Will My Horse Survive Colic Surgery?
There are no easy answers when it comes to colic surgery, just as there are no easy decisions. Unpleasant as the subject might be, talk to your veterinarian about what you'd do in the event of a severe colic, and map out a game plan.
Photo: Anne M. Eberhardt
For the record: I've endured the agony of seeing a beloved horse go through not one, but two surgeries—the first a colic surgery, the second to treat postoperative complications—and it was hell. If you've been there, you know what I'm talking about. If you haven't, I hope you never will.
Fortunately, my horse made a complete recovery and went on to live a useful life. When I look back on the whole nightmare, I wish I'd learned more about colic surgery and its aftermath before I had to make important decisions under sleep-deprived, emotionally wrung-out pressure. I know you don't want to think about the prospect of your horse in pain and facing hospitalization any more than you relish the thought of planning your own funeral. Realize, though, that unpleasant as the subject might be, it's a lot easier to contemplate the possibilities when you're calm and not faced with a crisis.
In this article, we'll do just that. We'll walk you through the process that leads to the large-animal hospital's door, and we'll tell you what to expect once you get there. You'll find out how equine insurance can help ease surgery's financial whammy, and you'll get an overview of the recovery process and the major complications that can arise.
Finally, we'll fill you in on research into ways to beat this dreaded disease and its aftermath.
Why Do Some Colics Require Surgery?
Colic is a catch-all phrase that's used to describe all manner of equine abdominal pain. Causes of colic range from gas and impaction to enteroliths ("stones" that form in the large intestine) and various kinks and twists in the large or small intestine. What causes colic, of course, is the big question. Veterinary researchers are working tirelessly to find the answer (or answers) to that question, but what they do know is that some colics aren't resolvable through medical means—drugs, hand-walking, stomach-tubing with mineral oil, and other non-invasive procedures. Enteroliths, for instance, usually require surgical removal. A strangulated segment of intestine, or "twisted gut," needs to be manually realigned or any dead or damaged bowel and surgically joining the healthy ends.
Regardless of the cause of the colic episode, the fact remains that, if your veterinarian exhausts the non-surgical options, and your horse isn't getting better, you'll be faced with the decision of whether or not to load him on a trailer and haul him to the nearest equine surgical facility for intensive monitoring, treatment, and possible surgery.
Go Or No Go?
It's after sundown, and the evening chill is setting in. Standing resignedly at the end of the lead rope, watching your veterinarian perform another oiled-and-gloved rectal exam on your dull-eyed horse, you feel exhausted. The vet straightens, peels off the gloves, and sighs. "Looks like this one's not going to get better on its own," he says. "Is surgery an option for you?"
Is surgery an option? A good question, and one that depends largely on the state of your pocketbook. Most large-animal hospitals ask for a deposit of 50% of the estimated fees at the time of admission, with the balance payable before Dobbin goes home. They accept credit cards if you don't happen to have the cash handy, but even so, $5,000 to $8,000 is a lot to pony up, so to speak, on short notice—and that's assuming a relatively straightforward surgery and a short hospital stay. If complications arise and Dobbin requires a longer post-op recovery period with lots of intensive care, your total bill can easily shoot up to the low five figures.
You hate the thought of putting a value on your horse's life, but if he develops a surgical colic, you might have to. Ask yourself: Am I willing and able to spend whatever it takes to try to make him well? If I'm willing but not able, can I afford to purchase an equine-mortality policy with a surgical or major-medical option, which will reimburse me for a fixed dollar amount of certain veterinary costs? (A few notes on equine insurance: You'll need to buy the mortality policy—at a rate based on a percentage of your horse's value and on his age and use—to be eligible to purchase the medical coverage. Surgery-only policies are less expensive than major-medical policies, but that's because they cover fewer of the associated costs. Talk to several equine-insurance companies if you're interested in purchasing coverage, ask lots of questions, and read the fine print carefully before you sign up and after you receive your policy.)
