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Arizona Equine Medical & Surgical Centre offers a range of equine diagnostic and treatment services at this facility in Gilbert, Arizona. .As the largest center of its kind in the desert southwest region we offer ultrasonography, nuclear scintigraphy, MRI, endoscopy and computed and digital radiology. The surgical facilities are equally extensive and include arthroscopy, colic surgery, laser surgery, laparoscopy and many types of soft tissue surgery.
Acupuncture is best applied as a complementary technique, promoting the well-being of the patient and assisting conventional therapies to achieve a positive result. Please remember, acupuncture therapy is meant to complement not replace conventional veterinary care.
Acupuncture is the stimulation of a specific site with a specific method, with the goal of a therapeutic homeostatic effect. The specific point on the horse's body is called an acupuncture point (acupoint). The ancient Chinese discovered 361 acupoints in humans and 173 acupoints in horses.
Current studies have demonstrated that acupoints are located in the areas where there is a high density of free nerve endings, mast cells, small arterioles, and lymphatic vessels. The acupoint connective tissue represents a different configuration when compared to the rest of the horse's skin. Stimulation of acupoints can induce the release of β – endorphin, serotonin and other neurotransmitters. Acupuncture for pain relief is well supported by many acupuncture scientific studies.
Dry Needling
There are several acupuncture methods, aquapuncture, hemoacupunture, dry needling, and moxibustion. Aquapuncture utilizes saline and vitamin B12 to prolong stimulation. Hemoacupunture involves aspirating blood to control inflammation. Dry needling is point stimulation without the addition of medications, dry needling lengths rand from 0.5 to 4 inches deep. Moxa is a traditional Chinese herb utilized with in moxibustion. Moxibustion involves heat application and burning moxa to help chronic degenerative conditions.
One of the primary goals of our practice is to provide prompt, high quality medical and surgical care in the field. Arizona Equine veterinarians provide comprehensive routine care to our patients on the farm from 8am to 5:30 pm Monday through Friday. Digital radiography, ultrasound and dentistry equipment are available for use by the ambulatory staff. The hospital has four ambulatory vehicles to travel to your farm or home.
Arizona Equine provides responsive services 24/7 for your equine partner. When you have a sick or injured horse time is critical! Our veterinarians and technicians understand how critical emergency services are to your horse's well-being. We have a full service emergency clinic located in the greater Phoenix area. Arizona Equine has four compassionate veterinarians and three experienced veterinary technicians readily available to help you and your horse every evening and weekend. After hours call the veterinarian directly at 480-322-9310
The adult horse has approximately 36 to 44 teeth. The number of teeth can be dependent on the breed of the horse and sex. The horse owner can easily lift their horse's lips and visualize the 12 incisors and 4 canine teeth (if present). The majority of the premolars and molars cannot be examined without a speculum.
Dentistry is a critical facet of your horse's overall health and quality of life. Routine floating performed by an experienced equine veterinarian can alleviate the pain of sharp dental points, other dental maladies, and may prevent future dental problems.
The veterinarians at Arizona Equine utilize a full mouth speculum; a bight focused light intravenous sedation, motorized and hand floats. We often use a dental mirror and periodontal probe. Yearly dental exams and floating can identify tumors, cheek ulcers, loose/cracked teeth, retained caps and decaying teeth.
What are some of the signs that your horse is experiencing dental problems? Signs include poor performance, weight loss, head tossing, inability to collect, stay collected or hold the correct lead, dropping/quidding feed, reluctance to turn to one side or another, and opening their mouth while carrying the bit.
Arizona Equine veterinarians can perform dentals both in the field and in the hospital. The doctors are experienced in routine floating and equilibration. Corrective work on wave, shear, hooks, ramps, parrot mouth, and all dental abnormalities are routinely addressed. Our doctors employ local anesthesia, nerve blocks, anti-inflammatories, and sedation for pain management.
Routine dental care provides enormous benefits to your horse. The Arizona Equine veterinarians have extensive training necessary to properly evaluate patients for concurrent disease processes. Some of these conditions include sinus infections, Cushing's disease, diabetes-like syndrome, kidney disease, liver disease, and heart disease. There is much more to dentistry than just teeth! Remember that all horses need regular dental care regardless of whether or not they are demonstrating signs.
Arizona Equine has the latest digital radiography tools. This technology is incredible and allows our veterinarians to take extremely detailed radiographs (x-rays). We have two systems available: a portable digital radiography system that allows us to take radiographs in the field and obtain instantaneous results; and a computed radiography system that we use both in the field and in the hospital.
Both systems have multiple advantages including: more rapid image viewing, elimination of chemicals required for processing, the ability to email high detail images, a higher level of image quality with enhancement of soft tissue structures and bone detail, and the ability to store and retrieve images easily. We obtain the images in a similar way as normal radiographs with cassettes and an x-ray source. The actual processing and viewing of the image is much different than the old "film-based" systems.
With the digital radiography system, a cassette is tethered to a computer and the image shows up on the screen almost immediately after the radiograph is taken. After image optimization, the file is saved on the computer. We can also print hard copies, or save the files on a compact disk for future reference.
With the computed radiography system, the cassette is processed in a developer much as a computer disk is inserted into a hard drive. Once the image is removed from the cassette it is displayed on a computer screen for evaluation, storage, and emailing.
We manipulate the images in both systems in order to better visualize the areas of interest. We are able to change the contrast and brightness with a click of the mouse to obtain an optimal radiograph. Being able to adjust these setting allows us to detect subtle fractures and changes in bone density.
We archive all of our radiographs with a service that saves copies on computers in Denver and in New York, thus ensuring that we will always have them available for viewing. We give you access to the images one of several ways: 1) We can print traditional looking x-rays with a thermal printer, 2) Burn a CD with your images, or, 3) Email you a link to the images. With an emailed link you can look at the images at your leisure, download them onto your computer, or you can forward the link to one or more people for their use.
The result is that we are able to provide the best radiographs available for our clients, which ensures accurate diagnoses.
Radiography is a very important diagnostic aid for a number of equine problems, including lameness evaluation, evaluation of the lungs, evaluation of the intestinal tract. The respiratory system (sinuses, lungs, etc.) is also imaged with radiography to diagnose certain conditions. We utilize several types of radiograph machines to obtain high quality radiographs. For field work, we have newer portable machines that are quite powerful, yet are easily handled. For hospital cases, we utilize a 1000 ma Machine that is very powerful, yet not very portable. The 1000 ma machine allows us to image large body parts that smaller machines are unable to penetrate. We obtain high quality x-ray films in the equine adult of the abdomen, shoulder joint, pelvic bones, back, and stifle.
At the hospital, we also have automatic processing equipment that allows us to develop films taken in the hospital to view the results right away. This lets us repeat x-rays that do not meet our high quality standards.
Endoscopy is a diagnostic tool that allows our veterinarians to examine some body cavities that are inaccessible otherwise. This includes the nasal passages, pharynx and larynx (interior throatlatch region), the trachea (windpipe), esophagus (passage to the stomach), stomach, rectum/small colon, uterus, urethra, and the bladder.
To accomplish these examinations, Arizona Equine uses videoendoscopy. This is a type of endoscope that has a camera chip at the end of a long, narrow tube (about ½ inch in diameter). The advantage of a videoendoscope as compared to a regular endoscope is that a videoendoscope allows the image to be seen on a monitor (TV screen) as the examination is being done, allowing anyone in the room to see what the veterinarian is seeing. A regular (non-video) endoscope projects images onto a small eyepiece that can be viewed by one person at a time. A videoendoscope also allows us to print out pictures for the owner to take home, or to be sent to the referring veterinarian.
We have two lengths of videoendoscopes available: a 1.5 meter scope (about 4 feet), and a 3 meter scope (about 12 feet). The 1.5 meter scope is used mainly for upper airway diagnostics, while the 3 meter scope is used for gastric (stomach) endoscopies.
This tool allows us to diagnose many different conditions, including: Gastric ulcers; Entrapped epiglottis; Laryngeal hemiplegia (roaring); Bladder stones; Uterine cysts; Sinus problems, etc.
Arizona Equine provides numerous internal medicine services. Dr. Ed Voss is a partner at Arizona Equine, and is also a board certified internal medicine specialist. Dr. Voss completed his three-year residency in internal medicine at the University of California at Davis.
