Browsing tag: pain

Communicating with pets: body language versus speaking English

One of the biggest challenges for vets is our lack of ability to have conversations with our patients. This isn’t always a huge problem: for example, if a dog has a broken leg, or a cat has an abscess, the problem is very easy to identify just by examining the patient. But we could still learn useful information from a verbal discussion. I would like to ask “How painful is it?”, or “Which cat attacked you?”. Treatment would also be easier to give if we could give our patients verbal instructions, such as “You must not chew this plaster cast off” or “You must let your owner bathe the sore area twice daily”.

Pain is a specific area where communication would be particularly useful. An animal in pain does not usually yelp or miaow. This only happens if the sore area is touched. More frequently, pain just causes an animal to become dull and quiet. If you could ask them, they would certainly tell you about the pain, but in the absence of language, you need to learn to interpret the more subtle signs of pain. Dilated pupils, an increased heart rate and rapid shallow breathing are all indications that an animal may be in pain. A better understanding of the non-vocal signs of pain in pets has led to much wider use of pain relief for animals, especially after surgery.

Over the years, vets have learned to understand the body language of their patients. If a dog holds his head to one side, he may have a sore ear. If a cat spends more time hovering near her water bowl, she is probably thirsty and may be suffering from kidney disease. A dog who stops wanting to go up steps will often be suffering from back pain. Close observation of animal body language can give plenty of information.

Owners also become very tuned in to their own pets’ attempts at communication. I have often been told that an animal ‘would almost talk to you’. Dogs in particular learn that if they behave in a certain way, they will get what they want, and they can be very persistent.

I know a Cavalier King Charles Spaniel called Chloe who always sleeps in the kitchen. Mrs O’Reilly, her owner, had recently started to put a big floor cushion on the tiled surface, to give Chloe a softer bed. After a few weeks, Chloe had learned the routine, and towards the end of the evening, Chloe recognised the signs that bedtime was approaching. The television was turned off, the doors were locked, keys were hung on the hook and finally Chloe’s cushion was put on the kitchen floor. Last week Mrs Reilly was away and her husband was doing the evening routine alone. He forgot about Chloe’s cushion! Chloe did her best to tell him that she wanted her cushion. Firstly, she followed him around, deliberately getting in his way so that he would surely know that she wanted something. When he did not understand, she went over to the cupboard where the cushion was kept, and she pawed at the door. He still did not get the message, and so finally she barked repeatedly at the cupboard door. Only then did the poor man understand what his dog wanted. As soon as he had placed her cushion in its usual place, Chloe contentedly lay down on it, and slept.

Pets cannot speak but they are much better than humans at using body language. If my dog could talk to me, the first thing he might say would be: “Why can’t you humans understand the most basic body language?”

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.

Ireland is living in the past: it’s about to become legal for members of public to dock puppies’ tails.

vet 092vet 091

Tail docking is a illogical, nonsensical form of puppy torture, and it looks set to become legal in Ireland.  The procedure is brutal: a pair of scissors, a sharp knife or a tight ring are used to chop off a young puppy’s tail. There is no anaesthetic, and it clearly hurts a lot (they squeal loudly), but the pups are too small and helpless to do anything about it. The pup above was brought to me for treatment after the amateur tail docking job had resulted in a chronic non-healing wound.

Tail docking has been banned in the UK since 2007: it’s completely illegal in Scotland, and in England and Wales, it’s only allowed for a small number of working dogs or when the procedure is needed for medical purposes under theAnimal Welfare Act 2006 or the Welfare of Animals Act (Northern Ireland) 2011. It’s also illegal to show dogs that had their tails docked after 2007.  The subject has been debated in detail elsewhere, but the evidence is clear: tail docking causes pain to puppies, and it does not reduce the incidence of tail injuries in adult dogs, even in working animals.

Tail docking is also illegal in most European countries: the fact that it has not yet been banned in Ireland is the only reason why Ireland is unable to become the 23rd European state to ratify the Council of Europe’s European Convention for the Protection of Pet Animals. (In fact, the UK is also unable to ratify this convention because of the illogical “working dog” exemption on tail docking in England and Wales).

Until last week, it seemed that tail docking was about to be phased out in Ireland. Suddenly, this has changed.

A new Animal Health and Welfare Act is due to be brought in by the Irish Minister of Agriculture Simon Coveney in the next few weeks. The new law has been carefully drafted in conjunction with veterinary bodies and animal welfare groups, all of whom are strongly anti-docking. The Act specifically prohibits “surgical procedures for cosmetic reasons” and it also bans  ”mutilated” dogs from being exhibited in the show ring. These clauses were introduced to stop old-fashioned and unnecessary procedures such as tail docking.

