Horses with colic

Re: Horses with colic

Mark Holmes — Fri, 04 Mar 2011 14:41:03 GMT

[quote user="beldather"]

Just to add further info to the use of flunixin, It is a drug that I will pretty much use on every colic I see (sorry evelyn ) And they used to be all impactions rather then spasmodic (its tough when all they can eat is dirt).
The important thing is to use a low dose. Normally give 1/4 of the full dose on first presentation. (usually about 2.5mls per 500kg) This gives long lasting and effective pain relief but does not appear to cover surgical colic pain.

Regards

Blair

[/quote]

I used to ask about referral from the outset and if it was definately off the cards they (the horse) got flunixin and I got a good nights sleep.

Re: Horses with colic

Bob Russell — Fri, 04 Mar 2011 14:37:07 GMT

Quote 'Where on earth do the people who regularly post on this site get the time?'

Coffee time, lunch time and whenever I am trying to avoid jobs I don't want to do! I drink a lot of coffee and as a practice owner I spend a lot of time avoiding boring jobs!

Re: Horses with colic

Michael Woodhouse — Thu, 03 Mar 2011 23:43:29 GMT

[quote user="Busybee"]

Just to add my piece to the mix....

Went to see a pony with colic HR 44,

Six hours later HR now 52

Was fine all night....then a phone call at 11am today..HR 60

Referral centre phoned this evening - peritonitis. 50:50 chance of survival :(

[/quote]

It's demise is there in the heart rates! A heart rate over 40 [especially if it's had buscopan/NSAID I want it off my hands]

Did you rectal and tube it the second time you saw the horse? A belly tap isn't hard to do if the owner won't refer.

Re: Horses with colic

Thomas Johnson — Thu, 03 Mar 2011 10:39:28 GMT

Always worth making sure you've got the phone number of your local referral centre with you, and not just to make a referral. During the seven years I did equine work in 3 different areas I always found the referral vets were very happy to give advice over the phone when I needed it.

Re: Horses with colic

Busybee — Wed, 02 Mar 2011 20:58:02 GMT

Just to add my piece to the mix....

Went to see a pony with colic yesterday, appeared spasmodic (HR 44, RR 40, gut sounds audible but quiet, pink mm, evidence of rolling, normal temp) so gave Buscopan and Ketofen (on advice from colleague), advised owner to walk pony, take away food initially etc.

Six hours later, owner phones saying pony had settled but still not 100%. HR now 52, RR 40, temp normal, gut sounds same, mm still pink, no more rolling, passed faeces while I was there. Spoke to referral centre (very helpful!!) who advised either try 2nd buscopan +/- rectal/tubing or send in to them. After speaking to the owner (horse not insured), opted for a 2nd buscopan and told owner to phone in 2 hours if still not right.

Was fine all night....then a phone call at 11am today....horse looking better overall but now appearing laminitic! Went out again. Horse very reluctant to move, HR 60, RR 60, gut sounds quiet R side, absent L side, mm still pink (!), temp 38.8. No heat in feet, very mild digital pulses, negative to hoof testers. At this point, getting very concerned! Spoke to owner and referral centre again and decided to refer in.

Referral centre phoned this evening - peritonitis. 50:50 chance of survival :(

Re: Horses with colic

Michael Woodhouse — Wed, 03 Feb 2010 23:43:07 GMT

[quote user="Vikki Halliday"]

We were always told at Vet school that it masked surgical colics in some cases, and I always started with buscopan, although you have to watch if you use heart rate as an indicator of a possible surgical as it always rises after admin of buscopan.[/quote]

It does, because the hyoscine is an anticholinergic (like atropine) - why it helps in horses in a COPD (RAO, whatever they call it now) crisis!

I have found the effect variable. Personally I suspect that sometimes the buscopan gives such effective relief from the pain of spasmodic colic that there is still a net reduction in heart rate (even if the hyoscine give a few extra bpm)!

I still use flunixin in colics if they don't respond to buscopan. So long as you are mindful you gave it when examining the horse and communicate that fact to the referral centre. Horses that have had flunixin and a HR >40bpm are surgical! I find most first opinion colics quite fun, if they don't respond to the recipes suggested above then I send them somewhere else!

Re: Horses with colic

Vikki Halliday LLB — Tue, 02 Feb 2010 22:14:47 GMT

[quote user="beldather"]Flunixin is by far the most popular drug used in Aus for colics.
[/quote]

I remember vividly as a new graduate reporting this finding to my then egotistical equine boss and being dismissed with " well that never happens when I give it".

