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QLuke
Dec. 29, 2011, 01:00 PM
I recently acquired ab3 year old OTTB who has been diagnosed by two vets in KY with left VF paralysis and laryngeal chondritis. Both vets recommended close to the same...
1) laser removal of part of the left arytenoid to increase opening of airway
If this doesn't work the next step is....

2) arytenoidectomy (left)
(sent email to Dr Parente at New Bolten and he said without seeing horse and fuzzy scope pic hard to tell but leaned toward arytenoidectomy)

Currently he is around 50% airway clearance. Neither vet saw him under tack. When ridden his breathing becomes labored after 10 min and this is at an easy canter.
I haven't started much training yet with him. However, I am already so attached to him AND he has the best mind/ attitude. I'm super excited at his potential but am so afraid the breathing is going to stop it all.
My questions are these
1) any one with experience with this?
2) what vet to use? I'm in Lexington so have access to some good ones
3) laser v. Arytenoidectomy
Really appreciate any advice/ shared experiences
Thanks!!

SophieGirl23
Dec. 29, 2011, 02:03 PM
I just had a horse with this. They originally thought that they would be able to laser the chondromas off, but on further scopings noticed that over 85% of his throat was compromised and the largest one was behind his previous tie-back surgery (apparently this is becoming more common with horses with previous tie-backs) and wasn't going to be easy to get to. They said the arytenoidectomy was the only way to even give him a chance at being able to be ridden again and that was just being able to be lightly ridden. They didn't think he'd be able to go back to eventing again. With all the complications they rattled off to me I choose to let him go. I ended up donating him for a throat study at the Marion Dupont EMC.

Hopefully, with less of his throat compromised you'll get better results?

cindylouwho
Dec. 29, 2011, 03:25 PM
You might talk with Dr. Gary Priest in Versailles. His wife is an upper level dressage rider and he does a lot of throat work in the TB world.

judybigredpony
Dec. 29, 2011, 04:21 PM
Before you go ahead w/ the Arytenoidectomy You need to 100% onboard for the after care. There is more to this than just a surgery and some lay-up. Did they tell you about reflux when eating and drinking? The success to fail rate and he most likely will be a very tough re-sell and need very specific life time care.
Not trying to throw an anchor out but do investigate the long term effects......

Try PM ing COTH'er Muleskick she has had experiances w/ both types of throat surgeries

caryledee
Dec. 29, 2011, 05:09 PM
I don't know which vets you have spoken with so far, but Dr. Woodie at R&R gave a presentation on throat upper airway problems/surgeries at WEG. I believe he specializes in them. I have been looking into throat surgery for my horse and if money was no object, he would go to R&R. If money and time were no issue, I might make the trip to New Bolton. :) Dr. Parente has written the book on the subject. Did you see this article? http://www.ivis.org/proceedings/aaep/2003/parente/ivis.pdf

ideayoda
Dec. 30, 2011, 08:05 AM
For what it is worth, is this on a lunge (treadmill) when the horse is up and open? Or only when ridden (lower/closed)? The first is very important when training (up and open...not dressage de jour) and combine it with surgery (if there is paralysis).

phoebetrainer
Dec. 30, 2011, 05:56 PM
Before you go ahead w/ the Arytenoidectomy You need to 100% onboard for the after care. There is more to this than just a surgery and some lay-up.

I second this. I had a horse (4 yr mare) who had a total left laryngeal paralysis. I ended up having a prosthesis fitted to hold it back - similar to a tie back. I was warned before the surgery that the surgery itself could almost be guaranteed to be 100% sucessful - its the aftercare that decides if the surgery goes on working. Not sure about an arytenoidectomy - but I was told: no excercise to cause even heavy breathing; no neighing; no coughing, choking etc (so careful with diet) - for at least 6 weeks.
Surgery was sucessful and I went on to event her. I had a few control issues initially though - previous to the surgery she had been unable to canter for more than about 200 m without running out of breath and having to stop. After surgery, I realised that I'd never really installed a stop button and we had to do some major re-training.

