When a delay in colic surgery is deadly

Taking a “wait-and-see” approach to the question of colic surgery can reduce a horse’s chances for survival and result in a more complicated, and expensive, recovery.

I’ve been a colic surgeon for the better part of 50 years. In that time, we’ve made tremendous progress in understanding and treating all types of colic. Thanks to research breakthroughs and technological advances, we can now save many horses that we would have lost just a few decades ago.

Veterinarians have become very good at determining which colic cases might need surgery. (Christiane Slawik)

But there’s still one key factor that can have a significant impact on a horse’s chances of survival. And this factor can’t be overcome with research, high-tech diagnostics or innovative surgical techniques. The factor? Delay. This is time lost, not because horse owners seek to put off the inevitable or avoid it altogether, but rather when they struggle to make tough decisions complicated by imperfect information, financial concerns and fear of the consequences.

A tragic chain of events

Here’s typically how it unfolds: A veterinarian will be called out to a farm to see a horse with colic. Treatment begins and the veterinarian soon determines that the situation may be severe enough to warrant colic surgery. Presented with the option of transporting the horse to a clinic with necessary facilities, the owners decide they can’t afford surgery. Or they “don’t want to put the horse through that.” So they opt for treatment on the farm. They state then that surgery is not an option.

When you say “no”

Of course, there is nothing wrong with deciding against surgery. I’ve been a horse owner and I know there are times when money is available and times when it isn’t. I also appreciate that sometimes surgery isn’t advisable, even when finances would allow it. These are decisions that only an owner can make, and there are no wrong choices. Problems arise when owners want to reverse their decision later.

Revisiting the decision

To pick up our scenario again. After declining to send the horse to a surgical facility, treatment continues on the farm for several hours, or maybe even a day, but the horse doesn’t get better. Maybe he’s even worse. Nothing else can be done at the farm and the veterinarian now brings up the possibility of euthanasia. Suddenly, the entire landscape changes. The owners decide they want to send the horse to a referral clinic. Of course, that’s their prerogative and minds do change. But now we’ve lost 24 hours—more or less—and the horse’s condition has deteriorated. By now, sections of intestine are so compromised that they will need to be removed. The same horse who may have sailed through surgery for a twisted gut the previous day now has less chance of survival, even if we can get him to the table relatively quickly. Our research has shown horses who have surgery early in the disease process don’t need to have intestine removed and have a better chance of complete recovery than horses who do.

The notion that colic surgery is to be considered only when everything else fails has led to the deaths of countless horses.(Adobe Stock)
A veterinarian’s experience

I’m not saying that all cases of colic need immediate referral to a surgical facility. In fact, most don’t. But veterinarians have become very good at determining which cases might need surgery. So if an owner rules out surgery when it’s first mentioned but backtracks on that decision once it’s the only option besides euthanasia, the risks and challenges of colic surgery have greatly increased. That means the owner will spend more money on a surgical procedure that now has a lower likelihood of success than it would have had earlier.

Fundamental truths

I’ve seen this heartbreak so often over the years that I am committed to educating horse owners so they can avoid it. This requires some frank discussions about common misconceptions surrounding colic and colic surgery. Toward this goal, I’ve compiled four fundamental truths about colic surgery based on the collective experiences of mine and of many of my colleagues:

1. Most horses, even old ones, can physically handle colic surgery.

The idea that colic surgery is harder on older horses is a common, persistent and damaging myth. Owners often think that surgery may be too much for an elderly horse. Instead they opt for medical treatment and hope that works. Then when that doesn’t, and they decide to try surgery, it’s too late. In fact, most of the horses lost to the “change of heart” colic situation are old horses.

Too many horse owners make the erroneous assumption that aged horses can’t survive surgery or it’s somehow “unfair” to put them through it. But numerous studies have shown that old horses—even those well into their 20s—can cope with colic surgery just as well as a 10-year-old or even a 6-year-old horse. Of course there will always be exceptions. Severe arthritis or chronic laminitis can affect a horse’s prognosis, but those are separate diseases. Age alone does not make a horse less likely to handle anesthesia, surgery and recovery.

There’s another, related misconception: The idea that a horse won’t be as athletic or “good” following colic surgery. There is no evidence that surgery has a long-lasting impact on equine performance. In fact, there’s plenty of evidence to the contrary. Horses have won major races, including the Kentucky Derby, after recovering from colic surgery.

2. Colic surgery is not a “last-ditch” effort.

The notion that colic surgery is a last resort has led to the deaths of countless horses. In the time it takes to try every medical option to manage a severe colic, the opportunity for successful surgery will likely pass. Blood flow will have been compromised and internal organs may be damaged beyond repair. If the veterinarian on the farm says the horse needs surgery and you think you might possibly want the horse to have it, do not “wait and see” if something else will work first. Make arrangements to get your horse to a surgery clinic.

Also remember that surgery might not be a given, even once you get to the referral clinic. I’ve seen, on more than one occasion, a horse walk off a trailer looking much better than when he went in. We presume that the jostling of a trailer ride can correct the problem. In those cases, we monitor the horse and treat him with medications, often sending him home without surgery. We are just as happy as the owners when it works out that way.

3. You don’t need full diagnostic procedures and aggressive medical treatment on the farm.

Diagnostic procedures, like rectal exams and ultrasounds, can be helpful in determining the cause of a horse’s colic and setting a course of treatment. Unfortunately, some diagnostics can take a long time and may provide an incomplete picture. One of the best predictors of the severity of colic is pain. If a horse is in intense pain, with an elevated heart rate and colic-related behaviors, a veterinarian may recommend referral for surgery without further diagnostic work, thereby avoiding a catastrophic delay.

Fluid therapy at the farm?

