By James Tate BVMS MRCVS

Focused On Racing!

A simplified diagram of the anatomy of the eye.

In the wild, the horse is a flight animal and thus good eyesight is essential in order to spot potential predators. Horses have good vision at day or night and, due to the placement of the eye socket, they can nearly see 360 degrees. The horse has a big prominent eye with lots of pigment and a ‘letter-box’ shaped pupil but it also differs from the human eye as it only has lashes on the upper lid and it has a ‘third’ eyelid. In many horses the third eyelid is hardly noticeable in its position in the corner of the horse’s eye closest to the head’s midline. This is because it usually has the same colour as the eye’s iris. However, in some horses the third eyelid is white and thus suddenly becomes obvious. In fact, some people do not like buying horses with too much white associated with their eye as they believe them to be hot headed and temperamental.

Photographs of three horses’ eyes. The horse on the left has ‘normal’ pigment both in its iris and its third eyelid. The horse in the middle has a ‘true’ wall eye, which means that its iris has very little pigment in it. The horse on the right has a non-pigmented, white third eyelid.

James examining a yearling’s eye.

The horse’s eye can be examined relatively easily, with the major problem being the hairs around the horse’s eye which prevent the veterinary surgeon from getting too close otherwise the horse will blink. Sedation, nerve blocks, local anaesthetic and pupil dilators can all theoretically be used to aid examination, but none are usually necessary for routine examinations. Eyes are no different to any other part of the equine body in that they can suffer from the usual problems – wounds, trauma, infections and cancer. Wounds to the eye itself, unless very superficial, can be serious. Fortunately, the horse is usually quick enough to close its eyelid and thus eyelid wounds and trauma are more common and generally less serious.

Above is a series of three photographs showing a healing wound to a horse’s lower eyelid following stitching.

The eye itself is a little different to other parts of the horse, mainly because it cannot swell significantly without causing the horse huge pain. Following trauma, it is sometimes possible to see blood within the front chamber of the eye, but then later oedema within the cornea is seen as a hazy blue effect. The word oedema simply refers to normal tissue fluid appearing where it should not. In a leg it is seen as a thick fluid-filling that leaves a thumb print for quite some time after pressure – this is referred to as ‘pitting oedema’. In a horse’s cornea, oedema is shown by a hazy blue appearance due to the fluid present within the individual layers of the cornea.

The horse on the left has just received a blow to the eye – the blood within the front chamber is obvious. The horse on the right has received a blow to the eye the previous day – there is still some blood visible in the eye but a patch of hazy blue oedema has now become obvious where the eye was struck.

The cornea is the transparent protective surface of the eye. Perhaps the most common problem associated with it is the corneal ulcer. There are many causes of corneal ulcers including viruses and fungal infections, but the most common cause is trauma. Whenever any damage to the cornea is suspected, the eye should be stained with fluorescine. This is a fluorescent dye that is not taken up by the outer layer of the cornea, but it is taken up by the second layer of the cornea and thus any damage is shown and healing is also easily monitored.

Fluorescine Staining. Note the horse’s nasolacrimal tear duct is seen easily as it exits at the nostril when fluorescine is used. Occasionally a horse may suffer from a blocked tear duct. In this case, no tears, and therefore no fluorescent stain, would be seen running from the nostril.

Most corneal ulcers are easily treated with topical, and sometimes oral or injectable antibiotics and corneal oedema is easily treated with topical and oral/injectable pain-killer/anti-inflammatory drugs. However, horses can get ‘melting’ ulcers, which seem to destroy the cornea and quickly eat into the eye. These cases are very severe and intensive treatment regimes are called upon that include restricting light and the administration of atropine and anti-collagenase agents, as well as powerful antibiotics. Even when treatment goes well, the horse’s future sight is likely to be impaired.

The horse on the left has a small corneal ulcer which is easily diagnosed by the fluorescent stain. The horse on the right has a large melting ulcer. The case on the left is easily treated but the case on right has a much poorer prognosis.

The above filly had a corneal abscess. After intensive treatment with antibiotics, atropine and anti-inflammatories, she was left with just a small scar.

Any part of the horse can succumb to cancer and the horse’s eye is no exception. Perhaps two of the most common examples include sarcoids seen at the eyelid and squamous cell carcinomas of the third eyelid. Sarcoids are common growth in horses and the eyelid is quite a common site. In some horses they cause few problems, but in others they must be treated and there are several ways in which they can be attacked, although none are entirely straightforward. Squamous cell carcinomas occur quite commonly in non-pigmented third eyelids and thus this is the only veterinary reason why one might not be as keen to buy a horse with lots of white associated with its eye. Although I doubt very much that this is why some are not so keen to buy horses with ‘white’ eyes.

The horse on the left has quite a severe sarcoid around its eye. The horse on the right has a squamous cell carcinoma of the third eyelid.

This article has only served to highlight a few of the major points regarding the equine eye. There are so many potential eye problems that many books have been filled with the subject. For example, glaucoma, whilst common in humans and dogs, is quite rare in the horse. Cataracts on the other hand, occur quite commonly in horses, usually either caused by anterior uveitis, old age or horses can be born with them. There is also a very important condition in some areas of the world called equine recurrent uveitis or ‘moon blindness’. This is the single most common cause of blindness in horses in the world. It is treatable but recurrences later in life are common. Fortunately, it is not that common in the United Kingdom.

A horse with a cataract. Horses usually focus through a lens in the centre of the eye. However, when a horse has a cataract, the lens has become mineralised and therefore the horse is unable to see through the lens, and likewise the onlooker can only see a blue/grey cloudy cataract.

I hope none of our readers’ horses have any eye problems during 2008. However, if they do then I can assure you that they will receive the best of care with all costs included in the training fees of horses residing at Mark Johnston Racing.

Worming Your Way Into Your Horse’s Formbook!

Everyone knows that worming horses is essential and that you should rotate which wormer you use, but there is a lot more to discover about the subject. Most people who worm horses have little idea about the actual worms that they are trying to prevent. If you walk into a yard and ask for the name of a worm that affects horses, the answer you are likely to receive is ‘ringworm’. But this is actually a fungus, not a worm! Parasites that do commonly affect horses include the large strongyles (e.g. strongylus vulgaris), the small strongyles or redworms (the Cyathostominae), tapeworms (e.g. Anoplocephala perfoliata), Ascarids (e.g. Parascaris equinum), pinworms (Oxyuris equi), and bots (e.g. Gasterophilus).

Worming horses is important because these parasites cause problems such as colic, weight loss, diarrhoea and ill-thrift. Both spasmodic and impaction colic can be caused by worms but perhaps ill-thrift and general lack of peak condition are more common signs of a worm infestation. What is considered a simple issue is in fact more complex and parasite associated disease is under recognised because diagnosis is not always straightforward and many parasitized horses show no outward signs of the worms inside. There is without doubt an over-confidence in the ability of wormers, to which many worms are resistant, as well as general poor knowledge of worm lifecycles.

 

Large strongyles used to be a major problem but thankfully wormers seem to work very effectively against them at all stages of their developments. However, when present, they can cause major problems because they are blood feeders and hence can cause obstruction in any blood vessel but perhaps most commonly gut blood vessels. In contrast, small strongyles which are also known as small redworms, are much more common mainly because no wormer is very effective against the period in their lifecycle when they ‘hibernate’ within the gut wall. In small numbers they cause very few problems but when present in hundreds of thousands then affected horses lose weight and are prone to diarrhoea. Treatment often consists of worming every day for five or six days with the likes of ‘Panacur’ and using off-license drugs such as ivermectin intravenously.

 

Tapeworms are also quite common in the horse’s gut. Generally, they do not cause many problems but they can accumulate in large numbers in one particular site, the ileocaecocolic valve, and can cause colic as a result. Not all wormers kill tapeworms but praziquantel and double-dose pyrantel are very effective.

 

Ascarids are only common in young horses as older horses tend to become immune. When present they generally only cause major problems by physical obstruction and diagnosis is easy as eggs can be found in faecal samples. Wormers work well to kill adult worms in the gut but not so well against juvenile worms found in the lungs.

 

Pinworms also cause few problems as they only attach themselves to the horse’s gut wall and feed on the gut content rather than cause much in the way of damage. When a horse is wormed, dead worms can be easily seen in faeces. Affected horses often scratch their tails against anything they can find particularly if worms are being passed at the time.

 

‘Bots’ are the intermediate stage of flies and whilst they like to live in the nice warm environment that is the horse, they cause no significant damage. They attach themselves to the horse’s leg, which causes the horse to scratch its leg with its mouth. Thus it ingests the ‘bot’ which matures in the horse before being passed out in faeces as a fly. Only avermectins such as ivermectin or moxidectin kill bots.

 

There are many types of horse wormer but we are far too confident in their abilities. Their widespread usage has led to a change in which parasites are common, as well as widespread resistance to wormers. The best example of this is the reduced importance of the large strongyle and the increased importance of the small strongyle due to their resistance to wormers. Only eleven wormers have been developed in 85 years and all of them can be fitted into three classes. The macrocyclic lactones, for example ivermectin, paralyse the parasite; the benzimidazoles, for example, Panacur, starve the parasite; and the pyrimidines, for example praziquantel, also paralyse the parasite but are the only class that is effective against tapeworms. Also, not only do they work in different ways, against different worms, but they also have different lengths of action. Pyrimidines, for example, only work for four weeks, whereas moxdectin works for thirteen weeks. As a result, careful thought must be given as to which wormer is given to a particular horse, what dose and how long before the horse is wormed again. Wormers should be rotated by class not by colour of box! However, no matter how ‘well’ a horse is wormed, if it is turned out into a field that is heavily contaminated with parasites, it is likely to pick up some worm burden – the environment and season cannot be ignored when worming horses.

