Sunday, July 2, 2017

The Biometrics Revolution 

Real Time Data for Horses 

By Pam Gleason

"How do you feel today." 

Doctors might ask this question of their patients and expect a meaningful answer. For equine veterinarians, however, it is often not so simple. Horses may tell you that something is bothering them by pointing at their sides if they have colic, or limping if they are lame. Some may have distinct facial expressions and grimaces, or pin their ears, or just look “NQR” (Not Quite Right.) 

But all horses are not equally expressive. Some can best be described as stoic: they may have something seriously wrong with them, but look as though everything were A-O.K. Since they are prey animals, stoicism in horses likely has an evolutionary benefit. Any animal in a herd that shows a predator that he is weak might be singled out to become the next main course. Acting as if everything is normal, even when it is not, might be a pretty smart thing for a horse to do.

WetCheq gives a real time picture of what is going on inside a horse.

Today, stoic horses present some problems when they do have serious ailments because their owners or veterinarians might overlook problems until it is too late. One way to assess a horse’s inner state is to keep a close eye on his vital signs, including his pulse and respiration rate, as well as his body temperature. If you know a horse’s baseline, and his heart rate is suddenly much faster than normal, you know that there is something wrong. 

Checking a horse’s vital signs is a good way to tell what is going on inside a horse, but heart and respiration rate don’t tell the whole story. Monitoring blood pressure is also important, particularly when a horse has to have surgery. When a horse is anesthetized in the clinic he normally has a catheter inserted into an artery to monitor his blood pressure, heart and respiration rate, which makes it possible to put him under relatively safely. An arterial catheter hooked up to monitoring equipment gives the veterinarian a pretty clear picture of how a horse is doing. 

When a horse comes out of anesthesia, however, it is not practical to continue to use an arterial catheter since the horse is likely to pull it out. Nor can an arterial catheter be used successfully when surgery has to be performed in the field rather than in the clinic, or on a horse that has an ailment like colic and needs to be kept under close watch. At most veterinary clinics, monitoring a horse’s vital signs requires someone to come in at regular intervals to check them. Although this certainly works, it has some drawbacks: it is labor intensive and decidedly low tech. In addition, it is possible for a patient to have a dramatic change in his condition before anyone notices. 

How can equine veterinary care move into the 21st century? Sharon Caswell, the founder and CEO of PonyUp Technologies based in Benbrook, Texas, has an answer. Her company has invented VetCheq, a noninvasive wearable device for horses that continuously monitors their full cardiac function including heart rate and blood pressure, along with their respiration rate. Users can buy an add-on tail wrap that also monitors body temperature. The VetCheq device, a small waterproof box, is attached to the horse’s leg in a wrap that looks like a competition boot. It gathers data, which it streams, via Bluetooth, to a computer or a tablet. The computer then uploads the information to the cloud so that veterinarians or horse owners can access real-time data on their horse’s condition from anywhere. Alarms can be set to alert users if a particular threshold is crossed, and the data can be stored and analyzed to discover the relationship between particular patterns of biometric data and a horse’s outward condition. 

Sharon Caswell, a lifelong horse owner and an engineer, says she first had the idea for VetCheq almost a decade ago when a little girl in Benbrook died as the result of a riding accident after her horse suddenly bolted.

In surgery: a boot instead of an arterial catheter.

“When I read about the accident, I thought with all the technology with have, wouldn’t it be a good idea to have something that could give us a better idea of what is going on inside of our horses?” she says. That idea led her to Empirical Technologies in Charlottesville, Va., a company that had invented a wearable device for soldiers in combat situations that keeps track of their vital signs and sends them to a remote computer.

“I called the company up and told them that I was interested in using something similar for horses,” Sharon continues. “And I lucked out: usually when you make that kind of call, they don’t want to talk to you. But it turned out that the owner of the company also has horses and was very interested in talking about the idea.”  Sharon made a deal to license the technology, and VetCheq was born.

