Communicating With Your Vet
The ability to communicate well is probably one of the most important skills for success you can develop no matter what you do for a living. It seems, at least in my life, that when something goes wrong (or not as well as I had planned), it usually can be traced back to some form of miscommunication. The art of communication--and I do believe it is an art--is something that comes easily for some people, while others have to struggle with the process.
The purpose of this article is to offer some guidance in communicating with your veterinarian. I think a reasonable goal is to make an effort to maximize the time you have with your veterinarian by preparing for that time. This serves both parties because your veterinarian potentially can make more efficient use of his or her time, and it can help your veterinarian make better decisions regarding the health and well-being of your horses.
At the root of failures to communicate lie many things. For instance, if you have a question for your veterinarian on Monday and he is not coming until Thursday, you might forget to ask because of poor memory, being too busy when he arrives to concentrate, or being too lazy to write it down so you will remember. All of these add up in one way or another to a failure to communicate. There also can be a reluctance to ask questions when you don't understand something. It works both ways, since some veterinarians will "talk over your head" about something without making sure you understand. But unless you ask him to explain, you are the one who loses out.
There are other forces at work in today's society that lead to failures to communicate. Life has become very fast-paced and high-tech, with communication via voice mail, e-mail, notes, and messages at an all-time high. Don't get me wrong; I use all of these options and there is significant benefit to them, but there is a potential disadvantage when not discussing something face-to-face.
In fast-paced communication, there are a loss of the body language and simple intuition, and a delay (or absence) in the ability for the horse owner to say, "Could you please repeat that, because I just don't get it." I think we must learn to balance and guard against losing too much of the human element.
You also should learn how to communicate better with your horses, as this generally is the information you are trying to convey to your veterinarian. I was taught to study the "art" of knowing, understanding, and observing the nature of animals. And, more importantly, I was taught to apply that to the recognition of abnormality and the association of that abnormality to a specific problem.
The growing science and technology of veterinary medicine are extremely important, but they go hand-in-hand with the simple powers of observation. You cannot treat something or have your veterinarian look at something that you fail to recognize in the first place.
While hustling through the nighttime chores, how well do you pay attention to the horses? Why do veterinarians evaluate for colic so many horses in the mornings beingwhich did not clean up their dinners the night before. Why had no one noticed?
It is very important to familiarize yourself with the personality, habits, and routine behavior of all your horses. As you know, the personalities of horses are as varied as the people who own and care for them. Certain problems can have extremely subtle signs in some horses. Some horses, as some people, have a very high tolerance to pain, and others completely fall apart at the slightest twinge.
Sometimes, very subtle changes in behavior can be the first sign of a medical problem. If you work on your powers of observation, you might be able to head off many problems. Knowing the normal from the abnormal is the basic foundation for good animal husbandry and veterinary medicine. Your powers of observation are very important for the early recognition of subtle abnormalities.
Get the Facts
Once your powers of observation have alerted you to a potential problem, it is time to obtain some objective information on the situation. The best place to start with this is a simple physical examination (see Back To Basics on page 70).
I believe that all horse owners or caretakers should be able to perform a basic physical examination. The information can be very helpful to the veterinarian. First, when you call your veterinarian regarding a problem, the ability to provide basic information over the phone often is a great help in prioritizing the emergency.
For example, if your horse has cut himself and has bled what appears to be a substantial amount (blood on the ground can appear to be a great deal more in quantity than it actually is), but the heart rate and respiratory rate are normal, the level of emergency might not be high. On the other hand, if that same horse's heart rate is 120 beats per minute, the gums are pale, and there is an elevated respiratory rate, the level of emergency would be significantly higher.
The physical examination should be approached in a methodical manner and include both a "hands-off" observation and a "hands-on" evaluation. I will describe here the basic methodology for physical examination, and I'm sure your favorite horse will be a willing and patient subject on which to practice. Although many of the techniques are straightforward, it would be useful to follow up these readings with a demonstration or lesson from your veterinarian in order to fine-tune the process. On that note, this is also a good opportunity to ask your veterinarian what specific information he or she would like you to gather before calling with an emergency.
The physical examination should assess changes in the horse's demeanor, the respiratory system, the cardiovascular system, body temperature, for evidence of shock, and hydration status.
For a brief minute, usually from a distance and outside the stall, you should observe the horse. Changes in the general demeanor of a horse can be significant. Is the horse abnormally anxious or depressed? Is the horse acting painful (flank watching, pawing, stretching, etc.) and if so, is there evidence of his having been down and rolling (is there bedding on him or in his mane and tail)? Note any abnormal posture or activity.
Don't just evaluate the horse; evaluate his environment, too. Is there evidence of pawing, rolling, or circling in the bedding of the stall? Has the horse been drinking and eating (normal amounts)? How many piles of manure have been produced today and, if any, is it of dry, soft, normal, or loose consistency? Obviously, if the horse is violently painful or bleeding severely, you do not want to spend an hour collecting this information, but if this process becomes part of your daily routine, the information can be noted in a matter of minutes.
After passive observation, the horse's heart rate and respiratory rate can be determined. I usually insert a thermometer into the horse's rectum and allow the appropriate time (three minutes) before reading it (making sure the thermometer is attached to his tail to avoid loss). During the "thermometer time" you can perform most of the rest of your evaluation. If the horse is a "dingbat" about the thermometer, and a fight ensues, his heart rate can be increased--let the horse relax for a minute or two before checking the heart rate, or recheck it after the thermometer is removed.
