Browsing tag: horse

Fireworks in the equine world! – How to keep your horse safe this Bonfire Night

This year, 5th November is on a Tuesday – and that means we’re not expecting a Fireworks Night so much as a Fireworks Week!

As prey animals, horses are by their very nature predisposed to panic at loud noises, especially in the dark. Bright flashes of light don’t help either! And panicked horses are rather inclined to run into things and hurt themselves (I’ve spent many hours stitching up horses who have lost arguments with fences, hedges, gates and stable walls).

There are three important elements to keeping horses safe when there are fireworks in the air:

1) Help them to avoid injury

2) Distract them

3) Keep them calm

To avoid injury, I generally recommend that horses be stabled when fireworks are expected. That probably means dusk to dawn for the next fortnight or so, but if possible, find out when displays are expected in your area. You can then focus on those dates and times (but don’t forget that many people will set off a few rockets for themselves and their families). Inside their stables, horses can still become frightened, but they’re not surrounded by the scary noises, and they can’t bolt and get up so much speed, so they’re less likely to cause themselves serious injuries. It can also be helpful to leave the stable light on overnight – more light inside the stable means flashes outside are less visible, but make sure your horse copes OK with the lights on overnight first!

If you don’t have stables, first of all, see if you can borrow one for a few nights, especially if you have a really spooky or nervous horse. If not, the next best thing is to “accident-proof” the field you’re planning to turn them out in as far as possible – make sure the fencing is safe, remove any wire, fill in potholes, etc. Also, consider tying white or pale feed sacks to fencing, to make it more visible in poor light – tie them tightly, though, so they don’t flap and cause a stampede themselves.

Distraction just means keep them busy so they’re less interested in what’s going on outside. This generally means a well filled hay rack, and any toys your horse likes. Turnips on a rope are good, and horse balls filled with food or treats are a favourite with my two, who’ll spend hours chasing the balls round the stable for a mouthful of pasture nuts!

Finally, calming. For a herd animal like a horse, the most reassuring thing is having stable mates within sight/sound/smell – this is vital, and if they can touch noses or groom each other, its even better. However, it may not be enough on its own, especially for very nervous individuals. If your horse is particularly panicky, you should contact your vet (as soon as possible now), as they may need prescription medicines to help them cope. If possible, its best to avoid sedation, as it may lead to the horse becoming more nervous next year (as with dogs and cats), but unfortunately, horses are so big and powerful it may be necessary for their safety and yours. Your vet will be able to advise you on the best strategy for your horses.

There is increasingly, however, a middle road, as there are a wide variety of calmers on the market. Most are based on magnesium or amino acid combinations; these can be good to take the edge off, but usually need long term use. Others (e.g. Calmex powder) are designed to work immediately, although there is often little scientific proof of their effectiveness. Another fairly new product on the market is Zylkene Equine. This is based on the milk protein casein, which studies suggest is broken down in the body into a benzodiazepine-like molecule. This has a similar effect to Valium to reduce anxiety and stress.

As usual, I’d advise you to discuss with your vet the exact product you’re thinking of using, as they’ll be able to give you impartial advice as to how effective a product is likely to be. This is especially important if your horse is on any other medication: just because a product is natural or herbal doesn’t mean it won’t interact or interfere with another medicine.

That said, not every horse needs anything extra – I’ll never forget going to one yard on bonfire night evening and seeing a row of horses lined up at the fence watching the fireworks display two fields off with every sign of enjoyment…

The bottom line is that you need to find out what works best for your horse: every horse is an individual, and they need to be managed as such. We may enjoy the fireworks – but not all of our horses do!

Horses and money – is it really either/or?

With the new financial year, and the recent bad weather, everyone involved in and working with horses is trying to make money go a bit further. Among other issues, the cost of medicines is rising every month (many drugs have seen their manufacturers put the price up 10 or 15% in the last few months), and feed bills are rising due to poor cereal harvests.

As a result, I’ve put together a list of “top tips” for saving money in the coming year.

Firstly, 5 things to do…

1) Make sure you worm smart - which doesn’t necessarily mean often! Many owners still worm religiously every 6-8 weeks; however, recent studies have shown about that 80% of the worms are in 20% of the horses. If your horse doesn’t have a high worm burden, it may be a waste of money pouring expensive wormers down him every other month. In addition, the more wormers we use, the higher the risk of worm resistance – there has been recognised round- or redworm resistance to every active ingredient available in the UK, so the less we use them, the longer they’ll be effective.

The way I like to recommend people go forward is to use Worm Egg Counts – your vet will be able to do these, or will have a lab they send them away to. The test simply takes a faeces sample and counts the worm eggs in it, giving you a good estimate of the number of worms in the horse. Remember, this test can only be done in the warmer months (the worms don’t lay eggs in the winter!), and it only tests for nematodes (round and redworms). To test for tapeworms, your vet will need to take a blood sample, but this usually only needs doing once or at most twice a year.

Depending on the test results, your vet will be able to advise you on the best worming strategy, and if you’ve got a low burden, it may not be necessary to worm at all, as long as your pasture management (poo-picking etc) is decent. I’ve seen horses wormed every month come back with such low counts that we stopped worming completely and, because they weren’t mixing with lots of other horses, they were still worm free a year later. That said, I’ve also seen horses that really do need that regular dose, so it does depend on the yard, the herd and the individual horse.

2) Consider warming up with unaffiliated competitions – and beware direct debits! Skip past this one if you’re not competing – but if you are, it may be possible to affiliate part way through the season, saving money by starting with cheaper unaffiliated events. How much you save depends on your sport, and your area (down here in Devon and Cornwall, unaffiliated events are are usually perhaps half to three quarters as much as an affiliated event), but at the very least you save the up-front cost of affiliation and membership.
That said, you can’t decide to cancel your affiliation if you’ve got a Direct Debit set up to automatcally renew it (as my brother found out this year, when he accidentally rejoined BE…!)

3) Buy medicines online. This is a fairly new area, and can be controversial. However, without any doubt you can save money on prescription drugs if you buy them from a reputable online pharmacy or dispensary. If your horse needs a prescription medicine, your vet is legally obliged to give you a written prescription if you ask for it (although they will normally charge an administration fee). In general, you can get the same medicines online for about half to two thirds the price.

However, its important to make sure you deal with a reputable company: as a rule of thumb, if they don’t ask for a prescription, or they’re not based in the UK, don’t touch them. In addition, you should check to see who is in charge of dispensing the medicines at that company – if they’re legit, they’ll be able to tell you the name and registration number of the pharmacist or vet who is responsible. Having worked in this sector, there are four companies I’ve dealt with who I would consider safe and reliable to buy from (AniMed Direct, MedicAnimal, MyVetMeds and VioVet), but that doesn’t mean that there aren’t other good ones out there. Bear in mind as well that a few companies change their prices through the day, and also make sure that the price includes VAT – if in doubt, phone them up and ask!

Although it seems like a hassle, for long-term medication (like bute or Prascend) or really expensive drugs (like Gastrogard), you can make a massive saving buying online.

4) Shop around for insurance… It may be you can get a better deal from a different company! However, before you change, make sure that your level of cover won’t be affected, and remember that you are legally obliged to disclose any relevant medical history. There are a couple of very bad insurers out there, and some fantastic ones, so do your research before changing – a company with a really cheap premium but who won’t pay out when needed are a false economy.

The other option is to cancel your insurance, and then set aside some money each month in a separate acount to cover vets bills. Do your sums first, but if you’ve got several horses it can save money to do it this way, and there’s no worry about exclusions or wondering if they’re going to pay out.

5) Does your horse NEED all those vaccines? Tetanus is a genuine life-saver. However, not every horse needs every other vaccine. If they’re not competing, not mixing with other horses much and aren’t on a big yard, its worth talking to your vet about flu vaccine, and if they’re not breeding stock either, herpes vaccine probably isn’t worth it.

6) If you have any health concerns about your horse – phone your vet! Most practice do not charge for a phonecall, and your vet will be able to advise you as to whether you need a visit, and if there’s any treatment or first aid you can give. Beware of consulting “Dr Google” – its an easy way to scare yourself, because for some reason, Google always lists the most serious and rare diseases first. If you do want to check out your horse’s symptoms online before calling your vet, I’d advise you to use the VetHelpDirect Symptom Checker – but talking to your vet is likely to be even more reliable!

