Videoendoscopic arthroscopic surgery is a minimally invasive surgical option to explore and correct abnormalities of joints and tendon sheaths. The same technique is commonly used in human knee surgeries, and greatly speeds recovery from surgery compared to traditional methods. Horses are anesthetized for this surgery. A small camera called an arthroscope is inserted into the joint space, and used to visualize all the joint surfaces and structures. Osteochondrosis lesions (OCD) can be treated by insertion of instruments through a second tiny incision (called a portal). Arthroscopy can also be used to remove infected tissue or traumatic bone chips from joints. The most commonly treated areas include knees (carpi), hocks, and stifles.
Acupuncture is offered at BEMC as a complementary treatment modality. Acupuncture can be useful for a variety of conditions in horses. Prescribed treatments are neuroanatomically based with emphasis on musculoskeletal conditions such as back pain, generalized body soreness/stiffness, lameness, saddle fit, the equine hoof, and equine gastrointestinal tract/colic. Acupuncture can help these conditions as well as others by increasing blood flow, relieving muscle tension and promoting relaxation. Electroacupuncture and massage techniques are often incorporated into treatments. While acupuncture is a very effective treatment for a wide variety of problems it is not a "cure-all" and is often integrated into a complete treatment plan that includes but is not limited to acupuncture alone. Appointments can be scheduled either at Bend Equine or at your barn.
Bone Marrow Derived Stem Cell Therapy
Stem cell therapy is a newly available treatment that uses your horse's own stem cells for treatment of musculoskeletal diseases. A sample of bone marrow is harvested from the sternum or pelvis of the horse and sent to a lab where the cells are expanded in number by culturing. These cells are then couriered back to the veterinary clinic. They are used to treat a variety of conditions, including tendonitis, desmitis (inflammation of a ligament), osteoarthritis, and OCD defects. Stem cells are injected directly into the site of the area that requires treatment, and develop into new cells of the desired tissue type to help in repair.
The field of Equine Dentistry is rapidly evolving, and the doctors at BEMC are committed to the ethical, professional, and diligent practice of this all-important aspect of your horse's health. We have a vast array of power and hand instruments that enable us to diagnose and treat any routine or abnormal dental condition. Our philosophy towards the practice of dentistry leans towards a "common-sense" approach, where aggressive floating and radical dental reconstruction are performed only when deemed necessary for the preservation of the teeth and the well being of the horse. We believe that a modicum of restraint is required when handling the motorized tools, and that the horse's comfort during the procedure be respected. The doctors and staff are committed to continuing education in the field of dentistry, and we are constantly upgrading our equipment and our practice of the craft. We now offer the following dental services: routine dental floating, correction of dental malocclusions (wave mouths, step mouth, etc.), tooth extraction, composite restorations, and treatment of apical tooth root infections.
BEMC has been instrumental in helping to establish guidelines and standards for the training and licensing of dental technicians, both at a state and national level.
Digital radiography is cutting edge technology that allows instant visualization of x-rays on a computer screen, and eliminates film. The difference between digital radiography and traditional radiography is analogous to the difference between digital photographs and film photographs. Results can be read instantly, and radiographs can also be manipulated to provide optimal contrast and brightness. Digital radiography also allows electronic storage of images; images can now be e-mailed to owners or other veterinarians, and stored on CD-ROMs. BEMC is equipped with three x-ray units. Our overhead unit is used for radiographing the cervical vertebrae (neck), abdomens, and thoraxes of adult horses. Myelograms can also be performed under general anesthesia to diagnose horses with cervical vertebral myelopathy ("wobblers"). Two portable units provide the capability for field radiography and high detail radiography of the limbs.
BEMC also offers interpretation of radiographs. Each year we review many radiographs sent to us from clients and veterinarians to help render surgical and medical opinions or to provide assistance in the management of ongoing cases. We understand the need for expediency. Referring veterinarians will receive a call or fax the same day the films are received unless for some reason, the consulting veterinarian is away from the office.
Internal medicine encompasses all things that do not involve surgery or orthopedic work. This leaves problems involving the lungs, heart, brain, spinal cord, intestinal tract, urinary tract (kidneys and bladder), internal organs (liver, pancreas and spleen), endocrine system, etc. These problems can include organ failure, infections, cancers, toxicities, metabolic problems such as Cushing's Disease and Metabolic Syndrome, and congenital problems. Some of the more common cases our internist sees are cases of severe pneumonia, liver disease, kidney disease, and neurological problems. Our neonatal intensive care unit falls under the umbrella of internal medicine as well.
