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New Standing MRI Has Already Helped Diagnose Nearly 70 Horses At Santa Anita

Can MRI technology, the gold standard for diagnosing human sports injuries, offer an effective diagnostic solution for veterinarians and racehorse trainers who prepare their horses to prevent racetrack fractures?

A group consisting of the Dolly Green Research Foundation and The Southern California Equine Foundation as well as several individuals, recently came together to purchase and install a Standing Equine MRI system, from Hallmarq Veterinary Imaging, at Santa Anita Park racetrack. The group is working closely with the Stronach Group, owners of Santa Anita, to introduce the technology to veterinarians and trainers.

“The Stronach Group is excited about the addition of a standing MRI to the existing diagnostic options for horses at Santa Anita Park,” said Dr. Dionne Benson, chief veterinary office for The Stronach Group. “Together with the standing PET (Positron Emission Tomography) system, which was installed at Santa Anita late last year, these new modalities greatly improve the ability to identify preexisting conditions, is an important step in ensuring horse safety and welfare.”

The groups began fundraising for the MRI last fall and were able to reach their target goals to allow purchase and recent installation.

“Hallmarq's Standing Equine MRI (sMRI) system brings the same diagnostic capability to equine clinical practice as the human sports medicine field” said Dr. Dan Brown, vice president and chief customer officer, at Hallmarq. According to Brown, there have been close to 70 horses diagnosed using the Hallmarq MRI at Santa Anita.

Brown said that soft tissues are very hard to evaluate on radiographs and bone changes will show up on MRI weeks before they can be seen on x-ray, which can make a big difference for a horse trainer contemplating entering a horse in an upcoming race.

With the equine patient being at the forefront of every design decision, Hallmarq's unique sMRI capability avoids the risks associated with general anesthesia and allows equine veterinarians to offer clients the most advanced lameness diagnosis method on an outpatient basis.

“Traditional lameness diagnosis is often a cycle of trial and review that relies on a slow process of elimination,” said Brown, a former veterinarian with over 20 years' experience in the veterinary profession.

“The integration of Hallmarq's standing MRI to our diagnostic imaging center at Santa Anita has been seamless,” said Dr. Ryan Carpenter, one of the on-track veterinarians at Santa Anita. “Being able to identify bone pathology at the earliest stages allows us to intervene long before these abnormalities could be seen on radiographs. Knowing that we have this technology at our fingertips where horses can literally walk out of their stall, undergo sMRI and be back in a matter of a couple hours speaks to the commitment to greater safety for our athletes.”

Hallmarq has developed unique equine expertise over almost two decades by imaging more than 100,000 horses at 100 sites over six continents. With Q-Care, Hallmarq's world-class support system, customers have experienced uptime of greater than 99% and upgrades to their systems to ensure that practices enjoy a diagnostic rate in excess of 90%.

Other racetracks have used the system, including the world-famous Hong Kong Jockey Club.

“We installed the Hallmarq standing MRI in 2013 and since then have performed hundreds of examinations of the lower limbs primarily in Thoroughbred racehorses,” said Dr. Paul Robinson, Head of Veterinary Clinical Services at the Hong Kong Jockey Club. “We have found the information obtained to be invaluable in the identification of injuries that are not visible on conventional imaging modalities and it has helped us to manage a variety of conditions using an objective, targeted approach. Of great interest in our population is the capability to perform multiple follow-up studies of the region of interest to monitor the healing process of subchondral bone lesions in the lower cannon bone of our thoroughbred population.”

Read more about standing MRI in this 2015 Paulick Report feature.

Standing Equine MRI Benefits:

MRI can show problems that are not visible, or at an earlier stage than they would show up on any other imaging method.
Standing MRI occurs under very light sedation, without anesthesia. This both eliminates risk of injury and makes it much easier for a client to say “yes” then conventional 'down' MRI.
MRI involves no radiation unlike, CT, bone scanning or radiography.

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Thoroughbred Makeover Diaries Presented By Excel Equine: The No-Plan Plan For OTTBs

“What are you planning to do with her?” I often ask my wife and trainer, Ashley Horowitz, as she's tacking up a horse to ride.

“I don't know,” is almost always her answer.

While that answer seems vague, like maybe she's being passive-aggressive in testing whether her husband of two months should already know the answer, I've learned that it's the most effective way to approach training horses. It puts the horse in charge of expressing what they're ready to learn and the rider in charge of crafting a positive experience.

