Dressage Today - - Content - By Harry W. Werner, VMD

How to Deal with Choke

In the horse, a di­ag­no­sis of choke refers to an ob­structed esoph­a­gus. Un­like hu­mans who ex­pe­ri­ence this con­di­tion, a horse with choke can still breathe. How­ever, the horse can­not move food or saliva to his stom­ach. Horses with choke usu­ally suf­fer sig­nif­i­cant dis­tress and dis­com­fort. They typ­i­cally dis­play the fol­low­ing signs: anx­i­ety, drool­ing, dif­fi­culty swal­low­ing, ex­ten­sion of the head and neck, cough­ing and re­gur­gi­ta­tion of food and frothy wa­ter on the muz­zle, stall floor and walls, feeder and wa­ter bucket, and on their front legs.

Al­though some cases of choke are mild and re­solve spon­ta­neously, pro­longed episodes can re­sult in a per­ma­nently dam­aged esoph­a­gus, as­pi­ra­tion pneu­mo­nia or death. We con­sider any choke episode to be an emer­gency. If you think your horse has choke, con­tact your vet­eri­nar­ian im­me­di­ately.

Un­til a vet­eri­nar­ian ar­rives, first aid con­sists of re­mov­ing all feed and wa­ter, pro­vid­ing quiet stall rest and ab­stain­ing from try­ing to re­lieve the choke. Try­ing to re­lieve the ob­struc­tion by pour­ing liq­uid down the horse’s throat or in­tro­duc­ing a hose or tube will not re­solve the con­di­tion and will very likely make things worse.

Risk fac­tors that can pre­dis­pose a horse to choke in­clude: dry foods, feed­ing large treat ob­jects (whole ap­ples and car­rots), in­ad­e­quate ac­cess to wa­ter, ag­gres­sive feed­ing be­hav­ior (bolt­ing of feed), den­tal dis­ease and in­ges­tion of for­eign ob­jects (usu­ally a prob­lem lim­ited to wood chew­ers).

A choke di­ag­no­sis rests on the pa­tient’s his­tory, the clin­i­cal pre­sen­ta­tion of the con­di­tion and the in­abil­ity to pass a na­so­gas­tric tube into the stom­ach. On oc­ca­sion, di­ag­nos­tic imag­ing modal­i­ties (ra­di­og­ra­phy, ul­tra­sonog­ra­phy, en­doscopy) are used to ac­cu­rately as­sess the size and na­ture of the ob­struc­tion.

In­tra­venous se­da­tion can re­lieve a horse’s anx­i­ety and re­lax the mus­cu­la­ture of the esoph­a­gus and the sphinc­ter lead­ing into the stom­ach. The seda­tive’s ef­fects can fa­cil­i­tate the process of pass­ing a na­so­gas­tric tube to the point of the ob­struc­tion so that the vet­eri­nar­ian can dis­lodge and move it via re­peated flush­ing of vol­umes of wa­ter through the na­so­gas­tric tube.

In the rare case where lo­cal flush­ing of the ob­struc­tion is un­re­ward­ing, esophagos­tomy surgery can be per­formed. Af­ter ap­pro­pri­ate se­da­tion, lo­cal anes­the­sia and sur­gi­cal-site prepa­ra­tion, the sur­geon makes a lin­ear in­ci­sion over and down to the ob­struc­tion. The block­age is then re­moved man­u­ally. The in­ci­sion is of­ten left open for a time and closed only af­ter tis­sue in­flam­ma­tion has sub­sided.

Af­ter­care for choke should con­sist of a wa­ter-only diet for at least 12 hours and non­s­teroidal an­ti­in­flam­ma­tory drug ad­min­is­tra­tion for sev­eral days. If any pos­si­bil­ity of as­pi­ra­tion of esophageal con­tents into the res­pi­ra­tory tract ex­ists, an ap­pro­pri­ate an­tibi­otic is also given. Once solid food is rein­tro­duced, it is best to soak the food be­fore feed­ing. Of­fer­ing soaked feed for sev­eral days can help the tran­si­tion from liq­uids to solids oc­cur un­event­fully.

As with any health con­cern, pre­vent­ing prob­lems is far prefer­able to treat­ment. You can min­i­mize your horse’s risk of choke by feed­ing treats in small pieces, with­hold­ing all solid foods fol­low­ing se­da­tion for at least an hour, pro­vid­ing free-choice palat­able wa­ter at all times, en­sur­ing that your horse’s teeth are in good con­di­tion, soak­ing dry food­stuffs prior to feed­ing and tak­ing mea­sures to pre­vent be­hav­iors such as wood-chew­ing and ag­gres­sive eat­ing.

A na­so­gas­tric tube is used by a vet­eri­nar­ian to dis­lodge an ob­struc­tion via re­peated flush­ing of wa­ter.

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