In this episode of StallSide Podcast, Dr. Ali Broyles joins us to discuss upper airway surgeries in horses. She covers common conditions that require surgical intervention, the techniques used, and the outcomes owners can expect. Dr. Broyles also addresses the importance of early diagnosis and shares practical insights for equine practitioners and owners. Join us for a fascinating conversation that highlights the critical role of upper airway health in our equine athletes!
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(silence) Today's episode of the Stall Side Podcast was brought to you by Rood & Riddle Veterinary Pharmacy
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Bart,
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how are you going today?
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I'm great
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Good afternoon,
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Peter
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How are you?
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I'm great
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Yeah,
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we've got a very interesting guest on the show today that we're really glad has come back to us
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Yes,
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I think people are going to love her,
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Dr
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Allie Broyles,
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who has kind of grown up with us,
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went away,
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did some things,
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worked for us in Saratoga,
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and I'm sure she'll tell her story
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But a great personality
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She's an excellent veterinarian,
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excellent surgeon,
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and thrilled she's back with us
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Yeah,
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I'm really interested in her take on upper airway surgery
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I mean,
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she's done a lot of like racing quarter horse work,
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and is very skilled in thoroughbreds
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And so it'd be interesting just to hear about any sort of contrast and similarities between sprinters,
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essentially,
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right,
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drag racers of the horse world,
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and actually thoroughbreds that run over a little bit of a longer distance
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But yeah,
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I'm really interested to see what she is going to say
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Extremely skilled surgeon and right up with the latest
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Right on
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She's a lot of fun
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And like I said,
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thrilled she's back
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So let's get her in
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Yeah,
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absolutely
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So on Stoolside this week,
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we have Dr
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Allie Broyles,
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who's going to talk to us about upper airway surgery in the horse
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Dr
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Broyles,
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welcome to Stoolside
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Thank you
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Thanks for being with us
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It's great to have you back in Lexington
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And thanks for coming on the show with us today
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Yeah,
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of course
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Happy to be here
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Yeah
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So Allie,
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tell us a little bit about yourself
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OK,
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so I grew up in Tennessee,
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Murfreesboro,
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which is in the middle part of the state
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My dad has always had horses and cattle,
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so grew up with horses and cows
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And I honestly can't remember why or when I wanted to be a vet,
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but I just always wanted to be a vet
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And initially,
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you know,
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I wanted to be a large animal vet
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But then later,
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probably in high school,
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decided I wanted to do just equine
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So went to college in Murfreesboro
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My dad was a college professor and I went to the college that he worked at
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And then after undergrad,
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I moved to Texas and I worked at the Four Sixes Ranch in West Texas for a year and a half
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And so I became a Texas resident there and then applied to vet school at A&M and got into A&M,
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went there
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And then my husband is also a veterinarian and he was in my class
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And so we got married after my internship here
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But yeah,
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so after vet school,
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did my internship here at Roon Riddle and then went back to Texas and worked with Brandon,
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my husband,
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for a few years,
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and then also worked part time for a racetrack practice that did mostly quarter horses and went to racetracks in Texas,
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Oklahoma,
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Iowa and Florida,
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kind of part time,
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and then came back in 2014 and did my residency here
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And then after my residency,
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worked at the Saratoga practice for a little while and then went back to Texas again as a associate surgeon at a practice near Fort Worth
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So quarter horse racing,
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tell us about that
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So quarter horse racing,
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obviously,
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they race a much shorter distance
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And believe it or not,
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the size of the quarter horse is about similar to the thoroughbreds
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They are pretty big
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Some people think that they're going to be a lot smaller
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But honestly,
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they're about they look their body type is similar to a thoroughbred,
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just maybe a little bit more muscular
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But I would say in Texas,
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Oklahoma,
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New Mexico,
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the quarter horse racing is quite a bit more popular in the western states
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But it seems like they have a race meet at the Red Mile now
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Have you been out there?
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No,
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I haven't been out there
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Quarter horse racing is a blast
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Yeah,
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it's a lot
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It's a lot of fun
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It is just it is twenty one seconds of chaos
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It sounds like the drag racing of the horse industry,
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doesn't it?
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That picture right back there,
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that's two quarter horses together going 440
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And that's actually a picture of me beating my dad
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That's why that says that
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I grew up quarter horse racing,
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too
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Yeah
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What a hoot
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Yeah
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But that's the fascinating thing about quarter horses,
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right,
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is that there's so many different conformations and they've been tailored to the career that people have
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Like cutting horses,
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you've got roping horses,
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you've got holder horses,
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you've got racing quarter horses
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Right
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And you sort of think that that's just a triumph for selective breeding,
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isn't it?
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Really,
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they've managed to have so many different sort of applications for the one style
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But we're here to talk about upper airway surgery today
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So give us your take on upper airway surgery
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What's your focus?
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What do you think you can do for the horse?
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And what are the current developments that you see coming down the line that are going to advance the science for everybody?
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OK,
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so probably the two,
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I'll just talk about the two most common surgeries that we do are for the two most common problems,
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I would say
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So recurrent laryngeal neuropathy is probably the most common reason a horse would come in for upper airway surgery
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And that is just partial paralysis or complete paralysis of the left arytenoid most commonly,
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or the flapper would be kind of the layman's term
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And so typically the horses that present and you can see it in all types of horses,
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obviously,
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but we see most commonly in thoroughbreds here and in Texas,
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we saw it in quarter horse race horses as well
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Not quite as common as it is in thoroughbreds,
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but we did see it occasionally
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And they present usually for poor performance,
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probably making a noise at exercise
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And the horse is most of the time been scoped by the referring veterinarian on the racetrack or the farm
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And they and now it seems like they're sending them in more earlier in the disease process
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Previously,
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people would sometimes wait until their arytenoid was completely paralyzed to send them in for surgery
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But now we kind of know that actually it's better if you go ahead and do the surgery before they're completely paralyzed
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So that's been a change in the thought process in the past few years
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What what's what's the advantage of sending them in earlier?
