Repairing Richie - Successful Colic Collaboration
When I visit the stable where I board Richie, my 22-year-old Thoroughbred gelding, I see him out in the pasture grazing peacefully with his two mares. His coat is shiny and his weight is good. His topline only hints at his age. There is no clue from his appearance or demeanor that two years ago he survived a lengthy and complicated surgical re-section of his colon to remove a rare cancer tumor. Nor can you tell that the surgery was preceded by more than 60 colic episodes in nine months, sometimes two a month, sometimes three a day.
Richie's care and recuperation involved successful collaboration among several veterinarians practicing conventional and complementary medicine, along with help from other holistic practitioners. Although it is unlikely a reader will encounter the same rare medical problem we did, I hope this discussion of the resources will help with other situations.
I believe that Richie's lifestyle and holistic health maintenance helped him to be a healthy horse with a serious illness, rather than a "sick horse". One veterinarian told me that Richie was "the healthiest sick horse in my practice". And when the first laboratory report after his surgery indicated that the mass removed was cancer, he still looked so healthy that my holistic veterinarian requested a second opinion from another laboratory. Unfortunately, it too came back with the same results. However, in the two years since his surgery we have seen no symptoms of the disease.
Richie lives about 25 miles from me in southeastern Lancaster County, Pa. He is on a 10-acre farm owned by a healthy, happily married, and emotionally stable couple, and the calm demeanor of all the horses reflects this, as my holistic veterinarian believes.
Twice a day Richie comes into his own stall to eat. The barn has a lot of light and ventilation. Each of the five stalls has half walls with the upper part separated by bars, one sliding door to the aisle, and a Dutch door to the outside. The feed is kept in the closed tack room in rodent-proof containers.
The other 23 hours a day he is out with one to three compatible horses, a large trough of clean water (heated in winter) that is regularly power-washed, and at least one run-in shed with dry footing that is picked out several times a week. His pasture grazing is supplemented with grass hay as needed.
He is not clipped, but due to his age we put an appropriate turn-out blanket on him as needed depending upon the weather.
When Richie began his series of colic episodes, the veterinarians and I discussed his management. They assured me it was excellent, and apparently not the cause of his colic.
Twice a day Richie eats oats and barley top-dressed with herbal supplements. These include "ABC's Plus" and either "Joint Jolt" or "Body Flex". He also has ABC's "A-Mix", "Minerals", loose salt, and "BVC" available free choice in his stall. Which ones and how much he eats seems to indicate how he's feeling, e.g. more of the "A-Mix" in bad weather and more of the "BVC" when he's due to be de-wormed. I de-worm him every six to eight weeks, and give a five-day double dose of fenbendazole in spring and fall for encysted strongyles and as an immune stimulant as recommended by his holistic veterinarian.
Richie's symptoms and bloodwork indicate that he is functionally hypothyroid. He does best on a low dose of a T3/T4 naturally derived medication, which is top-dressed on his feed twice a day.
The holistic vet treats him with acupuncture and chiropractic about four times a year as maintenance, more often if needed for specific problems. I consult with her about any changes in his supplements or medication, and she also supervises the performance dentistry she recommends. For many years he had only the traditional float of his molars. Then she recommended having his incisors balanced. An article in "The Whole Horse Journal" showed examples of 'good' and 'bad' and explained why it was necessary. Much to my shock he resembled the 'bad' example. As his mouth was in good condition and balanced we were pretty sure we could rule out incompletely chewed food as a cause of this colic. He continues to have mouth-balancing dentistry appointments twice a year, due to extensive damage from an old skull fracture.
Depending upon how quickly Richie's feet grow the farrier comes every four to six weeks. He collaborates with the holistic veterinarian to keep Richie's feet 'biomechanically balanced' and shod as she feels is necessary due to his age and old suspensory injuries.
