"Your horse is ready to be released to your care at home." These words bring relief that the surgery is past and your horse is ready to return to the farm. But then, you have an anxious moment wondering how to manage a post-operative situation. You are wondering what you should be looking for that might portend a back-slide in your horse's recovery, and what you can do to make him comfortable at home. In many cases, a successful outcome depends on proper post-surgical nursing care.
Simply because your horse has been removed from your veterinarian's premises does not mean you are left on your own to manage all post-operative details. Your veterinarian is still available as a constant resource for any concerns that you might have while the horse is in your care at home. Your main role is to be the critical evaluator of the overall health and progress of your horse.
The Basic Physical Exam
A critical feature of good post-op care revolves around learning to recognize what is abnormal. You'll want to check your horse's vital signs at least once or twice a day to ensure all is well with his basic health. Confinement, restriction of exercise, and the stress of any illness or surgery pose their own set of problems aside from the actual surgery, making these individuals more at risk for developing colic. By keeping a close watch on your horse's overall health, you might be able to head off impending trouble.
It is helpful to set up a chart (see "Sample Log for Patient Monitoring" on page 76) in the barn to keep track of information that you will monitor at least once or twice a day. Include in your chart:
- Rectal temperature--normal resting range 99.5-101°F (37.5-38.3ºC);
- Heart rate--normal resting range 32-44 beats per minute;
- Respiratory rate--normal resting range 12-24 breaths per minute;
- Intestinal sounds on both sides of the flanks;
- Attitude and appetite;
- Mucous membrane color and capillary refill time--normal color should be pink and capillary refill time should be less than two seconds;
- Quality and quantity of manure and urination;
- Water intake;
- State of the surgical site (see Incisions section below);
- Body posture and hoof comfort help monitor for developing laminitis; and
- Palpation of digital pulses--a bounding pulse might forecast impending laminitis.
Information obtained from these exams is invaluable to tracking the healing of your horse. Of course, you should know what is normal for your horse before an emergency arises. Also, you should discuss with your veterinarian what you should expect as your horse recovers.
Surgery is performed under as sterile conditions as are possible with careful disinfection of the incision site. Yet no matter how diligent the surgical preparation and technique, infection is still possible either in the deep tissues of the surgical location or in the skin surrounding the incision line. Regardless of the length of the wound, it will heal side-to-side; a long incision heals at a similar rate as a short one. No matter whether stitches or staples or nothing is placed, there are things for you to watch for that might tip you off to a problem:
- Increased heat around the surgical site;
- Pain associated with gentle finger pressure around the surgical site;
- Redness of the overlying skin;
- Swelling--localized or diffuse, particularly if it stays around the incision instead of moving to dependent regions;
- Drainage, particularly if it is a thick, creamy consistency rather than the expected
- small amount of clear serum;
- Offensive odor;
- Fever and/or lack of appetite;
- Worsening lameness, especially if associated with a limb wound;
- Separation (dehiscence) of the incision line with stitches or staples pulling out.
Upon discharge of your horse from the hospital, you'll get instructions about frequency of bandage changes, materials to use, ways to clean the wound, duration and dosing of antibiotics or other anti-inflammatory medications, and expectations for healing. If you are unsure about any of these procedures, be sure to discuss them with your veterinarian. Most times, he or she will visit your farm to change bandages and check on a surgical site at least a couple of times a week. Then instructions can be fine-tuned and modified to what is appropriate at that time.
If a horse's limb has been placed in a cast, you need to be especially diligent about checking the cast at least twice a day. Casts tend to create pressure sores that mean a great degree of discomfort, as well as causing a delay in recovery. Monitor the leg with the cast for increasing lameness, moistness at the edges of the cast, or any odd odor. Watch your horse's behavior: Is he chewing at the cast, stomping the leg, or placing the cast limb in unusual postures? Is he off his feed or depressed? These are signals that something might be wrong beneath the cast, and you should contact your veterinarian immediately.
