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.

Colic is every horse owner’s worst nightmare, but when the colicking patient is also pregnant, colic emergencies pose an even bigger challenge for their owner and the team of veterinarians entrusted with their care. In late February, a pregnant mare was brought to Palm Beach Equine Clinic by her owner for colic. Leading the PBEC team on this case were Drs Justin McNaughten DACT, Peter Heidmann, DACVIM, and Elizabeth Barrett, DACVS-LA. We spoke with Dr. McNaughten about the steps he and the team took to keep both the mare and foal safe.

What was the mare’s status when she was admitted to the clinic?

The presenting complaint was colic. At the time of admission, the mare had an elevated heart rate of 120 beats per minute. We then passed a nasogastric tube, which resulted in approximately 15 liters of spontaneous reflux. Once the stomach was decompressed, we proceeded with the rest of the colic work-up. As the mare was in the later stage of pregnancy, the foal occupied the majority of the abdomen. Findings on rectal palpation and abdominal ultrasound were inconclusive. The working diagnosis was ileus or decreased gut motility, but the root cause was still unknown. As part of the medical treatment, the mare had to be fasted. We started her on IV fluids with prokinetics, electrolytes, and dextrose as a source of nutritional support for the foal. Overnight, the mare remained comfortable but continued to have small amounts of reflux. The next morning, she was showing new signs of gas distension, which were not present at the time of admission. An abdominocentesis or ab-tap revealed elevations from the normal peritoneal fluid values suggesting that surgery was warranted. 

What factors did you take into consideration before deciding to treat the mare?

When we are dealing with pregnant mares, we often make decisions based on the stage of pregnancy. The biggest obstacle is trying to treat the mare and doing what is safe for the foal in utero. For example, we may use different medications that are safe during one stage of pregnancy and not another, or delay procedures until after the mare delivers the foal. In this case, the owner didn’t have an ovulation date because the breeding had occurred in a paddock. A couple of diagnostic tests can be used to provide a rough estimate of the foal’s gestational age, measuring fetal orbit and the fetal aortic diameter. The results are interpreted as a rough estimate as the reference values have not been determined for each breed. Unfortunately, in the mare, gestation length does not correlate with fetal readiness or her foal’s ability to survive once it’s born. We also performed a diagnostic test to help determine fetal readiness based on evaluating the mare’s mammary secretions. In this case, we specifically measured the pH level. 

Based on the mare’s need for colic surgery and the pH levels of her mammary secretions, the team of specialists discussed the options, weighing a fairly extensive list of potential risk factors for the mare and the foal. The owner was presented with the options of performing colic surgery with the foal still in utero or inducing parturition and performing colic surgery once she foaled. At the owner’s request, we induced foaling, which carries its own set of risks and can be life-threatening to both the mare and foal. 

In this case, fortune was on our side. Following a successful assisted vaginal delivery, the newborn filly was hitting each of our targets for neonates. Although the filly was not showing any external signs of prematurity, we took radiographs of the knees and hocks as a precaution. The x-rays showed that the filly was a bit premature based on the incomplete ossification of the cuboidal bones, which make up the knees and hocks. 

Following the delivery, the mare was then taken into surgery. During the colic surgery, Dr. Barrett identified and removed a very large fecalith, which we assumed was the root of the problem as it had the potential to obstruct the bowel. A fecalith is a hard concretion of ingested material that may increase in size and end up being a blockage in the gastrointestinal tract. 

What did their postoperative care look like? 

Post-surgery, the mare did very well. While hospitalized, she remained comfortable, tolerated refeeding, and displayed great maternal behavior. The filly was started on prophylactic antibiotics and given milk initially through a feeding tube until the mare had enough milk to sustain the foal. Approximately 48 hours after foaling, the filly developed signs of neonatal maladjustment syndrome, which manifests as neurologic abnormalities. One moment the foal was healthy, bright, and nursing, and the next, she was dull, listless, and disoriented. The condition subsided following IV administration of neuroprotective agents and through the use of the Madigan foal squeeze technique. The Madigan squeeze technique is a physical compression procedure that involves wrapping a foal’s upper torso with loops of soft rope and applying pressure for 20 minutes, which replicates the compression a foal experiences during birth. 

