Signs as subtle as standing quietly in the barn, refusing to eat hay or socialize with herdmates, can point to internal illness. | Photo: iStockI walked out to check on my two horses about an hour before sunset. Solstice was in the paddock, eating hay, snorting contentedly, and swishing his tail. When I walked up to the fence, he perked his ears and looked at me with bright, cheerful eyes.But Sabrina stood quietly in the run-in shed. She saw me approach, poked her head out, blinked, and sighed. She ambled out of the barn toward me, put her head over the fence, and waited for me to stroke her face.Wait. She wanted her face stroked? Sabrina was not well.As much as Solstice loves to be cuddled like a golden retriever puppy, his dam, Sabrina, acts like she has too much dignity for public displays of affection. Shed rather be chasing Solstice from every hay pile and pinning her ears when he tries to steal a bite. The last thing shed do is hang out in the barn watching him eat her hay and then come to me for a scratch on the head.Two hours later Sabrina was on the ground, curling her lip and groaning. Id already called her veterinarian, who determined from my description of her symptoms that she was colicking. Fortunately, with my vets help, Sabrinas colic resolved within a few hours.Horses can give us plenty of cues when theyre dealing with early illness. The problem is they dont; horses dont like to show that theyre sick.Theyre a prey species, so hiding any evidence of illness is a survival technique, says Elizabeth Davis, DVM, PhD, Dipl. ACVIM, associate dean of clinical programs, professor, and head of the department of clinical sciences at Kansas State Universitys Veterinary Health Center, in Manhattan.But they do give subtle signs, like Sabrinas uncharacteristic affection or her standing quietly in the barn or not eating hay. To help you recognize them and intervene accordingly, weve put together this 10-point list of warning signs.1. Diminished or absent appetiteHas your horse suddenly become picky about or even completely uninterested in his food? Thats a significant sign of brewing illness, our sources say. A change in appetite, whether for grain or hay or both, is a big indicator to me that something isnt quite right, says Davis. Whereas he used to take 15 minutes to clean up his bucket of concentrates, now it might take 45 minutes with some breaks to walk around a bit. Or he wont eat hay as vigorously and will get picky about it. Appetite changes could indicate gastrointestinal upsets such as colic. In fact, waning interest in food can signal a wide variety of internal illnesses beyond the GI system, says Kari Bevevino, DVM, of Roaring Fork Equine Medical Center in Glenwood Springs, Colorado.This is among the most important signs of disease in various systems of the body, she says. 2. DiarrheaAny change in poop production is worth monitoring. But diarrhea, in particular, deserves special attention, says Bevevino. Diarrhea can go from not-too-bad to very bad in a very short period of time, and early intervention is beneficial to both the horse and the veterinarian treating him, she says.An infectious diseasewhich can cause severe illness or death and can also spread to other horsesis the most alarming possible cause, Bevevino says. Salmonella and Clostridium bacteria, for instance, cause diarrhea-related infections with varying levels of clinical signs. Some horses remain bright and alert while others develop very severe disease, she says. Rapid treatment can ease discomfort, improve chances for recovery, and help the veterinarian and horse owner control disease spread.Other causes of diarrhea include sand accumulation in the colon, inflammatory bowel disease, and, less commonly, cancer, she adds. Regardless of the cause, diarrhea can lead to rapid dehydration and electrolyte losses, sometimes requiring pretty intensive therapy, Bevevino says.3. Lethargy, uncharacteristic calm or inactivity, and separation from the groupA horse thats lethargic and stays separate from the group might be shoing early signs of sickness. | Photo: iStockHorses should maintain a consistent activity level and keep up with the herd, our sources say. A sick horse might stand off by himself and stay quiet, Bevevino says. By quiet, I mean hell hang his head a little lower, hold his ears a little less perked up than usual, and not have his eyes quite as wide and bright as usual.You might also notice subtle lethargy, adds Davis. Under saddle he might need a little extra encouragement to get going, and he might run out of gas a little sooner, she says. Or the pasture pet suddenly isnt keeping up with the herdmates.4. Unusual BehaviorWhen caregivers pay attention to their horses and observe whats normal for each, theyll pick up more easily on whats not normal, says Davis. There are certainly variations on an individual basis, so its important for people to see the horses at least a couple of times a day to get to know them, she says.Casual observers might miss the subtle red flags. For example, the very social horse thats normally looking in your pockets for a treat is now standing back with his head down, she says. If youre really in tune, youll know when theyre telling you that somethings off. 5. FeverBody temperature is an objective measurementmeaning it has a numerical valuebut for it to have significance, you must recognize when to take it.You usually wouldnt know a horse has a fever just by looking at him or even touching him, Davis says. Sometimes you can see subtle signs, like patchy sweating or faster-than-usual breathing, but those dont always occur.Keep a digital thermometerone from any drugstore will doon hand, and learn to perform a rectal temperature check, Bevevino says. If the temperature is above 101.5 degrees Fahrenheit in an adult horse, chances are youve got a problem. Know that environmental factors such as extreme heat, however, could push the critical temperature limit up to 102 degrees. 6. Other altered vital signsIn addition to body temperature, uncharacteristic respiratory rate and heart rate could indicate impending illness, Bevevino says. You can use a stethoscope to take these measurements, but its not necessary. Count the number of breaths (with your ear up to the horses nose or chest) in 15 seconds, and multiply that by four to get the rate per minute, she says. Most healthy horses at rest should have a rate below 20 to 24 breaths per minute. You can take the horses pulse along certain blood vessels, such as those in the pastern or under the jaw. Count the number of beats you feel in 60 seconds, and compare that to the healthy averagearound 28 to 44 beats per minute in a resting adult horse.Keep in mind, though, that individual horses vitals vary, so familiarize yourself with whats normal for your horse when hes healthy. 