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Category: Patients

The Road to Grand Prix Glory: Royale is Back in Action Thanks to Palm Beach Equine Clinic

When rider Meagan Davis and owner Scott Durkin think about the goals they have for their dressage horse Royale, they have tunnel vision for the grand prix ring. Royale, a 16-year-old Oldenburg gelding (Routinier x Ironman) was well on his way to accomplishing that goal during the 2019 season when something strange started happening.

After arriving at their winter home in Loxahatchee, FL, from a northern base in Stone Ridge, NY, Davis kicked off Royale’s winter competition schedule with a show in January. The horse was coming off a very successful fall season that included CDI Intermediaire I and CDI Prix St. Georges victories at the New England Dressage Fall Festival and Dressage at Devon.

“Our first show was unusually chilly and I noticed that Royale was breathing a little hard and didn’t sweat very much,” recalled Davis. “I didn’t think that much of it because of the weather, but when we returned home and it warmed up, he wasn’t sweating at all.

“He could not catch his breath after being perfectly fit a month before,” continued Davis. “I rely on Palm Beach Equine Clinic for the care of all the horses in my barn and I immediately turned to Dr. Robert Brusie.”

Dr. Brusie is a Board-Certified Surgeon at Palm Beach Equine Clinic and was diligent about ruling out any physical causes of Royale’s obvious discomfort and decline in performance. After flexion tests, checking for musculoskeletal problems, and assessing soreness or wear and tear, Dr. Brusie turned to Palm Beach Equine Clinic’s Internal Medicine Specialist Dr. Peter Heidmann.  

“Dr. Brusie was watching me work him one day, noticed the decline in muscle, the lack of sweating, and labored breathing, and recommended we take a deeper look with a specialist,” said Davis. “That is why I trust Palm Beach Equine Clinic with the care of my horses. They have so many tricks up their sleeves, and their clients are fortunate that the veterinarians collaborate so well together in order to do what’s best for the horse.”

Dr. Heidmann’s first step was to asses any neurological causes by testing for equine protozoal myeloencephalitis (EPM) and Lyme disease. Both were negative. He then moved on to a nutrient analysis.

“When you see weakness and poor muscle mass in a horse, two of the things you test for right away are vitamin E and selenium deficiencies,” said Dr. Heidmann. “Both are common causes of decreased performance due to low concentrations in local soil or the soil where a horse’s hay derives from.”

No deficiencies were found in Royale, which prompted Dr. Heidmann to move on to muscle testing. He drew blood from Royale, put him in work, and then drew blood again four to six hours later. When comparing enzymes in the blood from before and after work, Dr. Heidmann looked for any large increase, which would indicate the problem was in the muscles themselves. Royale’s tests, once again, came back normal.

At this point, Dr. Heidmann returned to the case history and started following the shortness of breath symptom, noting, “Breathing abnormalities in horses are difficult to diagnose by simply listening because their chest wall is so thick. What I wanted to asses was prolonged recovery. This is done by placing a bag over a horse’s nose to get them to breathe deeply. Once the bag is removed, breathing should regulate within two to three breaths. Royale needed four to five breaths.”

Once Dr. Heidmann identified a possible cause, he performed abronchoalveolar lavage (BAL), which is essentially a lung sample used to identify abnormal cells. He inserted a small-diameter tube through the trachea, flushed saline into the lung, and then suctioned it back out.

“Sure enough, when I examined the sample, there was mucus and abnormal cells,” said Dr. Heidmann. “Despite his bloodwork being normal and no obvious infections, Royale was battling equine asthma or ‘heaves.’”

The treatment for asthma in horses is very similar to what’s done for humans and includes an anti-inflammatory bronchodilator drug and inhaled steroids. 

“While his breathing issues were significant enough to affect performance, Royale’s treatments were relatively mild with immediate and substantial improvement,” said Dr. Heidmann. “I used nebulized herbal remedies, steam, and Ventipulmin, which is an oral syrup.

“I’m a less-is-more person and veterinarian,” he continued. “I try to have the best outcome with the least amount of medications. Additionally, we created some routines that would minimize environmental dust and allergens, such as using a hay net, wetting down hay and bedding, or using chopped newspaper as bedding.”

Royale stayed on the prescribed medication through his trip home to New York and came off them at the end of May. Today, he is back in work and has regained the fitness and muscle he had during the fall. According to Davis, their goal is to step into the grand prix ranks during the upcoming season.

“My favorite cases are the sickest of the sick and the most elusive needle in a haystack,” concluded Dr. Heidmann. “Royale’s case definitely fell into the latter. It was really challenging, but rewarding because the outcome was a horse that is dramatically different than he was four months ago. But the most important part of this case for me was working together with Dr. Brusie. I would have not been successful in helping this horse if he hadn’t done all the work prior to coming to me. That kind of collaboration is what contributes to our success and sets Palm Beach Equine Clinic apart!”

