Starwood Equine believes in the use of both traditional and integrative medical approaches, and feels there is a place for both western and eastern medicine in our equine patients. The following article is intended to introduce you to the use of mesotherapy in the horse, and explain the science behind this treatment method. 

What does the mesotherapy treatment entail?

• Treatment entails multiple intradermal injections spaced approximately 1cm apart using a 27 gauge 4mm in length needle. A small amount of solution is injected at each site to stimulate the skin. Injection results in multiple small strategically placed bumps that will disappear within 24-48 hours following treatment.
• Treatment is often performed with saline, however a combination of medications such as a local anesthetic or a short acting corticosteroid may be used depending on your horse’s condition.
• Depending on the size and location of the region being treated, your horse may be sedated prior to the procedure. 

​How does it feel?

• The size of the needle is similar to that of an acupuncture needle.
• The intradermal sensation is synonymous to what is felt during a tuberculosis or skin allergy test, which is performed in the same manner. 

​Starwood Equine believes in the use of both traditional and integrative medical approaches, and feels there is a place for both western and eastern medicine in our equine patients. The following article is intended to introduce you to the use of acupuncture in the horse, and explain the science behind this therapeutic modality. 

Starwood Equine has a new tool for diagnosing infection and inflammation! The StableLab Test monitors levels of Serum Amyloid A, also known as SAA, which is a protein produced by the liver in response to inflammation. Running this simple 10-minute stall-side blood test for this biomarker protein enables Starwood doctors to have real time information regarding the severity of an infection. ​

Starwood Equine is excited to offer Pro-Stride Therapy, a drug-free advanced form of regenerative medicine for inflammatory joint treatment. In Equine Sports Medicine “regenerative medicine” is a term often used to reference clinical therapies that focus on utilizing the horse’s own body to promote self-healing. The Pro-Stride Therapy system accomplishes this self-healing by using the horse’s biological components (cells, platelets, plasma, etc.). 

​The procedure starts by taking a sample of the equine patient’s blood and processing the sample stall-side.  The processed Pro-Stride sample contains Platelet Rich Plasma (PRP) and Interleukin-1 Receptor Antagonist Protein (IRAP). PRP contains both the signals and the matrix proteins to “jump-start” the regeneration process. IRAP inhibits damaging inflammatory molecules in the joint.  In chronic injury such as osteoarthritis, healing becomes stuck in the initial inflammatory phase. Before healing can begin in earnest, the inflammatory signals must be silenced and replaced with signals which promote tissue regeneration. This is accomplished by using PRP and IRAP to work synergistically to promote joint healing. This concentrated solution is then injected into the affected joint. 

Benefits of Pro-Stride Therapy include:

• <20-minute blood processing
• Single visit/injection
• Clinically demonstrated to provide pain relief up to one year from a single treatment, with the potential for disease-modifying effects.*
• Natural (drug-free) therapy
• There are no drug withholding times for those competing at the FEI and USEF levels
• Excellent alternative for overweight or metabolically challenged patients to avoid steroid use. 

​Pro-Stride Injection will reduce pain associated with arthritis and deliver naturally occurring anti-inflammatory proteins. Pro-Stride Injection is capable of slowing cartilage degradation and improving mobility. This treatment has longer duration of efficacy when compared to traditional joint injections using steroids and hyaluronic acid.  It is also a great option for horses that initially respond to a steroid injection but have recurrence within just a few months.   Please contact Starwood Equine if you are interested in Pro-Stride Therapy for your horse.
 
*A. Bertone, Am J Vet Res 2014;75:141–1

Equine rehabilitation focuses on restoring or improving the health of horses. Executing a successful rehabilitation program requires a team effort with active participation from your veterinarian, trainer, rider, farrier, and barn manager. An accurate diagnosis is the most crucial step in designing a treatment plan tailored to your equine athlete's needs. Once the cause of an issue is identified a course of treatment can be created to address the problem whether it be an injury, misalignment, or lack of strength.

With a variety of treatment options now available for your equine athlete, it is important to make sure that the professionals you select to oversee your horse’s rehab program are well educated and correctly trained in the use of many therapy modalities. The University of Tennessee College of Veterinary Medicine offers the only university based program producing Certified Equine Rehabilitation Practitioners (CERP). The CERP program consists of a sequence of postgraduate courses designed to provide the participants with the necessary skills to design and implement comprehensive rehabilitation programs for commonly seen musculoskeletal, integumentary, and neurologic conditions in the horse. ​

The program achieves this by having veterinary professionals collaborate with physical therapy specialists to review equine anatomy, gait analysis, confirmation, lameness evaluation, and neurologic examination. Graduates of this course have received training for identifying which therapeutic modality is most appropriate for certain circumstances and hands on training for the best method of application, including: 

​Glaucomas refer to a group of ocular diseases that result from alterations in the formation and drainage of the aqueous humor, which is the fluid that is located in the space in front of the iris and lens. One of the most notable results is increased intraocular pressure. The pressure increases due to a decrease in the natural outflow of the aqueous humor. This fluid is not only important for providing nutrition to the cornea and lens, but is also critical for the optimal arrangement of the eye. The optic disk, which is located in the back of the eye, is the connection between the eye and the brain, and therefore can be damaged when the pressure within the eye remains elevated for prolonged periods of time. This can result in blindness.

