Stepping Stones Veterinary Wellness and South Jersey Equine Associates offer a wide range of ambulatory services conveniently at your own barn.

Ambulatory care is our focus. Our team provides a wide range of services on the farm from routine preventative care to evaluation of health or lameness issues to 24 hour emergency services. We are dedicated to create a lasting relationship that helps your horse, camelid, or goat from birth to seniority be healthy and comfortable.

Emergency Services:
No one likes to think about having an emergency with their horse, but it’s good to know that Stepping Stones Veterinary Wellness veterinarians provide help 24/7/365 to clients. Surveys show that providing emergency service on the farm where their horse lives is one of the most important things that horse owners look for when choosing a veterinarian. In pouring rain, summer heat or the cold of winter with snow-covered roads, our veterinarians are there when you need us!

Our veterinarians deal with a multitude of emergency situations. Some of our most common include: Colics, lacerations, eye injuries or other ocular problems, chokes, horses that are down and unable to get up, severe sudden lameness, cellulitis, loss of appetite, and allergic reactions. Difficulties with foaling (dystocias) are also absolutely emergency situations but fortunately are not quite as frequent in our practice.

Emergency fees apply to come out to your barn when you need emergency care. These emergency fees apply in addition to those for services, medications, and trip charges. Starting in 2018 we have adjusted our emergency fee structure and are offering a discount for horses who have been seen for routine preventative care in the last 24 months. Please see the Emergency Policy FAQ and Emergency Voucher Letter for more details.

Medical Exams and Consultations:
Medical exams include discussing your animal’s history and any concerns that you might have. One of our veterinarians will physically examine your animal and document the exam in the medical record. This documentation is very valuable as a baseline record later on should your four legged friend become ill. We are happy to discuss and evaluate body condition weight to help you manage your horse at a healthy weight. Any potential problems or concerns can be discussed with you and documented so they are available for future reference and follow-up. Our goal is to find medical issues prior to them becoming a larger problem.

Geriatric Care:
SSVW takes the care of your beloved older horses very seriously. Regular examinations, dental evaluations, other preventative care, and screening for PPID (“Cushings Disease”) are the foundation of effective geriatric care. Older horses are living much longer, healthier lives when they have good nutrition, parasite control, and regular veterinary care. Please call us with any concerns about your older horse in between our visits.

Equine reproduction services & Neonatal Care:
Our practice’s reproductive services focus on the mare and foal. Our mare services include reproductive management for breeding, uterine cultures, uterine cytology and biopsies, intrauterine treatments and artificial insemination with fresh, cooled semen, and early twin reduction. We also perform breeding soundness exams. We offer referral to other practices for stallions’ reproductive needs, or for more intensive reproductive monitoring for mares being bred with frozen semen or embryo transfer which require clinic boarding.

As newborns, foals do not have active immune systems of their own, and rely on passive transfer of immunity from their dam’s colostrum. SSVW recommends that owners call within 12 hours of a newborn’s arrival to discuss the best time for a neonatal exam and evaluation of colostral transfer of immunity. The post-partum and neonatal exams are very important. Both the mother and the baby are examined to evaluate for any abnormalities. Congenital problems of the foal may include cleft palate, cataracts, hernias, or entropion (where the eyelids roll inward and the eyelashes can rub on the cornea). Evaluation of the placenta is very important to ensure that no part of it was retained inside the dam, which could lead to life-threatening complications. The best way to save the placenta is to put it in a bucket with cold water and cover it to keep flies off and odors contained until the veterinarian can evaluate it. If freezing temperatures are present, please maintain the placenta in a warmer area.

Ophthalmology:
Eye problems are frightening, can threaten your horse’s future ability to see clearly, and often are an emergency. Ophthalmic issues can accelerate quickly without prompt diagnosis and treatment. Some of the most common conditions that we encounter include eyelid lacerations, corneal scrapes and ulceration, foreign bodies/material in the eyes, uveitis, clogged tear ducts, glaucoma, cataracts, and cancer involving the eye. SSVW veterinarians will evaluate the situation on the farm, form a diagnosis, and initiate treatment. When necessary, we refer our patients to an ophthalmologist at a referral center for a second opinion or advanced treatments. In more serious conditions, or when the patient won’t allow direct application of medications to the eye, our veterinarians will place a subpalpebral lavage (SPL) system to administer ophthalmic medications. In addition to regular ophthalmoscope evaluation, we also have a tonometer – a device that can help measure intra-ocular pressures, which is critical for diagnosing glaucoma.

