That morning at 8 a.m., like any other day, I went out to feed our herd of miniature horses. Everyone looked well and happy but an hour later, I noticed our 7 week old chestnut filly rolling repeatedly on the ground. At first I thought she was just having her usual dust bath, but when it continued, I knew she was colicking. A hurried call was put in to the vet. I brought her and her momma into our barn to monitor her more closely, and remove her from the other horses’ interference. Vital signs were taken and I noted that one side of her abdomen had plenty of normal gurgling noises but the other was silent. She was running a low grade fever. The vet gave her the usual treatments - mineral oil from the top per nasogastric tube and a small pediatric Fleet enema from the other end, both of which brought forth no results except to expel the enema. No oil passed through at all. She continued to roll and appear distressed. My vet wanted to pursue conservative treatment and not jump right into surgery. He suspected a hairball was the likely cause, and said he had seen this many times in dogs, which were more his specialty, so I trusted his judgment and waited it out, giving the foal shots of painkiller to ease her pain. I watched helplessly as she rolled again and again, pawed the ground, sat like a dog, stretched her back legs out when standing to make more room for the gas that was building every moment in her intestines, and finally lay on her back with her legs up in the air and her head twisted unnaturally to one side in obvious agony and pain. No more stools were forthcoming. I consulted with two other vets far away from our locale that specialized in equine surgery for a second opinion (with the blessing of our own vets here), and they advised that if we had not done surgery within 3 to 6 hours, there was no point in doing it now because she would likely have extensive necrosis of large sections of her bowel by now from lack of proper blood supply and would die anyway. They both advised putting her down and ending her suffering. She became too weak to get up and nurse on her own, so we tried giving foal milk replacer by bottle and she took a little off and on. That minimal hydration helped to keep her going. Repeat bloodwork the previous day had amazingly showed her not to be dehydrated yet. Many prayers were raised on her behalf for a miracle to save our poor baby. It was heart-breaking to watch. The fourth morning, the vet phoned to see how she was, and we brought her into the OR. Two hours later, it was over and the culprit that caused this colic was a hairball the size of a mature mouse!! This was exactly what our vet had expected to find, as he had just read an article about hairballs in his vet magazine a few days before our foal came to his attention. The hairball had lodged in her small intestine, whose lumen was no bigger than a pinkie finger, and it had completely obstructed her GI tract. Fortunately for her, no necrotic areas were found as the hairball had luckily not caused any interruptions in blood flow to the intestines. She was sutured up and returned to us feeling less pain than before the operation, despite an extensive incision in her abdomen. The reunion with her mom was joyful, and gave us all hope she would survive. The initial crisis was over. She would not be "out of the woods" for some time but this surgery, even though delayed, had saved her life. I gave her IM Antibiotics daily to stave off infection since the foal is at very big risk for peritonitis after surgery such as this. She had struggled valiantly for life; she did not want to die - she wanted desperately to live! What a fighter! I have been caring for her needs ‘round the clock for two weeks now, and she is doing very well. Her stools are firming up, she is passing gas, there is no•fever and her other vital signs (pulse, respirations,gut sounds) are normal. Her incision is clean and well-approximated with no evidence of purulence. I took out her sutures today, and had to smile because, as an RN, I have done this procedure hundreds of times in people, but never in a horse. When I come to the barn, she nickers and comes over to greet me and get a cuddle. I fancy that I see a smile on her lips as we slowly phase up her diet from just breast milk to a little hay.

As a result of this experience, I decided to write this article to warn other mini horse owners of the potential problems of hairballs in foals of miniature horses. I want to let other mini horse owners know about this threat so that they can take informed, definitive, and timely action to prevent needless foal deaths and suffering. As a little review, let’s first take a look at the signs and symptoms of a typical colic (taken from "www.myhorsematters.com":

• turning the head towards the flank
• pawing
• kicking or biting at the abdomen
• stretching out as if to urinate without doing so
• repeatedly lying down and getting up or attempting to do so
• rolling, especially violent rolling
• sitting in a dog-like position, or lying on the back
• lack of appetite (anorexia)
• putting head down to water without drinking
• lack of bowel movements, as evidenced by the small number of manure piles
• absence of, or reduced digestive sounds
• sweating
• rapid respiration and/or flared nostrils
• elevated pulse rate
• depression
• lip curling (Flehmen response)
• cool extremities

Our filly exhibited every one of these classic colic signs before surgery.

