Some areas of Normandy are akin to medical deserts. You call a dentist? They are not taking on new patients. You want an appointment with a dermatologist? The waiting time can be close to a year. But if, on the other hand, it is a horse that needs treatment, Normandy becomes the place to be. Excellent specialists in all equine pathologies - from eyes to intestines, including locomotion and neonatology - are gathered there in several very important care centres, illustrating the enormous progress made by veterinary medicine in a few decades.
Jean-Marc Betsch is one of the partners at the Méheudin clinic in Orne, which now has twenty-eight vets and as many assistants. In the late 1980s, this surgeon completed his internship at the University of Pennsylvania, a benchmark in teaching and research. "There, I saw everything that was possible, they were decades ahead of France! In our country, forty years ago, no one was doing tendon ultrasounds. Being able to put an ultrasound machine in the car was a huge step forward in terms of diagnosis."
The evolution of techniques has almost made the general equine vet disappear, at least for the ultimate treatment of the sport horse in the broad sense. The specialisation of practitioners developed from the 2000s onwards. Sébastien Caure, a pillar of the Livet Equine Veterinary Hospital Centre (CHVE), which brings together thirty-one practitioners in Calvados, explains: "What has really changed in the last thirty years is that we are bringing together a lot of different skills in the same place. The omniscient vet is over. The principle is to identify the horse's pathology as precisely as possible, and if we know what it has, we know how to treat it and make a prognosis for its career. So we need vets who are experts in their field and excellent technical facilities." This includes tools such as scanners, MRI, scintigraphy... all three of which are available at Livet, which also boasts a cutting-edge neonatology unit, led by the brilliant vet Valérie Picandet.
Dr Bruno Baup, who practices at the CHVE in Grenade-sur-Garonne, Haute-Garonne, confirms this need for "a precise response to each request, which means having the most qualified and diversified team possible in terms of skills". In this equine clinic, which has the label of equine hospital, they are developing orthopaedic shoes born from 3D printers as well as diathermy, a treatment technique based on an electric current that transfers energy deep into the tissues and has a biostimulating effect.
The improvement of treatment protocols and equipment makes it possible to save - in terms of life as well as sports career - horses that were once condemned, for a wide range of different pathologies: fractures, colic, complicated foaling, respiratory problems... According to Fabrice Rossignol, surgeon at the Grosbois clinic, which is located at the famous trotting training centre, everything has changed in recent decades, especially for the management of fractures: "We have improved surgical techniques, team training, general anaesthesia methods, and assistance with recovery. Modern implants (plates) from 3D printing are also a major advance."
Standing equine surgery, developed in France by Tamara de Beauregard, a veterinary surgeon at the Meslay-du-Maine clinic, is a major step forward because it avoids the complicated recovery phase, when the horse's weight becomes its enemy and can ruin a successful operation. "I started thanks to trainer Guillaume Macaire," says the surgeon. "I had operated on a Group horse which, unfortunately, fractured its leg on waking up. For the next operation, Guillaume said to me: 'Manage, you just have to operate on it standing up!'" This is the technique in vogue for fractures that are not too complicated. "It means having a good team with an anaesthetist who has to make sure that the horse is not too sleepy but doesn't move either, and three other people in charge of taking X-rays during the operation." The Meslay-du-Maine clinic is the only one in France where electrical conversion is practiced, a surgery aimed at solving certain cardiac fibrillations that cause poor performance and pulmonary haemorrhage by placing electrodes in the horse's heart and shocking it under general anaesthesia.
Thanks to advances in medical imaging, vets are "less and less in the dark", as Jean-Marc Betsch puts it. Interventional scanners, which are used in some clinics like Méheudin, allow vets to move around a stationary horse, so they don't have to anaesthetise it and/or take images during surgery.
Veterinary medicine has not finished evolving, it is even doing so at the speed of light! Jean-Marc Betsch is convinced that the importation of the PET scan, classically used for the detection of cancerous tumours in humans, will be the next major advance from the United States. "Traditional imaging tools can show an anomaly, but we don't necessarily know if it is the cause of lameness. The PET scan provides very precise physiological information about inflammation. We inject radioactive glucose into a horse and if the product is more active in one place, it reveals a 'hot' anomaly. In the United States, PET scans are performed on horses almost like ultrasounds."
But the early detection of pathologies during consultations, which allows for preventive action, is perhaps the real revolution in contemporary veterinary medicine. Modern diagnostic tools combined with a science of clinical examination, which is culturally one of the strengths of French practitioners, allow for this essential prevention for the career management of the sport horse. "Detecting problems at their very beginning, before they take a catastrophic turn, is the key to everything," explains Sébastien Caure. "This is of course done through imaging techniques, but also through raising awareness among clients: they now understand better that the earlier we act, the more chances we give the horse, whatever its problem." Regular monitoring can avoid having to repair a tendonitis or a fracture later on.