Intravenous (IV) Catheter Site
Most surgical procedures require placement of an intravenous catheter to administer drugs and fluids. Your horse will probably go home without the catheter in place, but you will still need to monitor the needle puncture site for any signs of phlebitis, which is infection or swelling of the jugular vein. If there is swelling, warm packs of epsom salt soaks can help draw out an infection and improve circulation, relieving some of the tissue edema and discomfort. It might be necessary for the horse to be on anti-inflammatory medications and/or antibiotics if the catheter site has developed an infection. Any blockage of the normal flow of the blood from the head to the heart via the jugular vein can cause swelling of that side of the face and jaw (another distinct clinical sign).
Issues of Confinement
Following many surgical procedures, it is necessary to confine the horse to a small space to limit movement and exuberant exercise. This is particularly true following colic surgery, other abdominal surgery (such as a Cesarean section), or orthopedic surgery. The amount of time a horse will be restricted to a stall-sized area is dependent on the type of surgery and any complications peculiar to that individual. Generally, most post-op recommendations require a horse to remain in a confined area for one to three months. Sometimes hand-walking is allowed and encouraged; sometimes not. This will usually be at the discretion of the surgeon.
This is the hardest part of post-operative care. Once your horse is feeling better following surgery, he will have an abundance of energy and be anxious to return to his normal routine out in the pasture with his friends. You might find yourself frustrated with having to keep a thousand pounds of fretting flesh in a quiet mode.
There are logistical concerns relative to confining a horse in a stall. Usually this means that the horse is enclosed inside, out of the sun, and away from visual or auditory contact with herd mates. Boredom can be extreme for these horses, and stall vices easily might develop. A confined horse often starts eating bedding or dirt and creates a colic situation. Stall confinement also creates a lot of extra cleaning work and expense for you due to the need to strip and re-bed the horse's stall each day. You might have to stall a companion horse to keep the recovering horse quiet, which means double the work.
This is your opportunity to be creative. There are effective alternatives to stall confinement. One is to create a stall-sized enclosure out-of-doors using commercial fence panels. Such panel enclosures can be enlarged as healing progresses. The panels can be moved to different locations around the property to allow your horse to graze a little green grass while in his small confinement, and/or to eliminate the buildup of urine-soaked ground.
If a horse is to be confined to a stall in a barn, make sure ventilation is at its best so ammonia fumes do not collect and create respiratory problems. Clean the stalls of all manure and wet shavings at least a couple of times of day. Opening the top part of the stall door so the horse can hang his head into the sun and watch the world around him helps curb boredom. It might also help to suspend a stall toy from the rafters to give the horse something with which to play. Use fly sheets and insect repellents as necessary to keep your confined horse as comfortable as possible.
For horses which will be confined for longer periods, it is wise to cut back any grain or concentrate portions of the diet, and to supply a quality source of grass hay. Adequate fiber in the diet is important to maintain good intestinal motility and to limit development of gastric ulcers. Having hay in front of the confined horse gives him something to do to alleviate the boredom. If more calories are needed to maintain body condition in a difficult keeper, then calories can be added by feeding additional fat in the form of vegetable oil or rice bran. Offering soaked beet pulp pellets provides extra calories in a fiber-based feed that is safer than the abundant energy supplies in grain products.
Not all veterinary hospital visits require general anesthesia or involve an actual incision site that you'll need to monitor. One situation that might require a visit to a veterinary hospital would be a problem with foaling, called a dystocia. Or the mare might have had a retained placenta that required aggressive daily treatment to clear the placenta and ensuing infection. (For more information on this condition, see article #4031 online.)
Once the mare is home, one thing you will watch for is abnormal vaginal discharge. It is normal for a mare to discharge some discolored fluid (lochia) for a week or 10 days following foaling. This would be a brownish-tinged, watery fluid--not creamy or thick. Exercise, when incisional concerns do not preclude it, is essential to
helping the mare evacuate her uterus. Besides all of the other items listed in your basic physical exam check, also watch for indications of discomfort during urination. Check her udder for heat, pain, swelling, or any thick discharge or clots of milk that might signal mastitis.
