An owner who found herself with a £5,500 vet’s bill that her equine insurance company refused to pay is sharing her story in hope it will prevent others from facing a similar situation.

Emma Gardiner told H&H she mentioned the stem cell treatment her vets had recommended for her mare Apple’s arthritis to her insurers when she called them to check how much she could claim – but when she sent in the bill, the company rejected it.

“I think I forgot that the insurance company is not my friend,” she said. “It’s left me completely shocked, and in financial difficulty.”

Emma said the rejection came as a surprise as she had had no previous issues with the insurers, who had covered kissing spines surgery for Apple last year. It was then found that the then nine-year-old former racehorse had neck and hock arthritis, and Emma’s vets recommended the stem cell treatment.

“The vets went through all the options and said they would probably be the best thing to give her a chance of a decent recovery,” Emma said. “I went ahead thinking the insurance would pay; it was an open claim.

“I had called the insurers a few months before; there was apparently a stem cell shortage so I had to wait. I wanted to check how much I had left of the £6,000 per claim, as I knew the treatment was expensive, so I asked, and told them what I wanted to do, and the person I spoke to said that was fine. The problem was, it was only verbal.”

Emma said the insurers told her the claim was rejected as the company classes stem cell treatment under organ transplant or gene therapy, which are not covered by the policy.

“Arguably, I should have read the small print first,” she said. “But even now, I can’t see anything about stem cells in there, they just say it comes under that.”

Emma praised the fellow liveries at her yard for their support, including suggestions on legal advice, and her “wonderful” vets who have been fighting her corner. She believes the insurers may now pay up to £1,000 of the bill, but that leaves a significant amount.

“I didn’t even pay that much for the horse!” she said. “My vets said it was one of the biggest rejected claims they’ve had, and they’re now warning other clients with the same company.

“It ruined Christmas; my husband and I officially cancelled it because we couldn’t afford it.”

Emma said some of her followers on social media suggested setting up a GoFundMe page, which she has done, and that her vets are letting her pay the bill in instalments.

The silver lining, she added, is that Apple is looking much better, and the treatment appears to be working.

“She’s massively improved,” she said. “All I wanted was for her to be happy, comfortable and enjoying life.

“But I want to make people aware; I can’t be the only one this has happened to, so if this saves someone else getting in this position – I always try to find the positives but have struggled with this one! But if I can do that, at least that’s something.

“I really want to raise awareness of the importance of reading small print in insurance policies.”

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A new form of stem cell treatment could give horses a better chance of recovering from tendon injuries, researchers have suggested.

Stem cell researchers at the Animal Health Trust (AHT) have found positive signs that stem cells originally sourced from embryos coped well in laboratory tests when exposed to inflammation. This is important as inflammation that occurs following an injury can prove damaging to adult tendon cells.

Tendon injuries are a common problem in horses and instead of regenerating healthy tendon tissue, they repair by forming scar tissue which pre-disposes the horse to a high risk of re-injury.

Stem cell treatment has been available for some years, but current treatments use the horse’s own stem cells.

This means they are not available for immediate use as they need to be extracted, cultured and separated from other cells, with the overall timeframe taking several weeks.

Current treatments also work by releasing factors to help tissue repair, rather than rebuilding the tissue itself.

However the embryonic stem cells grow forever in the lab so can be ready immediately and scientists also believe they work by helping to rebuild the tissue directly, reducing the amount of scar tissue laid down.

The recent work has been funded by the Horserace Betting Levy Board, Racing Foundation, Alice Noakes Memorial Charitable Trust and Beryl Evetts and Robert Lugg Animal Welfare Trust.

Using a laboratory model they found that adult tendon cells cannot produce “artificial” tendons efficiently when exposed to inflammation.

In contrast, they found that embryonic stem cells that were directed to turn into tendon cells behaved as normal when exposed to inflammation.

Dr Debbie Guest, head of stem cell research at the AHT said: “We were able to demonstrate that these tendon cells express different levels of receptors for inflammatory proteins on their surface.

“This means that these stem cells may provide a useful source of cells for clinical transplantation into the injured tendon as they are unlikely to suffer any negative effects from being placed into an inflamed environment.”

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A spokesman for the AHT said the team believes this opens up the possibility of further studies to understand more about how embryonic stem cell-derived tendon cells protect themselves from inflammation, with a view to developing new treatments that could be used to protect adult tendon cells following injury.

“Protecting tendon cells from inflammation could help to improve the regeneration of healthy tendon tissue to reduce the risk of re-injury and allow more horses to remain in active work,” added the spokesman.

“Funding for a follow up study by the Animal Health Trust, in collaboration with the Royal Veterinary College, has been secured from the Horserace Betting Levy Board and the team are hopeful that new treatment options for this old problem may soon be developed.”

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We have a couple of horses in for the rehabilitation of leg injuries at the moment. Often these cases will stay with us for a number of months and we most commonly get them straight from a period of box rest. I have to admit we tend to get rather attached to them when they come in for a long time — they’re like part of the family by the time they leave us.

