Horse Side Vet Guide ®

Equine Health Resource

What’s Wrong with Mr. Ed?

What’s Wrong with Mr. Ed?

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Since I have not met Mr. Ed the talking horse, I usually don’t ask a horse about their symptoms – and there are no symptoms in Horse Side Vet Guide®. – Dr. Thal

As a practitioner of equine veterinary medicine for 25 years, I have come to believe that it is very important for horse people (of all kinds) to understand the difference between a symptom, an observation, a vet diagnostic test, a clinical sign, diagnostic finding, a diagnosis, and a treatment. Unfortunately though, in the equine world, these concepts are regularly confused. This confusion yields faulty logic that too often results in poor choices, wasted money, and ultimately harm to horses. The misunderstanding has been a driving force behind my development of Horse Side Vet Guide. In creating HSVG, I very intentionally organized and related these categories in a sound way, in order to clearly define their place within the whole.
Let’s start with the word “symptom”. You hear it mentioned all the time in description of a horse’s signs. But did you know that a symptom MUST, by definition, be perceived, experienced AND DESCRIBED by a human patient? An animal therefore cannot have a symptom! A symptom is subjective and cannot be measured. In human medicine (with the exception of pediatrics – infants and young children), patients simply tell their doctor about their symptoms as part of the history and physical exam: “Doctor, my back is very sore and tender right here, and it really hurts when you touch it.” Symptom examples include descriptions of pain (of all kinds), dizziness, anxiety, nausea, chills, fatigue, itching, cramping, and numerous others.
Since I have not met Mr. Ed the talking horse, I usually don’t ask a horse about their symptoms – and there are thus no symptoms mentioned in HSVG!
Instead, HSVG contains a unique and extensive list of OBSERVATIONS – things that YOU might see, hear, smell or feel when interacting with a horse.  Your power of observation is the proper starting point for addressing any equine health issue.
Your ability to make accurate observations of your horse, like most skills,  improves with practice. The key is in trying to be as objective as possible.. For example, “I think my horse threw its back out…” – is an assumption and a conclusion. Again, consider what OBSERVATIONS are making you think that.  Perhaps the horse is reluctant to move forward, they may seem to abnormally flinch from pressure on their back from your hands, or maybe you think you see or feel swelling of the back?
A CLINICAL SIGN is an “informed observation” of illness, injury, or disease that a veterinarian sees or finds during an initial physical examination or in the performance of comparatively simple diagnostic testing. Examples of clinical signs include observations like weak pulse, pale gums, high heart rate, or digital pulse, among many others. Sometimes – not always – a clinical sign may be akin to an observation. As a non-vet, you are probably able to report certain clinical signs but may miss or misinterpret others. Your ability to report them accurately depends on, among other things,  your knowledge of what is “normal”, so you can determine abnormal.  As vets, we sometimes (but hopefully less frequently) make the same mistakes. My goal is to have you become a better observer. I want to be able to trust that when you tell me a horse’s gums are pale, that they really are. 
A veterinary DIAGNOSTIC is an examination or test that a veterinarian performs to gather more information about a patient’s condition. It might help narrow down the possible causes that result in an observation (or clinical sign) or help rule out diagnoses from a differential DIAGNOSIS list. Veterinary diagnostics range widely in cost and complexity. The value of the information to be gained from a diagnostic may also vary widely – some diagnostics may pinpoint the cause with great accuracy while others may simply help exclude some diagnoses from the list of possibilities. You should feel free to discuss the cost and value of any particular diagnostic with your vet. In fact, your vet should be very clear in describing these things when they recommend the test.
WHE ADR Smaller“Oh No! My horse is in excruciating pain, he must have broken his leg!” – is an assumed symptom combined with an assumed diagnosis. Instead of speculating or jumping to conclusions, it is always best to try to make accurate OBSERVATIONS. What are you really seeing? Perhaps the horse is very lame, reluctant to move forward, or maybe the affected limb is swollen? Perhaps there is heat in the hoof and a digital pulse in the lower limb? By using the proper diagnostics – maybe a physical exam, application of hoof testers and possibly radiography – your veterinarian may determine that it’s not a fracture at all, but merely a sole abscess.
I personally distinguish between a clinical sign and a “clinical finding”. A clinical finding is a result or interpretation of a veterinary diagnostic test. It is an objectively measurable indication of illness, injury or disease that results from more complex or specialized diagnostic testing. In most cases, it requires specialized training and experience in order to define and interpret it. The difference between a clinical sign and a clinical finding is a matter of degree, not kind. However, unlike a clinical sign, a clinical finding is never akin to an observation. (Clinical signs and findings are an important part of the matrix of equine health information but are currently located in the “backend” of the HSVG database, and are currently not publicly visible. Someday I hope to make them public too.)
A veterinary DIAGNOSIS – the underlying cause of a problem – is ideally determined by a veterinarian after performing the necessary diagnostics and interpreting the results. Sometimes a diagnosis is definitively reached, sometimes not. Often, in the process of performing diagnostic testing, many diagnoses are ruled out, but ruling one in definitively can be harder.
Once the diagnosis is determined, then appropriate veterinary TREATMENTS are identified and should be discussed with your vet. Just like diagnostics, treatments can range widely in both cost and complexity. Likewise, you should always ask your vet how to measure the efficacy of any particular treatment.
You have a vital role with respect to veterinary treatments too. Although treatments are provided or at least prescribed by your vet, your ability to observe is  critical to successful treatment. Your ability to provide feedback on how the horse has seemingly responded to the treatment is vital.  You may also need to continue to treat the horse at home and can help care for your horse before and after a diagnosis is reached. This is another place where your SKILLS & SUPPLIES come in.

The term “SYMPTOMATIC TREATMENT” applies when a veterinarian (or physician) treats the signs associated with a disease or illness, rather than treating the underlying cause. For example, a horse may be experiencing abdominal pain (a clinical sign), and outwardly exhibit this pain by pawing, getting up and down, and grinding their teeth (your observations). A vet may give the horse a shot of Banamine® for temporary pain relief (a symptomatic treatment), and then perform additional diagnostics to determine what condition is causing the colic (the diagnosis), and then consider appropriate treatments for that specific condition. The shot of Banamine® may help break the pain cycle in a horse with a simple gas bubble, but it will only temporarily lessen the signs of pain in a horse with a mechanical displacement of the large colon for instance.
We must be careful when using symptomatic treatments, because they often reduce (mask) the signs of illness or disease, and so can easily provide the person treating with false confidence that they have “fixed” the problem.
Note: The term “symptomatic” is a bit mismatched here. It  is borrowed from human medicine. Remember, horses cannot tell you or your vet about the symptoms they are experiencing. 

I hope this explanation is helpful. – Dr. Thal

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