Category Archives: Medical

Preventing Sand Colic ~? So important.

My vets have told me that the best way to prevent sand colic is to not let the sand get into the gut in the first place.

Easier said than done…

What happens if you have sandy soil and no matter preventative measures you take, they still ingest the sand?…


Just this week, two people I know have had sand colic experiences.  One fatal, one not.  Very difficult.  Sad.

For me, I had never had sand colic in my horses – ever – until Slick had an episode 2 years ago.  I’m sure his elder age and poor teeth didn’t help the situation… (they cannot digest fibers as well) but I have to say that feeding him wet, soaked beep pulp pellets, psyllium powder, tapioca pearls, chia seed and fiber – immediately helped.  Of course, I gave it all to him at once, so I’m not sure what worked and what didn’t, but the bottom line was the issue cleared up.

My Slick. I miss him.

My Slick. I miss him.  He suffered from sand ingestion, but I was able to fix it. thank horsegods.


Most vets will tell you to do whatever you can to keep the feed off of the sandy soil.  You can do this by:

–Putting down mats and sweeping them daily.

For me, I am on a hill so the mats slide all over the place.  One reader told me to border them with a 4×4 wood frame.  Good idea.

–On top of those mats, put bins and feed your hay in these bins.  Hopefully, the bins will be big and strong enough so that the horses cannot simply push the feed out and eat on the ground anyway.

For me, I have found that farmer crop bins (wine, grape, avocado) work very well!

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–Attach your feeders on the opposite side of the fence, so the horses cannot scrounge on the ground for fallen food.

For me, this cannot work because we have hot wire.  However, if you have constructed your fence in such a way that they can reach over to feed on the other side, this could work.  However, you’d probably have a lot of wasted or dirty food on the opposite side of the fence.

–Feed actual hay or forage and not pellets.  For senior horses, feed a high fiber, highly digestible feed that works its way through the gut successfully.


(If you have any other remedies that you feel work, please email me!)

Now this part is interesting…. I have had experience with Slick.  I was able to cure him… it was ongoing maintenance  from the initial attack, but he did have a normal gut after the first episode.

If the horse actually colics from sand ingestion, this is bad… his intestines could actually flip due to the weight of the sand.  Bad.  This requires surgery.

This is what my vets have told me to do over the years if I suspected sand colic:

–Call the vet.

–Feed lots of fiber – like very wet, soaked beet pulp pellets

–Add psyllium powder and tapioca pearls to stick to the sand and pull it out of the gut

–Continue feeding roughage, grass hay or forage (add Senior Feed for older horses to help add digestible roughage).

–Administer a colic remedy like “Say Whoa! to colic” or “Equine Colic Remedy” to keep the gut functioning while the roughage pulls out the sand (You can get a $10 discount if you purchase from Say Whoa! and use this code:  HMfund )

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Tapioca pearls. They are sticky in the gut. They attach to sand.

IT EFFECTS OLDER HORSES MORE…but it effects all horses.

Sand Colic does tend to effect older horses more – because they are not as able to use roughage to help clear the gut due to age and teeth.   Senior feeds that are easily digestible and contain high fiber are best to add to all of the ‘cures’ listed above.


Original article linked here.

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Click to go to the original article

  The answer is probably not what you think. . . . .

One of the most common questions I am asked as an equine vet is “how can I prevent sand build-up in my horse’s intestine?” In the aptly-named sandhills of North Carolina (Southern Pines, Aberdeen, Pinehurst and surrounding areas), we are plagued with sandy soil that can easily make its way into our horses’ GI tracts. Horses pick up the sand when eating hay or spilled grain from the ground. The sand can then accumulate in the intestines, causing colic, weight loss, diarrhea or other metabolic problems and electrolyte derangements.

sand filling the large intestine of a horse

sand filling the large intestine of a horse

Horse owners are rightfully concerned about diagnosing and preventing sand-related problems in their horses. I meet people who use wide varieties of “sand preventing” products for their horses, including psyllium powder (Metamucil), psyllium pellets (Sand Clear, Equi-Aid), beet pulp, wheat bran, rice bran, flax seed, mineral oil, chia seeds, and probably some I haven’t even heard of yet! While some people are absolutely convinced of a particular product’s effectiveness, their conviction is often based on the fact that they haven’t had a problem with sand while using a particular product.  As a veterinarian (and a scientist), I am always interested in what science can prove. In my opinion, the conclusions of well-designed scientific studies with large numbers of horses far outweigh the experience of one person who simply hasn’t had a problem. . . . yet.

