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2004 Spring 

 

Confronting Colic<

Colic…it is a word that can strike fear in the heart of horse owners. Actually, some owners think of it as nothing more than an inconvenience. They go to their trusty horse medicine cabinet or dig around in the tack room a bit and find their tube of flunixin meglumine (aka Banamine®) and give it to their horse and they are home free. But… what if it doesn’t work? Uh-oh -- you’re thinking, you mean sometimes that doesn’t work? Yep, that’s what I’m saying. Some of you have unfortunately dealt with a significant colic already, but if you haven’t before, this article will hopefully not only help you with dealing with one but ultimately will help in preventing colic in the future.

Okay, let’s get back to basics. Most of you have heard this little talk from me if I’ve ever treated a horse for colic at your place, but bear with me for the people who haven’t heard my little soapbox. Colic means abdominal pain. It is not a descriptive term describing symptoms although most of us (including me) will describe our horse as acting “colicky” and assumptions of what your horse is doing are automatically made. Most of the time colic is caused by a gastro-intestinal (GI) problem. However, other conditions can cause colic in horses as well. Kidney disease, liver disease, peritonitis (infection in the fluid surrounding the GI system), urinary tract disease, or foaling or reproductive problems can all be initially diagnosed as a general “colic” problem before further diagnostics--and these would all cause abdominal pain since all these organs are found in the abdomen. I’ve likewise been called out for a “colic” horse and found horses with high fevers (hey, they wouldn’t eat), hoof abscesses (they continued to act like they wanted to paw with that foot), dental abnormalities (again they wouldn’t eat), tying up (they acted very uncomfortable), the list goes on and on. Although conditions such as these may have some similar clinical signs, these wouldn’t be true “abominal” pain conditions. So you can see how the word colic may get overused in horses. It is for this reason we start asking you questions when you tell us your horse is “colicking”. We’d like to rule in or out some of the conditions that could be giving you a false colic before you administer your cure all medicine flunixin meglumine (Banamine®) and cover up signs of fever or pain or hurt the kidneys of a horse that is severely tying up.

Okay, now that we all know what colic actually means and we’ve briefly described some other causes of colic apart from GI problems, we will focus more on GI disorders resulting in colic symptoms. Types of colic you can get are numerous but are generally divided into two different categories. 1. Medical, i.e. those that are able to be managed and treated with medicine and supportive care and 2. Surgical, i.e. those that surgery is required for the horse to survive. Just a quick note, the medical ones are the ones to get if you have a choice, but you knew that. Likewise you can break down these two categories as well. Medical colics can range from gas (most common), simple impactions, parasitic infections, colitis, chokes, mild sand colics, etc.. Surgical colics range from volvulus (twists in the GI tract), vascular deficits (lack of blood supply to a certain portion of the GI tract from parasites migrating, a twist, or a bad impaction), displacements (GI tract in the wrong place), entrapments (GI tract flipped over a ligament in the abdomen), intussception (intestine going into another section of intestine), enteroliths, pedunculated lipomas, severe sand colics, severe impactions, etc.. There are several other less common reasons for both of these types as well, but this is a pretty comprehensive list. Some of these conditions are easy to diagnose and we can get you pointed into the right direction easily. Some of these conditions are harder to figure out and we tend to treat them symptomatically and supportively until further diagnostics can be made or a referral to a surgical facility is recommended.

