This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Respiratory System » Noises and Decreased Performane in Exercising Horses: Roarers »
  Discussion on Tie back & laser surgery
Author Message
Member:
ngossage

Posted on Tuesday, Dec 11, 2007 - 12:32 pm:

Afternoon. Hope everyone's staying warm & dry today. I’m taking my horse, Bobcat, to an equine hospital tomorrow. They’re going to scope him when we get there to determine his grade of roaring. (If I had to guess, I’d say he’s a III or IV, since he sounds like a Mac truck/freight train). He made a little noise when I bought him, but it wasn’t bad. A few years later, he’s in the best shape of his life, and the noise is worse. He’s had a few moments where he can’t breathe at all. This happens when he’s stressed/upset (working on the one lead change that’s hard for him). Initially, the surgeon & I discussed just performing the laser surgery, which they’ve found helps better with the noise, but when I told him about the difficulty getting air in the stressed moments, he thinks we may be looking at doing both the traditional tie-back, followed by the laser the next day.

So the initial plan is we’ll get him scoped tomorrow, tie back on Thursday, and laser on Friday. I can pick him up on Saturday morning. Dr. O, the surgeon said that even though they have no studies to prove it, they’re seeing more success with the tie-back followed up with the laser procedure. Does he mean there’s less chance of infection because the laser cauterizes/seals things up? (My insurance which doesn’t cover any of this, also said they’re seeing a lot of the combo procedure).

Wish me safe driving (2.5 hours) and a successful surgery & recovery for Bobcat. I’m a little nervous, even though I know it’s a routinely done surgery, it’s surgery on my big boy.

Nicole
Member:
frances

Posted on Tuesday, Dec 11, 2007 - 2:04 pm:

All the very best to you and Bobcat, Nicole. I hope all goes well, on the road and in the hospital, and that you bring home a healthy, happy and silent horse.
Member:
canter

Posted on Tuesday, Dec 11, 2007 - 4:17 pm:

Best of luck, Nicole. Keeping my fingers crossed for a successful surgery and trouble free hauling.
Member:
ngossage

Posted on Tuesday, Dec 11, 2007 - 7:22 pm:

Thanks, LL & Fran!

Will post an update when I get home tomorrow night.
Moderator:
DrO

Posted on Wednesday, Dec 12, 2007 - 7:25 am:

Hello Nicole,
Since he will do this standing, I am going to assume we are talking about unilateral laser-assisted ventriculocordectomy as this is the newest of a long list of procedures that have been tried for laryngeal hemiplegia (LH). We discuss surgical ventriculocordectomy in the article on LH at Diseases of Horses » Respiratory System » Laryngeal Hemiplegia. One change in the article which is being edited at this time, is a recent large study did find a positive effect of the surgical procedure in mild cases of LH. The new twist is using a laser in the standing horse.

The laser procedure has been reviewed for ill effects and found safe and effective at removing the ventricle. But the surgeon is right, there are no published scientific works for it's use in combination with a tie back (laryngoplasty). There are two small studies of it's use without the tie back procedure. The two small papers came to slightly different conclusions in my opinion. In one the long term effects on mild LH was positive and the other uncertain as the same level of noise had returned in 4 months post laser surgery.

As to what he meant about "improved outcome" with the combination, I am uncertain so you must address the surgeon directly on that. The articles I read suggest lasering when tie back is not an option for mild cases of LH. In studies comparing "plasty" and "plasty plus ectomy by surgery" it is hard to find a improvement in outcome when done together.
DrO
Member:
ngossage

Posted on Thursday, Dec 13, 2007 - 8:44 am:

Sorry I didn't post last night. Was a little pooped after the driving & day's events. Made it there and home safe & sound. Managed ok, except when I went to leave him. He could've cared less that I was hugging on him. He was happily munching on hay & glad to be off the trailer.

The scope showed that Bobcat is a grade 4 roarer, with the left side being completely paralyzed. Dr. O, it looked just like the picture on the right in the roaring article under the diagram. If I have this right, I think what he said was that when Bobcat has those stressful moments, he's sucking air in so hard through his right side, that it's creating negative force & causing that to close up as well, which is why we hear the horrific noise & he can't breathe at all. Does that sound right?