A mandatory prevention protocol was thus put in place in 2021 for the Melbourne Cup in Australia, a mythical race but one that has been heavily criticised due to fatal horse accidents: five between 2010 and 2020. Investigations showed that most of these deaths could have been avoided if the horse's fragility had been detected beforehand.
The limbs of horses pre-entered in the race are now scanned with a machine that allows them to be kept standing under sedation and not lying down under general anaesthesia. In 2023, fifty-two horses were scanned and five were excluded from the competition. The Melbourne Cup has not had a fatal accident since this protocol was put in place, which saves the lives of champions but also potentially the race itself! - Céline Gualde
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The miraculous horses running on racecourses
More seriously injured horses are being saved than you might think. Some of them then embark on a racing career or return to the scene of their exploits. One of the most remarkable examples is that of Rhialco, who carried the colours of a true lover of horses, Pierre Coveliers.
In 2012, Rhialco fell at the small open ditch in the Prix Héros XII and shattered his nose into twenty-two pieces. He was, in principle, condemned, but Pierrot Coveliers had decided to save him, and he is not a man to tolerate contradiction. Rhialco was therefore transported to Switzerland where he was operated on by the famous Doctor René Aebischer and his team, for an unprecedented operation: the complete facial reconstruction of the horse, including the sinuses. Two titanium plates of a good twenty centimetres were screwed into him. After a long convalescence spent partly in thalassotherapy, Rhialco returned to his trainer Emmanuel Clayeux and then to Auteuil racecourse where he won again on his comeback and five times in a row from September 2013, notably winning two Listed races and a Group 2, the Prix Léon Olry-Roederer! He finished third in the 2014 Grand Steeple-Chase de Paris.
"Many horses that we operate on for fractures race and win again, there are many more than you think," says Tamara de Beauregard. "Owners and trainers are more aware than before and ask for X-rays in case of an accident."
The most seriously injured horses must be able to count on their lucky star: a loving and stubborn owner. The crack horse Bon Augure, carrying the MacLennan colours, had just won four consecutive races at Auteuil when another competitor stepped on him in the 2015 Prix de Maisons-Laffitte, severing the tendons in both hind legs. The horse was a gelding, but Lynne and Angus MacLennan still had him transported to Grosbois to save his life. The horse finally returned to the boxes of Adrien Lacombe (where he is now retired), his jockey Angelo Gasnier, and won at Auteuil on his comeback race in March 2017, a year and a half later! He then went on to win three more races. "Our philosophy is to give every horse a chance to pull through, as long as it doesn't cause them unnecessary suffering. We consider each case individually," says Lynne MacLennan. "Bon Augure was our champion and we wanted to save him even if he was only going to be a leisure horse or a retiree in the field. We really didn't imagine that he could race again, and it's a miracle that it happened. But it shows that great stories are possible if we don't euthanize horses prematurely."
This year, the MacLennans gave a chance to one of their foals, who suffered an open fracture of a hind leg in the field. The limb was hanging by a flap of skin. L'Héritier - that's his name - was operated on at the CHVE in Livet by Dr Cyril Tricaud, who placed three plates not under but over the skin. The major risk, beyond the fracture, was infection of this contaminated wound. Six months later, the third plate was removed from the colt, who lives with a companion pony and will be able to start walking in-hand. His sporting future is obviously very uncertain, but we must leave room for dreams! - Céline Gualde
Photos: Rhialco, X-ray of the MacLennans' foal (sent to Manu), possibly a photo of the foal by Céline
Sébastien Caure, the king of clinical examination
Sébastien Caure likes to start by palpating his four-legged patients: his firm, expert hands feel their backs, limbs and hindquarters. His entire gloved arm explores their pelvises from the inside. Then, this graduate of the Nantes school, class of 1994, observes the horses in action according to an unchanging ritual: flexion tests, trotting in a straight line, on the circle on hard and then deep ground... before finally a sentence is passed: the horse has this, and that... A hypothesis that the targeted use of imaging generally confirms.
Sébastien Caure, an orthopaedic surgeon who is consulted in Normandy, at the CHVE in Livet, from Switzerland and Alsace, will not ruin you with X-rays! He likes to solve puzzles the old-fashioned way, trusting his encyclopaedic knowledge of the horse rather than scanning it from head to toe, as is often the practice: "clinical examination first, imaging as support!". The man is generally warm and approachable but does not give the client false hope. To Yannick Fouin, who presented a filly whose veterinary examination revealed a weak constitution, he asked:
• Do you train in Lourdes?
• No... Maisons-Laffitte
• Then don't try!
