Caring for a horse after colic surgery

  • What’s involved in caring for a horse after a colic operation? Andrea Oakes follows the process from hospital to home

    In roughly one in 10 cases of colic in horses, wherever a gastrointestinal obstruction cannot be treated by medical means, then surgery may be a necessity.

    The decision to operate is never taken lightly, however, since opening up a horse’s abdomen to investigate the many metres of intestines is not without risk. Sections may be displaced, distended or in some cases dying, due to obstruction of the blood supply, calling for resection (removal) of these diseased areas. Then there’s the challenge of anaesthetising such a large animal during the procedure and returning him safely to his feet.

    “A horse undergoing colic surgery may already be tired and sick, increasing the risk of cardiac arrest, myopathy (muscle disease) or bone fracture as he comes round from general anaesthesia,” says Rosie Olley MRCVS, a Bell Equine clinician. “Yet anaesthesia and surgery techniques continue to evolve – and horses tend to be more robust than we are. After his first shaky steps in the recovery room, it’s not uncommon to see a patient alert and neighing at the other horses once back at the clinic stables.”

    While surgery can save a horse’s life, there are usually a few hurdles to clear before he can leave hospital.

    Making ends meet

    Within hours, the internal healing process begins – even after extensive surgical repair.

    “Colic can mean a lot of things, from a hind gut twisted and distended with gas to a more complex issue such as entrapment or strangulation of the small intestine,” says Rosie. “Often, we have to ‘replumb’ the intestines, removing a length of the gut and sewing the ends of healthy intestine together. Almost instantly, the body starts to form a natural seal until these dissolvable stitches become redundant. The site heals quickly – usually within two to three days.”

    However, while the intestine has to heal, so as not to leak, it must also work.

    “The gut on either side of the join must learn to communicate, to move food along the intestines in a coordinated manner,” Rosie explains. “Until this peristalsis returns, a horse who has undergone small intestine surgery will not even be allowed water – generally for 12 to 24 hours – and will instead receive fluids through an intravenous drip.

    “Depending on the location, the intestine can be narrowed where it has been replumbed and must stretch to allow food through,” adds Rosie. “It’s harmful to starve the gut completely for too long, since many of the cells in the gut receive nutrition from the food within the intestine.”

    Patients are fed as soon as there is evidence of returning gut function (such as improved gut sounds or passing of droppings), starting with handfuls of grass and fibre pellets and building up to short periods of grazing and small amounts of hay. This is typically within 48 hours.

    “A common and potentially fatal complication is post-operative reflux, and ileus, where fluid builds up in the intestines,” says Rosie. “A nasogastric tube is inserted to drain the fluid, which can amount to six to eight litres every four hours. We must then control the horse’s hydration levels, until his system starts working normally.”

    Team approach

    The whole team delivers care during this critical period, in particular the nurses and the vets who live on-site.

    “We’re there to keep an eye on the patient,” explains Bell Equine head nurse Ruth Gravenell, a registered veterinary nurse. “We administrate medication and pain relief, monitor food and fluid intake, check faecal output and do any tubing – to give fluids or remove them due to reflux. We’ll take the horse for ultrasound scanning to assess intestinal function or for blood tests to check inflammatory markers.

    “These cases are potentially high-maintenance and require round-the-clock monitoring,” adds Ruth, explaining that up to half will colic again at some stage during recovery. “We also attend to any specific needs, using ice boots with a horse prone to laminitis, for example, or controlling arthritis with extra pain relief.

    “An important part of our role is pain scoring, so we’ll take time to watch the patient and note any signs of discomfort,” she continues. “We also monitor the surgical incision, which usually follows the linea alba, the natural ‘seam’ along the horse’s midline. Any infection can delay healing, so we change the dressing daily and fit a belly-band for support, as the incision is on the underside of the abdomen and gravity is not our friend.”

    Grooming the patient or leading him out for some sun on his back helps introduce normality to his life.

    “Grazing in-hand is the best thing, as biting and chewing grass helps prevent ileus, and these outings two or three times a day keep a horse’s mind active,” explains Ruth. “It’s all part of nursing him back to health.”

    Managing pain

    Pain management is a vital part of post-operative care. The hospital team uses a pain-scoring system to identify discomfort that may not be immediately apparent.

    “We observe a horse for 10 minutes, during a quiet part of the day, before trying to interact with him and judging how he responds,” says student veterinary nurse Claire Tottman. “We evaluate certain points, including appetite, respiratory and heart rate, evidence of ‘pain face’ (tension in the nostrils or facial muscles, for example) and signs such as tooth grinding, scoring each from zero to four. This creates an overall pain picture; a higher-than-expected total indicates a need to reassess pain relief.

    “While different breeds, types and ages have a different approach to pain, a usually stoical cob who goes off his food – but shows no other clues – would be a cause for concern.”

    Ready to leave hospital

    Once a horse can cope without constant supervision, his care can continue at home.

    “Most have finished medication by the time they’re discharged, which could be anywhere from around five days to many weeks,” says Ruth.

    All patients leave with detailed instructions about aftercare. This normally starts with eight weeks of box rest, wearing the belly-band, to allow the abdominal incision to heal fully and to reduce risk of hernia.

    “We expect a patient to fluctuate a little in his recovery,” she adds, citing recurring colic and surgical site infection (termed SSI, which occurs in around 25% of cases) as the most common complications. “Owners tend to know their horses best, however, when it comes to spotting subtle signs. We encourage them to contact us with any concerns or to discuss any management issues with our ambulatory vets during follow-up visits.

    “After colic surgery, there’s often no reason why a horse can’t return to what he was doing – even high-level competition,” Ruth concludes. “But it’s a slow process, so be prepared to give him time.”

    Nursing the convalescent – what to expect

    Once the horse is back at home, be prepared to:

    • Provide an enclosed area for eight weeks of box rest, with fresh water and ad-lib forage.
    • Walk the horse out to graze for 15 minutes, three times daily.
    • Watch for colic signs, such as pawing and rolling, or appetite loss. Monitor the amount of droppings produced and the horse’s general demeanour.
    • Check the incision for excess discharge, swelling or pain that could signal SSI. If infection develops, frequent dressing changes and cleaning of the incision may be necessary – your vet will advise you.
    • Fit the belly-band, if used, carefully, for full abdominal support. Re-adjust it regularly if the horse has lost weight or muscle and check for rubbing, especially over the back, withers and chest.
    • Vaccinate as normal, but consult your vet before de-worming.
    • Follow up with small-paddock rest before a return to exercise under veterinary supervision.

    Ref Horse & Hound; 12 November 2020

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