Author - Dr. Mike Scott

Dr. Mike Scott graduated form WCVM in 1993 and then completed a 1-year internship in large animal medicine and surgery at the Ontario Veterinary College at Guelph. In 1997, he completed a 3-year residency in large animal surgery at WCVM and attained a Master Veterinary Science degree. Two years later, he became a board certified large animal surgeon and has been Moore & Co.’s surgery specialist for seven years.


Xeophon the Athenian (431-354 B.C) is often referred to as the father of modern horsemanship, based on the fact that his writings on the subject are some of the earliest known.   In his work “On Horsemanship”, the first points made concern the purchase of horses:

“As our first topic we shall deal with the question, how a man may best avoid being cheated in the purchase of a horse.

Take the case of a foal as yet unbroken: it is plain that our scrutiny must begin with the body; an animal that has never yet been mounted can but present the vaguest indications of spirit. Confining ourselves therefore to the body, the first point to examine, we maintain, will be the feet. Just as a house would be of little use, however beautiful its upper stories, if the underlying foundations were not what they ought to be, so there is little use to be extracted from a horse, and in particular a war-horse, if unsound in his feet, however excellent his other points; since he could not turn a single one of them to good account.”

Xenophon’s treatise goes on to carefully describe physical attributes to look for and problems to avoid in the evaluation of a horse, and although his words were recorded almost 2500 years ago they ring true today. The purchase of horses has always involved some measure of risk; risk that the horse will have mental or physical problems or health problems that will make it unsound or unsatisfactory for the use intended.   A pre-purchase examination performed by a knowledgeable veterinarian is one tool that a buyer can use to help manage this risk.

Aim & Philosophy

Buying a horse can be an exciting experience for horse owners, and ideally should be the beginning of a new and rewarding relationship for horse and owner.   The buying and selling of horses is also essential for a vibrant equine industry.   Purchasers of horses hope to find an individual that will fulfill their expectations, which may be for sport performance, breeding, resale, or simply to learn to ride.    In the excitement of considering a purchase, it is easy for those involved to overlook or be unaware of subtle problems that may result in their prospect failing to meet expectations.   

A veterinary pre-purchase examination can identify and assess the significance of factors of a veterinary nature which have the potential to result in current or future health problems, impaired athletic performance, or other problems which can affect the horse’s ability to perform in the indented occupation.   People will often use the terms “pass” and “fail” when discussing the results of pre-purchase examinations, and tend to interpret examination results in this light.   The intention of a pre-purchase examination is not to be the defining criterion upon which a decision for purchase is made; the veterinarian does not decide if the horse should “pass” or “fail”.   The ultimate decision on the purchase of any horse resides with the purchaser.   Considerations in this decision should include the suitability of the horse for the intended purpose, the price, and the health status of the horse.   The veterinarian can provide information on the health status of the horse, essentially conducting a risk assessment for the purchaser.

In the purchase of a horse, the degree of acceptable risk varies with the situation and the individual at risk.   Someone buying an older horse as a first horse for a young child may be willing to accept some degree of risk for mild lameness as the horse will only have to do light exercise and may have training and temperament attributes that are attractive.    People buying horses that they think are not expensive are generally willing to take more risk.   Others tend to be more risk-averse when the horse is expensive, when they have high expectations for athletic performance, or when they have had a bad experience with a previous purchase.   The purpose of the pre-purchase examination is for the veterinarian to describe his or her examination findings and their significance, and to provide the purchaser with a balanced assessment of risk.

Before the Examination
Who’s Who?:  It is important to understand the different roles and responsibilities of the people involved in the examination and sales transaction.    The purchaser is the person who has commissioned the pre-purchase examination and is buying the horse.   This person will be paying for the horse and for the examination, and is the one who will own the information provided by the examination.   They may also have an agent, someone such as a trainer or coach who may have found the horse and arranged the pre-purchase examination.    From the veterinarian’s perspective the agent may be the primary contact person, but all parties involved should understand that they are working for the purchaser.   The seller is the person who is selling the horse.   They may be present at the time of the examination, but they are not paying for the examination and have no rights to the information provided by the examination.    The purchaser may allow them access to this information, but they are under no obligation to do so.   The seller may also have an agent present such as a coach or trainer who acts on their behalf to represent the horse.   In some situations, the agent may be acting on behalf of the buyer and the seller.   This is a potential conflict of interest, and some discussion between the buyer, the seller, and the dual-agent should take place before proceeding to the pre-purchase exam stage so that all parties have a clear understanding of their responsibilities.   The veterinarian is employed to perform the examination on behalf of the purchaser.   The veterinarian has a professional obligation to represent the horse fairly and the best of their abilities, but they are primarily working for the purchaser and not for any of the other people involved.

