Respiratory diseases and conditions are very common in horses1 and can have a wide range of different causes. Flexible endoscopes like the STERIS Endo-i® are used to diagnose these conditions. STERIS Quality Manager Lorraine Bone and her sport horse Flash have recently embarked on a respiratory diagnostic journey including both endoscopic and surgical procedures. We caught up with Lorraine at her yard in Swindon for Flash’s final Endoscopic examination and to find out more about their journey.
Can you tell us a bit about your horse Flash?
I have had Flash 18 months; he is an 18-hand sport horse (yep he is enormous!) and we show jump. When I got him, he also came with a fan club of people who have kept in touch with him through his career – I didn’t anticipate quite how popular he was! He is a such a lovely kind chap and is everyone’s friend – he has a huge personality and after finishing his tea he throws his dinner bowl over his door and across the yard to let you know he’s finished. He can also be mischievous and jumping gates into other fields is one of his party pieces!
Can you tell us about when you first discovered that he might need medical attention?
I noticed an issue as he started to get anxious when doing fast work – he didn’t get tired but presented as very excitable and strong – knowing him I could tell that although he looked excited it was actually anxiety. Once the cause was diagnosed (Laryngeal Hemiplegia), my vet explained that the nerve that controls the opening of the airway can stop working -the nerve runs from the larynx down the neck around the back of the heart and back to the larynx and it is common in big horses for this nerve to stop firing – this has been the case with Flash as it is a problem that has only just happened
Can you give us an overview of his treatment plan so far including endoscopic procedures and surgery?
I called my vet who gave him an examination – this confirmed he was not in any physical pain and from there his airway was examined and it immediately became clear that he was suffering from laryngeal paralysis. My vet referred him to surgeon Henry Tremaine for over ground endoscopy and treatment options. The time from diagnosis by my vet to being booked in to see Henry was 90 minutes!
I took Flash to the B&W equine hospital for an over ground endoscopy – we had already booked a surgery slot for the following day so all that needed to be decided was what procedure was suitable for him based on the results of the over ground endoscopy. The ridden over ground scope showed total paralysis of the left side of the larynx and he was diagnosed as grade 4 (the worst it can be). Flash was deemed pretty remarkable as the main symptom is fatigue due to the airway being blocked and in a lot of cases affected horses could not work at all – Flash had none of these symptoms and was able to gallop for long stretches showing no signs of fatigue – the vets still do not know how he was able to do this!
A Hobday procedure (using a piece of suture to retract and anchor the paralyzed left side of the larynx2) was performed under standing sedation, this removed the vocal cords to make a wider airway allowing Flash to breathe easier, the option of a full tie back was discussed but this is typically only needed for race horses – showjumpers usually are able to see enough improvement by doing the more conservative hobday procedure which is less invasive and with less risk of complication.
Can you tell us how Flash is doing now – are the vets expecting a full recovery?
Following 5 days in hospital, Flash came home and was allowed restricted turnout for 6 weeks to allow his airway to heal, during this time my other horse Isaac was his 24hr companion and buddy. I have to say Flash really was the model patient we had no complications and his time off was spent relaxing in a small paddock in the day and coming in at night to rest. The examination and endoscopy were performed just over 6 weeks after the procedure, and he has recovered well and the procedure itself was a complete success. Flash is now allowed to be ridden and will slowly get back up to full fitness -only when he resumes fast work will we know if the procedure has been successful for him to not panic when he needs more air. If it is not enough then a tie back (under standing sedation) will be performed.
Can you tell us a bit about when Flash had an examination using the STERIS Endo-i® Equine endoscope?
When we got to 6 weeks post-op, my vet came to examine Flash to check his progress and confirm that he had healed and was able to resume normal activities. We used the STERIS Endo-i® scope and compared to all the other scopes I have viewed, this one had amazing image quality and the ability to record the process and take pictures. It was so much easier to see on the screen than peering down a tiny eyepiece and as the images were on the iPad my vet was able to show me exactly what and where the surgery had been undertaken.
As an owner the biggest benefit to me was to be able to have the issues described to me looking at the same image the vet was looking at – when the initial scope was performed it was using a fibre scope and although I could look down it the vet could not tell if the scope had moved or rotated so I wasn’t really sure what I was looking at – with the Endo-i® it was easy!
Photography: Phil Warrington