|
|
Discussion on Recurrent choke in 10 mo old filly
|
| Author |
Message |
Member:
chrism
|
Posted on Monday, Mar 26, 2007 - 4:47 pm:
This little gal has now had 3 choke episodes in recent weeks - two within 8 days. She is on pasture, hay and has been switched to very small amounts of well watered sweat feed (from pellets, prior to first episode).
A few months ago, she was treated for a umbilical hernia and was scoped then, all seemed normal.
As a foal, she would sometimes get hiccups after nursing and made gurgling type noises other times.
She is a sweet as can be, but her friends (of which I am one) are very concerned about her health.
Any insights/thoughts from anyone beyond Dr. O's excellent article on choke? Could something else be causing choke symptoms - i.e. poisonous plant, congenital problem that is being exacerbated as she grows up, etc.?
She is being scheduled for another scope exam by a specialist.
Thanks for your thoughts, experiences.
|
Member:
mrose
|
Posted on Monday, Mar 26, 2007 - 10:34 pm:
Is she by herself when she eats or with bigger or more aggressive horses? The only time I had a horse choke it was gulping it's food down as fast as possible to keep another horse from getting it.
How about her teeth? Are they coming in o.k.?
The only other thing I can think of is maybe like you mentioned a congenital problem with her bite, or her palette or throat. Poor thing. Let us know what the scope shows.
|
Moderator:
DrO
|
Posted on Tuesday, Mar 27, 2007 - 8:24 am:
Hello Chris,
Two things occur to me. With the history of unusual noises and a previously normal endoscopic exam I wonder about a functional (nerve or muscle) disorder of the esophagus. Also possible would be accidental damage from the initial scoping. Let us know what they find when they re-scope.
DrO
|
Member:
chrism
|
Posted on Tuesday, Mar 27, 2007 - 4:03 pm:
Hi Sara, when she was allowed to eat pellets, then grain, she ate very casually - took a bite and walked around. There is no competition from other horses as they are fed separately.
Dr. O and Sara, when I know more after the scope, I will post.
Thanks,
Chris
|
Moderator:
DrO
|
Posted on Tuesday, Mar 27, 2007 - 4:40 pm:
Chris, was a thorough neurological exam looking for other neurological deficits, particularly cranial nerve function, performed? If not it should be part of the exam.
DrO
|
Member:
chrism
|
Posted on Tuesday, Mar 27, 2007 - 5:01 pm:
Dr. O,
I don't think anything has been done other than conventional therapy for helping to resolve each choke episode.
I will definitely pass your suggestions on.
I have handled the filly off and on and she seems normal in every way - playful, responsive to touch, curious, athletic, etc.
Thanks.
Chris
|
Member:
boomer
|
Posted on Tuesday, Mar 27, 2007 - 11:34 pm:
Hi Chris, please have someone test her gutteral pouch and the nerves surrounding it..I'm sorry, I may have spelled it wrong, but please have them check this out. Wishing you all the luck and blessings, Trish
|
Member:
chrism
|
Posted on Tuesday, Apr 3, 2007 - 6:23 pm:
Just to update.
The filly was checked over carefully at the vet's hospital and scoped very thoroughly. Since the case was unusual, all the vets in the practice were there.
I was told by the owner that nothing looks at all unusual other than a very slight flexible stricture near the stomach end. The 3 or 4 vets in attendance consider the case to be very unusual - i.e. no one has ever seen anything like it.
So, management plan is to not feed pellets at all, offer a bit of sweet feed (think handful) for meds and give her plenty of assorted hay and pasture.
My younger mare is the night time turnout baby sitter. 
|
Moderator:
DrO
|
Posted on Wednesday, Apr 4, 2007 - 8:55 am:
Do they feel the stricture clinically significant, after all there is supposed to be a stricture at the esophageal opening to the stomach. When the foal obstructed before normally you can estimate it's position by how far your ng tube goes down: did they feed the obstruction to be at the end of the esophagus?
I wonder if function studies with radiopaque (usually barium) substances has been contemplated. The foal swallows the substance which is then followed with a fluoroscope to see if there are functional problem areas.
DrO
|
Member:
chrism
|
Posted on Wednesday, Apr 4, 2007 - 5:12 pm:
Dr. O,
It is my understanding the stricture they noticed was not as expected, but nearly missed due to its relative insignificance. During the choke episodes, the obstruction settled at the base of the neck and there was a visible swelling there. I don't know how that relates to the ng tube position since I didn't ask about it. I do know they had a very hard time getting the ng tube inserted.
