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There are other special circumstances affecting the gastrointestinal (GI) system that can result in impaction of the small or large colon. The formation of fecaliths (a dehydrating and hardening of feces to the extent that it becomes stone-like), enteroliths (a mineral concretion) and meconium-induced impaction (early accumulation of fetal feces in newborns). Horses that have a recent and significant decrease in exercise, usually from an injury, can develop large colon impactions. Twice-daily feedings of grain can result in a measurable increase (up to 15%) in fluids secreted into the bowl from the cardiovascular system which can result in hypotension (reduction of circulating blood volume). This causes the renin-angiotensin-aldosterone regulatory to be activated resulting in the reabsorption of more fluid from the GI tract. This results in a dehydration of the feces and can also result in an impaction.

Four types of displacement colic are described in horses. Displacement occurs because most of the bowel is not anchored to the body wall but suspended from the dorsal abdominal wall in the mesentery. It is therefore relatively easy for a portion to move out of its normal position. Left dorsal displacementoccurs when the pelvic flexure moves toward the space found between the spleen, the left kidney and the nephrosplenic ligament the structure that attaches the spleen and kidneys to the body wall. Right dorsal displacement occurs when the colon lodges between the cecum and the body wall. The pelvic flexure can move to a position closer to the diaphragm resulting in a volvulus, a 180-degree twist along the longitudinal axis. Torsion (a twist along the axis of the mesentery) can also occur. The mesentery is the diaphanous tissue supporting the bowel through which veins, arteries and nerves are carried from the dorsal abdominal wall to the intestine.

Any type of displacement can result in an occlusion of the blood supply (partial or complete) to the involved portion of the GI tract.

Left dorsal displacement will often resolve itself following conservative medical treatment. In recalcitrant cases your veterinarian may elect to anesthetize the horse, put it on its left side, then quickly roll it to its right side while repeatedly pushing on the abdomen. Obviously, this is not a maneuver to be attempted by only one person.

An intussusception of the bowel occurs when a section of intestine “telescopes” into an adjacent section. This most often occurs at the ileocecal junction. When this happens, surgical correction is the only effective treatment. This condition is most common in horses about one year old and is almost always associated with tapeworms, other parasites, small masses and foreign bodies or severe diarrhea.

Epiploic foramen entrapment occurs when a portion of the small intestine (rarely the colon) becomes lodged in the epiploic foramen, also known at the foramen of Winslow. This opening is the communication between the abdominal cavity and the omental bursa. Entrapment of a loop of bowel can also occur through a rent (tear) in the mesentery.

Proximal enteritis (inflammation of the gut lining) is usually the result of infectious organisms, particularly Salmonella and/orClostridium species. Fusarium(a large genus of filamentous fungi) can also be the cause of enteritis. Fusariuminfections occur most commonly in the Southeastern U.S. Overfeeding a high concentrate diet can also result in enteritis. Horses suffering from enteritis have an increased risk of laminitis and thrombophlebitis. Colitis (inflammation of the lining of the colon) is most often associated with infectious caused by Salmonella species, Clostridium difficileand/or Neorickettsia risticii. This last organism is the cause of Potomac Horse Fever. Ingestion of toxic agents such as arsenic or cantharidin, as well as several plant toxins can result in colitis as well.

Gastric ulceration is associated with confinement (lack of adequate exercise), infrequent feeding, a high concentrate diet, over-use of non-steroidal anti-inflammatory (NSAID) drugs, and from the stress associated with shipping and/or performing.

Tumors that can affect the GI tract and result in colic include lipomas (fatty tumors) that form on the mesentery and stretch the connective tissue into a stalk as it enlarges. The stalk can wrap around a section of bowel, usually the small intestine. Neoplastic growths of the GI tract can also include lymphosarcoma, leiomyomas, adenocarcinomas and squamous cell carcinomas. The last of these usually involves the stomach.

Ileus is characterized by no, or very low, movement of the intestines. Between ten and fifty percent of horses will develop ileus following abdominal surgery, with over 80% of those animals having been operated on for correction of a strangulating obstruction. Diagnosis is made using ultrasound when more than three loops of intestine lack peristaltic waves.