So far so good. So it was a bombshell when it was made known last week that the Minister intends to allow tail docking by members of the public, by listing it in a Regulation under procedures that may be performed without the use of anaesthetics or pain relief. The other activities under this section are mostly agricultural tasks, such as ear tagging cattle, castrating sheep and removing piglets tails: these have been allowed to permit such traditional aspects of agriculture to continue (even though it can be argued that, logically, they too should be restricted).

The official bodies representing animal welfare in Ireland are incensed at this news: it’s worth reading the open letter that has been written to the Minister by Veterinary Ireland, the ISPCA and Dogs Trust. An online petition has been launched to gather public support against the new Regulation: you can sign it here. The petition was started on 10th November, and already has over 5000 signatures.

It isn’t too late to change the future for Irish puppies: the government must surely be listening to common sense and the voice of the people.

Lost in translation – do you know what your cat is really trying to tell you?

‘Miaow!’  One simple word, so many possible meanings.  Is she happy?  Is she hungry?  Is she scared?  It’s all in the tone in which it’s delivered.  And that’s just the miaow – researchers have documented 19 different vocal patterns in domestic cats ranging from purrs to chirps to growls, along with countless body language cues.  Do you really know how to interpret them?  Test your feline language skills below…

A deep, rhythmic purr

We’ll start with an easy one – a purr means she’s happy, right?  Possibly, but that may not always be the case.  In fact, cats purr for many reasons.  Young kittens and mother cats purr during nursing, possibly as a way of maintaining contact and communicating contentment.  Adult cats purr when they’re in the company of other cats or humans that they are friendly with, especially during grooming or petting or resting together.  And as most cat owners probably already know, they also purr when they want something.  This ‘solicitation’ purr contains some of the high frequency peaks also found in a human baby’s cry, and it is commonly thought that cats use this to their advantage when asking for food at 5am.  But what many people don’t know is that cats will sometimes also purr when they are nervous or even painful.  We don’t know exactly why they do it, but the important thing to remember is that purring doesn’t necessarily mean that a cat is happy, you need to look at the rest of their body language for clues.  Think of it like a human smile – we do it when we’re happy, but also when we want something or when we’re nervous.

Blinking, half-closed eyes

If you said this is a sign of contentment, you would be absolutely right.  A cat who stares without blinking is alert and confrontational, while a cat with half closed eyes is relaxed and feels safe in their environment.  Interestingly, this is one of the few ways that we can truly speak their language.  I use it all the time whilst consulting – before starting my exam, I catch their eye briefly and then blink slowly as if to say ‘It’s ok, you’re safe here’.  They almost always respond by blinking back, and are then much more likely to relax while I do what I need to do.  But even this isn’t always the case, as a cat in pain can also have squinty eyes, but the rest of their body language will be very different.

The tail flick

This is a really useful one to know as it can save you a scratch or two!  If you are petting your cat and notice that they start to flick their tail quickly from side to side, I’d suggest you take a break because it probably either means that they’re getting fed up with what you’re doing or they’re getting playful and are ready to pounce!  Often accompanied with a widening of the eyes which may help you recognise their increasing level of alertness.

Wee on the carpet

This may not seem like a method of communication, or at least you probably won’t be thinking rationally enough to see it as such at the time, but cats frequently use urine and even faeces as a way of getting their point across.  One of the first words that comes to mind when you discover such an incident is probably ‘spite’, but try not to take it personally and instead try to figure out why it may have occurred.  It may be that they are painful and need to see the vet, or that they are unhappy with your neighbour’s cat who keeps peering in on them from the window.  If the culprit is an intact male cat, talk to your vet about castration because there is a good chance that the underlying reason is territorial.

Grooming

Although this is usually associated with relaxed, friendly cats or members of the same family, grooming may serve another purpose.  Like the nervous purr, cats sometimes groom each other’s heads and necks when they’re feeling intimidated or antagonistic, possibly as an attempt to avoid overt aggression.  Chances are they’re feeling pretty comfortable when they start grooming you, although I have on occasion had a ‘nervous licker’ during an exam and even known a few cats to lick forcefully before they bite.

Chirping

It’s a funny sound, almost like a very excited miaow but broken and muted at times.  Often associated with a tail twitch and very wide eyes, it is a sign of extreme interest.  My cat regularly ‘chirps’ when looking out the window at the birds on the feeder.  An amusing, hopeful sound indeed!

