A Tale of Two Coughs. The novella.

Hello COTH. I have a very well preserved WB in his mid twenties who has developed a cough under two distinct unrelated conditions. I thought I would pick the collective brain of COTH while I study up on respiratory, swallowing and allergy issues. I really don’t know which one I have. Maybe I have all of them.

The problem: A mild cough began last fall which occurred only at the beginning of exercise. It completely disappeared over the winter (not much exercise occurring) then reappeared about a five weeks ago along with a more severe cough while eating.

Here are the relevant facts:

 1. Cough initially occurred once or twice upon exercise in a moist sand arena and occasionally produced clear phlegm but no nasal discharge. One good cough on the first trot circle and he was fine for the remainder of the ride. Horse is in very light work but not winded by normal exercise. Breathing is quiet and unlabored. 
 2. Stable staff reports they have recently heard horse coughing in grass turnout (very grazed down) where he spends approx 6 hours a day. It has been wet here so this doesn't seem related to dust. Currently no hay is being fed in turnout. His pasture mates are both healthy. 
 3. I witnessed a more severe coughing spell last night while he was consuming alfalfa. I thought it was the start of choke but it resolved itself in about thirty seconds of very distressed sounding coughing which ejected chewed hay from the mouth only. I wet ( not soaked) the remaining alfalfa and the issue did not repeat. This is the second time this has been noticed. The BM reported a similar episode while eating dry Timothy about three weeks ago, again with no nasal discharge. 
4. Horse is stalled at night on rubber mats with shavings. 
5. Horse is bright eyed, energetic, shiny and at a good weight. He has been eating hay more slowly but hasn't been off feed or ill in any way. He doesn't bolt or sling grain and doesn't quid. 
6.  He doesn't always cough while eating hay but when he does it seems deep and involves an open mouth and neck craning.  When related to exercise it seems more superficial. 

Here’s what I have done so far:

 1. Called vet. Teeth had a few points which were easily corrected but otherwise horse received a clean bill of health. Vet though tooth sensitivity might be an issue but teeth looked very good for his age. 
 2. Pelleted senior feed now fed wet from ground feeder. Horse already eats hay from ground/ clean rubber mat. 
 3. Inspected new hay....a bit stemmy and a little dusty so I am now steaming it for about an hour before feeding as often as I can which has been about 75% of his meals as of last week.  (I board but I am negotiating at least soaking... I doubt they will steam for me) 
 4. Put the horse on Freeway gold (too recent to tell if its working)
 5. Called the vet again. He doesn't seem too concerned but offered to do another work up if the above measures don't resolve the issue. He did not think the horse had choked or that he was at any increased risk of choke based on the prior exam. The horse has never choked in the past. 
 6. Horse is already on MSM. 

Here are my next options:

1. Call vet back for an allergy test. This might sound nuts but it seems like its a scratchy, dry throat issue....Although he foams up the bit like an expresso machine when ridden. 
1.5 Soak the hay 100% of the time and wait to see if that helps. Steaming kills spores but soaking seems to soften it more effectively. 
2. Switch to a chopped/ packaged hay to see if current hay is the issue. Barn hay is adequate but I wouldn't accuse it of being the highest quality. A couple of other horses have decided they won't eat it and one sensitive TB has developed a Timothy allergy. 
3. Move horse outside. Although the outdoor option is a pen/ shed row arrangement that is heavily sanded so this won't help a dust allergy once the weather becomes drier. 
4.  ...??

What would you do next if this was your beloved oldster? All of the above or something different? Am I missing anything important or am I getting too worked up over what is probably a seasonal allergy?

Update: Horse had a cracked and loose molar removed two days ago. He displayed a complete array of gagging for the vet post removal. The vet believes the problem is not choking rather difficulty swallowing hopefully brought on by incomplete chewing of hay. All his roughage is now soaked or steamed and he is being transitioned off of the rather stemmy timothy in favor of softer forage. We haven’t ruled out scoping for esophageal issues but this appears to be tooth related after all.

Have a bronchoalveolar lavage (BAL) performed to evaluate lung condition. On the east coast the go to expert is Dr. Amy Polkes…don’t know where you are though.

My beloved senior presented with many of the above symptoms as well. The BAL provided direction on how to care for him.