What is equine internal medicine? It is that part of equine veterinary practice that diagnoses and treats problems of a non-surgical nature. All equine veterinarians practice internal medicine during some part of their daily work, but they are not specialists in the field. Some veterinarians, like Dr. Voss, have spent 3-4 years after veterinary school in advanced training programs to learn the intricacies of equine internal medicine.
Dr. Voss diagnoses and treats respiratory problems, neurologic conditions, neonatal foal problems, skin conditions, and ophthalmic problems, among other problems. Dr. Voss accepts referrals from veterinarians' statewide, as well as from surrounding states.
Magnetic resonance imaging (MRI) is a diagnostic modality that provides a highly detailed look at the structures of the lower limb. It is used in difficult lameness cases to enhance our diagnostic power when used in conjunction with digital radiographs, joint and nerve blocks, ultrasonography and/or nuclear scintigraphy. An MRI uses a strong magnetic field to look at soft and hard tissues. Measurements are gathered and sent to a computer to be put together into an image that we can evaluate.
Arizona Equine installed a Hallmarq® standing MRI in 2005. The MRI is located in a specially designed room that is lined with copper to prevent any radio frequencies from interfering with the scan. The room also has a special climate control which maintains a constant temperature and humidity for the magnet. A unique computer in the room gathers the images and corrects for any movement to minimize the time required for a scan.
An MRI is done on your horse while standing with only sedation. No general anesthesia is needed to scan the feet or lower limbs below the fetlock. The MRI is done on one leg at a time and is typically reserved for a lameness that has been narrowed to a specific leg. Standing MRI's are safe for your horse and generally your horse can go home the same day. For cases which involve the hock or carpus, the horse is put under general anesthesia and the magnet is raised to scan the leg.
MRI is superior to all other modalities in the diagnoses of soft tissue problems in the foot. MRI images can also be used to look at the bones in the leg. All the MRI studies done at Arizona Equine are sent away to be read by a board certified veterinary radiologist with special training interpreting MRI images.
Nuclear scintigraphy is a diagnostic procedure that allows our veterinarians to diagnose difficult lameness cases. A very small amount of a radioactive substance is injected into the patient's vein. The circulatory system carries this substance throughout the patient's body and it localizes wherever there is increased bone turnover, or where there is increased blood supply to soft tissues. A device called a "Gamma Camera" is positioned over the horse's body to detect where the radiation has localized. Once an area of concern is identified with scintigraphy, the problem can be further defined with radiographs, ultrasonography, or nerve and joint blocks, if needed.
Scintigraphy has several advantages over traditional diagnostics in some difficult cases, including: 1) It is a much more sensitive indicator of bone damage than radiographs; 2) The Gamma Camera can be positioned anywhere on the horse's body, so we can image the back, head, or any other location needed. Clear radiographs of the back and pelvic regions are difficult to obtain in adult horses, so this is a huge advantage in diagnosing lameness; 3) Some areas of the horse can not be blocked in a traditional lameness examination; 4) With scintigraphy, very subtle causes of lameness can be detected. In a traditional lameness evaluation, a diagnosis is dependant upon the horse being visibly lame; and 5) Scintigraphy shows the blood flow to the distal limb, which can help in some injuries to tell when the blood supply has been lost.
Scintigraphy has several disadvantages, as well, when compared to regular diagnostics: 1) Radiation regulations require that the patient be hospitalized for 24 hours after the radioactive material is injected; and 2) In about 30% of chronic lameness cases, scintigraphy does not give a clear indication of the cause of lameness.
Arizona Equine Medical & Surgical Centre is pleased to announce the addition of EDDIE PALACIOS, CJF an American Farrier Association Certified Journeyman Farrier to our staff and the opening of the newly developed and Arizona's first EQUINE PODIATRY CENTER. The EQUINE PODIATRY CENTER facilitates on-site collaboration between an experienced highly skilled Certified Journeyman Farrier and the equine clinician responsible for the care of the horse. The EQUINE PODIATRY CENTER represents significant expansion of the services provided at Arizona Equine and is geared toward the prevention and treatment of musculoskeletal problems encountered by horses of any discipline, breed, or age. You may collaborate directly with our Certified Journeyman Farrier to develop a shoeing plan for your clients' horse or you can refer your clients' horse to our team of veterinarians experienced in the diagnosis and treatment of the full range of problems encountered in Equine Sports Medicine. The EQUINE PODIATRY CENTER combines the capability for advanced medical diagnostic evaluation (lameness evaluation, digital radiography, ultrasonography, nuclear scintigraphy, and when needed MRI) with the art and science of farriery using custom hand-made shoes or pre-fabricated shoes in conjunction with modern materials and techniques designed specifically for your client's horse.
Correct shoeing for balance and performance
"No Foot No Horse"
QUALIFICATIONS - Eddie is a graduate of Sierra South Horseshoeing School and is an American Farriers Association Certified Journeyman Farrier with over 12 years of farrier experience. Eddie adheres to sound principals of shoeing using custom made or prefabricated therapeutic shoes coupled with his expertise in working with new and modern shoeing materials.
AFFILIATIONS –Eddie is strongly committed to the enhancement of foot care for horses and has been active in farrier associations at both the local and national level. He currently serves as an American Farriers Association Tester. Eddie volunteered as an instructor teaching basic foot care to members of the San Bernardino Police Department & San Bernardino Sheriff's Department Mounted Enforcement Unit. Eddie has been a strong advocate for development of healthy veterinarian/farrier collaboration in his shoeing business and though participation in AAEP/AFA joint case discussions with veterinary students at Western University College of Veterinary Medicine. He also was an instructor at Sierra South Horseshoeing School and precepted apprentice farriers. He continues to enjoy exchanging knowledge and expertise with other farriers and students of the equine foot.
It is our goal that the EQUINE PODIATRY CENTER will serve as a valuable resource to optimize equine foot care for our clients, referring veterinarians and their clients, veterinarians working directly with our farrier and for local farriers tackling difficult cases day in and day out.
For appointments or consultations, feel free to call Eddie directly, the staff veterinarians at Arizona Equine, or the main Arizona Equine office number.
The prepurchase examination is a critical tool in assisting the potential owner with an impartial view of a horse's health. This exam will provide insights to ensure that an informed decision is made prior to the final purchase. Ideally, the buyer has tried the horse several times and had a trainer help guide the rider in the determination "that this horse is a suitable mount" for the buyer's intended purpose. Once your ideal mount has been selected, the veterinarian can consult with the buyer and determine the particular needs and expectations you have for the horse. Once your mount has been selected, the next step is to contact a veterinarian for a through prepurchase examination.
In general, a prepurchase exam will include several phases such as obtaining the horse's health history, and a detailed physical examination. The prepurchase evaluation includes the following examinations: lameness, ophthalmic, neurologic, respiratory, musculoskeletal, cardiac, oral, general condition, and conformation. Stallion and mare reproductive evaluations can be added to the prepurchase exam if the buyer requests. The lameness exam is performed at rest and following light exercise or riding if need be. Lameness assessment also includes trotting in straight lines/circles, flexion tests, and detailed palpation of the soft tissues of the legs and back.
The prepurchase exam can be divided into several stages, including a health/ performance history, examination in the stall at rest, a physical and lameness evaluation outside of the stall, and diagnostic imaging.
Once the health and performance history has been recorded, a thorough identification of the horse is recorded; this includes color, scars, markings, tattoos (e.g., American Jockey Club tattoos have an alphabet letter before the number; "A" represents the years 1971 and 1997, "B" 1998)., brands, possibly digital photographs, and an approximation of age via dental inspection.
The initial part of the examination often begins in a stall or area out of direct sunlight, dark enough for an ophthalmologic examination. Temperature, auscultation of the heart and lungs, and oral examinations can be done in the quiet confines of the stall. The veterinarian can evaluate the horse's stall for wood chewing (cribbing), the character of the manure and feed, and/or oral medication remaining in the feed bucket. The horse's general body condition is assessed. The body condition score (1–9) can be assigned a number from thinness (1) to obesity (9). Scores of 5 to 6 are considered normal. Each of the front and hind hooves are thoroughly examined; mismatching, abnormal foot conformation, dishing, type of shoeing, are recorded. The veterinarian then palpate the limbs, examine the hooves ( hoof testers), perform passive flexion tests, and document all findings.
