Chokes, Nosebleeds and Birthday Parties

The Call

Charlotte didn’t sound particularly worried in her voicemail as she recounted the events of the evening. Calmly, she explained how this evening’s feedings went as usual. She disclosed that all three geldings were overdue for dentals, and were otherwise a picture of perfect health. Until right before she made this call.

Around 6 pm, Charlotte’s daughter alerted her that Nike was coughing, drooling and running frantically around the paddock. He refused to be caught, and uncharacteristically showed no interest in the treats that were offered to him. “Nike never says no to a treat, so something is wrong.”

Thinking of choke and colic, I emphasized the importance of not feeding him anything. No treats, hay, water or anything else in the mouth until I could examine him. Charlotte reiterated this sternly to her daughters before lowering her voice in the phone, “Just a heads up, my daughter is having her birthday today so there’s a dozen 9 year olds running around the place.”

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A Few Words on Choke

Most owners can list the classic signs of choke such as food coming out the nostrils, drooling, coughing and acting stressed. There is also a common misconception that “choke” is the same in horses and people.

In horses, choke refers to obstruction of the esophagus. Usually, feed becomes lodged right after it is swallowed, or right before the esophagus enters into the stomach. In people, choking occurs when something obstructs the trachea or “wind-pipe.” In other words, inhaling one’s food or drink. Horses choke because food became stuck on the way down, never reaching the stomach. Their signs of distress are not because they can’t breath, but because of the pain from the esophagus spasming around the obstruction. Most chokes resolve before I can get there. Those that haven’t, usually resolve after passing a tube down the esophagus and pushing the bolus into the stomach. In some rare cases (especially when the choke has been going on for days before being seen by a vet), there is too much damage to the esophagus for the horse to recover…and in those cases, owners usually elect for euthanasia.

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Nike

On my way down the driveway, I passed the backyard teaming with children hyped-up on sugar. I pulled into pasture surrounding the tidy little barn. A forelorn girl stood patiently with a grey pony at the end of the leadrope. Except for the drool, he appeared relatively normal. It appeared that Nike’s choke episode had likely resolved in the 30 minutes it took for me to arrive. However, unlike the usual feed-pasted nostrils, Nike’s nostrils were clean and dry.

“Do you mind if they watch? Some of them want to be vets.” Charlotte asked. A classroom-sized gathering of nine-year-olds stared intently from outside the stall. I didn’t mind, but paused for a second to provide a disclaimer for what I was about to do.

To rule out choke, a nasogastric tube is passed up the horse’s nostril. With finess and timing, the horse swallows the tube. The tube is then advanced down the esophagus until it either collids with the obstruction or enters the stomach. This is the same technique used to administer fluids and electrolytes in cases of colic. While a relatively safe procedure, there is one complication in particular that can lead the unsuspecting spectors traumatized. A nosebleed.

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Nosebleed Criteria

There is a small area in the nasal cavity that contains the most sensitive and fragile blood vessels in the horse. In the event that the tube touches, scrapes or bumps this area, all hemorrhagic hell can break lose. We are talking substantial bleeding from the nose. The nosebleed isn’t life threatening, but it can be difficult to convince people of this when they see the blood cascading out like a waterfall. If the blood pouring out their horse’s nostril doesn’t freak them out, the snorting of golf ball-sized blood clots across the stall and splatter across everyone within a 6 foot radius will.

I’ve tubed over 300 horses since graduating vet school. I have come to believe in the Nosebleed Criteria. Although nosebleeds are rare, you can guarantee one if the following criteria are met:

1. Grey or white colored horse
2. 3 or more people watching
3. Someone insists the horse won’t get a nosebleed

It just so happened that all three criteria had been met in the middle of this birthday party. So when I felt the tube nudge up against the ethymoids, I wasn’t the least bit surprised when blood came rushing out of the nostril. The steady stream of blood pooled in the shavings below Nike’s face. I dodged golf-ball sized clots with every snort Nike made.

