Equine Colic: Diagnosis, Treatment and Prevention.
So today we're going to talk about equine colic. And what I hope to do today is to give you some information to prepare you with some advice as to how - what would be considered normal in your horse and when to - what are the clinical signs of colic as well as some of the risk factors that we know are associated with colic and ways that you might may be able to minimize those risks.
Colic is essentially a term that, for the vast majority of us we think of colic as being gastrointestinal pain. But colic is really - can be manifested as any kind of pain, although most commonly in the horse it is a sign of abdominal pain. But even with abdominal pain, we will sometimes have horses present with kidney disease or let's say a bladder stone or liver disease as well as others: musculoskeletal, laminitis, tying up, those types of things, and then reproductive diseases.
Although most people think of it as gastrointestinal, can just refer to a horse that is uncomfortable and not feeling well.
How do you tell if your horse has colic?
Well, to begin with one of the most important things you can do to get - help yourself is to know what is normal. And so that when you are worried about your animal, you can get out a thermometer and a stethoscope and get some vital parameters and decide if you really do indeed have a horse that is showing signs of colic.
A normal temperature for a horse varies from about ninety nine to one hundred and one point five. And that's Fahrenheit.
Heart rate of an adult horse should be between about thirty and forty four, forty five beats per minute. And the best way to assess, or listen to a heart is to either stick a stethoscope under the left elbow or, if you don't have a stethoscope, sometimes you can even place the palm of your hand under the left elbow and feel the pulse and get a heart rate. The alternative spot is to palpate the pulse under the mandible which is the bottom of the jaw if you run your finger along the bottom of the mandible you can feel about a pencil-sized vessel which is an artery and if you apply gentle pressure to that artery, you can count the pulse which is equal to the heart rate.
The respiratory rate for a horse should be about twelve to thirty six beats a minute, or breaths per minute. It is a lot harder to listen with a stethoscope and hear breath sounds. So one of the simplest ways to get - count a respiratory rate is to watch the nostrils. So get your watch out and then count the times the nostrils flare and use that to measure.
In addition to these , your TPR, it is a good idea to get - to have a stethoscope so that you can ascult, and test those sounds. Or if again, in a pinch you could just try to listen at your horse's flank to get a assessment of whether or not you hear any sounds at all, are they completely absent.
Signs of Equine Colic :
- Mild colic signs are :
- The horse will show evidence of maybe kicking at it's belly, laying down, looking at their side, curling their lips which is called the Flehmen response.
- They may be playing in their water, not drinking, grinding their teeth, refusing to eat or just turning their head and putting their head in a corner when they normally would be at the front of the stall when you walk up.
- Normal mucus membranes in a horse are also a really important thing to assess when you're about to call your veterinarian.
This picture right here is a horse with relatively normal mucus membrane. You can see they're relatively pink and that varies.
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| horse with normal mucus membrane |
Some will be lighter, some will be darker as opposed to this horse who's membranes are very dark pink and bright sort of reddish pink.
And then this horse is showing you a sign of a horse that is a little it dehydrated so when somebody pressed on the gum line, you can see they left a thumbprint here and that thumbprint lasted long enough that the veterinarian could actually take a picture.
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| horse with dehydrated mucous membrane |
So looking at the color and then assessing by blanching it how long it takes to refill is very helpful information for your vet. And a normal gum should be pink and moist so it should feel moist when you touch it and should have a refill so when you blanch it, it should refill usually around two to two and a half seconds.
- More severe signs of colic can certainly - signs that are much more distressing and worrisome are when a horse gets down and it's rolling or shows evidence of shavings on its back and is with evidence of dirt, breathing hard, sweating, severe sweating, and abdominal distention are all often - considered more severe signs of colic.
So if you think your horse has colic, probably the next step to figuring out whether or not you need to take action is simply call your vet and give them the - describe what's going on and get their input as to whether or not this is a colicy horse. Before you do that though, there's several things you should write down before you call to give him the most information to decide whether or not this is a situation they should come out and assess themselves.
While it doesn't probably seem to be important information, the breed and the gender of your horse can be useful in determining whether or not this is a serious disease.
Certainly older horses and actually some breeds of horses are predisposed to certain types of colic.
In addition, the type of colic signs and the duration of colic signs is very important as well as the severity of them.
And this can also - providing the temperature, pulse, and respiration will be very useful for the veterinarian to assess the degree of pain.
In addition, determining the last time your horse passed manure, whether or not the horse has been eating and drinking normally, and whether or not the horse has received any medications prior to or in the last few weeks prior to the episode of colic.
