Morgan Equine Veterinary & Farrier Hospital

Our practice is limited to equine veterinary and farrier services for performance horses. You will find descriptions of procedures and information to help you decide what services are right for your horse.  We have included some things to expect during an appointment as well as a helpful hints to prepare you for the visit.

You can either scroll down the page to find the following topics. As always if you have additional questions that are not answered here, please email Dr. Morgan directly.

Lameness evaluations are the focus of our practice and hospital. Dr. Morgan has a very specific methodology for evaluating soundness.

Once you arrive with your horse, you should check in before unloading. If it is raining, be sure your horse has a sheet on before it gets out of the trailer. We need their rump to be dry, if not, we blow dry a small area.

She begins by evaluating the horse in motion. The horse is fitted with the Lameness Locator (see below) and walked and/or trotted in a straight-line on a firm surface in-hand. She will be looking for asymmetry in gait and accessing neurological status. The horse will then be lunged on a firm or soft surface to the left and right at a trot and possibly a canter. Each horse is video taped and cataloged for future reference.

The horse will come back into the hospital for a physical examination. Systematic palpation of muscles, joints, tendons and ligaments starting at the head on the left side, moving around the body and limbs to end upon the right side at the head again.

Dr. Morgan discusses all physical findings, both static and dynamic, and assigns importance to them. She typically waits to hear about the history of the horse until this point so she can evaluate the horse with out any preconceived notions.

A diagnostic plan that fits into the goal and budget of the visit is discussed. It takes about an hour to complete the initial evaluation. The following is a list of items that may help you prepare for a lameness evaluation.

• Do not pre-medicate the horse with anti-inflammatory agents such as (but not limited to) banamine, bute, equioxx or isoxsuprine. They should be off all medication of this type for 12 to 24 hours if possible. They should remain on their special medications such as respiratory meds, thyroid meds, hormonal treatments,  antibiotics, etc. If you have a question about medications, please email Dr. Morgan.  
• Bring with you or have emailed radiographs or ultrasounds from other Veterinarians especially if they have been taken with in the last year. Anything older than one or two years may not be pertinent. 
• Do not have shoes removed specifically for the appointment. If the horse is due to be shod, you may want to wait, if it will be more than a week before the appointment you should probably keep his regular shoeing appointment and get him shod before the appointment.
  
• People shoes. Who ever is going to be jogging the horse should wear appropriate footwear. Everyone learns this one by the second visit! LOL.
  
• If you are experiencing the lameness issue while only under tack, please bring your riding clothes, a helmet and appropriate footwear along with your tack. You may be asked to ride your horse.
• A snack. Although we have water and tea available with small snack items, if you are coming for the first time with a new horse that needs a full lameness evaluation, it can get to be a long day.
• If you have a late fall, winter or early spring appointment, dress with layers. We keep the examination room and stable at about 50 to 55 degrees for the horses comfort. The conference room and offices are heated to human comfort, but the action usually happens in the examination areas.
  

The Lameness Locator by Equinosis is a state of the art, well researched wireless technology that provides objective data about how the horse is moving. Three small sensors are worn by the horse. One on the head to measure front limb lameness, one on the top of the pelvis to evaluate hind limb lameness and a sensor on the right front limb to tell the computer where to apply the data. 

Almost every horse that has a lameness evaluation, diagnostic work up or progress evaluation at Morgan Equine will also have Lameness Locator data collected.  It has allowed us evaluate lameness objectively. There is no more guessing. He is either better or he is not in most cases. Besides getting correct information, one of the biggest benefits is that we have seen a reduction in time and cost to the client in diagnostic procedures as well as fewer procedures for the horse to endure.

