Dry Beet Pulp Causes Simultaneous Choke

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This is a letter to everyone who feeds beet pulp. I just had a horrible experience that I want to share, so no one else has to go through what I did.

I’ve been feeding beet pulp for years in the winter to help keep weight on my Thoroughbred. I also started feeding it to a middle-aged Standardbred that we just took in. It’s a great adjunct to grain that helps keep weight on horses that are otherwise hard keepers.

As I’d been taught, I always fed beet pulp after it was sufficiently soaked. But a few years ago, I read an article that said beet pulp didn’t need to be soaked prior to feeding. The article said that it would soak up enough fluid in the horse’s intestines to expand and provide bulk. It seemed logical, and it made winter feeding one step easier. I did this for at least one year without any problem at all.

The past winter, I began slowly re-introducing beet pulp into the feed of my horses, Mike and Chance. This is where my nightmare began.

One night I was rushing to get everything done and forgot to give them their beet pulp mixed into their grain. By the time I realized it, they had finished their grain. I figured they could eat the beet pulp plain, so I threw it into their buckets, and they both ate it easily. Easily, that is, until the beet pulp expanded in both of their esophagi at the same time, causing them to choke at the same time. I couldn’t believe my eyes. I’ve been around horses all my life and never had the horror of seeing one horse choke, let alone two at the same time. And it was my fault.

The veterinarian was there quickly. He worked for an hour on Chance but was unable to relieve his obstruction. Since Mike’s obstruction was even worse, the vet said to take both horses to the hospital. I hooked up the trailer, called work to say I would be late and sped off with two choking horses to the veterinary hospital.

By the time we got to there, Mike’s obstruction had relieved itself. They tubed him just to make sure and kept him overnight for observation to make sure he didn’t develop aspiration pneumonia.

Chance was another story. They worked on him for at least an hour with little progress. At one point the tube they had in his nose seemed like it was going in but was actually kinking in his nasal passage. When the veterinarian pulled it out, it ripped through a turbinate in his nose.

He bled 8 or 9 liters of blood onto the floor at an alarming rate. (This is a rare but not unheard of complication of passing a tube into a horse’s nose.) Since I’m a physician in an emergency department, blood doesn’t bother me, however, the amount that Chance bled was so much that Mike, who seemed better, was being considered as a possible blood donor.

They continuously monitored Chance’s blood counts, started him on IV fluids, and tried to pack his nose to stop the bleeding. The blood poured out of both nostrils, and he sounded like he was drowning. At that point the vet decided to pack both sides of his nose, which would require a tracheotomy (a tube into his trachea so he could breathe).

At this point I stared in disbelief and cried, as I watch three vets and as many techs try to save my horse. Just as the veterinarian was about to make the cut into his neck, the bleeding slowed. The vet decided to hold on doing the tracheotomy or a transfusion and watch him for the night before attempting again to relieve his obstruction. At that point, I left the veterinary hospital and went to work.

By morning, Chance had stabilized, and the obstruction was gone. Chance and Mike went to the hospital on a Thursday night and Chance was to stay there until Sunday on IV antibiotics to treat his aspiration pneumonia. He came home on oral antibiotics for 10 more days and has been doing well, although now I am fighting to put back on the weight he lost during the incident.

Unfortunately, my story doesn’t end here. Mike came home on Friday, the day after his trip to the hospital, because he seemed fine. But, over the next two days, he deteriorated and wouldn’t eat. I had my veterinarian check him again, and we decided to go back to the hospital due to a suspected impaction and distended colon.

When we arrived at the hospital, the vets decided he had low-grade peritonitis and possibly an ulcer from the stress of his choke. He stayed at the hospital four more days for IV antibiotics and Gastrogard for ulcers. I took him home after that, but his appetite was poor. Within 24 hours, his heart rate was up and he looked colicky. His legs stocked up, and he didn’t want to move. I put him in the field, and he just stood there away from the herd.

My veterinarian and I kept in touch several times a day. Mike was mildly comfortable on Banamine, but I could tell the Banamine was just putting off the inevitable trip back to hospital. Mike had been spiking fevers over the weekend up to 103 and his heart rate was anywhere from 60-90. We returned him to the hospital.

The hospital veterinarian said his low-grade peritonitis was raging now, as being off IV antibiotics had allowed the process to flourish. We discussed all types of diagnostic tests, but Mike was too sick to wait. His only chance at survival was surgery to see exactly what was going on. I told them to do whatever was necessary. All I could think was all this was due to the dry beet pulp I fed them.

After the surgery, the vets called to say Mike must have had previous surgery when he was on the track at least 17 years ago and somehow the choke started a process where the old staple lines and scar tissue started to rip apart. They had to clean out all the abscess formation and repair his bowel. Mike was at the hospital for another 1 ?? weeks on IV antibiotics.

When he returned, Mike spent a month on stall rest then progressed to a small paddock for another month until he completely healed. He must eat soft, chopped hay, so it makes the trip through his narrowed intestine. He is bright and also trying to make up for his significant weight loss.

What seemed like a harmless timesaver to feed dry beet pulp turned out to be a financial disaster and, worse, nearly caused the loss of two horses in one night. If you’ve fed beet pulp dry without problem, you’ve been lucky. Stop now. It’s not worth the risk.

-Stephanie Ortega, M.D.

Veterinary Editor’s Note:
As eventually happened with both of these horses, chokes will often spontaneously resolve within a few hours. Many veterinarians will gently attempt to move the bolus on with a stomach tube but if that is not successful may elect to just sedate the horse mildly, especially if he is distressed and agitated, keep him in a quiet place and give it a little time.

Also, two presentations at the 1997 AAEP meeting and one at the 2003 Congress on Equine Medicine and Surgery at Geneva discussed the use of oxytocin to relax the esophagus. Studies have confirmed that this drug, which induces contractions of a hormone-primed uterus, causes relaxation in the equine esophagus. Atropine is useful for low chokes that occur close to the entry into the stomach, and lidocaine delivered to the area of the choke through the stomach tube may help relieve spasm.

It’s true that horses have been fed beet pulp dry under experimental conditions without finding any problems with choke. But, in real life, it does happen, and older horses are more prone to choke in the first place.

However, the choke does not occur because the beet pulp expands. Choke can happen with any type of dry feed — grain, hay, pellets — and happens when there is insufficient production o f saliva to make passage down the esophagus easy. The reason Stephanie got into trouble this time, without having problems for a year, is likely at least in part because when she was mixing it with grain the harder texture of the grain encouraged more chewing. Many horses will bolt down dry beet pulp without chewing well. We agree it’s pointless to take the risk, and at least a short soak is wise. If they do eat it quickly, the water will substitute for the lack of saliva from chewing.

Mike’s choke may have had nothing to do with the intestinal problem, at least not directly. Abscesses in the abdomen can smolder for years, causing either no symptoms at all — although difficulty holding weight is a very common — or repeated bouts of colic, often after heavy exercise.

Staple-line leaks are common in human medicine, too, and why most surgeons routinely reinforce stapled anastomoses with traditional suture material as well.

Shipping may have been enough to cause the abscess to begin leaking to some extent, and if the regular veterinarian’s suspicion of impaction was correct, that was probably occurring at the site of the surgical stricture and putting pressure on the line and the abscess. The impaction itself was probably multifactorial to shipping, restricted food and water at the hospital, and possibly throat soreness from the attempts to relieve the choke.