Monday, February 21, 2011

Beet Pulp

It is nice to be known for being good at something. In my particular case I had recently moved to an area where the previous veterinarian was not a horse person. When word spread around the equine community that I had a bit of horse sense, I quickly gained a following of devoted horse owners. Normally I would be flattered by this but as you might guess at times it can lead to some interesting situations. Just like everyone I know I enjoy a little time off. I had gone on a trip to visit some family for a long weekend. On my leisurely drive back home I received a concerned phone call from one of my devoted clients. She was concerned that her horse was choking and assured me that she wasn't going to have the other doctor look at it, but instead wanted my opinion.

Perhaps I should explain a little more about choke. In most choke cases that I deal with we are not talking about half-swallowing a peanut, not being able to breath, and needing someone to do some quick fist-to-gut action to save your life. Instead we are talking about an obstruction of the esophagus (the tube that takes food and water from your mouth down to your stomach). Lets continue with the story. Of course, the first thing that I told her was that I was not yet back home and would not be able to come right out. I recommended that another vet really should look at it to make sure she got the care she needed right away. Instead, upon finding that I was unavailable, she said that she thought the horse was going to be fine and just wanted to know for sure what things to watch for to make sure. Well the two big keys are if a choked horse can eat and drink they are no longer a choking horse. The owner called me back later to tell me that the horse was eating grain and drinking water and I thought it was the end of the story.

I thought wrong. She called me the next day, concerned about her horse again. Unfortunately finances were a major restriction in what the client was able to do for her horse so she was trying to manage as best she could simply getting advice over the phone. Again she assured me that the horse was drinking water and in my mind sound like it was still doing okay.

The next day rolls around and she finally decides that the horse is too valuable a performance horse and really needs to be looked at. When horse and owner arrived I knew we were in trouble. The mare was very gaunt, dehydrated, and weak. Bad, bad news. First we tried passing a tube. No luck. Next we tried an injection of a smooth muscle relaxant. No luck. Tube again: no luck. As I said before finances were a big constraint and the owner said she really was at her limit for spending and couldn't afford anything else.

Having heard of this but never tried it because of the risk for complications I offered another option. I said we could try to break the choke up (by this time we had figured out that our most likely cause of the choke was a pelleted dry beet pulp that the mare had attempted to eat three days prior) working from the top down. The idea was to flush small amount of water in and the siphon it back out with chunks of the beet pulp coming along for the ride. It would cost very little and would just be time and energy put into it. Unfortunately there was a good deal of risk of too much water being flushed and having it then breathed in to the lungs to start a bad case of aspiration pneumonia. With these concerns in mind the owner opted to go for it as it was pretty much her last and only chance to save this good horse.

After 45 minutes of flushing and siphoning I felt that little progress was being made. Of course I had other cases and appointments to take care of and couldn't stand their flushing all day. The owner, on the other hand said she was willing to sit and keep working at it for as long as I would let her stay. Seeing no more harm in that than just euthanizing the horse directly I showed her what to do and set about some of my other tasks. Checking in every few minutes and doing more flushing it seemed that very little progress was being made.

After what seemed like all afternoon we finally started to see some progress. There were actually some flushes that seemed to be working. The owner wanted me to take over again and I agreed to try one more time. A couple good flushes of water in were successful at siphoning a good long stream of beat pulp back out. On my next push down the esophagus I was amazed to find that nothing was stopping my tube. I continued pushing until I reached the stomach and I was relieved to say that we had just saved this horses' life. The owner and her friend started dancing around and hugging me and almost crying. No, I am pretty sure they were crying...but these were definitely tears of joy.
Sometimes it pays to never give up.