Unraveling the Complexities of Equine TMJ

Join the conversation with Dr. James Carmalt as we dive into the complexities of the temporomandibular joint (TMJ) and its crucial role in equine performance. James brings to the table a wealth of knowledge, sharing remarkable insights that will change the way you perceive this often-overlooked aspect of equine health. As we navigate through the biological marvel of the TMJ's healing abilities and the perplexing prevalence of its ailments, we uncover why these disorders can so easily evade detection, and their profound impact on a horse's capability to perform.

Our second segment shifts gears, delving into the common challenges faced by equine veterinarians. From colic surgeries to the nuances of lameness, we dissect the importance of sharing knowledge and collaborative efforts. Discover the personal journey that led James to his passion for TMJ research. We also dissect the decision-making behind publishing research and the vital connections that bind the veterinary surgical community.

The episode culminates with a reflection on the ever-evolving nature of veterinary practices and the paramount importance of listening—both to our peers and to the stories of our clients. Utilizing a blend of historical and contemporary research, we underscore the benefits of learning from the past to better our future endeavors. This episode serves as a reminder that our pursuit of knowledge and improvement is as enduring as the bond between humans and horses.

Full article: https://doi.org/10.2460/javma.23.09.0513

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Transcript

Speaker 1: 0:00

You are listening to Veterinary Vertex, a podcast of the AVMA journals. In this episode we chat about the role of the temporomandibular joint in equine pore performance with our guest James Carmel.

Speaker 2: 0:18

Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have James joining us. James, I followed your work for decades as a equine surgeon and equestrian. I'm super excited about this manuscript and talking with you today. Thank you so much for taking time to be here with us today.

Speaker 3: 0:37

Perfect. Thank you very much for inviting me. Finally, we got this manuscript done after months of actually planning it.

Speaker 1: 0:47

Well, we're excited to hear about it, so let's dive right in. James, your study discusses the role of the TMJ in equine pore performance. Can you give our listeners a bit of background on this review?

Speaker 3: 1:01

Yeah, this basically was the culmination of about 15 years worth of work. We've created a monster. So I wanted to try and shove a metaphorical monster back into the bag and zip it up somewhat. About 15, 20 years ago I was looking for something to do and one of my colleagues had really bad temperamentibular joint disease and I thought well, that's interesting, why don't we see it in the horse? Makes sense. We see it in dogs, we see it in cats, we see it in otters, we see it in soeyship. It's a huge problem in humans. Up to about 60% of all human adults, certainly in North America, will have at least one or two symptoms of TMJ disease. Now, the important aspect about that is that the pain associated with that is not necessarily only intraarticular. You have periarticular pain as well that can come from, let's say, grinding your teeth or headaches or something like that, which of course, we're not going to be able to deal with in horses or probably diagnosed.

Speaker 3: 2:12

But the intraarticular disease component and I thought well, why is it not there? It has to be there. It's a synovial joint, it's covered in cartilage, it undergoes a spectacular number of repetitive movements over the lifetime of a horse. It has to degenerate, it just has to, otherwise it cannot be a biological system that's perfect. There isn't one. So then that led me to think well, okay, either it's so highly adapted that in the horse it doesn't have disease, which makes no sense, or we're missing it. It's there and the horse, being a prey animal, somehow, is perhaps hiding it, or we are simply not good enough at picking it up. It's there, but we don't know. And that really led us into well, okay, let's start at the beginning. In order to have a joint that has problems, you need to have a joint that actually responds to an insult. So we took a bunch of horses, we insulted the temperamentibular joint with bipolar saccharide, which is a self-limiting synovitis model, and we put saline into the opposite temperamentibular joint and we did the same for the front fetlocks. Sure enough, the horses became lame. In the front fetlocks, the one that we injected with lipopolar saccharide, or LPS, got swollen, and the temperamentibular joints also got swollen. The horses wanted to eat. Still, which was fascinating, when we followed the cytokine profiles over time, specifically looking at the inflammatory cytokines, we found that they tapered off much, much faster in the temperamentibular joint than in the fetlock joint. And of course, any research leads to more questions, which is frustrating as hell heck, because you think you've produced the best thing since sliced bread, and of course it isn't. And that led us to think well, hang on, why would the TMJ respond to inflammation and quash that information faster? Is it simply because it's a different joint, different joint, different part of the body? Is it because there's an evolutionary mechanism there? If I'm slightly lame, I can run away from the saber-toothed tiger, but if I can't feed the machine, then I'm going to get gobbled up for sure, and that's kind of useless. Is there a fundamental difference? And in fact there is.