For more in depth information visit the Lameness Locator website at www.equinosis.com

Here is what clients say about the Lameness Locator:

Thank you Dr. Morgan for offering such a state of art piece of equipment that can make us better care takers/manager to our equine family. We have used the Lameness Locator for monitoring existing issues, relieving my questions about a possible issue, as a base line to compare the beginning and end of the season, and most recently a pre-purchase exam.
It allows owners to have clear cut data which Dr. Morgan explains in a way that is easy to understand. You can have confidence and peace of mind knowing that you are treating the correct area on your horse for the correct aliment.  It’s better management for your equine, not to mention to have this technology at such an affordable price you just can’t get any better! I recommend it to everyone, no question!  Sincerely, Alice Reed

Dr. Morgan has shown me a completely different way of accessing lameness.  A COMPLETELY DIFFERENT METHOD!!  Though some of the exams appeared the same, the way the exams were done and how they were evaluated was very different.
 In my horses initial evaluation, lameness was recognized by observation and the degree of lameness was determined using the Lameness Locator by Equinosis.  For the first time we had an objective numerical diagnosis of the degree of my horses lameness and where the lameness was.  With this OBJECTIVE numerical information Dr. Morgan accurately evaluated the response to specific nerve blocking.  She was able to PROVE with the Lameness Locator and ultra sound that my horse had a second injury area that was causing pain.
I now know, that we can know, if lameness is improving.  I can never go back to 'she looks a little better this week' or not.   I will never accept that type of evaluation again.  Thanks for being an advocate for my horse. With very warm appreciation and respect, Martha Barton

If you want quality radiographs, digital is the only way to go!

The coolest part for clients is that images are taken, viewed and interpreted immediately during the visit. You will know what is happening with your horse before you leave, and yes, we write it all down. Depending on the nature of the horse; sedation may or may not be necessary to take diagnostic quality images.

Dr. Morgan will evaluate the radiographs and explain any unusual findings and their significance. Usually, after radiographs are evaluated there are two possibilities. Either more information will be necessary to come to a conclusion or a therapeutic plan can start  to be developed.

It is easy to share images with other Veterinarians using our digital system. If you would like your horse's images sent to another Veterinarian, bring their email address and we will forward images to them for review.

Dr. Morgan gets very excited about musculoskeletal ultrasongraphy! It's one of her favorite subjects to talk about, to do, to teach, to research. Under the guidance of Dr. Jean-Marie Denoix and the International Society of Locomotor Pathology  she has learned how to effectively evaluate every joint, tendon and ligament in the horse from the neck, back and pelvis to the entire front and hind limb with an ultrasound.

Once a focal area of concern has been established, the horse may need to be clipped to be evaluated. Hair does not make a good acoustic window. The quality of the scan may be compromised if not clipped. In the summertime in some areas on the body this may not be necessary. The skin is prepared with warm water and acoustic ultrasound gel. The appropriate probe (big, little, deep or shallow) used to evaluate the area.

We use a GE Logic 7 ultrasound machine. Because it is not portable horses must come to the hospital for evaluation. Although there have been many requests, reproductive work is not with in our repertoire, sorry.  Initial ultrasound evaluations may take an hour to fully evaluate an area of concern. Progress evaluations typically take 20 to 30 minutes.

You may see Dr. Morgan do an ultrasound guided injection of a lesion or into a joint. It is truly the only way to confirm that you are treating the intended area. The probe is prepared with a sterile cover, the area to be injected is prepared with surgical scrub techniques and sterile injection protocol is followed. It is imperative that the horse remains still during this procedure, and even if they are so very good, a small amount of sedation may be administered.

Digital Ultrasound images are also easily shared with other Veterinarians. Be sure to bring their email address to the visit.

In order to determine a focal area of concern in the horse, we often utilize nerve and joint blocks. After a sterile preparation of the skin called "scrubbing", a small amount of anesthetic, similar to Novocaine that is used by human dentists, is injected under the skin near the nerve or nerve bundles or directly into the joint. The horse is then evaluated in motion to determine if there is improvement due to the "blocking" of pain.  

We "watch them go " at time equals 0 (right away) and if necessary at time equals 5 or10 minutes and potentially again at time equals15 or 20 minutes after the anesthetic was injected. If there has been no improvement, we go onto the next level of blocks. The first one will always be the lowest on the limb and we will work our way up the limb.

Blocking can take a half hour or 3 hours, it just depends on how far up the limb we have to go. Every once in a while it is necessary to block again on another day to prove the location of pain has been adequately identified. If multiple blocks have been done, most horses will get intravenous phenylbutasone "IV bute" to minimize tissue inflammation from the needles and the block itself. Some horses may be bandaged.

Overall, blocking is a very important part of the diagnostic process. You should expect to have this procedure included in your lameness evaluation.

