Frequently Asked Questions

Most asked QUESTIONS with my ANSWERS


Note:-Unless otherwise stated, questions are answered with reference to the condition Pharyngeal Dysfunction and the surgery Oral Palatopharyngoplasty (OPP), which is one of a number of procedures developed to reduce the incidence of this dysfunction.


1) Are there many different types of throat problems?

Yes !     About 35 at last count. Some are variations on a theme and others

           are quite distinctly individual.


2) Are there many different types of lung problems?

Yes!    Allergies (particularly springtime), infections (Viruses and bacteria), hyperresponsiveness (irritations), bleeding (EIPH), obstructive disease (COPD), lung consolidation, foreign material infections, pneumonia, pleuritis, bronchitis (inflammation) ..... and more.

Often a horse presents with several of the above, whilst one facet may either initiate or contribute to the other. There may also be an upper respiratory tract (throat) problem complicating these.


3) Can horses have more than one throat problem at the same time?

Yes! As with limbs unfortunately some individuals seem to acquire multiple problems.


4) Can horses have lung problems and throat problems at the same time?

Absolutely ! ... as the old saying goes “the knee bones connected to the thigh bone...”.  A dysfunctioning throat can lead to abnormal pressures being applied to the lower airways and certainly whilst the soft palate is displaced dorsally, contamination of the lower airway with oral material (from the mouth) is possible. Conversely lower airway disease can lead to increased overall airway negative pressures which can contribute to collapse of the upper airway. The important thing from an investigative point of view is to make sure that both areas are being considered.


5) Are these problems inherited?

(i) Yes, in most but not all cases of laryngeal hemiplegia (laryngeal paralysis).

             Therefore breeding from ‘severely’ affected animals is generally not

              recommended.

(ii) No,  in all cases of pharyngeal dysfunction that I am aware of. The problem is

               acquired, common and may occur in families but is not inherited. The progeny

              of particular stallions may have a higher incidence of audible DDSP (palate

              problems). The only common denominator that I have noted is that these animals

              are usually very fast off the mark ‘accelerate quickly’ and thus seemingly apply

              more pressure to their airways (negative or ‘suction’ pressure during inspiration)

              in a shorter space of time,  thus increasing the opportunity for airway collapse to

              occur. The plus is however, that these are often amongst the best performers.

              These should not  be excluded from breeding programs under the

               misconception that they will necessarily pass on this problem.


6) Do young horses ‘grow out ’ of these problems?

  In some cases and for different reasons the problem can be temporary. Particularly in yearlings, endoscopy often reveals a higher incidence of DDSP. This may well be associated with a more flaccid ‘juvenile’ epiglottis. As the epiglottis matures the incidence declines.

At 2 and 3 years the situation can differ though. Some reports have suggested that up to 90% of 2 yr olds that are ‘noisy’ early in the season become noiseless or less noisy by the time they turn 3..  It may however be a misconception to conclude that if the noise has gone, the problem has gone ! Performance i.e... ‘ability to get to the line’ is often a  more reliable guide for attributing ‘normality’. It is quite conceivable that at least a reasonable number of these young horses simply become ‘silent chokers’ ( amongst that 52%) or adopt an attitude of ‘not trying’ !  And why shouldn’t they ?  Who would enjoy choking?

Of interest, when several major trainers were asked to give an estimate of the number of these young ‘early noise’ horses that in their opinions eventually performed up to the expected mark?.. the answers were  “Not very many! ” and ”A few seemed to? ”.


7) Are there many different operations performed on horses throats?

Yes !    About 20 procedures at a quick count. It is with dismay that I too often

            hear trainers making reference to, and comparing results of, different ‘throat

            operations without being aware of the exact type of procedure performed. For

            example there are 10 different procedures for ‘palate problems’. So if your horse

            had a palate surgery,  (as with a bit change)........  what type ? 


8) Does throat surgery always, sometimes or in fact ever ‘FIX’ or ‘eliminate’ the problem totally?

In the ‘majority’ of cases No !       

                (i) The larynx. After most laryngeal procedures (tie-back, Hobday, arytenoidectomy, chordectomy) the larynx is no longer referred to as normal ! However the surgery may well render the horse able to compete successfully. Again different procedures approach the problem in different ways. One of the worlds foremost researchers in this area is an Australian, Ian Fulton BVSc , who hails from Victoria. Ian has developed a new procedure which looks to replace the damaged nerve in the larynx.

