Advancing Performance Horse Care with Dr. Liberty Getman: Regenerative Medicine & Emerging Research

Pegasus Co-Founder Jen Tankel is joined by Dr. Liberty Getman, DVM, DACVS, Equine Technical Services with Zoetis.

As advancements in equine medicine continue to evolve, regenerative medicine devices are playing an increasingly important role in supporting performance horses. 

In this episode, Dr. Liberty Getman breaks down how these devices are used in practice today, from joint therapies to the research guiding treatment decisions. We explore how veterinarians approach different options, what horse owners can expect from treatment timelines, and why factors like metabolic health and conditions like PPID matter more than many realize. 

This conversation brings clarity to a complex topic, helping owners and competitors better understand the science behind longevity, soundness, and performance.

Has your horse experienced lameness? Did you know that your veterinarian
can use the healing power of your horse’s own blood to help manage
lameness, joint pain, and more? The Pro-Stride ® APS regenerative
medicine device is designed to help keep horses feeling and performing
their best. Ask your vet if Pro-Stride APS may be a great option to help
support your horse’s joint health journey. Zoetis is always by
your side in the barn, down the centerline, and everywhere in between.

About Zoetis Equine: 

• Guest: Liberty Getman, DVM, DACVS, Equine Technical Services, Zoetis
• Research Release: Metabolic Effects of Pro-Stride® APS and Triamcinolone Acetonide Compared in Recent Research
• Research Release: Research Informs Use of Regenerative Medicine Devices in Horses With Cushing’s Disease
• Social: Follow @ZoetisEquine on Instagram and Facebook
• Blog: For more horse health tips, visit the Always by Your Side blog

🐴 This episode is brought to you by Pegasus.

Pegasus is the game-changer horse shows have been waiting for. It’s the first modern, cloud-based platform built just for equestrian events—free to use, no contracts, and ready for any discipline, anywhere.

 From fast entries to real-time results, Pegasus makes shows run smoother for organizers and easier for riders to stay informed and on schedule. Check it out at www.thepegasus.app

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Transcript

ProStride APS Sponsor Message

SPEAKER_00 0:00

Has your horse experienced lameness? Did you know that your veterinarian can use the healing power of your horse's own blood to help manage lameness, joint pain, and more? The ProStride APS Regenerative Medicine device is designed to help keep horses feeling and performing their best. Ask your vet if ProStride APS may be a great option to help support your horse's joint health journey. So Wettis is always by your side in the barn, down the center line, and everywhere in between. So welcome back, Dr. Gutvin. It's great to have you.

SPEAKER_01 0:45

Yeah, it's great to be back.

SPEAKER_00 0:46

So today we're diving into a topic that's become increasingly important for performance horses across every discipline: regenerative medicine devices and the research guiding how they're used in practice. So whether you're a casual rider, a high performance competitor, or someone running an equestrian business, understanding how advancements in equine medicine support longevity, soundness, and performance matters a lot. So I'm excited to welcome back Dr. Liberty Getman, an equine veterinarian, certified surgeon, and equine technical services veterinarian with SOETIS. Dr. Getman works closely with veterinarians across the country and is deeply involved in the research and education surrounding regenerative medicine devices used in horses today. For listeners, Dr. Getman, who might be listening in and meeting you for the first time, could you please describe your role in equine medicine and your specialty area in caring for performance horses?

SPEAKER_01 1:43

Sure. So again, thanks for having me back on. It's always great chatting with you guys. So I am an equine surgeon. And so what that means is just like in human medicine, you know, veterinarians can specialize, right? And so not only do we specialize in species, but we go a little bit further than that sometimes. And, you know, you certainly have your general practitioners, your equine vets that maybe do your vaccines and your wellness and your kind of everyday health care. Um, then probably many of you are familiar with having a sports medicine type veterinarian who will do a lot of your lameness exams and joint injections. And so I'm a surgeon by training, and that just means that after going to vet school, we then do an internship in residency, just like in human medicine, to specialize. And there are many fields you can specialize in. So we have veterinary internists, we have dermatologists, we have neurologists. So my training as a surgeon certainly I do a lot of surgery and was trained to do a lot of surgery. But within that, there's a lot of sports medicine and lameness as well. Um, and so we kind of combine those things in our specialty. And so in my daily practice, I would say, you know, I probably did 60% of my time doing surgery and about 40% of my time doing sports medicine and advanced imaging, so performing things like MRIs, bone scans, CTs, lameness exams, obviously, and joint injections. And so that's what I did in practice. I now work for Zoetis. And as you mentioned, my role now is mostly educational. So um I help educate veterinarians on some of the products that we have in the regenerative medicine device space and how they can use that to treat lameness in horses. I also educate vet students, I educate veterinary technicians and horse owners as well. So really my role is much more educational now.

From Racetrack Kid To Surgeon

SPEAKER_00 3:33

Gotcha. And did you always envision a career in equine veterinary medicine, or did your path essentially evolve along the way?

