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Part 3: Surgical Colic

As we saw in the previous part of this series, Medical colics are those which can be managed medically, usually on the yard. However, about 1 in 10 cases of colic require emergency referral to an equine hospital for surgery.

This is what most horse owners are terrified of. The general indicators that a horse has a surgical colic are:

1) Heart rate over 60 that isn’t relieved by injectable painkillers.

2) Dilated loops of small intestine on rectal exam

3) Positive stomach reflux from the stomach tube

4) A definite rectal diagnosis of a surgical problem.

5) “Toxic rings” – dark red or purple gums, that indicate that the horse is going into toxic shock.

Of course, it varies between horses, and the vet has to make a judgment call based on all the evidence available.

We also have to talk to the (by now usually frantic) owners about costs. Colic surgery usually costs between £4000 and £5000, but can easily be a lot more. Even if the horse is insured, it is important to check how much the insurance company will cover – there are a couple of companies out there who will only cover part of the costs of emergency surgery. If in doubt, always call your insurer’s helpline.

However, colic surgery is one of the most genuine emergency operations there is – and it can be truly life-saving….

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The death of Ben Fogle’s dog: his honest grief is helpful to us all

Ben Fogle has written a moving piece in the Sunday Telegraph about the loss of his Black Labrador, Inca. At twelve years of age, she had lost the power in both hind legs. Ben made the right decision for Inca, but it was still terribly difficult to go through the process of euthanasia. His article is unusually frank, with Ben describing how he “burst into uncontrollable tears” on the telephone when talking to his veterinary surgeon father, Bruce, about the situation. Then later, Ben describes the actual act of euthanasia:
“I carried her from the car into the house, burying my face into her fur, and laid her on the kitchen floor. Mum, Dad and my sister were all there. “I lay on the floor, hugging Inca while Dad injected her. Her breathing became heavy. I could feel her heart pounding and the warm blood beneath her skin. I breathed the familiar scent of her fur as I nuzzled into her thick coat. I have never sobbed like that in my life. It was a primal, uncontrollable, guttural sob as I felt her heart stop beating.I lay there on the kitchen floor clutching my best friend, unable to move. Wishing, hoping it was a dream, I held her lifeless body.”
Many readers have commented on the online version of Ben’s article, with some describing how tears were streaming down their face as they read his words.
Ben’s account will come as no surprise to vets and nurses: we witness people going through the emotional trauma of losing a pet every day, or even several times in one day. Perhaps the only surprising aspect is that the depth of grief isn’t discussed more commonly in public. It’s as if it’s only behind closed doors that it’s acceptable to express this level of grief for an animal……………………….

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But can’t he just die in his sleep…..?

This week my Granny died, which was sad for us all but she was very old, had had a wonderful life and her family was with her at the end. She had been in a home for some time and was cared for very well. When she became sick and bedbound, the doctors and nurses worked together to keep her comfortable and pain free, until she slipped away in her sleep. I am lucky in that she was the first person I knew well who has died and this experience has made me understand why many people hope this is how their pets will go. However, to die in their sleep is rarely a pleasant or pain free experience for our animals.

Although, just like people, our pets are living longer and healthier lives, inevitably there comes a time when their age catches up with them and illnesses develop. Advances in veterinary care mean we can do a lot for them but eventually we won’t be able to keep up with their problems. If they were people we would put them in wheelchairs or place them in a home where their needs could be catered for, for example being assisted to the toilet or spoon fed but this isn’t practical, or in most cases fair, to a pet who won’t understand what is happening….

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Colic: Part 2: Medical Colics

In my last piece, I looked at how the vet will examine a horse with colic. Following this, and using all the information from the history and workup, he or she has to decide if the colic is Medical or Surgical. The terms are more or less self-explanatory: a medical colic can be managed with drugs, while a surgical colic needs emergency surgery.

As a rule of thumb, 9/10 colics are medical, and can almost always be managed on the yard.

So, here are the common causes of colic that we see in the UK1 :

1) Spasmodic Colic. This is probably the commonest, and perhaps the least understood; I estimate about 80% of Medical colics are Spasmodic. Spasmodic colic can be caused by a stressful event, mild dehydration, or be genuinely idiopathic (i.e. we don’t know what causes it!). It can also be caused by severe tapeworm burdens. In a Spasmodic Colic, a section of the gut goes into a spasm, preventing anything from moving past it. It can be acutely painful, but usually responds really well to management with drugs. For any horse that has two or more bouts of spasmodic colic, I’d always recommend a tapeworm blood test to make sure it isn’t part of the problem!

