Pre-purchase Exam. تقييم ما قبل الشراء

Pre-purchase Exam.  تقييم ما قبل الشراء

  Pre-purchase Exam.  تقييم ما قبل الشراء Standards of examination, duration and required components (i.e. radiographs, etc.) vary wildly from veterinarian to veterinarian and within discipline.  Similarly, the emphasis of certain points of the examination is subject to great shifts based upon intended use, current level of training, age and intent for resale that all influence how the exam is reviewed.  

The pre-purchase has a place in deciding on whether to purchase an animal, but it must be put into perspective.  The unique requirements of buying any animal may be more overwhelmingly important in the decision making factor. 

The most advanced piece of equipment that you bring to the pre-purchase is your open mind (and the abilities of the veterinarian you are employing). In short, the ability to gather and interpret information.

 No amount of advanced equipment and imaging can outweigh the value of this process.  An essential part, of this process is good communication between you and the veterinarian.  We, as veterinarians, are simply advisors as to the physical abilities and disadvantages of a particular animal and how these problems may relate now and in the future to your intended use of this horse. 

Ancillary testing procedures must be interpreted relative to the physical exam findings and relevant history of the animal being examined. 

Radiology  

As the years of more advanced radiographic analysis of horses has progressed, the relative variation of what is “within normal limits” has changed many times over.  Perhaps the most important change in interpretation has been the revelation that any radiographic change MUST be evaluated in conjunction with its current physical presentation.  First, we are still re-interpreting information and learning at an alarming rate.  Second, the relative importance of any radiographic find that is considered NOT “within normal limits” must be put into perspective based upon clinical findings in order to place appropriate relevance on the finding. 

Ultrasound 

Ultrasound machines are less used during pre-purchase exams for a variety of reasons.  In the musculoskeletal system, tendons, ligaments, cartilage and joint fluid can all be examined. However, many of these structures can appear normal on an ultrasound exam, yet be of some concern clinically.  It is also very easy to create artifacts using an ultrasound that may, in fact, look like an injury.  If this were not bad enough, the relative time and exposure it takes to become a skilled examiner with an ultrasound is also more difficult and less available to the veterinarian than any other piece of diagnostic equipment currently in use.  If it is used, it is most likely to quantify an abnormality identified during the physical exam. Random scanning of tendons & suspensories, etc. should be discouraged as the relative likelihood of gathering useful information in absence of a clinical abnormality is low. 

In contrast, the ultrasound is an invaluable tool in a reproductive exam.  Its use and interpretation have reached great heights in the last decade.  I would recommend an ultrasound exam of the reproductive tract of any mare where breeding is going to be of high importance in the purchase decision. 

Endoscopy/Gastroscopy 

Standing endoscopy is still a poor evaluation technique of the dynamic upper airway stability in the horse.  For this reason, treadmill evaluation was developed.  However, even in this exercising environment the results can be questionable & frustrating as repeating abnormalities seen in the field cannot be identically reproduced.  Factors such as rider weight, head position, etc. are all poorly controlled in a treadmill environment.  The point is that if upper airway abnormalities are suspected due to the horse making noise during a lunge line exam, etc., then a standing upper airway endoscopy exam is warranted, but not conclusive. Gastroscopy is of limited availability as a 3-meter scope length is need for the exam. Evaluating horses for stomach ulcers are uncommon on a pre-purchase, but should be considered if any historical information or related clinical finding warrants this type of investigation.  Fortunately, gastric ulcers are usually easily managed.  However, they do represent an often under diagnosed and poorly managed category of performance horse healthcare. 

Nuclear Scintigraphy 

Nuclear scintigraphy, or bone scans, can have a place in a pre-purchase exam.  Nuclear scintigraphy represents an entirely different approach to imaging by visually displaying areas of inflammation. 

This equipment is best used as a screening procedure for horses that may have subtle problems that would affect their peak performance.  Very high-level performers may well be candidates for such an involved screening procedure where their ability to remain an outstanding athlete is paramount to the purchase decision, but few others demand such scrutiny.    

In order for the diagnostics to be of value, two important facts need to be understood.  First, the intensity of work the horse is in dramatically affects the testing outcome.  Speed of the performance horse workout is more relative than low or high level performance within a discipline.  Second, the age of the horse can dramatically influence results as well.

MRI 

Although MRI will undoubtedly revolutionize our diagnostic abilities for lameness, it is unlikely to be a common pre-purchase tool.  This is primarily due to the fact standing application of MRI seems to be of little value for anything other than foot images at this time. MRI under general anesthesia will be required for higher limb exams.  Along these lines, MRI is time consuming and should only be considered for a small area that requires such advanced imaging.  The concept of a “whole horse” MRI is a long way off.

Drug Testing

Drug testing has advanced, but there are limitations to this practice.  Personally, I pull and hold blood for a minimum of 30 days after a pre-purchase.  This is performed so that if an animal’s demeanor, soundness or general health take a dramatic down turn, their blood can be evaluated for specific drugs in light of these new clinical findings.  

Neurologic Testing 

A neurologic evaluation definitely should be part of the clinical exam.  If abnormalities are found, it is best to stop the exam at that time.  If no abnormalities are found, further neurologic testing should be avoided.  This is primarily due to the fact that neurologic problems are a definite concern, but the diagnostic testing for definitively proving what disease process exists is not as clear cut. 

Complete Blood Counts, Serum Chemistries, Thyroid Testing 

In the absence of any clinical abnormality, routine bloodwork is unlikely to uncover a problem.  Similarly, bloodwork done for Thyroid testing or other unusual abnormalities is often dubious at best.  If a clinical abnormality is found, consider some sort of testing. Similarly, understand the relative value and credibility of some types of testing before spending money on them.

A complete understanding of the abnormalities noted and their significance to your decision to purchase is ultimately guided by good communication and prioritizing these defects into the overall decision making process. 

Finding the “perfect” horse may be less of a search for the ideal animal and more the realization that the veterinarian chosen may be less confident in identifying concerns or communicating information about the defects found effectively. 

Regarding additional diagnostic testing, adding procedures does not mean the exam is necessarily any more thorough.  With a lack of clinical evidence to support the need for these procedures, further testing is likely a “low yield” procedure for retrieving more useful information in many cases. 

Perhaps my overall review has left you with a more negative and confused slant on the actual value of a pre-purchase. This was not my intention.  I believe there is a lot of information to be gained in most cases.  I merely wish to better educate you on the limitations of what can be done, and more importantly, shift the relative emphasis away from the new technologies for evaluation and back to the clinical exam, which should be the foundation for all decisions regarding purchase.  No diagnostic procedure by itself can reveal significant information on its own merit.  Rather, the entire exam and these procedures must be looked at in concert to draw conclusions.  Similarly, there can be abnormalities not found even with the best of technologies applied.  When the exam is completed, it comes down to intelligent thinking, good communication and experience that will ultimately serve to help make the best decision for your situation.