Equine Colic Update

Are you prepared for this equine emergency?
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Are you prepared for this equine emergency?

Colic is frightening, and for good reason. It can come on without warning, often without an obvious cause. And while the vast majority of horses recover, most without surgery, it can be fatal.

? Paula Da Silva/arnd.nl

? Paula Da Silva/arnd.nl

If your horse colics, your actions can help ensure that he survives. In this article, Janet Johnston, DVM, a staff veterinarian who focuses on gastrointestinal disease at the University of Pennsylvania's New Bolton Center, explains what to expect and how to handle this emergency. (For some tips on preventing colic, see "Block Colic" below.)

What You'll See
The classic signs of colic tell you that your horse is in pain. Pay attention if he

  • goes off his feed and shows little interest in grass.
  • curls his lip, grinds his teeth or shows other signs of mild distress.
  • doesn't pass manure in a normal time span?overnight, for example.
  • passes hard, dry manure or has diarrhea.
  • paws the ground or stands stretched out with his legs parked out in front and behind.
  • repeatedly turns to look at his flank or nips or kicks at his belly.
  • lies down and gets up (or tries to roll) repeatedly or sits on his haunches like a dog.
  • progresses to persistent rolling, which can be violent.

Not every colicking horse will show all these signs. Cases vary and, like people, some horses are more stoic than others in the face of pain. A little investigation may turn up other indicators. Check for

  • abnormal gut sounds. "It's a good idea to invest in an inexpensive stethoscope and be familiar with your horse's normal gut sounds before he shows signs of colic," Dr. Johnston says. Listen on each side by placing the stethoscope (or, in a pinch, your ear) at his flank, in front of and below the point of his hip. Normally, you'll hear several gurgles a minute with a louder rumble every minute or two. Silence is not good; neither is excessive noise.
  • elevated heart rate. Move the stethoscope to his chest, beneath his left elbow, to check his heart rate. (Or, without a stethoscope, find his pulse at the facial artery where it runs across the jawbone.) Using a watch with a second hand, count beats for 10 seconds and multiply by six to get the rate. A resting rate above 50 beats per minute indicates distress.
  • abnormal temperature. A rectal temperature over 102 F may indicate infection or inflammation.

The signs don't tell you what's going on inside. Your horse's gut may be distended by gas, blocked or even twisted. (See "Inside Story" on page 2 for details.) If gas is the only problem, he'll be better when he passes it. But some other conditions are life threatening. Since you can't know at the outset exactly what you're dealing with, take any sign of colic seriously.

What to Do
"If your horse is mildly uncomfortable and quiet?not trying to roll?it's probably safe to watch him for a short period," Dr. Johnston says. "If he's in greater pain or if his discomfort persists after an hour or two, that warrants a call to your veterinarian." If you're in doubt, call and explain your horse's signs?it's better to be proactive. Meanwhile,

  • take food away. "Impactions are a common cause of colic, and you don't want your horse to eat anything that might add to an obstruction," says Dr. Johnston.
  • keep a close eye on him. His signs may take a turn for the worse or seem to improve but then return, so watch for changes. "As long as he's quiet, let him rest in his stall?constant walking just exhausts people and horses," Dr. Johnston advises. But walk him if he tries to roll. "You want to prevent rolling because that could displace the colon, turning a simple gas colic into a more serious case," she says.
  • give a single dose of Banamine (flunixin meglumine) if your veterinarian agrees and you have this prescription medication on hand. Banamine, a nonsteroidal anti-inflammatory drug, seems to ease belly pain and may help your horse weather a mild colic episode. "Some people advise against this out of concern that the drug will mask signs of a potentially surgical colic, but in my opinion, one dose won't do that," Dr. Johnston says. A safe dosage rate is 1 milligram per kilogram of body weight, or 500 milligrams for a typical adult horse, every 12 hours.
  • don't repeat the dose. "Keep in mind that it will be half an hour to an hour before the drug takes effect, so don't give a second dose if your horse isn't better right away," says Dr. Johnston. "Higher doses and multiple doses may mask serious signs."