Blazer Back to Winning Ways after Sinus Cyst Surgery

Jo Ann Hopkins and her 12-year-old Appendix-bred gelding, Blazer, are currently placed third in points in the local 1D barrel racing circuit in Florida. However, just three months ago, Blazer underwent surgery at Palm Beach Equine Clinic for a growing cyst in his sinus. On August 1, 2015, Dr. Weston Davis, DACVS, performed the surgical procedure on Blazer for an expansile paranasal sinus cyst of the left paranasal sinuses, extending to the right concho-frontal sinus.

Hopkins noticed that Blazer, who she calls “George” for his laid-back attitude, had a raised knot on his head this spring and consulted with her local vet, Dr. Kelly Alderman. The area was monitored closely and remained the same until June, when Hopkins noticed Blazer wheezing while running barrels and the knot increasing in size.

Dr. Alderman performed radiographs on the site and aspirated the swelling where a substantial amount of fluid was removed. She confirmed that the bump was a suspected paranasal sinus cyst. At that point, Blazer was referred to Dr. Weston Davis of Palm Beach Equine Clinic, who advised Hopkins that the cyst was likely growing slowly within the sinus for a considerable amount of time with no clinical signs. The diagnosis was an expansile paranasal sinus cyst of the left paranasal sinuses, extending to the right frontal sinus.

For surgery, Blazer was placed under standing sedation and local analgesia (painkiller) and his head was aseptically prepared before Dr. Davis performed a frontonasal sinusotomy (incision into the sinus). He made an opening from the middle of Blazer’s head to the corner of his eye. Once the skin flap was elevated and the bone fractured, a large amount of fluid was evacuated, which is consistent with the contents of a paranasal sinus cyst. Dr. Davis also observed that the sinus cavity was extremely distorted and expanded. The cyst lining was debrided and removed, then the sinus was lavaged and a tube was advanced into the sinus cavity to facilitate drainage. The sinus was packed with gauze tied together and soaked in a dilute betadine. Finally, the bone flap was replaced and the skin was closed and covered with a sterile bandage.

The gauze packing was removed 48 hours after surgery and upon release from Palm Beach Equine Clinic, Hopkins was instructed to monitor the incision for heat, swelling and discharge. Bute, in the amount of 2g, was administered orally once a day for five days and Dr. Alderman removed the sutures after 10 days.

Hopkins characterizes Blazer as a sweet gelding with heart to spare, and is happy to report that his recovery has been fantastic. After six weeks of stall rest and rehab time to get back in shape, Blazer recently won his first barrel race after surgery. According to Hopkins, Blazer is running better than ever thanks to Dr. Davis and the staff at Palm Beach Equine Clinic.

OTTB Gets a Second Chance at New Career Thanks to PBEC

Palm Beach Equine Clinic is renowned for its exceptional care of performance sport horses of all disciplines around the world. Sometimes, the veterinarians and surgeons have the opportunity to treat the horses owned by their colleagues. This summer, PBEC veterinary technician Megan O’Neal experienced the clinic’s surgical expertise firsthand when her rescued off the track Thoroughbred was diagnosed with severe spinal impingement.

O’Neal adopted Blessing, a ten-year-old mare, almost three years ago. After Blessing’s career on the track ended, she was given to Pure Thoughts Horse Rescue in Wellington, FL. Blessing had moved through a few foster homes before O’Neal gave her a forever home. Blessing had been successfully jumping three-foot courses with one of her previous foster homes. After adopting Blessing, O’Neal was jumping the mare as well, but only about two-feet high. She had plans to compete, but Blessing’s behavior changed under saddle. The mare began rearing and bolting, endangering both herself and her rider. Her attitude on ground handling turned sour as well, no longer enjoying to be groomed and pinning her ears in agitation.

With the help of staff surgeon Dr. Weston Davis and the excellent imaging technology available at PBEC, O’Neal was able to pinpoint the cause of Blessing’s troubling change in behavior. The diagnosis was severe chronic back pain with dorsal spinous process impingement (kissing spine lesions). The vertebrae in her back from T16 – L1 were affected, which is the mid-section of the horse’s back, in the general region of where the back of the saddle sits.

The first course of action was to try several non-surgical techniques to treat Blessing’s pain. Dr. Davis tried treatments of intramuscular injections for arthritic pain and corticosteroid injections in between the spinal vertebras. A veterinary chiropractor adjusted the mare every few weeks. For almost eight months, several additional methods were tried to avoid surgery including acupuncture, back stretches and oral muscle relaxants. In July, when the pain continued after all their efforts, O’Neal finally decided that surgery was the only option for recovery.