2 weeks later, published study in Vet Record regarding what?

Increase in equine heart rate after administration of IV Buscopan.

HMMMMMMMMMMMM I'm never as green as I'm cabbage lookin!

Re: Horses with colic

beldather — Thu, 14 Jan 2010 21:24:18 GMT

Interesting once again on country differences.
Buscopan is obviously very popular in the UK, whereas here in Australia its use is pretty much frowned upon. Flunixin is by far the most popular drug used in Aus for colics.
I think that may be a result that most colics seen in UK are spasmodics whereas colics in aus tend to be impactions, where the possible ileus from buscopan would likely be detrimental.
My general approach is actually similar to Wrens friday colic, but for all of them. If typically spasmodic, Buscopan + Flunixin (Buscopan gives the immediate relief but likely to wear off within the hour, while flunixin can give the horse a good half day relief). If gut sounds are reduced then I will drop the buscopan and just used flunxin (1/4 dose if possibility of referral, full dose if O has no intention of referral) then just tube tube and tube some more.

Blair

Re: Horses with colic

Wren — Thu, 07 Jan 2010 11:12:19 GMT

And to add - when I started out I made a point of rectalling every colic, and every anorexic/dull/pyrexic horse I saw (actually still do). I figured that I'd had the opportunity to rectal about 3 horses in uni and that probably wasn't a broad enough experience base! Once you've rectalled a few normal/spasmodic horses you'll feel your first pelvic flexure impaction straight away.

I'll admit that I once missed a splenic entrapment, but I knew enough to know that it wasn't right, referred it and once the referral centre had given me a diagnosis I could store it for future reference!

Also never forget the 5pm Friday colic treatment - flunixin and buscopan (disclaimer - slightly tongue in cheek and only ever after confirming that it's not surgical). I have yet to be called back to one that's had this combo.

Re: Horses with colic

beldather — Mon, 09 Nov 2009 16:23:26 GMT

Regards

Blair

Re: Horses with colic

Hannah Wynne Richards — Mon, 09 Nov 2009 10:20:33 GMT

Paddy. As Becky said, in an ideal world she would always be able to discuss with colleagues. In the real world things aren't always so Utopian

A new grad may find him/herself in a situation where some policies are simply bad medicine

A new grad may find him/herself in a situation where some policies are actually illegal

A new grad may find that policy on a certain disease may contradict what was taught at Uni, and the staff member most concerned may refuse to discuss the problem, as it should be discussed between professional colleagues, but may simply adopt an attitude of "It's right if I say it is, even if it's wrong "

A new grad may find him/herself in a situation where a pre-existing feud between Boss A and Boss B may make it absolutely impossible to establish a proper working relationship with both, as despite the best of intentions not to take sides, the new grad may be forced to

A new grad may find that those who should be colleagues are actually bullies

Any one or more of the above scenarios can be extremely demoralising for a new grad. It is a little easier for today's grads as there are far more jobs available than there were for our generation, so it is easier to walk away from a difficult situation, but it can still be of inestimable value for someone caught in any of the above situations to have an experienced, senior member of the profession who is not involved in the situation, and who is prepared to give sympathetic, confidential and also fair advice. That is why I volunteered to join the mentor scheme

There is also the value, as Becky said of being able to discuss clinical problems with a wide variety of other veterinarians

Wynne

PS I agree with you on the value of building up a relationship of trust with one referral centre

Re: Horses with colic

Rebecca MacMillan — Tue, 03 Nov 2009 20:30:14 GMT

Paddy -

In an ideal world, yes, I would be able to sit down and discuss cases and scenarios step by step with my work colleagues but as you have already mentioned - time is a big issue and my colleagues are usually fairly busy. Catching them for a quick 5 min chat is about the best I can manage somedays, which I'm sure you'll agree, is not sufficient to discuss a blow by blow account of how to deal with a colic/choke etc (and besides I wouldn't remember it as well as I do having it written down in front of me and to be able to come back and refresh/reassure myself!).

Also ideally I would work in a practice where I had alot more constructive training, help and feedback, but unfortunately I don't. That's all there is to it. So that is why I have seeked out alternate sources of guidance instead of letting the worries and stress continue to pile up (of which there are many) and that in itself should be recognised and congratulated rather than being seen as a negative.

