Opinions on equine colic surgery

[eventualeventer]

I have a question/hypothetical situation for other pre-vet horse owners, horse lovers, horse haters, or others involved or interested in equine vet med.

Imagine that you have a horse that you are very attached to. The horse is in the prime of life with no other health issues. The horse is neither particularly stoic nor particularly neurotic and wimpy. In this hypothetical situation, the horse is well-insured/you are wealthy/a mysterious anonymous donor agrees to pay all of your veterinary bills.

If the horse experiences moderate to severe colic and is determined to warrant surgery, do you do colic surgery? What if the statistical likelihood of survival - based on the vet's appraisal of clinical findings, bloodwork (PCV/TP/lactate/electrolytes) and knowledge of both published and personal survival data - were thought to be 70%? 50%? 30%? 10%? 5%? Would you do surgery no matter what? How would intra-operative findings affect your decision -- would you do a small intestinal resection? Would you agree to take out the large colon? What about a second surgery within the same week? Third?

What I am getting at here is what other people think about the ethics of the effect of surgery and postsurgical care on the horse and the value of getting the horse through the illness vs. the value of minimizing suffering. Obviously, colic can be caused by any number of issues and there is no way to predict 100% which horse is going to get laminitis, have post-op ileus, colic again in a day, colic again in a month, etc., but we do have a rough idea of which cases are at greater risk.

To be honest, having worked at a referral hospital that does colic surgeries and seen cases from the simple displacement that goes home 2 days later to all sorts of sick-as-hell horses who suffer greatly before they die, I'm not sure what I think and what I would do with my own (hypothetical) horse or where I would draw the line. I'm curious to read what other people think.

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[shortnsweet]

Colic surgery saved my horse's life about 10 years ago, and he has been perfectly fine ever since, now at the ripe old age of 16...I cannot imagine my life without him...He had to be sent up to New Bolton, but they did everything they could to make him well again. Another horse in our barn went through the same thing this year, and has recovered perfectly.

Even if it had happened more recently, I still would have done everything to save him that is humanely possible. If it would cause more suffering than good, well then of course I would take the other route...The last thing you want is a member of your family to hurt...But if he/she was perfectly healthy to begin with and the chance of recovery was high, wouldn't you want to give them the chance??

 

[eventualeventer]

Colic surgery saved my horse's life about 10 years ago, and he has been perfectly fine ever since, now at the ripe old age of 16...I cannot imagine my life without him...He had to be sent up to New Bolton, but they did everything they could to make him well again. Another horse in our barn went through the same thing this year, and has recovered perfectly.

Even if it had happened more recently, I still would have done everything to save him that is humanely possible. If it would cause more suffering than good, well then of course I would take the other route...The last thing you want is a member of your family to hurt...But if he/she was perfectly healthy to begin with and the chance of recovery was high, wouldn't you want to give them the chance??

I am certainly for doing colic surgery and glad your guy is doing well. How do you define/judge/predict more suffering than good? Where would you draw the line?

 

[cowgirla]

I am certainly for doing colic surgery and glad your guy is doing well. How do you define/judge/predict more suffering than good? Where would you draw the line?

I know quite a few horses who have gone for colic surgery.
If there's one thing I've learned, it's an unpredictable surgery, and it's hard to foresee what will happen once the surgeon gets in there.

I've seen "perfectly healthy" young horses die on the table.
I've seen tired old nags with a slim chance of recovery live for years after surgery.
I've seen horses with "good chances" die within days from complications.

HOWEVER, without this surgery, there's a good chance these horses would have died anyway. The surgery at least given them a chance, and if money wasnt an object, I don't think I could deny a horse of mine that opportunity to live and succeed.

I don't think I would put any horse through a second surgery in a short timespan. Obviously at that point there's something more wrong, and I think euth would be the best option at that point.

Or, if the surgeon got in there, and things were much worse than they appeared, I would definitely consider euth without recovering the horse first. It all depends on how things look from the inside, I guess.

It's not a simple "yes or no" question...There's always the chance that something could go wrong, but it gives the horse a shot.

 

[shortnsweet]

I agree wth cowgirla..it is not a simple black and white scenario, there is soooo much grey area.

I cannot tell you for sure where I would draw the line, especially on my own horse. For me, it is a case by case scenario, with no "right" or "wrong" answer. It is one of those things that applies to any kind of surgery, and any species too, not just colic in horses. It is not cookie cutter with a guidebook attached..it why we are learning to become good vets 🙂

 

[eventualeventer]

Thanks for your thoughts. I've met people with all different views on this, from no colic surgery to surgery but no resection to being willing to do 3 surgeries within 2 weeks. I was just seeing what other pre-vets thought.

 

[VeganSoprano]

I agree that if $ is not an object, you do everything humanely possible and take things one minute, hour, or day at a time, as the situation requires. Ideally, decisions should be based on what is happening now, rather than on the fear of what might happen at some time in the future.

 

[ImaJerseyGirl]

To be honest, if it was my horse (stocky 13yr appyX mare) I would do it, but stop at multiple surgeries. One of my professors (who missed class all the time for surgeries) told us he had a much better idea once the horse was opened up. So yes- always open them up (with this nice rich uncle's help!) From there, it depends. If there is SI resection, it would depend on which part and how much- how much of a nutritional cripple is my horse going to be? Is she going to be worse off in the future because of it? A life worth living?
I would ask the vet to be totally blunt with me, I'm not fancy and would be an emotional wreck... which is why its good to think these scenarios through!

Depends on the horse too- she's pretty quiet. Some other's I know I don't think would do as well simply because of their personalities.

Interesting idea.

O/T
My prof also had us come up with an idea of how much money you would be willing to spend on your horse in this scenario know that to put the horse on the table is between $4-6K (his rough numbers, anyone have more accurate info?). He told us "make your decision now- before you get emotional!"

 

[cowgirla]

Had a friend do surgery on a horse of hers back in Feb.
Total cost of surgery and five days post op care was 8500. That didn't include the intial vet exam, done by another clinic, or the cost to ship him to the surgical hospital (about a half hour drive). Horse was fourteen, never been sick a day in his life before.
I've been told that's a pretty reasonable price too--at least for this area (northern new england).

Had another client do surgery at the same hospital, and the bill was more like 12,000. Horse was 12, healthy, but very rare form of colic--the ileum got stuck between the pancreas and the liver or something wierd like that.

So yeah, it's really hard to give an exact number!

 

[eventualeventer]

Cowgirla, that sounds like an epiploic foramen entrapment.

JerseyGirl, cost goes up dramatically with a resection due to the longer anesthesia, longer surgery, and longer recovery. For a simple displacement with no enterotomy or resection, $4K-6K sounds about right, including aftercare. For a horse that is sick looking (dehydrated, toxic, high lactate => something ischemic) and likely to need a resection and be sick as heck afterwards, I've heard estimates of $10K-$15K from admission to discharge. The surgeon will give you an estimate when you are giving consent for surgery.

I agree that you need to think and talk about these things ahead of time, both regarding money and what you think is reasonable to put the horse through. I've seen people who were probably reasonable people most of the time push horses way past what I (and many others at the hospital) thought was humane because emotions and the fear of losing their horse clouded their judgment, and some vets are afraid to really take a stand and say, hey, you're not doing your horse any favors here. What I really think is the least fair to the horse is to mess around and put off making a decision because you won't send them to surgery and won't put them to sleep. It never ends well for the horse, so I don't have much patience for those people.