I once had a client call to arrange a visit for us to “sew up her mare after foaling”. We thought that she meant the mare had torn a bit, but it turned out that she thought the foal was going to come bursting out of the mare’s side like a alien parasite, and she was delighted when we were able to tell her that she didn’t need to spend the £50 for an evening visit as long as the foaling went well…

So, thats your things to do, now five things to watch out for:

1) DON’T skimp on Preventative Health. Tetanus vaccination is a genuine life-saver, and regular, routine dental care will save money in the long run. I once had to spend five hours basically repairing an 11 year old stallion’s mouth because he’d never had any teeth rasped and the hooks had overgrown so much that one day he couldn’t open his mouth enough to chew. For the previous six months the owners had been pouring expensive concentrates into this pony to try and get the weight back on, but it was due to his inability to chew properly. If they’d kept up to date with routine dental care, it would have saved them a lot of money, effort and time!

2) Be cautious with cheap paraprofessionals. There are a lot of horse dentists, chiropracters, massagers, physios and assorted back people out there. Many of them are very good, some aren’t, and a few are downright dangerous. However, it isn’t immediately obvious which is which… There are a couple of things to bear in mind when you’re calling someone out.

Firstly, it is a criminal offence for anyone who isn’t a vet to diagnose a medical problem in a horse (with limited exceptions in the case of farriers dealing with a hoof problem, and BAEDT qualified dentists dealing with dental overgrowths). This means that your insurance policy will be invalidated if they make a diagnosis and act on it; it also means that in law you have no comeback if something goes wrong. In addition, if you allow anyone except a vet to prescribe or dispense a prescription only medicine to your horse (e.g. a dentist giving sedatives), you’re both breaking the law. Remember too, even qualified physios technically need a referral from your vet before they’re permitted to work on your horse.

Secondly, it isn’t necessarily a money saving technique to call in a paraprofessional. I remember seeing one client who had spent nearly a thousand pounds on physios, back people, chiropracters and alternative therapists, all of whom had given her a different diagnosis of her poorly performing pony. When my colleague was called out, she realised immediately that the horse was lame, and dug out an abscess from her nearside hind hoof. The horse was right as rain two days later – all for the princely sum of £48 plus a packet of animalintex.

Thats not to say there isn’t a place for paraprofessionals – BAEDT dentists, farriers, qualified physios and some other practtioners can be great to work with and bring a horse right again, but it needs to be a team exercise, as we all bring our different skills and expertise to the case.

3) DON’T buy ultra-cheap feed and fodder. Cheap, poor quality hay and haylage are never a good place to save money – if you’re lucky, you’re horse will need to eat more to maintain condition, and if you’re unlucky, they’ll suffer lung and sinus problems from spores, and possibly even listeria infection from bad haylage.

4) Be cautious about chopping and changing vets - many people use one vet for vaccines and another for out-of-hours and emergencies, or stud work. Sometimes this can save you money, but it can also lead to problems – a client of mine (who also used two other local vets) nearly lost one of her broodmares to a bad reaction to penicillin. It turned out that one of the vets had noted that the horse had reacted once before, but because they didn’t know she was using the other practices, they didn’t know to tell us. Fortunately in this case the mare survived, but it just goes to highlight the necessity for good communication. If you are going to use more than one practice, make sure that everyone knows who’s involved and who’s doing what, so that we can share notes if needed. Better still, make up your mind who you want to treat your horses, so they can provide continuity of care.

Keeping horses is, by its very nature, expensive. However, with care and forethought, you can make the money stretch a bit further, even as the prices are going up.

The Kinder Cut – Castration of horses

This is the time of year when people start to look at their cute little foals, and suddenly realise they’re starting to grow up fast… As a result, it’s also when we start to get phone calls from people to talk about gelding them.

If you are considering getting a colt gelded (“cut”), my advice would be to contact your vet, who will be able to advise you on the best approach in your particlar circumstances. However, I’m going to try and go through some of the commoner questions below, so you’ve got some basic information on the decisions to be made, the procedure, and what you’ll need to consider.

The first question, of course, is whether or not to get him cut. It’s an important decision, so these are my thoughts…
The majority of male horses are castrated, and for very good reason – very few people have the facilities, the time, or the inclination to manage an entire stallion. The old adage had it absolutely right – “You can tell a gelding, you can ask a mare, but you discuss the matter with a stallion”. Although there are some superbly well mannered stallions out there, it takes years of expert training – and in my experience they’re almost always more “bolshie” than a gelding, and much less forgiving of any mistakes. They are also much more easily distracted (e.g. by a passing mare), and prone to fighting.
Does this mean you can’t train them well and keep them happily and healthily? No, of course not – but it’s a lot harder. The majority of stallions can’t be kept in groups because of the husbandry regimes on most yards, so have to live on their own. That’s not good for their mental health, or their owners and riders! If someone has the knowledge and facilities to bring up a stallion, I don’t have a problem with that, and I wish them luck, but I’ve seen too many bored, frustrated and borderline dangerous stallions who haven’t been brought up correctly, and remain a liability.
Geldings, however, can be kept in groups, can mix with other horses, and are less likely to lose the plot or throw a temper tantrum. They also don’t present you with unexpected foals in your competing mares…
If you decide not to have him done, you need to be sure that you’re doing it for the right reasons. The majority of horses are not necessarily good breeding material – you need to take an objective look at him and decide if breeding from him is actually going to benefit the breed. If you’re avoiding doing it just because you don’t like the thought of the procedure, you’ll need to think long and hard about whether thats in his best interest – or yours.

If you are getting your colt cut, the next decision is when to do it. There are two major concerns – the time of year, and the maturity of the colt. In terms of time of year, it’s best to do it when the weather is cold enough to prevent flies from infecting surgical wounds. Ideally, then, this would be in late autumn or early spring, but gelding him in winter is perfectly acceptable if the facilities are suitable. Regarding the colt’s maturity, there is an upper and a lower limit.
The lower limit is the most rigid – except in an emergency (e.g. a strangulating hernia), I would never geld a colt until both testes had descended into the scrotum – because it’s really important to make sure you’ve got both! This usually happens between 6 and 12 months old, but it is a bit variable. In addition, the colt has to be strong and mature enough to survive the surgery, although with modern anaesthetics this isn’t as much of an issue as it used to be. The upper limit is much more flexible. Stallions into their twenties are castrated fairly commonly, but once they’ve passed through puberty, a lot of the stallionish behaviour is learnt, and won’t be reversed by castration, including some forms of aggression, and mounting behaviour. Sometimes, people like to wait until a colt is 3 or 4 years old before gelding, but I think that often even that is too late – although it does allow the colt to develop more muscle, he’ll also be developing stallion traits. In addition, the younger the colt, the smaller the testicles, and the smaller the testicles, the lower the risk of bleeding during the op. During puberty, the testicles increase dramatically in size, and as a result, their blood supply increases accordingly; the bigger spermatic artery in a post-pubescent colt is much harder to control bleeding from.
As a general rule (and it’s a VERY rough rule of thumb!) I’d normally look to geld between a year and eighteen months old. That said, there are a lot of exceptions – I once had to sort out the castration of a four month old colt because he’d started mounting his mother… There are also a number of opinions about weaning – before, after or at the same time? In this case, I think it depends entirely on the colt in question, and it’s an area (one of many) where I’ll usually defer to the owner’s judgement.

Before you go any further, its a good idea to get the colt thoroughly checked out – both testicles need to be present and easily palpable; if one is “shy” and difficult to find, I usually recommend checking again in a month or so. If it’s still inaccessible, the colt may be a cryptorchid (i.e. a rig, with one undescended testis). These colts should ALWAYS be castrated, and have to be done under general anaesthetic, if possible in a clinic. This is because the retained testicle, being kept at an abnormally high temperature inside the body, is more likely to become cancerous. Also, the defect may be genetic – and if so, he’ll risk passing it on to his offspring.

