A VET­ERI­NAR­IAN’S VIEWPOINT

Here are four im­por­tant ques­tions to ask be­fore you agree to pay for some­thing for your horse---whether a pro­ce­dure, prod­uct or ser­vice.

EQUUS - - Contents - By David W. Ramey, DVM

Bot­tom-line horse care: Here are four im­por­tant ques­tions to ask be­fore you agree to pay for some­thing for your horse---whether a pro­ce­dure, prod­uct or ser­vice.

Most peo­ple con­sider two main things when de­cid­ing whether to be­come the owner of an an­i­mal. First is how com­pli­cated and ex­pen­sive car­ing for it will be. Sec­ond is how much emo­tional re­turn you get on your in­vest­ment. Let me ex­plain.

Dog care can be very com­pli­cated and some­what ex­pen­sive. Dogs re­quire at least daily feed­ing, you have to get them looked after when you go on va­ca­tion, you have to clean up the yard from time to time, you have to take them for walks (which, of course, is good for both of you) and so forth. For their part, dogs are pretty much al­ways happy to see you, they sit by your side, they lick your face, they want to go on walks with you, and if called upon they will put up with wear­ing all sorts of out­fits, cos­tumes and sweaters. Dogs are a high­main­te­nance/high-re­ward sort of an an­i­mal. Most peo­ple love them.

Some peo­ple keep snakes. Snakes don’t de­velop at­tach­ments to peo­ple. They slither around in your hand when you pick them up, and they are ac­tu­ally a pretty cool con­ver­sa­tion starter for those folks who don’t have ophio­pho­bia. But over­all, a snake is a very low emo­tional re­ward sort of crea­ture. On the other hand, snakes only have to be fed pe­ri­od­i­cally, and there’s very lit­tle to pick up after. Snakes are low re­ward, but low main­te­nance, too.

Horses, I think, kind of fit in the mid­dle. They’re cer­tainly more com­pli­cated to take care of than are snakes. But they don’t re­quire as much at­ten­tion as do dogs. For ex­am­ple, you can leave them in the field with grass and wa­ter for a few months and

they’ll do just fine.

They’ll nicker when they see you: one of the most heart­warm­ing sounds in the an­i­mal king­dom. They won’t curl up in your lap---which is a good thing, in­so­far as pre­ven­tion of se­ri­ous in­juries to you goes---but they will let you brush them and dress them up and, of course, ride them. In gen­eral, I think of horses as a sort of medi­um­re­ward/medium-main­te­nance an­i­mal (there are plenty of individual ex­cep­tions, of course).

Given that horse care does re­quire some ef­fort, and horses can’t sit with you on the couch and watch tele­vi­sion, I think that the last thing that horses need is a bunch of folks telling you how com­pli­cated and dif­fi­cult it is to take care of them.

But this no­tion is tak­ing root in the horse world. In fact, the mes­sage is be­ing de­liv­ered from just about ev­ery di­rec­tion. Frankly, after car­ing for horses for more than 30 years, and watch­ing the com­mer­cial­iza­tion of all things equine, as well as ex­pan­sion of choices avail­able for the treat­ment of many con­di­tions, I worry that all of this noise is mak­ing the horse world a very loud, dif­fi­cult, ex­pen­sive and un­nec­es­sar­ily com­pli­cated place to be. In fact, it’s worse than that; it risks sep­a­rat­ing horses from own­ers by mak­ing own­er­ship a fi­nan­cially and emo­tion­ally de­mand­ing propo­si­tion.

Horses sur­vive---and thrive--with­out two things that are of­ten im­posed on horse own­ers: pre­ci­sion and cost. Pre­ci­sion and cost are the bane of peo­ple own­ing just about any­thing, be­cause pre­ci­sion usu­ally means dif­fi­cult, and cost means, well, it’ll be ex­pen­sive.

For ex­am­ple, one might be able to achieve a pre­cise di­ag­no­sis with de­tailed images from a horse’s puffy an­kle, but a lit­tle pa­tience and some rest might achieve the same re­sult at a frac­tion of the cost. I worry that a mis­guided em­pha­sis on pre­ci­sion and cost is caus­ing some peo­ple who might be in­clined to own horses to just not bother, and that it’s caus­ing some peo­ple who are in the horse world to leave.

So what can you do to coun­ter­act these pres­sures? Well, be­fore you pay for some­thing for your horse, be­fore you let some­body do any­thing to him, be­fore you buy some prod­uct or ser­vice, ask the fol­low­ing four im­por­tant ques­tions. QUES­TION 1: “Why is this nec­es­sary?”

This seems ob­vi­ous, but even in this mod­ern era, when there’s ac­cess to so much in­for­ma­tion, many peo­ple seem to take a lot on faith. You’re call­ing some­one to help you with your horse be­cause you be­lieve that the per­son is thought­ful and well-in­formed. You’re buy­ing some prod­uct or ser­vice be­cause you want to help your horse. I get that. But you re­ally do want to know why a par­tic­u­lar treat­ment or test is recommended for your horse. You don’t want to look like a bob­ble­head doll---sim­ply nod­ding mind­lessly---when it comes to dis­cussing your horse’s health.

The ques­tion “why” is not at all dif­fi­cult for some­one who is re­ally in­ter­ested in help­ing your horse. In fact, “why” ques­tions are eas­ily ad­dressed---and usu­ally wel­comed---if a per­son has taken the time to think over the sit­u­a­tion. If some­one isn’t will­ing to ad­dress the “why” ques­tion, can’t an­swer it to your sat­is­fac­tion, or gives you some an­swer that comes from out of left field (“Well, we need to sup­port his en­ergy” or “his rib is out of place” to name only a cou­ple of a whole bunch I’ve heard), there’s rea­son to be sus­pi­cious.

