Formulating prognoses and cost estimates in colic (Proceedings)
Veterinary care versus owner care
Generally, horse owners are astute at detecting signs of colic. These may include subtle not being enthusiastic about coming up from the field in the morning, not showing interest in other horses and people, or not finishing their feed. These signs should be taken seriously because in a number of occasions, these are the first signs of colic. From a veterinary standpoint, the onset of subtle signs of colic should be logged into the record because the overall goal of colic management should be to cut down the time to referral, when it is warranted. This means that owners should be encouraged to call their veterinarian during the first signs of colic so that veterinarians can give instructions over the telephone, or examine the horse. Both of these events (telephone consultation or examination) should be charged for appropriately. Telephone consultations are particularly difficult to charge for, and some discretion can be used. For example, a quick call to tell the receptionist that colic treatment has been instituted may not be appropriate to charge for, but a consultation in which the owner is looking for advice that requires veterinary expertise is worth considering charging for. Charge levels for consultation can be distributed via newsletters, or the owner can be advised by the receptionist when they call to try to reduce any misunderstanding or feelings of guilt by the veterinarian.
Allowing the owner to institute medical treatment for colic following telephone consultation is a difficult decision. At the very least, the veterinarian should be alerted to the first signs of colic so that the total duration of colic can be estimated. This will help when considering when to refer, and ultimately reducing mortality. In some states, it is not legal to allow an owner to give medical treatments, even with the permission of the veterinarian. North Carolina is an example of such a state. The next step in decision making is whether owners or trainers should be giving medications such as flunixin meglumine without veterinary supervision (in those states where it is legal). The major problem with this practice is that flunixin has a relatively long half-life (approximately 8-12-hours) so that if a horse does need to be referred, particularly where clinical signs are not recognized by owners, the likelihood of survival is reduced and the level of the medical bill is increased. One of the best medications to allow owners to administer is a short duration medication such as xylazine, because it will only last approximately 40-minutes, and the opportunity to assess a horse that has potentially more serious signs will not have been lost by a long duration analgesic. In addition, flunixin is frequently overdosed by giving it at its full dose more frequently than every 12-hours. Overall, the goal is to get any horse that requires intensive treatment for colic to the referral clinic within 3-4-hours.Decision making
For any farm that a veterinarian is familiar with, someone should always be present that can make difficult decisions. Specifically, if a horse requires extensive treatment, or needs referral, it can waste precious time trying to track down the owner. Trainers can be informed of this so that owners sign a document that allows that trainer to make decisions. This document can also include medical information, insurance information, and information related to payment, such as credit card information.