Your immediate plan of action with a horse exhibiting these types of signs should include:

• careful observations about behaviours as listed above
• accurate vital signs (listen to the foal’s heart apically with a stethoscope if you have one or put your ear to her left chest area, count pulse, check for gut sounds or lack of them with your stethoscope, and count respirations per minute) - these will greatly assist your vet in assessing the severity of your foal’s condition.
• notification of your vet as quickly as possible AND making sure the vet you call is intimately familiar with equines, especially small equines! The window of opportunity for surgical intervention is generally considered to be from 3 to 6 hours after the beginning of the colic, so time is of the essence! As we learned, a vet that is not specializing in horses or minis may be of questionable value to the mini owner in times like these, so choose your vet carefully and act quickly.
• assessment for shock by noting the capillary refill time (test this by pressing on gums adjacent to teeth, releasing, and counting the seconds it takes for colour to return; should be under 3 seconds)
• Also check the colour of the gums - is it healthy pink or dusky?
• manure checks in the foal’s living area - check bowel movements for colour, consistency, and frequency. If no manure is found, this is highly suggestive of intestinal obstruction by a foreign body like a hairball or torsion of the intestine.
• noting any recent changes in management, feeding (especially richer higher protein feed changes) or exercise, and letting the vet know about these.

As per the recent piece on colic in Miniature Horse World, there are several types and causes of colic. Because a hairball has the potential to completely obstruct the foal’s tiny GI tract, treatment is generally surgical, and the sooner the better. Foals that have hairballs or other obstructions where blood flow has not been cut off (nonstrangulating obstructions) have a lower mortality rate than foals that have•off (nonstrangulating obstructions) have a lower mortality rate than foals that have strangulating obstructions (where extensive damage has been caused by the interruption of blood flow to the intestines, causing areas of the intestine to die and necrose). Anaesthetic is much akin to that which is given to a largish dog. Maintaining blood flow to the affected area seems to be the most critical factor in the foal’s long term survival. With recent improvements in surgical techniques, preop preparation and anaesthetic management in horses, survival rates have gone up following intestinal surgery according to one study from the University of Illinois (see bibliography). The age of the foal has some bearing on the success of surgery also; foals over two weeks of age have a much better survival rate than younger foals. The risk of recurrent colic is always there, and the possibility of developing adhesions later on is ever present, but studies have indicated that the long term survival of foals that have had abdominal surgery for uncomplicated problems like hairballs is amazingly good. We do not know why some horses get hairballs and others do not.

Post-op care for these surgical cases includes the following:

• monitor vital signs and gut sounds regularly every 4 hours or more often if you see anything unusual or untoward developing
• check for stools post-op - they may be loose for awhile. Make sure the foal is producing stools regularly. Call the vet if there is no stool or it is very abnormal (eg. bloody).
• monitor how often the foal is nursing - your vet may advise you to keep your foal only on breast milk (no hay or supplements) for a time post-op to let the intestines rest and heal. Make sure your foal is nursing adequately and often enough to keep hydration up. If the foal is too weak to stand at first and nurse, try milking out your mare and giving the foal the breast milk per bottle (we did this and she accepted it much better than the commercial product we had available).
• make sure your foal is voiding regularly and normally - watch for concentrated urine, infrequent voidings, fever, or other signs of dehydration such as tissue turgor (pinching up a bit of skin and letting it go again should produce an elastic immediate return to its pre-pinched condition; if it stays up in a little "hill" after you let go, your foal could be seriously dehydrated).
• give any medications your vet prescribes exactly as he instructs (do not miss doses of antibiotics or give medications your vet has not prescribed).
• avoid giving grain or supplements until intestinal movement is normalized again and you have checked with your vet regarding the appropriateness of these - excessive grains or energy-dense supplements may increase the risk of colic reoccurring.
• keep your foal quiet and do not reintroduce the foal to a herd environment until it has completely healed up in order to reduce stress on the foal and help prevent a further colic episode. A smaller paddock with the opportunity to walk around is recommended; a large turnout area where the foal can run out freely and be too far away to monitor adequately is not a wise choice in the initial post-op period.
• keep careful records of management, feeding, and general health
• check the incision frequently to determine if the sutures are intact, if there is any fresh bleeding or pus drainage present. Consult your vet for further instructions should you see these signs. He may want to put your foal on a different antibiotic or have you cleanse or treat the incision with a particular antiseptic agent. We put on a some Boroform and had no infection whatsoever.
• try to take note of how often and how aggressively the foal is scratching her incision with her teeth; if she is aggressive enough to damage the incision, the sutures may not hold. Consult with your vet about measures to discourage or eliminate the foal’s ability to reach and irritate that area.
• provide clean fresh water in case the foal wants supplementary water in addition to breast feeding (our foal is sipping water quite regularly now).
• once the vet has advised you to upgrade the foal’s feed, you may gradually reintroduce good quality hay that is not stemmy or too coarse in smallish•quantities, gradually increasing to what the foal was taking in before surgery.
• suture removal should be done by your vet 10 to 14 days after surgery if the incision is healing properly.

