the shoes is too small. The foot that lands toe first is an indication that the musculotendinous unit of the deep digital flexor tendon is shortened or the horse is experiencing palmar foot pain. Lastly, the foot should be observed for an asymmetrical landing pattern that is dictated by limb conformation because, if severe, a heel bulb can be displaced proximally resulting in the foot conformation termed “sheared heels.”

Fig. 2 – Illustrations of what is considered good foot conformation. Lateral view shows straight bony alignment of the digit and a parallel hoof-pastern axis. DP view shows straight alignment of the digit and a line across the coronet is parallel with a line on the ground. Ground surface of the foot shows good proportions on either side of a line across the widest part of the foot. Note foot is basically as wide as it is long.

The Trim
The use of guidelines or landmarks when approaching the trim provides consistent, repeatable results that can be used on each foot regardless of the conformation. The three guidelines used are: 1. Trimming the foot to achieve a straight or parallel hoof-pastern axis, 2. using the widest part of the foot, which correlates closely with the center of rotation, and 3. trimming the palmar foot (heels) to the base of the frog or to where the heels of the hoof capsule and the frog are on the same plane (see Figure 3A and 3B). A closer look at these three guidelines, which are all interrelated, will help to show their importance.

Fig. 3A – Yellow dotted line shows the bony alignment of the digit. Red line shows the straight hoof-pastern axis.
Fig. 3B – Black line is the widest part of the foot and the yellow dotted line shows the heels trimmed to the base of the frog. Star is position of COR.

1. If the dorsal (front) surface of the pastern bone and the dorsal surface of the hoof are parallel or form a straight line, then the bones of the digit (in the hoof) are in a straight line, and the force from the weight of the horse will go through the center of the joint. Furthermore, and equally important, if the hoof-pastern axis is straight, the weight will be distributed evenly on the bottom or the solar surface of the foot.

2. The second guideline is the center of rotation (COR). The COR is located a few millimeters palmar (behind) the widest part of each foot. This guideline allows the farrier to apply the appropriate biomechanics to each foot. The foot is trimmed in approximate proportions on either side of the widest part of the foot, which addresses the moments on either side of the COR and provides biomechanical efficiency.

3. Lastly, the palmar section of the foot is trimmed to the base of the frog or trimmed such that the heels of the hoof capsule and the frog are on the same plane. Adherence to this guideline keeps the soft tissue structures (frog, digital cushion, ungula cartilages) within the hoof capsule, which is necessary to absorb concussion and dissipate the energy of impact (see Figure 4). It is important to remember that heels do not grow tall; they grow forward. If the heels migrate forward, the soft tissue structures will be forced in a palmar direction out of the hoof capsule. Furthermore, as the heels migrate forward, the weight is placed on the bone via the lamellae thus bypassing the soft tissue structures of the foot. Allowing the heels to migrate forward also decreases the ground surface of the foot. Two examples of this guideline are shown in Figures 5A, 5B and 6A, 6B where the palmar foot was managed appropriately, and a size larger shoe was applied.

Fig. 4 – Illustration shows the relationship between the osseous and soft tissue structures within the hoof capsule. If heels migrate dorsally, load is transfer to the bone (note arrow).
Fig. 5A – Heels have migrated dorsally and red circle shows the soft tissu structures displaced proximally out of the hoof capsule.
Fig. 5B – Same foot after the heels have been trimmed and a larger shoe has been applied.
Fig. 6A – Heels are low and have migrated dorsally with the soft tissue structures displaced proximally out of the hoof capsule.
Fig. 6B – Same fott after the heels have been trimmed and a larger showe and heel elevation applied.

The three guidelines described here can be applied to any foot and can serve as a basis for maintaining a healthy foot and a basic starting point for applying farriery to a horse with poor foot conformation or one with a distorted hoof capsule. Figures 7A and 7B illustrate a hoof where all three of these guidelines have been applied.

Fig. 7A – The three guidelines applied to the foot. Note the proportions on either side of the widest part (black line) of the foot.
Fig. 7B – Shows the length of the shoe and the wide expanse of the shoe creating a platform under the palmar section of the foot.

