Veterinary medicine and diagnostics have come a long way in the past hundred years, with technology once only dreamed about for horses coming in to regular use in clinics around the world.
At the forefront of the high-tech revolution is Radiologist Dr Sarah Puchalski, whose work at the Palm Beach Equine Clinic (PBEC) in Wellington, Florida, uses state-of-the-art surgical and diagnostic imaging equipment, including Equine Standing MRI (Magnetic Resonance Imaging) and a Nuclear Scintigraphy camera to quickly and accurately diagnose injuries.
Every horse owner dreads seeing signs of lameness or discomfort in any horse, whether it is a backyard companion or a top-caliber sport horse. But for performance horses, one of the first questions many owners ask upon contacting a veterinarian about a problem is, ‘Can the horse safely and comfortably return to work?’ With cutting-edge technology, that question can be quickly and accurately answered.
The Equine Standing MRI produces highly detailed images in several different planes to capture a complete image of a desired area. An MRI is best used to further define a specific area of both bony or soft tissue that has been pinpointed as the origin of lameness. The process can be completed while the horse is in a standing position and requires only light sedation.
Similarly, the process of a Nuclear Scintigraphy is a bone scan that begins with the injection of a radioactive isotope, specifically named Technetium 99. The isotope attaches to the phosphorous proteins localized within the bone and is absorbed over a few hours’ time. A specialized nuclear isotope gamma ray camera is used to capture images of the skeletal anatomy with a 360-degree view. Points of interest “light up” on the image to indicate increased metabolic activity and the site of injury.
Lameness or performance problems are most frequently approached through routine x-rays and ultrasounds, which can appear normal. Thus, it is difficult to diagnose subtle problems because the most common tools are not sensitive enough to diagnose in every case. The Equine Standing MRI and Nuclear Scintigraphy equip veterinarians with an advantage when troubleshooting a lameness issue and helps them to determine a correct diagnosis in a timely manner.
The Palm Beach Equine Clinic is also one of very few equine practices in the US with a Board Certified Radiologist on staff, and thanks to Puchalski, hundreds of MRI and bone scans are read each year at the clinic. In addition to being state-of-the art diagnostic tools, the technology also affords economic benefits to owners.
“MRIs can give a definitive diagnosis, and that saves time and money in the long run,” Puchalski said.
“For example, if a horse goes lame and is examined and treated empirically, which is a diagnosis based on likely problems through common diagnostic procedures, it either stays sound or it becomes lame again or even non-functional in three to six months. This method sets back the commencement of the appropriate therapy.
“What the MRI does is allow the horse to be treated early and correctly. Otherwise, you may not be treating the correct issue, and the horse could end up lame again very soon.”
Nuclear Scintigraphy does not produce a scan that is as specific, but it gives Puchalski the opportunity to procure a concrete diagnosis, as well as evaluate the whole horse for secondary problems.
“Oftentimes the primary problem in one place is making a horse sore in other places,” she said. “Owners like to know the root problem, but to also quickly diagnose secondary problems so the entire horse can be treated at once.”
Puchalski said the biggest benefit of the tech at the clinic is accessibility, particularly at the PBEC is the official veterinary hospital of the Winter Equestrian Festival and the Adequan Global Dressage Festival. “Anyone can call from the horse show to the clinic, get a scan scheduled quickly- in and out, get results fast, and then their training program can be changed immediately.”
Dr Sarah Puchalski, from Davis, California, was an associate professor at the University of California in its Department of Surgical and Radiological Sciences. In 1995, she received her BS in biology from Simon Fraser University in British Columbia, and in 1999 earned her Doctor of Veterinary Medicine from the University of Saskatchewan in Saskatoon, where she received the ACVS Outstanding Large Animal Surgery Student award that same year. Puchalski interned in Field Service and Sports Medicine at New Bolton Center at the University of Pennsylvania in 2001, and completed her residency in radiology at UC Davis in 2005.
Puchalski has devoted her career to teaching and improving equine health through the development and refinement of diagnostic techniques. In 2011, she contributed to two books on the topic of equine lameness. Her recent contributions include chapters in “Diagnosis and Management of Lameness in the Horse,” edited by Ross and Dyson, as well as in “Veterinary Computed Tomography and the Clinical Veterinary Advisor: The Horse, Equine Colic and Veterinary Clinics of North America.” She also has contributed close to 50 scientific articles concerning the diagnosis of equine lameness to many periodic journals.