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  Discussion on Food coming out of nose
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New Member:
Kitch

Posted on Tuesday, Jun 14, 2005 - 5:34 pm:

I have a 4-year old appy/TB filly cross that I have had since birth. Back on May 10th she started a cough, we had place a round bale in the pasture that I noticed had some mold after she started coughing. I Took her out of that pasture and put her in a field that had no hay, just good grass, soon after that I noticed a discharge from her nose that turned into a green discharge when she coughed, (which is quite often) that is when I discovered that some of what she ate came back out through the nose. If I feed her grain or hay, (and have noticed when she drinks as well) she starts coughing very violently and out the nose it comes. I thought at the end of May that she was showing some improvement but then it all started again on May 31st, she has been slowly DrOpping weight since this all started. On June 2nd a Veterinarian performed an endoscopic examination revealing a swelling at the pharynx and the pharynx showed no movement at all when she swallowed, the Veterinarian said it could be in part because of the swelling and that she is sedated. The Vet prescribed 20cc a day of Exodin ? antibiotic (I can’t remember the name, it is at home, I am at work) for 8 days and a anti-inflammatory injection for 4 days. I was seeing a slight improvement after about 7 days of treatment then on June 12th she was back at her worst again. The Vet suggests another 2 weeks of antibiotics and more anti-inflammatory, she said if this does not work we will have to send her to another clinic for to see if it is neurological. This filly has a very good appetite, temperature is normal, gut sounds are normal, all signs are normal except she cannot swallow, so far to this date she is just a pasture ornament, I was planning on starting her training soon. Please help.
New Member:
Kitch

Posted on Tuesday, Jun 14, 2005 - 6:55 pm:

Hello, Janine again, the antibiotic she was on is "Excenel"
Moderator:
DrO

Posted on Wednesday, Jun 15, 2005 - 8:10 am:

Hello Janine,
The top of my list for the cause of such symptoms would be recurring mild choke. But even when sedated a swallow should be accompanied by a complete closing of the larynx and this can be observed by endoscope. However the arytenoids when denervated remain in a partial closed condition: what did your vet say about the breathing position: did they should have looked paralyzed? It sounds like your vet is trying to describe bilateral recurrent laryngeal nerve (RLN) paralysis. Hmmm... did the vet make a comment as to the nature of the swelling?

The antibiotics and antiinflammatories are certainly good first steps but I hate to hear of the worsening. What antiinflammatory are you using?

Lastly let me say the RLN is particularly sensitive to toxins that impair or damage nerves. Have you been using any organophosphate fly sprays around the horse? I wonder if the hay might of had a tiny bit of botulism in it? The botulism would be good because it will reverse in time.
DrO
New Member:
Kitch

Posted on Wednesday, Jun 15, 2005 - 4:30 pm:

Hello Dr. O
Thanks for your reply.
We talked about the possibility of choke then dismissed it, it just didn’t seem right, would she not get better in time if it were choke?, she has not had hay or any amount of grain since this all began.
The Vet did not say anything about the position of the arytenoids in the breathing position, just that there was no movement when she swallowed, she does not seem to have difficulty breathing though, but that is at rest. The Vet did not elaborate on the swelling, just said there was swelling.
The anti-inflammatory she was on is Dexamethasone, she was getting 1 mg IM per day, a very small dose. The Vet said there have been reports of a few horses getting Laminitis after using this anti-inflammatory.
I have not used any fly sprays or anything like that on her at all, so that would not be a cause, the hay however was not good, it had quite a bad spot in the bail that I had not noticed until after. We did have an unusual wet warm winter and the bales were stored outside untarped, I had run out of hay and had to get more from a farmer. I have read all about botulism, scary. Her symptoms are not anything as bad as what I have read but I guess if she only ingested a small amount it would not be as bad as some, other than her paralyzed larynx, she seems just fine.
Thanks
Janine
Moderator:
DrO

Posted on Thursday, Jun 16, 2005 - 8:25 am:

There are cases of chronic recurring choke and most often is associated with esophageal diverticulums. I have never heard of a larynx that was just paralyzed to closing but abducts normally when breathing.

1 mg of dex a day is about worthless and while there is much talk about such associations with founder none have ever been discovered. If afraid of dex I would recommend therapeutic doses of phenylbutazone be used. If a 10 day course of bute and antibiotics are not successful perhaps referral to a equine hospital but the big concern in the meantime is the potential for aspiration pneumonia that will not go away until this is cured. Good radiographs of the pharyngeal areas may be helpful as may contrast radiographs of the esophagus.
DrO
New Member:
Kitch

Posted on Friday, Jun 17, 2005 - 3:29 pm:

DrO, I was thinking more about what you first said (mild recurring choke)and after discussing it with my Mother, we think that maybe that is what it is, I have not discussed this with my Vet yet. My Vet has put her back on Excenel, 20ml for 16 days and on oral Dex at 10ml for 7 days, we started this on Wednesday,(16th)we went oral this time because she is getting needle shy, I do have to be slow with the syringe to put it in her mouth otherwise it comes back out. After reading your articles about Dex and what you said I have no worries about it now.

