Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Ultrasound-Guided Celiac Plexus Block: A Breakthrough for Equine Intestinal Motility
A groundbreaking approach to equine intestinal motility takes center stage as Drs. Barbara Delvescovo and Marta Cercone join us to discuss their pioneering research on ultrasound-guided celiac plexus blocks in horses. Their remarkable findings reveal that this technique not only restores but actually enhances intestinal motility beyond baseline levels in normal horses—without causing discomfort.
Post-operative ileus remains one of the most challenging conditions in equine medicine, significantly increasing mortality rates after colic surgery. Traditional treatments often fall short, requiring a multimodal approach with limited options. This innovative nerve block technique offers a promising new tool that equine practitioners with basic ultrasound skills can implement in their practice.
The conversation takes fascinating turns as we explore the researchers' diverse backgrounds, from Marta's long-standing interest in neuromodulation to Barbara's clinical practice insights. Their journey reveals how mentorship and curiosity drive scientific discovery, perfectly captured in Marta's guiding principle: "True knowledge exists in knowing that you know nothing." They also share encouraging news for horse owners—contrary to common belief, many horses return to full athletic performance after colic surgery with modern management techniques. The team is now extending their research to clinical cases and inflammatory conditions, potentially transforming how we approach equine gastrointestinal disorders. For veterinarians seeking innovative solutions to challenging cases, this episode offers valuable insights into the intersection of regional anesthesia, ultrasonography, and equine medicine.
AJVR open access article: https://doi.org/10.2460/ajvr.24.11.0328
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Speaker 2:This is Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about how an ultrasound-guided celiac plexus block increases intestinal motility in normal horses, with our guests Barbara DelBescovo and Marta Circone Welcome to Veterinary Vertex.
Speaker 3:I'm Editor-in-Chief Lisa Fourier, and I'm joined by Associate Editor Sarah Wright. Today we have my very good friends and colleagues from Cornell University joining us. Barbara and Marta, thank you so much for taking that time out of your busy schedules to be with us here today.
Speaker 4:Thank you very much for having us.
Speaker 2:Thank you all. All right, let's try on over. So, marta, your AJBR article discusses how an ultrasound-guided celiac plexus block increases intestinal motility in normal horses. Please share with our listeners the background on this article.
Speaker 4:Yes. So a few years ago I was watching a roundtable about colleagues from one of the Congress talking about this approach that they were trying and referring to an ongoing clinical trial that they were doing in collaboration with the University of Milan. So I got interested in the topic, because I'm interested in neuromodulation mostly, and so I started studying more into it and figuring out, based on their initial work, if we could try to identify really how things would respond to these anesthetic block, starting from normal horses, and maybe try to design a ultrasound-guided approach to it.
Speaker 2:Very cool. And have you heard of our technical tutorial videos by chance?
Speaker 4:Yes, thinking about it.
Speaker 2:Awesome. And for our listeners who don't know, these are video articles. They're peer-reviewed and they're fully citable, so they receive a DUI recognized by the Dean's and Scholarly Outputs. So very cool. We'll look forward to maybe some content then from you in the future for that article category. So, Barbara, what are the important take-home messages from this AJVR article?
Speaker 5:What are the important take-home messages from this AJVR article. Yeah, I think you know, as Marta said, this could be a new technique and a technique applicable to post-operative ileus, which is such a challenging condition to treat and is usually treated with a multimodal approach, and so I think this new technique could be implemented in this multimodal treatment for post-op ileus and I think this could be really exciting. And I think also this being a ultrasound guided technique, this, for the practitioner, would require some basic skills with ultrasound guided injections and knowledge of the anatomy and targeted points, but is also something that is very applicable to our horse population. So I think these are the main take-home messages for the equine practitioner.
Speaker 3:Marty, you've been interested in neuromodulation and ultrasound guided techniques for a long time, but that's a really broad category. More specifically, what sparked your interest in this regional type of local, regional anesthesia?
Speaker 4:So it was the fact. In humans there is a lot about vagal stimulation to treat several different conditions, and the things that fascinate me is how much the brain, and anyway the nervous system, can affect in general all the other body systems. It's so fascinating. And then I've been working on electrical stimulation for some neurologic disease or peripheral neuropathy, like for a head shaking or recurrent laryngeal neuropathy in the horse, and so it really pushed me into finding out more. So what really happens if we block that plexus? That's why we got more interested in identifying exactly what happened, even just in normal forces, and then try to progress later on in other investigations. So I'm like I have a lot of questions and I try to work on finding the answers, even if most of the time there are only more questions showing up more than the answer. But it's a nice process.
