Pre-Purchase Exams

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Dr. Harry Werner, of North Granby, Conn., has been performing pre-purchase exams for 33 years, and he can recall numerous times when a pre-purchase exam couldn’t have revealed a physical issue that erupted later.

He recalled a client buying a horse who was stabled near the University of Georgia’s veterinary school, where he was sent for a pre-purchase exam that included radiographs (x-rays). Still, six months later, the horse became uncoordinated, and further radiographs later revealed osteochondritis dissecans (OCD) in a cervical vertebra, where no radiographs had been shot during the pre-purchase exam. ”Where do you stop with radiographs in a pre-purchase exam' There is a limit,” said Werner.

And sometimes an invasive test just doesn’t make sense. Werner recalled that a decade ago, when equine protozoal myeloencephalitis (EPM) was spreading and little understood, some veterinarians responded to clients’ concerns by performing spinal taps to test horses’ spinal fluid for the telltale antibodies. But a spinal tap can be a risky procedure, and some veterinarians faced lawsuits from sellers whose horses were injured by it. ”Sure, we can do things like a spinal tap, but the question is, are they relevant and are they worth the risk'” said Werner.

Similarly, Dr. Grant Miller, who performs nearly 100 pre-purchase exams a year from the practice where he works in Petaluma, Calif., recalled that once a horse died of colic, resulting from a small-intestine strangulation, just one day after his pre-purchase exam — and the new owner had paid for him. ”That’s not something you could find or predict, and it shows that there are a lot of uncertainties in buying a live animal,” said Miller.

How It Should Work

”The first thing a buyer should be concerned about in a pre-purchase exam is communication,” said Werner. ”It’s critical to communicate your wants and needs to the practitioner, and for the practitioner to be candid about the costs. In fact, in my experience, if there is a problem with a pre-purchase exam, 90 percent of the time it’s a case of poor communication by or with the practitioner, not medical incompetence.”

That’s why, before he schedules any of the approximately 75 pre-purchase exams he does each year, Werner has a one-on-one conversation with the buyer, either by phone or in person. ”It’s an essential conversation,” said Werner.

Werner wants to know exactly what the horse’s intended use will be so he can evaluate the tests he performs in conjunction with factors like the horse’s age, competitive history, breed and size. Plus, if the buyer is not a client, he also likes to know more about their experience, knowledge and expectations.

Werner also wants to make sure he’s the right veterinarian for the job. He believes that veterinarians should not perform pre-purchase exams on breeds or types of horses with which they’re not familiar. For instance, he won’t examine Paso Finos. ”I’m simply not familiar with them, their gaits or their competitions, so my results simply wouldn’t be of much use to the buyer,” said Werner. ”As a veterinarian, you have to be knowledgeable about the nuances of a discipline or breed.”

Every pre-purchase exam Werner performs begins with a physical examination of the horse. ”It’s the single most important thing,” he said.

Assuming the horse is calm and accustomed to being handled, Werner starts in a stall and checks the temperature, pulse and respiration, and eyes. Then he has the horse walked into the aisle to assess his conformation, general condition (thin, fat, obese, fit), observe scars as indicators of prior injury, and to evaluate his mental attitude (eager, dull, angry, anxious).

Next, Werner examines the head, checking the sinuses and the jugular vein (for signs of excessive medication). Then he palpates the neck, back and croup for signs of inflammation or pain. Next he examines the legs and joints for signs of injury or arthritis and checks the hoofs with hoof testers. He also observes the underbelly for scars that would indicate colic surgery. Throughout this examination, he watches for signs of neurological problems — things like the tail not lifting, asymmetry of the head or other body parts, or lack of co-ordination.

Exercise Under Saddle

Unless he’s found a serious problem during the physical examination, Werner’s next step is to see the horse exercise. And here’s where knowing the horse’s experience and intended use is critical. He won’t ask to see an FEI-level dressage horse jump or a jumper perform FEI-level dressage movements. But if the horse is an unstarted youngster, he won’t be able to see much. Weather can also play a significant role, as he won’t be able to see a horse jump or gallop if it’s 20 degrees with two feet of snow on the ground — unless the seller has an indoor arena.

But he does expect to see the horse walk, trot and canter under saddle, and to jump if that’s what his job is. He also has the rider gallop the horse around the arena once or twice to check the heart and lungs under stress. ”I want to see what the horse does. I want to see if it does it in a confident, sound manner,” said Werner.

Unlike many veterinarians, Werner performs flexion tests and the eight-meter circle while being ridden, not while being led or longed. ”I get to see the pattern, speed and gait I want with a rider on his back, and I have yet to encounter a horse with whom I’ve had to ask the rider to get off,” said Werner.

Miller performs flexion tests with someone leading the horse. And he watches the horse trot on soft and hard ground, in straight lines and while being longed. But he does not have the horse trot an eight-meter circle on hard ground or pavement. ”When is the horse ever going to have to do an eight-meter circle on the driveway' I feel I have enough lameness experience to pick up lameness without requiring the horse to do an inappropriate test,” said Miller.