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And is there like less downstream pathology?
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And if so,
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what is that pathology?
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Yes
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So actually,
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my resident or I actually did this paper,
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started collecting the data when I was a resident and then published it a few years after my residency
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And we looked at I think there was like six hundred tiebacks that we looked at and kind of compared,
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you know,
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ones that are partially paralyzed and ones that are completely paralyzed
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And at the time of surgery and then looked at how long it took for them to come back to racing likelihood of return to racing and then their earnings
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And and the reason we did that paper is because a lot of referring veterinarians were waiting to send the horse until it was completely paralyzed,
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thinking that if the arytenoid still had movement,
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it might cycle the prosthesis
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And so they would have a poor prognosis postoperatively if they had some movement
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And we didn't think that was truly the case
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So kind of wanted to prove that
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And in the paper we looked at grade three ones,
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which is still have a significant amount of movement,
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but they can't hold their abduction fully
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And then three twos and three threes,
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which is a little bit of movement,
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not completely paralyzed
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And then grade fours are complete paralysis
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And so all of the grade threes actually ended up taking less time to return to racing and were more likely to race as well
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And we and we don't know why that is
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We honestly thought it would be the same in threes versus fours,
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but potentially maybe it's a psychological thing for the horse that if they're complete,
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if they were running with complete paralysis,
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maybe they remember that
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I don't know
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That was our kind of only hypothesis of why there would be a difference there
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So would you find that true?
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And these are horses that were racing,
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right?
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What about in our yearling population,
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if you're finding those threes and fours?
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Because traditionally we've said just go ahead and break the horse and then next spring we'll see where they're at
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OK,
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but before doing the tieback,
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you know,
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I think I think we're still recommending to do that as far as to break the horse and then do it
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And the reason for that is because the at a yearling age or young two year old,
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their cartilage isn't as strong as later on
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So I think we have more failures on yearling horses than we do on adult horses just because the cartilage isn't fully matured
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So that would be the reason why
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Not necessarily waiting for paralysis
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So what are some of the complications of the tieback surgery?
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So probably the most common complications would be aspiration
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So if you have them tied back too much that they can't protect the airway or failure of the tieback
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I mean,
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you get a little bit of it's pretty normal to get a significant amount of relaxation postoperatively
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We do know that about six weeks is the cutoff for like if you go scope the horse after surgery at six weeks,
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the amount of abduction you have there is probably what you're going to have later on
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So we still tell people,
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you know,
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the success rate is about 65 to 70 percent
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But yeah,
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failure is a complication
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Aspiration pneumonia,
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incisional infection
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Those are probably the biggest complications
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OK,
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and so this is a solution,
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but it's not they're not as good as if you had a functional airway,
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correct?
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So what's the prognosis for a horse that has a tieback?
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How do they perform compared to everybody else?
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You're probably 70 percent at return to racing at their previous level
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At their previous level
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Yeah,
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But I mean,
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let's face it,
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it's a salvage procedure,
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right?
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Because you've got nothing
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Yeah,
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yeah,
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exactly
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If you don't do the tieback,
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then there,
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you know,
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a retinoidectomy is another option
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But in racehorses,
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it's not a good option
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Those horses don't usually do well because there is still tissue there that will obstruct the airway
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There is a new procedure where we are trying to,
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it's called a renervation,
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where we're trying to,
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you know,
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restore the normal function
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But we just haven't had good success in racehorses
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It might be a better procedure for a different type of performance horse
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But for racehorses,
00:11:04.889 - 00:11:09.889
it's just not able to hold the retinoid out during maximal exercise
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Gotcha
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So this is actually very timely,
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because I had a client yesterday,
00:11:14.139 - 00:11:18.929
they've got a yearling that's completely paralyzed on the right side
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And they go,
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so they asked me the question,
00:11:21.250 - 00:11:23.049
which I'm going to ask you,
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if we choose not to do the surgery,
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what is this horse capable of?
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You know,
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obviously being a racehorse is off the table
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But what are those horses capable of doing if you don't do a surgery?
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Well,
00:11:36.460 - 00:11:46.799
so one thing to consider in a horse with right-sided paralysis is to make sure it is recurrent laryngeal neuropathy and not laryngeal dysplasia,
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because a lot of laryngeal dysplasias will look like a paralyzed retinoid,
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and actually the Tyvek will not help those horses,
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just because their anatomy is abnormal
00:11:56.610 - 00:12:01.450
So a laryngeal ultrasound would be the next step to figuring that out
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But in horses with recurrent laryngeal neuropathy,
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if you don't do the surgery,
00:12:07.659 - 00:12:08.850
the Tyvek procedure,
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if it is a performance horse,
00:12:11.450 - 00:12:12.379
you know,
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that is,
00:12:13.149 - 00:12:13.570
you know,
00:12:13.570 - 00:12:15.570
a low-level performance horse,
00:12:15.570 - 00:12:18.370
that the people are just concerned about the horse making noise,
00:12:18.370 - 00:12:22.679
and it's not actually affecting its ability to breathe,
00:12:22.679 - 00:12:26.490
then you can just do a vocal chordectomy,
00:12:26.519 - 00:12:31.490
where we use the laser and remove the vocal cord in addition to the ventricle,
00:12:31.490 - 00:12:34.919
and that will help with the noise production,
00:12:34.919 - 00:12:37.730
and maybe give them a little bit more of an airway,
00:12:37.730 - 00:12:40.450
but it's not good enough for a racehorse
00:12:40.450 - 00:12:41.250
Yeah
00:12:41.250 - 00:12:44.330
So just because they're making noise doesn't mean that the horses are distressed
00:12:44.330 - 00:12:44.700
Yeah,
00:12:44.700 - 00:12:45.330
exactly
00:12:45.330 - 00:12:46.210
And that's,
00:12:46.210 - 00:12:46.929
you know,
00:12:46.929 - 00:12:50.500
in Texas we saw other types of breeds frequently that,
00:12:50.500 - 00:12:52.169
not racehorses,
00:12:52.169 - 00:12:56.090
that a lot of times the complaint was the horse is making a noise at exercise
00:12:56.100 - 00:12:58.059
And so you always have to ask them,
00:12:58.059 - 00:13:01.490
because there are complications associated with doing the Tyvek,
00:13:01.490 - 00:13:05.090
so you don't want to jump to a Tyvek if the horse doesn't need it
00:13:05.090 - 00:13:08.809
So try and extract that information out of the owner
00:13:08.809 - 00:13:09.200
Is it,
00:13:09.200 - 00:13:11.289
are you just concerned about the noise,
00:13:11.289 - 00:13:17.370
or do you think that the horse is having a hard time doing its job because it can't breathe?