This is probably NOT how you want to diagnose sand accumulation in your horse!

This is probably NOT how you want to diagnose sand accumulation in your horse!

The first question to ask about sand build-up in horses is: “how can we diagnose it?” There are six ways to diagnose sand in a living horse:

1.       exploratory surgery- this is obviously not a good option!

2.       abdominal radiography (X-ray): This is the most accurate way to determine whether a horse has sand present in the intestine, but requires specialized, high-powered x-ray machines that are usually only available at university teaching hospitals.

3.       abdominal ultrasound- using ultrasound to diagnose sand can be accurate, but relies on the veterinarian to be VERY skilled in abdominal ultrasound. The sand is not visible on the ultrasound, so the veterinarian must determine the location of the large colon and its motility rate as compared to normal horses.

4.       Rectal palpation (yep, the old arm-up-the-butt trick!)- usually only VERY severe sand impactions/ accumulations can be felt on rectal exams. Also, rectal palpation is not part of a standard exam, and will usually only be performed after a horse shows signs of colic.

5.       fecal sedimentation (float)- this procedure involves mixing fresh manure with water in a bucket or a long glove to determine how much sand settles out. There’s a BIG PROBLEM with this though- if a horse has sand in its manure, does this mean the horse has sand accumulated in its intestine, or does this mean that the horse is consuming sand, but is efficiently eliminating it in the manure? To my knowledge, no one has ever shown that fecal sand correlates in any way to sand accumulation in the intestine.

6.       listening for sand in the abdomen with a stethoscope- this method has been proven to be 75-100% accurate, and requires only a stethoscope and few minutes to listen to the horse’s belly. The “whooshing” sounds of sand can be easily appreciated, even by the horse’s owner! I routinely listen for sand in every horse twice yearly during vaccine appointments. In my opinion, this is the only practical and accurate method to determine sand accumulation.

diagnosing sand accumulation: listening to the abdomen                                 "floating" the feces                                    x-ray of sand in the intestines  

diagnosing sand accumulation: listening to the abdomen                                 “floating” the feces                                    x-ray of sand in the intestines


So if your horse is diagnosed with sand, or even suspected to have a GI problem associated with sand, what do we do about it? Many different methods of sand treatment/ prevention have been studied since the mid-nineties. In most studies, horses or ponies were administered sand via stomach tube, sandy feed mash or during a surgical procedure, and then different treatments were given to try to eliminate that sand. Here are the treatments, and the outcomes of the studies:

1.       psyllium (pelleted or powder)- There have been several studies over the years designed to evaluate the ability of psyllium products to clear sand. Most studies used ½ to ONE WHOLE POUND of psyllium per horse per day (that’s a lot)! Interestingly, even using that large amount, noneof these studies proved any real effect when compared to the control horses (horses who had the same amount sand inside them, but received no psyllium). In one study, the UNTREATED horses actually eliminated more sand than the treated horses!

(note: one study of a very expensive, brand-name psyllium product did show a positive result in a very small trial of eight horses. To my knowledge, that result has never been duplicated in a larger study. My personal experience with the product has been dissapointing)

there are hundreds of psyllium products available. . . . too bad they don't work!

there are hundreds of psyllium products available. . . . too bad they don’t work!

I think its also worth mentioning the many dosing schedules for psyllium products (Metamucil, Sand-Clear, etc). Horse owners are often told to administer these products for one week per month, every-other-week, twice weekly, every day, etc. The amounts also vary, but usually range from one ounce to one cup. These amounts are a far cry from the one pound used in scientific studies (and the one pound failed!), and these schedules are completely made-up!

2.       Mineral oil- a few studies looked at the ability of mineral oil (a laxative) to eliminate sand. It was not effective.

3.       Epsom salt- Epsom salt (magnesium sulfate) is another commonly-used laxative for horses. One study evaluated the effect of this product (given by nasogastric tube) on sand accumulation- it didn’t work very well by itself.

