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What makes dogs lame, and how can they be helped?

Why is a lame dog lame? The obvious, but incorrect, answer to the question is 'because it has a sore leg'. The correct answer is more complicated, but also quite obvious when you think about it. Firstly, what is a lameness? Everybody knows what a lame animal looks like - they 'walk wrongly'. But what is happening to make them walk wrongly? There are three main reasons why lameness may occur. Pain is the most common and most important cause of lameness. If an animal damages a limb, any further pressure causes more pain, and so the instinctive response is to rest the limb, by carrying it, or at least by not putting full weight on it. The type of damage can vary widely from a bruise to a laceration. The damage can be anywhere in the limb, from the toe to the shoulder or hip, and the result is the same - a lame animal. Long term diseases such as arthritis can also involve considerable pain. The second cause of lameness is instability. It is common for dogs to rupture the ligaments of the knee, and when this happens, the knee becomes unstable. If the dog tried to put weight on the leg, the knee would collapse. So the dog refuses to put weight on the leg. Any other joint can be affected in the same way by damage to the supporting ligaments. The third cause of lameness is stiffness. When a dog develops arthritis, the affected joint becomes swollen and gnarled - like many older people's arthritic finger joints. The swelling of the joint is due partly to new bone which grows around the arthritic joint as part of the disease process. This new bone acts like rust seizing up a metal hinge - it stops full normal movement of the joint. An elbow joint may only be able to move through half of its normal range of movement. The result of this new bone is that the joint is stiffer and less mobile than it should be - and this means that the animal is unable to use the limb in the normal way. Hips, shoulders and knees are also commonly affected in this way. So lameness can be caused by pain, instability and stiffness. What can be done to help lame animals? Weight control, controlled exercise and physical therapy are all important aspects: this always has to be individualised, and the best answer is to ask your vet what your pet needs in these areas. The new generation of painkillers provide excellent relief from pain. Immediately after an injury, dogs can be given drugs which prevent short term suffering until the injury is treated. In addition, if a disease involves long term pain (such as arthritis), this can be dealt with very effectively by continual daily medication, as advised by a vet. Instability of joints can often be well treated using new surgical techniques which may involve inserting artificial ligaments, using metal implants or by other methods. The stiffness of arthritis can be helped by using regular anti-inflammatory medication, similar to that used for arthritis in humans. There is also an animal-only anti-arthritic drug, given by injection, which can help considerably in some cases. Other therapies including hydrotherapy and acupuncture can also play a role, as can daily food supplements such as glucosamine chondroitin sulphate, and even special high fish-oil diets designed for pets with joint disease. Owners should be warned that it can be very dangerous to give human drugs to their pets, unless their vet has given them permission to do so. Toxic reactions are common, especially when some of the more modern human painkillers and anti-arthritic drugs are given to dogs. If you have a lame dog, you should ask your vet for advice on the best way to relieve the problem.
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The Drugs Don’t Work – Or Do They?

Today I put to sleep a lovely old Collie owned by a lovely man. It was definitely the right decision, the dog was really struggling on his legs and had become very depressed and withdrawn. This is a common scenario and very often the way that arthritic pets come to their end. In fact, a very similar thing happened to our beloved family Labrador, Molly, a few years ago and although she was still trying to get about and clearly happy to be with us, she was obviously in a lot of pain which could no longer be controlled. Euthanasia in these situations is a true kindness and although still desperately upsetting, is by far the best thing for the pet. However, just as I was discussing the euthanasia of this dog with his owner, he said something that stopped me in my tracks. ‘Well, we did try him on some of your arthritis medication a few months ago but to be honest it didn’t seem to be doing anything more than the Asprin I was giving him, so we stopped it’ Now, at this stage in the process there was no point in me making any comment on this statement (or my thoughts on giving pets human medications!) and you may think it sounds like quite a reasonable thing to say but to be honest, I really had to bite my tongue. Arthritis is a very common problem in older pets but it is also very under-diagnosed because the signs can be difficult to spot, mainly because our animals are so stoical in the face of chronic pain. Even just a bit of stiffness after rest can indicate a significant problem. The medications we have to treat it are extremely effective but often, and especially in the older pets with more advanced arthritis, just one drug on it’s own doesn’t completely combat the problem and they need a combination of medicines to really keep them comfortable. (Anyone with an older relative will probably be familiar with this concept; my granny seems to be on hundreds of tablets!) Our darling Molly was practically rattling in her last few months I had her on so many medications and supplements These kept her comfortable but eventually, they could no longer control her pain and give her the strength to get around, so the kindest thing was to let her go. My message is, if you have an older pet, firstly, don’t assume that them slowing down and stiffening up is a ‘normal’ part of aging (well, in a way it is but that doesn’t mean we can’t do something about it!) and if the medicines your vet gives you don’t make much difference at first, don’t assume that that is because there isn’t a problem or that nothing else can be done, it may just be they need different tablets or combination therapy to give them their bounce back! This is far preferable to leaving them to struggle in silence and although, in the end, their arthritis may mean they need to be put to sleep, it will certainly give them more time and mean their final months with you are pain free and comfortable. And finally, please don’t give your pets ANY human medications without talking to your vet about it first. Drugs often work very differently in animals than they do in people and some can be actually harmful.