Don't wait to call the veterinarian if your horse doesn't improve in a couple of hours or if his signs worsen or return. "Often people find the horse sick in the morning, watch him all day and then decide as night is coming on that it's time to get help. That's not good for anyone, especially the horse," Dr. Johnston says. "In a surgical case, there's a window of opportunity, a matter of a few hours, before serious damage occurs."

Block Colic

Cut colic risks with smart management:

Control intestinal parasites. Strongyles and other parasites can damage your horse's intestines and are a top colic cause. Work with your veterinarian to set up a deworming and parasite-control program.

Make sure he drinks. Water keeps food moving through his gut. If your horse doesn't drink enough, he's at risk for an impaction. Give him continual access to clean water. Offering salt, feeding mashes or soaked feed and warming water in cold weather are ways to increase -water consumption.

Feed forage. Your horse's digestive system is set up to process high-fiber forage like hay and grass. Large amounts of grain may raise the risk of gas and impaction. Meet most of his nutritional needs with forage, and divide his concentrates into several small feedings a day.

Avoid feed changes. Changes in concentrates or hay?or sudden access to pasture?can trigger colic. Gas production often increases as the beneficial microbes in your horse's gut adjust. When you do make a change, do it gradually over a period of days.

Turn him out. Light exercise and constant nibbling during turnout help keep the intestines in good working order.

Stick to a routine. Abrupt changes in lifestyle are linked to increased colic risk, so be as consistent as possible in work, feeding and turnout schedules. If there's a big change?stall rest, a move to a new barn, travel to a competition?be alert to the risks.

Don't rush meals. When your horse exercises, his circulation sends blood away from the digestive tract to his muscles. He also sweats, losing fluid. Follow the one-hour rule?wait an hour after feeding before you ride, and wait an hour after riding before you feed.

Check his environment. Patrol for bits of plastic and baling twine or other debris your horse could accidentally ingest. Check for poisonous plants and signs that he's chewing fences or other objects.

Cut sand intake. If your horse is fed in a sandy paddock, put his hay in a rack with rubber mats below. If he's turned out in an area with sandy soil, consider feeding a psyllium supplement. Psyllium turns into a gel when wet and may help move sand through the gut.

Arrange a dental checkup. If your horse can't chew his feed properly, he's at greater risk for impaction.

Barn Call
The veterinarian will ask about your horse's history?how long he's shown signs of colic, when he last passed manure, when and what he last ate, whether he has colicked before. She'll examine him for clues to the severity and cause of his condition. Besides vital signs and gut sounds, those clues may come from

  • mucous membranes. Gums should be moist and healthy pink, not dry, dark or bright red or purple, Dr. Johnston says. The vet will look for a toxic line, a red line that appears above the teeth when toxic compounds build up in the blood. Prominent blood vessels in the gums or the sclera (whites of the eyes) are another sign.
  • capillary refill time. The vet can test capillary refill by pressing a finger on your horse's gum to briefly block blood flow and then watching to see how long it takes for color (blood flow) to return. Anything over two seconds suggests that your horse is dehydrated. Pinching a fold of skin on his neck to see how quickly it snaps back is another test for dehydration.
  • rectal examination. A rectal exam may help the vet figure out what's happening in your horse's gut. She may be able to identify a displacement or an impaction in the large colon or locate areas that are distended with gas or fluid, for example. "Some practitioners use portable ultrasound units as part of the exam. I rely more on physical signs and the rectal exam," Dr. Johnston says.
  • gastric reflux. The vet may pass a tube through your horse's nose and down the esophagus to the stomach to draw off the stomach contents. A large amount of gastric reflux (fluid and undigested food) tells her that whatever is causing the colic is preventing the stomach contents from passing through the digestive tract.

Through the same tube, she may administer mineral oil and water to lubricate the gut. She may also give your horse medication intravenously, Banamine or an analgesic (painkilling) drug such as Rompun (xylazine) or Dormosedan (detomidine hydrochloride).