Don't get me wrong, the people I work with are helpful when I ask for it and I'm very glad I've been employed in a friendly working environment, with the right mix of species and a reasonable package. I probably worry uneccessarily that I annoy my colleagues with my questions, but as a new grad I am still asking so many! Therefore, if I can ask some of my more in depth questions to other professionals via a resource such as this, then I will take that opportunity.

Don't underestimate how much I appreciate the time and effort that people have put into responding to my posts, yourself included. Time is a very precious thing and I'm thankful that people do come on here and have discussions that we can all learn from - which is one of the main purposes of this site. Besides some people need to be able to talk to fellow professionals that aren't work colleagues in order to get fresh ideas and perspectives. Hopefully we will see more of you in the future, time allowing, as your post was very valuable - not only to me but for other members too.

Becky

Re: Horses with colic

Arlo Guthrie — Tue, 03 Nov 2009 14:30:02 GMT

[quote user="Patrick Marshall"]Where on earth do the people who regularly post on this site get the time?[/quote]

Paddy, that's a question debated at very considerable length here at VetSurgeon Towers, more precisely whether any vets have the time.

I always argue that it isn't whether people have time or not. We all have time one way or another. It's only a question of what our priorities are.

If you're one of those that see the Internet as a distraction, and forums as being populated by nutters, then I think it would be fair to rank this site quite a long way down in your list of priorities.

If, on the other hand, you see it as a very powerful research and learning tool, and you recognise that the more you put in, the more you'll get out, then I would hope it would move a bit higher up your 'to do' list! Particularly if you occasionally have questions to ask, and are not always here helping others.

Lastly, where a site like this sits on one's list of priorities obviously changes week-to-week, or even day-to-day. I often notice members go through spurts of activity, and then go quiet, sometimes for months.

All I can say is that the more people that use and contribute to the forums at any given time, the more valuable a resource they become for everyone.

Example: if, two years ago, you had come and described a case here, and asked what others thought, you would be waiting for a month or two before anyone replied.

Now you're more likely to get an answer the same day.

That's what this is all about. It's why I urge anyone who thinks they don't have time, to find time!

Re: Horses with colic

PATRICK MARSHALL — Mon, 02 Nov 2009 20:44:28 GMT

Becky,

I am glad to have been of some (hypothetical) help. I must admit that I am usually one of the 97% who view these forums on a sporadic/weekly basis rather than one of the 3% who actually post a reply.

I was prompted to reply on this occasion because I was rather surprised that you have had to resort to getting the advice/support you need on these matters from an on-line forum rather than from your colleague(s?) at work. Being expected to deal with colics/chokes etc without adequate advice or support is not only a particularly daunting prospect but also detrimental to you, the patient and the client in the short term; as well as undermining the reputation of your practice and the profession as a whole in more general terms.If adequate support is not available closer to home I would recommend seeing if you can establish a relationship with one of the major equine referral centres who are generally more than willing to help -especially if you use them even occasionally for a referral ......... I still phone Rossdales when I am uncertain even after 27 years qualified.

Where on earth do the people who regularly post on this site get the time?

Paddy Marshall

Re: Horses with colic

Rebecca MacMillan — Mon, 02 Nov 2009 19:29:45 GMT

Easy, yes? - I wouldn't go as far as that, but less scary than I had built it up to be, Martin

Thanks Paddy, that's great! Thank you so much for your excellent response. I feel much happier about this scenario now, but again we shall have to wait and see what my first one brings!

Becky

Re: Horses with colic

ms1083 — Mon, 02 Nov 2009 12:20:44 GMT

Paddy,

What a fantastic answer. Will try this next time, I generally don't rush to the call, give buscopam & seation and normally that is enough but if that does not clear in an hour or so I start paniking and getting the stomach tubes out. This has so far always worked but next time I will try your approach and give everything a bit longer. Good point about getting the owner to walk the horse.

Matthew

Re: Horses with colic

PATRICK MARSHALL — Sun, 01 Nov 2009 22:00:47 GMT

Choke:

Don't go rushing straight out to it - a significant number resolve themselves of their own accord within 20-30 minutes. Although a recent choke looks dramatic, the horse is not going to come to any harm in the short term. Get the owner to walk the horse for 5 minutes rest 5 minutes (in stable without access to food) for 3 cycles and then phone you back.

