Reining in Roaring

Earlier detection and new treatments for horse racing’s number-one performance problem

It’s a big day at the track. Years of training and thousands of dollars are at
stake. The gates open and your horse lunges forward. But his breath comes
in gasps. It looks as if he’s wearing a heavy mask that is blocking his access to
air. Worn nerves signal sluggishly to weakened muscles that barely respond
enough to open his airway. He slows and falls to the back of the pack.

This career-limiting problem affects nearly 8 percent of race horses and a higher percentage of sport horses. Oficially called “recurrent laryngeal neuropathy,” the common equine disease is better known as “roaring” for the strained sounds affected horses make when they try to run. It shares similarities with human vocal cord paralysis, a neurological condition
causing difi culty breathing and loss of speech and requiring tracheostomy and intensive surgery. Roaring starts early and
unseen, slowly wearing down the nerves that stimulate the muscle responsible for opening the larynx.

“Upper airway problems cause poor performance in many race horses,” said Dr. Jonathan Cheetham, an equine surgeon and sports medicine practitioner at Cornell’s Equine Hospital. “Symptoms often show in a horse’s second to fourth year, when a trainer has already invested thousands in its athletic career. The standard treatment, surgery called a laryngeal tie-back together with a ‘lazer hobday’ procedure to remove the vocal cords, returns 65-70 percent of treated horses to racing. But that’s after six weeks of recovery and another six weeks to regain fitness. It takes a toll on the horses, their trainers, and the racing economy.”

Taking roaring by the reigns, Dr. Cheetham and the Equine Performance Clinic team are helping to change how veterinarians look at and treat the disease. The team running the Clinic’s indoor treadmill offers good client service while researching new methods to diagnose disease earlier and improve treatments.

According to Cheetham, the horse is a useful preclinical model of human airway disease. Much of what he is learning and working out at Cornell could help restore function in human patients with laryngeal disease. The Equine Performance Clinic pioneered techniques using a trans-esophageal ultrasound to evaluate airway muscles in horses.  Developed at Cornell with support from the Harry M. Zweig Memorial Fund, these techniques could give human doctors a new view of deteriorating laryngeal muscles and let them follow progress after treatment.

The team is developing a novel treatment for roaring using a laryngeal pacemaker to electronically stimulate the muscle and maintain its function: another technology applicable to humans with vocal paralysis.

Cheetham has spent the past year developing new ways of detecting neurological disease earlier, thanks to a grant from the Grayson Jockey-Club Foundation.

“Motor nerves need insulation from myelin sheathes to carry signals quickly,” said Dr. Cheetham. “Laryngeal neuropathy works by breaking down myelin in the two major meter-long nerves controlling the horse’s airway muscles, slowing their conduction velocity and cutting off the muscles from adequate stimulation. If we can use nerve conduction velocity to detect early myelin breakdown we may be able to catch the disease before the muscle starts shrinking.”

Placing tiny needles into the nerves, Dr. Cheetham measured conduction speeds across their length to see how speeds vary across the nerves. Next he will validate a technique that does not use needles and look at how nerve conduction velocity at the weanling stage affects performance of 2-year-old horses with the hope of confirming it as a viable diagnostic and predictive tool. Validating such a test would expand the window of detection and open doors to earlier prevention and treatments, and aid understanding of the disease mechanisms that produce ‘roaring’ in horses.

“We have also been developing ways of enhancing nerve grafting using tissue engineering techniques,” said Dr. Cheetham. “If we can pick up problems early, we might be able to treat without invasive surgery or a permanent implant. It could be safer, cheaper, and faster, and may improve the success of recovery from airway diseases in both horses and humans.”

Discuss this work with Dr. Cheetham on Facebook
Visit the Equine Performance Center website

‘Scopes Magazine
October 2011

Life-saving surgery inspires gift to help the hospital see inside ailing wildlife

When their dog, Buzz, faced a life-threatening condition in October 2009, Richard and Stacy Hoffman drove their Scottish terrier six hours from Maryland to Cornell University Hospital for Animals, where a timely surgery saved his life.