The third phase of the prepurchase evaluation involves watching the horse move on different surfaces on a straight line and in a circle. The ideal surface is asphalt and if asphalt is not available then hard packed dirt. Walking and trotting the patient on either asphalt or hard packed dirt will exacerbate subtle lameness that may not be obvious in the arena or soft ground. Active flexion tests are performed on the front and hind legs. This exam is simply a test in which the joint is flexed for a period of time and then the horse is jogged away. The degree of lameness and number of steps the horse is lame following the flexion is noted. If an arena is available it may be of benefit to watch the horse being ridden or lounged. Having the horse canter/lope or gallop for 5–10 min will enable the doctor to evaluate breath sounds, auscultate (listen with stethoscope) and perform cardiac auscultation following exercise. The horse is then monitored during recovery. Frequently, the veterinarian will repeat trotting the horse in hand so that any subtle lameness that might have been accentuated during the exercise stage can be detected.
It is also valuable to perform a basic neurologic examination. : A brief neurological exam is performed on the head to make sure the cranial nerves appear to be within normal limits. A neurological evaluation is usually performed during the physical and the musculoskeletal exams. To assess the horse's ability to move its limbs normally, additional tests are performed. Some of these tests may include moving the horse in tight circles, backing with their head raised high, and stepping over poles. The final portion of the prepurchase exam includes any diagnostic procedures, including digital radiographs (particularly of the feet, hocks, and stifles), digital ultrasonography, MRI, endoscopy, nuclear scans, and blood work. The diagnostic procedures are chosen based on numerous factors (problems detected during the examinations, purchase price, client preferences, etc). Radiography is the most common diagnostic procedure performed. Arizona Equine Medical and Surgical Centre has portable computerized and digital radiographic equipment. All diagnostic test results can be emailed to the buyer's veterinarian if requested.
State and international disease testing will be reviewed with the buyer. Drug testing will be offered to the buyer and its limitations discussed. If the horse is purchased at a competition, or the seller is not known to the buyer, drug testing is strongly recommended. Even when a buyer does not wish to have drug testing, the Arizona Equine veterinarians highly recommend collecting blood at the time of the examination and storing the serum for approximately one month. The serum will be available for that month if any questions arise after the purchase.
The Arizona Equine veterinarians will provide a detailed summary report. The report will provide a review of all the systems examined, diagnostic procedures performed, and laboratory results. The ultimate goal of the Arizona Equine Medical and Surgical prepurchase exam is to provide detailed information that will enable the buyer to make an informed decision.
Again, it should be emphasized that the purpose of a prepurchase examination is to tell the potential buyer of any problems the horse CURRENTLY has. It is difficult, if not impossible, to predict which horse will develop lameness or other problems in the months to years after a purchase has been concluded.
Regenerative Medicine is a very exciting field and the Arizona Equine doctors are pleased to offer several forms of regenerative therapeutics for your horse. The goal of regenerative therapy is to aid healing by providing cells and growth factors that help repair damaged tissue. These cells and growth factors do several things: 1) they help rebuild the damaged scaffold of which tendons and ligaments are made, 2) they reduce inflammation in joints and soft tissues that can make the injury worse, and 3) they recruit cells from your horse's own blood and tissues to repair the injured tissue. As part of our regenerative medicine treatments, we provide the owner with a detailed rehabilitation program that is uniquely designed for your horse and its specific injury.
Arizona Equine offers several forms of regenerative medicine, PRP (platelet Rich Plasma), Stem Cells, and IRAP (interleukin-1 receptor antagonist protein), which is also known as autologous conditioned serum (ACS).
Platelet Rich Plasma (PRP): The goal of PRP is to utilize your horse's own growth factors and cytokines to assist the natural healing process. Cytokines and growth factors are substances that are very important in injury repair. Cytokines help attract cells from the blood or tissues to the site of injury to repair the damaged tissues. Growth factors act on other cells to speed the healing process. Platelets contain both of these substances in high concentrations and have been shown to be very important in the healing process.
Figure 1 – PRP after being spun down (left); Injection of PRP into a horse's injured tendon (right).
PRP is obtained by centrifuging your horse's own blood in a special centrifuge to concentrate the platelets in one small layer of the centrifuge tube. We remove only the platelet-rich fraction (Figure 1, left), and inject it into the injured site with ultrasound guidance. (Figure 1, right) The goal of PRP is to treat injuries that tend to heal poorly or slowly, such as tendon and ligament tears. Recent research shows that there may be benefits in using PRP in some joint injuries as well.
Stem Cells: A stem cell is a special cell that has the ability to turn itself into other types of cells. Stem cells can renew themselves and can turn into major specialized cell types of other tissues or organs. The primary role of stem cell treatment is to maintain and repair the tissue in which they are placed. Researchers have found that injection of stem cells into tendon or ligament tears results in the stem cell becoming a tendon or ligament cell, respectively. This enhances the healing process by "seeding" the injury with new cells that can grow and replace the damaged cells.
Figure 2 – Collection of bone marrow stem cells (left); Microscopic image of bone marrow stem cells (right).
The two tissues from which stems cells are collected in the adult equine patient are adipose (fat) and bone marrow. To harvest stem cells from fat, fat is surgically taken from the horse near the tail head. The fat is sent a lab, where it is spun in a centrifuge to collect all of the stem cells present in the fat. Stem cells collected in this manner can be prepared relatively quickly (1-2 days), but there are not as many cells present as in some other methods (about 400,000 cells are in each ml). There are a number of research studies that show that large numbers of stem cells are better for the healing process (larger numbers than can be obtained from spinning down fat). Because of this, the Arizona Equine doctors prefer to use bone marrow derived stem cells because we can get 10-20 times as many cells from the bone marrow process.
Bone marrow derived stem cells are collected via aspiration of the horse's bone marrow. The bone marrow is then sent to a specialized laboratory to grow the stem cells into very high concentrations. It takes 3-5 weeks to grow the stem cells into a large population for injection (8 to 10 million cells in each ml). Some of the stem cells are frozen at the lab and can be used for future injections if the need arises. Bone marrow stem cell collection and growth takes longer but yields a more concentrated and larger stem cell population. We feel that this enhances healing.
Autologous conditioned serum (ACS) – The technical term for this treatment is "IRAP". IRAP stands for interleukin -1 receptor antagonist protein. Interleukin 1 is a major promoter of inflammation in joint disease, so it stands to reason that if we can stop the actions of interleukin 1, it will help reduce joint inflammation. The premise of this medication is that it blocks interleukin-1's ability to act in the joint. There is some controversy about how effective the IRAP agent is, but some veterinarians feel that growth factors found in the IRAP treatment are beneficial.
Preparation of IRAP involves collecting the horse's blood, and incubating it at a specific temperature for 24 hours with glass beads. The glass beads stimulate the production of anti-inflammatory proteins including IRAP. We then inject the serum into the patient's arthritic joint with the goal of reducing inflammation which should improve joint function. One incubation usually results in the collection of enough serum for several treatments. The extra serum is frozen and thawed whenever more injections are needed.
Future treatments – Research into regenerative medicine remains a very active area, so we are confident that novel treatments will continue to be developed in the future. You may rest assured that the Arizona Equine doctors will keep abreast of all new developments in this field, and that we will implement new treatments when they are proven safe and effective. Returning your equine athlete to soundness as quickly as possible is our primary goal, and we will continue to work hard to make that happen.
Services provided:
Reproductive Workup
General Health - The mare should be optimal weight, have recently floated teeth and a low fecal egg count (dewormed if necessary, and vaccinated prior to breeding. If your mare is in excellent physical health several months prior to breeding, she will have a higher probability of conceiving and maintaining a pregnancy.
Vaccination - should include rabies, Eastern, Western, Venezuelan encephalitis, influenza, West Nile, and rhinopnuemonitis. Depending on geographical location, the mare may require additional vaccines. If the mare is to be bred to an EVA (equine viral arteritis) positive stallion, she should be vaccinated at least one month prior to breeding.
Uterine Culture and Cytology - Uterine culture and cytology – a sterile uterine swab is utilized to sample the mare's uterus for bacterial infection and inflammation. Ideally, the culture should be taken during estrus.
Prebreeding Ultrasound/Rectal Exam - The veterinarian examines the ovaries, uterus and cervix with both the ultrasound and digital palpation. Any abnormalities such as intrauterine fluid and endometrial cysts can be identified and treated if needed.
Uterine Biopsy - The biopsy evaluates the uterus for inflammation and fibrosis (scar tissue). Older multiparous and maiden mares undergo endometrial changes that will impact their ability to carry a foal to term. This tool will assess the mare's ability to carry a foal to term. Often, inflammation can be treated whereas fibrosis and scaring are permanent conditions. The uterus is placed into one of four categories:
Expected foaling rates of mares according to endometrial biopsy grade
|Degree of endometrial change
|Expected foaling rate (%)
|< 10
Lights - Mares are long day breeders, they are receptive to the stallion, ovulate, and become pregnant during the spring and summer months. Mares are transitional prior to and following the spring and summer. One of the most efficient methods to hasten the onset of cycling and ovulation is through the use of lights.
