Client Resources: Articles

The Decision

The call came in mid-morning. Gail was distraught. “It’s Ben, He’s bad. Real bad! Can you get here right away? I’m real worried about him. He’s down and thrashing.” I told Gail I would be there within the hour.

I thought about Ben as I drove to her farm. The big warmblood was Gail’s first horse. He was in his late twenties now. Every once in a while Gail would ease onto his back, and they would slowly walk around the farm. It had been two years since he’d been saddled and really ridden. Gail had gone on to be an accomplished dressage rider, and for years Ben had been the farm’s senior citizen. Ben was one of those horses who would never be traded or sold. He was just there to enjoy the grass and live his days out.

As I came up the long drive to the farm I could see Gail on the front lawn with a lead shank on Ben. In the time it took me to park and get to the back of the truck he was up and down twice. In an ideal situation I would do as I was trained. Make your diagnosis, then treat your patient. When the patient weighs 1200 pounds and is throwing himself to the ground that doesn’t work. I quickly pulled up a “cocktail” of 2 strong tranquilizers, and the next time he leapt to his feet, I managed to find his left jugular vein and slip the drugs in. Within a minute he stood with head hanging, and we had time to assess the situation and talk.

I asked the questions as I took his temperature, pulse and respiration, and listened for gut sounds. “How long has he been like this Gail?”

“It’s been about two hours. He ate all his breakfast and we turned him out. He started to act like this soon after his meal. I gave him some Banamine, and it seemed to help for about a half an hour, and then the pain hit again. He’s been so healthy. I just don’t understand it. What do you suppose is going on?”

“I’m not sure. His temperature is normal, but even with the tranquilizer his heart rate is up, and I don’t like the color of his membranes. I’m getting no gut sounds. I’ll do a rectal. Maybe that will tell us something.” I pulled on a long plastic OB sleeve and slathered it with lubricant. There was some manure in the rectum, but further forward it was just empty space, and I began to suspect some sort of blockage high up, beyond the reach of my fingers. I ran a stomach tube down his left nostril and into his stomach. Some stomach contents came back up through the tube, making my suspicion of a blockage even stronger.

“Gail, I’m worried about him. That was some pretty acute pain that he was going through when I drove up. Right now the tranquilizer is making him somewhat comfortable, but it isn’t going to fix the problem.” I told Gail that I had another stop just down the road and would check back in about an hour.

When I returned to the farm, Ben was starting to get uncomfortable again, and I knew that medicine alone wasn’t going to solve this problem. Rechecking his vital signs showed me that he was worse.

“Gail, he’s starting to crash. Normally I’d tell you that the only way to fix this problem is surgery, but given his age I’m not sure that we should consider that. He’s old, and even if he got through the surgery, his recovery is apt to be mighty rough.”

“You mean put him down? No way, not Ben, not now! I’ll get the truck and trailer and we’ll take him to the hospital.” All Gail could feel was her horse’s pain. Her husband arrived and also tried to persuade Gail that it might be best to end Ben’s life now, but she was not listening to him either. Within 10 minutes Ben was in the trailer. As she drove out of the yard Gail hollered at me: “Call the hospital and tell them we are on our way.” As she pulled away, I heard a big thump. Ben had gone down inside the trailer.

I called the hospital and explained the situation. They said that they would look him over when he arrived, and if they agreed with me, would try to dissuade her from surgery. I heard from them in the late afternoon. Ben had arrived wedged sideways in the trailer, and they had to use a “come along” to drag him out. Once he was out of the trailer he stood up but was a white lather from head to toe. Rectal exam with an ultrasound showed a probable entrapment, high up in the gut. Because of his age and his shocky condition the veterinarians on duty were reluctant to proceed with surgery and suggested euthanasia, but Gail persisted. Ben was anesthetized after some IV fluids were given. The problem turned out to be a complicated entrapment of the small intestine in a small opening behind the liver. The gut was pinched in a tight place and its blood supply was cut off. To get exposure to this area requires an incision that is measured in feet and not inches. There were anesthesia problems, and they almost lost him twice. About 2 feet of intestine had to be removed. He was on the table for almost 3 hours. His recovery was difficult. He never really came to his feet. Finally after 24 hours of around the clock care it was obvious that he wasn’t going to survive, and Gail agreed to euthanasia.

Gail has told me since that she made the wrong decision that day, and regrets putting old Ben through it. What got her was that he got hit so hard, so fast. It was a knee jerk reaction to try to do everything possible for him. She was simply not ready to say the words that would end his life. She knew that he would have to be put down someday, but in her mind that was years away.

What I am going to suggest is a way of making the hard decision when it is not an emotional time. Margaret Gardiner from Woolwich uses a system to deal with this situation. There is a notebook in her barn with each horse’s records. Every year each horse is assessed by the staff and the farm vet. As part of each record one of 3 categories is used to describe what to do should a decision need to be made. The three are: heroic, medium, and relieve pain.

Here is an example of how this would work. Let’s say you owned a horse like Ben. As a warmblood in his late 20’s you might well decide that, should he get colicky and need abdominal surgery, you might decline. The decision in this case would be to just relieve pain. In other words, if medicine given on the farm will take care of the problem you would do that, but you have already committed not to send him to surgery.

The opposite scenario might be a four year filly showing a great deal of promise. The word here might be “heroic.” That is, you would do anything you could to save her, and abdominal surgery with a good prognosis might be a “yes, go ahead.” A horse who you have set down as medium might mean something like, “OK, we’ll go to a hospital and get fluid therapy, but we are stopping short of surgery.” Finances may well enter into the decision. These days it is not unusual to have colic surgery and aftercare cost over $8000.

The 3 categories that Margaret Gardiner came up with dictate her future actions for every animal on the farm. I like them because they are quite descriptive, and are understood by staff that might have to make a decision in the owner’s absence.

My advice is to sit down once a year, maybe on January 1, or perhaps on your animal’s birthday and think about your horse or horses and what you would do if you were faced with a situation like Gail’s. Put it down in writing for yourself and for a possible caretaker if you are away. Really important decisions are best made when you are clear headed and can think apart from the emotions that we all feel. Making these decisions for each horse is just good planning and part of being kind to your animals.

 

David A. Jefferson, DVM

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