The use of a stethoscope can assist in determining respiratory rate and heart rate, but it is not essential. The heart rate can be determined by feeling for the pulse. The lingual artery can be felt under the jaw, where it lies just beneath the skin and on the bone. The heart rate also can be assessed by listening to the heart at the point of the elbow on the left side with a stethoscope. The normal heart rate for a horse is approximately 30-40 beats per minute.
The respiratory rate can be determined by watching the rib cage, feeling for the breaths at the nostrils, or listening to the breaths in the windpipe with a stethoscope. At the same time that the respiratory rate is determined, the character of breathing should be noted: Are the nostrils flared during inspiration? Is there air moving through both nostrils? Is there any noise being generated as the horse breathes? The normal respiratory rate for a horse is eight to 12 breaths per minute.
After determining the heart and respiratory rates, the color, moistness, and capillary refill of the gums can be assessed. Gums normally are pink, moist, and have a capillary refill time of about two seconds. The capillary refill time is determined by pressing hard on the gum line with your thumb, just adjacent to the teeth, and determining how long it takes for the blood you squeezed out to rush back into the area making the blanched white spot you created go away. Gums that are abnormal in color (bright red, dark red, bluish, or white) and have a capillary refill time greater than two seconds can be an indication of shock.
Don't forget about the thermometer. The horse's normal body temperature varies between 99.0° and 101.0° F.
I must state that, as mentioned earlier, all horses respond to physical abnormalities differently. For example, not all horses experiencing pain have an elevated heart rate. So, the above information is useful to provide to your veterinarian and to aid in the decision of when to call your veterinarian, but should there be any concern regarding the health of your horse, veterinary consultation should be sought.
It is a good idea to discuss, prior to an actual emergency, what your veterinarian's individual preferences are for some of the more common emergencies (colic, colic, and colic). Another important preparation is to have a back-up plan should your veterinarian be unavailable. Most veterinarians, if going out of town for a planned trip, will have another veterinarian or partner cover for him, but occasionally he will be tied up with a significant emergency and could be some distance from you.
It always is good to have a back-up source of care. Consult with your veterinarian on advice for what to do if this situation occurs.
The area of drugs probably deserves some special attention. The first thing I want to say here is be honest with your veterinarian regarding any drugs that have been administered to your horse. With that said, I must state that I feel strongly that you should not give any drugs, unless they are on the order of your veterinarian (by phone consultation) or it is something you have discussed in the past with your veterinarian in regard to a course of action for a particular problem.
There is nothing more frustrating for a veterinarian (and potentially dangerous for your horse) than to administer a medication and subsequently find out that other (or the same) drugs were given by the owner.
With respect to prescriptions, all drugs prescribed or dispensed to you should be labeled with instructions for their use. It seems that this area is one where great failures to communicate occur. Remember, if you don't understand the instructions, make sure you get clarification before treating your horse.
Most of these mistakes center around the math and units used to describe drug dosages. Being stuck somewhere between the metric and standard system does not help, but if you are unclear on milligrams (mgs) vs milliliters (mls) vs cubic centimeters (ccs), be sure and say so and get it clarified.
Another area regarding pharmaceuticals is administration. Don't be afraid to be tutored on giving an injection if that is what the prescription calls for and you will be the one doing it. Also, don't be afraid to speak up if you are uncomfortable giving injections or don't want to--there might be an alternative. In addition, you should not use leftover drugs from another horse (or yourself) without first discussing it with your veterinarian. There can be differences in concentrations or formulations that could be detrimental to your horse's well-being.
A final note here is that antibiotics should never be used without the advice of your veterinarian. There is a serious problem with resistant infections and the indiscriminate use of antibiotics.
Another way to improve communication with your veterinarian is keeping good records and being prepared for routine farm visits. If the speed and efficiency of the routine work can be maximized, you can make better use of your veterinarian's time (as can he or she).
All of the information on your horses should be kept in an organized recordkeeping system of either paper in a notebook or any one of the numerous farm management programs on computer. Whatever the method of recording, all information should be in one place and organized in an easy-to-access manner. This type of organization can increase the efficiency of performing routine tests and vaccinations as well as answer any immediate questions that might arise on the health care program of the individual horses.
If you have a lot of work to be done, make sure there will be enough help in the barn on that day and have everything ready to go. Make sure all the chores are done by the time of your appointment, and have all the horses gathered and ready. I have spent three hours on a farm to perform 15 minutes worth of work, with the other two hours and 45 minutes spent catching horses which didn't want to be caught.
If you have specific questions regarding one of your horses, ask ahead of time if your veterinarian can set aside 15-30 minutes to sit down and discuss some management issues. If your veterinarian cannot spare the time on that specific day, be respectful of his schedule and ask for a meeting at a future time. Be organized when you have your meeting and have your specific questions thought out in advance and written down.
A word of caution on the equine information blitz. If your horse is suffering from a specific problem and you want to learn more on the subject, it generally is more productive if you do some reading before having a conversation with your veterinarian. But, it also is good advice to see if there is anything your veterinarian has put together on the subject or would recommend rather than plowing through the information highway unguided.
Don't get me wrong, there is a plethora of good information available, both in print and on-line, but remember that information is only as good as its source. Although there is plenty of valid information out there, it is probable that there is an equal amount of poor-quality information.
Remember, anyone can place anything on the web with an air of self-proclaimed expertise, and it is very difficult to sort through the validity of that information. My usual thoughts go with the saying, "If it sounds too good to be true, it probably is."
About the Author
Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, N.Y. He is also an FEI veterinarian and works internationally with the United States Equestrian Team.
Ball authored Understanding The Equine Eye, Understanding Basic Horse Care, and Understanding Equine First Aid, published by Eclipse Press and available at www.exclusivelyequine.com or by calling 800/582-5604.
POLL: Visits from the Vet