Most of us know what the normal clinical signs of colic can include. Symptoms such as pawing, rolling, lifting the upper lip, refusal of grain (major surprise to most owners when their chow hound won’t eat), buckling of the legs as if they are weak, kicking at their belly, looking at their belly, stretching out as if they are going to bow, laying down, getting up and down over and over, etc…are often seen and attributed to abdominal pain or “colic”. Individual horses can respond very differently to pain. Certain horses (their owners affectionally call them “wusses”) will flail on the ground and you swear they will be leaving this life soon and they will only be experiencing a gas colic and once they pass gas they are fine. Other horses will stand stoically through severe surgical conditions and their dire circumstance may be under appreciated without a complete physical examination. Each horse is different and their condition should not completely be based on clinical signs; however, most horses do tend to go by the book and the worse the condition the more severe the clinical signs. While we are discussing clinical signs and what to look for, let’s do a quick discussion on what NOT to do. 1. Do not force your horse to walk hours upon hours. If your horse isn’t improving after at least one hour of walking, chances are 5 hours aren’t going to do anything more than tire him and make him weaker and dehydrated. 2. Same thing goes for lunging. If you were experiencing abdominal distress, would you go out for a jog to make yourself feel better? Of course not, so don’t expect your horse to want to do it either. 3. Give a dose of Flunixin meglumine (Banamine®) and if no change, do not keep repeating two or three times to see if multiple doses work. I will allude to several reasons why you shouldn’t first reach for this medication before evaluating your horse. Definitely do not repeat the dose if the first one doesn’t work; there is obviously more wrong than just gas if it doesn’t. 4. Do not call everyone under the sun BUT your veterinarian. If you are concerned enough to make 15 phone calls to several horse friends and colleagues and attempt all their tried and true remedies, then please make at least call number 2 or 3 be to your veterinarian. Okay, with that off my chest let’s get on to evaluating your colic horse.

A good physical examination is imperative when trying to decide what type of colic with which you are dealing. A complete physical examination includes temperature, pulse and respiration. Ruling out a fever helps decide if the horse is acting dull due to a virus instead of an actual colic. Increased pulse and respiration are common with pain and the actual value of them help veterinarians make decisions on how severe the pain may be or if the horse is beginning to go into shock. Mucous membranes (the horse’s gums) are evaluated for color and for capillary refill time (when you push on the gums how long it takes for the color to go back into the area). Dark mucous membranes with poor refill time often indicate shock. Gut sounds are listened to in all four quadrants (high and low on both sides of the flank area). Normal gut sounds should mimic your stomach rumbling; abnormal gut sounds are like rumbles echoing through a cavern (gas bubble) or complete absence of gut sounds can indicate different problems. After the initial examination Flunixin meglumine is often administered to evaluate how the horse responds to it, i.e. does it relieve the pain and decrease the pulse and respiration. A rectal examination is then performed to evaluate the GI tract and see if there are any abnormalities. A stomach tube is then passed through the nostril and down into the stomach. Horses cannot vomit and their stomach can actually rupture from pressure if fluid is backing up to it. By pumping a bit of water through the tube and then siphoning it off, a negative pressure can be created to remove extra fluid off the stomach. Presence of gastric reflux (fluid accumulation on the stomach) can indicate complications. I have had gastric reflux out of a horse’s stomach fill a 5 gallon bucket and it was likely close to rupturing at that point. If no gastric reflux is discovered, fluids and mineral oil are often administered. By the time this is all finished, hopefully the Flunixin meglumine is starting to take effect and the horse is improving. If the discomfort is continuing, sometimes an abdominocentesis (aka belly tap) is obtained as well. A belly tap is performed by carefully placing a needle into the lower abdomen of a horse and hopefully getting a few drops of fluid from around the horse’s intestines. The color and turbidity (cloudiness or clearness) of the fluid can give us diagnostic tools on what is happening to your horse. The above findings will then allow the veterinarian and the client to discuss what the next step in the horse’s therapy should be.

Most colics are medical colics and most medical colics are gas colics. Gas colics are just what they sound like--pain from gas distention in the GI tract, usually in the colon. As I said, this is the most common type of colic and yes...this is the type of colic that is usually easily treated with flunixin meglumine (Banamine®). That’s why it usually works and everyone thinks it is the wonder drug of the equine world. And don’t get me wrong, it usually does do a really good job with gas colics. But here’s the kicker...it works two different ways. 1. It helps as an anti-spasmoditic which helps relax the GI tract and allows the gas to continue to pass to get out the back end. That is why when you treat a colic with flunixin meglumine and they start passing a lot of gas, horse owners get all excited. Non-horse owners just don’t understand this and think we’re weird, but that is another topic entirely. But flunixin meglumine also works another way by 2. acting as an analgesic. This means it helps control pain or i.e. it covers up pain. This attribute can actually cover up symptoms temporarily and make owners think that their horse is better if it’s not. So worse case scenario - the flunixin meglumine kicks in, makes the horse not feel the twisted colon as bad and the owner believes the horse is improving and goes to bed and finds a dead horse in the stall the next morning. Yes, I know, I’m being morbid--but I want to impress upon you the importance of either contacting a veterinarian for further evaluation or at the very least, continuing to monitor your horse for a while after colic signs subside.