I did not hear any comments re radiopaque. They weren't at the vet school, so that may have limited that as an option.
I was promised a "full report" to send to you. Assuming I get it, I will be more than happy to send.
|
Member:
chrism
|
Posted on Sunday, Apr 8, 2007 - 10:19 pm:
Dr. O,
This is the text from the report:
Glandular region: WNL.
Esophagus: There is an approximately 20 cm length of the esophagus that does not fully expand. It does not appear to be a stricture. The mucosa is intact and appears healthy. The impression is that the motility is decreased. This area is located approximately 2.2 m from the nares and extends to 2.4 m.
Comment: Grade I EGUS and Esophageal motility disorder.
Recheck esophagus in 6 months.
|
Moderator:
DrO
|
Posted on Monday, Apr 9, 2007 - 10:01 am:
Functional obstruction of the esophagus appears to a rarely diagnosed entity in horses and I cannot find any case studies. Beside contrast studies, electromyograms, and ultrasounds might yield useful information from a diagnosis standpoint but the location of the problem makes these procedures problematic and if appropriate endoscopic tools not available may require thoracic surgery.
Without a cause to the functional abnormality it is hard to guess a therapy or prognosis. Treat the EGUS. General good nutrition including an evaluation of selenium and vitamin E status and if marginal supplement 1000 IU vitamin E daily. All things considered I might give the vitamin E anyway. Such a focal problem is unlikely to be a toxin but heavy metals, ionophores (lasalocid), and botulism cause neuromuscular disease. Lastly if trauma or non-infectious inflammation is on the rule out list corticosteroids would be in order.
Checking the human literature I did find this interesting proposition that might apply if the problem is decrease motility as opposed to a hypertonic muscular state:
J Clin Gastroenterol. 2007 Apr;41(4):366-70.
Bethanechol improves smooth muscle function in patients with severe ineffective esophageal motility.
Agrawal A, Hill A, Tutuian R, Mainie I, Castell DO.
Digestive Diseases Center, Medical University of South Carolina, Charleston, SC.
BACKGROUND: There is no therapeutic intervention that reliably restores smooth muscle contractility for patients with ineffective esophageal motility (IEM). Bethanechol, a direct-acting muscarinic receptor agonist, has been shown in healthy volunteers to produce a significant increase in peristaltic amplitude in the distal esophagus. AIM: To identify whether bethanechol improves smooth muscle contractility and bolus transit in patients with IEM. METHODS: Seven patients diagnosed with severe IEM documented by combined multichannel intraluminal impedance and esophageal manometry were asked to participate. IEM was defined by using the new proposed criteria of greater than or equal to 50% saline swallows with contraction amplitude <30 mm Hg either 5 and/or 10 cm above the lower esophageal sphincter (LES). In the supine position, the patients were given 10 swallows of 5 mL of normal saline then 10 swallows of viscous solution, each 20 to 30 seconds apart. Patients were then given 50 mg oral bethanechol. After 20 and 40 minutes, 5 swallows of saline and viscous solution were repeated. Studies were then analyzed by an investigator blinded to the relationship of bethanechol administration to the swallows. The analysis included measurement of distal esophageal amplitude (DEA) or the mean amplitude at 5 and 10 cm above the LES. RESULTS: The use of bethanechol significantly increased (P<0.05) the esophageal contraction pressures at 5 and 10 cm above the LES. The DEA increased (P<0.05) for liquid and viscous, 20 minutes after its administration. Forty minutes after bethanechol administration, DEA and also individual pressures at 5 and 10 cm above the LES were still increased (P<0.05) for liquid, but only the DEA increased (P<0.05) with viscous solution. There was also a significant increase in complete bolus transit for saline swallows, both 20 and 40 minutes (P=0.03 and 0.01, respectively) after bethanechol. CONCLUSIONS: Oral bethanechol significantly improves contraction pressures and bolus transit in the smooth muscle portion of the esophagus in patients with severe IEM.
DrO
|
Member:
chrism
|
Posted on Monday, Apr 9, 2007 - 5:33 pm:
Thanks Dr. O. I will pass your insights on.
|
Member:
chrism
|
Posted on Tuesday, Apr 10, 2007 - 2:14 pm:
The filly came in last night with another choke episode after only being on grass during the day. 
I'm told she looked like a pigeon. However, she worked herself through it without intervention.
Primary vet is consulting.
