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Pre-purchase examination (US)

ISSN 2398-2977

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Synonym(s): Prior-to-purchase examination, PPE

Role and responsibilities of the examining veterinarian

Introduction

  • Within the United States, any licensed veterinarian can perform a pre-purchase (PPE), although consideration for experience, knowledge of the various species and disciplines, and comfort with the examination should be weighed when performing or considering performing a PPE.
  • While not required, Professional Liability Insurance is highly recommended when performing an examination like a PPE.
  • PPE examinations are typically conducted on behalf of the prospective purchaser, though may be performed for the seller as a means of predicting outcome of the examination by another party or to identify problems that may need to be addressed prior to selling.
  • All the information, facts and evaluation resulting from the PPE examination are part of the medical record which is established based on the client/patient/veterinary relationship. Commonly, in the case of PPE, the client is not the owner but rather the prospective purchaser.
  • PPE examinations are most successfully performed if done under conditions that will most closely match the purpose for which the horse is intended whenever possible.
  • Conflicts of interest may arise, or be perceived to arise, when an examination is conducted on behalf of a vendor (seller).
  • Establish a routine method for conducting the examination to ensure all relevant parts of the horse are examined habitually. This is best achieved by establishing or using a document to record your findings during the examination. A worksheet typically provides a structure for the examination to ensure consistency and completeness of the examination.
  • The goal is to establish the facts (is there clinically detectable disease or injury) that may be used as the basis of an opinion on the horse’s potential to perform a desired service.
  • Markings and any identifying characteristics should be recorded.
  • Familiarity with breeds, colors of the horse, and associated terminology is recommended.
  • Blood tests for systemic health or drug screens are commonly taken and submitted or saved.

International guidelines

  • In the USA, the American Association of Equine Practitioners (AAEP) has a purchase examination committee which can advise practitioners on purchase examinations.
  • There is not a specific document or official certificate that must be used or submitted for a PPE examination in the US.

Baseline examinations

  • Any examinations can be part of the PPE, though some are certainly not routine. Typically included in the routine examination are:
    • Physical examination, including particular attention to auscultating the heart.
    • Musculoskeletal examination - static and dynamic.
    • Ophthalmologic examination.
    • Radiographic examination (views vary by discipline).
    • Upper respiratory endoscopy- if intended for racing or cross country/3-day eventing.

Speciality examinations

Before the examination

Client relations

  • It is very important to understand the intended use of the horse as this will influence the interpretation of the examination.
  • Discuss with the client their expectations and the limitations of the examination, eg:
    • The examination is reflective of the condition of the horse on the day of examination and cannot comment with certainty on past or future health conditions.
    • Diagnostic examinations have limitations as to the extent they can identify disease or abnormalities.
    • Ageing a horse by dentition is subjective and inexact Teeth: aging by dentition.
    • Discuss the cost of the examination and outline the costs of any additional examinations that may be requested by the client.
    • It is not the role of the veterinarian to help to negotiate the sale based on the results of the examination.
  • If the seller is a client of the examining veterinarian, it is recommended that the purchaser is informed before the examination is carried out. The veterinarian may only provide patient information from previous examinations to the purchaser with consent from the seller.

Contact the seller

  • If the seller is a client of your practice, tell them that you have been asked to conduct a PPE examination on their horse.
  • Request permission to reveal the full relevant history to the purchaser or tell the seller that the purchasing party may ask for this information and you will inform them that they will need permission from the seller before disclosing such information.
If the seller does not give permission to discuss the horse's history with the purchaser, do not provide historical information to the lawyer. Discuss information only ascertained during the PPE.
  • Results of the PPE should only be shared with the client on record. In most cases the client on record is the purchaser and not the seller, therefore, the results should not be shared with the seller without permission of the purchaser.

Intended purpose and level of performance of horse

  • It is important for the examining veterinarian to establish the purpose the purchaser intends to use the horse for, including the performance expectations.
  • The intended use of the horse may dictate which specialty examinations are performed.
  • Permission to perform the examination and all associated specialty examinations must be obtained from the vendor (preferably in writing) to minimize liability issues if a problem or injury occurs in the course of the examination.

Attendance at examination

  • The decision to have the seller present during the examination is up to the purchaser.
  • Advantages and disadvantages can be made for the presence of the seller during the PPE.

PPE examination

  • The PPE should begin with general observations and detecting subtle abnormalities and should always be conducted.
Record all findings in writing at the time of examination. Additionally, a video record of the examination may be useful for historical record keeping.

Static examination

  • Conduct in stable, stall, or confined space.
  • Observe for:
    • Consistency of feces.
    • Evidence of cribbing or stall walking.
    • Nasal exudate in water or feed pails.
  • Take note of the type of bedding if the examination is being performed at the horse’s home stall.
  • Examine horse carefully at rest noting general appearance, demeanor, conformation and body condition Musculoskeletal: conformation.
  • Assess age, either by examining the teeth Teeth: aging by dentition or by checking date on registered birth certificate.
Record the method by which you establish the horse's age. If you have any doubt or there are inconsistencies between dental, recorder and other findings, note these.
  • Document all markings and compare to previous documentation if present.
  • Note abnormalities or dental features Gastrointestinal: physical examination.
  • Examine the head and percussion of the sinuses.
  • Palpate laryngeal region for muscle atrophy or evidence of surgery.
  • Observe and record findings on auscultation of heart and chest Thorax: auscultation.
  • Examine the eye for general appearance and in the dark with an ophthalmoscope. Evaluate the 3rd eyelid for masses or raised plaques.
  • Monitor for dermatologic conditions: hives, patchy hair loss, raised nodules, melanomas (in particular on tail head, rectum, genital region), sarcoid and aural plaques, and pastern dermatitis.
  • Circle the horse in both directions, and thoroughly palpate the body and limbs (be systematic and consistent).
  • Take horse out of stall and conduct an examination of the musculoskeletal system Musculoskeletal: physical examination - adult, including the hooves Foot / shoe: examination and joints.
  • Examine for evidence of:
    • Palmar digital neurectomy (scars or lack of sensation) in the digital area.
    • Tail blocks or myotomy surgery.
    • Ear trimming.
    • Hair color alterations (due to dyes, cryosurgery, etc).
    • Surgical scars, especially colic surgery, laryngeal surgery or herniorrhaphy scars, periosteal stripping associated with angular deformity correction.

