Clinical research is the practical research into diseases in our horses that directly applies to their health and welfare. Dr. Bell has been a clinical researcher at the University and private practice level for many years. Our clinical research involves exploring innovations to help improve our understanding of the diagnosis, treatment and outcomes of various conditions in the horse.

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On-Going/Current Clinical Research Initiatives

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1. EQUINE TRIGEMINAL ASSOCIATED HEADSHAKER SYNDROME

Equine Headshakers Syndrome or Equine Trigeminal Neuritis is a insidious disease condition of the horse where it is thought that the trigeminal nerve becomes inflamed or irritated resulting in a characteristic 'head shaking' movement when the horse is exposed to exercise, sunlight, increased blood pressure or stressful situations. In its worst manifestation, the headshaking movement can be constant or near constant for the horse. Some of the classical signs are 'bobbing' their head up and down when exercised or when exposed to sunlight, rubbing their nose on the ground or their cannon bones, hypersensitivity of the face or mouth especially when bridled. There are other signs as well but these are the main ones seen. To date, an exact cause for the condition has not been found, however, the disease is believed to be similar in origin to trigeminal neuralgia/neuritis in people. This is a neuropathy where the nerve that supplies sensation to much of the face/muzzle is irritated particularly when exposed to sunlight, increased blood pressure or exercise. Diagnosis is based on the clinical exam findings consistent with headshakers syndrome as well as nerve blocks of the infraorbital canal/nerve and maxillary branch of the trigeminal nerve. Treatment has been limited to medical management when various medication to stabilize the nerve inflammation, however, no definitive long term successful treatment has been devised. Dr. Bell in collaboration with human neurosurgeons has been exploring a surgical technique to eliminate the source of headshaking at the trigeminal nerve. The procedure has been successful performed in a horse to date and we are looking for new patients that would like to explore the risks and benefits of this new procedure. If you would like to discuss this clinical research, please contact us for further information

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2. SACROILIAC JOINT DISEASE

Horses that develop sacroiliac joint disease can have changes in the ligaments and structures that compose the paired sacroiliac joints. These changes result in lameness and sometimes chronic lameness issues. Diagnosis is made with clinical exam and nerve blocks of the sacroiliac space or joints via ultrasound guidance followed by ultrasound evaluation of the joints or nuclear scintigraphy of the SI joint region. Treatment of sacroiliac joint disease is involved traditional injection of corticosteroid either directly into the joints via ultrasound guidance or via perfusion of the SI joint region with corticosteroids. Shockwave therapy has also been used to decrease SI joint pain. Many adjunctive therapies such as acupuncture, magnetic therapy, chiropractics and others have been tried to manage sacroiliac disease. Unfortunately, the exact nature of the injury is rarely determined. We are working on a diagnostic modality to definitely diagnose SI joint injuries and make directed and concerted treatment a viable option depending on the type of joint/ligament structure injury. If you have a horse with an SI joint/region injury that is refractory to treatments or chronically lame and would be interested in being involved in our study, please contact us.

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3. CORNELL ANESTHESIA RECOVERY SURVEY STUDY

We are happy to participate in a survey study currently being conducted by Cornell University at Equine Referral Hospitals across North America. The study is looking to identify risk and outcomes associated with equine anesthesia recovery.

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COLLABORATIONS:

Dr. Bell and associates participate in a number of research collaborations on various projects. We are currently involved in clinical research projects with the following research groups:

• Western College of Veterinary Medicine - University of Saskatchewan

• Iowa State University - College of Veterinary Medicine

• Institute of Veterinary Science - University of Liverpool, UK

As this work becomes published we will post our findings. Stay tuned.

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Previous Clinical Research Projects

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INTERNAL NEUROLYSIS FOR THE TREATMENT OF EQUINE HEADSHAKER SYNDROME (2018)

C Bell, L Hnenny, K Torske

This was a case report study on a horse severely affected with equine trigeminal nerve mediated headshaking syndrome. This case was treated conservatively without resolve and we developed a novel approach to the base of the trigeminal nerve behind the eye in order to neutralize the nerve dysfunction. In collaboration with a human neurosurgery, the internal neurolysis technique was employed and we saw dramatic improvement in the symptoms. Unfortunately, the horse had some residual clinical signs which resulted in it passing and we looked at the brain and nerves for a reason for the condition and for the effectiveness of the procedure.

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Fracture of the medial intercondylar eminence of the tibia in horses treated by arthroscopic fragment removal (21 horses).

Rubio-Martínez LM, Redding R, Bladon B, Wilderjans H, Payne RJ Tessier C, Geffroy O, Parker R, Bell C, Collingwood FA.

This was a multicenter study headed by Dr. Rubio-Martinez at the University of Liverpool looking are an uncommon intra-articular fracture in the stifle joints of horses. This fracture is usually the result of trauma and seen in performance horses. The fracture can result in long term complications such as severe arthritis in the stifle joints, however, our study showed that horses can be successfully treated with arthroscopic removal of the fragment(s) and returned to full athletic function with a progressive rehabilitation program. 

Results are published in the Equine Veterinary Journal (EVJ)

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Reconstruction of collateral ligaments with a novel construct using FibreWire and SwivelLock knotless suture anchors

​​Bell C, Lobb B, Torske K.