QLuke
Dec. 31, 2011, 05:36 PM
I have actually emailed Dr Parente and he could not make a good opinion based on scope pic I had but given what I told him, he was the only one who actually said he would probably do arytenoidectomy over the other options. Dr Rodgerson at Haygard and Dr Johnson in Lex both suggested laser first with possibility of further surgeries (arytenoidectomy, tie back?) if laser didn't help. He has not been in serious work with me yet.just off track in Nov but makes noise on lunge and it starts under tack at canter- hand gallop with little contact. I can't believe anyone would have raced him....
I just want him to not struggle, have more breathing capacity for lower level eventing and hopefully reduce noise some. I'm already o attached to him - he could be so much fun to event.,..

QLuke
Dec. 31, 2011, 05:38 PM
Phoebetrainer....where did you have surgery? Is there a name for the prothesis I could research or ask vet about?

judybigredpony
Dec. 31, 2011, 06:15 PM
I*s the Prothesis the one used in a "Tie Forward" surgery??

FairWeather
Jan. 1, 2012, 09:33 AM
Sounds like you have two issues, Chondroma and paralysis? It's alarming how frequent these issues are popping up in the TB world. :/

phoebetrainer
Jan. 1, 2012, 05:48 PM
Phoebetrainer....where did you have surgery? Is there a name for the prothesis I could research or ask vet about?

Ummm, I'm in New Zealand, so probably a bit too far to travel:D.
No idea of the name of the prosthesis sorry. This was some time ago - before laser was being used much in horses.

After the surgery, when I was discussing it with a group of people, one person who I didn't know said that she'd had the same thing done on a horse. She said it was great at first, but then it stopped working "after he'd galloped around the paddock". I asked if they'd been told not to let him breath heavily - ie gallop etc. She was "yeah, but he was breathing so much better and really wanted to":eek::yes: Rolls eyes. Why on earth would anyone spend money on an operation and then not follow instructions for after care?

caryledee
Jan. 2, 2012, 08:11 AM
Phoebetrainer....where did you have surgery? Is there a name for the prothesis I could research or ask vet about?

In my research, "Prosthesis" is sometimes a term used instead of "suture" when talking about a normal tie back procedure.

I've talked to a lot of vets/surgeons about surgery on my horse and have gotten different opinions on what should be done from practically all of them. It's hard to know what to do!

From everything I have read, the Arytenoidectomy seems like a last ditch effort when everything else has failed.

One other surgery that was recommended to me is the ventriculectomy/cordectomy, with or without the tie back procedure. From what I have read, this alone can increase airway 20-30%.

JMarcyQuay
Jan. 2, 2012, 11:53 AM
No experience with the arytenoidectomy, but I had a ventriculectomy/cordectomy WITH the tieback done with my horse two years ago. Best decision I ever made! He was a grade 3 roarer with major exercise intolerance; soldiered on through training level but started to really struggle. *knock on wood*, no issues two years out -- an occasional cough when he eats hay too fast, and a hilarious whinny, but other than that he's good to go. He is now competing Prelim/Intermediate and the difference in his airways is AMAZING!

Post-op care is as easy or difficult as you make it. I planned the surgery for late November; end of the season and no heat/bugs/sweat to deal with. Kept horse on stall rest for 6 weeks, with his best friend next to him, so there was no one to whinny for and no way to run around and damage surgery site. Two hours of daily handwalking (morning and night) kept them both sane; and being in the great white north, they're used to being inside for inclement weather anyway. Trach hole got cleaned and coated in vaseline twice a day and healed over in 2-3 weeks, can't even see a scar, you can feel a dime-sized patch of scar tissue if you palpate, but otherwise invisible. Was back in light work at 5 weeks and full work at 7, no problems bringing him back.

