UNDERSTANDING THE PREPURCHASE EXAM

The search is over: You’ve finally found the horse of your dreams. But before you sign the sales contract and load him onto the first trailer headed home, protect yourself with a prepurchase exam.

By Sushil Dulai Wenholz 
originally published on thehorse.com

The search is over: You’ve finally found the horse of your dreams. But before you sign the sales contract and load him onto the first trailer headed home, protect yourself with a prepurchase exam. Granted, There’s no magic crystal ball there to guarantee a horse that looks great on exam day will carry you to reach all of your equestrian goals. But a prepurchase exam, also known simply as a veterinarian check, can give you insights to help ensure you’re making a smart, informed decision before money changes hands.

Still, taking this step isn’t as straightforward as calling your veterinarian out, pointing to the horse and saying, “Get ‘er done.” Your veterinarian will need your participation to customize the exam for your needs and maximize its usefulness to you. That’s particularly true because of the numerous diagnostic tools that modern veterinary technology has made available- giving you more ways than ever to gain information on a horse’s health. Yet taking advantage of them all would send your veterinary bill skyrocketing from a couple hundred dollars to a thousand or more.

Understanding what to expect from the exam and getting an upfront idea of what tests you might be willing to spring for- and under what circumstances- will prepare you for the veterinarian’s visit and help you make the right choices for your needs, your pocketbook, and your dreams.

What’s the Point?
If a prepurchase exam can’t guarantee that a horse will be your perfect mount, why bother? For one thing, it could prove that a particular animal won’t be suitable, saving you from heartache and financial loss. Plus, it can expose health concerns not apparent to the naked or untrained eye that could present management issues now or later, giving you an opportunity to decide if you want to take on that problem.

In short, the true purpose of a prepurchase exam is “to help provide the buyer with enough information to make an informed decision as to whether a horse will meet their needs,” says Wendy Schofield, DVM, a practitioner with the Sport Horse Program at Hagyard Equine Medical Institute in Lexington, Ky. “We are there to assess general health, conformation, and soundness for intended use.”

Another goal of the prepurchase exam is to try and uncover any pre-existing conditions a horse might have, says David Celella, DVM, of Rockwall Equine Center in Terrell, Texas. “Any horse is salable and every horse has problems,” he says. “We’re trying to identify those problems and see if the buyer is willing to deal with them.”

What a prepurchase exam is not, note Celella and Schofield, is a pass-fail test or a guarantee of long-term health and soundness. Rather, it’s a snapshot of a moment in time.As Schofield explains, “We do the best we can to evaluate that horse on a given day, and to say this is how the horse is. But things change.”

Elements of the Exam
In general, a prepurchase exam will include three phases:

Basic health evaluation, including health history, temperature, pulse, respiration, general condition, and conformation;
Lameness assessment, including flexion tests, soft tissue palpation, and movement evaluation;
Ancillary diagnostics that might not come into play, including radiographs (X rays), ultrasound, and bloodwork.

Each phase in the process can include multiple steps. Exactly what’s included in your prospect’s exam depends to some extent on your expectations, says Celella. Do you want to know a horse’s tiniest flaws? Or are you only concerned with major issues? How you intend to use the horse is another factor in determining the extent and content of the exam and how you assess the results. So be prepared to discuss your goals with your veterinarian before he or she starts the exam.

“There’s a variability in what’s acceptable and unacceptable, depending on the buyer’s intended use, and a consideration for how much management it may take to keep the horse performing at the desired level,” says Schofield.

For instance, imagine you’re buying a horse for your child to grow up with and show for years, or you’re buying a horse that might be destined for resale. You probably want a thorough exam to help make sure there are no pre-existing conditions that could leave the horse unsound within a short period. On the other hand, if you’re looking at a dressage schoolmaster, you might opt for a less-intense diagnostic path. After all, it’s fairly safe to assume that the horse has some existing issues from previous years of work.

The Seller’s Role
A prepurchase exam isn’t just about the horse and the buyer, though. The seller also should be an active participant. That person should have a thorough knowledge of the horse’s health history-an essential component of the exam, according to both Schofield and Celella.

“I try to get as much information from the seller as I can,” says Schofield. “I ask for full disclosure, including prior medical issues, surgeries, treated conditions, as well as vaccines and deworming. I also ask if it’s okay to contact the (horse’s regular) veterinarian.”