Richie's 'conventional care' veterinarian is part of a small group practice I have used for 15 years, so most of the veterinarians know Richie, which is comforting in an emergency. She and the other veterinarians in the practice communicate well with the holistic veterinarian and are familiar with Richie's normal appearance and behavior, and he is familiar with them. Richie's conventional care veterinarian comes to give his vaccinations. We keep them to the minimum, and space them out to avoid stressing his immune system. She also gives him chiropractic adjustments if needed.
Treating the Colic
Richie's first colic episode was Dec. 11, 1998. From then until his surgery on Aug. 3, 1999 he had about 60 episodes of colic. His colic treatment involved a three-way strategy. We treated the colic episodes, tried supplements and medications to avoid colic, and tried to diagnose the underlying cause. Two problems confounded these goals. Richie reacted negatively to some appropriate conventional medications. And the correct diagnosis was such a rare cancer that it was virtually impossible to figure out the cause until his surgery and the histopathology report a week later.
Richie's colic symptoms were usually very mild. They included looking at his side, declining a treat, lack of appetite for his meal, a dull or depressed facial expression, pawing, walking with his head down but not grazing, or lying down quietly. We never saw him sweat from pain or throw himself around.
When he was not actually colicking, he looked normal and healthy. He was shiny and his weight was good. Due to his old suspensory problems, I rode him only for brief walks. But there was no change in his ability to enjoy them and he told the animal communicator that the exercise made him feel better.
About a dozen times I needed a veterinarian to help Richie's colic. The other episodes the farm owner or I treated successfully using methods the veterinarian approved (or at least was informed of and did not disapprove!). I usually called the conventional veterinarian's office to tell them I was treating him, and warn them I might need help. If I could resolve it myself, Richie would return to normal within 15-30 minutes. If not, I knew I needed a veterinarian.
The treatments we gave him ourselves started with "Rescue Remedy" sprayed on his gums several times. This seemed to help with his anxiety about the pain. He also was more relaxed when I was with him.
We usually gave him a syringe of ABC's "ProBi" and Naturade's "Stomach Formula" diluted with water. They have several soothing herbs in an aloe vera base and a veterinarian recommended "Stomach Formula" for both constipation and diarrhea. We sometimes also gave him electrolytes in warm water.
I usually put "Mineral Ice" on the acupuncture points the holistic veteriniarian showed me for colic - Large Intestine 4 (on the medial side of the front legs just below the knee) and Stomach 36 (on the front of the gaskin). I wasn't always sure exactly where they were, so I was pretty liberal with the "Mineral Ice".
Although the homeopathic Nux vomica is recommended for stomachaches, and Carbo veg for gas pains, these did not seem to help him. But Gelsemium seemed effective for getting him to drink.
I also did Reiki on him, and often worked on the acupressure points for colic including TTouch on his ears. If all this did not make him feel fine within a few minutes, then I gave him half the recommended dose of "Banamine" oral paste. If that did not work within about 20 minutes, I asked the veterinarian to come.
If the veterinarian did come, Richie usually improved with the warm water, medications and mineral oil the veterinarian gave him, sometimes with either "Stomach Formula" or " Milk of Magnesia" added to the solution. During the last few episodes before his surgery (during July's high heat and drought) he needed intravenous saline solution with electrolytes.
We kept a Colic Treatment Record chart handy - it had my phone number and the veterinarian's, it listed Richie's usual colic symptoms, and had columns where we could check off each treatment we used. In the stress of treating his colic, it also reminded me of which options I could try.
Supplements and Medications for Colic Avoidance
I consulted with conventional and complementary medicine veterinarians and herb experts to get ideas about what supplements or medications might help avoid the colic. I mention these to give you ideas to discuss with your veterinarian. It was not always clear what helped since nothing stopped the colic completely although with some the frequency decreased. Some things actually made it increase - even if they were appropriate.
We used doxycycline and colloidal silver in case he had peritonitis. The prednisone and homeopathic NosPred were for chronic bowel inflammation or arterial damage. The psyllium or chia seeds were for constipation or sand colic. Thiosinaminum homeopathic was for adhesions. For immune system support I used "Chvel", "Equinacea", or "Noni".