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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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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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Colic: Part 2: Medical Colics

In my last piece, I looked at how the vet will examine a horse with colic. Following this, and using all the information from the history and workup, he or she has to decide if the colic is Medical or Surgical. The terms are more or less self-explanatory: a medical colic can be managed with drugs, while a surgical colic needs emergency surgery. As a rule of thumb, 9/10 colics are medical, and can almost always be managed on the yard. So, here are the common causes of colic that we see in the UK1 : 1) Spasmodic Colic. This is probably the commonest, and perhaps the least understood; I estimate about 80% of Medical colics are Spasmodic. Spasmodic colic can be caused by a stressful event, mild dehydration, or be genuinely idiopathic (i.e. we don't know what causes it!). It can also be caused by severe tapeworm burdens. In a Spasmodic Colic, a section of the gut goes into a spasm, preventing anything from moving past it. It can be acutely painful, but usually responds really well to management with drugs. For any horse that has two or more bouts of spasmodic colic, I'd always recommend a tapeworm blood test to make sure it isn't part of the problem! 2) Impaction Colic. This is more common in some management systems - it is pretty rare, for example, in horses who live on grass. In these cases, the food in the large intestine dries out a bit too much, and turns into a putty-like material. It then gets stuck, typically at one of the 180- degree turns in the Large Colon. It's also strongly associated with moderate dehydration - as a horse gets dehydrated, he will move water out of the gut in order to keep up his circulating blood volume. This is a clever trick, meaning a horse can survive levels of dehydration that would kill a human. However, if the water isn't replaced, and he's been eating dry hay, his gut contents can become so dry they cause an impaction. This is why, many years ago, bran mash and Epsom salts were fed after hard work - both are good ways of rehydrating the colon and Caecum contents. 3) Gut displacements and entraptions. These are a bit of a mixture - some are medical, some are surgical, some look surgical but aren't, and some can be fixed medically but keep coming back so surgery is eventually needed. What many people don't realise is that the guts are in constant motion. Occasionally, a loop of intestine goes "wandering around" inside the abdomen, and gets stuck behind something else (for example, into a little gap between the spleen and the kidney). These can often only be diagnosed by rectal exam, and can feel really confusing, where nothing seems to be exactly where it should be! Each case has to be treated on its merits, and many can be resolved by lunging - presumably because jiggling everything around helps the intestines to fall back into their proper places! Personally, however, my inclination is generally to refer the horse as a possible surgical case, because it's amazing how often a trip in the box fixes a displacement or entraption. Of course, if they can't be rapidly resolved, they need to have surgery to put everything back, before any permanent damage is done. 4) Sand colic - I've only rarely seen these; they're normally caused by the horse drinking from sandy water. Over time, sand builds up in the intestines, causing irritation and sometimes an impaction. Management usually revolves around maintaining gut motion with laxatives and pain relief; however, surgery is sometimes needed to evacuate the sand and debris from the gut. 5) Inflammatory diseases, e.g. peritonitis or anterior enteritis. I'm including these here because they're not strictly surgical. However, they can be really hard to differentiate from surgical cases, and they're usually only diagnosed after referral, with the advanced techniques available at a referral hospital. 6) Other medical causes, e.g. diarrhoea, or stomach ulcers, can also cause a "Medical" colic; however, these cases require the underlying disease to be treated, at which point the colic symptoms will resolve themselves. Treatment for medical colics is focused around pain relief and maintaining hydration. Spasmodic colics especially respond very well to a mixture of hyoscine and a pain-killer, which relaxes the spasming gut segment, allowing normal gut movement to be re-established. Using a painkiller (e.g. injectable bute) can also be a really useful diagnostic test for whether a horse needs surgery - one of the standard guidelines is that a horse with a heart rate over 60 beats per minutes, 30 minutes after intravenous bute, is usually a surgical case. The other painkiller (flunixin meglumine) is almost never used, unless surgery is definitely not an option. This is because it is too powerful! Even horses with dead bowel can look bright, healthy and well, until the flunixin wears off. At that point, they crash, and are often too far gone to be saved. [caption id="attachment_2632" align="alignright" width="300" caption="Equipment for the medical treatment of colic"]Equipment for the medical treatment of colic[/caption] For impactions, rehydrating the gut contents is