When Your Horse Needs A Spe­cial­ist

Gone are the days when your lo­cal vet took care of all your horse’s health needs. Learn why spe­cial­ized care has taken an im­por­tant role, and which 5 spe­cial­ties are most likely to be ones your horse will need.

Horse & Rider - - Front Page - By Barb Crabbe, DVM Il­lus­tra­tion by June Brigman

I’m chat­ting with the oph­thal­mol­o­gist about a com­pli­cated case of uveitis when a call comes through from the ra­di­ol­o­gist. She re­ports her opin­ion about a re­cent pre-pur­chase exam. No sooner have I hung up the phone, than the sur­geon re­turns my call about sched­ul­ing an op­er­a­tion to re­move an ovar­ian tu­mor. Some days I feel more like an air traf­fic con­troller than a vet­eri­nar­ian!

As an equine prac­ti­tioner, I of­ten spend hours a day mak­ing all the con­nec­tions my clients need with other care providers. Frus­trat­ing? Some­times. But if I weren’t do­ing that, I wouldn’t be pro­vid­ing the best pos­si­ble care for my equine pa­tients.

In this ar­ti­cle, I’m go­ing to help you un­der­stand why “onestop shop­ping” may no longer be the an­swer to your horse’s health-care needs. I’ll ex­plain what vet­eri­nary spe­cial­ists are, and the most com­mon roles they’re likely to play in your horse’s life. You’ll learn why it’s so im­por­tant that a good gen­eral prac­ti­tioner be good at more than de­sign­ing an ef­fec­tive pre­ven­tive health-care pro­gram or di­ag­nos­ing and treat­ing your horse when things go wrong.

In fact, you’ll see how your horse’s health may de­pend on your vet be­ing will­ing and able to rec­og­nize when some­one else might do a bet­ter job.

Spe­cial­ist, De­fined

All vet­eri­nar­i­ans grad­u­ate from vet­eri­nary school with a de­gree that al­lows them to prac­tice medicine. A true vet­eri­nary spe­cial­ist is some­one who’s had ad­di­tional train­ing in a specifc area, be­yond the four years spent in vet­eri­nary school. In ad­di­tion to as many as four years of ad­di­tional train­ing, to be­come board cer­tifed in a specifc vet­eri­nary spe­cialty, these vet­eri­nar­i­ans are re­quired to pass rig­or­ous test­ing as well as pub­lish ar­ti­cles in scientifc jour­nals. The Amer­i­can Vet­eri­nary Med­i­cal As­so­ci­a­tion rec­og­nizes more than 20 of­fi­cial vet­eri­nary spe­cial­ties.

Not only do spe­cial­ists have ad­di­tional train­ing and cre­den­tials, they also usu­ally re­ally “spe­cial­ize” in prac­tice, mean­ing they only see specifc types of cases. That means they have more ex­pe­ri­ence, and of­ten bet­ter tools than your reg­u­lar vet. Who would you want per­form­ing a dif­fi­cult surgery on your horse? A board-cer­tifed sur­geon who does that same surgery sev­eral times a week and has the latest-model surgery ta­ble? Or a vet­eri­nar­ian who’s done it twice?

Board cer­tifca­tion in a spe­cialty guar­an­tees a cer­tain level of train­ing—that’s a given. Where it be­comes more dif­fi­cult to nav­i­gate the world of horse health care is when it comes to vet­eri­nar­i­ans who have a cer­tain em­pha­sis in prac­tice, yet aren’t of­fi­cially “spe­cial­ists.” This com­monly oc­curs in

the per­for­mance horse world, where many vet­eri­nar­i­ans em­pha­size lame­ness work. Although they might be lack­ing the of­fi­cial pa­per­work, the most skilled of these prac­ti­tion­ers have also pur­sued years of ad­di­tional train­ing, have more ex­pe­ri­ence, and are bet­ter equipped than the av­er­age gen­eral prac­ti­tioner.

Equine Spe­cial­ties

Here’s a run­down of the fve most com­mon ar­eas of spe­cial­ized care you’re likely to en­counter in your horse life.


Te spe­cial­ist: A ra­di­ol­o­gist typ­i­cally spends his days in­ter­pret­ing ra­dio­graphs, as well as re­view­ing im­ages from ul­tra­sounds or MRIs. In some sit­u­a­tions, a ra­di­ol­o­gist may be on site, most com­monly per­form­ing ul­tra­sound ex­ams where “hands on” makes a dif­fer­ence.