IRAP therapy is a novel therapy that has recently been developed for treatment of inflamed or arthritic joints. IRAP is an abbreviation for Interleukin-1 Receptor Antagonist Protein therapy. The treatment consists of the injection of an autologous serum sample into a horses affected joint. The serum contains anti-inflammatory proteins that block the harmful effects of Interleukin-1, an inflammatory substance that has been shown to worsen osteoarthritis by causing destruction of cartilage.
The autologous serum is obtained from the horse itself by drawing blood into a special syringe with glass beads. The blood is incubated for 24 hours to amplify the levels of the IRAP and then centrifuged to separate the blood cells from the serum. The resulting autologous serum is then injected into the affected joint on a weekly to biweekly basis for a series of 3-4 treatments.
The treatment has been extremely safe and is an alternative to traditional joint injections with corticosteroids or "cortisone".
Lameness Locator by Equinosis
Bend Equine is excited to be the first practice in the Northwest to offer the Lameness Locator. The Lameness Locator, developed by Dr. Kevin Keegan of the University of Missouri, and made by Equinosis, consists of three wireless gyrometers (movement sensors) that attach to the horse's poll area, pelvis and right fore pastern, and a tablet computer with software that interprets the data sent by the sensors. It allows highly sensitive detection of movement abnormalities and subtle lameness in any leg, or in multiple legs at one time. It can be used in complex or subtle lameness cases, as part of a prepurchase exam, or to help judge the success of treatments such as nerve blocks and joint injections. It is much more sensitive than the human eye it records motion data 200x/second, so is an asset even for the very skilled sport horse veterinarian. A lameness report is generated and can be stored either electronically or in hard copy for future reference as well. More information is available at www.equinosis.com.
Lameness/Sports Medicine and Treatment
Lameness diagnosis and sports medicine is a highly specialized area of equine practice that requires significant expertise. Thorough physical exams, lameness exams (sometimes under saddle), and knowledge of current therapies and treatments are necessary. A combination of diagnostic joint and nerve blocks are often used to help pin down the injured or abnormal area in a horse exhibiting lameness or decreased performance. Lameness clinicians also must be experienced in the use and interpretation of radiography, ultrasound, and other diagnostic modalities. Once the cause of the lameness is diagnosed, treatments can include therapeutic joint and tendon sheath injections, shockwave, mesotherapy, arthroscopic surgery, laser hock arthrodesis, and many other options. Lameness examinations are best performed at BEMC, which allows full use of our equipment and facilities.
BEMCs technology includes two lasers, a Lumenis 25 watt carbon dioxide laser, and a Lumenis 50 watt diode surgical laser. Dr. Schmotzer is a graduate of the laser surgery training course taught by Dr. Kenneth Sullins from North Carolina State University. We offer laser surgery as an option for the surgical treatment of many routine surgical procedures as well as new procedures we were previously unable to perform. Advantages of laser surgery include remarkable hemorrhage control, shortened anesthesia times, elimination of general anesthesia in some cases, endoscopic surgical capability, and reduction in post-operative pain.
Laser surgery is particularly well-suited for removal of all cutaneous neoplasms (skin tumors), including sarcoids and melanomas. Coagulation and thermal necrosis of the tumor bed destroys cancer cells not visible to the eye and decreases the chance of reoccurrence.
Other indications of laser surery include ablation of uterine endometrial cysts, palmar digital neurectomy ("nerving"), epiglottic entrapment, certain types of arytenoid chondritis and ethmoid hematomas, vocal chordectomy for horses with laryngeal hemiplegia, and laser hock fusion/arthrodesis for horses with bone spavin of the hock. Laser hock arthrodesis is an exciting advancement for the treatment of chronic painful bone spavin that is gaining popularity across the country as a minimally painful and effective way to treat this common condition.
Mesotherapy has been well established in Europe for many years with excellent results. Recently, we have been using this therapy to help treat multiple conditions including neck and back pain. The minimally-invasive procedure inhibits nerves carrying pain from deep structures in the spinal segment by stimulating nerves from a more superficial structure--the skin. A mixture of injectable solutions, often including Traumeel, Sarapin, and a corticosteroid, is administered at the level of the lesion and the surrounding area. The technique involves multiple injections usings tiny needles that penetrate only the intradermal (most superficial) layer of skin. Each injections deposits a small amount of solution into the dermis. The number of treatments needed depends on the condition being treated, but most typically a course is one to three sessions. Substantial improvement is seen after 1-2 weeks and can last 3 months to 1 year.
