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Category: Medical

The Importance of Healthy Breathing for ​Top Equine Athletes

Featured on Horse Network

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.

A Horse Owner’s Guide to Colic Surgery Recovery

What To Expect After the Unexpected Strikes

Featured on Horse Network

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.”

Stallion Considerations Before Breeding Your Mare

stallion breeding process phantom mare at palm beach equine clinic in wellington florida

While the traditional breeding process needs no explanation, there are multiple avenues available when it comes to producing a foal. It is important to understand your horse’s reproductive options before starting the breeding process, such as the different conception rates between fresh-cooled and frozen semen or how to guarantee a live foal out of your breeding contract. Palm Beach Equine Clinic veterinarian Dr. Katie Atwood previously guided us through what to expect regarding the mare’s side of this equation, and below she explains several considerations for the stallion’s side.

Start with the Future Foal’s Purpose

When selecting a stallion for semen purchase, the first step is to assess what will be the foal’s purpose and projected goals. Many mare owners will recognize certain weaknesses in their horse and choose a stallion that could compensate for those shortcomings to create the ideal foal. For example, if the mare doesn’t have the scope they would like to have in the foal, an owner might choose a particularly scopey* stallion. Chances are in favor of two talented horses creating a talented foal. However, Dr. Atwood stresses that it is impossible to guarantee that a certain mare and stallion combination will produce the desired result.

“In breeding thoroughbred racehorses, we see a lot of examples of this,” explains Dr. Atwood. “Some owners will repetitively breed a racing stallion but none of his foals will accomplish anything close in comparison to his accolades. You can’t always predict what will come out of the breeding match.”

Still, Dr. Atwood makes a point of impressing upon her clients the importance of first knowing what they want for the foal’s future. Then, consider the health, genetic makeup, and bloodlines of the parents-to-be.

“There are a few genetic diseases that are little known and currently being more researched, such as Warmblood Fragile Foal Syndrome and Hyperkalemic Periodic Paralysis. Testing for these diseases is becoming more common. There are also hereditary traits such as cryptorchidism or conformational issues which are genetically predisposed. Conformational traits can be a factor, so it’s important to take these into consideration when choosing the stallion,” says Dr. Atwood.

Minimizing Risk Through a Breeding Contract

“It is important to have a solid breeding contract in place,” Dr. Atwood recommends. “A detailed agreement gives the owner of the mare specific guidelines as to what they are entitled to receive.”

teaser mare next to phantom hydraulic mare
PBEC’s teaser mare “Onyx” next to the hydraulic phantom mare.

Every breeding contract is slightly different, so you need to read yours carefully and ask questions. The breeding contract should outline the fees, rebreeding rights, the method of breeding, and the number of doses of semen. Some contracts include a live foal guarantee, which means that you will receive doses of semen until your mare produces a foal that stands and nurses.

Depending on the stallion and his semen availability, you may have a certain number of breedings, or rounds of semen shipments, per breeding season outlined in the contract. The contract, however, can be amended and Dr. Atwood finds this is a common practice because of the unforeseen possibilities that accompany reproduction.

“It can be extremely variable, but many stallion owners, depending on the demand for that stallion and his availability, are flexible,” she notes. “So, if you have an issue with breeding your mare, it’s worthwhile to ask the stallion’s owner to amend the contract. For example, if it is late in the breeding season and the mare’s owner chooses not to continue breeding that season but would like to try the next season, a lot of times the stallion’s owner will agree to extend the contract to the following year for a fee.”

The Stallion’s Breeding Options

You can breed your horse through live cover, artificial insemination with fresh semen, fresh-cooled semen, or frozen semen. The success of any breeding method resulting in a pregnancy is extremely dependent on the mare and stallion and their management. The mare’s age, her prior number of pregnancies, and reproductive health are crucial, as well as the stallion’s fertility, the number of mares he is booked to, and the handling and processing of his semen. Artificial insemination with fresh-cooled or frozen semen is now the norm in sport horse breeding as there are fewer risks and logistical challenges.

sperm to be put under microscope for stallion breeding process and sperm analyzation

“The beauty of frozen semen is that it lasts forever,” Dr. Atwood says. “Once frozen and appropriately maintained, it is, in theory, good forever. The interesting part is that this can help diversify bloodlines. Sport horses have evolved a lot over the last several decades, and the traits we look for in a horse have evolved as well. There are qualities that we may have overlooked in certain breeds or disciplines because of trends or preferences at that time. With frozen semen, you can go back to a stallion frozen years ago who may be a great option for your mare.”