VetCheq is in now service at private clinics and in veterinary schools in several states while the algorithms it uses are being tweaked to make it more accurate in various different settings. It is already 95% accurate when used as a replacement for an arterial catheter in horses undergoing surgery. The next use for VetCheq is on standing horses that are recovering from surgery or have been admitted to the vet clinic for some other reason. 

Performance Equine Veterinary Services in Aiken is at the forefront of this technology. This January they started a project with PonyUp to gather data on horses in their clinic. This data is being sent to Texas A&M Veterinary School of Medicine, which will update the VetCheq algorithms for standing horses under a grant from the American Association of Equine Practitioners. Texas A&M will then validate the data in their clinic. The practitioners and staff of PEVS are excited about VetCheq’s capabilities. 

“I think it holds a lot of promise for colics, because when horses are in distress, their heart rate goes up,” says Kelly McKinnell, an account executive at PEVS who is leading the VetCheq project there. “If you have a really stoic horse that does not show many outward signs of discomfort, this is going to let you know; it won’t lie to you the way a horse might.

“We really want to use it on every horse that we see because it will tell us what is going on inside the horse,” she continues. “We can collect the data and be able to compare it from horse to horse and see what patterns there are. Then we can go back and say, for instance, every horse that had a bad colic had this pattern, and know in advance when a horse might be headed for trouble. There are endless applications that we are excited to use it for, including any intensive care horse that needs to be monitored. With a stoic horse, you can’t tell what is going on unless you are in there with your stethoscope getting their heart rate every five minutes. This device will make it possible to know the moment there is a problem.” 

Sharon Caswell hopes that VetCheq will also be used on competition horses to help trainers monitor their fitness. It might also be used at FEI events and at racetracks to assess recovery times. Another use is for owners and trainers to be able to monitor their horses remotely. 

“There are people with very valuable horses that might come out of quarantine, or that are being shipped and they can’t sleep at night worrying about their horse getting sick,” she says. “This can give them peace of mind since it will notify them immediately if any kind of trend starts to show up – elevated heart rate, respiration rate – they will be able to intervene immediately.” 

In the future, VetCheq’s information will be available as a smartphone app. There are also other uses for the technology down the line, such as wearable devices for horses that are being exercised. Sharon says that she is excited about the technology’s potential and about her company’s future. 

“The two great passions of my life are technology and horses,” she says. “I never thought there would be a way to put them together.  I feel really, really fortunate that I have been able to do this.”

This article is copyrighted and first appeared in The Aiken Horse. It is reprinted here by permission.

Saturday, July 1, 2017

The Lovely Bones

The Lovely Bones 

Functional Anatomy with Pamela Eckelbarger 

by Pam Gleason, Photography by Pam Gleason & Equus-soma

Pamela Blades Eckelbarger is keeping her old horse Petey in her garage in Aiken. It is not the whole horse. It is just the skeleton, cleaned, disinfected and polyurethaned. Petey’s leg bones and vertebrae are labeled and laid out in a careful display on a set of tables, arranged around his strangely expressive skull. His ribs are in a plastic tub nearby. There are some pictures of him too, from back in the day when he was a horse of flesh and blood. He was a lovely chestnut with a kind expression, and in his pictures he is jumping on the cross-country course with Pamela aboard.

“He loved to jump,” says Pamela. “He always had a smile on his face.”

Petey, properly Hail to Peter, was bred for the racetrack, but never made it there because he bowed a tendon when he was two. Seven years later, when Pamela, then a marine scientist, wanted to get ba
ck into riding, her family, who owned the horse, sent him to her. She evented him for many years, retiring him when he was in his early 20s. When he was 23, he developed tumors in his lungs and had to be put down. He was buried on the Eckelbarger’s farm in Maine, and there he lay for ten quiet years.

Meanwhile, Pamela had gone through some career changes. First, she was a professional horse photographer, running a successful business called Hoofpix. Then, she became interested in helping horses whose performance was limited by physical problems, so she started learning how to do equine bodywork. She soon had a company called Equus Soma, conducting business out of her home base in Aiken during the colder seasons and from her farm in Maine during the summers.