What to Expect:  The purchaser should have some understanding of what to expect before the examination takes place.   They have the responsibility for arranging the examination, either on their own or with the help of their agent.   The pre-purchase examination should not be arranged by the seller, as this creates a potential conflict of interest in which the seller could be accused of selecting a veterinarian with a particular bias.   If the horse is to be transported to the examination location this can be performed by any of the parties involved, although it is probably best done by the seller as they still own the horse and if anything should happen in transit they will be responsible.   If possible the buyer (and/or agent) should be present to observe the examination, be able to ask questions, and obtain the most information from the process.   The veterinarian should perform the examination in a safe and efficient manner, describing their observations to the purchaser during the process and summarizing their findings in a detailed and concise manner.   A medical record in the form of a pre-purchase examination report should be created during the examination, and at the end of the process the purchaser should receive a written report summarizing the findings.

What are You Paying For?:  The purchaser is paying the veterinarian to perform a thorough physical assessment of the horse and to provide the information obtained by the examination in a clearly understandable manner, both verbally and in written form.    The cost of this process will vary with the veterinarian and with the number of additional diagnostic tests performed.   In Alberta, the cost of the examination will typically range from $200.00-$500.00.   If radiographs are made, this will add an additional expense depending on the number of images made (a typical example would be approximately 8-10 views costing approximately $400.00).    Additional diagnostics such as upper airway endoscopy or blood tests would add to the cost.

Choosing a Veterinarian:  The purchaser should be involved in the selection of a veterinarian to perform the pre-purchase examination.   The examination should not be arranged by the seller, as this may create potential conflict of interest.   Ideally, the veterinarian selected should also not be the regular veterinarian for the horse.    Although it may seem like some familiarity with the individual horse would be an advantage, it results in significant bias (positive or negative) which can be difficult for the veterinarian to eliminate from their assessment.    It can often be helpful for the purchaser to ask their regular veterinarian to recommend an appropriate veterinarian or help them locate one.

Conducting a thorough and detailed pre-purchase examination requires the veterinarian to possess a significant degree of knowledge and experience.   Ideally, the person performing the examination should spend much or all of their time in equine practice and have an interest in and experience with this procedure.

Avoiding Problems:   Unfortunately situations arise in which some or all of the people involved in the transaction are dissatisfied or unhappy.    If everyone has an understanding of the pre-purchase examination process and their respective roles and responsibilities within this process this will help limit frustration based on confusion or unrealistic expectations.   

Typically complaints made against veterinarians relating to pre-purchase examinations are of two broad types.   In the first instance the veterinarian is accused of not detecting an abnormality that subsequently becomes a problem.   This most commonly relates to lameness occurring soon after purchase.   A careful and thorough examination procedure should help reduce the chances of making such errors.   Testing for drug administration may also act as a deterrent to lameness masking agents being used at the time of examination.    In the second instance the complaint is that the purchase was not informed of a condition or abnormality that could become a problem (e.g. a sarcoid).   To avoid this situation good communication before, during, and after the examination is necessary

Another frequent problem is dissatisfaction expressed by the seller.  This may be that the veterinarian improperly discriminated against the horse in question by providing the purchaser with incorrect opinions regarding the significance of the clinical findings of the examination.   Such examples include the diagnosis of lameness, the response to flexion tests, the significance of conformational defects, and opinions on the significance of radiological findings.   It is important for the veterinarian to represent the horse fairly and to confine his/her opinion to fact, which is supported by experience and knowledge of the scientific literature.