Not all stallions’ semen can be frozen successfully as some are unable to thaw and still produce a pregnancy. Another option Dr. Atwood recommends is fresh cooled semen, which is often a good choice when breeding an older mare.

“I’ve had instances with mares that couldn’t get pregnant with the owner’s first choice in frozen semen. In that case, I do recommend going with a different stallion or fresh-cooled if available. Fresh-cooled semen is a great option because the sperm is healthier in theory; they are younger, and their motility is usually better.”

What’s Involved in Breeding with Fresh or Frozen Semen

Many veterinarians process, freeze, and package their breeding doses differently, but with the same goal of providing enough to ensure a pregnancy. Industry experts recommend one billion progressively motile sperm per breeding dose. Realistically, half of the sperm will be dead upon arrival and the resulting 500 million progressively motile sperm is found to be an appropriate amount.

“A lot of people say, ‘you only need one sperm’ to which the answer is yes, in theory, you only need one sperm, but you still need the rest of them to push that one sperm along,” explained Dr. Atwood. “You can’t just put a single sperm in a uterus and expect to get a foal. It just doesn’t work that way because you need a higher volume to build momentum and get that one sperm where it needs to go to form an embryo.”

With fresh-cooled semen, Dr. Atwood checks the mare to see if she is ready to be bred and if so, she schedules the stallion to be collected the next day. With the collection, she utilizes a Computer Assisted Sperm Analyzer (CASA) to assess certain parameters of the stallion’s fertility and then uses a cooling extender agent to preserve the quality of the sperm. The mare can be bred and then checked 24 hours later.

If freezing the semen, Dr. Atwood will process and analyze the sperm, also use an extending agent, and then a cryoprotectant to prevent damage to the sperm during the freeze. She packages the sperm into four to eight half-millimeter straws per breeding dose. Then the semen is placed on a rack and cooled in a temperature-adjustable fridge to prevent damage or sudden shock before freezing. The straws can then be placed into a vapor box for about 20 minutes before being submerged in a liquid nitrogen tank and stored indefinitely. When using frozen semen, once the mare is close to ovulating, she is given an ovulatory agent to help the process begin within 36-48 hours.

straws in liquid nitrogen final freezing stage in stallion breeding process
Straws being submerged in a liquid nitrogen tank for storage.

If you’re considering breeding your horse, having a knowledgeable veterinary partner on your team will help streamline the breeding process. They will be able to address any questions or concerns about your individual mare and stallion combination, and maximize your chances of producing a healthy foal. Speak with a veterinarian about your horse’s breeding options by calling Palm Beach Equine Clinic at 561-793-1599 or visit www.equineclinic.com/reproduction-and-fertility.

*A horse that jumps with little effort and great power is thought to have scope and considered to be scopey.

Hoofbeats of Blue Melody: Pony Bounces Back After Foot Laceration

Blue Melody hoof laceration progression of healing through three weeks.
Featured in The Plaid Horse, Pony Edition of August 2021 Issue

The old adage “no foot, no horse” is undeniably one of the truest statements when it comes to the horse. Many intricate structures compose this foundation, and the overall health of the hoof is paramount. So, what happens when a portion of your horse’s hoof is suddenly missing?

Owners Josh and Laura Gross found themselves in this predicament when their barn’s owner, Ayriel Italia, called them to say that their daughter’s Welsh pony had cut herself and needed immediate medical attention. While in the paddock, Blue Melody – known as Melody – had gotten her left hind hoof underneath the gate and suffered a serious laceration.

“We were initially frantic without more information,” recalled Josh. “We consider Melody a family member, and her rider is an eight-year-old.” The self-professed novice horse-owner parents had been learning the ropes of equine health and care through supporting their young daughter Saylor’s passion for horses. They turned to the expertise and guidance of Italia and trainer Shanna Sachenbacher, who immediately called veterinarian Dr. Kathleen Timmins of Palm Beach Equine Clinic.