If your horse's pain isn't severe, he isn't dehydrated and the exam doesn't turn up anything that suggests surgery, he'll probably be able to get through the episode at home. Your veterinarian will give you instructions for his care. He'll need to be watched closely until his signs subside.

Afterward, Dr. Johnston says, "Keep an eye on him for a day or so." Be sure he's comfortable, his heart rate and gut sounds remain normal, his appetite returns and he passes normal manure. "Skip grain for a day and give him small, frequent feedings of good-quality hay. Controlled hand walks and grazing can be included," she adds. "If he continues to be OK, gradually return him to his regular diet and routine work."

At the Clinic
If your horse is dehydrated, needs more intensive management or has severe signs that indicate surgery might be necessary, he's likely to do better at a clinic that can provide a higher level of care than he can get at home. "The most telling sign is persistent pain, especially pain that persists after a drug such as xylazine or detomidine has been administered. A persistent heart rate above 60 can be telling in a ?brave' horse who shows few other signs," says Dr. Johnston. "A horse with large volumes of reflux or signs of dehydration usually needs fluids, and that's best done in a clinic."

Even if the signs aren't so clear, you may decide to take him in if you can't provide the care he needs or if you're in an area where it's difficult to get veterinary help quickly. "Pay attention to the weather. If he's not better and a storm is on the way, it may make sense to go before the storm makes travel too difficult," she adds.

At the clinic your horse can be closely monitored around the clock and get fluids through a continuous IV drip. At New Bolton Center, Dr. Johnston says, "We have a large nursing staff and a new facility with a camera in each stall for constant monitoring. And if the horse takes a turn for the worse, a qualified equine surgeon, internist or critical-care specialist is right there."

Clinic veterinarians also have access
to ultrasound and a battery of lab tests that can provide information about the nature of the colic. For example, peritoneal fluid (the fluid that lubricates the abdominal cavity) can be drawn with a needle and analyzed. That may be helpful in deciding if your horse needs surgery, Dr. Johnston says, as long as results can be obtained quickly.

Some types of colic are best treated at a clinic even when surgery isn't required. For example, a section of the large colon can move up and become trapped over a ligament between the spleen and the left kidney. There are two common nonsurgical fixes, Dr. Johnston says: "The first is to give the drug phenylephrine, which shrinks the spleen, and mildly exercise him to see if the colon will free itself from the ligament. The second is to anesthetize your horse and roll him in a way that may move the colon back into place." Both methods have risks?and when they don't work, she adds, "Surgery is the next step."

The cost of clinic care varies with location and with the way the clinic fees are structured. If your horse is referred to a clinic, you should expect an emergency fee. Some clinics bundle costs for various procedures into one set fee; others may have a lower emergency fee and separate charges for each individual test or procedure. "The overall cost is very dependent on the underlying problem, how sick your horse is and whether surgery is required. A simple, uncomplicated medical colic may cost several hundred dollars, but if your horse needs intravenous fluids and more intensive care, the price can go into the thousands," Dr. Johnston says. "Cost is something every practice is wrestling with. The ultimate goal is to do our absolute best for the patient as cost-effectively as possible for the client."

It helps to be prepared. Know where you'll take your horse if he needs clinical care and how you'll get him there. Know what you can pay and how you'll cover the cost, maybe through insurance or money set aside before he gets sick.

Inside Story

"Colic" is a catchall term for belly pain from just about any cause. Here are some common and less common variations:

