Equine Thermography (Marengo, #3-2005)

Lydia Nevzorova's interview by Galina Bruk.

G. B. Lidia, in our previous interview you touched upon a very interesting subject in my opinion – equine thermography. I would like to hear a more detailed explanation of this method for diagnosing equine diseases, its pro's and con's.

Lidia Nevzorova. Frankly speaking, the method has only pro’s, no con’s. Let me explain. It will take the vet one to two hours to diagnose a lame horse. The examination may often be traumatic and painful for the diseased animal – the horse may be asked to lunge at a trot on asphalt or concrete, the vet will do a large number of flexion tests, press on sore areas, use a twitch to help restrain the horse, give nerve block injections, etc. Still, there is no guarantee that the correct diagnosis will be obtained. The use of a thermographic camera will reduce examination time to 15-20 minutes. The horse will be allowed to stand still without anyone touching him. The procedure will not cause harm, pain or stress, and will accurately detect the site of injury. Furthermore, the diagnosis will be confirmed by thermographic images, which clearly demonstrate inflammatory lesions and will help with further diagnostics and treatment. Horse-owners often don’t trust veterinarians, and that makes it hard for the vets to prove they are right. Thermographic images make it an easy task and it is a very important factor to consider. The owner's trust in the vet may determine whether the horse receives proper and timely medical treatment. Without trust, the owner may think the diagnosis is wrong and ignore the vet's advice.

Besides, I suppose that we have all seen situations where different doctors present different diagnoses. Thermography makes it impossible. There can be no mistakes.

The most important advantages of thermography include it being a 100% objective, quick and harmless diagnostic procedure. Thermography causes no side effects as no radiation exposure is involved.

G. B. Is thermography a universal diagnostic procedure, which can deal with any case and any diagnosis, even the most complicated ones?

L. N. I am not saying that thermography is the only useful and effective diagnostic method, but it is the first one to be used to establish a diagnosis. If your horse goes lame, you should start with a thermographic study. The study will show if you need an x-ray or an ultrasound, or any other diagnostic test. My confidence in the universal nature of equine thermography is based on my professional knowledge of diagnostic principles. I was taught by the most prominent equine thermologists in the world .Tom Ivers wasmy teacher, my mentor, and my friend.He has dedicated his life to equine thermography and he has taught me a lot.

Everybody knows that a vet will feel the lame leg of the horse trying to find the inflammatory lesion, i.e. where the leg «feels warm».

This is the oldest way of identifying a disease; however, the human hand is unable to appreciate a change in temperature of less than 3.0 degrees C, while special attention should be given to the areas which are 1-2 degrees C higher/lower in temperature compared to the contralateral limb. To put it simple, if the temperature of the fetlock joint of the right front leg is 15 degrees C, then the fetlock joint of the left front leg should be the same temperature. A temperature difference signifies a problem.

Computer thermography gives a clear thermal image of any body part of a living creature.

Even insignificant inflammation associated with muscle or tendon strain, contusion, injuries from bitting, back injuries caused by improper saddling, non-visible hoof problems like laminitis, navicular disease and other lamenesses – they are all visible to the specialist on a thermographic image. Certainly, one needs knowledge and experience to interpret thermographic images accurately, however even a superficial glance at the thermogram is sufficient to see if there is a problem in the area or not. Simply speaking, healthy areas are in the cool end of the spectrum, while inflamed areas show up with a localized accumulation of red, orange or white in the hottest or most inflamed area. Similar equipment that existed 20 years ago could not guarantee 100% objectivity. Present day equipment, computer hardware and software is so advanced, that it allows to view everything wide-screen: ligaments, tendons, joints, and to locate the lesion with millimeter accuracy.

