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  Discussion on Pharyngeal Lymphoid Hyperplasia
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Member:
mjane

Posted on Monday, Jan 21, 2008 - 2:11 pm:

DrO,

My Morgan mare was diagnosed with Pharyngeal Lymphoid Hyperplasia September 2007. She will be 4 years old July 27 and has been in the same stable and in training since she was a yearling.

We purchased her as a two year old and she began her training for Pleasure Driving and English Pleasure. She has a very upright neck and naturally flexes well at the poll. Last summer she began to toss her head a little when checked up in the bridle and seemed to have some difficulty with breathing (some noise but not loud). She would also begin to tire after about 10 minutes of trot work. The trainer suggested the vet take a look at her and here is what followed.

1. Sept 07 endoscopy revealed grade IV PLH. Thickness in the retropharyngeal region was also noted externally. She was treated with Dexamethasone 2mg/ml 100ml and continued on Prednisolone 20mg. Her training was stopped and she had daily turn out for about 30 minutes either outside on a sand arena or in the indoor arena. Note: May 2006 she was diagnosed and treated for retropharyngeal lymphoidenopathy, pharyngitis, gutteral pouch disease; tympany, empyema

2. Oct 07 The second endoscopy revealed PLH had improved to Grade II. Everything else on exam was normal however the thickness in retropharyngeal region was the same. She continued her rest period to complete 2 months.

3. Dec 07 Training resumed slowly then increased over 2 week period. She would start very bright, alert and eager to work but after about 2 weeks she exhibited the same symptoms as before but not quite as bad.

4. Jan 08 Third endoscopy revealed PLH still at Grade II. Gutteral Pouches were clean, there didn't seem to be a problem with the epiglottis and each side of the larynx moved equally on ins/expiration. (It should be noted that this was a standing endoscopy) The retropharyngeal region is still thickened and is obvious when she is flexed at the poll.

5. The vet suggested resting her for a longer period or taking her someplace where she can be scoped while on a treadmill to see if it might be something else such as LH or Pharyngeal Collapse. He also sent her video endoscopy to a Respiratory specialist at Rood & Riddle in Lexington.

6. Jan 18, 2008 I spoke with the vet from Rood & Riddle and he thinks she is a bit too old for PLH Grade II to be causing her problem although it isn't out of the question. Of course he sees mostly race horses and they don't have to be checked up in the bridle to do their work. To do the treadmill endoscopy he would have me bring her tack to simulate her head position while at work.

The decision for me now is whether to bring her home where she can live out of doors with access to shelter for 2-3 months before having her checked again or taking her directly for the treadmill endoscopy. I was hoping to show her this spring but that is unlikely with either scenario.

After this long, drawn out post, would you be more inclined to go with additional rest in pasture for several months then have her scoped on the treadmill if there is no improvement or go for the treadmill endoscopy now? The two closest sites with a treadmill are both 10 hour drives. One is at Michigan State and the other Lexington, KY.

I look forward to your opinion.

Jane}}
Moderator:
DrO

Posted on Tuesday, Jan 22, 2008 - 6:30 am:

Based on the improvement with rest and that there still remains some hypertrophy, I would continue to rest this horse while attacking the remaining hypertrophy. After all even if you do find some other problem on the treadmill it strikes me until you cure the existing disease you cannot know if it is secondary to it or not.
DrO
Member:
shanson

Posted on Tuesday, Jan 22, 2008 - 10:44 am:

I'm curious... What does "checked up in the bridle" mean?
Member:
mjane

Posted on Tuesday, Jan 22, 2008 - 11:25 pm:

DrO,

Many thanks for your response and I agree with resting her first.
I have 2 more questions for you.

1. How long would you suggest resting her before repeating an endoscopy?
2. What type of treatment would you use for "attacking the remaining hypertrophy?"

Thanks,
Jane
Member:
mjane

Posted on Tuesday, Jan 22, 2008 - 11:45 pm:

Hi Sharon,

What I mean by "checked up in the bridle" is when a horse has it's neck up and head flexed at the poll usually when it is wearing a full/double/Weymouth bridle with two bits. The Bradoon bit helps keep the head high and the curb keeps the nose in. It's what you see in the Saddle Seat discipline where Saddlebreds and Morgans often compete. The same principle applies to Pleasure Driving when again you have 2 bits, the snaffle to keep the nose in and the overcheck to lift the head. This type of tack is best used on horses with a naturally high head carriage.
I hope this makes sense!
Jane
Moderator:
DrO

Posted on Wednesday, Jan 23, 2008 - 7:09 am:

These are really decisions that are best made by those who can examine the horse Jane but would also depend on your goals and resources. But we can make some general statements.

The most important treatment is rest and time in a nonstressful, dust free environment. Other treatment can be divided into specific and non-specific therapy. If the veterinarian can determine or suspects why there is ongoing hyperplasia he needs to address that first, basically the question is whether there is on-going infection. Once this is addressed nonspecific antiinflammatory therapy, like dex or pred might be logical as long as there is no infection.
DrO
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