SPEAKER_01 3:40

Um, I actually wanted to be a jockey, and you guys really can't see that now. But if I were to stand up, you'd realize I'm short and small, so I am the perfect size to be a jockey. My parents trained racehorses, racing quarter horses, actually, and my mom was a jockey. And so I was pretty sure that's what I was gonna do. But I think my mom, having been a jockey and and understood how hard that career is, um, in many aspects, right? Hard just in terms of making it, but also hard on your body. So she'd had a lot of broken bones doing that. And she said, absolutely not. You are not going to be a jockey. And so she said, I don't care what you do, but you've got to go to school for something. So growing up on the racetrack, I was always interested in the vets that helped us with our horses. So I I just assumed that I would be a racetrack vet. Um, but when I got into vet school, I really enjoyed my surgery rotations. I didn't know that you could be an equine surgeon. I didn't realize that was a thing. But in school, I really enjoyed that and so decided to pursue that after that.

What Zoetis Work Looks Like

SPEAKER_00 4:37

Wow. And well, I mean, imagine you still work with racehorses today as well. A lot. Yep. A lot. Wow. Feel a bit full circle. And within your career role at Zoetis, are you so you work closely with veterinarians and research teams, but what does your actual day-to-day look like? And what excites you the most about that work?

SPEAKER_01 4:54

Yeah. Um, the thing that's pretty cool about my career is no day looks the same as the next. And that's how it was I how it was when I was in practice too. I think that's what draws a lot of equine veterinarians into practice is that we don't have an office job. We don't have a nine to five job. And I don't know that most of our personality types are cut out for that. And so for me, some weeks I'm on the road traveling, helping our sales reps go into various veterinary clinics and educate veterinarians on some of our products. Sometimes that's, you know, an early morning meeting with the practice before they open and giving them a formal presentation. Sometimes it's a quick, you know, coffee break chat with a veterinarian. Sometimes it's more of a hands-on, hey, can you come into our practice and look at this case with me and do some consulting and help us figure out, A, what's wrong with this horse and B, how could we best treat it? So we do a lot of hands-on things like that. I also work with the team of scientists at Zoetis to help, you know, give them information on what equine veterinarians need, what products we need that are missing to treat different diseases and and issues with our equine patients. And so the team at Zoetis, we have some great scientists who are always working on new things to try to help treat our patients in better and different ways. And so I get to work with those teams a lot, and that's very interesting as well.

SPEAKER_00 6:13

Yeah, I bet. There's um never a dull day, I bet.

Why Steroids Aren’t A Long-Term Fix

SPEAKER_01 6:16

Nope, there isn't.

SPEAKER_00 6:17

Okay, so going on to performance horse injections, which I know is a big, it's a big topic and things that um a lot of our listeners will be interested in as well. So joint injections and intra-articular therapies have become increasingly common in performance horses, but from your perspective, how has this area of equine medicine evolved over time?

SPEAKER_01 6:37

Yeah, I think that's really exciting to think about um and just the advancement that we've had and the types of therapies that we can use intra-articularly in our equine patients and also in our human patients, our dog patients as well. And so one thing that we know is that, you know, joints are similar across species. And so some of the therapies that can be used in humans can also be used in our equine patients. They can also be used in our canine patients. And all of these fields are really learning from each other, right? So we see what's happening on the human side and vice versa. A lot of times, you know, human medicine kind of takes a cue from what we're doing in equine medicine. And I think one of the most exciting things is that historically the way we've treated joints in our equine patients and in our human patients has been with treatments like corticosteroids and hyaluronic acid. And those treatments are effective in that they relieve pain, right? They definitely make you or your horse feel better if you have arthritis that's causing pain. If you inject a joint with a corticosteroid and hyaluronic acid, that horse or that human is going to feel better. But what we learned over time is that those treatments are kind of like slapping a band-aid on something, you're not really fixing anything, right? And so while that corticosteroid might make the horse feel better, over time, long term, if you repeatedly inject corticosteroids into a joint, you're actually creating some joint damage. You're kind of contributing to that joint damage. You're not slowing down the progression of disease. And so on both the equine and the human side, we've really been looking for therapies that would, of course, make you feel better, right? That's what we want. But we also want to help treat that joint, you know, not just slap a band-aid on it, but help heal the joint, help decrease the inflammation, perhaps slow down the progression of arthritis in that space. And so that's where these regenerative medicine therapies have come into play. Um, you know, in the last 15 or so years, they've been used much, much more frequently on both the equine and the human side. And these are therapies that are typically made from the patient's own blood or bone marrow that you can take from that patient, process in a device, extract things that are going to help heal that joint and decrease inflammation and decrease pain, and then put that back into a joint.

SPEAKER_00 8:50

Oh, that's so interesting. So it's almost like, okay, so with the with the previous injections, it's like to your point, it's a it's a band-aid, but over time it actually will do more harm. And so if you were to just kind of switch your approach, that is a more long-term, sustainable option that actually helps them get like get better.

SPEAKER_01 9:09

Exactly. And I think a lot of people have historically thought, oh, well, these joint injections, you know, I think for horse owners and and even some veterinarians, it can be confusing, right? Because an injection sounds like an injection and you don't realize that there are different types of injections. And I think many horse owners think that they're being preventative and prophylactic and doing some of these joint injections. And if you're using a regenerative therapy, you are, right? You hopefully are being more prophylactic and helping heal that joint. But if you're using something like a steroid to your point, you're actually causing more harm long term. And so it's it's my job and the job of an equine veterinarian to kind of know how these newer therapies work and help educate our clients on why we want to use these types of therapies now instead of things like steroids.

