Horse Colic Surgery: Making Hard Decisions

Knowing what to do if your horse needs colic surgery, and how to afford it, can save his life

Your heart pounds as you try to soothe your sweaty 21-year-old gelding, who is struggling as pain clutches his abdomen. You remind yourself to stay alert when he almost catches you with a hoof as he paws. He swings his head around to look at his flank and swishes his tail wildly. The more agitated he gets, the more you worry. Then the veterinarian’s voice interrupts your thoughts, confirming one of your worst fears.

“It’s definitely a severe colic, and he needs to go to the nearest equine veterinary hospital for an evaluation,” she says. “He may need surgery, but they can tell you more once he gets there. We need to get him there immediately.”

Your thoughts begin to whirl. Colic surgery? Will he survive that? Can’t we just manage him at the farm? How will he handle the two-hour drive? Do I need to put air in the trailer tires? How much will surgery cost? How will I afford it? How long will he have to stay there?

For horse owners in this situation, the questions come fast and furious; a severe colic diagnosis with referral for possible surgery can be upsetting and scary. But with a calm, clear head and quick decision-making on the part of the owner and veterinarian, many horses have a good shot at surviving such an emergency. In some instances, however, you might have to make difficult decisions for the sake of the horse. While it can be unsettling to think about all the possible scenarios, planning before colic happens could save your horse’s life.

When Colic Strikes

The chances of a good prognosis for a colic case increase the sooner you recognize the clinical signs. Ideally, you should already have a plan in place for what you’ll do if a horse colics, says Jarred Williams, DVM, PhD, Dipl. ACVS-LA, ACVECC, clinical assistant professor of large animal emergency medicine at the University of Georgia’s College of Veterinary Medicine, in Athens.

Typical colic signs include pawing, looking at or biting the flank, excessive sweating, rolling or wanting to lie down, playing in the water bucket but not drinking, lack of fecal output, poor appetite, abnormally high heart rate (more than 50 beats per minute), loud gut sounds or lack of normal gut noises, anxiety, dark mucous membranes, depression, unwillingness to move, and more. You should call your veterinarian to evaluate the horse immediately and do as he or she instructs you to until help arrives.

Always have a truck and trailer at the ready, should an emergency happen, and know which referral center your veterinarian sends patients to and where it is located.

Time Is of the Essence

Anthony Blikslager, DVM, PhD, Dipl. ACVS, professor of equine surgery and gastroenterology at North Carolina State University’s (NCSU) College of Veterinary Medicine, in Raleigh, says that when dealing with colic, the first step is making a triage decision. “For colic, the only thing you care about is whether the horse needs to be referred for further evaluation,” he says. “You don’t have to know why the horse is colicking. You just need to know it’s concerning enough that you want to get it to the next level.”

Williams says accurate diagnosis of the lesion (defined as any abnormal change in tissue) type and prompt treatment and referral are the most important steps. A horse with a suspected strangulating obstruction, for instance, needs immediate referral and assessment at a hospital, especially if it involves the colon, such as a large colon volvulus. “These can have significant cardiovascular collapse and respiratory difficulty due to pressure on the diaphragm, so immediate surgery is necessary, as they can die within a short period of time—hours,” he says.

David Freeman, MVB, PhD, Dipl. ACVS, chief of large animal surgery at the University of Florida’s College of ­Veterinary Medicine, in Gainesville, says delaying referral to the hospital to give intravenous fluids on the farm can sometimes make things worse. “This is done in the belief that the horse is dehydrated and will be in a better state when presented at the surgical facility,” he says, when, in fact, he needs to get to the clinic right away.

If a horse is not responding to pain-killing medications, it’s urgent you get him to a referral hospital, says Freeman. Any delay can turn what would be a minor surgery into a major one with an increased risk for postoperative complications and death, he adds.

At the Referral Hospital

Often, it’s not realistic for veterinary surgeons to evaluate the horse as quickly as they would like due to the distance many horses live from a referral hospital. Williams often sees horses four to six hours after owners noticed the first signs of colic.

Once the horse reaches the referral hospital, a veterinarian there will perform a workup, which usually takes 40-60 minutes, says Blikslager. He or she then shares the findings with the owner, suggests either medical management or exploratory surgery, and provides horse’s prognosis.

To determine prognosis, Williams says the attending veterinarian uses a variety of parameters to gauge severity, such as packed cell volume and systemic lactate (increases in blood lactate indicate cells aren’t getting enough oxygen). He or she might also monitor systemic glucose (also assessed on blood samples), abdominal lactate (from peritoneal fluid from an abdominal tap), heart rate, and whether the horse is in shock.

“These factors are often more important for predicting outcome than the amount of time since the colic began,” he says. 

Factors that affect an owner’s decision to send a horse to surgery include:

  • Lesion type;
  • Prognosis;
  • The horse’s health history and whether he has any other conditions, especially those that could affect his ability to survive surgery and heal normally, such as pituitary pars intermedia dysfunction, equine asthma, or an underlying inflammatory condition;
  • Whether the horse has colicked before;
  • Whether the horse will be able to rise after surgery (doesn’t have osteoarthritis or other conditions that could impact his ability to get up);
  • The owner’s emotional attachment to the horse;
  • Cost of care;
  • Risk that comes with anesthesia;
  • Time required for recuperation;
  • Age of the horse; and more.

Part of the decision-making process might involve the horse’s value and whether he can return to his intended use. If his prognosis to return to function is poor, his worth will likely plummet once he goes through a surgery, says Blikslager. And while most colic surgery patients do return to their intended purpose, the recovery period is a long one.