Speaker 3: 4:55

The temperamentibular joint is covered with fibrocartilage rather than hyaline cartilage, and that is absolutely fascinating, because if you think that most of the other joints that we, as equine vets, look at are covered in hyaline cartilage and any healing is fibrocartilage and it is considered inferior, well, if it's inferior, why would you line an entire joint with inferior cartilage? It makes no sense unless you realize that it is that inherent healing capability? That is, in fact, the nugget, because if you can't heal this joint and then you can't feed the machine, you get gobbled up by the tiger. Well, now you're not likely to pass on whatever it is, you've just evolved or tried to evolve. So then we said, okay, well, that's fine. In response to inflammation, does it accrue change with age? So we followed. Actually we got a bunch of horses that were going to be euthanized, dissected their joints out.

Speaker 3: 5:54

Sure enough there were more changes as the horses aged, which makes sense. It fits the biological picture. Then we thought, all right, well, look, we must be, we're missing it surely. So I got a bunch of different colleagues in Europe and in North America. We looked at over, we read about 1300 CTs. We published on just over a thousand and we found that 40% of them actually had changes.

Speaker 3: 6:21

Now the problem is those horses had undergone CT for reasons other than TMJ disease and they was no history of them having a TMJ problem. So now the question is are those differences pathological or are they just different? And in fact in humans, about 40% of the human population have variations in normal morphology when you look at them on CT and MRI. But still 40% is a big number. So then we thought, okay, well, look, we now know the joint is responsive. We know that change accrue with age. We've proved it with CTs and live horses proving that, sure enough, the incidence of these abnormalities actually increases with age. There's a surprise so now we need to go hunting for the needle in the haystack is show me that this is truly a problem.

Speaker 3: 7:29

Now I'm not talking about horrific nasty, lost your leg kind of a problem. I'm talking about your horse walking around. You wouldn't think that there was an issue with this horse, but it's having some performance issues and the client is feeling something, or the vet's noticing something, or the horse is chewing weirdly. We had a client just a fantastic client bring us a horse, drove 18 hours to bring it to us. The vet are diagnosed with TMG disease.

Speaker 3: 8:01

I was incredibly skeptical. I'm like, oh yeah, sure enough, the horse was lame, okay. The caveat here, though, was this horse had thrown the lady into the wall twice, and the second time she had been knocked out. She said, well, what are we going to do? I said, well, get off the rotten horse. That's the first thing you're going to do. But it was fascinating. This horse had a baseline lameness, very mild right-hand lameness, and we put it in a sursingle and side rains and videoed it trotting and walking to the left and to the right, and had the lameness locator on it too, because we didn't want to be guilty of bias, and we really tightened the horse up as we went along and, incrementally, did that.

Speaker 2: 8:51

And the horse got lame which is interesting.

Speaker 3: 8:56

We then took the horse right back to baseline, blocked the temperamentibular joints and repeated the lameness exam with the sursingle and all the rest. The baseline lameness remained, but the horse did not get lame.

Speaker 1: 9:13

And now.

Speaker 3: 9:13

I'm thinking, ok, this is weird. How can you have changes in a temperamentibular joint that affect the body as a whole? Then you go to the human list and, sure enough, a lot of elite athletes shooters, golfers, archers are wearing bike plates. And there is a tie-in between a crucial equilibration in humans and an elite sport performance. Well now, I'm thinking, ok, well now, look, we are controlling these horses under saddle with, yes, the leg, obviously, your seat, but also in your hand and through the bridle, and the major point of contact is the mouth, which is then linked to the base of the skull. So what happens if we inflame that temperamentibular joint? Does it change rain tension? And sure enough it does.