SPEAKER_00 9:56

Oh, okay. And so, and you mentioned that's for horses and for humans. Does that logic still apply for like, say, dogs as well? Yeah.

SPEAKER_01 10:03

And so, you know, joint injections are less common in dogs, but certainly people do them. And these therapies can also be used on our canine patients, on our feline patients. So uh when it comes to joint care, it is similar across species and similar principles are gonna hold true. And so steroids are gonna make everybody feel better, but they're gonna contribute to everybody's joint disease. These regenerative therapies can be used in pretty much any species.

Choosing Therapy Starts With Diagnosis

SPEAKER_00 10:28

Okay. So, and on that note, too, because there are multiple approaches and options that are available on the market today, how do veterinarians think through which type of therapy or device might be appropriate for a specific course or situation?

SPEAKER_01 10:41

Yeah, and that's again where my job comes into play because it is an ever-changing space and it can be very confusing because there are lots of these regenerative therapy options on the market and they all act a little bit differently. And so what I try to get veterinarians to understand is a couple of things. One, you need a really good diagnosis. You need to know what you're treating, right? And so if the horse comes to you and say they're hesitating over a jump, or it's a barrel horse who's going a bit past the first barrel, but that's really their only sign of lameness, you know, just kind of starting to inject things willy-nilly probably isn't going to work. It may work initially, but eventually, if you don't know what you're treating, you're not going to be very effective. You know, kind of the throwing the kitchen sink at it approach works until it doesn't, right? And so you really do need a good diagnosis. So I try to really help veterinarians understand that in order to pick the most effective treatment, you first need to know what's wrong. It's not enough to know that the horse looks a little off behind. You need to know, okay, that horse looks a little off behind, it's refusing the jumps, it's lame right hind. I've isolated that lameness to the hawk. We know the horse has arthritis in the hawk. That's what I need to treat, right? So that's a diagnosis. So you do first need a diagnosis because the way you're going to treat a joint disease would be different than how you might treat a problem with a soft tissue structure like a torn tendon or ligament. So you need a good diagnosis. You need to know what is causing the horse's lameness or what is causing the horse's performance issues. And then once you know that, you can pick the appropriate therapy because some of these therapies, like I said, are going to be better for soft tissue injuries, and some of them are going to be better for joint problems like arthritis or cinnovitis.

SPEAKER_00 12:23

Right. Yeah, not just going and injecting or but it that reminds me, I remember in college, um we had like a medical student center, and it was like if you had like a cold, a flu, a sniffle, it didn't matter what, the doctors there will just prescribe you a ZPAC. It's like a Z-PAC for everything.

SPEAKER_01 12:41

And you know, that might work the first time, right? Especially on your lame horses. If your horse isn't performing well and you take it to the vet and you inject hawk stifles and coffins, that might work the first time just by process of elimination. But if you have a horse who that isn't working for, or you want to be more specific and you actually want to know what you're treating and what the prognosis is and what the best choice is, then it's really important to have an accurate diagnosis.

ProStride Timeline And Expected Results

SPEAKER_00 13:04

Yeah, that makes a lot of sense. Yeah. Just apply a little bit of common sense and first principle thinking there. Okay, so so on that note, when veterinarians use a regenerative medicine device like prostride APS, what does the general treatment timeline look like? And when might owners begin to notice a positive change?

SPEAKER_01 13:19

Yeah. So if you're using something like prostride, and that is one of the regenerative medicine devices that we have to help treat joints, typically we are using prostride and joints either for a horse that has arthritis, or sometimes it's a horse that just has sinovitis, and that just means joint inflammation. So a joint that's a little angry, upset, but doesn't have full-blown arthritis. So you can use prostride in both of those situations. And what I tell my clients is that the joint injection itself to you as a horse owner is going to be very similar. It's just what we're using is different, right? So the protocol will be similar to if you're using a corticosteroid and hyaluronic acid. So you're still gonna bring your horse into us, you know, we're probably gonna sedate it. It's gonna take about 20 minutes. We're gonna pull some blood from your horse, we're gonna put it in the prostrate device, centrifuge it, and then extract some platelets and white blood cells and some other healing proteins that we're then gonna put back into your horse's joint. But that's gonna look like a normal joint injection. The downtime after a joint injection isn't gonna be any different than what you would have for a corticosteroid and HA. So every vet kind of has their own protocol. You know, for me, it's one day up in a stall, two days of light activity, and then they can return to full work. But the important thing to know about these regenerative therapies is because they are working on a cellular level, you're not just slapping a band-aid on it, they do take a little bit longer to reach their full effect. So your horse can definitely go back to work at the same time frame that it would after a corticosteroid injection, but in order to see the full effect of that treatment, you probably need about three or four weeks. So the force can still be in work, but know that it's going to continue to get better out to about three or four weeks after that prostride injection. The good thing about doing something like prostride, though, is although it may take a little bit longer to see the full effect, hopefully it's also going to last longer as well. And so, you know, we've got studies that have shown that a single injection of prostride can last for up to a year in most cases. Now, obviously, that's gonna depend on why your horse needs the injection, right? If it has severe arthritis, it probably isn't gonna last a full year. But if it's a horse that has some mild inflammation, some mild sinevitis, or some mild to moderate moderate arthritis, then yeah, one injection of prostrite is gonna last hopefully about a year. And so you shouldn't need to inject prostride as frequently as you would a corticosteroid and hyaluronic acid. So yes, you may have to wait a little bit longer to see the full effect, but you're not gonna have to do it as frequently. And it's gonna be healthier for the joint long term than those corticosteroids are.