Predisposing Factors to Colic :
1- Change in feed / environment :
Any time something changes in the horse's life, it always makes them a little bit more susceptible to colic simply because it may throw off their normal routine. We know that miniature horses are more prone to colic particularly foals because of their predilection to eat abnormal feedstuffs like shavings and wood, etc,.
High grain diets are associated with increased risk of colic and certainly changing diets rapidly can - or switching over to a different grain, can increase the risk of colic.
A change in weather - well, it may not initailly make sense and, quite honestly, we're not exactly sure what the risk factors are. But certainly, when the weather changes, particularly gets very cold or gets very hot we often see an increased risk of colic in, most commonly think that's at least partially associated with the fact that horses may change their water intake.
2- Water availability and consumption :
Water as apredisposing factors for colic, water availability and consumption. Of course, if the water is not palatable, the horse will be less likely to drink adequate amounts. In addition, keeping it warmer in the winter. Some horses do not like to drink cold water, particularly if they're older horses with sensitive teeth will be important.
And very occasionally, a few years ago we did have an outbreak of colic at one barn and the assessment of the situation, we realized that there had been a short in the electrical fencing. And the horses when they tried to drink out of the automatic waterers, were getting shocked.
So sometimes looking in to make sure that the situation is normal that there aren't any problems that aren't obvious when you first evaluate them.
3- Parasites - Ginseng :
Parasites are a big problem for colic, but primarily in youngsters because youngsters don't have the immunity that older horses do.
So whereas an adult horse that's exposed to ascarid eggs on the pasture is able to clear them and not develop a severe ascarid infection, the young horse will quicky develop one which can lead to colic and particularly at times, dewormed with something that kills off a large volume of adult parasites, they can get an impaction.
The picture on the right here, there's a fairly graphic picture of ascarid impaction of the small intestine in a young horse. So ascarids particularly in young horses can be a significant problem.
In addition, small strongyles are usually called Cyanthostomes, can be a problem for all ages and are the one parasite where we are seeing the greatest amount of resistance to our routine dewormers or anthelmintics. So knowing your parasite and having adequate parasite control can be very important in trying to minimize colic.
4- Sand :
Michigan, and I didn't realize when I moved here that Michigan was basically a sandbar. I was kind of shocked coming most recently from California that there was actually sand in the soil in Michigan. But there is a large amount and so we had lots of sand colic in California and we continue to have lots of sand colic in Michigan. Much of Michigan has sand in its soil. And so any horse that's on a sandy pasture or fed off of the ground, is at risk for developing sand colic.
This picture actually an x-ray taken of a horse with sand colic and shows sand inside the abdomen of the horse. So this is actually outlining the large colon. This very white material in that x-ray is actually sand that's settled down into the large colon. And as you can imagine, just like on the beach as it settles out and fills up and fills up, it can ultimately obstruct that large colon and cause an impaction.
5- Poor Dental Health:
Poor dental health is certainly a predisposing factor. Every year we get older horses that come in with impactions because they're unable to masticate or chew their food adequately. When a horse has a severe abnormality to their mouth like this horse in the below picture, they're not going to be able to grind their food effectively and the surface here is very irregular and it's supposed to be in a horse's mouth but if they have these severe points.
So you can see in the rostral or front portion of this set of teeth. You can imagine that this horse is not going to be able to have that nice rotary movement that they use to grind their feed and so they're going to swallow feed that is much longer fiber and have a much greater risk that that fiber will impact them down the road.
6- The Use of NSAIDS:
The use of drugs, and it doesn't have to just be non-steroidals but that's certainly one of the more common drugs that we see problems with, can also predispose for colic.
So non-steroidals like Banamine or Bute are the common terms for these drugs, can predispose horses to colic because of the increased risk of causing both stomach ulcers or gastric ulcers or colonic ulcers which occur in the hindgut of the horse. And these can result in recurrent and sometimes quite severe pain in a horse when they're used either excessively or, in some situations unfortunately, even when they're used appropriately horses can develop ulcers in either the stomach or the colon.
7- Foreign Bodies :
Other factors that play a risk for colic - foreign bodies. We had a horse in just this winter that ate its buddy's blanket. of course it was a young horse, a yearling. They're much more prone to doing that and ingested a fairly long piece of the blanket which subsequently obstructed its distal intestine requiring surgery.
Every year we have a horse that does something like that whether it be twine, or a blanket was quite impressive.
8- Uterine Torsion :
Mares that have recently foaled are at much greater risk for developing what's called a large colon impact - or torsion which is a surgical lesion.
9- Older horses " Lipomas " :
Older horses have a greater risk of developing fatty tumors in their abdomen and these fatty tumors can actually hang off of the intestine somewhat like a tetherball and wrap around the intestine and strangulate it or cut off the blood supply requiring surgery to fix it.