Richie was also a source of some ideas. He requested the "brown pills" ("Eucommia 18") to help the prednisone "go where it was needed". The holistic veterinarian and my acupuncturist agreed it was an appropriate yang tonic along with topical sandalwood oil. Richie also asked for the "milky white liquid" so the veterinarians prescribed "Milk of Magnesia" and his colic subsided.
One veterinarian thought Richie had ulcers and prescribed carafate. But he colicked more often. Another veterinarian recommended a five-day double dose of fenbendazole, which is supposed to help ulcers, boost the immune system, and act as a gut astringent - he colicked on day #6 - as we were also fighting a substantial worm load, which previously resisted the fenbendazole in normal doses, a double dose of pyrantel pamoate, and 2 weeks of daily pyrantel tartrate.
I believed that having had reliable, accurate communication with Richie was vital. I had been able to find out how he felt, if he was in pain, where and how it hurt, and whether a treatment was effective. After I had driven 25 miles home from a colic episode it was also comforting to have the animal communicator check him to confirm that he still felt OK. (She also told him that any time he needed me, he could contact her, and she would call me to go help him.)
Before we shipped him to the veterinary hospital for additional diagnostics, the animal communicator told him where he was going and why, and also asked for his consent before surgery. He wanted to know how much it would hurt, how long it would take to recuperate, and how much he would colic afterwards. We said it would hurt very little (not only were we wrong, but so were the veterinarians who said surgery does not hurt animals the way it does humans). We were right about the recuperation taking 30-60 days. And we said that he might not have any colic after surgery.
She explained to him that he would wake up lying down in a room. He should take his time and stand up carefully when he was ready. His surgeon later explained that recovery from anesthesia can be severe, but confirmed that he was unusually careful about standing up.
When we talked with him the following morning, after a surgery that was much longer and more complicated than what we originally described, we had some apologizing to do. My decision to continue with the lengthier and riskier surgery had to be made instantly, without time to consult Richie - if indeed we could contact a horse under anesthesia. Richie told the animal communicator that he felt as if he had been hit by a herd of horses and as if someone had rummaged in his gut. We explained that they did exactly that. He also wanted people to understand how painful it was after surgery. We could see his cramps from passing manure and painful stretching to urinate.
Apparently Richie was aware of the veterinarian's amazement that he survived five hours of surgery. About a week later Richie said, "I've already given you surprises, and there's more to come." After his one-year anniversary I learned that it had been expected he would live only a couple of months.
We had used a variety of techniques to try to figure out what had been causing Richie's colic. Like the blind men and the elephant, we had many theories and most were correct to some degree. We used veterinary knowledge, bloodwork, fecal exams, medical intuition, applied kinesiology, and traditional Chinese medicine before going to the veterinary hospital in August for further diagnostics. There they used endoscopy, ultrasound, a peritoneal tap and rectal palpation by a surgeon ("with a long educated arm").
Between the time I scheduled the hospital diagnostics appointment and his admission a few days later, Richie developed an impaction. The peritoneal tap was normal. The endoscopy showed stomach ulcers. The rectal exam and ultrasound indicated that he might have a 'simple displacement' of his intestine, which could be fixed with a brief uncomplicated surgery that had a 90% success rate. (I felt guilty about delaying these diagnostics so long, but the surgeon explained that although the ultrasound showed the area of impaction, if done sooner it would not have shown the tumor or its location.)
By the time Richie entered surgery it was late in the afternoon. Therefore when the first surgeon discovered that Richie required a bowel re-section he met with me so I could decide (immediately!) whether to continue surgery or to euthanize Richie. The surgeon quickly explained many reasons why this surgery would be far more difficult and expensive, and that Richie would have less than a 50% chance of surviving. The possible complications included not surviving the anesthesia, infection, fever, founder, abscesses, adhesions, the sutures not sealing, and the intestine's peristaltic motion not resuming.