Steroids And Metabolic Side Effects

SPEAKER_00 15:48

Gotcha. Okay. And and um, yeah, it's interesting because with other injections, like you were saying, I remember we had to do these injections. I don't know if it was monthly, but it was certainly more than just once or twice a year. So um, okay. So then shifting focus a little bit, so or or focusing on the metabolic research topic. So one area of recent research has focused on metabolic health in horses receiving droit therapies. What does this research suggest when it comes to regenerative medicine devices like prostrate APS?

Spotting Metabolic Issues And Risk

SPEAKER_01 16:17

Yeah, so the metabolic system of horses and metabolic disease is a really interesting and emerging area of research for us. You know, I think historically we all used to think Cushing's disease and metabolic disease is for those old horses, you know, those old pasture ornaments that are in their 20s and they're retired. And what we've come to find through lots of research is a couple of things. One, our horses are competing longer, right? It's not uncommon for us to have horses in their mid to even late teens still competing at a very high level. So we have older horses that are competing, but we also know now that we test more horses for metabolic disease, we are starting to see metabolic disease in horses younger than what we historically thought. So it again is not uncommon to see a horse who is eight, 10, or 12 years old that may be testing positive for metabolic disease. So not full-blown cushing disease, those are actually two different things, but metabolic disease can act similar to cushing disease in horses, and it can make them very sensitive to things like sugar. It can make them more prone to foundering, especially if they are exposed to steroids. And so that's something that as veterinarians, we're always worried about. You know, we know if a horse has metabolic disease, those horses are going to be more sensitive to the corticosteroid injections. Those corticosteroid injections may cause that horse to founder if it does have metabolic disease. So we're always trying to make sure that we're not using corticosteroids in those patients. But again, like I said, because there's a lot of emerging research coming out, we're finding that subclinical metabolic disease is actually probably more common than we thought. Metabolic disease is actually quite hard to diagnose in the early stages in horses. So you could have a horse that has subclinical metabolic disease that may not quite test positive for metabolic disease yet. And so because of that, I think, you know, in general, we are starting to be a little more conservative in our corticosteroid use, not just because it's not great for the cartilage, right? As we discussed earlier, it's it's gonna make the horse feel better, but it's not really good for the cartilage long term. But it doesn't just affect the horse's joint. So when you put a corticosteroid into the horse's joint, we know that that horse can have systemic or metabolic effects from it. And so there's been some really good research done out of both the University of Kentucky's Gluck Equine Research Center and the University of Georgia looking at metabolic disease in horses and what happens to horses when you put a corticosteroid injection into a joint and how that affects a horse systemically. And they found a couple of interesting things. One is that even in horses that are metabolically normal, so younger horses, no metabolic disease, they don't have subclinical metabolic disease, when you put a standard dose of triamcinolone, which is a type of corticosteroid, into a fetlock joint, and that's a very routine injection that a lot of horses get when they're showing, right? Um, an ankle of a corticosteroid like triumsenolone, within about two hours after that injection, you're already affecting that horse's metabolic parameters in a negative way. And some of those effects can last out to five days, depending on which parameter you're looking at. And so we know that from this research, we can say even healthy horses, when you put steroids into their joints, that can have a negative metabolic effect on healthy horses without metabolic disease. And so it just makes us much more cautious when we're treating these patients with steroids. And it again is another reason to reach for a more natural solution like a regenerative medicine device, such as prostride. That same study that was done at the University of Gluck also put prostride in horses' joints and measured those same metabolic parameters, and they did not see any negative effects after a prostride injection. And so from that study, we were able to say that, you know, you need to be cautious when you're using steroids as your joint injections, just for what they're doing to the joint, but because they can also affect the metabolic health of the horse. Whereas more natural therapies like prostrite aren't going to have any negative metabolic effect.

SPEAKER_00 21:17

For the, you know, new horse owners or for those that aren't as familiar with the metabolic, you know, like potential issues, yeah. What are some of the obvious signs that your horse might have a metabolic issue?

SPEAKER_01 21:29

Yeah, for me, I think about, you know, the kind of your poster child would be the horse that's maybe early to mid-teens, um, isn't quite shedding out the way that it should, has some or abnormal fat deposits. So maybe the horse in general is not overweight, but it could have a crusty neck. And that's a pretty classic sign of it, or fat deposits on either side of its rump, that's kind of one spot you can look. So on either side of the tail head, crusty neck, a little bit of fat right along the rib cage, kind of like right in front of where the girth would sit. So if you notice that your horse overall has a good weight, but is having these abnormal fat deposits, or if it's a little bit lower to shut out, some other things we see sometimes is horses that are getting chronic skin infections or wounds that don't quite heal the way that they should. These could all be signs of a horse whose immune system and their metabolic system isn't working quite normally. And so if you suspect anything, any of those things, there's a couple of simple blood tests that your veterinarians can do to rule in or out metabolic disease. And like I said, it's a little bit tricky. Horses can have subclinical metabolic disease for quite a while before they actually test positive on those blood tests. So sometimes if they have those clinical signs like not shedding out abnormal fat deposits in their, you know, mid teens, then your vet may still treat your horse as if it has metabolic disease because sometimes it can be a year or two before they truly test positive for it. Even if they have some of those signs.

