Our chronicle of 24 hours during foaling season at one of the country's top equine hospitals continues in this excerpt from the Eclipse Press book Equine ER by Leslie Guttman. Last week, a mare with severe colic came in. Today, medical staff continue to try and assess what her problem is, and time appears to be running out.
Dr. Embertson was calm as he discussed the situation with the owner, telling her that they were going through standard diagnostic procedures to try and figure out the origin of the mare’s colic. Embertson is always even, stoic, contained. Californians would say he has good boundaries. He is in his early fifties, tall, trim, one of those men who although he has lost all his hair, wears his dome well, like a professional athlete.
Embertson explained the mare might need surgery.
Would the colicking mare end up in the operating room?
“I don’t want to put her through that torture,” she replied.
“Let’s see if we can figure out a little more what’s wrong with her,” Embertson said, adding that he wanted to do a rectal palpation.
But first intern Dr. Alexandra Tracey needed to finish an ultrasound. As she scanned the beige probe across the mare’s abdomen, she saw the large colon had quite a bit of gas in it. But that was all the intern could see.
The owner was now becoming distraught. She was embarrassed by her emotions and explained to Embertson how much she loved the horse. He told her he understood. He and his wife were having a birthday party on Sunday for one of their ten horses; the mare was turning thirty.
Embertson began palpating the mare. He could feel the large colon was displaced (out of its normal position), but it was impossible to tell how severely and whether part of it was twisted, shutting off blood flow to tissue and other organs. While he palpated, Dr. Albert Solé Guitart quickly collected peritoneal fluid – liquid from the abdominal cavity. If there had been a gastrointestinal rupture, the fluid would show elevated protein and white blood cell levels, and, usually, bacteria and plant material.
Then the vets refluxed the mare (obtaining stomach contents via a tube, threaded down through the nasal passage). They found the amount of drained liquid wasn’t excessive, signifying the mare’s problem likely wasn’t originating in her small intestine. Because the small intestine is closer to the stomach, more fluid would have probably come out if it were. The problem was farther downstream in the gastrointestinal tract. After a short while, the results came back from the mare’s bloodwork and peritoneal fluid. The values were normal, meaning, at least for now, she didn’t have a rupture.
Embertson told the owner about the displacement. From the amount of pain, it was also likely the mare had a twist in the large colon. The options at that moment were: surgery; waiting to see if the colic would resolve on its own with the clinic’s help (providing fluids, pain meds, and laxatives); or euthanization. But those options were more complicated than they sounded. Surgery entailed cost, perhaps more than she might want to spend. The average cost for a colic surgery is between $4,500 and $6,000.
Even though the hospital does successful surgeries for large colon displacements all the time, the cost could go up if they ran into unexpected problems on the table, or if the mare didn’t recover well. If they waited to see if the situation would resolve, then the issues were 1) how long could they manage her pain, and 2) if they eventually did decide to do surgery, then they would have likely put the mare through significant pain for nothing. Also, waiting too long to operate could create more, possibly fatal, problems such as a rupture. Euthanization, of course, meant no turning back.
Embertson said he thought it was unlikely the mare’s colic would resolve on its own, saying, “She’s got 300 milligrams of Rompun (the brand name for xylazine) in her,” but was still struggling.
In the stall, the mare collapsed again.
Next: Did the mare survive?