Joint injections can be included as part of the therapeutic plan to alleviate joint pain. There are typically three components to a joint injection. A steroid to decrease inflammation, a hyaluronic acid product that helps repair the joint and an antibiotic to reduce the chance of infection.

As with all procedures there is risk of infection and you should be aware of that.  We are extremely critical of joint injection preparation. We take all precautions to reduce the risk of infection.  A series of sterile scrubs are done at the site before the appropriate sterile medications are injected. Some joint injections are done with Ultrasound guidance, some are not. All areas that can be protected by a bandage are. All injection sites should be monitored carefully for 72 hours post injection. If there is any pain, heat, swelling or unexpected lameness, Dr. Morgan should know about it immediately.

Most horses will be given a few days off, then around day 3 or 4 post injection, they go back to work with a lighter riding workout than they were previously doing. By day 5 or 6 they are back up to normal riding habits, unless they have been given a specific riding and exercise protocol.

You may have heard or read about the acronyms IRAP, PRP or Stem Cells in conversation or horse magazines. But what does that mean for you or your horse?

They represent a few of the new Regenerative Medicine products that are available. Once a lesion or problem has been identified and proved to be the issue that is causing pain, regenerative products may become part of the therapeutic plan.

The general principle is to use the patients own blood or fat to concentrate naturally made factors that promote healing. Each of the products seem to produce favorable results for certain types of lesions or pathology. So it is important to have a correct diagnosis to choose the most appropriate product. They also take time to collect and prepare prior to administering. Some products take up to 3 weeks to concentrate before the initial injection. Many also require several injections  to complete the protocol. That is why they tend to be more expensive. 

We are able to facilitate any of the 3 regenerative medicine treatments listed below.

What is it?
IRAP (Orthokine) was originally developed in Europe, and has been used extensively in Germany.  IRAP (Interleukin-1 Receptor Antagonist Protein) is an anti-inflammatory protein found in the patients own blood  that counteracts the destructive effects of inflammatory proteins such as Interleukin-1 (IL-1) within the inflamed joint. 

What is it used for?
Indications for use of IRAP/Orthokine in the joint include horses with a well defined synovitis/capsulitis, particularly those horses that do not respond well to conventional anti-inflammatory joint medication and horses that have had arthroscopic surgery and have been found to have focal cartilage diseases. 

Orthokine is NOT recommended for use in tendon sheaths or bursae, in joints where there are bone fragments, fractures, meniscal or ligamentous injury unless it has been successfully treated arthroscopically, in bone cysts, or in horses with advanced osteoarthritis (low success rate). 

What is the procedure?
Levels of IRAP and other anti-inflammatory proteins in the blood can be increased and produced for joint injection by incubating a 50ml sample of blood from your horse for 24 hours.  The syringe contains glass beads coated with a substance to enhance production of anti-inflammatory proteins including IRAP.  The syringe must reach the incubator as soon as possible after the blood has been harvested from your horse.  After 24 hours, the syringe is centrifuged, and the serum collected.  The amount of serum collected from each 50ml syringe of blood is usually between 20-25ml.  This yields 5-6 doses of IRAP, but the number of doses available for use from each collection is dependent on the specific joint. 

Once the serum has been harvested, it is filtered and then frozen in single dose aliquots.  We then submit a small sample of each batch of serum for microbial culture to ensure to the best of our ability that that product that is released for joint injection is sterile.   Injections are released for use about 8 days after original blood collection.  Injections are kept frozen until immediately before use.  Once thawed and immediately before they are used, each individual dose is again sterile filtered.

In general 2-3 treatments of the joint are performed, at 8-14 day intervals.  The volume injected at each treatment is 1-8ml, depending on the joint. After injection, we routinely bandage the joint if possible for 2 days, and the horse should be kept on 3 days of strict stall rest, followed by 10 days of hand-walking (30-45 minutes).  Once the course of injections and the final hand-walking period is completed, horses should receive one week of ridden walk exercise, followed by one week of ridden walk and trot, before returning gradually to regular training programs. 

The joint should be monitored carefully for heat, swelling or increase in lameness. If you notice any of these signs, please contact us immediately.  Adverse effects of this product have not been reported after extensive use in people and horses in Europe, though if you have any concerns about your horse after injection you should contact me directly.

