A frequent presenting complaint for pleasure and sport horses in our geographical area is a recurrent cough. The causes of the cough can vary; one of them is the so-called recurrent airway obstruction, allergic in its nature. Untreated mild to chronic symptoms may have negative consequences on the horse's performance. The proper diagnosis of the disease as well as prompt initiation of therapy is extremely important for the wellbeing of the horse.

The video shows the endoscopic picture of a recurrent airway obstruction with significant accumulation of secretions in the bronchial tree. The horse was successfully treated in our clinic with a ten days prevent further development of the disease.


Endoscopic picture of a recurrent airway obstruction case before treatment

TRANSENDOSCOPIC SURGERY OF THE UPPER AIRWAY

Endoscopy is not only a diagnostic tool, it can also be used to guide minimally invasive surgical procedures.
This video for example shows a transendoscopic removal of a subepiglottic cyst using a diode laser. The horse presented with dysphagia and cough that resolved after surgical treatment.


Laser removal of a subepiglottic cyst

The Aquillion device from Toshiba has been strengthening the diagnostic capabilities of our clinic and offers our equine patients an examination at the highest level.

It is a 32-rower, this is considered the "gold standard" in veterinary medicine. Due to its large opening (gantry), the horses’ head and neck can be examined standing, and the distal limbs under general anesthesia, in less than 30 seconds.

Computed tomography (CT) is an multi-dimensional X-ray examination. The generated slice images (0.5 mm thick) provide a detailed 3D view of the affected region of the horse's body.

A computed tomography is enormously helpful when it comes to the exact localization of pathological changes and thus to the best planning of the surgical procedure. This is needed, for example, in dental problems, especially involving the paranasal sinuses, or in numerous orthopedic problems such as bone cysts, fissures, and mostly complex fractures. In addition, soft tissues (tendon and ligaments) can also be imaged and highlighted with special contrast techniques. Using contrast techniques it is also possible to image for the first time articular cartilage surfaces and its defects.

This advanced examination method completes our diagnostic range of X-ray, ultrasound, endoscopy, scintigraphy, which, as you know, are always state-of-the-art, to optimally assist you and your horse.

In order to keep the quality of the results at the highest level, a so-called 4-eye principle is routine for us. By teleradiology, the results of the investigation are evaluated not only by our specialist, but also by highly specialized national colleagues.

Some upper airway conditions are dynamic, which means that are only visible during exercise. Even a few minutes delay between riding or lunging and a static endoscopy can cause a negative diagnosis.

The dynamic endoscope allows us to examine the upper airway during excercise, and the same circumstances than make the problem noticeable to you can be exactly reproduced during the examination..

Does your horse make airway sounds under stress but show no symptoms at rest? Is the performance capability of your horse clearly reduced?

This non-invasive procedure offers a clear diagnosis and the answer to how functionality can be restored.

Our associate veterinarian Dr. Simone Belenski has successfully completed her advanced training in chiropractic at the IAVC (International Academy of Veterinary Chiropractic)

If your horse presents any of the following symptom, he or she may need a veterinary chiropractic exam:

• in case of a persistent stiffness and resistance to rider's aids;
• in case of different forms of lameness, if necessary after clarification by the veterinarian;
• on a horse that is reluctant to lift the legs;
• in the case of unilateral head stiffness and / or tail retention at rest and at work;
• stiffness of the neck;
• after an abortion;
• after falling or getting casted;
• in the case of unexplainable refusals of the obstacle;
• with timing errors in the different gaits;
• in case of signs of pain with movement;
• in any case, as soon as possible after onset of the disease, if there are changes in the movement.
  

Recent problems are easier and faster to treat than old and chronic ones.

Contraindications may include:

• administration of pain killers
• acute bleeding
• fractures

After clarification by the treating veterinarian, the horse can nevertheless benefit from an ancillary chiropractic treatment in the following cases:

• horses with suspected arthrotic changes
• Kissing spines
• Some tumors

To get a deeper insight into the type and scope of treatment, please follow the link at the bottom of the page.
Please use the respective e-mail contacts for appointments and other queries. We will be happy to write you back or call you if you want to contact us.


Please note:

• We need a surface which is as even as possible, with a firm footing, big enough to allow moving the horse in a small circle
• The place of the examination should be quiet, the horse should be familiar with it and there shouldn’t be clutter or equipment that can be dangerous to the horse, therapist or holder. A non-slip floor and not too tight space are necessary.
• We are happy to find a clean and dry horse with picked hooves.
• Please complete your medical history before the appointment, send it by e-mail and bring it to the appointment. It is used for preparation for the treatment and, if necessary, for the follow-up.