How to prevent colic ( Decreasing risk factors )?
So how do we prevent colic? Well, unfortuately, the best management in the world can't guarantee that you will never have a colic but there are things we can do to try to minimize the risks.
1- Make feed changes slowly :
Making feed changes slowly is very important. If you do decide to switch over to a new feed or add something to your horse's diet, whether it be to try to get the animal to gain weight or to try to give them some particular source of energy or vitamins, etc, you need to do it carefully and slowly.
- When you add a new grain, start out mixing in small amounts with the old grain and then slowly transfer them over to it.
- When you turn a horse onto pasture, make sure you do it slowly particularly in the spring when the pastures have the highest sugar content and are at the greatest risk for not only causing colic but potentially laminitis.
- We know that sweet feeds or what are also referred to as concentrate feeds can predispose to colic symptoms and should never be fed in a larger than two or three pound at any one feeding. If you feed more than two pounds, actually much of that sweet feed grain will not be digested in the small intestine and will actually make it to the large colon being fermented there and causing gas and potentially problems associated with colic.
In addition, sweet feeds don't buffer the stomach nearly as well as hay feeding does. And so when you feed sweet feeds or concentrates, the pH in the stomach drops more severely than it does with hay resulting in an acid environment and making the likelihood of ulcers, stomach ulcers, worse. If you are going to feed sweet feed, it's probably best to feed it after you've fed some hay so that you have a nice thick hay mat that's buffering the stomach. And certainly, it's also probably best if you are going to feed sweet feeds that you don't feed them before you ride. Probably the best thing to feed before you get on your horse, particularly if you're going to have a heavy work, is again some hay so they have a nice hay mat in their stomach to kind of buffer for their job.
I just want to mention that there is a difference between sweet feeds or concentrates and what are called complete pelleted feeds.
Complete pelleted feeds are labeled as such because they contain all of the nutrition a horse needs to survive. And so a horse can live completely, healthfully on a complete pelleted diet with no hay at all. Other than the fact that the horse will probably be lacking the opportunity to chew because they'll be ultimately ingesting pelleted diets more rapidly than hay. These diets provide everything that a horse needs and the big difference besides the fact that it's adequate in calories and protein and vitamins is that complete feeds have a lot of fiber in them which we'll not necessarily in the concentrates. So to be called a complete pelleted feed, it must have greater than sixteen percent fiber in it. And so if you're looking at a pelleted feed, all pelleted feeds are not necessarily complete feeds unless they say in it they can provide the complete nutritional requirements of a horse including a fiber of at least sixteen percent.
2- Always provide fresh water :
Other ways to minimize the risk of colic, obviously always providing fresh water, cleaning the water buckets and tanks regularly and making sure that they don't freeze in the winter. Alternatively, especially if you travel and you worry about your horse maybe not drinking as well when it gets water from a different source. Just like you or I, they can taste a difference in water.
You can also train your horse to drink an electrolyte source as well. And there's some recent evidence that suggests that feeding a slightly sweet water, so adding sugar to your water you can actually get your horses to drink more - that they develop a taste for that as well. So if you get your horse to a point where they actually like those types of water, then you can add that to water at a show or when you're traveling and the water will be more palatable to the horse.
If you do that though, it is really important to make sure you still provide a fresh water source with no electrolytes or sugar so that if the horse just wants water and doesn't have a salt craving, it has something to drink. So you'll have to provide two different types of water whether it be electrolytes or sugar and then fresh water.
3-Parasites / Infectious diseases management :
As far as parasite management, the bottom line in today's day and age is that with resistance factors and with heavily parasitized pastures, you really need to do more than just increase the frequency of deworming.
With the fact that dewormers , many parasites are resistant to some of the most common dewormers like Ivermectin. Really the only way you can know if you're doing an effective job is to do an egg count on the feces of your horse. And this doesn't necessarily have to be on every single horse, you can collect a couple of samples from horses in a couple of different environments and run those a couple times of year and generally they're fairly cheap to do and cost less than the dewormers and will help you determine if you're actually - the dewormers that you're paying for are actually doing the job we need them to do.
In addition to fecal egg count and alternating products, pasture management is going to become probably one of the other tools for our future in parasite management because with increased resistance in deworming, we're just not going to be able to use a lot of the anthelmintics as effectively and so rotating pastures and dragging pastures, etc, is going to become very important to try to minimize parasite contamination and parasites as a cause of colic.
If you are raising young horses - foals and weanlings, it's very important that those animals be in your cleanest pastures because we know they're the most susceptible because their immune system is not geared up as well as an adult horse to fight off the parasites that they ingest. So young stock should always go on your cleanest pastures.
