Keeping Your Horse Sound
Each lameness exam is different depending on the history, presentation and physical exam findings of the lame horse. In general, you can expect the veterinarian to palpate the horse’s body and limbs, observe the horse at a walk, trot and canter, perform limb flexions, and perform nerve and/or joint blocks.
Nerve and/or joint blocks help the veterinarian localize the source of lameness more specifically. A small amount of anesthetic is injected around a nerve or into a joint and if the lameness resolves after the anesthetic has numbed the structure, that area is localized as the cause of the lameness. If the lameness is unchanged, additional blocks are then performed to continue the investigation. Nerve blocks are performed from the bottom of the leg and proceed upward to avoid numbing too many structures at one time; this step-wise process helps localize the source of lameness more specifically. Most veterinarians work with a combination of nerve and joint blocks to work up complex lameness cases, but this can vary depending on the case. A full lameness exam including all the necessary blocks can take from 40 min to up to several hours.
In our sports medicine work, ultrasound is primarily used to evaluate tendons and ligaments in the legs. Additionally, it can be used to evaluate the surface of bones and joint margins to investigate subtle bony abnormalities that may not be able to be seen on radiographs. Ultrasound guidance is used for injections of deeper joints, such as the articulations of the cervical facets in the neck and the sacro-iliac joint space in the pelvis.
Northwest Equine has two digital ultrasound machines and 4 different probes to give us a large variety in the diagnostic ability of our machines.
Digital radiograph (x-ray)
Radiographs can be used to diagnose or rule-out problems such as osteoarthritis, bone cysts, fractures, tooth root abscesses, and laminitis, among others. The radiographic images can also be used to monitor the progression of conditions such as arthritis and laminitis and to guide therapy.
Northwest Equine has three digital radiography units to provide horse-side evaluation of orthopedic and other bony conditions. Because the images we obtain are digital, we are able to manipulate the images to examine them in detail and to send them to our clients or other veterinarians in different formats.
Pro-Stride APS is a proprietary system whose output produces a concentrated solution of cells, platelets, growth factors, and anti-inflammatory proteins (including IL-1ra).
- <20 minute blood processing (no incubation)
- Clinically demonstrated pain relief at 52 weeks following a single injection*
- Natural - Drug-Free
- Ambulatory convenience
Interleukin-1, also known as IL-1, and tumor necrosis factor alpha, also known as TNF-alpha, are the key pro-inflammatory proteins called cytokines which need to be blocked from damaging the tissue. These inflammatory cytokines bind to the cell surface receptors on the cartilage and start the process of cartilage breakdown which ultimately leads to joint pain and damage.
There are several naturally occurring inhibitors (anti-inflammatory proteins) of the pro-inflammatory cytokines IL-1 and TNF-alpha. These include the interleukin-1 receptor antagonist protein (IRAP), also known as IL-1ra, SIL-1r, also known as Soluble interleukin-1 receptor and STNF-rs, known as Soluble tumor necrosis factor receptors. All of these are highly concentrated within Pro-Stride APS.
- Pro-Stride does not require an incubation period
- Pro-Stride's output is not an autologous conditioned serum (ACS)
- Pro-Stride is never frozen
* A. Bertone, Am J Vet Res 2014; 75:141-151
Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment modality that can improve blood flow and speed the healing of many types of orthopedic and soft tissue injuries. Shockwave therapy has been successfully used in equine sports medicine to treat many soft tissue and bony problems, both acute and chronic. Common conditions that we treat with ESWT include: suspensory ligament tears or strains, tendon injuries, osteoarthritis, collateral ligament injuries, back pain, and muscle tears.
Shockwave therapy employs high energy sound waves that are focused within the probe head. Each probe head is designed to reach a certain depth. When the shockwave reaches the target tissue at the appropriate depth, the energy is released into the surrounding tissue, stimulating new blood vessel growth resulting in tissue regeneration in tendons, joints, and bone.
Once the area of injury is determined (by radiography or ultrasonography), the area is prepared by clipping and cleaning the skin. Gel is applied to the skin and prior to the start of therapy, the horse is sedated. The number of shockwaves and energy level varies with the structure and condition being treated. Most treatment sessions last 15-20 minutes and are repeated two to three times every two to four weeks.