Thoughts From Dr. Stephen O’Grady
Most competition horses now show year-round instead of on a seasonal basis. My observation is based on years of experience regarding the farriery performed on these horses. Many of these horses are given a rest from competition prior to leaving for Wellington for the winter show season. Many horses arrive with very reasonable foot conformation. However, upon arrival, horses are often shod with various specialty shoes, wedges, pads, pour-ins, etc., as a means of protection and perhaps to enhance their performance.

As the season progresses and the workload becomes more intense, the sole thickness starts to decrease, and the feet become softer from multiple baths. Now the farriery that was applied for protection at the onset may be causing pressure on the thinner, softer structures of the foot, thus becoming somewhat detrimental. The horses continue to be trimmed and shod on a monthly basis, and the farrier may not be aware of the change in the integrity of the hoof structures, especially the sole, and perhaps some horses may be over-trimmed. As the season progresses into March, the structures of the foot deteriorate further as a result of the workload. Many horses begin to become foot sore. At this point, the farrier options become limited because all the protective methodology was already used at the beginning of the season.

One recommendation would be to refrain from trimming the sole (trade the hoof knife for a wire brush), create ground surface in the palmar foot with a rasp, and decrease toe length vertically from the dorsal section of the foot to preserve mass. Always remember that adequate breakover in the shoe is important, as it decreases the stress in the deep digital flexor tendon and decreases the moment about the distal interphalangeal joint, both of which preserve sole thickness.

I remember the words of Joe Pierce when I was an apprentice learning the farrier trade many years ago, “No one will know if you leave the last few rubs of the rasp on the foot, but everyone will know if you take a few too many rubs!”

Palm Beach Equine Clinic offers a farriery consultation service to both veterinarians and farriers. This unique service provides a second opinion or simply “another set of eyes” available to both professions when treating difficult farriery cases. Please call 561-793-1599 or visit equineclinic.com for more information.

Featured on Horse Network

By Amanda Picciotto Feitosa/Jump Media

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.

kissing spines surgery weston davis palm beach equine clinic
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.

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.

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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.

What To Expect After the Unexpected Strikes

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Every owner dreads having to decide whether or not to send their horse onto the surgical table for colic surgery. For a fully-informed decision, it is important that the horse’s owner or caretaker understands what to expect throughout the recovery process.

Palm Beach Equine Clinic (PBEC) veterinarian Weston Davis, DVM, DACVS, assisted by Sidney Chanutin, DVM, has an impressive success rate when it comes to colic surgeries, and the PBEC team is diligent about counseling patients’ owners on how to care for their horse post-colic surgery. 

“After we determine that the patient is a strong surgical candidate, the first portion of the surgery is exploratory so we can accurately define the severity of the case,” explained Dr. Davis. “That moment is when we decide if the conditions are positive enough for us to proceed with surgery. It’s always my goal to not make a horse suffer through undue hardship if they have a poor prognosis.”

Once Dr. Davis gives the green light for surgical repair, the surgery is performed, and recovery begins immediately.

“The time period for the patient waking up in the recovery room to them standing should ideally be about 30 minutes,” continued Dr. Davis. “At PBEC, we do our best to contribute to this swift return by using a consistent anesthesia technique. Our team controls the anesthesia as lightly as we can and constantly monitors blood pressure. We administer antibiotic, anti-inflammatory, anti-endotoxic drugs, and plasma to help combat the toxins that the horse releases during colic. Our intention in the operating room is to make sure colic surgeries are completed successfully, but also in the most time-efficient manner.”

Colic surgery recovery often depends on the type and severity of the colic. At the most basic level, colic cases can be divided into two types – large intestine colic and small intestine colic – that influence the recovery procedures and outlook. 

Large intestinal colic or impaction colic is characterized by the intestine folding upon itself with several changes of direction (flexures) and diameter changes. These flexures and diameter shifts can be sites for impactions, where a firm mass of feed or foreign material blocks the intestine. Impactions can be caused by coarse feeds, dehydration, or an accumulation of foreign materials such as sand.

Small intestinal colic or displacement colic can result from gas or fluid distension that results in the intestines being buoyant and subject to movement within the gut, an obstruction of the small intestine, or twisting of the gut. In general, small intestinal colics can be more difficult than large intestinal colics when it comes to recovery from surgery. 