Their experience inspired several donations to the Companion Animal Hospital, and as strong supporters of animal welfare they were keen to learn more about the College’s commitment to animal care. The Hoffmans oversee a family foundation that funds projects supporting otherwise overlooked wildlife. When they took a tour of Cornell’s Janet L. Swanson Wildlife Health Center, which provides hospitalization and medical care to sick or injured wild animals brought in by the public with the goal of releasing them back to their original habitat, they knew they had found a match.

“Some wildlife species get a lot of attention while others that might not be quite as ‘sexy’ fall under the radar,” said Richard Hoffman. “It’s important to us and to Earth’s ecosystems that species don’t dwindle because no one noticed or cared. We took a tour of the Center and saw the work they do helping local wildlife and training students who could someday translate that experience to a greater scale, and we wanted to give something tangible to help.”

Through a gift from their foundation, the Hoffmans helped the Center purchase four pieces of imaging equipment that will provide invaluable diagnosis and treatment options for the animals treated at the Center while simultaneously building a multimedia library usable for teaching and research in wildlife medicine.

“The biggest new piece is an endogo®HD, a totally portable, wireless, high-definition endoscopic imaging platform that can record, store, and play back images and videos taken from inside an animal’s body, making it particularly useful for diagnosis and teaching,” said Dr. George Kollias, Jay Hyman Professor of Wildlife Medicine and Chief of the Center. “We also purchased a small-diameter rigid endoscope for birds and small mammals that allows veterinarians to use surgical instruments to take biopsies, retrieve ingested foreign bodies, and conduct minimally invasive surgeries.”

For their tiniest patients, the Center purchased a fully functional miniature endoscope. Finally, all endoscopes were updated with new, more powerful light sources.

“We use this technology to help diagnose and treat wildlife when laboratory tests and other diagnostics don’t provide definitive answers,” said Kollias. “It lets us use minimally invasive techniques to visualize the organ surfaces and to take tissue samples if organs or tissues safely. The equipment is also particularly useful in species for which there is little or no published clinical laboratory data or disease description.”

The Hoffmans hope their gift will help veterinarians, students, and researchers find ways to prevent future problems in wildlife and promote research to help wildlife.

‘Scopes Magazine
February 2012

Endoscopy all the way down

endoscopeWhen you need to see “guts,” endoscopy gives the inside scoop. Recent advances in endoscopic technology have led to smaller endoscopes that can go further into the body, see more clearly, take bigger samples, and serve a wider array of patient needs. The gastroenterology section of Cornell’s Hospital for Animals now utilizes new lines of updated fiber-optic technology.

The first-ever slimline large-channel portable veterinary endoscopes can connect to a lightweight laptop and easily be moved to an animal. This makes them particularly useful in surgery or for bringing to animals that should not be moved. When flexible endoscopy is not the answer, it may be time to swallow a pill. Wireless capsule endoscopy provides high-quality imaging throughout the entire GI tract without requiring anesthesia. Each single-use “Endo capsule” made by Olympus employs a tiny camera that takes pictures all the way through the digestive system and transmits data wirelessly to a receiver worn by the patient.

“We choose the most suitable imaging technology for each patient” said Dr. Kenneth Simpson, professor of internal medicine and gastroenterology. “Portable endoscopes work well in the surgery room. Capsule endoscopy is a great option for pets that cannot be anesthetized safely, or in cases when you need to see the entire gut. It can’t take tissue samples but it can help determine the nature and severity of intestinal damage and whether further intervention is needed. It is likely to be particularly useful in investigating the source of gastrointestinal bleeding.”

The gastroenterology and parasitology sections have teamed up to use capsule endoscopy for research sponsored by pharmaceutical company Novartis to safely validate anti-parasitic drugs.

Slimline large-channel biopsy-capable endoscopy, portable endoscopy, and capsule endoscopy are now available for clients and referring veterinarians.



