The Ins and Outs of the Pre-Purchase Examination, was delivered at New Bolton Center on July 5 by Midge Leitch VMD, DACVS, a New Bolton Center staff veterinarian in the Section of Sports Medicine and Imaging. It defined, in her opinion, what should be considered reasonable expectations for the buyer, the seller and the veterinarian. The following is a summary of Dr. Leitch’s presentation:

Looking into the Future
In preparation, I like to discuss with my buyers/clients the real possibility of resale as a ‘way out’ should a horse turn out not to be as suitable as hoped. It is pertinent to consider the age and likelihood that the current buyer may be the final owner of a horse, especially if that horse fits into the category of schoolmaster and is in his/her mid-teens at the time of purchase.

I believe a warranty or guarantee about the medical/surgical history; the age (and height for divisions determined by height) and suitability should be negotiated between the buyer and seller and/or their professionals.

There are potential conflicts of interest for the veterinarian that need to be acknowledged and avoided:

• The far from unique circumstance when both the buyer and seller are clients of a veterinarian;
• That the veterinarian may have private knowledge of a horse as a result of previous examinations or consultations;
• Veterinarians are known to have a personal financial interest in horses and certainly this is an obvious area for conflict of interest.

Traditionally veterinarians have been discouraged from making predictions about the horse at the time of the pre-purchase exam (PPE); however, in reality, no one is interested only in how the horse appears on the given day of the examination. Instead, what buyers hope to determine from this examination is how well the horse will serve their future purposes.

A well-established clear veterinarian/client relationship prior to the examination is essential. Determining the answers to the following questions may suffice in when such a relationship does not exist:

• What are the client’s expectations for the examination?
• What is the client’s level of experience?
• What are the client’s expectations for the horse?
• Is anyone assisting the client with the choice of the horse and/or its future training?

Equally important is ascertaining the veterinarian’s level of experience, both as a veterinarian and with the type of horse and with the type of athletic endeavor expected of the horse. I encourage both veterinarians and potential clients alike to decide against entering into this sort of relationship if a clear level of comfort is not established.

What’s Included?
The components of a PPE can vary depending upon the price and intended use of the horse. The basic examination is going to include a physical examination of the horse at rest, plus clinical examination of the horse in motion. Imaging (radiographs and ultrasonography) is always a consideration. Endoscopy or evaluation of the airway is an option. Blood work can include a complete blood count, a chemistry panel, fibrinogen and serum titers such as a Coggins test. A drug screen including both plasma and urine should be discussed and considered carefully – one or the other can result in a false negative screen. The administration of a small amount of diuretic will ensure the availability of a urine sample if it is not otherwise readily obtainable and permission to administer this should be obtained from the seller who should give it readily.

Following a thorough physical exam, I like to observe the horse in hand, walking and trotting on straight lines and in circles, on both hard and soft surfaces, followed by flexion tests, a neurologic exam and then on an incline. Observing the horse under tack or in harness or on a lunge line follows. I like to listen again to the heart and lungs, preferably after a brief period of more strenuous exercise. If endoscopic examination is included, it is best done immediately after some strenuous exercise.

Beyond the Basics
The buyer’s input as to how much more complex the examination should become in terms of imaging, etc. is essential. The buyer’s intentions for the horse in terms of level of competition and re-sale should certainly be factors influencing this decision. The veterinarian can provide some advice as to what is most appropriate given the age, breed, history, intended use and value of the horse in question. Abnormal clinical findings may of course indicate the need to perform imaging of specific areas.

Age should be a significant factor in determining whether or not liver and kidney function tests should be performed.

Appropriate conditions for all of the examinations be insisted upon both by the buyer and the veterinarian. Removal of shoes for radiographs of the feet and cleaning and trimming of the feet or clipping the hair to produce an improved ultrasound image certainly require the permission of the seller. Sedation and restraint and dilation of the pupils are generally necessary and sellers should give permission for these without reservation, perhaps with the exception of removing hair.

