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Dr. Rick Mitchell Q&A: What’s Next in Veterinary Medicine?

Dr. Rick Mitchell, part-owner of Fairfield Equine Associates and a member of the EQUUS Foundation’s board of directors, talks about technology and conditions worth watching, research funding, and more

by Glenye Cain Oakford | Jan 18, 2022, 3:34 PM EST

Dr. Rick Mitchell
Photo: Courtesy of Dr. Rick Mitchell

Dr. Rick Mitchell understands horses inside and out, as both an equine veterinarian and a longtime equestrian. He grew up among horses at his family’s North Carolina farm and competed as a child in both the saddle seat and hunter jumper disciplines before becoming focusing on hunter jumper sport exclusively as an adult. He has served as a licensed judge, coach, and trainer during his varied and successful equestrian career.
A graduate of Oklahoma State University’s College of Veterinary Medicine in 1974, he’s now part-owner of Fairfield Equine Associates in Newtown, Conn., where he practices equine medicine and surgery with an emphasis on lameness and imaging. He has also served as an attending veterinarian for the United States Equestrian Team at several Olympic Games.

Dr. Mitchell has served on a number of boards, including those of the United States Equestrian Federation and the American Association of Equine Practitioners. He currently serves as a director for EQUUS Foundation and chairs the AAEP’s Foundation for the Horse  Advisory Council, among numerous other roles.

In 2021, we also spoke with Dr. Mitchell about the importance of mental health awareness among equine veterinarians.

You’ve mentioned before that you'd like to see more funding for veterinary research. What areas would you specifically like to see more research (and funding) devoted to?

“Part of my interest in more funding for more research is that I chair the Foundation for the Horse, which is the foundation arm of the American Association of Equine Practitioners. Our foundation is really directed at three areas: research, education, and benevolence or welfare for horses.

“The research is a big part of what I’ve worked toward funding for. There’s a myriad of issues that horses have that we really don’t know enough about. For example, osteoarthritis is an ever-present problem in the horse that every level of equestrian sport or pleasure-riding has an issue with. Even on the human side, they still have problems managing traumatically induced arthritis. A lot of the arthritis we see in our equine patients is related to chronic repetitive trauma: the horse continuing to do the same thing over and over again: jumping a jump, doing a piaffe in dressage, running barrels—practice, practice, practice. Those kinds of things can sometimes lead to repetitive damage that subsequently results in osteoarthritis development. “But why? And what can we do to prevent that from happening? Is there a better way to condition the horse? Is there a better way to nourish the horse? Are there supplements that really have validity and really may help joints maintain and repair?

“There’s quite a lot there, and I think the answers are going to be with understanding what effects the genetic makeup has and what effects certain genes might have. And maybe we could develop better exercise and conditioning programs that horse could undergo that might get them fitter and better prepared for what we’re asking them to do. 

“Relative to other things in research, I think we’re also behind in understanding and improving anesthesia for surgery in the horse. The human and small animal side are well ahead of us in many instances, but also the horse is inherently more difficult to anesthetize and to control and to regulate blood pressure, etc. That’s in part simply because of their size and the amount and type of drugs required. I feel there’s a lot more we can learn about equine anesthesia, and I’ve gotten that information from my younger associates, too, who have just recently graduated from veterinary school—they, too, feel that there’s still a lot to be learned.

“Another interesting research subject is endocrine disease. That’s a big deal with our older horse population. We’re recognizing more and more endocrine disorders: equine metabolic syndrome and equine Cushing’s syndrome or what is more properly called pituitary pars intermedia dysfunction (PPID). Why does it onset at certain ages? We know that some of these things are related to aging. Is there something we can do to prevent the aging effects that cause PPID to occur? With equine metabolic syndrome, what sets off insulin dysregulation and is there some way we can control it better than we currently do?

“We need to know more about respiratory disease and equine asthma. What better ways are there to manage and control it? 

