Modern veterinary diagnostic technologies allow doctors to capture highly detailed images which can make a difference in having the most accurate diagnosis and determining the best course of treatment. Capturing these images, however, is another feat in itself. Imaging Technicians work to create a clear and comprehensive diagnostic profile by operating advanced technologies while keeping the patient still, calm, and comfortable. Spearheading management of all Palm Beach Equine Clinic patients for Magnetic Resonance Imaging (MRI) is Camille “Cami” Glaff. A Jupiter, Florida, native, Cami has been an essential team member of PBEC since March of 2016.
Get to know PBEC MRI Manager Cami Glaff
What is your background with horses?
I have been riding horses since the time I learned how to walk. I grew up trail riding and began competing on the hunter/jumper circuits when I was around 10 years old. I pursued a career with horses by studying Business Management with a specialization in Equine Science at St. Andrews University in North Carolina. I represented my school in the saddle by competing on their Intercollegiate Horse Show Association (IHSA) team throughout my four years there. I spent my first year after graduation as a groom and rider traveling to shows on the circuit. However, I discovered that I was more interested in the medical aspect of the horse industry, and I have been with PBEC ever since.
Have you always worked in the Imaging Department?
I joined Palm Beach Equine Clinic as the MRI Technician and quickly advanced to be the Manager of this department. I have also cross trained in other aspects of our imaging modalities so that I am able to properly operate our Nuclear Scintigraphy and Computed Tomography (CT) technologies as well. When I am not with an MRI or Imaging patient, I try to lend a hand by helping in other departments as needed.
What does a typical day as the MRI Manager entail?
When a horse is dropped off at the Clinic for an MRI, I perform a brief exam to note their vitals, place an intravenous catheter, and pull their shoes off. Once we are ready to begin the MRI, it is my responsibility to make sure we acquire the best images possible for our radiologist, Dr. Sarah Puchalski, to examine. The MRI is extremely sensitive to motion, and because of that I have to ensure that the patient is properly sedated, calm and comfortable so that we can obtain sharp images.
Once the horse is settled into position for whichever site is being scanned, I make slight adjustments to the unit’s magnet to make sure it is in the precise location needed. Depending on the site being scanned, such as the fetlock or suspensory origin, and the patient’s compliance, it may take anywhere from one to two hours to completely image the area. Once the scans are completed and are up to our standards, they are sent directly to our radiologist, Dr. Sarah Puchalski, who generates a complete MRI Report for the client typically within 24 to 48 hours. The hospital staff and I monitor the patient to make sure any sedation is properly wearing off to make sure they are safe to return home. It is always a team effort to make sure everyone is happy and that the horse is receiving the best possible care!
What aspects of your job do you most enjoy?
I enjoy being able to work with different horses each day. Every horse has its own unique reaction to being in a new place and being asked to stand very still throughout the scan. Being able to accurately read and handle each horse is a challenge that I appreciate.
I also find it rewarding to be a part of making a difference in a horse’s treatment plan. Acquiring the best possible images that may have the answers a veterinarian needs to make the most effective treatment plan.
When not at PBEC, what do you enjoy doing or where can we find you?
In my free time, I can usually be found outdoors. Whether I am going hiking with my dog Ryder, exploring new biking trails, or relaxing on the beach, I am always happiest outside.
Typically, when a horse’s gait feels off or may be lacking usual impulsion, the rider often assumes it to be an issue of lameness associated with the forelimbs or hindlimbs. However, that may not always be the case. Utilizing advanced diagnostic imaging techniques, Palm Beach Equine Clinic is able to accurately pinpoint the specific area that is affecting overall performance. In many cases, the cervical vertebrae are often identified as the cause of lameness, asymmetry, and poor performance.
The neck is composed of seven articulating cervical vertebrae
running from the head to the thorax, named C1 through C7. The neck allows
movement of the head while protecting the spinal cord and providing an avenue
for nerves to travel. Impingement on the spinal cord and nerves connected to
the cervical vertebrae can exhibit neurologically as ataxia, neck pain, or
Signs of Lameness Related to the Neck
In a lameness exam, a veterinarian will perform flexion tests and
palpate areas of the body looking for decreases in the horse’s range of motion
or pain upon flexion. The rider may pick up on subtle lameness issues
associated with the neck by feeling a change in the horse’s suppleness or
resistance to yielding in a certain direction. Lameness may even present itself
as a difference in the horse’s balance, such as being heavier on the forehand,
or performance issues such as late lead changes. The tried-and-true “carrot
test” can also show if a horse is resistant to flexing their neck.