Grateful pig owner gives gift of sight to Cornell’s future animal patients

TrixieHours before she was scheduled to leave for vacation, Dr. Nita Irby received a distressed call in the ophthalmology service. Trixie, a beloved miniature potbellied pig, was suffering from an undiagnosed painful eye problem that had been ongoing for several months. Irby agreed to see the pig and in May 2011 Kathy Ruttenberg, a successful artist hugely inspired by her relationships with her adored pets, drove Trixie four hours to the Cornell University Hospital for Animals (CUHA).

“Trixie was squinting, had a great deal of tears from her eye, and was clearly in pain,” said Irby. “Examining her eye, we found a small, shallow ulcer scarring on the eye and hairs trapped in the eye that might have been causing ulcers. We carefully removed the hairs and Trixie improved within days.”

Unfortunately, a week or so after the eye healed it became painful once again and Trixie returned to the CUHA for a second examination.

“We found nothing abnormal other than a small ulcer at a new location on the eye,” said Irby. “But her hair coat appeared unhealthy and her skin seemed abnormally scaly. Dr. Danny Scott in dermatology diagnosed congenital ichthyosis and prescribed colloidal oatmeal baths and nutritional supplements. In follow-up appointments Trixie’s coat has been looking great. At her last visit the Zeiss operating microscope was used to carefully examine the eye and diagnose a qualitative tear film deficiency. Although Trixie’s eye has continued to cause intermittent painful episodes, we hope to see an improvement over the next four to six weeks as the new medication we prescribed begins to work.”

“From the moment I first called, Dr. Irby was there for us”, said Ruttenberg, who contacted the Hospital wanting to donate in Irby’s honor shortly after the initial visit and soon decided to fund the purchase of a new phacoemulsification machine used by the ophthalmology service for cataract removal surgery.

“Shortly after Trixie’s initial visit, the ophthalmology service discovered a major potential hardship,” said Irby. “Ophthalmology provides a life-changing service by removing cataracts from dogs, cats, horses, and many other animal species to restore sight to animals blinded by cataracts. The surgery requires a phacoemulsification machine, the same device used on humans that utilizes ultrasound to break apart the lens and remove the pieces from the eye. The manufacturer was phasing out our model and would soon stop making the packs we needed to ensure each patient has a new, sterile setup for surgery. We had no money to upgrade to a new machine. The very next day after hearing that we could not purchase the new machine Kathy asked me how she could provide more support to us. Our new machine has been ordered and will arrive any day. Kathy’s gift will help restore vision to many, many animals now and in the future.”

Ruttenberg is well known for her love of animals, which has been the subject of several news articles, including one in The New York Timescovering her habit of sleeping with Trixie and others from her menagerie of 70 animals in her mountain home in upstate N.Y. Her generous gift to CUHA will help many animals live better quality lives.

“Dr. Irby exudes such positive energy,” said Ruttenberg. “We need more good vets like her, and I wanted to give a gift in her honor. Cornell’s hospital strongly impressed me with its professionalism and warmth. Everyone was so nice and knowledgeable and clearly adored animals. From the technicians and staff to the students and faculty, they were patient talking me through things and sharing my care for Trixie. There is nowhere else in the world I would leave my pig.”


Cornell College of Veterinary Medicine News

New Lyme disease test for horses and dogs will help improve treatment

Bettina WagnerRomping through summer fields seems like a harmless pleasure for dogs, horses and humans alike. But just one bite from the wrong tick can rob an animal of that pastime. The bacteria Borrelia burgdorferi catch rides with certain species of ticks and can cause Lyme disease in animals the ticks bite. Catching the disease early is paramount because it becomes progressively harder to fight as the bacteria conduct guerilla warfare from hiding places in the joints, nervous tissues and organs of their hosts.

A new test for Lyme disease in horses and dogs, developed by researchers at the Animal Health Diagnostic Center (AHDC) at the College of Veterinary Medicine at Cornell, will improve our understanding of the disease and pinpoint time of infection, opening possibilities for earlier intervention and more effective treatment plans.