00:13:17.370 - 00:13:18.139
That's interesting,
00:13:18.139 - 00:13:18.750
it talked about,
00:13:18.750 - 00:13:19.029
like,
00:13:19.029 - 00:13:22.129
laryngeal surgeries for loss of function
00:13:22.129 - 00:13:24.690
You mentioned there was another most common type of surgery,
00:13:24.690 - 00:13:27.370
and another problem that was sort of most common
00:13:27.370 - 00:13:27.700
Okay,
00:13:27.700 - 00:13:33.610
so dorsal displacement of the soft palate is probably the second most common thing that we see in racehorses,
00:13:33.610 - 00:13:37.850
and then other breeds of horses as well
00:13:37.850 - 00:13:39.169
This is a little bit difficult,
00:13:39.169 - 00:13:43.370
more difficult to diagnose on standing endoscopy,
00:13:43.370 - 00:13:45.450
they won't always do it
00:13:45.450 - 00:13:48.490
So a lot of times we're diagnosing it with dynamic endoscopy,
00:13:48.490 - 00:13:52.889
and watching their airway at exercise
00:13:52.889 - 00:13:53.549
The,
00:13:53.549 - 00:13:54.990
interestingly,
00:13:54.990 - 00:13:59.730
recurrent laryngeal neuropathy is an inspiratory disease,
00:13:59.730 - 00:14:03.490
and displacement of the soft palate is an expiratory disease
00:14:03.490 - 00:14:08.129
So sometimes if the people are talking to you about the sound the horse is making,
00:14:08.129 - 00:14:11.970
or what the horse does when it makes that sound and can't breathe,
00:14:11.970 - 00:14:14.039
you can kind of decipher what it,
00:14:14.039 - 00:14:15.570
which one it might be
00:14:15.570 - 00:14:19.389
So for displacement of the soft palate,
00:14:19.389 - 00:14:20.970
a lot of times they'll stretch their neck out,
00:14:20.970 - 00:14:22.929
or kind of open mouth breathe,
00:14:22.929 - 00:14:25.210
and they make more of a gurgling sound,
00:14:25.210 - 00:14:27.769
because they're having a difficulty getting air out,
00:14:27.769 - 00:14:31.649
instead of with recurrent laryngeal neuropathy,
00:14:31.649 - 00:14:33.809
those horses are having trouble getting air in,
00:14:33.809 - 00:14:36.269
and they often make a more of a,
00:14:36.269 - 00:14:37.120
you know,
00:14:37.120 - 00:14:39.289
classic roaring sound
00:14:39.289 - 00:14:39.539
Yeah,
00:14:39.539 - 00:14:41.330
that's interesting about the position of the head,
00:14:41.330 - 00:14:41.750
because,
00:14:41.750 - 00:14:42.159
you know,
00:14:42.159 - 00:14:43.169
that's something that,
00:14:43.169 - 00:14:43.450
I mean,
00:14:43.450 - 00:14:44.220
they're just trying to,
00:14:44.220 - 00:14:44.440
like,
00:14:44.440 - 00:14:45.210
straighten things out,
00:14:45.210 - 00:14:45.570
right?
00:14:45.570 - 00:14:47.049
So that's interesting,
00:14:47.049 - 00:14:49.129
just by just talking to somebody,
00:14:49.129 - 00:14:50.850
you can get a pretty good idea what's going on
00:14:50.850 - 00:14:51.330
Yeah,
00:14:51.330 - 00:14:53.570
and so even in the standing exams,
00:14:53.570 - 00:14:55.070
a lot of those horses displace,
00:14:55.070 - 00:14:55.769
and they're displaced forever
00:14:55.769 - 00:14:58.090
That has nothing to do with performance
00:14:58.090 - 00:15:01.129
That's not necessarily an indicator that those horses are going to displace when they race,
00:15:01.129 - 00:15:01.409
is it?
00:15:01.409 - 00:15:02.139
Correct,
00:15:02.139 - 00:15:02.639
yeah,
00:15:02.639 - 00:15:03.250
yeah
00:15:03.250 - 00:15:03.779
Yeah,
00:15:03.779 - 00:15:05.809
so as far as endoscopy goes,
00:15:05.809 - 00:15:06.289
you're talking about,
00:15:06.289 - 00:15:06.490
like,
00:15:06.490 - 00:15:07.889
overground dynamic
00:15:07.889 - 00:15:09.659
Treadmills used to be pretty big,
00:15:09.659 - 00:15:10.169
right?
00:15:10.169 - 00:15:12.809
And so people have gone away from treadmills now
00:15:12.809 - 00:15:17.490
So why is that that people have left treadmills behind and have gone for the overground?