Horses that have a fracture of their insertion or origin of a collateral ligament are often very painful and can develop unstable joints as a result. This ultimately results in severe arthritis and lameness. Traditionally collateral ligament injuries would have been treated conservatively with casts or heavy bandaging and then stall rest. Some foals can be treated with reconstructions but collateral ligament reconstruction in the adult horse had not been previously described. We looked to develop and described with clinical outcomes, the use of a suture anchor construct to rebuild collateral ligament injuries in horses.

The results are published in the Equine Veterinary Education journal (EVE)

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Balloon Sinuplasty for the treatment of equine sinusitis conditions

Horses that develop primary or secondary sinusitis or sinus inflammation have long struggled with a means to drain the sinus without aggressive surgical intervention. We sought to design and implement a minimally invasive surgical procedure to improve drainage of the equine sinus system  via the natural nasomaxillary opening (NMO) into the nose. The procedure involve endoscopic surgery to place a dilating balloon into the nasomaxillary opening of the horse and increase the diameter of the opening to allow for greater drainage via the natural anatomical structure (rather than making a surgical access hole elsewhere in the sinuses from the nose). In this project, we successfully dilated the NMO in both cadaver and clinical cases to improve the drainage in a minimally invasive manner.

The result are published in the Veterinary Surgery journal (Vet Surg)

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Equine Cushings Syndrome/Pituitary Adenomas

Equine Cushing Syndrome is a type of generalize metabolic dysfunction in horses affected by a tumor in the pituitary gland at the base of the brain. This tumor, known as an adenoma, is a space occupies mass within the normal pituitary gland that is functional and produces (over produces) various hormones and signalling proteins in the body with very detrimental effects on the health of the horse. Some of the most common clinical sings associated with pituitary adenoma's are excessive or curly hair growth, not shedding out their hair coat each summer, laminitis, increased propensity for infection, excessive fatty weight gain, poor muscle building, increase drinking and urination without obvious reason. The tumor that causes this condition in horses is very similar to the condition in humans. Dr Bell in collaboration with several human neurosurgeon colleagues and veterinary surgeons has developed several approaches to removal of the pituitary adenomas from the horse's brain. The approach is via the basisphenoid bone either through the sphenopalatine sinus or via a ventral approach through a pharyngotomy or via the paired guttural pouches. With access to the sella or the bony cavity in which the pituitary sits, the pituitary tumor is removed and the horse is relieved of the effects of the tumor. Dr. Bell has also developed another approach via the temporal bone of the skull to access the pituitary from above rather than below to remove macroadenomatous tumors (macroadenoma tumors are more rare but cannot be fully removed via the ventral approach). The approaches developed have been refined in the cadaver models but have yet to be fully proven in the clinical cases. The advancement of CT and MRI studies available of the equine brain and skull will further advance this technique and we look forward to working with clinical cases in the future to resolve this condition. If you would like more information on this exciting new area of clinical research, please contact us.

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PUBLICATIONS

Rubio-Martínez LM, Redding R, Bladon B, Wilderjans H, Payne RJ Tessier C, Geffroy O, Parker R, Bell C, Collingwood FA (2017). Fracture of the medialintercondylar eminence of the tibia in horses treated by arthroscopic fragment removal (21 horses).​Equine Veterinary Journal. Early View Article July 2017

Bell C, Lobb B, Torske K (2016) Collateral ligament reconstruction in two horses following traumatic avulsion fractures using a knotless suture anchor construct. Equine Veterinary Education. Early View Article Nov 2016

Carmalt JL, Bell CD, Panizzi L, Wolker RR, Lanovaz JL, Bracamonte JL, Wilson DG. (2012) Alcohol-Facilitated ankyloses of the distal intertarsal and tarsometatarsal joints in horses with osteoarthritis. Journal of the American Veterinary Medical Association; Jan 15; 240(2): 199-204

Carmalt JL, Bell CD, Tatarniuk DM, Suri SS, Singh B, Waldner C. (2011). Comparison of the response to experimentally induced short-term inflammation in the temporomandibular and metacarpophalangeal joints of horses. American Journal of Veterinary Research; Dec; 72(12): 1596-1591

Charavaryamath C, Fries P, Gomis S, Bell C, Doig K, Guan le L, Potter A, Napper S, Griebel PJ. (2011) Mucosal changes in a long term bovine intestinal segment model following removal of ingesta and microflora. Gut Microbes; May 1; 2(3): 134-144

Tatarniuk DM, Bell C, Carmalt JL. (2010). A description of the relationship between the nasomaxillary aperture and the paranasal sinus system of the horse. Veterinary Journal; Nov 186(2): 216-220

Bell C, Tatarniuk D, Carmalt J. (2009) Endoscope-guided balloon sinuplasty of the equine nasomaxillary opening. Veterinary Surgery; 38 (7): 791-797

Bell C, Taylor D.S., Howard R.D., Werpy N. (2009) Outcomes of navicular bursa injections in horses with MRI diagnosed foot pain: 23 cases (2005-2007). Journal of the American Veterinary Medical Association; April 1; 234(7): 220-225

Bell C. (2007). Neuromuscular dysfunction associated with bilateral guttural pouch tympany in a foal. Canadian Veterinary Journal, Feb; 48(2): 192-4.

Epelman S, Stack D, Bell C, Wong E, Neely GG, Krutzik S, Miyake K, Kubes P, Zbytnuik LD, Ma LL, Xie X, Woods DE, Mody CH. (2004). Different domains of Pseudomonas aeruginosa exoenzyme S activate distinct TLRs. Journal of Immunology; 173(3): 2031 – 40.