No one could dodge the blood splatter.

I felt pressure on the tube give as I advanced the final 6 inches into the stomach. If Nike had choked, it had cerrtainly resolved by now. Unfortunatrely, his nosebleed had not resolved yet. When I gave the good news to Charlotte, she didn’t seem to hear me. Her eyes were fixated. Her expression was purely mortified. Not a single attendee of her daughter’s birthday party was spared. Evidence of the emergency and the nosebleed was all across the girls’ faces and outfits.

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20 minutes later, Nike’s nosebleed had slowed to a trickle. And I pulled out of the driveway leaving Charlotte to wonder how on earth she was going to explain this to the parents that would be arriving any minute.

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Colics for Days

The C-Word No One Wants to Hear

The list of causes for colic is endless. Sometimes I say it could be due to a cloud moving across the sky in a particular way…meaning it could be anything. The most common type of colic I see is gas (spasmodic) colic. These tend to resolve quickly, especially with the help Banamine (anti-inflammatory). Most of the time, to the frustration of many clients and equine effianados, the cause of a particular episode remains a mystery. While spasmodic colics can strike at any moment, I see more cases during the changes in seasons and during drastic weather/temperature fluctuations. Hottest days and coldest nights. Colic, simply defined, is abdominal pain. Pain associated with the gastrointestinal tract (the gut) can be due to gas (we all know what gas cramps feel like!), shifting of part of the tract into an abnormal position and therefore displaced, imbalance of natural GI bugs, diarrhea, impactions, twists in the gut or due to other diseases in the abdomen (tumors, infection). While 90% of the colics I see are simple gas colics…the past 2 weeks have really thrown a statistical curve ball.

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Impactions

Last year, I had 3 cases of colic that were due to impactions in the gut. Impactions can be complete (nothing is passing through the clogged pipe) or partial (mostly just liquid passing through, sometime small amount of manure). In the past 2 weeks, I have diagnosed 7 impactions. Usually, I see impactions in the fall. This year, the transition to spring definitely brought in the new. Impactions (basically something in the colon or small intestines that impedes flow, like poorly digested/broken down feed material) can occur anywhere in the GI tract, but particular parts of the horse’s anatomy predispose certain areas to become blocked. These are areas where a large diameter is going to a small diameter, or where the gut suddenly takes a hairpin turn. The most common location is called the pelvic flexure, and accounts for 5 of my 7 recent cases. I think one of the most astounding and stressful aspects of impactions is that they can go either way…as in, some can be managed fairly easily in the field, some may be fatal without surgical intervention. Sometimes, even surgical intervention is not enough.

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Working the Cases

Of my 7 cases, 3 were referred to our local hospital for surgical or intensive management. For the two cases that did not have a referral option (finances, owner choice etc), one made a full recovery over the course of a week. Unfortunately, the other one had to be euthanized within 12 the following 12 hours. All of the impactions were diagnosed by performing a rectal palpation. After identifying the impaction, I assessed how impressionable it is. Some impactions are so firm that I cannot make an impression or indent (feels like a baseball). Others, I can almost mold with my hand (like dough). The more impressionable the impaction, the more likely we will be able to resolve the issue in the field…which becomes a labor-intensive endeavor for vets and owners alike! After identifying where the impaction is, how impressionable it is and how large it is, the next assessment is comfort. If pain cannot be managed, referral becomes the next avenue. Otherwise, the mainstays of treatment in the field is tubing (passing tube from nostril to stomach) in order to administer fluids/laxatives/electrolytes…sometimes requiring 3-4 return farm visits a day for 2-3 days. Discomfort is managed with NSAIDs, and horses are held off feed until they are passing manure and recheck rectal palpation confirms that impaction is gone. In some cases, IV fluids are necessary.

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Additional Info for the Curious at Heart

Vetstream has a great client hand-out about colic that I have included below…for those who want to learn more or brush up on the colic basics.

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