Scratching on your new leather sofa

Again, try not to push human emotions onto your cat and assume that they’re doing it to get back at you for going out to dinner instead of spending time with them the night before.  In actual fact, cats have scent glands on the bottoms of their feet and between their toes so scratching (including the visual signs that are left behind) is another method of letting other cats know that this is their territory.  Make an effort to find out the underlying cause, or at least be sure to provide them plenty of other more suitable places to ‘sharpen their claws’.

Hissssssssss!

No surprises here, if you hear this sound, back off.  Cats are instinctively tuned into this sound and are therefore easily frightened by any noise that resembles a hiss such as aerosol spray cans or our own frantic ‘psssssssst!’ when we catch them up on the kitchen counter.  If their hiss escalates to a spit, don’t just back off, turn and walk away.  Quickly.

If you were surprised by some of the answers above, spend some time observing your cat over the next few weeks.  You’ll be amazed by what you find when you know what to look for!  Even those fluent in ‘felinese’ can learn something new from their cats every day.  The more you understand what your cat is trying to tell you, the better your relationship will be so it’s definitely worth the effort.

Do you know when your pets are poorly?

It may seem like a silly question, of course you would know when your pets are sick wouldn’t you? They share your life, your home and you know them really well, just as you do other members of your family. However, what many people don’t realise is that our animals are extremely adept at masking signs of illness and often by the time we realise there is a problem, they have been struggling for a while.

This blog was inspired by a cat I saw last week. She was owned by some lovely clients; regulars with their other pets and they definitely have their best interests at heart. I didn’t blame them for not noticing sooner this one was poorly because a) felines are notoriously good at hiding illness and b), you know, I’m a vet, so really I should be quite good at spotting when animals are sick but I don’t expect others to be.

However, I think they may have realised they had left it a little long to bring her; several times during the consultation the husband mentioned that they had waited because she didn’t seem in ‘distress’ and here in lies the nub of the matter for this cat, and for many of the pets I see.

Animals are very, very good at hiding when they aren’t feeling well or are in pain. You could say they are made of much sterner stuff than us humans, and they probably are, but in the main this characteristic comes from millennia of evolution; in the wild sick creatures are soon picked off by predators. This means that even when they feel dreadful animals will do their level best to behave as normally as possible or they may simply go off and sit quietly in a corner or curl up and sleep much more than usual. What they won’t do it moan or groan (or winge and demand tea and sympathy!), the most we might get is a reduced appetite or a limp. This is especially true of problems like arthritis, cancer or kidney failure, all of which are common in older pets.

Sadly this little cat had the latter of these and I will tell you how this tale ends now; blood tests showed her renal function was so damaged the kindest thing was to put her to sleep. Many people would think it almost impossible to not notice a pet was so sick they were near death but this is not the first time I have dealt with a case like this and it won’t be the last.

Obviously you don’t want to be dashing down to the surgery every 5 minutes when a pet isn’t quite themselves but neither do you want to leave things too long. So what is best to do? My advice would be to always be aware of how your pets are and if they have seemed ‘off’ for more than a day, ring your practice for a chat. A good clinic should take the time to speak to you and help you decide whether there is really a problem or not or use the symptom checker on this website!

Cat Henstridge BVSc MRCVS – Read more of her blogs at catthevet.com

Ask a vet online – Why is my staffy rubbing his bum on carpet after his glands were done? – Anal gland problems in dogs.

Question from Jo Padfield

Why is my staffy rubbing his bum on carpet after his glands were done. Pls

Answer from Shanika Winters (online vet)

Hi Jo and thank you for your question about your dog’s anal glands. I will explain a little about what anal glands are, where they are and why dogs have them followed by a discussion of what can go wrong with them and how these conditions are treated.

What are anal glands?

The anal sacs (commonly called the anal glands) are a pair of sacs found either side of the anus (bottom); they are around 1cm across and open via a duct (tube) in the anus. As with your dog the anal sacs often become blocked and or infected and this is called anal sacculitis. The substance inside the anal sacs is produced by glands that line the inside of the sacs, this smelly substance should be passed each time your dog does a poo, and leaves a scent marker to other dogs.

What goes wrong with the anal sacs?

Diseases of the anal sacs include anal sacculitis as mentioned and less often tumours. Other conditions around the bottom include anal adenoma (small non-cancerous lumps around the anus), anal furunculosis (cracked infected skin around the anus usually found in German Shepherd Dogs) and perianal hernia (where muscles weaken and separate either side of the anus allowing pelvic and abdominal contents to push through, seen in older uncastrated male dogs).
It is really important to have your dog thoroughly examined by your vet to make sure that the condition has been diagnosed correctly so that the correct treatment can be given.

How are blocked anal sacs treated?