 

Every horse must be wormed no matter what its purpose and racehorses are no different. Racehorses are banned from receiving many drugs that could be perceived to improve performance, however, wormers are not performance enhancing and are therefore allowed with one exception – levamisole, a drug that is thought to have some immuno-stimulatory properties. Having said that, it is probably not wise to worm a horse that is just about to run in a race as they cannot be guaranteed to be at the top of their game if they have dead parasites passing through their bodies.

 

 

Colic – a Pain in the Belly!

The word ‘colic’ simply refers to pain that originates from within the abdomen but it usually conjures up an image of a horse rolling around in agony prior to requiring death-defying colic surgery. It is most commonly associated with intestinal disorders but can theoretically be caused by abdominal pain of any origin, and in fact, other disorders such as tying-up are commonly mistaken for colic. On average in the UK, there is one colic case per ten horses per year and of these colic cases one in ten has serious medical or surgical conditions that must be recognised quickly.

A horse with colic appears restless, dull, dejected and inappetant, often sweating. It shows all the signs that might be expected given that it essentially has bellyache – looking at its flank, pawing the ground, stretching, lying down and rolling. The actual source of pain can be caused by excess fluid, food or gas in a specific gut location, intestinal spasm, displacement, entrapment or a twisted loop of gut. Some colic cases pass very quickly and may simply be related to the fact that horses cannot vomit, however, others can be fatal.

When a horse is showing signs of colic it is essential to first consider its history. For example, if a horse has just been exercised, it may in fact have tied-up rather than having colic. Also, it is essential to know if the horse has eaten up, passed any droppings or on any current medication, for example, pain-killers. If a horse has colic whilst on pain-killers then any pain that it exhibits is actually much more severe than it seems, as the pain has been masked by the drugs it is already receiving. When assessing a horse with colic it is essential to check its vitals signs – heart/pulse rate, respiratory rate, temperature and mucous membranes. It is easy to listen to a horse’s gut sounds, which are usually decreased in colic cases except spasmodic colics or swimming colics. The region of the problem is often identifiable, for example, an area of decreased motility or gas formation can be diagnosed by listening to the gut sounds. More information is also gained by performing a rectal examination through which it is possible to palpate approximately one third of the abdomen, feeling for distended, painful pieces of gut – perhaps most commonly a pelvic flexure impaction, which is easily identifiable as it rises up into the horse’s pelvis. Other helpful diagnostic tools include the use of a nasogastric tube to examine the contents of the horse’s stomach, abdominocentesis (using a needle to test for fluid in the horse’s abdomen) and more rarely the use of imaging techniques, for example, ultrasonography.

 

Colic of any type is a painful condition and thus the mainstay of the initial treatment is to reduce the pain. However, it is essential not to mask a serious problem and many veterinary surgeons have a general rule that a horse should not receive painkillers twice without either a firm diagnosis, for example, a pelvic flexure impaction, or being at a hospital where the horse can undergo colic surgery should it be necessary. If a horse has a twisted gut, for example, then the sooner surgery happens, the better – the longer it is delayed, the less chance the horse has of survival. Other treatments commonly used in horses with colic include sedatives, fluids, electrolytes, antispasmodics such as ‘Buscopan’ for spasmodic colics and lubricants such as liquid paraffin for impactions.

 

As colic can be caused by any problem in the abdomen that gives the horse pain it is not surprising that there are nearly endless possible causes, however, some are more common than others. ‘Spasmodic’ colic, whilst probably over diagnosed, is quite common. Essentially, it is when a horse has an episode of colic and on examination it has obviously increased gut sounds prior to receiving an antispasmodic injection which cures it! The cause is unknown but the outcome is excellent so nobody seems to care, although worms have been suggested as a possible cause. The only other common colic that causes increased gut sounds is a swimming colic. Horses that have just swum start to colic a few minutes after swimming. Treatment consists of letting the colic pass with or without treatment depending on the severity of the episode. The cause is not actually known although the shock of a horse going into cold water and ingestion of significant quantities of water (which contains some chemicals) have been suggested as possible reasons with the former possible reason being dismissed on the grounds that horses still have swimming colics in hot countries with hot swimming pools.

 

The horse can be considered to be poorly designed in many ways and its gastrointestinal system is no exception. The tortuous passage of the horse’s gut, particularly its large intestine, is verging on the ridiculous and there is one turn of gut that is especially badly designed. The pelvic flexure refers to a sharp turn of the horse’s colon at the point of the smallest calibre, just as the food is beginning to become more solid due to water reabsorption. The result of this is that horses commonly get impactions of solid food material here. Diagnosis of pelvic flexure impaction colic is usually quite simple as such an impaction is quite easily palpable via a rectal examination and a change in diet, exercise or management also seems to predispose a horse to this type of colic. Treatment involves pain relief and stomach tubing salt in order to draw water into the gut and soften the impacted food, as well as some sort of lubrication, which is usually liquid paraffin, to help the impacted food material pass through the flexure more easily. The prognosis for affected horses is excellent but it can take several days to clear such an impaction fully.

The colics listed above are perhaps the most common types of colic, however, unfortunately there are several types of colic which require surgery. One type is known as left dorsal displacement of the left colon also known as ‘nephrosplenic entrapment’. The horse’s colon becomes hooked over the ligament between the kidney and the spleen. Sometimes the piece of gut can become unhooked with exercise and rolling, but often surgery is necessary to manually correct the entrapment. Another type of colic which always requires surgery as fast as possible is ‘colonic volvulus’ otherwise known as a twisted gut. This is a very severe colic which must be operated on immediately if the horse is to have any chance of survival. The twisted piece of gut essentially poisons the horse and thus the surgeon faces a race against time to remove the affected gut before the horse dies.

 

Other causes of colic include acute enterocolitis, peritonitis (infection in the abdomen), anterior enteritis, and strangulating small intestinal obstructions that can be caused by tumours, intussusceptions, mesenteric tears, scrotal hernias and intestinal twists. However, let’s hope that the reader never has to learn about such colics. One final cause of colic that I would like to cover is gastric ulceration in the horse. This has become a rather hot topic in the equine press of late, mainly due to our increased awareness and the subsequent frenzy of products available that claim to treat them. The facts are essentially that ulcers in the equine stomach are common but unless severe their significance is questionable. Moderate ulceration is often found in normal healthy racehorses that are performing well and skinny, poor-looking racehorses that are running badly often have no ulcers! Nevertheless, severe gastric ulceration can cause problems such as poor performance, poor body condition and reduced appetite, as well as mild colic. Diagnosis is carried out by introducing a gastroscope into the horse’s stomach. There are several treatments available on the market, however, only omeprazole has been proven to be effective in significant scientific trials carried out on horses and it is expensive, which is in stark contrast to the vast number of cheap alternatives available. Unless the affected horse has very severe gastric ulceration, turning it out in a field is by far the best treatment.

 

With reference to horses in training at Mark Johnston Racing, we take colic extremely seriously. Whilst our incidence of colic is nowhere near one in ten, if there is even a possibility that the horse could require surgery for its abdominal discomfort then it is injected only once with painkillers and sedation as necessary and carefully transported to Greenwood Ellis and Partners Veterinary Surgeons at Newmarket, our colic surgeons of choice. Whilst many colics pass without much event, there are a small minority of cases which should be operated on as soon as possible and it is these cases that make us take any colic case so seriously.

 

Is Conformation Relevant? Does a Show Horse Win More Money than an Ugly Horse?!

This year’s yearling sales have already begun with Fasig Tipton, Deauville and Doncaster already having been. Next is the turn of Keeneland, Goffs and Tattersalls Newmarket to lay host to thousands of blue-blood thoroughbreds desperate to have their conformation analysed by trainers, owners and those conformation experts – the bloodstock agents. Each sale catalogue comes illustrated with photographs of the current superstars sold at last year’s sale, but does examining a horse’s conformation really give you a better idea as to whether you are looking at next year’s superstar?

One thing is certain – a perfectly conformed horse in all areas except one bent foreleg will cost considerably less than the same horse with perfect conformation. Is it really correct to pay so much more to have little or no conformational faults, or should we be concentrating on certain faults and not others, or perhaps pedigree, size and stamp are more important? One only has to stand at the Tattersalls paddock for a minute to hear the phrase “I couldn’t buy a horse with a front leg like that”. At this point I would like to question the evidence supporting an opinion like this.

It is possible to name several poor horses with good conformation and several with bad conformation, but there wouldn’t be any point in doing so as you wouldn’t have heard of them. We only hear about the good horses whose conformation often becomes exaggerated by winning lots of races. There are several horses with conformation as poor as Attraction’s, but our attention is never drawn to them. Likewise, lots of poor horses have near perfect conformation but we tend to think that the like of Secretariat has better conformation because he won the American Triple Crown. This article will attempt to illustrate some aspects of conformation before examining some of the available evidence concerning its scientific relevance to performance.