BOT­TOM LINE: “Why” ques­tions can help pro­tect against over-di­ag­no­sis and over-treat­ment. QUES­TION 2: “What else?”

In just about ev­ery in­stance, you have op­tions. The horse who has a bit of swelling over his ten­don may not have any swelling or any prob­lem in a week; if it’s a se­ri­ous in­jury, the swelling or prob­lem will still be there in a week. One alternative to ul­tra­sound and in­jec­tions---surely, the cheaper

The ques­tion “why”

is not at all dif­fi­cult for some­one who is in­ter­ested in help­ing your horse.

one---might be to just wait a week.

The “What else?” ques­tion is sim­ply a re­minder that, when it comes to treat­ing most con­di­tions, there are many ways to go. You want the best thing for your horse, but of course, that begs the ques­tion of what “best” means. And here’s your an­swer. “Best” means:

• the treat­ment or pro­ce­dure that’s most likely to help.

• the treat­ment or pro­ce­dure that’s least likely to hurt.

• the treat­ment or pro­ce­dure that’s the most eco­nom­i­cal (as­sum­ing that you care about such things).

Ide­ally, your ques­tion, “What else?” will prod some ex­tra thinking. It also con­veys your in­ter­est in know­ing all of the op­tions, so that you can com­pare price, amount of time in­volved and likely out­comes. The only op­tion that re­ally mat­ters is the best one for you and your horse.

BOT­TOM LINE: When it comes to tests or treat­ments, there are usu­ally a num­ber of ways to go, all of which may get you where you want to go (healthy horse). Make sure you learn about all of them be­fore you pick one of them.

QUES­TION 3: “What if I don’t?”

Keep in mind that, in many sit­u­a­tions, if you de­cline a test or treat­ment, the world is un­likely to come to an end, and your horse may get bet­ter any­way.

Take, for ex­am­ple, a horse with a ten­don in­jury. What if you don’t do an ul­tra­sound exam? Will the treat­ment be any dif­fer­ent? Will it make a dif­fer­ence in out­come? (Note: Ask these same ques­tions be­fore you agree to an MRI to in­ves­ti­gate your horse’s lame­ness.) If you need to get your horse back to rid­ing sound­ness as soon as pos­si­ble, per­haps close mon­i­tor­ing will be im­por­tant. But how about if you’re happy just to give him a year off? Maybe that will do just as well, and for a lot less ex­pense and ef­fort.

On the other hand, if your horse needs colic surgery, and you de­cide against it, his life is go­ing to end. Not a good re­sult, for sure, but this is in­for­ma­tion you need to have. Most im­por­tant, if you know the likely out­come, and you can’t af­ford the so­lu­tion, at least you’ll be able to keep him from suf­fer­ing, which is very im­por­tant.

BOT­TOM LINE: “What if I don’t” ques­tions help you make bet­ter de­ci­sions, be­cause they help you un­der­stand the po­ten­tial out­comes with­out treat­ment. They may help save you money, too.

QUES­TION 4: “Then what?”

This ques­tion is all about know­ing what you and your horse might be in for if you do se­lect a treat­ment.

Say you have a horse with os­teoarthri­tis and you’re thinking about treat­ing him with one of the many types of in­jec­tions avail­able. You’d want to know

when you’d have to treat him again. You’d want to get some idea of how likely it is that he might re­spond. You might want to know how quickly he’d re­spond, or how long he’d be ex­pected to be bet­ter, if he got bet­ter. You’d want to know if the treat­ment would change the out­come of the dis­ease, too.

Like­wise, when con­sid­er­ing an ex­pen­sive pro­ce­dure, you might want to con­sider its rel­e­vance and im­por­tance for an old horse who might do just as well with an in­ex­pen­sive one.

BOT­TOM LINE: Al­ways try to get some idea of what you’re in for, with or with­out treat­ment.

These ques­tions come from my many years of prac­tice as an equine vet­eri­nar­ian. Al­though I keep an open mind and con­sider var­i­ous pos­si­bil­i­ties when I ex­am­ine a horse, it’s not un­com­mon for him to turn out to have what I sus­pect from the start---and for me to have a pretty good idea from the be­gin­ning of what he needs to have done. That’s fine---in fact it might be one of the ben­e­fits of my long ex­pe­ri­ence ---but it doesn’t mean that I don’t want the owner to ask ques­tions and, per­haps, chal­lenge my as­sump­tions.

I urge horse own­ers to par­tic­i­pate in the di­ag­nos­tic and ther­a­peu­tic process. Don’t just ac­cept what you’re told---ask these four ques­tions and more each time you get a rec­om­men­da­tion for a pro­ce­dure, treat­ment or prod­uct for your horse. Not only will you be a more in­formed con­sumer, but you’ll be bet­ter able to en­sure that you’re do­ing the right thing for your horse and your­self. About the au­thor: David Ramey, DVM, is a grad­u­ate of the Colorado State Univer­sity School of Vet­eri­nary Medicine. Since 1984, his clin­i­cal prac­tice in South­ern Cal­i­for­nia has spe­cial­ized in the care and treat­ment of sport and plea­sure horses (RameyEquine. com). In ad­di­tion to be­ing a full­time prac­ti­tioner, Dr. Ramey is also an ac­tive ad­vo­cate for the ap­pli­ca­tion of sci­ence and ev­i­dence to vet­eri­nary medicine. He is an in­ter­na­tion­ally rec­og­nized re­searcher, lec­turer, blog­ger (Doc­torRamey.com) and au­thor, hav­ing writ­ten 13 books, 5 book chap­ters, and over 100 pa­pers and let­ters pub­lished in pro­fes­sional jour­nals and pro­ceed­ings.

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