Sacro Iliac Injection!

The ultrasound image above is centered over the cranial edge of the pelvic rim. The red line corresponds to the pelvic rim and the green line corresponds to the transverse process of the last lumbar vertebrae.

The picture above shows the "cranial" approach with a long spinal needle for treatment of the sacro-iliac joint (SI). From the exterior of the horse it is very difficult to visualize the SI joint however proper alignment of the spinal needle via ultrasound guidance will result in accurate treatment of the SI joint space. The needle is inserted in front of the pelvis and guided just below the rim of the pelvis (see pic below)

This technique requires ultrasound guidance of a skilled operator. The typical complaint from the rider/trainers include poor performance, no obvious lameness, unwilling to maintain a particular lead, cross-cantering, and painful response to deep pressure over the gluteous musculature. The Sacro iliac joint can be visualized per rectum and may also be evaluated via nuclear scintigraphy. The response to treatment usually requires 10-14 days before a clinical improvement is noted and it can be very significant. The most interesting aspect of SI inflammation is that these horses are rarely lame however their performance as diminished!

The above ultrasound view is per rectum and shows the SI joint. In this case, there are bony changes around the joint which are consistent with arthritis.

Chondroids!!

The image above consists of many 2-3cm chondroids that were removed one by one from a horse's guttural pouch. This horse was a young filly at a sale barn that contracted the dreaded strangles infection (see my previous post concerning strangles in horses) yet continued to have a purulent discharge from her nasal passage for weeks. Unfortunately, the filly was not scoped to determine if the original infection resulted in abscessation within the guttural pouch. Over time, the purulent debris in the guttural pouch becomes hardened and resembles smooth, stone like objects known as chondroids. These objects are basically hardened pus that are typically filled with the bacteria that causes strangles in horses. 

The above images consists of the view through the endoscope into the guttural pouch revealing the lodged chondroids. There are two ways to remove these structures: 1) a surgical approach or 2) through an endoscope. The surgical approach is probably easier in the long run but there are more risks involving sensitive structures such as cranial nerves and large blood vessels. The endoscopic approach can be very slow considering that each chondroid is removed via a snare as imaged below. If these chondroids are not removed, the horse may likely remain "infectious" to other horses and will persist with a purulent nasal discharge. Most important message to you is that if your horse has a persistent nasal discharge, I strongly recommend a through endoscopic exam which MUST include evaluation of both guttural pouches!!

Kissing Spines!

The radiographs below are of the dorsal spinous processes of  the vertebral bodies in the top-line of a horse. Essentially, these bones are directly below the saddle and directly below the rider's center of gravity. As such, they represent some of the most stressed areas during riding under saddle. The first two radiographs are of the same horse and the yellow circles correspond to where the spinous processes are in contact with the each other. This is also know as "Kissing spines". This horse presented for a chronic history of a tender back and unwillingness to move forward at the trot and/or canter. The 3rd radiograph is that of a normal horse. There is significant space between the spinous processes. These spinous processes are slightly cranial to the ones depicted in the previous 2 radiographs.  Unfortunately, the diagnosis of kissing spines is not favorable for the horse to have a performance career without chronic back pain. There are therapies aimed at reducing the pain and muscle spasm associated with this condition which include; saddle fitting, shockwave therapy, mesotherapy, acupuncture, chiropractic adjustment, deep message, and cortisone injections. I strongly recommend having radiographs taken of any horse with a chronic history of back pain to determine if this might be the cause!! 

DreamHorse.com - Horses for Sale - Dream Horse Classifieds

DreamHorse.com - Horses for Sale - Dream Horse Classifieds

Patent Bar Horseshoe

The Patent bar horseshoe, is used to keep a horse from bearing weight on an injured leg. The shoe features a bar between the heels, which is raised 1 to 1½ inches to decrease the angle between the pastern and the cannon bone. In doing so, the shoe relieves stress on the flexor tendons and suspensory ligament.

 (The above shoe was constructed by David Boles and Marcus Lybarger)

The tenosynovitis imaged below is that of a horse with a severe injury to its deep digital flexor tendon in the pastern area (see ultrasound pic below). The horse was a grade 4/5 lame at the walk and was not willing to place his heel on the ground. By setting a patent bar shoe on the affected leg, the horse can bear weight on the limb with minimal strain on the injured deep digital flexor tendon. Over time, the heel elevation of the patent bar shoe is lowered until the horse is walking normally on the limb. This process usually takes 2-6 months depending on the extent of the injury. In addition, daily walking is encouraged to minimize the development of adhesions within the injured tendon/ligament. During the rehabilitation period, we recommend daily ice therapy, topical Surpass cream, and a series of extracorporeal shockwave treatment over the injured tendon/ligament. 

Severe tendinitis of the deep digital flexor tendon in the area of the pastern. The image on the left is a longitudinal view and the image on the right is a cross-sectional view of the same lesion. The dark or black area in the center of the image corresponds to fluid accumulation and fiber disruption (core lesion) within the body of the deep digital flexor tendon.

Equine Pharyngitis!!

