Choking, Tubing, and Pneumonia?

This past March my old mare (who was in her thirties) choked on her food. I called my vet and he gave me the advice of holding her head up for five minutes and letting it down for two - repeat for thirty minutes - in hopes that the impaction in her throat would dislodge itself and she could go on about her daily business. Unfortunately this didn’t work and I had to have my vet come out - he tubed her and in the process broke some capillaries in her nostrils. She didn’t bleed too much, but there was some blood coming out of one of her nostrils. The following day she developed signs of pneumonia. I’ve read that choking is directly related to aspiration pneumonia - but I don’t know how common this is?

The reason I ask is this: A friend of mine’s horse, who was three years old, passed away this morning. He choked, had the same treatment with the tube, developed pneumonia, and passed away. This has me thinking: is pneumonia that much of a risk when a horse chokes? I never realized it could be so serious - and for a horse as young as that to have developed the illness and die from it is just striking. I thought I understood with my old gal, seeing as how she did have some previous issues coming out of the cold weather (it had been a fight to keep weight on her, and it was also thought she was a cushings horse).

I guess my question is this: should I be worried with the way my vet is handling this procedure?

Aspiration pneumonia is a significant risk with choke in horses of any age. Sedation followed by tubeing (if necessary) is pretty standard but generally if the choke is severe enough to warrant tubeing the horse is started on antibiotics right away.

Pneumonia is a HUGE risk when a horse chokes. HUGE. When food isn’t going as it should down the esophagus, the chance is really great that the horse will inhale some of it into the lungs.

Horses who choke should be very closely monitored for any sign of pneumonia, and those that choked badly, were choked for an extended duration, or those that have other risk factors (like being 30 years old) should probably be put on antibiotics prophylactically.

Tough to say if you should be concerned with how your vet managed things, though. I’ve certainly never heard of holding the head UP to help clear a choke…I’ve always been told you want the horse as calm as possible, with the head as low as possible. You should have been advised of the pneumonia risk, and what to watch for. I would have expected antibiotics for a 30 year old horse.

The whole idea behind holding the head up was to have her saliva pool and possibly help break up whatever had been caught in her throat (is what was explained to me). But that’s beside the point because it didn’t work. Having treated my old gal (sedation/tubing) I asked my vet if there was anything else and he told me to continue normal routine but to keep an eye on her, but for anything else she should be okay. Once she was turned out she laid down and rested for a good fifteen minutes before standing and finding shade in her preferred spot. Nothing was EVER mentioned to me about the risk of pneumonia - she seemed fine the following day, but towards the evening she had developed the signs and symptoms of pneumonia. My vet came out the following day and only prescribed antibiotics then. I had a shot to give her once a day and oral antibiotics that I had to squirt in her mouth two to three times a day (I think it was only two though). When she didn’t improve my vet later came out, took her blood while I was at work (he never contacted me after he came out to draw - I had to call him) - he said she looked bad, that he figured it was pneumonia and the bloodwork would be back later tomorrow. She died early the following morning.

In that regard I am very upset with him.

But hearing of my friend’s horse passing this morning over the same experience (to the T) it raised some red flags with me - I had never known how common and expected it was for pneumonia to follow a choke… I had never been informed. :frowning:

The two horses I have know that choked and had to be tubed were put on antibiotics. They were also watched carefully for signs of pneumonia. Pneumonia is a huge risk with horses that choke.

I’m very sorry about your mare :frowning:

Head up and pooled saliva is pretty much a recipe for an aspiration, I’m afraid to say. Where is the saliva supposed to go when it can’t go DOWN? It will back up and down into the lungs.

When I’ve had a choked horse, I will watch for perhaps 10-15 minutes before calling the vet. I will often give some IV sedation. My vet has advised in the past to rub/stroke down the length of the esophagus on the left side if the horse will tolerate that. If the horse doesn’t pass the choke in that amount of time, I call the vet and he comes out. If the horse is still choked when he arrives, he gives more sedation and tubes the horse. If the vet can’t get the tube down, the horse goes to the hospital so they can pick apart the bolus with the scope.

After the choke, we discuss our pneumonia risk and the horse is placed on antibiotics if needed. I think we used Naxcel and then Excede last time. The horse is also given banamine or bute to address the inflammation caused by the choke. The horse is kept off of ALL hay and dry grain for several days, and is only permitted to eat soaked to mush senior. The risk of a repeat choke is significant directly after the choke, as the esophagus will swell and be inflamed around where the bolus was stuck.

I’d say that yes, from what you’ve added with your second post, your vet handled the situation improperly.

Agree with everyone above. I was taught that any significant choke that didn’t clear on its own should receive antibiotics prophylactically - that goes double for an older horse with Cushing’s that doesn’t have the best immune system to start with.

I routinely put esophageal choke cases on antibiotics to reduce/eliminate the likelihood of developing aspiration pneumonia.

I’ve seen many horses of all ages and conditions get “choke” over a 20-year period, and not one of them came up with pneumonia. It was only in the past two years I’ve had a vet even offer prophylactic SMZ’s, which I declined in lieu of taking temp and watching appetite for the next 72 hours.