4.       Combination of psyllium and Epsom salt: one study showed good success in eliminating sand by using 1lb of Epsom salt PLUS 1lb of psyllium, given by a stomach tube, daily for seven days. That’s nice, but is definitely impractical and expensive unless your horse is currently sick. I use this method on horses that are already showing signs of colic due to sand.

5.       Wheat bran- only one study evaluated wheat bran’s ability to eliminate sand. It was not beneficial, and this was another study where the *untreated* horses actually eliminated more sand!

6.       All other products- flax, chia, and other products have never been studied to determine their ability to eliminate sand from the horse’s intestines. Based on all the research of other products, I think it’s highly unlikely that there would be much benefit from these products. Remember, supplements are not regulated by any agency, so they can make any claim they want, from preventing sand to preventing death- but just because they say it, does not make it true!

Chia in particular has been touted on certain internet sites as reliably “sand clearing.” It is important to note that the so-called scientific studies mentioned on these sites are NOT published in any scientific journal, and are only available on the websites of the companies that want to sell you chia!

OK, so now that I’ve bashed all the commonly-recommended sand-clearing products for horses, its time to tell you what really DOES work! Are you ready?

It’s hay.

That’s it.

Studies (and my personal experience too) have overwhelmingly demonstrated that providing 1.5% to 2.5% percent of body weight per day (15 – 25 lbs for a 1000lb horse) in hay (or forage) will produce the best results when trying to eliminate sand from a horse’s intestine. It is important to note that while no one has studied the effect of an equal amount of grass (instead of hay), it would presumably have the same results. Research environments usually don’t have sufficient space to study horses on large, grassy fields, so we are left to observation in this case. Horses on large, grassy fields usually don’t accumulate as much sand, and moving a “sandy” horse to such a pasture may help them eliminate sand.

THIS is how you treat sand accumulation in horses!  

THIS is how you treat sand accumulation in horses!

There is one important exception in my opinion though- the older horse. Many old horses (20-plus years old) are provided plenty of hay or grass, but are unable to utilize it properly due to bad teeth, or other unknown digestive difficulty. These horses are the ones in which I most commonly hear sand during their twice-yearly exams. When I do hear sand in a horse this age that is being provided an adequate amount of hay, I usually recommend that the horse be changed to a commercial Senior grain (Purina, Triple Crown or Nutrena work well), and fed about 6lbs twice daily. These grains are high in fiber and very digestible. Most horses will be free of sand within a few weeks!

The only other important factor in preventing sand accumulation in horses is preventing them from consuming it in the first place! The biggest culprit for sand ingestion is grain dropped onto sandy soil (common in horses fed in the paddock or pasture). The horses then “scrounge” for the remaining grain, and take in the sand. Stopping this process only requires a little creativity. Some excellent solutions include the use of stall mats under feeders (they will need to be swept free of sand a few times per week), hanging feeders on the “wrong” side of the fence, or constantly moving ground feeders to a new spot in the pasture where the grass is thicker (this will probably get old after a while).

So it’s simple: use creativity to stop your horse from consuming sand in the first place, and save your money on the commercial sand prevention products. . . . you can put that money toward hay or high-fiber grain when necessary!

Cleaning up dropped grain is the most common way that horses ingest sand.  

Cleaning up dropped grain is the most common way that horses ingest sand.

Using mats or plywood under a feeder can prevent a horse from dropping grain into sandy soil.

Using mats or plywood under a feeder can prevent a horse from dropping grain into sandy soil.

Placing a feeder on the "wrong" side of the fence can keep fallen feed out of the horse's reach

Placing a feeder on the “wrong” side of the fence can keep fallen feed out of the horse’s reach

If you have questions about this post, or would like a list of references, please email Dr. Kivett at



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Clinical Crisis: Why Are So Many Veterinarians Committing Suicide?

I read this article today and it really made me think… how are my veterinarians – emotionally?  I thought about it and they are all over worked and exhausted and … just not happy people.  Hmmmm.  I guess I wrote it off to overwork, being on ‘call’ or foaling season… but the mood never changes.  It is always something.