00:15:17.490 - 00:15:17.789
Yeah,
00:15:17.789 - 00:15:22.220
so the nice thing about the overground is you can more easily replicate,
00:15:22.220 - 00:15:22.450
you know,
00:15:22.450 - 00:15:28.129
the horse's environment of where they're actually having the upper respiratory obstruction
00:15:28.129 - 00:15:31.020
So they can be in their normal tack,
00:15:31.020 - 00:15:31.880
you know,
00:15:31.880 - 00:15:34.609
on the racetrack,
00:15:34.609 - 00:15:34.809
you know,
00:15:34.809 - 00:15:36.649
have the rider in place
00:15:36.649 - 00:15:40.730
And all those things can affect what you see on the exam
00:15:40.740 - 00:15:41.929
So especially with,
00:15:41.929 - 00:15:42.330
like,
00:15:42.330 - 00:15:44.730
dorsal displacement of the soft palate,
00:15:44.730 - 00:15:47.170
a lot of times head position will affect that
00:15:47.170 - 00:15:50.389
So maybe not even a racehorse,
00:15:50.389 - 00:15:53.610
but a dressage horse or saddlebred or something like that,
00:15:53.610 - 00:15:54.919
when their neck is flexed,
00:15:54.919 - 00:16:01.129
they're going to have different obstruction than when their neck is straight
00:16:01.129 - 00:16:01.869
OK,
00:16:01.869 - 00:16:03.950
and so surgically,
00:16:03.950 - 00:16:06.649
what can you do about that dorsal displacement of the soft palate?
00:16:06.649 - 00:16:07.080
I mean,
00:16:07.080 - 00:16:07.450
like,
00:16:07.450 - 00:16:09.370
obviously that's a major issue
00:16:09.429 - 00:16:11.169
So how can you surgically approach this?
00:16:11.169 - 00:16:12.480
More than one approach,
00:16:12.480 - 00:16:13.969
some better than others?
00:16:13.969 - 00:16:14.519
Yeah,
00:16:14.519 - 00:16:16.489
so there's multiple approaches
00:16:16.489 - 00:16:17.129
I mean,
00:16:17.129 - 00:16:21.929
probably the gold standard would be a laryngeal tie forward
00:16:21.929 - 00:16:23.150
And that procedure,
00:16:23.150 - 00:16:24.360
unlike the tieback,
00:16:24.360 - 00:16:26.370
has a lower complication rate
00:16:26.370 - 00:16:29.360
Probably the biggest complication with that is that,
00:16:29.360 - 00:16:29.569
you know,
00:16:29.569 - 00:16:30.330
it doesn't work
00:16:30.330 - 00:16:34.139
Or they have some incisional seromas,
00:16:34.139 - 00:16:36.880
but you don't have the higher risk of,
00:16:36.880 - 00:16:37.210
you know,
00:16:37.210 - 00:16:41.289
significant complications like aspiration pneumonia
00:16:41.289 - 00:16:45.850
The procedure below that maybe that is frequently performed,
00:16:45.850 - 00:16:47.650
but maybe is not the gold standard,
00:16:47.650 - 00:16:49.009
is a myectomy,
00:16:49.009 - 00:16:54.210
which we do the myectomy during the tie forward procedure anyway
00:16:54.210 - 00:16:57.290
But a lot of times we'll get horses that they've had a myectomy
00:16:57.290 - 00:16:59.090
You can do those standing on the racetrack
00:16:59.090 - 00:16:59.620
I do,
00:16:59.620 - 00:17:00.080
you know,
00:17:00.080 - 00:17:03.210
racetrack veterinarians will do them in the field
00:17:03.299 - 00:17:07.329
And I did them in the field on quarter horse racehorses
00:17:07.329 - 00:17:08.430
But then if that doesn't work,
00:17:08.430 - 00:17:10.769
sometimes they'll send them for the tie forward later on
00:17:10.769 - 00:17:17.049
Can you give us just a brief 10,000 foot overview of what those two surgeries are,
00:17:17.049 - 00:17:18.930
the myectomy and the tie forward?
00:17:18.930 - 00:17:19.930
Yeah
00:17:19.930 - 00:17:28.529
So the myectomy is where you cut the muscle that kind of attaches to the thyroid cartilage
00:17:28.589 - 00:17:31.900
And so that muscle is called the sternothyroidus,
00:17:31.900 - 00:17:42.230
and we think that maybe when you cut that muscle that it's not pulling the larynx back so that it's less likely to displace
00:17:42.230 - 00:17:45.039
So and then when you do the tie forward,
00:17:45.039 - 00:17:53.309
what you're doing is you're basically pulling the larynx forward and up over the soft palate
00:17:53.309 - 00:18:01.119
And so you're kind of holding it in place there so that the position of the larynx versus the soft palate is different so that they're,
00:18:01.119 - 00:18:01.829
you know,
00:18:01.829 - 00:18:04.930
to decrease the rate that they do displace
00:18:04.930 - 00:18:08.089
Does that alter the horse's ability to swallow or the way it swallows?