Horse Preparation:   Some consideration should be given to the preparation of the horse for the examination.   The seller should ideally have the horse clean and well groomed in preparation for the exam.   If the feet are in need of trimming or shoeing, this should be done a week or two before the exam if possible.   The horse should at the very least be halter broke, safe to handle, and ideally know how to trot in hand.    It is not uncommon to be presented with horses that are barely broke, covered in mud and dirt, and with overgrown or poorly maintained feet.    This type of presentation makes for a more difficult exam, fails to impress the buyer and veterinarian, and may make the horse less saleable.     Ideally the horse should be in training or in work around the time of the examination, but not have been worked on the day of the examination.   If the horse was worked in the hours prior to the exam, it may be “warmed up” and subtle lameness or stiffness may not be apparent.    One situation that gets veterinarians in trouble and decreases the predictive value of a pre-purchase examination is when a horse that has been at pasture for some time is being bought for athletic use.    In this situation, the horse may have chronic lameness issues that are not apparent at the time of the exam but arise a month or two after return to work.    I usually warn clients of this risk at the time of the examination, and may place a higher degree of concern on any subtle abnormalities that are noted during the exam.

The Examination Procedure

Location:   When a pre-purchase examination is arranged, some consideration should be given to the location in which the exam is to be performed.    The exam can be performed at the stable or place where the horse lives, or at the veterinary clinic.  Regardless of the location, a quiet, clean, well-lit environment is needed.   He horse needs to be reasonably relaxed so that he can be safely examined.    Ideally the examination should be performed partly indoors so that the room can be darkened for examination of the eyes and mouth.   An electrical power supply will be needed if radiographs are to be made.    An area with smooth, level, firm footing is needed so that the horse can be trotted in hand, and an arena or other area appropriate for working the horse on the longe line and/or under saddle is also needed.   Attempting to perform a pre-purchase examination in the middle of a field in winter with no shelter or facilities (on a hill, in a snow storm, at 10:00 at night – don’t laugh, it happens!) is not conducive to a thorough exam result.

History & Disclosure:   The examination process begins with the identification of the horse and recording of the name, age, sex, breed, registration, and any other relevant vital statistics.   The veterinarian will ask the seller (if present) questions about the history of the horse in order to determine what the horse has been used for, how hard it has been worked, any health issues it may have had, and what types of general health care routine has been followed such as vaccinations, deworming, and dental care.   I will typically ask the seller specific questions about whether the horse has ever been lame, ever had any health problems, ever had surgery, or ever had joint injections or other medications and record this information on the pre-purchase examination document.

Physical Examination:   A thorough physical examination is then performed on the horse at rest.  The general appearance, body condition, and coat condition is assessed.  The vital parameters of temperature, respiratory rate, and heart rate are recorded.   A nose to tail examination of the horse is conducted, passing the hands over ever part of the body. The cardiovascular system is evaluated by listening to the heart and lungs and assessing the circulation and mucous membranes.   The head is carefully examined for symmetry and any signs of injury or abnormality.   The appearance and function of the eyes are assessed with external and internal (opthalmoscopic) examination.    The mouth and teeth are examined, both to confirm the age of the horse and to check for dental abnormalities.   In most situations the dental examination is relatively cursory, as a detailed dental examination usually requires sedation of the horse and the use of a mouth speculum and other tools which would not be appropriate in the pre-purchase situation.    The horse’s body is examined for skin lesions, or scars, which may indicate previous injury or surgery.   The external urogenital system is examined.    Each leg is carefully examined, and any abnormalities such as joint swellings, enlargements, tissue thickening, reduced joint motion, or other abnormalities are recorded.    The feet are carefully evaluated and their sensitivity is assessed with hoof testers.    The hoof tester is a large hand caliper which is used to apply pressure to specific points on the hoof.   A painful response to hoof tester pressure should not be found in the normal horse with a strong, healthy foot.   An experienced veterinarian develops a consistent examination routine, which can be applied to every horse in a thorough yet efficient manner.