The average fecaliths can be just fecal material or other foreign objects including pieces of binder twine, mane or tail hair, etc. Those found in miniature foals are described as 4 to 6 cm in size (a normal fecal ball should only be 1 to 2 cm. in size to pass normally). Since the lumen it must pass through is only about the size of your pinky finger, it is easy to see why these foals obstruct. Fecaliths and hairballs are fairly common in ponies (especially Shetland), particularly in the late fall, we are told, when the grasses become coarse and the weather is cooler, reducing water intake by the pony. JAVMA’s article on this subject states that foals of these smaller equines are thought to be unable to digest hay that is too coarse or in too large a quantity than their immature little digestive systems could tolerate. The vet will have to differentiate this colic’s cause to determine if it is related to any of the following causes: impaction of the small or large colon, large intestine, large intestine displacements, ileus, small colon hematomas, intussusception, mesenteric and abdominal abscesses, phytoconglobates, and phytobezoars. In our foal, we tried two enemas with no success, and multiple enemas is generally noted not to be successful in the studies either. All it will do is assist in the diagnosing process (ie. if the horse is totally obstructed, only the enema will be returned). Fecaliths and plain hairballs should be seriously considered if the mini foal is displaying a progressive non-responsive colic, and you as owner of the foal must be quick to find a professional to perform the necessary surgery to remove these promptly. In large horses, a left flank laparotomy can sometimes be done in the standing position to bring out a section of small colon containing the fecalith, then inject it with a "softening solution" of saline and doctyl sodium succinate (the same as the stool softener used for people), and facilitate the excretion of the fecal mass that way. This is not done in mini foals; they require surgery to actually open the intestinal segment and manually remove the fecalith, which exposes the foal to greater risk of peritonitis, the most frequent equine post-operative killer after this type of surgery.

Today our filly is well again and romping around her pen. She is slowly gaining back the weight she lost after the surgery, and it is heartening to see her little tummy coming back to its normal roundness and watch her play. The experience has left us with a better understanding of this problem and a sense of hope that we can help others in the miniature horse world by spreading the word that this is often a curable condition. Barring later adhesions or other long-term problems, this filly should live to a ripe old age if managed well. We hope this article has been of assistance to you and that none of you ever has to go through the heartbreak we had to go through to save your precious foals. Our filly sends you her hello!

BIBLIOGRAPHY

Veterinary Treatments and Medications for Horsemen
Eqine Research Inc. - Equine Veterinary Series (1977)
Box 535547, Grand Prairie, Texas 75053

"Fecal Impaction in Four Miniature Foals" an article in Clinical Reports, JAVMA, Volume 200, No. 2, January 15, 1992.

"Understanding and Controlling Colic" an article on the internet website: "www.myhorsematters.com"

"Prognonsis afer Small Intestinal Surgery in Horses Better Than Previously Thought" - an article on the internet website: "www.usyd.edu.au" by the University of Sydney, Australia

"Good Outcomes For Some Foals Needing Surgery for Colic" - an article from the internet website: "www. usyd.edu.au"