Post-surgery, the mare did very well. While hospitalized, she remained comfortable, tolerated refeeding, and displayed great maternal behavior. The filly was started on prophylactic antibiotics and given milk initially through a feeding tube until the mare had enough milk to sustain the foal. Approximately 48 hours after foaling, the filly developed signs of neonatal maladjustment syndrome, which manifests as neurologic abnormalities. One moment the foal was healthy, bright, and nursing, and the next, she was dull, listless, and disoriented. The condition subsided following IV administration of neuroprotective agents and through the use of the Madigan foal squeeze technique. The Madigan squeeze technique is a physical compression procedure that involves wrapping a foal’s upper torso with loops of soft rope and applying pressure for 20 minutes, which replicates the compression a foal experiences during birth. 

After a few days, both mare and foal were discharged to the care of the farm. At home, the pair were placed on stall rest followed by additional exercise restrictions allowing time for the mare’s abdominal incision to heal and the filly’s cuboidal bones to fully mature. Now, exactly one month later, I’m happy to say that both the mare and her foal are thriving. 

Palm Beach Equine Clinic is available 24/7 for any equine emergency and works regularly with referring veterinarians. For more information, call 561-793-1599.

veterinary medical manipulation / chiropractic benefits for dressage horses - Dolton Roxanne Trunnell by Dr. Natalia Novoa

In order for top-level performance horses to compete at their best, they must have full range of motion throughout their bodies as well as the ability to move freely. When a horse is out of alignment, a joint, whether it is in the spine or elsewhere in the body, is restricted in its normal range of motion. Veterinary medical manipulation, or what is known as a chiropractic adjustment in humans, is a form of alternative medicine that aims to solve this issue. The goal of any adjustment is to restore the optimal range of motion to that joint, which will subsequently alleviate inflammation in and pressure on surrounding nerves and soft tissue. 

Dolton, a nine-year-old Hanoverian gelding owned by Karin Flint, is a well-known name in the para-dressage world. The gelding won two individual gold medals with Roxanne Trunnell at the 2020 Paralympic Games in Tokyo, Japan. Dolton was special from a young age and won his first bronze medal when he was only six years old at the 2018 FEI World Equestrian Games. The pair is trained by Andrea Woodard, who often rides Dolton herself and stays very involved in all aspects of his care. Woodard and Dr. Natalia Novoa of Palm Beach Equine Clinic, who have worked together to treat Woodard’s own horses, thought Dolton could benefit from medical manipulation.

Dr. Natalia Novoa regularly helps Dolton, a para dressage horse, with veterinary medical manipulation. Photo courtesy of Dr. Novoa.

“What I found with Dolton was very common with any dressage horse,” noted Dr. Novoa. “When working with Dolton I make sure that he is correctly aligned. I also address any pinched nerves, tight muscles, tight myofascial, and anything else that could create pain. I saw that the adjustments and the myofascial release were very beneficial for him.”

When a horse is out of alignment, it may result in their gait appearing different than usual, even at a walk. If one area of the body is not functioning properly, horses have to compensate, which  can result in many common sport horse injuries. Medical manipulation aims to fix this issue by applying varying amounts of pressure to specific segments of the horse’s body, mainly focusing on the spine. This form of manual therapy, performed by a certified practitioner, often targets joint issues and muscular development. Additionally, medical manipulation can help in stimulating nerve reflexes and reducing pain.

“I like that I can tell Dr. Novoa what I’m feeling, and she tells me what she feels,” described Woodard. “We trust each other’s judgment, which helps in pinpointing where the issue is in the horse. Sometimes it’s something in Dolton’s body that’s not sitting how it’s supposed to. If something is out of position and Dolton is not moving how he is supposed to, other parts of his body can get sore.”

