The horse health check
Ben Sturgeon, Bsc, BVM&S, Cert EP, MRCVS
Every horse owner should be able to check a horse’s condition for signs of illness, injury, or fatigue.
The health check is critical with competitions, and it is very useful
in day to day management. Many potentially serious conditions can be picked up at an early stage by a simple series of tests. No sophisticated equipment is required. A stethoscope, a watch and a thermometer are all
the equipment required, along with a basic understanding of the difference between normal and abnormal.
With practice, you can examine the horse in less than 5 minutes using a systematic method of examination.
I like to break the examination in to 4 areas of consideration called the “SOAP”, where this stands for:
- S – Subjective
- O – Objective
- A – Assessment
So in any animal we can subjectively assess it, for example, its attitude or demeanour. This is “subjective” but could provide a few clues; is it quieter than expected, is it chewing or weeing less? Then we would objectively assess. This means finding areas that can be definitive assessment on top of the initial subjective. The next stage is the “assessment” – is the horse dull? Does it have a temperature or another indicator as to why the horse is dull? You are then building a picture where the last aspect comes into play – “plan”. What do you do with the information you have gathered? Is the horse dull because it has a fever and then needs investigation and potential treatment, or is it dull and you can find no definitive reason, if so you can simply monitor and re-assess or does your horse require further veterinary investigation possibly by blood test for example.
This system can be applied to an individual area, i.e. a swollen tendon or an area of hair loss, to a whole horse scenario, i.e. a horse off its feed, or to a physiological presentation i.e. a horse with a change in its drinking. With any presentation examination, evaluation and a little thought go a long way. But to do this you need to be able to perform a basic examination of your horse.
A complete examination involves two parts: examining of the horse at rest and in motion.
The Horse at Rest First of all, note the horse’s general condition and attitude. Is the horse over or underweight? You should be able to feel the ribs, but the ribs should not be visibly obvious. Is the hair coat sleek or dull? Is the horse alert or lethargic?
Check eyes for redness, clouding, puffiness or discharge. A glassy or sunken eyed look is an indication of a problem. Ears should be alert and moving. The nose should be free of discharge and the lining of the nasal passages should be pink. Normally there is no nasal discharge, or a slight watery, clear discharge may be present. A bloody, purulent, yellowish, creamy white or greenish coloured discharge is abnormal.
Mucous Membranes/ Capillary Refill
Lift the horses’ upper lip and look at the gums (the mucous membranes). Mucous membranes should be pink, shiny, moist and slippery. If pale, dry or tacky this can indicate dehydration. Colours such as pale white, jaundiced, brick red, bluish, purplish, or muddy are indicative of a serious problem. Pressing a thumb or finger on the gum to “blanch” the area determines capillary refill time.
Upon release of the pressure, count the seconds that elapse while the colour returns. Normal time is up to 2 seconds. Delays for 4 or more seconds are an indication of reduced blood circulation potentially due to reduced volume (blood loss or dehydration) and/or decreased blood pressure (shock).
While dehydration leads to changes in a number of the areas examined, the most common means to quickly check hydration status is the skin pinch test. As an animal dehydrates, the skin elasticity reduces. When the skin on the point of the shoulder or above the eye is pinched and pulled gently away, it should quickly return to normal.
A skin tent that remains for over two seconds indicates dehydration. It is important to know the normal skin pinch results on your horse as there can be a variations due to age and breed. For this reason it is important to test the same area each time to maintain consistency.
To take the heart rate, place the bell of the stethoscope on the chest wall, behind the elbow. The heart rate is heard as “lub-dup” which is one beat.
You should hear a clear two-beat sound for each heartbeat. Count the rate for 15 seconds and multiply by 4. Heart rates of 25-48 beats per minute are normal in resting horses. A persistent elevated resting heart rates (i.e. not from excitement) could be pathological. A fit horse should recover to a normal rate within 2-5 minutes of the exercise (extreme exercise may take longer). Higher rates may indicate over-work, fatigue, heat stress, dehydration, pain or illness.
Gut sounds are evaluated with the stethoscope by listening over the upper and lower flank on both left and right sides. Normal gut sounds are heard as bubbling and gurgling roughly every 5-10 seconds. You should practice listening to normal horses to get an understanding of normal sounds. Abnormal sounds would include pinging and ringing with the sounds varying in both quality and frequency. An absence of gut sounds is potentially serious.
To measure the respiratory rate, watch flank movement or nostril flare. Count the number of breaths in 15 seconds and multiply by 4. Normally, the respiratory rate is one to four at rest (about 8 – 16 breaths per minute). Elevated rates may be observed in excited horses or during hot/humid weather when the horse is trying to cool. Breathing should be regular and without effort or sound. Laboured breathing, wheezing, grunting, groaning, coughing or other sounds indicate a problem.