The newest scientific research shows that irritation of the gastric mucosa as well as gastric ulcers account for approximately 70-80% of the performance-limiting diseases in high performance horses. The clinical symptoms are highly variable and include but are not limited to weight loss despite normal blood parameters or regular deworming, poor condition, recurrent colic, or poor performance. The exact diagnostic is made only with gastroscopy and it is crucial for the comprehensive therapy of these diseases.

The video shows a horse with clear changes to the gastric mucosa (gastric ulcer). After 28 days of treatment with Omeprazole, the symptoms as well as the clinical picture had clearly improved.


Gastric ulcer

As one of the first veterinary clinics in Europe, we offer our patients an alternative to treatment of joint diseases with hyaluronic acid and corticosteroids. This has been very successful in human medicine. This is comprised of IRAP (Interleukin-1 receptor antagonist protein processing system) or ACS (autologous conditioned serum). These forms of therapy were developed by the German company ORTHOGEN and ARTHREX in America. In human medicine ACS is used for osteoarthritis, muscular diseases, and nerve root diseases (i.e. areas of back pain).

Studies at the University of Colorado, USA, supported by clinical experiences in diverse hospital settings, have documented higher success rates using these new forms of therapy in sport horses than with traditional therapies. The first step of IRAP and ACS therapy is sterile obtainment of the patients’ blood. The blood is prepared using the highest hygienic precautionary measures into special syringes and incubated for 24 hours. Following the production of the ACS or IRAP, the products are filtered, pulled up into single dose syringes and frozen. The frozen products can be stored up to 9 months.

In the special IRAP syringes, one will find chromium-coated beads which stimulate the surface of the cells. Once contact is established, blood cells begin in turn to produce protein which has the ability to bind to the interleukin 1 receptor without activating it (antagonist effect). The result is that the action of interleukin-1, one of the major inflammatory citokines in the joint, is blocked, and the clinical effect is a potent anti-inflammatory and chondroprotective action.

Each patient has their own specific products prepared and frozen. Each patient will be treated with 3-5 joint injections distanced over 14-21 days. Left over injections can be frozen up to 9 months.

PRP
PRP (platelet rich plasma) is a method of regenerative medicine. The production of PRP is done through special procedure which is comprised of concentrated platelets rich in growth factors. The growth factors released by the platelets induce a better regeneration of damaged tendons and ligaments. To obtain PRP, blood is taken from the patient and then subsequently prepared in different stages of centrifugation. The prepared serum fraction, rich in growth factors-containing platelets, is to be immediately injected into damaged tendons and ligaments under ultrasound guidance. The preparation takes less than an hour, so the horse can be treated shortly after blood withdrawal. The product cannot be stored for later use.

Through scintigraphy the horse would be intravenously injected with a radioactive drug substance (Technetium diphosphate bound). This compound accumulates itself within 3 hours in bone. In areas of inflammatory processes, it is enriched significantly stronger than areas of non-inflamed bone. With the help of a Gamma-Camera the entire skeletal system and ligaments can be examined for inflammatory processes. In contrast to radiography, the signs of bony remodeling can be seen at an early stage. Furthermore it allows areas which are otherwise diagnostically inaccessible such as the pelvis (Iliosacral joint) or the vertebral bodies with small articular processes to be captured.

In our scintigraphy station, we have the newest generation Detector Camera from the company MiE. The image processing system is attached. If your horse would need a scintigraphy, please arrive at 9 am on the day of the procedure. It would be then be prepared for the procedure and injected with the radioactive substance. The procedure itself lasts approximately 3 hours and is done under standing sedation. General anesthesia is not necessary for this diagnostic procedure. Due to radiation safety standards, afterwards the horse must stay in a special stall for 48 hours.

DO YOU REALLY KNOW ABOUT COLIC SURGERY?

You have found your horse laying down and looking at his belly. Then he started getting up and down, pawing and looking visibly uncomfortable. You have called your veterinarian immediately and in the meantime you have walked your horse for an hour. Your veterinarian has examined the horse and sent him immediately to the clinic, and here you are, it’s midnight, it’s cold outside, you are exhausted and sleep deprived and on top of all of that, you need to decide if your horse can go for colic surgery.

We understand that nobody want to be in this situation!
Our team at Pferdeklinik Großwallstadt is prepared to guide you through this difficult process, and believe us, we do this every day. Sometimes multiple times a day. What for you is exceptional and emotionally challenging, for us is a daily routine. So you can trust us and we are here for you. We want you to have all the tools to make an INFORMED DECISION when it comes to your horse’s health, based on the LATEST SCIENTIFIC EVIDENCE and on the work of dozens of colic surgeons around the whole world. We want to present you with facts, and destroy the pony club myths.