Lameness Exams & Consultations:
SSVW offers veterinarians experienced in lameness diagnosis and performance evaluation. This area of practice requires a good grasp of anatomy, a keen eye for gait analysis, and sensitivity in detecting subtle abnormalities. Thorough history taking, observations of work under saddle or on a lunge line, and a combination of diagnostic nerve and joint blocks are often required to determine the cause of unsoundness. Experience in the use of and interpretation of diagnostic modalities such as radiography, and ultrasound is essential.

After diagnosis, our veterinarians recommend treatment that may include therapeutic joint or tendon sheath injections, regenerative therapies, acupuncture or chiropractic sessions, or a multitude of other options.

Depending on the initial findings, we may pursue consultation with sports medicine or surgical specialists for a second opinion on the case or review the images with our SSVW colleague veterinarians back at the office.

Diagnostic Imaging – digital radiography, ultrasonography, endoscopy:
At Stepping Stones Veterinary Wellness, we offer digital radiography utilizing two units as of the fall of 2016, one of which can be used wirelessly. The MyRad® digital radiography unit utilizes a wireless generator, making it possible for us to obtain radiographs even in the middle of a field without any electrical power. With both our units, we obtain images at the farm and will perform an initial evaluation of the images and discuss them with you while working with your animal. Depending on the initial findings, we may pursue consultation with sports medicine specialists for a second opinion on the case or review the images with our SSVW colleague veterinarians back at the office.

Our ultrasound units allow us to evaluate your horse in real time and then save images that can be referred to later or sent for a second opinion. We use our ultrasound units for evaluation of lameness and musculoskeletal injuries (primarily lower limb tendon and ligament imaging), for reproductive imaging of the uterus and ovaries, as well as for imaging for a variety of soft tissue abnormalities.

SSVW utilizes a 1 meter endoscope that allows us to visualize upper airway structures in real time. For lower airway or gastric endoscopy needs, we provide referral to providers with access to more advanced equipment.

Chiropractic Care:
While most people think of chiropractic as a modality to use for back pain, true, it does so much more! Chiropractic is ultimately functional neurology. Restoration of normal movement to the animal’s spine and joints allows the entire nervous system to function better. The nervous system is a vital part of the function of every single body system. The body can heal itself if allowed to do so. This is a function of innate intelligence – which is how the body actually heals itself given the opportunity. The veterinary chiropractor uses their hands to deliver a specific adjustment intended to relieve a subtle malpositioning called a subluxation, to allow the body to heal itself. Subluxations occur when joints between vertebrae don’t move the way they should when properly aligned.

Dr. Beth Hirsch pursued chiropractic training at Animal Chiropractic Education Source in Texas, and completed over 240 hours of chiropractic specific training. Chiropractic has quickly become her favorite treatment modality due to the immediate results that can be achieved and how something so simple can dramatically influence the patient for the better. She has lots of client success stories. The best results occur when hoof trimming is balanced, teeth are appropriately cared for, saddle fit is addressed, and nutrition is optimized. These steps minimize continued inflammatory events that can be the cause of subluxations. Chiropractic care is a process, not a procedure. While one adjustment can certainly help, the best overall health results come from a treatment plan that includes routine adjustments to maintain good health for optimal nerve function for longer life.

Dentistry:
Dental care is changing as horses live longer; good care of horses’ teeth has had a strong contribution to the increased lifespan of equines, as well. The development of better and safer medications for sedation than existed for prior generations has allowed veterinarians to provide more sophisticated interventions than ever before. Here at Stepping Stones Veterinary Wellness, we utilize the use of sedation and full mouth speculums with strong illumination to closely examine your horse’s mouth. With an oral speculum exam, our doctors can see and address tooth overgrowths as well as soft tissue problems. Power tools or hand floats may be utilized to address better balance and comfort in your horse’s mouth.