In the state-of-the-art hospital at PBEC, Blessing was sedated to obtain pre-operative radiographs that map the exact site of the lesions. She was placed under general anesthesia and the surgical site was sterilely prepared. Dr. Davis made a single 20cm incision on the dorsal midline over the palpable dorsal spinous processes. Eighteen-gauge needles were inserted at regular intervals and used as radiographic markers to identify the interspinous spaces. The incision was extended through the supraspinous ligament at each site. Dr. Davis used sterile surgical equipment, known as a bone rongeur, to elevate the soft tissues and resect some of the affected dorsal spinous processes (DSPs). The rongeurs, which are similar to large pliers, were used to slowly remove the edges of the overriding bone. This process frees the space between adjacent vertebrae until widened enough that the index finger of the surgeon could easily pass in the interspinous space. The site of resection was lavaged to remove any loosed tissues. Lastly, Intra-operative radiography was used as needed to confirm location and completion of the surgery. Following confirmation, the supraspinous ligament was internally closed with absorbable sutures. The skin was closed with surgical staples and a stent was sutured in place over the incision. After several weeks of healing, the stent and staples were removed.

The surgery was performed without complication and Blessing was provided a good prognosis. Soon after surgery, the space that was created between vertebrae filled with a non-painful, fibrous scar tissue. Blessing went home the following day after surgery. She was monitored closely at home and received routine peri-operative antibiotics (gentamicin and penicillin) and anti-inflammatories (phenylbutazone) for pain. Recently, O’Neal was given the okay from Dr. Davis to resume riding for normal exercise. O’Neal looks forward to continuing her partnership with this special mare. Thanks to Dr. Weston Davis and the team at Palm Beach Equine Clinic for their exceptional care to get Blessing back to happy and healthy!

Bal a Bali Makes a Comeback with Palm Beach Equine Clinic

Thoroughbred Brazilian Triple Crown winner Bal a Bali was admitted to Palm Beach Equine Clinic (PBEC) on August 3, 2014. The elite athlete was treated for life-threatening laminitis by Staff Surgeon Dr. Weston Davis of PBEC in conjunction with Dr. Vernon Dryden just months after his Triple Crown win in March of that year.

Brazil’s 2014 Horse of the Year, Bal a Bali (Put It Back—In My Side, by Clackson) took an impressive win in the Grande Premio Cruzeiro do Sul (Brz-I) to become the country’s 12th Triple Crown winner. He finished the race in track-record time at Gavea racecourse.

Following his last start in June 2014, Bal a Bali was purchased by Fox Hill Farm and Siena Farm and imported to the U.S. in late summer, but unfortunately contracted laminitis during his travels. Bal a Bali was in a Florida quarantine scheduled to fly to trainer Richard Mandella’s stable in California when the problems developed.

Bal a Bali was quickly moved to Palm Beach Equine Clinic where he was received by Dr. Weston Davis, who would oversee his care in hospital for the next three months. PBEC set aside a barn as a quarantine unit to meet the horse’s final import requirements where he was treated with aggressive cryotherapy – a gold standard of laminitis care. Hospital Staff monitored Bal a Bali in the cold-water spa continuously for the next several days through the severe acute phase of his disease, and then he was gradually weaned out of the spa as he improved clinically.

On two occasions, Dr. Davis performed Intravenous Regional Perfusions of the feet with state of the art Stem Cells. A myriad of other medical therapies were administered though the course of his stay. Progression of laminitis was monitored closely with the use of radiographs, and advanced farrier management for the optimal sole support and mechanics to decrease strain on his fragile lamina. By October, the horse was cleared to travel to Siena Farm in Kentucky. There, Dr. Dryden continued to treat the horse and he was then flown to California in January.

After a nine-month recovery process, Bal a Bali made a miraculous return to the track for his North American debut in May 2015. He cruised to victory in the $100,000 American (G3), a one-mile turf race for three-year-olds and up at Santa Anita Park. At that point, the five-year-old horse had captured 12 of 13 career starts and earned $570,078. Bal a Bali’s comeback was no doubt a result of the outstanding care he received at Palm Beach Equine Clinic under the extraordinary supervision of Dr. Weston Davis and Dr. Vernon Dryden. Thank you Fox Hill Farm and Siena Farm for the trust you placed in PBEC.
 photo takenby: R A Y E T T A    B U R R/ B E N O I T   P H O T O

PBEC Saves Nelson Pessoa’s Artemide d’Ecaussinnes

The Miracle Horse: Artemide d’Ecaussinnes

By Jennifer Wood Media, Inc.

Owning a horse comes with a degree of uncertainty and worry. If your horse has a traumatic accident, sometimes the very best you can hope for are swift care and an eventual recovery. For show jumping legend Nelson Pessoa, seeing his horse Artemide d’Ecaussinnes with a severe trauma in the ring was a shock. But what came afterward surprised him even more.

