Well, the weather sure hasn’t gotten any warmer, but we’re still thinking spring here at TPE. This week we’re discussing the importance of a yearly “routine” physical examination, often referred to as a “wellness” examination. What is included in this exam varies a bit from vet to vet, and practice to practice. We consider a wellness examination to be a thorough physical examination including listening to heart, lungs, and GI tract, taking a weight and body condition score, checking lymph nodes, taking the temperature, examining the skin, teeth and eyes, palpating the limbs and flexing joints, feeling the digital pulses and examining the hooves… you get the idea. The whole kit’n’kaboodle.
You might be asking, “Why does my horse need an exam like this? He seems perfectly healthy.” For the same reasons that your physician recommends a yearly examination for you, your horse (and dog, and cat, and goat, too!) should be examined at least once yearly by a vet, even if nothing seems to be the matter. In our opinion, it’s even more important for your animals to receive this routine exam than it is for you! Our domestic animals don’t live as long as humans, which means they age faster than we do. More things change from year to year, making an annual exam even more crucial. Not to mention, our animals can’t tell us in words what might be troubling them – finding an abnormality on a physical exam might be the first sign of disease.
So let’s take you on a little journey… through the equine routine physical exam. We’ll describe each step, and give you a little insight into some of the more common things we’ll be checking for. (PS – the word of the blog is “auscultation”, which is vet-speak for “listening to something with a stethoscope”. Good word, huh?)
1. Heart auscultation: We listen to the heart with three things in mind – rhythm, rate, and the heart sounds themselves.
Rhythm is the steady, consistent beat of the heart. When the rhythm is interrupted, we are able interpret the change in timing of beats. Think of a drummer that doesn’t match the band. This is called an arrhythmia. A couple arrhythmias we hear are:
Second Degree AV Block: The horse’s heart rate is slow at rest, and their heart
Heart Rate is the number of times the heart beats in a minute. A horse’s normal, resting heart rate is 32-44 bpm. (This can vary up or down slightly.) A high resting heart rate can indicate heart abnormalities, sickness or pain is so large that they sometimes “drop beats.” This is known as “second degree AV block”, which is a fancy term for “every so many heartbeats, one is skipped.” It’s very common in horses, and usually no reason to worry.
Atrial Fibrillation: A -Fib, as it’s known in the industry, is an uncontrolled
fluttering of the atria (the top two chambers of the heart). A-fib causes a
completely random heart rhythm, which can be dangerous.
Heart sounds are ausculted on both sides of the thorax to detect murmurs. Murmurs are generally caused by imperfections in how the heart valves open and close. Some heart murmurs are very common in horses, and can be insignificant, but others can indicate a problem. We document any murmurs we hear, and if they worsen from one year to another, or are otherwise concerning, we may recommend a cardiac ultrasound to diagnose the specific problem.
2. Lung auscultation: We listen carefully to both sides of the chest, and in all “lung fields”. Generally, we divide the lungs into left and right “ventral lung fields” (which surround the heart and just above it), “middle lung fields” (which are in the center of the chest on both sides), and “dorsal lung fields” (closer to the spine). We are listening for abnormal sounds, which is pretty much anything that doesn’t sound like a soft breath. “Crackles” and “wheezes” are the most common abnormal sounds, and indicate inflammation in the lungs. We may also listen over the trachea, for mucus in this structure.
3. GI auscultation: We listen to the four “quadrants” of the abdomen (upper left, lower left, upper right and lower right) for the normal, grumbling gut sounds known as “borborygmi”. We want these sounds to be consistent and fairly active in all quadrants. A decrease in gut sounds can indicate poor GI motility, and increased/fluidy or very gassy sounds can indicate hypermotility. We also listen at the lowest point of the abdomen for sand in the large colon, which (fittingly) sounds like waves at the beach.
4. Temperature: This simple test is always performed rectally in a horse (can you imagine taking it orally?). A horse’s normal rectal temperature is 99.5-100.5 F, but mild elevations up to 101.5 F may be seen due to exercise, trailering or excitment. We diagnose a temperature around 102 F or higher to be a “fever” in a horse. A fever can indicate inflammation or infection.
5. Weight taping and Body Condition Scoring: Tracking the weight of a horse from year to year is important to detect trends in weight gain or weight loss. A scale that will tolerate the weight of a horse, however, is a little hard to come by. So, various calculations for estimating the weight based on other measurements have been devised. The best calculation so far that we’ve found is one that takes into consideration the “heart-girth” (the circumference of the horses’ chest, just behind the elbow) and the length of the horse from shoulder to hip. (There’s a good website which helps with the calculation, and a few smart phone “apps” exist as well.) Even more important than the estimated weight of the horse, however, is the body condition score. This is a number from 1 to 9, 1 being emaciated and 9 being obese, which gives an indication of how appropriate the horse’s weight is for his size. It is determined by the amount of fat over a horse’s ribs, hips, spine and crest of the neck.
6. Oral Exam: A full equine oral exam is impossible without placing a speculum to open the horse’s mouth (which often requires sedation), but many times we can get a “peak” during a routine physical exam. We’re looking for the molars to be nice and level, without “waves”, “steps” or “hooks”. We’re also checking for excessively sharp enamel points, which develop on the outside of the upper teeth and the inside of the lower teeth. If we see anything concerning, we’ll recommend a full oral examination with sedation and a mouth speculum in place (which should be performed yearly on most horses as part of their routine dental care, anyway – stay tuned for the blog on that topic, coming up!).
7. Eye exam: During a routine wellness exam, we’ll shine a bright light into the eyes to check the clarity of the cornea and lens, and be sure the pupils contract normally. If we’re performing a full ophthalmic exam, we’ll also examine the eye with an ophthalmoscope. With this tool, we’ll examine the retina and optic disk, as well as magnify the structures at the front of the eye to see them more clearly.
8. Palpations: Finally, we run our hands over the entire horse, feeling for lymph nodes in the throat latch, checking the skin for inflammation or external parasites, and feeling the muscles of the neck and back for soreness. We pick up each leg, flexing the joints, palpating the tendons and ligaments, and checking for pain or stiffness. We palpate the digital pulses above the hoof, and examine the hooves for cracks, thrush, and white line disease.
Wow! That does seem like a lot, doesn’t it? Fortunately, we can be doing a lot of this while we’re chatting about your farm’s deworming program, or what your plans are for the show season… so it doesn’t seem to take that long. A good, thorough routine examination can usually be completed in about 5-10 minutes, but the information we gather can be very helpful! So, the next time you’re having us out to vaccinate, or do some dentals, think about adding a wellness exam to the visit – your horse may thank you!
