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Category: Patients

Quick Intervention Helps Foal Return to Loving Family

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.

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.

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.

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.

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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Easy Breathing for Dickens

A performance evaluation led to uncovering a paranasal sinus cyst obstructing airflow through the horse’s right sinus.

Respiratory health can easily be overlooked. Unlike with a horse’s gaits, owners and riders do not typically pay close attention to a horse’s breathing for subtle irregularities or inconsistencies. Yet, respiratory function must be up to par for an equine athlete to pump the voluminous amounts of air in and out of their lungs required during exercise. When the horse’s respiratory system is not functioning up to par, the horse could have labored breathing, exercise intolerance, and prolonged recovery after exercise.

As rider Madison Aguilar was bringing Dickens – a 14-year-old Quarter Horse – back into a training program, she noticed some performance issues under saddle. She scheduled a performance evaluation with Dr. Meredith Mitchell to assess Dickens before moving forward with training and increasing his workload. As Dr. Mitchell was watching Dickens being ridden, she saw his breathing was exacerbated after only light work. She went up to him, simply held her hands over his nostrils, and noticed that there was no airflow coming out of his right nostril.

After taking digital radiographs (x-rays) of the horse’s head, Dr. Mitchell identified a paranasal sinus cyst responsible for Dickens’ breathing troubles.

Dickens Before Surgery radiography
Radiograph of Dickens used to identify a paranasal cyst.

To relieve Dickens, they scheduled surgery to remove the paranasal sinus cyst with board-certified equine surgeon Dr. Weston Davis. Once at the Equine Hospital, Dr. Davis used an endoscope to examine inside the horse’s nasal passages. They found two cystic structures in his right maxillary sinus and then proceeded with a standing maxillary flap surgery to remove the cysts.

Dickens surgery palm beach equine clinic paranasal sinus cysts

“We sent the cysts for pathology tests and luckily the results showed they were benign,” said Dr. Mitchell. “Reoccurrence of the cysts is unlikely, but we will follow up with radiographs six months post-surgery to make sure Dickens is still healthy, happy, and able to breathe easy.”

“I am so thankful to my vet for being the best at her job and the whole crew at Palm Beach Equine Clinic for making sure this boy was comfortable and recovering well during his time in the hospital.”

Madison Aguilar
Dickens success story post surgery

Dickens is now home and on the road to recovery with full, unobstructed breathing. Subtle and gradual changes in a horse’s health, behavior, and performance can be difficult to pinpoint. Routine performance exams and wellness checkups can be key to uncovering these subtle issues and taking action to address problems early on.

Whenever there is a question involving the health and well-being of your horse, do not hesitate to call your Palm Beach Equine veterinarian at 561-793-1599.

Show Jumper Returns to Top of Leader Board After Colic Surgery

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.”

Taking a Chance on Madison

Palm Beach Equine Clinic helps one mini donkey survive a roller coaster of health concerns

The popular veterinary adage, “if only they could just tell us how they feel,” never rang more true than in the case of an 11-year-old miniature donkey mare named Madison. Owned by Sariah Hopkins, “Madi” came to Palm Beach Equine Clinic by referral and was diagnosed with hyperlipemia, a common issue in miniature donkeys. Madi’s case, however, was never exactly how it seemed.

Hopkin’s describes Madi as the “center of attention.” Rescued from an animal hoarding situation by Safe Harbor Sanctuary in Nashville, TN, where Hopkins serves on the Board of Directors, Madi was officially adopted by Sariah and her husband Joel in 2015.

“She was one of 40 horses and donkeys being kept on four acres of land,” said Sariah, who relocated to Juno Beach, FL, with Madi in tow in 2018. “She has always had a super sweet, calm personality, but likes to kick up her heels. We’ve done behavioral health therapy work with foster children and she makes everyone who meets her fall in love. She is so engaging.”