If you can't afford to purchase equine insurance and can't afford to pay for colic surgery outright, your decision will have been made for you. But if you OK the trip to the hospital facility and you hold an insurance policy, don't pull out of the driveway until you place a call to your insurance company—most have 24-hour toll-free numbers—to alert them of the situation and inform them of your vet's advice and your plans. If you don't, your company might deny coverage. Don't put off a trip to the vet clinic if for some reason you can't reach an insurance company representative beforehand, urges Nathaniel A. White II, DVM, MS, Dipl. ACVS, the professor emeritus of Equine Surgery at the Marion duPont Scott Equine Medical Center in Virginia. "We haven't had an insurance company deny a claim when a horse arrived and we confirmed the need for surgery or even completed it before the insurance company could be notified," he says.
Your vet probably will call the nearest large animal hospital, alert the staff that you're on your way, and brief the attending veterinarian on what to expect when you arrive. You might be fearful of transporting a colicky horse; your vet might administer medication to keep your horse's pain in check for the drive so he's less likely to panic or thrash around in the trailer. Oddly enough, the trailer ride actually seems to help some colicky horses; it's not unheard of for a horse to arrive at the hospital feeling better than when he left home. (Don't count on a trailer ride as a cure, though.)
At The Hospital
Experienced staffers will be on hand to help unload your horse and take him to an examining area when you arrive. You'll check in at the admitting desk and fill out the necessary forms. The attending veterinarian(s) will complete a thorough examination to confirm that surgery is needed (or, determine if it's not needed). If the veterinarians advise surgery, your horse is insured, and time permits, place another call to your insurance company before the surgical team goes ahead, and document the time of the call and the name of the insurance representative.
As your horse undergoes general anesthesia and the surgery starts, there's nothing else to do but wait for what will seem like a very long time (it could be several hours before your horse is transported to a recovery stall). It is sometimes possible for you to observe the surgery through a window. (If you can watch your horse suspended belly-up with a tube down his esophagus and windpipe, you're a stronger person than I was when my horse went through colic surgery.)
The question uppermost on your mind, naturally, will be the same one that titles this article: Will my horse live? Will he recover okay?
As with any human surgical procedure, colic surgery has its share of risks and complications. No surgery is 100% guaranteed to be successful, and no surgery is guaranteed not to have post-operative complications.
White has been performing colic surgeries for more than 40 years. "I've seen a major improvement in veterinarian and owner response to colic. Horses are getting treated earlier, and the earlier a horse gets to surgery, the lower the likelihood of complications," he says.
Earlier response, combined with improved surgical and aftercare procedures, make for impressive statistics. According to White, many hospitals claim survival rates as high as 80%-90%.
Still, complications can and do happen. Here, according to White, are the ones veterinarians least like to see.
Colic is a disorder of the digestive system, and in some cases, part of the intestine suffers damage or dies. The affected bowel can release bacteria, which in turn release endotoxin (a lethal toxin) into the system. The endotoxin can depress the heart and inhibit circulation to the entire body and affected bowel, thereby starving it for oxygen and nutrients. In short, it can kill the horse. That's why White calls endotoxic shock the most dangerous colic complication.
Endotoxic shock is not associated with surgery per se; it can occur even before a colicky horse gets to the operating room. White suspects shock whenever he sees a horse with pale or bluish mucous membranes and a skyrocketing heart rate. A heart rate of 80 beats per minute or more is a telltale indicator of severe shock.
Endotoxic shock isn't always treatable, and that's why it's such a dangerous complication, says White. The existing treatment methods, which include an antiserum, aren't effective in all cases. Seeking treatment early is your best defense against your horse's developing endotoxic shock.
The risk of infection is present with all surgeries. Colic surgery, which often entails removing fecal material out of opened bowel, can be especially risky. Veterinary surgeons are ultra-careful when they clean out the bowel and administer appropriate doses of antibiotics to reduce the risk of infection, but peritonitis still can develop. A raging infection can prove fatal.
As the injured bowel heals, it can form scar tissue, particularly at an incision site. This scar tissue can adhere (thus the name) to something it shouldn't—even itself. Adhesions can obstruct blood flow or the intestines themselves, and cause chronic colic and pain. A second surgery might be needed to break down the scar tissue. In some cases, the surgeon will opt to bypass the adhesion entirely by rerouting the affected section of bowel.