Conformation is defined as the form or outline of an animal. This may be expanded to include the relationship of form to function, in the horse’s case, its gait. The conformation of the Thoroughbred racehorse today is a result of natural selection as well as the demands we have put on it. The assessment of a horse’s conformation is a personal process but many begin with the body, move onto the limbs and then assess the horse’s gait. The conformation of the body assesses the horse’s balance and centre of gravity but in my opinion is an underestimated area of the assessment. Conformation textbooks detail limb ‘faults’ for pages, but hardly even mention the future athlete’s body. When examining a yearling as a potential superstar surely it is vital to assess its height, length, width, girth and muscle mass, not to mention its neck, head, outlook and temperament. When examining the biomechanics of the galloping Thoroughbred, it seems obvious that its propulsion comes from its backend, hence the commonly held belief that sprinters are bigger in this area than stayers. It also seems obvious that any horse should have a large girth allowing plenty of room for the heart and lungs, but perhaps this is even more important for the stayer than the sprinter. The result of the conformation assessment of the body is comments like short-coupled, weak behind, weak necked, narrow and tubular. I would also suggest that this is an area in which so-called amateur owners can provide valuable insight when looking at yearlings as the ‘experts’ seem to spend too much time assessing minor details and forget to look at the horse!

The assessment of limb conformation is quite complex but should not be debatable – a curb is a curb and back at the knee is back at the knee – conformation can change a little as the horse matures, but usually it is the onlookers assessment that varies, not the horse. The horse is assessed from a number of angles both at rest and in motion. It is important not to get too carried away with each limb section individually as the overall balance of conformation is more important. Both hindlimb and forelimb conformation is equally important but their functions should not be forgotten – the hindlimb is providing most of the athlete’s propulsion whereas the perhaps the most important function of the forelimb is simply not to break.

Much is said about the side-on conformation of the knee in relation to the rest of the forelimb. National Hunt trainers traditionally will not buy a horse that is ‘calf-kneed’ or ‘back at the knee’ believing that it is predisposed to injuring a tendon, but on the other hand, a certain Mark Johnston goes out of his way to buy such a horse believing it to be more likely to be faster than a horse who is ‘buck-kneed’ or ‘over at the knee’. From a veterinary perspective, horses who are over at the knee have extra strain placed on their sesamoid bones and the suspensory ligament, whereas horses who are back at the knee have extra strain placed on their carpal ligaments, as well as having extra compression placed on the front aspect of their knee bones, thus knee chip fractures should theoretically be more common in such horses. However, statistical evidence for such injuries is severely lacking and as an anecdote, the over at the knee horse below had minor knee problems on its right fore before being retired as a stallion due to a suspensory branch problem in its left fore, whereas the back at the knee yearling below is just about to complete a full year’s training without taking a lame step or winning a race!

 

Many buyers will not buy a horse with long sloping pasterns, however is this sensible? A long sloping pastern theoretically predisposes to injury of the flexor tendons, sesamoid bones and the suspensory ligaments. However, upright pasterns, which are not considered to be anything like such a serious fault, theoretically predispose a horse to fetlock joint injuries, ringbone of the pastern joint and navicular disease.

 

When looking at a yearling’s forelimb from the front there are several terms that are widely brandished about – base-wide/base narrow, toed-out/toed-in and offset/rotated from the knee and/or fetlock not to mention whether the horse is considered to have enough forelimb strength or ‘bone’ (usually determined by the circumference of the cannon). In order to be accurate, the yearling must be standing square (with both front feet together) and in almost all circumstances the horse’s gait will mirror its forelimb conformation. None of the above conformations are considered desirable, however all are seen in the paddock for most Group/Grade One races, which is hardly surprising when it is remembered that the forelimb’s purpose is mainly not to break and thus has little relevance to the potential superstar’s future ability.

 

The hindlimb of the racehorse is where the majority of its propulsion comes from and thus despite the fact that there is less lameness here than in the forelimb, their conformation is every bit, if not more important than that of the forelimb. Whilst some of the forelimb conformational points carry relevance to the hindlimb, for example, pastern angle and foot path, some new points are considered. When assessing the hindlimb from side-on, hindlimb/hock position is generally considered to be either ‘sickle-hocked’, ideal or ‘camped behind’/‘post-legged’. Sickle-hocked horses are predisposed to curbs (injury of the plantar ligament) and considered to have weak hind legs. However, it is also considered a ‘fault’ to have the limb too far behind the body as well as having an excessively straight hindlimb as the former condition is likely to be associated with upright pasterns and the latter condition theoretically predisposes the horse to hock arthritis and a ‘locked stifle’.

 

When assessing the hindlimb from behind, the onlooker is assessing pelvic and muscle symmetry, hock/hindlimb conformation and pastern/foot conformation. ‘Cow-hocked’ horses are considered to have one of the worst hindlimb conformations because there is excessive strain on the inside of the hock joint, which may cause hock arthritis. However, this comment should be taken with a large pinch of salt when assessing yearlings as to some extent this is a normal conformation in weak, growing young thoroughbreds. ‘Bow-legged’ yearlings also have a reduced value. This conformation is most commonly evident in heavily-muscled horses in which there is excessive strain on the outside aspect of the limb in the bones, ligaments and joints. When a horse has good conformation in front, and is base-narrow behind, many types of interference can occur between the fore and hindlimbs.

 

So, having considered some of the conformational faults of the thoroughbred and cited some of the veterinary reasons why, it would now make sense to advise potential purchasers to avoid horses with significant conformational faults. However, surely the statistical evidence must be considered. In 2002 one of the most renowned equine orthopaedic surgeons in the world, Dr Wayne McIlwraith, presented the findings of his extensive research into thoroughbred conformation leading him to famously question the operations to correct mild deviations from the ‘normal’ limb. In fact he concluded that “a perfectly correct leg is not ideal for soundness” and some degree of carpus valgus can be a good thing. The extensive study came up with some mildly unexpected conclusions – a longer toe increases the odds of knee problems, a longer shoulder decreases the odds of a fracture and offset knees lead to fetlock problems, not knee problems. It also came up with some perhaps unsurprising conclusions – a longer pastern predisposes to forelimb fractures, thoroughbred foals achieve 95% of their full height by 18 months of age and manipulating the knee for cosmetic reasons is not helpful and can contribute to unsoundness.

McIlwriath’s study however considered just one set of results. The late Peter Calver conducted an even more extensive survey of the conformation of thoroughbred yearlings seen at the sales, which was completed by Anthony Stirk and several members of Glasgow University. The study categorised and looked for statistical differences in the performances of many different conformations, for example, back at the knee, offset, weak hocks etc. However it concluded that pedigree (sire) was more important and that it was difficult to determine if conformation actually affected performance at all, or if horses performed poorly due to other, inherited characteristics, such as heart and lung function or size.

In summary, assessing the conformation of a Thoroughbred yearling is complex, personal and of questionable relevance. The size and shape of a future athlete should be relevant, as should its limb conformation. However, neither is proven to be relevant in determining whether or not it can win a Group/Grade One race. This is the beauty of the sales – what one man loves, another hates, and no-one knows for sure who is right until at least a year or two down the line! Personally I like to follow my late grandfather’s advice: “a good big ‘un will always beat a good little ‘un!”

 

Pelvic Fractures – What’s the Crack?!

Fractures of the pelvis are quite common in racehorses but their significance can vary from being a frustrating setback to a fatal injury. The pelvis is made up of several bones – the ilium, the ischium, the pubis and the acetabulum. The pelvis is a hugely important skeletal structure connecting to the horse’s spine at the sacrum, forming the sacro-iliac ‘joint’, and joining the hind limb at the femur, forming the hip joint. As a result, pelvic fractures have to be treated somewhat individually depending on where the fracture is and the stresses and strains upon it.

Although pelvic fractures can be caused by trauma, such as a fall, or a horse doing ‘the splits’, they are actually much more common in racehorses as a result of cantering, galloping or racing. It is, of course, possible to fracture any of the pelvic bones, but perhaps the most common fracture is that of the ilial wing. A horse with a pelvic fracture is not surprisingly lame, however, what can be surprising is that some are not actually that lame at trot – horses with pelvic fractures often walk lamer than they trot. In fact, the most common signs of a pelvic fracture are often that of pain – sweating, obvious discomfort and a lack of appetite.

The pictures shown in this article would lead one to believe that it is easy to diagnose a pelvic fracture from the obvious asymmetry, however, at the time of injury, this is not necessarily the case. The asymmetry shown in the photographs is the result of bony displacement and muscle atrophy (degeneration due to disuse) and so if the displacement is not obvious enough to drop one side of the pelvis immediately, then the pelvis usually appears symmetrical at the time of injury. An experienced veterinary surgeon can often diagnose a likely pelvic fracture from the clinical appearance of the horse – pain on deep palpation of the pelvis and general gait and posture – however, even then, an imaging technique is required to confirm the diagnosis. Bone scanning (nuclear scintigraphy) and radiography can be used to diagnose a fractured pelvis, however, it is unlikely that the horse would be fit to travel to a hospital for such a procedure. Therefore, ultrasound has become the best and most widely used method for pelvic fracture diagnosis. Although ultrasound cannot penetrate bone, its reflection on the surface of the bone creates a very clear image of the pelvic bony surface and hence any mildly displaced fracture or callus formation can be easily seen. It is also important to examine the horse rectally in order to palpate the internal surface of the pelvis to fully assess the damage, especially in fillies that may become broodmares in the future.

The treatment for a pelvic fracture is box rest. Surgery is unlikely to be an option (except in some traumatic fractures involving chips), therefore restricting movement for a period of time is the only treatment and in some cases the use of cross ties is necessary to prevent the horse from getting up and down. Traditionally, all pelvic fractures were box rested for three months, however, more recently there has been a move to reduce this period of complete rest to as little as four to six weeks in some straightforward cases. Ultrasound scanners have revolutionised the way in which pelvic fractures can be returned back to training due to their ability to accurately diagnose and monitor healing and have become an essential aid in judging when horses are fit to return to exercise. Following the period of box rest, a lengthy spell of increasing walking exercise is necessary (at least six weeks before any ridden exercise or turn out is attempted).