Proper dental maintenance not only allows horses to chew more efficiently and utilize their feed better; it also allows them to perform better. Did you know that how horses chew influence how they move? Chewing patterns are a learned behavior called a central pattern generator. If an imbalance in his mouth causes a horse to have to think about how he chews in order to avoid discomfort, rather than have chewing be an unconscious activity, this distracts neurologic attention from other rhythmic motion activities. This means that how an animal chews influences its nervous system in such a way that it affects how it performs other rhythmic activities like how it walks, runs, and jumps. Thus an imbalance in a horse’s mouth can influence his athletic ability.

New Equipment: Oral endoscope!
In the fall of 2017 we added our oral endoscope as a new piece of practice equipment. This tool allows us to identify, diagnose, and treat problems in the horse’s mouth earlier and more accurately. We can find periodontal disease, cavities or tooth fractures, and ensure complete extraction when a tooth needs to be removed. We can take still pictures or video with this tool. It also is phenomenal to be able to show clients what is going on inside the mouth via the camera screen – so much easier than craning and twisting to try to get at the right angle to see in the horse’s mouth directly! See below for a couple of examples of pictures of before and after cleaning out an area of feed packing between cheek teeth.

Vaccinations:
At SSVW we choose vaccine products that we believe to be the safest and most effective options available for your horses. Administration of appropriate vaccinations on an individual basis is a common preventative service we perform for our patients. A horse that travels extensively for shows certainly has different needs than a beloved pet that doesn’t leave his home pasture. In addition, an animal’s overall health situation will affect whether vaccinations are considered to be safe or a potential risk to administer. Horses that have had prior vaccine reactions are carefully handled and plans are discussed to determine what protocol is safest for them.

We offer a number of vaccinations and work with each client individually to come up with a plan for each horse based on his individual situation and needs.
Click here to learn more

Parasite control:
Parasite control is an important part of a preventative health program. Resistance to dewormers has been documented more frequently, and leads us to recommend individualized deworming plans for horses rather than treating the herd as a single entity. Simply deworming every horse every 6-8 weeks can increase drug resistant parasites, and should be avoided. The cornerstone to appropriate deworming relies on fecal egg count testing. This diagnostic test allows us to determine the level of parasite shedding that is occurring and gives us a baseline prior to deworming to evaluate if the dewormer used is effective or not. You can provide us with one fresh fecal ball for a quantitative fecal egg count.

The best parasite control programs also focus on environmental control measures to help decrease pasture contamination. One of our favorite website articles on this subject is: horsesidevetguide.com/parasite-control

Nutritional Consultation:
Body condition is an important part of overall health. Some animals may have trouble maintaining a healthy body condition, whether that is overweight or underweight. Our veterinarians will discuss your animals’ diet and their current body condition as well as various options for changes to help your friends be healthier and live longer lives.

Farrier Consultations:
The saying “no foot, no horse” is one that has true meaning. Soundness, comfort and overall health are vitally tied into good hoof health and regular foot care. Managing horses with various musculoskeletal issues can be directly influenced by how the horse is shod or trimmed. At Stepping Stones Veterinary Wellness, we want to be involved in a team approach to your horse’s best health including hoof balance. We are happy to interact with you and your farrier to help come up with a plan that is individualized to your horse’s needs. Digital radiography is a tool that we often employ in these consultations, and we partner with your farrier by sharing the images and discussing our findings with them. If they are not able to be present at the appointment, we are happy to communicate with them directly so you do not have to try to explain our perspective.

Laboratory Testing:
Diagnostic tests are an integral part of diagnosing illness and disease, monitoring an animal’s recovery, and assessing health status. We work with a variety of laboratories to provide the best care for your horse. Some of the most common diagnostic tests we perform are Coggins tests (testing for Equine Infectious Anemia) and routine screens including CBC, Chemistry and Fibrinogen levels. Culture and sensitivity testing are also commonly submitted, as are Lyme Multiplex testing, and ACTH/ Insulin levels.
We also test serum amyloid A (SAA) levels stallside. The test takes about 10 minutes to complete. While a simple yes or no result can be achieved by hand without a reader, we do have a stall side SAA StableLab® reader that can be brought to the farm and provide quantitative results to help us in our decision making about a particular horse’s situation and the medications chosen to treat it.

