Palm Beach Equine Clinic is one of the foremost equine surgical centers in the world with three board-certified surgeons on staff, led by Dr. Weston Davis. As a busy surgeon, Dr. Davis has seen many horses with the dreaded “kissing spines” diagnosis come across his table. Two of his most interesting success stories featured horses competing in the disciplines of barrel racing and dressage.
The words “your horse needs surgery” are ones that no horse owner wants to hear, but to Sara and Kathi Milstead, it was music to their ears. In 2016, Sara – who was 17 years old at the time and based in Loxahatchee, Florida – had been working for more than a year to find a solution to her horse’s extreme behavioral issues and chronic back pain that could not be managed. Her horse Two Blondes On Fire, a then-eight-year-old Quarter Horse mare known as “Flossy” in the barn, came into Sara’s life as a competitive barrel racer. But shortly after purchasing Flossy, Sara knew that something wasn’t right.
“We tried to do everything we could,” said Sara. “She was extremely back sore, she wasn’t holding weight, and she would try to kick your head off. We tried Regu-Mate, hormone therapy, magna wave therapy, injections, and nothing helped her. We felt that surgery was the best option instead of trying to continue injections.”
At the time, Sara and her primary veterinarian, Dr. Jordan Lewis of Palm Beach Equine Clinic (PBEC), brought Flossy to PBEC for thorough diagnostics. They determined Flossy had kissing spines.
Kissing Spines Explained
In technical terms, kissing spines are known as overriding or impinging dorsal spinous processes. The dorsal spinous process is a portion of bone extending dorsally from each vertebra. Ideally, the spinous processes are evenly spaced, allowing the horse to comfortably flex and extend its back through normal positions. With kissing spines, two or more vertebrae get too close, touch, or even overlap in places. This condition can lead to restrictions in mobility as well as severe pain, which ultimately can lead to back soreness and performance problems.
“The symptoms can be extremely broad,” acknowledged Dr. Davis. “[With] some of the horses, people will detect sensitivity when brushing over the topline. A lot of these horses get spasms in their regional musculature alongside the spinous processes.” A significant red flag is intermittent, severe bad behavior, such as kicking out, bucking, and an overall negative work attitude, something that exactly described Flossy.
With dressage horse Lakota owned by Heidi Degele, there were minimal behavior issues, but Degele knew there had to be something more she could do to ease Lakota’s pain.
“As his age kicked in, it was like you were sitting on a two-by-four,” Heidi said of her horse’s condition. “I knew his back bothered him the most because with shockwave he felt like a different horse; he felt so supple and he had this swing in his trot, so I knew that’s what truly bothered him.” Though she could sense the stiffness and soreness as he worked, he was not one to rear, pin his ears, or refuse to work because of the pain he was feeling.
Heidi turned to Dr. Davis, who recommended a surgical route, an option he only suggests if medical treatment and physical therapy fail to improve the horse’s condition. “Not because the surgery is fraught with complications or [tends to be] unsuccessful,” he said, “but for a significant portion of these horses, if you’re really on top of the conservative measures, you may not have to opt for surgery.
“That being said, surgical interventions for kissing spines have very good success rates,” added Dr. Davis. In fact, studies have shown anywhere from 72 to 95 percent of horses return to full work after kissing spines surgery.
After Lakota made a successful recovery from his surgery in 2017, he has required no maintenance above what a typical high-level performance horse may need. Heidi attributes his success post-surgery to proper riding, including ground poles that allow him to correctly use his back, carrot stretches, and use of a massage blanket, which she has put into practice with all the horses at her farm. Dr. Davis notes that proper stretching and riding may also prolong positive effects of injections while helping horses stay more sound and supple for athletic activities.
Lakota, who went from Training Level all the way up through Grand Prix, is now used by top working students to earn medals in the Prix St. Georges, allowing them to show off their skills and earn the qualifications they need to advance their careers.
Flossy was found to have dorsal spinous process impingement at four sites in the lower thoracic vertebrae. Dr. Davis performed the surgery under general anesthesia and guided by radiographs, did a partial resection of the affected dorsal spinous processes (DSPs) to widen the spaces between adjacent DSPs and eliminate impingement.
Sara took her time bringing Flossy back to full work. Within days of the surgery, Sara saw changes in Flossy, but within six months, she was a new horse.
