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Wow. Crazy choke story! Update, #27. Good news/bad news

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  • Wow. Crazy choke story! Update, #27. Good news/bad news

    My two year old has had a few issues with choke in the last few months. She is a very eager eater. She'd choked a couple times on her grain, and we'd made changes to resolve the issue. Her previous chokes were always high in the esophagus and did not require any vet intervention to resolve.

    She choked again Saturday night. I got a call late Sunday morning that she was snotty and not eating, but the new barn had never seen a choke so didn't ID it as such. When I got out in the early afternoon (a case of the snots just didn't make me rush), it was really apparent what we were dealing with--vet was called ASAP. He advised banamine IV while we waited and was surprised at the 102.2 temp.

    The choke was just in front of the stomach and cleared easily (unusually so) but the vet felt there was more resistance on the tube than there should be. Two hours post banamine temp was 102.4. Naxcel was prescribed. No food for 24 hours, then mash for 7 days. Vet advised to get the horse worked up, as he felt something unusual was going on.

    The vet I use for complicated stuff came out today to evaluate. Scope was relatively normal, but with impressive abrasions between 1.2 and 1.4 m with a slight narrowing toward the end of that. Could not tell what was causing the narrowing, as it was outside of the esophagus. Scar tissue a possibility, as was abscess. Tumor unlikely based on the age of the horse. Vet pulled blood for a fibrinogen level--high fibrinogen = abscess.

    Got a call at about 7:30 tonight. Fibrinogen THROUGH THE ROOF. Over 1300. Vet says not the highest she's seen, but in the top five. Course of action is Excede + Rifampin for 30 days, then recheck. Prognosis is good.

    I'm terribly impressed at how sharp my vets are for catching this, and I am honestly thrilled that this horse was choking. I don't think we would have caught it otherwise. I have weird shit happen to my critters all the time, but this is certainly a new one. I'm glad I was aggressive on the follow up here! I'm hopeful that this will resolve without further problems and we never see a choke again...
    Last edited by Simkie; Jan. 15, 2013, 12:29 AM.

  • #2
    Scary!!! Glad you caught it. Those internal abscesses can be SUPER tough to diagnose!


    • #3
      Just curious if someone could explain what may have caused this abcess?

      Do vets believe it was from previous choke?
      "There is no fundamental difference between man and animals in their ability to feel pleasure and pain, happiness, and misery." - Charles Darwin


      • Original Poster

        No, it is not from a previous choke. The abscess is in the chest, external to the esophagus. It may be bastard strangles, internal pigeon fever or just another type of infection that's taken up residence in the chest. We'll likely never know, as getting a culture of the infectious material would be terribly risky. Better to just hit it hard with antibiotics and make it go away.


        • #5
          Oh my. Scary stuff. Glad you guys caught it! Jingles for a speedy recovery!
          A good horseman doesn't have to tell anyone...the horse already knows.

          Might be a reason, never an excuse...


          • #6
            That's just insane! Good luck to you and your mare!


            • #7
              I wouldn't rule out an increase in temperature and fibrinogen due to aspiration.
              "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

              ...just settin' on the Group W bench.


              • Original Poster

                Ghazzu, we did discuss aspiration pneumonia. The lungs were clear on Sunday and the vet who cleared the choke felt there was something more complex going on--tumor or abscess in the chest. He's quite bright and it's the type to go worst case just because.

                I did not ask the vet specifically about an aspiration pneumonia with regard to the fibrinogen when I spoke with her yesterday, but I'm under the impression that over 1300 (I think she said 1380?) is exceedingly high, and indicative of something big and long-term occurring?

                How would you rule out an aspiration pneumonia? I value your opinion and certainly want to make sure we're nailing this down.


                • #9
                  Originally posted by Simkie View Post
                  Ghazzu, we did discuss aspiration pneumonia. The lungs were clear on Sunday and the vet who cleared the choke felt there was something more complex going on--tumor or abscess in the chest. He's quite bright and it's the type to go worst case just because.