Upon arriving at the barn, Dr. Timmins saw that Melody had an approximately two-inch-wide section of her hoof missing.

“A full thickness portion of the lateral hoof wall and the coronet band had been completely excised,” described Dr. Timmins. “It was a deep wound that exposed the sensitive laminae of the hoof. Thankfully, a thin section of the weight-bearing portion of the hoof distal to the laceration was spared, and the wound did not go deep enough to communicate with the distal interphalangeal joint or the coffin bone.”

Blue Melody's initial hoof laceration being cleaned at Palm Beach Equine Clinic in Wellington, Florida.

The sensitive laminae are an interlaced network of connective tissue, nerves, and blood vessels beneath the hoof wall. This highly-vascular layer attaches to and protects the coffin bone. Injuries to the coffin bone or joint structures can be devastating, often with long-term effects on the horse’s soundness and on the development of the hoof. In Melody’s case, Dr. Timmins found the laceration to be “more bark than bite,” as it did not affect those critical structures. Although Melody would likely have some degree of abnormal hoof growth from the damaged coronary band, Dr. Timmins had an encouraging prognosis for the pony.

“Dr. Timmins was so responsive that by the time we arrived at the barn to fully learn what had happened, the wound was already cleaned and wrapped, and we were told that Melody would make a full recovery,” explained Josh.

Blue Melody hoof laceration healing
Melody’s hoof as of April 1, 2021.

After an initial assessment and treatment of the wound at their barn, Melody was brought to Palm Beach Equine Clinic so that she could be observed and receive comprehensive medical care. Intravenous antibiotics were administered, and the laceration was thoroughly cleaned and bandaged with an added frog pad to support the hoof. Melody progressed well and was able to be discharged only 48 hours later. Along with a lesson in proper cleaning and wrapping of the wound, Dr. Timmins gave Melody’s owners and caretakers antibiotic and nonsteroidal anti-inflammatory medications. She also recommended a biotin supplement to aid in healthy hoof growth and advised that Melody would benefit from a few weeks of shoes with clips, which would provide lateral support to the section of the hoof wall that lost integrity.

With a full team supporting Melody’s recovery, the injury and medical care become less daunting to the Gross family. Only two weeks after the laceration, the wound showed great improvement, and Melody was able to be shod and very lightly worked. Four weeks after the injury, Melody received the green light from Dr. Timmins to resume full work with Saylor in the saddle.

Blue Melody with rider Saylor Gross
Saylor and Blue Melody.

“Dr. Timmins’ responsiveness and calm demeanor made all the difference. She put our minds at ease, took great care of our extended family member, and helped her get back on her feet (hooves!) more quickly than we expected.”

Josh Gross

Injuries to horses’ legs and hooves can be unnerving. Having a veterinarian immediately assess an injury and determine if it affects any vital structures is crucial for recovery. In case of an equine medical emergency, do not hesitate to call the veterinarians of Palm Beach Equine Clinic at 561-793-1599.

Blue Melody's hoof laceration healed well.
Melody’s hoof as of June 4, 2021.

Put Your Best Foot Forward

Dr. Bob Brusie examining the leg of a horse - summer hoof health from Dr. Stephen O'Grady at Palm Beach Equine Clinic

How to Keep Horses’ Hooves Strong Through Summer

Read this article on The Plaid Horse

Proper hoof health is hard to achieve any time of year, but during the hot summer months, a solid, healthy hoof is even more difficult to attain due to an increase in moisture in the environment. Each July, the American Farriers Journal dedicates a week of the calendar to recognize farriers for their dedicated commitment to delivering hoof care to horses. To honor our hoof care experts, we spoke with veterinarian and farrier Dr. Stephen O’Grady on how moisture contributes to a weaker hoof infrastructure and offers steps owners and managers can take to help keep moisture away and strengthen horses’ hooves.

Summer can bring scorching temperatures, so we tend to use more water to keep horses cool, both at competitions and at home. In many areas of the country, the humidity levels also increase during this time of year, adding moisture to the air and preventing hooves from drying as quickly. What happens to a hoof with excess water is similar to what would happen to a wooden plank that’s placed in a water trough: it becomes waterlogged, then softens and becomes weaker as a result.

