The team at Palm Beach Equine Clinic is excited to welcome Dr. Christopher Elliott. Dr. Elliott was born and raised in Brisbane, Australia, and graduated from the University of Queensland’s School of Veterinary Science in 2007 with First-class Honors. Since then, he has become board-certified in Sports Medicine and Rehabilitation. Dr. Elliott has experience working at Fédération Équestre Internationale (FEI) equestrian events in more than 20 countries. As well as being a dedicated FEI Veterinarian, Dr. Elliott has been a Private Athlete Veterinarian, Team Veterinarian, Permitted Treating Veterinarian, and Official Veterinarian. Dr. Elliott is the Veterinary Services Manager for FEI Competition at Wellington International for the 2023 Winter Equestrian Festival. Keep reading to learn more about Dr. Elliott and his role as a veterinarian at Palm Beach Equine Clinic.

Dr. Christopher Elliott specializes in Sports Medicine and Rehabilitation.
Photo courtesy of Dr. Christopher Elliott

When and why did you decide you wanted to become a veterinarian?
Like most young boys I knew, I had illusions of grandeur that I was going to be playing cricket or rugby for Australia. As I got older, I decided I needed to knuckle down on my studies and veterinary medicine made sense. I decided this around the age of 15 and, since then there was nothing else I could possibly imagine I ever wanted to do. My background in horses from my father’s side and my love of animals from my mother’s side led me to veterinary medicine as the perfect career and lifestyle choice for me.

What advice would you give someone who wants to become a veterinarian?
Young people considering a career in veterinary medicine should spend as much time as possible working in practices in order to fully understand what makes it a challenging career choice. Aspiring veterinarians should take the time to truly understand what the profession is really about. I love being a veterinarian and it is all I could possibly imagine ever doing, but some people have a job that pays for their lifestyle and other people have a job that is their lifestyle. Young people who would like to become a veterinarian should be positive that it is the career they want and enjoy before committing to it.

What aspects of equine medicine interest you most, and what types of cases do you find most rewarding?
My chosen specialties are Sports Medicine and Rehabilitation. Ever since I became a veterinarian, the unique challenges of keeping equine athletes fit, sound, and competing at the highest level have always appealed to me. I enjoy performance management, investigating lameness, and helping my clients achieve their equine athletic goals. Regardless of the competition level, each combination of horse and rider has specific aspirations, and it gives me great satisfaction to help achieve those goals. Whether it be in the pony ring, at the grand prix level, or Olympic level, they all pose their unique challenges and are equally enjoyable.

Dr. Christopher Elliott in Geneva, Switzerland.
Photo courtesy of Dr. Christopher Elliott

What is your role as the new Veterinary Services Manager for FEI Competition at Wellington International?
My job as the Veterinary Services Manager is to provide veterinarian services during each week of FEI competition. Tasks range from coordinating our Palm Beach Equine Clinic treating veterinarians on the showgrounds to assisting during the arrival exams and horse inspections. I am also the Attending Veterinarian ringside for each night class and FEI class. I have been working within the FEI all over the world for close to 15 years, and I look forward to working at this prestigious venue this year.

What are some of your other hobbies or interests?
I love traveling with my wife, Kjersten Lance, and going on fun adventures around the world. I enjoy all things sports related as well. I love watching team sports, especially live at the stadium. Coming from Australia, I played cricket and rugby and still follow them closely. A little-known fun fact about me is that I collect stamps.

Palm Beach Equine Clinic (PBEC) returns as the Official Veterinarian of the Winter Equestrian Festival (WEF) and Adequan® Global Dressage Festival (AGDF) for the 2023 show season. The veterinarians of Palm Beach Equine Clinic will be on-site to provide excellent care to all of the competing sport horses as well as those in the surrounding Wellington area.

Although we all hope emergencies will never occur, owners and riders can rest easy knowing that top sport horse veterinarians will be immediately available to help resolve equine medical emergencies. Palm Beach Equine Clinic veterinarians will provide veterinary services at the Annex Office located on the Wellington International showgrounds. Dr. Christopher Elliott, board certified in Sport Horse Medicine and Rehabilitation, will be the lead veterinarian at the showgrounds. Veterinarians will be available at the show to provide diagnostic evaluations, treatment, emergency care, and regular veterinary needs. At AGDF showgrounds at Equestrian Village, PBEC vets are on-site to help with any problems that arise during competition days.