Another misconception is that it’s necessary to administer intravenous (IV) fluid therapy on the farm before transporting a horse with a suspected surgical lesion. This is probably of little benefit, consumes time, and even appears to have a harmful effect on the horse that needs surgery. It is also costly and requires supervision of the horse and time to deliver the large volumes usually given. Also, IV fluids are expensive, and the money spent on them reduces your ability to afford colic surgery. Fluid therapy is effective when administered at the surgical facility immediately before or during surgery, when the stabilizing benefits are most likely.

Confirming the diagnosis

What’s more, if a horse is referred to a surgical clinic, we are likely to redo the diagnostic work anyway. This isn’t to pad the bill, but to see if the situation has changed since the exam on the farm. We, as surgeons, do not expect a referring veterinarian to do a complete colic workup before sending a horse to us. We’d much prefer to see the horse sooner.

Is age a factor?

Most of the preceding problems arise in old horses with colic caused by a strangulating lipoma. This type of colic is caused by a fatty tumor, the lipoma, wrapping around the intestines. It is common in older horses (>10 years) and can only be treated surgically. Strangulating lipomas appear to cause little pain, so severity of the disease is easily underestimated. A quick ultrasound examination of the ventral abdomen can confirm this diagnosis by demonstrating distended small intestine. However, negative findings on ultrasound might mean nothing. Regardless, old horses with colic have a strangulating lipoma until proven otherwise and should be sent to a surgical facility without delay.

4. Delays increase the cost of colic surgery and the risk of complications.

There is no denying colic surgery is expensive, and it has become more so over the past few years. In most places it will run between $6,000 and $10,000. Insurance—if an owner has it—may not cover the full amount. I’m never going to minimize the hardship this cost can place on a family, nor judge an owner for deciding they can’t spend that much to save a beloved horse. What I want owners to understand, however, is that colic surgery doesn’t cost less if you wait. In fact, the opposite occurs. Colic surgery delayed by indecision is likely to lead to a more complicated, and expensive, procedure and recovery.

Plan now for hard decisions later

So, with these fundamental truths in mind, how can you keep a tragic situation from unfolding should your horse develop colic? I recommend preparing now, when there’s nothing at stake. We can all make good, rational decisions when we’re calm and conditions are normal. But decision-making becomes increasingly difficult when emotions run high and time is short, when hypotheticals become reality and maybe family members disagree. That’s why it’s important to discuss options and devise a plan when your horse is healthy, and no one is stressed. It’s the same reason people have wills or end-of-life directives written up when they are healthy. It’s not morbid to think ahead about whether you’d send a horse to surgery—it’s responsible ownership. Here’s how you might want to start that discussion:

Considering hypotheticals

Consider the starkest hypotheticals. In the context of the colic truths I’ve outlined, confront the toughest question directly. If a veterinarian said your horse’s best chance of surviving colic was surgery, would you do it? Be honest with yourself. A lot of people say “surgery is not an option” when what they really mean is “surgery isn’t an option right now, but it may be in a few hours if he doesn’t get better.” And, as I’ve seen so often, this sort of thinking can lead to situations that make a terrible situation worse.

Once the decision against surgery is made, reversing course becomes more and more costly as time passes. (Adobe Stock)
Each horse’s needs

It’s important to consider these hypotheticals for every horse you own. What is the best decision regarding one horse might not readily apply to another, and their age and occupation may have nothing to do with the decision you ultimately make. Also try to include the people involved in your horses’ care in these conversations. If everyone is on the same page, harder decisions are easier to make. If family members are at an impasse or reluctant to have the conversation, ask your veterinarian to weigh in, and even include the surgeon that might be involved, to get an accurate estimate. Hearing how real-life examples unfolded might help move the conversation forward.

How much can you afford?

Talk about finances. The majority of equine clinics require payment at the time of service. Some insurance policies cover colic surgery, but not all do. Many will pay for only a portion. So that means owners will need to be prepared to pay anywhere from $5,000 to $10,000 or more for surgery. Of course, it would be wise to keep an emergency fund for veterinary expenses, but that’s not feasible for many people. Some horse owners designate a particular credit card for veterinary emergencies. Online fundraising is an option these days, and the equine community will often rally to help, but it takes time to raise those funds and the clock is always ticking. With each passing hour, the chance of successful surgery drops. So think now about where you might get the money for surgery if the need arises.

Again, no one will fault you if you cannot afford to pay for colic surgery. Veterinarians understand that it’s expensive and families have other priorities, like mortgages and food. This is a personal decision for you and your family to make, but avail yourself of all resources and professional opinions that can help you.

Revisit these discussions as needed. Situations change, finances change, and families change. All of these might also change your decisions around colic surgery for a particular horse. This isn’t a topic you need to return to frequently, but considering the options in light of new developments might lead you to different conclusions.

The decision

When I’m discussing a colic case and surgery comes up, most horse owners don’t jump on that option, and I don’t blame them. It’s a costly route that might not be the right one for every horse or every family. But it’s important to understand that once the decision against surgery is made, reversing course becomes more and more costly as time passes. In my conversations with horse owners and other veterinarians, that’s the message I’m trying to share. My goal isn’t to advocate for surgery, but to spare people the anguish that can result if they change their mind after the window for a successful surgical outcome has passed.

About the author:

David Freeman, MVB, MRCVS, PhD, DACVS, is the director of the Island Whirl Equine Colic Research Laboratory at the University of Florida in Gainesville. After receiving his veterina ry degree from the Veterinary College of Ireland in 1972, Freeman earned his doctorate at the University of Pennsylvania. He is board certified by the American College of Veterinary Surgeons and the Royal College of Veterinary Surgeons.

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