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OTTB Breathing problems- paralyzed VF

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  • OTTB Breathing problems- paralyzed VF

    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!!
    Last edited by QLuke; Feb. 20, 2012, 07:36 AM.

  • #2
    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?
    http://community.webshots.com/user/sophiegirl23

    Comment


    • #3
      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.

      Comment


      • #4
        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
        Last edited by judybigredpony; Dec. 29, 2011, 04:23 PM. Reason: added

        Comment


        • #5
          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...rente/ivis.pdf

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          • #6
            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).
            I.D.E.A. yoda

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            • #7
              Originally posted by judybigredpony View Post
              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.

              Comment

              • Original Poster

                #8
                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.,..

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                • Original Poster

                  #9
                  Phoebetrainer....where did you have surgery? Is there a name for the prothesis I could research or ask vet about?

                  Comment


                  • #10
                    I*s the Prothesis the one used in a "Tie Forward" surgery??

                    Comment


                    • #11
                      Sounds like you have two issues, Chondroma and paralysis? It's alarming how frequent these issues are popping up in the TB world. :/

                      Comment


                      • #12
                        Originally posted by QLuke View Post
                        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.
                        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" Rolls eyes. Why on earth would anyone spend money on an operation and then not follow instructions for after care?

                        Comment


                        • #13
                          Originally posted by QLuke View Post
                          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%.

                          Comment


                          • #14
                            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.

                            Comment

                            • Original Poster

                              #15
                              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....

                              Comment


                              • #16
                                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.

                                Comment


                                • #17
                                  Dr. Robert Holland in Lexington is the absolute best. Good luck.
                                  "Gallop as if you were to die tomorrow, jump as if you were to live forever."

                                  Comment

                                  • Original Poster

                                    #18
                                    Update partial arytenoidectomy/cordectomy

                                    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...

                                    Comment


                                    • #19
                                      Originally posted by QLuke View Post
                                      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." 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.

                                      Comment


                                      • #20
                                        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.
                                        McDowell Racing Stables

                                        Home Away From Home

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