Fact 1

Colic is a syndrome, not a disease. In fact, colic only means “abdominal pain”. Causes of colic can be diverse and span from gas and spasm in the large intestine, an impaction of the large colon, cecum or small colon, a displacement of the large colon, a torsion of the large colon, an impaction of the small intestine, a strangulation of the small intestine, or even gastric ulcers, among others.

Fact 2

The home veterinarian needs to be called as fast as possible. The first line of colic exam and treatment is normally done by your veterinarian at home. That is very important and can be LIFESAVING. What he or she will do is to do a full physical exam, perform a nasogastric intubation, a rectal exam and give the drugs that he or she thinks are appropriate to make your horse feel better. Also he or she will know, thanks to his/her diagnostics and clinical experience, whether or not your horse needs to be referred to a facility where further diagnostic, intensive care and surgery can be performed. NO VETERINARIAN, NO MATTER HOW PREPARED OR HOW GOOD HE OR SHE IS, CAN MAKE A DIAGNOSIS 100% OF THE TIME. Rectal exams allow us to palpate at most 30% of the abdominal structures and the problem may not be within reach.

Fact 3

COLICS ARE TRUE EMERGENCIES and the picture can change very quickly. Therefore WE WILL REPEAT the diagnostics once your horse is here in the clinic. Also, we will perform an abdominal ultrasound and sometimes an abdominocentesis to evaluate how severe the inflammation of the intestine is.

Fact 4

Colic surgery is both diagnostic and therapeutic. In fact, the proper name is “EXPLORATORY LAPAROTOMY”. We will try to gather as much information as we can in a noninvasive manner, however sometimes the findings are not definitive. In such cases, if your horse keeps having pain despite the medications, taking him to surgery will allow us to make a proper diagnosis and direct the treatment accordingly, BEFORE THE SITUATION WORSENS.

Myth 1 

“All horses that undergo colic surgery are in such bad conditions that they die”. Absolutely false! As we already said, colic can mean a million different things and it is the severity of the primary disease that dictates the survival rate, not the fact that the horse goes to surgery. In fact, fast surgical intervention IMPROVES THE CHANCES OF SURVIVAL compared to delayed intervention.

Myth 2

“My horse will never be the same”. Absolutely false! Horses that undergo colic surgery can proceed to having a COMPLETELY NORMAL LIFE, ALSO AS ATHLETES. Two recent American studies proved that over 70% of racehorses returned to the same level of performance and earnings after colic surgery. The recovery time after an uncomplicated colic surgery is three months.
• Tomlinson JE, Boston RC, Brauer T. Evaluation of racing performance after colic surgery in Thoroughbreds: 85 cases (1996-2010). J Am Vet Med Assoc. 2013; 243: 532-7. 
• Hart SK, Southwood LL, Aceto HW. Impact of colic surgery on return to function in racing Thoroughbreds: 59 cases (1996–2009) J Am Vet Med Assoc. 2014; 244:205-211. 

Myth 3

“My horse is too old for colic surgery”. Absolutely false! Age is not a disease- not in horses anyhow! For the majority of the conditions operated on, including resection and anastomosis, the survival of geriatric horses is no different than for their younger counterparts.
• Southwood LL, Gassert T, Lindborg S. Colic in geriatric compared to mature nongeriatric horses. Part 2: Treatment, diagnosis and short-term survival. Equine Vet J. 2010; 42: 628-35. 

Myth 4

“Horses don’t recover fully after resection and anastomosis of the small intestine”. Absolutely false! Colic surgery has made huge progresses in the past 10 years and we know a lot more about it than we used to 15 years ago. That has resulted in a tremendous improvement of the prognosis also for small intestinal resections, historically associated with a bad prognosis. We can confidently say that survival to discharge is higher than 90% for strangulating lesions and long term survival (6 years after discharge) ranges between 70 and 80%. 
• Freeman DE, Schaeffer DJ. Clinical comparison between a continuous Lembert pattern wrapped in a carboxymethylcellulose and hyaluronate membrane with an interrupted Lembert pattern for one-layer jejunojejunostomy in horses. Equine vet. J. 2011; 43: 708-713.
Seeing your own horse having colic can make you feel powerless and can be an emotional rollercoaster. WE ARE HERE FOR YOU! We bring years of specialized training and we have thousands of cases under our belts. Your horse will have the best chances of a successful outcome.