Beginning in November, exposing the mare to 16 hours of continuous lights per day will mimic the onset of spring. Usually, 50% of the mares will ovulate following 70 to 80 days of artificial light. Bring the mare into a stall prior to sunset and leave the light on until 11 pm. The light must be bright enough to read newspaper print from anywhere in the stall. The mare must not be able to place her head in a dark space, out a window or stall door.
Breeding your mare with cooled semen enables the horse owner to select stallions that may not be available locally. Shipped cooled semen refers to breeding mares with semen that is chilled (not frozen) to 41 degrees Fahrenheit (5 degrees Celsius). Chilled semen is usually fertile for 1 to 3 days after collection.
Prior to breeding your mare, a uterine culture and cytology may be required by the stallion farm. Culturing maiden mares is not necessary if the owner has knowledge that the mare has never been bred. If the horse owner can determine that the mare is in heat (estrus), the next step is to have the veterinarian ultrasound her reproductive tract. A mare that is in heat will demonstrate a large follicle 30mm or greater and endometrial folds (the uterus takes on a particular appearance). The veterinarian will contact the breeding farm and coordinate the shipment and insemination of semen.
Frozen semen is frozen in liquid nitrogen to – 196 Celsius (-320 Fahrenheit). Frozen semen has an infinite shelf life (as long as the liquid nitrogen tank is maintained adequately) until thawed. Breeding with frozen semen can be very successful, but the appropriate mares should be selected. The advantage to frozen semen is that the stallion's show career is not interrupted; overseas stallions are available to mare owners (importation of semen is rigorous), stallion illness/death, and decreased concerns with overnight/airline shipping. Not all stallions freeze well, approximately 25% poor, 50% adequate and 25% acceptable/good. Therefore, the mare owner should ask the stallion owner "What is the post-thaw motility" prior to purchasing straws. An additional point of interest is the breeding dose; the dose has ranged from 300 million to one billion total sperm. This breeding dose can be in 4 to 6 one half ml straws. If 6 straws contain 500 million sperm cells and the post thaw motility rate is 50%, then there are 250 million progressively motile sperm available for that breeding.
|Access to international stallions
|Lower fertility rates
|Access to stallions despite illness, death or competition schedule
|Not all stallions freeze well; 25% freeze well, 50% freeze acceptably, 25% freeze poorly
|Overnight shipment errors
|Breeding dose ranges from 300 million to one billion total sperm per dose*
*The total sperm number refers to all progressively motile and dead/circling sperm. Therefore if the breeding dose contains 800 million sperm but has a post thaw motility of 20%, only 160 million sperm are available for fertilization.
The goal with frozen semen is to breed within a window of 6 to 8 hours prior to ovulation up to 6 hours post ovulation. Accordingly, once the mare receives either HcG or Deslorelin, ultrasound exams occur every 6 hours to evaluate for impending ovulation. There are several options for breeding with frozen semen; the Arizona Equine doctors will work with the owner select the ideal protocol for their mare.
Shockwave therapy is a treatment modality used by equine veterinarians to treat some tendon and ligament injuries in the leg. Shockwaves are created by a machine and a veterinarian guides the waves over the injured area for a specific amount of time. Shockwaves improves the healing time of tendon and ligament injuries by increasing blood supply to the damaged area. Shockwave therapy typically involves multiple treatments with the device over a period of weeks or months to assist with healing of the injured area.
If you ask someone "what is sports medicine?" you are liable to get many different answers. In its broadest interpretation, the term means any type of medical or surgical procedure used for athletic horses. This usage would include all of equine medicine and surgery. The term as normally used means "the diagnosis and treatment of sports related injuries".
Arizona Equine has a number of specialists that practice Equine Sports Medicine exclusively. These specialists include Drs. Rick Howard, Scott Taylor, and Ed Voss. Drs. Howard and Taylor are board certified by the American College of Veterinary Surgeons and have been practicing equine sports medicine since 1990. Dr. Voss is board certified by the American College of Veterinary Internal Medicine, and has been practicing equine sports medicine since 1992. All three doctors completed four years of extensive training after veterinary school in their respective specialties. Dr. Howard also obtained a PhD and conducted research into equine joint disease for a number of years after his surgical residency. Drs. Howard, Taylor, and Voss work predominantly in the clinic while working up sports related injuries. Dr. Gayle Leith is a boarded member of the American Board of Veterinary Practitioners – Certified in Equine Practice. Dr. Leith first became boarded in 1995, she successfully recertified in 2005 and 2015. She is certified until 2025. The American Board of Veterinary Practitioners members must re-certify every 10 years to maintain their diplomate status. ABVP certifies veterinary practitioners with exceptional knowledge, skill, and competency in the care of the total patient. ABVP Diplomates are certified in clinical practice for the species in which certification is granted. Most veterinarians performing broad-based clinical practice are not board certified. The ABVP board certified veterinarian has demonstrated they are capable of providing a level of clinical practice.
Drs. Gayle Leith and Tresha Robinson also practice equine sports medicine in the field. Much of the equipment used to diagnose and treat sports related injuries is kept in the hospital, but Drs. Leith and Robinson are adept at determining if cases can be diagnosed and treated in the field, or if they need to come into the clinic.
So, as you can see, Arizona Equine is very well staffed with exceptionally skilled veterinarians that have close to 100 years combined experience in equine sports medicine. This is only a portion of the puzzle, however. The other vital part of equine sports medicine is diagnostic imaging.
In the middle of the 20th century, technology to diagnose and treat equine sports related injuries was almost non-existent. Since the 1970's there have been amazing advances in technology that have resulted in many new diagnostic imaging tools used in the equine athlete. Arizona Equine has aggressively invested in these tools and will continue to do so. A description of some of these tools and their usage in equine sports medicine follows:
Physical Examination
This tool is one of the oldest used in equine sports medicine, probably dating back to the first cave-man that tried to determine why his horse was lame! We can't over-estimate the importance of this tool. Many horse owners have heard the term "Dr. X" is a great leg-man (or woman)". What this means is that this veterinarian is skilled in detecting problems in the sport horse just by a physical examination. Some of this skill can be taught, but in the case of most veterinarians, it a skill honed by years of experience. Our specialists have gone through this process and most of them have 20-30 years of experience in diagnosing and treating equine sports injuries. They have also had the added advantage of being able to confirm the results of their exams with advanced diagnostic equipment such as that listed below. This is extremely important, as it allows the doctor to confirm without a doubt that what they observed on the physical examination was what was truly wrong.
Radiography (x-rays)
Radiography has been in use in horses since the mid 1950's, but technological advances allowed for the development of digital radiography over the past 10 years. Digital radiography has many advantages over analog (film) radiography, including increased detail; the ability to lighten, darken, or change the contrast of the image afterwards; the ability to transfer the images over the internet; the ability to store the images cheaply forever; the ability to observe the image almost instantaneously; as well as other advantages. Arizona Equine has digital systems in the hospital that allow us to obtain radiographic images of any part of the horse, including areas such as the abdomen or the back. We also have a portable digital system that allows us to take superb images of the legs in the field. The correct interpretation of the images is of paramount concern. Great images that are interpreted wrongly are no better than poor images. Our sports medicine specialists have extensive training in the interpretation of radiographs and provide correct interpretations along with great quality radiographs.
In this imaging modality, ultrasound waves are used to show the structure of soft tissues, including areas commonly injured in athletic horses. Tendons, ligaments, muscles, and joints are some of the areas that ultrasound is used to image in sport horses. Ultrasonography has been used since the 1970's in horses, but, like radiography, recent advances in technology have vastly improved the quality of the images over the past 10 years. We have invested in ultrasound equipment that allows us to obtain the best images available from any clinic. This is another area in which our specialists have advanced training in interpretation of images.
Nuclear Scintigraphy
Nuclear scintigraphy is an imaging modality commonly referred to as a "bone scan". A bone scan is a series of images obtained after injecting a very small amount of radiation into the horse's vein. A simple explanation for how it works is that the radiation is distributed throughout the horse's body by the blood system. Areas of inflammation have more blood going to them than do areas that are not inflamed, which is why inflamed areas are hot and swollen. Many times the inflammation is in an area that we can't touch or feel easily (Inside a bone, or in the hip region, for example) so we have a difficult time identifying where it is located.