Neonatal Intensive Care Unit
There is nothing more rewarding than bringing a healthy, active foal into this world. Fortunately, most foalings are uneventful and we are blessed with a beautiful new baby horse that just needs good basic health care. Some foalings, however, go terribly awry. The baby can be inadequately developed and unable to function outside the womb without supportive care. The mare can have foaling problems (dystocia) causing damage to the foal's body, brain, and internal organs. The mare can also not produce milk or can reject the foal. All these scenarios as well as innumerable other situations can be life threatening to the foal if it is not hospitalized for intensive care within hours after birth. Babies have no reserves, so timing is critical and quintessential to their survival. Always call your veterinarian if your foal does not seem right after birth. Waiting even a few hours can mean the difference between life and death.
At BEMC, we have established a full service neonatal foal intensive care unit. It is a heated and full padded foal stall. We have the ability to do complete supportive care including: controlled intravenous fluid care, indwelling stomach (parenteral nutrition), supportive bed care, urinary support, lung support ranging from oxygen insufflation to full ventilatory support, and complete internal medical treatments and diagnostics for all neonatal diseases. As you can see, these are very time and labor intensive cases. A critically ill foal needs to be tended at minimum hourly throughout the day and night. Some foals are so critical that they can never be left unattended.
Our goal is to provide the optimal care for your sick foal to give it the best opportunity for survival. This often requires a substantial emotional and financial commitment on the owner's behalf. We keep owners informed of their foal's prognosis and progress to ensure optimal care of your foal while tailoring therapy to individual and financial needs.
Dr. Schmotzer is experienced in the management of most ocular (eye) infections, immune-mediated, corneal and uveal diseases, glaucoma, and surgical conditions of the equine eye. BEMC is well-equipped with all necessary advanced ophthalmology equipment, which includes a Heine hand-held slit lamp biomicroscope, a Tonopen tonometer, direct and indirect ophthalmoscopy, and specialized ophthalmic surgical instruments. We also carry equine contact lenses for non-healing corneal ulcers.
In addition to medical treatment of ophthalmic disorders, our surgeons also perform many ophthalmic surgeries every year. For those uncommon cases where lens extraction is indicated or desired, we can invite a human or veterinary ophthalmologist to our facility to perform that procedure.
Platelet Rich Plasma
Platelet Rich Plasma (PRP) is a new therapy that can help heal and repair injured tendons and ligaments on a cellular level. PRP is a blood by-product produced by special centrifugation of the patients blood. Rich in growth factors, PRP is a natural, patient-derived product that is safe, effective, and one of the best ways to enhance tendon healing. The procedure to completed in the standing horse under sedation and a local nerve block. In most cases, a single PRP injection will aid in resolution of a tendon injury; the treatment can be repeated if necessary for severe or non-responsive injuries.
We offer consultation and advanced therapeutic shoeing with both glue on and traditional shoes to treat hoof and lower limb problems such as laminitis, quarter cracks, hoof imbalances, underrun heels, angular limb deformities, and other disorders.
BEMC offers a full range of reproductive services for both mares and stallions, from artificial insemination to semen freezing and embryo transfer.
Mares can either be brought to our facility for breeding, or we can perform ambulatory breeding services. We offer mare/foal care and boarding at a reduced rate. We are experienced in all types of breeding, from fresh semen to cooled and frozen semen. We also offer embryo transfer.
Our cooled semen program allows stallion owners to offer cooled, transported semen for their breeding operation. The doctors can collect semen from your stallion and ship it anywhere in North America. Our facility features a safe, enclosed breeding shed with a teasing wall, and breeding phantom for stallion collection and our staff is experienced at handling and training stallions.
An initial chilled semen test trial panel is recommended for stallions entering the program to determine the appropriate antibiotic to use in the semen extender and what cooling period best suits the stallion. Samples from one or two ejaculates are processed and cooled for 48 hours, checking longevity/motility at 12, 24, and 48 hours. Once the stallions semen longevity is known, our veterinarians can determine the best method of shipping the semen.
We also offer a semen freezing service for stallion owners that wish to store semen indefinitely or ship frozen semen internationally. Determination of suitability for freezing can be determined by testing semen by freezing and then thawing to determine motility. Frozen semen is stored in liquid nitrogen tanks at -196 C. Frozen semen can be stored at our facility for a monthly storage fee or shipped anywhere in the world.
In addition to normal reproductive services, we offer specialized treatments such as deep horn insemination, subfertile mare management, twin management, infertility workups and treatments for both mares and stallions, including laser removal of endometrial cysts.