Identifying Lameness through Diagnostic Imaging
Historically, neck issues related to performance are generally
diagnosed through a process of ruling out other areas of the body. Diagnostic
imaging can now be the most powerful and effective tool for identifying the
cause of lameness related to cervical injury and hereditary malformation.
Computed Tomography (CT) scans have revolutionized the ability to
assess the entire neck and can be performed while the horse is standing and
under light sedation. Computed Tomography images can be rendered into
three-dimensional models and sliced in any orientation, allowing the
veterinarian to evaluate the vertebrae in great detail that is incomparable to
standard radiographs (x-rays). These comprehensive CT scans offer veterinarians
a thorough profile so they can accurately diagnose and initiate an effective
A standing CT scanner is the latest addition to Palm Beach Equine
Clinic’s arsenal of diagnostic
imaging modalities. Currently, Palm Beach Equine Clinic is the only
equine hospital in South Florida offering this capability. Compared to other
modalities such as MRI or Nuclear Scintigraphy, Computed Tomography offers a
valuable return for its rapid acquisition of images. If you suspect there is an
issue in your horse’s neck please, contact Becky at Palm Beach Equine
Clinic at 561-793-1599 to schedule an appointment.
Palm Beach Equine Clinic has the most advanced state-of-the-art diagnostic imaging equipment available. More specifically, Equine Standing Magnetic Resonance Imaging (MRI) allows Palm Beach Equine Clinic to quickly and accurately diagnose injuries for their clients.
Every horse owner dreads seeing signs of lameness or discomfort in any horse, whether it is a backyard companion or a top-caliber sport horse. For performance horses, however, one of the first questions many owners ask upon contacting a veterinarian about a problem is, “Can the horse safely and comfortably return to work?” Using Palm Beach Equine Clinic’s cutting-edge equine standing MRI technology, the clinic veterinarians are best equipped to answer that question.
The equine standing MRI produces highly detailed images in several different planes to capture a complete image of the desired area. An MRI is best used to further define a specific area of bony or soft tissue that has been pinpointed as the origin of lameness. The process can be completed while the horse is in a standing position and requires only light sedation.
Lameness or performance problems are most frequently approached through routine x-rays and ultrasounds, which can come back normal. Thus, it is difficult to diagnose subtle problems because the most common tools are not sensitive enough to pick them up. At Palm Beach Equine Clinic, the Equine Standing MRI gives veterinarians an advantage when troubleshooting a lameness issue and helps them to determine a correct diagnosis in a timely manner.
Hundreds of MRIs are read each year at Palm Beach Equine Clinic. In addition to being a state-of-the-art diagnostic tool, the equine standing MRI technology also affords economic benefits to owners by having their horse’s problem diagnosed and treated safely, effectively, and quickly.
In the past, when a horse’s gait has felt off or lacking in its usual impulsion, it was often assumed to be an issue of lameness. Now however, thanks to the improved diagnostics readily available at the Palm Beach Equine Clinic veterinarians are able to more accurately pinpoint the problem area. Perhaps surprisingly, it’s not always in the legs or hooves. With increasing frequency, the horse’s neck is being diagnosed as the root of the issue.
The Anatomy of the Equine Neck and What Can Go Wrong
In order to understand the problems that can arise in association with the horse’s neck, it’s important to first understand the anatomy.
The neck is composed of seven cervical vertebrae running from the head to the thorax, named C1 through C7, and each articulating with each other. The primary purposes of the neck are to move the head and to protect and transport the spinal cord and nerves, which run through the middle of the vertebrae.
Such a major role as the protection of the nerves and spinal cord can also come with some major risks and complications, with clinical signs of these problems generally presenting themselves either neurologically, as neck pain, or as lameness in the front legs. These more specific symptoms may include:
Ataxia or clumsiness – Ataxia is defined as the “lack of control of bodily movements”. In the case of an ataxic horse, you may begin to notice staggering, sudden loss of balance, or even an inability to remain upright. Ataxia is generally an indicator of a neurological condition or damage to the spinal cord itself, caused by either developmental issues, trauma, or an infectious disease such as equine protozoal myeloencephalitis (EPM). Such neurological cases can often be the most debilitating.