Photo: Sébastien Caure
Fabrice Rossignol, international star of surgery
He is the maestro of the Grosbois clinic where he has been practicing since 1994, the one who receives patients from all over Europe as well as racehorses injured on Parisian racecourses. Fabrice Rossignol also operates in Germany, Belgium, Sweden, the USA and the Middle East. The man is a specialist in respiratory surgery but also in fractures. He chose this discipline "for the complexity of the field, because there are many things to invent."
His latest innovations concern the treatment of roaring by nerve implants (nerve grafts) and the improvement of muscle prostheses thanks to new generation implants from 3D printing.
Fabrice Rossignol also trains surgeons abroad because, according to him, "a good surgical technique is one that is disseminated and used as much as possible elsewhere."
Tamara de Beauregard, the Madonna of the operating theatre
While the veterinary profession is becoming increasingly feminised, this conquest does not seem to have yet reached the operating theatres where men remain in the majority. Tamara de Beauregard is, at Meslay-du-Maine, one of the French pioneers of this discipline. A graduate of the Toulouse school in 2004, she then completed an internship and a surgical residency in Ghent, Belgium. Her vocation came very early, as she was four years old when she decided on her future profession: "A horse escaped from my father's and crashed into a car on the motorway. We had to euthanize it. I said to myself: I want to become a surgeon and save horses."
Tamara de Beauregard perhaps never feels as good as when her arms are plunged up to her shoulders in the belly of a sleeping horse, whose future depends on her prowess. "It's adrenaline every day, we face challenges, questioning and surprises every day. That's rare in a job!"
Jean-Marc Betsch, the free electron
He answers us from Arizona, where he is attending a conference. The man is a jack-of-all-trades, who did his military service at the Saumur Cavalry School before briefly managing a Thoroughbred stud farm and then joining the Méheudin clinic in 1990, created by Dr Moisant, "the first to consider the trotter as a sport horse". Jean-Marc Betsch also holds a university degree in equine law and another as a reproduction centre manager. He is also vice-president of the AVEF, the French association of equine veterinarians. A specialist in orthopaedic surgery, he is passionate about sports horse medicine and has participated in numerous studies on the subject. It is no coincidence that Méheudin boasts a treadmill where racehorses can undergo exercise tests by cantering. The clinic, which has undergone major renovation work, merged with the nearby Boisrie clinic in 2021. Activity therefore continues on both sites.
From man to horse and vice versa
If horses now have a scanner "their size", with a diameter close to a metre, it is thanks to the high percentage of the American population suffering from obesity. The medical care of these people required the creation of these scanners, which could be described as "high capacity", which have also been adapted by veterinary clinics. The techniques of coelioscopy or laparoscopy, which allow small cameras to be inserted into the horse's body for minimally invasive surgery, also come from human medicine.
For the management of joint rheumatism, on the other hand, the horse is a pioneer! "I did my first hyaluronic acid injections in the joints of trotters ten years before it was applied to humans," says Bruno Baup. A treatment designed to "lubricate" the joints. "Equine treatments are precursors for everything related to the use of stem cells and auto-immune material that can be injected into joints or tendons, avoiding the harmful effects of corticosteroids."
Jean-Marc Betsch points out that in the United States, laboratories are funding equine research on osteoarthritis "because the horse is a very good model: what works for the equine athlete will work for the human athlete", the ultimate target market.
Three Equine Veterinary Hospital Centres
In France, three sites have obtained the CHVE (Centre Hospitalier Vétérinaire pour Équidés) label: in addition to Livet in Calvados and the equine clinic in Haute-Garonne, there is the Conques clinic, not far from Bordeaux, created in 1981 by Dr Serge Lenormand.
The equine hospital label corresponds to specifications defined by the Veterinary Code of Ethics. The requirements are high in terms of premises (e.g. a room for recumbent surgery and a room for standing surgery), equipment and personnel (number of full-time vets, having at least one specialist in surgery or internal medicine, etc.).
A vet and an assistant must be present on site 24 hours a day, 7 days a week to deal with emergencies.
CIRALE, a centre of excellence
Established in 1999 on the Normandie Equine Vallée site in Goustranville, CIRALE (Centre d'Imagerie et de Recherche sur les Affections Locomotrices Équines) is the Normandy equine centre of the Alfort National Veterinary School. With research, teaching and clinical practice as its vocations, CIRALE is a world-renowned reference centre for the study of locomotor disorders and factors limiting performance in sport and racehorses. The figurehead of CIRALE is Professor Jean-Marie Denoix, a world-renowned specialist in equine locomotor disorders.
More recently, the Kinésia physiotherapy centre opened its doors with the aim of developing horse rehabilitation programmes. It should be noted that the horse racing laboratory, dedicated to the fight against doping, is located on the same site.