                      (ii) The pharynx. A number of conditions of the pharynx are regarded as ‘abnormalities’ e.g. entrapment of the epiglottis,  whilst the more common presentations such as DDSP and dynamic pharyngeal collapse , whilst regarded as abnormal or inappropriate when they occur during exercise, are all very ‘normal’ occurrences when the horse is swallowing.

SO !... if we were to stop DDSP (displacement of the soft palate) from occurring, then the horse would be unable to eat. “It could be done!”  as I have often remarked to trainers, but you would need to have him nominated for a race soon after... i.e. before he starves to death !    So we don’t fix them with surgery . We do however aim to reduce the incidence or intensity of the particular problem.


9) What other  factors should be considered  before going to surgery?

The success (reduction in the incidence of premature fatigue) will be as dependent on  the management of ‘other  factors’ inhibiting oxygen supply to the tissues as it will be on the surgery itself. If the horse is a bad bleeder or has chronic lung problems then the prognosis is guarded. i.e. supplying good air to bad lungs is like putting a new carburetta on a car when the motor is ‘blown’.

Cardiac problems (although rare) and serious leg problems should also be taken into account.


10) When do I have the surgery performed (Timing)?

If the problem exists in the young unraced horse then it might be beneficial to have it performed prior to its experiencing ‘asphyxiation whilst racing’. i.e. prior to having to deal with race associated nervousness... reluctance etc. It may also be prudent to make this decision early in the season so that even with the post operative ‘down time’ the season is not lost in total. With older racing horses it may be best with less dramatic cases i.e.

temporarily manageable,  to delay surgery till the end of the season so as not to interfere with racing schedules.  More acute cases are obviously dealt with ASAP.


11) How does OPP surgery work?

OPP surgery is a little like an internal ‘face lift’. The aim is to remove some  redundant tissue and to tense others. The surgery is not however performed to remove something that shouldn’t be there i.e. an abnormality or abnormal tissue. As with a ‘facelift’ we are simply ‘modifying’ normal tissues. As discussed previously surgery is performed to reduce the incidence of pharyngeal airway narrowing or collapse occurring at an ‘inappropriate time’.

An analogy would be.... You have just purchased a new car which is designed to perform  all the tasks for which you normally require it (children to school, motorway trips to business meetings...etc). A month later you hear that there is an ‘amateur road race club’ starting up in town. “Fantastic” you say seeing this as a means of dealing with your ‘Mid Life Crisis’. But now you ask yourself , “Will my car be suitable for amateur racing?” Answer ; It may well be though it may also require some modification to better cope with the added pressures of road ‘racing’. Often a carburetta modification is at the top of the list. For your horse (which in all fairness ‘we’ have selected for racing, whilst ‘nature’ or evolution didn’t )  racing plates, special diets and exercise programs are all modifications from the norm (wild state) designed to help the animal better cope with the rigours of ‘elite performance’. Performing OPP surgery is similar in principle to these, although dissimilar in that it becomes a permanent change.

Note: Other surgeries such as Tie-backs are performed to treat acquired abnormalities (paresis or paralysis)... breakdowns!!  


12) When should the surgery be referred to as ‘successful ’ ?

Most horses present for surgery unable to complete either workouts or races...i.e. they experience ‘fatigue’ before the Winning post  / end of workout. The idea of surgery is in the main to transpose the onset of fatigue to ‘anywhere’, even one step past the post.

Once a horse is doing his best work ‘on the line’ it is reasonable to assume ‘normality’. I usually say to the trainer that within 8 months of surgery (comprised of post op rest , training and 4-5 races) ‘they’ are probably in the best position to answer that question!


Another commonly touted measure of success is;  Did he Win a race / races after surgery?   Academics regularly argue the validity of this point. However, it is not  an  unreasonable meter given that few trainers will consider surgery if they don’t feel that the horse is at least capable of winning a race. Thus a reasonable number of horses should win after surgery.

Horses may also win despite surgery and may improve after successful surgery but not enough to win.


13) How does surgery fail?

With an OPP, surgery can ‘fail’ in two ways.

       (i) Surgery failure...if the stitches come out during the first 6-7 days after surgery. This is why a special diet / bedding is recommended. This would be similar to a laryngeal prosthesis pulling through the cartilage (avulsion). To determine whether the sutures have come out an examination under anaesthetic is required.

