Exploring – the Comeback Kid

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Canadian eventer Jessica Phoenix barely needs an introduction anymore, especially after the spring she’s enjoying thus far, but in case you didn’t know….at just 28 years of age she’s already been a regular on the Canadian squad. In 2007 she was a member of the Canadian Team at the Pan Am Games in Brazil, and she was all ready to go to Hong Kong in 2008 until an injury put paid to those hopes, (more on that later), she completed the Blenheim CCI 3* in England on two horses in the autumn of 2009,  came 3rd at the Bromont CCI 3*, just weeks after having her first baby in 2010, and later that year represented her country at the WEG in Kentucky. Jessie has got 2011 off to a cracking start, winning the OI at Pine Top, the advanced at Red Hills, also coming 2nd in the 2* CIC there, and numerous other placings already.

Let’s talk about her horse Exploring.
Jessie bought him as a four year old OTTB (off the track thoroughbred, my very favourite kind), and he’s now 14. 12th place individually and a member of the silver medal winning team at the Pan Am Games in Brazil in 2007, as well as some consistent results secured the pair a place on the Canadian Olympic Team in 2008, but her dream ended abruptly when a routine check-up shortly before the last training camp in Virginia revealed a lesion in his tendon,
“It was about three weeks before we were supposed to leave, and I had Dr Christiana Ober out to have a look at him, just a routine check-up. He was sound, he was never lame, but there was a little heat in the tendon so we decided to be proactive and scan it, and then that’s when we found it”.
On Dr Ober’s advice, Jessie took Exploring home to Canada, to the Toronto Equine Hospital, where they decided to try a relatively new treatment – stem cell.
“They drill a hole into his (Exploring’s) sternum, about the size of your little finger,  and they remove the bone marrow, and that was the worst part. It was still fairly soon after we’d discovered the injury, and the disappointment of not going to the Olympics, so our nerves and emotions were pretty fragile, and to have them drilling into my horse like that right in front of me was quite difficult, not a great experience!  They make a small incision with a knife, use a little hand drill and then extract the bone marrow with a needle. Then they send the bone marrow to the Atlantic Veterinary College in Prince Edward Island in Canada, put it in a lab until they get some of the stem cells, (in excess of ten million!) and then they ship it back to Toronto, and it’s just a tiny little vial, of about 5 or 10ccs, and then they inject it directly into the tendon, where the lesion was.”
At this point, I need to introduce Dr Laura Werner, a new surgeon at Hagyard Equine Medical Institute, here in Lexington, although the West Coast Young Riders are probably already familiar with her as their team vet.  I enlisted Dr Werner to explain stem cell to me in layman’s terms because she’s had some experience with it and she’s a keen eventer herself.
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From Kentucky originally where she started her eventing, and interned at Hagyard’s, she has now returned to Lexington after 12 years in the wilderness – California! not eventing again until fairly recently. She brings with her two horses, one unfortunately who is allergic to Bluegrass, a conundrum that she is trying to solve as Spring is definitely coming and the grass is growing greener (blue-er?) day by day. Her main goal will be the AEC’s later this summer, but I’m impressed that her main goal isn’t just getting to the barn once she starts describing her schedule to me!  Luckily (for me) she’ll be the FEI vet at lots of events that I’m longing to go to also, so I’ll be able to pick her brains on EN’s behalf on location! Did I mention that she has EventingNation.com bookmarked as a favourite place on her iphone?  We’re going to be BFF’s!
Back to the subject in hand: Stem Cell, or Regenerative Medicine Therapy. Dr Werner tells me that the most ideal type of stem cells are also the most controversial – those which come from an embryo or cells from the umbilical cord that can be banked and stored at birth, because they have the most potential to become other cells and make anything – tendons, cartilage, bone, nerve tissues etc.  As we age, as humans and animals, our cells have less potential.
“What’s becoming common in horses right now is they take a sample of the bone marrow and then they culture it, and they can help differentiate it with the technology available to become either tendon, cartilage, bone, or nerve tissue.”
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All Vet photos thanks to Dr Dwayne Rodgerson
“If you have a tendon injury, tendon never repairs as well as the tissue that originally was there, it just heals over with a scar.  So by using the stem cells they have growth factor as well as cells that can help replace that tissue with as close to the original tendon structure as we can. This way it heals better, and the possibility of recurrence of injury is a lot lower with using stem cells versus just letting it heal on it’s own, and having it essentially just like your skin  would heal with a scar. The same thing with cartilage: cartilage never replaces itself, so sometimes they’re using stem cell therapies in horses’ joints to help that cartilage heal as close to that original cartilage that was present as possible. In horses we don’t use it a lot for nerve tissue, but there is that possibility.  I think they’re probably doing that a lot more in humans, with spinal cord injuries and research for Alzheimer’s and Parkinson’s disease, but that’s where the controversies exist.”