Pessoa purchased Artemide d’Ecaussinnes, an eight-year-old BWP gelding, at the beginning of the year. The young horse showed at the FTI WEF with Pessoa’s rider, Stephan Barcha, and another junior rider, Joao Victor Castro. “It’s a horse that shows a lot of promise, to be a nice horse for speed classes or a junior horse. It’s a horse with a wonderful character,” Pessoa said.

Artemide’s trajectory changed in the blink of an eye on Friday, January 31, in the DeNemethy Ring in a 1.40m class. With Castro riding, the pair had a miscommunication at an oxer and landed on the standard. In a freak accident, the wood sheared from the attached metal strip holding the jump cup, which then went into the horse’s stomach. Luckily, horsemen on the side of the ring and the jump crew reacted quickly to be at the horse’s side, and the horse’s groom, Waldeci da Silva ran from the in-gate to help keep Artemide’s organs inside his body. In the gruesome accident, it was the quick thinking of these individuals that helped save his life.

“It was just really bad luck, it wasn’t anybody’s fault,” Pessoa recalled. “The horse was looked after really quickly. The staff from the show grounds was really good. They made the necessary decisions to help him.”

Those helping in the ring had the unenviable job of holding Artemide’s intestines to keep a bad situation from turning worse. Dr. Hillary Clayton was there shortly to start bandaging the horse, and
the Palm Beach Equine Clinic was quick to react as well, bringing the equine ambulance in immediately to transport Artemide less than a mile away to Palm Beach Equine Clinic (PBEC), where he went into surgery with no delay. All in all, only 30 minutes elapsed from the time of the accident to when Artemide went into emergency surgery.

The surgery was led by Dr. Robert Brusie and Dr. Weston Davis of PBEC, which has three Board Certified surgeons. Dr. Brusie praised the quick thinking of fellow competitors, the DeNemethy Ring jump crew Rafael Rios, Cesar Morales, and Steven Sarmiento, as well as da Silva. “I called (horse show manager) David Burton and told him his people did a fantastic job keeping (the horse) quiet. That injury is really painful, with intestines out of his abdomen. The horse was panicky all the way over here until we anesthetized him, with extreme pain. I was really pleased with the way everything worked. We rehearse these kinds of things, (but) we mainly have fractures, ruptured tendons, as injuries. We do have drills before the season with the ambulance driver. It paid off. Nothing was a surprise, and nobody wondered what to do next. It’s being ready and prepared.”

When Dr. Brusie and Dr. Davis performed the surgery, they were pleased to see that while it was a traumatic injury, there were no vital organs pierced and that the horse’s bowel only had a tear in the section outside of the horse’s abdomen. A second incision was made in the horse’s abdomen to help facilitate the surgery. “We were really fortunate with that guy,” Dr. Brusie remembered. “We ended up taking out about two feet of intestine. He broke a couple of ribs (too).”

“It was good luck for us that the (Palm Beach Equine) Clinic is very close,” Pessoa said. “Dr. Brusie did an unbelievable job.”

Artemide’s miraculous recovery is the combination of quick thinking and amazing care at Palm Beach Equine Clinic, but Pessoa believes the horse’s mindset is what solidified his chances of recovery. “One important point is that the horse is an unbelievable patient. Two hours after he was back in the stable, he wanted to eat and he was drinking. We were waiting for an infection or a temperature, but he had no temperature. It was like it was just a little cut. Twenty-four hours after the surgery, the horse was looking like nothing happened with him,” he explained. Dr. Brusie agreed, “It’s a really good temperament horse. It took a lot of courage for him to stand there and not thrash around. He’s a good horse.”

Artemide is currently getting back in shape by walking on a treadmill. Dr. Brusie compared his situation to colic surgery, where after 10 days recovering at PBEC, he went home, and he can be ridden again 30 days after surgery.

Pessoa expressed, “They said it was a miracle. I really want to say for everybody that has a horse here at this horse show, this clinic is something. You hope things like this won’t happen, but for sure with the number of horses and the amount of jumping here, things like that happen sometimes. It’s a great thing to have this support. People don’t always realize this – we realize now because it happened to us. I’m very grateful for them.”

Along with Drs. Brusie and Davis, Pessoa also gave thanks to Dr. Jorge Gomez and Dr. Selena Passante, his treating veterinarians, along with “the staff, the jump crew from the horse show, they saw the situation and helped save the horse.”

“We had no idea whose horse it was; we just had to save his life,” said Dr. Brusie. “This horse was meant to live. I was amazed neither one of those sites had any infection after we were done. It was meant to happen, and he was meant to live. It was a good feeling and a day when it was good to be a veterinarian.”

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