Hernias can result in incorporation of a loop of bowel and signs of colic. Standardbred and Tennessee Walker stallions are prone to a large inguinal ring and inguinal hernias. Umbilical and diaphragmatic hernias are rare but can occur in any breed of horses.

Non-bowel related colic include the ingestion of toxins, uterine tears and torsions, disease of the liver, ovaries, spleen, urinary system, or testicular torsion. Inflammatory conditions of the pleura (lining of the lungs and thorax), uterine contractions, laminitis and rhabdomyolysis can all present with signs resembling colic.

Parasitic infestations with Parascaris equorum(roundworms), Anoplocephala perfoliate(tapeworms), cyathostomes(Strongylus-type roundworms) and Strongylus vulgariscan all result in colic. The larvae of Strongylusspecies migrate out of the GI system and find their way into the arterial system. They are sometimes found in the cranial mesenteric artery where they can cause vasospasm as well as blockage. The regular use of modern anthelminthics has reduced the incidence of this problem.

Impaction colic is most commonly found in the pelvic flexure of the colon. It usually consists of poorly digested food lodged where the colon turns back on itself and narrows (the pelvic flexure). This condition is easily diagnoses via rectal examination, an indispensable part of the physical exam when called on a colic case. This condition is most commonly seen when the horse is confined in a small space, not receiving enough exercise and is being fed a large volume of concentrated feed, pellets and/or grain. It can also occur if the animal’s teeth need floating or if there are other dental issues preventing normal chewing (mastication). It can also occur if the animal cannot take in adequate water.

Colonic impaction will almost always respond to medical treatment. Sometimes high enemas will resolve the issue when mineral oil pumped into the stomach is not sufficient to move the blockage.

In the Southeastern U.S. coastal Bermuda hay is commonly available and used to feed horses. This type of hay can result in an impaction of the terminal ilium, the portion of the small intestine where it joins with the cecum (a large blind sac where fermentation aids digestion of roughage) and the entrance into the colon (large intestine). Obstruction of the ilium can also be the result of ascarids (intestinal parasites) after the horse has been treated for the infestation and is passing large numbers of the dead parasites. It is most commonly seen in young horses following their first deworming. When equine tapeworms are an issue treatment can result from a blockage of these dead or stunned parasites in the small intestine. When this condition occurs, the animal will usually exhibit intermittent moderate to severe abdominal pain. Distended loops of small intestine can sometimes be found on rectal exam. Ultrasound diagnosis may be necessary to identify this type of colic. Severe cases may result in gastric reflux. This usually responds to nasogastric intubation and the release of the accumulated gases from the stomach. Cases that are non-responsive to routine treatment may respond to warm soapy water or carboxymethylcellulose enemas providing the site of impaction can be located and reached rectally.

Less commonly encountered is hypertrophy of the longitudinal and/or circumferential smooth muscle layers of the small intestine (ilium or jejunum). The condition may be idiopathic (of unknown cause), or neuronal dysfunction usually associated with parasitic migration, particularly of the larval stage of ascarids. It may also be the result of increased tone of the ileocecal valve. This leads to hypertrophy of the smooth muscle of the ilium because it has to push ingesta through a smaller orifice. This diagnosis is usually made during surgery and can occur following the removal of a portion of intestine and the anastomosis (rejoining of the bowel) resulting in stricture.

Sand colic can occur when horses are pastured on sandy or heavily over-grazed pastures or fed on the ground. When I practiced in Arizona (back in the 1960’s) it was relatively common for backyard horses kept in small corrals to be fed on the ground on loose dirt. The ingested dirt or sand mostly accumulates in the pelvic flexure but may also be found in the right dorsal colon or in the cecum. The sand or dirt will irritate the mucosa (lining) and can result in diarrhea. Examination of the manure will often reveal the presence of sand and/or dirt. Accumulation and the resulting weight and abrasion on the mucosa can also result in a lack of colonic motility rather than hypermotility and diarrhea and in severe cases, rupture and peritonitis.

