The Well-Equipped Vet
Technology has transformed our music, photography, movies ... our entire popular culture. Whether it's uploading a video on YouTube, posting last night's party pix on Facebook, or updating our iPods, we use technology daily.
What has made our lives more interesting has also helped keep our horses healthier. With the advent of digital and video veterinary equipment, our veterinarians can reach a more accurate diagnosis faster. For them, professional consultation with a specialist is only a click away.
In many cases, our veterinarians can show us the problem right on their laptop computers in minutes. Therapy and healing can begin sooner, not only getting you and your horse back in the arena, but often avoiding delays that allow injuries to coalesce into permanent problems.
Old Radiographs Get New Life
X ray machines might be the most common tools that veterinarians carry, and today the resulting radiographs likely are digital. Although some vets might still use film equipment, the time it takes to process film usually makes that too cumbersome. Instead of a horse owner having to wait for the vet to go back to the lab to develop X rays, direct digital radiographs can be seen almost instantly on a computer.
Not only does this allow veterinarians to point out the diagnosis to owners during the same vet call, vets can check the usefulness of the image immediately. If the angle doesn't show the problem clearly, then he or she can make adjustments on the spot instead of having to return for another set of radiographs. Digital radiographs also show better definition.
"The image quality from a digital machine is far superior to the older conventional or traditional versions," says Tom Hutchins, DVM, of the Equine Sports Medicine & Surgery Clinic in Weatherford, Texas. "The expense up front will yield a great return on the investment."
Hutchins says depending on the unit and options, a direct digital radiography system can cost from $80,000 to $120,000. Less expensive for a practitioner would be computed radiography, which uses a plate with a phospor screen that a machine reads and digitalizes, and costs from $30,000 to $50,000. However, processing time is still needed, whereas a direct digital image can be displayed almost immediately.
The Ultimate in Ultrasound
Almost as essential as radiograph equipment is a digital ultrasound unit. The two are practically two sides of the same coin, since a vet will often use radiographs to look for bone problems and ultrasound for tendon and ligament issues. Ultrasound is also used to detect pregnancies and reproductive problems.
Hutchins says ultrasound equipment varies considerably, with some small, portable machines costing less than $15,000. Smaller ultrasound machines might not be able to detect as much as the more expensive equipment, but they can allow a veterinarian to perform reproductive scans and some soft-tissue scans.
"The machine we use at the clinic is a digital ultrasound and has various probes for specific scanning capabilities," he says. "We are able to scan almost any soft tissue structure on the horse from the most superficial to a depth of about 40 cm. This capability has allowed us to see things that could not be imaged otherwise."
There also is therapeutic ultrasound equipment used to send heat to deep tissues and promote healing by increasing blood flow and reducing swelling and edema. Therapeutic ultrasound equipment differs from diagnostic equipment in that the sound waves are of a different frequency.
While veterinarians can offer therapeutic ultrasound treatments, rehab and layup facilities are more likely to have that equipment. For example, Don Shields, DVM, a veterinarian who runs a layup facility in Bradbury, Calif., found therapeutic ultrasound so beneficial at his farm that he created a therapeutic ultrasound device that can be strapped onto a horse and used in a stationary application.
Vets can refer your horse to a rehab facility if necessary, but many of these facilities are affiliated with a veterinary clinic, which allows patients to take advantage of a wider variety of diagnostic and therapeutic equipment than a vet can carry in a truck or SUV. Clinics such as Equine Sports Medicine & Surgery and Alamo Pintado Equine Medical Center in Solvang, Calif., have this advanced equipment because they deal with a large number of performance horses.
"The absolute essential equipment (for a referral hospital), in my opinion, is the radiographic equipment, ultrasound, endoscopy, MRI (magnetic resonance imaging), nuclear scintigraphy, and laboratory equipment," says Carter E. Judy, DVM, Dipl. ACVS, of Alamo Pintado. He notes that whether the practitioner is examining medical problems, orthopedic problems, or both, this array of equipment will help elucidate the cause.
Most practitioners carry some form of portable endoscope for checking the horse's upper airway and esophagus.
"The light sources for the scopes are either battery powered or can be plugged into an outlet," says Hutchins. "Battery-powered scopes are very handy if an electrical supply is not available or in the case of working horse sales, especially Thoroughbred horse sales, where buyers almost always request a horse be scoped for any upper airway defects prior to purchase."
A video endoscope allows real-time review of the exam on a monitor and has recording capabilities. Because many of these systems use large monitors, video endoscopes are not generally portable, although some portable systems are starting to come on the market. One is currently available for small animals, and an equine system is in the works.
Video endoscopes up to 3 meters long are available, allowing a veterinarian to perform gastroscopy to search for such things as stomach ulcers or parasites.