SPEAKER_00 22:56

Gotcha. Okay. It's really helpful. And so why is metabolic health an important consideration for for performance horses? So even those that appear otherwise healthy?

SPEAKER_01 23:05

I think the biggest thing that we think about and the most obvious is that any horse with metabolic disease is going to be at a higher risk of foundering or developing laminitis. And so, you know, whereas a normal horse, you could turn out on that nice lush spring grass that we're hopefully going to have here in a couple of months, you'll find your horses with metabolic disease, even though they seem pretty normal, those are the type of horses that if you put them out on that lush green grass and they eat too much grass, those horses can get a little foot sore and even develop laminitis or founder. So that's the biggest one. Metabolic disease definitely puts them at risk of foundering. We know that if you couple that with using steroids in these horses, that puts that risk even higher. So certainly that's a horse you would want to avoid using corticosteroids in their joints. But then, like I mentioned, there are other things that are maybe a little less obvious. So maybe the horse just isn't quite as thrifty. Some of these horses you actually notice will lose muscle mass, even though they're gaining those fatty deposits. So, you know, a horse that's in good work that should be in good muscle condition, but you notice their muscle mass itself is not that good, even if they are getting kind of a crusty neck. And again, we think, you know, a lot of these horses aren't very normal immunologically. So they may not deal with an infection as well as your typical horse would. And maybe they're getting more rain rot, more nagging skin infections, things that they're not able to clear quite as quickly as you think that they should. So those would all be typical of a horse that has metabolic disease.

SPEAKER_00 24:33

Okay. And so kind of going to um, you know, talking about cushions. So you mentioned cushions before. For those that aren't familiar with cushions, could could you actually just set that up as to what that is and just like define it for the audience?

SPEAKER_01 24:44

Yeah. And so cushions is an actual defined pituitary adenoma. So a part of their brain gets this benign growth that um sort of dysregulates their hormonal system. And so metabolic disease has some of the same signs, some of the same clinical signs, but Cushing's disease typically we think of as older horses, you know, late teens to early 20s, they're typically gonna test much higher on some of those blood parameters that we're talking about, and they're gonna have much more obvious signs. So while metabolic disease and Cushing's disease aren't the same thing, they're kind of on the same spectrum as far as the types of clinical signs that you will see. But Cushing's disease, typically much older horses, their clinical signs are gonna be much more severe. So they are much more likely to develop laminitis kind of for no reason. Sometimes they will have a much longer hair coat. That's pretty classic for these guys. They don't shed out like their normal counterparts would. They are again getting those big crusty necks and fat deposits, long hair coat, unthrifty. So that's, you know, in a way, if you want to think about metabolic disease and Cushing's disease on a scale of one to 10, you know, you'd say metabolic disease is kind of from a one to six, and Cushings is probably from like a seven to ten, as far as the types of clinical signs that you'll see in those cases.

PPID Safety And ProStride Output

SPEAKER_00 26:01

Okay, gotcha. Yeah, I, you know, I had a Mary, she did advanced level eventing. Uh, you know, with with me, I competed up to prelim with her. And then um, she had bone chips in her knee and ultimately had to be retired. But shortly after she was retired, she developed Cushing's disease. And so yeah, she had the very long code. It was actually quite curly. And it was really sad. We didn't know if there was any kind of correlation between her retirement and developing cushions, or if it just happened to be like the, you know, her age. She was, I think, almost almost close to 20 at that time.

SPEAKER_01 26:31

Yeah, and I think 20, and and there have been, you know, studies. There was another study that we'll probably talk about in a minute that was done at the University of Georgia that looked at horses with Cushing's disease. And that is one of the things they found in that study. Horses with Cushing's disease were older, much older. So metabolic disease is probably going to be in your, you know, middle-aged athletes. Cushing's disease is going to be horses that are getting close to retirement age typically. And whether there's any correlation, that's hard to say. But it is much more common in horses that are older.

SPEAKER_00 26:59

Yeah. Okay. Yeah. And on that note, too, so why might regenerative medicine devices be a helpful option for horses diagnosed with PPID?

