Tuesday, August 6, 2013

Colic Surgery

                                                           by Laura Crum

            I have had a few friends lately (both on the internet and in real life) who have either lost a horse to colic or had a serious colic, and the subject of colic surgery has come up. Since I have actually gone through colic surgery with a loved horse I thought I’d write a post on what I learned, in the hope that it might help someone else make a decision.
            First off, I have always been someone who said I wouldn’t do colic surgery. Too much risk, too hard on the horse, too expensive, the rehab is long and hard, many horses are never 100 percent…etc. I knew people who had done colic surgery, with varying results, and I felt pretty sure this was not a path I wanted to take.
            But…five years ago, when my son’s horse, Henry, colicked, I did, in the end, choose colic surgery. I had some pretty specific reasons for this. 1) My son had lost his beloved pony to cancer a year previously, and I was desperate not to lose Henry at this point, 2) Henry was sound and strong and in perfect health otherwise, 3) ultrasound showed a mass in his intestine that the surgeon thought was a pile of sand or small stones that needed to be removed and they felt this was a relatively straight forward surgery, and 4) Henry was in excellent shape for surgery…all his vital signs were very good. The vets at the equine center convinced me that surgery was Henry’s best chance.
            I was told the surgery would probably cost $7500, and though I had to put it on my credit card (I do not have that kind of extra money lying around), it was not an impossible amount for us as a family, and my husband was in agreement that we should try it. I would not have done the surgery if it would have been a serious financial problem for our family. (By the way, when all was said and done, with rechecks, post op problems…etc, it was more like $10,000, and people have told me that it is $12,000 today at that same equine center.)
            I was also told that Henry had a very good chance of going back to full work, which for him was walk, trot, lope trail horse. I forget the actual statistics now, but they were pretty good. The down side was that Henry had just turned twenty, and one in five rehabs had some sort of problems. Anyway, I made the choice to try the surgery.
            Those who have read this blog know that it did work out and Henry has been 100% fine for five years post surgery. Given the exact same set of circumstances, I would make the same choice. I do know the surgery was needed—I have the cantalope-sized stone they took out of Henry’s intestine on my living room shelf. However, if another one of my horses colicked tomorrow and I was faced with surgery, I think I probably would not choose this option (though again, it might depend on circumstances).
            Why? Well, having been through it, I really understand what it entails, which I certainly did not before. So let me see if I can describe the process well enough that others can understand my thinking.
            First of all, I would only consider colic surgery if the horse was, as Henry was at the time, vital and pretty much irreplaceable and completely sound and in full use. The horse would have to have an excellent prognosis going in, as Henry did. A horse that was already in distress with poor vital signs is just not a good bet. And finally (though I didn’t think much about this at the time) the horse would need to be the sort to be a good patient.
            Because the rehab was just as difficult as I had feared. First off, the horse has to be confined in a 15 by 15 stall for the first month and, guess what? They would prefer he didn’t roll. (You can easily see why.) I have no box stalls, so I built a 15 by 15 stall out of panels, under a pasture shed roof. Oh, and this just happened to be in February—it rained pretty much non-stop during the first part of Henry’s rehab. The stall had to be kept immaculate, because it was vital to keep the incision clean. So I bedded this stall VERY lightly, so Henry wouldn’t want to roll, and I cleaned it three times a day.
            The horse must be hand walked three times a day as well, and hand grazed on green grass three times a day. The horse must be fed four small meals of hay a day. Then there’s antibiotics and pain meds as needed. Taking care of Henry was almost a full time job. Fortunately, I had the time to do this.
            Henry had to go back to the equine center once a week for rechecks during the first month (and the equine center was an hour away). During these rechecks they changed his bandage (which was a huge thing that wrapped around his barrel and supported the incision). But after the first month, they had me buy a “hernia belt” (very expensive) and from then on I changed Henry’s wound dressing every two or three days myself. I learned to do it competently, but it would have been a dangerous business with a flighty horse inclined to spooking or kicking.
            Henry ended up with a couple of (very common) post surgical problems. First he got an infection (he was on antibiotics for a couple of months) and then he developed a hernia. Neither of these problems was a big deal in the grand scheme of things (though, of course I didn’t know that at the time), but they caused me a lot of worry and some expense and certainly many extra rechecks with the equine center.
            After six weeks of confinement in a stall, even the docile Henry was very full of himself and a pain to handle—I cannot imagine what this would be like with any sort of hot horse. I was worn down with worry and the constant care giving. I had been told that we could go back to riding Henry in three months, but it wasn’t until the end of four full months of rehab that we got cleared to actually ride the horse. And it wasn’t until we were six months out from surgery that we were taking him on trail rides and picking up the lope. It was a long haul.
            Six months is not a long time if you simply turn a horse out in pasture and let him heal. But this was four months of constant, every day, three and four times a day, hand walking…etc. It was a lot of work. I worried constantly that Henry would get adhesions, or a serious hernia that would require more surgery, or mean the end of him. In retrospect, since I know the horse is fine, this worry was pointless. And, of course, since I did my very best to take good care of Henry, and this was all that I COULD do, the worry was pointless in any case. But I couldn’t help worrying. It was very stressful.
Eventually rehab progressed to the point where my son could ride Henry—bareback at the walk. And this was the one and only point in all the time we’ve owned him when (the now feeling way too full of it) Henry ever dumped my kid. (My son wasn’t hurt, but it wasn’t our best moment, that’s for sure.) And then came two months of slow, careful under saddle exercise, while the horse lived in a small (20 by 20) pen. Lots of stall cleaning and pen cleaning involved, too. Again, a lot of work.
            Yes, it was worth it to me. Under the circumstances in which I made that choice, I would do it again. But I probably would not choose it today for any horse on my property. None of them have the disposition to be the excellent patient that Henry has/had, and Henry himself is 25 years old. All of my horses are in their late teens or older. Bearing in mind that we all must die sometime, I don’t think I would put myself or any of my horses through that ordeal just to extend their lives. The one exception might be Sunny—but I am not sure how he would deal with the rehab. He hates taking meds and will kick if he feels the need. I think it might be an unworkable combination.
            So yes, even though I had a successful result with colic surgery and I am very grateful that I spent the money and the time and the blood, sweat and tears to keep Henry with us, this hasn’t made me feel that I would want to do colic surgery in the future. I can’t, of course, make any recommendation on what others might want to do, because every situation is different, but I hope my story may help someone else to at least have a little more understanding than I had going into the process.
            And please, if anyone else has insights to offer, feel free to give them in the comments. 