Lameness – You can think of the spinal cord and the nerves in the neck like an interstate, with the spinal cord itself acting as the major highway. As you are “driving” along the interstate, every so often there are little exits, which is where the other nerves come out. Should there be any impingement on the interstate or spinal cord itself, you’re likely looking at more severe complications – much like an accident on the highway. Should there be impingement on the nerves coming off of the spinal cord, it will more likely present itself like an accident a little way off an exit – not affecting the interstate itself, but possibly causing problems that spread elsewhere. That is where we see lameness issues arise.
This can be more difficult to pin down, but can often be due to pressure on the smaller nerves that pass through the openings in the vertebrae and supply the front legs. Arthritis of the articular facet joints of the vertebrae is another common reason for lameness, as anytime these joints become arthritic or inflamed, it can easily translate to the forelimbs.
Neck Pain – This will often go hand-in-hand with lameness, as factors such as arthritis of the articular facet joints can lead to both symptoms. Other possible reasons for neck pain include trauma or inflammatory diseases.
Diagnosing the Problem
Neck problems, particularly those related to lameness, are generally diagnosed through a process of exclusion, first performing nerve blocks to or ruling out lower regions of the horse’s body. Palpation of the neck, testing of the neck’s movement, and full neurological exams may also be performed in addition to a full lameness exam, depending on the horse’s symptoms.
Once other regions of the horse are ruled out as the location of the problem, veterinarians are now able to use diagnostic images such as radiographs, nuclear scintigraphy and standing CT scans to specifically locate problems in the neck like never before.
In years past, those diagnostic resources were left for last-ditch cases when veterinarians really could not pinpoint any other problems. Today, with the advent of more modern technology, better radiographs, better ultrasound machines, and the more advanced imaging of nuclear scintigraphy and CT scans, veterinarians are able to readily utilize advanced diagnostics to save time and money, and to find the root of the problem more quickly and accurately.
The neck is one of the areas that has most clearly benefited from the progression in advanced imaging. While neck problems have likely been prevalent for some time, veterinarians are now finding those diagnoses more common, as they are able to more accurately locate the issue – particularly at clinics like Palm Beach Equine Clinic. Often these issues will go undiscovered or undiagnosed in the field, but they can be identified at Palm Beach Equine Clinic thanks to the readily available imaging tools.
As an example, if arthritic factors are suspected, nuclear scintigraphy can be used to look for areas of increased bone turnover. On the resulting bone scan, veterinarians are looking for areas where there is an increased calcium uptake because the bone is actively remodeling. These areas will appear darker on the scan and are generally a good indicator of a boney injury or arthritis, with the darker “hot spots” often appearing above the articular facet joints.
Also new and groundbreaking for the diagnosis of equine neck problems is the use of a Computerized Tomography or CT scan, with the ability to scan a standing horse with light sedation on the near horizon which will be available at the clinic this upcoming winter season.
Once a solid diagnosis is arrived upon, the proper treatment protocols can be prescribed. Depending on the root of the problem, possible treatments may include shockwave therapy, regenerative therapies such as interleukin-1 receptor antagonist protein (IRAP) therapy or platelet-rich plasma (PRP) therapy, or one of the most common treatments, injections of the facet joints.
In the case of facet joint injections, veterinarians at Palm Beach Equine Clinic are able to medicate under ultrasound guidance, guiding a needle into the joints and delivering corticosteroids or similar medication. Surgery is also an option as a final approach to severe complications.
In milder cases, treatments may also just call for increased time off, chiropractic treatments, or the administration of non-steroidal anti-inflammatory (NSAID) medications.
If you suspect any issues with your horse’s neck, contact Palm Beach Equine Clinic any time by calling (561) 793-1599 to schedule an appointment.
At Palm Beach Equine Clinic in Wellington, FL, the team of Board-Certified surgeons are experts in minimally invasive surgical techniques, aiming to reduce joint disease, resolve lameness, and improve the longevity of sport horse careers.
Arthroscopy (or arthroscopic surgery) is a minimally invasive surgical technique that can be performed on an injured joint or synovial structure to accurately explore and treat pathology. The surgery generally involves two very small (8mm) keyhole incisions. The first incision is where the surgeon will insert the arthroscope, which is an instrument with a small surgical grade camera installed that allows a complete, clear view of the interior joint surface. The second small incision is created to insert the surgical instrument to perform the procedure.
