Who uses the Equinosis Q with LAMENESS LOCATOR®?
By Kevin G. Keegan, DVM, MS, DACVS
July 25, 2014
The question about what characteristics are common among equine veterinarians that embrace this equipment and, conversely, what characteristics are common in those that are lukewarm or dismissive is a very interesting one, and one that I have thought of much over the last several years.
I have been using some version of body-mounted inertial sensors for lameness evaluation now for over 10 years and have either described or demonstrated it to a wide range of equine veterinarians since 2007. From these experiences and observations, I have framed the following perspective.
There are two types of veterinarians that are more open to and, in some cases enthusiastically embrace, the use of this equipment for their lameness evaluations:
The first is the young veterinarian, who is not so far removed from their undergraduate university science and professional veterinary education, where they are daily presented with instructions of the science of medicine. They of course need this before they can later develop their “art” of practice, which only comes with time down the road of experience. Many would hastily think that it is because the young veterinarian is more accustomed to computers and technology, but I do not think this is the most important difference.
It is true that there are some “old-timers” who still don’t have e-mail, who get stymied by computer terms, or find themselves helplessly wandering through on-screen computer windows trying to figure out what to do, but this is a relatively low hurdle that can be overcome with user friendly designs, good training, and just a little practice (the entire computer industry understands and concentrates on this). Think about how intuitive most phone and computer interfaces are today.
Also, the utility of the inertial sensor equipment has very little to do with the fact that it uses a computer, but that it uses sensors which sample faster, more times per second, than any human (unless you are a superhuman like super- or spider-man) can. The utility of this equipment really is more parallel to the utility of a microscope or a telescope. It allows you to see things that you cannot see. That is all it does, but, of course, this is really helpful.
A knee-jerk dismissal of the use of this equipment frequently presents the case, for which I wholeheartedly agree, that no computer can do a better job at diagnosing lameness that the properly trained and experienced equine veterinarian. But this is a “bait and switch” technique and it really, in my eyes, reveals an unfounded underlying prejudice, because no reasonable equine veterinarian with any amount of experience in the field, would trivialize the art and science of lameness evaluation in such a way as to think that the bulk of lameness diagnose lies simply in lameness detection, which is really a simple measurement problem.
Lameness evaluation success depends on a much broader background of knowledge base and personal experience. This is patently obvious to me anyway.
The second type of veterinarian, who utilizes and appreciates this type of equipment, seems to me to possess two simultaneous characteristics:
- They are experienced, i.e. they have been exposed to many types of lameness and have seen all variations of lameness presentations;
- They are confident in the client persona, i.e. what their clients think of them.
Please notice that I am not including veterinarians in this category who are only very experienced, because some very experienced veterinarians still have to go through the day proving to their clients that they are really good at what they are doing, and some very confident veterinarians are not very experienced.
You need to have both characteristics. Every really truthful experienced equine veterinarian knows and admits that sometimes he/she cannot be totally certain that a horse they are looking at is lame, or that the lameness is in a certain limb, or that the block they have just performed made the horse greater than 50% better. It is simply a fact of any diagnostic process of more than moderate difficulty, and lameness detection, in many cases, is not easy.
Here is an example. I heard from one of my colleagues that, in a conversation with another veterinarian, who is not interested in the use of the equipment, mentioned that one of his clients, after viewing the use of the equipment on someone else’s horse, said to him, “Doc, if you have to use a computer to tell me where my horse is lame, then I’m getting another vet”.
This reminds me of similar exclamations I have heard in the past concerning tendon injury and ultrasound. Who is driving here, the trained professional, or the impressionable client? I appreciate and respect that this opportunity to develop and build a client persona can depend upon certain regional or specific practice-related circumstances and that it may not be possible for some. However, this seems strange to me as I have never had a client say something like this to me about my use of the equipment. I think clients appreciate that the person that they have entrusted to try to find out what is wrong with their horse cares about the problem, is thinking hard, and is employing whatever is available to get to the heart of the problem (of course as long as it does not cost too much).
I do think there are some anomaly “types” both for and against the use of this equipment. Some are looking only to make things easier or quicker, and I do think that with time and training technology can in some instances do this. My use of the equipment streamlines my lameness evaluation in many instances, but I have used it for many years on all my lameness evaluations. However, any objective measurement can sometimes make things harder, because, as we all know, what you desire (like the 5th block on a horse at 6 PM on Saturday evening) is not always what you get.
A rarer breed, strongly against the use of this equipment, are those who believe that they are more talented or have special abilities compared to your average practitioner, i.e. the Rembrandts or Beethovens of the equine lameness world. But I think measuring lameness in horses is more like riding a bike than like painting a masterpiece or composing a symphony, once you know what to do (or what to look for), and once you get the hang of it is it pretty straight forward.
Please note that I am distinguishing between the relatively simple concept of detecting lameness, which as I said earlier is a simple measurement problem, from the much more difficult and entire task of lameness diagnosis, which is much more dependent upon skill and experience.
These Rembrandt/Beethovens are simply never unsure. If they believe the horse has a left hind limb lameness when lunging to the right, despite what anyone else (client or other veterinarian) sees or thinks, this is what the horse has, no question. And if they think the horse improved 70% after a high suspensory block, the horse did indeed improve 70%, no question about it.
I wish I was like this, then my days would go better and quicker, and I would be much happier. But, alas, this is not my case. Because I have had others looking over my shoulder for most of my career (good students, interns, residents, other clinicians), I, in fact, know that I am sometimes wrong, actually more than I liked to admit. It no longer bothers me.