“Many people do assume that after the colic surgery is successfully completed their horse is in the clear,” said Dr. Chanutin. “However, during the first 24 to 48 hours after colic surgery, there are many factors that have to be closely monitored.

“We battle many serious endotoxic effects,” continued Dr. Chanutin. “When the colon isn’t functioning properly, microbial toxins are released inside the body. These microbials that would normally stay in the gastrointestinal tract then cause tissue damage to other bodily systems. We also need to be cognizant of the possibility of the patient developing laminitis, a disseminated intervascular coagulation (overactive clotting of the blood), or reflux, where a blockage causes fluids to back up into the stomach.”

  Colic surgery incision healing.

Stages after surgery

Immediately Post-Surgery

While 30 minutes from recumbent to standing is the best-case scenario, Dr. Davis acknowledges that once that time period passes, the surgical team must intervene by encouraging the horse to get back on its feet.

Once a horse returns to its stall in the Equine Hospital at PBEC, careful monitoring begins, including physical health evaluations, bloodwork, and often, advanced imaging. According to Dr. Davis, physical exams will be conducted at least four times per day to evaluate the incision and check for any signs of fever, laminitis, lethargy, and to ensure good hydration status. An abdominal ultrasound may be done several times per day to check the health of the gut, and a tube may be passed into the stomach to check for reflux and accumulating fluid in the stomach.

“The horse must regularly be passing manure before they can be discharged,” said Dr. Chanutin. “We work toward the horse returning to a semi-normal diet before leaving PBEC. Once they are at that point, we can be fairly confident that they will not need additional monitoring or immediate attention from us.”

Returning Home

Drs. Davis and Chanutin often recommend the use of an elastic belly band to support the horse’s incision site during transport from the clinic and while recovering at home. Different types of belly bands offer varying levels of support. Some simply provide skin protection, while others are able to support the healing of the abdominal wall.

A belly band covering the incision.

Two Weeks Post-Surgery 

At the 12-to-14-day benchmark, the sutures will be removed from the horse’s incision site. The incision site is continuously checked for signs of swelling, small hernias, and infection.

At-Home Recovery

Once the horse is home, the priority is to continue monitoring the incision and return them to a normal diet if that has not already been accomplished.

The first two weeks of recovery after the horse has returned home is spent on stall rest with free-choice water and hand grazing. After this period, the horse can spend a month being turned out in a small paddock or kept in a turn-out stall. They can eventually return to full turnout during the third month. Hand-walking and grazing is permittable during all stages of the at-home recovery process. After the horse has been home for three months, the horse is likely to be approved for riding.

Generally, when a horse reaches the six-month mark in their recovery, the risk of adverse internal complications is very low, and the horse can return to full training under saddle.

When to Call the Vet?

Decreased water intake, abnormal manure output, fever, pain, or discomfort are all signals in a horse recovering from colic surgery when a veterinarian should be consulted immediately.

Long-Term Care

Dr. Davis notes that in a large number of colic surgery cases, patients that properly progress in the first two weeks after surgery will go on to make a full recovery and successfully return to their previous level of training and competition.

Depending on the specifics of the colic, however, some considerations need to be made for long-term care. For example, if the horse had sand colic, the owner would be counseled to avoid sand and offer the horse a selenium supplement to prevent a possible relapse. In large intestinal colic cases, dietary restrictions may be recommended as a prophylactic measure. Also, horses that crib can be predisposed to epiploic foramen entrapment, which is when the bowel becomes stuck in a defect in the abdomen. This could result in another colic incident, so cribbing prevention is key.

Generally, a horse that has fully recovered from colic surgery is no less healthy than it was before the colic episode. While no one wants their horse to go through colic surgery, owners can rest easy knowing that.

“A lot of people still have a negative association with colic surgery, in particular the horse’s ability to return to its intended use after surgery,” said Dr. Davis. “It’s a common old-school mentality that after a horse undergoes colic surgery, they are never going to be useful again. For us, that situation is very much the exception rather than the rule. Most, if not all, recovered colic surgery patients we treat are fortunate to return to jumping, racing, or their intended discipline.”