Equine Internal Medicine in Madison, Georgia & Beyond
Gastroenterology
While colic is one of the most common ailments, the term “colic” is rather non-specific and only means “abdominal pain”. When treating colic, we aim to categorize the problem into one of three broad classifications:
Non-Strangulating Obstruction
A blockage of normal ingesta flow while not having a compromise in blood flow to the GI tissues. While there are exceptions, many non-strangulating obstructions (e.g., an impaction or displacement) are treated medically (without surgery) with fluids and supportive care.
Strangulating Obstruction
A blockage of normal ingesta flow while also compromising blood flow to GI tissues which usually causes rapid decompensation, severe pain, and necessitates colic surgery to correct.
Inflammatory
A variety of conditions causing severe inflammation of different portions of the GI tract. Inflammatory conditions, such as colitis, enteritis, or peritonitis, can cause severe pain and are typically treated medically.
Cardiology
People often say horses have “a lot of heart”… that’s true! The average 1,000-lb horse’s heart is often larger than a human head and can weigh 8-10 pounds!
Like humans, horses can also develop heart disease which is most commonly detected on routine exams during auscultation of the heart as a murmur, arrhythmia, or both. While some murmurs or arrhythmias can be considered incidental or of no major concern, others can be of great concern causing exercise intolerance and danger to the people handling that horse.
Ophthalmology
The eyes are delicate structures and are susceptible to a host of problems. Corneal ulcers and scratches are a common occurrence and when they become infected with bacteria and/or fungi, they can become an expensive (in both monetary and time-consuming sense) problem. Horses can also develop conjunctivitis (a non-contagious inflammatory condition of the tissue surrounding the eye) and uveitis (a severely painful inflammatory event inside the eye itself).
Eye injuries and diseases are a serious problem as they can be very painful and progress rapidly. We examine eyes grossly as well with a direct ophthalmoscope, which is a hand-held microscope, to examine the fundus (retina, posterior chamber), lens, etc. We keep a variety of stains to further help us identify eye injury and medications to treat a variety of problems.
Severe Eye Issue Treatment
In severe cases of eye issues, we will commonly place SPLs (subpalpebral lavage systems) to facilitate medicating eyes on horses that are either too painful or are not amenable to placing ointment in the eye by hand. We frequently manage horses in our clinic that require more intensive treatment. We also place SPLs in horses that remain at home and help the owners manage them.
Respiratory
Common owner complaints for horses with respiratory disease include coughing, nasal discharge, abnormal behavior (lethargy, inappetence, etc.), respiratory noise while working, as well as exercise intolerance or decreased performance.
When examining horses with complaint of respiratory issue, we try to place them into three broad categories:
Infectious Respiratory
This horse is “sick” with infection, either bacterial, viral, or fungal. Common diagnostic procedures include bloodwork, thoracic ultrasound, thoracic radiographs, and transtracheal wash (getting a sample of fluid/material in the lungs by passing a small catheter through the trachea). Samples from a transtracheal wash can be cultured to identify a pathogen and have a sensitivity performed to identify which drug (antibiotic, specifically) would be most effective. There are also certain infections which can be contagious between horses. We also discuss biosecurity measures to prevent further spread between horses at the farm.
Inflammatory Respiratory
Horses can have a variety of inflammatory conditions associated with their airway and we commonly diagnose them with bloodwork and analysis of fluid/debris from their airway which can be collected via bronchoalveolar lavage Inflammatory diseases are often managed with anti-inflammatory drugs such as NSAIDs, steroids, antihistamines, etc. This often takes a period of drug dosage trials to find the appropriate regime of medications for each individual horse.
Structural Respiratory
Horses can have structural abnormalities, especially in their upper airway (laryngeal region) that can cause exercise intolerance, coughing, and sometimes evidence of infection. These are commonly diagnosed with endoscopy of the upper airway.
Neurology
Horses that are neurologic pose a risk to owners as they often are unable to walk and be handled safely due to risk of tripping, falling, etc. Common neurologic problems seen in horses include EPM (Equine Protozoal Myelitis), Wobblers (Equine Cervical Vertebral Instability and/or Stenosis), various neuromuscular disorders or degenerative problems, and more.
Neurologic exams
Neurologic exams are often a bit different from a standard physical exam, as you will see the veterinarian performing different maneuvers to test the horse’s strength, balance, stamina, reflexes, and mental status. Other tests include a variety of blood tests, radiographs of the cervical (neck) spine, etc., with treatment in accordance with diagnosis.
Endocrinology
The three most diagnosed endocrine disorders in horses are: PPID (Pars Pituitary Intermedia Dysfunction more commonly known as Cushing’s Disease) and EMS (Equine Metabolic Syndrome) and ID (Insulin Dysregulation).
These endocrine diseases are usually noted by the client who reports changes in weight or muscle tone, overgrowth of the hair coat/abnormal shedding, changes in sweating, or laminitis/founder.
PPID commonly affects older horses (>15yrs) and can cause a host of issues: laminitis, hypertrichosis (shaggy and long hair coat), sweating abnormalities, ligament laxity/dysfunction, etc. While this management is lifelong, in most cases it’s fairly easy with once daily oral medication.
EMS and ID can affect horses of any age but the most commonly diagnosed breeds include: ponies, Morgans, and miniatures as well as donkeys. EMS and ID are similar to type II diabetes in humans; they can produce insulin, but their body is resistant or insensitive to it which causes a systemic increased blood glucose (blood sugar) and, in turn, this causes a host of issues. With this disease, dietary management and exercise are imperative for weight management. Medications are also used to improve insulin sensitivity.