Reading this article helped me put it in perspective.

The part that hit me the hardest was that vets are trained that euthanasia is a kinder way to go than suffering.  So, if that is your mindset, why not apply it to yourself.  Wow.  A slippery slope, which also begs other questions…

I think it would be good for all of us customers to be aware.

Original article posted here.

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Click image to go to the original article

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“I thought 2 ccs would be swift. I planned to hit my vein. I am often told I have great veins,” she says. “I remember it was freezing cold. Ridiculously cold. But I was going outside because I didn’t want to make a mess in my mother’s house.”

Earlier in the day Jones had spent hours crafting suicide notes. There was one for her mother, another for her sister. There was one for her husband and one for her young daughter. She had double checked her life insurance policy to make sure it would still pay her family if she died by suicide, because she didn’t want to leave them responsible for her student loans.

“I was very pleased with myself for being so proactive. I figured it was the least I could do, but that’s because in my mind, I was doing this to make my family’s lives easier,” she says.

That New Year’s Eve in 2010 was a culmination of a professionally and personally trying year for the 34-year-old Jones. After months of job related stress and unhappiness, the equine reproductive veterinarian had just been fired from a workplace she describes as toxic. She had also been dealing with serious health problems—an unexplained neurologic issue doctors suspected was Multiple Sclerosis.

“I was told if it was multiple sclerosis it was probably the primary progressive type that is pretty aggressive and I would be in a wheelchair within 10 years,” she says.

“I felt like if I was physically disabled I’d be a burden, and then there was the thought of not being able to practice veterinary medicine. Even though practicing caused me so much stress and unhappiness at that time, when I thought of not being able to do it, I couldn’t think of my life without it,” she says.

Jones sat with the vial of horse tranquilizer for several hours in the freezing cold. She sat there until the sun began to peek over the horizon, then walked back inside. “I was hypothermic,” she says.

“I came inside and sat on the couch for a while, and went to bed around 6 a.m. I woke up a few hours later and went about New Year’s Day like everything was fine.”

“I don’t know why I didn’t do it. I’m just grateful I didn’t.”


A familiar story

Jones’ story is not an unfamiliar one in the veterinary profession. In the last decade there has been an explosion of research into mental health and suicide within veterinary medicine. A 2008 U.K. study first raised alarm bells when it found veterinarians commit suicide at a rate of four times that of the general population and twice the rate of medical doctors and dentists.

Numerous high-profile suicides have shaken the veterinary community in the last few years. In 2014, Dog training pioneer Dr. Sophia Yin took her own life, as did New York City veterinarian Dr. Shirley Koshi, bringing the topics of job stress and mental health to the forefront of professional conferences.

“That’s what we’re taught—when the pain is too bad, euthanasia is the one thing left we can do.”

One of the first mental health surveys of U.S. veterinarians, conducted in 2014 by Dr. Randall J. Nett and Dr. Tracy Witte, found one in six veterinarians may have considered suicide, and one in 10 have experienced serious psychological distress.

Witte, a suicide researcher at Auburn University, first became interested in the topic in 2010 when she saw the alarming U.K. study showing the abnormally high suicide rate among veterinarians.

“I thought that was interesting, but as I dove into the literature, I noticed that there was a lot of gaps in knowledge,” she says.

She is now working to fill those gaps and also looking at the job stress levels of other workers employed in the veterinary field, including vet techs and vet assistants, who she says show similar job stress levels to veterinarians. The research is twofold: identify why veterinarians are at risk for suicide, and identify what interventions will help reduce the suicide rate.

Based on the data Witte has collected, work overload is one of the most commonly cited causes of psychological distress in veterinarians. Dr. David Bartram, author of the 2008 U.K. study, says his findings are similar. He cites work-life conflict, conflict with animal owners and staff management responsibilities as the major stressors veterinarians face.

“We’ve got a lot of vets saying they’re not interested in managing staff,” says Bartram. “They want to be vets but they are temperamentally ill-suited or don’t have the training or resources required [to manage an office].”

“People go to vet school not because they want to be a small business owner and entrepreneur, but because they want to work with animals, and managing a small business causes stress,” added Witte.