The diagnosis is the result of careful observation of the conditions in which the animal is kept and fed, abdominal auscultation for the sounds of hyper or hypo motility (too much or too little) and gas accumulation. Radiographs or ultrasound may be required to make the diagnosis. Medical treatment with laxatives is often effective especially with the addition of psylliumhusk. Psylliumis the common name for several members of the plant genus Plantago. Commonly marketed products of this include; Metamucil, Pinch, Fybogel, Kansyl and Luelax. Mineral oil treatment alone is less effective since it will usually float on the surface of the accumulation without penetrating. Psylliumbinds to the sand and helps to remove it. Animals with this condition may also suffer from rapid overgrowth of Salmonellaor other bacteria so antibiotic added to the treatment may be indicated. If signs of severe colic do not respond to medical treatment within a few hours surgery is indicated. Where grazing or feeding on the ground cannot be avoided prophylactic treatment feeding a pelleted psylliumproduct may be recommended by your veterinarian.

Impactions of the cecum are uncommon. They can occur when horses ingest bedding or as a result of post-operative or other pain therapy involving the use of opioids resulting in GI stasis and constipation. Because of its function as a fermentation vat gas and fluid accumulation is rapid and can lead to rupture within a day or two, if not corrected surgically. The condition can usually be diagnosed on rectal exam but rupture can occur early in the progression of the condition.

Gastric impactions are rare. It can occur following ingestion of foods that swell after eating, ingestion of bedding or poor-quality roughage, dental problems, ingestion of a foreign object or disease that interferes with normal gastric function. Ingestion of persimmons form a sticky gel in the stomach and feeding haylage can be problematic. When I practiced in Arizona ingestion or feeding of mesquite beans was a problem. Feeding sugar beet pulp can also be problematic. Diagnosis using gastroscopy or ultrasound may be necessary. Gastric impactions will often respond to treatment with water or other fluids via nasogastric intubation.

Colic is a general term used to signify abdominal pain. It is a sign of a problem, not a diagnosis. Colic can be the result of a number of gastrointestinal or abdominal problems. Most often the problem originates in the colon, the large intestine, of the horse. However, colic can also be the result of a tumor, peritonitis, a variety of plant poisons, uterine tears, torsion of the uterus, renal problems, and others.

Some of the causes of colic respond to medical treatment, others can become fatal without surgical intervention. In domestic horses, colic is the leading cause of premature death. An estimated 4-10% of the horse population will die from complications of colic. A much larger percentage will suffer from colic at some time during their lifetime.

Many different types or causes of abdominal pain in horses are commonly described. They include; gas and spasmodic colic, impaction colic, displacement in the form of torsion and volvulus colic, intussusception colic, entrapment colic, inflammatory colic, ulcerative disease colic, foal colic, herniation colic, colic the result of uterine tears or torsions, as well as other possibilities.

Perhaps the most important signs of colic that should result in a call to your veterinarian are; anorexia (won’t eat), looking around at the abdomen, depression, sometimes grunting with pain, kicking at the abdomen with a hind hoof, sinking or falling to the ground and moderate to violent rolling on the ground. Because of the manner in which the gastrointestinal tract is suspended in the equine abdomen, and its weight, a horse rolling in pain on the ground is susceptible to a tear or twisting of the mesentery (the tissue from which the intestinal tract is suspended within the abdomen) through which the intestine can twist on itself resulting in torsion (twisting of the bowel on itself longitudinally through a tear in the mesentery) or volvulus (when a loop of intestine twists around itself vertically with the mesentery that supports it resulting in bowel obstruction). When this happens the blood supply to the affected intestine is blocked or cut off entirely leading to death of the tissue, gangrene and death without successful surgical intervention.

Because of the danger of a twisted intestine from rolling the first instruction your veterinarian will provide when contacted is to keep the horse up and walking. You need to do everything possible to not allow the horse to go down and roll.

To treat uncomplicated colic your veterinarian will generally start treatment with analgesia (pain relief), if the animal is very anxious perhaps sedation, then the insertion of a nasogastric tube. The nasogastric tube will relieve any gas accumulation in the stomach and possibly from the first portion of the small intestine and will be used to pump in intestinal lubricants, laxatives and sometimes surfactants to prevent further gas accumulation. If the colic is severe and the animal doesn’t respond to the initial treatments within a reasonable amount of time it may be necessary to support the horse with intravenous fluids and possibly with nutritional support. In severe cases treatment for endotoxemia (toxins produced in the gut) may be necessary.