Once you’ve decided when, there’s another important decision you and your vet will have to make, and that’s the details of the procedure. Basically, there are two factors to decide – firstly, do you want him done “at home or away”? Secondly (a related point), do you do him under standing sedation or down under a general anaesthetic?
Regarding the location, it depends on your practice’s policy and facilities. Many practices now offer castration at the clinic, but the majority of people still choose to have the op done at home. The advantage of having it done at a clinic is that the procedure can be cleaner, and all the equipment and apparatus is there; in addition, many practices charge a callout fee for coming to the yard. However, that’s offset by the fact that you’ll have to transport the colt to the clinic; in addition, I think it’s usually less stressful for the procedure to be done at home, assuming the appropriate facilities are available. Exactly what facilities you need depend on the technique that’s going to be used.

There’s a lot of debate as to this decision, and some frankly ridiculous comments from some badly-informed people out there. I’m going to talk through the options and the pros and cons.
The two main options that you’ll need to think about for the procedure itself are whether to have the op done under standing sedation or general anaesthetic. In some cases, the decision is easy – miniature horses and small shetlands should almost never be done standing, because they’re too small for the surgeon to get good access and control the site, for example. Draft breeds are at a higher risk of eventration (see below, when abdominal contents escape through the castration wound), and so need a different surgical technique, which may be easier under a general; and fully adult stallions bleed more so may need better surgical access – again, a general anaesthetic makes this easier. However, most colts can be done either way, so you and the vet need to decide which you prefer.

Under standing sedation, the colt is given intravenous sedatives (see my blog on sedatives) so he becomes very dopey. He will continue standing up, but his head will drop, and he is likely to adopt a wide-based stance (which makes surgical access easier!). However, its important to remember that he is still to some extent aware of what’s going on, so local anaesthetic is injected into the testicles (perhaps 20ml into each one, plus some under the skin of the scrotum) or into the spermatic cord (although I find that that’s easier said than done, with most colts pulling the testicles up tight to the body wall so the cord is difficult to access from outside) to numb the area. The castration is then performed with the vet working from standing beside the horse. This approach avoids the risk of a general anaesthetic, and means the horse will recover from the sedative faster. However, the degree of sedation achieved is variable, and some colts appear to be more aware of the procedure than one would like, no matter how much sedative you pour into them. There’s also a MUCH higher risk of the vet or their assistants being injured – unsurprisingly, some colts object violently if they realise what you’re doing…
In addition, the surgical access is poorer (the vet is having to work upside down, and largely by feel) so if there is a complication, it is harder to control it.

Under a general anaesthetic approach, the colt is sedated and then given an injection of a general anaesthetic. He’ll become very sleepy, and then lie down. Once he’s out, an assistant lifts up the top leg, giving the surgeon access. The disadvantage is that most vets will only do a GA on a horse if there’s another vet along to monitor the anaesthetic, which may affect the cost. In addition, a GA is a risk in its own right – one study suggested that the average mortality rate from GA in a horse is 1% (although this includes colics and emergency operations – the risk for a young, healthy colt is much lower). On the other hand, the risk of injury to the vet or assistants is much lower, and the risk of surgical complications is also much reduced, as the surgeon can see exactly what they’re doing.

Is either one definitively better than the other? No. However, it is a decision to take WITH your vet, as they may have a preference that will affect their efficiency. For what its worth, I’ve done geldings both ways, and personally I prefer to do them under general, because its safer for me and everyone else around – and if there was to be a complication, I’ve got a better chance of finding and fixing it at the time.

The procedure itself is pretty much the same whichever way up the horse is. Along with sedation, I give an injection of an anti-inflammatory and painkiller, and antibiotic cover (no procedure done on a yard or in a field can ever be truly sterile, so I’d prefer to make sure there are antibiotics on board when we start). In the past, vets didn’t routinely give painkillers as well as the sedation (which contains a painkilling component), but personally I don’t think its fair not to.

There has historically been quite a mystique about the procedure itself – probably because people are a bit shy to discuss it. As a result, there is sometimes serious confusion – remember, gelding is NOT the same as a vasectomy, and it can’t be reversed… Not even (as apparently happened to a colleague of mine) if the client stops you as you’re about to drive off and, holding up a neatly severed pair of testicles, asks the vet to reattach them because she’s changed her mind…

So, here’s a quick run through the procedure:
The area of the groin is scrubbed with a skin disinfectant, and a final check is made that both testes are accessible. Whichever one is held closer to the body is the one I’ll start with, just in case it is retracted later. I’ll then scrub up so my hands are sterile. Some vets wear gloves, others don’t – I don’t think it really matters as long as they’ve scrubbed thoroughly. Gloves add an additional sterile barrier; but on the other hand they can reduce your feel and grip, so it depends on what the vet is happiest with.
Once the scrotal area is scrubbed, the vet will use a scalpel blade to cut through the skin of the scrotum. There are a couple of different options from here on, but the principle is the same; to cut down through the tissue to the vaginal tunic (the membranes that surround the testis itself) and then gently pull the testicle down and out. In an “open” castration, the tunic will be opened, in a “closed” technique, it gets left intact and the testicle pulled down still inside. Once there’s enough slack in the spermatic cord (containing the blood vessels, nerves etc that supply the testicle), the emasculators are applied across the cord, with or without the tunic, depending on the technique. These are a clever bit of kit that crush the cord, preventing it from bleeding, while at the same time cutting off the testicle itself.
(Quick aside here – I was doing a gelding once and, as is customary, I showed the removed testicle to the owner to show it had been done; he was a teenage lad and he fainted dead away. Interesting ethical problem there – do I try and help the unconscious boy, or do I just keep working on the anaesthatised horse who’ll soon wake up? Fortunately, he recovered on his own before I had to scrub out, but he was pretty green around the gills for the rest of the morning…)
In an older stallion, most vets will put a suture through the cord to ligate the artery, but this increases the risk of infection, so we don’t always put one in if doing an Open procedure. After removing the emasculators, the vet will check closely for bleeding from the stump. If there isn’t any, they’ll repeat the procedure on the other side. If the surgery is taking place in the field, the vet will usually leave the incision open for drainage; closing it seriously increases the risk of post op swelling and infection.

As a note, there is always a bit of bleeding after the operation. The rule of thumb is, if you can count the drops, its fine! There’s also invariably some swelling of the sheath, but again, it isn’t usually anything to worry about. If in any doubt though, you should contact your vet. Your vet will give you instructions for post op care, but the most important thing is to keep the new gelding moving, to reduce the swelling and encourage drainage.

The complications to be aware of are bleeding, eventration, and infection.
bleeding is pretty obvious – some oozing from around the incision is normal, but there shouldn’t be any significant haemorrhage from the stump of the spermatic cord. If there is, or if there’s a lot of blood – call your vet! Uncontrolled bleeding is an emergency that may require a repeat surgery to control it.
eventration, is when abdominal contents prolapse through the inguinal canal, and it’s more common in draft breeds. This is the main reason we’d do a Closed castration, as it ties off the tunic; but it does increase the risk of infection. Eventration usually involves some fatty tissue (the omentum) and although it needs urgent surgical repair, it isn’t usually life threatening. Very occasionally, however, it progresses to evisceration, where loops of intestine come through. This is very serious, but (touch wood) it’s also very rare.
infection is uncommon, and usually responds to antibiotics. In a few unlucky cases, though, a schirrous cord forms, where abscesses form in the canal. These take months of management, and in the end, treatment is usually surgical removal of the infected tissue.

These complications are very rare, and even if they occur, they’re usually fixable, so don’t get scared of the possibility! I only mention them so you’ve got an idea of what to look out for.

The last thing to bear in mind is that the gelding may still show sexual interest for some weeks after castration (at least, if he was before), and may even be fertile for a time: although he can’t make more sperm without testicular tissue, there will still be some “in storage” in the spermatic ducts. I always advise that a newly gelded colt or stallion should be isolated from mares for at least 6 weeks, after which any remaining sperm will have died or been flushed out, and his testosterone levels will have declined to the point where he won’t have any hormonal urges.

The bottom line is this: although it doesn’t seem a nice thing to do, for most colts in most situations, gelding leaves them happier and more content than they would otherwise be as entire stallions.

Sedatives and Sedation in Horses

We routinely sedate horses in practice – after vaccination, it’s probably the most common “routine” job that we do. So, what are we doing? How do the drugs work – and why doesn’t it always happen the same way?

“Sedation – a state of rest or sleep… produced by a sedative drug.”

