“You have to set your client up for success and expectations” when you refer a colic case, advised Jesse Tyma, DVM, DACVS-LA, of Mid-Atlantic Equine Medical Center in episode 80 of the Disease Du Jour podcast.
There are about 40% of AAEP member veterinarians practicing solo with no brick-and-mortar facility. Many other equine/mixed animal practitioners don’t have large animal surgical facilities. That means most of those veterinarians will have to refer severe colics to clinics or surgical facilities for advanced care.
Tyma said the attending veterinarian should do a good colic work-up on the horse and “put the pieces together.” She also reminded practitioners that older horses have more severe colics.
She advised young veterinarians to hone in on the exam to make the determination early if the horse should be referred. “The majority of colics in the field are mild and self-limiting,” she noted. “But remember the sooner you get a horse to surgery, the better the outcome.”
Tyma covers clinical skills from working up a colicky horse to aftercare of the surgical patient. She provided many tips for veterinarians early in their practice careers on managing not only the horse, but the client.
Tyma advised young veterinarians to “find their narrative with clients” when talking about referring horses. “Does that horse have the option for referral or surgery?” she posed. “What is the insurance status? Are there exclusions? Do you have a trailer?
“In a calm manner you need to determine if the horse can be referred, determine insurance status and understand transportation options,” said Tyma.
She also said clients have varying experience with colicky horses. Some know the process, and others don’t.
Tyma also advised young veterinarians to not get “stuck running fluids in the field.”
She said it’s easier to get oral fluids ink but leave the nasogastric tube in place for reflux.
The cost of referral is another point that veterinarians need to help owners understand. “The veterinarian should know cost expectations and can set the client up to know what care costs at a referral center, or the client will suffer from sticker shock,” said Tyma. “When clients are stresses, remember they have selective listening.”
If you as a veterinarian are new to an area, get to know the referral centers that are available. “They are all a little different,” said Tyma.
She said there also is the possibility that a colicky horse that is referred to a medical/surgical facility will arrive without colic. “It resolves on the way,” said Tyma.
She added that veterinarians should make sure you talk to the client about the possibility of surgery or medical management options. The the attending veterinarian should follow up with the referring vet on what was found and recommended follow-up care.
Tyma said the attending veterinarian will need to do post-surgical care when the horse is sent home from the hospital. “You have to set the client up for expectations on managing incisions and medications feeding, exercise or other restrictions for one to three months, monitoring manure output, and so on,” said Tyma.
Don’t miss these and all the other great tips from Tyma in this podcast.