G. B. Which horses need to undergo thermography more frequently than other horses?

L. N. Absolutely all racing and sport horses should undergo regular thermographic inspection. Everybody knows that there is a huge gap between what is and what should be. In western veterinary practice thermography is nearly a common everyday procedure, which allows to timely spot the first signs of inflammation. This of course is mostly the case with expensive athletic horses. The owner realizes that if he doesn’t fix the problem in due time, the horse may be unable to participate in a number of sporting events or may become disabled. A thermographer examines the horse before each race. If the thermographic image reveals even the slightest inflammation – the horse is withdrawn from the training and is stabled for a week until the next examination. After the examination, the horse is slowly re-introduced to exercise. It helps prevent serious and sometimes incurable injuries, which may require lengthy and costly treatment.

Although we do not train our horse for sport I examine our horses regularly.

G. B. In which country is thermography most widely used?

L. N. Thermography is most common in the USA. In Great Britain the method has also aroused interest; however, it is not very popular as it is opposed by British veterinarians for many reasons. These reasons include traditionalism, habit and general reluctance to compete with a powerful diagnostic method like computer thermography. It is well-known that «A good veterinarian is wrong 50 percent of the time, while thermography is never wrong». No veterinarian wants to know that his diagnosis was a mistake. Nevertheless, all large European practices have their own thermographic cameras.

Thermography is also used in the Olympics: there is no time for a complete examination before the start of the athletic event; the use of a thermographic camera allows to reduce the scanning time to 2-3 minutes.

G. B. Where in our country can a horse owner do a thermographic examination?

L. N. I have heard that there is a thermographic camera in Moscow, but I have never heard of anybody using it. Thermographic imaging is a valuable diagnostic tool, but you need to know how to use it. I’m afraid that at present I am the only practitioner to offer complete thermographic examination, which is a shame.

G. B. We have just discovered the downside to this method – its limited availability! Of course I'm only joking. seriously speaking, is the opposition of veterinarians, their reluctance to compete with computer thermography the only reason for the slow adoption of the method in Russia?

L. N. Certainly, in our case, it’s neither the most important nor the main obstacle. There is another reason that hampers the adoption of thermography – the high price of the equipment. Due to the high price, it took me a long while to make up my mind to buy the thermal camera. We had finally decided to purchase the thermographic camera when my horse Lipisina became seriously ill. One «fine» day the horse simply stopped eating – she stopped swallowing. She chewed the food just fine but after that the food would fall right out of her mouth. Together with one of the best veterinarians in our country, we thoroughly examined the horse and everything seemed to be alright. We suspected the most dreadful diseases, including esophageal atrophy. These were horrible days. On the third day of her illness, we bought a thermographic camera. I checked the horse the following evening and successfully identified the root cause of the problem. It turned out that the horse had parotitis – an inflammation of the parotid glands, which are large salivary glands located in front of each ear. Sometimes stones form inside the salivary glands. After a while the stones came out and the horse got well. I must say that before it all happened the horse had also had lumps behind her jowls, like many horses do, and nobody had ever told me what it was. Now I know better, but fortunately the lumps are no longer there.

G. B. Can ultrasound, which as a more common diagnostic method, be a substitute for thermography?

L. N. Ultrasound is a fine and a highly useful diagnostic method. However, to do an ultrasound you will first need to know which part of the body you need to examine. Secondly, ultrasound images are harder to interpret. Thirdly, ultrasound is not suitable for all tissues and all cases. Fourthly, ultrasound requires special preparations: you need to shave the area that will be examined, and, fifthly, the procedure is rather lengthy, which is a downside.

Actually, thermography is not a substitute for x-ray or ultrasound, but is a necessary primary diagnostic tool. When a veterinarian sees lameness in a horse, he is not always able to say if it is shoulder lameness or if the lameness is caused by inflammation of the distal (lower) joints, or even if the problem is in the contralateral limb. Thermography will help locate the inflamed area with 100% accuracy. This will make the vet’s task considerably easier, as he will then be able to choose which diagnostic tool (x‑ray or ultrasound) he will need to use next. As you must know, repeated exposure to x-rays could be harmful. If the cause of lameness is not clear, the vet may need to take x-ray images of all four limbs. The primary use of thermography allows to identify the limb or joint which needs to be further diagnosed using ultrasound or x-ray.