AareneX said...

Even "minor" minimally invasive surgery (like Fiddle's ovariectomy) is scary and stressful for the owners (and payers of bills). I would *absolutely* do it again, knowing what I know now.

But colic surgery isn't minor or minimally invasive. And it's a LOT more expensive (adds to the stress, if nothing else).

It's good to have your perspective, Laura. Thanks! I hope I never need to add to it.

Laura Crum said...

Aarene--I hope neither you nor I ever need to acquire more knowledge on this subject(!)

Mindy said...

Hi Laura: This brings to mind my last horse (before Lily) who had to be put down due to colic. The barn owner found her thrashing in her stall and immediately got her up and called the vet. She determined that her gut had most likely twisted due to the rolling and told me she needed to go to the equine hospital for, at the very least, a more thorough exam. I knew I wouldn't be able to afford the surgery ($10,000 to $20,000 estimate by my vet), but I at least wanted them to see if there was anything that could be done without surgery. When she got off the trailer about an hour later, she seemed fine - whinnying and looking around. Within 20 minutes she was trying to roll again and after an examination by the vet, I was told that her gut had more than likely ruptured during the trailer ride. When the gut ruptures, they have approximately 20 minutes of relief before it becomes toxic. At that point, surgery was no longer an option - the vets said she'd more than likely die on the table. So, I lost an amazing horse that night two years ago and not a day goes by that I don't think about her. I'm very, very fortunate to have found Lily (or maybe she found me) not long after.

Laura Crum said...

Mindy--I have been through this with a horse that I was caring for (for my uncle). This mare had the same relief that you describe and the vet said her gut had almost surely ruptured. We had her euthanised. And yes, this is a lot of the problem when talking about colic surgery. Some horses have virtually no chance, so surgery is not a good option. So sorry you had to go through that, but so glad you found Lily.

Anonymous said...

A very useful summary. I've never had a horse who's been a candidate for colic surgery (knock on wood many times), although I've had horses colic, but it's definitely not something to enter into lightly, either for the horse, or for the owner who will have to provide the care you describe. To me the biggest consideration would be: can the horse handle the surgery and recovery, both in terms of its health going in and its temperament - although there are long-term (months) tranquilizers that can be used with horses that are too nervous I don't know if they can be used after colic surgery. The type of colic and the prognosis is also important - impactions, stones, twists or other types of colic, as you point out, can affect the decision as the risk of complications is higher in certain cases.

Laura Crum said...

Kate--Just as you say--I think the decision has to be based on a lot of different factors. I agree with all of what you said in your comment (especially the knocking on wood part).

Alison said...

Wow, Laura, thanks for the blow by blow. Fortunately, I have never had to make the decision for a horse, and I hope I never have to. Usually doctors/vets do not clearly spell out all the possible problems and the post op difficulties. Hearing it from you was an eye-opener. Thanks!

jenj said...