After the physical exam, Werner discusses what further ancillary tests to do on the horse, based on his findings so far. These include digital radiographs, ultrasound and thermographic imaging, as well as such laboratory tests as a complete blood count. He prefers clients to be present for the pre-purchase exam, or to at least be immediately available by phone, so that he can consult with them about the need for more tests and what they indicate.

The most common ancillary exam is radiographs, which he always recommends for young warmbloods, ”mainly because these horses have such a high frequency of bone disease, and radiographs give us a fair chance of pi cking that up.” But he said he probably wouldn’t recommend radiographs on a 12-year-old with a current competitive record who showed no cause for concern in the physical examination.

”The client should be asking what ancillary studies do I need to reasonably protect my investment' But they have to understand that none is going to guarantee there won’t be any problems in the future,” said Werner.

Deciding which ancillary examinations to perform is where inexperienced buyers, especially parents, often get into trouble. They often know little (if anything) about horses, they have no idea what the radiographs or ultrasound will or will not reveal, and often they don’t understand the requirements of their child’s sport or discipline.

For instance, Werner said that sometimes the physical examination reveals that a horse makes a noise while breathing during exercise. Whether that’s a concern or problem depends on the horse’s intended use. It may not be a concern at all for a pleasure horse or trail horse, or even for a show jumper. But if the horse is to be a show hunter, many judges will consider that an unsoundness.

In that case, Werner said he’d recommend using an endoscope to examine the horse’s throat and airways. But he noted performing an endoscopic examination on a horse that doesn’t make a noise cannot guarantee that a horse will never develop a breathing problem. ”As a veterinarian, you have to do the best you can to try not to predict the future,” said Werner.

Technological Evolution

”Technology is probably the No. 1 thing that’s changed about doing pre-purchase exams in the last 30 years,” said Werner. ”Digital radiographs have had a great impact on how quickly we reach for radiographs. If there are any questions, they often facilitate answers.”

Nor did veterinarians have flexible fiber-optic endoscope, ultrasound and thermographic imaging 30 years ago. And laboratory tests have become far more sophisticated, quicker and easier. Werner can check for HYPP in Quarter Horses just by pulling a few tail hairs and sending it to a laboratory for DNA analysis. And he performs relatively inexpensive drug tests on about two-thirds of the horses he examines.

Each of these technological advances has given veterinarians new tools to look inside of the horses their clients are considering purchasing. They can now find old injuries or sites of potential problems that they never could have found a quarter century ago, and that’s led to a range of questions and issues that didn’t come up with pre-purchase exams then.

Werner said that the temptation with these imaging modalities ”is to allow a pre-purchase exam to turn into an in-depth lameness exam, and that’s something we have to guard against.”

For instance, he frequently examines horses that are intended for excited kids desperate to buy their potential Pegasus. Naturally, Werner’s examination finds a problem, and the mother, desperate to keep her child happy, ”grasps at straws, asking me to do more tests. But this isn’t meant to be a diagnostic examination,” said Werner.

Frequently, the poor mother knows even less about horses than her daughter, and that’s another way the pre-purchase exam has changed. ”Years ago, most of the people buying horses were horsemen, so you didn’t get the bumps in the road you get with well-meaning but uninformed buyers today,” said Werner.

That’s why Werner and Miller each require clients to talk with them before they schedule a pre-purchase exam. ”I often have people say one of two things to me. The first is a parent buying a horse for their child, who’ll say to me, 'I just was him to be safe.’ Well, since no vet can appraise safety, I tell them to go buy a parakeet. The second is, 'This horse is going to be an investment.’ So I tell them not to buy a horse, to go buy a mutual fund,” said Werner.

Lack of knowledge about horses and the million ways they can get hurt, sick or become otherwise unable to perform ”reflects in their actions when things don’t go the way they want them to go” after the purchase. In other words, they call their lawyer to file a lawsuit, often claiming the veterinarian was incompetent because he didn’t see signs of some ailment.

So Werner records everything he sees during a pre-purchase exam, in case he needs it in the future. ”What I do might be deemed excessive, but it surprises me how angry they can get way down the road,” he said.

Werner has his own worksheet, which he fills out as he conducts the exam, which he uses to review the horse in person or over the phone during and immediately after the examination, and which he then polishes up to send to the client after the examination. He always takes photos of the horse from both sides, from the front and back, of the head, and of any areas where there is a question or concern. He then provides copies of his findings and radiographs to the client’s veterinarian.

Miller has a 10-page worksheet of his own design, covering everything from the horse’s vaccination and worming dates to the buyer’s experience and intended use, to his exam findings.

”I view this as I’m taking an inventory of the horse to tell you whether or not this horse is well suited for its intended purpose,” said Miller. ”But I’m not clairvoyant. I tell them what they’re getting with this horse, and they have to decide whether it’s a big deal or it’s something they can live with because, otherwise, it’s the horse they’re looking for. And that takes a lot of communication.”

Article by John Strassburger, our Performance Editor. A graduate A Pony Clubber, John has decades of experience in eventing, steeplechasing and dressage. As editor of The Chronicle of the Horse for 20 years, he covered six Olympics. With his wife, he operates Phoenix Farm, in California. He has written two books, ”John Strassburger: the Things I Think Matter Most” and ”George H. Morris: Because Every Round Counts.”