Arthroscopy is used to treat a broad range of injuries inside of a joint. Chip fracture removal is a procedure that is particularly commonly in both young Warmblood horses with developmental disease and in racehorses travelling at high speeds. A small chip fracture can cause persistent irritation in the joint as well as arthritis if left untreated. It is best removed immediately so that no further damage is created. The surgeon can go into the joint, remove the chip, and clean up the surrounding cartilage. Most horses recovery quickly and return to their normal athletic activity.
“In many horses, we consider arthroscopy as a prophylactic measure, intervening after injury, but before the development of a generalized degenerative arthritic cycle ensues,” Dr. Davis stated. “Arthroscopy is definitely something that you want to do early in the game if you feel like the horse has joint disease, or a chip, or cartilage disease, or an undefined injury that is not responding appropriately to medical therapy. Arthroscopy can be curative for some of these horses. But if you do not intervene early on in the course of the disease and there is already advanced arthritis, then you have missed your window.
“Arthroscopy is a preferred treatment because it is minimally invasive so most horses can go right back to work,” Dr. Davis continued. “In a typical scenario, we thoroughly explore the joint with the arthroscopic camera, we remove a chip or repair a lesion, and the horse is not lame after the surgery. Because of the small incisions, there is minimal aftercare and horses are often able to go back to work quickly.”
Other common indications for arthroscopic surgery are meniscal disease in the stifle, subchondral cystic lesions, primary cartilage lesions, and debridement of damaged tendinous/ligamentous tissue (such as deep digital flexor tendon tears in the navicular bursa). The surgeons at Palm Beach Equine Clinic can perform arthroscopy on virtually any joint in the horse. Anything from the Temporomandibular Joint (TMJ) of the head to the navicular bursa within the hoof capsule can be explored and treated with this minimally invasive approach.
Almost all arthroscopies are performed under general anesthesia with the horse on its back. New renovations at Palm Beach Equine Clinic include a set of stocks of adjustable height adjacent to a surgeon’s pit, allowing the surgeons to have eye-level access to the joint they are working on, enabling many new procedures on the legs of standing horses.
Minimally invasive surgery allows for a simple and quick recovery for the horse. The traditional horse would be on stall rest with a bandage on until the sutures come out at two weeks, and then start doing some light hand walking and physical therapy. Barring severe damage in the joint or associated tendon/ligament disruption, most cases will undergo a six-week rest and rehabilitation protocol, then return to normal work.
As always, the advanced diagnostic imaging at Palm Beach Equine Clinic permits the surgeons to get a complete evaluation of an injury involving a joint to ensure the best possible outcome. Depending on the injury type, digital radiographs, ultrasound, MRI, and Nuclear Scintigraphy, or a combination thereof, may be used for pre-operative diagnosis and planning. Ultrasound and digital radiography are available for intra-operative use. Intra-operative CT scanning will also be available in the future with the new additions at Palm Beach Equine Clinic.
“When you are inside the joint with an arthroscopic camera, you have the most complete picture of the surface and health of that joint,” Dr. Davis noted.
Every horse owner dreads seeing signs of lameness or discomfort in any horse, whether it is a backyard companion or a top-caliber sport horse. For performance horses, however, one of the first questions many owners ask upon contacting a veterinarian about a problem is, ‘Can the horse safely and comfortably return to work?’ Using Palm Beach Equine Clinic’s cutting-edge technology, Dr. Puchalski can quickly and accurately answer that question.
The Equine Standing MRI produces highly detailed images in several different planes to capture a complete image of a desired area. An MRI is best used to further define a specific area of both bony or soft tissue that has been pinpointed as the origin of lameness. The process can be completed while the horse is in a standing position and requires only light sedation.
Similarly, the process of Nuclear Scintigraphy (bone scan) begins with the injection of a radioactive isotope, specifically named Technetium 99. The isotope attaches to the phosphorous proteins localized within the bone and is absorbed over a few hours’ time. A specialized nuclear isotope gamma ray camera is used to capture images of the skeletal anatomy with a 360-degree view. Points of interest “light up” on the image to indicate increased metabolic activity and the site of injury.
Lameness or performance problems are most frequently approached through routine x-rays and ultrasounds, which can appear normal. Thus, it is difficult to diagnose subtle problems because the most common tools are not sensitive enough to diagnose in every case. At PBEC, the Equine Standing MRI and Nuclear Scintigraphy equip veterinarians with an advantage when troubleshooting a lameness issue and helps them to determine a correct, quick diagnosis.