Besides all of this information, we do know there are certain bottom lines and one of them is that you should always deworm for tapeworms once a year after the first frost, killing frost, and then currently the drug of choice is a drug called Praxiquantel which is currently available in several combination forms. Strongid is also effective against tapeworms although the efficacy on tapeworms is not nearly as high as Praxiquantel and you have to double dose them with it to have an - to kill off, I think it's approximately forty to sixty percent of tapeworms.
4- Dental Care :
Additional ways to decrease risk factors is dental exams and good dental care. So generally most veterinarians will say an annual exam to check for whether or not a horse needs to have its teeth floated is helpful. That will depend again on the horse. Older horses or horses with severe problems like the picture in the below of this horse with a severe parrot mouth, these are animals that will need probably more frequent floating because they're going to prone to developing severe problems.
And truthfully, once you can manage them when they have small hooks and small waves, it's a lot easier on the horse, the veterinarian and your wallet than it is .
If you wait until they have severe problems and need to do fairly aggressive floating. There are, just a brief mention, there are a lot of equine dentists out in the world these days and an equine dentist is not necessarily a veterinarian. There is a difference - there are places that train lay people to be dentists. And while certain, I'm sure there are a fair number of equine dentists that are not veterinary trained that can do a decent float, there are some advantages to having a veterinary dentist because not only can they do dental care, they also are capable of looking at the whole horse, doing a physical exam, they understand the drugs that they use and have, understand the potential risk factors etc,.
So you will get a little bit more, or I personally think a lot more out of using a veterinary dentist for your dental exams and dental care.
5- Sand :
As far as sand goes, living on a sandbar the way we do, the bottom line with prevention of sand colic is to prevent ingestion of sand. And so there are many products out there that are marketed to help clear sand. But the best way you can prevent sand colic is to try and prevent your horse from eating it and that can be done by several ways.
- One is put - if you are feeding in a place that doesn't have any grass and it's a sandy lot, is to put mats or even carpets underneath the feeders so that if the food is pulled onto the ground, the horse isn't eating off the sand.
- And then those mats can be swept or shaken periodically to get any sand that might accumulate on them off.
- Prevent horses from eating the stuff that they pull out and throw all over the ground or limit the amount of time they have access to a sandlot if they tend to be a horse that vacuum-cleans and will hoovers around the sandlot looking for any last little bit of grass.
- Not allowing your pastures to get too short so that they're less likely to rip the roots up and ingest sand as well. Or if worse comes to worse, feeding them indoors may be an alternative as well to minimize sand ingestion.
- As far as trying to increase the clearance of sand there is limited data really that says that psyllium or what's commonly called SandClear is effective in removing sand. The jury's still out if you will. It may bind sand and may alter the motility of the GI tract such that it helps clear it, but it certainly is not the magic bullet and will not prevent sand colic. So it can certainly be used in adjunct with these management recommendations but shouldn't be used with the assumption that it will prevent all sand colic that you might see.
6- Drugs :
If you do have to use drugs like Bute or Banamine which are called non-steroidals, make sure you use them as minimally as possible and make sure you watch for signs that a horse may be starting to develop problems with them. The signs that we typically look for in horses that are developing non-steroidal toxicity are : a decrease in appetite, mild colic signs after eating, decreased interest in grain, weight loss, and in more severe cases you might see swelling under the chin, between the front legs, along the belly, or in the sheath or mammary tissue.
If you see these signs, these signs of swelling is a concern and you should contact your veterinarian to have them do a more thorough physical exam and potentially a little bit of bloodwork.
The problem with non-steroidals is what can happen is : if your horse develops non-steroidal toxicity whether it be gastric ulcers or colon ulcers, they will show signs of colic at which point you may administer a dose of non-steroidals like Banamine to control the pain which actually continues or exacerbates the damage and they will re-colic. And if you keeping giving the drug, even though you're controlling the pain temporarily, you are actually worsening the disease.
Colic Treatment :
Probably the key to treatment of colic in terms of successful treatment is to recognize the problem early.
Certainly our world leads to a better outcome. We are much more successful in having our patients go home if they're colic is recognized and treated early. We may be able to correct problems by management, for example an impaction ,if it's mild, we might be able to just increase water consumption or even just pass a tube and give them water, force them water to try to resolve it versus if it's been going on a long time or the bowel's compromised it may be very difficult to resolve. And with sand early on, before it severely impacted or accumulates to a significant degree, you may be able to just manage the horse by making management changes and allowing it time to clear the sand that has already accumulated. So early recognition will really help you in terms of dealing with colic when it comes your way.