You’ll need one when: Your gen­eral vet­eri­nar­ian may rec­om­mend sub­mit­ting ra­dio­graphs to a ra­di­ol­o­gist for re­view if he has ques­tions about a spe­cific find­ing. A ra­di­ol­o­gist who sees hun­dreds of films each week of­ten can help de­cide whether a bone chip is old or new, or whether a “funny look­ing” line is a frac­ture or some­thing in­signif­i­cant. A ra­di­ol­o­gist of­ten will re­view ra­dio­graphs for pre-pur­chase ex­am­i­na­tions, and may have an opin­ion about whether cer­tain find­ings are likely to af­fect the horse’s fu­ture sound­ness.

If your horse re­quires an ul­tra­sound ex­am­i­na­tion to eval­u­ate a ten­don or joint prob­lem, a ra­di­ol­o­gist may be called upon for dif­fi­cult-to-im­age ar­eas. Ul­tra­sound is an area where non-board-cer­tifed prac­ti­tion­ers who have ex­ten­sive train­ing and ex­pe­ri­ence also may have the ex­per­tise you need.


Te spe­cial­ist: A sur­geon per­forms life-sav­ing colic oper­a­tions, re­pairs frac­tures, re­moves bone chips, and su­tures dif­fi­cult wounds. Some sur­geons em­pha­size soft-tis­sue surgery or ortho­pe­dics, while oth­ers per­form all dif­fer­ent types of pro­ce­dures.

You’ll need one when: Per­haps the most com­mon time that you’ll en­counter a sur­geon in your horse life is if your horse has a colic episode that re­quires surgery to re­solve. You also may need a sur­geon to cor­rect an or­tho­pe­dic prob­lem. Many gen­eral prac­ti­tion­ers do per­form some surg­eries, and are quite skilled and well-equipped for cer­tain things. For more com­pli­cated pro­ce­dures, your reg­u­lar vet should rec­og­nize when sur­gi­cal re­fer­ral would be ad­vised.


Te spe­cial­ist: An oph­thal­mol­o­gist spe­cial­izes in care of the eyes. He’ll usu­ally ex­am­ine your horse in per­son, per­form di­ag­nos­tic tests, and rec­om­mend a treat­ment plan. He also per­forms surgery on eyes, such as cataract re­moval.

You’ll need one when: Your gen­eral vet­eri­nar­ian usu­ally will rec­om­mend an oph­thal­mol­o­gist if your horse has a se­ri­ous in­jury or a prob­lem that isn’t re­spond­ing well to treat­ment, such as an in­fected corneal ul­cer or se­ri­ous trauma. He also may want an oph­thal­mol­o­gist in­volved if your horse has a chronic prob­lem, such as equine re­cur­rent uveitis, that re­quires on­go­ing care. If your horse has a

prob­lem that re­quires surgery on his eye, the oph­thal­mol­o­gist (rather than a sur­geon) is likely to per­form it.


Te spe­cial­ist: A der­ma­tol­o­gist spe­cial­izes in skin dis­eases. In vet­eri­nary medicine, a der­ma­tol­o­gist also f lls the role of al­ler­gist. He’ll per­form skin test­ing and for­mu­late the serum used for hy­posen­si­ti­za­tion (al­lergy shots).

You’ll need one when: You’re most likely to re­quire the help of a der­ma­tol­o­gist if your horse has chronic hives. He might also be called to help di­ag­nose and treat an un­usual skin dis­ease, or man­age med­i­ca­tions for a chronic skin-re­lated prob­lem.


Te spe­cial­ist: Although lame­ness typ­i­cally falls un­der the surgery spe­cialty for board cer­tifca­tion, many vet­eri­nar­i­ans who em­pha­size lame­ness di­ag­nos­tics and treat­ment in their prac­tice aren’t true “spe­cial­ists.” A lame­ness ex­pert typ­i­cally sees horses with com­pli­cated or dif­fi­cult-to-di­ag­nose prob­lems, and of­ten has more ad­vanced di­ag­nos­tic tools avail­able, such as nu­clear scintig­ra­phy or MRI. He may have ad­di­tional train­ing skills when per­form­ing ul­tra­sounds. He’ll be ca­pa­ble (and ex­pe­ri­enced) when per­form­ing a wide va­ri­ety of treat­ments, such as com­pli­cated joint in­jec­tions, or such re­gen­er­a­tive ther­a­pies as platelet-rich plasma or stem­cell treat­ments.

You’ll need one when: Your vet will rec­om­mend re­fer­ral to a lame­ness ex­pert if your horse has a prob­lem that’s proved dif­fi­cult to di­ag­nose or has failed to re­spond to treat­ment. He also may re­fer you for specifc di­ag­nos­tic tests, such as a nu­clear scintig­ra­phy of MRI, that aren’t avail­able in a gen­eral prac­tice. You may need the as­sis­tance of a lame­ness ex­pert to per­form a pre-pur­chase ex­am­i­na­tion, par­tic­u­larly if you’re spend­ing big bucks on a high-level per­for­mance horse.

