Surgery or no surgery?

Dr. Kimberly Brokaw, DVM

(3/2014) One should always know if your horse is a candidate for colic surgery. While every horse owner hopes that he or she is never in the position of having to decide if they need to take a horse for colic surgery, every horse owner should know the answer before their horse colics. The majority of colics that I see and treat are simple colics that resolve with medication, hand walking, and nasogastric fluids. However, for those that don't, surgery may be required.

There are many factors involved in determining if your horse should have colic surgery. When you come home with a new horse you should already know if he is one you would operate on and you should reevaluate this decision every year. There are a number of factors that play into that choice. Is the horse otherwise healthy and likely to survive anesthesia and recovery? Is the horse valuable enough (real value or emotional value) to warrant surgery? Will your horse load in the trailer to go to a surgical facility? Can you afford a $10,000-$15,000 surgery? Will your horse be manageable during the prolonged recovery and stall rest after a major abdominal surgery. Those and numerous other questions should be answered before you have a sick colicy horse and the vet asks you "do you want to go to a referral hospital?"

When I go on vacation my pet sitter has treatment authorization to take the horses to Leesburg for colic surgery should they need it. My one horse is young and healthy and a good candidate for surgery. The other one is old, has arthritis, had to undergo chemotherapy for cancer a few years ago. He truthfully is not an ideal candidate, yet as the owner I have told her that he is to have surgery if he colics and needs it.

There are several different types of colic and differentiating which type the horse has is important for determining what kind of treatment is needed. A gas colic may require nothing more than a couple of medications and a few minutes of hand walking. An impaction colic usually requires a lot more hand walking, medications, and fluid therapy (either given via nasogastric tube or IV or both). Displacements, entrapments, and torsions almost always require prompt surgery for the horse to survive. Colic surgery can be relatively simple and uncomplicated, or can involve major and repeated surgical interventions as well as medications. When necessary, colic surgery is most likely to be successful if it is done early after symptoms begin and before the gut begins to leak intestinal contents.

Recently, a horse belonging to the editor of this newspaper, coliced. He and his wife have owned horses for over 35 years and, like most experienced horse owners, had dealt with a fair number of colics. The editor's wife worked many years as a veterinary nurse in a horse hospital and has lots of experience caring for colic patients at the hospital.

The editor and his wife called me on Valentine's Day while I was out riding my horse. In a calm voice, I was told that Archie was colicing. Not a bad colic, and while they had given Banamine, they wanted me to come out and take a look at him. When I arrived, he was bright and alert but mildly uncomfortable. Heart rate and temperature were normal but his intestinal sounds were too quiet on one side and too loud on the other. We decided to sedate him and pass a stomach tube to give him electrolytes and water. Afterwards, he seemed to be doing well so we put him in his stall to rest while the sedation wore off. I then joined Mike and Audrey in the kitchen under the guise of wanting to see how Archie did when his sedation wore off, but really to eat all of the Valentines cookies that Audrey had made.

After dinner, we went back out to the barn. Archie looked great. He was banging at his stall and wanted his hay. I instructed Mike that he could give him a few handfuls throughout the night and we would see how he did. The next morning I received a phone call that everything was looking good. There were several piles of manure in the stall and Archie wanted breakfast. It was looking like it had been a bit of an impaction and that he was through it. Archie was given a warm mash for breakfast and I was expecting to not hear anything else.

I was wrong. The following evening, I was called back. Archie was painful again. As I walked into the barn, I asked "is he a surgical/referral candidate?" The answer was "no" to surgery, but "maybe" to hospital care. While I had not even performed a physical exam prior to asking the question, it was important information to know as

I designed a treatment plan. There are several things that play into what makes a horse a surgical candidate. Most important is the wishes of the owner. What makes a horse a candidate in my mind versus the owners' mind can be very different. I did not think Archie was an ideal candidate for surgery. His age alone, increased his chances of anesthetic complications. He also had a history of orthopedic issues, increasing his risk of fracturing a leg in recovery. Those, in addition to the usual risks associated with colic surgery, and the months of recovery afterwards, were what made me question if he would be good for surgery. In talking with Mike, he also had the financial reasons. He has two other younger horses in the barn that would require care and any money spent was less money for the others is a medical issue should arise with them.

Archie was tubed again. Examination per rectum was performed and distended bowel was felt. The owners were prepared for a long night of walking. I also left them with several syringes of sedation and pain relief to give as needed to keep Archie comfortable while we tried to see if he could work through the colic.

At 6 the next morning, Mike called to say that the night had been horrible and it had been a real challenge to keep Archie walking and comfortable. I went out to their farm again. There was an odor in the air. An odor that I can't describe other than as the odor of a horse that needs to be hospitalized. I din't have to recommend that option, the Hillmans had already decided on it.

The trailer was dug out of the snow and Archie marched on the trailer. While he hadn't been in a trailer in years, having had a long career of eventing, he felt at ease with the trailer and calmly loaded. I've seen other horses that have refused to load when colicing and unfortunately it has cost them their lives. A veterinary emergency is one time when it is essential that a horse load easily into the trailer. I gave Archie more sedation and pain medications for his drive to Leesburg.

While Archie made the journey down to Leesburg, he did not come home. His intestines had displaced and had started leaking fluid into the abdomen. Even if surgery had been done, the surgery would have been high risk and Archie would have likely not survived. Few do when the stomach ruptures.

When deciding what to write about for this month's paper, Mike encouraged me to write about his horse. I usually wait a few months before writing about a case, especially one where I'm as emotionally involved. It is never easy losing a patient, especially one you've known for years. It is natural to go back and question how you approached the case and what could have been done differently to save him. The initial reaction is to want to send every colic for surgery but that doesn't guarantee survival and the majority of colics don't need surgery. So after much reflection I still believe Archie's treatment was appropriate even though the outcome was not what I wanted or what the owners wanted. Sometimes, even good management will not be enough to have a horse survive colic.

Read other articles by Dr. Kim Brokaw