Within a horse’s hoof, there is an exchange of fluids between the outer hoof wall and the inner section of the foot which consists of the bone, blood, and soft tissue structure. This fluid gradient helps keep the hoof wall healthy and promotes overall hoof health. When there is excessive moisture on the outside of the foot, the fluid gradient shifts toward the hoof wall and becomes overloaded with moisture, thus, the foot becomes saturated and the interchange of fluids is no longer effective, affecting a hoof’s mechanical properties.

The lack of flexibility caused by excess moisture creates a softer foot, which ultimately, as the weight of the horse presses down on the hoof, leads to issues such as flattening of the sole, flaring of the hoof wall and hoof wall cracks. A soft foot is also prone to losing shoes, due to its inability to hold nails well. The hoof structure was not designed to withstand as much water as we often subject it to during the summer months. However, there are ways to limit exposure to moisture, even in the hottest temperatures.

It is best to tackle issues that accompany moisture by going straight to the source and minimizing the amount of water that comes in contact with the hooves. This can be accomplished in several ways:

horse being bathed at palm beach equine clinic wet hooves - summer hoof health summer hoof health from Dr. Stephen O'Grady at Palm Beach Equine Clinic

1. Give your horse fewer baths.

Cutting down on how many times per day a horse is hosed can be difficult with competition horses that need to stay clean and that may be exercised, ridden, or shown several times per day. Still, it is important to be strategic about using water, especially on the legs. At home, try to occasionally let your horse air dry in front of the fan if a bath isn’t entirely necessary. Body clipping will help your horse’s heat tolerance this time of year and you may not have to use the hose after every ride.

2. Avoid standing water

If you must bathe, be sure the horse isn’t standing in excess water that rises over the hoof capsule. Try to shower off the horse in a dry area so the surface underneath the horse does not contribute to the moisture level. After being bathed, move the horse to a dry surface so their hooves can thoroughly dry.

3. Use hoof shields to direct water away from the hoof.

A good preventative tool to use while hosing is tight-fitting bell boots that cover the hoof and prevent external water from running down onto the hoof. The same effect can be accomplished with a gallon-sized Ziploc bag. Simply cut the bottom of the bag, place the horse’s foot inside, and seal the bag just below the fetlock to prevent excess water from sliding down the hoof.

4. Stand the horse in sawdust.

Sawdust and similar materials have a drying effect on hooves. If hooves become saturated for any reason, let the horse stand in deep sawdust to extract the moisture. Shavings would work also, but sawdust is the most effective for absorbing moisture.

Juan Martinez Hoof Polishing by Jump Media - summer hoof health from Dr. Stephen O'Grady at Palm Beach Equine Clinic
Photo courtesy of Jump Media

5. A shellac-type hoof dressing product can help prevent the hoof from absorbing too much water if applied before baths or turnout.

The majority of hoof dressings are intended for this purpose, however.  Ask your farrier or veterinarian to recommend options that will do the job when used one to two times per week. Boric acid powder can also be applied to horses’ feet once or twice a week, serving as an astringent for the hoof.

6. Avoid turning out early in the morning.

When humidity is high, the grass at dawn will have a high dew level, meaning horses will be standing on wet surfaces during the first hours spent outside. Though temperatures are cooler as the sun is still rising, for overall hoof health it’s best to wait until the grass has dried.

7. Farriery may need to be changed during the summer months to compensate for the increase in moisture.

Open the lines of communication between veterinarian and farrier. Veterinarians and farriers often do not communicate regarding a particular horse. This is a crucial step to ultimate hoof care. Each professional has a reason behind their decisions, and if the two work together as a team, the horse has a much higher chance of achieving optimal hoof health than if they each operated on their own agenda.

tips for keeping hooves strong through the summer from Dr. Stephen O'Grady at Palm Beach Equine Clinic - summer hoof health

Achieving a healthy hoof is not solely a farrier’s job; it is a whole team effort and requires dedication and attention. By implementing these recommendations into your horse care routine, you can play a role in how moisture affects your horse’s hooves. When considering the effects of excessive moisture on the hoof wall, it’s important to understand there are other factors involved, including the age of horse, breed, genetic makeup, foot conformation, and current farriery practices. With open communication and implementing these measures as a team, you are on the right track to achieving a stronger and overall healthier hoof.