Mak­ing the Most of Spe­cial­ized Medicine

With all these op­tions avail­able, it’s easy to see why sin­glevet care re­ally isn’t the an­swer any more. It’s also easy to un­der­stand why it’s tempt­ing to seek out spe­cial­ized help for ev­ery prob­lem. To make the most of spe­cial­ized care, keep these few sim­ple rules in mind.

Work with your vet. It’s al­ways best to keep your own vet­eri­nar­ian in­volved with your horse’s care, even as you seek spe­cial­ized help. If your vet rec­om­mends re­fer­ral, take his sug­ges­tions. Even more im­por­tant, if you’re the one re­quest­ing a sec­ond opin­ion, it’s al­ways best to ask your reg­u­lar vet for in­put and ad­vice. Your vet knows you and your horse well, and has your best in­ter­ests at heart. He can share your horse’s history and is likely to be con­nected to all the best spe­cial­ists (and know who to avoid!). As the di­rec­tor at the hub of your health-care team, this per­son can help you make all the right de­ci­sions to pro­tect your horse’s health.

Don’t wait too long. Noth­ing is more frus­trat­ing for a spe­cial- ist than to frst see your horse when he’s too sick or lame to be helped—es­pe­cially if that dis­ease or lame­ness could have been di­ag­nosed and cured in its early stages. Once again—if your own vet rec­om­mends re­fer­ral, take his ad­vice. And if you feel like you haven’t re­ally fgured out what’s wrong, or that your horse isn’t re­spond­ing well to treat­ment, ask your vet whether re­fer­ral op­tions ex­ist that might help. Re­mem­ber, your vet is prob­a­bly the best per­son to help you fnd qual­ifed, re­li­able opin­ions, so don’t make the mis­take of seek­ing ad­vice from un­qual­ifed or self-pro­claimed “ex­perts,” only to fnd that you aren’t re­ally get­ting what you need.

Check out cre­den­tials. Just be­cause some­one claims to be an ex­pert doesn’t mean he has the train­ing or skills to sup­port those claims. Even if this per­son has a glossy Web site or is pop­u­lar in the lo­cal barns, that’s no guar­an­tee he can pro­vide the help your horse re­quires. Look for board cer­tifca­tion as an in­di­ca­tor that the prac­ti­tioner has in­deed had spe­cial­ized train­ing. And for those bona fde non-board­cer­tifed ex­perts out there, don’t be afraid to ask about their ad­di­tional train­ing and ex­pe­ri­ence with your horse’s type of prob­lem. Once again, your own vet most likely knows what the best re­fer­ral op­tions are and can gen­er­ally help you steer clear of the wannabes.

Bud­get wisely. There’s no doubt about it: Spe­cial­ized care is ex­pen­sive, es­pe­cially when it comes to ma­jor surg­eries or such di­ag­nos­tic tests as nu­clear scintig­ra­phy or MRI. It’ll be ter­ri­bly frus­trat­ing for both you and the spe­cial­ist if you learn what your horse needs, and sim­ply can’t af­ford it. Con­sider start­ing a health-care sav­ings fund with emer­gency cash you can count on when your horse’s care gets com­pli­cated.

Another al­ter­na­tive is to con­sider ma­jor med­i­cal in­sur­ance, which can be pur­chased at min­i­mal cost along­side a mor­tal­ity pol­icy. Good in­sur­ance usu­ally will pay for most (if not all) of what­ever com­pli­cated di­ag­nos­tics or treat­ments your horse re­quires—al­low­ing you to make de­ci­sions based on what he needs, rather than on what you can af­ford. And don’t spend all your funds be­fore you get there! It won’t help your sit­u­a­tion if your horse is lame and you spend thou­sands of dol­lars on joint sup­ple­ments, acupuncture, and body work—only to dis­cover he has a lig­a­ment in­jury that re­quires an ul­tra­sound to di­ag­nose and re­gen­er­a­tive ther­apy to heal—that you no longer can af­ford.

Fol­low through. Fi­nally, com­pli­cated prob­lems of­ten take a va­ri­ety of di­ag­nos­tics, mul­ti­ple ther­a­pies, and plenty of time to heal. You’ll have best re­sults if you fol­low through with treat­ments, take your horse back for rec­om­mended rechecks, and main­tain com­mu­ni­ca­tion about ad­just­ments to your horse’s treat­ment plan. If your vet works with the spe­cial­ist of­ten, chances are he’ll be in­volved in the on­go­ing care—and will help main­tain con­tact with the spe­cial­ist to help guide your horse’s progress.

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