Since horses can't talk and tell us where they hurt, or where they are inflamed, we need another way to determine the location of the injury. This is where a bone scan comes in. It is a very sensitive indicator of where inflammation is located. A bone scan can pick up inflammation that doesn't show up in an x-ray or ultrasound for months or years, if ever.
The specifics of how this test works is as follows: The radioactive isotope (the substance that is injected) gives off gamma rays (a form of radiation) that are detected by our machine. If there are more gamma rays coming from a certain area of the horse's body, then there is more radioactive isotope in that area, which means that area is inflamed.
A bone scan is very safe because of the tiny amount of radiation used. The radiation is essentially gone from the horse after 24 hours, so we are required by law to keep the horse until the day after the bone scan so that there is no chance of a person being exposed to it.
There are several advantages to Nuclear Scintigraphy: We can examine the entire horse in about 2 hours from when we start the scan, so it is a great screening tool when we don't know where a horse hurts; It is the most sensitive indicator of inflammation that we have available, so it shows areas of inflammation that we can't find any other way; It is very safe, as the radiation used is very small; It can be done standing; Results are available by the morning after the scan before the horse leaves; Everything is digital, so images can be sent over the internet.
There are several limitations of Nuclear Scintigraphy: The horse must stay overnight by state law; it is a day-long procedure overall (it takes 2 hours for the isotope to be delivered, then we wait to scan until 2 hours after the injection, and the scan takes 1-2 hours depending on what we scan); the scan is better at picking up bone problems than it is for soft tissue problems.
In summary, for cases in which we have problems determining where the horse hurts, a bone scan is the ideal diagnostic test.
Magnetic Resonance Imaging (MRI)
MRI is a well-known imaging test to most people because of its common use in human medicine. Unless you are a physicist, you probably don't want to know how this test works! Basically a magnetic field aligns the hydrogen atoms in tissue and these atoms give off radiofrequency (RF) waves in response to changes in the magnetic field and the application of other RF energy to the system. The machine detects the RF waves given off by the hydrogen atoms and creates an image of the tissues. I warned you! Luckily, we don't have to understand all of the details of how it works to use the machine and get good images!
While a bone scan allows us to image the entire horse to find out where it hurts (screening tool), an MRI gives us the best detail of a small area of the patient that is available today. Therefore, MRI is best used when we know (within 5-8 inches) where the pain is coming from.
There are several fundamental properties of MRI that determine when our specialists use MRI, and why we use the MRI system that we use:
1) Resolution: What do we mean by "resolution"? In layman's terms, this means how clearly we can see the structure of the area we are examining. For each imaging test that we use, how clearly we are able to see is determined by the resolution of the image that results.
Resolution is how close two objects have to be for a person to tell that there are two objects and not one. Imagine you are driving on a desert road and a forest is in the distance. When you are 10 miles away you can't tell one tree from another, so you have poor resolution (your eyes can't see separate trees). When you are 1 mile from the forest you have better resolution. You can see that there are some large trees that are separate from each other, but you can't tell if there are any smaller trees there. When you are entering the forest, you have great resolution. You can see not only separate small trees, but also separate bushes and other plants.
Now imagine that your horse has torn a ligament in his fetlock (ankle). If the tear is really large (say it's 1/2 inch in diameter), then we can see the tear with an ultrasound machine. We don't need an MRI, as it won't help us any more than an ultrasound. If the tear is 1/32nd of an inch in diameter, we can't see it with an ultrasound, but it would be very clear on an MRI. For soft tissues, MRI has MUCH better resolution than does ultrasound, radiographs, or a bone scan. We use MRI when we need better resolution.
2) Can the MRI be done standing? In 2005 Arizona Equine was one of the first clinics in the United States to purchase a novel MRI machine designed specifically for use in the standing horse (Hallmarq system). This machine was designed by an engineer in Great Britain because he could not understand why his horse had to be anesthetized to obtain an MRI of its feet. You can find details of this system here: http://www.hallmarq.net/. This is the only system in the world that allows images of the feet of the horse to be obtained standing. Hallmarq has won numerous awards for innovation. In 2015 Hallmarq was awarded "The Queen's Award For Enterprise" by the British Royalty for its work to help horses. We are proud to be partners with Hallmarq, as they have helped horses immeasurably with their products.
Theoretically, areas higher up the leg can also be obtained standing, but the resolution suffers somewhat due to patient motion. At Arizona Equine we want the best images possible, so for scans of areas including the fetlock and above, we use general anesthesia. About 95% of our MRI scans are done standing, because most of the problems causing lameness in the horse are below the fetlock.
3) Magnet size of the MRI machine: As the size of the MRI magnet increases, the resolution of the image gets better. The physicist's reasons for this are beyond this discussion. So the best system is the one with the biggest magnet, right? Not necessarily! To understand why, we'll talk about the differences:
There are two broad categories of MRI machines based on the size of the magnet: High Field and Low field. High field magnets are those that have ratings of 1-2 T. T is short for Tesla, which is a unit of magnetic strength. The bigger the number is, the stronger the magnetic strength. Low Field magnets are generally considered to be those of 0.2-0.5 T. Currently there are two MRI machines in Arizona and both are low field magnets. The closest high field magnets are in Santa Barbara, California and Fort Collins, Colorado.
Why didn't the clinics in Arizona put in high field magnets if the resolution is better? We can only speak for Arizona Equine, but for us it came down to how much resolution do we need, and can we do the scans standing? Before buying this system we met with several veterinary radiologists and each of them told us that the low field magnets will produce exceptional images, and that any problem that creates lameness in a horse should be visible on this machine. We have found this to be true over the last 10 years.
We like the analogy of television. If you are a fan of "Dancing With the Stars", do you need an HD or 4K television set to determine who is the best dancer? No! You can tell who the best dancer is with a regular TV, even though an HD or 4K TV image looks prettier. The same is true with MRI. We want enough resolution to see the problem, but don't need more if it requires general anesthesia.
The second consideration was whether we could do the scans standing, and this is not possible with any high field machine, or with any low field machine other than the Hallmarq system. This is why we have a low-field Hallmarq system.
Treatments Options
Once our specialists use all of their bright, shiny toys to determine where your equine athlete's problem is located, what can they do about it? This is, after all, the most important thing to the owner.
Targeted therapy is of the utmost importance. If we can treat exactly what is wrong and nothing else, then we have a better chance of helping your horse recover. What types of targeted therapies are there?
1) Injection of medications: There are a number of medications that can help relieve inflammation and stop the pain associated with certain lameness conditions.
One of the most commonly used is corticosteroid injections into joints (steroid injections). Corticosteroids are a class of very potent anti-inflammatory drugs that not only relieve pain, but interrupt harmful negative cycles that can cause more joint problems if left untreated. There are several different kinds of corticosteroids that are used in different circumstances. The specialists at Arizona Equine are skilled at using the correct one to get your equine athlete back to work.
Hyaluronic acid is another drug that is commonly injected into joints to help relieve pain and inflammation and to speed healing. Many times it is used in conjunction with corticosteroids for optimal results. Hyaluronic acid is a natural substance that is found in healthy joints; it is a very slippery substance to the touch. It is called a boundary lubricant because it helps the joint tissues slide across one another easily. It also helps prevent harmful inflammatory substances from entering the joint, which reduces continued joint inflammation. The injectable form was originally extracted from rooster combs, but it is now produced in the laboratory.
Bisphosphonates are a class of drug that helps to prevent abnormal bone loss. Arizona Equine was one of about 20 equine clinics nationwide (and the only one in Arizona) to test the first bisphosphonate drug for FDA approval in the United States – Tildren. We found that it was safe and helpful in treating several equine problems. This type of drug has been used in horses in Europe for the last 20 years with good results in treating navicular disease and hock arthritis.
In some pathologic disease processes the horse's body responds to inflammation by removing too much bone from a given area (navicular bone as an example). This can be detrimental in the long term, and can create a negative cycle that leads to permanent lameness. Tildren, or drugs like it, can interrupt this cycle and stop the bone loss. As a result of the study that we participated in, these drugs are now FDA approved and available in the United States for treating certain equine lameness conditions. Os-Phos is another bisphosphonate that is also on the market and is commonly used in horses.