       (ii) Procedure failure... is when all goes well with the surgery but the horses ‘work / racing does not improve. There is unfortunately never a 100% success rate. Hopefully though with good surgery , post operative care, and astute post operative management (trainer, exercise rider, jockey, yard veterinarian) success will occur in the majority of cases.


14) If the result isn’t good  after surgery ,can anything else be done?

Yes and No !  In some cases there may be no further course of action and then it must be concluded that surgery failed to improve the situation  or at least significantly. However there have been enough instances where further surgery, or the addition of another technique has made the difference between ‘success’ and ‘failure’. If the original surgery broke down then the scar tissue can be removed and further sutures placed. Medical protocols may also be of assistance.


15) How important is noise elimination with surgery?

A lot less important than we once thought. Many horses that have had useful outcomes with OPP surgery still make a biphasic noise when ‘hard on the bit’ i.e, are pulling against the rider. This is often described as being a different pitch (often sharper) after surgery. It is also of interest that in recent reports researchers have been unable to equate less noise with improved race form with laryngeal (tie-back) surgery.

Again we are not performing a surgery to eliminate noise but to reduce the incidence of premature fatigue.   It is interesting to consider the situation of  ‘an open window in a wild rain storm’. One hears an irritating clapping noise from the flapping blinds as wind and rain stream through the open window. In walks the ever aware butler who announces “I will FIX the problem Sir!” at which he tears down the blinds. “Problem solved!”. ..........?????

Question; How do you ‘eliminate’ noises with throat surgery? Answer; Perform a ‘throat-ectomy’!


16) Can horses have several procedures performed on them at the same time?

Yes! Some estimates suggest that up to 50% of horses that have laryngeal paralysis also suffer from inappropriate DDSP. DDSP may well be secondary to the first problem but unfortunately it still often occurs after surgery has been performed on the larynx. So why not attend to both. There are quite a variety of ‘combination’ surgeries performed in different countries around the world.The philosophy of many surgeons is to do as much as possible under one general anaesthetic.


17) How can I tell if my horse has already had throat surgery?

With laryngeal surgery (Tie-back) endoscopy and an examination of the surgical site usually , but not always, answers this question. However with an OPP procedure, which is performed in the back of the mouth, a general anaesthetic is required to allow a full examination of the surgical site.


18) How much time off after surgery? 2 weeks, or maybe 6 months would be better?

From 6 to 12 weeks is  the recommended range. Any shorter and you are not allowing for airway inflammation to settle. Any longer appears to be of no extra benefit. You would be better off utilising the extra time in ‘Stretch / Rest’ training to assist in the recovery of useful lung function.

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QUESTIONS 19 to 22  were answered by ‘professional  thoroughbred TRAINERS’  from their experiences with horses after OPP surgery over a 15 year period.


19) Should I take my time getting him ready for his first race? Any benefit?

No!  About the ‘universal’ 10 to 12 weeks for a Flat runner and whatever extra for a national Hunt (jumping)horse. Too long spent doing long slow work appears to lead to an increased incidence of bleeding (EIPH). This may be because when they are finally allowed to gallop seriously , they are so keen that they overdo the lung stretching. i.e. gallop ‘Brilliantly’ prematurely! Regular incremental increases in respiratory (lung) demand are preferable.



20) If the horse needs ‘plenty of work’ then how much and for how long?

(i) The best simple guide is to add a furlong or two to your race in terms of the horse’s preparation. i.e. if you are getting him ready for a 5 furlong race , give him enough work for a 6 or 7 furlong race.... particularly in the lead up. Treat him like the ‘fatter’ horse in the stable.

(ii) This type of work will eventually tell on the horse though. So give him 2-3 races and then back to a week or 2 of walking only . Then back to full training and another 2-3 races etc. The alternative is to string 6-7 races together but after this the lungs often begin to ‘sting’ a little and ‘race form’ drops away. If this occurs, 5-6 weeks in the field is required to let the lungs settle.

(iii)  This Race / Rest protocol is of most importance in the first season. After this ‘normal’ racing schedules apply. The first season is regarded as a ‘Recovery preparation’. You as a trainer are looking to ‘recover’ good lung expansion / function.


21)Can I do the  plenty of work initially and then keep him ‘sharp’ between races, as he’s a sprinter?

Have a look at your horse and check his feed container! Chances are there is no leftover feed and thus without work your horse is just upgrading its ‘body fat’ content..... and that may well be how he races! In later preparations this may be possible. Initially though it would be worth trying the ‘extra furlong or two’ plan.


22) How do I know if it is too much work for him?