We generally recognize the following major types of colic; excessive e gas accumulation in the intestine (gas colic), simple obstruction (impaction colic), strangulation (volvulus or torsion colic’s), non-strangulation or infarction colic (blockage of a blood vessel to the gut), inflammation of the gastrointestinal tract (enteritis or colitis), colic from peritonitis (inflammation of the peritonium, the lining of the abdomen), and ulceration of the gastrointestinal lining or mucosa (ulcerative colic).  I will describe each of the various types of colic in future articles.

Joseph’s journal;

9 Tevet, 4816 (December, 1066)

The situation worsens. I was not harassed on the way to the palace this morning, a departure from what happened all this week. However, I could hear the shouting and screams of pain from the direction of the Jewish quarter of the city. My bodyguards hustled me along while glancing nervously over their shoulders. I was unable to determine if they, the guards, were more concerned for my safety or for the danger to themselves should I be attacked.

As soon as I was inside my offices in the palace the guards all disappeared. I sent one of my clerks to ask if I could have an audience with King Badis. The clerk returned to report that Badis was away, at one of his horse farms, and was not expected to return for several days. I sent three apprehensive clerks out to discern which, if any, generals were in the palace. They all returned to report none of the generals were expected at the palace today. I then ordered the commander of the palace guard to come to my office.

After about twenty minutes the man sauntered in, a man I know well. Chief of the Lambuni Zanhadja tribe. His name is Yaha ibn Umar al-Lambuni and I have crossed verbal swords with him on several occasions. I know he speaks ill of me to King Badis.

Salem al echem sir,” I greeted him.

Salem al echem Vizier. What can I do for you this morning?”

“I was wondering what the situation is in the Jewish quarter and what, if anything, you are doing to gain control of that situation. On my way in this morning it was obvious rioting was occurring and people were being injured.”

“I was not aware there is a situation in the Jewish quarter, Vizier. Do you have information about what is happening?”

“Nothing specific. I know that the mood of the population of Granada is increasingly anti-Jewish and this morning on the way to the palace I could clearly hear evidence of unrest and violence emanating from the Jewish quarter.”

“Really, I am not aware of this. I will send some people to investigate. However perhaps your people have brought this on themselves with their superior attitude and stiff-necked insistence on exercising power and control over my people.”

I did not respond, simply stared at him waiting.

“Oh, very well, I will look into this for you Vizier and see what can be done.”

He turned and left, but not in a great hurry. Forty minutes later I could hear a crowd approaching the building. Somehow, they had gained entrance into the Alcazaba. They were gathering outside our building. Soon the shouting began:

“Kill the Jew, kill all Jews.” Their chant was repeated over and over, gaining in strength and volume.

As I write this I’m sitting at my desk, my clerks are huddled on the floor of my office. Outside the office the sounds of a confrontation can be heard. A strong voice with a Nubian accent orders the crowd to disperse. There is angry shouting interrupted by the rhythmic thumping of swords against shields and the sound of marching leather-soled sandals on the pavement. There is a cacophony as objects, clubs and perhaps swords, strike shields and helmets then the scream of someone stabbed and shouting from the crowd as they retreat.

The door to the outer office opens and I heard the Nubian commander order the door shut and barricaded. Then a knocking at the closed door to my office. A loud voice with a Nubian accent shouted through the door.

“Vizier, it is Captain Appou ibn Naojil I served your father Ha Nagid. Do you remember me?”

“Yes Captain, I remember you very well. Please come in, I am very happy you have arrived.”

I went over, unlocked and opened the door. A tall ebony man stood in the doorway his glittering white teeth bursting from his mouth in a wide smile.

“I have only twelve men with me but we are resolute. We will defend. We do not forget all you and your father have done for us. The situation is not good. The mob outside is huge and it will be impossible for us to force our way through it to bring you to safety. Unfortunately, many of the Berber soldiers are joining the rioters. We will do the best we can.”

“I understand Captain, and I am extremely grateful for your support.”

