Expert Q & A | Surgery

Helping owners ride the colic ‘roller coaster’

By Adam Marcus

The prospect of colic surgery can be traumatic for horse owners. What can equine veterinarians do to help? Margaret Mudge, VMD, DACVS, DACVECC, a clinical professor of emergency critical care and the section head of surgery at The Ohio State University College of Veterinary Medicine, in Columbus, discussed the topic at the 2026 annual Equine & Farm Animal Veterinary CE Conference at The Ohio State University in January. The interview has been edited for length and clarity.

MEV: As you point out, colic surgery is something of a luxury good, with highly elastic demand. In other words, horse owners often forego the procedure because of cost. How do you handle the initial conversation when you know the cost will likely exceed whatever threshold you think the owner might have?

Dr. Mudge: Having a critical case of colic is very emotionally charged. I think sometimes we have a tendency when we know that the horse needs either surgery or euthanasia, like with a strangulating problem like a large colon volvulus, to stress that the situation is very time sensitive. And I used to lead with, “Your horse needs surgery, and this is how much it’s going to cost.” Of course, a little bit less direct than that, but essentially trying to be very time-efficient, be straight up with the owners, and recognize that cost is often the limitation for owners. And the message I got from some UK research on the owners’ end of the experience is that you do have to deal with the money, but the horse is not a commodity. It’s a family member. They really want to talk through what’s the best thing for the horse without the money part of it, at least at the start.

Sometimes the money is not the thing that’s making them say no. Sometimes it’s the comorbidities that the horse has—really bad arthritis or maybe a variety of things that play into that. But sometimes they decide that surgery and anesthesia really aren’t in the horse’s best interest, and that has nothing to do with the finances.

MEV: You have called colic an “emotional roller coaster” for owners. Given the importance of preserving a working and comfortable veterinary-client relationship, what are some non-medical steps clinicians and facilities can take to support the owner’s mental health during a crisis, and keep clinicians sane in the process, too?

Dr. Mudge: I think in vet med in general, we’re recognizing the importance of preserving everyone’s mental health, and owners definitely are part of that. We have social workers here at Ohio State who can help both the clinicians and staff members, but also the owners. That’s used more on the companion-animal side, but we also see a variety of emotional attachments with large animals. Some of us who are large animal veterinarians grew up on farms and have maybe a little bit more of a practical farm mentality. So, we have to recognize that for a lot of owners, their horse is just as much part of the family as the dog that sleeps in bed with you.

The other thing that I think is helpful is, if they do decide to euthanize their horse or they go through with treatment and the horse still doesn’t make it, we have a cremation service that we work with that is used to dealing with large animals. And they’re compassionate. They communicate well with our clients. I think that there’s certainly value in giving the owners options and closure.

MEV: When it comes to colic, owners often have myths like, as you say, “passing manure means a horse is okay” and other bits of misinformation. In your experience, what’s the most effective way to counteract misconceptions without making the owner feel too judged or condescended to?

Dr. Mudge: The thing we probably encounter most often is the myth that horses never come back the same from colic surgery. Meaning, if you have a performance horse, you’re not going to have a performance horse at the end of it. But there are enough studies out there in a variety of disciplines that show the vast majority of horses—including in racing and sport—if they live through their colic episode, they have a very good chance of getting back to the same level of work that they were in before they got sick. I think that’s on us to get the message out more forcefully. We are all familiar with that literature, but then it’s about getting that to clients—providing brief in-the-moment education on the actual studies out there and the percentages for return to performance and work.

MEV: One of the points you made is the importance of having some of these conversations before there’s an emergency. Data show that owners generally don’t have an emergency treatment plan to fall back on, which means they don’t have explicit treatment goals to balance against their financial expectations. When is it appropriate to start having those conversations, and do you have any suggestions for helping them go smoothly?

Dr. Mudge: It’s a good question. There are many very well-managed training barns with trainers who educate clients on how much a critical case of colic or colic surgery might cost and who will either require or strongly advise them to get insurance with medical coverage so they are prepared for those expenses. MeV

Related listening: in The Cost of Care, an Equine Express Podcast episode, Dr. Dawn Hoover talks about the money conversation in equine emergencies and how to prepare owners for the cost of colic care.

FOR MORE INFORMATION
Burrell K, et al. UK horse owners and veterinary practitioners’ experiences of decision-making for critical cases of colic. Equine Vet J. 2024; 56(6):1216-1228.
https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.14124

Lightfoot K, et al. Use of human behaviour change models to investigate horse owner intention to adopt emergency colic recommendations. Equine Vet J. 2023; 56(1):147-158.
https://beva.onlinelibrary.wiley.com/doi/full/10.1111/evj.13955