Speaker 3: 10:03

We just finished a study looking at the effect of injecting again the lipopolar saccharide into horses on the treadmill. It changes their head position and it also changes the rain tension. They try and get away from the tension in the handless hand, and we had that actually objectively measured by these rain tension devices. But the handler could feel it. They knew which side I had injected, simply by the feel in the hand, and that blew it open for me. Because now, all of a sudden, these clients saying I feel something, but I don't know what it is now that opens a whole new avenue, because, if I take you back to the horse, that we blocked the temperamentibular joints on on the surcingles when we took that horse to CT. It had huge mandibular cysts and really, really nasty arthritis of the temperamentibular joints, which we took to surgery. The horse did well for nine months and ultimately failed, which sucks, but you've got to start somewhere. But it proved. That singular case proved that, yes, you could have naturally occurring non-end-of-stage joint disease in the temperamentibular joint and it'd be a clinical problem to the horse. So that's a long answer to a short question. But what it really did now, though, is throw stuff wide open.

Speaker 3: 11:36

Horse clients are interesting people, most of them. Some horse beds are interesting people too. They're a bit like magpies. If it's shiny, they kind of want it, and if it's new and shiny, they really want it. And you go into a barn and it's like, oh, my horse has this. It could be something horrific. Oh, really, well, my horse doesn't. I better go and get that diagnosed for my horse.

Speaker 3: 12:04

And it's even more exciting if it's difficult to disprove which TMJ disease is. It's very difficult to prove it, but it's also equally very difficult to disprove it. So now every horse and I'm being melodramatic, of course, but now we have a large number of horses whereby they can't find the reason for the poor performance so it must be TMJ disease, and the purpose of the article was to go back and say no, no, no, no, no, no, no, no, no. Let's think about this Hock arthritis bone spamming is significantly more common than TMJ arthritis. Back pain is significantly more common. Eiph is a lot more common in barrel racing horses than we think, and it will lead to resistance and not wanting to go into the arena and changes in behavior. So how about you just logically work up what's going on, as opposed to jumping on the bandwagon? So that was really where that came from, because, having opened the box, as I said, and the monsters got out, now everybody's seeing the monster and it's not there the majority of the time.

Speaker 1: 13:18

That's fascinating, especially like the human TMJ too. I had no idea that that was so prevalent and also that kind of almost like mirrored, with some horses they're also presenting for, so very interesting.

Speaker 3: 13:30

Yeah, it is fascinating. Of course, now we've got clients that say, well, I've got TMJ problems, so my horse, I mean he must feel the same way. No, he doesn't, yep.

Speaker 1: 13:40

Yep, definitely have heard that before. For some other things too, in different species.

Speaker 3: 13:46

Yeah.

Speaker 1: 13:48

So you provide a very comprehensive background for this review. Now, what were some of the important findings from this review?

Speaker 3: 13:56

Well, the findings basically were that common things occur commonly. They just do. That's why they're called common. And yes, everybody likes cool stuff, you know. And as you get further along in your career, whatever career you're happy to be in, the incidence of new stuff falls off. Now, when you first start in your career, everything is new. It's super scary because you don't know what you're doing. But it's new the further along you get.

Speaker 3: 14:28

You know like, okay, you know what, if you've done 20 years and you've done lots and lots of colic surgery, the chances of you being surprised when you open the next abdomen is pretty low. Now, don't mean to say it's not there and that's what keeps us opening out. It's like oh, could it be in this one? Is it in this one? But the same, with lameness.

Speaker 3: 14:46

You know what, if you do primarily, I don't care what you do, whether it's raining or roping or barrel horses or dressage horses, common things are common. And finally I go oh God, here we go again. And then something new comes along. Oh, now I'm excited, I've got to go find this in you know my next X number of horses. And sure enough, you find it. Well, no, it's not there.

Speaker 3: 15:10

It's because you want it to be there, and so one thing that I've really worked hard on we have a Facebook page actually, which we'll get to that, the Facebook page has been a double-edged sword, but one of the nice things about it is that I've got vets from all over the world and clients are on the Facebook page and they send me CTs and case histories and we consult and you know we've got really really good case reports, not published yet but of these vets are going out there and they are getting an independent test rider to ride these horses and blocking the joints without letting know what the test rider has done or found, and videoing them and sending us the videos.

Speaker 3: 15:58

And that's fascinating because it means that we've got buy-in from veterinarians. We've also got buy-in from clients, because some clients just want to know. They know that probably it's the end of the road for their high-level performance horse, but they want a diagnosis to hang their hat on and it allows you to rule out the other common stuff. Now go chasing the really non-common and finally hang your hat on something, and that's. I found that fascinating and we're beginning to rein it back a little bit, I think.