There are a lot of risks of that kind of surgery and there are horror stories, but there are also a number of successes.

QLuke
Jan. 3, 2012, 06:43 PM
Thanks so much for all of the suggestions and recounts of your experiences....it all makes me nervous but hopefully there is a reason for everything and without the breathing issues I never would have gotten Moe and I can only hope for the best outcome. I think we will probably start with the laser surgery and see how he does...I got pics of his most recent scope and am forwarding them to DrParente....

southerneventgirl
Jan. 8, 2012, 09:22 AM
Very interested to hear what you find out and what happens with your guy. I have an almost identical issue. I got an ottb from a rescue. Have had him a couple of months now and he has lots of trouble breathing after he works. Was told when I was looking at him that he had a 'tie-forward' surgery done and that performance work should be no problem but that he needed down time from the track and they were not sure that he could have raced again anyway even after healing.
I too am loving this guy, his movements are outstanding, good conformation, uphill, light etc. but I'm worried that there is more to his problem now. (I didn't start off working him the moment I got him since I was trying to find out when his surgery had been done etc, and then the holidays hit etc) but now that he is in light work he is having problems catching his breath after he canters for a short period.
He has an appt for Tuesday to get scoped to see what's up.

olympicdreams04
Jan. 9, 2012, 12:41 AM
Dr. Robert Holland in Lexington is the absolute best. Good luck.

QLuke
Feb. 19, 2012, 10:48 PM
Well He finally had the surgery. Dr rodgerson at Haygard did it 1 1/2 weeks ago. We have been home for one week and trach was removed 9 days ago. we are on 2x day cleaning with betadine and coating surrounding skin with furazone to prevent scalding from sputum. He has two ~4 inch incisions, one under throat latch and one on neck where trach was. Throat spray and SMZ twice a day as well. Obviously, he is on stall rest and handling it wonderfully. Truthfully, I wasn't totally prepared for the intensity of the after care or enormity of the surgery. I knew we were going in for a parial but didn't know the left vocal cord was going to be removed as well. He is eating hay, grass and a mash very well. I am MOST concerned with what I saw today....water squirting out of trach hole after he drinks water. I am a speech therapist and understand laryngeal anatomy. I know he basically lost the entire left side of his "throat" and half of the trap door that protects the trachea/lungs from foreign objects/liquids ....that said, i can't find ANY definitive info on the web about aspiration after this surgery. Rodgerson didn't seem very concerned/worried when I questioned it after the surgery (yes I was the owner who stayed at Haygard all day..I even got to watch the whole surgery!!)...
So what I m MOST worried about now is the long term effect now of this possible aspiration that I think I am witnessing...

JMarcyQuay
Feb. 20, 2012, 07:55 AM
Well He finally had the surgery. Dr rodgerson at Haygard did it 1 1/2 weeks ago. We have been home for one week and trach was removed 9 days ago. we are on 2x day cleaning with betadine and coating surrounding skin with furazone to prevent scalding from sputum. He has two ~4 inch incisions, one under throat latch and one on neck where trach was. Throat spray and SMZ twice a day as well. Obviously, he is on stall rest and handling it wonderfully. Truthfully, I wasn't totally prepared for the intensity of the after care or enormity of the surgery. I knew we were going in for a parial but didn't know the left vocal cord was going to be removed as well. He is eating hay, grass and a mash very well. I am MOST concerned with what I saw today....water squirting out of trach hole after he drinks water. I am a speech therapist and understand laryngeal anatomy. I know he basically lost the entire left side of his "throat" and half of the trap door that protects the trachea/lungs from foreign objects/liquids ....that said, i can't find ANY definitive info on the web about aspiration after this surgery. Rodgerson didn't seem very concerned/worried when I questioned it after the surgery (yes I was the owner who stayed at Haygard all day..I even got to watch the whole surgery!!)...
So what I m MOST worried about now is the long term effect now of this possible aspiration that I think I am witnessing...