There are other medications that are used for specialized problems, such as back pain. Sarapin is a drug that is derived from the pitcher plant. Purified forms are used to help relieve back pain, in conjunction with corticosteroids. Other medications are developed from time to time to help treat equine sports injuries. The veterinarians at Arizona Equine evaluate these as they become available and use them when it is shown that they are safe and helpful.
2) Regenerative therapies are a class of treatments that have been developed over the last 10 years, and are showing a lot of promise. These treatments revolve around using substances from the horse's body that the body uses to heal itself. We collect these substances from your horse, and after concentrating them or enhancing them, we inject them into the area that is injured.
IRAP is a substance that is normally present in the horse's joint. We can concentrate it from the blood and inject it into the joint to help relieve inflammation. It attaches to certain receptors in the joint that cause inflammation and block them from being used to create inflammation. This was used routinely 10 years ago, but has slowly fallen out of favor as better treatments have been developed. We still occasionally use this treatment for very specific cases.
PRP is short for Platelet Rich Plasma. Platelets are particles in the bloodstream that allow the blood to clot. They also contain a number of growth factors that help the body heal after injury. In order to use them therapeutically, they must be concentrated for injection. There are a number of ways to do this, but we use a centrifuge to spin down the patient's blood. After spinning the blood for 15 minutes or so at 2400 rpm's, we are able to collect the portion that contains the platelets. We then inject this into tendon or ligament injuries to help speed the healing process. We are also using this treatment in some joint conditions as well. We have had some great results with this treatment and it is one of our front line therapies for tendon and ligament injuries.
Stem Cell therapy is also an exciting treatment that has been developed recently. Stem cells are cells found in the tissues that are "precursor cells". Precursor cells are very young cells that are able to transform into a large number of different types of specialized cells. For example, a stem cell can turn into a tendon cell if needed; or a blood cell; or a bone cell; or a neurologic cell. There is a lot of research going on into the use of these cells to heal human and animal disease. In the horse, there are several ways of collecting these cells for use therapeutically: Fat collection; Bone marrow collection; or using stem cells that have been harvested from mare's placental membranes (embryonic stem cells). We have used stem cells in both joints and soft tissue problems (tendon and ligaments). Stem cell therapy can be very expensive, so the specialists at Arizona Equine will guide you to use it only in cases where we are certain that its use provides a benefit that justifies the expense. Stem cells don't help every condition, and it is important to be discriminating in their use.
3) Shockwave therapy is a treatment that uses a certain wavelength of ultrasonic sound waves to stimulate healing and pain relief in certain tissues. The most advantageous shockwave therapy is "focused". These shockwaves are produced by certain shockwave machines and create waves that go to a certain depth in the tissues and release their energy. This energy release stimulates the tissues in that area to bring in more blood supply to enhance healing. The energy release also deadens some of the nerves for a period of time to relieve pain. We have found shockwave therapy useful in treating tendon and ligament injuries as well as some back and neck problems.
4) Acupuncture is an adjunctive therapy that is used to stimulate healing and relieve inflammation. Dr. Tresha Robinson is certified in acupuncture and uses it in a variety of cases to help enhance the healing process. She would be happy to discuss its use in your particular horse's case.
5) Chiropractic, massage, and body work is also an adjunctive therapy that may help in some equine athletic problems. While we don't maintain a chiropractor or massage therapist on staff, we work with a number of them across the state and guide our clients and patients on when these treatments are indicated for certain conditions.
6) Rest or controlled exercise, while listed last, is extremely important in the treatment of many equine sports medicine injuries. The goal for most of our clients is the long term soundness of their equine athletes. While many of our treatments can speed the healing of our patients, they can't magically replace the body's healing process. This healing process takes a certain amount of time. The body's healing process sometimes requires complete rest, but sometimes is better accomplished with a reduced level of work. The specialists at Arizona Equine can guide you to the appropriate amount of rest or work that is ideal for the long term success of your equine athlete.
In summary, Arizona Equine has you covered for any equine sports medicine problem that you may have. If you have any questions, or would like to discuss a case, give us a call!
Arizona Equine provides complete surgical services for its patients.
*** Slide Show of the Recovery Process ***
Equine surgery has progressed rapidly over the last 20 years, and Arizona Equine provides all of the latest procedures and techniques.
One of the most important factors when considering a surgical procedure is the experience and training of the surgeon. Arizona Equine has two surgeons:
Dr. Scott Taylor, who is board certified by the American College of Veterinary Surgeons.
Dr. Rick Howard, who is board certified by the American College of Veterinary Surgeons.
Both Drs. Taylor and Howard completed three-year residency programs in equine surgery after veterinary school. This training consisting of very thorough training in all aspects of equine surgery by recognized experts in the field. Arizona Equine is fortunate to have two surgeons with the training and experience of Drs. Taylor and Howard.
Some of the surgical services provided at Arizona Equine:
Colic Surgery:
Horses are unique among domestic animals in that the anatomy of their intestinal tract makes them very susceptible to displacements or twists of parts of their intestines. In some cases these problems require surgery to correct them. The surgeons at Arizona Equine perform an average of 60-100 colic surgeries each year. The survival rates with colic surgery vary depending upon what problem is encountered and what complications occur.
Arthroscopy is a surgical technique in which a small telescope and camera is placed into a joint to enable either the diagnosis of joint problems or to allow bone chips to be removed. The image is projected onto a monitor for convenient viewing by the surgeons. The main advantage of arthroscopy is that very small incisions are used, which allows the patient to return to exercise much faster with much less damage to the joint. Drs. Taylor and Howardroutinely perform arthroscopy.
Laparoscopy is much like arthroscopy in that small incisions are made in a body cavity to allow insertion of a telescope and camera to either diagnose or treat problems. With laparoscopy, however, the body cavity that is examined is the abdomen or the chest cavity. This allows the diagnosis of some cases of chronic colic, abdominal neoplasia (cancer), peritonitis, pleuritis, and some other more obscure conditions of the chest and abdomen. Laparoscopy is also used at Arizona Equine to remove cryptorchid testicles (retained testicles) from the abdomen. This allows the identification and removal of all testicular remnants in horses that either have been castrated, but still act "studdy", or in horses that have never been castrated and have one or both testicles retained.
Laser surgery:
Arizona Equine has invested in two types of lasers with which the surgeons can perform surgical procedures: A Diode laser, and a CO2 laser. A diode laser is used in certain upper airway (nose, throat, or windpipe) surgical procedures to allow the surgery to be done with the horse standing. In these cases the horse is usually sedated and the procedure done through a videoendoscope. The CO2 laser is very useful for the removal of skin tumors. It allows for very precise removal of cancerous tissue without damage to surrounding tissues. It seals capillaries and minimizes bleeding as it cuts, which results in less pain for the horse.
General orthopedic surgery:
Drs. Howard and Taylor have a lot of expertise and interest in orthopedic surgery. Arizona Equine has the facilities and equipment needed to repair many types of fractures in the horse. Due to the generosity of a donation from Bob and Carmen Grimes from Tucson, Arizona the clinic was able to install a special sling recovery system that helps horses with broken legs recover from anesthesia after surgery. This system has been used numerous times and has helped to save 4-5 horses with broken legs that were repaired at the clinic.
General soft tissue surgery:
Drs. Taylor and Howard are also adept at numerous soft tissue surgical procedures, including neurectomy, prosthetic laryngoplasty (tie-back procedure for roarers), enucleation, tumor removal, colic surgery, etc. In summary, just about any type of surgical procedure that is done for horses is done at Arizona Equine.
Ultrasonography is a diagnostic tool in which soft tissues are examined, as opposed to diagnostic radiology, in which bones are examined. Over the last 10-15 years, ultrasonography has played an increasingly large role in equine veterinary medicine. Newer ultrasound machines are extremely powerful and have many features to help today's equine veterinarian provide accurate diagnoses.
Arizona Equine has kept up with advances in ultrasound technology by continually investing in new machines. We currently have a hospital ultrasound unit that has several different probe capabilities, including 3 MHz, 5 MHz , 7,5 MHz, and 10 MHz. This allows us to image anything from very superficial soft tissue structures like tendons, to deeper organs such as the heart, liver, kidneys, or spleen. This machine also allows us to use Doppler technology to better diagnose some blood flow conditions in the heart.
We also have several portable units that allow us to give a definitive diagnosis of pregnancy, twins, and other reproductive issues. These portable machines may also be used to diagnose tendon problems in the field, although our clinic machine is better for those problems because its resolution is better.


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Not all Millennials are Millennials.
Thats the title of a CPA Success blog written by Bill Sheridan, editor for the Maryland Association of CPAs.