The Benefits of Biologics: Regenerative Medicine for the Equine Athlete

Palm Beach Equine Clinic veterinarian Dr. Bryan Dubynsky examining the horse's front leg before administering a self-derived biologic treatment.

Veterinarians Help Horses Self-Heal to Maintain Optimal Health and Performance

When horses are not performing up to their usual standards, regardless of discipline, the signs can be subtle. Usually, it is the rider who first picks up on a slight feeling and questions whether something is off. A horse may suddenly be lacking impulsion, be uneven in its stride, or tripping more than usual. In the jumper ring, a horse’s discomfort can present itself as rails down. Riders can easily attribute these issues to their own shortcomings, but the veterinarian is able to understand if, and decide when, there may be an underlying issue. Helping equine athletes reach their full potential and maintain optimal health is the goal of sport horse medicine.

Sebastian, a 13-year-old Selle Francais gelding, had garnered accolades in the jumper ring at competitions around the world. While competing at the 2021 Winter Equestrian Festival (WEF) in Wellington, Florida, his performance was waning. He was not jumping the clear rounds he had cranked out consistently through his career, knocking down rails while jumping off his right lead in particular. Although owner Serena Marron had just purchased Sebastian in the fall of 2020, she knew that something was not right. She was aware of Sebastian’s capabilities and conferred with her veterinarian, Dr. Bryan Dubynsky of Palm Beach Equine Clinic, to get to the root of his performance issue.

Sebastian - Serena Marron - Sportfot photo from Winter Equestrian Festival 2021 in Wellington Florida 2
Serena Marron and Sebastian competing at WEF 2021 (Photo by Sportfot).

“Sebastian had a super clean vetting with no previous injuries, but his right-side fetlocks would often get a little sore,” said Marron. “My trainer and I decided to have Dr. Dubynsky evaluate Sebastian, and he opted for a self-derived biologic treatment in all four fetlocks and hocks. I’ve had horses respond well to this type of treatment in the past, so I knew it was a reliable option.”

Self-derived biologic treatments are a form of regenerative medicine, which encourage the body to self-heal through stimulating naturally occurring biological processes. Regenerative medicine is used to treat or prevent joint disease and soft tissue injuries and works to decrease some of the detrimental biologic processes that can inhibit or slow recovery. By promoting healing and a healthy joint environment, veterinarians are better able to support horses throughout their athletic careers. 

regenerative self-derived biologic therapy for horses

“Biologic agents found in the horse’s own blood can be harvested, concentrated, and returned to the affected area of that same horse,” explained Dr. Dubynsky. “This self-derived serum combines naturally occurring growth factors and anti-inflammatory mediators, among other agents, that can improve the structure, strength, and speed of healing. In equine sports medicine, we commonly use regenerative therapies to treat musculoskeletal injuries and as a preventative therapy to proactively preserve joint health.”

Some regenerative therapies, like the biologic treatment used for Sebastian, can be prepared stall-side and administered during one appointment. Autologous (self-derived) serums are natural and steroid-free with no drug-withholding times for horses competing in FEI or recognized competitions.

“As with many horses performing at the top of their respective sports, Sebastian had obvious synovitis in his joints,” noted Dr. Dubynsky. “Opting to treat this inflammation with a self-derived biologic as opposed to a corticosteroid promotes better long-term joint health instead of a quick fix.”

Palm Beach Equine Clinic veterinarian Dr. Bryan Dubynsky performing a flexion on the horse's hind leg before administering a self-derived biologic treatment.
Palm Beach Equine Clinic veterinarian Dr. Bryan Dubynsky performance evaluation on the lunge line before administering a self-derived biologic treatment.

After the injections, Sebastian was given a couple of weeks off from jumping to let the regenerative treatment do its job. Upon returning to full work, the difference in Sebastian was very apparent to Marron.

“I could tell the treatment worked right off the bat,” said Marron. “I could feel a difference in his body by the way he propelled off the ground and how he felt in training the day after a big class. He felt all around more balanced and even on each lead, which was a noticeable improvement.”