The withers, shoulders, back, rump and girth should be palpated for evidence of sores, pain, bumps and tight/reactive musculature. The aim is to detect any variations between sides as well as pain, sensitivity, or tightness that would cause pain. The limbs can be palpated for pain, swelling or heat, especially in joints, ligaments and tendons. The foot should be checked for condition, shape, and general shoe fit. Note any cracks, founder lines, stone trauma etc. that may be present.
Evidence of heat or swelling evident in any area on the body maybe cause for concern and require investigation. If the horse is in pain or exhibits a response such as pulling away, this needs to be addressed.
To take the temperature, place a lubricated thermometer into the anus and gently press it against the wall of the rectum. Normal temperature for a resting horse is 37.5 to 38 ̊C. Temperatures of > 40.5 ̊C indicates fever. If the horse has been exercising it may increase to 39.6 ̊C but should not exceed 40.5 ̊C and should fall when exercise has stopped. On removing the thermometer, check the tail and anal tone. The anus should constrict immediately in response to slight digital pressure. The tail should clamp in reflex when first touched. A flaccid tail and loose anus are often found in exhausted horses as well as in some neurological diseases.
Appetite and Water Consumption
Normal horses anticipate daily feeding. Horses exhibiting disinterest in food, become picky eaters or go off feed may be developing a problem. The horse will generally drink roughly equivalent amounts of water daily, with adjustments for temperature, diet, seasonal and exercise changes.
It is important to monitor water consumption daily for optimal health.
The manure should be formed into moist balls. If the manure is dry, or loose, this may be an indication of a problem or change in diet, water consumption, or other factors. The amount of manure passed each day is also important to notice. The amount, colour and frequency of urination should be noted. Urine is normally cloudy in horses.
The skin should be observed for flaking, oozing or signs of irritation or parasitism. Hair loss should be noted. Obvious signs of “pruritis” (itchiness) should be addressed.
The Horse in Motion
The next part of the examination is to assess the horse while walking and trotting.
This stage of the examination is done with an assistant who trot the horse in a straight line for approximately 20 meters away from and toward you. The footing should be level, even and reasonably firm. Trot the horse on a loose rein at a steady slow trot, stride length and height should be consistent. Do not hold the horse with a short lead as this restricts normal head motion. Note any changes in gait, stride, hiking, head nodding or swaying, hopping, as well as head, back and tail carriage/ curvature. Listen for any unevenness of hoof beats on the ground. Learn the normal attitude of your horse. The horse should be bright and alert and willing to trot. A horse that seems sour, disinterested, dull or unwilling to move may have a clinical problem.
Cardiac Recovery Index (CRI)
The cardiac recovery index is a useful indicator of a horse’s fitness or an emerging lameness. It can also help determine if the horse has been over- worked or if the horse is fatigued. Take the horse’s heart rate prior to trotting is less likely to get stuck in it whilst avoiding damaging the sensitive part of the tooth and then placing a temporary filling after cleaning out the pocket. The intention is that the gum repairs under the filling before it falls out or is removed at a follow up examination. These may need repeat treatment throughout the horses’ life or may develop in other areas of the mouth. Depending on the original cause there can be some drifting of the teeth after treatment or the gap may not be present when the damaged tooth has been worn and is replaced by potentially healthier tooth erupting through normal wear.
Caries can occur around the edge of the teeth (peripheral caries) or on the chewing surface in the folds of enamel (infundibular caries) This is bacterial infection that destroys the tooth material and is graded dependant on how deeply it affects the tooth. The risk with this is that it weakens the affected teeth and could lead to fractures. The horses’ teeth are sensitive and contain a large amount of nerve tissue and a healthy blood supply, sometimes they are considered inert non-sensitive tissues that just get shaped by rasping which is simply not true. Caries will be painful and requires treatment, it can progress to periodontal disease and, as mentioned before, fractures. Infundibular caries is repaired by drilling out the diseased tissue and filling it with a plastic material.
There are some equine dental specialists that are now attempting root canal treatment in some of the very diseased teeth to try to save them from being extracted. This is still very much in its infancy and the technique is really at research trial stage and will not be advised routinely yet but is exciting for the future as it could reduce the number of extracted teeth significantly.
In conclusion dental treatment and general oral medicine has progressed enormously in the last few years and we should be expecting much more of the examination at our routine dental visits and recognition of these diseases will be more common and, therefore, treatment will be necessary more common. A full examination of the mouth and subsequent treatment is best performed under sedation for the best experience for the horse and the person doing the work.