We usually treat blocked anal sacs by manually emptying them out, this can be done by inserting a gloved finger into the anus and gently squeezing on the sac to empty the contents into a piece of tissue paper. The anal sacs can be emptied from the outside but this does not allow the anatomy of the sacs to be examined as thoroughly. Some owners feel confident that they can learn to empty their dog’s anal sacs, this is something to discuss with your vet who can show you how to do this.
If there is infection in the anal sacs then your vet might give your dog antibiotics, this can be given orally or put directly into the anal sacs after they have been flushed out. If the anal sacs are going to be flushed out, most dogs will need sedation or general anaesthesia to allow this to be performed, a small cannula (plastic tube) is passed into the anal sac via the opening of the duct on the anus and saline is then flushed in and the glands then emptied, the process is repeated until the glands appear clean. Antibiotic and anti-inflammatory preparations can then be put into the anal sac. Sometimes steroids may also be given to ease the irritation caused by anal sacculitis.

Anal sacs sometimes are not properly emptied if your dog has soft poo or diarrhoea; this usually improves once your dog’s poo is firm again and can be helped by a change in diet.

When is surgical removal of the anal sacs an option?

If there are severe repeated anal gland infections and the dog does not tolerate medical treatment and manual emptying of the anal sacs then surgical removal is considered. The procedure is performed under general anaesthesia and does carry a small risk of disturbance to the dog’s ability to control passing poo. In most cases the lack of control when pooing is temporary but due the closeness of the nerves controlling continence to the anal sacs themselves there is this risk of them being damaged. Remember that your vet will discuss the pros and cons of a procedure with you so that a joint and informed decision can be made by you with the help of your vet.

I hope that this answer has been helpful for you and that your dog starts to feel more comfortable soon.

Shanika Winter MRCVS (Online Vet)

If your dog has a problem with its anal glands please book an appointment to see your vet, or use our online symptom checker

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.

Competition Vetting

Horse Jumping, photo by EDWARD McCABE

Horse Jumping, photo by EDWARD McCABE

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

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

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

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

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

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

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

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

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

Part 3: Surgical Colic

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

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

1) Heart rate over 60 that isn’t relieved by injectable painkillers.
2) Dilated loops of small intestine on rectal exam.
3) Positive stomach reflux from the stomach tube.
4) A definite rectal diagnosis of a surgical problem.
5) “Toxic rings” – dark red or purple gums, that indicate that the horse is going into toxic shock.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Domino sleepingAlthough, just like people, our pets are living longer and healthier lives, inevitably there comes a time when their age catches up with them and illnesses develop. Advances in veterinary care mean we can do a lot for them but eventually we won’t be able to keep up with their problems. If they were people we would put them in wheelchairs or place them in a home where their needs could be catered for, for example being assisted to the toilet or spoon fed but this isn’t practical, or in most cases fair, to a pet who won’t understand what is happening (there are many people who would argue this is no kind of life for a person either but that is a whole other debate). For a pet, when they can no longer get up and out to do their toilet or feed themselves properly, or when their illnesses or pain can no longer be controlled with medication, this is the time as owners we should objectively assess their quality of life and decide whether it is fair to let them continue. Also, just as important is your quality of life, it is hard work caring for any pet, let alone an elderly one who may be incontinent or senile.

The vast majority of pets who reach the end of their natural lives are euthanased by their vet. This is inevitably a sad experience for their owners (and us) but is far preferable than allowing them to slip away on their own. Many people hope this will happen, having probably experienced death this way with people as I recently did myself, but it is very different for animals. Bodies are designed for living and will go on doing so regardless of how painful or unpleasant it becomes for the individual. When people die in their sleep they are usually heavily medicated and cared for to ensure they are not in any pain or dehydrated but this doesn’t happen for our pets. If an animal dies this way, they have usually suffered to a large extent; likely being dehydrated, malnourished and in pain. Although from the outside they might look peaceful, they are anything but; it is simply all their exhausted body can manage.

This is why when our pets become infirm and their quality of life declines to a point where living is a struggle and not the joy it should be, by far the kindest and most humane thing we can do as owners and vets is to euthanase them in a painless and peaceful way. I often say it is the one big advantages we have over human medicine; we can stop the suffering before it becomes too great. Although it may seem daunting your vet will talk you through the procedure and make sure you are happy with the process and your decision. You will be able to stay with your pet if you want to and most vets will come to your home if your request it. Euthanasia means ‘a peaceful death’ and as a pet owner it is the final act of kindness you can bestow upon your companion.

If you are worried that your pet may be ill, talk to your vet. Try our Interactive Symptom Guide to check any symptoms they are displaying and help decide how soon you’ll need to visit your vet.

More Useful Information

Examining your pet

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

Medicating your pet

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

Worming & Flea Treatment

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