This makes me feel so much better about our decision with Oberon. Thank you, so very much.

Val said...

Thank you for a very informative post. This is definitely worthwhile knowledge, even if every horse owner hopes to never need it.

I knew and worked with two nice therapy horses (both fjords) who did not survive colic surgery. Both were relatively young and would have been calm enough for the rehab, but neither one made it out of the hospital. These horses were certainly irreplaceble in a sense, but luck was not on their side. Colic terrifies me, because so often it does not end well and there are no guarantees even if no expense is spared.

Mindy said...

Thank you, Laura. Cricket was very claustrophobic and definitely wouldn't have been a good candidate for complete stall rest, which is one of the things that was pointed out to me during her visit to the equine hospital. I knew a lot was involved in their recovery from colic surgery but it's a lot more involved than I thought! I'm so glad Henry recovered and is doing so well!

Kerrin said...

We have had three horses die/euthanized with colic since we started keeping horses here at the City Limits in 1999. All were older (20,20 and 34) and the first two were retired broodmares, the oldest was a retired child's first horse. One was ours (mother of our beautiful Triscuit), one was a rescued horse/pony that was 'accidently' in foal at age 20 (which is why we rescued her) and the third was our good friend's child's first horse, child having grown up and moved on to a much younger performance horse. Every one of these mares had a colic that did not respond to medical management and every one was euthanized as soon as we realized the mare was not going be OK without surgery. No regrets whatsoever.

I was down at the local referral hospital with a horse for a non colic problem and saw a beautiful young (4 or 5?)pinto gelding that had had colic surgery a month before. He had many complications including laminitis and after $22,000 the owner could go no further and the surgeon took over the ownership/responsibility for that horse. I heard later that he was eventually euthanized anyway.

We also say 'no colic surgery' but we also have individuals for whom we might make the same decision that you did with the same hopes and fears. Some good friends of ours have had colic surgery on both of their beloved Arabs, one relatively young, one relatively old and both with excellent outcomes.

We did do surgery on a young mare with an umbilical hernia that suddenly entrapped her bowel causing colic. However, we had rescued the mare knowing she would need hernia surgery eventually and the emergency doctors at the referral hospital were able to free the trapped bowel by pushing the hernia in, so the surgery could wait until the next day, not an emergency anymore and they didn't have to open her all up, just had to repair the hernia. That whole thing cost about $4000.

Unfortunately that young mare became unsound (hocks) and likely will never be ridable so she is retired at age 10. In retrospect her successful surgery was probably 'too expensive' even though it was very affordable as colics go.

I loved your post and think you should submit it to Equus for publication. They print a story about a horse/horse experience on the back page of each issue. Other horse owners could benefit from what you learned.

Laura Crum said...

Thanks Alison, jenj, Val and Kerrin--Glad you found the post helpful. I did fear all the possible post-surgery complications (a lot), but the ones Henry had were very minor. It may be that we were lucky, but I think part of it was that Henry was (as they put it at the equine hospital) a rockstar of a patient. Not just in being quiet and cooperative, but his will to live was strong and his cheerful demeanor remained intact throughout the long rehab process. He really was an excellent patient.

One of the main reasons that I went forward with the surgery was that the surgeon was pretty clear on what the problem was and that he felt it was very fixable. It was a relatively straight-forward surgery (though they did find a big stone that they didn't spot with the ultra-sound). The unknown variable that I worried about was how compromised the intestine might be--but it turned out to be quite healthy. We were lucky.

RiderWriter said...

It is SO HARD to decide what to do sometimes when your beloved animal is sick. You have to balance the will to live/feelings of the animal, the "fixability" of the situation, your feelings, your ability to care for the convalescent and last but not least, for most of us there are pocketbook concerns. In retrospect I do think I have made the right call with my animals so far, but I'm dreading a time when I simply won't know what to do, or will have to deny care because I simply can't afford it.

I find the case of Barbaro endlessly fascinating for many reasons, not the least of which is this dilemma. Part of me thinks he should have been euth'd right away after his accident, and part of me is glad his owners tried literally everything under the sun to save him. Of course with them, the money was no object - I speculate that the final tab had to be six figures. The owners and Barbaro's doctors swear that he had an immense will to live and they did not give up until it was clear HE was, but I'm still not sure if it was right to put him through all that.

Laura Crum said...

RiderWriter--I felt very deeply confused when I made the choice to do colic surgery on Henry. In the end I looked the vet in the eye and asked him if it was the right choice. He sounded so sure that I went with it. But it wasn't an easy choice for me to make. Just a little over a year before I had chosen NOT to remove a kidney on our pony--with this same vet. I would make the same choices again--but both times it was very hard.

lilyrose said...

