The Complete Physical Exam
…things aren’t always as they appear…
A yearly physical exam is an important way to assess your horse's overall health and well-being. While your horse may seem healthy to you, there may be conditions you likely won't notice from the outside. During an exam, the veterinarian will establish a baseline for your horse as well as detect any abnormalities that could potentially lead to future health problems. Using this information, the veterinarian is then able to offer healthcare and nutritional recommendations.
What Are They Looking For?
The doctor wants to hear a rhythmical, consistent beat at no more than 44 beats per minute. They will check to see if there are any changes to the normal lub-dub rhythm that would indicate the horse has a heart murmur or abnormal rhythm.
Heart abnormalities can range in severity and clinical significance. The more severe the murmur or disruption in beat, the more likely the horse is to have some degree of intolerance to exercise, sedation, and other activities that cause a change in heart rate.
The doctor evaluates the sounds of air moving in and out of the trachea and lungs on both sides of the horse. They listen to see if the breaths are rhythmical and smooth, with no more than 24 breaths per minute (though this can be skewed if the horse is sniffing). They specifically listen for areas with no noise or moisture (crackles and wheezes). They also note if any nasal odor or discharge is present and, if so, the color, consistency and laterality.
Crackles, wheezes, squeaks, squeals, and silence are all indicators of potential illnesses, such as pneumonia, heaves, and upper respiratory infections.
Due to the size and structure of horses, their internal organs are not palpable externally, unlike small animals. Therefore, doctors listen to (or auscult) the horse's gastrointestinal system to check for any abnormalities. Specifically they listen to the borborygmi, or gut sounds, to evaluate the progression of gas and ingesta within the GI tract. They also take the opportunity to listen for the presence of sand.
Hypomotile (too slow or absent) or hypermotile (too fast) sounds can indicate gastrointestinal disturbances, such as colic or diarrhea. Without proper identification and treatment, sand accumulation can be a silent killer.
Body temperature is an important indicator of what is going on internally in the horse. The tail tone, anal reflexes, vaginal conformation (if applicable), and presence of skin tumors are also evaluated while taking the horse's temperature.
An increase in body temperature is commonly the first sign of illness and frequently present before any clinical signs are evident.
The eye is a small and complex structure. A standard exam involves a series of tests that check the vision and health of the horse's eyes. First, the doctor examines the eye grossly, evaluating the color, shape, and consistency of the tissues and testing the pupillary light reflex. Next, using an ophthalmoscope, the doctor can visualize the numerous internal structures, including the lens, retina, and optic nerve. Then, in some cases, an estimation of the degree of blindness can be roughly determined with an obstacle course vision test.
The eye can have imperceptible abnormalities only found through examination, such as corneal abrasions or ulcers, uveitis, cataracts, and conjunctivitis. Treatment of these conditions ranges widely and can be detrimental if not appropriately diagnosed.
The mucous membranes are examined for moistness and coloration and the horse's capillary refill time is taken. The doctor smells for any foul odor coming from the horse's mouth and will check the horse's teeth by running their fingers along the sides to evaluate sharpness or inconsistencies in the dentition. This is only a rough guess of the condition of the teeth and a more in-depth exam may be recommended especially if the horse is having difficulty eating or trouble with the bit.
Poor dental health and condition can lead to difficulty maintaining weight, discomfort while chewing, and general unthriftiness. Odor frequently indicates the presence of a bacterial infection, which may be due to gingivitis or a diseased tooth. Abnormal texture or color of the gums can indicate dehydration, poor circulation, or other systemic illnesses.
Skin & Haircoat
The quality of a horse's skin and coat is a good reflection of the horse's nutrition, metabolism, parasite load, and overall health. The vet wants to see a sleek, shiny haircoat with smooth skin. They will typically look for any abnormal growths, areas of hair loss, skin irritation or even punctures you may not have noticed.
Horses that have an improperly balanced diet or high parasite load frequently will be a "poor-doer", with an inadequate haircoat, pot-bellied appearance, and/or poor body condition. General assessment can also lead to a presumptive diagnosis of a metabolic disease such as PPID. It is important to diagnose and treat skin tumors, such as sarcoids or squamous cell carcinoma, and skin diseases, such as rain rot and mud fever, to prevent further progression.
Each leg receives a cursory once-over, looking for any swelling of the joints or tendons, increased temperature, or other abnormalities. The veterinarian will evaluate the way your horse moves as you are bringing him in from the pasture or from the stall, looking for any gait abnormalities.
Swelling, tenderness, heat, or other irregularities on the leg can indicate current or previous issues that may be potential complications for the athletic future of the horse. Arthritis, bone chips, tendon lesions or tears, and joint inflammation are just a few of the many issues that can arise throughout a horse's life and athletic career.
The saying "No Foot, No Horse" is indicative of how important it is that the horse's hooves be managed appropriately. The doctor evaluates the feet for overall condition and shape. Hoof temperature and digital pulse may be assessed if an issue is suspected.
Poor hoof quality may be due to dietary imbalances, poor farriery practices, or metabolic disease. An increase in temperature and a prominent digital pulse can indicate multiple issues, ranging from a simple abscess to a case of laminitis. The veterinarian may want to consult with your farrier in a team approach to ensure the best hoof care possible.
Throughout an exam the veterinarian takes note of the horse's stance and general behavior. What the horse does and how he holds himself can indicate his overall wellness. Abnormal behavior or appearance is one of the first clues that something may not be right.
Depression may indicate systemic illness, abnormal stance may indicate a neurologic disorder, and abnormal aggressive or anti-social behavior may indicate pain, whether it is due to injury, illness, etc.
The weight and muscle tone of the horse's body is evaluated and may be scored according to Henneke System. (Click Here for a description of this body score system.)
The Body Condition Score ("BCS") can illustrate many issues such as simply underfeeding to problems relating to parasite infection, maldigestion (inability to utilize food), insulin resistance or Cushing's. It is also a good way to document changes in the horse's nutrition status and ability to handle exercise.
How Often are Exams Needed?
For most horses a yearly exam is recommended. For geriatric horses, which can experience rapid changes in their health, a twice-yearly exam is suggested. Horses who have chronic or recently diagnosed health issues may require more frequent rechecks; the veterinarian usually provides a recommended schedule.
An Apple A Day...
Preventative maintenance is cheaper in the long run when compared to emergency care or treatment for a preventable illness. A physical exam can be performed quickly yet it can provide important information that would otherwise be easily missed. It is a simple, cost effective and preventative way to increase the general health of your friend and help ensure you will have a long and healthy life together.