If done routinely, medical manipulation can benefit a horse’s natural balance, topline, and overall performance while also aiding in pain and soreness relief. Once Dr. Novoa began working with Dolton on a regular basis, it became easier for her to not only focus on the areas he needed help with the most, but also to fix them.

“The more I continued working with him the better he performed,” commented Dr. Novoa. “We were able to identify the misalignments and any patterns so that we could more easily correct them. He was progressively more comfortable with treatments as we continued with a regular program in place because he knew what to expect. He is a very sensitive horse. I know his areas of strength and weakness, so we developed a system that works for him, and we continue to have great results.”

Being certain that Dolton’s body is functioning properly is extremely important in para-dressage. Flint makes sure that both Woodard and Dr. Novoa are integral in his care so that Trunnell and Dolton can be confident stepping into the ring.


“With para-dressage you never know what you’re going to get that day with your body,” described Flint. “This means that it is really important to know what horse you’re getting. That’s why chiropractic work, all their care, and overall health is so important.

“The reason we like Dr. Novoa is that she’s very knowledgeable about the physics and mechanisms of the horse,” continued Flint. “Someone who isn’t familiar with this can do more damage, which is true with humans too. Someone who doesn’t listen to signals can end up putting the horse in more pain. She is very, very good at what she does.”

Sport horses are able to perform at their best when they are comfortable and have proper range of motion throughout their body. It is helpful to have horses examined by a certified veterinary medical manipulation practitioner to check that their body is moving properly and to decrease the chance of an injury due to compensation. Call Palm Beach Equine Clinic today at 561-793-1599 to set up an appointment.

Featured in The Plaid Horse

A new life is something to celebrate, but when a newborn foal has complications and a fever of unknown origin, the fear can be overwhelming. For Robin Hogan of Myrland Stables in Davie, Florida, getting her newborn foal the help it unexpectedly needed was the first priority.

Hogan fell in love with her mare Vogue, a black and white Gypsy Vanner, when it came to her barn for training. The two connected instantly. There was only one caveat; Vogue was pregnant. Still, Hogan welcomed the added bonus and was excited for the chance to raise a foal that could eventually join Vogue in the equine therapy program that she is planning.

Vogue had a somewhat difficult birthing, but eventually “My Wildest Dream,” known in the barn as Eros, was born. Everything seemed good as Hogan navigated the early days of caring for Eros and his mother after birth, but at only four days old, Hogan noticed that Eros’ playful, spirited attitude had changed.

foal with patent urachus
“Eros” owned by Robin Hogan.

“He was a little bit on the lethargic side,” remembered Hogan. “I walked Eros and his mom out to the pasture, and he seemed to decline when he was there, like it must have taken all his energy to get to the pasture. It was surprising because just the day before he was running around, and even the night before he was running and playing. It just happened that quick. It was crazy. I noticed he was peeing out of his umbilicus (navel) which was a big red flag.”

Hogan was able to move Eros back to the barn and found that he had an extremely high temperature. Hogan called her veterinarian, Dr. Natalie Carrillo, and they were able to bring the foal’s temperature down slightly. However, when it spiked again, he was administered intravenous fluids and the decision was made to take Eros to Palm Beach Equine Clinic (PBEC) in Wellington, Florida.

Hogan noted, “PBEC had come highly recommended, and I thought, ‘If you’ve got a chance to save him, this is it.’”

Eros was admitted to Palm Beach Equine Clinic and placed under the care of board-certified internist Dr. Peter Heidmann and Dr. Sidney Chanutin. Upon examination and palpation of the foal’s umbilicus, they noted urine dripping out.

During fetal development, the umbilicus is connected to the urinary bladder via a tube called the urachus. Normally, within a few hours after birth, the urachus will shrink and close at the navel, and then urine is diverted to empty through the urethra into the bladder. When the urachus does not close completely, urine can dribble out from the umbilicus. This condition is referred to as patent urachus, and it may happen within the first few weeks of life, even after the urachus originally appeared to have sealed at birth.

Eros was diagnosed with patent urachus, along with omphalitis (infection of the umbilical stump) and septicemia (bacteria present in the blood), which are severe complications commonly seen in foals.