Both of our current stem cell horses have been treated for superficial digital flexor tendon (SDFT) injuries, but are at different stages in the recovery process. Often the vets will recommend a period of paddock rest in the middle of the horse’s programme, and one of the upshots of ‘phase one’ is to help to in the preparation for this turnout stage.

It sounds crazy to say that you need to prepare a horse for going out in the field, but post-injury you have to be sure that you’ve exposed the leg to enough controlled exercise and allow the healing process to take hold, prior to turning them out.

We seem to get more rehab cases that have been treated with stem cell than cases that have just been rested or treated by other methods. I think there are various reasons for this, but predominantly it seems to be racehorses and either proven competition horses, or those deemed to have a bright future ahead of them, that come to us to begin their return to work.

In our experience, one of the benefits of stem cell therapy is that it cuts down the amount of complete box rest required, with the horses able to start some form of exercise much earlier, albeit in a very controlled environment. Although you’re still pretty much talking about a year away from competition or racing in terms of recovery, evidence and opinion suggest that the chance of re-injury is less than by rest alone, or other traditional methods.

We use the treadmill for rehab cases during their walk and trot work as it allows us to exercise the horse in a very safe and measured way; the surface is wholly consistent, the duration can be dictated to the second, and the speed set to work the horse optimally.

As a result we can just get on with their work, without worrying about them being fresh or jumping around. This in itself is another reason horses are referred to us: the once beautifully-behaved animal can become a fire-breathing dragon, ready to pounce on its owner at the first available opportunity during in hand walking. And who could blame it?

Athletic horses are used to working hard, going out in the field, going off training and travelling to competitions. The treadmill offers a great option for these cases, who benefit from the routine and the need to concentrate on where their feet are landing! Fingers crossed that our current 2 continue to make a full recovery.

All the fun of the fair

I wrote in my last blog that we were preparing for Hartpury’s Summer Fair earlier this month; well, what a great day. We had people from all walks of life through our doors and every one of them was happy for us to show them what we do here.

My boss’ son Max came along to help us with the final preparations for the day, which added an extra level of amusement to proceedings. I was doing the final bit of horse-polishing ready for our last tour at 2.30pm, when he came storming through the treadmill room pointing at his watch. “Fizz, its 2.26! We need you now!” he said. Well, that was me put firmly in my place by an 8-year-old! That boy will go far.

Fizz

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Read more about stem cell therapy

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Many of the long-term consequences of injury or disease occur because the body’s structures cannot repair themselves.

This is because cells can’t adequately work out what to do or there has been a lack of a stem cell response. Therefore any repair of an injury may fail to replicate the normal structure.

Equine tendon injuries do heal slowly by producing scar tissue, which, while strong enough to allow some activity, is mechanically very different from a normal tendon.

This is why horses that have sustained a tendon injury often reinjure the same place in the future.

Stem cells have a unique ability to change their function and take on different guises; they can become specialised cells of cartilage, bone, tendon, fat, muscle or nerves.

By using stem cells, we can improve the quality of healing by providing cells that have the ability to recreate normal tendon tissue, rather than simply scar tissue.

Candidates for stem cell therapy are horses with overstrain injuries where an ultrasound scan reveals a clearly defined hole in the tendon.

The first step is to extract the stem cells from a sample of the horse’s bone marrow, which is taken either from the sternum (chest) or tuber coxae (near the point of the croup) under sedation and local anaesthesia.

The cells are then cultured, a process that takes an average of 18 days.

Not every sample will yield a useable culture – and we are not exactly sure at this point why this is – but fortunately the majority do.

The cultured cells are suspended in bone marrow supernatant (clear fluid) before being implanted several weeks later into the lesion in the tendon.

Stem cell surgery is by no means a quick fix. The horse then has to undergo a carefully controlled rehabilitation programme, which takes approximately one year.

It follows exactly the same lines as a programme for a horse not treated with this type of therapy.

For the full veterinary article on stem cell therapy see the current issue of H&H (1 December 2011)

Do you want to find out more about stem cell therapy?

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Stem cell treatment specialist VetCell Bioscience Ltd hopes to offer its pioneering treatment to sports horses after having been bought by Quy Bioscience.

VetCell was the company responsible for the treatment that allowed hunter chaser Dream Alliance to return to the track two years after suffering severe tendon damage in the 2008 Grand National.

Dream Alliance went on to win the Welsh National in December 2009 and run in this year’s Grand National.

A spokesman for VetCell said: “We are keen to offer this treatment to a much wider range of equine athletes, especially eventers, showjumpers and dressage horses and are looking to expand our business across the world.”

VetCell was formed in 2005 in partnership with the Royal Veterinary College and the Institute for Orthopaedic and Musculoskeletal Science to develop the veterinary use of stem cell technology.

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More articles on stem cell therapy

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Stem cell treatments for tendon injuries have become commonplace in sports horse medicine.

The stem cells are harvested from the bone marrow of the horse, purified and treated with factors that promote them to grow into tendon cells.

They are then injected into the injured parts of the tendon where they grow to produce good quality tendon tissue.