If the clinical signs (arching of neck, salivating, continuous chewing etc) have abated then the chances are the choke has resolved. Get the owner to check this by offering a small amount of food (ideally a handful of grass). Prehension, chewing followed by swallowing normally will indicate resolution of the problem. Horse that still have a choke may chew enthusiastically but DO NOTswallow the food bolus.

If the choke persists then a visit will be required. The position of the choke can be checked by stomach tube (cervical, thoracic inlet, heart) but I would NOT advocate trying to dislodge the impacted material with the tube. Buscopan iv +/- a small dose of acp generally works. Leave the horse in a stable without food or edible bedding. It can take up to 8 hrs for the choke to resolve and the buscopan works for about that long. The horse will not come to any harm but should be checked regularly by the owner. if it appears to have resolved then feed small handful of grass as above.

If it hasn't resolved in 8-12 hrs repeat the procedure. You can check progress or otherwise by stomach tubing. If the stomach tube goes all the way into the stomach then the choke is resolved. Check the horse eats and swallows properly before leaving it.

Cases that persist beyond 24-36 hrs are best referred to a centre with the correct equipment for removing the impacted material/give iv fluidsand supportive care.

Prevent recurrence by putting brick or similar in manger to discourage the horse from bolting food, check teeth- may require floating, avoid feeding sugar beet pulp, dry nuts, incorrectly cut carrotts/apples etc

Hope this is some help

Paddy Marshall

Re: Horses with colic

Martin Jones — Tue, 27 Oct 2009 22:23:29 GMT

Easy, yes?

The point is that you had a plan, and you followed it; that it resolved quickly is just a bonus. Always have the next step in your mind, and you won't go far wrong.

As Wynne says, well done. These are unequivocal triumphs

Martin

Re: Horses with colic

Hannah Wynne Richards — Tue, 27 Oct 2009 12:37:56 GMT

CONGRATULATIONS !!!!!! Seriously, well done.

Wynne

Re: Horses with colic

Rebecca MacMillan — Tue, 27 Oct 2009 12:20:16 GMT

Just thought I'd let you know...

I had my first colic yesterday and thankfully it went ok! It seemed to be spasmodic as on clinical exam it had an increased resp rate but its heart rate was normal and it had produced faeces a couple of times in the 2 hours before they called me. Temp was normal, couldn't feel anything abnormal on rectal and it still had gut sounds, though markedly decreased on the right hand side. It kept trying to lie down and/or kick at it's belly though. Worked out a dose of buscopan and finadyne based on its weight, asked the owners to carry on walking it. and to give us a call in an hour - hour and a half. The horse had settled down, the resp rate decreased and the horse appeared much more comfortable, yay! Haven't heard anything further, so hopefully the horse has recovered overnight.

I'm just pleased that I've my first colic over with and survived!

Now then... choke.... any suggestionss/tipes or comments?

Re: Horses with colic

Edward Jones — Sat, 19 Sep 2009 07:48:35 GMT

If things have returned to normal after treatment then my general principle feed-wise is not to change things too much, after all it's it's a break in routine that can lead to a colic.

So after checking that that the owner isn't doing anything too weird with the feeding I tend to advise a half or third size meal + hay initially then back to normal at the next mealtime.

Not that I'm a specialist in these things, what do others say?

More fun than colics are the chokes :-) Recommended approach when called?: have a cup of tea and wait for the owner to phone back to say it's cleared (tongue in cheek) ;-)

Re: Horses with colic

Rebecca MacMillan — Fri, 18 Sep 2009 22:23:30 GMT

Thanks for all your advice, everyone has really helped and made me feel much more confident in my own abilities!

Hope you don't think I'm daft for being apprehensive, but as I say I'm lucky if I see one large animal a week at the moment, so the thought of seeing a colicky horse out of hours makes me pretty nervous - but as I say, I'm feeling much happier about it all now!

Just a quick question though, what do you advise feed wise for a horse with/recovering from spasmodic colic?

Re: Horses with colic

Evelyn Barbour-Hill — Fri, 18 Sep 2009 13:52:38 GMT

Examine carefully when you get there. Basic examination: don't get flustered, don't jump to conclusions; you can do this, you were taught to. An all-over look; how is horse behaving; mucous membranes (normal is good, congested or injected is bad); pulse; heart rate; temperature (any rise is bad); gut sounds. Personally I think one should always do a rectal exam straight away too: even if you are not quite sure what you are feeling, it gives you some clues.