Dynamic Examination:    Following the physical examination at rest the horse is observed in motion, which is sometimes referred to as the dynamic exam.   A handler walks the horse towards and away from the examiner at a walk and then at a trot.   The horse is also turned in tight circles in both directions.    This step should be performed on firm level footing.   The horse is observed carefully for movement abnormalities such as conformational gait abnormalities, stiffness, or signs of lameness.   The horse then worked in an arena, round pen, or other area where it can be observed trotting and cantering or loping in both directions.   Again the horse is observed for freedom of movement, stiffness, gait abnormalities, or lameness.    Before or after working the horse in an arena flexion tests are performed.

Flexion Tests:   Flexion tests are an important but sometimes controversial part of the pre-purchase examination.   The flexion test is a provocative test used to induce lameness.   It involves holding the leg up and applying firm, steady pressure to the flexed joints for a minute and then releasing the limb and observing the horse as it trots away.   A “normal” horse may exhibit 2 or 3 lame steps but should then trot normally, which is termed a “negative” test result.   If the horse appears lame for multiple strides after trotting away this is considered an abnormal response, or a “positive” test result.   The flexion tests are valuable in identifying horses with hidden or sub clinical sources of pain.   The test is non-specific because it is nearly impossible to flex a single joint without flexing other joints or nearby tissues.   There is a relatively high degree of false-positive and false-negative results with flexion tests, meaning that normal horses can exhibit a positive response and horses with underlying injury can sometimes have a negative test result.   So if these tests are not specific and can be false why do we use them?   The reason is that when they are performed and interpreted in a consistent manner by a veterinarian used to doing them they still have some predictive value.    In one retrospective study, 151 sound horses were followed over 6 months.   Twenty-one percent of horses with a positive forelimb flexion test developed lameness in the area being flexed, whereas only 5% of horses with a negative flexion test subsequently developed lameness.    Flexion tests are also of value in that a positive result will focus the attention of the examiner on the tested limb.   If other clinical abnormalities such as joint swelling or positive hoof tester response are also present the index of suspicion that a problem may exist begins to increase.    It is an important principle of diagnostic testing that the value of a test result increases when considered in the light of other concurrent test results.   Flexion tests on their own lack diagnostic accuracy and are of little value, but a positive flexion test result will alert the veterinarian to pay closer attention to the leg and if additional abnormalities are found the combined observations may be very meaningful.

Examination after Exercise:   While the horse is being exercised longe line, in a round pen, or under saddle it is also observed for respiratory noise, coughing, and exercise intolerance.   After it is exercised sufficiently to elevate the respiratory and heard rate the horse is re-examined while it recovers.  The heart rate, respiratory rate, and lung sounds are evaluated.   This provides some additional information about cardiovascular function, degree of fitness, and possible abnormalities such as heart murmurs or lung pathology.   This step usually completes the physical examination portion of the pre-purchase exam.   The veterinarian will usually summarize and discuss their findings at this point, and if additional tests are considered necessary they will be recommended.

Ancillary Testing
Diagnostic Imaging:   The most common diagnostic aid used in pre-purchase examinations is radiography.   Although not a required part of the pre-purchase exam, radiographs are often requested or recommended.  Radiographs provide additional information about the musculoskeletal system of the horse, and can be a valuable addition to the examination.    Situations where radiographs would be made or recommended include:
• When clinical examination findings identify an abnormality requiring further clarification.
• If the intended use of the horse is for high-level performance.
• If the horse is being purchased for re-sale.
• If the horse is young or unbroken, as it may have developmental bone and joint abnormalities such as osteochondrosis that may not have associated clinical signs because the horse has not been in work.
• At the request of the purchaser.
• If the horse is expensive.

It would seem that radiographs would be of obvious value in any situation, but it is not always a black and white situation.   Abnormalities may be seen on radiographs that are not affecting the horse and will not do so. Pathology or injuries leading to lameness may be present that do not show up on radiographs, as these images only show the bone and do not provide much information about soft tissues such as cartilage, tendons, or ligaments.    Making the conclusion that the horse “x-rayed clean” can be a dangerous or mis-leading oversimplification.   Any abnormalities seen on the radiographs must be carefully interpreted with the results of the clinical examination in mind.