Coggins:
In 2017 we made the change to digital Coggins tests rather than using paper forms. You will be able to access and download your Coggins results online once the test results are available, on www.myvetlink.com. We will need to collect your email address for registration on this site and we need to obtain 3 pictures of your horse. If you wish, you may take the pictures and email them as small image sizes to us, as long as they meet the required criteria. Otherwise we will need to take the pictures of your horse on the day of our visit. If you would rather not deal with email registration and accessing the website please let us know and we can arrange to have a copy mailed to you.

Horses need to be clean in order to see markings for pictures. The pictures need to include the whole horse – nose, ears, tail – and legs need to be staggered (not square – so we can see all four legs individually in the photo to document markings) – one picture from each side of the horse and another from the front of the horse so facial markings can be seen. The horse needs to take up about 90% of the picture without having people prominently visible in the picture. When taking pictures they need to be oriented so that the sun/major ambient light is behind the camera. Once these pictures are uploaded, we won’t need to repeat them each year. Coggins tests in following years will only require drawing the blood because we will be using the previous pictures. The veterinarian can take the pictures of your horse during their visit, but if you wish to submit your own pictures, that can be arranged as well if they meet all requirements.

Surgery:
Because we are an ambulatory practice, our surgery capacity is limited to those procedures we can safely do in your horse’s home environment. The typical surgeries we perform are laceration repairs on an emergency basis, castrations for horses with normally descended testicles, and mass removals. For the vast majority of laceration repairs and mass removals, the patient remains standing and the procedures are performed under sedation and local anesthetic. Castrations we typically perform in recumbency with your horse lying on the ground under general anesthesia. Castration appointments are typically weather dependent as we most often perform them in the pasture to give the horse adequate room for recovery for general anesthesia. If your horse has more advanced surgical needs, we are happy to discuss referral to veterinary hospitals with advanced surgical facilities.

Equine pre-purchase examinations:
A pre-purchase examination (PPE) is a very detailed examination performed on behalf of the buyer prior to purchase of a horse. Interpretation of findings is tailored to the particular goals that the buyer has for the horse they are considering. Our veterinarians take these examinations very seriously and thoroughly document the findings. Ultimately it is not our decision whether or not to purchase the horse; it is the buyer’s. We hope that our findings and interpretations can help guide the buyer in the right choice for them, or at the very least inform them of any current health problems so they are aware of them prior to purchase. In some cases, our findings have helped buyers negotiate a lower purchase price on an animal. The PPE is a thorough head to tail examination of the animal and its body systems, as well as an evaluation of soundness and flexion tests. Upon completion of the PPE itself, further diagnostics, most commonly digital radiographs, are often performed. What radiograph studies are recommended depends upon the findings of the PPE physical exam as well as the intended use of the horse, and whether the horse is intended for resale or not. Having baseline radiographs can be valuable to have as a reference later on if a problem emerges, or when resale is pursued, as an abnormality that has not changed radiographically and with which the horse has been successfully performing will often quiet the next buyer’s concerns. Drug testing may also be discussed on a case by case basis.

Acupuncture:
Acupuncture can be used to treat a variety of concerns and issues including pain, arthritis, behavioral issues, fertility problems, laminitis, and neurologic conditions. It is also helpful for improving performance. Acupuncture is an ancient treatment modality that has been around for centuries. There are multiple ways to explain how it works – from a western medicine perspective, acupuncture points are often areas of decreased electrical resistance and increased electrical conductivity, in conjunction with a higher amount of free nerve endings, mast cells, lymphatic vessels and arterioles compared to non-acupuncture points. Stimulation of these points acts on the nerve endings and sends a message to the brain that can help the body heal. From an Eastern perspective or philosophy, it all has to do with balance vs imbalance. Energy, called qi (and pronounced “chee”) moves through the body via pathways called meridians. Blockage of the meridians as well as excess or deficiency type energy patterns all cause imbalances and imbalances lead to disease, pain or illness. Stimulation of acupuncture points is done so in a specific way to help restore balance and free flow of energy along the meridians. Dr. Beth Hirsch completed 130 hours of training through The Chi Institute of Traditional Chinese Medicine in Reddick, Florida in 2008. She completed her Veterinary Acupuncture certification via internship hours and a case study, and became a certified veterinary acupuncturist in 2009. Acupuncture can be combined with other treatment modalities including chiropractic or western medicine treatments. Techniques used for treatment are case dependent and could include dry needling, electro-acupuncture, aqua-acupuncture, and hemo-acupuncture.