“I took a three-day class in whole horse dissection a few years ago, and it was amazing,” says Pamela. This experience convinced her that it was crucial for people to have a personal acquaintance with equine anatomy. If they could see what was inside their horses and how the bones and the joints fit together, then they would have a far better understanding of how equine movement works. They would also be able to see all the things that can go wrong and why certain training methods and
practices are not a good idea. She started to think that it would be helpful to have her own horse skeleton so that she could take parts of it around with her, to show her clients the anatomical structures where their own horses were having difficulties.

“But to buy a skeleton is very expensive,” she says. “It costs $9,000 to $12,000. I learned this, and then I thought ‘I know where there is a skeleton.’ So I went and broke the news to my husband: we are digging Petey up.”

Last summer when she was back up in Maine, she called the man who had helped her bury her old horse in the first place (ironically, he was also named Peter), and he returned to the farm with his excavator. Petey was buried deep, and he had been laid out flat in his grave. Peter used the excavator to dig down several feet, and then, as soon as they saw the first hint of horse bones, the excavator was sent away and Pamela climbed into the pit to do the rest of the digging and uncovering by hand.

“It was like an archaeological dig,” she says. “It was cool.”

She uncovered Petey as carefully as possible, photographing the process along the way. Then she started removing the bones, studying how they went together, and labeling each one before carrying it out. She let the bones dry in the sun and then assembled them for cleaning with hydrogen peroxide. After a decade underground, almost everything that was not bone was gone. That made the task easier for Pamela, both physically and emotionally. Essentially the only organ that was left was the remains of his brain, which had to be removed from his skull. “That part was hard,” says Pamela. “Because I looked at it and I thought, that was Petey. That was my horse.”

Last fall, when Pamela and her husband came down to Aiken, she brought Petey with her in a set of plastic tubs, then unpacked him and arranged him in her garage where she was able to study all the bones more carefully. She learned a lot.

“First, I learned that he had a fused hock,” she says. Horses have a large joint in their hock, which is what allows their hind leg to bend. Below it, there are three smaller joints that contribute to the leg’s mobility. She holds up Petey’s right hind cannon bone, which has two small, flat tarsal bones firmly attached to it; the two normally moveable joints between them are completely gone. Arthritis in a horse’s hock joints is quite common and is a major cause of hind limb lameness. When the arthritis progresses to a point that the bottom joints fuse together, many horses become sound again. This seems to be what happened to Petey.

Pamela found other places on his skeleton that indicated that he might have been in some kind of pain for at least part of his career.

“There is something called Wolff’s law that says that wherever a bone is stressed, more bone will grow in that place to stabilize the area,” she says. “That’s something that really fascinated me, finding extra bone on his skeleton that shouldn’t have been there.”

One place she found extra bone was on his vertebral column, where he showed symptoms of having “kissing spines” meaning that the top edges of the vertebrae on his back touched and rubbed against one another. Kissing spines are thought to be caused by the weight of the rider pressing down on the back. He also had extra bone at the vertebra where his neck joined his body (T1) and on the right side of his sacroiliac joint, where his vertebral column connected to his pelvis. (Did this have something to do with his fused right hock? Perhaps.)

“He didn’t really have symptoms of anything that I recognized, but every once in a while, he would be off. I might not have been sophisticated enough at the time to know what was wrong,” says Pamela. “Doing this is kind of like ‘CSI.’ That’s why I love it.” Aside from these small abnormalities, Petey’s bones are in excellent condition and show no signs of deterioration. They are clean, cool, pleasant to the touch, and completely odor free. Pamela encourages people to pick them up and examine them, to put the joints together and see how smoothly the bones glide back and forth. The bones are of different weights and thicknesses, depending on their function. Petey’s cannon bones are heavy and dense – they feel as strong as steel. His ribs are flat and lightweight, seeming almost birdlike by comparison. You can examine all the bones in his legs and his feet, see his hoofwall – he is even still wearing a shoe. You can pick up the navicular bone, that small, boat-shaped structure that can be the cause of so much lameness. Petey’s is smooth and perfect, with no bone spurs or other abnormalities.