Most pelvic fractures heal very well and the prognosis for a return to racing is often very good. There is an endless list of top class horses who have suffered a pelvic fracture before winning world class races, including the yard’s very own Fruits Of Love, dual winner of the Hardwick Stakes at Royal Ascot and winner of the Dubai Duty Free at Nad Al Sheba, as well as the Epsom Derby winner of two years ago, Motivator. The complete recovery time from a pelvic fracture to the racecourse can vary greatly from five or six months to a year and a stress fracture could take even less time to recover.

Perhaps the most common question that is asked by an owner following a pelvic fracture is ‘why did it happen?’ The answer is probably that thoroughbred racehorses that compete on the flat are athletes which are always likely to pick up injuries, and as young horses, they are more likely to fracture bones than injure soft tissue structures. In fact, upon close consideration there are not many bones that these athletes do not break with alarming regularity – it is simply the position of the pelvis surrounded by a huge muscle mass that makes it slightly different in its treatment. At Mark Johnston Racing, it is assured that all horses receive the best of care following such an injury.

 

Tying Up

We have all had muscle cramp at one time or another, but when a horse ‘ties up’ it has cramp all over its body. The condition comes under the guise of a number of names – setfast, azoturia, rhabdomyolysis, exertional myopathy etc. and this serves to highlight its complexity. The science behind the disease is quite poorly understood. Exercise is the predisposing factor but explaining why a horse should tie up on one particular day can be difficult. For a variety of possible reasons, it is thought that exercise results in an increase in lactic acid production and a reduction in oxygen received by the muscles, which in turn causes more lactic acid production thus resulting in a vicious cycle of muscle degeneration. Thankfully, cases are usually fairly mild, but very severe cases can result in kidney problems and, extremely uncommonly, even death.

Tying up is commonly associated with too much carbohydrate intake for the level of exercise that the horse is currently doing and hence if a horse has been rested for some reason and kept on full feed, then it becomes ‘at risk’ for tying up. There are also several other factors that seem to play a part in tying up – being female, genetics, disease processes, electrolytes, vitamins and trace elements. A ‘typical’ case might be a highly-strung two-year old filly that has just had a few days off for a minor problem, who then goes out to exercise and gets over-excited before succumbing to this ‘cramp-like’ disease. A case like this is fairly easily explained, however, certain horses seem more prone to tying up than others, and thus must be managed slightly differently.

A horse showing many of the signs of tying up – sweating, stiffness of gait, muscle trembling and obvious discomfort

A horse that has tied up is usually stiff, reluctant to move and sometimes unable to move and if a tie up is suspected, the horse should be led home or picked up by horsebox to limit any further damage. On close examination tied up horses sweat, scrape the ground, breathe hard, tremble, have firm painful muscles (particularly the rump) and often have discoloured, dark urine. In fact, they have many of the same clinical signs as a horse with colic, however, a horse that has tied up must always have just been exercised, whereas a horse with true colic (abdominal pain) is less likely to have just been ridden.

The rump and lower back are often the most notably affected muscles.

The appearance of a tied up horse is often diagnosis enough, however, all possible cases should be blood sampled for confirmation and to assess the severity of the muscle damage. Two muscle enzymes are measured creatine phospho-kinase (CK) and aspartate amino-transferase (AST) and usually, if a horse has tied up, a massive increase is seen – CK rises quickly and falls quickly, whereas AST moves up and down more slowly.

A graph showing the rising and then falling of CK and AST levels in the blood following a typical tie up. At MJR we routinely blood sample the morning after the suspected tie up and every few days afterwards.

Myoglobin released by the damaged muscles can turn the urine dark red after tying up and then recovery urine samples gradually become more straw-coloured.

A selection of urine samples taken from the same horse following a very severe tie up. The sample on the left was collected very soon after tying up, the ‘normal’ sample on the right was taken after recovery.

As soon as a horse is suspected to have tied up, physical activity should cease at once, and hence ideally a horsebox should pick up the horse. In terms of drugs, non-steroidal anti-inflammatory drugs are usually indicated (e.g. ‘bute’ or ‘Finadyne’) and prolonged courses can hasten full recovery. Severe cases can be treated with intravenous fluids and electrolytes also have an indication. Management is key to prevent any further tie up episodes. Generally, keeping the horse moving as much as possible is the main point therefore good practice includes walker exercise before being ridden, being turned out and having the horse on an appropriate level of feed for its exercise. There are of course many feed supplements available for this problem, however, if the horse is already being fed a balanced diet, then they should not be necessary. Important points when dealing with a recurrent case include possible supplementation with electrolytes (e.g. salt) and reducing carbohydrate levels in favour of increased dietary fat.

In summary, tying up is a common condition that is usually seen in mild forms that are easily treated and managed if good practice is observed. However, the causes and science behind the disease is not so well understood and thus recurrent cases can be a real problem. At Kingsley House we are in the fortunate position of being able to treat any possible cases immediately, which I believe is essential in limiting muscle damage, as well as being able to take regular blood samples to assess when the horse can be safely returned back to full exercise. I hope that none of our inmates tie up in the near future, however if they do, we will of course be on hand to deal with them straight away.

 

Caution To The Wind!

You can have the fastest horse on the planet, but if it cannot breathe, it will not win many races. Men have been interfering with horses’ wind for centuries, but so far only with limited success. When a horse is heard to be making a noise for the first time, it is of serious concern. Sometimes the concern is only short lived as the horse may only have a mild respiratory infection or a sore throat, however, on other occasions the equine athlete in question is on the verge of being diagnosed with a problem that will always limit his or her performance.

The equine athlete is anatomically designed on a knife edge in so many respects. In last month’s Klarion I described how the horse is precariously balanced on the equivalent of our middle finger. Add to this the obscure anatomy of the horse’s gut leading to regular occurrences of painful and life-threatening colic episodes, and it is easy to get a sense of just how the thoroughbred has been built for athletic ability rather than soundness and the horse’s respiratory system is no exception. The horse has a massive, efficient cardio-respiratory system but unfortunately air is inhaled and exhaled through an unreliable larynx and a rather narrow complex nasal system, especially considering that the horse is an obligate nasal breather and thus cannot receive any air through its mouth. It is for this reason that any abnormalities in the upper respiratory tract of the horse can cause serious problems with regard to the amount of oxygen received by the equine athlete in question.

When faced with a horse that makes a respiratory noise we have a few diagnostic tools at our disposal. Firstly, and perhaps most importantly, we must analyse the noise that the horse is making. Is the noise inspiratory (when the horse is breathing in) or expiratory (when the horse is breathing out), or is there both excess inspiratory and expiratory breathing sounds? Also, the noise must be accurately described as certain noises are characteristic of certain abnormalities. For example, an inspiratory ‘whistle’ or ‘roar’ made all the way up the canter often indicates laryngeal hemiplegia (paralysis of the left side of the larynx), whilst an expiratory ‘gurgling’ or ‘choking’ sound whilst the horse is at peak exercise or pulling up at the top of the canter may indicate dorsal displacement of the soft palate. Endoscopy is also a crucial diagnostic aid, however, it can have its limitations when carried out in a resting horse. If the horse has a respiratory infection, a sore throat (pharyngitis) or an obviously paralysed larynx then endoscopy is a great diagnostic aid, but in other cases scoping a horse at rest can lead to little in the way of information as to why a horse is making such a noise. For this reason, equine veterinary medicine has looked to technology for assistance. The idea of ‘scoping’ horses on a treadmill whilst galloping came first. Whilst this certainly has some merits it does come with some downsides such as the poor surface and the question of whether a treadmill truly represents an equal test to a gallop or race on turf. There is now a new idea of fixing a scope in a horse’s nostril that transmits a signal which can be picked up miles away and thus the horse’s larynx can be watched from a distance as the horse gallops up Middleham Moor. As yet only a prototype of this ‘over-ground’ endoscope exists but could this be the future of accurate diagnosis of equine wind problems?

By far the most common condition that causes an abnormal inspiratory sound, and possibly the most common cause of any abnormal respiratory sound in the thoroughbred racehorse is idiopathic left laryngeal hemiplegia (paralysis of the left side of the larynx). This condition is caused by degeneration of the nerve that supplies the left side of the larynx such that the left side of the larynx hangs into midline causing an inspiratory ‘whistling’ or ‘roaring’ sound during cantering or galloping and thus obstructing airflow to the lungs. The cause of this nervous degeneration is not known for sure but this again leads me onto yet another poor anatomical point of the horse. The right laryngeal nerve has a simple route, branching off from the vagus nerve (which comes from the brain) travelling directly to the larynx – obvious and simple you would have thought. However, God decided that the left laryngeal nerve shouldn’t have it so easy (thereby supporting the argument that left is the side of the devil!) and instead it must travel all the way to the heart, where it wraps around the pulsing aortic arch, before coming all the way back to the larynx. It has been strongly suggested that the structural changes in the nerves arise through transport defects and so the condition may be related to the length of the nerve fibres. The left laryngeal nerve is the longest in the body and thus it stands to reason that it is commonly damaged and perhaps unsurprisingly, there is also data to suggest that the bigger the horse, the greater its chance of developing laryngeal hemiplegia.