Speaker 2: 16:34

You crack me up. You speak the truth about equine clients, riders, and I'm trying really, really hard not to be one of them and not to roll my eyes and sound like that. When I go out to the barn and somebody's like, oh, my horse is TMJ, I just put my head down and keep walking. James, you talked about your colleague who had severe TMJ, which then you got to thinking, I wonder about in horses. But also again, the flip side of getting into basically social sciences is what it turns out right with trying to manage the shiny thing. What really inspired you to keep on this research interest in the TMJ in horses? That's a good question.

Speaker 3: 17:12

I think.

Speaker 3: 17:13

I'm a very basic person. I don't have the skill set that a lot of my colleagues do that you do, lisa, in your research area to follow things down to the minutiae and keep going after the. I'm a very shiny kind of guy. I want to ask a question, get an answer and use that answer relatively quickly. The beautiful thing about chasing an area that hasn't been explored before it's very easy to become the expert because nobody else has published in it. It also means you can ask really naive, slap-forehead kind of simple questions. Nobody looks at you and is like what is wrong with you? This was done 200 years ago.

Speaker 3: 18:03

Because nobody's done it, you can do some really cool stuff and watching these horses come alive again that sounds really bleh. You got this horse. It's in pain, it's doing what you want it to do because it's that well trained. You block the joint and this horse you see it in their eyes. They go and do what they were designed to do. They chase the cow, they get into the spin, they sit down and it doesn't hurt anymore and the client feels it. There's a light bulb moment. And when you look at the pre and post videos of some of these TMJ horses with a test writer and I don't speak a lot of the languages that they're using. You can hear the sound and the pitch change from the test writer Wow, what did you do? This feels different, and that, for me, is like okay, we did it. There's something that we managed to achieve.

Speaker 2: 19:12

Yeah, very cool. I'm sure you know this, but everything in arthritis and musculoskeletal disease now, and other diseases too, it's about the lack of resolution of that inflammation. James, you talked about like you've got all these great ideas and projects to do and all the other things going on and writing these narrative reviews in the area that you are the key opinion. Later you started this whole area. What inspired you to stop, take a breath and write this narrative review and thank you for sharing it with Javma?

Speaker 3: 19:43

Oh well, firstly, the reason I shared it with Javma was A I knew of your work and because you're a surgeon in this area, you were probably approachable. So that was nice and you are, which is fantastic. Secondly, there's no other avenue, what is sort of I mean, I could write a clinical commentary, let's say, for EVE. That is somewhat of a personal thing, but it's very difficult to find, at least in my view, and then maybe you know better, but it's very difficult to find a personal opinion piece that is not a chapter in a textbook, and so I wanted to get it out there in a wide readership journal. There's no point in me publishing this in, you know, the Altamongolia Journal of the Horseford because, nobody's gonna read it.

Speaker 3: 20:37

It's probably a very good journal, but nobody's gonna read it. But at least with Javma I know. Firstly, this is roughly in North America, where I'm working B you've got a huge readership, which means that my opinion, whether you like it or not, is gonna get out more, and it tells us once again that we just need to slow down. I mean, I've published that 10 or 15 years ago and nobody stopped, which is kind of good because we found lots and lots of cases.

Speaker 3: 21:09

But I think a lot of people are misdiagnosing these horses because steroids are unbelievably powerful and they go well beyond the joint structure that you inject and especially in the head, given where the TMJ is. For example, all the cranium and nerves exiting the base of the skull, all the structures around the base of the pole, the mandible, the larynx, all of those structures are gonna be affected by your intraarticular steroid injection. And so it's very easy to believe that you got it right. In fact you didn't. You stuffed it up. You believed your own. Yeah, you believed it, which is very easy to do, but you gotta step back and go. Really did I truly do what I think I did, and that was the nice thing I could show my or share my complete failure in that in that horse, having injected the TMJ and found out it had a paracondola fracture, I go well, never mind.

Speaker 1: 22:15

You have to start somewhere right, and you learn everything, even if it's, like you said, like a misdiagnosis or you miss something, then you never make that mistake again.

Speaker 3: 22:22

So Well, I don't know about that. I think on a school learner, I tend to make the same mistakes multiple times. I guess the most important thing and the one thing I tend to talk to the students about is makes me sound old, but it's self-reflection. You know, it's very easy to do what you do because you do it that way, because that's the way you were taught to do it. Well, that's great. Maybe that is the only way to do it, but maybe, after the fifth time that it's gone wrong in your hands, maybe it's time to sit back and go.