The image above was from a 10 year old gelding that presented for a history of coughing and mild nasal discharge. The cough was intermittent and would vary from day to day. Recently, the cough had worsened as had the summer heat! Based on the history, the most likely cause was predicted to be heaves (AKA: COPD). However, when the endoscope was introduced into the gelding's upper airway it was clear that we were dealing with something quite different. There was evidence of pharyngeal scarring (cicatrix) and active pharyngeal ulceration  in a 360 degree (red circle below) range.  These findings were consistent with active inflammation and chronic changes. In addition, there was chronic, active inflammation of the arytenoids (green arrow).

The cause of pharyngeal inflammation/ulceration varies and is often never determined. In some cases, it may be complicated by bacterial infection. In some cases, the inciting cause is presumed to be an environmental irritant that the horse is chronically exposed to. The chronic inflammation results in scarring or cicatrix formation that can result in narrowing of the pharynx. Pharyngeal cicatrix formation is a serious complication that has no reliable remedy!  As such, a chronic couch (>2 weeks) should be evaluated via endoscopy prior to the development of scarring. Pharyngeal inflammation is typically treated with forced rest and topical antibiotics/steroids in the form of a nasal flush. 

Flood = Mosquito = Sleeping sickness (AKA: Encephalitis)

Yearling paint with EEE (non-vaccinate)
The gelding died within 2 days of showing clinical signs!

This year has been a record year for many parts of Florida with regards to rain fall. Although this has been a great thing for our over-all drought conditions, it has created a situation that may result in the awakening of a sleeping monster, also known as equine encephalitis. Depending on the virus, horses in the southeastern United States may be afflicted with the virus that causes Eastern Equine Encephalitis (EEE) or West Nile Encephalitis. Sadly, the mortality rate for EEE in non-vaccinate horses is nearly 100% and approximately 30% in non-vaccinate horses with West Nile virus. These viruses are transmitted via the mosquito and tend to be most prevalent during the warmer months of the year. Due to the excessive rain in Florida, there are many areas with various amounts of flooding and sitting water. These are ideal conditions for an explosion in the mosquito population!  Already in Alachua county, a sentinel chicken tested positive for the virus that causes EEE.


The good news is that these diseases are nearly 100% preventable through proper vaccination. At a minimum, horses should be vaccinated 2x per year for these dreaded diseases. However, with the explosion of the mosquito population this year, I recommend vaccinating 3x per year and vaccinating your horse within the the next 30 days if it has been more than 3 months since the their last vaccination. 
Please contact your veterinarian today and make plans to protect your horses!! 


You can read more about these conditions at the following site

http://www.aaep.org/eee_wee.htm

Cleft Palate!

Image 1

The first two images are from a yearling thoroughbred that presented for a long history of nasal discharge, coughing while eating, and the presence of water exiting from nostrils while drinking. The filly had been treated with antibiotics prior to the exam. Endoscopic exam revealed a defect within the soft palate that extended nearly the entire length of the soft palate. In addition, the epiglottis was entrapped by the aryepigltottic fold. 

Image 2

 The defect within the soft palate is known as a "cleft palate" and most likely has been there since birth. Fortunately, this is a relative rare condition! Normally, the palate plays the role of separating the nasal passages from the oral passage. Hence, a horse is an obligate nasal breather and the palate keeps water and feed from entering the airway. When a cleft palate exists, there is communication between the air passage and oral passage resulting in feed and water going the "wrong way". This may consist of feed material exiting the nostril and/or traveling down the trachea into the lungs. If these horse go undiagnosed they are typically "poor doers" with failure to thrive secondary to chronic respiratory infections. Sadly, there is little to be done to help such a severe cleft palate. Less severe cases may be addressed with surgical intervention with mixed results. 

Image 3

The third image if that of a "normal" horse. The epiglottis is visible and is resting on top of the complete soft palate. Diagnosis of a cleft palate is often made immediately after birth during a thorough post-foaling exam. The veterinarian should palpate the length of the hard and soft palate with their finger to make sure it is normal. If missed at foaling, the diagnosis can be made quite simply with an endoscopic exam. 

Survey Results

PHD Veterinary Service Survey Results




Thank you for your comments and suggestions!

Equine Hirsutism

The horses pictured below are both suffering from a condition known as equine hirsutism. The condition can be described as an irregular or excessive hair coat throughout the year. Normally, a horse will develop a winter coat for the cooler months and then shed the coat throughout the spring months. Horses suffering from  hirsutism will develop a thick coat throughout the year and will require regular, full body clips to keep cool during the hot summer months. 

By far, the most likely cause of equine hirsutism is equine cushing's disease. This is an endocrine disorder that is centered in the brain of the horse and results in excessive cortisone production. Much more serious than a persistent shaggy hair coat, horses with cushing's disease are highly susceptible to founder (laminitis) and a compromised immune system. Testing for equine cushing's disease is a tricky process and may involve measuring serum levels of cortisol and ACTH. In addition, horses can be tested via a Dexamethasone suppression test which may be risky procedure if the horse has a history of founder. As such, it is commonly recommended that if the horse is suffering from hirsutism, it should be assumed that the horse is likely to be also suffering from equine cushing's disease and should be treated for the latter. Recently, the preferred drug of treatment knows as Pergolide became available to equine owners in the form of a FDA approved drug called Prascend. Horses as young as 10 years of age can develop these symptoms and should be treated sooner than later!

Read more about equine cushing's disease @

http://www.aaep.org/health_articles_view.php?id=340