Ambulatory Services

Radiography
Portable x-ray machines allow any joint to be radiographed on location. Some areas with increased density, such as lungs, shoulders, and hips may need to be referred to our hospital. In addition to our ambulatory vets taking x-rays on location, we have an ambulatory radiology team consisting of two radiology technicians: Hal Roberts and Patti Green.

Endoscopy
Endoscopic examination of the upper airway is a common way to evaluate the breathing capacity of (particularly) young racehorses. First and foremost, the size of the airway is considered to be significant in the amount of air the horse is able to take in.

Please find below an anatomic diagram for your reference:

The arytenoid cartilages are critically examined for symmetry of form and function, as well as the indication of infection or inflammation as often occurs with chondritis or pharyngitis. Ideally, both arytenoids abduct readily on inspiration in a synchronous manner and show the ability to maintain an abducted position. The size, shape and consistency of the epiglottis is also important in predicting possible problems such as dorsal displacement of the soft palate (DDSP), or epiglottic entrapment. The epiglottis should be free from evidence of inflammation or abnormal structure such as a cyst, which can interfere with normal throat function.

Many abnormalities associated with the upper airway of race horses can be diagnosed in the quiet, standing animal. However, some conditions only occur at high speeds and therefore must be diagnosed on a treadmill where the horse’s throat can be evaluated as it is during exercise. DDSP and epiglottic entrapment are examples. Exercise induced pulmonary hemorrhage (bleeding) is the only condition that requires diagnosis immediately post-exercise. This is accomplished by passing the endoscope down into the trachea to observe the blood. Other structures of the upper airway and nasopharyngeal area can be examined using the endoscope but are not as typically associated with preventative or prepurchase situations.

Colic evaluation
Acute abdominal pain is a common complaint encountered in our ambulatory practice. Assessment should begin with historical questions concerning signalment, duration (including time last seen normal), last time fed, and any treatment administered prior to the arrival of the veterinarian. A thorough physical exam should then be performed noting temperature, mucus membrane condition, abdominal auscultation, evidence of diarrhea or bloating, and general attitude. Sedatives may be given at this time if necessary to facilitate the exam, or relieve pain. A nasogastric tube should then be used to recover as much reflux as possible; the amount and physical characteristics of the reflux should be noted. A rectal exam can then be performed, if size and temperament of the horse will allow for it.

Laceration repairs
Lacerations are a common occurrence. A skin wound can be caused by either blunt or sharp trauma; and should be cared for quickly to optimize the healing process. First aid, veterinarian consultation or treatment, and prescribed wound care are all important factors in laceration repair.

When an owner encounters a wound on their horse, they should remember three goals of first aid, which are: preventing further injury, slowing blood loss, and minimizing contamination. Horses are often very excitable after being hurt so getting them into a quiet environment such as a dark stall is important. Even though it would be rare for a horse to bleed to death from a skin wound, many seem to bleed profusely. Applying a clean, dry dressing with moderate pressure can control most of these lacerations. The use of a tourniquet above leg wounds is discouraged by most veterinarians, due to improper application that can do more harm than good. If a laceration is contaminated by soil, washing the wound lightly with a water hose can be beneficial in minimizing infection. Covering the wound with a clean, dry dressing will also prevent further contamination.

Whether a laceration requires the attention of a veterinarian depends on use of the horse; location, severity, and age of the wound; suspected injury to deeper structures; and desired cosmetic result. Usually the experience of the owner with wounds and the use of the animal dictate whether a veterinarian is called; however, even the smallest cut over a tendon or joint can be dangerous. In general, there is an average golden period of eight hours before a wound becomes too contaminated to suture closed immediately. If an owner does want a laceration examined and/or repaired by a veterinarian, it is recommended to call quickly and avoid applying any topical wound products to the injury. It is also important that the veterinarian knows the tetanus vaccination history of the horse. The veterinarian has to consider several factors before determining whether a wound can be sutured closed or treated as an open wound. The goal will always be to optimize the healing of the injury.

If a veterinarian has treated your horse for a laceration, it is important to follow their recommended wound care instructions. Antibiotics are often prescribed due to the environment the horse lives in. If a wound has been closed with sutures, the site should remain as dry as possible and covered with a bandage if on a leg. Open wounds should be cleaned frequently. Flies are a big concern this time of year and control should be maintained around the wound. Above all else, observing sutured and open lacerations for signs of infection will determine how fast the injury will heal. If such complications occur, let the veterinarian know. Quick and sufficient attention will make sure that your horse’s battle scars remain small and heal quickly.