The aftercare is pretty intensive and REALLY important. My guy healed beautifully and without any scarring, but I was cleaning the area 2-3 times a day (it was during college, apartment was 1/2 mile from the barn, much easier logisitically than many people's situations). Coating the trach area with vaseline (but not the sutures on the incision!) and running your finger around the edge to clear out gunk while it's open help a lot with preventing scalding.

Aspiration is the biggest worry. I will say, my horse did have some initial troubles drinking -- same thing you described with your horse. First drink of water after surgery, water starts coming out of trach hole, I'm thinking "oh no...what have I done." :eek: My horse figured out real fast how to keep that from happening, I saw it maybe twice, then he got the hang of drinking and I never saw it again.

As I mentioned in my previous post, occasionally my horse will aspirate hay particles if he's eating too fast -- a few coughs and he's good, and he remembers to slow down. He usually dunks his hay, so that helps a lot too, many people soak hay for horses that have had tieback or similar surgery, but my picky one doesn't like it that way. What my vet said has held fairly true; a good majority of tieback horses will occasionally aspirate a small amount while eating, but not enough to cause harm, and will cough to solve the problem...so they will be the horses that will have that "barn cough" that makes everyone turn their head to try and figure out which horse is getting sick, but won't present any problems undersaddle. Methods to slow down eating help a lot, and most horses become accustomed to eating with their "new" throat, some just take some time to figure out that their anatomy changed.

Laurierace
Feb. 20, 2012, 09:23 AM
Aspiration is your biggest worry and one that never goes away unfortunately. I am sure they told you this but make sure you are feeding him off the ground for the rest of his life.

QLuke
Feb. 20, 2012, 04:10 PM
I think he is healing nicely I just can't get anyone (vet that is) to tell me what to do. His surgeon is out if town til Wed, hopefully he can make me feel better. I'm thinking I really wont until another scope is done to see what the closure really looks like. I was adviced to feed on the ground but now was told to give water on the ground as well. Any suggestions for a stall bound horse? I guess just offering it to him and then taking bucket out which I hate to do. ??
If he does get pneumonia what symptoms do I look for and is it pretty life threatening for a horse??
I feel just awful that I have possibly made things worse for him by electing yo do this surgery.....

Incantation
Feb. 20, 2012, 06:38 PM
I am not sure if it would be appropriate for your situation, but I use a 40qt muck bucket for water for most of my horses. I use a piece of baling twine to anchor it to the stall wall so they don't tip it. My dunker likes it better than hanging buckets too.

Laurierace
Feb. 20, 2012, 06:40 PM
I never gave the water on the ground but I guess it couldn't hurt. Put a five gallon bucket on the ground and use screw eyes on either side to secure a bungee cord if you want. Pneumonia isn't usually life threatening, I have dealt with it more times than I can count and everyone recovered. They generally just look sick. Maybe running a fever with a cough too but the first thing I notice is they just aren't as bright. I am sure your horse will be fine.

JMarcyQuay
Feb. 21, 2012, 07:40 AM
I think he is healing nicely I just can't get anyone (vet that is) to tell me what to do. His surgeon is out if town til Wed, hopefully he can make me feel better. I'm thinking I really wont until another scope is done to see what the closure really looks like. I was adviced to feed on the ground but now was told to give water on the ground as well. Any suggestions for a stall bound horse? I guess just offering it to him and then taking bucket out which I hate to do. ??
If he does get pneumonia what symptoms do I look for and is it pretty life threatening for a horse??
I feel just awful that I have possibly made things worse for him by electing yo do this surgery.....
These surgeries look UGLY. Several vets warned me before I had my horse done that it was going to be very, very gory, and look way worse than it is. I can send you pictures of my horse's, if you would like, but they're really disgusting. They told me he could come home from the clinic when he stopped bleeding, "oh in about four days." :eek:

Wet down hay and grain. My horse lived on soaked beet pulp for the first week (he won't eat soaked pellets, texture issue) then moved to non-dusty wet-but-not-soaked-and-squishy grain. Feed on the ground. Others gave some good suggestions for watering on the ground too, especially if he's having issues. I will say, with my horse, he does now eat and drink in normal-height feed tubs without issue (his hay is still on the ground). I know that's not the case for all, and some will be always restricted to ground feeding, but just offering another story...some go back to eating and drinking just as they did before.

