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Ask a vet online – ‘my dog only has one testicle down – what is the best age to have him neutered?’

Question from Pam Gilmour Hi my chi(huahua) is 6 months , he only has one testicle. I will be having him done, what would be the best age to wait to see if it will come down? Answer from Shanika (online vet) Hi Pam and thank you for your Question regarding the best age to have a dog castrated which has a retained testicle. I will start by explaining a little about the testicles, what they are, where they develop and what can go wrong along the way. The testicles are two oval shaped structures normally found in the scrotum (loose sac of skin near your dog’s bottom). Testicles are male sexual glands and produce the hormone testosterone along with sperm and various other secretions which assist in reproduction. The testicles start developing while the puppy is inside the mother’s uterus (womb); they are at first located inside the abdomen (tummy) and just behind the kidneys. A few days after your puppy has been born the testicles should be in the scrotum, they travel from their starting point down through the abdomen and through an opening called the inguinal ring in order to get to the scrotum. When you take your puppy to the vets to have his first examination they will check for the presence of two testicles in the scrotum, if these cannot be felt then this will be checked again on future visits.  If both testicles are not present this condition is referred to as cryptorchidism (retained testicles), either one (unilateral cryptorchid) or both (bilateral cryptorchid) of the testicles may be missing from the scrotum.  In very rare cases on or both of the testicles has not actually developed at all. What should you do if your dog has cryptorchidism? Your vet is likely to suggest that you wait to see if the missing testicle comes down into the scrotum at a later date, this would usually be by 6 months of age but in some cases can occur up to 1 year of age. What to do if the testicle does not appear? Your vet will discuss a castration procedure with you in which both testicles are removed, it is a simple procedure to remove under general anaesthesia the testicle present in the scrotum, the retained one has to be located in your dog’s abdomen, and this can take some time. The surgical procedure to find and remove the testicle from the abdomen can be tricky as the testicle which has not found its way to the scrotum is often smaller and therefore not so easy to locate in amongst the contents of your dog’s abdomen. Why should I have my dog castrated if he has cryptorchidism? If the testicles are not in their correct location in the scrotum there is an increased chance of them becoming diseased, such as developing into cancerous tissue. Also a dog with cryptorchidism is likely to have reduced fertility and would not be an ideal candidate for breeding. I hope that I have managed to answer your question regarding the timing of castration in a cryptorchid dog and have managed to explain some of the reasoning behind why it happens and what the best plan of treatment is. Shanika Winters MRCVS(online vet) If you are worried about your dog please book an appointment with your vet or use our online symptom checker.
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Ask a Vet Online – ‘My yorkie has problems with her front dew claws they split so she is constantly licking her paw’

Question from Sharon Barrett I have a yorkie she has problems with her front dew claws they seem to split so she is constantly licking her paw is there anything I van do to ease her discomfort please? Thank you, her brother also has the same problem they will be 5yrs in April... Thank you.x Answer from Shanika Online Vet Hi Sharon, thank you for your question about your dog’s dew claws. In order to ease your dog’s discomfort caused by the splitting dew claws it is important to understand what dew claws are and why they are splitting. What is a dew claw? The dew claws are small toes in the position in which we have our thumbs, they are considered to be a ‘vestigial digit’ in the dog. Vestigial refers to the fact that dew claws are usually much smaller than the other toes and now serve very little function, some people do however see their pets using their dew claws to help grip objects. Dew claws can be found on both front and back legs but are more common on the front legs. Not all dogs have dew claws and some may have had them removed when very young. Why is the dew claw splitting? A claw or nail is formed by the tissue in the nail bed, any damage or disease of the nail bed itself can lead to a weak claw which is prone to splitting. Diseases that can affect the nail bed include bacterial or fungal infections and traumatic damage. Overgrown claws and or weak claws are much more prone to catching on things, cracking and splitting. The nail bed is a very sensitive structure with a good blood supply, so damaged claws can cause a great deal of discomfort to your pet and may bleed. How can I ease my dog’s discomfort? Firstly by ensuring the dew claws are kept correctly trimmed, there will be less chance of the claw catching on things when the dog walks or plays and therefore less chance of splitting.  As with the rest of a dogs nails the dew claw has a small blood vessel running through it from the nail bed, this is often referred to as the ‘quick’, care must be taken to trim the nail using a pet nail trimmer and leaving a few millimetres of nail after the blood vessel. If the blood vessel is accidentally cut into then firm pressure should be applied plus or minus a cauterising agent (this is a substance that helps to stop the bleeding). If in any doubt then ask your vet or veterinary nurse to trim your dog’s claws for you. Can my dog’s diet affect its nails? A good balanced complete dog food should contain all the essential nutrients your dog need to maintain a healthy body, however it is though that the B vitamin Biotin may help hair and nail growth. B vitamins are water soluble and supplementation under the direction of your vet is worth considering. Should I consider dew claw removal? Any surgical procedure should only be undertaken after careful consideration and discussion with your vet. Once a dog is adult then the dew claws have a very good nerve and blood supply and therefore removal is a very similar process to amputating any other toe. Toe amputation requires general anaesthesia, post -operative wound care (dressings) and pain relief. We usually advise dew claw removal if there are repeated incidents of dew claw damage and or infections that are causing pain and suffering to your pet. In conclusion the best long term solution for your dogs might be to have their dew claws removed but this decision should be made between you and your vet taking into consideration your pets circumstances. I hope that this answer has been helpful to you. Shanika Winters MRCVS
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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.
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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.
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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. 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.
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