What about the imperfect horse?
When should a pre-purchase examination be concluded? At the first sign of a serious deficit? What about a lengthening list of minor deficits? What concessions in the area of physical imperfection are necessary if the “fit” of rider to horse is good and not an easy one to establish? All of these questions require consultation between buyer or the buyer’s representative and veterinarian during the examination.

A second opinion may be invaluable in evaluating the seriousness of imperfections especially with regards to the eyes, heart and lungs. Any buyer should be enthusiastic about a veterinarian’s request for a second opinion as it is evidence of the veterinarian’s desire to do the best possible job for his/her client.

As regards the imperfections, the buyer should be delighted if the veterinarian suggests a consultation or interpretation of findings. Remember that clinical evaluations are opinions; I try to remember to precede all of my observations with “in my opinion these findings are within the normal limits for a horse of this age and work history” or “in my opinion this finding constitutes a minimal, moderate, significant or severe risk considering the intended use of this horse.” With conformation and soundness, the question is whether or not the abnormalities are outside the acceptable limit for the athletic requirements or the intended use. If nerve blocks are to be involved in order to determine the specific source of a lameness, then the seller’s consent is imperative.

Documenting the findings
The records of the examination constitute medical/legal records. Radiographs, ultrasounds, blood work, etc. must all be appropriately labeled, and are the property of and to be by the veterinarian for 10 years. Written evaluations may come in the form of a copy of the actual pre-purchase examination record or as a presentation of the findings and conclusions. While the buyer is entitled to have copies of the imaging, there may be additional costs for duplicates. If the buyer requests, the originals must be forwarded to another veterinarian but remain the property of the performing veterinarian. Without the express permission of the buyer, the information gleaned from an examination may not be utilized by the veterinarian for any other transaction.

Pre-purchase examinations can be intriguing, but only if the veterinarian enjoys the challenge of the puzzle, i.e. what are the observations and what will they mean. Failing every horse one examines is a disservice to everyone involved – the client, the horse, the seller.

A practical checklist
The following extensive list of questions or observations came from one of my clients who claims I am the source and that I suggested she should sort out prior to a PPE. They appear in no particular order:

• Feet: even, with no cracks, thrush or white line disease
• Competition record; papers
• Grinding teeth
• Snaffle/double bits (will horse ride in both?) – Important for dressage prospects
• Safe
• Comfortable to sit
• Tendons - wind puffs---does horse get wrapped?
• Watch eating, drinking
• No cribbing, weaving, shipping problems
• Will it cross tie?
• Can you clip both ears and body
• Lunging
• Turnout
• Does he make noise eating or riding?
• Good weight - Ulcer - stomach problems-----is he thin?
• Okay with spurs, whip
• Can you pet him (head and butt) while riding?
• Bumps on back; back soreness
• Walks in and out of stall quietly
• Rides with other horse----not afraid of horses coming towards him
• Travels wide or narrow with hind legs
• Toes in or out
• Swishing tail while riding
• Eyes, nose bones even or injured
• ‘Eye cancer’ under eyelid
• Built uphill
• No bump on croup
• Neck not below wither
• Able to stretch down under saddle
• Turnout----daily schedule
• How many owners?
• Vet record – colic surgery, allergies
• Back horse under saddle and from the ground
• Scars anywhere—on coronet band
• Test for spooking
• Can he stand in trailer while at shows?
• Picking feet up for blacksmith
• What does he eat---vitamins, shot record?
• Stopping, rearing, bucking
• Girth-----how does he act when tightening?
• Nose band tight or loose
• Melanoma - on grey horses
• Sarcoids – skin, prepuce
• Putting blanket on/off
• Ears forward friendly or back, in general or in stall, with other horses
• Mounting block
• Can you adjust stirrups, girth while mounted?
• Look in ears-----warts

In conclusion I would say that, if the buyer and veterinarian have a clear understanding of the expectations of the pre-purchase examination and the buyer and seller have reached an amicable agreement about the expectations of this examination and the buyer has done due diligence in terms of selecting an appropriate prospect, the pre-purchase examination can be an enjoyable, if challenging experience for all those involved.