Simple impactions we have discussed before in previous newsletters. Often we relate these to problems with water consumption, especially in the winter months as discussed in the last couple newsletters. An impaction isn’t rocket science; it’s simply an impacted amount of feedstuff or feces in a section of the GI tract. We see this more often in winter months because water sources freeze, and the horses don’t have enough water to keep all the dried feedstuffs in his GI tract moist and moving. However, we can also see these for other reasons. Consider the young, pot bellied, unthrifty looking foal with the poor hair coat that you just bought last week at the sale. You think to yourself, I’d better deworm this poor thing. You give him a nice dewormer, a bit extra because you think he looks “extra” wormy, and the bucket load (literally) of roundworms all die at once and head for the exit door. That huge mass of dead parasites can get stuck in one of the twists and turns of a horse’s GI system and cause problems. Horses with bad dental abnormalities that can’t chew their feed well will swallow larger than normal particles of feed and predispose themselves to impacting. Pica (eating abnormal things) can cause problems with impactions as well. When I was young our young filly decided to eat her mom’s tail just because it was there (thick, full and beautiful all the way down to the ground of course) and became impacted with a hair ball. Hey, first hand experience; it can happen. Most impactions can be treated with fluids, fluids, fluids and more fluids. A few impactions get past the point of no return and require surgery to clean out the impacted area. Surgery is often more necessary the longer an impaction is present. Here’s the worse case scenario for an impaction. Your horse is acting “colicky” and you decide to treat with flunixin meglumine (Banamine®) to see if he feels better, and thank goodness he does. Sometimes flunixin meglumine will relax the part of the GI tract that is constricted around the impaction and allow the impaction to pass, but not often. Usually what happens, as we alluded to before, flunixin meglumine will make the horse feel better and the horse will start eating again and everyone is happy. However, the impaction then becomes BIGGER because now the horse is eating more food and it is going to get stuck in front of the impaction that is already there and when the flunixin meglumine wears off the “colic” symptoms will return. Now at this point you need to make the decision to call your veterinarian because if you retreat with flunixin meglumine, the vicious cycle will continue until the pain relief isn’t enough anymore since the impaction is now the size of Bismark and will likely require surgical intervention. Just telling you like it is.

Another common medical colic is an inflammatory condition. It can be inflammation of the colon (colitis), of the intestines (proximal enteritis), of the stomach (gastritis), etc... These can be caused by several different factors including parasites, sand, certain drugs, bacteria, etc... The actual cause is sometimes not even determined but the treatment is usually supportive and similar in all of the “regional” cases. Inflammation of the front end (intestines) usually causes fluid to back up in the stomach and the fluid needs to be drained. It is very difficult to determine between a surgical condition and a medical condition in this case; most of these horses are opened up surgically to rule out surgical problems and then closed back up when they realize it is inflammation. Inflammation of the back end (colon) usually causes severe diarrhea and can be life threatening because of severe losses in fluid and protein in the diarrhea. Most of these respond to therapy in the field, but some need to be referred for more intense management to a referral facility.