As far as the initial colic treatment that your veterinarian will probably do, it will depend to some degree on what he or she finds when they examine your horse. The good news is that really the vast majority and probably less than ten percent of horses that colic actually require referral or colic surgery. As a resident I was shocked when we did ambulatory practice, how many of the colics that I saw out in the field really resolved with just maybe one or two treatments versus my experience in the hospital was that 50 percent of colics or more needed surgery. So the truth is most of the horses that you and I own out in the field will have mild episodes of colic that never really require having surgery.
- So the general treatment for colic when your veterinarian comes out to look at the horse, first of all they'll do a good physical exam, assess the horse for pain, for gum color and hydration, for bowel sounds and also look at the manure production, water intake, etc.
- A rectal exam is probably one of the most commonly preformed diagnostic tests to look again, to palpate to see if you can feel an impaction or evidence of a twist, etc.
-Passing a stomach tube or what we would call a nasogastric tube is helpful for two reasons -
- one, since horses can't vomit like people, if there stomach gets distended with fluid, they will - they can get very painful and so decompressing the stomach will help them a lot in terms of pain control and being able to manage them.
- On the other side, if a horse does not have a lot of distension of it's stomach, you can use the stomach to treat colic. So if you think you have an impaction, giving oral fluids by stomach tube fluids and salt will help to soften that impaction and control it or to resolve it.
And pain medications that we use vary but in general I would say the more common ones we use are non-steroidals again, alpha two agonists which is Xylazine , or most people might know it as Rompin, Detomidine and then Torbugesic with the additional drug of Boscopan which is antispazmodic.
And then oral fluids generally in most colics that you find basically mild signs and no clear evidence of severe disease. When you pass a tube, giving some fuilds with electrolytes and possibly some oil is often a diagnostic and therapeutic type of procedure.
Like I said before, most colics that your veterinarian will come out to see really are going to respond with just one or two treatments. It is unusual for a horse to continue to colic after being seen once or twice and being treated as I've just described. However, there are times where your horse does not respond and you're stuck with neeidng to make a decision as to whether or not you're going to try to keep having your veterinarian treat it at home or whether or not it's time to refer to a surgical facility. And this is something I would strongly recommended everyone to consider before they're ever faced with the problem because it's much harder to make that decision when you're under stress and anxious about your horse's wellbeing.
So having a clear plan on what you would and wouldn't do if you have - if one or the other of your horses colic, prior to that ever occuring it will take away a lot of the stress in that decision making when you're faced with it. So knowing what your plan would be helps because if the animal does not respond and the veterinarian feels that it would be indicated to refer it, it's nice to know okay, with this horse we do want to do that and hook up the trailer and off you go.
If in the situation that that's not an option, for whatever reason the horse has got other problems, it's a disease, it's unlikely to be fixed even with surgery, sometimes the kindest thing you can do is to not let your horse suffer and make that decision again. But it will help you a lot if that decision is made prior to having to be faced with it because it's quite difficult to do when you're just stressed and in a situation with a painful animal.
If you do come to a referral hospital like MSU, what exactly are we going to do?
Well, we are going to repeat some if the things your veterinarian did in part because we want to feel it for ourselves so we can assess progress, etc.
And two, because sometimes things change. With trailer rides, we do term the therapeutic trailer ride where sometimes just a ride to the clinic will fix a horse which is a wonderful outcome.
- So a rectal exam is one of the first test we will do at a hospital. - We will pass a stomach tube again because of the risk of fluid accumulation and the fact that they can't vomit, we need to decompress them because if there stomach gets very distended, it can be life-threatening. They can either, rarely, but occasionally rupture their stomach or sometimes spontaneously re flux even though they can't vomit, fluid will actually come up their esophagus and potentially they can aspirate it and have problems with pneumonia. So it's really important to pass a tube and make sure that's not going on.
- And if not, potentially give oral fluids like we talked about before.
- Abdominal ultrasound is probably the one tool that in the last ten to fifteen years has become a huge part of our repertoire, I sometimes feel like the ultrasound is my right hand and is a very useful diagnostic tool.
The picture below is actually a picture of several loops of very distended small intestine.
You shouldn't be able to see these balloon-type structures in the abdomen. And the fact that you are seeing them can be a very strong indicator that the horse has a twist or a strangulation of its small intestine.
So abdominal ultrasound is commonly done unless we are very comfortable with the diagnosis before we actually reach for the ultrasound.
- Abdomenocentesis (An abdominal tap or a belly tap ):
some people will refer to it is when we prepare a little sterile field on the ventral part of the horse's belly and put a little local anesthesia and take a sample of fluid that bathes the intestines and the abdomen.
So this fluid that kind of keeps everything moist.