“Surgery was a big success,” said Sara. “Flossy went from a horse that we used to dread riding to the favorite in the barn. It broke my heart; she was just miserable. I didn’t know kissing spines existed before her diagnosis. It’s sad to think she went through that pain. She’s very much a princess, and all of her behavioral problems were because of pain. Now my three-year-old niece rides her around.”
Sara and Flossy have returned to barrel racing competition as well, now that Sara graduated from nursing school, and have placed in the money regularly including two top ten finishes out of more than 150 competitors.
“I can’t even count the number of people that I have recommended Palm Beach Equine Clinic to,” said Sara. “Everyone was really great and there was excellent communication with me through every step of her surgery and recovery.”
By finding a diagnosis for Flossy and a way to ease her pain, Sara was able to discover her diamond in the rough and go back to the competition arena with her partner for years to come.
What To Expect After the Unexpected Strikes
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Every owner dreads having to decide whether or not to send their horse onto the surgical table for colic surgery. For a fully-informed decision, it is important that the horse’s owner or caretaker understands what to expect throughout the recovery process.
Palm Beach Equine Clinic (PBEC) veterinarian Weston Davis, DVM, DACVS, assisted by Sidney Chanutin, DVM, has an impressive success rate when it comes to colic surgeries, and the PBEC team is diligent about counseling patients’ owners on how to care for their horse post-colic surgery.
“After we determine that the patient is a strong surgical candidate, the first portion of the surgery is exploratory so we can accurately define the severity of the case,” explained Dr. Davis. “That moment is when we decide if the conditions are positive enough for us to proceed with surgery. It’s always my goal to not make a horse suffer through undue hardship if they have a poor prognosis.”
Once Dr. Davis gives the green light for surgical repair, the surgery is performed, and recovery begins immediately.
“The time period for the patient waking up in the recovery room to them standing should ideally be about 30 minutes,” continued Dr. Davis. “At PBEC, we do our best to contribute to this swift return by using a consistent anesthesia technique. Our team controls the anesthesia as lightly as we can and constantly monitors blood pressure. We administer antibiotic, anti-inflammatory, anti-endotoxic drugs, and plasma to help combat the toxins that the horse releases during colic. Our intention in the operating room is to make sure colic surgeries are completed successfully, but also in the most time-efficient manner.”
Colic surgery recovery often depends on the type and severity of the colic. At the most basic level, colic cases can be divided into two types – large intestine colic and small intestine colic – that influence the recovery procedures and outlook.
Large intestinal colic or impaction colic is characterized by the intestine folding upon itself with several changes of direction (flexures) and diameter changes. These flexures and diameter shifts can be sites for impactions, where a firm mass of feed or foreign material blocks the intestine. Impactions can be caused by coarse feeds, dehydration, or an accumulation of foreign materials such as sand.
Small intestinal colic or displacement colic can result from gas or fluid distension that results in the intestines being buoyant and subject to movement within the gut, an obstruction of the small intestine, or twisting of the gut. In general, small intestinal colics can be more difficult than large intestinal colics when it comes to recovery from surgery.
“Many people do assume that after the colic surgery is successfully completed their horse is in the clear,” said Dr. Chanutin. “However, during the first 24 to 48 hours after colic surgery, there are many factors that have to be closely monitored.
“We battle many serious endotoxic effects,” continued Dr. Chanutin. “When the colon isn’t functioning properly, microbial toxins are released inside the body. These microbials that would normally stay in the gastrointestinal tract then cause tissue damage to other bodily systems. We also need to be cognizant of the possibility of the patient developing laminitis, a disseminated intervascular coagulation (overactive clotting of the blood), or reflux, where a blockage causes fluids to back up into the stomach.”
Stages after surgery
While 30 minutes from recumbent to standing is the best-case scenario, Dr. Davis acknowledges that once that time period passes, the surgical team must intervene by encouraging the horse to get back on its feet.
Once a horse returns to its stall in the Equine Hospital at PBEC, careful monitoring begins, including physical health evaluations, bloodwork, and often, advanced imaging. According to Dr. Davis, physical exams will be conducted at least four times per day to evaluate the incision and check for any signs of fever, laminitis, lethargy, and to ensure good hydration status. An abdominal ultrasound may be done several times per day to check the health of the gut, and a tube may be passed into the stomach to check for reflux and accumulating fluid in the stomach.
