Seattle facility takes surgical, medical rehabilitation to next level

SEATTLE — Just over two years ago, Dr. Mark Dedomenico, MD, a renowned cardiovascular surgeon with a passion for developing elite equine athletes, opened one of the nation's most luxurious and state-of-the-art equine training and rehabilitation facilities.

Pegasus Equine Rehabilitation and Training Center in Redmond, Wash., about 20 miles east of Seattle, provides five-star amenities for injured racing and sport horses in a scenic, meticulously tended, 100-acre setting.

The mission is not only to assist in the animals' recovery, but to study and refine rehabilitation techniques to restore equine athletes quickly to high-performance levels.

Pegasus is a working farm — one that not only rehabs horses post-surgery and breaks and trains young Thoroughbreds about to embark on racing careers, but also features a research center, where Dedomenico hopes to learn more about the true nature of musculoskeletal injury and disease rehabilitation. That involves training and working with renowned equine experts from around the nation, in addition to practitioners from Washington State University College of Veterinary Medicine.

Every aspect of Pegasus' design has been considered to enhance horse health, safety and healing, its owner says. Horses walk on rubber-brick paths and similar walkways in the barn. Their stalls are bedded with wood shavings on soft-rubber, air-cushioned flooring.

The picturesque complex, which can house up to 130 horses, draws Thoroughbreds from Kentucky, California, Oregon and Western Canada, as well as those from Washington state. Other sport horses and dressage horses come to Pegasus for rehabilitation. And stallion barns, although not presently used for breeding, offer future potential.

Among the various Pegasus amenities are a 16-foot-deep equine swimming pool, an underwater treadmill called Aquatred, a hyperbaric oxygen chamber, eight Eurocisers, a 17,600-square-foot Polytrack™-surfaced indoor arena, and five-eighth-mile Polytrack-surfaced training track. There are several oversized paddocks, used mostly for exercise and to allow the horses some sun.

Dedomenico and the facility operations manager, Lynn Lockhart, traveled to horse farms throughout the country for two years gathering ideas before they built Pegasus. "We wanted to really set it up right," says Lockhart. "It has to work."

And work it does. The equine pool allows horses recovering from surgery to maintain their cardiovascular fitness without any concussion or stress to limbs, joints, tendons or ligaments. The underwater treadmill provides exercise with minimal load to limbs and joints, while incorporating some weight-bearing rehabilitation. Horses easily adapt to it and get a full-body workout.

Eurocisers allow for individual free movement at controlled speeds of 1 mph to 25 mph, allowing the horses to walk, canter or trot according to their needs. The 110- by 160-foot indoor arena and the training track both are surfaced with Polytrack, a combination of natural and synthetic materials including polypropylene fibers, recycled rubber and wax-coated silica sand. The cushioned surface allows for safe, higher-impact movement to properly condition the horse's bone, cartilage and joints to restore full function.

"You need to jar a horse's limbs to stimulate bone growth and cartilage development to get the osteoblasts and osteocytes functioning," Dedomenico says. "That's why the Aquatred works so well."

It's been said that swimming assists in this process as well, and they're trying to prove this at Pegasus. The regimen in the pool, the Aquatred and the Eurocisers are individualized, depending on the horse and its condition. "We start them out gradually, get them used to the equipment and see what they can take, watching them closely," explains Mary Knight, director of horse operations. Once they've progressed, they move on to the Polytrack training track for significant training.

Special therapies

Pegasus also employs several special therapies to assist in the healing process. The hyperbaric oxygen chamber is used in treatment of surface wounds, soft-tissue injuries, infections, tendonitis and laminitis. Recently a 5-year-old racehorse came to Pegasus for hyperbaric oxygen therapy to assist in the healing of a large surface wound on the foreleg. Within 90 days, the wound had healed and the patient was ready to start swimming and using the underwater treadmill.

Pegasus uses P3 electromagnetic pulse therapy for tendon and ligament issues, swelling, joint stiffness and muscle strains. P3 is commonly used for back soreness, especially for muscles of the back, croup and hamstring.

Success has been reported with treatments of 15 minutes per day for three to five days, sometimes with temporary relief and in other cases long-term benefits. It has also been shown to benefit chronic suspensory desmitis (a common cause of both fore- and hind-leg lameness).

Pegasus also employs hot/cold compression therapy, which has been popular with professional human athletes to treat sore or strained muscles. Applied to the horse's legs, it reduces swelling and discomfort of strained tendons and muscle tears.

According to James Orsini, DVM, Dipl. ACVS, associate professor of surgery at the University of Pennsylvania School of Veterinary Medicine's New Bolton Center, it is "the standard of care for cold therapy." Cold therapy is used to minimize damage following injury and helps equine athletes heal faster during rehabilitation, reducing pain and inhibiting muscle spasms.

Horses at Pegasus are treated to Equissage, a deep-tissue massage machine that increases circulation while easing and toning muscles. It also is said to enhance lymphatic drainage and increase joint mobility, improving movement and performance. The Equissage "Back Pack" gives deep, cylcoidal massage to help speed healing.

Another tool employed at Pegasus is infrared digital thermal imaging, for visualizing changes in body temperature, detecting the first signs of edema and muscle strain.

It can uncover abnormal patterns in soft tissue, including nerves, muscles, tendons, ligaments and organs, showing areas of inflammation, infection, injury and nerve damage.

Equine infrared imaging also can detect musculoskeletal injuries several weeks before they are visually detectable, and can further help follow the horse's response to treatment.

Research for the future

Besides Pegasus' state-of-the-art amenities, Dedomenico and staff are beginning to conduct research to find the best way of those available to rehabilitate horses.

In the first research project, 24 to 32 horses will be divided into three treatment groups. A chip will be inserted in each horse's lower limb and removed after 30 days, giving sufficient time for osteoarthritis to start to occur. The researchers will look at enzymes and biomarkers for bone/cartilage deterioration.

One group of horses will go into the Aquatred as their sole treatment. Another will go into the hyperbaric oxygen chamber the day after surgery and then into the Aquatred as soon as the wound is healed (about a week to 10 days post-surgery). The third, or placebo (control), group will receive a common post-surgical regimen. Researchers will then compare the healing among the three groups at 180 days and a year later.

Another study will add swimming, taking horses from the hyperbaric oxygen chamber to the equine pool and then the Aquatred.

"Within a few years we hope to have more answers about the healing process," says Dedomenico.

He and the Pegasus staff expect to make noteworthy progress in equine training and rehabilitation and adding significantly to the that knowledge base.

"We've got to find a way do things better," says Dedomenico.

"I think we can heal horses a lot faster using the hyperbaric oxygen chamber, swimming pool and Aquatred, and then getting them back to form on Polytrack."

They've made substantial progress with the many horses they've already treated. In early spring this year, Hystericalady, a 4-year-old filly, came to Pegasus for rehabilitation.

On May 5, she ran to a four-length victory in the Grade 1, $300,000 Humana Distaff at Churchill Downs on the Kentucky Derby undercard.

The results speak for themselves.

Ed Kane is a Seattle author, researcher and consultant in animal nutrition, physiology and veterinary medicine, with a background in horses, pets and livestock.