They're going to do the tie-back surgery today, and call me when he's back in his stall. I didn't realize how long he'd be under anesthesia (2.5 hours). Tomorrow they'll perform the laser surgery. I asked him if the laser surgery helped the overall outcome because it lowered the risk for infection and he said no. He then explained it, but I was a little fuzzy & not sure I'd repeat it correctly here, so I'm going to email him for a written explanation and will post it here when I hear back from him.

I'll also ask him if they're tracking or doing a study on horses that they've performed tie back & laser on vs just tie back to see if they're getting any solid data.
Member:
ngossage

Posted on Thursday, Dec 13, 2007 - 5:11 pm:

Update:

Surgeon #1 called me around lunchtime to report that Bobcat was doing fine & recovering from the tie-back surgery & anesthesia. He thought they had the sutures in a good position, and that there was plenty of cartilage for the sutures to hold on to. He explained how sometimes the cartilage can be thin, and the sutures don't hold as well.

Surgeon #2 just called & said the ventricularchordectomy went well & Bobcat was back recuperating in his stall. They removed the vocal cord on the left side and the saculum.

When I asked him why they felt the tie back was more beneficial when done along with the laser surgery, he said because by removing the vocal chord, there's a little bit more room for air to get through, and by removing the saculum, which sits behind the tied-back cartilage, it doesn't put tension on the sutured area.

He said they don't pull back the sutured area all the way open, to help minimize choking/coughing. He said they open it to an intermediate position.

They found a small ulcer under the soft palate, and he wasn't concerned about it, since he felt that Bobcat could have been flipping his palate in the stressed moments and that could have potentially caused this. He thinks with the rest & antibiotics, he'll be fine.

The surgeon said that in all likelihood I'll be bringing home a different horse now that he can breathe better - one with more energy (he's always been a lazy boy). Uh oh! :-)

The surgeon also said that it will take about 3 months to notice a significant difference with the noise because the scar tissue has to mature. He said Bobcat will sound "breathy" when he whinnies (poor boy already sounded girlie).

I asked if they had any ongoing studies about tie back alone vs tie back w/ the laser, and he said no, that they only do about 12 or so of these procedures a year, so not enough to compile data.
Member:
canter

Posted on Thursday, Dec 13, 2007 - 7:24 pm:

Glad to hear Bobcat is recouperating nicely, Nicole. I'll be interested to learn how this all ends up.

Just curious, if they removed the vocal cords, how can he make any noise at all?
Member:
ngossage

Posted on Thursday, Dec 13, 2007 - 9:18 pm:

I'm not sure-it was my understanding the surgeon only zapped one cord. Dr. O, do they have one on each side?
Member:
ngossage

Posted on Thursday, Dec 13, 2007 - 9:47 pm:

Thanks, Fran! :-)
Member:
frances

Posted on Friday, Dec 14, 2007 - 4:23 am:

All sounds very good, Nicole - you must be so relieved. Good luck with his convalescence, and the increased energy levels!
Moderator:
DrO

Posted on Friday, Dec 14, 2007 - 6:39 am:

The vocal cords are not removed. The horse has two and one is paralyzed and interferes with breathing. It is tied back. The other is left in place so the voice is altered but not gone. You can see pictures of this in the article referenced above.
DrO
Member:
ngossage

Posted on Sunday, Dec 16, 2007 - 11:08 am:

Update: Picked up Bobcat yesterday morning from the hospital, and while he was happy to see me, he didn't want to leave. Almost like he was thinking: where's she taking me now - enough!

So far, he hasn't had any coughing/choke episodes. The swelling is minimal. He's to have 3 weeks of stall rest (hand walking permitted), with 3 weeks of paddock t/o; no riding. He received his last 25mls shot of penicillin last night (2 locations IM), and will be on 1 gram of bute for 3 more days. Daily temperature checking for a week, site inspection for heat/swelling, and throat spray 2x a day via nasal catheter for 2 weeks. The sutures come out on 12/27.

He seemed very comfortable within 10 minutes of being at the rehab barn, and wasn't concerned at all when I left. I'm going to visit him on the weekends, and then bring him home on Jan 6 for his 3 weeks of paddock t/o.

Dr. O, I might have missed it reading the articles that relate to this, but what kinds of diseases could have happened to him if I hadn't done the surgery? Respiratory disease? Stroke?
Thank you.
Member:
scooter

Posted on Sunday, Dec 16, 2007 - 12:17 pm:

Nicole sounds like he is doing well! Hope the rest of his recovery goes as smoothly
Moderator:
DrO

Posted on Sunday, Dec 16, 2007 - 5:17 pm:

Nicole the clinical signs in the article I reference in my post above are the problems you might see with laryngeal hemiplegia.
DrO
Member:
ngossage

Posted on Tuesday, Dec 18, 2007 - 6:47 pm:

Thanks, Dr. O.