Northwest Equine uses the VersaTron ® system, which was designed specifically for equine patients and has been used in therapy of equine injuries for over 10 years.
Interleukin-1 receptor antagonist protein (IRAP) is a potent anti-inflammatory used in the management of osteoarthritis in horses. Whole blood is taken from the horse into the IRAP® syringe, which contains specially coated glass beads. The syringe is then incubated, centrifuged, and the serum extracted for re-injection into the horse from which the blood was taken. This product does not have the cartilage-damaging effects that can be seen with intra-articular corticosteroids and is frequently effective when corticosteroids are no longer effective in a particular joint. Additionally, IRAP® is very effective in managing osteoarthritis in horses for which corticosteroids are contraindicated, as in horses with PPID (equine Cushing’s disease).
Initiating therapy with IRAP® involves an initial blood draw followed by a series of three injections spaced 7-10 days apart. After completing the initial series, many horses are able to be maintained with a single IRAP® injection in each affected joint every 6-12 months.
Northwest Equine Veterinary Associates has been treating horses with IRAP® since its approval in the United States nearly 10 years ago with very promising results and many happy success stories.
PLATELET RICH PLASMA (PRP) THERAPY
Platelet rich plasma (PRP) has been receiving quite a bit of attention in both equine and human sports medicine in recent years. Platelets release various growth factors that are important in wound healing and tissue repair, collagen production, hyaluronic acid production, and ingrowth of blood vessels. A PRP clot serves as a fibrin matrix which serves as a scaffold for tissue repair and a reservoir for retention and slow release of growth factors.
Northwest Equine Veterinary Associates has the Magellan PRPTM system, which allows for safe and rapid on-site separation and preparation of platelet rich plasma.
STEM CELL THERAPY
In horses, stem cells can be cultured from either adipose (fat) tissue or bone marrow. Stem cells are multipotent cells that have the potential to develop into multiple cell types, such as bone, cartilage, muscle, fat, and others. This therapy has shown promise in treating tendon and ligament injuries as well as advanced joint disease. Northwest Equine Veterinary Associates is equipped to harvest both bone marrow and adipose tissue for culturing of multipotent stem cells. After harvesting, the sample is sent away for culturing at a separate facility before being shipped back to our office for use either at your farm or at our clinic.
Buying a horse can involve a large investment of time, money, and emotion. Most horses are not sold with a money-back guarantee and this is why a purchase examination is so important. A purchase examination starts with a phone call (typically made by the buyer) to our office to schedule the examination. During this phone call, our office staff will get the buyer’s information, the seller’s information, and the horse’s information. They will then email a buyer’s and a seller’s form to be filled out by the appropriate parties. The seller’s form is necessary to give the veterinarian a complete medical history and a history of the horse’s previous use. The buyer’s form is important to help the veterinarian determine what the buyer’s goals are for the horse and the buyer’s familiarity with the horse.
The purchase examination typically consists of a thorough physical examination including an ophthalmic examination, neurologic evaluation, and a brief oral exam. The musculoskeletal system is evaluated in depth including palpations of the neck, back, and all four limbs. The horse is observed at the walk and trot on a hard surface and is observed at the walk, trot, and canter on a softer surface. Flexion of the joints on all four limbs is performed and the horse is evaluated at the trot to look for any subsequent lameness. Based on the buyer’s needs and budget, radiographs may be performed to investigate any potential problems. Blood tests that may be run with a purchase examination include: a complete blood count, biochemistry screen, and fibrinogen; EIA (Coggins) test; and a drug screen. A fecal sample to check for parasite eggs may also be collected at this time. Ultrasound, endoscopy of the upper airway, and a complete reproductive evaluation and breeding soundness examination can also be performed upon request.
A complete report will be prepared by the veterinarian and provided to the buyer with all associated paperwork. The goal of this report is not to pass or fail the horse. Rather, the goal is to provide the buyer with information regarding any existing medical problems and to discuss how those problems may impact future performance so that an informed decision can be made.