And we evaluate that fluid for its color, its protein and its cell count and those can be indicators of compromise to the intestine.
The picture below is several different samples of fluid and you can see normal being the first sample on the left and getting progressively more abnormal, darker color and even looking a little bit bloody or hemmorhagic.
And just assessing color and protein can give us a good indicator whether or not the intestines of the horse are potentially being compromised helping us to determine whether or not .
We should recommend the horse have a surgical exploration or colic surgery, or to continue to try to treat them medically.
- IV Catheterization :
IV fluid therapy is probably one of the most common things we will do with horses with colic, especially if we cannot give them oral fluids because there stomach is distended and they're not absorbing oral fluids so the placement of an IV catheter and IV fluid therapy to rehydrate them is not only important for the fact that it rehydrates them, but when the intestines become dehydrated, they actually loose their motility and so trying to get things to start moving and maybe resolve an impaction, is very important to try to potentially help resolve a medical colic.
- Abdominal Radiographs :
Abdominal x-rays are useful in some situations because horses' abdomens are so full of hay or fiber, you do not get the same kind of detail that you would in a dog or cat or human x-ray of the stomach or the abdomen. However, in adult horses we do still x-ray them primarily to look for two things; sand and potentially what are called enteroliths or stones in the GI tract. In smaller horses like miniatures and foals, x-rays are more helpful because they do enable us to look for either severe gas distension like the picture below, which may potentially help us determine whether or not the horse has a twist or something that requires surgery.
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| Gas distension in equine xray |
Many horses that do come to the hospital do not need surgery to repair them. They may simply need to be rehydrated and that restores motility and resolves whatever spasmodic or impacted problem they have.
Mild impactions of feed or sand, many of those horses we can manage with stomach tubes, oral fluids and pain meds, and fluid therapy.
This is a picture of a horse who's actually got a nasogastric or a stomach tube in and a muzzle so he can't pull it out and is receiving both oral fluids and IV fluids in an effort to try to resolve an impaction.
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| Horse who's actually got a nasogastric or a stomach tube |
Horses that come in with stomach or colon ulcers, those are considered medical diseases, they will not be cured with surgery and so trying to manage them with drugs that help heal gastric ulcers or colon ulcers and prevention of further exacerbation is the tenent of therapy. And then the gas or spasmodic colic which is really a diagnosis that's made after the fact - so a horse comes in with no obvious reason for often a very violent colic and the horse gets better either on the trailer ride in or after rehydration. Depending on the other findings, sometimes it's the diagnosis that they've had some gas distention and their intestines have spasmed and they've been painful as a result of that.
If your horse does come to a referral hospital like Michigan State University, the average cost for medical colic, it really does vary depending on how long the horse is in and how severe their colic is, but probably kind of a general range is usually about twelve hundred dollars or upwards. Sometimes they can be several thousand if the horse just doesn't resolve the disease quickly or requires long term IV fluids or intensive care, it probably would be twelve hundred to twenty five hundred is a good range. Generally they're in the hospital a little less than a week. They may receive intravenous or oral - and oral fluid, pain control, and then the key once they resolve their colic, the keys that we require before we will send them home is to make sure that they're back on normal feed and normal water intake and passing normal manure.
So before we will send a horse home that has had a medical colic, we want to be sure that they've completely resolved it and they're as close to normal as they can possibly be in a hospital setting.
When do we - how do we decide if your horse needs surgery?
- There are many factors that come into this and so I'll touch on a few. But probably the number one reason that we will determine a horse needs colic surgery is pain. Pain that is either not responsive to pain meds or persistent pain.
- In those situations it is often due to the fact that whatever's going on in their abdomen is a surgical lesion because those do tend to be persistant and very painful diseases. Other strong indicators that your horse may need surgery again, unrelenting or violent pain, severe distention of the intestines, the horse may appear bloated and when we rectal them there's so much distention that you can't even get your arm in, ultrasound findings like I showed you earlier of distended loops of the small intestine, reflux when a stomach tube is passed, and again, pain that even if it's not severe is persisting for several days. So despite medical therapy, every time you try to feed the horse they get painful again.
These are just some pictures of horses going into surgery. When they're anesthetized they're picked up by a hoist by their legs and placed on a surgery table which is then wheeled into surgery.
This horse has been anesthetized and laid down. Once it's in surgery it's kept under anesthesia by the gas machine which is shown in the picture .
Surgical lesions vary. This is an example of a horse that had a twist or what's commonly called a twist or a large colon volvulus where the large intestine basically twists itself around and cuts off its own blood supply.
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| volvulus |
And you can see that this picture - the intestine is fairly severely damaged. It's got - it's black and green in spots and probably needs to be removed, that section of it.