Speaker 3:It's just important to be curious, but you guys are obviously a great team in being finishers and getting this work done and across the publication line, which is not easy, so congratulations. Thank you, barbara. Earlier, sarah asked you what were some of the take-home messages, but, as Marta just said, every time you do a study, more questions, something surprises you. For you, what were some of the most surprising findings from this article?
Speaker 5:Yeah, good question. I think one of the most surprising facts looking at the results of this study was knowing that the motility increased even beyond baseline. And so in these healthy, sedated horses, right, we had the baseline motility assessment and then when in some of them, in a group of them, we did the block, the motility actually went beyond baseline. And so we were expecting or hoping for some effect on the GI motility. But when we saw the actual results we were very pleased and we were really surprised by that.
Speaker 3:Follow-on thing that people listeners might be wondering does that make them crampy?
Speaker 5:And not in this case. So in this healthy, sedated population, they were not crampy, no.
Speaker 4:Pretty cool, yeah. In fact, we couldn't see much happening on these courses until we really went and evaluated the ultrasound video blindly. So that was rewarding also, for, anyway, we didn't know what to. No-transcript.
Speaker 2:So, marta, what are the next steps for research in this topic?
Speaker 4:and also an inflammatory response in horses in which we induced endotoxinia by injecting LPS. So that was our second research experiment and at the same time we've been conducting also a clinical trial here at Cornell on cases that are admitted for colic and trying to evaluate also beyond the post-operative ilus if we can provide more anesthetic relief in horses, for example going through spending laparotomy.
Speaker 2:Very cool. Thank you for sharing and for our listeners who are not watching the video, lisa has a very cute puppy joining us this morning on the podcast, and so artificial intelligence is a really hot topic in veterinary medicine. There's even symposiums about it. Now we have our very own artificial intelligence supplemental issue coming out in AJVR very soon.
Speaker 5:So, barbara, do you see a role for AI in this area of research? Yeah, for sure. The most challenging, one of the highest challenges of this study was to try to objectively evaluate it. Evaluating motility, gi motility, and so what we did, we tried to do the most objective possible evaluation, blinding the videos and randomizing them, and then retrospectively evaluating them and scoring them, and I think this could be something that would be very well done by an AI algorithm and that could really provide, you know, more objectivity to these sort of similar evaluations as well, and evaluating videos for GI motility is definitely one of them. So if we had had that possibility, that could have definitely been implemented in this study, for example really know AI and folks like us who know clinics.
Speaker 3:So we're accumulating these questions and going to provide them to those that are really on the extreme side of AI who don't know what the clinical questions might be.
Speaker 2:Yeah, so stay tuned. Maybe we'll have to do a podcast episode on the take-homes from that. We'll see. For those of you just joining us, we're discussing how an ultrasound-guided celiac plexus block increases intestinal motility in normal horses, with our guests Barbara and Marta. And cinnamon yeah, forget cinnamon.
Speaker 3:Marta, both you and Barbara, coming from Italy, have fascinating backgrounds and very diverse training, but how did your training prepare you to write this article?
Speaker 4:Well, in a way, working for my PhD on ultrasonography definitely paved the way for just keep your own doing that type of work. And then I've been so lucky to have great mentors, starting from Italy with Dr Paper and for my PhD, and then coming in Cornell, dr Ducharme and then, of course, julita in the most most recent years. So I've been very fortunate. So I've been pushed through all my possible limitations when trying to do research or clinical work. And, yeah, I own my mentors, all of these.
Speaker 3:Barbara, how about you? Like it's not. None of these paths are linear, so I think it's really cool to tell listeners, especially junior listeners, that you know it wasn't for any of us, it wasn't a straightforward path.
Speaker 5:No, definitely not a straightforward path. So I owe a lot to people who have inspired me and trained me as well. I had more a clinical practice type of background and, you know, trying to see the challenges in clinical practice and then, once you, you know, I got to Cornell, approach more the research world and try to answer some of the questions that came up alongside my short career. But mainly clinical was really helpful. It's kind of a path that is coming all together. So I'm really grateful to everybody who has helped me and is currently helping me.