For Jones, her identity was wrapped up in being a veterinarian, so when work conflict arose it was that much harder psychologically to deal with. During her vet school years she had even resigned herself to the fact she might never have a partner or family.

“I wasn’t going to have kids or a family. Just work-work-work. I thought I was content with that direction, I was ok with doing nothing but working, but then I ended up meeting my husband and realizing that might not be the best course in life and there were other things than just work.”

“Sometimes my husband has said to me, ‘I’m jealous because I have a job, but you have a career, it’s part of you,’ and I say to him, ‘that’s not always a good thing.’”

The other contributor to suicide and psychological distress, according to research, is the exposure to euthanasia and access to drugs used in euthanasia, coupled with the knowledge of how to use them effectively.

“As veterinarians, we do view death as the end of pain,” agrees Jones. “That’s what we’re taught—when the pain is too bad, euthanasia is the one thing left we can do. So when we’re in that much psychological pain we’re going to look at it that way.”


What is being done

According to Dr. Bartram, professional veterinary bodies throughout the English speaking world are taking notice and beginning to talk about these issues.

“It still has a tremendously long way to go, but it has changed considerably. There’s hardly a veterinary conference in the English speaking world when wellness isn’t on the program somewhere. That’s a seachange,” he says.

Indeed, the stigma around talking about mental health and suicide and reaching out for help is lifting. In 2015, two veterinary students—Taylor Gaines and Amanda Carlson—started the blog Beasts Unburdened, offering support and tips for handling stress and looking after mental health. They even have a space on the site where students can share their experiences anonymously.

Gaines was moved to create the blog following the suicide of a second year Ohio State veterinary student. He wanted a place where students and veterinarians could share their experiences anonymously and lift some of the stigma and isolation associated with mental health issues and suicide.

Gaines says that veterinarians need to talk about these issues in “a real way.”

“Not just a vague ‘sometimes people feel sad’, but people need to step up and say ‘I have felt like I wanted to/have tried to kill myself. I am still here, here is why,’” he says.

“I can’t say I know exactly how it will get better, why it gets better, but it does and I’m incredibly grateful I didn’t do it.”

Last year, they informally surveyed veterinary students at the University of Wisconsin and Virginia-Maryland College about sleep and study habits. The average respondent reported sleeping 6.74 hours per night and studying 4.1 hours per day, not including class time. Participants reported on average working 37% more than they thought was reasonable.

At the veterinary school level Carlson says some schools have organized retreats for faculty to attend that focus on promoting wellness within the profession. “The momentum for these projects continues to pick up steam, but a lot of dismantling of the previously established stigma need time to be effective.”

For practicing vets, Witte says that state veterinary bodies are implementing wellness programs with support and hotlines veterinarians experiencing psychological distress can contact. Alabama, where Witte lives, has one of the oldest of such programs in the country. And there is a similar program in the U.K. with a 24 hour hotline that veterinarians can access if they are feeling psychological distress.

Gaines says that clients need to be aware of the stress and struggles associated with the veterinary profession as well. “I can tell you, vets are not in this for the money,” he says. “Ask them how their day is going. Tell them thank you and you appreciate them and what they do for you and your animals.”

For Dr. Bartram, something as simple as ensuring an hour lunch break in the work day can reap myriad rewards in the psychological health of veterinarians.

“Actually book a lunch hour and force everyone to take their lunch and sit together for half an hour. Something where you can chat to your colleagues informally can produce a great return on investment in terms of mental health,” he says.


Moving on

Six years after coming so close to ending her life, Jones is in a much better place. Her neurologic issues have cleared up and she has found new employment at a clinic in New York State with the “greatest group of people.”

A healthier and happier Dr. Jones.

To keep herself mentally healthy, Jones periodically checks in with a counsellor and now ensures she sets aside time each week—no matter what her workload—to spend time with her husband and daughter. Learning to navigate that work life balance wasn’t something she was taught in veterinary school, it was something she had to stumble across herself.

It was just two weeks after her brush with suicide that she was offered her new job.

“The biggest thing I would want any person in that same position I was in to remember is that it does get better. I can’t say I know exactly how it will get better, why it gets better, but it does and I’m incredibly grateful I didn’t do it.”


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