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Up the Nose

My phone rang at 10:30 PM that winter night.   In a vet’s house when the phone rings after 9:00,  you can bet it’s not a social call. I had been Julie’s vet over 15 years, but I didn’t recognize her voice right off.  She was panicked.

“Dr J!   You know I’ve had horses forever, but I’ve got something here I’ve never seen before. I think you need to get right out here. It’s Pete, my old gelding.  He was OK at feeding time tonight. He gobbled down his grain real fast like always and seemed fine. But I just got back from barn night check, and I think he’s dying.

Through the years  I have found  that if I deliberately talk slowly when I have an excited caller, the panic at  the other end seems to lessen, at least somewhat.  I tried it.

“Julie, What is Pete doing, is he down? “

Slightly slower: “No, no he’s not down, but he’s sure not right.”

“Julie, tell me what you are seeing.”

The pitch of her voice started to rise again. “You are going to think I’m crazy, but I think his brains are coming out of his nose!”

At this point it was hard for me to keep to my slow pace as Julie’s excitement was starting to affect me. I forced myself to speak calmly,

“Did I hear you right? His brains? Through his nose?”

The words spilled out: “Oh Doc, it’s awful, it’s all whitish green and foamy. He  gurgles in his throat, his neck is all tight and he keeps going in circles in his stall.

That was the tip off for me, and I realized what was probably happening.

“Julie, I think I know what’s going on, and can probably help.  This is what I need you to do. Get all the hay out of his stall, and take the water pail out. I’ll be there within the hour. Chances are we can fix this. “

I pulled into Julie’s barn yard about 45 minutes later. Pete’s stall was the first on the right, and Julie was in there with him, rubbing his neck. He was one uncomfortable horse. His eyes were wide open and he kept flexing his very tight neck. Sure enough, a greenish white foam was bubbling out of both nostrils.

“Julie, it looks like he’s choked.”

“Oh, is that what’s going on? I’ve never had that happen. That means he’s got some food stuck part way down his throat, right?”

“Exactly. What you see is coming out of his nose is a mixture of saliva and some feed. I remember that you said he gobbled his grain.   Did you happen to have any beet pulp mixed in with it?

“Yes, how did you know that?  I like the beet pulp because it’s low in sugar.”

“That’s right, all the sugar has been extracted out of the beets, and what is left is a good feed, but the process makes it very dry. That’s why I recommend soaking it for several hours. Two parts water to 1 part  beet pulp is about right. If it’s not served wet, it can get stuck on the way to the stomach.”

“I haven’t soaked it because I’m feeding a pelleted beet pulp that you aren’t supposed ‘’to have to soak.’

“I’ve heard that too, but in the last couple of years we’ve even had it cause some chokes. There is also a newer form of beet pulp which is shredded and sometimes mixed with soy. It is probably less dangerous, but in any form I recommend the soaking.”

As we talked I drew up some IV tranquilizer for Pete so we could try to move the mass in his neck. After his head dropped I passed a stomach tube through his nose and down his throat.  I hit the obstruction about half way down his neck. With some warm water pumped in and gentle pushing the mass passed down into the stomach.

Pete was an old timer. They seem more prone to choke, perhaps because they don’t drink as much as they should. In our practice we see many more cases in the winter, probably because of the partial dehydration, but also because summer grass has so much more moisture than dry hay.

Pete had three things going against him:  it was winter, he tends to bolt his grain, and he was eating beet pulp. Unfortunately we can’t do much about winter other than warm the water which does encourage drinking.  Adding oral electrolytes also gets horses drinking more. If you feed beet pulp or other dry food, make it a rule to soak. If you have a grain gobbler, a dozen golf ball size rocks in the grain dish will slow him down some.   (This does make for noisy feed times.) A common practice on the race track is to feed hay first to take the appetite off a bit so that horses don’t dive into their grain with quite as much gusto.

When food gets stuck in the esophagus on the way to the stomach it causes a buildup of saliva (which horses produce a lot of) on top of the mass. Once a bolus of food is caught, the saliva and any food that a horse eats after he is choked will back up in the throat, and finally start running out the nose. It can’t come out of the mouth because of the horse’s long soft palate. It tends to foam because as the horse breaths his wind cutting through the saliva produces bubbles, and yes, sometimes it really does look like brains coming out of the nose.

Most chokes clear on their own. The food mass may soften with the saliva,  and the muscles of the esophagus can then push the mass along. If the mass does not move, the situation has the potential of becoming more serious. Saliva continues to be produced, and the horse keeps swallowing.  As quarts of the slippery fluid back up to the top to the throat,  the whole mess starts to come up and out through the nose, especially when the head is lowered.   The potential danger is that some of the backed up fluids may spill over into the trachea and down into the lungs potentially causing inhalation pneumonia.

It’s important to keep a choked horse from eating or drinking. More food and water just makes the condition worse.   As a first aid measure I will sometimes tell owners to give a couple of raw egg whites to a choked horse in the hopes that their slipperiness will lubricate the stuck food and help it to pass.   Lately a new drug, called Buscopan, that relaxes smooth muscle, has proved helpful in treating choke. Even so, some horses that have been choked for several hours may be difficult to relieve. Banamine is often given to relieve the inflammation, and antibiotics are commonly given in case some of the backed up feed gets into the windpipe.  Surgery may be considered as a last resort.

Choke is uncomfortable. If you have ever made the mistake of swallowing too big a bite of food and having it catch momentarily on the way down, you can appreciate a horse’s distress, particularly if the condition goes on for hours.  Call your vet early on if your horse is choked. The advice may be to wait a bit, as most chokes do relieve themselves, but if you call the second time they will probably want to come out to try to move the obstruction.


David A. Jefferson, DVM


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