Lameness evaluations
Musculoskeletal problems in horses are common, and accurate diagnosis of those problems is required in order to minimize the length of time an individual is out of work. The lameness evaluation allows the ambulatory practitioner to pinpoint the origin of pain or discomfort.

Evaluating lameness begins with obtaining a good history from the owner or trainer. Conformational faults and lack of symmetry are noted. The horse should be observed at a walk and trot while traveling in a straight line on as hard a surface as is available. If the problem is subtle, observing the horse at a trot while traveling in a circle can be helpful. Flexion tests may also be necessary. The key is to ascertain which limb (or limbs) is involved before then isolating the specific area.

In practice, the majority of lameness originates from the distal limb, and the foot is commonly the source of pain. Thorough evaluation of the foot involves use of hoof testers, evaluation of digital pulses, and observation of how the individual is shod. Once the foot has been assessed, the practitioner must perform a careful visual and digital examination of the rest of the limb looking for heat and/or swelling. Often, no obvious outward signs are present, so nerve blocks must be utilized.

Nerve blocks involve injecting local anesthetic over nerves at specific sites starting distally with the foot and working upward until the horse goes sound, or at least improves significantly. The lameness can be isolated to the area between the block that produced an improvement and the previous block. The practitioner can then perform further diagnostics, such as radiography or ultrasonographic examination, to provide an exact diagnosis of the problem. Once a diagnosis has been made, treatment is implemented. Treatment may involve a shoeing change, anti-inflammatory therapy, stall rest, joint injection, etc.

Occasionally, lameness can be so subtle that nerve blocks do not serve to isolate the problem sufficiently. It is in those instances that referral to a hospital setting becomes a consideration for the ambulatory practitioner, where scintigraphy is often used to provide a diagnosis.

Sales work
Peterson and Smith offers pre- and post-purchase examinations of thoroughbred horses offered for sale through selected OBS, Keeneland, and Fasig-tipton sales companies. All of the OBS sales that take place in Ocala, Florida are covered by at least two veterinarians on the sales ground and at least one surgeon at the hospital to review radiographs. Additionally we cover the Fasig-Tipton July and Keeneland September yearling sales in Lexington, Kentucky. At the sales in Kentucky one of our surgeons is available at all times to read radiographs in the repository and at least one (usually two) veterinarians are on the grounds to provide any other services that may be needed. At all sales we provide the highest quality of service available and hope to expand the number of sales we attend in the future as our clientele continues to grow.

Fetal sexing
Fetal sexing is a safe, inexpensive, and entertaining management tool that utilizes an ultrasound machine during a specific stage of pregnancy to determine the gender of the fetus. Some may question the necessity of this procedure, but others find it to be a helpful management tool.

You may be able to more closely predict next year’s income by estimating the value of a colt versus a filly from a particular mare or sire. You also may plan to sell or keep a mare depending on what sex she is carrying. For instance, you may be more likely to keep and foal an older, well-bred mare that has thrown nothing but colts if it is determined that she is carrying a filly that may one day replace her in your breeding stock. Thirdly, many people simply enjoy the idea of knowing whether to expect a “baby girl” or a “baby boy” the following spring.

The procedure is performed using trans-rectal ultrasonography to identify the position of the genital tubercle in relation to the stifles and tail head. The tubercle will be seen closer to the tail head on a filly and towards the abdomen on a colt. Due to the embryological changes occurring at this time, it is important that the procedure be performed as close to day 60 (post breeding) as possible (58-70). The risks or drawbacks in performing this procedure are similar to that of a regular pregnancy check.

Ultrasound - reproductive
The ultrasound has become a familiar tool for pregnancy diagnosis in the mare and also has strong merit for use in any routine reproductive exam.

In recent years, we have learned more about how the uterus responds to the hormonal influence of a maturing follicle and how those changes appear on the ultrasound. With most mares, as the ovulatory follicle matures, uterine edema will steadily increase resulting in the appearance of large “folds” in the uterus on ultrasound. As the follicle approaches ovulation, this edema will dissipate more quickly than it came and in most mares be gone or be very slight before they ovulate. Because of this progression and then regression of uterine edema, the ultrasound then provides us with another measure by which to predict ovulation which manual palpation alone doesn’t provide. The amount of edema that each individual mare will get varies, but most will get at least some as they build an ovulatory follicle. Because of the variation between mares it is important to observe this progression in edema for that individual mare rather than looking for the “text book” example of edema in a mare.

