Colic First Responders
The word “colic” can bring fear to the heart of any horse owner. Heck, even though it does not qualify to be called a disease (it is more specifically a symptom of many diseases that are defined by a painful problem in the horse’s abdomen), it is second only to old age as a cause of death to our horses.
Nationally, out of a population of one hundred horses, four to ten cases of colic can be expected over a year. The average loss of use due to colic is two to three days a year. The value of the horses lost to colic in the United States is approximately seventy million a year, and the total cost to the United States equine industry is one hundred and forty four million dollars a year.
I, myself, have a more personal hate of this “condition.” In my practice no other illness can take so many patients from a state of health to one of pain and potentially life threatening complications so quickly. No other illness can create such rapid consternation in my clients due to the stress of not knowing fully what is happening to their horses (83% of colic cases nationally are “idiopathic,” meaning not having a defined cause). In addition, the stress of the potential economic impact of colic can be devastating to a family. (A small percentage of colic cases require quick response referral surgical treatment that can cost on average $4,000to $5,000). I also hate this “disease wanna be” because it has the greatest ability to take me away from my family, at the most Godforsaken hour; in the most inclement of weather, and has an uncanny knowledge of the holidays… I once ran a streak of four consecutive Christmas Eves where I was called away to treat colic episodes. It became a family joke that Santa must be a-comin’ because Dad was leaving for another colic call.
Although colic episodes can be caused by many different abnormalities, most can be grouped into one of three categories:
1. INTESTINAL DYSFUNCTION: This is the most common group. The gut is in the proper position in the abdominal cavity and the walls of the gut are normal but the horse’s bowels are not working properly. It includes things as spasms (disordered motility), gas colic, impaction and ileus (decreased motility).
2. INTESTINAL ACCIDENT: This occurs less frequently. The gut is in an abnormal position and/or location. It includes twists of the gut (torsion, volvulus) and entrapment of a section of the intestine in a tight space. This type of colic almost always requires emergency surgery.
3. INFLAMMATION OR ULCERATION: This happens when you have inflammatory changes in the wall of the gut such as gastritis in the stomach; enteritis in the small intestine; and colitis in the large intestine. This type of colic can be caused by many factors like stress, medications, infection and parasites.
Veterinary researchers and board-certified veterinary surgeons have greatly increased the chance of our horses surviving colic. Researchers are currently working on the role of endotoxins in colic and how to minimize their effects. They are showing us how to use non-traditional modalities like ultrasound, laparoscopic exams, and pancreatic enzyme evaluation to help diagnose colic cases. They are developing new medicines to treat colic and have started to define how breed, age, gender, and management practices affect the potential to have colic in the horse. Board-certified veterinary surgeons have made great strides in the area of surgical intervention. Dr. David E. Freeman, professor and associate chief of staff at the University of Florida exemplifies this by a great statistic, “between 1968 and 1986, 49% of the horses undergoing small intestinal surgery died, in 2005 that number was down to 12%-18%.” However, all the research, knowledge and new medications and all the skills of the veterinary surgeons mean little if they are not applied in a rapid and appropriate manner. This is where you and I come in.
First responders, like firemen and policemen, are individuals who provide rapid response to an emergency; they provide rapid and appropriate evaluation and administer rapid and appropriate initial treatment. Note the repetition of “rapid” and “appropriate.” In the emergency world of colic it is you, the owner, and I, the vet, who collectively are the first responders.
What is the importance of time in treating colic? According to Dr. Anthony Blikslayer at North Carolina State University, who has twenty years in colic research, “it used to be that horses were referred to hospital several hours into the colic episode after every other avenue of treatment had been exhausted. That’s not the case anymore, which contributes to better survival rates.” Dr. Blikslayer also warns us, “Typically, when survival depends on intensive hospital care, a horse needs to be admitted within three to four hours of the onset of colic.”
You and I have specific, yet equally important roles as colic first responders. Remember that Time is our number one enemy in diagnosing and treating colic. The owner’s quick recognition of the signs of colic is crucial in producing a favorable outcome. Colic signs can include some or all of the following:
1. Turning the head towards the flank
3. Kicking or biting at the belly
4. Stretching out, like standing to urinate without urinating
5. Repetitively laying down
7. Leaving food or refusing food
8. Acting thirsty but refusing to drink
9. Lack of bowel movements and sounds
10. Inappropriate sweating
11. Rapid breathing
12. Elevated pulse
After recognizing the signs of a potential colic, you, the owner, must reach the vet as soon as possible. Be able to provide that signs of colic are present, the time the signs first appeared, the intensity of the signs and if possible, a temperature, pulse rate and characterization of the gut sounds. In addition, the presence or absence of bowel movements, the color and moisture of the gums and any pertinent medical history and management changes, especially changes in feeding. While communicating with your vet, please write down and carry out any initial instructions that he or she provides. Please remember to keep your phone lines open. Use another phone line to make other calls. Most, but not all, colic calls require a timely, rapid response/farm call from a veterinarian. If a farm call is indicated, while waiting for your veterinarian to arrive, prepare for some potential scenarios
1. Locate your horse to where it can be observed.
2. Move your horse to shelter if the weather dictates.
3. Set up lighting if necessary.
4. Call friends for backup help.
5. If your horse is insured, notify the insurance company of the condition.
6. Make sure a trailer is available for transportation if determined to be necessary.
How can a general practitioner be a good first responder? Any veterinarian who takes more than four hours to respond to a colic call has, in my opinion, greatly reduced his or her effectiveness as a first responder. The veterinarian, as a first responder, must evaluate the condition quickly and accurately; he/she needs to initiate treatment as early as possible. The veterinarian must quickly determine if the colic is one that should be treated medically or referred for advanced critical care and/or surgery. The tools a veterinarian uses to minimize the importance of time in an emergency colic situation include
1. A medical history review
2. A complete physical examination
3. Rectal palpation
4. Passage of a nasogastic tube
5. Collection and evaluation of abdominal cavity fluid
6. Blood testing
7. Repeat evaluation
It is now clearer than ever that the outcome of a colic episode is most greatly influenced by the quickness of how it is identified, responded to, evaluated and treated. To this end, the owner and the veterinarian have a critical role. We, together, are colic’s first responders.