Cold Laser Treatments:
The cold laser system that we use at Stepping Stones Veterinary Wellness is the Avant LZ30X system with special additional homeopathic and veterinary treatment settings. It is a Class 3B laser that operates at bright red and infrared settings. Cold laser therapy can be useful in countless situations. The wavelength of light emitted by the laser is one that triggers healing in damaged cells. It can be useful in cases of pain by decreasing inflammation, increasing blood flow and circulation, and improving wound healing Photons emitted by the laser interact with cells in the body and trigger the mitochondria inside the cell to respond, improving healing on a cellular level. This is another modality that can help activate the body’s own healing mechanisms. Treatments are often incorporated with chiropractic adjustments. An average treatment session lasts 6 minutes. We have recently added a second system to our practice in order for us to offer rentals of the unit in appropriate cases, following the initial veterinary workup.

Myofascial Taping and blade work:
Functional kinesiology taping is a new modality that Dr. Beth is currently becoming educating in. Stay tuned for more information.

Microchipping:
Microchips are becoming more common in the equine and camelid world, and are a service that we are offering for our patients. Microchips are tiny computer chips encased in glass (about the size of a grain of rice) that can hold electronic data about the animal. While they won’t prevent theft, they can be used to prove the animal’s identity. Microchipping is especially helpful in cases of natural disasters and if a stolen animal is located, in order to help prove ownership. Microchipping is a low cost way to ensure you have an additional tool at your disposal if the need should arise.

For show horses, this means of identification is about to become a requirement for many. The USEF has passed a rule that now requires all hunters, jumpers and equitation horses to have microchips in place in order to accumulate points as of December 1, 2017. There will be a one year grace period, but come 2019, in order to compete at USEF sanctioned shows, all horses must have their microchip identification number recorded with the USEF. What to expect: we scan your animal to see if a microchip is currently present. If none is found, then we can place one. Microchips are placed on the left side of the horse’s neck along the nuchal ligament. We then repeat the scan and make sure the newly embedded chip reads easily. We provide you with documentation and registration information for the chip so you can register it as needed.

We offer Datamars microchips – they are superior as they are made from a more rugged durable and lighter weight polymer compared to standard glass microchips, that are more prone to migration and breakage. See more information and a visual via this video from Holistic Horse Fans.

Online pharmacy:
With a valid veterinary client patient relationship (VCPR), we can provide convenience and discounted prices on prescription medication via our online pharmacy. A valid VCPR is required by law in order for a veterinarian to legally provide or prescribe prescription medications. Our practice requirement is that we need to have a documented basic physical examination on file for your animal no less than 1 year from the date of prescription request. In many cases for more acute problems, we would need to have seen the animal sooner. This is to help your animal be cared for most appropriately, and it is the law. We want to be part of ongoing wellness support and care for the lifetime of your horse! Our online pharmacy contains lots of other products that are non-prescription also. You can check it out here: http://steppingstones.vetsfirstchoice.com/

VCPR:
The Veterinay Client Patient relationship as it pertains to prescription medications:

The VCPR is the foundational agreement for the interaction of you, your veterinarian and your animal in terms of provision of veterinary care. The area where we often run into the most confusion about this is in requests for prescription medications. It is our practice policy (supported by the AVMA recommendations as well as legal requirements) that we need to have a valid VCPR before we can provide prescription medications for our patients. This entails having a timely physical examination (a minimum of annually, sometimes more frequently if medically needed) prior to providing prescription medications. We are careful to document our exam findings so they can be referred to later on in order to detect changes over time. When we schedule your animal for a vaccination visit, it is common for the doctor to ask if you have any health concerns about your pet and if you wish for your animal to have a wellness exam documented while we are there vaccinating. This makes it easier for us to handle some medical issues via phone with prescription medication recommendations and can in some instances avoid an emergency farm visit. We encourage all of our clients to take advantage of our wellness examination services in order to catch problems early on rather than waiting until they become urgently necessary.