That’s the dictionary definition, and it makes it sound lovely and simple – give a drug, and the patient goes to sleep. Of course, in reality (as usual with anything equine!) life isn’t that easy…

For those who haven’t seen it before, a sedated horse doesn’t lie down, but their head gets lower and lower, and they may require something to lean on to help them balance. It’s also important to remember that a sedated horse CAN still kick – they’re just much less likely to do so! It often seems that the horse is still more or less aware of what’s going on around them, but they’re too sleepy to care about it. As a result, we’d almost invariably use pain relief and local anaesthetic as well if we’re carrying out a surgical procedure.

There are a wide range of situations in which we like to use sedation. Generally, it’s to make the horse more amenable when something nasty or scary is being done to them. Of course, this varies from horse to horse. There are quite a lot of horses out there that need a sedative before the farrier can trim their feet; and there are others that will allow you to suture up a wound without sedation or even local anaesthetic (not recommended, but occasionally necessary).

Probably the most common reasons we sedate horses for are…

1) Stitching up wounds, to stop the horse wriggling!

2) Tooth rasping, especially when using power rasps and dremels

3) Some surgical operations – for example, many vets prefer to castrate colts under standing sedation, rather than a general anaesthetic. This is because sedation is much safer than a general anaesthetic… On the other hand, the surgery is easier and safer (for the vet, as well as the horse) if the patient is completely “out”, so it comes down to the type of horse and the preference of the vet doing the op.

It’s important to remember that all sedatives temporarily alter the way the horse’s brain and body works, and have a serious impact on the heart and circulatory system. As a result, they’re all prescription-only medicines, and your vet will want to satisfy themselves that the patient doesn’t have any underlying heart problems etc before using them. Overdose of a sedative is rarely fatal in a healthy horse, but it can still be dangerous, especially if there is any underlying illness that makes them less good at maintaining their blood pressure. Its also vitally important to tell your vet the horse’s whole medical history if you’re asking them to give a sedative – there have been cases of horses who were being treated with a (very safe) antibiotic (TMPS); the owner forgot to tell a vet this, and the combination of sedative and this antibiotic has resulted in a heart attack (technically, a fatal arrhythmia).

There are three routes by which we normally give sedation:

1) By syringe or in feed.
This is the slowest, least powerful and least reliable way to sedate a horse, but it has two advantages – you don’t need a vet to come and do it, and you don’t need to get so close to the horse to give it.
The drug most commonly used is ACP, sold as Sedalin or Relaquin paste. Occasionally ACP tablets are used, although there are strict restrictions on when a vet is allowed to prescribe tablets instead of paste. There is a newer drug now available as a syringe, detomidine (sold as Domosedan gel), which is absorbed across the membranes in the mouth so shouldn’t usually be given with food, but does work faster and give better sedation than ACP.

2) By injection into the muscle.
Many injectable sedatives can be given into the muscle – this injection is more reliable than by mouth, but requires much higher doses than if given into the vein (in my experience, you need 4-5 times as much, and it takes about twice as long to work). It’s only usually needed if the horse is too wild or dangerous to get a vein, but it’s quite useful to “take the edge off”, and then I can top up with intravenous sedatives if needed. The other situation where I’ve occasionally used it is when a severely colicing horse has to take a long ride in a box to get to a surgical centre. In these cases, I have sometimes given the driver a preloaded syringe so that if he horse freaks out or goes crazy in transit, they can give it something to calm it down and relieve the pain until they arrive.

3) By intravenous injection.
Intravenous sedation is by far the best option if possible – it works fast (usually 5-10 minutes), you need lower doses, and you get much better sedation than by any other route. This is what I’ll be concentrating on below.

There are three “families” of drugs used to sedate horses:

Acepromazine (ACP).
This is a very “dirty” drug, in that it affects a wide range of body systems. It can only produce mild to moderate sedation on its own, and the effects are very variable between horses. It’s important to remember that once sedation has been achieved; increasing the dose WON’T result in deeper sedation, just more side effects. It also has no painkilling properties.
There are two side effects in particular that we as vets watch out for with ACP. Firstly, it can lead to significant drop in blood pressure, because it makes peripheral blood vessels dilate (this is why it’s sometimes used in laminitis). The second effect is much more interesting – ACP is a mild muscle relacant of some muscle types, so it can be useful in azoturia and choke. There’s one exception though (male readers of a senstive disposition, look away now…): ACP is a very powerful relaxant for the retractor penis muscle. This is the muscle that holds the penis in the sheath, and even low doses of ACP usually lead to male horses “dropping” the penis. This can be useful, but unfortunately in some horses (especially stallions, with a larger and heavier penis than most geldings); the paralysis of the penis can be quite prolonged, which can result in penile trauma. In extreme cases, this can be permanent or lead to gangrene, requiring amputation. Bottom line – if at all possible, avoid using ACP in stallions and entire colts!
ACP does, however, have a place in sedation – when mixed with other drugs, it often prolongs sedation and means that the doses of each part of the combination can be dropped, reducing the risk of side effects.
A quick note on ACP tablets – under the current Veterinary Medicines Cascade laws, it is illegal to use ACP tablets instead of paste in horses unless the vet has a clinical reason (unfortunately, price isn’t considered good enough) to think that they are more appropriate. As a result, if your vet refuses to give you the tablets, they’re not trying to rip you off – they’re just obeying the law.

Opiates
Although opiates on their own are only very weak sedatives in horses, when combined with other drugs they lead to much deeper and smoother sedation than any other drug on its own. The drug usually used is butorphanol, which is a synthetic opiate (it’s a mu/kappa agonist/antagonist related to buprenorphine, for anyone interested) that has a fairly good painkilling effect as well as potentiating sedation from other drugs. Fortunately, it also has very few side effects, although its worth bearing in mind that any other opiates (e.g. Pethidine or Fentanyl) that the horse is given up to about 8 hours later won’t work quite like they’re supposed to, as the butorphanol will partially block their activity.

Alpha-2 Drugs
These really are the mainstay of sedation in horses (and in dogs and cats, for that matter). Alpha-2 drugs act by tricking the body into thinking it’s produced too much adrenaline, so it stops releasing it, resulting in reliable deep sedation. They’re also pretty powerful painkillers.
There are three drugs that are commonly used, with slightly different properties. Detomidine and Romifidine are both fairly long acting drugs (30-40 minutes after i/v use), and when mixed with butorphanol are the standard sedative preparation for intravenous use, or on their own into the muscle. Detomidine is also available in a syringe for oral use.
The third drug is xylaxine; this is a bit different in that it gives milder sedation, and only lasts 20 minutes or so. It’s particularly useful for sedating horses for nerve blocks etc, where in half an hour they need to be completely recovered and able to trot up.

Before I sedate a horse, I always have a good listen to the horse’s heart, and check its pulse and colour to make sure its cardiovasclar system is healthy. I’ll then double check it’s not on any medication, and then give i/v sedation.
I like to use either detomidine or romifidine mixed with butorphanol for routine sedation – I personally prefer detomidine, but that’s probably just because it’s what I “grew up” as a vet using! For longer lasting procedures, or if I want muscle relaxation (especially for dentals where I want the tongue nice and floppy!), I add ACP into the mix.
Dosage is incredibly variable between horses and experience and judgement is more important than all the book learning available. As a rule of thumb, the bigger the horse, the less sedative per kilo of body weight it needs (so Shetlands often need as much as a light hunter). In addition, it depends on temperament – the more highly strung or excited, the more sedatives are needed. The other thing to remember is that apparently identical horses, in the same circumstances, may react very differently – the dose that will have Alf so deep his head’s on the floor will have Brutus untouched, while Charlie is in the “Goldilocks” zone where he’s just right. Of course, it also depends how deep the sedation you want – although personally, I’ve found that if you aim for “light sedation” to start with, you usually end up having to top the horse up halfway through.
Once the injection’s been given, it is VITAL to give the horse time for it to work in a quiet, dim, calm place. If the horse gets excited while you’re waiting for the sedative to kick in, it won’t work well. This is doubly true for oral sedatives, but it applies to injections as well.
During the procedure, its sometimes necessary to top up, which is fine – the great thing about the drugs we use is that they work fast enough i/v that you can monitor their effects more or less in real time. Recovery is usually rapid and uncomplicated, although it’s important not to let the horse eat anything until it’s completely woken up, or it may choke.
Very occasionally, I’ve had a horse that refused to wake up, or went too deep. After my first one, I took to carrying the antidote (Atipamezole, aka Antisedan or Sedistop) with me when I sedated sick or old horses. It’s very expensive, but it works within a minute or two to reverse the effect of alpha-2 drugs – and once they’re reversed, the horse wakes up incredibly fast!