Sheridan attended a workshop on general differences in which the instructor asked the audience to throw out one-word descriptions of Gen Y.
Answers included entitled, self-centered, blameless, narcissistic and impatient.
It's convenient to lump all Millennials into a silo and slap a few labels on it, Sheridan writes. But those labels simply don't apply to everyone in the silo.
Thats exactly the point I try to drive home when I give attendees at my Gen Y sessions a test, in which they have to guess which generation made certain statements about their job. Most of the test-takers fail and I explain that believing that everyone of a certain age acts the same way is equivalent to believing everything in the horoscopes.
Our employees are individuals. Each has unique qualities that he or she brings to the office, Sheridan writes. Maybe our workforce differences have more to do with personalities than generations.
Hmm ..

subset: commoncrawl


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Ongoing Supervision -- California 2017-2018
Ongoing Supervision is ideally suited for individuals and small groups of people working in multicultural environments, experiencing race-related challenges, or wanting to get "re-energized" in their commitment to changing racism, sexism, heterosexism, classism, and other "isms". Participants include: staff and managers from both the public and private sectors; administrators, faculty and staff from educational, religious, and cultural institutions; consultants, clinicians and community activists; and everyday folk committed to social change.
Previous participation in VISIONS' training, either "PACE Level I: A Personal Approach Change and Equity", and/or participation in an ongoing consultation/training with VISIONS at your workplace or community group. Please reach out to us if you are interested in joining this group for the first time.
The cost is $2,000 for new/1st time participants, $1,575 for those who are returning. The cost includes all 4 sessions and covers all materials. If necessary, please contact Emma Keough at 617-541-4101 to discuss payment plans and options.
Each session last two days and runs from Sunday (6-9 pm) to Monday (9:00-4:30 pm). Pasadena sessions are held at All Saints Church 132 N Euclid Ave, Pasadena, CA 91101. Oakland sessions are at the First Unitarian Church of Oakland at 685 14th St, Oakland, CA 94612. Sessions alternate between the two locations, please see dates below:
October 15-16, 2017- Pasadena
January 21-22, 2018- Oakland
April 15-16, 2018- Pasadena
June 10-11, 2018- Oakland


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19 September 2016
About the Hall of Fame
The purpose of the Michigan Senior Olympic Hall of Fame is to recognize and honor outstanding athletic performances, as well as outstanding contributions made to the success of the Michigan Senior Olympics by athletes Board Members, and volunteers. The award will be presented to not more than 3 individuals each year. Nominations may be submitted by anyone, self-nominations are acceptable. The award may be granted posthumously.
Eligibility requirements:
- Has exhibited good sportsmanship and citizenship
- Has been a positive ambassador for the Michigan Senior Olympics
- Has volunteered time and/or money to the Michigan Senior Olympics
- Has set a record in Michigan Senior Olympic competitions
- Has competed against at least one other athlete in most events
- Has well-represented Michigan in the National Senior Games
How is someone nominated?
Michigan Senior Olympics
650 Letica Dr.
Rochester, MI 48307
All nomination forms and documentation must be postmarked by June 1 of the year they are to be considered. Nominations received after June 1 may be held over for consideration in the next year's nomination process. All nomination forms will be reviewed by the Executive Director to verify that the person being nominated meets the aforementioned eligibility requirements. If nominated but not selected, a nominee will automatically continue to be considered for selection in the ensuing years. Qualifying nominations will be presented to the Board of Directors for review and approval before being forwarded to the Selection Committee. The Selection Committee will consist of three individuals chosen annually by the Board of Directors, and will include at least one Board member. Successful candidates must receive approval of at least two of the three members of the Selection Committee. Presentations of the awards will be made at the Celebration of Athletes dinner held in conjunction with the following Michigan Senior Olympics competition.
Clara "Lulu" Gamble of Kalamazoo has been involved in the Michigan Senior Olympics since 1990. She has participated in various events throughout the years including Pickleball, Badminton, Racquetball, Powerlifting, and Track & Field. Lulu has also attended several National Senior Games competitions and represented Michigan by bringing home multiple medals. She also holds several state records in javelin and shot put. "The most popular kid on the block had a bat and ball. I was not that kid. Few sporting activities were available in my youth especially if you were a "southern belle"." After my wage earning years I discovered the senior games and started to sample as many as available. What fun. Wonderful friends surfaced. Aided by some super pals, I have had many experiences on the state and national level. Winning a lot of medals impresses my family and friends. To me, they are reminders of good times and fun with a host of playmates.
Stan Koster, currently a resident of Zeeland, has always competed in athletics, including winning 12 varsity letters in three sports in the small rural high school in McBain. He continued competing in numerous track and field events at Calvin College where he was a record holder in pole vault and javelin. In 2000 he returned to competition by competing in the Senior Olympics, focusing on the javelin, all as part of rehab from a bout with cancer. Stan has competed in the MSO games 14 times, winning the gold every year except his first year. He holds the state record for age brackets (65,70,75,80). He has also competed in numerous National Senior Games, winning the gold medal 5 times (2001, 2005, 2007, 2011 and 2015) breaking the national record in Houston in 2011. He currently is listed in the top 10 national performances in three age categories (70,75, 80). And in 2005 Stan won the World Masters Games javelin competition in Edmonton, Canada. "MSO has been an important part of my life and I am most grateful for this. At a time when I needed to refocus Senior Olympics provided an opportunity. Along the way we have met some wonderful people who have enriched our lives in ways that likely would not have happened without these experiences."
Manny Hauer is a good example of why a healthy active lifestyle is something for which we should all strive, Manny is 106 years old. When asked for his advice for living a long life he always says walk daily, eat healthy foods, and limit red meat. He said that the MSO played a large roll in his ability to implement his philosophy. Manny Competed at 100 years old and the last time at 101 years old. He won a gold medal and set the record for 100+. The Olympic committee had to establish a new category of 100+ for Manny. He also holds the record for 95+ years old. The Michigan Senior Olympics gave Manny a focus for his life. As soon as he completed one race he began training for the next year's race. He was an inspiration not only to those who competed in the Olympics with him but too many people in the community who know him. His perseverance and resilience has been a wonderful example and inspiration to his children, grandchildren and great grandchildren and other family and friends.
Join us for the Celebration of Athletes Dinner and Hall of Fame Ceremony!
Registration will open in April
MSO Hall of Fame Members


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Got questions about how to use the international terminal? Wondering if you can use the international terminal to catch a domestic flight, or vice-versa?
Find answers to your questions in the AJC's guide to the international terminal, part of the AJC's extensive coverage of the opening of the terminal and Concourse F in 2012.
Got any other questions about the international terminal? E-mail Kelly at email@example.com.
More AJC coverage of the international terminal:
May 2012: New international terminal up and running
New terminal means long, winding walks for some
TSA adds PreCheck lane to international terminal
The new international terminal: What cost so much?
New terminal brings pleasures, perturbances
Off-airport parking lot opens near international terminal


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Welcome to Casa Nicola and enjoy another facet of Tuscany's outstanding natural beauty, high in the mountains above the cities of Florence, Lucca, Pisa and Pistoia.
Casa Nicola is the perfect place for large family or group gatherings with 20 beds. It offers flexible accommodation as, just by closing a couple of doors the house is turned into 3 self-contained large apartments.
Less than an hour's drive from the airports of Pisa and Florence with direct road links to Lucca and Pistoia you will find the Medieval mountain village of Popiglio and Casa Nicola which is in the heart of the village with clear views across three valleys.
This former monastery was bought in 2006 by the present owner, a British artist, and has been extensively refurbished into a main house and two comfortable apartments, all stylishly and comfortably decorated with all her creative talents. The house is ideally located for people who enjoy the peace and tranquility of the mountains but still within easy reach of all the major Tuscan towns such as Florence and Siena.
If you are planning a special celebration Nicola and her team are more than willing to help and can arrange in advance:
- Tuscan Cookery Lesson at the house
- Wine Tasting
- Art History Tour of Lucca, Pistoia or Florence
- Celebratory meal cooked at the house
Please click on the menus for details.
If you are keen walkers, anglers, food-lovers, or just wanting to soak up Tuscany's excellent climate and unspoilt natural beauty, this is the ideal place for you.
***Special Promotion***If you are interested in renting the entire property for a group gathering, the first week will cost €2100. If you would like a second week, I am offering a substantial discount of €600. To take advantage of this special offer please contact me for details. Contact details below.