Adding radiographic evaluation to a pre-purchase examination will significantly increase the expense, so it is important to ensure that quality information is obtained in return.   Quality information can only be obtained from properly made images of sufficient number and quality, interpreted by and experienced and qualified veterinarian.    A single radiographic image only provides a two-dimensional view of the region from one perspective.   A full series of images of a specific area generally requires at least 4 views from 4 different angles; at a minimum 2 views of a given joint or region should be made.    Making quality images takes a co-operative horse, a handler, and at leas two knowledgeable people to operate the equipment.   Trying to make radiographs of an un-cooperative horse in a difficult environment with insufficient help leads to poor quality images, which give limited or mis-leading information.

The equipment used to make the images is important. Film radiographs have long been used, but recently digital radiography (DR) systems have become fairly commonplace.    A series of well made film images is still be better than a series of badly made digital radiographs, but when used properly DR has several advantages. The images are generally of better quality. They can be viewed instantly during the examination, and if a particular shot needs to be repeated it can be done immediately. The digital image files can be burned on a CD for distribution, and the image files can be transmitted by email, which can be helpful. The main drawback is increased cost compared to film, but the benefits appear to outweigh the cost difference.

The accurate and realistic interpretation of pre-purchase radiographs is a difficult task for the veterinarian. There is a danger that subtle abnormalities may not be detected or under-estimated, and perhaps an even greater danger that minor abnormalities will be over-interpreted. Radiographs on their own may be meaningless, they should be interpreted with some knowledge of the horse and the results of the clinical examination.   In order to provide the most useful information, the veterinarian should have significant experience with pre-purchase examinations and an in-depth knowledge of equine diagnostic imaging, anatomy, pathology, and lameness. If there is uncertainty about the significance of results, a second opinion from a colleague or a board-certified radiologist may be helpful.

Laboratory Tests:   These may include routine bloodwork, testing for infectious disease (such as the Coggins test for equine infectious anemia), or drug testing.    These tests are usually performed at the request of the purchaser, although the veterinarian may suggest them if there is some reason to do so.   It is becoming fairly routine to collect a serum sample from the horse, freeze it, and hold it for a month or so in case a problem develops shortly after the examination.    The stored sample can be analyzed at a later time if there is some question as to whether the horse may have been under the influence of some medication at the time of the exam.

Endoscopy:   Some large breed horses such as Thoroughbreds, Warmbloods, and Draft horses are predisposed to certain throat and upper airway problems that can affect the performance or have the potential to do so.    If the client is concerned about this possibility or if the clinical exam revealed some reason for suspicion (such as a respiratory noise during exercise), an endoscopic examination of the upper airway may be performed.    This is a relatively quick and minimally invasive test with minimal risk for the horse.   It should be performed on the un-sedated horse, and sedation may depress the function of the throat and larynx leading to a false-positive result.

If the Horse is Lame:  Most horses presented for pre-purchase examination are lame!   This may seem surprising, but in my experience it is a common finding occurring approximately 50% of the time.   In a published retrospective evaluation of 510 pre-purchase examinations, 271/510 (52.8%) of horses were lame at the time of the examination.    In most situations, it would seem that the horse has a chronic, mild lameness of which the seller is unaware.   The horse may not appear lame when it is at home or when it is ridden.    When the pre-purchase examination is performed the horse is examined critically from every perspective.   Often the examination is performed on harder footing than what the horse may be ridden on, which will make subtle lameness more apparent.

If the horse is significantly lame, this usually results in the termination of the pre-purchase examination.   In some cases, the purchaser may elect to re-examine the horse in a couple weeks in the chance that the cause of the lameness is something simple and acute that will resolve with a short rest.  

When the horse is found to be lame, the next question that is obviously asked is why?  It is important to realize that a pre-purchase examination cannot usually answer this question.    Diagnosis of lameness in many situations requires a lameness examination.    Lameness examinations use different techniques to localize and identify the cause of lameness, including invasive techniques such as diagnostic nerve and joint blocks.   As they do not yet own the horse the purchaser does not have the authority to give permission for invasive techniques to be performed on the horse, particularly if those techniques involve some risk.   Furthermore, the purchaser should not bear the responsibility of diagnosing the reason for the horse’s lameness; this is the responsibility of the owner.   If the horse is found to be lame during the pre-purchase examination, the best course of action is for the owner to then make their own arrangements for a lameness examination in order to determine the cause.