With the use of the ultrasound we also have the ability to measure follicles much more accurately than by palpation alone. This is an aid in ovulation prediction but has even greater value when this information is used to select the time to administer an ovulatory agent such as Ovuplant or HCG. When a mare is in heat and a follicle has developed from 34mm to 36mm in size it has an excellent chance of responding to one of these ovulatory agents and ovulation should occur within 24 to 48 hours. This allows much more predictability in deciding when to breed your mare. Your veterinarian can further define this process by observing uterine edema and coupling that information with follicular size. The end result is an enhanced ability to more accurately predict the optimal time to breed a mare; which should result in a higher conception rate and fewer “doubles” or multiple breedings.

By routine use of the ultrasound in performing reproductive exams the veterinarian also has the ability to assess the presence of uterine fluid. A small accumulation of clear uterine fluid can be present in the normal mare when she is in heat, however most mares have none. When fluid is present it may represent uterine inflammation or infection. It’s fair to say that all veterinarians deal with the frustration of obtaining negative cultures on infected mares in spite of good culture technique and a good laboratory. The appearance of uterine fluid can alert the veterinarian to the fact that this mare may be infected regardless of the culture results. An especially advantageous time to evaluate the presence of uterine fluid is after a mare has been bred (24 or 48 hours later). The normal mare has the capacity to clear her uterus of any seminal fluids within 24 hours, and those that don’t are prone to becoming infected by contamination and should probably be treated.

Another reason to ultrasound mares when checking for ovulation is so that the veterinarian can be certain to differentiate between a follicle and a corpus hemorrhagicum (the ovulated follicle.) Even the most experienced veterinarians can be fooled when only using their hand.

The ultrasound is simply an additional tool in evaluating the reproductive status of a mare. It isn’t meant to replace the speculum, the teaser or good record keeping. When all the tools at the disposal of the broodmare manager and the veterinarian are used together we can get closer to reaching our goal of more pregnancies with fewer breedings.

Ultrasound – soft tissue Shockwave therapy
There are two types of extra corporeal shock wave therapy (ESWT):

1. High energy forward shock wave – high intensity at focal point (Versitron)
2. Low pressure, radial shock wave – radiates out from point of origin, greatest energy level at skin, decreasing energy as it penetrates. (Equitron)

Shock wave therapy acts by increasing circulation, stimulating bone cells and stimulating neurotransmitters. It aids in the rapid recovery of: bucked shins, suspensory ligament injuries, tendonitis, navicular disease, bone lesions, and analgesia. While an aid to recovery other lay-up procedures (stall-rest, hand-walking, etc.) may need to be followed.

Pharmacy All departments are supported by the practice pharmacy. The Pharmacy, run by Cheryl Hurn, Pharmacy technician, can provide any prescribed medication from stock or by special order. The pharmacy stocks over 95% of the medications used by the practice, and special orders can usually be filled within 24-hours.

Dentistry
Dentistry is an additional service offered by Dr. Adam Cayot of Peterson & Smith Equine Hospital’s Ambulatory Department. Most equine dentistry involves prevention. If your horse's teeth are regularly cared for, the maintenance process will not be overwhelming and you should be able to avoid most dental or health complications. This is all dependent on your horse's diet, hardness of teeth and jaw alignment. By keeping an eye on your horse's teeth, you can determine how quickly your horse's dental surfaces are changing and get them cared for before complications arise.

Part of prevention is knowing whom to call when you need equine dental care and being able to contact a veterinarian schooled and experienced in this process of realigning a maloccluded mouth. Making these kinds of corrections to a horse's dentistry requires advanced skill and specialized tools including power tools. Most horses will require some level of sedation, usually a mild tranquilizer, since the objective here is to produce proper angles and levels which could be difficult, if not impossible, if the horse is resisting the procedure. Doing the proper job the first time will often mean longer lasting results and much less work required on following dental visits.

Podiatry
Peterson & Smith Equine Hospital's podiatry service offers lameness diagnosis of the lower limb with an emphasis on hoof related problems. Advance diagnostics, such as digital radiography and ultrasonography are utilized. Successful treatment options are well established and provided for hoof related lameness and disease. Evaluation in order to prevent hoof lameness and enhance performance are major components of the podiatry service. This service is offered through the ambulatory or hospital settings by Dr. Ben Nabors.