2) Impaction Colic. This is more common in some management systems – it is pretty rare, for example, in horses who live on grass. In these cases, the food in the large intestine dries out a bit too much, and turns into a putty-like material. It then gets stuck, typically at one of the 180- degree turns in the Large Colon. It’s also strongly associated with moderate dehydration – as a horse gets dehydrated, he will move water out of the gut in order to keep up his circulating blood volume. This is a clever trick, meaning a horse can survive levels of dehydration that would kill a human. However, if the water isn’t replaced, and he’s been eating dry hay, his gut contents can become so dry they cause an impaction. This is why, many years ago, bran mash and Epsom salts were fed after hard work – both are good ways of rehydrating the colon and Caecum contents.

3) Gut displacements and entraptions. These are a bit of a mixture – some are medical, some are surgical, some look surgical but aren’t, and some can be fixed medically but keep coming back so surgery is eventually needed. What many people don’t realise is that the guts are in constant motion. Occasionally, a loop of intestine goes “wandering around” inside the abdomen, and gets stuck behind something else (for example, into a little gap between the spleen and the kidney). These can often only be diagnosed by rectal exam, and can feel really confusing, where nothing seems to be exactly where it should be! Each case has to be treated on its merits, and many can be resolved by lunging – presumably because jiggling everything around helps the intestines to fall back into their proper places! Personally, however, my inclination is generally to refer the horse as a possible surgical case……………….

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Colic: Part 1: Diagnosis and Workup

It’s something all horse owners dread – colic. However, colic is a symptom, not a disease in its own right, and has a wide range of different causes. This is the first in a three-part series where I’ll be looking at colic in horses – its diagnosis and treatment, and what happens if your horse has to be referred for surgery.

Put simply, all colic is, is abdominal pain. However, before you’re tempted to dismiss it as a stomach ache, it’s worth remembering that the horse’s intestines are as complicated as a major chemical factory! Anything that causes disruption to their function is potentially life-threatening.

Occasionally, colic pain comes from a non-intestinal source, e.g. Liver disease (think ragwort poisoning, or liver fluke), or a kidney issue. In mares, it can also be caused by certain disorders of the reproductive tract. However, the vast majority are due to disease, damage or malfunction of the intestines.

If you call your vet and tell them that your horse has colic, they’ll treat it as an emergency, because it can be….

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Getting ready for an anaesthetic at the vets

At one time or another we all have to face our beloved pets having an anaesthetic which can be a scary process if it’s not properly explained. Fortunately most veterinary practices have a fantastic team of nurses that can help you understand the procedure. (NB. I have used “he” in the article for continuity but this goes for all dogs a

and cats regardless of gender).

To give you a head start, here are some top tips:

1. The number one golden rule for preparing for an anaesthetic is no food after midnight (this does not apply to rabbits or guinea pigs). Also, some practices may give you an earlier time say nine or ten o’clock but the principle is still the same, basically no midnight feasts and no breakfast. The reason for this is two fold. The main reason is to stop your pet vomiting and potentially inhaling it. This can also prevent nausea on recovery. Another reason is to try and prevent any ‘accidents’ on the operating table which increases the risk of contaminating the surgical environment although to safe guard against this, some practices routinely give enemas and express bladders before surgery. So, while it breaks your heart to tuck in to steak and chips with Fido giving you the big brown eyes treatment console yourself with the knowledge that you are actually acting in his best interests to help minimise the risk of anaesthetic.

2. Give your pet the opportunity to relieve himself before coming into the surgery. Obviously this is easier with dogs but while we advise taking dogs for a walk before coming in we don’t mean a five mile hike on the beach with a swim in the sea, we mean a nice gentle walk around the block to encourage toileting. If you bring your dog in covered in dirt and sea water, you’re increasing the anaesthetic risk as we have to keep him asleep longer while we prep him. (See my previous article about how we prepare your pet for a surgical procedure).

3. Tell the nurse when she is admitting him whether you have noticed any unusual behaviour. Vomiting, diarrhoea, coughing or sneezing can all be indicators of problems and may need to be investigated prior to anaesthesia. Also tell the nurse if your pet is on any medication, when he last had it and bring it with you if you can. This way, if your pet needs to stay in after his operation, they will have everything he needs without adding extra to your bill…………

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Equine ER – Dealing with traumatic injuries

I recently had to stop on the side of the road to help out a family whose trailer had rolled over, trapping their horse inside. By the time I’d got past the queue of stationary holiday traffic, they’d already done the first aid basics, and it was great to see how well they’d coped. However, it made me think about what owners can do in emergency situations for shock, trauma and blood loss in horses.