The two most productive rides I've had on my 4-year-old bay OTTB filly Cubbie Girl North since my last Thoroughbred Makeover Diaries edition was published came when I didn't know what we were going to do until we were actually doing it. And, those two rides, which were back-to-back in a span of 72 hours, couldn't have been more different.

First, on Aug. 27, Ashley and I rode together with our 7-year-old son, Chase, for the first time as a family since the footing was finished in the brand-new indoor arena on our farm in Parker, Colo. Chase was trotting one of his first full courses of jumps, and they were all either cross rails or verticals about 12 inches high.

“Why don't you do the same thing?” Ashley asked.

I trotted to the first jump, and Cubbie took a big leap. Over the previous two months, we had completed five events at Beginner Novice where the jumps can be up to 2'7.

“Keep going. She needs to realize this isn't a big deal,” Ashley said.

This was a fun jumper round for Cubbie and me. It's the highest we'd ever done at 2-9, but it was our smoothest of the day. Although we did demolish the corgi jump. Yes, I'm wearing a tutu for a fundraiser. Read more Thursday in my next @RRP_TBMakeover article for @paulickreport. pic.twitter.com/f6jy8iAkY6

— Jonathan Horowitz (@jjhorowitz) September 23, 2020

As we trotted more and more one-foot jumps, Cubbie started settling into a steady rhythm, and she stopped making a big deal about them. We then cantered the course and called it a day. Boring never felt so rewarding.

Then, three days later on August 30, Cubbie and I were riding at a fundraiser at nearby Platinum Farms. We were in the start box preparing to school a round on the cross country course. While courses were set up for different levels, the informal nature of the fundraiser meant that riders could mix together heights of different jumps while they were on course.

“Are you going to do the first jump Beginner Novice or Novice?” Ashley asked.

“Beginner Novice,” I answered, thinking we'd at least get our rhythm at the 2'7 height I knew we were comfortable at before attempting the biggest jump height we've ever faced at 2'11.

“Thirty seconds,” the starter said, indicating how much time was left until we would leave the start box.

“No, I'll do the Novice one,” I screamed to Ashley, changing my mind and figuring Cubbie and I were ready for a fun challenge since she'd been feeling good in stadium jumping rounds earlier in the day.

We did the first Novice jump, then went over a ditch, then took the Novice corner, and rolled through nearly the entire course taking the biggest jumps we've ever done together…just three days after taking the smallest jumps we've ever done together.

Ashley Horowitz and Emily's Pegasus jump up a bank at the Mile High Derby on June 14, just one month and one day after the 4-year-old chestnut filly completed a 23-race career at Fonner Park in Nebraska.

Both rides were incredibly valuable despite being incredibly different and unexpected. However, both rides were actually the result of the same approach. It's the approach that Ashley has used with countless OTTBs, including her newest project, Emily's Pegasus, with whom she competed in the Mile High Derby one month and one day after the 4-year-old chestnut filly's last career race at Fonner Park in Nebraska.

It's the approach our friend, Brit Vegas, has also used as one of the most prolific trainers at the Retired Racehorse Project Thoroughbred Makeover, the event that I've announced for the past five years and now would like to compete in.

“It's the No Plan Plan,” explained Brit, who has ridden at every Thoroughbred Makeover since the first one was held at the Kentucky Horse Park in 2015. “Being good at retraining OTTBs is the ability to listen to the horse that you're riding in that moment and deciding, 'Do they enjoy what you're doing right now?' or 'Is it too much?' and making the decision for them whether you continue to train and teach or take two steps back.”

While I have my hands full with Cubbie as the first horse I've ever trained directly off the track, Brit plans to compete four horses at the Mega Makeover in 2021. Although the format of the Thoroughbred Makeover seems like it would be stressful with just 10 months to retrain a former racehorse for a new career, Brit has shown that doesn't have to be the case.

“Almost every horse I've taken to the Makeover I've brought along in the last two months of going, and they always end up in the top 10 regardless,” said Brit, who made the finale in Field Hunters in 2019 with Bombmarito.

I've made more progress with Cubbie in the last two months since the announcement in July about the postponement of this year's Thoroughbred Makeover took the pressure off our training. Instead of evaluating every ride and how it affects our goal of making it to the Makeover, I now appreciate the challenges and rewards each individual ride brings for its own merits.

I stressed in July about whether we'd be ready for the Makeover, and now I believe we would be. We've improved with every show, culminating in our best finish ever at the Mile High Derby on Kentucky Derby Day where we were one of just four clear cross country rounds out of the 11 competitors at Beginner Novice.