Epilog:

It was 9, Tevet, 4816 (December, 1066). A mob, numbering hundreds, stormed the Alcazaba. Captain Appou ibn Naojil and his twelve Nubian infantrymen cut and slashed and fought valiantly. The mob pressed ever forward, stepping on and jumping over their wounded and slain comrades. They took advantage of the close quarters of Joseph’s outer office. So many infuriated men were jammed into the small space, the Nubians, despite their skill, training and discipline, were unable to maneuver and fight with efficiency. They were smothered by the overwhelming number of men who, crazed by the wounding and death of their comrades, kept pressing into the office, slipping on the blood and bodies of the slain but pressing, pressing forward until the Nubians were unconscious or dead on the floor, their blood mixing with the blood and severed body parts of the mob.

Joseph, following the instructions of Appou ibn Naojil, barricaded himself and his clerks into the inner office. Once the Nubians were neutralized and dispatched the mob broke in the door using a doorjamb ripped from the wall of the outer office as a battering ram. Joseph stood in front of his desk, his clerks cowering behind it. He held the sword given to him by Appou ibn Naojil in his right hand, a dull ceremonial knife in his left. Driven by fear, frustration and rage he stabbed and slashed and screamed to God to make him as strong as Sampson. He managed to inflict superficial wounds on three attackers but using clubs, and weapons taken from the fallen Nubians, they beat him to the floor and continued striking him until he was unconscious.

They drug him into the courtyard where two beams from the now destroyed outer office had been fashioned into a large cross. Two ends rested on the pavement stones and a third bean held the cross upright at a twenty-degree angle. From an unknown source spikes and a hammer were produced. They stripped Joseph naked, nailed him to the beams, then stabbed him with knives in the abdomen and chest leaving him to die slowly.

Before crucifying Joseph, they beat to death all of his clerks, none of whom were Jewish. While the murder of Joseph was taking place mobs, incited by rabid Imams and disenfranchised Arabs and Berbers, rampaged through the Jewish quarter of Granada, murdering an estimated four thousand Jews, destroying homes and shops and a synagogue. In front of the synagogue the mob ignited a bonfire of religious scrolls and books. No troops were ever dispatched to control the mobs or to deter them.

Joseph’s wife Sarah managed to flee the city with their son Azariah. Mother and son arrived safely at Lucena where they were taken in and protected by the Jewish community of that city. Azariah died of an unknown illness before his Bar Mitzvah.

There is no written record of King Badis’ or Prince Abdallah’s response to Joseph’s death. Badis continued to rule until his death in 1073. Abdallah inherited the kingdom and ruled from 1073-1090.

Joseph’s journal;

4 Kislev, 4816 (December, 1066)

The situation for Jews in Granada is deteriorating. Badis has assigned body guards for me, a unit of infantry who guard my home and another who accompany me back and forth to the palace. The increased level of anti-Jewish sentiment appears to have been incited by a poem published by Abu Ishak. He is determined and never ceases his efforts to castigate me and my people. A copy of his most recent effort was brought to me by one of my scribes this morning. It reads:

Do not consider it a breach of faith to kill them, the breach of faith would be to let them carry on.

They have violated our covenant with them, so how can you be held guilty against the violators?

How can they have any pact when we are obscure and they are prominent?

Now we are humble, beside them, as if we were wrong and they were right!

 This morning on my way to my offices a crowd of people followed us shouting for the soldiers to leave me so they could give the dirty Jew what he deserves. Fortunately for me the soldiers ignored the taunts and did their job. However, they were stoic, I could not determine if they harbored the same feelings of resentment or not.

Joseph’s journal;

20 Kislev, 4815 (December, 1064)

This month was historic for Granada. King Badis named Prince Abdallah as his successor. I am pleased and relieved. Abdallah continues to come to me with questions and to ask for guidance as he grooms himself to assume responsibility for the kingdom. I am vindicated.

I am not yet thirty years old. Unfortunately, I feel more and more like an old man. I sneeze often during the day and night, my nose runs almost constantly, I have fits of coughing. I have trouble sleeping because of this annoying illness and the result is I am easily distracted. The incidents of anti-Jewish rhetoric and physical attacks are increasing again and I am frustrated with all the attempts I make to lessen them.

My inability to effect change in the Jewish community is also frustrating. I do not have the influence over the community that my father enjoyed, no demanded. Most of the Jews in Granada who enjoy some measure of authority were given their positions and power by my father. They seem to feel little allegiance or loyalty to me. My proposed solution to lessen the anti-Jewish attacks by encouraging stricter adherence to the Torah, particularly with reference to the lending of money for gain, are met with derision. I have spent considerable effort trying to convince the money lenders to stop charging interest, or at least to charge only minimally. They ignore my logic despite the danger to themselves.