[QUOTE=Raincityrider;7517504]

Here are my next options:

1. Call vet back for an allergy test. This might sound nuts but it seems like its a scratchy, dry throat issue....Although he foams up the bit like an expresso machine when ridden. 
1.5 Soak the hay 100% of the time and wait to see if that helps. Steaming kills spores but soaking seems to soften it more effectively. 
2. Switch to a chopped/ packaged hay to see if current hay is the issue. Barn hay is adequate but I wouldn't accuse it of being the highest quality. A couple of other horses have decided they won't eat it and one sensitive TB has developed a Timothy allergy. 
3. Move horse outside. Although the outdoor option is a pen/ shed row arrangement that is heavily sanded so this won't help a dust allergy once the weather becomes drier. 
4.  ...??

What would you do next if this was your beloved oldster? All of the above or something different? Am I missing anything important or am I getting too worked up over what is probably a seasonal allergy?[/QUOTE]

Discuss with your vet what will be tested for in the allergy test - sometimes it’s not what you think/expect :slight_smile:

Confirm that shavings supplier has not changed, then contact the supplier & confirm that they have very consistent starting product (mills in my area do not, shavings are highly variable no matter who the supplier).

I’d try soaking the hay before switching - with the pre-pack hay, you are making assumptions about consistency, uniformity which may not be valid, contact the manufacturer for details, look at the distribution network etc.

If you move horse outside now, can you still bring him back in later?

First, thanks for reading through my extremely long post. COTHers are the best!

I had not even thought about the shavings Alto, thanks for pointing that out. My stall neighbor just tested her TB for allergies so she might have some information to share with me since we use the same clinic. I would probably have a stall if I need to bring him back in but likely at a much higher rate. I can live with that though.

Bathsheba, do I need to have him in clinic for a BAL? I am guessing yes, since there is intro of a sterile solution into the lungs. I am on the complete opposite coast unfortunately but there is a decent vet hospital about three hours north of me.

I think I need to have yet another conversation with my vet. I hope he doesn’t think I am stalker…

The first sounds like the old man cough to me and the second sounds like chronic choke. They can choke on anything including grass.

Allergy induced asthma/IAD? Mine first presented in fall 2012, in “deep” winter it got better, presented again in spring. Definitely worse inside than out and once he gets the tickle he will cough while eating, doesn’t matter if it’s hay, grain, etc. Round bales of dubious quality aggravate it especially. Had two different vets do the “bag” test and pretty much came up with the same diag. Can you put him on grass/out 24-7 to see if he changes?

Nope, you don’t have to go to a clinic; a qualified vet can do it safely on the farm. I’d call Amy and ask for recommendations in your area.

[QUOTE=Laurierace;7517894]
The first sounds like the old man cough to me and the second sounds like chronic choke. They can choke on anything including grass.[/QUOTE]

I think it looks a lot like choke too. I have explained the situation to the barn staff and they have agreed to soak his hay from now on. This came about so suddenly I have to wonder if he has experienced some sort of trauma to his esophagus. I hope it isn’t due to a mass or something more sinister.

Once they choke once they are very prone to choking again due to the swelling. Banamine is generally prescribed for the first few days to keep the swelling down. I don’t know if soaking hay helps with choke but it definitely helps to soak everything else.

Do this - Have a bronchoalveolar lavage (BAL) as said above. I let my horses lungs get quite bad before it became obvious to me that something really serious was going on. His lungs had ton’s of crud in them and it only evidenced as a single cough when beginning exercise or a bit more coughing when eating. The muck in his lungs would accumulate at the opening to his trachea and food would stick to it when he ate his soaked hay pellets and trigger coughing to dislodge the stuck feed. Same thing at the beginning of exercise, a single cough would clear the worst away from the top of the trachea. But my vet pointed out that his over-all respiration rate was higher, he had a doubled expiration where he would breathe out then push harder to finish pushing air out.

The lavage showed his lungs were just filled with junk (my non-technical term) and some permanent damage was done. My vet had a specialist exam him, do the lavage and prescribe a treatment.

chicamuxen

It sounds like a BAL is the next step and I have a call in to the vet to discuss. I have heard there is a WB predilection for development of IAD. The old guy has not been in enough work to see a real change in his exercise tolerance so this may have been going on longer than I realize.

On the choke front, I have never seen him have an issue with the steamed hay or the wet grain so I am hoping that those measures will be preventative. A BAL isn’t going to tell me anything about choke. I am not sure there is a definitive test for choke except experiencing an episode which requires intervention. To date he has been able to clear himself after a few deep coughs. Another reason to keep him inside is the 9pm barn check which would likely catch him having a problem with his pm feed. No one is likely to notice him having issues outside.

BTW For anyone considering Freeway Gold the horse seems to love the stuff. I give it high marks for palatability.