This week I would like all of you to sit back and relax while I tell the story of Dr. Lacher’s Thanksgiving. It’s a tale of joy and sadness. It’s a tale of three colics with much in common with that other story about three things: Goldilocks and the Three Bears.
It started on Wednesday evening around 6pm. A little peek into the lives of our veterinarians: most of you call about colics around 7-8am and 5-6pm when you head out to feed. Matt, the 30 year old pony, had been normal at breakfast, but on arriving home from work, his owner found him down and rolling. Dr. Lacher was leaving the clinic to head home, so she simply turned left instead of right and headed to Matt.
As she pulled up to the farm, Jane said, “Matt has lived here for the last ten years and has never had a sick day in all those years! I’m so worried!”
Dr. Lacher replied, “I will be honest, I’m very worried too, but let’s get Matt some sedation and pain relief and see what we have going on.”
Our Docs see a lot of colics. Once you see your first 10-15 colics, you start to notice little things (and sometimes big things) the moment you pull in to a farm. The horse has a pained look in his eye, there is sweat at the flanks, he isn’t just laying down, he’s going up and down repeatedly, and many more subtle signs tell our Docs that things are worse than they seem.
For Matt, it started with his history. A thirty year-old horse with no history of colic suddenly colicing is very often bad. Dr. Lacher noticed Matt had a sheen of sweat over his entire body as soon as she got close to him. Added to that, Matt simply couldn’t get comfortable. He wasn’t quietly laying down; he was up and down and up again in the 30 seconds it took to drive up the driveway.
“I’m giving Matt a large dose of sedation and a morphine-type drug for pain,” Dr. Lacher informed Jane. “Next, I’m going to draw a small amount of blood to run a lactate test.”
“We use lactate in the Emergency Department!” Jane replied. Jane is the nurse you want to have if you ever end up in the Emergency Room. She’s fantastic!
“Yep, we have been using it in horses in much the same way human doctors do for the past 6 years or so. We want his number to be less than 3.0,” said Dr. Lacher. Jane and Dr. Lacher stared at the lactate meter for the longest 13 seconds in history awaiting results. The number loomed large at 7.2.
Dr. Lacher took a deep breath, “That’s not a good number. Let’s see if we can figure out why it’s so high and then we can make decisions from there.” Jane nodded her agreement.
After passing an NG tube in to Matt’s stomach, a rectal exam, and an abdominal ultrasound, it was determined Matt had a strangulating lipoma. This is a fatty tumor that forms over many years. One day all the forces of Mother Nature align and the tumor wraps around the small intestine and cuts off the blood supply. The only cure is colic surgery and this is not one of the “easy” colic surgeries. This one is long, very hard on the horse, and is often followed by a horrible bout of laminitis.
“I think there is only one decision I can make,” Jane stated. “Matt has had a great retirement and a wonderful life. I don’t want him to experience all that pain!”
So under a beautiful sky full of stars, Dr. Lacher and Jane walked Matt to the back field and said goodbye to him. Jane told him how much he was loved and how much she appreciated all he had taught her daughter. Dr. Lacher reflected on all the things these great old horses have contributed to the people around them as she drove home.
‘Twas the night before Thanksgiving and all through the house not a creature was stirring not even a mouse. When what to my wondering ears should I hear but the sound of the BeeGees singing Staying Alive. OK, I wasn’t actually there, but this is what I heard from one of the cats that lives at Dr. Lacher’s house. Around 12:30am her phone rang with another colic. This time it was, Zippy, a 28 year old Morgan with no history of colic.
“Uhoh,” said Dr. Lacher, “Here we go again. I really worry about the old guys colicing!”
Weekend/Emergency Tech/Awesome Husband Justin replied, “So, where are we are heading to?”
This time as Dr. Lacher and Justin pulled up to the farm they saw a horse laying quietly on his side. He was calm as Dr. Lacher put her stethoscope to his chest and abdomen.
“36,” Dr. Lacher stated matter-of-factly “and some gut sounds.”
“36 is good?” asked his owner, Linda.
“36 is very good!” Dr. Lacher replied. Turns out heart rate is one of those important things our Docs use to determine how bad your horse is actually colicing. Anything less than 48 is pretty darn good. Anything over 60 is very worrisome to our Docs. Dr. Lacher went on to explain that the fact that Zippy was laying quietly and willing to remain standing were good signs. Zippy had a calm eye, some gut sounds, and wasn’t sweaty or agitated. All really good signs. His lacate was 1.8. That’s really, really good.
