Chapter 4: Choke: Bob Smiley
As I was driving to Anna’s to see her horse with “the green stuff coming out of his nose,” I felt edgy. It’s always that way when I’m heading to an emergency. I try to talk myself into relaxing, but it never works. You would think that after all these years, I’d be able to take it all in stride. I wonder if paramedics go through mental gymnastics on their way to accidents. Is there a cure for this?
I remember my first, “just me alone” emergency call. A horse got curious about a wild animal in the pasture. He bent his head down to check out an adult porcupine and then snapped back up quickly with a nose full of quills. Dealing with porkies is common in our area, but again, this was my first all alone emergency. I was so nervous that, when I got close to the farm, I pulled the truck over to the side and opened The Merck Veterinary Manual that I always carried in my truck. Four years of vet school and now on the spot I doubted my ability to get things right. I hurriedly read how much sedative to give the horse for this condition and reviewed the best technique for pulling quills. It was months before I dared drive anywhere without that book.
Years later, I’m still a little nervous on my way to every emergency. The butterflies now fly more or less in formation, but they are still there, flapping their somewhat softer wings. I have never been able to stop the self-talk. On my way to a farm call I mentally review what I know about the condition I’m scheduled to see. Then I go over the usual treatment for it. Here’s how the dialogue with myself went that day on my way to Anna’s:
OK. Choke. In horses, food sometimes gets stuck on its way to the stomach. Just like in people, it’s often caused by eating something dry. The swallowed food gets caught about half way down the esophagus. The horse continues to produce and swallow saliva, but that starts to backup when it hits the blockage. Before too long the mixed mess starts to come out the nose. Some may trickle down the wind pipe. If it gets all the way to the lungs without being coughed up, the horse will get a nasty pneumonia.
Maybe this is just a snotty nose from a respiratory disease. No, I think he must be choked. Mary said green. That means food, rather than the creamy pus from an infection. Hope it hasn’t been going on for too many hours. Will I be able to get there in time to relieve it easily? Mary said the horse was shaking its head. I remember a case of horse rabies years ago where head shaking was the first sign. I missed its significance. No, don’t be stupid. This horse is vaccinated annually. I’ve vaccinated him for rabies for years! The vaccine is totally protective. So this can’t be rabies. Well, it’s never wrong to consider rabies. I wonder if Anna has taken his temperature. A high temp in a choked horse might mean some of it reached the lungs. I’ve had a few chokes through the years that I couldn’t resolve and had to send them to surgery. I wonder if Anna has surgical insurance on this one.
My ETA is now ten minutes. Time enough to mentally review treatments. First, I’ll have to give him a strong sedative and then an anti-spasmodic to relax the esophagus. If the mass doesn’t pass, it means getting out the stomach tube. The plastic tube is 8 feet long and roughly ¾ the diameter of a garden hose. I’ll pass it through the nose to the back of the throat. When the horse swallows, I’ll be able to push it down to the obstruction. My next job will be to pump water into the tube to get a siphon started. If I lower my end of the tube into a bucket, the mix of water, saliva, and chunks of the food will come up the tube and out. I’ll have to repeat this messy job until the mass is reduced in size enough to pass into the stomach.
As I pulled into Anna’s driveway, I put on my doctor mask which says, “Never fear, Ben Casey of the barnyard is here.”
Sure enough, the horse was choked, and it took half an hour of work to relieve it. During the process both Jack and I got totally wet with the slurry mix. At one point the end of the tube slipped out of the bucket, and Jack got a face full.
“Anna, from the looks of what came up and out, I think you might not have soaked the beet pulp long enough before you fed it.”
“What beet pulp?”
“This beet pulp right here.” I showed her the clumped material in my hand that had come up the tube. “It’s what was stuck in his throat. It should be soaked for 24 hours before feeding, or it gets stuck on the way down.”
“I’ve never fed beet pulp in my life. I was always afraid of causing a choke!”
“Rightly so.” I poked the material in my palm. “See this dry stuff? That’s beet pulp.” I smelled it. “Mmm that’s interesting, there is also some molasses in here.”