Dr. Chanutin performed an ultrasound examination on Eros, which confirmed the patent urachus and helped determine the presence and extent of infection in the umbilical structures. Blood cultures and a complete blood count were taken, as well as bacterial cultures of the navel to determine which bacteria were causing the infection. This helped the veterinarians confirm the appropriate antibiotic choice for the foal.

In some cases, surgical removal of the infected navel structures is needed. Surgery can fully close the opening between the urachus and the bladder, but thanks to a quick and thorough veterinary diagnosis, Eros avoided surgery.

Eros recovered at Palm Beach Equine Clinic for two weeks with his mother Vogue by his side. He was treated with systemic antibiotic therapy, anti-inflammatory therapy, and gastroprotectants (Omeprazole). His umbilicus was treated topically to promote closure of the patent urachus.

After discharge, Eros remained on medication for an additional four weeks. His owner reported that once he returned home, he soon returned to his normal, happy self. Hogan remarked, “I was going through all these emotions having never had a colt before, and then he puts his little head on my shoulder, and I thought well we’re going to give you all the care we can! It was such a scary learning experience for a new horse owner. It was a steep learning curve.”

Hogan credited her barn manager, Alicia May, for helping care for Eros, as well as Dr. Carrillo and the veterinarians of Palm Beach Equine Clinic. “I have such confidence now in my veterinary care team. I have to say it’s all a team effort,” she said. “I had no doubt that my horses were in the right place for this kind of situation.”

Having fully recovered, Eros is now seven months old, and Hogan is training him regularly, getting him used to working with humans and becoming less sensitive to his environment in preparation for his future equine therapy work with his mother Vogue.

Palm Beach Equine Clinic is available 24/7 for any equine emergency and works regularly with referring veterinarians. For more information, call 561-793-1599.

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.
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.

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Patients

Walking on Wire

Zeke was rescued from a life of neglect and was in extreme discomfort caused by a wire wrapped around his left front pastern.

In February of 2021, Baby Girl Horse Rescue and Veteran Therapy Ranch in Fellsmere, Florida, rescued six Belgian Draft Horses that were headed for slaughter after a life of neglect. Ezekiel, known as “Zeke”, was one of the gentle giants who rescue organizer Van DeMars described as still having spirit in his eyes despite his desperate condition. “When I found out about Zeke, I insisted on buying him even if it was only to give him some care and then have to put him down humanely,” DeMars reflected. “I just did not want him to have to make the long, hard trip past the border to die a scary death.”

Zeke was suffering from a severely swollen, actively infected, and draining wound on his left front leg. He was lame at the walk and in evident pain and discomfort. Once Zeke arrived at the rescue, their veterinarian Dr. Karie Vander Werf took radiographs that painted a grim picture. The radiographs showed a metal wire had been wrapped around Zeke’s pastern bone, deeply embedded through the soft tissue and into the bone. She then immediately referred Zeke to board-certified surgeon Dr. Weston Davis for surgery at Palm Beach Equine Clinic.

Once Zeke arrived at Palm Beach Equine Clinic, Dr. Weston Davis, assisted by Dr. Sidney Chanutin, took additional radiographs to thoroughly assess the location and depth of the wire. “The radiographs confirmed a metal object was circumferentially wrapped around the mid-pastern bone, embedded into the soft tissue and remodeled the bone itself,” Dr. Chanutin revealed. On February 24, Zeke was put under standing sedation, given a local nerve block, and the wire was carefully extracted by Dr. Davis.

Radiograph of Zeke by Palm Beach Equine Clinic showing wire deeply embedded into pastern bone.
Radiograph showing the wire wrapped and imbedded into the bone.
Posterior radiograph view of Zeke by Palm Beach Equine Clinic showing wire deeply embedded into pastern bone.
A posterior view of the pastern.

“Had the wire not been removed when it was, the infection would have continued to proliferate,” said Dr. Chanutin. “The infection and invasion of the wire into the soft tissue and pastern bone could have potentially cut Zeke’s life short.”

wire removal by Dr. Weston Davis. Palm Beach Equine Clinic Rescue Patient Success Story
Dr. Weston Davis removing the wire from Zeke’s leg.