SPEAKER_01 27:07

Yeah, we really want to encourage veterinarians and horse owners to use a regenerative therapy in horses with Cushing's disease. Because, like I mentioned, these horses are very at a very high risk of developing glaminitis, right? And so, you know, these are the horses where they live in a grazing muzzle or on a dry lot. And if they happen to sneak five bites of grass, they'll get a little bit foot sore, right? Because they're that sensitive to the sugar that's in grasses. And so these horses are very sensitive to a lot of things metabolically. They're kind of teetering on the edge at all times. And even a even a small dose of steroids put into these horses' joints can kind of tip them over the edge and make them develop laminitis. So we know that these regenerative therapies, these all natural therapies that are made from their own blood or bone marrow, are going to be a lot safer for them because it's not going to put them at risk for developing laminitis. So many veterinarians already use these types of therapies in horses that do have Cushings disease because we have lots of horses that are diagnosed positive for Cushings that are still competing. You know, I think we do a better job of managing these horses now. And again, our horses are competing longer, maybe at a lower level, but a lot of them are still being ridden and doing athletic things and maybe have some arthritis that their joints need to be treated, right? But I think it for a while, veterinarians were concerned that perhaps horses that had full-blown Cushing's disease maybe couldn't make a good regenerative therapy. Maybe they couldn't make a good prostride. And the reason veterinarians worried about that is because we know horses with Cushing's disease, their immune system isn't quite normal, right? Their metabolic system isn't normal, their immune system isn't normal. And when we make these regenerative therapies, we're using your horse's blood and capturing some of those immune cells and proteins and cytokines to put back into your horse's joint. And so the veterinarian's concern was, well, this horse doesn't have a normal immune system. If I make prostride from it, will that be a good output of a prostride kit? Since we need the horse's immune cells and immune system to make that prostride product. And so there was a study that was done out of the University of Georgia again, and they looked at just that and they compared horses that had Cushing's disease with normal horses that did not, and they made prostrid kits from both of those groups. And what they found is there was no difference in the output. So horses with Cushing's disease, the output of a prostried kit was identical to the output of a prostried kit made from a metabolically normal horse. And so that made veterinarians feel a lot better, and that yes, we can use these all natural therapies in our Cushing's disease horses, and you're going to get a good output from those kits. Even though they're not immunologically normal, they'll still make a normal prostride.

SPEAKER_00 29:47

Interesting. So in that case, too, so you have a horse that has cushions, you're able to utilize the device on that horse that has cushions. Is does that mean that you're going to essentially resolve Cushings? Like they will be cleared from it, or it's just it's going to be a more manageable like symptom, if you will.

Who Is A Good Candidate

SPEAKER_01 30:02

Yeah. So it won't help their Cushing's disease itself. And there are other medications that you can use for that, but it will help manage their joint disease if they're a horse that needs joint injections. So far, far safer to use prostride as a joint injection in horses with Cushing's disease than it is a steroid, because we know, again, those horses with Cushing's disease are at high risk of founding and you compound that risk if you put a steroid into their joint. And so if a horse with Cushing's disease needs joint care, it's much safer to use a regenerative therapy like prostride on those horses because it's not going to have that increased risk of causing them to founder. But it won't help their Cushing's disease itself. And we do always recommend that if your horse is tested positive for Cushings, to try to get that regulated before doing any types of joint injections on them. First of all, you probably don't want to continue to ride and compete on that horse if it's very unregulated and it's Cushing's disease, right? And so there are other medications and therapy that you can give them systemically before you would, you know, want to treat them. That being said, that study that I just mentioned, it was a research study with a research herd at the university. And those horses, their Cushing's disease was not regulated. They were not on any medication for it. For lack of a better term, they had kind of raging Cushing's disease, and yet they still made a good prostride kit. So we know that you can make a good prostride from those horses that do have Cushing's disease, even if their disease isn't well regulated. Gotcha. I mean, is there even a cure for Cushings at this point? There's no cure, but you can manage it. So there's a medication called Frescend or pergolide, and there are a couple of other medications. You know, each veterinarian kind of has a cocktail that they like to use, but it's mostly getting them on a medication like presend or pergolide, and then doing serial blood testing to see if their ACTH and insulin levels are normalizing, and then getting them on a dose of that medication daily that keeps those blood tests normalized. And when you do, you see a lot of their clinical signs improve. You know, they start to shed out better, they're not having these foot soreness episodes, their body mass is improving. So horses, once you get those blood values regulated with those systemic medications, they do much better clinically for sure.

SPEAKER_00 32:20

Have you noticed that there are any trends? I mean, I know you mentioned the age, of course, but are there any other trends that you've noticed within, you know, your experience that, you know, maybe it's certain breeds, certain locations, certain, you know, types of activity that a horse might be more susceptible to developing a metabolic disease? Yeah, and it's interesting.

SPEAKER_01 32:38

I think now that we test for it more and are more aware of it, it seems like we're seeing more of it, but I don't know if we're actually seeing more of it or if we're just getting better at testing and looking for it. I have seen, I think, as far as trends for me, I've seen younger horses in the quarter horse performance world testing positive for metabolic disease at a much younger age than I would expect. So, you know, not uncommon for me to see seven and eight-year-old quarter horses, whether they're rainers, cutters, pleasure horse testing positive for metabolic disease. And to me, that's unusual, but maybe it's not. Maybe I just started looking for it more and then diagnosing it more. So I think that's the biggest trend that I would say is, you know, metabolic disease can occur in horses younger than what we previously thought it could. And so I think, you know, as an owner, as a veterinarian, if your spidey senses are kind of telling you something's a little off with this horse, like, huh, this horse is a little bit rounder than it should be. It's kind of a little butter ball. Every spring it gets a little foot sore after it goes out on pasture for the first couple of times, or, you know, huh, it's neck's getting a little bit cresty. Even if it's only seven or eight years old, I think it's worth testing that horse because I think we are seeing it in younger horses than we previously thought.

