Page 1206 - Adams and Stashak's Lameness in Horses, 7th Edition

1172 Chapter 12

evaluation, general comments, communication com­ Thorough evaluation of the cardiovascular system is
ments, imaging interpretation, and comments concern­ important especially in sport horses. Accurate assessment
VetBooks.ir worksheet should be maintained in the medical record. challenging depending on the veterinarian’s equipment
of the heart and identification of heart murmurs can be
ing any specialty testing that was performed. The
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Use of a dedicated PPE worksheet will help to reduce the
and ability to detect subtle murmurs. Evaluating the
risk of an incomplete exam and inaccurate recall of find­ horse before and after exercise can be useful; however
ings in the formulation of the final report. There are a the effect of exercise is a poor guide to the significance of
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number of forms online that can be used as a guide for a murmur. A murmur may be physiologic or may be
designing a PPE worksheet that is specific for the veteri­ due to disease, not all of which affect a horse’s perfor­
narian’s needs and wishes. mance negatively, depending on the nature of the mur­
The basic PPE should include a visual inspection of mur. Key factors to take into consideration include (1)
the horse both in and out of the stall, during work, and the intended use of the horse, (2) safety to horse and
following work. Any noted abnormal behavior or vices rider, (3) the prospective buyer’s understanding and will­
should be noted. This will give the veterinarian an idea ingness to accept risk, (4) the horse’s past performance
of the horse’s response to an unfamiliar environment record, (5) age of the horse, (6) if the prospective buyer
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and personnel, recovery from exercise, and any changes considering resale, and (7) insurability. If a heart mur­
in stance or movement throughout the exam. Overall mur is identified and the veterinarian cannot be confi­
body condition and conformation should be closely dent that it is a physiologic murmur (i.e. second‐degree
evaluated and recorded. 2,11,15,21,24,26 atrioventricular block), further investigation utilizing
Physical Examination: An overall general examina­ echocardiography and electrocardiography is recom­
tion of the horse should be performed using a muzzle to mended. If the intended use for the horse is breeding,
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tail inspection of all body systems. It is also important to many horses with moderate to severe cardiac disease are
have knowledge of a horse’s age based on dentition. perfectly suitable for breeding purposes. 17
Confirming that the horse’s dentition corresponds to the Any abnormalities that are identified during this ini­
age on record is important, as it is not uncommon to tial stage of the physical examination should be dis­
have marked discrepancy between the two in some cussed with the prospective buyer and referral offered if
cases. Auscultation of the thorax and abdomen is per­ the veterinarian is not familiar with the findings and
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formed during the initial exam. Auscultation of the uncomfortable with the interpretation.
lungs using a rebreathing bag is often performed follow­ Musculoskeletal Examination: Physical examination
ing the dynamic exam. Palpation at this stage concen­ of the musculoskeletal system should follow a system­
trates on skin health, identifying any lumps, bumps, or atic approach and be detailed and methodical to avoid
swellings, and careful inspection for common surgical straying from the system. In the equine athlete it is very
scars (ventral midline, neurectomy, laryngeal, etc.). In common to identify or palpate abnormal variations of
the gray horse careful inspection for melanoma lesions normal that are considered blemishes (mild fetlock, ten­
at the base of the tail, in the perianal region, and in the don sheath, and tarsocrural effusion) and insignificant
region of the parotid salivary glands is important. If firm to the horse’s future soundness. Recognizing obvious
swellings are identified in the parotid region, considera­ asymmetry between like effusive structures is of greater
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tion of upper airway endoscopy including inspection of clinical significance than symmetry between structures.
the guttural pouches is advised. It is common to find For example, eliciting a mild response to deep palpation
melanotic plaques in the guttural pouches of gray horses of the proximal suspensory in the front limbs of horses
with melanoma affecting this region. 5,7,27 In geldings and in work is a common finding; eliciting the same response
stallions it is advised to obtain permission to sedate the in the hindlimbs should be of greater concern, depend­
horse to allow close inspection of the penis and pre­ ing on the degree of response. 20
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puce. Small precancerous or cancerous lesions cannot Step Four: Dynamic Examination
be identified without close visual inspection. In mares, This portion of the examination is best performed over
the seller should be questioned as to the mares’ potential multiple level surfaces in an area with minimal distrac­
for pregnancy. If the response is unclear, it should be tions. Having an assistant employed by the veterinarian
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suggested to the prospective buyer that an examination who is familiar with PPEs and soundness evaluation is
for pregnancy be performed. 26 helpful and can help assure an efficient and uncompli­
The ophthalmic examination should be performed in cated examination. To accurately evaluate a horse’s gait,
a dark quiet space with an ophthalmoscope. The goals the horse should be relaxed and trot freely on a loose
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of the ophthalmic examination should be to identify the lead. The basic PPE should include observing the horse at
presence of an abnormality, state if an abnormality will the walk and trot on the straightaway, at the trot and
or will not have a significant effect on functional vision, canter on the lunge, and after upper and lower flexion
and state whether the abnormality is likely or unlikely tests of all four limbs. The response to flexion tests is
to progress over time. The veterinarian should not highly variable and should be interpreted with caution. A
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document any quantitative comments concerning visual positive flexion test does not always correlate with the
impairment or subjective statements with respect to the presence of lameness in a particular limb. Many horses
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horse’s suitability for riding with suspected visual will trot off asymmetrically following flexion, but the
impairment. It is generally viewed as inappropriate response should resolve within 2–3 strides to be consid­
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and unnecessary to routinely dilate a horse’s eyes during ered a negative response. 6,22 As long as all parties agree,
the PPE. The exception to this is if an abnormality is and owner and rider consent is obtained, it is advised to
identified and the veterinarian, with the owner’s permission, also observe the horse under saddle. 11,15,26 It is recom­
wishes to more fully examine the eye. 12 mended to use the horse’s own tack to reduce any