This disorder is not a desirable one to have for a number of reasons not least the fact that it is a progressive disease and hence a small problem in a two-year-old can rapidly become a huge problem in a three-year-old. Nevertheless, surgical treatment is commonly attempted and there are three main operations. A ‘Hobday’ operation refers to the removal of a large portion of the left side of the larynx and thus theoretically reduces the amount of respiratory obstruction. However, many argue that although this alleviates the noise (as the left vocal cord has been removed) it struggles to reduce the obstruction significantly and hence they prefer the ‘tie-back’ operation. Here the larynx is actually permanently tied open and thus theoretically the obstruction is alleviated, however, things are never so simple in wind surgery and occasionally the larynx can end up in a bit of a mess if things do not go well, for example, the stitch breaks down. Hence the last resort is to insert a permanent metal tube in the horse’s throat through which it can breathe, by bypassing the larynx altogether. This can also be very messy and it is not easy to keep the tube clean, however, Party Politics did win a Grand National with a tube in his windpipe!

Young unfit horses coming into training for the first time often sound ‘thick’ in their wind and they can also make an expiratory gurgle when pulling up at the top of the gallop, especially if they have a sore throat (pharyngitis). This condition essentially comprises of acute inflammation of the pharynx characterised by enlarged white spots (lymphoid follicular hyperplasia). It is a condition that will affect almost all horses at some stage and has a virtually one hundred percent prevalence in animals less than two years of age. The exact cause of the condition is unknown but it is essentially caused by challenge to the young horse’s immune system. It is not a serious condition and it usually self-resolves with time. However, various treatments may be attempted including anti-inflammatories, antibiotics and immuno-stimulants.

Perhaps the most common cause of an expiratory ‘gurgling’ sound is dorsal displacement of the soft palate. During normal breathing, the soft palate sits in front of the larynx just below the epiglottis allowing maximum airflow through the larynx. During eating on the other hand, the soft palate rises above the larynx, directing food into the food pipe (oesophagus). What happens in this condition is that the soft palate rises up during exercise thus blocking airflow and causing an expiratory gurgling or choking sound. Although the clinical signs of this problem are quite characteristic, confirmation of the diagnosis can be quite difficult as the larynx often looks normal at rest and thus the use of a treadmill or over-ground endoscope may be necessary for an absolute diagnosis. There are many possible treatments probably because none of them are one hundred percent effective. Firstly, if there is concurrent respiratory infection, it should be treated. Secondly, if the horse is unfit, it should be trained more before considering anything more radical. Next on the list is the application of various items of tack – these include a cross-noseband, a tongue-tie, a spoon-bit, a ring-bit or an Australian noseband. If none of these work then surgery can be attempted. There are a number of possible operations but perhaps the two most common are the cauterisation of the palate with a hot iron (in an attempt to make the palate firmer so that it does not displace during breathing) and the tie-forward operation (where the larynx is manually tied forward with steel stitches to reduce the amount of soft palate that is available to rise up and block the airway). However, the reason for the amount of operations that are performed is because none of them work perfectly – in fact, they all have approximately a sixty percent success rate!

The last ‘common’ upper respiratory condition that I shall describe is epiglottic entrapment or aryepiglottic fold entrapment. The epiglottis is the tongue-like structure that sits in front of the larynx, but this is yet another anatomical feature of the equine athlete that can cause problems. Basically, the epiglottis becomes enveloped by a mucosal fold which causes a gurgling or choking sound that may be inspiratory or expiratory. The cause is not completely understood but diagnosis can be made relatively easily at rest if the horse has an ulcerated epiglottis representing the regularity with which the horse entraps its epiglottis, or alternatively a treadmill or over-ground scope can be used. Treatment again involves checking for infection and using different tack, however, surgery can often be successful, at least in the short term, by cutting the mucosal fold.

No discussion of equine wind problems would be complete without at least touching on respiratory infections and breaking blood vessels. Not only does respiratory infection inhibit a horse’s performance, but it can also cause some of the respiratory abnormalities mentioned above, as well as predisposing a horse to breaking a blood vessel. The cause can of course be viral or bacterial, although often the exact cause is never known and antibiotics are the treatment of choice when necessary. Diagnosis is fairly simple and usually includes at least a few of the following – coughing, nasal discharge, a high temperature, excessive blowing, poor performance, excess mucous found on endoscopy, ‘dirty’ tracheal washes and a blood result suggesting infection. Snotty noses and coughing is essential in the development of any yearling, however, a snotty nose in your Royal Ascot runner is a serious problem.

There has been much discussion about the breaking of blood vessels or exercise-induced pulmonary haemorrhage. The reason for this is the lack of full understanding as to why exactly it happens. Currently there are three theories – increased pressure in the tiny capillary blood vessels of the lungs, low-grade small airway disease, and mechanical shock caused by the lungs ‘banging’ against the chest during galloping. All theories have credibility, however, the bare facts remain that we do not know why horses bleed and we do not know how to stop them. Treatment therefore, perhaps unsurprisingly, includes various lotions and potions and perhaps the only really proven drug that can help to reduce bleeding in some horses is frusemide (‘Lasix’), however, this is forbidden in British racing. As a result, British trainers use all sorts of products that are probably unlikely to help at all, and the only two things available at our disposal that really help are antibiotics (to treat any respiratory disease) and an altered training regime (to allow the lungs to heal before returning the horse to training).

In summary, equine wind is a complex subject and I have only succeeded in scraping the surface of a very large subject. I sincerely hope none of your horses at MJR suffer from any of the problems discussed above. However, if they do, all treatment is of course given free of charge when on full fees.

Lameness Investigation

What Dunnit, Where and When will he run again!

Lameness investigation is a little like detective work or trying to solve a murder-mystery. Like the killer, the cause of lameness must be found and once the culprit is found, the sentencing begins – should the horse be sentenced to cell-rest? And if so, how long for? What can be done to help and when can he be safely re-introduced into the society of cantering/racing? Often when a horse is lame, the cause is obvious – a swollen fetlock, an infected ‘nick’, or a hot, painful foot. However, sometimes the cause is not so obvious, or perhaps we just want to be sure – hence the full lameness investigation.

A flexion test being performed – these can be very informative.

Some clues are helpful, but some are ‘red-herrings’ and can mislead the investigation. Like detectives, vets also take past history into account, as well as looking for an obvious culprit, but we too require evidence. X-rays and scans are essential, but we must beware of incidental findings. Nerve blocks are the ‘gold standard’ for lameness localisation, but above all the diagnosis must make sense – for example, a horse that is only walking/trotting is unlikely to have sustained a stress fracture and a horse that is pulled up lame mid-canter is unlikely to have just a sore foot.

The first stage of the lameness investigation is clinical assessment. This is vitally important, and whilst we need the rest of the investigation to find proof, the diagnosis must fit in with what we see. Firstly, is the horse lame? Then, where is it lame and how lame is it? We must also bear in mind that it is possible to have more than one lame leg, in fact, this is very common in joint pain, for example, knees, fetlocks, hocks etc. Certain problems present themselves with characteristic gaits, for example, a horse with an upper limb problem often drags its toe, whereas a horse with a sore foot puts its toe down extremely carefully. Occasionally, things become complicated, for example, the horse that is sound in the yard, but which gets lamer the further it goes – the chief suspects for such a lameness in our population of horses would be a sore foot or a stress fracture. A good clinical assessment should look for heat, swelling, resentment of palpation of any structures and flexion tests can also help. If flexing a horse’s fetlock for 45 seconds greatly increases the lameness, then there is a reasonable chance that there is some pain in that joint. However, these tests should not be taken as gospel and results should always be compared with the other leg (front or hind) and this principle goes for the lameness investigation as a whole.

A nerve block being performed. This injection forms part of the three blebs of local anaesthetic (via two needles) that numb the whole of the horse’s hind leg from the hock to the foot.

The second stage of the investigation is the nerve blocks. Local anaesthetic is injected into very specific locations to numb areas which could be the source of the lameness. Once the horse is sound, you know the place that you have just numbed is the cause of the lameness. There are two types of nerve block: firstly, a regional block, where local anaesthetic is injected around specific nerves thus numbing the whole of the limb below the injection site, for example, a palmar digital nerve block numbs most of the foot, an abaxial sesamoid nerve block numbs the foot and pastern, and a 4/6-point nerve block numbs the fetlock, pastern and foot etc. Secondly, an intra-articular nerve block where a specific joint is numbed, for example, the middle knee joint. Regional blocks must be performed in sequence (from bottom to top) as obviously once a horse’s hind leg has been numbed from the hock down, it is impossible to then block just the foot without waiting for the original block to wear off, which may take several hours. Intra-articular blocks on the other hand, can be performed in any order, as it is just a specific joint that is being numbed. Nerve blocks are the gold standard for lameness localisation as the principle of numbing the source of pain and making a lame horse sound appears simple, however, things in veterinary science are never that simple! There are problems such as dealing with only a very mild lameness or the diffusion of the local anaesthetic into a neighbouring structure. An example of this might be the diffusion of local anaesthetic from the knee into the upper cannon or the proximal suspensory. The other main limitation of nerve blocks is that the upper limb is essentially ‘out of bounds’ because whilst a few upper limb blocks do exist, they can be difficult to carry out and it is impossible to numb most of the upper leg. Nevertheless, all criticisms taken into account, nerve blocks remain the mainstay of lameness localisation.

Rogerio x-raying a tibia. At MJR we are in the privileged position of being able to x-ray a horse every day if we think it could help to diagnose the problem.

