Annual Wellness Exams
Saturday, September 11, 2010
Wellness care can result in a healthier, longer life for the horse at a more predictable and manageable cost for the owner. The thing about horses is they can't talk to you to tell you what's wrong. Sometimes they are "speaking," but their communication is so subtle that without a trained eye or experience, you might miss some issues that are important to a horse's well-being.
With that in mind, it is a sound practice to have your veterinarian complete at least an annual or semiannual wellness exam. By implementing such an exam once or twice a year, you will be taking a proactive approach to your horse's care, and you will be avoiding problems in the future.
Harry Werner, DVM, owns an equine-exclusive practice in North Granby, CT. As an active member and current president-elect of the American Association of Equine Practitioners (AAEP), Werner is committed to providing excellence in health care to his clients' horses. Werner remarks, "Following AAEP principles, our practice's mission has always been to provide veterinary care that improves the health and welfare of the horse. In our experience, providing proactive wellness care for our patients--and educating horse owners and associated equine professionals about the value of such care--helps us meet our mission statement goals."
Werner emphasizes how effectively this strategy has worked for him: "In more than 33 years of practice, I've seen fewer medical emergencies, communicable infection cases, dental disease, and parasite-related colic when educated horse owners and trainers recognize the value of preventing health problems. Proactive wellness care means healthier, active horses and fewer veterinary visits."
Frequency of Exams
Usually an exam is performed at the time of biannual routine vaccinations in the spring and fall. Your veterinarian has the expertise and experience to determine when something is seemingly out of normal limits with your horse. Werner reports, "In my experience, limiting wellness examinations to once a year risks missing early recognition of some common health problems. With early recognition comes the opportunity for early correction. Hence, I recommend biannual wellness examinations for the adult horses in my practice."
Jay Altman, DVM, owner of Equine Medical Service veterinary clinic in Fort Collins, Colo., concurs: "For an owner who expects a lot of their horse or is involved with consistent competition, a wellness exam should be performed at least once or twice a year."
Altman also recognizes the value of discovering problems prior to implementing regular preventive care. He remarks, "Equine veterinarians are so in tune in picking up details about a horse that it is valuable to examine a horse prior to vaccination or other routine care. Clients with an established relationship are good about communicating noteworthy concerns, such as whether the horse has been off feed or sluggish, or has had a slight cough. I'll hear about such concerns prior to vaccinating, and, with newer clients, a wellness exam allows close observation of the horse while asking the owner questions."
In addition, a wellness exam is an effective means of establishing a partnership between a veterinarian and a client, and it is a way to familiarize a veterianarian and a horse with each other.
What is a Wellness Exam?
Werner applies a carefully designed protocol to his wellness exam: "I prefer to begin a wellness examination in the horse's stall and have the horse brought out and walked briefly. In the stall, I measure temperature, pulse, and respiration, note any cardiac arrhythmia, murmur, or respiratory abnormality, and determine the horse's body condition score. I examine eyes and gums and inspect the external ears, hair coat, and perineum (around the anus). I always palpate the sheath on geldings and stallions. I check for any lymph node abnormalities, skin lesions, and evidence of external parasites (tick bites, summer eczema, fly-struck ears, or mange). I then see the horse walk and note any obvious unsoundness, hoof problems, limb swellings, or ataxia (incoordination). Additional appraisal of the nervous system is performed in conjunction with many of these examination techniques. For instance, assessment of proper tail lift and anal sphincter response occurs as rectal temperature is taken; evaluation of cranial nerves occurs as eyes, ears, and gums are evaluated; skin sensory response to focal pressure is observed throughout the general exam. Fecal sampling for parasite analysis is also part of our wellness examination process."
Altman also applies his preventive health care mission to his clients' horses. He notes that his examination starts as he drives onto the premises: "My first impression is made as I see the horse from a distance," he notes. "That may mean I see the horse from the windshield of my truck, or as an owner walks the horse up to me, or as I walk into the barn aisle or look over the stall. This allows me to note the horse's posture, attitude, and whether his eyes are bright and alert. I also can evaluate the coat condition and his body condition score. As the horse walks toward me, I get a feel for the way he moves that might signal gait inconsistencies or neurologic deficits."
A thorough physical exam lets a veterinarian review past problems in their current state to determine if progress is being made. Altman has honed his method of performing a physical exam, remarking, "I'll do a basic physical exam of temperature, heart rate, and respiratory rate, while listening to the heart for arrhythmias or murmurs, and to the lungs for indications of airway obstruction or congestion. If there are breathing concerns based on what I see or from an owner's comments, I'll hold off the horse's air for a few moments and then listen to his lungs as he takes deeper breaths. I'll also examine mucous membrane color and capillary refill to assess the efficiency of the circulatory system. Color of the membranes provides information about anemia or icterus (jaundice in the whites of the eyes), either of which might indicate internal problems. I'll examine the teeth to determine if dental care is needed to ensure efficient grinding of the feed. An eye examination is useful to identify previous or active flares of uveitis or other systemic problems that might otherwise go undetected."
