When does it make sense to refer a colic ?

Colic is a common equine problem and a veterinarian who spends any part of their professional time dealing with horses will have to manage a horse with colic at some point. Deciding whether, and how, to send a horse with colic to a referral clinic can be a source of stress to the treating clinician and to the client. Sometimes the choice is not really a choice. It is a case of referring the horse, or euthanasing it. This may seem harsh, but in reality, one part of the job of a veterinarian is to make tough decisions. Addressing the client’s wishes and concerns is one thing, but ultimately the welfare of the animal needs to remain paramount. It is also important to remember that referral is an active process in which one professional colleague contacts another and they agree on a case transfer. Before the animal is sent. “Just take the horse to Dr. X” or “Call Dr. Y” is not a referral.

There are four reasons when it makes sense to refer a colic. A surgical lesion has been diagnosed (with or without considerable pain); the horse is in uncontrollable pain; a desire, or need, for a second opinion; or a situation where the management required to address the problem would be facilitated by referral.

If there is an option to refer, the ultimate questions becomes ones of animal health status and the more practical ones of whether the clinician has the materials, expertise, staff, and time to deal with this colic? Irrespective of the underlying colic problem, if the veterinarian does not have the latter at their disposal, then referral is the only ethical option. However, it is important that the referring veterinarian only send animals that they believe will benefit from the transfer. Sending horses that are unlikely to survive the transport, or those that are so sick that they will not survive the intervention for which they were referred (e.g. surgery), is irresponsible. If the primary care clinician can determine the packed cell volume (PCV), total protein (TP) and lactate concentration of the horse’s venous blood it will help them determine the likelihood of a successful outcome. This can be combined with an assessment of the lactate concentration of the abdominal fluid, if it is safe to perform an abdominocentesis.

Horses with colic require management and monitoring. Veterinarians providing after-hours service typically do so for a wide geographical area, or for more than one person. As such, they typically diagnose and treat the colic and leave the monitoring of the animal to the owner, trainer, or horse manager. They do not have the time. Nor can the horse owner afford to have veterinarians sitting and monitoring the animal. Intravenous (IV) fluids are routinely administered on farm. However, if there is a need for prolonged IV fluid administration with, or without, intermittent nasogastric intubation (such as an impaction colic) then moving the animal to a central facility (whether it is a “referral” or not) may be more efficient and result in improved case management.

Dr. James Carmalt graduated from the University of Cambridge in 1998. He did an internship in large animal medicine and then went into general practice in Tasmania (Australia). Following that, he did two back-toback residencies (Equine Practice and Large Animal Surgery) combined with a Masters degree (Equine Dentistry) and a Fellowship of the Royal Veterinary College (FRCVS). Dr. Carmalt is currently a full professor, with tenure, at the University of Saskatchewan in Canada. He holds a PhD and Diplomate-status (by examination) with multiple internationally recognised speciality Colleges including equine practice (ABVP), equine dentistry (AVDC), equine surgery (ACVS), sports medicine & rehabilitation (ACVSMR). Dr. Carmalt travels extensively to work for individual clients, private practices and academic institutions.