“We’ve offered Lyme disease testing for years,” said Bettina Wagner, the Harry M. Zweig Associate Professor in Equine Health and lead developer of the test, “but we have recently been able to improve our techniques with the multiplex testing procedure. The new test exceeds its predecessors in accuracy, specificity and analytical sensitivity.”

The multiplex procedure, which can detect three different antibodies produced in response to the bacteria associated with Lyme disease using a single test on the sample, eliminates the need for separate tests. In addition, it requires smaller samples and answers more questions about the disease. Multiplex technology has been used for the last decade, but the AHDC is the first veterinary diagnostic laboratory to use it to test for Lyme disease.

Different kinds of antibodies can be found in the body at different stages of infection. The new test can distinguish and measure these differences, giving more information about the timing of the disease.

The bacteria that cause Lyme disease are particularly difficult to detect, according to Wagner, because after infection they tend to hide where they can’t be found. They bury in the joints of dogs, causing arthritis or lameness. Serious kidney disease has also been associated with Lyme infections in dogs. In humans and horses, they also burrow into the nervous system, in the spine or the brain, causing pain, paralysis or behavioral changes. By the time such clinical signs appear, the bacteria are usually not in circulation anymore.

Horse“Now we can distinguish between infection and vaccination and also between early and chronic infection stages,” Wagner said. “That was not possible before. You were able to say whether an animal was infected, but not when it was infected, or how far the infection had developed.”

The test and information the test provides can help veterinarians make advanced decisions about treatment. After the long treatment period ends, veterinarians usually conduct follow-up testing to see if it was successful.


Cornell Chronicle: June 16, 2011

New MRI machine brings CUHA to the forefront of medical imaging

CUHA has upgraded its Magnetic Resonance Imaging (MRI) capability, offering unprecedented opportunities for advanced medical imaging. As part of the Janet L. Swanson Imaging Suite, the MRI and the recently installed 16-slice Aquilion LB CT scanner mark a huge leap forward in the Hospital’s clinical and research capacities, continuing CUHA’s commitment to innovation.

New System Features
The 1.5T Toshiba Vantage Atlas MRI scanner employs a high-field magnet capable of scanning any animal up to the size of a large dog, some large farm animals, and the limbs or heads of horses. A moveable table allows an anesthetized horse to be brought close enough to the magnet to scan those parts that can be pulled into the bore. Most veterinary colleges have similar systems though this model has the latest software and hardware available at 1.5T field strength. It is a “work-horse” scanner in the human imaging field.
“The exceptional detail and clarity of the image quality make it easier to diagnose more accurately,” says Dr. Peter Scrivani, radiologist at CUHA’s imaging department. “We are able to get more information about the patient’s health and disease status during the same length of examination, because the image acquisition time is shorter and the new scanner has additional functionality. The extended clinical applications offer a major advancement. We expect to use the machine mostly for neuroimaging and musculoskeletal imaging, and there is potential for thoracic or abdominal applications.”

Scanner Facility
Summer renovations at the Hospital ensured that the MRI can be operated with optimal efficiency and safety. The control room provides easy viewing of the scanner and patient and connects to a fully equipped anesthesia room for small animals. Equine anesthetic induction and recovery stalls are adjacent to the scan room. A large door at the back of the exam room opens directly to the large animal hospital, making it easy to accommodate imaging needs for equine and other large animals. A full complement of MRI-compatible monitoring equipment keeps anesthetized patients stable throughout the exam.

Available Services
The Toshiba MR and CT scanners comprise the Janet L. Swanson Imaging Suite and are now operational and available for CUHA patients by referral. Small animal MR scans are available daily. Horse scanning is progressing and protocols are under development. Veterinarians who would like to discuss the use of these modalities for their patients are welcome to contact the Imaging Section at the CUHA for advice and referral information. Please call 253-3060 for appointments or -3241 to have a radiologist consultation.