Fecalith :
This is an example of what's called a fecalith which is essentially feels like a stone but it's a very firm compressed mass of ingesta and it's fairly common in miniatures again because of their abnormal eating behaviors and in foals.
And so this little guy came in and had a fecalith obstructing his distal intestine and we could not, as you can imagine, this would be very difficult to soften with electrolytes or to lubricate with oil and ultimately this little guy needed surgery to remove that.
- Enteroliths, I mentioned earlier that we can see on radiographs, these are two examples of them.
They're actually formed by minerals, they actually form stones and can be fairly large. I've seen one that's been the size of about a volleyball in a horse.
These are much more common in western horses - California and Texas predominantly but we do occasionally see horses that present with enteroliths or what a lot of people will refer to as stones in the GI tract.
These obviously when they're this big cannot be managed medically.
When they're small, occasionally horses will actually pass them
in their manure and so they can pass them before they become a severe problem.
Sand impaction that does not respond to medical treatment ?
Occasionally, and it's not ideal, but occasionally horses with severe sand impactions will have to have surgical correction because they cannot break down the sand themselves.
And the sand can settle out and actually almost appear to be as hard as concrete.
And so they require surgery where we actually go in and break down that impaction and empty it out of the intestines and then sew up the intestines and put them back.
In addition, horses that are at risk for surgical colics or sand colics are horses that are fat because of the risk of strangulating lipomas.
- Small intestine Lesions :
And horses that tend to eat everything in their environment because of the risk of sand ingestion.
This is a picture of a horse with actually a similar lesion and a twist of its small intestine and you can tell they're much smaller loops, they look like giant sausages, if you will.
And again, the blood supply was compromised because of a strangulating lipoma which was the fatty tumor I mentioned that can hang like a tether ball and wrap around the intestine. This horse had to have the intestine removed and the healthy parts reattached and then it was recovered uneventfully.
This is a picture of a strangulating lipoma.
Again, the dark loop is the intestine and this large mass is the fatty tumor and the tether ball or stalk that it hangs off of has actually twisted itself around the intestine cutting off its blood supply and it subsequently had to be removed at surgery.
Surgical costs in todays day and age, if a horse comes in for colic surgery it does depend a little bit on what type of surgery it has, but kind of the estimates we give are anywhere from three thousand to seventy five hundred dollars for the entire surgery and post-op recovery.
With surgical small intestinal diseases generally having a greater expense in part because the horses often take longer to get back onto food and get off of fluids and antibiotics.
With large intestinal problems, they tend to have them, generally have a more rapid recovery.
On average, horses that have colic surgery will be in the hospital about a week give or take a few days. And again, this is in part to make sure that everything is going well and that the horse is eating and drinking and passing manure normally and hasn't had any complications.
Peri-operative Complications :
Complications that we worry about in the immediate post-operative period, we worry about :
- Anesthesia because we have a thousand pound animal that is asleep and now is going to wake up laying on a mat and we have to hopefully get them up safely without injury. When horses have colic and distension of their intestine, they're more prone to having ileus which is a medical term for poor motility of their intestine and this is actually worsened by many of the things we have to do. Anesthesia increases that risk, handling the intestine also increases that risk so post-operative ileus is a common complication though usually not a long term complication.
These horses are often very sick because their intestines are so badly damaged, they've absorbed a lot of intestinal toxins that can make them sick. They have catheters in their veins. And again, with being so sick that they can have problems with catheter infections, incisional infections, laminitis, abnominal incisional hernias, and sometimes they can develop scar tissue in the abdomen that can result down the road. Sounds like a lot of people lost sound - I hope it wasn't anything critical. As far as when your horse does have colic surgery, what's the long term prognosis? So what's the chance your horse will come back to being a normal healthy horse? Well with large intestine colic surgeries, it's very good again, with exceptions. But in general, if you look at the literature and certainly at our success rate, probably ninety percent of horses will go home. So certainly a fairly good prognosis. Small intestine is a little lower than that and there are certain things that will increase or decrease that percentage, but generally the average is seventy to eighty percent of horses will go home in the short term and do well. Because a true diagnosis isn't always made before we go to surgery, unfortunately it's difficult to give people a really accurate prognosis until we get in there. And that - and certainly the next few days if the horse develops any complications is really the key to determining if the horse is going to have an excellent prognosis or not. Ways to minimize your stress when your horse - whether or not your horse is going to have colic. There is equine insurance that's available that will provide either medical insurance, medical/surgical insurance where if you get a policy, they will pay a certain amount of the costs. Usually you settle, you set the fees as well as mortality insurance which just provides that if the horse doesn't survive, they will reimburse you for the cost of your horse. In general, the cost of insurance is cheaper than the cost of going to a referral hospital certainly for a year and does