In practice, sedating horses is as much an art as a science, and there’s rarely one “right answer” – it depends on the horse, the circumstances, and what you’re trying to achieve. The main purpose is to allow us to treat your horse effectively and humanely.

If you are worried about any problems with your horse or pony, please talk to your vet or try our Interactive Equine Symptom Guide to help decide what to do next.

Rain Scald, Mud Fever and Greasy Heels – Wet Weather Care for Horses

I heard on the news recently that last year was one of the wettest on record. I don’t know if it’s true – but it certainly feels about right! The big danger to our horses from this, of course, is Rain Scald and Mud Fever.

Most people have probably come across Rain Scald on occasions – the scabs hidden away in the coat feel like mud, until you pull them up and see the characteristic “paint brush” appearance as the hair stays stuck in the scab. Rain Scald is caused by a bacterium called Dermatophilus congolensis. This usually lives (fairly) harmlessly on the skin, but if the skin gets and stays wet, the bacteria can invade and set up an infection.

Most cases are mild, with just a few scabs here and there, but (especially in older horses and those with Cushing’s disease) it can be more general and leave large raw patches. Even a mild case can put a horse “off games” if the scabs or raw patches are under the saddle.

Most cases resolve on their own with simple care – gently brush out the scabs, and most importantly keep the area dry to allow it to heal. That said, older horses and those with other diseases may need a helping hand, in which case a short course of antibiotics from your vet will usually clear it up. HOWEVER… Unless the underlying problem is sorted, it will rapidly return! Prevention is far more important, and that means keeping the skin as dry as possible. Remember, if your horse gets wet, that’s fine as long as he can then dry out thoroughly. It’s if the skin stays constantly wet that problems ensue – and watch out for rugs, especially in early autumn! When it’s wet, but not that cold, horses can easily sweat up under their rugs, and sweat seems to be even worse than rain for causing Rain Scald.

The other thing to watch out for, of course, is Mud Fever. This is an infection of the skin behind the heels (its sometimes called Greasy Heels), and is most common in horses with long feathers. It’s a far more complicated disease than rain scald, and has a large number of contributary causes. The most important is wet weather, of course – as the skin gets wet, bacteria can invade, as in rain scald – long feathers keep the water trapped in the area, slowing down the drying, so cobs and heavy horses are more prone. However, mites are also a known cause (the first signs are usually stamping of the hind legs), and its not just bacteria, because some cases include yeasts and other fungi as well. Sometimes, really aggressive bacteria like Pseudomonas can establish themselves, and they can be really difficult to manage.

The symptoms vary, but generally it first presents as scabs in the angle of the heels behind the pastern. If untreated, or as the infection gets worse, cracks in the skin can open up and start oozing fluid and pus, and the legs thicken. Eventually, lymphangitis can occur and ultimately, the skin can slough or even become gangrenous.

Initial treatment is very simple: wash the affected area with a skin disinfectant (like Hibiscrub or similar), and once the scabs are softened, gently wash them off. This may take several days of work! If the infection progresses, or doesn’t improve, you will need veterinary attention.

Most cases respond well to a course of first-line antibiotics (e.g. Penicillin/Streptomycin or Timethoprim Sulpha); however, if it doesn’t respond in a week or so, I would always take a swab for bacterial culture and sensitivity testing. This give you a much better idea what bacteria you’re dealing with, and how best to kill them – I had a case once which turned out to be a multi-resistant Pseudomonas infection, that needed some really powerful off-license antibiotics to resolve it. Sometimes you can use topical antibiotics (creams, ointments etc), and in severe cases, I have occasionally used a “bespoke” ointment that I made up from several different antibiotics and an anti-inflammatory. If there are mites involved, most vets will use an injectable anti-mite drug; however, this isn’t licensed for use in horses so has to be put up by your vet.

As usual, prevention is much better (and cheaper!) than treatment, though, so keeping the heels dry is vital. Sometimes using an aqueous cream like zinc and castor oil, or Vaseline, can be useful in encouraging the water to run off – but if you do use them, make sure you wash it off and dry it thoroughly once or twice a week before reapplying, so it doesn’t get too thick.

Of course, in an ideal world, keep the horses out of muddy fields and trackways… But given the recent weather, I fear we’re all going to have to be a lot more careful to keep our horses and ponies warm and dry this autumn.

If you are worried about any symptoms your Horse or pony may be displaying please talk to your vet or try our Interactive Equine Symptom Guide to help decide what to do next.

Equine Education (Part 2 – Vet Students)

Have you ever wondered who the young person trailing behind your vet is? They appear, at best they’re introduced as “so-and-so, who’s seeing practice with us”, and then they disappear, never to be seen again…

Well, the odds are they’re vet students who are “seeing practice” with your vet.

Training as a vet is a long process – vet students spend 5 or 6 years at university doing lectures, practicals and clinical work. However, in that space of time, they also have to do the equivalent of an extra year of “EMS” (Extra-Mural Studies, generally known as “seeing practice”). This is their chance to get out of the lecture theatre, away from the ivory towers and out into the real world of practice!

As vets in practice, our job is to take these students and teach them the nuts and bolts of veterinary practice. They’ll learn the science, and all the theory, at vet school; however, there is also an art to veterinary practice, and that’s our responsibility. For example, if the client can’t afford the best treatment, how do you proceed? Or if a client refuses consent for a surgical procedure, what other options can be explored?

At the vet schools, students tend to learn a lot about the more esoteric and uncommon diseases, operations and procedures – this is because they operate referral hospitals (although Nottingham uses an expanded version of the EMS system for virtually all their clinical tuition). Although they do have first opinion practices, in all seven schools the teaching tends to be biased towards the rare and exotic. Out in general practice, however, the axiom “Common things are common” applies – for every septic pedal joint, there are dozens of simple hoof abscesses!

It can also be useful to us having students along (opening gates, for example – sounds silly, but when you have yards with five or six sets of gates, it gets very time consuming stopping to open and close each set!). In addition, though, they will often have learnt new approaches, new solutions to problems, that we can use. For example, I once had a student along with me when I was dealing with a stallion with an injury in a VERY sensitive area. To examine it properly, I would need to nerve block the whole area – time consuming and potentially dangerous. However, my student at the time had learnt in her pharmacology lectures that it had recently been discovered that one of the local anaesthetic agents I was carrying was effective through the thickness of the skin. We therefore applied it with gloves – and managed to numb the area enough to examine him properly.

In one practice where I worked, I did an awful lot of equine dental work. In some situations, we used a powered dremel; however, we didn’t routinely carry it, so if there was an intermediate case, we’d usually try and complete the work by hand, rather than come back later. Now, I can assure you that rasping down large hooks and ridges is physically very hard work! Having a student to alternate with makes it go much faster and more efficiently – which often means less time and sedation.

The big problem vet students have, however, is getting enough clinical experience in practice. Some clients are, sadly, unwilling to allow a student to carry out even simple procedures (like giving injections, or drawing blood samples). If you think you might be in that situation, I’d like you to consider three things…

  1. The vet will be closely supervising, and will be in a position to step in at any point if they aren’t happy.
  2. We wouldn’t ask the student to do it if we thought they’d make a hash of it.
  3. Most importantly of all, if they don’t get a chance to practice as students, they won’t develop the skills they need as graduates. That means they won’t get the experience they need if they’re going to grow into good horse vets – because they didn’t get the practice they needed as a student under controlled conditions.

So, for the sake of your horses in the future: please allow the student to carry out any procedures that your vet thinks they’re ready for!

BEVA Congress 2012 – How Horse Vets Keep Up to Date

Equine Education (Part 1 – CPD)

As vets, we’re always trying to do the very best for our patients. However, veterinary medicine is constantly changing – every year, hundreds, even thousands of new papers are published, new drugs become available, and new machines and tools come on the market. What was the “gold standard” of treatment for a disease ten years ago might now be proven to be more harmful than helpful! At a recent conference (BEVA Congress – see below for more on that…), John Walmsey, one of the foremost and best respected members of the profession, gave the plenary lecture talking about the massive changes that have taken place in equine veterinary care in the four and a half decades since he graduated. The drugs we have now are far more effective, the machines and tools more robust and more useful. Even ten years ago, MRI in the horse was really rare and (to be honest) unreliable; now it’s a standard tool in working up a complex lameness. As a result, with the field of knowledge constantly changing, it’s more important than ever for vets in practice to keep up!