This was a very informative post, Laura. I always said no colic surgery for my horses. Four years ago we opted for the surgery on our much loved Holsteiner/Arab cross. He was twelve years old, and otherwise in excellent health and very fit.
I watched him as he was hanging out with his buddies...everything looking normal. One of my other geldings decided to roll and of course-everyone else followed suit. When my boy got up and shook-he suddenly looked awkward. Walked a few steps very stiffly and went down for another roll. I thought something was wrong right away because of the way he was acting. He started pawing at the ground and walking uncomfortably. After about twenty minutes I decided to call my vet. Of course it was late afternoon on a Saturday, so that meant emergency charges. After checking him out-our vet said he was pretty sure it was a twisted bowel. He called our equine hospital and told them we were coming. Thirty minutes later, the vet team at the hospital met us as we pulled in with the trailer. They did a quick assessment and agreed with our regular vet's diagnosis. We had a very short window of time to decide. We felt he deserved a chance. We actually got to observe the surgery through a viewing window. Very interesting-but would have been easier to watch on someone else's horse. The vet untwisted the intestine-made a small slit to empty out what had built up in there and closed him up. No loss of intestine-which meant a good prognosis. He stayed in the hospital for five days. We visited once-but he became agitated when we left without him, so the vet said not to visit again until we could take him home. The recovery was nerve-wracking for me too. It was a full time job! Same deal-several very small meals a day-stall bound for a month-then hand walking several times a day for months. He was not happy about not being turned out with his buddies, but he did enjoy all the extra attention he received. He is a very sensible minded horse so all went pretty smoothly. He was my husband's favorite endurance horse and was cleared for work one year after surgery and has since completed 300 endurance miles. But my husband rides very conservatively on him. We now consider him semi-retired. We now only trail ride him at a walk and trot. He seems content with that. This is a horse that truly loved his job. I'm glad we went ahead with the surgery but I don't think I could ever face it again.

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Laura Crum said...

lilyrose--My feelings/experience has been much like yours. Glad I did it for Henry but don't think I could face it again. I was totally NOT up for watching, though I was offered that option also. Henry's surgery was slightly different, as they had to remove a pile of mixed sand/stones from one area of his large intestine, and a big stone from another area--involving two openings of the intestine--and then the whole intestine was flushed out--as much as they could--and put back inside the horse. But, like your horse, it was considered a pretty straight-forward surgery.

I have heard of healthy horses rolling and suddenly twisting the intestine, as yours did. Considering how often horses roll, it is a very scary thought. I have also heard of this happening in a horse that was just bucking for fun in his corral. Makes me shiver--knocking on wood.

GunDiva said...

Colic surgery has never been an option for me, simply because of the cost. Money aside, since Estes didn't live with me, there's no way the rehab could have happened. Mom and Bill have a lodge to run and I'm over an hour away from them.

I'm glad it worked out for Henry, though. It's good to hear a positive outcome from surgery.

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kim r said...

My Haflinger mare colicked very suddenly on August 22, having been totally healthy and showing no prior signs. We ended up taking her 2 1/2 hours away, to the vet school at Washington State University in Pullman. She had two surgeries. The first removed 40 pounds of sand from her cecum; the second removed a "shrink-wrapped" mass of sand and manure from the large intestine. She stayed at the vet school for 11 days, and the total bill was $6300. I also had sworn that I would never do colic surgery. However, this mare is very special because of her fabulous temperament. I have an artificial hip, and I know this mare is as safe as any horse can ever be. Still, the first month of rehab nearly killed me. I work full time, and it was brutal trying to get out to keep her stall clean and walk her. Fortunately I have friends and a husband who helped out. Fiowna is now on her month of pen turnout, and she seems to be doing well. We're working on clicker training and gentle ground work, as per instructions. Still, I have to say that I don't know that I'd do it again, especially with a horse that was difficult to handle. Fi has been terrific -- there's that temperament thing again -- but it would be impossible with a "hot" horse. The irony, to me, lies in the fact that I was certain my mare couldn't have a sand colic, because I had used a psyllium product every month for the three years I have owned her. Apparently, she had picked up a huge sand load in her previous home. Where I live (eastern Washington state), we are in the desert -- sand everywhere. I have switched to a different psyllium product, one that uses pre-and pro-biotics, and you can bet that I will be monitoring sand in her droppings every month. Still, the whole thing has been expensive and awful. I am hoping that Fiowna will have a full recovery, and that I"ll be conditioning her gently by Thanksgiving. But there are no guarantees with colic.