Phone: (352) 237-6151

A Tradition of Leadership & Excellence in Equine Medicine

Ambulatory Service

th ambuexamThe Ambulatory Service has grown into the largest ambulatory fleet of veterinarians in the southeastern United States. It covers a 30-mile radius of Ocala (see map) and offers a 24-hour coverage. Since 1995 over 50,000 horses have been attended, making this a very large segment of services provided by Peterson & Smith. Services provided range from single patient management to large farm consultations. Each ambulatory clinician carries the necessary equipment to function efficiently and maintain a high quality of medical care. They are provided technical assistance so that they may concentrate their efforts on patient and client needs.

Additional services include:

Radiography

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

Endoscopy

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

Please find below an anatomic diagram for your reference:

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

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

Colic Evaluation

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

Laceration Repairs

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

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

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

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

Lameness Evaluations

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

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

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

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

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

Pre and Post Sales Purchase Examinations

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

Fetal Sexing

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

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

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

Ultrasound - Reproductive and Soft Tissue

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There are two types of extra corporeal shock wave therapy (ESWT):

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

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

Reproduction

Coming Soon.

Pharmacy

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

Dentistry

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

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

The ambulatory service is staffed with skilled clinicians, having extensive experience in equine reproduction and training horses; and highly trained technicians and administrative staff.

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