Letter to the Editor: E. C. Hart, DVM

I read Dr, Ramzan's Op-Ed with great interest as the subject of videoendoscopy in the U.S. is front and center (again), so please consider the comments I bring up in this letter so we–as a unified industry–can all feel comfortable moving forward with video endoscopy.

Before reading this rather lengthy piece, please understand that I'm totally in favor of using video endoscopy at sales, but I do have some concerns. After reading Dr. Ramzan's letter, I realize that vets all over the world have their own concerns.

Very similar to what has happened with radiographs being viewed in the repository, who decides if the videoscope is of good enough quality to use? Vets in the repositories often discuss what to do with radiographs that are non-diagnostic, whether it's just poor angles, movement on images or poor quality images due to the equipment. I'm concerned the same thing will happen with videoscopes. Who will be responsible for approving the quality and the content of the scopes prior to the sale? In addition to the date and time of the scope, will the videos be 30-45 or 60 seconds in duration, will nasal occlusion have to be part of the process, will the type of restraint (twitch, lip chain or no restraint) be included in the record? The basics might be covered with the wording in the conditions of sale, but I think we have to have some recourse spelled out other than simply using an arbitration panel post-sale. I've seen many videoscopes that are of excellent quality and would be acceptable as an alternative to performing multiple endoscopic exams on horses. However, I've also seen videoscopes that are not good enough to make a determination of the function of the upper airway. Without addressing this, we're leaving ourselves open to the same problems we're experiencing when viewing poor quality radiographic images. In those cases, we can recommend additional X-rays, but the whole point of the videoscope is that the horse only gets scoped once.

Another issue is the post-sale arbitration panel–it has to be fair to both buyer and seller. I think no vet from the group that took the videoscope should be on the panel. It's human nature to support the decision of the practice that employs the vet, so it's a definite conflict of interest. (To those of you who think this sounds pretty elementary, it does happen quite often). And with something so subjective as an endoscopic exam, I think the panel has to be comprised of unbiased people who have a great deal of experience in this field. That might not be as easy as it sounds. On that subject, spending time in arbitration is valuable time a vet doesn't have to spare at most sales. Furthermore, what if the horse scopes a 2A/B post-sale, thereby meeting conditions of sale, but would have been eliminated from consideration by a lot of clients if they'd had the opportunity to have their vet scope it pre-sale?

If the exams are performed on the sale grounds, I can see situations where the horse might not scope as well after a long stressful van ride in the heat. This doesn't seem fair. Or what if the seller ships the horse from out of state just to find out the horse doesn't meet conditions of sale? The obvious answer is that the horse should be scoped just prior to getting on the van, but that means those out-of-state sellers have to pay for an additional scope at the farm and a videoscope at the sale and the horse still might not scope well after the stress of the van ride.

Another scenario that I've seen on numerous occasions is that a horse might scope fine when it first arrives at a sale, but after a few days of showing, I've seen everything from kissing lesions to horses with chondritis, ruptured sub-epiglottal cysts/

abscesses and even 2B or less airways. So a client who relies solely on the videoscope could end up purchasing a horse with a problem and would have no idea unless they had it scoped post-sale. The client might pass on another horse only to find out that the one he/she bought has an airway issue.

I think positively identifying the horse isn't going to be a problem if the exam is performed on the sales grounds. I'm sure the attorneys for the sale companies have discussed the fact that these are medical records and what happens if they end up floating around sale grounds on laptops or iPads?

I think we have to make sure we are still doing our due diligence for our clients while making the process better for the seller (and the horse).

With a large sale like Keeneland where horses have to be removed from the stalls in order to accommodate the next group of ship-ins, I can see vets hoping they can find horses in holding stalls the following morning and also hoping they can find someone representing the seller to hold the horse for a post-sale scope.

None of us has time to spend going from barn to barn looking for horses. Theoretically we should be out vetting the next group and can't afford to get behind in our work schedule.

To reiterate, I am in favor of using videoscopes as part of the pre-purchase examinations, but the veterinary community has the responsibility to protect both the buyer and seller, and we all need to be comfortable with implementing videoendoscopy at the sales. I'm just trying to think of all the pros and cons to this so we can make sure everyone feels comfortable using videoscopes.

I encourage sale companies to be very proactive by keeping buyers and sellers informed along the way and by encouraging input from everyone before implementing videoendoscopy at the sales.