After trading Tennessee for Florida, Madi didn’t adjust to her change in environment with ease. According to Sariah, a systematic decline in her health started while the mare tried to adjust to a new barn, environment, farrier, and life. “She was depressed,” said Sariah. “She wasn’t her bright-eyed self. She’s a donkey and she will eat anything so when she went off her grain and refused alfalfa, I called a local vet to pull fluids and run blood work.

“I reviewed the results with my vet in Tennessee who knows Madi and her history,” continued Sariah. “They were catastrophically bad, and she told me I needed to get Madi to a clinic immediately. I was referred to Palm Beach Equine Clinic by my friend Nataliya Boyko. Within minutes, I was on the phone with her vet, Dr. Bryan Dubynsky, and soon after we were on our way.”

Madison Miniature Donkey Palm Beach Equine Clinic Patient
Madison being treated by the team at Palm Beach Equine Clinic

Once Madison arrived at Palm Beach Equine Clinic, she was treated primarily by Dr. Abby Berzas and overseen by Dr. Dubynsky. They diagnosed her with hyperlipemia, and she remained at the clinic for two weeks.

Hyperlipemia is a common metabolic disease of ponies, miniature horses, and donkeys. In affected patients, an increase in serum triglyceride concentrations (hypertriglyceridemia) puts them at risk for liver failure, renal failure, and multiorgan dysfunction that can ultimately lead to death.

Genetically, donkeys are designed to live in harsh environments with poor-quality forage. As a result, they tend to put on weight and gain excess fat reserves when living on relatively lush pasture. Unfortunately, when they stop eating for any reason – usually stress induced –  hyperlipemia may develop due to a ‘negative energy balance’  where more energy is being used than is being taken in through eating. The essential organs of the body still require a food supply, so it uses the energy that has been stored as fat deposits. The result is that free fatty acids are circulated to the liver and converted to glucose for use by the body.

Madison Donkey Success Story Palm Beach Equine Clinic Abby Berzas success story equine hospital

However, donkeys are not able to efficiently turn off this fat release. The blood soon fills up with excess fat in circulation, causing them to become very sick and uncomfortable. This circulating fat is measured in the blood as triglycerides.

Madison’s case presented as a severe spike in triglycerides, which can be reduced by introducing sugars into the system. The sugar causes the body to release insulin and drive the triglycerides down.

“She responded well the first day, but we didn’t see the improvement that we would have liked or that she needed,” said Dr. Berzas. “We started more aggressive treatments the following day with insulin therapy and antibiotics. The dextrose caused a physiological increase in insulin, but it wasn’t enough. As soon as she had insulin therapy her triglyceride levels started coming down. They decreased significantly and she started eating again.”

Madison remained on insulin therapy for a week and was evaluated hourly by Palm Beach Equine Clinic veterinarians to monitor the possibility of hypoglycemic shock. When Madison was able to eat regularly and maintain low triglyceride levels without any help, she was discharged.

“I had access to Madi daily, and we made the most of her time in the hospital with long hand walks, grazing, and relaxing in her stall,” said Sariah. “I got updates from the clinic every two to three hours when I wasn’t there, and without any more clinical signs, she appeared to be improving.

Madison Miniature Donkey Palm Beach Equine Clinic Patient

“But, when I got her home she still was not herself,” continued Sariah, who spent hours sitting in Madi’s stall with her. She moved home to Sariah and Joel’s private farm while they did all they could to eliminate the stress that had supposedly led to Madi’s condition. “She was good for 24 to 48 hours and then would slide backwards again. One afternoon, I was sitting in her stall and she had a coughing fit that I was able to video. I sent it to [Dr. Berzas] and she came out to the farm to check on Madi.”

Dr. Berzas performed a thoracic ultrasound and spotted comet tails in her lungs, leading to one thing: pneumonia.