7. Weight loss and change in body conditionIllness can take its toll on a body, causing gradually visible signs, say our sources. With an underlying illness it can get easier to see the ribs, Davis says. That could be true weight loss, or it could be lost muscle mass, especially over the topline, giving the appearance of weight loss.This kind of muscle atrophy coincides with illness primarily due to protein metabolism issues, she explains. Because these appear over time, they might be more difficult for owners to detect because they see the horse regularly, says Bevevino. Soliciting an outsiders view can help, but an even more useful tool is photography. One of the best monitoring devices we have is the camera in our phones, she says. Take regular photos from the same angle and lighting to keep track of your horses changes in body condition. 8. Change in coat qualityCoat issues are usually easier to detect in spring and summer, when horses should shed out well and have slick, shiny coats, says Davis. But problems can be visible in the fall and winter, too. Regardless of season, if the coat looks a little rough or dull, or if theres hair loss or thinning compared to previous years, those are signs that somethings not quite right, she says. Metabolic disorders such as pituitary pars intermedia dysfunction (formerly known as equine Cushings disease) can cause coat problemsoften a lack of shedding and elongated (guard) hairs, as well as patchiness or other unusual patterns. Dont ignore any coat issues, because they can be related to a variety of internal illnesses. Modifications in the coat are a huge sign for me, Davis says. Because hair quality is related to nutritional status, coat changes are likely to reflect changes in appetite or nutrient absorption ability.Gastric ulcers are a common culprit for poor coat quality, she says. Theyre just not getting the nutrients they need, and their overall health status declines because of those ulcers.9. Change in bowel habitsFecal character, consistency, and overall output should remain fairly constant, says Davis. If their diet is consistent, they should be passing the same type and amount of material every day, she says. Be observant when cleaning the stall or walking around the paddock. If you dont find any feces in the stall, thats not normal and could suggest an impaction, she says. But if things are moving too quickly, causing frequent or soft feces, that could mean a disruption in the gastrointestinal tracts relatively fragile microflora.Short-lived changes might be normal, resulting from stressful events such as separation from other horses or transport. But changes that last hours or days could represent parasite burdens, reactions to antibiotics, or other gastrointestinal issues. In severe episodes horses bodies might absorb bacterial byproducts in the intestines and develop a serious condition called endotoxemia, which often requires management using intravenous fluids and anti-inflammatories, Davis says. 10. A gut feeling somethings wrongSometimes your intuition is the earliest indication of illness. You know your horse, and something is telling you hes feeling off. Even if the subtle changes are difficult to describe, our sources say these observations are important to report to veterinarians. Thats because, for all their scientific knowledge, they dont usually know your horse as well as you do.If youre worried, Im worried, Bevevino says. Horses are tough and tend to mask the severity of their disease, but a lot of times they cant fool a really in-tune handler. Testing and TreatmentSubtle signs of illness dont usually point to specific diseases. Your horse might be signaling that he has any of a number of conditions ranging from liver disease to infection, pneumonia to colic, because so many of these cause similar early signs. Instead of waiting for more obvious issues, call your veterinarian. If the condition seems to be progressing slowly, it may be okay to schedule an appointment for in a few days time, says Bevevino. But if the signs seem acute (sudden in onset) or progress rapidly, your vet should probably come immediately, because even early signs can mean serious issues and, of course, early treatment is always preferred.Your vet might not know what he or she is treating initially, but a thorough examination will help: palpating different body parts, including the limbs, listening to heart, lung, and bowel sounds, checking mucous membranes, and assessing hydration status, always looking for signs of discomfort and inflammation, says Davis. A general blood test can reveal abnormal blood parameters that might point to the affected body system. A urinalysis might provide critical information about kidney function and metabolism. Ultrasound allows the veterinarian to check vital organs such as the lungs and liver, says Bevevino. If the horse is hospitalized, high-quality radiography can allow the vet to check for issues such as gastrointestinal and pulmonary (lung) diseases. If your veterinarian suspects an infectious cause, he or she might run a polymerase chain reaction (PCR) test on the appropriate samplewhether blood, feces, tracheal wash, nasal dischargeto see if the DNA for the agent is present and target treatment, she says. To check for inflammation, your veterinarian might test for protein markers of acute inflammation, such as serum amyloid A (SAA). We might do the test one day and then repeat it in a day or two, Bevevino says. That way, we can determine if inflammation is a component of the disease and, if present, is it improving, staying the same, or worsening? Its something we have in our arsenal to not only evaluate but monitor response or lack of response to treatment. Specific treatment depends on what diagnostic testing reveals, our sources say. But in the meantime, most horses benefit from supportive care such as intravenous fluids, anti-inflammatories, and stabling in a calm, comfortable environment. Take-Home MessageRecognizing illness in its earliest phases can lead to targeted treatment that can hasten healing and increase a horses chances of recovery. By learning to pick up on the earliest signs of disease, handlers can get their horses the intervention they need faster.