Celella asks the seller for all of the horse’s medical records before the exam. Then he goes a step further, and it’s a step he realizes might be controversial.
“I have the seller fill out a questionnaire before the exam and sign off on it,” he explains. Included are questions related to diverse aspects of the horse’s health history, including such behavior issues as cribbing. The form also features a disclaimer stating that the exam can only consider what’s happening with that horse at one particular point in time.”I like to be upfront,” he adds, “and I do my best to turn (the exam) into an open forum between all parties.”

The Basics
Every veterinarian has his or her own “order of events.” However, many will start with the basic physical evaluation, including listening to heart and lungs; examining the eyes, ears, and teeth; taking pulse, temperature, and respiration readings; and getting an overall impression of the horse’s condition.

The veterinarian will also probably evaluate the horse’s conformation. This can be a tip-off to issues that might surface later in the lameness exam or could indicate areas of concern, given a horse’s intended use. For example, if a buyer is looking for a Grand Prix jumper, a veterinarian would likely point out long, extra-sloping front pasterns that might not hold up well under the stresses of that sport.

As part of this evaluation, the veterinarian will also likely pay attention to the horse’s hooves and how the animal is shod, says Celella. After all, he notes, “Deviations in the foot can be indicative of deviations in the bone.” And that can lead to lameness issues down the line.

Most veterinarians will use hoof testers (metal, tonglike tools) to apply focal pressure to different areas on the horse’s foot. Sensitivity or reaction can indicate inflammation, soreness due to hoof imbalance, sole bruising, poor shoeing, or caudal (toward the tail) heel pain, explains Schofield.

Evaluating Movement
For performance horses, the lameness evaluation is often the key portion of a prepurchase exam. The results can point out the need for additional diagnostics and frequently are a deciding factor in whether a buyer proceeds with the purchase.
In general, the veterinarian will begin by watching a horse move in-hand at the walk and trot, in a straight line, on a hard, level surface. According to Celella and Schofield, this allows the veterinarian to see:

• How the horse’s feet land;
• Alterations in limb movement;
• Abnormalities in the footfalls or the pattern of the footfalls;
• Obvious signs of lameness, pain, or weight-shifting when the foot lands;
• Asymmetry with the way the body or pelvis moves.

“Different surfaces provide the chance to evaluate movement differently,” says Schofield. “You’re better able to see how the foot lands on a hard surface than a soft surface, and sometimes you can even hear a subtle weight shift as the foot hits the harder ground. Other lamenesses tend to be more evident on a soft surface or on a circle.”

Thus, the next step in the lameness evaluation is ideally to watch the horse go both directions in a round pen or on a longe line, preferably in dry, relatively soft footing, such as sand. Schofield and Celella explain that this setup can:

• Highlight a shortness of stride, particularly in the hind end;
• Allow the horse to move more freely at faster speeds than traveling in-hand allows;
• Show the horse’s movement at the canter, including any difficulty in picking up a particular lead;
• Demonstrate fluidity (or lack thereof) in transitions;
• Accentuate a lameness, because the circle puts more pressure on the inside legs;
• Uncover potential respiratory issues, such as if a horse makes noise while traveling at speed, gets out of breath easily, or recovers slowly. Plus, the veterinarian will be able to assess the heart and lungs after exercise.

The Big Stress Test
Joint flexions are considered by many buyers to be the central, even pivotal, element of the soundness assessment. Yet, says Schofield, “Flexion tests are quite subjective, and there is a lot of variability.” And that can cause confusion for the buyer.
She notes that the test itself is meant to simulate stress on a particular region or joint. 

To do this, the veterinarian will flex a single leg joint tightly and hold it in place for a set period of time, usually from 30 to 90 seconds. As the veterinarian releases the joint, the handler immediately trots the horse off. The veterinarian looks for any signs of lameness (usually “forgiving” the horse if the first step or two appears off).

The veterinarian then rates any lameness, usually on a scale of 0 to 5, with 0 being totally sound. A horse rating 5 on the scale, says Schofield, is “very, very lame in the first few steps off and then shows very significant lameness persisting for the typical ‘down and back.’ These horses usually have some baseline lameness, but a (positive) 5 response horse may be resentful of even holding the limb in flexion for the desired time, and some remain sore for the duration of the exam-usually a big red flag!”

Variability is most likely to creep in when the veterinarian is flexing the joint. An individual’s strength, how tightly they hold the joint, and even slight variations in how they hold the joint can all make a difference in how the horse reacts to this test. Two different veterinarians could easily get two different “readings” on a flexion test done on the same horse on the same day.