G. B. Does thermography allow to diagnose inflammation of internal organs, abdominal cavity, for instance?

L. N. The fact is that almost nobody does it at present. I don’t do it either. Judging by the human thermography, this is very popular in Western countries and in Russia. The Army Medical College in St. Petersburg and in Nizhniy Novgorod uses this method to diagnose a wide range of diseases and injuries of internal organs. However, it’s almost never done for a horse, although it is possible. Over 99% of all problems in the athletic horse are related to the musculoskeletal system; therefore this problem receives priority attention. Besides, one cannot embrace the boundless. I specialize in diagnosis and treatment of problems of the musculoskeletal system.

Of course, there are some terrific examples confirming that thermography is unique. Thermography was used in one of the zoos to identify pregnancy in a female panda following artificial insemination. The staff didn’t dare touch the panda for fear of a miscarriage. Thermography identified the presence of twins, which was later confirmed by the birth of two baby pandas.

G. B. Lidia, you call yourself a hippologist, why do you distance yourself from veterinary medicine? As far as I know, you have studied abroad?

L. N. I have graduated College of Equine Studies in Newmarket, England, and I am currently studying Equne Science at another college to acquire a deeper knowledge of equine practices. This is not veterinary medicine in the usual sense of the word. I don’t provide treatment, don’t perform surgery and don’t prescribe medicines. I advise on all matters related to preventive care and treatment of diseases, including proper care and maintenance (stable and pasture), correct saddling which is an important part of horse health maintenance, musculoskeletal system diagnosis, training, dieting and breeding issues, -- all of which didn't previously exist in our country. The way horse owners do it here is call a vet if the horse falls ill and treat the horse as prescribed, totally forgetting about preventive measures. And as I have learned from my own experiences there wasn’t anyone to tell the horse owners what to do. Ten years ago I, like many others, was desperately searching for information on horse care to no avail. And thus I had to go abroad, go to the West.

Actually, I have great respect for veterinarians. The previous absence of proper education is none of their fault. Some of the Russian veterinarians are very talented, highly skilled professionals, who never stop their education. Besides, veterinary treatment is not my bread and butter. Many fail to understand this, but it is my conscious decision to avoid giving a one-man diagnosis, although my knowledge and my experience allow me to do so in the majority of cases. I always examine the horse in the presence of the attending veterinarian. We discuss results and make conclusions. I give my opinion and suggest treatment, but it is up to the attending vet to decide what information will go to the horse owner. The vet is also the one responsible for medical treatment.

The advice I give is of recommendatory nature. Thermographic examination allows to pinpoint the problem area and can be followed by other diagnostic tests. As it is, in 90% of all cases thermal images are sufficient to make an accurate diagnosis. As a rule, my diagnosis is confirmed by x-ray examination. I always prefer to work together with veterinarians and farriers. My goal is to cure the horse and I never oppose myself to them as the only specialist the horse owner needs to consult. I’m not a veterinarian.

G. B. Lidia, why have you decided against becoming a veterinarian? This could have been of help to you, considering your current specialty.

L. N. To tell you the truth, I am hampered by my excessive love for the horse. The job of a vet is not only to diagnose, but to stitch the wounds, to castrate, and sometimes to put the sick animal to sleep. These I cannot and won’t do – I am probably too sentimental for these kinds of things. I don’t even vaccinate my horses myself, instead I call a vet, even though my education and my diploma state that I am able to do it. Not being a trained veterinarian, I nevertheless study veterinary science, follow its progress and improve my knowledge. I have a great home library, including the best English language books on veterinary medicine. Veterinary studies are in included in the College curriculum. Students study methodically and take examinations. I should have a full knowledge of the subject, must know everything about the causes of the diseases and their treatment. I also visit all postmortal examinations of horses in our region.

It has been my conscious decision to specialize in thermography. In many cases, it is the only applicable equine diagnostic method. How else can you examine the neck or the spine of a horse in our country? There is no other way.