In the past few years, minimally invasive surgery has been used increasingly for joint and synovial structures. Diagnostics, therapy, and length of rehabilitation are all considerably improved or shortened.

Arthroscopy

The first video shows a 3 year old thoroughbred colt with a lesion in the medial condyle of the femur. The change seen arthroscopically is a depression of the cartilage with a small subchondral cysts. The cyst was debrided and injected and the loose cartilage around it was debrided. The prognosis for a further racing career despite the operative procedure is guarded to good.


Osteochondrosis in the stifle, treatment of a 3 year old Thoroughbred horse

The second video shows a 14 year old Warmblood horse with chronic recurring lameness. During the arthroscopy a lesion in the medial meniscus was diagnosed and debrided.


Arthroscopy of a meniscal injury

Laparoscopy

In the last few years minimally invasive abdominal surgery (laparoscopy) has become more popular for certain diagnostic and surgical procedures such as liver and spleen biopsy, ovariectomy, as well as cryptorchid (retained testicle in the abdominal cavity) operations. Laparoscopy is very effective in performing these procedures. The stress of the operation as well as the rehabilitation time can be significantly shortened.


Laparoscopy of a retained testicle (Cryptorchid)

Here is an example of a minimally invasive procedure on a 4 year old Quarterhorse with testicles located within the abdomen.

Fractures are not very common in horses, nevertheless they do occur and they can be fatal.

Here at Pferdeklinik Großwallstadt we offer state of the art techniques for first aid, diagnostics and treatment of these challenging cases. Our practice is equipped with traditional dynamic compression plates and screws as well as witch locking technology, which, along with the expertise of our surgeons, will offer your horse the best chance for recovery. From more routine cases such as pastern arthrodesis, condylar fractures and olecranon fracture to the more complex long bone fractures, we will give you and your horse a diagnosis, a prognosis and a plan according the latest scientific knowledge in this specialized matter.

We know these cases are also an emotional challenge for everyone involved, and we are here to assist you in every way.

Targeted strengthening & optimal build-up

Our newly opened sports and rehabilitation center offers your horse an Aquatrainer (water treadmill), thermium and solarium in order to provide targeted strengthening and an optimal build-up of muscles, tendons, joints and ligaments.

On the other hand, we provide horses with a tailored personalized training program during the convalescence phase after injuries and operations.

Each horse will - in consultation with your veterinarian - receive a training program tailored to his or her needs; our experienced team of veterinarians is taking care of the well-being of your horse. Furthermore, we offer osteopathic and chiropractic treatments through trained specialised veterinarians of our team.

In addition to an in-patient stay, there is of course the possibility to use our sports and rehabilitation center on an outpatient basis.

Further information and information about our pricing can be obtained by calling the main number of the Pferdeklinik Großwallstadt during business hours.
Please make appointments through the Pferdeklinik Großwallstadt.

Our sport and rehabilitation center (headed by Dr. med. Vet. Kerstin Fischer) is located about 200 m from the actual clinic area on the well-known western resort Jomm Ranches.
(www.jomm-ranches.de, Astrid and Johannes Orgeldinger)

Stem cell therapy is the gold standard of all regenerative medicine. It is used in the most advanced sports medicine and surgery institutions across the globe, and we pride ourselves of offering you and your horse this option for treatment of tendonitis, desmopathy, and arthropathies by transferring stem cells into lesioned or diseased tissue.

Since the beginning of August 2008, we offer, in conjunction with the 2F-Stemcells GmbH, the most reliable technology for collection and culture of stem cells. We collect bone marrow from your horse’s sternum with a minimally invasive, very well tolerated technique that is performed under light sedation and local anesthesia.

• After a specialized and delicate laboratory preparation, lasting about 3 weeks time, your horse’s autologous stem cells are ready to be injected into the target structure.
• Ligaments, tendons, menisci, joints and tendon sheaths can be treated with stem cells.

Stem cell therapy improves significantly the quality of the healing in terms of regeneration of tissue as similar as possible to the original.

The goal of all dental treatments is to further balance the horse’s bite. A completely balanced bite is crucial to obtain good equestrian work.

We are well aware of the importance of a balanced bite; we founded the EquiProDenta GmbH with the Pferdeklinik Großwallstadt to guarantee an excellent service for anything that concerns the horse’s teeth, mouth and maxillofacial system.

The dental treatments are performed in accordance with the guidelines of IGFP (Internationale Gesellschaft zur Funktionsverbesserung).www.igfp.eu

Traditional correction of teeth is done under standing sedation as well as the vast majority of surgical procedures.