The third step of the investigation is imaging and final diagnosis. The area of interest as localised by the nerve blocks, for example, knee, pastern, upper limb, can be x-rayed, scanned with ultrasound, scanned with nuclear scintigraphy (‘bone scan’) or all three as necessary. Example diagnoses include a pastern stress fracture diagnosed by an x-ray, a suspensory ligament problem diagnosed by ultrasound or a pelvic stress fracture suggested by ultrasound and confirmed by a bone scan. However, complications do arise. A stress fracture is essentially a fracture that is not displaced and such fractures are particularly tricky to diagnose as often at the time of injury x-rays show nothing, as the fracture line is so small and the bone in question has not had time to remodel. In fact, it is only in sequential x-rays taken over a period of days that the remodelling done by the bone in question makes the stress fracture obvious and this can easily lead to misdiagnoses. For example, a horse’s lameness could be abolished by the injection of local anaesthetic into its knee and x-rays reveal small joint changes, hence a diagnosis of knee pain would be made. However, subsequent x-rays may reveal a stress fracture of the upper canon, the bone just below the knee, which was the cause of the lameness all along but was impossible to diagnose on the first x-ray.

A series of three x-rays taken in chronological order. The first show just a suggestion of a proximal cannon stress fracture, the second confirms the fracture a few days later, and the last shows good healing of the fracture. Note the remodelling done by the bone to heal the fracture shown as a white area in the third picture.

Having hopefully reached a diagnosis, the final step is deciding upon an action plan. This could vary from a few days rest, to an anti-inflammatory injection, to surgery at Greenwood Ellis and Partners, Newmarket. We have all the equipment in-house necessary to carry out a full lameness investigation with the exception of nuclear scintigraphy, however, we commonly confer with Simon Stirk of Ripon and David Ellis of Newmarket at the diagnosis/prognosis stage to ensure that the best route for recovery is taken.

Lameness investigation is an extremely important part of racehorse veterinary medicine. It can be simple and rewarding, or complex and frustrating but you can be sure that at Mark Johnston Racing, your horse always receives the best attention.

A Few Pounds Lighter!

Will it Make Him a Few Pounds Faster or the Owner a Few Pounds Poorer?

Between the end of last turf season and now, several colts have made the transition into geldings are now weighing in a few pounds lighter! The castration procedure is relatively simple and is outlined via the photographs below. At Kingsley House we do all castrations with horses standing but sedated and under local anaesthesia, however, horses can also be castrated under general anaesthesia and indeed if castrating a ‘rig’ or cryptorchid (a horse with only one descended testicle), then this is what we do. In our opinion the main factor that affects the speed of recovery after gelding is the management post-castration.

Step 1: First the colt’s identity is checked, then the testicles and then the heart, and if all is ok, he is sedated. Following this, the testicles are surgically scrubbed and local anaesthetic is injected into each testicle.

Whether a horse is gelded standing or under general anaesthesia (and hence whether the skin incision is left open or closed respectively), the potential enemies of recovery from castration are pain, infection and swelling. In order to combat these, we have established a specific post-castration routine that works very well. Firstly, with regard to pain, part of the sedation is a morphine-like drug which forms the first leg of pain-relief. This is followed up by an intravenous painkilling drug after castration as the horse wakes up fully. This stems any discomfort until evening stables when further painkillers are given in the feed and these are given in feed every day for a minimum of five days. In order to avoid infection, aseptic technique is used during the procedure (high level of cleanliness) and all recent geldings return to a completely clean bed of shavings. On top of this all horses receive a course of at least five days of antibiotics. The length of this course depends on speed of wound healing, which is monitored daily by our veterinary team.

Step 2: A 4-5cm incision is made in the skin through which the testicle is pushed out.

In order to prevent swelling, anti-inflammatory drugs are given for at least five days, but, perhaps most importantly, all recent geldings are kept to a routine involving plenty of exercise. Horses stay on stable rest for the remainder of the day in order to prevent any excess haemorrhage, but the next day they are taken for a short walk and trot exercise. The reason for this is two-fold. Firstly so that any post-operative swelling is reduced and secondly so that there is a rider to monitor the horse if necessary. This is much more preferable to exercising this new gelding for the first time on a horse-walker where he would be left unobserved – it is often easy to forget that he has just undergone an operation. Whilst the horse is on drugs, his regime is to be ridden at walk and trot in the morning, and then, he can be put on the horse-walker at evening stables as necessary. As soon as the drugs are finished and the gelding wound is healed, he can return to cantering exercise if required. The result of this regime is extremely rapid recovery from the gelding operation – the best result for all concerned.

Step 3: The tunic containing the testicle is also incised.

What may not alter so quickly however, is the temperament of a colt. To give some idea of the length of time the male hormones persist after gelding, it is interesting to note that a ‘new’ gelding could actually impregnate a mare up to two months after castration. This brings us nicely onto why we geld horses at all. If one was to survey a group of trainers/owners/staff, the answers would probably be along the lines of: temperament, ease of handling, increased soundness etc. etc. On the other hand others could argue gelding can take both the physical and mental edge away from a horse – some say “why would anyone give a gelding an anabolic steroid injection, shouldn’t they have just left his testicles?” Whilst there are multiple individual exceptions the general consensus probably lies somewhere around the fact that geldings have less temperament issues than entire horses, and if a horse could end up good enough to be a stallion, it is economic madness to geld him.

Step 4: The connection to the epididymis (situated at the base of the testicle) is isolated using finger and thumb dissection. This can then be emasculated (cut and crushed).

However, despite most people in the horse industry being all too aware of that last fact there are a few notable Group One performers who lost their chance of fatherhood. For example, Da Hoss, the dual Breeder’s Cup Mile winner who was gelding before racing. As a son of Gone West, from a good female line, he would definitely have earned a respectable stud pitch – so surely connections are kicking themselves that they threw away the chance of owning a successful and profitable stallion? However, these particular connections have always maintained that not only would his temperament have prevented him from winning any Breeder’s Cup races had he been left entire, but his notorious unsoundness may also have prevented him from hardly seeing the racetrack at all. He is just one of many Group One winning geldings including Collier Hill, Teleprompter and of course our very own Yavanna’s Pace, each of which had their own reasons for being gelded.

Step 5: The testicle is pulled away from the colt’s body and the emasculators are closed on the connections to the testicle with the nut facing the ‘nut’ – important but easy to remember! This way the testicle is cut off and the connections are ‘crushed’ so the blood vessels are sealed.

So having established that castrating an unruly and uncooperative colt may well increase his success on the racetrack, what then about an uncooperative filly or mare? We all know about gutsy champion mares such as Attraction, but anyone who has had anything to do with more than one filly probably has had something to do with a filly of questionable resolve. We spey cats and dogs so why can’t we spey uncooperative fillies who do not have spectacular broodmare pedigrees? The answer is that we can, but that we choose not to do so as the operation carries considerably more risk than the simple gelding illustrated in the pictures. However, this does not stop everyone from trying to manipulate the mare’s reproductive cycle.

Step 6: Repeat steps 2 – 5 on the next testicle and remember to tell the office what you’ve done so they can sort out the paperwork!

It was realised many years ago that mares in the early stages of pregnancy usually run faster than they did when not pregnant. This has led some people, particularly in other continents, to try all sorts of ways to manipulate their hormones. These ideas range from inert beads that seem to prevent a mare from cycling to the arguably rather cruel procedure of impregnating a mare and then aborting her after 35 days so that she will continue to believe herself pregnant until 120 to 150 days after conception. This leads onto all sorts of ethical considerations, and indeed I am sure that most people would consider the last-described procedure cruel in a female athlete and many consider it unethical in an equine athlete.

In summary, for as long as horses have run in races, man has tried to interfere with their sex hormones – that is why we routinely test for hormone levels in ‘dope’ boxes after racing. Indeed it is interesting to note that we have reached a point whereby it is considered acceptable to surgically remove a colt’s testicles (and therefore his sex hormones), however it is not acceptable to administer any sex hormone artificially or to interfere at all with a mare’s cycle. This is undoubtedly an interesting ethical conclusion we have come to – for example, if someone did spey a mare, would it have to be declared in the racecard? I would suggest that the reason in fact for this conclusion is not ethical but is purely related to convenience – it is easy and convenient to geld a colt, therefore it is allowed. I hope I have at least provoked some thought…

P.S. Should you wish to remove your colt’s testicles (and therefore his sex hormones), please contact me and I would be delighted to carry out this procedure for you. Providing he is on full training fees, the service will of course be included free of charge!

 

The First Cut is the Deepest?

We humans manage to injure ourselves with remarkable regularity – paper cuts, skin grazes, falls etc., but compared to racehorses, we’re positively careful! Whether it is due to intelligence levels, athletic work and races, the horse’s flight response, or just the plain exuberance of a fit athlete, it is quite unbelievable just how often a racehorse manages to break its skin barrier and shed blood. Often the injury in question is no more than a superficial skin graze that only requires cleaning, however, on occasion a wound can be a very serious thing, as it can threaten participation in a big race or even a horse’s life.

Many wounds are relatively may just requires cleaning (left), or a few staples/stitches (right)

Without doubt the most vital part of wound care is rapid inspection. At Kingsley House, I am in the very fortunate position of being able to see all our wounds at the earliest opportunity. The veterinary textbooks talk of a six to eight hour ‘golden period’ within which a wound can often be cleaned and stitched or stapled, and it is during this period that early treatment with intravenous antibiotics/anti-inflammatories really can prevent a wound from getting out of control. This initial examination is also crucial in assessing other (potentially more important) injuries, controlling bleeding, cleaning the wound thoroughly and generally taking the necessary steps, which may vary greatly from the superficial graze in need of cleaning, to the skin flap in need of stitching, to the joint penetration in need of a general anaesthetic for repair as soon as possible.