King Badis is still content to leave all the details of operating the government in my hands. The demands on my time, and the complicated decisions that must be made, weigh heavily on me. I often wonder how my father managed to do this job so successfully for so long. I feel inadequate and with my uncle now gone there is nobody with whom I can let off frustration by talking through the problems I am struggling with. I know I served that purpose for my father. My son Azeriah is too young to understand. My wife Sarah, bless her, is a woman, concerned only with problems women face. A few weeks ago I was desperate. I tried to unburden myself by sharing some of my concerns with her. I know she is intelligent and capable of analyzing. I sometimes talk with her about the various interpretations of the intellectuals about points raised in the Talmud. She learned much about these matters from her father, my teacher. She is not stupid but this time she just stared at me. Her face was shrouded with the inability to understand what it was I wanted or needed. We sat in silence with our knees touching. The lavender scent she uses in her hair assaulted my olfactory senses, causing me to sneeze repeatedly. I sniffed and fumbled for the piece of linen in my pocket that I use to wipe my nose.

“I don’t know what it is you want me to do or say Joseph. Your nose is running.”

Joseph’s journal;

12 Marchehvan 4814 (November, 1064)

 Today was a good day. I thank God for it. I spent the morning with the students in my Yeshiva. Our discussion of Talmud was up-lifting. Most of the students were actively involved and thinking, thinking in innovative and creative ways, about both the obvious as well as the hidden meanings of the words. My heart soared and my brain smiled.

Granada has been calm the last few months. The incidents of Jews being attacked on the streets has diminished. The army has been deployed only to answer occasional raids by Arab and Berber tribes with no hope or thought of conquest. We have been able to reduce the numbers of employed mercenaries, since the threat of war with our neighbors has lessened. The economy is in the process of recovering and tax revenues are up as a result. I cope on a daily basis with the details of keeping our complex government and economy operating smoothly but I have been fortunate in recruiting bright, intelligent assistants who are willing to take on responsibilities and reduce my workload.

Lately I meet with the king only once a week, unless there is something that specifically requires his approval or attention. He is content with this arrangement. I am told his drinking has slacked and although he partakes every day he is less often incapacitated.

Prince Abdallah has finished his apprenticeship in my offices, but still shows up on a regular basis to inhabit the library and pour over documents relating to our history. Lately he is requesting access to current documents dealing with ongoing negotiations and intrigues. Occasionally he will come to me with specific questions or background information. I do my best to give him what he asks for and more, when possible.

Abdallah is also spending considerable time honing his warrior and command skills, serving as an aid to General Abu ibn Mohammad. I invited the General to my home this week and over a leisurely dinner extracted the information that he was pleased with Abdallah’s progress and grasp of military tactics and strategy. General Abu was one of my father’s favorites. He understood and put into practice all my father taught him. He told me he feels he is honoring Ha Nagid by being frank and honest with me. He explained that he believed Abdallah should be named successor to Badis. Then cautioned me. His opinion on this must be limited to himself and now me. For obvious political reasons he could not afford to promote any one prince over another. I told him I fully understood. I have the same issues.

General Abu did share that on the last excursion he made to put down a minor insurrection, in a small town near Jaen, Abdallah conducted himself with considerable bravery and skill. Abu told me Abdallah clearly won the admiration and loyalty of the troops he was commanding.

Whenever the opportunity presents I mention Abdallah’s progress and aptitude to King Badis. He takes the information in, but does not indicate interest or pleasure. I never press the issue.

Abu Ishak of Elvira has become more and more a pest. Badis refuses to grant him an audience after asking for my frank opinion of the man. When I told him he nodded. Abu Ishak has taken up what seems to be permanent residence in the city. He is being supported by several wealthy Arabs, as an intellectual and teacher. He also serves as tutor to the children of several of the Berber tribal chiefs who have never been thrilled with the fact that my father, and now I, have greater power than they do. Abu Ishak speaks out against me whenever the opportunity arises. Based on the reports of these activities that I receive I must admit he is eloquent as well as insidious.