Dynamic examination

A safe area for examination must be used.
  • A short examination of the horse at the walk and trot over 20-30 m (25-35 yards), going away from and coming towards the examiner should precede more strenuous exercise. Additionally, watch the horse move from the side and note stride length.
  • Repeat as many times as necessary to determine lameness or gait abnormality.
  • Use an experienced, independent handler whenever possible.
  • Ensure that the horse can move freely and that your view is not obstructed in any way.
  • Manipulative tests, eg turning, backing, flexion tests, can be done at this stage.
  • Do not continue the examination if there is lameness or any another reason which prevents safe exercise, eg pregnant, untrained or fractious horse.

Strenuous exercise

A more thorough examination during exercise can be performed, however this is optional.
  • To assess the cardiorespiratory and musculoskeletal systems during and following exercise.
  • Exercise the horse so that respiratory rate and depth are increased, but do not exhaust the horse.
  • If the horse can be ridden, have an experienced rider trot 10 m circles in both directions followed by canter for 5-10 min, then gallop the horse, passing close to the examiner regularly so that respiratory noises can be heard Thorax: auscultation.
  • Stop the horse, auscultate the heart and observe respiratory rate and rhythm.
  • Re-exercise the horse if necessary or uncertain about findings.
  • If the horse cannot be ridden, exercise on the lunge.

Observe rest following dynamic examination

  • Allow to recover from exercise.
  • Continue to observe cardiorespiratory system Heart: examination - overview.
  • Take note of time to return to normal rate of breathing.
  • Ask and document historical information: vaccination status, behavior around other horses, shoeing, behavior for clipping, loading and traveling.

Additional examination

  • If there is uncertainty about the condition of the feet, seek owner's permission to remove shoes.
  • Blood sample and label immediately.

Limited examinations

Reasons for conducting a limited examination

  • Pregnancy.
  • Immaturity.
  • Unbroken.
  • Written request from client.

Client authorization

  • Discuss the limitation of a limited examination with the client.
  • While not mandatory, obtaining permission in writing for the limited examination is recommended when performed.
  • Document why and how the examination is limited.

Other veterinary examinations

After the examination

The report

  • Give the client a clear written report regarding the findings of the examination.
  • The report should contain:
    • The description of the horse with sufficient information to fully identify it.
    • The time, date, and place of the examination.
  • List all the abnormal or undesirable findings from the examination and express an opinion as to the functional effect of these.
  • List in detail on the report all of the procedures performed in connection with the purchase examination.
  • Any findings or opinions should be qualified by reference to any tests recommended by the veterinarian but not performed.
Do not express an opinion as to the suitability of the animal for the purpose intended.
  • Note on the report any recommended examinations that are omitted and the reasons for the omission.

Documentation

  • Retain the name and address of all parties involved with the examination, eg the purchaser, vendor (seller), agent, witness, etc.
  • Keep copies of all certificates, telephone reports, written requests, records and worksheets relevant to the examination for the period of applicable under the statutes for the state the examination was carried out in.
  • Give the client a clear opinion on whether or not the horse is fit for the purpose intended based on evidence acquired during the examination.
  • Give a short verbal report on abnormalities you have observed.
  • Remember that opinions vary between veterinarians about the significance of some faults.
  • Even if the horse is not recommended for purchase, make sure the record is detailed in full.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Van Hoogmoed L M, Snyder J R et al (2003) Retrospective evaluation of equine prepurchase examinations performed 1991-2000. Equine Vet J 35 (4), 375-381 PubMed.
  • Parker J & Habin D J (1995) Examination of the equine eye as part of the prior to purchase examination - Part 2. Equine Vet Educ 7 (1), 43-48 VetMedResource.
  • Parker J & Habin D J (1994) Examination of the equine eye as part of the prior to purchase examination - Part 1. Equine Vet Educ 6 (6), 333-341 VetMedResource.
  • Anderson G F (1992) Evaluation of the hoof and foot relevant to purchase. Vet Clin North Am Equine Pract 8 (2), 303-318 PubMed.

Other sources of information

  • Swanson TD (2011) Miscellaneous Musculoskeletal Conditions. In: Adams and Stashaks Lameness in Horses. 6th Edn. Ed: Baxter GM. Blackwell Publishing, USA. pp 1091-1094
  • Beeman G M (1992) Examination for Purchase. In: The Veterinary Clinics of North America. W B Saunders, USA. pp 425. 
  • Royal College of Veterinary Surgeons (1991) Colors and Markings of Horses. Royal College of Veterinary Surgeons, UK.

Organisation(s)

  • American Association of Equine Practitioners (AAEP), 4075 Iron Works Parkway, Lexington, KY 40511, USA. Email: aaepoffice@aaep.org. Guidelines for reporting purchase examinations.