Coupled with advanced technology, Palm Beach Equine Clinic is also one of very few equine practices in the U.S. with a Board Certified Radiologist on staff, and thanks to Dr. Puchalski, hundreds of MRI and bone scans are read each year at Palm Beach Eqine Clinic. In addition to state-of-the art diagnostic tools, the technology also affords economic benefits to owners.
“MRIs can give a definitive diagnosis, and that saves time and money in the long run,” said Dr. Puchalski. “For example, if a horse goes lame and is examined and treated empirically, which is a diagnosis based on likely problems through common diagnostic procedures, it either stays sound or it becomes lame again or even non-functional in three to six months. This method sets back the commencement of the appropriate therapy.
“What the MRI does is allow the horse to be treated early and correctly,” continued Dr. Puchalski. “Otherwise, you may not be treating the correct issue, and the horse could end up lame again very soon.”
Nuclear Scintigraphy does not produce a scan that is as specific, but it gives Dr. Puchalski the opportunity to procure a concrete quick diagnosis, as well as evaluate the whole horse for secondary problems.
“Oftentimes the primary problem in one place is making a horse sore in other places,” she said. “Owners like to know the root problem, but to also quickly diagnose secondary problems so the entire horse can be treated at once.”
As the official veterinary hospital of the Winter Equestrian Festival (WEF) and the Adequan® Global Dressage Festival (AGDF), Palm Beach Equine Clinic sees a high concentration of sport horses in need of care. In turn, owners of those horses are eager to see their horses quickly and happily return to competition.
“The biggest benefit to Palm Beach Equine Clinic and the Wellington community as a result of these MRI and Nuclear Scintigraphy scans is accessibility,” concluded Puchalski. “Anyone can call from the horse show to the clinic, get a scan scheduled quickly- in and out, get results fast, and then their training program can be changed immediately.”
About Dr. Sarah Puchalski
Dr. Sarah Puchalski is from Davis, CA, where she was an associate professor at the University of California in their Department of Surgical and Radiological Sciences. In 1995, she received her BS in biology from Simon Fraser University in British Columbia, and in 1999 earned her Doctor of Veterinary Medicine from the University of Saskatchewan in Saskatoon, where she received the ACVS Outstanding Large Animal Surgery Student award that same year. Dr. Puchalski interned in Field Service and Sports Medicine at New Bolton Center at the University of Pennsylvania in 2001, and completed her residency in radiology at UC Davis in 2005.
Dr. Puchalski has devoted her career to teaching and improving equine health through the development and refinement of diagnostic techniques. In 2011, she contributed to two books on the topic of equine lameness. Her recent contributions include chapters in “Diagnosis and Management of Lameness in the Horse,” edited by Ross and Dyson, as well as in “Veterinary Computed Tomography and the Clinical Veterinary Advisor: The Horse, Equine Colic and Veterinary Clinics of North America.” She also has contributed close to 50 scientific articles concerning the diagnosis of equine lameness to many periodic journals, including Veterinary Radiology & Ultrasound: the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association; Veterinary Pathology; Equine Veterinary Journal; the American Journal of Veterinary Research; Equine Veterinary Education; Journal of the American Veterinary Medical Association; and Journal of Veterinary Internal Medicine.
Palm Beach Equine Clinic provides experience, knowledge, availability, and the very best care for its clients. Make Palm Beach Equine Clinic a part of your team!
While competing in South Florida, horses and riders from around the globe have access to Palm Beach Equine Clinic’s state-of-the-art hospital for all of their sport horse needs. Palm Beach Equine Clinic has a team of over 30 veterinarians, which includes three Board-Certified Surgeons, a Board-Certified equine Radiologist, and numerous other experts in their fields. All competitors and their traveling veterinarians are welcome for the support of services and collaboration throughout the season.
Referral Veterinarians Welcome
The referring relationship between veterinarians is most commonly seen in the specialty departments of surgery, internal medicine, ophthalmology, and advanced diagnostic imaging. At Palm Beach Equine Clinic, the advanced diagnostic imaging and surgical technology is unmatched, and the three Board-Certified Surgeons are skilled in many procedures that require high levels of expertise and advanced current equipment. As a result, many veterinarians refer their clients to the facility for specialty services.
Dr. Weston Davis, one of the Board-Certified Surgeons on the staff at Palm Beach Equine Clinic, works with many referral cases. Throughout the year, veterinarians from all over Florida frequently refer their clients to Palm Beach Equine Clinic for surgical procedures and advanced diagnostic imaging. The referring veterinarians may range anywhere from general practitioners to other surgeons that do not have access to surgical facilities or the most modern diagnostic imaging modalities while on the road.