00:18:08.089 - 00:18:08.309
No,
00:18:08.309 - 00:18:09.089
usually not
00:18:09.089 - 00:18:09.730
I mean,
00:18:09.730 - 00:18:12.970
I will say sometimes post-operatively,
00:18:12.970 - 00:18:15.539
like in the first couple of days,
00:18:15.539 - 00:18:17.730
the horses have some discomfort,
00:18:17.730 - 00:18:18.309
you know,
00:18:18.309 - 00:18:20.450
like putting their head all the way down
00:18:20.450 - 00:18:22.630
You can tell it's a little discomfort or,
00:18:22.630 - 00:18:23.190
you know,
00:18:23.190 - 00:18:25.089
uncomfortable for them to do that,
00:18:25.089 - 00:18:26.630
to stretch their neck out
00:18:26.710 - 00:18:28.220
But then that seems to go away,
00:18:28.220 - 00:18:28.740
you know,
00:18:28.740 - 00:18:30.309
in the first few days or so,
00:18:30.309 - 00:18:31.369
but no swallowing
00:18:31.369 - 00:18:34.730
I've never had a horse have any issues swallowing with that procedure
00:18:34.730 - 00:18:35.730
Okay
00:18:35.730 - 00:18:38.579
That's interesting because I think altering the architecture like that,
00:18:38.579 - 00:18:38.890
I mean,
00:18:38.890 - 00:18:41.490
they just probably quickly learn the way around it
00:18:41.490 - 00:18:42.490
Yeah
00:18:42.490 - 00:18:43.490
Yeah
00:18:43.490 - 00:18:45.049
And you mentioned some new techniques that are coming down the line
00:18:45.049 - 00:18:49.849
You mentioned about the re-innovation technique for the laryngeal hemiplegia
00:18:49.849 - 00:18:54.250
Any other new techniques coming along or diagnostics for upper airway dysfunction?
00:18:54.250 - 00:18:55.250
No
00:18:55.319 - 00:18:55.740
I mean,
00:18:55.740 - 00:18:56.440
right now,
00:18:56.440 - 00:18:57.069
you know,
00:18:57.069 - 00:18:59.819
we routinely we're doing dynamic endoscopy,
00:18:59.819 - 00:19:01.410
laryngeal ultrasound,
00:19:01.410 - 00:19:04.650
and obviously standing endoscopy
00:19:04.650 - 00:19:06.930
Typically here at the hospital,
00:19:06.930 - 00:19:18.849
if any horse that's getting standing endoscopy is likely going to get a laryngeal ultrasound just because it gives us good information about the architecture of the larynx,
00:19:18.849 - 00:19:20.539
laryngeal cartilages,
00:19:20.539 - 00:19:22.750
and then just the more you do it,
00:19:22.750 - 00:19:27.289
I feel like the more information we get from the laryngeal ultrasound too
00:19:27.289 - 00:19:27.700
But,
00:19:27.700 - 00:19:28.190
yeah,
00:19:28.190 - 00:19:36.809
not every horse gets a dynamic endoscopy if it's pretty convincing on standing endoscopy and laryngeal ultrasound
00:19:36.809 - 00:19:39.140
You mentioned earlier about laryngeal dysplasia,
00:19:39.140 - 00:19:41.970
and I was going to ask you about that at a time
00:19:41.970 - 00:19:42.220
I mean,
00:19:42.220 - 00:19:44.930
you're talking about right-sided problems and making sure that wasn't the case
00:19:44.930 - 00:19:46.450
How do these horses usually present?
00:19:46.450 - 00:19:52.809
Do they present any differently and this is just like a differential that you work out or is there something unique about these horses?
00:19:52.809 - 00:19:55.130
And how does this come about?
00:19:55.130 - 00:19:56.130
What's missing?
00:19:56.130 - 00:19:57.130
What's mal-formed?
00:19:57.130 - 00:19:58.130
Yeah
00:19:58.130 - 00:19:58.410
So,
00:19:58.410 - 00:20:00.130
for laryngeal dysplasia,
00:20:00.130 - 00:20:11.130
a lot of times they just present as yearlings because they've been born with this deformity and it's diagnosed when you guys are scoping them for sale
00:20:11.130 - 00:20:13.690
Or maybe when they go to be broke,
00:20:13.690 - 00:20:24.529
they make a noise like a horse with a paralyzed urethnoid and you scope them and they have what looks like right-sided recurrent laryngeal neuropathy
00:20:24.529 - 00:20:32.490
But it's just much more common for them to have a left recurrent laryngeal neuropathy versus a right
00:20:32.490 - 00:20:34.099
And most of the time,
00:20:34.099 - 00:20:41.130
what appears to be a right-sided paralysis is more likely laryngeal dysplasia
00:20:41.269 - 00:20:46.569
And how this occurs is just a malformation
00:20:46.569 - 00:20:49.650
It's a fourth brachial arch defect is the term
00:20:49.650 - 00:20:55.539
And what happens is the cartilages on the right side are just not,
00:20:55.539 - 00:20:57.970
they're not in the correct position
00:20:57.970 - 00:20:58.230
So,
00:20:58.230 - 00:21:04.490
there's a gap between the thyroid cartilage and the cricoid cartilage that's not normally there
00:21:04.490 - 00:21:11.210
And that's why doing a tieback on those horses just doesn't work because the anatomy is not normal
00:21:11.210 - 00:21:12.210
Excellent
00:21:12.210 - 00:21:13.450
That's pretty interesting stuff,
00:21:13.450 - 00:21:13.769
yeah
00:21:13.769 - 00:21:14.220
And so,
00:21:14.220 - 00:21:19.079
we get the occasional neonate in here that we've actually found some problems because yeah,
00:21:19.079 - 00:21:24.390
there's a little bit of milk going in and you actually scope them and your heart sinks a little bit,
00:21:24.390 - 00:21:24.630
right,
00:21:24.630 - 00:21:25.730
because you just look at that and say,
00:21:25.730 - 00:21:27.730
"There's something not right about that" So,
00:21:27.730 - 00:21:28.869
they call somebody clever,
00:21:28.869 - 00:21:29.650
like one of the surgeons,
00:21:29.650 - 00:21:31.730
and they come and have a look at it
00:21:31.730 - 00:21:32.650
And they sort of say,
00:21:32.650 - 00:21:33.009
"Yeah,
00:21:33.009 - 00:21:40.210
it's a malformation and you just can't do anything for people" But these foals are like so compromised that they're aspirating
00:21:40.210 - 00:21:40.700
Right,
00:21:40.700 - 00:21:41.210
yeah
00:21:41.210 - 00:21:44.490
And it seems to be varying degrees of laryngeal dysplasia
00:21:44.490 - 00:21:45.200
Some are more,
00:21:45.200 - 00:21:45.710
you know,
00:21:45.710 - 00:21:47.009
malformed than others
00:21:47.009 - 00:21:47.460
Yeah,
00:21:47.460 - 00:21:48.009
yeah
00:21:48.009 - 00:21:51.130
And I probably just see the worst ones because that's the ones that get into trouble early
00:21:51.130 - 00:21:51.720
And you know,
00:21:51.720 - 00:21:52.549
the worse they are,
00:21:52.549 - 00:21:53.730
the earlier we find them
00:21:53.730 - 00:21:54.980
And then you get something,
00:21:54.980 - 00:21:55.640
as you say,
00:21:55.640 - 00:21:58.809
around yearling age when everybody has a lot of hope for the horse
00:21:58.809 - 00:22:00.430
And then something like this turns out,
00:22:00.430 - 00:22:01.809
which is pretty unfortunate
00:22:01.809 - 00:22:02.279
Yeah,
00:22:02.279 - 00:22:02.589
so,
00:22:02.589 - 00:22:06.849
any other away surgeries that you'd like to talk about today?