Dr. Christopher Elliott at Palm Beach Equine Clinic’s Annex Office located on the Wellington International showgrounds.
Photo by Jump Media

At its main facility, Palm Beach Equine Clinic has an extensive team of more than 30 veterinarians offering a wide variety of services and remedies including internal medicine, emergency care, reproduction and fertility, alternative medicine, regenerative medicine, dentistry, podiatry, and more. From sport horse evaluations to non-traditional alternative medicine therapies such as equine medical manipulation and acupuncture, Palm Beach Equine Clinic veterinarians think outside of the box to prevent and treat injuries.

At the main facility, Palm Beach Equine Clinic has a team of more than 30 veterinarians offering a wide variety of services.
Photo by Erin Gilmore

Offering exceptional knowledge, capabilities, and commitment, the team at Palm Beach Equine Clinic is thrilled to be part of equine athletes’ success during the Wellington winter show season and beyond.

What Does Palm Beach Equine Clinic Offer?

Cutting-Edge Technology
The modern medical imaging modalities at Palm Beach Equine Clinic allow veterinarians to gather all the information they need to make a timely diagnosis and are available for all equine patients, even if their primary veterinarian is not at Palm Beach Equine Clinic.

Surgical Center
Palm Beach Equine Clinic’s 24/7 emergency services are led by three board-certified surgeons, who perform some of the most advanced and least invasive surgeries in the world. Head of surgery Dr. Robert Brusie, as well as Dr. Weston Davis and Dr. Jorge Gomez, make up the team of surgeons who are adept in many procedures from colic cases to injuries that require high levels of expertise and advanced equipment.

Palm Beach Equine Clinic is home to three board-certified surgeons.
Photo by Jump Media

Internal Medicine
Understanding why a talented prospect may be coming up short makes Palm Beach Equine Clinic veterinarians determined to find the answers and develop solutions. PBEC proudly offers internal medicine services led by board-certified internal medicine specialist Dr. Peter Heidmann. Going beyond standard veterinary care, the staff at Palm Beach Equine Clinic can identify the root of subtle changes in a horse’s health or performance with internal medicine evaluations and diagnostic procedures. Comprehensive internal medicine offerings include respiratory, cardiac, gastrointestinal, and neuromuscular evaluations.

Alternative Medicine
Employing a holistic approach to treating patients, Palm Beach Equine Clinic considers all the available avenues for health care. Alternative medicine therapies are often used in conjunction with traditional medicine and can be uniquely tailored to enhance a horse’s performance and overall health. Alternative medicine offerings include acupuncture, equine medical manipulation adjustments, Chinese herbal medicine, laser therapy (photobiomodulation), and extracorporeal shockwave.

Palm Beach Equine Clinic often uses alternative medicine in conjunction with traditional medicine therapies to enhance a horse’s overall health.
Photo by Jump Media

Reproduction and Fertility
Palm Beach Equine Clinic offers a broad array of reproductive and fertility services for stallions and mares, available at the equine hospital or in the barn. With expert care and advanced practices, PBEC maximizes the likelihood of a successful pregnancy. As the process of breeding sport horses is ever changing, Palm Beach Equine Clinic proudly offers clients modern reproductive services to produce the talent of the future.

Palm Beach Equine Clinic is partnered with Hagyard Equine Medical Institute (HEMI), one of the leading equine medical centers in advanced reproductive medicine. Through the partnership, equine reproductive specialists work collaboratively with Palm Beach Equine Clinic to expand upon the traditional reproductive services currently being offered.

Palm Beach Equine Clinic has provided the highest quality of equine health care for 41 years. With a world-class facility, state-of-the-art technology, and great compassion for the horses, Palm Beach Equine Clinic is committed to providing the best possible service for both patients and owners.

6:30 a.m. – 7:30 a.m.: Family Time/Morning Ritual
I like to start my morning with my two boys who are four and six years old. We get up and play a little before breakfast. We then all load into the car to head to school.

8:00 a.m. – 9:15 a.m.: Hospital Rounds
When I arrive at Palm Beach Equine Clinic, I convene with the hospital staff to discuss the hospitalized patients. There are about 15 horses currently hospitalized with us, though some of them are only here for MRI and bone scans or other outpatient procedures. During rounds, the hospital’s patient-care team of veterinarians and technicians make a plan for each patient and debate the best treatment strategies. This is an opportunity to make sure everyone is on the same page with the specific rationale for each treatment plan, and also an opportunity to quiz some of our younger veterinarians on the relevant science.