I’m surprised to learn that stem cell therapies are actually quite common.
“People will keep stem cells banked and they might be used in these upper level event horses in their joints. Among upper level horses it’ is fairly common, they are using it in joints as not only maintenance, but as prevention too. If they know there’s a problem there, they’ll put stem cells in the joint to help, somewhat as a treatment but also looking further down the road for these upper level horses. Tendon and ligament injuries are so common in these horses as well too, that it’s used commonly for these also. The main drawback is the expense. Some of these treatments, plus the cost of storing the stem cells –  you’re looking at several thousand dollars at a minimum.”
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Most people will typically have multiple treatments on their horse too, which means keeping their stem cells banked for a period of time.  There are other similar types of treatment available, which are less expensive.
IRAP ( Interleukin-1 Receptor Antagonist Protein) and PRP (Platelet RIch Plasma) are both blood derived. They’re not stem cells but growth factors, and do more or less the same thing, and the IRAP will also decrease arthritis processes in joints to some extent.
There are risks to the therapies: the horse can sometimes reject or react to the cultures, even if they’re from the horse’s own cells, or bacteria can sometimes grow within the culture despite all the efforts taken to prevent the risks, and infection can develop. More work is being done to develop “donor” stem cells already harvested and banked that can be ready to be used as needed to make the system more available, although that does increase the risk of rejection somewhat.
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Insurance companies are becoming more accepting of the therapy, but cost is still the most limiting factor, and ultimately what makes a lot of clients decide to go with one of the alternative therapies.  Hagyard’s does not have a stem cell bank, there are several companies and some of the major universities in the US who have facilities to store stem cells,
“Cornell, Colorado and Davis are probably some of the leaders in stem cell selection so they have established labs, where they culture, grow and store the stem cells, and there are a number of private companies and veterinary practices that have the capability and/or are developing their stem cell capabilities.
Dr Werner can’t give me a percentage on probability of success rate, there are just too many variables,
“Some of those injuries, tendon, ligaments, and arthritis, but especially tendon injuries, despite all the treatment that we do, the rehabilitation of the horse is just as important as what you’re doing there, it’s a multi-systemic process going on, so I think what we do is definitely helpful but there are additional factors involved as to whether or not the horse comes back, so I think  with tendon and ligament  injuries the rehab is just as important as whatever you do to the tendon to try to make it heal.”
So how DID Jessie bring Exploring back, seeing as he was at Blenheim about a year later in September 2009, won the Advanced at Red Hills just over a week ago, and is headed to Rolex in about a month’s time?
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“With Exploring, although they had recommended stall rest, I actually kept him turned out in a small, confined paddock, and it was on the side of a hill, so he had to keep going up and down the hill. Gradually I extended it little by little, and I started riding him pretty soon afterwards, just walking him, then building him up slowly.”
Now, apart from running her hands down that tendon every single day, she treats Exploring like any other horse. She says you can feel the slight scar tissue there, and a very slight bump, but if you weren’t looking for it you probably wouldn’t notice it, and more importantly there’s been no change in his leg since the treatment.
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The biggest difference for Exploring these days might be Jessie’s perspective. Since becoming a mother to Jacob right before Rolex last year, she says she “treats the horses more like horses, and less like babies, for sure! I feel like I’m even more competitive now that I’ve had a child, I get pretty determined.”
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Jessie’s WEG horse Exponential, another freakishly good OTTB (“it’s hard to match that heart”)  won his first outing this spring, the OI at Pine Top, and touch wood, will join Exploring at Rolex in a month’s time. There will definitely be hordes of Canadians cheering them on there, and plenty of converted fans from other nations too, myself included.
 Thank you to Jessica Phoenix, and Dr Laura Werner for sparing me so much of their precious time to talk to me, and explain the gory and scientific details with such patience.  Go Jessie, Go Canucks, and Go Eventing!

This article is also published on SamanthaLClark.com

 

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