Colic and Surgery

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Colic. We all know what it is. We don’t like it and we wish we didn’t have to deal with it. Unfortunately, for as long as we own, train or manage horses, we will have to face it. Colic has been, and still is, one of the greatest concerns of horse owners.

Defined as abdominal pain, colic is really a clinical sign and not a diagnosis. It is also often a management problem caused by how much we’ve altered the horse’s natural lifestyle. Changes in the weather, abrupt changes in feed, too much concentrate, not enough roughage, overexertion, disease, internal parasites and infection (anywhere in the body) are all contributing factors that can lead to conditions such as gas build-up, a twisted intestine, or blockage. Signs of a problem range from mild discomfort to violent rolling and thrashing, but if 30 minutes goes by and the symptoms are unrelenting or worsening, call your veterinarian.

The most common type of colic is spasmodic, in which the intestine becomes overactive and the muscle walls spasm. Fortunately, most of these episodes are minor and relieved with painkillers (often Banamine) and muscle relaxants. However, if your colicky horse doesn’t respond to medication, the veterinarian will usually administer more powerful drugs. Anthony Blikslager, associate professor in Equine Science at North Carolina State’s College of Veterinary Medicine, feels that while these medications are good painkillers, they’re not that friendly to the gut. He has focused his research on COX-2 inhibitors similar to the human drug Vioxx to treat colic without stomach upset. Even though these drugs have been pulled off the human market because of associated heart problems, Blikslager feels that because of the horse’s healthy diet and lifestyle, they have better hearts.

Another option for the vet in the field is to pass a nasogastric tube into the horse’s stomach in an effort to remove excess fluid and gas. Mineral oil, which acts as a laxative, may also be administered to clear a blockage. Many times this will relieve the pain, but if none of these treatments work, the condition is very serious. Rectal palpation in the field and ultrasound at the hospital may find a severe blockage or twist that will require surgery.

It is best to think about the potential for colic surgery and whether you or your clients can afford it before a crisis happens. That way you, or your clients, can be prepared for the worst-case scenario. Generally speaking, Blikslager says a medical colic runs $2,500 to $3,000; $3,500 to $5,000 for a simple surgery and $6,000 to $8,000 for surgery that involves removing intestine. He recommends getting mortality and major medical insurance for your horse. “It’s not as expensive as you think,” he says, and “$7,500 in major medical insurance will cover you for most anything that is savable.” Of course, after care will add to the bill, and prices vary across the country.

Survival rate is directly related to the speed at which the horse makes it into the hospital. David Freeman, professor and associate chief of staff at the University of Florida’s College of Veterinary Medicine, notes that improvements in survival have changed even in the last 10 to 15 years. “One of the biggest factors is that everybody has become aware of the value of colic surgery,” he says. “That includes referring vets, owners, insurance companies, surgeons, and anesthesiologists. People are much quicker about sending a horse to a hospital for surgery than they were 20 or 30 years ago. If horses are coming in sooner then the success rate is higher.”

The most common conditions that require surgery are any type of intestinal displacement of either the small or large intestine. These “intestinal accidents,” as Blikslager puts them, are not the owner’s fault. They often just happen. But when the vet opens up the horse, there are several procedures that may occur. First, a needle may be inserted into the intestine to remove gas, or a flipped or twisted intestine may be straightened out. The surgeon may need to open the intestine to remove hard-packed material or stones. If a blockage or twist has been in place long enough, blood flow may be compromised. In that case, the damaged section of the intestine must be removed and the parts resected. Unfortunately, in cases where there is too much damage or where the location of the damage doesn’t allow for resecting, the horse can’t be saved.

Following surgery, one possible complication is ileus, which is a lack of movement in the intestines due to low-grade damage. If the intestines aren’t able to move food through, it is considered a functional blockage and that, sadly, can’t be fixed. It is also estimated that 50 percent of surgery cases will have other problems in the future.

Survival rates to discharge are 80 to 88 percent in horses that had a completed surgery of the small intestine. Freeman reports that most deaths occur in the first 10 days, and 69 percent of them happen in the first 100 days with a much lower percentage of deaths after that.

The layoff duration varies according to the severity of the initial illness, size of the surgical wound and how the wound has healed. Horses with simple surgeries that recover without complications go home after a couple of days. They are typically on stall rest for two to three weeks and are able to return to full work in six to 10 weeks.

Freeman has seen a number of advances that can improve survival. “The growth in specialty colleges in anesthesia, surgery, internal medicine and critical care have taken colic treatment to another level. Ultrasonography has greatly facilitated the decision to perform surgery and can even identify the specific lesion in some cases,” he says.

Freeman cites improved understanding of the disease itself and its varied causes as areas of future study. Research and special interests have focused on the issues that are critical to survival, and every research project provides good information. Typically, each project looks at very small aspects, which have to be clinically built upon. Still, “we have a long way to go,” says Freeman. “There are a lot of horses we are not saving. A few years from now maybe we could. We need to find ways to prevent colic. That’s probably the biggest challenge we have.”