Extracorporeal shock wave therapy, more commonly known as just shockwave, is a relatively new treatment modality that has shown efficacy in treating certain conditions. To date the most successful applications for shockwaves have been suspensory ligament desmitis, chronic muscle soreness (back pain) and fibrosis, and tendonitis, although it has also been used with good results for horses with chronic heel pain (navicular syndrome) and other tendon injuries. Shockwaves are high-energy sound waves, which are generated by compressed air. A hand piece is used to focus and transmit the waves. The waves travel through tissues via contact with the hand piece, affecting the soft tissue and bone structures in a targeted area. Shockwave is performed on a sedated, standing horse, and treatments usually take 20 minutes or less. Our unit is portable, so can be used on ambulatory calls as well as at the hospital. Shockwave is usually administered in a series, with several treatments at 2-3 week intervals. It is important to have a firm diagnosis prior to treating with shockwave, so a lameness workup is generally required prior to treatment.
BEMC offers advanced equine surgical services, including colic surgery, fracture repair, arthroscopy, distal check ligament desmotomy, palmar digital neurectomy, tibial neurectomy, cryptorchidectomy, ophthalmic surgery, sinus surgery, upper respiratory surgery, removal of cancerous growths, and many other procedures. Our surgery suite is equipped with a two ton hoist to safely move your anesthetized horse, a hydraulic lift table, padded recovery rooms, and an enormous variety of surgical instruments and equipment.
Abdominal surgery is most commonly performed to treat a surgical colic. This is an emergency, life-saving procedure in most cases, performed to treat displaced or twisted intestine, or severe impactions. Bend Equine Medical Center is one of only three institutions in Oregon to offer this advanced procedure. Our surgeons and technical staff are on call to provide this service. Colic surgery requires a well-coordinated team of 4-5 people, and round-the-clock monitoring for several days post-operatively.
We also perform a variety of other abdominal surgeries, including resection of infected umbilical stumps in foals, cryptorchidectomies to remove retained testicles, removal of bladder stones, etc. All surgical cases are monitored by a veterinarian or technician specially trained in equine anesthesia; blood pressure, heart rate, EKG, oxygenation, and other variables are closely monitored during surgical procedures.
Our clinicians use ultrasound extensively to diagnose abnormalities of tendons, ligaments and joints. Dr. Schmotzer and Dr. Krebs are graduates of specialized courses on equine ultrasound taught by world leaders in the field such as Dr. Jean Marie Denoix and Dr. Virginia Reef.
Our internal medicine specialist uses ultrasound to image the internal organs, including kidneys, liver, spleen, intestines, heart, uterus, and ovaries. Ultrasound allows us to look at different internal organs to examine their health, any underlying diseases, take ultrasound-guided diagnostic samples, and give prognostics on recovery of a sick or injured horse.
We have several different ultrasound machines. Each machine has a strength and special application. One machine, 2 mHz to 4 mHz, can image the heart, check for blood flow (color flow Doppler), and visualize internal organs. Two machines, 2mHz to 10 mHZ, are capable of imaging tendons, ligaments, joint structures, and many other areas of the body. The fourth machine, 4 mHz to 6 mHz, focuses on reproductive ultrasound to monitor estrus cycles, uterine/ovarian health, and early embryonic development. Please feel free to ask us about our ultrasound services. It is a wonderful diagnostic tool that is non-painful and non-invasive to the patient.
Video Gastroscopy and Endoscopy
Suspect problems from your horses throat to its airway to its lungs? Respiratory videoendoscopy is the answer. Endoscopy images your horses airways with a video camera. It allows us to identify problems, take diagnostic samples, take bacterial cultures, and perform specialty therapeutic procedures (e.g., antibiotic infusions, laser treatments, and other technical interventions). This procedure is essential in diagnosing the cause of chronic respiratory diseases and infections. Gastroscopy, video camera imaging of the stomach, is the only way to truly diagnose gastric ulcers and monitor therapy. The 2.5 meter gastroscope is also essential for diagnosing other types of stomach disease (tumors, infections, obstructions, etc) as well as esophageal diseases (recurrent choke, swallowing problems, tumors, ulcers, etc). Without endoscopy and diagnostic sampling, an owner may invest a lot of money in unnecessary, inappropriate, and ineffective treatments while delaying appropriate care of their horse. This can negatively impact your horses recovery. All forms of endoscopy are minimally invasive. Horses are generally lightly sedated, and do not mind the procedure at all. The information gained leads to directed therapy and definitive diagnosis of your horses problem which will give your animal the optimal medical or surgical outcome.