In serious accidents, the most common injuries are probably bruises and lacerations – jagged cuts, caused by broken metal and debris cutting through the skin. However, puncture wounds and broken bones are also not uncommon, and it can be really difficult to determine what’s a mild graze, and what’s a deep, dangerous puncture wound in the field, let alone by the side of a busy road! If you’re faced with a real emergency like this, remember three things – first, make sure you and anyone else around are not at risk. Second, get someone to call a vet and any other emergency services ( e.g. the police to close the road, the fire brigade to cut horses and people out of the wreckage, and of course ambulances for any human casualties). Finally, assess the horse(s) and do what first aid you can at the scene….

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How Do You Know If A Cat Is In Pain?

It sounds like such a simple question, but the answer is actually far more complicated than we think. And it’s not just cat owners who struggle with this question, those of us who have studied these creatures for years still frequently miss signs of feline pain. Because when it comes to showing signs of pain (or any illness for that matter), cats are masters of disguise. In the feline world, complaining gets you nowhere, and showing signs of weakness can get you killed. Sure, some cats in pain will cry out, but if you see a cat crying out in pain, the problem is likely very severe indeed. Besides, cats cry out for many reasons, so even if you do see this, how can you tell if it is due to pain or some other form of stress? Next time you think your cat may be in pain, try to remember some of the following signs of feline discomfort:

• Lameness:
Ok, we’ll start with an easy one. But you’d be surprised how many people come to me with a limping cat who insist that they are not in pain….

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Sammy’s Story – Feline Diabetes Isn’t As Scary As It Sounds!

Sammy is a lovely, and much loved, 13 year old moggie who has always been the picture of health. Healthy appetite, healthy weight and body condition – and he seemed pretty happy too. But a few months ago his owner noticed him at the water bowl more than she used to. At first she didn’t think anything of it, but with the extra drinking came extra urination, and it also seemed to be associated with an increase in appetite. But still she assumed that this was normal as the weather was getting colder and he was spending more time inside. However, at his next annual check-up with me, we found out that he had actually lost almost a pound in the past year. I recommended a blood and urine test and his owner agreed, and when the results came back the answer was clear – Sammy was diabetic.

His owner was in tears. How could she possibly cope with a diabetic cat? She works full time and has two small children, and besides, she has no medical training so how on earth would she be able to give an insulin injection twice a day? She even thought about having him put to sleep because she simply wasn’t going to be able to handle his condition. But we had a nice long chat about what it means to be diabetic and what the treatment would and wouldn’t entail, and by the end of the conversation she was willing to give it a try.

What is diabetes?….

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How we prepare your pet for anaesthetic.

Once you relinquish your pet to the green fairies, you may be wondering what actually happens “out the back”.

Well, wonder no more. Firstly we make sure that we have an accurate weight for your pet as this is what we use to calculate the dose of the drugs that we give your pet. Once we have this we settle them in a kennel with nice squishy blankets while we go and get everything prepared.

If you have opted for, or we have recommended, a blood sample before anaesthesia then your pet is taken to a quiet part of the practice where we can safely take the sample. To take the sample, a patch of hair is shaved over the jugular vein which runs down the side of the neck, to one side of the windpipe and a needle is inserted to collect the blood. Most animals tolerate this quite well with the gentle yet firm restraint that we green fairies have down to a fine art. Some animals on the other hand object quite vociferously and may have to have the blood sample taken once they are anaesthetised. Not ideal but better if they are getting too stressed.

Once the results have come back and been received by the veterinary surgeon, they can decide what to pre-med with and whether the use of intravenous fluids is necessary. Intravenous fluids are usually considered if there is any elevation of the liver and kidney enzymes which show that these organs need a little help during anaesthesia as that is where most of the drugs used are metabolised. Some veterinary surgeons also advocate the use of fluid therapy during routine bitch spays as a spay is a fairly major and invasive procedure and fluids help maintain blood pressure and support the body during this procedure.

There are a few ways that we can induce anaesthesia in your pet. One way is to use the anaesthetic gas and get them to breathe the gas in via a mask or an anaesthetic chamber. This way is usually used with smaller creatures such as rabbits, guinea pigs and rats and they fit into the anaesthetic chamber and can have oxygen administered in this way before the gas is turned on.

More Useful Information

Examining your pet

Simple ways to check the health of your pet. Vets use these techniques as part of their clinical examiniation.

Medicating your pet

Arming you with the same simple techniques for stress free pill giving.

Worming & Flea Treatment

Information and advice in treating your pet for worms and fleas.