In the mean time, I wondered if in the case that this is muscular/neurological issue whether massage therapy would be helpful (since I am cert'd). Any thoughts? Or guidance about what areas to concentrate on which might stimulate muscles/nerves? Just a wild idea. I went ahead and did her neck, withers, chest areas in the absence of any focal areas, which she loved.
Thanks.
|
Member:
mrose
|
Posted on Tuesday, Apr 10, 2007 - 4:53 pm:
I would think it would help; if nothing else it would help relax her muscles which seems like it would help. I know with people who sometimes "choke" and can't swallow all of a sudden, if they totally relax, the food will usually just slide down. I realize horses aren't people, but still it seems to me like it might help.
|
Moderator:
DrO
|
Posted on Wednesday, Apr 11, 2007 - 7:30 am:
Christine, using the results of the endoscope it sounds like the effected areas are out of reach of massage. You should note that while choked, massage of the distended area of the esophagus itself is contraindicated as it may damage the esophageal lining.
DrO
|
Member:
eoeo
|
Posted on Wednesday, Apr 11, 2007 - 7:47 am:
I have refrained from getting into this discussion, waiting to see how and if it is resolved. The reason is that we had an 8 month old filly who choked two years ago. We took her to a Veterinary hospital where they scoped her, and pushed it through. We brought her home, in two days, she choked again. Back we wnet, they scoped, got it through and kept her for 3 days. We left her at a farm that fed her water soaked, gruel for three weeks and she choked on that. We put her down. It did not resolve itself. We spent $4000.00 trying to get her through it and it did not. She was a fantastic filly but we could not see improvement even with the extra care. There was something wrong with her esophagus apparently and it would not work right.
We could not put her through any more. I still miss Bubbles but we did the right thing. The vets had never seen a choke in a horse that young. You are in my prayers but the prognosis doesn't seem too good. EO
|
Member:
chrism
|
Posted on Wednesday, Apr 11, 2007 - 9:52 am:
Re massage, I was sort of on the thought of "stimulating" areas that might, which might in turn, help with the esophagus area I can not reach and is not normally a massage target. I agree, no massage during a choke episode.
LKR, thanks for your telling of your experience. I am sure you miss your filly - they are so sweet and cute at this age. The primary vet and owner are considering what if anything, can or should be done.
|
Member:
chrism
|
Posted on Thursday, Apr 12, 2007 - 3:23 pm:
LKR - I showed your post to my friend who owns this filly. If you don't mind, would you email me the contact information for your vet who attended Bubbles? The thought is that my friend's vet could perhaps discuss or fax the case information for comparison. My email is silkesmom@yahoo.com
Thank you so much. And I do understand if this is asking too much.
Chris
|
Member:
chrism
|
Posted on Tuesday, Apr 17, 2007 - 5:48 pm:
We have a preliminary diagnosis, pending further diagnostics at the vet school - "persistent aortic arch."
I am told it is very rare and the prognosis is not promising as the choke episodes can increase in frequency and duration and complications such as pneumonia can develop. In this filly's case, the choke episodes continue, approximately weekly, even though she is only fed hay and pasture. She is able to "clear" the choke within about 30 mins.
I will post what the test results when I know them.
|
Moderator:
DrO
|
Posted on Tuesday, Apr 17, 2007 - 7:24 pm:
Christine, do you know how they identified the abnormality?
DrO
|
Member:
chrism
|
Posted on Wednesday, Apr 18, 2007 - 9:33 am:
Dr. O,
I think the prelim prognosis was based on detailed conversation between attending vet and vet specialist at NCSU. NCSU specialist is requesting funding to do requisite testing to confirm diagnosis as a teaching case. I think the test is with barium and xrays. But my information is indirect and I may not be correct on that part.
I'll update as I learn more.
|
Member:
chrism
|
Posted on Tuesday, May 15, 2007 - 4:51 pm:
I am sorry to report ...
The owner had her filly was put to sleep last week as she continued to have choke episodes that were becoming more frequent and longer lasting. She was clearly miserable during each episode. The last episode was a disturbing three hours long.
The persistent aortic arch diagnosis was never confirmed via testing. Rather than continue to wait for funding to do the test, the owner decided it was more compassionate to put the filly to sleep.
Everyone at the barn is missing the sweet filly. She was a kind and gentle soul.
Chris
|
Moderator:
DrO
|
Posted on Wednesday, May 16, 2007 - 9:12 am:
My condolences to the owners Chris,
DrO
|
|
|