Don't touch the sutures. Make sure they're dry, then leave them alone. They will heal on their own. Just monitor when they need to be taken out, and if you opt to do it yourself, understand that usually a "mattress stitch" is used instead of the normal suture, so they come out differently.

I don't know what your schedule/driving time/etc allows, but I usually cleaned the surgery area 2, sometimes 3 or 4 times a day. Thoroughly wash hands, get clean paper towel and wet with warm water. Wipe down whole trach area (avoiding sutures!) and remove all "gunk" that drains from trach (sometimes it's a little bit of nasty goo, sometimes it's a chunk of grossness, as long as it smells fine and only looks mildly gross, it's not infected...goo is normal). Surgeon instructed me to take a finger or two and fish around just inside the edge of the trach hole and make sure it's clear. As it heals, this will become harder and harder to do -- some mornings I was re-opening the hole that had closed over with goo the night before. A few days later, it was healed completely shut. It took probably 3 weeks total to close, then the remaining dent became a smaller and smaller scab until it was fully healed. I'm one of those people that picks at everything, so picking at scabs and trach goo and crusties was natural for me. Some people were repulsed by that...:lol:

Once the trach hole is clear and the area is cleaned, liberally apply vaseline to the entire outside of the trach hole, and downward a few inches towards the chin area. Again, avoid the sutures! Every time I would clean, I would have to wipe off the vaseline that I had put on earlier that day, and re-apply later, but it kept my horses from getting any sort of scald or skin irritation. Plus, the vaseline will sometimes attract a little bit of hay or shavings here and there.

I also hand-walked my horse several times a day to keep him calm and happy. I started walking/occasionally trotting undersaddle at 5 weeks or so, with the throatlatch on my bridle removed. We were back in light work (with a throatlatch, both incisions were completely healed over) at 6-7 weeks, jumping at 8 weeks, and foxhunting at 10 with no troubles. No issues since then (two years ago) and both scars are not visible to the untrained eye now. If you palpate the area, you can locate them, but otherwise they're invisible. The trach scar is maybe the size of a quarter.

If you do want to see pictures, let me know, they might make you feel better -- I have pics from surgery day and then from 3 weeks later and the difference is HUGE.

Derid
Feb. 22, 2012, 09:42 AM
They've told you correctly....it's really gross, when my guy came home the hole was so large I could put my fist into his throat, I could feel compressed air coming out the incision. Being a picker too:D, I just kept cleaning. But, 3 weeks and the incision was gone.

Destrier did cough initially when eating, but after the first week or two this subsided as well. I did take it slower than recommended bringing him back. Kept him in his stall (hand walking) an extra week, then put him in a round pen for 2 hour intervals for a month, then all day for a month, and finally dumped him out with a couple of broodmares for the winter. All in all, 6-7 months without any riding. Did this make a difference, I don't know. but, it didn't hurt.

The surgery was Fall 2009, and he has had NO issues. His whinny sounds like the laugh of a dirty old man. I can live with that. And, he is very happy. Plays hard in the field with his buddies, and never says no/or I can't, when asked to give more undersaddle. The surgery was the best gift I could give to this horse.

visorvet
Feb. 26, 2012, 11:51 AM
I feel just awful that I have possibly made things worse for him by electing yo do this surgery.....

Don't torture yourself. The horse had a significant problem and could not be used normally as he was. Lots of horses have this surgery and do just fine. Training and a job is what secures a horse's future more than anything, and with luck that is exactly what you have given this horse. A gift!