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  Discussion on Infection of cartilage/vocal folds around windpipe
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Posted on Thursday, May 9, 2002 - 7:03 pm:

Dr. O.,
My horse has been in the hospital for two weeks with respiratory distress caused by a complete closure of the windpipe due to inflamation. Her windpipe was totally closed for a period of time and she had a tracheostomy. After heavy antibiotics and anti-inflamatories her vocal folds are almost back to normal and the trach was being removed today. She started all this with a cough that sounded very deep, no fever, no discharge, nothing that indicated an infection. It then went on, over a few weeks, to labored breathing, into full blown heaves and asthma type sounds as her windpipe was closing, which is when we rushed her to the hospital. She does not have COPD or allergies so we are wondering if you have heard or seen this before and what could have possibly caused it? Obviously we just do not want this happening again when we finally get her home and are not sure what really happened and why. Any answers or insight? She has been at the Littleton Large Animal Clinic in Littleton, CO, which is supposed to be a very top-notch place to be. Other details: The horse is an Arabian Mare, 22 years old, and she foundered severely three years ago, which is why she was not given steroids. We were told by most vets that if the horse has foundered before you do not give them steroids or they will founder again. Is this a myth or true? Another vet told us it could be a myth. She has Cushings disease so gets a dose of Cyproheptadine on her Equine Senior every morning and gets hay morning and evening. Thanks for your help!
Donna C.

Posted on Friday, May 10, 2002 - 6:18 am:

Hello Donna,
Without any clue as to the primary cause of the cough, I have to admit this is a bit of a stumper. What were the findings on the endoscopic exam of the upper air way?

I believe the most likely scenerio is upper air way inflammation/irritation caused by a virus or foreign body > cough that exacerbated the irritation > swelling of the tissues that either filled the upper air way or because of the large amount of negative pressure caused the upper air way to collapse.

It is uncertain that steroids actually predispose to founder and if it does it appears to be quite rare. Horses with Cushings given steroids in the dex-suppression test no increase incidence or exacerbation of preexisting founder was noted.

All things considered I think you should switch to pergolide which we think is more effective than cypro and may help protect your horse better against future infections.
DrO

Posted on Friday, May 10, 2002 - 10:56 pm:

Your scenario seems to be the most likely one, and one that everyone seems to be leaning toward. She has been scoped so many times lately I'm surprised she's still putting up with it. The first time we had her scoped for this her windpipe was not closed at all but the cartilage around it was inflamed, endemitris? he called it, but he had not seen anything quite like it before. On the night we took her into the hospital, a week later, I saw the scoping on a TV screen and by that time the windpipe was almost closed. The right side was much larger than the left even though both were inflamed and swollen. At that time they thought it might be a mass, or a tumor, but as the week went by and the swelling decreased they could tell it was not a tumor or mass at all, just inflamed, infected cartilage. The rest of her upper air way was in excellent shape and looked normal.

I saw her tonight and she looks and feels great. The next dilemma is how to let the tracheostomy hole heal, inside out or sew it up and leave an air pocket. As I was told, most horses with a tracheostomy do not live so they don't have as much experience with this. They have decided to let it heal from the inside out to avoid the air pocket, since she is no longer being used for show and is mostly retired at her age. We'll see what happens.

We did not know about pergolide until going through this ordeal. One of my next questions was going to be if we should switch so you beat me to it. Why do you think this will protect her better against infections and why is it more effective?

I appreciate your attention to this matter! Thanks.
Donna C.

Posted on Saturday, May 11, 2002 - 10:07 am:

It is not the tracheostomy that is the reason they do not live, it is the fact it is reserved for horses with severe disease. I would allow the trachosotmy hole heal open. The article on Cushings compares the various durgs available for this disease.
DrO

Posted on Monday, May 13, 2002 - 12:37 pm:

She's healing well and will be home this week. Thanks for your advice.
Donna C.
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