“Petey’s new job is teaching,” Pamela says. In addition to taking specific bones and joints around to her bodywork clients to help them visualize structures inside their own horses, Pamela has been inviting interested people to come to her garage to see the entire skeleton. “I’ve had about five groups of people so far,” she says, adding that this summer, when Petey goes back to Maine with her, she is taking him to the local Pony Club there where they will have a ‘bone rally’ to help them learn equine anatomy.

Over the winter, Petey was even joined by two more skeletons, an 8-12 year old former polo pony (she is called Jane Doe, because Pamela does not know her name) and a 3-year-old Thoroughbred filly named Winnie, who was put down after suffering multiple problems, including ataxia in her hind legs. Both of these skeletons were given to Pamela here in Aiken, and both have contributed to her understanding of equine anatomy and the way incorrect riding and conditioning might affect a horse’s bones.

“This is my prize,” she says, pointing to the skeleton of the 3-yearold. She holds up one of the filly’s vertebrae, which is not solid like the vertebrae of the older horses. Instead, at its end it has a separation that looks almost like a fracture. It is not a fracture: it is a growth plate.

“I had always heard about growth plates, but I had never seen them. It was just a phrase to me,” she says. “But to see them like this was a real eye opener. Horses’ growth plates fuse down low in the legs first, so that the foal can get up and run. The last place they fuse is in the vertebral column, and that happens when a horse is 6 to 8 years old. This means those vertebrae have not finished turning into bone; they are still partially soft tissue. You have to think about methods of training, how you might take a young horse and put him on the lunge and maybe he acts up a little and you jerk on the rope. That might be enough to cause the growth in his neck to get asymmetrical. Trainers need to be aware of these things with young horses.”

Another training issue that Pamela hopes to raise awareness of is the negative consequences of using tight bridles and drop nosebands. She likes to bring Petey’s skull with her when she travels to the different stables where she works. She puts a bridle with a flash noseband on the skull to demonstrate where the straps put pressure on the horse’s head. “There is a very important facial nerve called the trigeminal nerve that comes out of the skull in three places. One is where the flash noseband goes. If you put pressure there, it can cause a lot of pain and make the horse resist.”

Pamela and her bones have gone back to Maine for the summer, but when they return in the fall, she is hoping to have more people come to see them for themselves so that they can gain a better understanding of equine anatomy. She is also hoping to collect some more skeletons, although she says they have to fit certain criteria. First and foremost, they must be horses that have been buried for long enough that only their bones will be left, since she would not be equipped to handle them otherwise.

“I’d love to have more horses between 3 and 8 years old, to look for growth plates and congenital deformities.” (Although she says she is not a vet and can’t be sure, she may have found a cause for Winnie’s ataxia: an area of extra bone growth on one side of one of her neck vertebrae that may have impinged on her nerves.) “I’d also love to find skeletons of horses that had issues people couldn’t figure out. But I can’t get too many,” she adds with a laugh. “Or my husband will kill me for taking over the garage.”

Pamela lifts the top half of Petey’s skull to show how his jaw hinges onto it at the temporal mandibular joint. Turning it over, she points out the chamber where his brain was and the complicated, fluted hollows of his nasal cavity. Then she puts the skull back down on the jaw and pats it affectionately.

“People ask me if it is upsetting to me that this was my own horse. It really isn’t – maybe it helps that he was buried for ten years,” she says. Does she feel like he is back with her? That they are partners once again, this time working together to educate people rather than to get the best score at the horse trials? She smiles. “No. Maybe. I do talk to him,” she admits. She looks at the skull and pats it one more time.

“Petey, you are such a good boy,” she says.

This article is copyrighted and first appeared in The Aiken Horse. It is reprinted here by permission.