00:22:06.849 - 00:22:07.859
You've talked about,
00:22:07.859 - 00:22:08.329
you know,
00:22:08.329 - 00:22:08.789
as I say,
00:22:08.789 - 00:22:09.039
DDSP,
00:22:09.039 - 00:22:11.289
you've talked about laryngeal hemiplegia
00:22:11.289 - 00:22:14.259
Is there anything else that is becoming more of a problem,
00:22:14.259 - 00:22:15.170
more prominent,
00:22:15.170 - 00:22:19.529
people are realizing it's more performance limiting that can be addressed surgically?
00:22:19.529 - 00:22:25.890
I guess the other thing we see probably most commonly is epiglottic entrapments
00:22:25.890 - 00:22:26.730
And you know,
00:22:26.730 - 00:22:30.730
sometimes that's confused with displacement of the soft palate
00:22:30.730 - 00:22:31.720
But actually,
00:22:31.720 - 00:22:33.980
what an epiglottic entrapment is,
00:22:33.980 - 00:22:36.369
is where there is a band of tissue
00:22:36.369 - 00:22:41.369
It's the subepiglottic tissue that flips up and traps the epiglottis
00:22:41.369 - 00:22:48.089
And then the surgical correction for that is to transect that band of tissue
00:22:48.089 - 00:23:02.809
And it can either be done with the laser standing or under anesthesia through the oral cavity with a hook blade or some scissors or a combination of both
00:23:02.809 - 00:23:05.990
It's kind of a tricky procedure as far as,
00:23:05.990 - 00:23:07.490
a lot of times,
00:23:07.490 - 00:23:12.930
that subepiglottic tissue that you transect will become inflamed
00:23:12.930 - 00:23:17.410
And so you do have to really watch those closely after surgery
00:23:17.410 - 00:23:18.210
Because one,
00:23:18.210 - 00:23:19.400
they can re-entrap,
00:23:19.400 - 00:23:20.099
or two,
00:23:20.099 - 00:23:24.970
that tissue will get inflamed and cause some problems later on
00:23:24.970 - 00:23:27.599
So it's not always a straightforward procedure,
00:23:27.599 - 00:23:29.369
even though it sounds simple
00:23:29.369 - 00:23:30.369
Yeah
00:23:30.369 - 00:23:32.809
Because of this tissue in the wrong place,
00:23:32.809 - 00:23:35.730
is there any like ulcerations or anything that actually occur?
00:23:35.730 - 00:23:37.849
And how do you sort of recognize those?
00:23:37.849 - 00:23:38.549
Yeah,
00:23:38.549 - 00:23:40.650
so preoperatively,
00:23:40.650 - 00:23:43.650
you can kind of decide maybe,
00:23:43.650 - 00:23:48.410
or have an idea of which ones are going to have more trouble after surgery,
00:23:48.410 - 00:23:50.569
because they present in varying forms
00:23:50.569 - 00:23:51.589
So sometimes,
00:23:51.589 - 00:23:54.500
the tissue is-- it must have been very acute,
00:23:54.500 - 00:23:57.890
and the tissue's not inflamed at all
00:23:57.890 - 00:23:59.609
And those tend to go pretty well
00:23:59.609 - 00:24:00.750
But sometimes,
00:24:00.750 - 00:24:05.769
it may be a few days or even a week or two that the horse has been entrapped
00:24:05.769 - 00:24:08.440
So that tissue is more thickened,
00:24:08.440 - 00:24:09.190
and yes,
00:24:09.190 - 00:24:11.609
it can be ulcerated as well
00:24:11.609 - 00:24:14.490
And then if it's been entrapped for a really long time,
00:24:14.490 - 00:24:18.250
you can get some malformation of the epiglottic cartilage
00:24:18.250 - 00:24:24.569
And that is difficult to resolve once you get the malformation of the cartilage itself
00:24:24.569 - 00:24:26.890
How does the cartilage change with that condition?
00:24:26.890 - 00:24:29.650
It's usually like fairly pointy and triangular and symmetrical
00:24:29.650 - 00:24:30.930
So what do you see in that situation?
00:24:30.930 - 00:24:31.660
Yeah,
00:24:31.660 - 00:24:33.619
so a lot of times,
00:24:33.619 - 00:24:35.420
it'll be blunted,
00:24:35.420 - 00:24:41.539
or even I've had a couple that were just kind of zigzagged at the end,
00:24:41.539 - 00:24:45.930
like it's been kind of smashed up against that tissue
00:24:45.930 - 00:24:53.369
And once the cartilage-- there's not much you can do to restore that normal structure of the cartilage
00:24:53.369 - 00:24:54.019
Anything locally,
00:24:54.019 - 00:24:54.440
medically,
00:24:54.440 - 00:24:55.130
you do with these?