SPEAKER_00 33:50

That's really interesting. And so what I know too, so when a when a veterinarian is evaluating whether a horse could be a candidate for a regenerative medicine device, what signs or factors are they typically considering?

SPEAKER_01 34:01

Yeah, I think um, you know, A, again, back to that diagnosis, what are you trying to accomplish in that patient? And then B, the severity of disease. And so when we talk about, you know, joint disease and whether it's cynovitis, so just inflammation of the joint or arthritis, I think these regenerative therapies are extremely beneficial in most cases until they get to the point where that joint has no more cartilage left, right? So if you have an end stage joint, you know, a horse that is crippled at a one of the X-rays, their arthritis would be graded as severe. In those cases, those joints, with these regenerative therapies, what we're trying to do is protect the cartilage that's there and keep that joint from losing any more cartilage. And once the cartilage is gone, you can't put it back. Nothing can put it back. And so for me in my practice, you know, I think I would always reach for a regenerative therapy for a joint in a horse that just has some mild inflammation or is lame on a scale of, you know, two to two and a half out of five or less, a regenerative therapy is probably going to be my go-to product in that horse. Once the horse gets to be about a grade three lame or more, I'm not saying I wouldn't use regenerative therapies in those cases, I would, but understand that at some point there is a point of no return. You know, once the cartilage is gone, once the joint has enough damage that it's severely damaged, these are the types of joints that if you were a human, they would be telling you to get a joint replacement, right? And we can't do that in a lot of joints in horses. We can fuse some of them, but we can't replace any of them. Once the joint disease or arthritis has progressed to that level, these regenerative therapies, that's not really their place. And we really want to be using them when there's still some cartilage left. We're still trying to keep that joint happy and healthy. So for me, I think I would use a regenerative therapy in most cases unless it has severe joint disease. And what is a fused joint? So a fused joint just means that, you know, in a joint, um, you have two bones touching each other, but on the ends of those bones, there's cartilage. And that cartilage is nice and slick so that it can glide. Um so that when you bend your knee or your horse bends its ankle, that bending and gliding is a very slick surface and allows it to happen easily. When you develop arthritis or your horse develops arthritis, that cartilage starts to erode and get eaten away. It's kind of like potholes in a road, right? So when the potholes are small, you still have a chance to use one of these regenerative therapies like prostride to put it in the joint and come and fill in those potholes. But once the potholes get really, really big to where it's taking up like 90% of the road, then it becomes very, very hard to fill that damage in, right? So once all of that cartilage is gone and you truly have bone on bone, there's a lot of friction there. Um, at that point, those ends of the bones can kind of stick together and not allow that joint to bend very much. And so that would be a fused joint. Now, it doesn't happen very often in horses. And the most common example where it does happen and can happen is in the lower hawk joints, because those joints don't need to move very much, right? They only move a couple of millimeters at a time. Horses very commonly do get arthritis in their lower hawk joints. And eventually, once that cartilage is gone and those joints kind of stick together, they can't move anymore, but that also takes away the pain. So in those joints, those joints can naturally fuse, or we can surgically help them fuse if we know that there's not enough cartilage left in there to try to help that joint. But there's really not many other joints in the horse that do that naturally. There's some we can do it surgically too. So we can surgically fuse a horse's pastern or ankle or a carpus, but those are pretty involved surgeries to do that.

SPEAKER_00 37:38

Right. Okay, gotcha. I mean, it's the same horse that had cushions before I got her. She had her hawks fuse. So that's also why she was, you know, she wasn't able to compete at advance anymore, but she was still able to compete at a very high level. But I was 14 when that happened. So I didn't really fully understand then, you know.

Questions To Ask Your Veterinarian

SPEAKER_01 37:53

And I think it's really confusing. And I think it's a term that's used improperly a lot, but that is the very, probably the only joint in the horse that can fuse and still give you a pretty athletic horse because those joints don't move very much to start with. If you were to take a joint like your shoulder or your horse's ankle, right, that really needs to bend. You think about a horse and watching a horse go and watching how much that ankle bends. Although we can fuse that joint surgically, those horses are not athletic after that because you've taken away a lot of that natural motion of that joint.

SPEAKER_00 38:25

Yeah, totally. I mean, there weren't any issues with her hawks after that. It was, yeah, the the bone chips that she ended up needing surgery for were in her knee. So you know, I assume that they were unrelated, but still probably the end result of a high-level competition.

SPEAKER_01 38:39

I can say it sounds like she had a good long career probably due to those things.

SPEAKER_00 38:44

She was depressed when you retired. That's why I was like, is that why she developed cushions? Because she she did not like, you know, going from that to a pasture pet. A lot of horses don't.

SPEAKER_01 38:52

The true athletes, just like any athlete, right, they like their job. And, you know, yeah, I think it can be a little hard for them to stop doing it.

SPEAKER_00 39:00

Yeah. Well, that's been really helpful. So, okay, so going into um questions that horse owners should feel comfortable asking their veterinarians when discussing these options. So there's a lot of different terms that, you know, we we discussed a lot of different types of therapies and things like that. But when um, you know, like what would you say are some of the questions that those horse owners should should be asking their vets?

