In recent times, and I’m sure sometimes to the frustration of my clients, I have become much stricter about referring clients on for veterinary examination and diagnostic workups. This is for a whole host of reasons, with a few including (in no particular order, but certainly not limited to) the following:

…my duty of care as an equine health professional to know where to draw the line between the scope of my practice and the responsibility to call in or hand over to a veterinarian — which sometimes includes refusing to perform massage on your horse if potential or known contraindications to bodywork exist, until veterinary advice has been sought and permission obtained (with further instructions if required) for me to proceed

…more confidence in identifying potential issues that absolutely require a veterinarian to either confirm or rule out a diagnosis, prior to development of an appropriate rehabilitation or general conditioning program

…new research and technological advances that are contributing to easier investigation of subtle or more complex musculoskeletal problems (especially soft tissue injuries!!!)

…increasing recognition of subclinical gait abnormalities, which goes hand in hand with the growing interest in preventative health care and management across the equestrian community and the desire of horse owners to learn more and take an interest in their horse’s performance and wellbeing (hooray!!!)

…the fact that I do this kind of work because I love horses, and while I have to make a living, I get really, really sick of seeing the same issues over again when resolving even a small underlying problem could gain better results. I have a conscience, and to put it bluntly, I don’t want your money if it isn’t going to help your horse!

One issue that pings my call-the-vet radar more often these days, is the presence of often-subtle movement and posture abnormalities that cause me to question whether the horse is exhibiting neurological deficits. These things that make me go “hmmm…” often include poor coordination, strange foot placements at rest, reports of stumbling or klutziness, and my (least) favourite: “It’s like he has no idea where his feet are.”

Now, my radar may be a little hypersensitive compared to most, but this is not without good reason. In part, it’s because my own research has a substantial focus on neurological abnormalities in the forelimbs (versus widely recognised symptoms that are more likely to be picked up in a routine clinical exam by your veterinarian, whether or not you have raised concerns as a rider).

The other reason is the simple fact that I’ve had enough personal experience and dangerously close encounters as a rider, handler and professional-person-expected-to-get-underneath-the-wobbly-uncoordinated-horse that if red flags appear, I will raise the matter with you and may request that you speak to your veterinarian about a neurological examination.

Some might see this as a little pedantic, but this is the bit where I feel compelled to remind you that this is about one thing: the safety of you and your horse.

To that end (and the words that sparked this post in the first place), I’ll leave you with the very wise and refreshingly pragmatic words of Drs De Lahunta and Glass, taken from my Veterinary Neuroanatomy and Clinical Neurology textbook.

Remember, if I ask you to follow this up with your veterinarian, I’m hoping for a clear bill of health as much as you are — but safety always comes first, especially when it is so easy to have your veterinarian check your horse over and rule out any serious problems.

 

ON HORSES EXHIBITING SIGNS OF SPINAL CORD DISEASE, A.K.A. “WOBBLER’S SYNDROME”:

“Obviously, the owner needs to be informed of the potential danger associated with riding a patient who may appear to be recovered but may well have permanently lost enough axons at the site of the

[spinal cord compression] to cause the animal to stumble when in a stressful situation.

A normal neurologic examination in no way guarantees a normal spinal cord!

It is one thing to repair a large-breed dog surgically with this disorder so that it can walk up and down stairs without assistance, but a human life is put in danger when a surgically repaired horse [ed. note: or, IMHO, a mildly affected horse, or for that matter, a subclinically affected and/or undiagnosed horse!!!] is put back into service.

On the racetrack, many human lives are put at risk when one of these operated horses is loaded into the starting gate. The veterinary surgeon, as well as the owner of the patient, must accept the consequences of this risk.”

 

ETA (because this off-the-cuff post is getting more attention than expected):

Although safety is the focus of this little rant, a similar blanket statement applies to virtually every other issue I might refer on to a veterinarian that doesn’t have an overt safety risk attached to a potential diagnosis… And that statement would be that when I put my foot down and insist you see a veterinarian, it isn’t to be difficult, but because I have your horse’s well-being at heart. There are countless techniques and tricks I can use to support veterinary treatment or exercise prescriptions in rehab situations, but I can’t do that until I have the vet’s diagnosis and plan, along with their permission to go ahead with whichever techniques or interventions I might have in mind.

If you would rather listen to the next person who will tell you not to bother with a vet because they can fix it in a session or two, or keep getting therapists back without seeing any progress because of underlying problems, that’s up to you. I’m not under the illusion that all problems can be fixed — but if we have the full picture, we have a shot. Then, and only then, we can work out how to manage the irreversible issues most effectively. The kind of plateau I want to see occur with client horses is the sweet spot where horse, rider and therapist are happy with the benchmark we have reached and can back off to routine maintenance. If my results plateau when I can still see glaring issues, I’ll speak up — because it usually means I’m not the right bodyworker for your horse, or that it’s time to go back to the vet for further investigation.

So next time your bodyworker raises an issue with you and recommends you consult a veterinarian, just remember that we are trying to do the right thing, knowing full well we might lose a client if our concerns fall on deaf ears. The reality is that I want to see your horse happy, healthy and performing well, and sometimes your horse will need more than just my hands to make a significant change.