Speaker 3: 22:53

Okay, either I am not the surgeon that I think I was, or B I need to do this a different way for it to work for me. But if you keep blindly doing what you're doing without thinking about what you're doing, you're gonna come off the rails at some point, and especially with this TMJ stuff and I say neck arthritis is another thing Do I really want to be injecting the arthritic facets of, let's say, a mid-teens horse who's showing neurological signs before I inject them? Well, now, that's a very important question, because do I want the 60 or 70 year old lady riding that horse when, all of a sudden, the steroid injection is no longer work and she gets pile driven into the wall and breaks her head or her neck.

Speaker 2: 23:43

Easy on the 60 year old there, James.

Speaker 3: 23:48

So okay, so maybe the 20 year old, they're equally, equally dangerous, you know? But yeah, you just need to think about what you're doing.

Speaker 1: 23:58

And to our listeners who are just joining us. We're chatting with James Carmel about equine TMJ and equine poor performance. So you're a board certified in four different specialties, which is incredible. How did that experience of obtaining that level specialty prepare you to write this? Manuscripts.

Speaker 3: 24:18

Well, I'm a slow learner. So, and I'm in this, I'm lucky because I'm in an academic area where you know if it takes you a long time to achieve something, they're not about to jump all over you. You know, you're a government employee, which means if you take 10 years to achieve it, you're probably actually on track. If you do it in two, then you're working too hard. But no, no, I'm just joking. I guess the beauty of it is I started out wanting to be a general practitioner. That's all I wanted to do. I did not want to be an academic. I sure as hell did not want to do equine surgery, and so I did an equine practice residency to start.

Speaker 3: 24:58

I got bored in practice, so I came back and I did it. And then, as we were talking about before the show here, you know, I was sitting there with my mentor, who's 20 years older than me and fantastic lady. I'd run her own business, run her own practice, came back into academia and she was my mentor who taught me everything. But then I thought well, at the end of the day, I've got a piece of paper that says I'm bored, certified in equine practice. Well, this is great and I'm king of the king of the hill until you realize that she's got 20 years of experience and no piece of paper, and so if she and I went and competed for the same job, they would take her in a heartbeat, because the piece of paper basically says you've met a certain set of criteria. It doesn't mean you're actually any good at doing anything, and I still see that today.

Speaker 3: 25:47

I go and work for general practitioners and equine surgeons in Europe who've never had the benefit of a residency, and they have phenomenal hand skills and I learn just incredible amounts from them, and they're self taught and they have a completely different way of going about things, which we don't have. We are taught in a line because this is the way it is done and that's the way you must teach it, but these people have found a way to do things differently.

Speaker 2: 26:13

Now, there's a lot of similarities.

Speaker 3: 26:15

but learning from people that are good at what they do shouldn't be based on whether you've got a piece of paper or not, because that's it means nothing. And then I was lucky enough to do a vacancy in the surgery residency program and I thought well, look, if I go and get a surgical residency, maybe my mentor and I could go for the same job and I'd outcompet her. So I did that. And then she happened to be really, really interested in dentistry. And nobody wants to look in horses mouths. It's much too sweaty Power dentistry has changed things a little bit, but nothing goes according to plan.

Speaker 3: 26:52

It's not like taking a chip out of a joint. It's nice, you're there in your gown and your gloves and you're oh, pluck out, it comes. That'll be a lot of money, please and, by the way, look how cool I am In dentistry the teeth fracture. You take a lot of their money. You end up being very good friends with the clients because you see them back repeatedly because nothing goes according to plan. So, anyway, I got into the dentistry. And then, because I kept seeing these horses with problems and sport horses well, that was the sport medicine one. And then I realized, well, hang on, that ties in perfectly into this narrative review, because the TMJ and sport horse performance marries the horse surgery, dentistry and the sport aspect of it. So I guess I've been very, very lucky. I've been in the right place at the right time. I probably wouldn't change Well, I might, but I probably wouldn't change what I've done over the years.

Speaker 1: 27:51

That's absolutely incredible, and we're so happy that you're able to share your experience with Javma, too, in the form of this narrative review. Now, this next set of questions is really important for listeners. The first one is going to be about the veterinarian. What is one piece of information the veterinarian should know before discussing the equine temporal mandibular joint with the client?