As a buyer, this variability can cause some confusion over what’s considered a “good” result: What number signals cause for concern? It can help to ask your veterinarian that question beforehand. Most important, says Schofield, make sure you consider the big picture, not solely the flexion.
“Flexion backed up with clinical impressions backed up with X rays-they all go hand-in-hand,” he says.

The Final Phase
A typical prepurchase exam also includes thorough palpation of the horse’s soft tissues. Here, explains Celella, the veterinarian is primarily feeling for any evidence of current or past injury, such as heat, tenderness, or unexpected thickness.

Many prepurchase exams end there, after the basic physical evaluation and soundness assessment. At that point, the buyer might have enough information to make a decision. People who move forward with additional diagnostics usually do so for one of two reasons (or both):

A red flag has popped up during the initial exam. It’s enough of a concern to warrant further investigation, but not enough to be an automatic deal-breaker in the buyer’s eyes. The buyer wants to obtain as much information on the horse’s health as possible, even if the exam so far has yielded satisfactory results.
Veterinarians often fall into one of two camps when it comes to recommending additional evaluation measures. Some tend to advise further tests only if they’re concerned about something from an earlier part of the exam.

Celella falls into this camp. In fact, he goes so far as to say, “If the horse is not sound, I usually advise the buyer to let the seller figure out what’s wrong with it. And I tell the seller that I would be happy to reevaluate the horse later if they want to get the horse checked out by their own veterinarian first.”

“I don’t recommend continuing diagnostics on an unsound horse,” says Schofield. “However, with suitable prospects, I try to put everything in the buyer’s court and make sure they know what screening tests are available that might generate useful information.”

Some buyers, she continues, know exactly what baseline testing they want done. “Other times I’m surprised by how a client wants to spend their money, but if it allows them to make a better decision, even on a relatively inexpensive horse, that’s their call,” she adds. “They need to be comfortable weighing the value of the money, time, and emotion spent on the horse with the risk of not looking for potential or existing problems that simple screening X rays might pick up.”

If a buyer does decide to go that extra mile, what tools come into play? Today, the veterinary community has many advanced diagnostic aids available. Among them are X rays, ultrasound, bloodwork, endoscopic exams and neurologic exams.

X Rays: To the Bone
Radiographs are probably the diagnostic aid most commonly used as part of a prepurchase exam. Celella tends to suggest them only if an earlier step in the exam has raised a red flag, such as a significantly positive flexion test or effusion (swelling) of a joint capsule or tendon sheath. These findings might suggest inflammation due to injury, arthritis, osteochondritis dissecans (OCD), or a chip in the joint.

Celella might even suggest bypassing some X rays simply because he has a pretty good idea what he’ll find. For example, he explains, “If it’s an A-circuit jumper or cutter that has actively been showing and is exhibiting soreness, I know the hocks will look bad. I don’t need to look at pictures. It’s a maintenance issue, and then it’s a question of whether the buyer is willing to deal with it. X rays probably aren’t going to change my recommendation.”

Schofield, on the other hand, believes that “you can never go wrong having a baseline set of X rays on a horse. It’s important so we know what degree of pathology we started with–or know if there is any,” she says. “X rays are a valuable tool, and while I try to be practical for the client’s sake, I also try not to guess when we have the ability to back it up with imaging.”
That way, she explains, if the horse is bought and starts having a problem after a few months in training, there isn’t any question about whether the fetlock had a chip at the time of purchase.

The caveat to this, she adds, is that the buyer needs to balance the expense of the X rays (or any diagnostic tool) against the value of the horse. For instance, if you’re looking at a $1,500 horse, you might not want to spend $1,000 on X rays. On the other hand, even Celella says, “If it’s a horse that costs $50,000 or more, I’ll X ray everything I can. I don’t want to miss anything.”

Exactly which views are taken depends on why the X rays are being done in the first place. But the horse’s breed, intended discipline, and age play a role.
For instance, says Schofield, “With a dressage horse who is going to work a lot with collection and really use his hindquarters, it might be very important to X ray the hind fetlocks in the set of screening films. On the other hand, for horses working at speed turning barrels, I would consider X rays of the hocks and front feet very important and might not rate hind fetlock films as high a priority”.