“If the Makeover were happening this year, you see that things would just be coming together for you and Cubbie right when they need to,” Ashley said.

I realize that the correct answer to “What will you be doing in October 2020 with Cubbie?” is “I don't know.” No one could have predicted how 2020 would play out, but the change in plans is the best thing that happened on the journey Cubbie and I are taking together. Zero plans are often the best plans of all.

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When Digging For A Diagnosis Becomes Harmful

Equine and pediatric medicine has many parallels, notes Dr. David Ramey in an article for Horse Network, including a propensity for overdiagnosis.

Ramey draws multiple similarities between the two, including that both horses and children are reliant upon adults to make medical decisions for them. Additionally, neither small children nor horses can talk, so diagnoses must be made on observation and testing.

Ramey says that a horse may have an issue where a diagnosis is warranted, but determining an exact diagnosis can be difficult—and in some cases harmful–to the horse. An ultrasound can be a helpful tool to use if a horse is colicking and a diagnosis on whether surgery is needed is imperative. However, sometimes a precise diagnosis isn't needed. If a horse is older and sore, using every diagnostic tool to determine where it is unsound may not change the treatment or the outcome—it simply adds to the owner's expense. In Ramey's words, “'Overdiagnosis' describes a situation when an abnormality is found, but detection of that abnormality doesn't actually benefit the patient.”

Though vets have multiple diagnostic tools at their disposal, their use doesn't always behoove the horse or the owner. Using every tool available to find a diagnosis might physically harm the horse: It's imperative that the owner and vet agree that the benefit outweighs the possible risk of the test or procedure.

Psychologically, naming the issue may change the perception of what a horse can do. Some owners then become focuses on “fixing” the problem, adding in supplements and other treatments that the horse may not need. Finally, the financial strain on owners who choose to offer treatments to horses that may not garner long-term improvement can be immense.

Ramey offers some thoughts on why veterinarians may seek to over diagnose the equines in their care:

Industry influence
Defensiveness
Incentives

Owners may attempt to seek out concrete diagnoses for their own peace of mind; uncertainty is not well tolerated by most people.

The benefit—to both horse and owner–of performing a test or procedure should be discussed before an owner agrees to pay for it. Many equine conditions improve on their own, so immediately throwing every test and procedure at the horse may result in the same diagnosis as waiting and not doing additional tests.

Dr. Richard Bowman: Guardian Of Minnesota Racehorses

Prior to the intervention of Dr. Richard Bowman, the bulk of racehorses retiring from Minnesota racetracks were sent to slaughterhouses in Mexico or Canada, reports the Star Tribune.

A vet with the Minnesota Racing Commission, Bowman was first asked to help find a retiring racehorse a home in the late 1990s. Now, he gets asked for help several times each week. When he learned of how many horses needed assistance in finding homes when they could no longer race, he opened his 4,000-acre cattle ranch in North Dakota to Thoroughbred and Quarter Horses that are too injured, old, lame or slow to continue their careers as racehorses at Canterbury Park in Shakopee, MN.

At the ranch, which is nine hours from Canterbury Park, he focuses on rehabilitating and adopting out as many horses as he can (nearly 600 so far). The horses that are too unsound remain in his care at the ranch indefinitely—there are 35 such horses on the ranch currently. Now a 501(c)3 charity called Bowman Second Chance Thoroughbred Adoption, the program is famous for welcoming every horse in any condition, taking in the horses many others will not.

Each horse that enters Bowman's program is assessed for personality, temperament and ability. Once rehabilitated, the horses that are adoptable are paired with an adopter. Bowman's horses have been adopted out all over the United States; they do everything from hunters, jumpers, eventing, cattle work, polo ponies, dressage and other disciplines.

Bowman is one of three Minnesota Racing Commission veterinarians, along with Dr. Christy Klatt and Dr. Lynn Hovda. The trio are tasked with ensuring the horses racing at the state's tracks are sound and healthy to race; they also assist with rehoming nearly 60 racehorses each year.

Some of the horses are adopted directly from the track; those in need of temporary shelter go to Hovda's farm. Most of the horses head West to the Bowman ranch, where they settle into a less-pampered lifestyle before they are prepared for adoption. In addition to horses retiring from racing finding homes, the veterinarians team with Canterbury Park officials to pull two to three horses with ties to the state's tracks from kill pens each year. They are able to prevent these horses from being shipped to slaughterhouses outside the U.S.

Learn more about Bowman Second Chance Thoroughbred Adoption here.