I decided that since Richie's tests indicated he was a healthy horse with a 'mechanical problem' I should allow him the chance to live. So I approved continuing the surgery, but silently sent Richie permission to die if he disagreed. Another surgeon, who was on night shift with the emergency team, took over the rest of the five-hour surgery. She finished around midnight.
She explained that a tumor had severely constricted his right dorsal colon from a normal diameter of ten inches down to only one or two inches. The 'downstream' portion was normal, but the 'upstream' part was abnormally thickened, firm, and hard from the muscles pushing the food through the tiny opening. Suturing the two radically different sections together was extremely difficult.
The stress from this stricture, and perhaps also the "Banamine" and/or the prednisone, caused his stomach ulcers. A week later the histopathology report from the laboratory identified the tumor as colonic adenocarcinoma. A second laboratory reported that the cancer had invaded the lymphatic system and metastasized, and his prognosis was "poor".
There had been a long list of theories about what was causing his colic. Many were correct. Based on the time of day of his colicking, and the reaction of his Large Intestine acupuncture meridian, the holistic veterinarian had correctly diagnosed the stricture in his large intestine. The applied kinesiology and medical intuition correctly indicated a problem with parasites and the intuitive was correct about adhesions. The endoscopy confirmed that the veterinarians had correctly diagnosed the ulcers.
The post-operative care at the hospital included doting nurses, intravenous saline solution and antibiotics. Richie also had many people visiting, praying and doing Reiki for him, an acupuncture treatment, and brain integration from a distance that instilled positive affirmations for his recovery. As soon as he could eat he started getting omeprazole for his ulcers, and some hand walking with grazing. He had a brief low fever, but no other adverse reactions to the surgery.
After six days he was discharged to an equine therapy facility, where he got the largest stall with the most light and best view. In addition to stall rest with more hand walking and grazing, he got laser treatments of his incision (and his suspensories), papaya for his ulcers, and the homeopathics Thiosinaminum to prevent adhesions and Traumed for pain, along with additional chiropractic and acupuncture treatments.
When he was due to be transferred to his old barn a few miles up the road, I checked with a medical intuitive/animal communicator. She confirmed my intuition that he was not quite ready to be moved. About a week later he made the trip comfortably, and was turned out into a small paddock attached to his stall. Next he was able to go out in the field with his friends for slowly increasing amounts of time, until finally he was back to his normal routine.
According to the hospital records and the international equine clinicians' network, Richie is one of very few horses with colonic adenocarcinoma. The hospital's veterinarian recommended keeping him happy, feeding low residue food, and doing a follow-up endoscopy to check his ulcers. I also used my own research, intuition, common sense, and asking Richie what he wants and how he feels. For instance, an anti-tumor supplement made him feel worse. But the red clover buds he requested were an appropriate herb. I support his immune system by alternating vitamin C with the Chinese herbal mix Fu Zheng, and his holistic veterinarian treats him with intravenous ozone several times a year, when he requests it. I also had an animal communicator perform a soul retrieval since these are recommended after traumas such as surgery or lengthy illness.
In addition to Richie's will to live and a lot of luck, I believe we owe his current health to the successful collaboration and communication among his conventional and complementary health practitioners along with the diligence of his caretakers. And I let him know that I appreciate every additional day I have with him.
Postscript from Veterinarian
Richie continues to amaze us all with his continued strengthening and apparent good health. His defiance of the poor prognosis is possible only through the accurate observation of his deviation from mechaical, physiologic, and emotional balance, and the immediate attention to reestablishing that balance with whatever constructive means are necessary. His owner, Susan, has been an exemplary caretaker and has made this possible, so he continues to live happily.
About the author:
Susan Rifkin Ajamian is a writer who learned about complementary medicine through caring for Richie and her 21-year-old cat, Cassandra. Susan is grateful to her husband and the many people who helped them with information, skill, and moral support.