Endotoxic shock, infection, or bowel distention can cause ileus, a condition in which the bowel ceases its normal motility (natural movement). Veterinary surgeons can't predict with certainty which cases will develop ileus, but several measures exist for attempting to jump-start the bowel and to prevent additional complications. One is to keep the bowel empty by keeping the stomach empty using a stomach tube and by feeding the horse intravenously, so fecal material can't get backed up in the intestine. Another is to administer one of a variety of drugs designed to stimulate the autonomic nervous system or a painkiller such as intravenous Lidocaine; pain itself can inhibit the bowel from resuming normal movement.
Contamination at the incision site can impede the healing process and lead to the development of an incisional hernia, a painless bulge in the abdominal wall that's visible externally. Incisional hernias can be of varying sizes; if it's just a small "bubble," your veterinarian might advise that it be left alone. A large hernia, however, eventually could trap a portion of bowel and cause another surgical colic episode; such hernias usually require surgical repair.
White is especially conscious of the risk of hernia if the horse present for colic surgery is in a debilitated or shocky state, as he's found that such horses heal more slowly than their more robust counterparts. He takes extra precautions with at-risk horses, such as an extra-long period of abdominal bandaging to support the weakened incision site. The development of improved suture materials, which are stronger and less inflammatory than their predecessors, also has helped reduce the risk of hernia development, he says.
Strange as it might seem, laminitis (painful inflammation of the tissues in the hoof, which can lead to the coffin bone's rotating out of position), is a complication associated with severe disease and shock, says White. Veterinary experts believe that the release of proteins and endotoxins, which can be released during intestinal disease, could be associated with colic and laminitis. Unfortunately, the incidence is erratic. It's impossible to predict a colicking horse's chances of developing laminitis. Some horses in severe shock don't founder, and others in relatively good shape do. As a result, hospitals hedge their bets by taking precautions with many surgical cases, such as applying cold pack to the feet and supporting the foot with padding or foot pads to minimize pain.
Anesthesia, a concern of most horse owners facing a colic surgery, actually poses little risk, says White. "Many horses actually come out of anesthesia with their vital signs better stabilized than when they went in," he says. "If a horse dies under anesthesia, he almost certainly had sustained so much internal damage that he was going to die anyway."
Even aged equines generally deal just fine with anesthesia if they're otherwise healthy, he adds. As with humans, the better shape the horse is in before the surgery, the better his chances of coming through the anesthesia with no problems and bouncing back in a relatively short period of time.
What Are My Horse's Odds?
Experts can point to a few factors that have been shown to affect a horse's chances of surviving colic surgery. Horses under six months of age suffer fewer colics overall, says White, but have a lower colic surgery survival rate because they are at greater risk of developing adhesions. Horses which graze on sandy soil might be more prone to developing "sand colic," while horses in California, Florida, and some midwestern states have a higher risk of developing enteroliths than horses elsewhere in the United States. As a breed, Arabians appear more prone than other breeds to developing intestinal "stones."
Researchers know that some types of colic have higher survival rates than others. Few parasite-related colics require surgery, says White; surgeries to remove non-strangulating obstructions, such as enteroliths and impactions, have high success rates. The dimmest prognosis is for colic caused by strangulation of the small intestine. The survival is related to the duration of the strangulation. The longer the intestine is strangulated the lower the chance for survival. Early recognition and surgery can result in survival as high as 90% if surgery is done early, White reports.
Your veterinarian, as well as the hospital staff, will do their best to advise you of your horse's chances before they operate, and, once the problem is identified, the veterinary surgeon will give you the best estimate for a prognosis after the procedure is completed.
One factor that White found to be influential in colic surgery survival is completely intangible: the horse's personality. Like people, some horses are fighters, while others are made of weaker stuff. Some horses seem to give up in the face of pain and discomfort; others rally and respond to the ministrations of their owners and caretakers.
There are no easy answers when it comes to colic surgery, just as there are no easy decisions. Unpleasant as the subject might be, talk to your veterinarian about what you'd do in the event of a severe colic, and map out a game plan. Make any needed arrangements, such as for equine insurance, before you need them. Don't wait to seek veterinary care if you think your horse is colicking, White urges. If you can't reach your veterinarian, or if he or she can't get to your horse promptly and you think the horse is in bad shape, go ahead and call the surgical facility and make arrangements for an emergency examination.
"I don't know of any hospital that would turn you away because you hadn't been referred by a veterinarian for this emergency," he says.
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