“As a rule, we are friendly with referring doctors and take care of their clients with as much high-level care and professionalism as possible,” Dr. Davis stated. “It is important to us to maintain good relationships with the veterinarians that refer to us for specialty work. We always try to facilitate whatever level of involvement they desire. If they want to come and be there for the surgical procedure, we make that happen, and if they just want to send the case and not be as involved, we can do that as well. However, we also always collaborate with the referring veterinarian and the client as a team. If they send a horse in for a surgical procedure, we are going to do the procedure and then connect the client with the referring physician for the follow-up.”
Talented Surgeons and Advanced Diagnostic Imaging
The cutting-edge services available at Palm Beach Equine Clinic are made possible by the expertise of the hospital’s talented surgeons, along with the assistance of state-of-the-art diagnostic imaging and comprehensive surgical and medical resources. The combination brings many of the best veterinarians in the world to Palm Beach Equine Clinic for assistance with their most complex cases.
Among the hospital’s features, the latest in surgical technology enables less invasive operations that result in faster recovery times for the horse. Dr. Davis explained how diagnostic imaging is used during surgery to help guide procedures and assure the best possible result.
“Magnetic Resonance Imaging (MRI) and other advanced diagnostic imaging modalities can often be used for three-dimensional mapping to help enhance the surgical technique,” he noted. “There are some fractures in particular where the surgeon can map out the exact configuration of the fracture off of the MRI scan. We are then able to place markers with the MRI to guide a more exact, refined surgery.
“Intra-operatively, x-rays are taken to view progress, particularly for fracture repairs,” Dr. Davis continued. “The digital radiographs allows us to view the fracture in two planes to ensure optimal screw placement and fracture repair. Ultrasound is also frequently used in surgery for some of the more delicate procedures, specifically with soft tissue.”
Other surgical procedures may be guided with Arthroscopy, which aids in visualization of a joint; Laparoscopy, which uses a camera inserted into the abdomen; or Endoscopy, which is used in upper airway procedures. With the most advanced diagnostic imaging technology onsite, Palm Beach Equine Clinic is the go-to hospital for equine owners and referral veterinarians from around the world during the winter season in Wellington.
Palm Beach Equine Clinic provides experience, knowledge, availability, and the very best care for its clients. Make Palm Beach Equine Clinic a part of your team! To find out more, please call 561-793-1599.
Dr. Sarah Puchalski is a Diplomate of the American College of Veterinary Radiology whose specialty includes the interpretation of diagnostic imaging including Radiographs, MRIs, Nuclear Scintigraphy, and CT scans. Dr. Puchalski’s job requires a high level of specialization to properly review imaging to produce comprehensive written reports for referring veterinarians. In addition to her full-time position with PBEC, Dr. Puchalski reads imaging cases for clinics all over the world. Many veterinarians and owners request a consultation as a second opinion on Pre-Purchase examinations radiographs and ultrasound evaluations.
Pioneering Equine Diagnostic Imaging Modalities
Palm Beach Equine Clinic has always been a pioneer in advances of technology within the equine veterinary industry. Almost 30 years ago, Palm Beach Equine Clinic bought the first ultrasound for equine practice in South Florida. Twenty-five years ago, Palm Beach Equine Clinic installed the first Nuclear Scintigraphy gamma ray camera to perform bone scans. Twenty years ago, Palm Beach Equine Clinic assisted in developing Computed Radiography (CR) for horses. Currently, Palm Beach Equine Clinic has the most advanced surgical and diagnostic imaging equipment available, including a standing MRI unit, MiE gamma ray camera, Digital Radiography, Video Endoscopy, and a bevy of additional diagnostic equipment.
“Palm Beach Equine Clinic has a great case population and great equipment, which is a huge bonus for someone doing what I do,” Dr. Puchalski stated. “The equipment is exceptional, the technical staff is excellent, and the case population of the region is obviously amazing.”
Nuclear Scintigraphy Imaging
Palm Beach Equine Clinic proudly offers an updated Nuclear Scintigraphy lab (bone scan) that houses the MiE Nuclear Scintigraphy gamma ray camera. Nuclear Scintigraphy is typically used to diagnosis injuries or bone remodeling within the skeletal anatomy of the horse. This specialized camera is equipped with sharper contours for precise imaging that results in accurate lameness diagnoses. Advanced software provides the ability to acquire high quality images despite small movements from the patient. This feature reduces the time required to complete a study, which provides quicker results.