I watch my horse and his feed as we do with all of them. This is more important with the raced horse who may have been working and racing under sufferance (lack of air) for a reasonable period of time (6 mths or more) prior to surgery. I’m always looking for indications that the lungs may be taking a little more blood than usual or that the airways are becoming inflamed. This mostly occurs where normal lung tissue interfaces with previously injured tissues. Injured tissues are those which have undergone some form of semi-permanent or permanent change due to chronic airways disease or bleeding.This is a bit like watching a ‘tendon’ through its first preparation after injury. At some stage the ‘interfacing’ good and bad tendon tissue will pull against each other, with the possibility of minor inflammation (heat and swelling) resulting. Similar events can occur in the lungs with increasing exercise demand, however we can’t see or palpate these as we can with the tendon. The horse however appears to sense these changes. This is probably due to some associated bronchospasm ‘tight chest’. The behaviour or attitude to work that was improving, now tends to revert. This ‘change of behaviour’ (ears back, aggressive, nervous not wanting to come out of the stall, beginning to rush his work again...etc) is usually the ‘FIRST sign’ that pain or discomfort is entering the equation....i.e. time to stop work.  His coat may also change next (dull, dry) which of course takes longer to appreciate,  but his appetite is less likely to be affected after surgery. If however his feed intake does decrease significantly then training should cease. At this stage (like the tendon) you can have your vet reexamine the horse (lung wash - tracheal wash) but most importantly confine exercise to walking, until these changes have reverted for at least 3-4 days!  Also, like the tendon, the earlier the inflammation / bleeding is detected, the less damage occurs resulting in a shorter layoff period. When horse, coat  and attitude improve work can recommence.  This normally takes between 1-2 weeks.

I tend to refer to this as “All or Nothing”  training, or with reference to the lungs “Stretch and Rest”  training! i.e. ‘All’ is the solid work required to ‘stretch’ the lungs. However if lower airways damage was present prior to surgery then at some stage in the stretching process inflammation may recur. ‘Nothing’ (walk / jog, or paddock) is the ‘Rest’ period which encourages regression of this inflammation. 


23) How do I get a full seasons racing out of him?

First do the surgery at the appropriate time to allow for a rest in the ‘off season / time’ (unless it is an acute problem), and secondly choose a convenient time for a ‘Lung rest’. Mid season, or during the wet / hard if he doesn’t like these surfaces i.e. Work ‘the rest’  or ‘rests’ around his racing program and not vice versa . Normally, for the first preparation I would give a horse 5-7 races before 5-6 weeks in the paddock... or less races with shorter breaks , for example... 3 races then 2 weeks of walking, then 3 more races and two weeks walk ....etc. The horse (behaviour, coat ..) or its race form will tell you when its had enough.... but less often the ‘feed bin’ after surgery.    

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24) Any medical treatment useful or required?

Ventipulmin (Clenbuterol) used for the first 48hrs after a race can help to rid the lungs of any debris that may have entered the airway during the race. This will reduce the chance of the lungs becoming inflamed. This medication must be prescribed by your veterinarian and withdrawal guidelines heeded.

Other lung treatment is at the discretion of your surgeon and or your yard veterinarian and will depend on the state of your horses lower airways. There is no treatment recommended for its throat.


25) Can I swim my horse after surgery?

Yes, after successful OPP surgery. No, after a laryngeal Tie-back. If however the horse was a poor or non swimmer before OPP surgery, be cautious as it may well resent reentering the water, for obvious reasons.


26) For how many seasons can I expect the surgery to help my horse  - can he race for?

Ultimately with successful surgery the limitation on racing life has more to do with the general ‘wear and tear’ factor. There have been numerous young (2-3 yr olds) that after surgery have raced on for 6-7 years. If a horse presents for surgery with significant lung damage from previous racing then one would expect a reduced racing life. ‘Class’ of course is an important factor with regard to racing life. If there are no races left to Win given its innate ability then early retirement (in very good health) may be on the cards.

The majority of successful surgeries have meant at least 3-4 useful seasons of racing. 

 

27) How important is aerobic fitness with these horses , with or without surgery?

Very important! The fitter the horse the less chance of premature fatigue. The problem with the preoperative horse is that such things as , repeated airway infections, bad attitudes (doesn’t want to work) and weight loss with or without reduced appetite tend to hinder the trainers ability to get the miles into them.


28) How important is appropriate riding with or without surgery?