The process of keeping up to date is known as CPD (Continuing Professional Development), and we are expected to do at least 5 days a year. It can be made up in a number of ways, including lectures, seminars, webinars, practical courses and reading journals and papers. Like most equine vets, I receive the big journals Equine Veterinary Journal and Equine Veterinary Education, which (respectively) publish papers on equine science and equine surgery and medicine. I also try to attend relevant courses and lectures as often as I can.

In September, I was at the BEVA (British Equine Veterinary Association) Congress in Birmingham. This is one of the biggest gatherings of horse vets in the world, and I try to go most years. Congress lasts for three days of lectures and seminars, as well as a large commercial exhibition. It’s a great place to go to pick up the latest ideas, new treatments and medicines, and catch up with colleagues from across the country. I sometimes think we learn almost as much from talking over cases with colleagues as we do in the lecture theatres!

This year was notable for…

  • The debate over firing of tendons. (Quick recap on that one – the Royal College, our regulatory body, does not permit firing of tendons etc; some equine vets think firing should be permitted again in certain circumstances; however, others disagree. The argument goes on!).
  • Andy Bathe from Rossdales in Newmarket had some hilarious stories about working at the Olympics, as well as a number of thought provoking points. For example, some of the showjumpers were receiving a wide range of different (legal) medications to keep them performing at their peak throughout the competition; and every single dose of every single medication had to be certified by an official vet on a separate form. That led to a HUGE pile of forms for the FEI vets to certify each day!
  • There was also a long session on current approaches to laminitis – unfortunately, none of the existing theoretical studies are an exact match for the real disease, and researchers are still plodding along, gathering information. Sooner or later, we will have a good understanding of the condition; however, at the moment we have to be content with identifying horses and ponies who are at high risk, and managing them to minimise the risk. There aren’t any easy tests available to measure how high the risk is, however, so it still comes down to the clinical judgement of the vet on the ground.
  • New work being done on RAO (Recurrent Airway Obstruction, what used to be called COPD). Almost all the vets in the audience, as well as the panel of experts, agreed that this year has been especially bad for summer pasture associated RAO, and that cases seem much more resistant to normal treatment than usual. No-one knows why, but it seems likely that the unusual weather has resulted in more pollen than usual (or at least, more of the particularly reactive pollens). One lecturer from Switzerland had a fascinating paper to present on the genetic basis of RAO – he and his team have identified at least 2 different genes that can cause it, one of which is also associated with extra resistance to worms and other parasites. Unfortunately, though, it looks like it will be a long time before there is a simple genetic test, because there are another 11 genes that are also involved… as usual with any horse disease, nothing is as simple as it at first appears! However, he did have one useful tip… In Switzerland, a horse with summer-RAO is routinely moved into the mountains, which seems to reduce the severity. Obviously, this isn’t always practical here, but one UK-based expert on the panel suggested moving to the coast for the same reason – to remove the horse from the source of the allergens that are causing the problem.
  • As well as the main lectures, there is always one lecture theatre devoted exclusively to Clinical Research – vets and scientists (and mostly people who are both) present their papers on all sorts of subjects, ranging from Soft Tissue Surgery to Reproduction to Imaging to General Medicine. If I tell you that papers presented include “Carbon Dioxide laser surgery with adjunctive photodynamic therapy as a treatment for equine peri-ocular sarcoid: Outcome and complications in 21 patients” and “Validation and reliability of orthoganal ultrasonographic projection dimensions of the kidney in the horse”, you should get some idea of the level of science being presented!

Of course, after Congress, every delegate takes home a copy of the Proceedings – a (big fat) book containing a summary of all the lectures and papers presented. In addition, all the lectures are recorded and vets can access them online, if there was a lecture in particular that they missed. For a lot of us, Congress is only the beginning – on the train home, or over the next few weeks, vets across the country will be reading up on papers and lectures in their particular areas of interest. At most practices – including mine – whenever anyone has been on a course or conference, they then have to boil it down into practical, “hands-on” information. We then present it to the other vets (and nurses etc, if it involves new techniques or machines), so that everyone’s patients can benefit from the new knowledge. Sometimes it’s hard – it can be very difficult for all of us to accept that a long-cherished treatment has been proven not to work! – but for the sake of all our patients, we work hard to use the most up to date information, and not to be trapped in old, comfortable ideas that aren’t as effective.

The other side of veterinary education, of course, is the education and teaching of students that happens in practice. I’ll be talking about that in my next blog!

Competition Vetting

Horse Jumping, photo by EDWARD McCABE

Horse Jumping, photo by EDWARD McCABE

Like everyone I know, I was glued to the Olympics – great job Team GB, especially our first Dressage and Show Jumping medals for a long time!
However, I wonder how many people think about the infrastructure and planning that go into keeping the horses fit, safe and healthy when they compete?
I’ve been a treating vet at a lot of competitions over the years, including Endurance events, local, regional and National Championship Pony Club events (where the standard is often as high as at many BE competitions!) and the International Show Jumping at Sheffield Hallam Arena. I was also on the vet team as a student at Badminton back when they still had roads and tracks before the cross country.

The vets that people most often seen are those on the Ground Jury at competitions – the notorious “Trot Up” before the competition starts, and again (in eventing) before the horses go forwards to the show jumping phase. At Badminton and most other big events, there are two vets – one on the Ground Jury, along with two or three other worthies – and one in the Hold Box. If there is a question over a horse’s fitness to compete, they get sent to the hold box, where the second vet examines them to see if there is a medical problem rendering the horse unfit. This is a very contentious area – I’ve never yet been at an event where the Ground Jury and the vets didn’t come in for a barrage of criticism over their decisions. However, it’s important to realise that they have to balance several factors:

Firstly, if a horse is unlevel on the trot up, it may be truly lame, or it may have a “mechanical lameness” – in other words, an abnormal gait that is non painful, and does not render it unfit (on welfare grounds) or unsafe to compete. To help them decide, they trot the horse up before the competition, and then note down any anomalies of gait or stride.
Secondly, there are some horses with minor injuries who can appear far more badly injured than they actually are. This is the reason for the Hold Box – a horse with a mild lameness due to a stone in it’s hoof (yes, it does happen, I’ve seen it!) will probably trot up sound once the offending pebble has been removed; likewise, I once saw a hopping lame (7/10 at trot, for anyone interested) horse go 100% sound after a misfitting stud was removed.
Thirdly, of course, the Ground Jury and the vets have to watch the riders or grooms who are trotting up the horse. It’s an old joke in the profession that the shorter the skirt and tighter the top of a woman competitor, the more carefully you have to check the horse, because she’s trying to distract your attention from something!

The role of the vet as a judge of fitness is of course expanded in Endurance competitions, where every horse has to be checked at various points along the track to ensure it is fit to continue, and that its heart rate drops enough to be permitted to go on. Different events have different requirements for judging, but as a general rule, the horse has to trot up sound and well hydrated, and have a heart rate below a certain value (e.g. 80 beats per minute). I was at one big competition once where there was a dispute over whether the (leading, international competitor’s) horse was sound or not. The decision was passed to a panel of 3 vets, none of us having seen the horse before that day, and its soundness or otherwise put to a secret ballot.

This used to be standard practice at two- and three day events, when there was a roads and tracks phase before the cross country. In these competitions (and there are still a few ongoing, regional Two Day Events in various corners of the country), the vet is present simply to determine whether the horse is fit and safe to continue. I once had to pull a horse because it was obviously “not right” – not an easy decision for a vet student at a CCI 3*! The rider appealed the decision – and while we were waiting, it tied up completely, and had to be recovered by the horse ambulance. I still shudder to think how badly it might have been injured if we had allowed it to run cross country.

At these events, riders, trainers etc can be very keen for the vet to pass a suspect horse as sound (although strangely, it doesn’t seem to be such a problem at Pony Club) – however, we’re really not trying to ruin your day (honest, and no, we don’t get paid to “fail” some competitors horses either), we’re just trying to make sure that an injury doesn’t ruin your horse’s week, month or season!