The specific requirements for this relationship can change for a particular patient and/or situation.

Examples:
1) a patient has had an exam within the preceding year but has a chronic health problem that can change its health status significantly in less than a year’s time;
2) a patient has had an exam within the preceding year but has suddenly developed a significant new problem. Both of these situations could mean that the veterinarian will need to see your animal again before they can feel comfortable providing medical advise and prescriptions for a problem.

Resources:

  • https://www.avma.org/public/PetCare/Pages/VCPR-FAQs.aspx
  • https://www.avma.org/KB/Resources/Reference/Documents/VCPR_printable.pdf
  • http://www.thehorse.com/articles/31234/veterinarian-client-patient-relationship-overview
  • https://www.aaha.org/professional/resources/veterinarian_client_patient_relationship.aspx
  • https://www.avma.org/KB/Resources/Reference/Pages/VCPR.aspx
  • Camelids:
    SSVW provides care for camelids including llamas and alpacas. Complete wellness care as well as treatment for injury and illness is available. We also provide emergency services for camelids and crias.

    Canine Chiropractic & Cold Laser:
    SSVW offers chiropractic care and cold laser therapy for dogs at your home or on a limited schedule at our office in Millville.

    Most people think of chiropractic as a modality to use for back pain. While this can be true, it does so much more! Chiropractic is ultimately functional neurology. Restoration of normal movement to the animal’s spine and joints allows the entire nervous system to function better. The nervous system is a vital part of the function of every single body system. The body can heal itself if allowed to do so. This is a function of innate intelligence – which is how the body actually heals itself given the opportunity. The veterinary chiropractor uses their hands to deliver a specific adjustment intended to relieve subluxations, to allow the body to heal itself. Subluxations occur when joints between vertebrae don’t move the way they should when properly aligned. Dr Beth Hirsch pursued chiropractic training at Animal Chiropractic Education Source in Texas with over 240 hours of chiropractic specific training. Chiropractic has quickly become her favorite treatment modality due to the immediate results that can be achieved and how something so simple can dramatically influence the patient for the better. She has lots of client success stories, but the best results occur when nail trimming is balanced, teeth are appropriately cared for, and nutrition is optimized to minimize continued inflammatory events that can be the cause of subluxations.

    Chiropractic is a process not a procedure – while one adjustment can certainly help, the best overall health results come from a treatment plan that includes some routine follow up adjustments to help manage subluxations before they become a significant problem.

    The cold laser system that we use at Stepping Stones Veterinary Wellness is the Avant LZ30X system with special additional homeopathic and veterinary treatment settings. It is a Class 3B laser that operates at bright red and infrared settings. Cold laser therapy can be useful in countless situations. The wavelength of light emitted by the laser is one that triggers healing in damaged cells. It can be useful in cases of pain and by decreasing inflammation, increasing blood flow and circulation, and improving wound healing. Photons emitted by the laser interact with cells in the body and trigger the mitochondria inside the cell to respond by improving healing on a cellular level. This is another modality that can help activate the body’s own healing mechanisms. Treatments are often incorporated with chiropractic adjustments. An average treatment session is 6 minutes. We have recently added a second system to our practice in order for us to offer rentals of the unit in appropriate cases following the initial veterinary workup.

    Goats
    We are now seeing goats for scheduled appointments! We strongly encourage our goat clients to schedule an annual wellness exam for their goats in addition to routine vaccinations. This gives us time to discuss deworming, foot care, nutrition or other concerns.

    We find that regular preventative care and proper management in our goat patients greatly decreases potential emergencies. We do not guarantee emergency coverage for goats, as goat work is subject to availability of specific doctors. Should you require emergency care, please call us to check if a goat-specific doctor is on call at that time.