Sebastian soon regained his reputation for agile, clear rounds. The pair was able to successfully resume competition plans by jumping in the FEI two- and three-star divisions for the remainder of the WEF circuit. They now plan to continue competing at that level throughout the summer, along with national grand prix classes. “Sebastian has spent years jumping at the five-star level,” added Marron, “so we do whatever we can that will help him continue feeling his best.”

Sebastian - Serena Marron - Sportfot photo from Winter Equestrian Festival 2021 in Wellington Florida
Serena Marron and Sebastian competing at WEF 2021 (Photo by Sportfot).

Horses can reap the benefits of self-derived biologic treatments well before a serious injury occurs that could derail training or require a lengthy recovery. Different forms of regenerative therapy, such as stem cells, platelet rich plasma (PRP), and interleukin-1 receptor antagonist protein (IRAP), are actively being researched and improved upon. This evolving facet of equine medicine is now a common component of the competitive horse’s comprehensive, long-term care. 

“Traditional medicine tends to focus on treating the symptoms of health problems while regenerative medicine targets the root causes,” explained Dr. Dubynsky. “Non-steroidal anti-inflammatory drugs and corticosteroids can diminish the body’s healing response over time, and they do not address the underlying condition. In contrast, self-derived biologics stimulate normal, healthy tissue production instead of weaker scar tissue that is prone to re-injury.”  

Although Sebastian only underwent the self-derived biologic treatment, regenerative therapies can often be used in conjunction with other medications or alternative therapies. Palm Beach Equine Clinic’s veterinary team carefully assesses each horse to determine which treatments would be the most beneficial for the individual horse. To speak with a Palm Beach Equine Clinic veterinarian about your horse’s performance or regenerative therapy options, call 561-793-1599 or visit www.equineclinic.com.

Spring Flowers Bring Pollen Showers: How to Help Your Horse Cope with Allergies

A PBEC patient with a swollen eye due to allergies or a bug bite.

Got allergies?  Well, chances are, your horses do, too.

With warmer temperatures and spring blooms pushing up pollen levels, it seems like everyone at the barn – human and animal – is coughing and congested. If you have ever wondered what you can do to help a horse suffering from allergies, Palm Beach Equine Clinic veterinarian Dr. David Priest shares his knowledge on addressing allergies and helping horses breathe easy. In his daily veterinary work, Dr. Priest primarily focuses on equine respiratory health. He is experienced in treating conditions ranging from concerning coughs to obstructive or mechanical issues affecting airway function, such as recurrent laryngeal neuropathy (commonly known as “roaring”).

Types and Triggers of Equine Allergies

An allergy is an immune system response to a typically harmless substance, called an allergen. Allergic reactions can range from mild, gradual annoyances to sudden and severe. Generally, allergies manifest two ways in horses; in the respiratory tract or as topical skin allergies.

2. Respiratory Allergies

Respiratory allergies are somewhat similar to asthma in humans and are most commonly referred to as inflammatory airway disease. These respiratory allergies are most often caused by environmental allergens, such as dust, mold, and pollen. Nasal discharge, tearing eyes, and coughing can also be linked to respiratory allergies.

An increase in respiratory rate or an increase in respiratory effort – such as labored breathing or exercise intolerance – are two classic signs. Also, when a horse has a thick mucus-like discharge from its nasal passages, it is concerning to veterinarians as it could indicate an infectious type of respiratory illness. A veterinarian can distinguish whether the culprit is an allergen or if there is an underlying mechanical cause of the respiratory issue. Additionally, horses that experience a dramatic change in their environment may be affected. For example, those traveling from New York to Florida may suffer from completely different allergens such as tree pollens or smoke caused by the burning of sugarcane fields.

2. Skin Reactions

Allergies affecting the skin commonly appear as hives, dermatitis, or hair loss. The administration of topical products as well as a change in the type of stall bedding can trigger such reactions. Topical skin reactions can occur in a specific area or cover the horse’s entire body. Allergies to the common bacteria Dermatophilosis can occur resulting in a painful skin condition. Oftentimes, antifungal or bacterial shampoos can help alleviate this reaction. Consulting your veterinarian is key to determining if your horse suffers from allergies that may undermine your horse’s health or future.

The same allergens that cause respiratory symptoms can also cause skin reactions, but veterinarians tend to approach treatments differently for the two types of reactions.