SPEAKER_01 39:21

Yeah. I mean, first of all, what's the diagnosis? Right? What are we treating? And I think, you know, it's our job as veterinarians to um help give you the tools to understand our thought process as well. You know, if I look at your horse, I watch it go, I don't really tell you what I'm doing, I walk it into the clinic, shoot some x-rays, and say we need to inject this, you probably don't know why I'm saying that. And so hopefully you have a veterinarian that you feel very comfortable asking questions of and having conversations. And hopefully your veterinarian is doing a good job of explaining to you step by step what they're doing, what they're seeing, and why they're doing it. So, first of all, what's the diagnosis? Um, what are the treatment options for that diagnosis and what's the prognosis, right? Those are the big ones. But I think you definitely should ask your veterinarian what they're putting in your horse's joint if you together decide to do a joint in gym. Don't be afraid to ask them, what are you using? Why are you choosing that? I think a lot of veterinarians are sometimes hesitant to discuss using a regenerative therapy. If they've always done a corticosteroid and hyaluronic acid in your horse, they may assume that that's still what you want and they don't necessarily want to rock the boat, or maybe they they just assume that that's what you want because that's what you've always done in this horse, right? And so if you're hearing about these regenerative therapies and they're interesting to you, then definitely have a conversation with your vet veterinarian. And if you're if the topic of joint injection comes up and you're gonna get your horse's joint injections, ask them if they have regenerative therapy options and would that be appropriate for your horse and just have that conversation. Because I know in my practice, you know, with these therapies, probably about 65 to 70 percent of the joint injections that I did on a daily basis were with a regenerative medicine device. I moved away from using corticosteroids in most cases, not all, um there's always gonna be, you know, a time and place to use a corticosteroid. But I think these regenerative therapies are so much better for the joint long term. Um, and they're gonna be better for, you know, the life of your horse as far as it keeping it happy, healthy and sound, and that joint happy and healthy and sound for many, many years. And so, but that does take some conversation and some trust on both parts. So just have the conversation. You know, what's the diagnosis? What are my treatment options? Do you offer any regenerative therapies? And do you think that's appropriate in this case?

SPEAKER_00 41:47

And these therapies are accessible to anyone, right? Like the veterinarians are able to get this. If this is something that someone's listening and they're like, oh, this is really interesting. I want to explore this with my own horse. And then maybe they haven't done this with their veterinarian before, but if they do want to pursue this, their veterinarian does have the ability to be able to provide this. Is that is that a fair statement?

Final Takeaways On Soundness

SPEAKER_01 42:04

Absolutely. And many of these therapies, and certainly the therapies that Zoetis provides, are ambulatory as well. So a lot of our veterinarians can do these treatments on the farm. So with our devices, we have the pro-stride APS, which is a joint therapy, but we also have a platelet-rich plasma called restogen PRP. Typically, we're using that in soft tissue injuries, so tendon and ligament injuries, suspensory injuries, things like that. And both of those therapies, you know, take less than 20 minutes to make, and they can be done either at the hospital or on the farm. So they're they're easy to do, they're stall-site, and and many, many, I'd say most vets that are doing lameness have these therapies available pretty readily.

SPEAKER_00 42:48

Okay. And you know, Zoetis always provides us with really great resources and notes. So we'll include more about those regenerative medicine devices and the research that was conducted in into our episode show notes. So as you wrap up, is there one takeaway that you would love performance horse owners to remember from today's conversation?

SPEAKER_01 43:07

Yes. Um, and maybe I I know I haven't said this yet, but my my sort of marching orders to my clients, because I think it can be very stressful to have a horse that has a lameness problem. I don't think that. I know that. I know it's stressful for you guys. And so understand that horses are athletes, they do athletic things, they're gonna get athletic injuries, right? Turn on the TV on any Saturday or Sunday and watch the guys playing football, basketball, baseball. They are doing athletic things, they're getting athletic injuries. And even if those injuries sideline them for a couple of weeks or months, they come back, right? And so we now have all of the same options that our human professional athletes have at our fingertips to treat these lameness problems. And it's really improved the prognosis for our patients. You know, it's given us tools to treat injuries that 10 or 15 years ago maybe would have been career-ending injuries for our horses, and now they no longer are. So get an accurate diagnosis. It all starts there. Um, from there, choose the appropriate therapy. And these regenerative therapies really have been a game changer in how we've been able to treat our equine athletes and keeping them happy and healthy and sound.

SPEAKER_00 44:16

Yeah, and that's really great advice. It's like, um, yeah, everyone freaks out when their horse is any bit lame. They don't know why. They go online. It's like it's like the WebMD. So just go to what is the resources and talk to your vet first. It is.

SPEAKER_01 44:29

Get a diagnosis because often it's not as bad as you think. Um, and even a diagnosis that might seem bad probably has a better treatment option for it now than it did 10 years ago. So don't be scared.

SPEAKER_00 44:41

Well, that's great advice. Well, thank you so much, Dr. Gutman. Really appreciate all the wisdom and for coming on and talking about this. So um thanks again for for being on. Appreciate it. Yeah, thanks for having me.