Surgical colics are too numerous and diverse to list each singly. What may be helpful is to explain the criteria we use to determine between medical and surgical colics. There are three factors, excluding the horse’s signalment (age, breed and environment), that help us decide whether a horse needs to be evaluated at a surgical facility…1. Non-responsiveness to pain medication. 2. Abnormal rectal findings. 3. Presence of gastric reflux. Regardless of what the surgical condition is, these are the clinical parameters that are most important in our decision. Do we need all three to consider a horse for surgery? Nope. I’ve sent horses for surgical evaluation based solely on the fact that I could not get them comfortable. Conditions such as pedunculated lipomas in older horses can cause severe pain that I can’t control medically, but it will take a lot longer for the other two parameters to be met if they ever are. Regardless if they are, the horse needs surgery ASAP if it’s going to survive. If your horse has all three, then yes our decision is much easier. What does surgery mean? If your horse is deemed to need a surgical evaluation, you will need to transport your horse to a surgical facility. My facility of choice is Purdue University Large Animal Hospital. Your horse will again be evaluated by a surgeon and they will go over their findings, cost estimates and your horse’s prognosis with you before further therapy takes place. An abdominal surgery usually runs between $3000-$5000 for an uncomplicated surgery and post-operative stay. These can be difficult decisions to make in an emergency situation. It is better to sit down with all the parties involved (your family, other part owners of the horse if it is leased, your spouse, etc…) and discuss these situations before they happen. To make this easier you can download our emergency consent form off our website at www.greenerpasturesvet.com (found under helpful resources) or request one to be sent to you that you can fill out and keep on file somewhere easily accessible to the horse’s caregivers or veterinarian in case of an emergency. It will help you go through the steps that are usually needed to make these decisions while filling out the required information.

So what are you telling me Doc, now that you’ve scared the jeebers out of me? How can I prevent this from happening to my horse and me? Husbandry is very important in helping to prevent most types of colic. Static diets without a lot of changes in types can help prevent a lot of gas colics. Prevention of cribbing and air sucking can help prevent gas colics. Timely feedings with smaller frequent meals can help prevent impactions. Good amounts of clean, fresh, unfrozen water will help in preventing impactions. Regular dental work will help the horse grind their feed better and help prevent gas colics and impactions. Regular grazing on quality pastures helps with normal dental wear, lubrication of the GI tract and prevention of impactions. Regular deworming programs helps with colitis, gas colics and prevention of impactions. Regular vaccinations can help prevent certain types of colitis such as Potomac Horse Fever. Feeding horses up off the ground will help prevent consumption of sand and dirt and help prevent sand colics (colitis). As you may have noticed, I’m not really giving you much on helping to prevent surgical colics, because there is really not much we can do. In theory if you do practice good husbandry your chances of a surgical condition are lessened; but I’ve seen impeccably cared for horses have surgical colics requiring life saving surgery. Criteria such as age (e.g. pedunculated lipomas in horses 18 years or older) and areas (e.g. for severe sand colics) can be factors, but oftentimes we do not know why certain horses need surgery and others do not.

Although I cannot give you much to lessen your chances, there are some measures you can take to help reduce your financial risk involved. There are medical and surgical insurances you can take out on your horse to help defray some of the costs of a colic surgery if the need arises. Check out most of your area horse insurance agencies or ask friends in the equine industry, and they will likely point you in a good direction for their favorite carriers. There is also a program through Pfizer called the Preventicare Program which you can enroll. The criteria included in the program states you need to get annual physical examinations, dental care and vaccinations through a qualified veterinarian as well as purchase Pfizer’s daily dewormer and twice annual paste dewormers through a qualified veterinarian. If you do this and get accepted into their program, they will cover the cost of a colic surgery up to $5000 if it is ever required. This will cover up to $5000 but be limited to the cost of surgery and three days of aftercare—so if there are post-operative complications that require the horse to stay for an extended period of time there may be some unexpected costs. Your horse will not be able to enroll if he 1. has had previous colic surgery, 2. has had a history of chronic colic or 3. is under 5 months or over 20 years of age. But, if you enroll your horse into the program BEFORE he’s 20 years you can keep him into the program until he’s 24 years old. You need to re-enroll each year but they send the enrolling veterinarian all the paperwork to help you remember. These are good options for people who feel that surgery will definitely be an option, and it allows you to help reduce some of your financial risk which helps with your emotional risk of the decision as well.