Of course, that brings me on to the treating vets at an event. Any equestrian competition will have a vet either on call or – especially at big events – on site. Some events (like the Pony Club Championships, Badminton or the International Show Jumping) will have the horses stabled on site. At these, there will usually be some vets assigned to the stables area, and others out on the course or at the arena.
Nowadays, we also have access to Equine Ambulances and their fantastic staff. They may look like normal horse trailers, but inside they have slings, winches, padded walls and often lowering floors – everything you need, in fact, to quickly and safely evacuate an injured horse.
The job of the course/arena vets is to be first on the scene and assess the state of the injured horse. They will give first aid, stabilise any strained tendons or suspicious fractures, and then decide where to send the horse. The big decision to make is whether it’s best to send the horse back to the stables (and if so, on foot or in the ambulance?), or refer them directly to a hospital facility. Fortunately, injuries that need immediate referral are rare; and most cases will be sent back to the stables. While assessing the horse, I like to have screens available – it doesn’t mean I’m preparing to put the horse down, but it does mean I can examine them in a calmer, more private environment. If we do need to put a horse down, we’ll usually try and move it off the track or away from the arena in the ambulance, to get some privacy.

While the course vets have to perform in the blaze of publicity, the stables vets are equally important. During the competition, the stables vets will keep in touch with their colleagues on the course, either by phone or (usually) radio. Quite often we’ll listen in on official channels as well so we can be leaning the right way if there is an incident! It’s the stables vets who will deal with most injuries and accidents during the competition, and it can get pretty hectic, stitching up rows of horses in succession…
At many competitions, there will only be a couple of us, looking after several hundred horses, 24 hours a day. I remember one memorable competition several years back where the night after the cross country phase, I got about an hour’s sleep – the rest of the night I was up treating the colicing, the sprained and strained, and the just “not quite right”. Most of my patients that week were mildly dehydrated – it’s amazing how much more horses need to drink after competing in hot weather! That’s the only time I can remember when I had to ring up a local practice to borrow more electrolyte salts, because I’d used up everything I took with me… (And the next year, when I took boxes and boxes of the stuff, they competed in gales and torrential rain, and I actually had cases of rain scald to treat… Well, that’s the English summer for you!).

If you are concerned about your horse, talk to your vet or try our Interactive Horse Symptom Guide to see how urgent it might be.

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.

So, what causes a surgical colic? Probably the most common are:

1) Twisted bowel. If a length of bowel twists around itself, it can cut off the circulation. At this point, the gut begins to die, and unless it can be removed by surgery, and quickly, the horse will go into toxic shock and die. This commonly happens in the small intestine or occasionally the colon, but there’s also a condition where the caecum gets turned partially inside out (an intussusception).

2) Small intestinal blockages. Horses rarely eat things that get stuck in the small intestine (although it can happen). More commonly, a really heavy worm burden can simply block up the bowel; with the bowel overfull, the blood supply starts to fail, and the gut, again, can die. I once had a patient who was a little foal with a severe colic; we removed two gallons of worms from her small intestine!

3) Strangulating Lipomas. These are really common in older horses and ponies. A small, benign, fatty tumour forms somewhere in the abdomen, causing no harm at all. However, it grows on a stalk, and eventually, the stalk gets wrapped around a length of gut, cutting off the blood supply… This results in the bowel dying, as if it had twisted. Fortunately, these are usually really simple surgical procedures; unfortunately, older horses and ponies are less likely to be insured for surgery.

There are also a number of medical conditions that can mimic those requiring surgery – particularly peritonitis and anterior (or proximal) enteritis. Horses with these conditions are often referred for possible surgery because it’s very hard for the vet in the field or on the yard to be 100% certain they’re not surgical. I think that most of us would say it makes a lot more sense to have the horse at the hospital, with a surgeon on call, to make the definitive diagnosis, rather than waste time in the stable, and risk having to then decide it needs surgery when it’s still an hour or more away in travelling time from the hospital!

So, what happens when the vet decides that a colic case isn’t suitable for medical management?

Firstly, they’ll talk to you about the options. If a horse isn’t insured, or there’s no money for treatment, it is a perfectly respectable and responsible decision to decide, sadly, to put the horse to sleep rather than prolong its suffering.

Hopefully, of course, that won’t be the case. Once you and the vet have decided that referral is the way forward, your vet will get in contact with a referral hospital. If you’re very lucky, it will be one run by your vet’s practice, but in most cases, it will be a specialist referral hospital. I must say here that not every centre with surgical facilities is able to cope with emergency colic surgery – they need not only to have the facilities (knock-down box, operating theatre, recovery box etc), but also the staff (not only a surgeon, but also enough vets and nurses to take care of your horse in the vital recovery period). Your vet will have a list of suitable referral hospitals – generally, its best to send the horse to the closest one with the shortest transport time, but your vet will be able to advise you.

Making an emergency referral is simple – but only your vet can do it. A referral hospital will not accept referrals from the horse’s owner! Once you’ve made the decision to refer, your vet will call them and speak to the veterinary team on call, who will be available 24/7/365 (when I was part of one such team, we ALWAYS seemed to get our referrals at about 10pm!). They’ll let him or her know what they want done during transport – generally, they’ll describe what painkillers they want given, and what samples they want taken (don’t be surprised if your vet gives you a couple of blood tubes to take up and give to the referral team). In addition, they’ll sometimes ask the vet to put in a stomach tube and tie it in for the journey – this is to prevent the stomach from getting over-full and bursting if there’s an obstruction in the small intestine. Don’t forget your horse’s passport – legally, they do need it even when being rushed to emergency surgery.

Your vet will generally give you directions and a contact number for the hospital, and send you on your way. Remember, they can’t normally go with you, because your horse’s colic, while devastating, is probably only one of several cases they’ll have to deal with.

If there’s a problem (e.g. your horse getting distressed) in transit, call your vet or the referral number you were given – but if at all possible don’t stop unless they tell you to! Remember, you’re on your way to the best equipped help available.

On arrival at the hospital, you can expect to be met by the veterinary and nursing team. Your horse will be rushed to an assessment area, and you’ll probably be given a lot of scary-looking paperwork to sign. Generally, this comes into 2 parts – firstly, you’re signing to give consent for whatever they need to do (and remember, a lot of drugs aren’t technically licensed for use in horses, because the manufacturers haven’t paid for an official license for that drug in horses. It doesn’t mean a drug is dangerous or experimental, it’s probably used on a daily basis by the hospital. You’ll have to sign consent to use unlicensed medication – it’s absolutely routine, and nothing to worry about). Most hospitals will also ask to see your passport – if you haven’t got it, or it isn’t signed to mark the horse as “not intended for human consumption”, legally the hospital can refuse treatment (although they rarely do).

The second set of paperwork you’ll sign is a bit more pedestrian – you’ll be signing to say that you will pay for any treatment!

While you’re contemplating the paperwork, your horse will be undergoing another examination by the veterinary team. This is to establish what’s going on, and what’s changed since your vet examined him back on the yard. They may well repeat some tests – most colic conditions are dynamic (i.e. constantly changing), and sometimes the change is more useful in working out what’s going on than a one-off test. Other tests they may wheel out include ultrasound – the powerful ultrasound systems available in a hospital environment can give the vets a lot more information about what’s going on. The vets will then make a decision about what to do – don’t be disappointed or worried if they don’t rush immediately to surgery! They may decide to try a course of medical treatment first (remember, they don’t have to rush as much as your vet does – if your horse’s situation deteriorates, they can operate at a moment’s notice).

In many cases, however, they will decide to take the horse straight to theatre. If so, you normally won’t be able to follow, so I’m going to describe what happens once you’ve been gently steered in the direction of a waiting room.

To begin with, the horse will have an intravenous catheter fitted, to allow easy access for fluids and drugs. A horse with colic is systemically weakened, so will almost invariably be given intravenous fluids during surgery. He’ll then be given a premed – this is a sedative, designed to make induction into anaesthesia gentler. It will usually contain the drug acepromazine, because the use of this before surgery has been demonstrated to reduce the risks of anaesthetics.