Some wounds have too large a deficit of skin to be closed and therefore must heal by ‘second intention’. Note the ‘proud flesh’ in the second picture from the left

There are four stages to wound healing: inflammation, debridement, repair and maturation. All of the stages are necessary, but there are several factors that hinder wound healing at the various stages: infection, trauma, movement, location, blood supply, dehydration and a phenomenon called ‘proud flesh’. Proud flesh is essentially over-granulation of a wound and is particularly important in the horse, in fact it hardly occurs in any other species. The problem is not just the fact that a cosmetic ‘proud’ lump is left after healing, but also the presence of proud flesh actually slows healing down. There is no doubt that lack of blood supply in the horse’s lower limb is a major cause of proud flesh, however, it is also caused by movement, infection, some ointments and the absence of a bandage.

The stitching of an eyelid wound, which healed well by ‘first intention’

All wounds must be cleaned carefully but if the wound is to be stitched then it is especially important as debris and dirt can be trapped inside. Wounds can be stitched and thus heal by ‘first intention’ if they are fresh and the skin edges have good blood supply, or they can heal by ‘second intention’ in cases of large skin deficits. In primary wound closure, metal skin staples can be used (easy and fast but take little tension), or there are several different types of suture, some of which are absorbable and some of which have to be removed. When using sutures, there are also several different stitching patterns that can be used depending on the location of the wound and thus the tension that will be on the stitches, the most common of which are simple interrupted and cruciate patterns. Healing by second intention relies on epithelialisation and contraction to close the wound; proud flesh is the ‘enemy’ of this type of healing.

A wound on a tongue before and after stitching

The next step is usually a dressing for the wound. Sometimes this is not necessary, for example, in a minor wound on the body, however, most wounds occur on the horse’s lower limb and therefore require a bandage. The aim of the dressing is to provide the best conditions for healing. The first layer of the bandage is crucial as it provides the healing environment. Most dressings use a non-adherent contact layer along with an ointment such as a hydrogel (draws debris from a wound), a healing cream or a cream containing a corticosteroid (to inhibit the formation of proud flesh). This is then followed by various layers of padding/support, depending on the amount of immobilisation required, and finally a layer to withstand the external environment – rain, mud and a horse’s teeth! Bandages are initially changed frequently (e.g. twice daily), but as time goes on they are left on for longer and may be changed twice per week before being dispensed with. These bandage changes allow for monitoring of healing, looking for pain, swelling, discharge from the wound and the changing nature of the healing tissue. This also determines the necessity for antibiotics or anti-inflammatory drugs.

Wounds can be very interesting and quite striking. Sometimes the cause is obvious, an over-reach in a race for example. However, there are occasions when we have absolutely no idea how a horse has injured itself – if only they could talk!

ONLY SKIN DEEP?

By James Tate BVMS MRCVS

This month I will take you on a short tour of the skin problems we deal with on a regular basis and their variable significance. Skin is the biggest organ in any mammal and serves a number of basic functions including protection, heat regulation and sensation. Skin disease is manifested by itchy skin, hair loss, scaling and crusting, weeping and seeping, alterations in pigmentation and nodular lesions. Diagnosis is usually easy as appearances are quite classic, however samples can be taken and sent off for analysis if necessary.

A racehorse’s skin is very much like any other animal’s skin and thus can be damaged by many things from the rub of a rider’s boot to the impact of a hard surface from a fall. However, most problems that affect the skin of racehorses are related to infectious diseases and of these the most common is a fungal disease usually known as ‘ringworm’ or dermatophytosis. Do not be fooled by the name, it is not caused by a worm that burrows in the shape of a circle, but is in fact caused by one of two fungal pathogens, Trichophyton equinum var equinum and Microsporum equinum. Ringworm is a worldwide disease that is highly contagious and can be transferred directly or indirectly by tack, rugs, brushes etc. It is a disease that mainly affects young horses unless the infection burden is particularly high or, perhaps more importantly, if the horse’s immune system is suppressed. The health of any older horse in particular that contracts ringworm during a season must be questioned.

In the equestrian sector as a whole there is a certain stigma attached to ringworm and there is a tendency to deny that a horse has the disease. However, I believe that most infectious skin diseases with raised nodules are in fact caused by a fungal pathogen whether or not the classic ring-shaped bald batches of skin are present. Ringworm does not necessarily have to be treated as spots usually disappear in a few weeks without any help and sunlight actually kills it. If treatment is necessary, either because the infection is severe, or if the horse is ready to race, then there are several topical treatments that can help to kill the pathogens involved.

There are several other infectious skin diseases of note including the likes of dermatophilosis or ‘rain scald’, however, the other disease that I am going to touch on is pastern dermatitis. The horse’s pastern is a problem area due to its location so low to the ground and problems are definitely more common in horses with white legs. Affected skin tends to be crusty with erosions, ulcerations, swelling and redness. The cause of every case does not have to be the same but there is no doubt that wet conditions, all-weather surfaces and some sort bacterial infection all play a part. If the skin begins to swell then a course of antibiotics is necessary, but apart from this, management and keeping the area as clean as possible at all times of day is the most important, although rubbing in various creams and ointments can also help. Again, one has to question the health of a horse with severely cracked heels as it is an infectious disease and a horse with a suppressed immune system is more likely to suffer from cracked heels. Whatever the exact cause, it is essential that a racehorse’s pastern is non-painful during a race as this can inhibit performance and thus every care must be taken to ensure that minor cracked heels do not progress into something more serious.

Horses can also suffer from many immune-mediated skin diseases such as pemphigus and ‘sweet itch’ but these are relatively rare in comparison with allergic reactions otherwise known as urticaria or ‘hives’. Horses generally come up in fluid-filled circular lumps of variable sizes over quite large areas of their body and often the lumps disappear nearly as fast as they appeared. The cause often remains unknown but possible allergens include foods, drugs, infections, insect bites, vaccines, plants, heat and bedding. If the lumps do not disappear by themselves, or with the help of a cold hose and exercise, then the injection of corticosteroids intravenously will get rid of them. If the allergy persists then tests can be done to establish the specific allergen or allergens.

Horses’ skin does not escape disease caused by the big ‘c’ but fortunately by far the most common equine cancerous skin condition, the sarcoid, is usually fairly manageable. Sarcoids are rather strange skin growths that can occur in all ages, breeds and colours of horses and mainly affect the head and legs. There are several types of sarcoid and horses can be affected with one small nodular sarcoid on the inside of a back leg or can be covered from head to toe in horrendous verrucose sarcoids. Small sarcoids that are not growing in size in a place where they do not cause problems do not have to be treated but if treatment is necessary then options include a rubber ring or suture to kill the root of a nodular sarcoid, chemotherapy, radiation therapy, the injection of BCG, excisional surgery or Liverpool University’s sarcoid cream. Horses do get several other types of skin growths, most commonly melanomas in grey horses, which carry a variable prognosis, and warts in young horses, which drop off spontaneously after a period of weeks and thus are insignificant.

There are of course many, many more diseases that affect a racehorse’s skin but the majority of common ones have been mentioned above. Parasites such as mites and lice can also cause skin damage and must be treated if found. On the other hand, white plaques can often be found in a horse’s ears that cause no problems and do not need to be treated. Perhaps the main thing with skin diseases is that when abnormalities are seen, then the strength of the horse’s immune system must be questioned. If a racehorse develops ringworm and cracked heels, is it really a healthy horse who will win races? This season one particular skin abnormality has sparked much debate as to its cause and relevance – a ‘dirty’ face. If a horse that is having its face groomed twice daily develops a ‘dirty’/bald face, what causes this and is it a sign of ill health? The answers to these questions are unknown but what is certain is that if your horse develops a skin problem at Mark Johnston Racing, it will be treated free of charge as part of our all-inclusive training fees!

PRE-PURCHASE X-RAYS IN KENTUCKY

By James Tate BVMS MRCVS

Having just returned from the yearling sales in Kentucky, this month I am going to discuss the pre-purchase x-rays on show at Keeneland. MJR went to Keeneland Sales in Kentucky this year armed with a team consisting of Mark, my colleague Rogerio’s wife Claudia (who is also a vet), Elen Lawton (a vet student) and myself. Our work there consisted of examining 400 of the 800 horses in books one and two as well as their x-rays. Every yearling has a full set of at least 32 x-rays stored in what they call the ‘Repository’ (a fantastic word!).

Yearlings sold in Kentucky have been offered for sale with full x-rays for at least ten years now and indeed now most yearlings sold at the Goffs Million Sale, Tattersalls Book One and indeed Baden Baden Yearling Sale have a full set of x-rays available for viewing. At first, the tendency was to read quite a lot into every little change visible on these x-rays, however as time has gone on, the significance of changes seen on the x-rays of a sound horse with no swellings or soreness has come into question. Veterinary papers have been written on the significance and this year, the CBA published a layman’s guide to this for prospective purchasers at the sale. However, the availability of x-rays has a greater significance than just prognosis for soundness. Vendors quite understandably want their best yearlings to realise their full sale potential and hence their x-rays must be clean. As a result a huge number of the best yearlings at Keeneland have had key-hole surgery to ‘clean up’ their joints. Vendors start to x-ray their yearlings at the turn of the year, so that if any abnormality arises, America’s finest veterinary surgeons can make their x-ray films as beautiful as their pedigrees and bodies. Given that the significance of most x-ray ‘abnormalities’ is questionable to say the least, is this really the right thing to be doing?