Speaker 2:It's always nice to look back and thank our mentors, so this next set of questions is going to be very important for our listeners, and the first one is going to revolve around the veterinarian's perspective. Barbara, what is one piece of information the veterinarian should know about multimodal management of colic and paralytic ileus?
Speaker 5:Yeah, I think you know post-op ileus, or ileus in general, is a very, very hard condition to manage and to resolve, and we know that it significantly increases our mortality in our post-op colleagues, and so it's a very, very common and very hard condition to manage that. Unfortunately, we haven't found a single drug or management strategy that works for sure, and so our management is always multi-model, and so I think, in the context of needing a multi-model approach, this new technique could really be implemented as one of the strategies, one of the treatments, and so this could be something to add that might be very helpful for managing this very challenging condition that remains really challenging, although all the new ongoing research that kind of runs around it.
Speaker 2:And Marta on the other side of the relationship. What's one thing that clients should know?
Speaker 4:Yes, I think colic can be very scary for owners. First of all, how the horse really behaves during a colic episode is pretty scary, and the idea of a major surgery and then all the complications that can arise after that and would the horse go back in work or not those are all aspects that frighten the owners a lot. But I think there has been so much improvement in the surgical approach and in the medical approach for the management post-op that I think there is a sort of idea that after colic surgery horses are done with their performance. I don't think that is the case. Every case is different from the others, but the percentage of horses that return to full activity without any problem it's getting better and better. So I just would tell the owners to give the horse a chance, if there is an economic budget that can support that.
Speaker 3:Yeah, really well said. It is a terrifying experience. For the first time anybody sees it and it's really good to remember that in the clients. Super great to see both you guys, even if it's virtually. Today. As we wind down, we ask a little more of a fun question. So, marta, while we have you, what's the oldest? And you're welcome to hold it up if you have it oldest or most interesting item on your desk or in your desk drawer.
Speaker 4:So I cannot hold it because I taped it to my computer, but it is so, just on the line of what I was saying, that we always have a question that we try to answer and trying to expand our knowledge and realizing that it's limitless. When I first came in Cornell and I was assigned the task, somebody before me left a tiny piece of paper with printed it and motto that I thought it really fit with my approach to veterinary medicine and so I kept it for the past 13 and more years. And this says that true knowledge exists in knowing that you know nothing. And it really sort of reflects what I thought even before getting in this route.
Speaker 3:Amen. Do you know whose computer it was?
Speaker 4:I don't know. It was on one of the research rooms. I had an idea, but I'm not sure so I prefer not to mention it at this moment. But yeah, I think it was one of the PhD or postdocs from Dr Ducharme's lab.
Speaker 3:Very good. Well, maybe they're listening and they'll give you a shout. Maybe, Barbara, you know my children and I'm looking over at my dining room table where there's one complete puzzle, one that's half done, another one that just came out of the box. When you do puzzles, do you start with the border exterior or the middle internal pieces?
Speaker 5:Yeah, I have to say I find them quite hard, especially the one with the million tiny pieces, and so I always have to start from the exterior. I think it's my you know my way to have a structure and kind of feeling like I'm getting somewhere. But truly I think otherwise I couldn't complete one if I wasn't starting from the exterior, where I know at least that what I'm looking for. And so yeah, but I don't do them very often, I have to say.
Speaker 3:A full-blown career and a couple of young kids and a husband. So you're showing your surgeon shoes, sarah, and I have this running tally that most of the time, surgeons start with the border and internists seem to start with more like a color or a theme or something in the middle. We get some hybrids too, but you're definitely showing your surgeon shoes.
Speaker 2:I actually was over at my aunt's house this weekend and her son does all these really cool intricate Lego sets and I was like, ooh, maybe that's a question for the future. If we have any Lego people, how do you put together your really intricate Lego sets?
Speaker 3:The instructions Try not to lose the tiny pieces.
Speaker 2:There's nothing worse than stepping on a Lego. Well, thank you so much, barbara and Marta. I really appreciate you being here today sharing your article with AJVR and sharing your knowledge, too, with our listeners. Thank you very much.
Speaker 4:It was quite a fun.
Speaker 5:Yeah, yeah, thank you so much much guys for having us and to our listeners.
Speaker 2:you can read Barbara Marta's article on AJVR. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