What is PRP?
PRP, Platelet Rich Plasma, is the platelet concentrated plasma obtained from anti-coagulated whole blood via a centrifugation process. The platelet concentration needs to be at least four times that of whole blood to be considered “platelet rich”.

What is it used for? PRP is being used clinically by equine veterinarians for tendon and ligament healing and granulation of tissue defects. Normal  PRP therapy is recommended for both recent tendon and ligament injuries and those injuries that have not healed using traditional rest and controlled exercise. Recent injuries can be injected 2-4 weeks after occurrence. For horses with severe joint disease (osteoarthritis or osteochondrosis) that are no longer responding to traditional joint therapy (injection with hyaluronic acid and corticosteroids). Three treatments at two-week intervals are recommended.

How does it work?
When the platelets are injected into the lesion, they are activated by exposure of the damaged tissue. The platelets release their granular contents which include such anabolic growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-ß (TGF-ß) and vascular endothelial growth factor (VEGF). These growth factors stimulate progenitor cells to migrate to the wound, and help with wound fibroblast expansion and wound matrix production.

What is the procedure?
Making PRP is a simple procedure that takes only a few minutes using the Vet-Stem GenesisCS Component Concentrating System. 52 ml of whole blood is drawn aseptically from the horse with a 60 ml syringe that has been preloaded with either 8 ml of CPD or ACD anticoagulant. The mixture is transferred to the special centrifugation tubes and processed stall side. The PRP is ready in minutes to be injected back into the same horse’s lesion. 

There is another collection procedure that requires bone marrow as the source for stemcells. If a horse is going to surgery and PRP is needed for joint repair, that is a much more complex procedure and takes approximately 3 weeks to culture cells before they are ready to be used. Bone marrow is retrieved through the sternum in a horse that is sedated. This is a minor surgical procedure. Bone marrow is delivered to Cornell University, where they prepare the samples for use.

What are they?
Stem cells are derived from the animal's own fat and contain high yield of mesenchymal stem cells as well as other regenerative cells that produce cytokines and growth factors. They are able to differentiate into multiple cell types and  produce extracellular (structural) matrix that allows healing to get started.  Stem Cells harvested for use in equine regenerative medicine are adult adipose (fat)-derived cells. The fat collection procedure delivers significantly more regenerative stem cells than a fresh bone marrow procedure.

What are they used for?
Acute tendon and ligament injuries. Recent independent studies have demonstrated improved healing and fiber patterns. Ultrasound images show a rapid filling of the injured site and elegant tendon regeneration.

The Treatment of chronic degenerative (osteoarthritis) joint disease with VSRCs has proven to be effective even in chronic cases that are non-responsive to traditional therapies. Clinical improvements have ranged from modest improvement to life-saving. In cases of moderate to severe degenerative joint disease, Vet-Stem-treated horses have shown clinical improvement for up to 12 months and owner satisfaction above 85%.

What they are NOT used for
Vet-Stem believes there are certain conditions in which stem cells will have little or no value including:

• Degenerative suspensory ligament desmitis
• When a soft-tissue (tendon/ligament) lesion is not detected by current imaging modalities
• When there is an infection present in the injured area

What is the procedure?
A small amount of fat is collected typically from (2) three inch incisions made on the rump of the horse who is under sedation with local anesthesia. The fat sample is shipped overnight via FedEx to the Vet-Stem laboratory for processing, isolating, and concentrating of stem cells. The cells are then returned for implantation at the site of the injury or intravenously within 48 hours of collection.

Chiropractic work on horses should be done by a Veterinarian or Human Chiropractor who has been certified by the American Veterinary Chiropractic Association or similar organization with national credentials. If your "chiropractor" does not have a DVM or DC behind their name with extensive veterinary chiropractic training, they are preforming work illegally and you are paying an under-qualified individual who does not have liability to you, your horse or any governed board. It's illegal in most states, including NY.

Dr. Morgan received her animal chiropractic training and certification after veterinary school from the American Veterinary Chiropractic Association. The most beneficial part of the training was how to understand the very complex vertebral structures and how the body reacts to dysfunction.

Many horses with primary neck, back or pelvis issues benefit greatly from chiropractic manipulation. In her experience, horses are typically not "repeat" offenders. That means that most vertebral "subluxations" are temporary or have occurred because of a single situation and are easily adjusted.  If there is an issue that keeps coming up, there is usually a primary limb lameness with a secondary neck, back or pelvis issue that resolves itself once the horse is sound.

