I recently received a call from a worried client. She had just fed Rusty, an aging and adorable Shetland Pony, his evening grain. Rusty dove into his grain, as usual, and my client went about a few chores. When she came back to check on Rusty, she found him standing in the corner, head low, neck stretched with foam and brown discharge coming from his nostrils and mouth. Rusty had only finished half his grain and he kept arching his neck and coughing. He looked like he was trying to throw up.

Rusty was choking.

I have seen a number of horses for choke in the past month. Most horse owners know immediately when their horse is choking but sometimes owners are unsure of what is happening to their horse — and of what to do next. Because choke can lead to serious, even life-threatening, complications in a horse, it is important to understand the signs of choke, and what to do (and not do) in the face of a choking horse.

Choke, also known as esophageal obstruction, can happen to any horse at any time — though certain horses can be more likely to choke. Horses that “bolt” their grain or hay, like the stereotypical overzealous pony, may be prone to choke. Horses having poor dentition (often older horses) may also be prone to choke, as they are less able to break down their feed.

Recognizing a choking horse is relatively straight-forward. Though a choking horse may not present exactly as described above in the case of Rusty, there are tell-tale signs. Coughing and discharge from the nostrils and/or mouth are almost always present in a choking horse. The low head, stretched and arched neck are also stereotypical presentations in a choking horse.

If you do recognize that your horse is choking, don’t panic. The good news about choke in horses is that, unlike humans, horses can still breathe while choked. The bad news is that choking requires immediate medical attention. While horses sometimes are able to clear an obstruction without medical intervention, it is impossible to know if a given choking horse will be able to do so. And because the risks of and complications from choke are so serious, immediate medical attention must be sought. If your horse is choking, don’t wait. Call your veterinarian.

I emphasize this point because I sometimes hear of people trying to “fix” a choking horse on their own. Specifically, I hear of horse owners sticking a water hose into their horse’s mouth to “flush out” the choke. Water hose “flushing” will not work. The obstruction is lower down in the horse’s esophagus. By “flushing out” a choke in this manner you actually increase the risk that the horse will aspirate water and food into his lungs.

In addition to not trying to “fix” a choking horse on your own there are a few other basic recommendations to follow — while waiting for your veterinarian to arrive. Don’t panic. Remove all food and water access. Do not give a choking horse any oral medication.

To treat a choking horse, a veterinarian will begin by sedating the horse. Sedation will cause the horse to relax — and importantly for treating an obstruction, the horse’s neck to relax. The veterinarian will then pass a nasogastric tube up the nasal passage, down the throat and into the esophagus of the horse. The veterinarian will locate the obstruction in the horse’s esophagus with the passed tube and then will force the obstruction into the horse’s stomach using the same tube. This process is often time consuming, taking patience, finesse, and force to relieve the choke.

There are serious complications associated with choke in horses. Scar tissue may form within the esophagus at the site of the obstruction — from the trauma caused by the obstruction. This scar tissue can predispose a horse to future choke episodes. A horse can also develop aspiration pneumonia as a result of getting grain/hay into the trachea and then in the lungs. These complications (and others) are serious and may require further medical attention.

In the majority of cases a choke can be relieved with veterinary attention. Unfortunately, this is not always the case and there are those instances that end tragically. I will never forget an old, retired, school-horse that choked on a carrot fed by a well-meaning passer by. The horse was well into his 30’s and did not have teeth to chew the carrot. Carrots are notoriously difficult to relieve with the nasogastric tube. I was unable to relieve the choke and the horse had to be euthanized. It was a tragic outcome for everyone.

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