“And, lastly, intestinal abnormalities, not so much colic but some of the low-grade, chronic enteritis or colitis that we see. Are some of the issues that we see with low-grade, chronic diarrhea in horses a genetic issue? Or is it a food-source issue? Are we seeing horses with abnormalities that are related to intolerance of certain types of protein sources? This issue is another thing that I think is really common, and we don’t know enough about it. I don’t recall in my days as a young vet seeing quite this number of horses with low-grade diarrhea that we see so frequently now. Is there some common denominator that we need to determine?

“Those are some research subjects that I think could be funded and would do a lot for the welfare of the horse. 

“The Foundation for the Horse grants anywhere from five to 10 young researcher grants every year, ideally for graduate students and young researchers, like, say, a young Ph.D. who has just gotten their lab set up at a university. These people are there, and we have a very strict grant review process that is very selective. Very intelligent and skilled previous and current researchers review these grant applications. We’re hoping that the Foundation for the Horse is going to become a central clearinghouse for a lot of grant money in the future.”

What emerging diseases, conditions, or injuries do you think horse owners and managers should be more aware of or are likely to hear more about over the next decade?

“We still have a lot to learn about musculoskeletal disease and how to manage it, anything from  arthritis to things like navicular disease, which isn’t really strictly arthritis—it’s actual inflammation of the navicular bone and is a bone pathology, and there are other bone pathologies that mimic it. I think we need to learn more about how to manage damaged bone.

“We also need to learn more about how tendons and ligaments heal. All of these products we hear about—bone marrow concentrate, mesenchymal stem cells, autologous stem cells, allogeneic stem cells, and on to extracellular matrices—what is it about these products that stimulates healing? Do we need to put all this extra stuff in there? Do we need to put the cellular debris in there or is there a stimulatory growth factor or some other agent that brings about the trigger for the body to start healing?

We used to think that if we put stem cells into tissue, they transformed into that tissue. Now we know that’s not the case. Those stem cells do something to direct the body to heal. How? What is it? We know some of it but not all, and the more we can learn, the more purified product we can ultimately put in these tissues to stimulate them to heal. So more therapies, or more refined therapies, are something we can look for in the future.

“We’ve got a few products that have come along that are somewhat more refined, and they’re very exciting. “Some of these newer products include orthobiologics derived from equine amnion and from the horse’s blood that purify certain proteins and have an anti-inflammatory or stimulatory effect. That’s a big area of research that I think we’re going to learn more about.

“From the sport horse side, I think we fail to recognize early soft-tissue problems. For example, I think we fail to recognize suspensory ligament issues. I was lead author on a paper that was published in June in the Equine Veterinary Education Journal about a survey of horses we’d done over a 10-year period in the Wellington, Fla., area that were here competing. We took 10 years of lameness exams and ultrasound exams and identified what we saw to be the more common lesions present, and suspensory ligament problems led the way. The issue there is that so often they’re mild and low-grade at first, and they’re missed by the trainer or the owner. It’s not through negligence, but just because maybe the horse comes out one day and maybe feels a little funny and then three minutes later it’s warmed up and feels great. That happens on a periodic basis, and then one day after a show it’s really lame. 

“As horse owners, veterinarians, and trainers, we need to be more aware of the subtleties of soft-tissue problems and be more vigilant. That’s possibly going to require more frequent visits from the vet to look more critically at the horse and say, ‘I didn’t get this flexion response or see the palpation response the last time I saw this horse three months ago.’ I think as horses have increased in value, in the last 10 years I’ve seen more inclination for people to spend more money to fix a good horse than to buy another one. People want to do the best thing for their horses, and they also don’t want to lose their investments.”

What new technologies or developments in veterinary medicine do you see coming that will help horse owners/managers?