Speaker 3: 28:15

There's a lot of other stuff that's going to cause the same clinical signs. That is significantly more common than temporal mandibular joint disease. Now that doesn't mean to say it's not there. It doesn't mean to say it's not important.

Speaker 2: 28:29

What it?

Speaker 3: 28:30

means is just make sure you take a step back and look at everything else, and that includes the rider. Maybe the reason that this person has lost 300s, 1000s of a second on a barrel run is because they've got arthritis or they've got a knee problem, so they're not actually coming out of the saddle properly, which means the horse isn't moving properly and it's got nothing to do with the horse. And we've had a number of those where you basically look at the client, you medicate the client and the horse goes better and you didn't actually touch the horse, and so you've really got to look at everything. And it's truly the art of veterinary medicine.

Speaker 3: 29:16

The thing with TMJ disease is it is a singular item in a textbook that you can hang your hat on. Right there, it is TMJ disease, but it doesn't occur in isolation and even within the body of the horse. The body of the horse doesn't just happen to be in that staple on its own. There's a bunch of other horses and there's a bunch of riders and the trainers and the clients, and so you've got to keep an open mind, really open to the point. You could probably confuse yourself, to be honest with you.

Speaker 1: 29:51

That sounds like good advice, though for a lot of different things. I think just having an open mind veterinary medicine is very, very important. So on the other side of the relationship, what is one piece of information that the client should know about equine TMJ disease?

Speaker 3: 30:07

So I think there are many different types of client. You know, there's the really well-informed client. There's the client who is actually the head of orthopedic surgery at the local hospital. There's the client that basically is a master craftsman but knows nothing about your area, as in the vet medicine or the horse. I think the client needs to be aware that they are asking for an opinion on somebody that they may be feeling, which is very difficult for somebody to actually go after and track and stick a finger on, and that sometimes these things take time. And when they go to the human hospital and they go wait for blood work and then they wait for the results for three or four days and then they might get an MRI. But again, in socialized medicine up here in Canada you'll get an MRI but it's in 18 months time.

Speaker 3: 31:00

Don't expect to come to VetX with your problem that has been a problem for months, maybe years, and expect an instant fix in a 45 minute consult. Because if you get an instant fix, there's either two, there's two reasons why you've got one. Either it was so blessedly obvious that anybody could have done it and you probably should have sought an opinion earlier, or two, it's really really complicated and the vet has no idea what they're doing. So they're just kind of blowing you off, trying something right, and that's not true. But at the same time, don't be the type of client that a vet wants to please by doing something.

Speaker 3: 31:43

Sometimes the art is not do it. So, for an example, we had a client last week convince your horse to got TMJ disease. Okay, let's just start at the beginning, and she probably does. But you know what? Let's start at the beginning, because common things are common. Well, you trot the horse, it's laying by it. You flex the horse, it flexes positive with the hogs. You X-ray the hogs, it's got hog disease. It's got back pain when you palpate it and it bucks when the lady buckles the cinch up. Oh, but it's got TMJ disease maybe.

Speaker 3: 32:24

But you know what? How about, if you'll indulge me, let's treat the hog disease first. We may or may not treat the back at the same time, whether it's you using a medical therapy whether it, because of course that's gonna color the whole situation. And in three weeks time we'll have you come back and if there's still a problem, we'll take the next step. Sure enough, luckily managed to convince the client, which is great.

Speaker 3: 32:53

He could be wrong, that's okay, I don't mind being wrong, I'm wrong most of the time and you also tell the client. You know what you might be right, but your horse also has another problem. So three weeks later the horse came back completely different horse. And the lady says so I bet those steroid injections in the hogs would have really affected the TMJ, wouldn't they? Well, yes, sometimes the steroid in the body does get there, but luckily for you, the majority of the problem was in the hogs. And so how about you come back to me next time and in about six or eight months, when the disease raises ugly head, and we'll do the same treatment again which may affect the TMJ? Again, it's keeping an open mind and being able to discuss it without bias or prejudice.

Speaker 2: 33:48

So the listeners out there, you can't see me but I'm howling, laughing at James's comments because it's the day in the life of maybe small animal too, but certainly equine practitioners. You know that oftentimes, james, my idea of getting home and having a good day was that I got home safe, right, I didn't get hurt. I had a good day. I didn't get hurt. Today I was recently. I was at Beva last week and somebody sitting next to me had a mug Beva for the listeners is British Equine Veterinary Association and somebody had a mug that says please don't confuse your Google search with my veterinary degree. That was pretty funny.

