We now have digital video endoscopy!

We are excited to bring you all news of a new service offered by our clinic. One of the most common chronic problems many performance horses can have due to the stress of competition is gastric ulceration. According to recent studies using hundreds of horses across the country, a conservative estimate reveals that as many as 60% of horses have gastric ulcers. This estimate gets significantly higher as you look closely at the population of athletic performance horses only.

CASE STUDY: This is a QH gelding that had been having bouts of frequent urination while riding. Blood was noted in the urine on multiple occasions. Bloodwork was normal however urinalysis showed increased protein, crystals and blood. Abdominal ultrasound was performed which showed large mineralized masses in the bladder as well as mild mineralization of the kidneys. The owner elected to have us scope the bladder with out digital video endoscope. The following video shows direct visualization inside the bladder. We found multiple large stones. Being a gelding, removal of these stones is something that must be done surgically. A new technique was used at Colorado State university where the stones were removed in a standing surgery without the necessity of general anesthesia. The gelding recovered without complication and there has since been no recurrence of the bladder stones.

 

Treatment of gastric ulcers can be very expensive, it is therefore important for you as an owner to have the correct diagnosis before beginning this treatment process. A months worth of gastrogard is usually prescribed for the treatment of ulcers and can cost upwards of $1,000. The only definitive way to diagnose this disease is by direct visualization of the ulcers inside the stomach along the gastric mucosa. Blood work can sometimes be suggestive of ulcers, but cannot confirm the problem. Seeing as the need to make the correct diagnosis for the best possible treatment is our primary goal at Boulder valley vet, we are proud to announce that we have just invested in a 3.3 meter video endoscope that is ready for use. The scope is fully portable, allowing us to examine your horse on the farm instead of hauling your horse to the nearest referral center. It is also fully digital and allows digital video and picture capture for your records and referral consultation.

Here are some common presenting complaints for a horse with gastric ulceration:- Change in eating and drinking behavior
– Weight loss
– Change in attitude
– Recurrent colic
– Dull hair coat
– Less-than-optimal performance
– Foals may also grind their teeth or lay on their backs
In addition to the diagnosis of gastric ulcers, the scope is also instrumental in several other ways. Horses that choke can often have tearing along their esophagus that will lead to stricture and recurrent choke. The scope will enable us to identify those cases and begin early treatment. Although this particular endoscope is long enough to reach the stomach, standard upper airway exams may still be performed with the added benefit of the digital monitor and video capabilities.
In addition to the diagnosis of gastric ulcers, the scope is also instrumental in several other ways. Horses that choke can often have tearing along their esophagus that will lead to stricture and recurrent choke. The scope will enable us to identify those cases and begin early treatment. Although this particular endoscope is long enough to reach the stomach, standard upper airway exams may still be performed with the added benefit of the digital monitor and video capabilities.
Here is an image of an obstruction in the esophagus caused by a food bolus. This is commonly known as choke. Many chokes can be easily resolved without further complication, however those that are more difficult to resolve can often result in tearing along the esophageal mucosa. Depending on the direction of the tear, some tears will result in a narrowing of the lumen of the esophagus. These narrowings are called strictures and will predispose the horse to future choke episodes. Strictures that are severe enough will often result in the demise of the horse as they can be very difficult to correct. Using an endoscope we can detect the early signs for horses that will be prone to stricture and initiate early treatment, giving the horse the best possible chance for full recovery.
Upper Airway Endoscopy

Here is a video of an upper airway endoscopy we performed. This is a 15 year holsteiner gelding used for jumping. The main complaint was inspiratory stridor or “roaring” when the horse was in heavy work. On physical exam the horse had a significant upper airway noise when breathing in during work. There are several differentials for this finding including epiglottic entrapment, dorsal displacement of the soft palate, and laryngeal hemiplegia. In this case a diagnosis of laryngeal hemiplegia was made based on the endoscopic exam. If you watch the video, you will see the two arytenoids in the back of the throat as the vertical flaps opening and closing as the horse breaths. These are the barrier to the opening of the trachea. Both of these arytenoids should open fully when the horse breaths in so that that there is a maximal amount of airflow to the trachea. The right arytenoid is actually on the left of the screen, and the left on the right. If you watch the video you will see that the right arytenoid (left of screen) abducts normally, while the left has very little to no movement. This is due to damage over time to the left recurrent laryngeal nerve, leading to a paralysis of the arytenoid. These can be graded from 1 to 4, 4 being the worst and representing a total paralysis of the nerve. In this case, we have a grade 3/4 laryngeal hemiplegia. In some cases this requires a surgery called “tie back” where the left arytenoid is sutured back into the open position in order to allow for better airflow to the lungs. It can also be combined with a surgery called a ventriculocordectomy where the vocal cord is removed to reduce the noise that is heard on inspiration. Severe cases can have paralysis of both arytenoids, however the vast majority of cases are isolated to the left side.