While neither the rescue nor the veterinarians could tell with certainty how this had happened to Zeke, it was apparent by the location and way the wire was twisted that it was likely placed there intentionally. It was clear the wire had been embedded into Zeke’s pastern for months, based on the level of bone remodeling that had taken place.

Reflecting on how he felt dropping Zeke off for surgery, DeMars said, “I was afraid but was very confident in Dr. Davis. I knew that if anyone could get that wire out and give Zeke a chance to have a normal life, it would be him. Later that evening, I got a text of a picture of the wire and I was in shock that they had already gotten it out so fast. I was elated beyond belief.”

Wire removed from zekes leg post-surgery. Palm Beach Equine Clinic Rescue Patient Success Story
The picture Van DeMars received showing the cause of Zeke’s pain.

Remarkably, Zeke’s stay at the Palm Beach Equine Clinic hospital was less than 48 hours. He was then transferred to Dr. Vander Werf’s farm for aftercare, which included daily bandage changes, antibiotics, and wound care.

It only took a few weeks post-surgery for Zeke to finally experience pain-free days at Dr. Vander Werf’s facility. “He’s been a sweet boy through all of this, but only a day or two after the surgery, we really got to see his personality,” DeMars said. “He’s just a mischievous boy who even busted into Dr. Vander Werf’s feed room and is best friends with a little mini pony. We know he must have been in intense pain because he has become a completely different horse now.”

Zeke sneaking into the feed room. Palm Beach Equine Clinic Rescue Patient Success Story

In early April, Zeke was able to arrive at his new home of Baby Girl Horse Rescue and Veteran Therapy Ranch. The group of Belgian Draft Horses rescued alongside Zeke have come to be known as the “Titans.” They are destined to be part of the Titan Project, an endeavor to provide equine assisted therapy for veterans and first responders suffering from post-traumatic stress disorder and other related issues.

“Zeke is quite famous now, especially among the veterans,” explained DeMars. “People who suffer from post-traumatic stress disorder are able to derive strength through Zeke’s story and many have been reaching out through social media asking when he’s coming home so they can come see him. So, his future job is just to be groomed and taken care of. He’s going into retirement to be spoiled.”

The veterinary team at Palm Beach Equine Clinic is dedicated to protecting and providing the best possible outcome for every patient. Through swift action by the rescue and expert veterinary and surgical care, Zeke now has a new purpose and will live out his days in a safe, healthy environment. In the wake of Zeke’s immense suffering, he is now miraculously on the path to paying it forward by providing veterans and first responders the relief and support they need.

zeke in the sunrise at baby girl horse rescue

For more information or to support Zeke by donating to Baby Girl Horse Rescue and Veteran Therapy Ranch, go to https://www.facebook.com/Babygirlhorserescueranch.

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.


In January of 2020, Palm Beach Equine Clinic veterinarian and board-certified surgeon Dr. Weston Davis performed colic surgery on Bull Run Jumpers Prince of Peace. Piloted by Kristen VanderVeen, “Prince” has proven he has fully recovered and is back in peak condition in August of 2020 by claiming the top spot in the $36,600 Traverse City Speed Classic CSI3* at the Great Lakes Equestrian Festival.

Congratulations to this fantastic pair from the entire PBEC Team!

Palm Beach Equine Clinic is incredibly proud to have been entrusted with the health and well-being of Prince and numerous other colic surgery patients who have gone on to make full recoveries, returning to training and competing as they were before the colic.

Each colic surgery case has its own specifics, and during Prince’s recovery, he particularly benefited from strategic veterinary use of the regenerative therapy RenoVo to strengthen the abdominal wall at the surgical incision. Dr. Davis adjusted Prince’s recovery plan as he returned to more intense exercise by using this regenerative medicine to provide some cellular scaffolding and growth factors to encourage proper tissue repair of the abdominal wall.