Speaker 3: 34:29

Well, yeah, I said well, why aren't you blocking my horse? Well, it's got a hind limb lameness and it's spending more time airborne than it is on the ground. So you know what? That is what the textbook says. Well, yes, google says you should do X. You should do X. Well, when you can train your horse so he spends more time on the ground, then maybe I'll consider blocking it. Well, I want you to block it. Well, then you should go to vet school, and if it's still only four years time when you're done, then have at it.

Speaker 2: 35:02

That's awesome. Thank you for sharing your career path and your just, honest assessment of clinical practice and in your passion right, you can hear your passion and curiosity, which is really important for everybody to know that you know, especially our younger listeners. We don't know it all. Every day is the school days and all my trainees know, I say, and it's constantly evolving. And as we wind down, james, we asked this one personal question and what I would like to hear from you is what is the most interesting or the oldest item in your desk drawer?

Speaker 3: 35:35

Yeah, we would talk about that. It's actually a java paper, believe it or not. Awesome, there was. As an intern I was trying to track down Dr Radistitz was my mentor as a junior intern and we were treating a cow with lumpy jaw with sodium iodide and I thought this makes no sense. Like, why would you treat it? What would make you suddenly think you know what? I know, I'll just go get some sodium iodide and give it to this cow, like there's got to be a basis behind that. Turns out it's a 1932 paper in Java by a guy called Fakasan who thought it might be a good idea to try it. And sure enough, it worked. And so you know I was thinking wow things.

Speaker 3: 36:20

It's a lot more difficult to get stuff published these days because I'm pretty sure that your journal wouldn't accept. I just figured I'd give it a go and just, but most people wouldn't either. I think one of the things that we do, just to get a little segue, one thing we do badly as a profession and I think also that the journals is publishing our abject failures and things that don't work because we're all doing stuff and reinventing the wheel. If I could actually read a paper, it's like well, you know that was a really stupid idea but it actually works Like oh, wow. Or you know, don't do that and spend three years chasing that idea. It was done in 1980. Some poor PhD students spent three years doing it. It never worked the way you were trying to work it, so either it was never going to work or there were tweaks. But we don't do that, we only ever publish our successes, and that it makes it very difficult.

Speaker 2: 37:24

We need to launch a journal of abject failure. But the listeners that don't know. Java is 1877, I think was the first issue, so 150ish years old. So that manuscript's old, but not that old James.

Speaker 3: 37:40

No but you're right, the journal of abject failures would probably, it would probably have a pretty high subscription rate Anyway. But no, it is a fascinating area and, as I said, certainly from the TMJ side of things, the sociological aspect of it and tying the clients into it, and it's a lot more. You do get into this kind of diagnosis area by spending time with the clients, listening to the clients, not asking a question and expecting a stock answer, but letting them talk, because when they talk, yes, you might have to hold up the sieve and 95% of it gets caught in the sieve, but the 5% that comes through the sieve might be useful. The one or two words that they drop as an afterthought as they're going out the door can fundamentally change your diagnostic pathway. Or they're like oh, whoa, whoa, whoa, whoa, whoa, stop, come back.

Speaker 3: 38:44

What did you just say? Well, I noticed when you know, because I sit out there in the evenings and I drink my beer and I wash the horses in the sunset and you know, at this particular ambient lightness and this and this, the horse does X. Well, it turns out it's got a cataract and when the light drops below a certain level on the horizon it goes through. The horse can now see. Well, you didn't think about that and all of a sudden you haul them back off the trailer and you look in their eyes and you go oh come on, did I really miss that? That's just stupid. But you've got to listen. You asking a question and hearing an answer is not the same as listening. And listening is an art and I think men in general are not very good at it. But you have to listen to your clients.

Speaker 1: 39:42

Especially active listening. It's so important and, just as we wrap up, thank you again, James. We just really appreciate you being here today and for sharing your work with Jafma.

Speaker 3: 39:51

Well, thank you very much for inviting me.

Speaker 1: 39:53

Thanks to our listeners. You can read James's manuscript in print, jafma or on our journals website. I'm Sarah Wright with Lisa40A. We want to thank each of you for joining us on this episode of the Veterinary Vertex Podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or on our platform. You'll listen to.