Dr. Lacher put on the big, long sleeve and did a rectal exam. “It’s one of the few ways we have to figure out what’s going on inside this big abdomen. And I’m happy to say that all his parts seem to be in the right places, though he does have a bit of an impaction in his large colon,” she reported.
Dr. Lacher gave Zippy some sedation, muscle relaxers, and pain relievers. Then she and Justin tubed him with our scientifically formulated electrolyte mixture for colics. This formula helps horses get water in to the GI tract which breaks up the impaction. It also had just the right amount of sodium and potassium in there to correct deficiencies colicky horses often get.
“Call me if you need me or have ANY questions,” called Dr. Lacher as she and Justin headed home for a few hours of sleep.
Thanksgiving morning arrived quietly, for about 30 minutes. Around 7:30am the BeeGees were at it again. Stayin Alive could be heard coming from the house as Dr. Lacher and Justin fulfilled their horse feeding duties. This time it was Stephanie calling about her horse, Blue. He was uncomfortable and definitely not interested in breakfast. Personally, I can’t imagine not being interested in food but horses are weird.
As Justin and Dr. Lacher pulled up to this colic Dr. Lacher said, “Oh we are going to be OK with this one.”
“How can you possibly know that?!?” exclaimed Justin.
“I just do,” was Dr. Lacher’s reply.
Allow me to explain what Dr. Lacher meant by “I just do.” Blue was standing in his stall, looking at his sides but not trying to lay down. He had no hay, shavings, or grass on his sides or back, letting Dr. Lacher know he hadn’t been rolling much, if at all, before Stephanie found him acting colicky. Blue also just plain didn’t look as painful as Matt, or even Zippy. His eye was quieter, and while he was clearly uncomfortable, he just wasn’t as frantic as Matt. Dr. Lacher did her exam on Blue and confirmed her suspicions. Blue had a heart rate of 36, gut sounds all over his abdomen, and some gas on rectal palpation.
“Blue is going to be just fine. He has a typical gas colic. They do great with some sedation to relax them, Banamine to help with the pain, and a whole lot of fluids and electrolytes pumped in to help overhydrate them,” Dr. Lacher explained as Stayin’ Alive sounded from the truck. It seemed the Thanksgiving weekend was going to be a long one.
The phone call was from Zippy’s owner. He was still unhappy. While he wasn’t as uncomfortable as the previous evening, he wasn’t interested in food and was laying down quietly. After talking through the possibilities with Linda, Zippy got to go for a trailer ride to the Clinic. I love when the horses come to the clinic so I can perform CAT scans on them!
Zippy was definitely uncomfortable when he stepped off the trailer at the clinic. Dr. Lacher performed her usual exam on him and found his heart rate was a bit high at 48 beats per minute, and he didn’t have the greatest gut sounds. She put that long glove on again and did a rectal exam. Zippy’s impaction was softer but it was still there.
“Sometimes these impactions need a little bit more help. Let’s get an IV catheter in Zippy and get him started on some fluids. I’ll tube him with some more fluids too, just to make sure he is super hydrated,” said Dr. Lacher.
Zippy got started on IV fluids and got some more medication to help his pain. Then Dr. Lacher pulled out her ultrasound machine.
“Because Zippy isn’t back to normal, I’m going to use the ultrasound to look inside his abdomen a different way and see if any of his small intestines are distended or if there’s free fluid,” Dr. Lacher explained.
Zippy’s ultrasound looked great. His small intestine wasn’t distended and I could see it moving on the screen. That was pretty cool. There also wasn’t any free fluid around the intestines. Dr. Lacher told us this would show up as black areas between the intestines. She said Zippy’s large colon was also looking pretty darn normal. While we were checking stuff, Zippy got another lactate. We all breathed a sigh of relief when it was 2.6, a little higher, but still a pretty good number.
By late afternoon on Thanksgiving as I was finishing up the turkey bits Justin brought me, Zippy began looking for food in his stall. This is a really good sign. When colics start looking for food Dr. Lacher always gets really excited. I thought poop was a better sign, but she says they can poop and still be colicing, and that looking for food usually means the colic is all better. Zippy continued to be fed small amounts throughout the night and got to home on Friday morning. I’m sure Linda was very happy to have him back!
I hope you have enjoyed my tale of three colics. I learned a lot about what our Docs look for in a colic. Heart rate seems like a really important clue. If you want to learn how to take your horse’s heart rate, come on by the Clinic or ask us when we are out at your farm. Our Docs and Technicians are always happy to teach!
Until next week,
Tony
