Vet’s View: choke: emergency or not?

Vet’s View: choke: emergency or not?
Vet’s View: choke: emergency or not?

The thought of choke often brings to mind images of someone gasping for breath and turning blue, while making frantic gestures towards their neck so their dinner companion knows to perform a life-saving Heimlich maneuver. In people, choking very often involves food going down “the wrong pipe” — that is to say, instead of traveling down the esophagus and into the stomach, the food has gone into the trachea or windpipe and is preventing the person from breathing.

This very rarely happens to horses. When a horse “chokes,” 99.9% of the time it means that something is in the “right tube”, the esophagus, but it has become stuck somewhere between the pharynx (the back of the throat) and the stomach. This is certainly uncomfortable; maybe you can recall taking too big a bite or not chewing quite enough and the feeling of that mouthful uncomfortably sliding down to your stomach.

When a horse chokes, you may see several different signs. He may seem to cough or gag. He may stand with his head and neck extended. Oftentimes there will be a very anxious appearance to the eye. However, the number one sign that your horse has choked is saliva plus or minus feed stuff coming out of the nostrils, especially when the head is lowered. You might even find puddles of this liquid mess in the stall or around where the horse has been standing. If the esophagus is completely blocked, there is nowhere for the saliva to go. The horse continues to produce saliva to aid with swallowing, but eventually it will build up enough that it will pour out of the nostrils when the head is lowered. This can cause one of the biggest complications to choke in the horse — aspiration pneumonia, which occurs when this saliva and foodstuff cannot be swallowed down or come out the nostrils and some of it slides down into the trachea and into the lungs. This is also why one of the most important treatments in choke is to get the horse to relax and keep the head lowered.

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Why does choke in horses happen? In BC, the most common cause of choke is beet pulp. While beet pulp can be a great food, it is important the pellets or flakes be soaked for at least twelve hours before being fed. Dry beet pulp can cause quite hard impactions in the esophagus. Certainly other dry foods can cause problems, and even improperly chewed hay or a large chunk of apple or carrot can cause can obstruction. This is why all horses who choke should also receive an oral exam by a veterinarian to make sure their teeth are all in good working order, as not properly chewing food can certainly lead to further episodes. Very rarely, other odd foreign bodies such as a wood piece or rock create a problem, but this usually only occurs in foals, as older horses are generally quite nimble with their upper lip in carefully selecting what goes into their mouths!

What to do if you see signs of choke: first, take a moment to watch. If your horse just seems uncomfortable and maybe coughing a bit but seems to be breathing all right, it is probably not a “911” emergency. Very frequently the choke will resolve without treatment in a few minutes. Don’t try to give anything to the horse by mouth — take away all feed, and definitely do not try to force any water down the throat, as this increases the chances of the water and saliva going down into the lungs. Keep the horse as calm and quiet as possible and try to keep the head lowered. If the choke does not resolve within 30 minutes, it is time to call the vet. That being said, if you see labored breathing, meaning he seems to be using his abdominal muscles to pull air in or out, or if there is a snoring or whistling sound when he breaths in or out, that IS a “911” emergency that the vet needs to see immediately.

The vet exam will include several items. First the vet will want to sedate the horse with  intravenous drugs. This will help the horse to relax, as well as decrease the spasming of the esophagus around the stuck food which is causing the pain. The vet will then pass a stomach tube down the esophagus. Oftentimes that action will push the obstruction down to the stomach where it can get digested normally. If the tube does not slide down easily, the vet may very carefully use warm water lavages to flush the obstruction down. Very rarely, if the obstruction remains stuck, the vet will recommend that the horse go into a clinic for an endoscopic exam. A flexible camera can be used to see what exactly is stuck and, if necessary, to help remove the object. An added benefit to using the scope is the vet can then get a good look at the lining of the esophagus to make sure there are no ulcers or damage and ensure that there was no other reason for the choke, for example a tumor or “pocket” into the wall of the esophagus. The vet will also use a stethoscope to auscultate the lungs to see if there are obvious signs of aspiration pneumonia, which can include crackles or wheezes in the lungs.

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Most horses respond very well to choke treatment and can return to work by the next day. However, it is important in all cases of choke to monitor the horse’s temperature for five days after the episode. If he did get some fluid into his lungs, he will usually spike a fever within this timeframe. If fever is present, your vet will want to begin a course of antibiotics, if the horse is not already on them, in order to treat the pneumonia. Other rare complications include strictures (shrinking) of the esophagus or even esophageal rupture, which can be deadly.

Overall, choke can certainly be very frightening to witness in your horse. However, as long as it is properly and promptly treated, it is unlikely your horse will have any lasting damage. Make sure you are keeping up on his oral and dental health, as poor teeth are much more likely to   continue to cause problems. Don’t hesitate to call your vet if you have any questions!

 

Author: Dr. Janine Veronneau was born in Alberta but raised in Edmond, Oklahoma where she graduated from College of Veterinary Medicine at Oklahoma State University in 2011. After five years in small animal practice in North Carolina and Germany seeing mostly canine athletes she decided she greatly missed the equine world. She is an avid horseback rider who has the most fun when galloping on a cross-country course. Professionally she is interested in sports medicine, rehabilitation, and internal medicine.