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Darth Vader / Anakin Skywalker
Anakin has always been a tragic character. Burdened with the promise of an illustrious career as a Jedi Knight, the responsibility of being the Chosen One, and the death of his mother, Anakin's slow but steady spiral down the Dark Side of the Force eventually sealed his fate as the Dark Lord of the Sith. He betrayed all that he stood for, and destroyed all that he ever loved - including his relationship with his friend, mentor and master, Obi-Wan Kenobi. Worst of all, his quest of finding absolute power to stop Death as seen in his visions, led him down a path that resulted in him tragically killing Padme, his beloved wife, in a cruel twist of fate which he inflicted upon himself. Here, I want to portray Anakin's regret. He takes one last glance towards the Light before pledging his allegiance to the Emperor, and adopting the name that is synonymous with fear itself, Darth Vader. Anakin Skywalker: Toshiro Assistant: Alter Ego by MizDesert Shot with the Sony A7RII + FE 24-70mm f2.8 GM lens tethered to Capture One Pro 11 in Macpherson Photo Studio. Retouched on Capture One Pro 11.Read More


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Resourcing Small Church Leadership
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What a blessing it is to serve with each of you in the Kingdom work our God has called us to. Pennie and I are humbled to have the opportunity to serve the BSCLN. I was asked to serve with the Coordinating Council almost seven years ago as a consultant...read more
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The Instigator
Pro (for)
The Contender
Con (against)
Should college and healthcare be government-controlled?
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1. Unlike a business transaction for the selfish interest of oneself, college and healthcare exist in the first place to make humanity better as a whole. College is a place for intellectual stimulation and discovery of new knowledge. Sure, college can make you more marketable in the professional field, but the institution exists in the first place to enhance the betterment of a society as a whole, not because someone is chasing after the money. In regards to healthcare, it is meant to save those who are ill, which is somewhat similar to defense; it is there for the common interest of people. To me, it would be absurd to say that you don't get the protection from the police or military because you're poor. Similarly, it would be absurd to say that, no matter how smart you are, you don't deserve to go to college because your parents can't afford to pay. Or even worst, no matter how bright your future can be, you don't get treatment because you don't have the money.
2. If the government has a complete control over college and healthcare, the cost can be significantly reduced since the government is a mega business entity itself. This is not to be confused with the government paying for college tuition and health insurance because the respective colleges and insurance companies can charge as much as they can and still ask the government to pay for it, which of course is bad. What I'm saying is that, the government should have a complete control over colleges and healthcare industry to make these services accessible to every citizen while significantly reducing the cost and eliminating any profit-making opportunity in those industries that are meant to serve the common interests of the people.
3. When it comes to sustainability of a nation, having a college degree would be the most ideal solution to a long-term economic growth. For example, in the U.S., most of the manufacturing and non-skilled jobs were sent abroad to cut down the labor cost. On the other hand, most of the PhD candidates in the STEM fields are rewarded to foreigners each year because America doesn't have enough qualified domestic students to fill those seats. Instead of fighting over those cheap manufacturing jobs with foreigners, why can't we, as a nation, educate the people to compete in the professional world?
First I want to challenge a few of the premises here. I'd argue that college is indeed a transaction. The student wants to learn, and pays the institution to teach them (or gets a scholarship, etc.). This can be done to increase pulling power in the job market, or for purely academic purposes, etc., but it is still a transaction. On the subject of healthcare I'd also argue that your premise is incorrect - not all healthcare is meant to save those who are ill. We also have preventive care and palliative care, and - side note that I'll reference later - many argue that an increased focus on preventive care would save money in the long run.
To address another premise, I believe the analogy to the police or the military isn't an accurate one. Safety is required for a productive society to exist - no one would be able to go to work if every time they left the house someone came and burned it down, or stole all of their possessions, unless they could afford private security. The same applies to preventing foreign invasion - a functioning society has to be safe, so to speak, on both international and domestic levels. These things clearly benefit every individual in society in a way that universal healthcare or education do not - person A may or may not be adversely affected by a lack of formal education or access to healthcare in person Z, or indeed in themselves, but definitely will be adversely affected without some kind of legal and defense system.
On the point made in your final sentence, that it would be absurd to say that one can't have medical treatment because one doesn't have the money - I don't think that's an argument for government controlled healthcare. We currently don't have government controlled healthcare in the way that you mean, and yet anyone with a health problem who walks into an ER will be treated. On the similar point about college being denied to those who can't pay, let's go back to your original definition of why college exists: 'a place for intellectual stimulation and discovery of new knowledge', that doesn't exist 'because someone is chasing after the money' i.e. wants to be marketable for jobs. If we aren't concerned with improving chances at attaining a job in this case, then the actual college degree is irrelevant. Again we can find an alternative to government control of college if our goal is to provide intellectual stimulation and new knowledge to people - we can even do this online for free if we'd like. And, as a last point, no one says that no matter how smart you are you don't deserve to go to college because you can't pay - colleges offer scholarships to such students.
In reply to paragraph 2: The essence of this paragraph is that government can significantly reduce cost.
I think we can very easily dismiss the idea that putting government in charge of something makes it more cost-effective just by looking at real world examples. To give just one, an article from The Fiscal Times (link below) states that between 2002-2012 the US government gave out $688 billion worth of entitlement program payments to the wrong people. Intrinsic to the idea that we should put government in charge of such institutions because it'd reduce costs is the idea that it wouldn't reduce quality. For an example here I'll point you to the recent DOJ report stating that, when agents smuggled fake bombs and guns through airport security, the TSA failed to catch 95% of them. And example of reduced quality / efficiency would be the VA scandal, discussed in more detail below.
The problem with putting government in charge of institutions lies in the incentives. In the private sector if you don't do your job properly you're fired, in government it's typically much more difficult for people to get fired. You're also generally not going to be replaced on an agency level - read about the history of the CIA, for example, and you'll see that if they had been a contractor rather than a government agency they would have been discarded decades ago. Let's wrap this back in to the healthcare question, specific to the VA. The VA recently went through a scandal re: how long veterans had to wait to receive necessary care, with many dying during those waiting periods. At the same time, according to HuffPost's review of an internal audit, the VA was overpaying workers by millions of dollars (see link below). "The jobs of some 13,000 VA support staff have been flagged by auditors as potentially misclassified, in many cases resulting in inflated salaries that have gone uncorrected for as long as 14 years. Rather than moving quickly to correct these costly errors, VA officials two years ago halted a broad internal review mandated by federal law. As a result, the overpayments continued."
You referenced accessibility in this paragraph as well, but let's think about the potential consequences of government controlled healthcare. Is there a concern that, in an effort to cut costs, some patients would be denied access to certain types of preventative care? If that were the case, would it cost more money in the long run anyway? Is it likely that patients would be able to get any sort of treatment they wanted / thought they needed, or would it be subject to government approval? If the employees in charge of approving treatments weren't competent, are we confident that they would be replaced? Would doctor's salaries be reduced, and would that create a concern that over time the quality of doctors would decrease? History has shown us very clearly that government bureaucracy is inefficient and short-sighted, largely due to problems around the incentives, and I think that's sufficient to cast significant doubt on the claim that government would significantly reduce costs, and the unstated but necessary claim that it would not reduce quality of care.
In reply to paragraph 3: Economic growth and sustainability.
You argue that our nation should educate people to compete in the world. The first point is that your original definition of education was based on intellectual pursuits and exposure to new knowledge, with the job market being a secondary concern. The argument you're making here indicates that putting the government in control of college should solve the problem of us falling behind in fields like STEM - here I'll propose an alternative. Computer related fields are perfect for a new kind of trade school - for example, if you want a high paying cyber-security job in certain places, what is required is a certification which in turn requires an 18 month course. What we need to do to catch up in these sectors is to create a demand for trade schools that teach programming, cyber-security, and other skills valuable in the new digital economy. This could be created by the government, or it could not - in either case I'd again ask the question; does our history tell us that the government would do a good job if put in charge of such a task? How does our government perform in its current education role? Beyond that I'll ask you to reconcile this argument with the original point about college being a humanitarian institution.
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October 30, 2009 --Specialist Jared Stanker of Evergreen Park was among 18 Americans killed earlier this week. Stanker's family traveled to Dover Air Force Base in Delaware where his body and 17 others arrived Wednesday night.
The president saluted those who died and also met with some of their families as he considers whether to send more troops to Afghanistan.
The president will meet with his joint chiefs of staff on Friday to decide what to do next in Afghanistan.


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