I try to work in close contact with veterinarians. Fortunately, I know excellent professionals who are not afraid to hear an alternative opinion. They invite me for thermographic screening, to help them better diagnose the disorder. This is not a sign of the vet’s incompetence, but the proof of a serious attitude to his work. I enjoy working with such people as we share the same goal: to help the horse. Clever and experienced veterinarians with a solid professional reputation do not fear working with me.

Unfortunately, I have also encountered negative attitudes. Some guard their professional space most jealously. They fail to understand that they are limiting their own professional growth. Clearly no specialist can know it all, and it makes it the more difficult to understand, how a person can turn down an opportunity to learn more and to cure the horse. Besides, every doctor knows that medical diagnostic devices which were specifically developed and tuned to detect inflammation are far superior to human perception. Moreover, there are diseases that cannot be diagnosed otherwise, for example, the so called «dead limb syndrome» or the «thermoamputation» phenomenon, where a certain part of the body doesn’t show on a thermal image, as is it cold. This is usually caused by a pinched nerve, insufficient or disrupted blood circulation in the affected local area, and, if we are talking about a limb, it may also be a sign of atrophy. A veterinarian is virtually incapable of detecting this problem as he doesn’t observe any symptoms, like synovitis, and the limb itself feels cold. Up until today, nobody in Russia deals with diseases that are caused by improper saddling. The consequences of incorrect saddling may be compared to those arising from a lifetime of wearing shoes that are 2-3 sizes smaller than your feet and having to dance in them as well. What will happen to you? Improper saddling causes dramatic pathological changes in the horse’s back and muscle atrophy. Farriery and hoofcare are not less important. I thoroughly study everything related to the theory of hoofcare and hoof balance.

To become an orthopedic farrier in the West one will have to study for 6 years to qualify as a veterinarian and extend it for 4 additional years to receive a specialty in orthopedic farriery. A great number of horses suffer every day and every minute from shoeing. Incorrect hoof trimming damages the hoof balance and can lead to a dislocation of the bone; the weight distribution becomes uneven leading to an inflammation, and a fever – the inflamed area becomes clearly visible on a thermal image, while still undetectable by hand. The many powers of thermography allow me to be very persuasive and convincing. People can see the lesions for themselves, they understand that I’m not making anything up and are much more willing to follow my recommendations. Thermography is also an invaluable tool for diagnosing lameness. Lameness is often attributed to the shoulder joint, but in reality, shoulders are rarely the cause of lameness due to a strong muscular structure, etc. The most common cause of lameness is hoof problems.

Thermography can detect evidence of tendon or ligament damage two weeks before the lameness. Most often, tendon injury doesn’t occur in a single moment. As a rule, the injury takes time to develop and to show: the horse is not lame, no signs of inflammation are evident, and only a thermal image will show the future trauma.

G. B. Lidia, I’d like to offer you to have a regular column in our newspaper.

L. N. Certainly, how can I say no to you? I feel that people need my professional expertise and I’m willing to give my advice. I don’t just help the horse owners, I help the horses, and this is what I live, work and study for. A column in «Marengo» will make my job easier. Your newspaper is distributed all over the country. As far as I know, in many areas, where there is no access to Internet, your newspaper is the only accessible source of information on horse care. I think that your newspaper has a great potential and I’m sure that our cooperation will benefit Russian horses.

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Shoulder trauma, damage to a major nerve center. Before thermography the horse was treated for “hoof lameness”.

Purulent inflammation of the toe of the hoof, the horse demonstrated slight lameness. Before thermography the horse was treated for problems in diagonal hind leg.

The back of a healthy horse with a uniform cool skin surface temperature (on the left), and the back of a horse showing major back damage caused by improper saddling and training (dressage). The horse resisted the bit, refused to collect itself, but didn’t demonstrate obvious lameness. The recommendation was to get a proper well fitted saddle and introduce a new training regime after completion of the therapy course. Three months later the horse won the Prix St. Georges.

«Thermoamputation», loss of innervation and blood circulation in the limb caused by a pinched nerve in the thoracic spine, very low temperature of the left leg. The only apparent symptom was arrhythmia. The disease, if not detected, can lead to serious damage and limb atrophy.