                  I did not ask the vet specifically about an aspiration pneumonia with regard to the fibrinogen when I spoke with her yesterday, but I'm under the impression that over 1300 (I think she said 1380?) is exceedingly high, and indicative of something big and long-term occurring?

                  How would you rule out an aspiration pneumonia? I value your opinion and certainly want to make sure we're nailing this down.

                  I'm certainly not saying that there isn't an abscess--the endoscopic exam which showed narrowing is quite suggestive of that.
                  I was simply commenting that a rapid development of fever and an increase in fibrinogen could occur in the absence of an abscess.
                  (I once examined a mare who had choked during the night and had a fever of 105.5 the next morning.)

                  In any event, the antibiotics should cover any aspiration pneumonia.

                  Good luck and lest us know how things go.
                  "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

                  ...just settin' on the Group W bench.


                  • Original Poster

                    Little Miss Trouble seems to be feeling better and started really cleaning up her mashes yesterday. She is brighter, her whinny sounds less sad and she is coughing less when she does eat.

                    First dose of Excede in this AM, and Rifampin just arrived from Precision, so first dose of that will be tonight.

                    Ghazzu, if a aspiration caused the fibrinogen to spike, my concern then would be just what IS causing the choke? I'd really like (oddly enough) for this horse to have an abscess in her chest. Explains the choke, and also means that if we fix the abscess, the horse will no longer choke. Nice and tidy Would you see a 1300 + fibrinogen level in a newly minted pneumonia?


                    • #11
                      Is it possible to ultrasound the thorax? Might be tricky trying to visualize an abscess near the cardia, but would be interesting.

                      Fibrinogen is an acute phase protein, and can rise dramatically in a short time.
                      But it certainly doesn't mean that there isn't an abscess there.

                      And just to give you a little more info on my personal perspective, I tend to assume some degree of aspiration pneumonia on any choke that doesn't resolve very quickly and treat accordingly.
                      I'm paranoid like that.
                      "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

                      ...just settin' on the Group W bench.


                      • Original Poster

                        It's only money and time, right? My vet is out at a conference until sometime next week, though. Think we'd see anything after 4 days of Naxcel and two doses of Excede and a weekish of rifampin?


                        • #13
                          I don't know--but I think the rifampin was a clever idea, if there's an abscess.

                          I suspect your vet is at the AAEP meeting?
                          I'm jealous.
                          It always falls during the end of the semester...one of these years, I'll pre-record the last week, and go.
                          Haven't been in years.
                          "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

                          ...just settin' on the Group W bench.


                          • #14
                            Glad you found the cause for the choke. What sharp vets you have. They're keepers.

                            Being that it is now 2 days following her choke, you would have already found symptoms of pneumonia by now. These develop really rapidly, usually within 8 - 16 hours following choke. I don't think you have to worry about that now, although pneumonia is a genuine complication that can follow choke.

                            So, you did good, wow what a heart-stopper though, hey!