“The horse must regularly be passing manure before they can be discharged,” said Dr. Chanutin. “We work toward the horse returning to a semi-normal diet before leaving PBEC. Once they are at that point, we can be fairly confident that they will not need additional monitoring or immediate attention from us.”
Drs. Davis and Chanutin often recommend the use of an elastic belly band to support the horse’s incision site during transport from the clinic and while recovering at home. Different types of belly bands offer varying levels of support. Some simply provide skin protection, while others are able to support the healing of the abdominal wall.
Two Weeks Post-Surgery
At the 12-to-14-day benchmark, the sutures will be removed from the horse’s incision site. The incision site is continuously checked for signs of swelling, small hernias, and infection.
Once the horse is home, the priority is to continue monitoring the incision and return them to a normal diet if that has not already been accomplished.
The first two weeks of recovery after the horse has returned home is spent on stall rest with free-choice water and hand grazing. After this period, the horse can spend a month being turned out in a small paddock or kept in a turn-out stall. They can eventually return to full turnout during the third month. Hand-walking and grazing is permittable during all stages of the at-home recovery process. After the horse has been home for three months, the horse is likely to be approved for riding.
Generally, when a horse reaches the six-month mark in their recovery, the risk of adverse internal complications is very low, and the horse can return to full training under saddle.
When to Call the Vet?
Decreased water intake, abnormal manure output, fever, pain, or discomfort are all signals in a horse recovering from colic surgery when a veterinarian should be consulted immediately.
Dr. Davis notes that in a large number of colic surgery cases, patients that properly progress in the first two weeks after surgery will go on to make a full recovery and successfully return to their previous level of training and competition.
Depending on the specifics of the colic, however, some considerations need to be made for long-term care. For example, if the horse had sand colic, the owner would be counseled to avoid sand and offer the horse a selenium supplement to prevent a possible relapse. In large intestinal colic cases, dietary restrictions may be recommended as a prophylactic measure. Also, horses that crib can be predisposed to epiploic foramen entrapment, which is when the bowel becomes stuck in a defect in the abdomen. This could result in another colic incident, so cribbing prevention is key.
Generally, a horse that has fully recovered from colic surgery is no less healthy than it was before the colic episode. While no one wants their horse to go through colic surgery, owners can rest easy knowing that.
“A lot of people still have a negative association with colic surgery, in particular the horse’s ability to return to its intended use after surgery,” said Dr. Davis. “It’s a common old-school mentality that after a horse undergoes colic surgery, they are never going to be useful again. For us, that situation is very much the exception rather than the rule. Most, if not all, recovered colic surgery patients we treat are fortunate to return to jumping, racing, or their intended discipline.”
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.
“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.”
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.”
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.”
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.
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.
When Debbie Cruz imported her 2012 Friesian from Europe, she was excited to welcome the gelding into her life. However, the mount she purchased as a gelding from The Netherlands still had a lot of stallion left in him. Literally.
Marquis, Cruz’s hopeful dressage mount, arrived safe and sound to her home in Miami, FL, in early 2020. When he started to display quintessential stallion-like behavior, she called her veterinarian, Dr. Joseph Zerilli, to help her determine the cause of this very “un-gelding like” behavior.
“I was told that he had been gelded while in The Netherlands, but when he came home, he was acting exactly like a stud rather than the sweet gelding I thought would be arriving,” said Cruz. “I wasn’t sure what the cause could have been, but I knew something wasn’t right.”
Dr. Zerilli performed a blood test as part of his exam, which revealed very high levels of testosterone for a horse that was supposed to be a gelding. The level of testosterone present was a solid marker for a retained testis, one that would require surgery to remove. Marquis was referred to Dr. Weston Davis, a board-certified surgeon at Palm Beach Equine Clinic in Wellington, FL.
Dr. Davis used a hCG stimulation test and abdominal ultrasound to determine if testicular tissue was present and the source of Marquis’ testosterone levels were confirmed: he was a cryptorchid. Also known as a “rig” or “ridgling,” a cryptorchid horse has one or both testes that are not fully descended into the scrotum. In Marquis’ case, he had a retained left testis within the abdomen.