Dermatology
Horses commonly develop insect allergies, especially to flies, gnats, and other biting insects and, thus, skin allergies are a condition that we diagnose and treat/manage regularly.
Horses can have other skin conditions which we often diagnose with bloodwork and biopsy of lesions. Immune mediated diseases (e.g., pemphigus folacieus, urticaria, etc.) and tumors or masses (e.g., sarcoids, warts, lymphoma, sarcomas, etc.) are also seen commonly.
Neonatology
- Immediate neonatal care: exams, enema(s), umbilical care, joint and conformation evaluation and care.
- IgG testing:
- Foals that do not have a sufficient IgG level (<800mg/dL) means they did not receive enough antibodies in the colostrum from their dam. This can mean the quantity and/or the quality of colostrum was lacking. This is termed “failure of passive transfer.”
- Foals that have failure of passive transfer are at very high risk for life threatening systemic infection termed “sepsis” or “endotoxemia”. Sepsis means there is bacteria in the bloodstream which can seed other body structures: joints, lungs, GI tract.
- Plasma is a blood product with concentrated levels of antibodies and healthy immune system factors. At Piedmont Equine, we harvest, process, and store our plasma from a herd of healthy, vaccinated horses that have had no exposure to another blood type (maiden mare, gelding); we call this “in-house plasma”. We also keep commercial, hyper-immune plasma on hand. These commercial varieties are from donor horses that are hyperimmunized against specific pathogens that commonly cause disease in foals such as: Rhodococcus equi, Salmonella spp., Clostridium spp., Escherichia spp., Streptococcus spp. etc.
Sick foal management
Septic foals often need aggressive, intensive care. We provide all needed care and services such as IV fluid therapy including partial parenteral nutrition, feeding tube placement and management with enteral nutrition management, oxygen supplementation, limb splints for conformational abnormalities, joint lavage, etc.
Muscular Diseases
We see a host of genetic muscular diseases in many of our patients but especially in the Quarter Horse and Warmblood populations. We can assist in performing genetic testing for common muscular diseases including, but not limited to, HYPP (Hyperkalemic Periodic Paralysis), PSSM-1/2 (polysaccharide storage myopathy), RER (recurrent exertional rhabdomyolysis). Many muscular diseases first present as a tie-up like episode or precipitous loss in condition and muscle mass as well as onset of weakness.
Many muscle diseases require dietary and medical intervention for lifelong management.
Diagnostic Abilities
We keep a variety of diagnostic equipment, tests, and materials on hand to provide primary, secondary, and tertiary level of diagnostic capability.
Endoscope
1-meter and 3-meter
These digital scopes are used to evaluate upper respiratory system, sinuses, stomach, uterus, etc.
Digital, Portable Radiography
We maintain multiple units within the practice. All units produce images immediately and are mobile for use in the clinic as well as in the field.
Portable Ultrasound Units
We have portable ultrasound units with various probes for different uses: rectal probe for reproductive exams, tendon probe for examination of tendons, ligaments and some bony structures, and curvilinear probe for thoracic or abdominal examination.
In-House Bloodwork:
- Complete Blood Count (CBC) – especially useful for detecting infection and/or inflammation
- Chemistry (Chem) – evaluates electrolyte balance, kidney and liver enzymes, muscle enzymes, inflammatory status
- Serum Amyloid A (SAA) – infection detection and response to medication
- Lactate – assesses hydration, inflammatory, and tissue health status
- Fibrinogen – assess early phases of infection and inflammation responses
- Pack cell volume/total solids (PCV/TS) – assess hydration and anemiaBlood glucose
Other Testing:
Other laboratory tests (bloodwork, specific disease testing, genetic testing) is performed routinely. We send out samples for testing/analysis at least once per day during the week.
Other gastroenterological issues we commonly manage and treat include:
EGUS (Equine Gastric Ulcer Syndrome)
A definitive diagnosis of stomach ulcers is only made with an endoscopic exam; a 3.5-meter video endoscope is passed in the same way as a nasogastric tube (through the nostril, down the esophagus to the stomach) where all tissues can be visualized in real time. We use the scope to monitor horse’s response to treatment as well.
Internal Images of Equine Gastric Ulcers
Hindgut ulcers
Hindgut ulcers occur in the large colon which is not accessible via endoscope. These ulcers are largely diagnosed based on clinical signs, ruling out of other problems, and fecal occult blood tests. Like gastric (stomach) ulcers, hindgut ulcer treatment can involve extensive management or husbandry changes such as diet, exercise, supplements, medications, etc.
Inflammatory Bowel Disease
Inflammatory Bowel Disease is similar to Crohn’s disease in humans. The most common owner complaint is diarrhea or loose manure and weight loss/failure to gain weight despite a good appetite and being fed appropriately. Diagnosis of this disease is commonly made by ruling out other potential problems, blood work, rectal mucosal biopsy, and treatment trials. While this issue most commonly occurs in older horses, it can be seen in adult horses of any age.
GI lymphoma
While cancer is fortunately uncommon in horses, it does happen. And lymphoma affecting the GI tract is one of the more common presentations of cancer we will see. These horses often present similar to those with Inflammatory Bowel Disease with diagnosis based on bloodwork and rectal mucosal biopsy. Due to patient size/weight, chemotherapeutic treatment is very often not practical due to dosage requirement, expense, and risk of exposure to these medications by the horse’s handlers. There are other therapeutic options that, while not curative, are palliative, less expensive, and less risky to handle.
Digestive allergies
Perhaps not as commonly diagnosed as it is in dogs and cats, horses can have allergies to different feed stuffs in grains/feeds, forages, etc. Diagnosing horses with food allergies often takes quite a bit of time and patience on the owner’s part when going through food trials and other treatments.