Richard Wheeler, DVM, was born in the U.K. and graduated from the Royal Veterinary College, London, in 2002. Dr. Wheeler then completed a two-year internship at Greenwood, Ellis and Partners (now Newmarket Equine Hospital) in Newmarket. In 2005, he moved to Wellington, Florida, to join Palm Beach Equine Clinic and he became a partner in 2009. Dr. Wheeler’s primary concentration is equine sports medicine. He is an FEI Veterinary Delegate for show jumping and dressage and has authored several published articles on the topic of equine sports medicine. Dr. Wheeler has served on the board of the USHJA Horse and Rider Advocates Committee. In 2016, Dr. Wheeler became a founding director of the Sport Horse Research Foundation. Dr. Wheeler and his wife, Jessica, have two children. Do you have a question you want Dr. Wheeler to answer? Send questions to editor@sidelinesnews.com.
My 7-year-old warmblood dressage horse recently became lame and was diagnosed with a subchondral bone cyst of the medial femoral condyle. What exactly is this, and what are some of the treatment options?
Before and after surgical treatment of subchondral bone cyst of the medial femoral condyle of a 7-year-old dressage horse using a transcondylar screw
Photo courtesy of Dr. Robert Brusie, DVM, DACVS, Palm Beach Equine Clinic
Subchondral bone cysts are lesions within bones adjacent to a joint. They’re often associated with lameness and can be difficult to treat. The medial femoral condyle is part of the stifle joint and is a common site for such lesions. In some cases, we believe that these are developmental, a failure of the bone to correctly develop. More recently, we have identified these lesions as a result of trauma to the bone, which causes inflammation within the bone leading to degeneration.
Many treatment options are available, such as conservative treatment with rest, injection of corticosteroid into the cyst, surgical debridement and, more recently, packing of the cyst with regenerative therapies such as bone marrow or stem cells. As in many cases where there are many treatment options, no single therapy has been shown to offer consistent favorable long-term results. Recently, the surgeons at Palm Beach Equine have used a technique described by Dr. Santschi and others in 2015. This surgical technique involves the placement of a screw across the cyst using radiographs as guidance. The idea is that this alters the biomechanical forces through the bone. We’ve seen very good results with this technique, and in time, we hope to see long-term positive results. In April, I performed a follow-up exam on a dressage horse that underwent this procedure in 2016 as a 7-year-old. She returned to training after a couple of months and is now showing successfully and is 100 percent sound.
As an adjunct to surgery, we often use regenerative therapies such as platelet rich plasma (PRP) and/or stem cells intra-articularly to help manage secondary arthritis and bisphosphonates for bone pain.
My horses really seem to hate fireworks and the Fourth of July is coming up. Do you have any suggestions to keep them less stressed?
There are several management and medical options. The specific plan will depend on your horse and farm. I’d discuss the plan in advance with your trainer and veterinarian. Researching local planned events will allow you to estimate the likely level of disruption in your area.
Deciding whether to leave the horse in a paddock or stall will depend on your horse and normal routine. Either way, make sure the environment is safe and secure. Earplugs can be used to reduce sound stimulus. I would suggest you try this well in advance to see how your horse responds. Similarly, closing windows may reduce visual stimulus, but it is important to keep the routine similar and not make drastic changes that evening. Building up to the night, you may try to leave lights on in the stable and play loud music.
Techniques to desensitize your horse may be useful in preparation; they should be managed under professional guidance and will take time and preparation.
A panicking horse is a dangerous situation and you must be very careful not to put yourself in a dangerous situation.
If you are close to a large planned display, it might be useful to move your horse to an area where fireworks are prohibited. We’re fortunate in Wellington that they’re not allowed in the equestrian areas.
As a last resort, your veterinarian may prescribe a sedative. I would suggest that this is tried prior to the event to assess how your horse responds.
My horses and I are moving to a new area that’s too far away from my current veterinarian. What should I be looking for in a new vet for my horses?
As with any professional relationship, a lot will depend on your personality and approach to horse care. Generally, I’d recommend you look for a practice with good horse experience. If you are competing with your horses, I recommend someone within the practice who has experience with your discipline.
As with most aspects of medicine, the equine veterinary world has become increasingly specialized. Many equine veterinarians will focus on one area of practice, such as lameness, surgery, internal medicine or reproduction. In some cases, they will have received further training in these areas.
At Palm Beach Equine Clinic, we try to provide our clients with a team approach. We’ll bring in veterinarians with specific interests and experience to help with specific cases. We also often work with veterinarians and equine professionals outside of the practice both on a referral and first opinion basis. I believe it’s good advice to find a vet who is a team player.
If your veterinarian is not part of a surgical practice, I recommend you plan where the horse will be sent in case of a surgical emergency. Such situations can be stressful and often not at convenient times; therefore forward planning is very useful.