Ultrasound: Beyond the Bone
A veterinarian won’t typically suggest ultrasound during a prepurchase unless he or she has felt something indicative of a current or past problem during the palpation phase of the exam, agree Celella and Schofield. Specifically, says Schofield, “If I find a tendon or ligament that feels thickened or asymmetrical, or that has a degree of soreness and inflammation, that might be a case for further investigation with ultrasound.”

Endoscope: A Closer Look at Airways, Stomach Lining
Although still not a common component of a prepurchase exam, “scoping” a horse has become more prevalent in recent years. As Schofield explains, an endoscopic exam of the upper airway can help a veterinarian “identify airway disease or paralysis of the larynx. It can be valuable, especially for a horse like an eventer that works at speed and needs endurance.”

Gastric scoping, which allows for a thorough evaluation of the stomach (for instance, to spot ulcers) is not usually part of a prepurchase exam. It’s a more invasive test and requires that the horse not be fed beforehand, explains Schofield.

Bloodwork: Coggins and Beyond
A Coggins test is the most common example of bloodwork during a prepurchase exam. Schofield says some clients might also request a “standard wellness profile,” including blood count and blood chemistry-a basic screening for organ function and overall health. In particular, notes Celella, a blood test might be a good diagnostic aid if the horse has lost weight or is in poor condition. Drug testing can be another component of bloodwork. Schofield notes that it’s becoming a more common request, particularly among upper-level sport horse buyers.

Neurologic Exams: Part of the Big Picture
A true, in-depth neurologic evaluation “is not something you should do on a prepurchase exam,” says Celella. “If there is a reason to suspect neurological issues, then you shouldn’t be buying the horse.”

Schofield notes that most veterinarians are probably noting neurological health markers throughout the exam, such as facial symmetry and eye blinks. A veterinarian might have a horse back up or turn in tight circles to assess balance or coordination, she adds. If everything is normal, the veterinarian probably won’t even mention it, “but, in the big picture, the neurologic system is what we’re assessing,” she says.

What About…
There are numerous other diagnostic tools available to the equine veterinarian and horse owner, including scintigraphy (bone scans), thermography, and electrocardiograms (ECG; readings of the heart). But they are rarely seen during a prepurchase veterinarian check.

“My opinion is that thermography is too subjective and of limited diagnostic value, and scintigraphy is relatively expensive,” says Schofield. As for an ECG, she adds, if an arrhythmia is detected, then the seller, not the buyer, should be the one responsible for checking into the problem.

Take-Home Message
By the time a prepurchase exam is done-whether you opted for just the basics or the deluxe version-the veterinarian should have “had their hands on every square inch of that horse,” says Celella. As a buyer, it’s then your job to listen with an open mind to your veterinarian’s findings.

On the one hand, notes Celella, “You should know you want the horse before you get to a prepurchase exam. Don’t do this as a tiebreaker. On the other hand, don’t be so attached that no matter what I tell you, you won’t listen. We call that a ‘post-purchase exam!'”

As part of your prepurchase reviews, you might also want to talk with the horse’s regular farrier. In addition, you might consider asking a qualified, unbiased farrier to check out the horse if you have any concerns about hoof shape, special shoeing needs, cracks, bruises, and the like.

Preparing yourself in advance means you’ll know going in what to expect from the experience, and what you’re willing to deal with as a horse owner. Communicating openly and honestly with your veterinarian ensures that everyone is on the same page and lets you make the most of the vet check. Together, these two steps will help set you to make a wise buying decision-and that means giving you the best shot at truly taking home the horse of your dreams.

If you’re looking to buy a mare or stallion for breeding purposes, you’ll want to have your veterinarian conduct a different type of prepurchase exam–one that focuses on the horse’s reproductive health. 

PREPPING FOR THE PREPURCHASE:

To-Do List

• Request the horse’s health history (including vaccination, deworming, and farrier records) from the seller, as well as any previous X rays.
• Get the seller’s permission for the horse’s current veterinarian to release information on the horse to you and/or your veterinarian.
• Talk to your veterinarian about what will be included in the basic exam and what he/she will charge. Ask about costs for additional diagnostics that you might consider.
• Ask yourself:
• What do I want to use the horse for?
• How long do I expect to own/use the horse?
• Have I spotted any issues of concern during earlier visits with the horse?
• What management issues, if any, am I willing to deal with?
• What are “deal-breaker” issues for me?
• What is my budget for the prepurchase exam?
• What additional diagnostics am I willing or able to pay for? —Sushil Dulai Wenholz