“Let me see. Yes, you’re right. I can smell that. Not only have I never fed beet pulp, we’ve never had any molasses here.”
“Seriously? You never feed beet pulp, and you never use molasses to sweeten things for the horses?”
“No, Bob, never. How could he have gotten into this?”
“Great question. It’s not like beets grow wild in pastures, and if they did, this is beet pulp, which means it came out of a bag. The beets have been commercially leached of all their sugar, and then all the moisture is removed in a huge drier. These processed beets are our human source of sugar. The dried pulp that is left after the sugar is extracted is pure fiber, and that’s good for horses. But it but tastes blah. We mix molasses with it so the horses will eat it.”
“Well, I’m serious, Dr Bob, I’ve never had either material on the place.”
“Have you guys just been on vacation and maybe had someone feed your horse for you? Or, could one of your boarders have fed it to your horse?“
“We’ve been right here, and I’m the one who feeds up. I’ve got four people who board here, and almost all are good friends, but I’ve never seen anyone bring a bag of beet pulp or molasses into the feed room. ”
“I have one boarder who is a complainer. ‘You aren’t giving my horse enough hay, the lighting in here is terrible, when you are going to fix the paddock fence…..’ It goes on and on. Just to keep her happy, I even had her horse’s stall lengthened by two feet because she said he didn’t have enough room!”
“Well, maybe that boarder isn’t poisoning your horse, but she is certainly poisoning the barn atmosphere.”
“You’re right, Bob, and I should sit down and have a conversation with her. If she isn’t happy here, she should move on.”
Half an hour later I pulled into the office driveway and turned off the truck. I stayed behind the wheel for a few minutes to think. If Anna didn’t feed the pulp or the sweetener, who did? Could that griping boarder have fed the beet pulp? I know Anna’s husband, Bill, and although he doesn’t share Anna’s interest in horses, he has always seemed to support her love of equines.
All of a sudden the smell coming from my clothes and Jack’s fur hit me. “Hope nobody’s around, Jack. Only you will enjoy the way we smell. “ As we entered the clinic by the back door, I stumbled over Jack as he tried to beat me inside, anxious to see Deb.
“Hi, Doctor Bob, how’s your day going?” Then, quickly Deb added, “Ooo, the way you smell, maybe not so good. What have you and Jack been rolling in?”
“It’s that bad, huh? We had a choked horse at Anna Schmidt’s barn. He’s happier now. Before we were done, we both got pretty slimy. Stomach contents never smell good. I think I’ll shower here at the hospital before I head for home.”
“Not a bad idea. Jody will appreciate that. You’ve got a complete change of clothes in the laundry room. Just throw everything you have on into the washing machine. Turn it on, and I’ll move everything to the drier when it’s done. Jack smells like he got a dose as well. I’ll give him a quick bath if you’d like.”
“Appreciate that. As always he had to be in on the fun. I want to say hi to Charlie before I go. When you see him, please tell him that after I get cleaned up, I’ll be here in the drug room restocking my truck. Right now the shower is a priority. I’m sure you’d rather not have me hanging out the way I smell. We can’t afford to be driving clients away holding their noses.”
“Well, Dr Charlie wouldn’t care. After all, he’s the guy that expresses the dog anal glands. He’s also the one who takes on the dogs that have been sprayed by a skunk. Some of the stuff you vets get into just isn’t very flowery. Anyway, I’ll tell him you want to say hi. “
Twenty minutes later both Jack and I were presentable. Charlie came into the drug room and found us.
“I heard you had a choke.”
“I did, and it was odd.”
“Well, it was a typical beet pulp choke, but Anna has never fed it. Yet, that’s what it was. She said there has never been any beet pulp on the place. There was also some molasses mixed in with it. She’s never used that either. She showed me the grain room. She’s right. There’s no beet pulp or molasses in there.”
“How do you explain the choke, then?”
“I can’t. She has a boarder who’s always griping, and her husband isn’t crazy about horses. That’s all I got.”
“Join the club. Yesterday was topped off by what looked like a cat poisoning.”