Very important ! Pharyngeal airway collapse given the right / wrong situation could conceivably occur in any horse during exercise. A riders balance , rein pressure adjustment, and sense of timing are extremely important in giving the horse the best opportunity to breath efficiently. As surgery ‘cures’ nothing these factors apply both pre and post operatively and in fact for any horse !  i.e. ‘it’s just good riding’.


29) Are blinkers / hoods of any use after surgery?

In general if blinkers are worn pre-operatively (unless only recently added.. without success) then they are most often worn post operatively. Post operatively they are occasionally added if horses ‘go to sleep in a race’ (particularly a sprint) and the jockey has trouble keeping them even ‘a little on the bit’.The blinkers of course tend to put the horse nicely ‘on the bit’ to save the jockey having to ‘work on the horse’ the entire race.


30)  Will a lack of race confidence still be a factor after surgery?

If the horse has raced under sufferance (with a breathing disability) prior to surgery then nervousness and an unwillingness to try under pressure has often resulted. It is unrealistic to think that the horse will immediately discard its fears once surgery has been performed. Subsequently it would normally take 3-4 races after surgery for nervousness to regress and confidence and thence good race form to be recovered. It is not uncommon for the first race or two post operatively to be very ‘ordinary’ performances.


31) Is deep / wet ground still a factor after surgery?

Yes ! You may still find that the horse that ‘slips and slides’ on sticky ground tends to ‘loose’ the bit more often, setting up the opportunity for pharyngeal collapse (choke - gurgles). This may necessitate the need to race him on firm tracks.


32) How does pain affect breathing?

In several ways. If the horse is overtly lame and its length of stride is affected, then length of breath (these two factors are of course intimately related) should also. So reduced stride -> reduced tidal volume (air passing from nostrils to lungs) -. reduced gas exchange -> greater chance of premature fatigue.

Pain if distracting (distracting the horse from its breathing / bit holding) may also indirectly increase the opportunity for pharyngeal airway collapse. 


33) Does ability to jump affect breathing?

Again if hitting jumps (due to poor ability to jump) or jumping into other horses whilst negotiating a jump, leads in any way to decreased pharyngeal tone (as with sticky / deep ground) then the opportunity for ‘choke’ increases. Surgery may reduce the opportunity for this to occur but it does not negate it.


34) Can schooling a horse over jumps help its breathing?

It would appear so. A series of small jumps whether in a circle or straight line are placed at a short but equal distance from each other. To safely negotiate the first fence the horse must organise its stride (and thus breathing) otherwise contact with the fence and pain may result. Repeating this exercise at regular intervals (between jumps) appears to teach  at least some horses to organise bit holding , throat tone and head position in a manner that promotes ‘good breathing’. For this reason schooling of Flat runners as well as fence horses can be a useful post-operative training aid. 


35) After retirement from racing, due to the inevitable ‘wear and tear’, will the surgery still be of benefit to my horse / me?

In most cases Yes! Reports of horses 10-12 years after surgery being in great health (weight carrying, willingness to exercise, behaviour) are quite common. Even with ‘wear and tear’ many have become very willing and exercise tolerant  X country , hunting or general pleasure horses after racing.


36) Should I have surgery performed on my ‘hunter’, X country horse that has the same problem?

Common sense should prevail here. Is this problem concerning either yourself or the horse?

Are we intending to keep each others company for the next 8-10 years? The rest I leave to you........!


37) Is the incidence of these problems increasing or are we just in a better position to diagnose them these days?

It is often said that “even with all the breeding selection and scientific striving of recent decades it would appear that the horse goes no faster”. Also often overheard is “We never had anything like this number of breathing problems years ago”.

- Flexible fibre optics and high speed treadmills (given that up to 52% of horses with DDSP appear to make no abnormal noise) have naturally increased the chance of diagnosing dysfunctions that have previously been missed. The ‘noiseless’ horse was once branded as being “not interested in racing” or worse.

- There also appears to be a tendency for modern training protocols to encourage ‘speed’ at  the expense of ‘stamina’. These efforts have led to ever decreasing track record times, but may also be contributing to functional airway collapse with fatigue. 


38) What about ‘tubing’ a horse? (tracheotomy)

The major positive should be supplementary air supply.

The negatives.. The daily care / cleaning required. The possibility of tissues collapsing around the tube and restricting airway. The air is not ‘conditioned’ by the nasal turbinates and thus the efficiency of gaseous exchange may be compromised

It is usually temporary, so the horse may eventually be the loser.


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