If it is choke, will this work?, I have my doubts, do we use a muscle relaxant? I will look for an article on your site to read.

If she is not better by the time I have finished with the Excenel then we will take her to a Equine Hospital, the closest one is at Spruce Meadows, Alberta, a 14 hour drive, that is a long time without food, I would have to stop along the way and pick grass for her.

I really appreciate your input on this, I love your site, thanks a bunch,

Janine
Member:
Jvinoly

Posted on Friday, Jun 17, 2005 - 10:27 pm:

Janine, if it is helpful to you, an equine hospital just opened up in Kamloops, BC. It is called Accord Veterinary Hospital. It may save you a 14 hour trip.
Moderator:
DrO

Posted on Saturday, Jun 18, 2005 - 8:39 am:

Whether your treatments will help or not depends on the cause. If some inflammatory or infectious process is at work yes this or time alone in the case of botulism will work, none of these will fix a diverticulum of the esophagus however.
DrO
New Member:
Kitch

Posted on Saturday, Jun 18, 2005 - 12:51 pm:

Thanks Jim appreciate knowing there is one in Kamloops, it is a lot closer.
Janine
Member:
Kitch

Posted on Saturday, Jun 18, 2005 - 1:16 pm:

DrO, If it is Diverticulum of the esophagus, what can be done about that? I witnessed a horse choke very severely from dry beat pulp once and the attending Vet gave the horse muscle relaxants, would that help?
Janine
Member:
Eoeo

Posted on Saturday, Jun 18, 2005 - 4:53 pm:

I would recommend putting the horse down. It will probably not resolve itself. We went through 3 chokes and $4000.00 and put. our filly down. They kept saying that she would probably be alright, then, prognosis is not good. A lot of money in between. Put her down if you find that and take your losses. More money won't help the situation.
Moderator:
DrO

Posted on Sunday, Jun 19, 2005 - 9:08 am:

No muscle relaxers will not help. It will depend on the size and location Janine. As LKR suggests esophageal surgery in not for the meek but some issues would be easier to address than others. But why not wait for a diagnosis before contemplating the prognosis of a particular situation.
DrO
Member:
Kitch

Posted on Monday, Jun 20, 2005 - 7:19 pm:

DrO, Since she does not seem to be suffering from all this we will wait to see the outcome. She has been back on Excenel and Dex for 5 days now and has 3 more to go of the Dex and 11 more of Excenel. Her coughing is at its worst after she manages to steel grain or hay from somewhere, runs, or goes to the meadow where the grass is tall and plentiful, if she is on a low field she does not cough to much. Her spirit is high and despite the needles and the syringes stuffed in her mouth with awful tasting liquid she still is happy to come in, she does not get rewarded with grain or anything els tasty, just a good brushing, and she is still happy.
Thanks again,
Janine
Member:
Kitch

Posted on Monday, Feb 27, 2006 - 7:54 pm:

Just to let you know the outcome of my filly, after trips to different veterinarians we determined that the epiglottis was not functioning, it would lay like a wet noodle when she swallowed allowing the food to enter the trachea. There was no physical evidence of anything wrong, Dr. Gareth Fitch suggested possible led poisoning, I ruled that out so your suggestion of botulism seems to be the only explanation, Dr. Fitch said to give her four to six more months. She learned how to get her mash down her esophagus, she would twirl her heard when she swallowed and seemed to get most of it down, so if any off you are thinking how bad she must have looked, it was not that bad. On October 5th I started to see an improvement and in three weeks she was back to normal, it was a tough five and a half month but we survived, I just hope there was no damage to the lungs. Thanks again for you help.
Janine
Member:
Paul303

Posted on Tuesday, Feb 28, 2006 - 1:49 am:

Janine: Thank you so much for your follow-up. It helps us all to hear the outcome of as many cases as possible. Good or bad, they all carry a message and a good dose of wisdom. The fact that your outcome was favorable, brings us our dose of wisdom with a bonus of good cheer. Thanks again!
Moderator:
DrO

Posted on Tuesday, Feb 28, 2006 - 8:34 am:

I second the thanks and congrats on the good outcome of a very interesting case.
DrO
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