In a normal stallion, the testes gradually descended from just below the kidneys, through the inguinal canal, and into the scrotum. This happens either in utero or during the first few weeks of life. Occasionally, either one or both testes fail to descend for reasons that are still not fully understood by veterinarians. A cryptorchid stallion can be further classified as either inguinal when the testis is in the inguinal canal, or abdominal when the testis remains in the abdominal cavity, which was the case for Marquis.
“During surgery, the horse was placed under general anesthesia and we used the laparoscopic camera inserted into the abdomen to examine the retained testis,” said Dr. Davis.
A laparoscopy is an endoscopic procedure where a fiberoptic video camera and surgical instruments are introduced into the abdomen through a small incision. This permits the observation of the inside of the abdomen and allows abdominal surgeries to be performed without a large incision into the abdominal cavity.
“We could see that there was torsion, which indicates restricted blood flow and often pain, as well as severe enlargement,” said Dr. Davis. “The testis, which had become quite large, was then exteriorized through an enlarged paramedian incision. Marquis recovered from anesthesia without complication and with an excellent prognosis.”
“The biggest victory in this rather rare case is that the horse was relieved of pretty severe discomfort and the owner could enjoy the gelding disposition she was expecting.”Dr. Davis
Aside from pain from the torsion and subsequent enlargement within the body, Marquis’ risk of developing malignant (cancerous) tumors was increased with the testis left inside his body. Prompt diagnosis and surgery likely prevented more critical problems in the future for Marquis.
After recovering from surgery at Palm Beach Equine Clinic’s onsite hospital, Marquis was returned home to Cruz without his retained testis and a new attitude.
“I am very grateful to have had my horse seen by Dr. Weston Davis and his staff. I am not only happy that he was able to get his surgery with one of the best surgeons in the country, but also that it was such a success.”Debbie Cruz
Marquis’ recovery progressed quickly after he returned to his home barn, and he is now back in the tack with Cruz. “I am looking forward to a long journey with him,” she said. “I am thankful to everyone at Palm Beach Equine Clinic for the care they provided Marquis. I couldn’t see myself going anywhere else.”
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.
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.
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.”
Palm Beach Equine Clinic is Changing the Prognosis for Condylar Fracture Injuries
Palm Beach Equine Clinic is changing the prognosis for condylar fracture injuries in race and sport horses. Advances in diagnostic imaging, surgical skillset, and the facilities necessary to quickly diagnose, treat, repair, and rehabilitate horses with condylar fractures have improved dramatically in recent years.
Most commonly seen in Thoroughbred racehorses and polo ponies, a condylar fracture was once considered a career-ending injury. Today, however, many horses fully recover and return to competing in their respective disciplines.
What is a Condylar Fracture?
A condylar fracture is a repetitive concussive injury that results in a fracture to the cannon bone above the fetlock due to large loads transmitted over the cannon bone during high-speed exercise. On a radiograph, a condylar fracture appears as a crack that goes laterally up the cannon from the fetlock joint and out the side of the bone, essentially breaking off a corner of the cannon bone, sometimes up to six inches long.
“A condylar fracture is a disease of speed,” said Dr. Robert Brusie, a surgeon at Palm Beach Equine Clinic who estimates that he repairs between 30 and 50 condylar fractures per year. “A fracture to the left lateral forelimb is most common in racehorses as they turn around the track on a weakened bone and increased loading.”
Condylar fractures are further categorized into incomplete and non-displaced (the bone fragment hasn’t broken away from the cannon bone and is still in its original position), or complete and displaced (the fragment has moved away from the cannon bone itself and can often be visible under the skin).
Additionally, condylar fractures can occur laterally or medially. According to fellow Palm Beach Equine Clinic surgeon Dr. Weston Davis, most condylar fractures tend to be lateral on the outside condyle (a rounded projection on a bone, usually for articulation with another bone similar to a knuckle or joint).
“Most lateral condylar fractures are successfully repaired,” said Dr. Davis. “Medial condylar fractures tend to be more complicated configurations because they often spiral up the leg. Those require more advanced imaging and more advanced techniques to fix.”
What is the Treatment?
The first step in effectively treating a condylar fracture through surgery is to accurately and quickly identify the problem. Board-certified radiologist Dr. Sarah Puchalski utilizes the advanced imaging services at Palm Beach Equine Clinic to accomplish exactly this.
“Stress remodeling can be detected early and easily on nuclear scintigraphy before the horse goes lame or develops a fracture,” said Dr. Puchalski. “Early diagnosis of stress remodeling allows the horse to be removed from active race training and then return to full function earlier. Early diagnosis of an actual fracture allows for repair while the fracture is small and hopefully non-displaced.”