00:24:55.130 - 00:24:59.369
Because you mentioned ulcerations and that sort of excessive tissue that can develop
00:24:59.369 - 00:25:01.069
Besides the surgical part,
00:25:01.069 - 00:25:07.490
what does-- like any sort of like topical medical or systemic medical things and convalescent periods for those horses,
00:25:07.490 - 00:25:08.769
how do you manage those?
00:25:08.769 - 00:25:09.099
Yeah,
00:25:09.099 - 00:25:10.210
so sometimes if they're really,
00:25:10.210 - 00:25:10.849
really swollen,
00:25:10.849 - 00:25:14.359
you might go ahead and start them on medications even before-- and you know,
00:25:14.359 - 00:25:16.730
maybe wait 24 hours to do the surgery
00:25:16.730 - 00:25:25.029
So you might start them on some anti-inflammatories systemically and with throat spray or nebulizing
00:25:25.029 - 00:25:26.470
And then also antibiotics,
00:25:26.470 - 00:25:29.690
because there's usually some infectious component as well
00:25:29.690 - 00:25:31.690
And then post-operatively,
00:25:31.690 - 00:25:33.930
we monitor them very closely
00:25:33.930 - 00:25:34.480
You know,
00:25:34.480 - 00:25:36.190
while they're in the hospital,
00:25:36.190 - 00:25:37.769
we'll scope them every day
00:25:37.769 - 00:25:40.049
And then when we send them home,
00:25:40.049 - 00:25:44.119
we try and look at them once a week or once every other week,
00:25:44.119 - 00:25:46.450
depending on how they're progressing
00:25:46.450 - 00:25:47.319
And yeah,
00:25:47.319 - 00:25:52.109
they're usually sent home on throat spray or nebulizing,
00:25:52.109 - 00:25:54.329
if they have nebulizer
00:25:54.329 - 00:25:55.759
Oral antibiotics,
00:25:55.759 - 00:25:56.519
banamine,
00:25:56.519 - 00:26:00.970
and then also some steroids like prednisolone or even dexamethasone
00:26:00.970 - 00:26:05.009
I found the nebulizer to be very helpful with a lot of those
00:26:05.009 - 00:26:05.470
Yeah,
00:26:05.470 - 00:26:09.849
nebulizing like antibacterials or corticosteroids or silver
00:26:09.849 - 00:26:10.849
Even just the silver spray
00:26:10.849 - 00:26:11.849
Silver spray
00:26:11.849 - 00:26:12.849
Yeah
00:26:12.849 - 00:26:13.849
It's helpful
00:26:13.849 - 00:26:14.009
But yes,
00:26:14.009 - 00:26:14.849
you can put a lot of stuff in the nebulizer
00:26:14.849 - 00:26:15.240
Yeah,
00:26:15.240 - 00:26:15.849
you can
00:26:15.849 - 00:26:16.849
Yeah
00:26:16.849 - 00:26:17.849
Yeah
00:26:17.849 - 00:26:18.849
Yeah
00:26:18.849 - 00:26:19.089
But yeah,
00:26:19.089 - 00:26:19.359
that just,
00:26:19.359 - 00:26:19.599
you know,
00:26:19.599 - 00:26:20.809
it's just really not just surgery and done
00:26:20.809 - 00:26:21.220
I mean,
00:26:21.220 - 00:26:26.430
this is a real comprehensive approach to these horses because it's potential to be career-ending if it's not,
00:26:26.430 - 00:26:26.849
right?
00:26:26.849 - 00:26:27.180
Yes,
00:26:27.180 - 00:26:27.849
for sure
00:26:27.849 - 00:26:28.849
Yeah
00:26:28.849 - 00:26:29.849
Yeah
00:26:29.849 - 00:26:30.029
Well,
00:26:30.029 - 00:26:30.299
you know,
00:26:30.299 - 00:26:30.779
one thing I found,
00:26:30.779 - 00:26:31.740
and this is just a little bit of a jump,
00:26:31.740 - 00:26:35.650
when a few years back we had a large farm that had a strangles issue
00:26:35.650 - 00:26:37.819
And so when we got everything pretty well cleared up,
00:26:37.819 - 00:26:38.539
it kept recurring,
00:26:38.539 - 00:26:40.170
and so we had to find the culprit
00:26:40.170 - 00:26:45.130
And so we did endoscopy on the guttural pouches of about 200 mares
00:26:45.130 - 00:26:47.059
The most striking thing that I found,
00:26:47.059 - 00:26:47.539
though,
00:26:47.539 - 00:26:51.410
was how much pathology some of these older horses are living with
00:26:51.410 - 00:26:53.099
And so we figured out,
00:26:53.099 - 00:26:53.839
you know,
00:26:53.839 - 00:26:54.180
oh,
00:26:54.180 - 00:27:01.809
that's why this horse can never gain weight because her retinoids are just massive and draining
00:27:01.809 - 00:27:04.170
And so we actually did surgery on a couple of those horses
00:27:04.170 - 00:27:07.910
So I think it's probably a good thing for veterinarians and owners to remember,
00:27:07.910 - 00:27:09.529
especially with older horses,
00:27:09.529 - 00:27:11.460
when you have a workup for a weight loss,
00:27:11.460 - 00:27:15.690
to make sure you look at their upper airway because a lot of stuff can happen in these older horses
00:27:15.690 - 00:27:16.690
Yeah
00:27:16.690 - 00:27:17.690
And sometimes it's an incidental finding
00:27:17.690 - 00:27:19.829
You look there and the airway's almost like closed over,
00:27:19.829 - 00:27:21.049
or they acutely close over