“One of the things that is obvious from looking at some of the ads I’ve gotten from the AAEP convention is that there are a lot of new stall-side tests that are being advocated to evaluate a horse’s health. I think we may see the ability to more quickly identify some infectious diseases and possibly even some other things, like endocrine abnormalities, in stall-side tests. I think you’re going to see more of that stall-side diagnosis and stall-side processing of orthobiologics, which originate from the horse’s own blood; I think also we’ll see more of those orthobiologics being used, right there where the horse lives. That’s a big deal.

“We’re seeing a constant improvement in imaging equipment. Ultrasound machines have gotten more sophisticated and easier to use, and the image quality is better and better. Radiology is so much better. I look back at what I had for radiology equipment when I graduated from veterinary school, and it was so primitive. You’d take 50 X-rays for a pre-purchase examination and find that six of them didn’t come out right or didn’t expose, so you had to go back and do it again. And the image clarity 45 years ago was not what it is now. Today, there’s no excuse for a bad X-ray, because we have such wonderful equipment, and it’s becoming even more portable and easier to use.

“It’s also amazing what we’re starting to see with cat scans (CT): standing CT machines, machines that won’t require anesthesia for most examination of the horse. It’s great to be able to look at neck issue in a horse, for example, without having to anesthetize it. And even if you do have to anesthetize the horse, the new machines are so fast and so easy to use that the horse only has to be out for a very brief amount of time, maybe 20 minutes. It makes things safer. 

“Endoscopy equipment advancements are allowing us to do better exams of the upper airway and gastrointestinal tract with video endoscopes and so forth. And all of this equipment is getting easier to use and easier to record information and transfer it to your database.”

In addition to being an equine veterinarian, you’re also an equestrian yourself. Tell us a little about your own involvement with horses outside of the veterinary setting.

“I grew up in a family that, back in the day, did a bit of everything. When she was a kid, my mother rode saddle seat, she fox hunted in the winter, she’d show saddle seat at one horse show and jumpers in another. That was back in the 1920s and 1930s. When I came along, I had the opportunity to ride a little walk-trot saddle seat, too, but by the time I was about 10 or 11 years old I gravitated to the hunting and jumping. So my real horse-showing started out with pony hunters, and I moved on to junior hunters from a fairly early age, by about age 12 or 13. I had some nice junior hunters that we showed in North Carolina, Virginia, and Maryland. I moved on to have a really lovely amateur-owner hunter and did very well nationally back in the late 1960s.

“When I started vet school in the fall of 1970, the showing was put on hiatus for a little while. But my spouse at the time and I started teaching some youngsters and taking them to horse shows while I was in vet school. So I continued to keep a hand in it.

“I had a diversion in the mid- to late 1970s into the Appaloosa horse world through my first wife, and I rode and trained a world champion senior English pleasure horse. It was just a matter of riding it correctly as an English horse.

“I got my judge’s license and was a hunter jumper judge for the then American Horse Shows Association. I was a licensed steward at the same time, so I stayed busy with those things. 

When I got out of vet school and started practicing, I started riding again and had a couple of nice horses of my own. But when the practice got really busy, I stopped for a while. 

“But then in the late ’90s Jane Forbes Clark offered a horse to me to ride. It was a Grand Prix jumper they were contemplating retiring. His name was Fortus. I showed him for two years. The first year I was reserve champion at the Winter Equestrian Festival and the second year I showed him, I was Winter Equestrian Festival champion in 1999. I went on to win the North American League for 35 and older in the adult jumper division. I had a ball.

“Shortly after that, I had spinal fusion and that fixed me, but it abruptly ended my riding career at the age of 50. I missed it terribly for a while, but I devoted my time back to more veterinary medicine and more learning. I got certified in a couple of specialty things and ended up getting my diplomate status in the American College of Veterinary Sports Medicine and Rehabilitation. “So life has a way of steering you in the right direction.

“I’ve been all over the world and visited every continent except Antarctica because of the horse. What a wonderful opportunity! It’s fantastic.”