He’ll then be led into a knock-down box: this is a special padded room, designed to make induction of anaesthesia safer. Then he’ll be anaesthetised with an injection containing (usually) a mixture of 2 anaesthetic agents, ketamine (no, it’s not a tranquilizer, it’s an anaesthetic) and diazepam or a similar drug. Shortly after the injection, he’ll go wobbly, and then quickly lie down.

Once he’s asleep, the team will swing into action: a tube will be passed down his throat to help him breathe and he’ll be moved into the operating theatre. While this was going on, the surgeon(s) will have been scrubbing up, ready to start.

Once he’s in theatre and safely ensconced on a well cushioned table (to prevent pressure sores etc), he’ll be put onto anaesthetic gas to keep him asleep.

Colic3 - SurgeryThe surgery involves a long incision down the midline of the belly. The surgeons can then have a good look through all the intestines, to find the problem. This is the exciting, sexy bit, but it’s actually pretty simple in principle: “if in doubt, cut it out”. In other words, removing devitalized (dead) bowel, emptying out anything in the bowel that shouldn’t be there (e.g. a caecal impaction), replacing anything that’s got stuck in the wrong place (e.g. an entrapment) and untwisting anything that’s tied up. There are usually at least 2 surgeons, because one person is needed to hold loops of intestines (and they don’t stay still – sometimes they wriggle around in your arms)! Meanwhile, the anaesthetist will be carefully monitoring all sorts of parameters (heart rate, blood pressure, ECG, reflexes, breathing and blood gasses can all be monitored at many hospitals) and adjusting the anaesthetic and any other drugs to give the safest and most effective anaesthetic.

Once whatever the problem was has been found and (hopefully) sorted out, your horse will be returned to the recovery room. In many ways, this is the most dangerous part of the procedure. Horses are very prone to breaking things when they wake up, so everything is done to keep it as calm and quiet as possible. Sometimes, the veterinary team will help the horse to rise, using hoists and lifts; other times, it works out better to let him get up in his own time. In either case, he will be moved into a padded room, and left in dim light, as quietly as possible, so he wakes up slowly.

Once awake, and steady on his feet, he’ll be moved to an intensive care box; he’ll almost certainly be on a drip to keep him hydrated. At regular intervals through the next 24 hours (or longer) he’ll be checked by vets and nurses. In some cases, the guts don’t start working properly on their own, and medication may be needed to encourage motility (e.g. a lidocaine drip). Although everyone gets excited about the surgery, it is this recovery period that is in many ways the most important in getting a good long-term prognosis.

As time goes on, the vets and nurses will try and tempt the horse to eat – normally, we’ll try and get him eating fresh grass as soon as possible. As soon as he is stable enough and eating on his own, he’ll be sent home – most horses do better in their own home environment, so as soon as they no longer require advanced medical intervention, they can go home. Once home, it’s important that the discharge instructions from the hospital are followed – it can be tempting to try and speed things up, but don’t rush it! Major abdominal surgery takes time to recover from.

Colic is a worrying condition to have to deal with as an owner, especially as it often seems to come out of the blue. However, if you ever have to go through it, I hope that having read these blogs, you’ll have some idea of what’s being done, and why. Remember, our aim as vets is to help your horse and, if at all possible, send him home to you fit and well.

If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.

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.

Not an emergency! I like to use ketchup and a good natured pony for Pony Club First Aid Training. If you want to know more, contact your vet - many practices run great first aid training courses for clients.

Not an emergency! I like to use ketchup and a good natured pony for Pony Club First Aid Training. If you want to know more, contact your vet - many practices run great first aid training courses for clients

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.

When assessing the injured horse, I find it really useful to look at it in two stages – the Primary and Secondary surveys. The Primary Survey is designed to find injuries that are immediately life-threatening, and need addressing NOW.
This would include serious fractures, significant bleeding, breathing difficulties and any neurological disorders (half a tonne of fitting horse is a danger to itself and everything within ten to twenty feet).

I like to start at the nose and work rapidly to the tail, running my hands over the horse, looking for wounds or areas that don’t feel right, and assessing how the horse responds. If you find a wound that’s gushing blood, it needs to be stopped; a “grating” feeling under your hands when you feel along a canon bone often indicates a fracture, which must be stabilised.

In an emergency situation, the key is to stabilise the horse until it can be moved to a safer location for further workup, and it is vital to be quick, but also smart. Don’t get so bogged down with relatively minor injuries that you miss somethng life-threatening! A wound that that oozes can be left until you’ve finished the primary survey; one that’s running with dark blood needs seeing to, one that’s spurting may kill the horse before you’ve finished unless you address it immediately.

To stop bleeding, apply pressure – even a major arterial bleed can be slowed, if not stopped, by a padded up numnah pushed into the wound by one or two people (ideally two, so you can swap over when you start to get tired). One of my horses was staked on a hack many years ago, when a piece of wood flicked up into his groin and tore the femoral artery. His life was saved by two of the people out riding with him, who pulled off their jackets and forced it into the wound, slowing the bleeding until a vet could arrive to pack it closed. The major risk areas for bleeding are the groin and neck, where major blood vessels run close to the surface and can easily be damaged.

It is really important when doing a primary survey to check for signs of shock – horses are incredibly tough, but they can still suffer internal bleeding and blood loss, even if nothing’s obvious, so roll up the horse’s lip and check the colour of his gums. Then press on them so they go white, and time how long it takes for the colour to return. A normal, healthy horse will have nice, pink gums and a capilliary refill time of less than 2 seconds. White or very pale gums indicate shock, probably from blood loss, as can a prolonged refill time, while blue gums may indicate heart problems.

A horse that is behaving abnormally need to be treated with extreme caution – concussion is uncommon, but it does happen, and is often more dangerous to the people around than it is to the horse! There’s nothing you as an owner can do about it, so make sure you’re ready to jump clear if needed.

A suspected fracture is a nightmare for any horse owner; however, it’s worth remembering that some fractures in some horses can be repaired surgically. The most effective form of first aid is to immobilise the limb with a thick bandage and/or splints – however, unless you know exactly what to do, don’t try to apply splints without a vet’s instructions. Some fractures, sadly, are irreparable – I once got called to a horse that had fallen over trotting across its field, the person who called said it had a “small cut”. When I arrived, his hock was pointing the wrong way round, and sadly I had to tell the owner that there was nothing that I could do, except put him down to remove the suffering.

Once the primary survey is completed, and everything addressed as best you can, you need to consider moving the horse to safety. If possible, wait for the vet to arrive first, but this may not be possible if you are in an unsafe or inaccessible location. Remember, a horse with anything significant on the Primary Survey isn’t fit to be moved anywhere until it has received veterinary treatment! In the case of my roadside horse, we were able to borrow a box to move him off the road to a nearby restaurant car park (I know, not perfect, but we had to improvise at the time!).

As soon as you’ve got him to a safe place, it’s time to carry out a Secondary Survey. When they arrive, the vet will probably repeat what you’re doing – but if you’ve already carried out a survey, you can bring anything important to their attention, speeding up treatment.

The Secondary Survey is a full examination of the horse, checking every lump or bump, scrape or cut for further significance. If a vet is doing it, we’ll often clean up wounds and probe them for depth as we go along; however, please don’t do this yourself! We need to see everything as far as possible as it is if we’re to properly assess it. We’ll always be grateful, though, if you can tell us what there is and where – e.g. “three grazes and a cut on the left flank, swelling over the right eye and a deeper wound on the right hock” allows us to prioritise the swollen eye and the deep wound, before we check over the grazes.
Now is the time to apply pressure to any oozing or dribbling wounds, to check the feet (I’ve seen otherwise apparently normal horses prove to have deep cuts in their soles from climbing over broken metal to escape – and immediately after the incident, appear completely sound under the influence of adrenaline). Periodically, recheck the gums to make sure that the horse isn’t becoming “shocky”.

Remember, horses are almost unbelievably tough – it is amazing what they can survive. My horse who got staked lost about half his total blood volume, but he made a complete recovery and lived for another ten years in excellent health; and the horse in the road accident, despite being thrown across the road, appears to have got away with cuts and bruises.

So, even if it looks a disaster, it’s always worth trying first aid until a vet tells you otherwise, because it really can save a horse’s life.

Check with your vet to find out if they run first aid courses so you can be prepared.

More Useful Information

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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.