Pictures: Upon arriving in Florida, this horse was hit with a allergic reaction causing hives all over its body accompanied by severe itching. The patient was initially treated with tripelennamine (injectable antihistamine) and dexamethasone, and then prescribed oral antihistamines and given an allergy and skin supplement to allow the horse to more comfortably adjust to its new environment.

Diagnosing Equine Allergies

Like most conditions, your veterinarian will start by getting a history of the problem, when it first appeared, and any changes that may have occurred recently in the horse’s diet or environment. They will follow with a physical examination, noting the site or region of the horse’s body where there is a flare up. Specific tests such as a biopsy and culture can be performed to rule out other skin conditions or causes – parasites, bacteria, or tumors. A bronchoalveolar lavage (BAL) or a tracheal wash where the veterinarian collects respiratory secretions and then performs a cytology of that fluid can determine if there are abnormalities or specific types of bacteria causing an infection. Serum (blood) allergy testing or imaging, such as an ultrasound of their chest, may be utilized to assess airway health and function and determine if the cause is allergy related.

Treatment and Taking Action Against Allergens

As in a visit to the human allergist, horses can undergo intradermal (skin) allergy testing to pinpoint the source of a horse’s reaction. For this procedure, the horse has a large patch of hair clipped down on their neck so that tiny amounts of various allergens can be injected into a grid pattern. The veterinarian will examine this grid during different time intervals for signs of an allergic response and determine if a targeted treatment can be taken against those specific allergens.

Photos: A PBEC patient with a swollen, tearing eye aggravated by itching, and its improvement after treatment with prescribed Neo-Poly-Bac-HC (eye medication), flunixin meglumine (Banamine), and protection by a fly mask.

Once the veterinarian determines your horse is suffering from allergies and not another condition, the first thing you can do is try to identify and eliminate the allergen. Figuring out what may have been associated with the onset of the allergic reaction is an inexpensive solution, and often the most effective approach.

From a stable-wide perspective, the most important thing you can do is try to minimize dust and flies, two of the most common allergens. While horses are not generally allergic to flies, some can be allergic to fly bites or specific fly species. Insect bites also increase the horse’s stress level, which can further contribute to the immune system’s response.  While eliminating insects and environmental allergens is impossible, there are several tactics barn managers can take to mitigate both problems.

A good manure disposal system can cut the population of insects in the barn, as will a reduction in any standing water, especially in the springtime when flies and mosquitoes start to reemerge. Owners can protect their horse from insects by using fly sprays, masks, sheets, and boots, and keeping horses inside during times of the days when bugs are most active. Dust- and pollen-related allergic reactions tend to occur when horses are in the barn because it is a closed-air environment. Dust control tactics, such as wetting hay and shavings, keeping barn aisles clean and swept, and managing fresh airflow in the barn with fans and open doors and windows all contribute to better airflow.

Veterinary treatment is the next line of defense in treating allergies. For acute reactions, some horses benefit from short-term treatment with corticosteroids or antihistamines. Those treatments, however, can have side effects and are prescribed when other interventions, such as modifying the environment to reduce the allergen, are ineffective. Immunomodulatory therapy (allergy shots) is another option that may be effective and can be discussed with your veterinarian.

Knowing how to identify allergies affecting your horse and taking steps to eliminate the allergens will lead to easier breathing and happier horses in your stable. For more information, contact Dr. David Priest at Palm Beach Equine Clinic by calling 561-793-1599.

Keeping Horses in the Game

Navigating Lameness Prevention and Treatment

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

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

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

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

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

Keys to Catching Lameness Early

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

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

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

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

Treatment Options

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

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

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

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

What to Expect BEFORE Your Mare is Expecting

Considerations for Breeding the Sport Horse Mare

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

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

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

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


Start with a vision for the future foal

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

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

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

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

Evaluating the mare’s reproductive soundness

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

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

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

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

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

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

Getting the timing right

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

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

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

embryo transfer breeding mare Dr. Katie Atwood

Considering a surrogate mare

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

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

What the surrogate mare process entails

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

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

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

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

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

Speak with a veterinarian about your mare’s breeding options

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

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

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


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Master of Manipulation

Veterinary Medical Manipulation Case Study

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

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

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

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

Case Study

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

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

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

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

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

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

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

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

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

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

Dr. Lukens

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


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