Freeman says many healthy senior horses do well, even after major colic surgery, despite the myth that old horses can’t handle anesthesia and surgery. However, if the horse has other conditions that could affect his quality of life, the owner might realistically consider euthanasia.

Health considerations aside, it all boils down to one of the biggest factors for electing to do surgery: finances.

Affording the Procedure

The general expenses involved in colic surgery at NCSU, says Blikslager, include:

  • $1,500 for the initial workup;
  • $1,000 for initial exploratory surgery;
  • $2,500 for a small intestine resection (surgical removal of the damaged part), although this cost varies by type of surgery; and
  • $3,000 or more for the aftercare, depending on complications.
  • He says the costs to manage a horse medically are a lot less than surgery. At NCSU the average colic bill, between medical and surgical cases, is $4,200. On the high end it could be $8,000-$10,000.

Fortunately, some horse owners have payment options besides their bank accounts. At NCSU, says Blikslager, owners can apply for a loan with CareCredit. If that isn’t enough, the hospital has a pool of donated funds available for those who can’t afford surgery yet meet the hospital’s guidelines and whose horses have a reasonable prognosis for recovery. However, each referral hospital has different financial assistance options.

These days, another way owners pay for a medical emergency is through crowdfunding. Search sites such as ­GoFundMe to find a multitude of campaigns underway to fund horses’ surgical or medical care.

As owners figure out finances, any delay before surgery can affect the horse’s prognosis. This is why equine insurance can be such a blessing. Blikslager says if a horse is insured with basic medical coverage, then the decision to say yes to a colic surgery is an easy one, because insurance covers it. To ensure this, NCSU staff members verify benefits with insurance company adjusters after owners have provided all pertinent policy information.

However, there are many nuances when it comes to equine insurance. Blikslager says if an owner buys mortality insurance but not major medical, and the horse develops a colic that can be treated, whether medically or surgically, the insurance company will mandate that the horse receive treatment and will not pay out if he is euthanized without it.

“If the veterinarian says there is no reasonable treatment option, then of course euthanasia is best to stop the suffering, and mortality would then pay out,” he says.

Blikslager also cautions that surgical insurance only pays for the actual surgery and not for pre- and postoperative costs, which are where most of the expenses lie.

“Unless you have a really, really ­valuable horse, the loss-of-use policy is really difficult to cash in on because you have to prove the horse can no longer (fulfill) his intended purpose,” says Blikslager. “That’s going to be a long, drawn-out affair with the insurance company.”

Euthanasia

Blikslager says he usually discusses euthanasia early on in case owners don’t want to or can’t continue medical treatment. “A lot of people feel really bad for their animals,” he says. “And the horse might be in really bad shape, and they may not have much in the way of ­funding.”

Blikslager says the veterinarian must be the objective force and not react emotionally, so he or she can lead the client through the decision-making process.

Freeman says the main priority is managing the horse in a humane way; he reminds the horse owner that the purpose of euthanasia is to relieve suffering.

The veterinarian should also discuss with the owner the time ramifications of delaying the decision—euthanasia vs. ­surgery—and how it can both prolong pain and decrease the chances of a successful surgery.

Horse Colic Surgery: Making Hard Decisions

The Recovery Process

After surgery, says Blikslager, it’s easy to manage most complications (shock, endotoxemia, electrolyte imbalances, dehydration, reflux, etc.).

He says around 15% of hospitalized colic surgery patients develop incision site infections, which can manifest as swelling, pain, and/or drainage. Infections in the body wall can lead to hernias.

Between Days 2 and 3 postop, NCSU staff members begin reintroducing feed slowly. Some horses colic again during this time, especially if adhesions are forming between intestines and the abdominal wall, says Blikslager. After about a week the horse should be ready to go home, presuming he did not have any serious complications and hasn’t colicked again.

Once home, confine the horse to a stall for a month, then to a small paddock for a month, and then return to exercise slowly during the third month. It might take another three months for the horse to return to his previous level of conditioning if he was an athlete. While return to full performance can take up to six months, says Blikslager, rehab modalities, such as underwater treadmills, can shorten that period.

Long-term survival rates often depend on how long the colic had been going on before the horse went to surgery. The biggest risk to survival involves adhesion formation. If a horse colics again, it becomes more difficult to save him with a second surgery.

When Surgery Isn’t an Option

Sometimes surgery isn’t an option because of finances, logistics (no way to get to a referral hospital), etc. In this case the best option is to try to manage the horse medically, whether under your veterinarian’s care at home or at the referral center.

“Waiting for the horse to respond to medical treatment is a reasonable approach if the horse is not showing severe signs of distress or pain,” says Freeman. However, some horses might have certain types of life-threatening colic that simply cannot be fixed.

There’s nothing you can do to resolve a strangulating obstruction without surgery, for instance. “Dead or dying bowel will not fix itself medically,” says Williams.

But if the horse has a nonstrangulating obstruction, you have more options for managing it medically.

Therefore, when surgery isn’t an option, determining whether an obstruction is strangulating or nonstrangulating is of utmost importance when coming up with a treatment plan, says Williams.

(Learn what types of colic require referral at TheHorse.com/110804.)

In Summary

Form your colic plan for each horse before an emergency arises. And consider purchasing equine major medical insurance, which can help make the decision to send a horse to life-saving surgery an easy one.

“Great communication is imperative to outcome, and the more that has been set up prior to colic, the smoother things may go once a situation arises,” says ­Williams.

There are many ways to help improve a colicking horse’s odds. Proper preparation and advances in colic care mean it’s no longer the death sentence it once was.