Following the basic exam, Altman begins a thorough hands-all-over examination, checking for any swellings, lumps, or bumps anywhere on the horse, and ascertaining if there is abnormal distention of a joint that is worthy of further evaluation. He remarks, "The horse can't talk, so my hands-on exam helps me interpret subtle signs from the horse. While doing my hands-on investigation, I'll obtain a verbal history from the owner that updates previously known information, or, if the horse and owner are new to me, will provide pertinent medical details. We can also discuss a horse's behavioral changes or peculiar idiosyncrasies."
After obtaining the hands-on details, the veterinarian can assess the horse's environment more closely. Altman says, "On the farm, I can examine the horse's living arrangements--both stabling and herd dynamics --and I can review and tailor an appropriate diet for that horse. Being on the farm also allows me to inspect the hay for quality, dust or mold, or storage concerns that might influence respiratory health."
In many cases a horse is boarded at a facility, and Altman urges, "Horses at a boarding facility should be handled just as they would at a private barn, i.e, every horse should be managed the same in regard to vaccine frequency, deworming strategies, dental care, and at least an annual wellness evaluation. All horses should be required to have a negative Coggins test and a health certificate prior to entering the farm."
At the time of a wellness exam, Altman also recommends a brief soundness check as useful to obtain a baseline on a horse for future reference. This gives an opportunity to watch the horse move when there is not a current musculoskeletal crisis or to uncover subtle gait inconsistencies that--if caught early--could be more easily addressed. If a possible lameness issue is discovered during the brief check, then the owner can arrange another appointment with the veterinarian that allows time to perform a full lameness workup.
Altman says, "Since musculoskeletal and orthopedic issues are such a big part of a performance horse, a helpful tool an owner can use is video imaging to retain for future comparison."
Altman notes that a horse's cooperation is important for obtaining the best information during a wellness exam. He comments, "Horses that have been handled a lot can be trained to accept a thermometer and other exam components. With basic good manners and respect for people, most horses will usually cooperate for veterinary attention. An owner should rely on their vet to communicate the safest and most helpful handling position."
Basic Wellness Exam Procedures
• Usually the veterinarian analyzes the horse’s gait on the longe line or under saddle at the beginning of the soundness/lameness exam, then he performs all hoof testing, palpation, and flexion tests in order to focus on the leg or legs in question. Neurologic function is also assessed with the horse in motion.
• The veterinarian listens to all quadrants of the gastrointestinal tract (on both sides of the flanks) for presence, frequency, and quality of intestinal motility.
• The veterinarian assesses the gums for color and moistness.
• An ophthalmoscope lets the veterinarian look at the internal structures of the eye for signs of active or chronic inflammation, for cataract development, or for indication of systemic disease. This exam is normally done in a dark environment to allow the eyes to dilate.
• All areas of the hip and quadriceps muscles can be probed and palpated to identify areas of soreness.
• Applying hoof testers across the heels helps the veterinarian check for pain in the navicular structures.
• A thorough hands-all-over examination checks for swellings, lumps, or bumps anywhere on the horse. Jay Altman, DVM, owner of Equine Medical Service veterinary clinic in Fort Collins, Colo., uses this to interpret subtle signs from the horse.
The Young and the Old
The neonate and young, growing horse can experience rapid changes in their health status, especially in their musculoskeletal systems. Werner suggests that veterinarians perform relatively frequent wellness exams to appropriately monitor young, growing horses. He explains, "We see foals at 12 to 24 hours, 4 weeks, 4 months, 5 months, 9 months, and 10 months of age during their first year of life. This schedule permits proper neonatal care, timely recognition of angular limb problems, and effective immunization against relevant infectious diseases.
"Given the limited time window of surgical opportunity, early recognition of developmental orthopedic disease (DOD) is a priority," he stresses. "Any evidence of joint effusion (fluid escape into the joint), lameness, tendon contracture, or angular limb deformity is promptly noted and investigated with further diagnostics. When appropriate, such conditions are treated surgically and/or via farrier care in collaboration with the veterinarian's input. Conditions such as umbilical hernias and retained testicles can be monitored for satisfactory improvement or the need for surgical repair."
Old horses need a more critical assessment as well. Altman remarks that the presence of geriatric-related problems is not necessarily based on specific age, but on physical condition. He notes, "Geriatric horses should be examined more often than the preteen or teenage horse, at least twice a year, and, in some cases, three to four times per year. "
Werner is intent on identifying aging problems early on, stressing, "Geriatric horses are well-served by biannual wellness examinations. This schedule allows for early detection and monitoring of Cushing's disease, renal or liver dysfunction, chronic lameness, and nutrition concerns, as well as ensuring proper attention to the dental needs of the older horse."
Werner sums up the reasons why wellness exams are effective. He says, "Preventive veterinary care is a 'win-win' effort for horses and owners. For the horse, proactive wellness care maximizes quality of life through prevention and early treatment of disease. An owner has a healthier, more active animal ready to share time together at their intended discipline or activities--plus minimized costs for veterinary care. In short, wellness care works! It results in a healthier, longer life for the horse at a predictable and manageable cost for the owner."