Likely your friend with the young horse was just very, very unlucky. Nosebleeds during tubing are pretty common; aspiration to the lungs less so. I’ve never heard the “hold their head up” thing at all; we usually try to massage it through, or just give the horse a couple of hours to clear it; if that doesn’t work, then tubing it is.

BTW, VERY important to wet their food for a few days at least following a choking episode; and we usually give them a small dose of Banamine besides.

I’m not a vet, I don’t play one on TV and I didn’t stay at a Holiday Inn Express last night but I am a nurse and when I read your initial statement, the first thing that struck me was heads up. In my business, that is a recipe for aspiration. If a patient is regurgitating on the OR table, we put the head down to let the contents run out. Head up, it goes down into the lungs along with the gastric acid that came up with it which does the most damage.

Choke in horses is a little different than above. Their esophagus is packed full of food rather than “vomiting”. I think if the food bolus is below the level of the trachea, MAYBE it would be ok to raise the head. Again, not a professional.

Reading this thread with interest, as my 28yo gelding chokes easily, and had been treated fot itfour or more times this year. However, he has not been tubed. We have been lucky in thst the food passed thru with ‘massage’ of the left side of his neck, twice with 2 oz of water syringed down the throat (emergency tactic directed by vet, as she was two hours out). She has always advised to monitor him closely for pneumonia. We ALWAYS soak his feed now, and mash it and add warm water to soup consistency. We watch him eat, then wait as he performs his rituals of salt block then water then hay before leaving.
When he chokes, we
Call vet
Massage neck, while scratching his belly because he relaxes and lowers his head

This seems to work for him, but again we have not had issues since mashing his food and making thing gruel.

EDITED: the ONLY TIMES we syringed water down his throat was under vet supervision, she was in transit and horse’s condition was declining, and IT IN NO WAY WAS ENCOURAGING OR RECOMMENDING THIS ACTION UNDER ANY CIRCUMSTANCES!!! Further, my statement wasthst we now always feed soaked feed, not that we give it to him while choking. WE REMOVE ALL FEED AND WATER AT THE FIRST SIGN OF CHOKE AND CALL THE VET. geesh.

[QUOTE=Brockstables;7854290]
Reading this thread with interest, as my 28yo gelding chokes easily, and had been treated fot itfour or more times this year. However, he has not been tubed. We have been lucky in thst the food passed thru with ‘massage’ of the left side of his neck, twice with 2 oz of water syringed down the throat (emergency tactic directed by vet, as she was two hours out). She has always advised to monitor him closely for pneumonia. We ALWAYS soak his feed now, and mash it and add warm water to soup consistency. We watch him eat, then wait as he performs his rituals of salt block then water then hay before leaving.
When he chokes, we
Call vet
Massage neck, while scratching his belly because he relaxes and lowers his head

This seems to work for him, but again we have not had issues since mashing his food and making thing gruel.[/QUOTE]

To me, if it is a choke, you wouldn’t want to give them water. It would increase the chance of aspiration if the bolus doesn’t move.

Yes, the standard advice is that if a horse is choking, you should remove all access to food and water from the horse because of the danger of aspiration, until the choke clears.

One other thought: if you actually catch a horse choking there’s some decent chance that the horse has choked before and you just didn’t see it.

I would always call the vet for a choke.

I’m sorry about your mare.

3 years ago this month, we lost our 30 year old mare due to aspiration pneumonia that was a direct result of choke. We (and she) made a huge try with oral, IV, and rectally administered antibiotics over a two week period, but unfortunately, nothing was enough. Pneumonia is a very real and very serious potential complication of choke.

There are a lot of nasty bugs in a horse’s mouth, and with all of the saliva produced during a choke, it is very easy for even a tiny bit to wind up in the lungs- I would not want to hold the head up and encourage that.

This is so scary. Two or so years ago my 26ish Cushings gelding was NQR in the field; wouldn’t eat anything and spit out water when he tried to drink. Called vet, she said to get the hose and gently squirt water in his mouth a few times. I walked him afterwards and he blew aout huge cigar-shaped wad of grass.

She never mentioned antibiotics, pneumonia, or even soaking his feed. I was lucky to be there because his symptoms were so subtle that I KNOW no one would have seen anything wrong. And afterwards, reading about choke here, squirting water isn’t really a good thing to do.

Guess were were extremely lucky.

I am sure a horse can choke on any feed but we switched my mare to Senior and to my knowledge, never choked again. My vet’s rationale was Senior “disintegrates” easily.

I had an old mare who choked 1 time and had to be tubed. She stood with her head hanging with tons of saliva coming from her mouth. She was tubed with no complications after the fact.

I now have a mare who has choked on me twice in the past few months. I think she eats too fast, and her symptoms seemed like colic at first (trying to go down, stumbling, etc). After a discussion with the vet after the 2nd incident we realized it was actually choke (drama queen!). She passed them on her own both times, but now her alfalfa pellets are soaked longer and she eats them almost soupy. Thanks for this thread - it’s giving me more to think about and keep an eye on if I end up with another incident.

It’s a good idea to give a horse banamine for several days after a choking incident. The choke itself can cause the esophagus to become inflamed and swollen and that can then cause a subsequent choke.

Both antibiotics and anti-inflammatories are SOP after a serious choke. Even those that clear by themselves in a few minutes, get carefulley watched. And all future feeds are soaked.