  • Gas colic is discomfort brought on by excess gas in any part of the intestines. It's common, and the outlook for recovery without surgery is generally good.
  • Anterior enteritis is inflammation in the section of the small intestine closest to the stomach. The cause isn't always clear. The small intestine stops working and becomes distended with fluid that backs up into the stomach. This is usually treated medically.
  • Impactions typically develop when a wad of undigested feed blocks the flow through the intestinal tract. Most impactions can be treated medically, but -severe ones may require surgery.
  • Ileal impactions occur in the last section of the small intestine, near the -cecum. Two factors seem to be associated with blockage here?infestation
    with tapeworms and ingestion of coastal bermudagrass hay, which is widely fed in the Southeast.
  • Sand colic develops when a horse takes in particles of sand or grit as he grazes or consumes his feed. The sand settles in the gut, and over time it irritates the intestine wall and may build up to create a blockage.
  • Enteroliths are intestinal stones. They form when minerals build up around something indigestible that the horse consumes, and a large one can block the intestine. They're usually treated surgically.
  • Large colon displacement is just that?a section of the gut out of place.
    It's fairly common because parts of your horse's large colon can move freely
    in the abdomen.
  • Large colon volvulus occurs when a section of the colon moves out of place and twists. It's life threatening because the twist may strangulate (cut off blood supply to) the affected section, and it requires surgery.
  • Strangulated intestines -develop in several other ways. Older horses sometimes develop tumors -(strangulating lipomas) that cut off blood supply in the small intestine. Or a section of the small intestine may get trapped in a space between the liver and pancreas (the epilioic foramen). This is rare but seems more common in horses who crib. Intussusception occurs when a section of intestine telescopes into itself. Strangulations and intussusceptions are treated surgically.

Surgery
Some types of colic can be fixed only surgically. If the gut is twisted, for example, the blood supply may be cut off (strangulated) and sections of intestine will begin to die. Those sections will have to be removed (resected) if your horse is to survive. But even when the exact nature of the problem is unclear, Dr. Johnston says, some signs point to surgery:

  • persistent pain, especially lack of response to analgesic medication
  • abnormalities detected on the rectal exam
  • large amounts of gastric reflux
  • markedly abnormal peritoneal fluid

The nature and severity of the problem affect the cost. Quotes for colic surgery can range from about $5,000 for a simple large-colon displacement to $10,000 and more for a strangulation in which sections of intestine are removed. The cost can be higher if your horse develops complications postsurgery.

"People used to fear colic surgery, and fifty years ago they had good reason?many horses didn't survive it. But a lot has changed since then. A better understanding of the development of the disease and improved surgical techniques and medications have greatly improved outcomes," says Dr. Johnston. "For the best outcome, go to the most experienced clinic within reach, and go sooner rather than later. Timing can make the difference between success and failure."

Your horse is monitored closely after surgery, receiving intensive care as needed, and he stays in the hospital until he's eating again. How long that takes depends on the case. "For some conditions, such as large-colon displacement, we reintroduce water and begin to offer small amounts of good quality hay as soon as six to twelve hours after surgery," Dr. Johnston says. There's a longer delay after small-intestine surgery, but either way your horse doesn't go home until he's back on full feed. "We usually start back on something like senior feed, which is formulated to be easy to digest," she adds.

Your horse goes home with instructions for feeding and aftercare. You'll need to monitor his temperature, keep an eye on the incision for abnormal swelling or signs of infection and restrict his exercise. "Your horse needs time to heal from surgery," Dr. Johnston says. Generally, she recommends

  • 30 days of stall rest with hand walking,
  • 30 days of turnout in a small paddock with controlled exercise. He may need sedation initially to minimize exertion and
  • another 30 days of turnout at liberty and light work under saddle?no jumping or hard work with weight on his back.

"Most horses return to a reasonable level of athletic performance after surgery," she says. Several studies put the rate of return to full performance at about 70 percent, even for racing Thoroughbreds.

Is a horse who colics once more likely to colic again? Statistics say so, but they don't tell what will happen with your horse. "It depends a lot on the cause," Dr. Johnston says. "One horse may travel in hot weather, not drink and develop an impaction?a one-time event. Another may have a delicate digestive tract and have recurrent bouts of gas colic. Or a horse may develop painful abdominal adhesions after colic surgery. Each patient can have a unique set of problems.

"The thing to remember is that a successful outcome depends on many factors," she adds. "Being proactive and seeking veterinary advice early and referral to a clinic if necessary are the absolute best steps you can take to give your horse the best chance for survival and a long, productive life."

This article originally appeared in the November 2012 issue of Practical Horseman magazine.SaveSave