Dr. Peter Heidmann is the head of Internal Medicine at Palm Beach Equine Clinic.
Photo by Jump Media

Today, I got into a good conversation with another senior clinician regarding the ideal choice of blood thinners to limit the risk of clotting in a sick patient. Although we did not totally agree, our diverging opinions provided some perspective to the young veterinarians during rounds. Honestly, even without complete consensus on any given topic, this kind of dialogue challenges us to remain abreast of the medical literature, helps us provide articulate and succinct presentations, and ultimately, promotes optimum patient care.

Get a behind-the-scenes look at a day in Dr. Peter Heidmann’s life while working for Palm Beach Equine Clinic.
Photo by Jump Media

We also discussed modifying the treatment strategies for a six-year-old stallion who had colic surgery about 18 hours earlier. He was experiencing the all-too-common problem of “post-operative ileus” where the small intestine was not returning to normal motility as quickly as we would like. We increased the regimen of prokinetic drugs, which are IV medications that can help increase the contractions of that sluggish small intestine. We also discussed the possibility of increasing his hand-walking, which can improve his motility.

As we made our way through the barn, we talked about rechecking the current insulin levels of a 15-year-old Hanovarian mare who has been fighting founder for more than a week. If the insulin remains high, we may need to modify her treatment regime, including increasing her dose of metformin, a medication that can help modify the concentration of insulin in her bloodstream. Thankfully, it came back as normal when we checked it with the handy patient-side test called Wellness Ready.

Other notable cases included a mare who is hospitalized with us on foal-watch since her pregnancy is nearly full-term, a polo pony with a corneal ulcer (eye trauma), and an almost totally better horse that had presented to the hospital with a fever of unknown origin. After the fever had abated on its own within hours of hospitalization, he was set to remain boarded until his PCR tests confirm that he wasn’t shedding any infectious diseases and he could safely return to his home barn.

9:15 a.m. – 10:15 a.m.: Updating Clients
After hospital rounds, I spend a little bit of time returning calls and updating clients and owners on their hospitalized patients. I also document patient updates and client conversations in the medical record for each horse.

10:30 a.m. – 11:30 a.m.: Farm Call ¬– Follow-Up Gastroscopy
I arrive at a local farm along with one of our young veterinarians to do a recheck gastric scope to see how well a nine-year-old gelding has responded to 27 days of treatment for gastric ulcers. Our exam a month ago showed moderate gastric ulcers (Grade 2 out of 4 in severity) in the upper stomach (the “margo plicatus,” where the squamous stomach lining meets the portion that produces acid). There was also thickening around the pylorus, the outflow tract (“exit door”) at the bottom of the stomach. It’s good to see that the horse is acting much better, gained some weight, and has a healthier hair coat since we started treatment with Gastrogard omeprazole last month. We need to see how he has responded to a combination of medications, and hopefully, discontinue the anti-ulcer medications if possible. After a round of light sedation, we pass the endoscope into the stomach. The Grade 2/4 gastric ulcers are totally resolved, which is great news. The pyloric outflow tract is only a little bit better. Although it requires treatment twice a day, we recommend the addition of misoprostol, which is a medication that is often considered more likely to help resolve problems at the pylorus. We also discuss a plan to make sure that the horse has continuous access to grass hay and/or fresh grass in turnout. This can help prevent ulceration and, in some cases, promote healing without the necessity of additional medication. We write the prescriptions and make a plan to repeat the stomach scoping in another three to four weeks.

11:45 a.m. – 1:15 a.m.: Farm Call – Respiratory Evaluation
We continue to a second local farm to follow up on a case of suspected respiratory problems in a nine-year-old chestnut jumper mare. Earlier in the week, the mare’s regular veterinarian, who works with us at Palm Beach Equine Clinic, had been asked to evaluate her for shortness of breath and occasional coughing during and after work. The mare had been performing well, but had been a bit sluggish for the past three months. Recently, her symptoms had become much more obvious, especially after the mare finished training or competition. This raised the trainer’s concerns about asthma or possibly, Exercise-Induced Pulmonary Hemorrhage (EIPH).

Her physical exam is normal, including the “re-breathing exam”, where we ask the mare to breathe deeply by placing a medium trash bag over her nostrils. This test is the equine equivalent of when your doctor asks you to breathe deeply so they can hear your lungs. Her re-breathing is pretty normal, but it sounds like there might be a little bit of airway-narrowing in her caudo-dorsal lung fields, which is near where the back of the saddle would sit. We take a look at the lung surfaces using ultrasound, and there are no abnormalities there.

Next, in order to obtain a better understanding of what kinds of factors might be affecting her breathing, we scope her upper airways under light sedation. There are no significant abnormalities in the nasal passages, nasopharynx, larynx, guttural pouches, or the top of the windpipe. Based on this news, I recommend collecting a sample from the lower lung fields, which is called a bronchoalveolar lavage (BAL). A microscopic analysis of this sample will help us better determine if there is asthma, bleeding, or any sign of bacterial or fungal infection.

With a little bit of local anesthesia in the nasal passages, and a bit more in the windpipe and lower bronchi to minimize discomfort and coughing, we flush 240 milliliters of saline into her lungs, and aspirate it right back out. I can tell from the foaminess that we got a good sample. The good news is that while there is a little mucous, the sample is clear, so at least there hasn’t been any lung bleeding very recently. We discuss a plan to limit exposure to environmental dust and use nebulized bronchodilators and herbal medications while awaiting the results of the BAL fluid analysis. The results should be available in 24 to 48 hours.

1:14 p.m. – 2:30 p.m.: Prepare Prescriptions and Process Samples
We finalize and prepare prescriptions for the horse with stomach ulcers, including organizing the fat supplement they had requested. We also process samples from the respiratory case, and prepare to ship it out to the lab that specializes exclusively in reading BAL samples. I document the respective case details. I am almost done with these projects when one of the young veterinarians asks me to come out to the hospital barn to help assess how the stallion with post-operative ileus has responded to his prokinetic meds.

2:30 p.m. – 3:15 p.m.: Check In on the Stallion
I repeat the ultrasound exam on the stallion who, at this point, is about 24 hours post-operation for small intestinal colic surgery. The fact that our surgery team didn’t have to remove any compromised bowel bodes well for him, but we didn’t like the small intestinal distension this morning, especially so soon after his surgery. The good news is that the bowel is already moving a lot better than it was earlier in the day. Whether this represents a response to the prokinetic medications we recently started, or he is benefitting from a little more distance from the time of surgery, or both, we are happy with this improvement. We update the orders to continue with the current low dose of prokinetic drugs overnight.

3:15 p.m. – 5:30 p.m.: Finish Documenting and Reviewing Literature
I complete the documentation and records from our earlier farm calls. I also review the recent literature on a new prokinetic medication that can be given orally. Additionally, I review a recently revised consensus statement regarding Cushing’s disease. After that, I call a few clients in advance of farm calls that I will do tomorrow.

5:45 p.m. – 6:15 p.m.: Hospital Rounds
I wind down my day with evening hospital rounds to coordinate with the young veterinarians. We double-check the doctors’ orders on each patient, confirm plans and contingencies for overnight care, including feeding, medications, fluid therapy, and other treatments. We organize which member of our team will update horse owners, trainers, and also the referring veterinarians involved in every hospital case. We finish by briefly discussing the anticipated schedule of events for tomorrow’s planned procedures.

6:35 p.m.: I arrive home and enjoy dinner with my family.

Featured on Horse Network

By Amanda Picciotto Feitosa/Jump Media

Equine ulcers have long been a common concern for horse owners. Our understanding of ulcers has dramatically improved over time through medical advancement, and there is currently more nuance to the diagnostics, treatment, and management of horses suffering from these internal sores. Gastroscopy and ultrasound have become more readily available, and their increased accessibility have allowed non-specialty practitioners more experience and a greater comfort level with these tools. These developments throughout the industry have led to more animals being correctly diagnosed and appropriately treated.

Jordan Lewis, DVM of Palm Beach Equine Clinic (PBEC) sees a variety of equine ulcer cases. She breaks them down into three categories: gastric ulcer disease of the squamous mucosa, gastric ulceration of the glandular mucosa, and colon ulcers of the right dorsal colon. 

Equine gastric ulcer disease of the squamous mucosa refers to the ulcers found on the stomach’s inner lining closer to the esophagus. They are primarily caused by exposure to stomach acid and vary in severity depending on the amount of time the stomach’s lining has been in contact with the stomach acid.

“We often see this increased stomach acid exposure with the squamous mucosa in performance horses due to the mechanical aspects of exercise and abdominal pressure,” Dr. Lewis described. “The increase in acid production and contact time can also be seen in fasting animals and animals with delayed gastric emptying or slowed motility.”

Glandular mucosa describes the stomach lining around the pyloric region closer to the intestines. Ulcers found here are typically caused by a decrease in mucosal blood-flow as well as a decrease in mucus production, which normally serves as a protective barrier for the stomach lining. Stress and non-steroidal anti-inflammatory drugs (NSAIDS) such as phenylbutazone (“bute”) or flunixin meglumine (“Banamine®”) are the usual culprits in this case.

Similarly, ulcers found in the colon are also usually caused by stress and NSAID administration, leading to a decrease in the mucosal wall protection resulting in ulceration and inflammation. 

“In some cases with colon ulcers of the right dorsal colon, we see minimal thickening noted on the right abdominal wall, but other times it can be more severe thickening with more ominous clinical signs of colic, fever, hypoalbuminemia (protein loss), ventral and limb edema, and diarrhea,” detailed Dr. Lewis.

The tricky thing about ulcers is that they do not always present with the same symptoms in every horse. It can be difficult to know when it’s time to be a little more invasive in order to take a closer look at a horse’s digestive system. At a minimum, persistent symptoms warrant a veterinarian consultation.

“The range of symptoms can vary from mild to severe,” Dr. Lewis explained. “The horse might be being a picky eater, or they might exhibit moderate to severe colic symptoms like signs of abdominal discomfort such as pawing or rolling. Even still, some horses present with the only outward sign being poor performance.”

Dr. Lewis uses varying diagnostic tools for a complete understanding of the affliction. Sometimes she will perform the Succeed test, which is a fecal test that generally helps indicate the presence of ulcers. Another option is to perform a gastroscopy with a three-meter endoscope to see the stomach where both forms of gastric ulcers are found. Ultrasound is the primary diagnostic tool to look for thickening of the right dorsal colon wall indicating ulceration in the colon. Basic bloodwork to determine total albumin, a protein made by the liver, also helps indicate more severe cases of colon ulcers.

Once a horse has been diagnosed with ulcers of any variety it’s important to begin treatment, especially since horses suffering from ulcers are predisposed to colic. Because each type of ulcer disease has a different underlying cause, the treatment protocol and medications are also different.

Though omeprazole paste used to be thought of as the cure-all, today we know that it is only part of the puzzle. Dr. Lewis recommends an omeprazole paste for at least a four-week period and uses other medications in conjunction with this depending on what type of ulcer she is treating. For horses that have ulcers of the squamous mucosa experiencing more severe, colic-like symptoms, Dr. Lewis adds a dose of sucralfate before meals to the protocol. If she finds ulcers in the glandular and pyloric region of the stomach, misoprostol and prostaglandin analog is used. For ulcers of the right dorsal colon, sucralfate is used as a coating agent while misoprostol is used as a treatment.  

In addition to medication, some lifestyle adjustments can aid in maintaining an ulcer-free digestive tract. “It’s helpful if we can provide a more natural, less stressful environment for these horses with continuous grazing on pasture or hay as well as more turnout,” stated Dr. Lewis.

She continued, “Horses with gastric ulcers do well on adding alfalfa hay as a buffering agent before a grain meal, while horses with colon ulcers do well on a low-bulk diet, meaning less forage and a more complete feed-based pellet. Adding a psyllium-based supplement can be helpful for these horses too.” 

Even with the best curative efforts, some horses can continue to suffer from ulcers, underscoring the importance of monitoring your horse for any changes even after treatment. Because sport horses have an increased likelihood of developing gastric ulcers due to exercise, their constant work also increases the odds of them have recurring ulcers. Personality and demeanor also play a part.

“Horses that have recurrent ulcer disease tend to be horses that internalize more and are stressed easily,” said Dr. Lewis.

She highlighted some additional measures that can be taken to help continuously protect the stomach’s lining, noting the importance of a regulated diet and more opportunity to relax, as well as treatment with a prophylactic dose of omeprazole paste.

If you think your horse feels a little off from their normal behavior, it might be time to discuss different diagnostic options with your veterinarian. Trust your gut – it might just help your horse’s too.

Vinceremos Therapeutic Riding Center hosted area first responders at its facility in Loxahatchee, FL, on December 6, 2021. The annual event provides training by veterinarians from PBEC for first responders in handling horses during an emergency. The Winter Equestrian Festival season sees the influx of thousands of horses each winter. These sessions have successfully educated area first responders in equine care during a crisis to create a safer community for the horses.

Dr. Janet Greenfield-Davis giving the demonstration to the area first responders. Photos courtesy of Vinceremos Therapeutic Riding Center.