Without stem cells the horse has to rely upon scar tissue to heal the tendon and this is neither as elastic nor as resilient as proper tendon tissue.

Similar problems occur when the cartilage in the stifle is torn or crushed.

The stifle of the horse corresponds to the knee of a human and, like people, horses have a pad of thick cartilage that separates the bottom of the thigh bone from the top of the gaskin bone.

This cartilage is called the meniscus and it can be injured by excessive stress, twisting or wrenching of the joint.

Once it is damaged it will not heal, but becomes more and more frayed and tattered.

Currently, the best treatment is to remove the loose, frayed portion and allow the fresh, straight edge to heal with scar tissue.

But now vets are hopeful that they can also offer stem cell repair for damaged stifle cartilage.

This would provide a useful treatment and could make the difference between permanent lameness and recovery for some sport horses.

For more of the latest veterinary research and developments, see the current issue of Horse & Hound (17 September, ’09)

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A successful treatment for tendon injuries in horses is to be tested on people.

The pioneering stem cell treatment, developed by VetCell Bioscience in Cambridge, has been so successful in horses it will now be trialled on human beings with tendon injuries.

In tests on more than 1,500 horses with tendon problems, half were less likely to re-injure themselves over a three-year period if their tendons were injected with stem cells, as opposed to receiving only conventional treatments — like box rest, icing and anti-inflammatory drugs.

David Mountford, chief operating officer of VetCell Bioscience in Cambridge said: “It’s a very exciting development because if successful, it will greatly simply an athlete or football player’s route back to full fitness.

“In addition, the treatment could alleviate or cure long-term tendon injuries in older human patients, such as prolonged shoulder injuries.”

The stem cells, which are a basic form of cell before it has become flesh, bone or tendon, are derived from the patient themselves and not the more controversial embryo route.

The treatment implants millions of the patient’s own stem cells directly into the injured tendon or ligament to aid the body’s natural healing of the injury.

Mr Mountford said: “These are adult stem cells, so there’s no embryos involved. The horse or human will provide their own stem cells.”

The tests on humans will be focused on a notoriously tricky and often persistent injury for some, the Achilles tendon.

Professor Nicola Maffulli, a sports medicine and orthopaedic consultant said: “The move from clinical veterinary to human medicine is inspiring and unusual. We normally see the translation happening the other way around.

“I am very excited to be involved in the human studies and hope that the results will herald a new era in the treatment of musculoskeletal soft tissue injuries.

“At present the management of human tendinopathy [tendon injury] is more an art than a science but this approach could potentially reverse that situation.”

Human trials will begin in 2011.

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The Henry Daly-trained top hurdler Mighty Man ruptured a superficial flexor tendon on his off-fore in the Champion Stayers’ Hurdle at the Punchestown Festival on 26 April. He had been in the lead with just two flights to go.

“It’s pretty much the end of his career,” owner Nicky Hanbury told H&H. “He’s back home now and is enjoying the four-star treatment he deserves.”

Mighty Man is currently undergoing stem cell surgery but his recovery is not expected to be rapid.

“If nothing else he’s sure to have a happy life with us in Leicestershire,” added Mrs Hanbury.

The seven-year-old Mighty Man had been trying to match his spectacular performance in the Liverpool Hurdle last month, where he had been victorious over BlackJack Ketchum and the reigning Ladbrokes World Hurdle champion, Inglis Drever.

Jockey Richard Johnson told BBC Sport: “He broke down on his off-fore and I had been niggling for four flights before that. The ground was perfect, it is just an injury that could have happened anywhere. It happened before we really got racing.”

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Tendon injury is a major cause of lameness in athletic horses. Eventers and racehorses, particularly national hunt horses and point-to-pointers, are susceptible to injury of the superficial digital flexor tendon.

Until recently, the only scientific treatment for these injuries was prolonged rest to allow natural healing. Recent developments in tissue engineering have enabled stem cell technology to be used to treat tendon and suspensory ligament injuries.

Stem cells are immature cells produced by the body that grow into whatever type of cells are required to replace old or diseased ones. The horse is able to fend off the effects of ageing and recover from injury and disease by the growth and differentiation of stem cells.

Stem cell therapy involves harvesting stem cells, usually from the bone marrow of the horse to be treated. This tissue is sent to a specialist laboratory, where the stem cells are selected and multiplied by cell culture.

The purified cell sample is then transported back to the vet supervising the treatment, who injects them into the injury site. Here, the stem cells will develop into tendon cells and produce new tissue to replace the damaged tendon.

The whole science of tissue engineering is very new in both the medical and the veterinary world. Scientists are still learning about the best ways to purify and treat stem cells to ensure as many as possible turn into tendon cells and assist the process of repair.

Trials to evaluate the effectiveness of this treatment are also in their early stages. Although there have been some well-publicised successes, it is too early to state with absolute certainty that this method of treating strained tendons is better than rest alone.

Scientists will continue to evaluate stem cell therapy as a treatment for tendon injuries and, within a few years, it should be possible to determine the true benefits of treatment.

• This veterinary feature was first published in Horse & Hound (12 January, ’06)