"Image-capture or recording equipment can be added to video endoscopes to archive images for the patient record," says Hutchins. "This is great for follow-up exams for comparison purposes."
Judy says the clinic vets also use video endoscopy when performing minimally invasive surgeries such as laser surgery.
"Video endoscopy definitely makes the images easier to see and utilize compared to traditional endoscopes," he says. "It has helped to revolutionize the use of the endoscope. Video endoscopy is very useful for upper airway evaluation. It is also the most reliable way to diagnose gastric ulcers and monitor their healing and progress."
Hutchins says a veterinarian can practice quite well with good radiographic, ultrasonographic, endoscopic, and laboratory equipment.
"All of these pieces of equipment are portable and will pay for themselves relatively fast," he says.
I Was Working In The Laboratory ...
What laboratory equipment veterinarians carry varies, but they can draw blood for later analysis with their own lab equipment or by a clinic or hospital with which they are associated.
"Being able to perform blood work for health screens is very important," Hutchins says. "Blood samples are taken to perform complete blood counts (CBCs), serum chemistries, and measure electrolytes. CBCs are used to evaluate a patient's health status or to determine if systemic infection is present based on the values reported. Serum chemistries are used to evaluate organ function in a given patient."
Referral hospitals generally have a blood cell counter, chemistry and electrolyte machines, and a device for blood gas analysis. Because turnaround time is quick, it is often easier for a vet to draw blood and send it out for analysis than to do it himself.
"This makes the need for many of these machines excessive for the average field practitioner," Judy says, "since they can get almost any test run within 24 hours without having to maintain a lot of complicated equipment."
Fortunately for horse owners, vets can pinpoint most problems with a thorough clinical exam, coupled with radiography, ultrasonography, endoscopy, and laboratory tests. In some cases, however, they might recommend more advanced diagnostics than are usually found at a clinic.
It is becoming more common that equine veterinarians offer MRI and nuclear scintigraphy. Nuclear scintigraphy requires injection of a radioactive isotope to show "hot spots" where bone is remodeling and trying to fix a problem. MRI equipment, which uses magnetic fields to create images, allows vets to examine patients even more closely.
"The MRI has revolutionized the accurate diagnosis of orthopedic problems in the horse," says Judy. "Structures that were not visible using other diagnostic techniques are now clearly visible. This has not only made the diagnosis more accurate, but has improved our ability to direct therapy more effectively."
Judy says an MRI unit can image limbs up to and including knees and hocks, the head and cranial neck, and--in some case--stifles.
"One key factor with MRI is knowing where to look," Judy says. "It images a relatively small region, 30-40 cm in length, so it is essential to have completed a thorough lameness examination with diagnostic nerve blocks to know where the region of pain is. When radiographs and ultrasound fail to produce a diagnosis and the region of pain is known, then MRI can be indispensable for an accurate diagnosis."
Rising Tides of Shock Wave
Many clinics and some practitioners also offer extracorporeal shock wave therapy. This machine delivers high-frequency sound waves to alter the state of tissues to promote healing. Hutchins says it has been reported to improve the rate and quality of repair in tendon and ligament strains, stimulate new bone formation, and relieve back pain in horses.
While shock wave machines can be portable, they are more often found at clinics. Hutchins says that shock wave therapy typically involves three treatments 10 to 14 days apart, depending on the injury.
Oxygen to Heal
Some clinics have added hyperbaric oxygen chambers. The chambers are large enough for an adult horse. The horse breathes in oxygen under pressure.
Hutchins says in his experience, hyperbaric oxygen therapy can help infection, inflammation, and edema (fluid swelling), and it can be used to aid the treatment of such conditions as laminitis, navicular syndrome, abscesses, and soft-tissue injuries. It has also been used following colic surgery to treat a compromised bowel.
Judy says, "It helps to reduce inflammation, control infections, and promote healing in ways that other modalities don't."
Stem cell therapy is a rapidly developing field that has the potential to help many injuries. Hutchins says hyperbaric oxygen therapy might aid healing in conjunction with stem cell therapy.
When your horse has a problem, your veterinarian might use a combination of diagnostic methods and treatments. Veterinarians are using newly developed equipment all the time. But no matter how much equipment vets have, the knowledge and experience they bring with them will always be critical.
"The most important piece of equipment that is essential for all of this to work is the people who know how to use it," says Judy. "Without people knowledgeable in its use, all of the equipment would be useless."
About the Author
Tracy Gantz is a freelance writer based in Southern California. She is the Southern California correspondent for The Blood-Horse and a regular contributor to Paint Horse Journal, Paint Racing News, and Appaloosa Journal.
POLL: Rehabbing the Injured Horse