Equine glaucoma can be divided into three categories, including primary, secondary, and congenital types.

1. Primary glaucoma is generally associated with biochemical alterations of the internal structure of the eye. The changes in this category may not be visible.
2. Secondary glaucoma, also common in horses, has several identifiable characteristics such as uveitis, iris and ciliary body tumors, and lens dislocation. In these cases the aqueous humor drainage pathways commonly get clogged with inflammatory debris, tumor cells, or lens material, causing increase pressure.
3. Congenital glaucoma, which is mostly reported in foals, can be associated with developmental abnormalities. 

​In general, most cases of glaucoma are seen in horses with recurrent uveitis, which is inflammation of the uvea (the middle layer of the eye between the retina and the whites of the eye). Horses older than 15, and Appaloosas have higher prevalence of uveitis. Recognition of subtle clinical signs help to catch glaucoma in early stages. 
 
Clinical Signs:
- enlarged globe
- cloudiness of the cornea
- small white streaks within the cornea (stria)
- vision deficit, small pupils, corneal edema
- squinting of the eye
- increased discharge
- increased redness around the margins of the globe.
 
A great aid in diagnosing glaucoma is through the use of an instrument called a tonometer. This tool helps to measure intraocular pressure of the eye. Normal intraocular pressure is between 17 and 28 mmHg. An increased intraocular pressure is defined as glaucoma. Starwood Equine is proud to provide our clients with access to earlier diagnosis and treatment with the use of this instrument. 

​Treatment of glaucoma can vary based on the primary cause of the disease and the horse’s level of vision. The goal of treatment is centered around increasing the flow of fluid within the eye. There are several medical options for treatment, including Timolol and Dorzulamide, and non-steroidal anti-inflammatory drugs such as Banamine. If medical avenues do not solve the problem, there are other options such as cyclophotoablation; a procedure in which a laser is used to destroy the ciliary body, which is the structure in the eye that produces fluid.

Healthy Joints are critical to achieving maximum performance in our equine athlete partners. Healthy joints are made up of articular cartilage and joint fluid. Cartilage helps the bones move smoothly against one another. Joint fluid, a viscous fluid made up of hyaluronic acid and proteins, aids in shock absorption.
 
Joints can become damaged through trauma or degenerative joint diseases, such as osteoarthritis, trauma, or repetitive motions that create inflammation. The effect of these processes is a net loss of cartilage and viscosity of the joint fluid. The joint fluid loses hyaluronic acid which decreases its viscosity and ability to absorb concussion. These changes can cause pain as bones rub together without the cushioning. The discomfort caused by decreased joint health can present many different ways. Some examples include stiffness, lameness, positive flexion test, resistance to extending legs fully in work, hesitance to jump, or a reaction to landing from a jump.

​Current proactive treatments include:

1. Adequan is a commonly used treatment for joint support. Adequan is a polysulfated glycosaminoglycan commonly abbreviated PSGAG. This is chemically similar to the substances found in cartilage. Adequan improves joint function in two ways. It increases hyaluronic acid concentration in joint fluid and inhibits proteolytic enzymes that break down cartilage and joint fluid. Adequan has the benefit of decreasing inflammation in the synovial membrane that surrounds each joint which can decrease pain.
 
It is recommended that an Adequan series of seven injections be given in the muscle twice a year. Studies have shown that Adequan reaches joints within two hours of injection. In forty-eight hours post injection, Adequan causes increased levels of  hyaluronic acid in joint spaces. Within ninety-six hours Adequan can be found in joint cartilage.
 
2. Legend is another treatment for joint support that is frequently prescribed. Legend is hyaluronate sodium, commonly known as hyaluronic acid. The hyaluronate molecules are long chains that form a network with existing joint fluid. This helps restore the lubricating effect of joint fluid and eases the pain. It causes change within days of being injected. Legend is a great choice for extra joint support before a show.
 
3. Pentosan is a compounded drug that has anti-inflammatory properties. A dose is given in the muscle once weekly for four weeks, then once a month. It is currently not sold in the United States and therefore must be compounded by a pharmacy. It is not regulated by the FDA at this time. Starwood veterinarians recommend the use of FDA approved medications whenever possible.
 
These medication can be used as both a preventative measure and to slow the progression of osteoarthritis once it has begun. We encourage you to schedule an exam so that Starwood veterinarians can discuss a proactive approach to protecting your horse’s joints. ​

​This year marks the 100th anniversary since Einstein first proposed the concept of the laser in 1917. Now, 100 years later, Starwood Equine is able to offer therapeutic laser therapy to our clients. Laser therapy is a scientifically proven, FDA-approved tool used to reduce pain and inflammation. It also promotes faster healing for a variety of conditions from superficial wounds, infections, and other acute conditions, to more chronic soft tissue and musculoskeletal diseases.