Bone scans are also very useful in defining multi-limb lameness origins for the hard to diagnose, long-duration lameness cases. Typically, Nuclear Scintigraphy scans isolate points of injury to be identified further with other diagnostic techniques, such as digital radiology and magnetic resonance imaging (MRI).
The clinic offers an MRI lab containing the innovative Equine Standing MRI manufactured by Hallmarq, which scans the equine distal limb in a standing position requiring only light sedation. MRI is very useful to further define a suspected lameness origin by acquiring more defined images of boney and soft tissue structures.
Palm Beach Equine Clinic (PBEC) is one of the few equine hospitals in the country to have a full-time radiologist on-site during season. With the addition of Dr. Sarah Puchalski to their staff, as well as the installation of the most state-of-the-art imaging equipment, Palm Beach Equine Clinic has become a leader in diagnostic sport horse imaging.
Dr. Puchalski is one of very few board-certified equine Radiologists in the country and one of the most high profile of those in the world. Early in her career, Dr. Puchalski earned the respect of the best in the industry and strives to continue to contribute advances for equine sports medicine and diagnostic imaging.
Dr. Puchalski’s job takes extensive training and a high level of specialization to properly review diagnostic imaging, including MRIs and Nuclear Scintigraphy bone scans to produce written reports for referring veterinarians. In addition to her full-time position with Palm Beach Equine Clinic, she reads cases from all over the world on a daily basis. Many veterinarians and owners request to consult with her for a second opinion.
Potential for Growth
After eight years working as a faculty member at the University of California Davis, Dr. Puchalski decided to take a job with Palm Beach Equine Clinic in December 2013. She had been consulting on Palm Beach Equine Clinic cases for several years prior to the move and felt it was a natural progression. Palm Beach Equine Clinic made huge advances to their in-house imaging technology under her direction.
Almost 30 years ago, Palm Beach Equine Clinic bought the first ultrasound for equine practice in South Florida. Twenty-five years ago, Palm Beach Equine Clinic installed the first gamma ray camera to perform bone scans (Nuclear Scintigraphy). Twenty years ago Palm Beach Equine Clinic developed Computed Radiography (CR) for horses. Currently, Palm Beach Equine Clinic has the most advanced state-of-the-art surgical and diagnostic imaging equipment available. Onsite, they have a Hallmarq standing equine MRI unit, MiE gamma ray camera, Digital Radiography, Video Endoscopy, and a bevy of additional diagnostic equipment.
“ Palm Beach Equine Clinic has a great case population and great equipment, which is a huge bonus for someone doing what I do,” Dr. Puchalski stated. “The equipment is exceptional, the technical staff is excellent, and the case population of the region is obviously amazing.”
Palm Beach Equine Clinic is dedicated to providing exceptional veterinary service for the horse, and Dr. Puchalski proudly supports that mission through her work. She diagnoses issues from complicated images that assist veterinarians in the proper, effective treatment plan. She is able to provide a second opinion on routine diagnostic techniques such as radiographs and ultrasounds. She is also able to provide diagnostic reports for pre-purchase examinations based on the imaging submitted.
For Dr. Puchalski, the potential for future growth in diagnostic imaging services at Palm Beach Equine Clinic is huge.
“There are new technologies coming into the market for imaging all of the time and Palm Beach Equine Clinic will remain abreast of those advances,” Dr. Puchalski said. “Going forward, we are looking to acquire new equipment, and I think it is fair to say that the hospital will see an increasing role with different kinds of cases. There are a lot of changes in the market that occur very quickly, so we are always trying to figure out the best thing for this practice.”
Finding Time to Ride
In addition to working with PBEC locally and assisting veterinarians around the world, Dr. Puchalski competes her Oldenburg mare, Lucia de Luxe, in the Medium and High Amateur-Owner Jumpers.
Dr. Puchalski splits her time throughout the year between her homes in California and Florida. She is based in Wellington for about five months, and enjoys competing at the Winter Equestrian Festival, for which PBEC serves as the official veterinarians.
Although her horse is currently injured, Dr. Puchalski normally rides every day and enjoys the flexibility of her job that supports her riding schedule.