Foaling mares are at risk of serious displacement colic within the first 60 days following foaling due to the enlarged amount of space still present in the abdomen.
Most routine castrations are performed on the farm, with all post-op care placed in your hands. Gelding a horse is one exception to the general rule of confinement following surgery. Whether the colt or stallion is castrated standing or recumbent (lying down under general anesthesia), in most cases the surgical incisions over the scrotum are left open to heal by granulation. An open incision allows appropriate drainage following removal of the testicles from the scrotal sac.
During the day following castration surgery, the horse should be confined to a stall to allow adequate clotting of blood vessels. In the first 24 hours, you will need to monitor him carefully for any signs of hemorrhage, which is a frequent complication of castrations. Another complication to watch for is scrotal hernia (protrusion of a piece of small intestine through the castration wound). This is an emergency necessitating immediate veterinary attention.
Usually, all proceeds well and the day following the surgery you will find yourself enforcing active exercise based on your veterinarian's instructions. Your "new" gelding might be sore and not very willing to move at first, but once he gets going, he will feel better. It is preferable to exercise your newly gelded horse vigorously for 20-30 minutes twice a day for up to two weeks following surgery. He can be run around an arena or round pen, put on a longe line, or ponied from the back of another horse.
Exercise allows ample drainage, minimizing the swelling around the incision sites. Most horses won't let you touch the surgical site, which is just as well. They have an excellent built-in fly swatter to keep the insects at bay, and even if the horse lies down from time to time, dirt does not tend to collect in the surgical area. Stalls should be bedded with straw rather than shavings for the week following a castration; wood shavings do tend to find their way into the castration site and could slow or complicate healing.
Things to monitor in your recently gelded horse are attitude, appetite, rectal temperature, excessive swelling, abnormal drainage from the castration site, or any sign of rear end lameness that could be a side effect of swelling or infection. Persistent swelling of the scrotum and prepuce could signal infection, and is often accompanied by a fever. By two weeks after surgery, the castration site should be well healed in any age horse. Should any abnormal swelling persist, ultrasound of the area is indicated along with diagnostic blood work. Antibiotics are not generally used for a routine castration unless a complication develops.
A horse which has had cryptorchid surgery, or has been castrated using the technique of a closed, sutured incision, will need to be stall-confined with restricted exercise for a couple of weeks post-operatively.
Other Care Options
Many horses flourish under a lot of attention. Grooming, muscle massage, and hand-walking are all ways for you to coddle the healing horse. Tendon injuries often require diligent hand-walking strategies to achieve the best rehabilitation. Passive range-of-motion manipulations like stretches and gentle flexion/extension of joints are beneficial to tendon and joint repair during the convalescent period if recommended by a veterinarian. Such exercises minimize adhesion formation while increasing range of motion of the limb.
Some post-operative wound sites might improve with hot or cold packs. Cold therapy is generally used within the first three to five days to reduce swelling and pain, while heat therapy is useful after the initial few days to dilate blood vessels, improving circulation and relieving tissue edema as healing proceeds. Cold would never be applied to an area of infection. Be sure to discuss with your vet whether it is appropriate to apply hot/cold water to a surgical site or if dry thermal compresses should be used instead.
No matter the type of surgical procedure your horse undergoes, you'll be responsible for the care of your horse once he is released to go home or the procedure is completed on the farm. Diligent monitoring and proper preparation on your part will ensure that your horse heals quickly, and that he is happy in his own surroundings.
POST-SURGICAL DAILY EXAM
The following are important aspects of your horse's health and attitude. Evaluate each one at least one to two times per day following a hospital stay; this will help you catch any problems early and give you valuable information for the veterinarian if complications arise.
- Rectal temperature
- Heart rate
- Respiratory rate
- Mucous membrane color
- Capillary refill time (CRT)
- Intestinal sounds
- Digital pulse
- Number of bowel movements
- Number of urination spots
- Water consumption
- Surgical site check
About the Author
Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.
POLL: Horse Height