Just received an update on Bobcat, and he has a temperature of 102.4. Today was his first day without bute. Sat-Mon, he was at 100.5. There is no heat or swelling at the suture site, and he's eating, drinking, pooping, and acting fine. They gave him a gram of bute tonight after the temp check, and will check him again before bed & in the morning. I called the vet, and she said we did what we were supposed to, and to let her know how he is in the morning. She said he may need a few more days of bute, and to keep an eye on the site for heat/swelling.
Member:
ngossage

Posted on Tuesday, Jan 1, 2008 - 10:34 am:

Bobcat's doing fine enjoying his mini vacation/rehab. No more fever after that one night. However, he is coughing a few times during the day, though not while eating. The rehab barn say they think it's been less coughing at the end of last week than he was before. I left a message for the surgeon last week, but haven't heard back yet to let him know and to find out how much coughing is an indicator that the tie-back has to be undone. Dr. O, once they cough like this will they always, or is he just getting used to having more air and maybe it's tickling his throat?

Was also wondering about some of the herbal supplements I've seen advertised to help with coughing. They claim to help break up the mucus/decrease coughing. Do any of these help/work in this situation? Looked for a thread on respiratory supplements & in the nutrition section, but didn't see anything. Would appreciate a point in the direction I could research (or not waste my time :-) ). Thanks!

Dr. O, I'll also double check with the surgeon on the vocal chord removal during the laser process. I was pretty sure he told me they completely removed it and not tied it back, but maybe I was confused. :-) Will let you know what he says.

I get to bring Bobcat home this coming Sunday for his 3 weeks of paddock turnout-yippee!

Here's to a Happy, Healthy, Horsey, New Year!
Moderator:
DrO

Posted on Wednesday, Jan 2, 2008 - 9:01 am:

Though I cannot assess your horse Nicole, a chronic low grade cough is a common complication of tying back the arytenoids and "vocal cords". The vocal cords are part of the arytenoids (see the image in the article on laryngeal hemiplegia (I have fixed the link to the images). The ventricularchordectomy you posted about above is not the "vocal cords" but the laryngeal saccules. If some other surgery was done I would be interested in the details.
DrO
Member:
ngossage

Posted on Monday, Mar 3, 2008 - 9:04 pm:

Evening, all. Thought I'd post an update on Bobcat's post surgery/recovery. The occasional cough has completely dissipated - though we are still feeding him his grain & hay from the ground. He had a little clear serum leak out from the incision site several times early on, but the vet told me it was fine, and that as the cartilage settles, little pockets are created, and the serum leaks out. Never any blood.

He's been back to "work" for 5 weeks. We started out doing short hacks down the road a few times a week. Starting this week we'll be doing more ring work. Vacation/hacking out every time is now over. :-) We are walking/trotting & have cantered 2x-NO NOISE!!! I'm very happy that he can get the full amount of oxygen now. So far, no behavioral changes, ie, more, spunky horse now that he can breathe properly. My trainer & I are both amazed at how quiet he is now.
Member:
canter

Posted on Tuesday, Mar 4, 2008 - 7:22 am:

That's great news, Nicole. Now all you have to do is ENJOY!
Member:
scooter

Posted on Tuesday, Mar 4, 2008 - 7:34 am:

Nicole that is great. Bobcat is probably very happy to be breathing normally again.

Do you think he is quieter because he can now breathe better? Would make sense. Keep us updated and enjoy your rides!
Moderator:
DrO

Posted on Tuesday, Mar 4, 2008 - 8:02 am:

Excellent Nicole, delighted to hear things are going so well.
DrO
Member:
ngossage

Posted on Tuesday, Mar 4, 2008 - 6:31 pm:

Thanks, everyone!

Diane, yes, he is quieter because he can breathe much better. Prior to surgery, his left air passage-way was completely blocked.
He can't really whinny now, but is a happy camper otherwise.
Member:
ekaufman

Posted on Tuesday, Mar 4, 2008 - 8:34 pm:

What a great outcome! Good for you and great for him. I'll bet he's so relieved to be able to move and breathe at the same time.
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC