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Internal Medicine: What’s it all about?

PBEC President Dr. Scott Swerdlin often says, “If you want to attract equine veterinary specialists, you have to have impressive facilities and technology in place.” PBEC is one of the few veterinary clinics in the country to offer their clients the talents of board-certified specialists in nearly every branch of equine veterinary medicine. One such specialist is Dr. Peter Heidmann, a graduate of Tufts University School of Veterinary Medicine, who joined the PBEC team in 2016.

Dr. Heidmann, DVM, MPH, specializes in the treatment of internal medicine cases at PBEC. What attracted him? Facilities! In the heart of South Florida’s horse country and at the center of the busiest winter competition schedule in the world, PBEC boasts an internal medicine and infection disease center at its Wellington-based clinic. The crown jewel of the center is the ability to stop airborne disease dead in its tracks with U.S. Department of Agriculture (USDA) approved isolation stalls that completely enclose horses in their own environment with individual filtered air flow systems that never reach other horses.

On top of secure isolation and individual air flow systems in their internal medicine facilities, PBEC also constructed areas for each stall where medications are prepared, equipment is stored, and dirty bedding is handled. To further mitigate risk, veterinarians, technicians, and staff take every available precaution, including foot baths before entering the stalls and Tyvek suits, gowns, and masks, providing multiple layers of protection against spreading disease. In some cases, a specific team of doctor, technician, and intern is assigned to a patient and won’t touch another horse for the duration of the treatment.

Additionally, diagnostics is not a guessing game at PBEC. With advanced imaging equipment, including a computed tomography (CT) machine, standing magnetic resonance imaging (MRI), and nuclear scintigraphy camera (bone scan), as well as radiography (x-ray) and ultrasonography capabilities, PBEC is armed and ready to quickly and accurately diagnose internal medicine cases.

Dr. Heidmann refers to the facilities and his work at PBEC as a luxury, saying, “I’ve managed many cases in various facilities going all the way back through internship, fellowship, and residency, but this is as nice as any place I have ever worked. It makes the risk to the horses so much lower, but also removes the anxiety for myself because I’m able to look a client in the eye and tell them that there is no risk. I don’t have a concern about disease spreading from one patient to another because at PBEC we have the tools that we need.”

But, to understand how the tools are most effective, one must understand what exactly internal medicine is. In an effort to define it, Dr. Heidmann noted, “What you’ll see on the American College of Veterinary Internal Medicine (ACVIM) website is an emphasis on organ systems and organ system problems – respiratory disease, gastrointestinal disease, and neurologic disease being three of the most prevalent.

“What it really entails is a way of analyzing problems specific to the organ systems,” he continued. “It can be all over the map, and that’s part of what makes the specialty so fun and interesting.”

The most common internal medicine cases can be split into three categories: gastrointestinal (GI) problems, neurological system issues, and respiratory diseases.

GI problems in horses
“When it comes to GI issues, I usually see horses in two categories,” said Dr. Heidmann. “Number one are the horses that may need to go to colic surgery and the horses that just had colic surgery. The other is horses with intestinal infections, often colitis in which they have heavy diarrhea.”

According to Dr. Heidmann, all of the treatments for colitis tend to boil down to the same thing: replacing their ongoing losses and letting the intestine heal itself. It doesn’t matter if it’s colostrum, salmonella, Potomac Horse Fever, or any other kind of infection.

To learn more about emergency colic care at PBEC, click here.

Equine neurologic system
The nervous system in a horse is made up of the brain, spinal cord, and several different kinds of nerves that are found throughout the body. These create complex circuits through which animals experience and respond to sensations. Unfortunately, many different types of diseases can affect the nervous system, including birth defects, infections, inflammatory conditions, poisoning, metabolic disorders, nutritional disorders, injuries, degenerative diseases, or cancer.

“PBEC has an incredible ability to do advanced imaging and diagnostics on neurologic conditions,” said Dr. Heidmann. “With equipment like the standing CT, we can do scans of the head and neck with contrast – a CT myelogram – which really ups our ability to diagnosis a condition.”

PBEC is able to locate problems not only on the top or bottom of a horse’s neck, but also on the sides of the neck – an area previously inaccessible to view even from myelograms under anesthesia.

“That’s part of the satisfaction of the job that I do; It’s not just ‘here is my experience and here is what I guess is going on.’ I have all of these options at my fingertips for diagnostics and tests. We can confidently confirm our clinical suspicions and then do treatment based on that.”

Respiratory disease in horses
As common as a cold for a human or acute in nature, Dr. Heidmann further breaks down the different kinds of common respiratory disease in horses into three categories:

Equine Asthma “Heaves”
The majority of the horses competing in Florida during the winter season are cared for impeccably, which reduces the occurrences of chronic respiratory conditions or significant lung conditions. As a result, what is most commonly seen is equine asthma, or heaves.

According to Dr. Heidmann, equine asthma is treatable through a combination of nebulized medications, nebulized steams, oral medications, or injections. These methods serve to quiet the inflammatory response similarly to how an inhaler helps relieve a human with asthma problems.

Acute Infections 
Viral cases of respiratory disease include flu and Rhinopneumonitis, or rhino, caused by one of two types of equine herpesviruses; EHV-1 and EHV-4. While vaccinations are the easiest method to prevent cases of flu and rhino, these problems are a big concern because they spread so readily. While proper biosecurity protocols go hand in hand with vaccinations, isolation is key when it comes to infectious diseases affecting the respiratory system, according to Dr. Heidmann.

Shipping Fever
The most severe kind of respiratory disease found in horses is shipping fever, which is an infection that takes advantage of a horse’s stress while traveling and results in an immune compromise. While treatable, these infections require two to three or more months on antibiotics that transition from injectable to oral, according to Dr. Heidmann.

Call Palm Beach Equine Clinic today at 561-793-1599 to learn more about their internal medicine capabilities.

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