vital, but pain relief is also really important. In these cases, Epsom salts and water by stomach tube are really useful. There is some controversy over the use of liquid paraffin in impaction colics. If the horse later has to go to surgery, the presence of liquid paraffin in the gut can cause major headaches for the surgeons; on the other hand, it can be a marvellous lubricant to help move things along. Personally, I tend to give any impaction colic a bucket by stomach tube containing a mixture of water, electrolytes and Epsom salts; and if I'm sure it's not surgical, I'll add in a litre or two of liquid paraffin as well. Liquid paraffin is horrible stuff to work with, and if all you've got to give it with is cold water, it's not easy to mix in; I like to mix the water and electrolyte tablets or sachets together first in a bucket, then add the paraffin. The tube is passed down the nose and (hopefully first time!) into the gullet (if it goes into the wind pipe, start again...), and down all the way into the stomach. To check it's in the right place, I always feel for it passing down the throat, listen for air moving as the horse breathes, and then suck on it to see if I get lots of air back (means I'm in the airways) or nothing (means I'm in the gullet) or, worst of all, a mouthful of stomach contents. This means the tube is in the stomach, which is great, but it tastes truly vile! Once I've carried out all those tests, I'll pour in a tiny amount of clean water, just to be sure - if the horse coughs, it means the tube is in the windpipe despite all my tests, but it's not the disaster it would be if I'd poured in a couple of gallons of liquid... To get this lot into a horse, some people use stirrup pumps - they're a bit like bicycle pumps, and attach to the end of the stomach tube. This is used to pump fluid from the bucket down the tube - they're great if you've got them, although you have to be careful not to overfill the stomach. However, most of us still use syphons and funnels. The tallest person present (usually me...) attaches a funnel to the top of the tube, then fills the funnel from the bucket. They then hold the funnel as high as they can, so the liquid runs down the tube into the horse's stomach. You then repeat this until either the bucket is empty or the funnel stops running, which normally means the stomach is full. It's messy, and can be physically pretty hard work, but it’s a vital part of treating an impaction colic. Personally, I quite often use it to rehydrate the gut of any severe medical colic, because anything that causes gut stasis can lead to a secondary impaction if you're not careful. I'd normally treat a definitely diagnosed impaction with injectable bute for pain relief. There is some evidence to suggest that the use of anti-spasm drugs like Buscopan can help to encourage normal gut action, even though they are designed to work as gut relaxants, but I think that particular debate is still open. To maintain hydration, some vets also like to start a drip line for intravenous fluids. This won't help the gut (any excess fluid will be excreted by the kidneys before it gets there), but it can help to support the circulation of the horse. Personally, my thinking is that most colics that are so severely dehydrated that they need a drip are either surgical or have another, underlying disease; however, there are always exceptions! Chronic, ongoing colics can be a nightmare to manage - they're typically low grade, spasmodic colics, or mild impactions. In these cases, a more thorough examination (including blood tests) is indicated, to try and rule out any underlying disease. Chronic impaction problems tend to be management related, and can usually be resolved with minor tweaks to management. However, your vet will often want to check your horse's teeth - this is because dental problems can result in poorly chewed food, which can make impactions more likely. My experience with the chronic spasmodic colics is that if there's no other underlying cause found, they can occasionally respond nicely to a course of probiotics. I had an incredibly frustrating case once of a horse that had repeated bouts of colic, that we never got to the bottom of. I was being called out every few weeks (and the yard was nearly thirty miles from the practice, which made each visit something of a nightmare!). Eventually I suggested we try a month's course of probiotics... and the next time I saw the horse was nine months later for annual vaccination. Any further colic episodes, I asked? No, they replied - nothing since we started the probiotics. Although it isn't a cure-all, it can apparently help in some cases! Of course, not all colics are medical - about 10% require surgical management. In the third and final piece of this series, I will look at the indications for surgery, the types of colic needing surgery, and then I'll go through what happens when your horse is referred to an equine hospital for emergency surgery. 1 This is based on my clinical experience in the Midlands, Wales and the South West of England. In some parts of the country, other causes will be more common - for example, on the South Coast, Sand Colic is more common. However, it seems to be fairly rare in most areas, so I'm not going to cover it in great detail. 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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