Of the 400 x-rays viewed by MJR at Kentucky, a staggering 18.3% had certificates stating that they had received surgery on at least one joint. If you combine this with the fact that it is currently not mandatory to state that a yearling has had conformation-correcting surgery (usually periosteal strips or wires and screws to ‘straighten’ a horse’s leg as it grows), then it does make you start to wonder about the ethics of the situation. Also worthy of note is that, of the horses that had been operated on, no significant difference was seen in the prices that these yearlings realised. On average in the first four days of the Keeneland Sale the average was $161,667 and the median was $200,00. Of the 18.3% of the yearlings that had undergone arthroscopic surgery, the average was 3.5 times more and had a median of 20% more. In fact, even the sale topping Kingmambo colt, which was purchased for $11.7 million was amongst those that had received arthroscopic surgery.

However having said all of this, the American’s aren’t noted for doing things by halves, and the yearlings themselves are quite magnificent to look at. Those in book one and two are really quite stunning as well as having fantastic pedigrees. In reality, it is a rare case that such surgery could actually harm the yearling, however, what could be questioned is the necessity for the surgery. This amazing sale has consistently produced some of the best horses in the world, but did they really require surgery?

Nevertheless, the x-rays must be viewed. There are certain changes that are visible on a yearling’s pictures, especially if it correlates to a visible swelling on the animal, that should seriously affect its value. These include sesamoid fractures, large osteochondrosis dissecans lesions (OCD’s), and generally bony changes in certain areas that commonly cause problems in thoroughbred racehorses. Out of the 400 horses, 8 horses were considered to have major issues on x-rays (2%) and of these yearlings only four were sold (the others were either withdrawn or did not reach their reserve) and the price they attained was only approximately a third of the sale’s cumulative average.

In summary, the necessity for full sets of x-rays at yearling sales has to be questioned on several counts. Firstly, the significance of most changes are not fully known; secondly it leads to a high incidence of ‘unnecessary surgery’; and thirdly changes seen on x-rays that may have affected a horse’s value, once operated on, are then considered to be ‘cured’ and are bought as if they have never had a problem. There is quite a substantial list of high class horses that were ‘failed’ by the majority of American vets including Xtra Heat, Farda Amiga, Favourite Beat, Artie Schiller and Unbridled’s Song. However, given that yearling x-rays are here to stay, they must be read as avoiding major problems is a necessity. As always all purchases are at cost, and this service is free of charge for owners at Mark Johnston Racing.

ONE STEP AT A TIME

By James Tate BVMS MRCVS

Having introduced our new ultrasound scanner last month, it is now time to begin my series of clinical articles, and what better place to start than at the bottom, with the most common problem – the horse’s foot. As all of our owners will know, foot problems are extremely common in the horse, but fortunately in the main they are straightforward and relatively quickly cured.

The signs of a foot problem usually include a hot foot with an increased blood supply, diagnosable by palpating an increased arterial pulse to the foot as the blood vessels run down the back of the fetlock. Other aids include carefully applied pressure with hoof testers, x-rays, ultrasound and the use of local anaesthetic to numb the foot, thereby confirming whether or not the cause of lameness is indeed the foot.

Foot Structure

As with many injuries, there are several factors that make a problem more or less likely to occur and as always, prevention is better than cure. The horse is rather precariously balanced on one digit, the equivalent of our middle finger, and the hoof that we spend so much time addressing is, in fact, the equivalent of our finger nail. Thus, the conformation, trimming and shoeing of the horse’s foot needs to be just right. Each horse’s foot has individual needs, for example, retaining as much heel as possible, reducing the length of the toe, or trying to work at the inside-outside balance of the foot. On top of this, feet must be kept short, shoes must be nailed on well and carefully placed. Shoe selection is also vital – steel shoes are worn for regular work, lightweight aluminium plates are worn for racing and, in problem cases, a special shoe may be required such as a heart-bar or egg-bar shoe.

"Tubbing" a white line abscess

The most common problems that affect the racehorse include: shoeing-related lameness, foot bruises, white-line abscesses, hoof cracks and pedal bone fractures. Perhaps the most common and minor foot problem relates to shoeing. Racehorses are commonly shod at least once a month in steel shoes but are shod in lightweight aluminium plates for racing, which do not usually remain on for more than seven days. Hence a horse that is racing regularly is also being shod regularly. Even the most careful of blacksmiths will occasionally put a nail slightly too close to the sensitive white line and in trying to keep the feet nice and short, may take a foot back ever-so slightly too far. The result is a foot-sore horse who usually recovers very quickly from this minor setback, sometimes necessitating removal of the shoe, but not always.

Removal of a poultice - white-line abscess

Foot bruises can be very simple or quite complex depending on the individual foot. Some bruises relate to the horse standing on a stone, whereas others relate to poor foot conformation that predisposes the horse’s foot to bruising, usually at the heels. Treatment of a suspected bruise usually involves removal of the shoe, cold therapy such as swimming and iced ‘bubble-booting’, a padded foot dressing and occasionally painkiller/anti-inflammatory drugs in severe cases.

Quarter Crack

Quarter Crack with patch

A severely lame horse with a hot foot and a large pulse usually has a white-line abscess. One of the many anatomical ‘faults’ of the horse is the weak point on the bottom of the foot where the hoof wall meets the sole of the foot, the white-line. If dirt manages to penetrate this white-line and track up into the foot then an abscess may form. This is excruciatingly painful for the horse until the shoe is removed, the sore point located by hoof testers, and a hole is dug in the foot releasing the infection usually in the form of grey pus. This is incredibly satisfying both for the horse and the vet! This is then followed by tubbing the foot with warm Epsom salts to draw any infection out and poulticing the foot to fully open the tract and ensure the infection is drawn out as soon as possible so the horse can be shod and return to racing. Abscesses do vary both in severity and the length of time required for the horse to return to soundness.

Foot anatomy

The horse’s hoof wall can also form many cracks, for example, sand cracks, quarter cracks, and vertical cracks. If any crack becomes severe then it can cause a serious problem, but perhaps the most common crack in racehorses is the quarter crack, so- called as it occurs either on the outside, or more commonly on the inside quarter of the hoof wall. While a ‘hair-line’ crack on a well-trimmed foot may never cause a problem, cracks can easily get out of control causing pain and lameness to the horse, instability to the hoof, and perhaps most seriously it can damage the coronary band that produces new hoof and therefore the problem will never go away until the defect has grown out of the hoof, which even in the most well managed of cases may take months. Treatment entails careful trimming of the foot and occasionally a patch to prevent further opening of the crack.

x-ray diagnosing a pedal bone fracture

Finally, foot problems would not be complete without covering pedal bone fractures. Inside the hoof capsule, sits the ‘pedal’ bone along with a very small amount of the lower pastern bone and the joint between the two is known as the ‘coffin’ joint. Problems concerning the coffin joint are relatively unusual in young racehorses, however, fractures of the pedal bone are not. Such a fracture is usually sustained by a traumatic event such as the horse kicking a wall or galloping on an uneven surface but sometimes the cause is never known. There are some horses who do struggle to recover from these injuries, however, in most cases the hoof wall acts as a fantastic cast, stabilising the fracture and once the bone has fused back together, it is stronger than ever. An egg-bar shoe often aids healing especially while the horse is on box rest which usually lasts for a minimum of six weeks prior to starting walking exercise, although it can be longer, so I am afraid patience is essential.

This article has in no way covered every foot problem that your horse may encounter but I have tried to outline as many common problems as possible that we deal with on a day-to-day basis. I hope that the next time your horse has a foot injury, this article may at least help to illustrate the exact problem. I should also point out that when horses are on full fees, they do of course receive all veterinary treatment at no extra cost.

NEW ADDITION TO THE VETERINARY TEAM

By James Tate BVMS MRCVS

Since last month’s news, there has been an exciting new addition to the veterinary team at Kingsley House – the best ultrasound scanner in Yorkshire! The Sonosite Titan is a state-of-the-art no-compromise ‘laptop-sized’ scanner that combines excellent image quality with superb portability. From now on any horse in training with Mark Johnston Racing can be scanned whenever and wherever, for free, as part of our inclusive training fees.

Pelvic Fracture

Ultrasound scanners in racehorses are generally used for diagnosing pelvic fractures and tendon/ligament injuries, however, they can also be used in any number of situations. Our scanner will be used both to accurately diagnose injuries but also to monitor healing and thus get our horses back to training as fast as is safely possible. With a pelvic fracture, for example, the scanner commonly diagnoses a displaced fracture of the ilial wing. In the past many vets then perform a re-scan at approximately 6 weeks post-injury before deciding whether the horse should have anywhere between 6 and 12 weeks on box rest prior to beginning walking exercise. Now, with the use of a vastly superior scanner, we are able to re-scan our pelvic fractures as often as we wish and hence monitor callus formation and return our horses to walking exercise as fast as each individual case allows, which is often less than the 3 months box rest that used to be considered standard.

Healing Pelvic Fracture

The scanner will also be invaluable to us in our treatment of tendon or ligament injuries. Rather than stopping a horse or carrying on with a horse on the basis of a good or bad scan we will be able to monitor changes in a horse’s tendon or ligament on a daily basis and thus bring racehorse ultrasound scanning to a new level. To the best of our knowledge no other racehorse trainer can offer any comparable service.

Tendon Scan

The Titan will be operated by myself and Rogerio De Sousa, however, in this age of digital technology a second opinion is just a mouse-click away. Simon Stirk of Ripon and Greenwood and Ellis of Newmarket provide our referral service when unusual cases present themselves.

This is a wonderful new addition to our service that we are very excited to bring to our owners free of charge when horses are in-training.