So take home a message from all of this. Good husbandry, careful owner evaluation, early intervention, careful drug administration and future planning can all lead you to a more well-informed and prepared plan of attack against colic. If you have any questions about this article or would like to start your horse on a better husbandry program to help prevent future colics, please contact us. If your horse experiences a lot of colic episodes, further diagnostics may be in order to help get to the root of the problem. If you are interested in further information on Pfizer’s Preventicare program you can click on the link under helpful resources on our website.

Just an FYI - You were probably annoyed during the entire colic article with me alluding to flunixin meglumine the entire time rather than Banamine®. I can hear you now “C’mon Doc, just call it Banamine®. It’s easier to say and we all know what it is”. The problem is Banamine® keeps going on and off the market and I have often been forced to find it by other sources such as compounders or in its generic form. The actual name of the medicine in Banamine® is flunixin meglumine and if you get used to that word and you find a bottle of it in your medicine chest, you won’t think twice about what it is. See, I have a plan. Client education is a powerful thing. (Say it with me…floo-nix-in meg-loo-meen)

 

Did You Know?

Did you know that the horse as a species tends to shed a large number of spores of Clostridium tetani, the organism that causes tetanus? It is one of the reasons that it is important to keep your horse up to date on his tetanus vaccine, especially considering not only do they shed a lot of it but they’re so darn susceptible to it as well. It is also important in consideration with your small ruminants you have on your farm. Sheep and goats housed in conjunction with horses are more likely to contract tetanus, and their vaccinations should be maintained up to date as well.

 

Flu/Rhino Vaccines

The normal influenza/rhinopneumonitis (Flu/Rhino) vaccination protocol that most of you have grown accustomed to has changed slightly, especially in regards to your young stock. It is now widely recognized to vaccinate your young foals three times, one month apart, as part of their initial vaccination protocol. Traditionally, we have treated them once, repeated it in approximately 3 weeks, and then kept them on an adult protocol after that. Now, after the maternal antibodies have worn off at approximately 7-8 months of age, they should receive the three doses for the best immunity boost and protection against these diseases.

 

Spring Is in the Air

Spring is in the air and we’re getting geared up for our quality, preventative care programs for your horses. With vaccinations and dental work filling our days, please keep in mind that you may need to call in advance if you have a specific day in mind for your spring work (i.e. if you have a day off you’re hoping to work with). Many clients have already started scheduling appointments in March and April so call early if you are needing specific day requirements and don’t wait until the last minute unless time is NOT of the essence to you. Thanks for your continued support. We look forward to another healthy year full of quality care for your horses.

 

New IL Permit

The Illinois Department of Agriculture has instituted another safeguard for protecting their state livestock. Beginning February 1st, it is now required to obtain a permit for all imported livestock (including horses) into the state of Illinois for production or exhibition. The permits will be issued no more than 72 hours prior to transport into the state. This means when you obtain a health certificate from us for your horse to enter IL, 72 hours prior to your trip we will need to obtain a permit number for you to put on the health certificate. Likewise, since the health certificate is good for 30 days but the permit number is only good for 72 hours, if you travel into IL again within the 30 days ANOTHER permit number will need to be obtained. There is a phone number we can give you to obtain additional permit numbers (to get you through the 30 days that your health certificate is usable) so you will not need to keep contacting us. Just to keep you up to date.

For those of you who do not know, a negative coggins (EIA) test and health certificate is required any time you cross state lines with your horse. For more information, check out our past newsletters online, 2003 Summer/Fall.

 

Overheard

At the recent conference I attended I was listening to an estate lawyer speak on financial planning for the future. As he introduced himself he was kidding around stating he knew how most people “perceived” lawyers but that he’s seen equine veterinarians put on those big gloves all the way to their armpits and reach into a horse’s “back end”. He then stated, people may think poor of me from a misconception of what lawyers do, but ya’ll just bring it on yourself doing things like that.