For more information on colic surgery, regenerative therapies, or to talk to Dr. Davis about your own horse’s needs, please call 561-793-1599 or fill out the form below.

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Bella Ciao: Back Out Front

Maurizio Sano, Bella Ciao, and groom Angel Mijangos at Gulfstream Park West. Photo courtesy of Alessandro Sano
Maurizio Sano, Bella Ciao, and groom Angel Mijangos at Gulfstream Park West. Photo courtesy of Alessandro Sano

Racehorse Bella Ciao Undergoes Surgical Repair

Trainers Alessandro and Antonio Sano reviewed a daunting x-ray on the morning of April 19, 2019. Their three-year-old Thoroughbred filly Bella Ciao, owned by Cairoli Racing Stable and Magic Stables LLC, had just finished a breeze in 49 seconds flat when she suffered a fracture in her right front leg.

She exited the track at Gulfstream Park West, her home racecourse in Miami Gardens, FL, with her racing fate hanging in the balance.

“She is a tough filly with a lot of heart, and she walked herself back to the barn where we had x-rays taken,” said Alessandro, who met with the track veterinarian right away to identify the problem. “When we saw it, we were nervous that she was headed to the breeding shed, and her career was over.”

Alessandro and his father, however, were not willing to give up on their special filly. They entrust Palm Beach Equine Clinic’s board-certified surgeon, Dr. Robert Brusie, with care of their entire string of racehorses, and quickly decided to send the x-rays for his review. Dr. Brusie quickly identified a condylar fracture and advised a surgical repair. Immediately after her diagnosis was confirmed, Bella Ciao made her way to the Hospital at Palm Beach Equine Clinic.

Identifying a Condylar Fracture

A condylar fracture is a repetitive strain injury that results in a fracture to the cannon bone above the fetlock. The fracture is a result of excessive strain and weight carried over the cannon bone during high-speed exercise. It emerges from the fetlock joint running laterally up or medially out the side of the cannon bone, essentially breaking off a corner of the bone.

“A condylar fracture is a disease of speed,” said Dr. Brusie. “A condylar fracture was once considered the death of racehorses. As time and science progressed, it came to be considered merely career-ending. Currently, veterinary medical sciences are so advanced that we have had great success with condylar fracture patients returning to full work.

“Luckily, with today’s advanced rehabilitation services, time, and help from mother nature, many horses can come back from an injury like this. My prognosis for Bella Ciao after surgery was very good,” said Dr. Brusie.


Dr. Brusie performed Bella Ciao’s surgery and inserted five screws to repair the fracture.

Digital radiographs show a condylar fracture to the right front leg, and the five screws that completed the surgery.

Digital radiographs show a condylar fracture to the right front leg, and the five screws that completed the surgery.

From left to right: Digital radiographs show the condylar fracture to the right front leg, and the five screws that completed the surgery.


“He does an excellent job with all of our horses. We wanted to give it a shot for Bella Ciao, and it paid off,” said Alessandro. He and his father, Antonio, have worked with Dr. Brusie on many horses, including a past Kentucky Derby runner and horses winning in excess of million-dollar purses. “He told us that she would be back to the track, so we followed his instructions perfectly.”

Back On Track

Dr. Brusie prescribed stall rest and hand walking for the first several months of Bella Ciao’s recovery. She slowly began jogging, and then breezing.

On October 27, 2019, she returned to the track in a $45,000 Allowance race. With Leonel Reyes up in the irons, Bella Ciao made her comeback in storybook fashion by winning that race and coming out fit, sound, and healthy. Now a four-year-old, Bella Ciao won again on April 30, 2020, and most recently placed third in a $60,000 race on June 27.

“While treatable, a condylar fracture is not an easy injury to come back from, but Dr. Brusie is one of the best surgeons in the country, and we trusted him,” said Alessandro, who has been working with Dr. Brusie since he and his father moved their business from Venezuela to the U.S. in 2010. “She recovered brilliantly, and we could not be happier with how she is going now. She is a special filly, and we are thrilled that we took this chance on her.”