Xylazine gives you pain relief and sedation for long enough to do a rectal but is short acting so it masks nothing.

(If you take your arm out from the rectum and there is blood on the glove, refer immediately)

You are not necessarily looking to make an exact diagnosis, only to decide "is this surgical?"

So count up "bad" and "good" signs. If it's nearly all good, then Buscopan. If there are several "bad", refer immediately. If it's about equal, then try for more information IF you are confident about the procedures and you have the facilities ( stomach tubing, blood sample); otherwise wait and re-assess later for changes.

Always always arrange to go back in about an hour, an hour and a half. (If the client declines, or rings you up in an hour to say "don't come, he's all right now", that's then their decision). Re-examine clinical signs: if there are now more "bad" ones, refer immediately.

If you are reasonably confident about stomach tubing, if you didn't do it at the first then do it at the second exam if the horse is not fully recovered; any reflux is bad.

I wouldn't give ANY flunixin or other NSAID unless you are 100% sure there is nothing serious (and you probably won't be that sure). It's too good and it's too long acting, so it masks. (Some are better than others in this respect but I can't remember which offhand). (Or, I suppose, if you know things are bad but the client refuses referral. That would relieve the pain till your senior colleague can come and pronounce on euthanasia.)

Once you've made the decision to refer, you can speak to the referral clinician on the phone and follow their requests as to what drugs to give.

These things generally seem to be at night in ill-lit stables. Mucous membranes can be hard to assess in poor light. Get yourself a decent head light, LED probably best. It will be useful for all sorts of things. Beware getting your iv injection intra-arterial when the light is poor.

Re: Horses with colic

Hannah Wynne Richards — Sun, 13 Sep 2009 12:50:05 GMT

I agree with Matthew and Martin. You can't do any harm with Buscopan. Try to stop rolling b4 IV fluids, or you could have a nasty mess with IV tubing and catheter pulled out of vein. I would try to avoid detomidine or xylazine if concerned about circulation, but would use them if necessary to control pain. Same with NSAIDs. Flunixin much better than bute. Judge every case on its merits, and refer sooner not later.

If you are really scared, give Buscopan, and call for help if not better in half an hour

Wynne

Re: Horses with colic

Martin Jones — Sat, 12 Sep 2009 19:50:30 GMT

Rebecca

Would echo the advice above; every vet has a slightly different slant on colics, but if you were to follow the excellent - and beautifully articulated - guidance above, you won't go far wrong.

The only thing I have to add is that you should always ask one question at the outset: if this turns out to be surgical, are we going to go for it? Point out that two grand goes nowhere, and that it would be a referral, meaning payment up front (obviously, put this into client friendly terms).

If the client says yes to surgery, then don't panic and do your work up. 95% are still spasmodic colic, or 'undefined', and buscopan/NSAID/tubing, together with walking and watching, WILL fix them. Then talk about roughage/wet grass/subsequent laminitis/etc. If, on the other hand, they start to look like the college colics, refer them QUICK. You get to go back to bed (at some point), the horse is in safe hands and the client is happy with the rapidity of the service. Everyone wins.

If the client says no to surgery, then relax: surgical colics cannot be fixed medically, so it won't be your fault, and again there are few that don't respond to buscopan/NSAID/stomach tubing. Don't forget the occasional entrapment - although these often sort themselves after rolling around for a while. Those that progress are beyond your remit, and PTS is entirely appropriate on welfare terms.

If I could add one more thing, it's fluids. Both spasmodic colics and (especially) impactions respond well to as much fluid as you can dump into the veins as quickly as you can. All those shut-down splanchnic beds get re-opened, and the guts kickstart again. Very impressive at the bedside. Remember also in these cases to ask the owners to look out for obviously discoloured poo - this is usually the stuff that was impacted, and gives you a confirmation on the diagnosis.

And don't be afraid to phone a colleague. There's always the magic horse bod in every practice, and they should be out like a shot.

They're not that scary

Martin

ps. and any clients who give you grief about being a greenhorn, give the horse 1ml/100kg butorphanol iv, first warning them that it may drop at the knees and go wobbly briefly. It'll ablate most any pain, and make the horse happier and more inclined to chew. You'll look great, and you can go home safe in the knowledge that that single jab just cost them £50-100 - and was entirely appropriate.