“One of the best parts of what I do is the flexible schedule,” she admitted. “I try to ride every day and fit everything else around it. I can really do my job from anywhere. It can be completely web-based, which I love.”
“First thing in the morning, I check into the clinic and check on the imaging cases for the day,” Dr. Puchalski detailed. “I usually read some MRI and Nuclear Scintigraphy cases and then go ride mid-morning. Then I come back and read cases for my other clients. PBEC is a big chunk of my work, but a lot of my cases also come from global clients; I have clients all over the world.”
From a Small Town to Big Dreams
Dr. Puchalski grew up on a small-town acreage in British Columbia and started riding at a very young age. She got her first pony when she was four years old and continued riding at a three-day eventing barn next door to her home. Early on, Dr. Puchalski knew that she wanted to be a veterinarian. Dr. Puchalski graduated with a BS in Biology from Simon Fraser University in British Columbia, and completed her Doctorate of Veterinary Medicine from the University of Saskatchewan in Saskatoon. She interned in Field Service and Sports Medicine at New Bolton Center at the University of Pennsylvania, and completed her residency in Radiology at UC Davis in 2005. During her internship at the New Bolton Center, Dr. Puchalski decided to pursue a career as a Radiologist thanks in part to one of her valued mentors, Virginia Reef, at the University of Pennsylvania.
“Dr. Reef was a huge influence on my career direction at that stage,” Dr. Puchalski noted. “Ginny was an influence in me becoming a radiologist, and then as a radiologist, I was mentored by Tim O’Brien at UC Davis – he is a founding father of equine radiology.”
Continuing to Have an Influence
Prior to joining PBEC in 2013, Dr. Puchalski spent eight years on the faculty of UC Davis providing research instruction and clinical service. Dr. Puchalski has published many scientific articles in diagnostic imaging and equine injuries which was a huge component of her early career.
“Once you have published research, the spinoff is then to publish in textbooks and other literature, so I have done a number of chapters for major lameness and diagnostic imaging textbooks as well,” Dr. Puchalski explained. “I have published more than 50 scientific articles and performed over 100 presentations all over the world on lameness diagnosis and diagnostic imaging in sport horses. I am currently trying really hard to still publish study results and be involved with universities, but also have a very busy private practice caseload.”
Outside of work and horses, Dr. Puchalski enjoys the challenges of Crossfit. In addition to her time spent in Florida and California, she also spends several weeks every summer working and showing at Spruce Meadows in Calgary, Alberta, Canada.
Dr. Puchalski is an integral part of the team at Palm Beach Equine Clinic and will continue to serve PBEC’s clientele as diagnostic imaging advances into the future.
Palm Beach Equine Clinic provides experience, knowledge, availability, and the very best care for the horses of Wellington. Have them be a part of your team! To find out more, please visit www.EquineClinic.com or call 561-793-1599. “Like” them on Facebook to follow along on what happens in Wellington and more, and get news from their Twitter!
More About Dr. Sarah Puchalski
Dr. Puchalski is a Diplomate of the American College of Veterinary Radiology whose specialty includes the interpretation of radiographs in addition to other diagnostic imaging techniques.
Dr. Puchalski is from Davis, CA, where she was an associate professor at the University of California in their Department of Surgical and Radiological Sciences. In 1995, she received her BSc in biology from Simon Fraser University in British Columbia, and in 1999 earned her Doctor of Veterinary Medicine from the University of Saskatchewan in Saskatoon, where she received the ACVS Outstanding Large Animal Surgery Student award that same year. Dr. Puchalski interned in Field Service and Sports Medicine at New Bolton Center at the University of Pennsylvania in 2001, and completed her residency in radiology at UC Davis in 2005.
Dr. Puchalski has devoted her career to teaching and improving equine health through the development and refinement of diagnostic techniques. In 2011 she contributed to two books on the topic of equine lameness. Her recent contributions include chapters in Diagnosis and Management of Lameness in the Horse edited by Ross and Dyson, as well as in Veterinary Computed Tomography and the Clinical Veterinary Advisor: The Horse, Equine Colic and Veterinary Clinics of North America. She also has contributed close to 50 scientific articles concerning the diagnosis of equine lameness to many periodic journals, including Veterinary Radiology & Ultrasound: the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association; Veterinary Pathology; Equine Veterinary Journal; the American Journal of Veterinary Research; Equine Veterinary Education; Journal of the American Veterinary Medical Association; and Journal of Veterinary Internal Medicine.