Once the injury is identified as a condylar fracture, Palm Beach Equine Clinic surgeons step in to repair the fracture and start the horse on the road to recovery. Depending on surgeon preference, condylar fracture repairs can be performed with the horse under general anesthesia, or while standing under local anesthesia. During either process, surgical leg screws are used to reconnect the fractured condyle with the cannon bone.
“For a small non-displaced fracture, we would just put in one to two screws across the fracture,” explains Dr. Davis. “The technical term is to do it in ‘lag fashion,’ such that we tighten the screws down heavily and really compress the fracture line. A lot of times the fracture line is no longer visible in x-rays after it is surgically compressed. When you get that degree of compression, the fractures heal very quickly and nicely.”
More complicated fractures, or fractures that are fully displaced, may require additional screws to align the parts of the bone. For the most severe cases of condylar fractures, a locking compression plate with screws is used to stabilize and repair the bone.
Palm Beach Equine Clinic surgeon Dr. Jorge Gomez approaches a non-displaced condylar fracture while the horse is standing, which does not require general anesthesia.
“I will just sedate the horse and block above the site of the fracture,” said Dr. Gomez. “Amazingly, horses tolerate it really well. Our goal is always to have the best result for the horse, trainers, and us as veterinarians.”
According to Dr. Gomez, the recovery time required after a standing condylar fracture repair is only 90 days. This is made even easier thanks to a state-of-the-art standing surgical suite at Palm Beach Equine Clinic. The four-and-a-half-foot recessed area allows doctors to perform surgeries anywhere ventral of the carpus on front legs and hocks on hind legs from a standing position. Horses can forgo general anesthesia for a mild sedative and local nerve blocks, greatly improving surgical recovery.
“A condylar fracture was once considered the death of racehorses, and as time and science progressed, it was considered career-ending,” concluded Dr. Brusie. “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.”
When Margo Crowther of Fort Myers, FL, was looking to add a new addition to her string of barrel racing horses, she made one very important phone call. That call was to Palm Beach Equine Clinic. Dr. Weston Davis, board-certified surgeon and veterinarian at Palm Beach Equine Clinic, has been working with Crowther to keep her horses healthy, as well as performing career-saving procedures.
In 2016, Dr. Davis helped Crowther and her 2012 Quarter Horse mare Shes Packin Fame, or “Sissy,” return to the ring after what could have been a detrimental injury. Sissy suffered a rare slab fracture to the central tarsal bone in her left hock while competing in a barrel racing competition. After a diagnosis aided by Palm Beach Equine Clinic’s advanced diagnostic imaging equipment and a surgery performed by Dr. Davis, Shes Packin Fame not only returned to running barrels, but the mare was also back to winning the next year.
When Crowther found a new prospect named Grandiose Guy, or “Mater,” she turned to Dr. Davis to ensure her intended purchase would be a good fit. The Quarter Horse gelding was named the Barrel Futurities of America (BFA) Horse of the Year just after she purchased him, crowning him the top four-year-old in the country.
“When I was thinking about buying him, I called Dr. Davis and sent him videos of the horse working to review,” said Crowther, who started the purchase process late last year and chose to involve Dr. Davis in all aspects of the pre-purchase evaluation. “The horse was in Georgia, so he reviewed them from Palm Beach Equine Clinic in Wellington and gave me the stamp of approval. Once a pre-purchase was performed, I sent all the x-rays to Dr. Davis and he told me to move forward.
“I trust Dr. Davis and the team at Palm Beach Equine Clinic so much!” continued Crowther. “Barrel horses work hard and it’s so important to have a great relationship with the vet who oversees their care and knows them well in order to keep them happy and healthy.”
Regardless of breed or discipline, a pre-purchase exam involves certain steps that allow the potential owner and veterinarian to investigate the horse’s health and condition. The veterinarian gathers and interprets information by physically examining the horse’s body systems and conformation, as well as reviewing the health history. A lameness assessment is completed, including flexion tests, soft tissue structure palpation and movement evaluation. Diagnostic medical imaging tools, such as radiography, ultrasonography, endoscopy, magnetic resonance imaging, nuclear scintigraphy, or computed tomography, may be used to provide a more detailed and comprehensive profile of the horse.