Most people cant believe that you can adjust a horse. They are so big. How can it be possible? It is possible because we are not adjusting a whole horse, we are evaluating and manipulating just one small vertebral segment at a time. We are looking for correct range of motion and flexibility.  We won't say that it is easy work, because it can be difficult to get in the correct position for manipulation and difficult to get horses to go through range of motion, but it should not be a dramatic performance. Definitely no mallets or hammers of any kind.

Trained by the International Veterinary Acupuncture Society, Dr. Morgan has utilized acupuncture as a complimentary therapy for the past 15 years.

The most recent needle therapy Morgan Equine incorporated has successfully helped many horses is Mesotherapy. It is especially helpful in chronic back pain horses where bone lesions of the neck and back can be documented. It is one of her favorite therapy's for sore backed horses.

The horse is given a light sedation and the back is prepared using a sterile technique. Several medications are combined in a large syringe that is attached to a "meso-injector" which is a small cartridge that accepts 5 very small needles. The needles are placed into the skin and medication is "blebbed" into the skin, causing the skin to rise to accommodate the medication.  The blebs reduce in about an hour, but the main target is a pain feedback mechanism that is located in the skin layer.  We have had excellent results with this therapy.

Horses are typically not ridden for 3 days after mesotherapy and all saddle pads and blankets must be washed. If you know that your horse is getting mesotherapy, please bring a clean stable or turn out sheet for your horse to wear home.  

Dr. Morgan is available for phone consultation specifically on lameness issues. The fee is based on an hourly rate and you are only billed for the amount of time used. This is a very useful way to work with other veterinarians when pre-purchasing a horse long distance or to get a second opinion.

Be prepared with email addresses and other contact information as well as video links, digital images or other supporting media.

 A credit card must be on file prior to consultation. Visa and Master Card accepted. Email Dr Morgan to get started. vet@morganequine.com

Horses teeth continue to grow and change shape throughout their lives. That is why dentistry is important to a horse's well being and partially why horses are living longer healthier lives.

There is a difference between floating and dentistry. Typically, non-veterinary (lay) persons preform floating by using hand tools to remove sharp points on the large teeth along the sides of the mouth called molars.

Veterinary dentistry includes the use of sedation, pain medication and full mouth examination with a mouth speculum. With this method, the overall condition of all of the teeth and gingiva are assessed, incisors are aligned, table surfaces leveled and canines are reduced if present. Dr. Morgan uses a Power float with a rotating diamond disc to reduce teeth. Unlike hand floats, it allows access to the last molars and the greatest benefit is how kind the equipment is to the soft tissue. We can also determine the best interval for dentistry. Contrary to belief, once the mouth is balanced, every other year dentistry is adequate for most horses. It's not always about taking off as much tooth as you can. It's knowing how much tooth to leave.

Dentistry takes about 45 minutes to an hour per horse. The only time Dr. Morgan will travel to a barn is for dentistry. There must be a minimum of 4 horses and maximum of 6 to schedule a dentistry barn call with in a 60 mile radius of Morgan Equine.  Call fees are based on mileage and evenly divided by the number of horses seen.

You can schedule an appointment via email or by calling Dr. Morgan directly.  Email typically works better.

vet@morganequine.com

Generally there is a morning and/or afternoon appointment available. The average appointment lasts between one and four hours per horse for a lameness evaluation with a diagnostic workup.  Typically only two horses are seen for new lameness evaluations in a day. Progress evaluations are fit into the schedule as the individual horse requires and are a priority.

If you anticipate that Farrier services will be required for your visit, you must mention in advance as Dallas is not always available for  in-hospital appointments.  Typically it is easier to schedule with Dallas first and Dr. Morgan will accommodate.

The hospital is open during the week Monday through Friday and approximately one to two Saturdays or Sundays per month.  We are available by appointment only. Have a look at the Appointment and Calendar Page to get an idea of appointment times that are available.

It is essential to note that we are not an emergency hospital, but will see your horse if we are available, you must call first. We make every effort to accommodate current clients schedules and special needs. If you have any questions - just email! vet@morganequine.com

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