“We were wracking our brains to figure out what the original stressor might have been that led to the hyperlipemia, but Madi did not display any signs of pneumonia at the clinic and did not cough once,” said Dr. Berzas. Then, there it was! Donkeys are stoic, tough animals, and sometimes they don’t give us traditional clinical signs.”

While hyperlipemia was the result, pneumonia was the cause.

“Cortisol, also known as the ‘stress hormone’ has a vast array of effects within the body, and it is one of the first triggers for the body to recruit energy from the its peripheral stores,” explained Palm Beach Equine Clinic Internal Medicine Specialist Dr. Peter Heidmann. “It minimizes discomfort and increases blood pressure and metabolic rate, basically saying, ‘Now is not the time to conserve energy for the future. I need energy now in order to survive.’ In Madison’s case, the infection prompted the body to need more than average energy – it needed extra fuel to fight the infection.” 

The typical diagnostic procedure for pneumonia is a tracheal wash procedure, but after consulting with Dr. Heidmann, Dr. Berzas elected to try and mitigate any further stress on Madison by choosing a less invasive procedure. Instead, Dr. Berzas used a special stylette that allowed them to go through the nasal sinuses and cleanly aspirate back cellular fluid for analysis. This option is called a Bronchoalveolar Lavage (BAL), and is most typically used for diagnosing cell types in the lungs.

“After culturing her fluid aspirate, she went back on antibiotics and responded well,” said Dr. Berzas. “She also had nebulizer treatments that delivered antibiotics directly to the lungs, which is the best way to treat the infection.”

happy healthy Madison miniature donkey

One month after the pneumonia diagnosis, Sariah was proud to report that Madi had made a full recovery. “When we brought her in that first day, we frankly were getting ready to say goodbye,” said Sariah. “We were devastated, and Dr. Dubynsky agreed to try and save Madi. Thank goodness he did!”

Once the pneumonia was cleared, Madi’s routine returned to normal and the hyperlipemia was no longer an issue. Today, Madi is happily running Sariah and Joel’s farm.

“Palm Beach Equine Clinic treats some of the top sport horses in the world, but I feel that Madi – a very special donkey – received the same treatment. Dr. Berzas was 100% available to me, and she championed Madi. I could not be more thankful to her and the entire team of veterinarians and staff who rallied around our Madi.”

Sariah Hopkins

“When we have a case that’s particularly challenging to diagnose,” Dr. Berzas remarked, “it just reminds us of how fortunate we are to be part of a team of specialists. At Palm Beach Equine Clinic, we are able to tap into the knowledge and experience of our fellow veterinarians from different specialties, and really deliver that value for the patient.”

Madison, happy and healthy sunbathing.

Sariah chronicled Madi’s condition and recovery on her Facebook page, developing quite a fan base for the little donkey. Madi’s story is far from over, but now she’s telling it herself and can be followed on Facebook as @MadisonJoelleDonk.

Happy Birthday Belle: Recovering Geriatric Colic Case Turns 34

When Jennifer Penn learned that her horse Belle was in the beginning stages of a bout with colic in February, she knew she was not ready to say goodbye to her beloved horse. The 33-year-old American Quarter Horse named “Wagners Mint Joker”, but known to Penn and her family as Belle, was the horse of a lifetime.

Penn’s mother, Becky Seton, and late grandfather, Bob Lowery, both of Vero Beach, FL, purchased a then 12-year-old Belle for Penn in 1998. “We were both 12-years-old and it was a match made in heaven,” recalled Penn. “I had outgrown my show pony, so it was time to look for an all-around horse that I could show and have fun with. I am an only child, so she is like a sister to me. As I grew up, I experienced life right alongside her.”

Belle quickly lived up to her reputation as an all-around horse, actively competing with Penn at AQHA breed shows, open and 4-H circuits throughout Florida, show jumping events, and they excelled in western trail competitions. Belle even pulled a cart for a time!