Crowther purchased Mater and started running him at the beginning of last year, bringing him to the largest one-day rodeo, The American, in the Dallas Cowboys stadium in Texas in February. The competition had a $1 million payout and Mater and Crowther placed fifth.
“After so many runs, we brought him home from Texas and got him over to Dr. Davis for any maintenance work that needed to be done to keep him feeling his best,” said Crowther. “I am very picky about where I take my horses; there has to be good ground and I will not run their legs off. In conjunction with that, maintenance work with Dr. Davis is important. He performs flexion tests, utilizes the imaging at Palm Beach Equine Clinic if necessary, and makes recommendations about my horses’ health and overall well-being.”
Dr. Davis sent Mater home from Palm Beach Equine Clinic with a clean bill of health and Crowther gave the gelding a little time off before their next run. After returning to work, Mater headed to the National Barrel Horse Association (NBHA) Florida State Championships in Kissimmee.
Crowther’s diligence and Dr. Davis’ knowledge paid off when Mater won both his runs and clinched the open final at NBHA Florida State Championships. With more than 700 entries, Mater and Crowther topped them all and were crowned overall champions of the event.
“Palm Beach Equine Clinic and Dr. Davis have been a huge part of the success I have had with all of my horses,” said Crowther. “They are always there when I need them, whether I’m headed to the clinic in Wellington or they are coming to me in Fort Meyers. It’s nice to be able to know your vet will be there for you whenever you need them.”
Feature in the March 2019 issue of Wellington The Magazine
The horses at the Vinceremos Therapeutic Riding Center perform miracles every day. Whether by carrying a person coping with a physical disability to a sense of independence, providing comfort to a soul suffering from emotional trauma or teaching a child beyond the confines of a classroom, the Vinceremos horses are heroes. But they aren’t the only ones wearing capes. A local group of dedicated and passionate equine veterinarians share in the magic.
The veterinarians of the Palm Beach Equine Clinic (PBEC), based in the heart of Wellington, have been caring for horses in South Florida for decades. Founded by Dr. Paul Wollenman in 1981, PBEC has grown to include a staff of 40 veterinarians, with five boarded specialists and the most state-of-the-art facility in the country. Situated in the winter equestrian capital of the world, Palm Beach Equine Clinic treats the top-performing show jumping, dressage, polo and racing athletes throughout the year.
Official Veterinarians of Vinceremos Therapeutic Riding Center
In addition, the clinic is a saving grace for the horses of Vinceremos. The 23 specially selected horses stay true to the nonprofit’s mission of conquering disability and hardship in people of all ages. Founded in 1982, Vinceremos, based in Loxahatchee Groves, serves people from all stations in life with physical, cognitive and emotional disabilities through the power of equine therapy. The treatments they offer include therapeutic riding and carriage driving, hippotherapy, equine-assisted learning and equine-assisted psychotherapy.
Palm Beach Equine Clinic does its part by keeping the horses healthy and happy with pro-bono veterinary care.
“We have the people and, most importantly, the horses, of South Florida to thank for the success that PBEC has enjoyed over the years,” said Palm Beach Equine Clinic President Dr. Scott Swerdlin, who spearheaded the clinic’s involvement with Vinceremos in 2011. “It is our honor to give back to that community through our work with Vinceremos. The whole team is dedicated to each and every horse we treat, as well as to the riders who love them.”
While their commitment to the nonprofit is extensive, it’s not about the hours spent or the cost of time and supplies. Swerdlin and his team focus on a bigger goal; healing horses so they can heal people. “There’s no greater reward than seeing how the horses of Vinceremos benefit their riders,” he said. “You see the riders light up and how excited they are to be on those horses.”
Swerdlin is proud of the clinic’s work with Vinceremos. “I continually remind my team that it is a privilege to treat the caliber of horses we have in Wellington and that should compel us to give back to the community,” he said. “The response from Palm Beach Equine Clinic veterinarians has been overwhelming. The entire team has volunteered to be involved.”
From routine treatments and services, such as vaccinations and health exams, to emergency care, Palm Beach Equine Clinic veterinarians are available to Vinceremos night and day. Last summer, such emergency care was called on, and one Vinceremos horse got a second chance at life thanks to a group of devoted veterinarians.