It is becoming more common for experienced horse professionals to have a prospective sales horse evaluated before offering it for sale, a so-called “pre-pre-purchase” or “pre-sale examination”.    They have learned that although they may think they know their horse they can often be surprised when they come to sell it.    A pre-sale exam can be an advantage for the seller, as it lets them have a good knowledge of the current health and soundness of their horse, may affect their determination of price, protects their professional reputation, and lets them market the horse with confidence.

Concluding the Examination
At the conclusion of the examination, the veterinarian should summarize their findings, explaining their significance and highlighting the main attributes of the horse and the main areas of concern.    Often the seller will be present during this discussion, and will want to hear the findings.   This is reasonable and initially helpful, but it is also important for the purchaser to have a chance to talk to the vet alone.    The purchaser may not be comfortable asking certain questions in front of the seller.   The veterinarian should facilitate the opportunity for a private discussion, and if this does not happen the purchaser should not hesitate to request this.

The way in which the opinion of the examining veterinarian is presented to the purchaser can be controversial.   Unfortunately, it is a frequent perception by the purchase that a veterinarian’s examination prior to purchase provides a warranty that the prospective animal is free from all impediments currently and in the future and that such an examination in some way guarantees a risk-free purchase.   This perception has been perpetuated to some extent by the use of terms like “pass”, “sound”, “suitable”, or “serviceable” all of which when used in the context of a pre-purchase examination imply a degree of warranty.    The veterinarian’s role is not to make the final decision or provide any warranty or guarantee regarding the horse, but rather to provide medical information and a summary of the risks represented by this information.   In order to be simple and consistent in doing this, I assign one of 4 levels of risk to the horse based on the examination findings.   Even a perfectly normal horse has some un-quantifiable risk of developing a problem in the immediate future, which represents a baseline.   If the examination revealed no significant abnormalities, the horse is considered to have “no increased risk” for developing a problem.    If problems were identified, the horse will be assigned to one of the next most appropriate risk levels as follows:

o “No increased risk”
o “Mild degree of increased risk”
o “Medium degree of increased risk”
o “High degree of increased risk”

Although this categorization is somewhat subjective, it is based on all of the information obtained in the examination summarized to the best of the examiner’s ability.   The purchaser can then use this risk-assessment, consider it in light if their attraction to the horse, its suitability, and the price, and make an informed decision regarding purchase.

Summary
The Webster’s dictionary defines the word “vet” in two ways; as a noun meaning veterinarian and as a verb meaning “to evaluate for possible approval or acceptance.   To vet was originally a horse racing term, referring to the requirement that a horse be checked for health and soundness by a veterinarian before being allowed to race. Interestingly, this concept has taken the general meaning “to check”.

A significant part of the equine veterinarian’s job remains the “vetting” of horses, another term for the pre-purchase examination.   The role of the veterinarian in this process is to provide the prospective buyer with medical information that is relevant to his/her decision of whether or not to buy the horse.   It is a challenging task usually taken seriously by those asked to perform it, which should be of value to the purchaser and increase the chances of a long–lasting and rewarding partnership of horse and owner.

 

i Dyson SJ: Evaluation of the musculoskeletal system. Part 4. The use of flexion tests and small diameter longing.   In Mair T, editor:   British Equine Veterinary Association Manual: the pre-purchase examination, Newmarket, 1998, Equine Veterinary Journal.

ii Van Hoogmoed LM, Snyder JR, Thomas HL, et al.   Retrospective evaluation of equine prepurchase examinations performed 1991-2000.   Equine Veterinary Journal (2003) 35 (4) 375-381.

iii Anderson BH, Ritmeester A, Bell B, et al. Examination of the equine athlete prior to purchase. In: Hinchcliff KW, Kaneps AJ, Geor RJ eds. Equine sports medicine and surgery. St Louis: Saunders; 2004; 1201.

 


 

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