When Penn was 18, she started her own lesson program with Belle at the helm. “Belle provided a solid foundation for many riders, both young and old,” she said. “She not only taught me how to become a horsewoman, but she has also impacted so many young people’s lives and taught them showmanship skills. She’s special to me and my mother Becky, but also to so many people who have gone on to become very successful horsemen and women.”

While Belle was partially retired in 2018, the same year she was the guest of honor and Penn’s wedding, the mare gave her last lesson about six months ago. She was still being ridden once a week with the occasional trail or pony ride for yet another up-and-coming rider.

Jennifer Penn Geriatric Colic Case Palm Beach Equine Clinic Surgery

Belle was thriving in retirement until colic threatened to disrupt her life of luxury.

On Saturday morning, February 1, Belle had not been drinking from her water buckets, did not finish her breakfast, and had only passed manure twice throughout the night before; abnormal signs that Penn took very seriously. “She’s tough as nails, so she was not showing any signs of discomfort; she was just standing there quietly in her stall. By knowing her habits we were able to identify a problem and make early decisions.”

Belle was initially treated by her primary veterinarian, Dr. Kelly Alderman of Alderman Veterinary Services based in Fellsmere, FL. Based on Dr. Alderman’s recommendation, Belle was transported to Dr. Karie Vander Werf’s Treasure Coast Equine Emergency Services in Palm City, FL, where an ultrasound on Sunday showed a displacement of her large colon.

“It was very obvious to us that if we were going to consider surgery, we would have to do it sooner rather than later,” said Penn. “The decision was made to preserve her strength and transport her to Palm Beach Equine Clinic for Dr. Weston Davis to operate on her.

“It was because of his confidence in the surgery despite her age, that I had a peace in the decision to proceed with surgery,” continued Penn.

One of three board-certified surgeons at Palm Beach Equine Clinic, Dr. Weston Davis performed the emergency colic surgery to remove a right dorsal impaction in the large colon and correct a severe displacement caused by the altered motility within the intestines.

“Her primary veterinarian had done everything that she could medically do for the horse before referring the case to Palm Beach Equine Clinic,” said Dr. Davis. “In some colic cases, a prolonged course of medical treatments might result in the horse no longer being a surgical candidate. When things were not improving quickly enough, the horse was sent to us. Our main concern was to determine if Belle was as healthy a surgical candidate that she could possibly be.”

According to Dr. Davis, Belle’s physical examination and blood work revealed her to be a very healthy, albeit geriatric, colic case. “She is the oldest horse that I have performed colic surgery on. At the time of her arrival, Belle was well-hydrated with balanced electrolytes levels and stable organ systems. She was an overall good candidate for colic surgery, even at 33-years-old,” he said.

While not every geriatric colic case is well-suited for surgical intervention, Dr. Davis considers two factors before moving forward with any surgery. “The surgery has to make sense for the horse, meaning that they are a healthy candidate with the ability to recover, and they have the will to live,” said Dr. Davis, who noticed how resilient Belle was from the moment he saw her. “The other point is that the surgery needs to be financially reasonable for the client. In Belle’s case, there was a will to live, and a strong emotional connection with this horse.”

After a successful colic surgery, Belle was moved to recover in the Palm Beach Equine Clinic Hospital where she was cared for round-the-clock by Dr. Candelaria Chunco and hospital staff.

“Dr. Davis was great, and Candelaria was fantastic,” said Penn. “They were both so kind, and I received regular text updates. I knew that they were invested in her recovery. When she stood up after anesthesia, I remember Dr. Davis saying to me, ‘this horse is a badass’, and she really is!”

Belle returned home to Vero Beach, FL, on February 19, and celebrated her 34th birthday on March 27. “Her recovery was slow, but she is doing well, regaining an appetite, working her way back to regular turnout, and starting to act like her old self again,” said Penn. “She is an incredibly special horse to not only me and my mother, but to my husband, family, friends, and the horse community here. It’s so wonderful to have her back home.”

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