Vinceremos favorite Clark Kent — a sturdy black mount with an eye as kind as they come — suffered an injury to his right front leg. The laceration extended into his tendon sheath, which is a layer of membrane around a tendon on the back of the lower leg. What could have been a simple cut on the surface was much more serious.
Initially treated on-site at Vinceremos by Dr. Marilyn Connor, Clark Kent was then transported to PBEC for surgery to repair the injury. The case turned into a team effort and involved the work of surgeons Dr. Weston Davis and Dr. Michael Myhre, as well as Dr. Janet Greenfield.
After surgery and a recovery period at PBEC’s onsite equine hospital, Clark Kent returned to Vinceremos to recover. He was back to his therapy work by fall, giving riders a sense of independence and confidence with his skills on the lunge line and his forward way of moving.
“This treatment was no easy feat, but the veterinarians and staff of Palm Beach Equine Clinic took a tragedy and turned it into a miracle. Clark Kent was surrounded by extraordinary veterinarians and technicians throughout his care,” Vinceremos Director of Development Susan Guinan said. “The diligence of this team makes miracles happen every day. We are so appreciative of Palm Beach Equine Clinic and their team of veterinarians. They give so much support to Vinceremos and the horses here. They keep them in top shape so we can impact our community in such a special way through equine therapy.”
Rewarding for Horses and Humans
For Connor, it’s cases like Clark Kent’s that convinced her to pursue veterinary medicine. Growing up around horses, she spent time volunteering with a therapeutic riding program before attending veterinary school at Texas A&M.
“It was a very rewarding experience to be able to give back to a cause that is important to me. And even more so now that I can do that in a different capacity as a veterinarian,” said Connor.
She can often be found checking on the horses of Vinceremos while on the job. “Being able to help horses as special as the ones at Vinceremos and the people who love them is what ultimately made me realize I wanted to be an equine veterinarian,” Connor said.
A horse was recently admitted to Palm Beach Equine Clinic (PBEC), based in Wellington, FL, with symptoms that included bleeding from the nostril. The patient’s referring veterinarian had diagnosed the horse with an ethmoid hematoma, which in layman’s terms is essentially a mass that fills with blood in the nose or sinus cavity.
The patient was placed under the care of PBEC’s board-certified surgeon Dr. Weston Davis and Dr. Michael Myhre. They performed an airway endoscopy to locate and evaluate the hematoma that the referring veterinarian had identified. After confirming the diagnosis, Dr. Davis and Dr. Myhre were eager to ensure that it was the one and only hematoma they were battling.
PBEC is one of an elite group of equine veterinary clinics to have a computed tomography (CT) machine in their arsenal of diagnostic imaging equipment. A CT gives veterinarians a unique look at the head, neck, and spine of a horse that they would never be able to accomplish with other imaging modalities. After a CT of the patient’s sinuses, more masses were indeed identified.
“This was a fairly typical presentation of an ethmoid hematoma, but there were certainly more masses than normal,” said Dr. Myhre. “It’s for this reason that the CT was very useful. If we were not able to obtain the scans that we did, we may have missed the masses that were located deeper in the sinus.”
The cause of an ethmoid hematoma is unknown, but the mass resembles a tumor in appearance and development without being neoplastic. Horses with extensive masses may have reduced airflow and an expanding hematoma can cause pressure necrosis of the surrounding bones, but rarely causes facial distortion. Treatments of the ethmoid hematoma can range from conservative management to surgery. The conservative treatment route includes the injection of formalin – a mixture of formaldehyde gas and water – into the mass using a guarded endoscopic needle. Once injected, the mass typically regresses rapidly, but recurrence is common. For some cases, surgical excision is achieved via a frontonasal bone flap procedure.
Due to the location and advances nature of the masses in this case, injection was not an option and the CT imaging was used to plan a surgical approach. “After sedation and a local block, we went into the sinus through a flap approach where we took a section of bone, cut it into a flap, and moved it back so we could go into the sinuses through a nice window,” said Dr. Myhre. “We removed a mass four centimeters in diameter as well as several smaller masses two to three centimeters in diameter, then flushed the area and closed.”
According to Dr. Myhre the advantages of a standing procedure included fewer risks from bleeding and fewer risks of recovering from anesthesia.
Post-surgery, the bone flap will require several weeks to heal, but the skin itself healed within one to two weeks, which is when the horse was cleared to return to normal activity.