                            I have 1 mare that is a choker. Her first episode was excitement-related. She had just moved to our place and was running around like an idiot and grabbing food here and there and poof, choked. This one nearly killed her. By the time the vet got there, blood was coming from her mouth, her nose, mixed with green slime gooping everywhere, and she was trying to lay down, violently shaking, and was getting shocky with blue gums. Vet figured she ruptured her esophagus. Even though we started her right then and there are IV Excenel, plus penicillin and gentamicin, she had florrid pneumonia within 24 hours. Vet inserted a chest drainage tube because she was literally drowning and over the course of 2 days removed 20 Liters of fluid from her lungs. She dropped a few hundred pounds, as she was not allowed to eat for a few days until the esophagus healed (this heals rather quickly) but she survived. You don't even want to know how many thousands that vet bill was. The second choke happened 3 days after she foaled, again probably anxiety-related, but I was able to resolve that one myself and again vet recommended more Excenel so she went on a long course of that, but she was fine. The third episode of choke again was life-threatening and was most likely a result of scar tissue from the first serious choke episode narrowing her esophagus. Vet had to insert a tube to push the food bolus down, and as he was withdrawing the scope, abraded a small artery in her nose which produced extremely brisk bright red bleeding. Probably the first and only time I saw my vet go pale and get anxious. We both thought she was going to bleed out, because how can you reach up her nose to pressure an artery up there! He managed to stuff a whole bottle of blood stop powder up there, plugged her up really good, which made her want to snort, so sedation was in order until things had settled. She lost her pregnancy, obviously, with that trauma. She now chokes all the time probably at least once or twice a week, and the mare is so used to it, she just moves off quietly away from the rest of the herd and stands quiet. She has learned that if she stays real quiet and just waits, it tends to pass. Sometimes I need to help her by adding a bit of water to her mouth with a syringe and even rarely still add some banamine for pain. She gets everything fed wet and mushy and space meals every 6 hours so she learns the schedule and doesn't get too hungry. I always keep Excenel on hand now, just for her. It's liquid gold and VERY expensive, but super-duper stuff for pneumonia.
                            Practice! Patience! Persistence!


                            • Original Poster

                              Ghazzu, yes, that sounds right. She frequently attends such things, and I think that's one of the reasons she caught Blush's c-spine arthritis so quickly several years ago--she'd just been to a conference about it spinal issues. Had a whole book of example radiographs! That a bummer it lands just at the end of the semester for you.

                              Rodawn, that is a terrifying story about your mare! OMG! I do not expect to see any signs of pneumonia as we treated with Naxcel right away, which is the same drug as Excenel. We've now switched to Excede, which is the same drug, but an extended release version, plus Rifampin, which is an okay antibiotic on it's own but allows better penetrance of the antibiotic into an abscess (right, Ghazzu?) and I think we are continuing that for 30 days.

                              I gotta say, Rifampin is a wild red/orange color. It looks like paint pigment. I'm glad I was told it will make her urine red, too, because that would have freaked me out.


                              • Original Poster

                                And, in typical fashion for a horse that belongs to me, Seven went downhill today. (Seriously, why is it always MINE that have the complicated, crazy issues?)

                                This AM she was bright and eager to eat, but had several cow pie manure piles in her run. I picked up some probiotics on the way home from the barn, figuring I would add to her usual ration, but was not overly worried. (As an excellent example of foreshadowing, I eyeballed the Bio-Sponge at the vet supply place and thought "I should pick up a couple tubes of that...you know, just to have. Eh, next time.")

                                This PM she had not eaten, was depressed and not interested in food, had manure down her hind legs and a temp of 102.7. Cow pie manure piles now liquid. Sigh.

                                Gave banamine, called various vets. Out of town vet who scoped and prescribed Excede and Rifampin unavailable. Vet who cleared choke said banamine, stop Rifampin, monitor hydration and hospitalize for fluids in the AM if dehydrated, as colitis probable.

                                An hour after banamine in (IV), Seven's temp was down to 101.7 and she was so-so interested in food (but eating, so yay.)

                                We will see what she looks like in the morning :-/


                                • #17
                                  Have been following your story.. ugh.. little prayers things clear quickly. Pls keep us posted.


                                  • #18
                                    Hoping things improve quickly for your girl!
                                    "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

                                    ...just settin' on the Group W bench.


                                    • Original Poster

                                      AM update:

                                      Temp 99.2, CRT good, membranes slightly tacky but not bad--hydration doesn't look 100% but it's not BAD, either. Seven was bright and had eaten her soaked senior overnight, but not the soaked alfalfa pellets. Eager and looking for food. Manure still a mess.

                                      Vet who prescribed rifampin and excede says to stop everything and she will assess when she returns later this week.


                                      • #20
                                        Simkie: Thank you for posting about your horse. Makes us all ever more vigilant over out guys. And good luck too.

                                        I did have a horse who choked frequently. FOr him, he had TMJ. His teeth had to be done twice a year and we had a chiro work on him.

                                        Again, good luck with your horse.
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