definitely minimize your stress about the possibility of occuring. So other ways is to set aside a fund so that you have - so that if something does happen, you have a source of income. If you do go out of town and leave your animals with other people, make a plan - have a plan, have numbers available and have it thought out exactly what you would and wouldn't do should your horse have colic and require colic surgery. And that's the end of my lecture and I'd be happy to take any questions. I see that there's been a lot of questions and answers by Dr. Garcia. If people have a additional questions, I will certainly be online for for a bit longer so ask away. Somebody just asked a question about how much colic insurance costs. I would say in general medical insurance for colic or for medical/surgical insurance is usually about four to seven hundred dollars a year. Most companies require if you're going to have medical/surgical insurance you also have mortality and that's where the additional cost usually comes from. There is a question about the use of Banamine on the farm and Banamine is a fairly potent pain reliever and there are situations where horses are very painful and to decrease the risk of the horse injuring itself or other personnel, I think Banamine can be used judiciously but with any other drug - as with any other drug does have potential side effects and so using it once in certain situations a good idea. But repetitive use can get into trouble I guess would be my comment. Oh, there's a lot of questions. Let's see. Okay, someone asked what is a long term prognosis of small and large bowel colic requiring surgery? Well, you're right. We're talking about short term. With large colon, the long term prognosis is fairly close, I would say probably again, eighty percent or so. With small intestine, the long term really depends on the study you look at. But the small intestine, you can have anywhere from long term survival of about a year or more being about eighty percent, some report a little less than that - maybe sixty five to seventy five percent. There's a question on whether or not rolling can make colic worse. There's really not any research. Most people, the reason that your veterinarian or most people will say don't let your horse roll, there's a risk that your horse will hurt itself or whatever. And because you could argue with certain types of colic, displacements, etcetera, moving may actually help restore the appropriate position of the intestine. but generally, rolling is considered a bad idea because the horse can hurt itself. So most of the time we will recommend that if your horse is trying to violently roll, you should probably get it up and walk it and try to stop it from rolling. There's a lot of questions coming in here. As far as Metamucil or Psyllium for the treatment of sand. I would say that use of those drugs has not been definitively shown to be one hundred percent effective. But it also has not been shown - there are some studies that it shows it may have some benefit in helping to clear sand and so I think it's a good idea if you know your horse is ingesting sand, to try a product like that but I also think that the best way to prevent sand colic is to try to limit the ingestion of sand. Somebody else asked a similar question on the preventative medicine which I'm assuming when you're talking about preventative medicines for sand colic you're talking about SandClear type of products or psyllium. And again, there is data that says - conflicting data, there's a little bit of data that suggested it may actually increase clearance of sand but it's certainly not the magic bullet. And to prevent it you need to control the ingestion. A question that's come up is a horse that has had colic surgery in the past at greater risk for having another colic episode? On average, with certain diseases, yes. There is an increased risk so what's called the large colon displacement, those horses have a higher risk for having a large colon displacement down the road as well. There's a question about does beet pulp cause colic? And beet pulp feed appropriately has not been associated with an increased risk of colic. When a horse has colic surgery, the recovery time for colic surgery is a very good question. Generally the rule of thumb is after colic surgery ninety days before you have your old horse back. The first thirty days are spent in a stall completely stall-rested. The horse can be hand walked as much as you'd like but it cannot be, do any kind of trotting or other exercise. After thirty days, the next thirty days up to sixty the horse can have a little more activity, can have a small paddock if you'd like, but again no major exercise. And then after sixty days, a horse can gradually be returned to work. The things that might affect that timing is whether or not the horse has had complications associated with the surgery which might change that ninety day period. Does exercise help produce the chance of colic/ In studies that have looked at risk factors for colic, horses that are outside that are not stabled that have access to pasture feeding or are fed longer periods of time etcetera, have a decreased risk. So certainly it would seem to imply that being able to move around improves - decreases the risk of colic. But as far as does exercising you horse so taking it out and jumping it every day, those types of things has not really been shown. There's a question about whether or not horses colic with a change of season, is this rare or is it common would be the flip side. Like I said earlier, we seem to have every year there does seem to be an increased incidence of colic associated with changes in temperature I would say. Although in a study looking at risk factors, that was not actually shown to - prove out to be a risk factor specifically. But it does seem that when horses, when there's a very cold snap or a very hot increase in temperature that we do see an increased incidence of colic. But it doesn't appear to be specifically associated with the temperature so it must be something else that's occurring at the same time. Well, if there's not any more questions, which I don't see any more, then I think we're done.
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