00:27:21.049 - 00:27:22.049
Yes
00:27:22.049 - 00:27:23.400
And you're looking at it and sort of thinking,
00:27:23.400 - 00:27:24.650
this has been going on for a long time
00:27:24.650 - 00:27:25.130
And they'll be,
00:27:25.130 - 00:27:25.269
oh,
00:27:25.269 - 00:27:25.470
yeah,
00:27:25.470 - 00:27:25.789
you know,
00:27:25.789 - 00:27:27.170
she's just breathing a little bit funny
00:27:27.170 - 00:27:27.859
Or as you say,
00:27:27.859 - 00:27:29.630
had trouble putting weight on her
00:27:29.630 - 00:27:32.690
She stood where the neck sort of stuck out and everybody wondered why
00:27:32.690 - 00:27:37.849
It's because their laryngeal cartilages are on fire and they're losing their airway
00:27:37.849 - 00:27:39.970
Interesting stuff
00:27:39.970 - 00:27:40.970
Yeah
00:27:40.970 - 00:27:41.970
Yeah
00:27:41.970 - 00:27:42.329
So,
00:27:42.329 - 00:27:42.970
yeah
00:27:42.970 - 00:27:43.250
Well,
00:27:43.250 - 00:27:45.130
thank you for coming in and seeing us today
00:27:45.130 - 00:27:51.890
It's been a fascinating tour of the upper airway of the horse and the surgeries that are actually possible to fix things up
00:27:51.890 - 00:27:53.589
And you've had a very interesting career,
00:27:53.589 - 00:27:54.930
like racing quarter horses
00:27:54.930 - 00:27:57.410
You've got me convinced I have to go and have a look at some
00:27:57.410 - 00:27:58.410
We need to go
00:27:58.410 - 00:27:59.410
We need to go
00:27:59.410 - 00:28:00.410
We've got to go
00:28:00.410 - 00:28:01.410
Yeah
00:28:01.410 - 00:28:01.759
We've got to go because,
00:28:01.759 - 00:28:01.910
you know,
00:28:01.910 - 00:28:02.410
I've sort of seen video
00:28:02.410 - 00:28:03.410
They start here and they sprint
00:28:03.410 - 00:28:04.210
It's sort of like,
00:28:04.210 - 00:28:04.660
you know,
00:28:04.660 - 00:28:06.109
the Usain Bolt of the horse world,
00:28:06.109 - 00:28:06.559
you know,
00:28:06.559 - 00:28:08.250
they just drag race and that's it
00:28:08.250 - 00:28:09.250
And they're gone
00:28:09.250 - 00:28:10.029
And as you say,
00:28:10.029 - 00:28:11.210
it's pretty quick
00:28:11.210 - 00:28:12.390
And the thoroughbreds,
00:28:12.390 - 00:28:16.730
we just watch him go around the track and potentially have different problems
00:28:16.730 - 00:28:17.230
But I mean,
00:28:17.230 - 00:28:22.089
this airway sounds like it's pretty common between the two breeds and within disciplines within the breed
00:28:22.089 - 00:28:23.089
Yeah
00:28:23.089 - 00:28:24.960
So in quarter horse racehorses,
00:28:24.960 - 00:28:26.970
one thing about them is they don't,
00:28:26.970 - 00:28:33.250
they can get by a little bit better with these airway problems because they don't have to run as far
00:28:33.250 - 00:28:37.960
So I do feel like we had a better success rate and with tiebacks in those horses,
00:28:37.960 - 00:28:40.609
because even if you help them a little bit,
00:28:40.609 - 00:28:41.240
you know,
00:28:41.240 - 00:28:43.329
they didn't have to go very far
00:28:43.329 - 00:28:46.210
So how many times did they breathe in that 21?
00:28:46.210 - 00:28:46.599
Yeah,
00:28:46.599 - 00:28:47.210
exactly
00:28:47.210 - 00:28:48.210
Right
00:28:48.210 - 00:28:48.740
Because I mean,
00:28:48.740 - 00:28:49.210
it's a sprint
00:28:49.210 - 00:28:50.210
Right
00:28:50.210 - 00:28:51.210
Yeah
00:28:51.210 - 00:28:52.210
The thoroughbred is like with the stride
00:28:52.210 - 00:28:52.529
Breathe,
00:28:52.529 - 00:28:52.880
breathe,
00:28:52.880 - 00:28:53.210
breathe
00:28:53.210 - 00:28:54.210
Right
00:28:54.210 - 00:28:55.210
Yeah
00:28:55.210 - 00:28:56.210
So that's probably why we don't do that
00:28:56.210 - 00:28:57.210
Yeah
00:28:57.210 - 00:28:58.210
Something to think about
00:28:58.210 - 00:28:59.210
Yeah
00:28:59.210 - 00:29:00.210
Okay
00:29:00.210 - 00:29:00.539
Well,
00:29:00.539 - 00:29:01.210
excellent
00:29:01.210 - 00:29:01.339
Well,
00:29:01.339 - 00:29:01.490
again,
00:29:01.490 - 00:29:02.210
thank you for coming on Stoolside
00:29:02.210 - 00:29:03.920
This has been a fascinating talk and yeah,
00:29:03.920 - 00:29:05.160
I'm much more knowledgeable,
00:29:05.160 - 00:29:05.730
I think
00:29:05.730 - 00:29:06.730
Me too
00:29:06.730 - 00:29:07.730
Yeah
00:29:07.730 - 00:29:08.730
Hopefully our listeners are as well
00:29:08.730 - 00:29:09.730
Yeah
00:29:09.730 - 00:29:10.730
It was a good conversation
00:29:10.730 - 00:29:11.730
Yeah
00:29:11.730 - 00:29:12.730
So that's StallSide for this week
00:29:12.730 - 00:29:13.289
We've been talking to Dr
00:29:13.289 - 00:29:14.730
Ali Broyles here at Rood and Riddle about upper airway surgery
00:29:14.730 - 00:29:15.930
See you next time