Working Against Time

An equine vet takes us through the diagnosis and treatment of a horse with a metal sliver in its tongue.

BY PIPER WHELAN

Recognizing the signs of a horse with metal embedded in its tongue can be the difference between life and death. Acting quickly in this situation is vital to ruling out other ailments with similar symptoms and ensure the problem doesn’t escalate.

“It’s what we would consider an emergency,” says Dr. Jordan Cook of Moore Equine Veterinary Centre in southern Alberta.

“Anytime you have a horse that is either drooling, has a lot of discharge coming from its mouth or its nose, they’re not wanting to eat, or they seem to be having difficulties eating or swallowing, definitely you want to get that horse checked out right away.”

Horses can get small pieces of metal stuck inside their mouths if it’s in their feed by accident, which may occur if little bits of wire or debris in a hayfield are picked up and baled. Another common way this can happen is when giant tires are used as hay feeders. “There’s little pieces of wire or metal inside the actual tire that’s being used as a feeder itself, and those can break down and then… work their way into the hay, and the horse takes a mouthful and doesn’t realize that there’s a small little piece of metal inside of it,” says Cook.

While metal slivers in horses’ mouths aren’t a frequent occurrence, it shows up enough that it’s something to be on the lookout for. “We see it a couple times a year,” she says. “It’s common enough that it’s something that we’re always have in the back of our mind if we’re seeing a patient that might be drooling or having some difficulty eating.”

Due to these symptoms, it’s often mistaken for choke, colic or a broken tooth. “We’ll have people call in thinking their horse is choking or maybe thinking that their horse might be colicking a little bit because all of a sudden they don’t want to eat,” says Cook.

After ruling out those issues, veterinarians will then look to see if there is a foreign object stuck inside the horse’s mouth. Metal or other objects are more likely to get lodged inside the tongue than embedded elsewhere in the mouth because it’s used to push the food back into their throat when swallowing.

If caught early enough, it’s somewhat easier to remove the metal from the tongue, though it will still require surgery to do so. Under anesthetic, the horse lays on the surgery table and has its mouth opened with a speculum so the surgeon can access the tongue. The surgeon will use the x-rays to guide them in carefully removing the metal from inside the tongue. If metal is left in the tongue too long, however, it can begin to migrate and cause more dangerous problems. The body, Cook explains, tries to dislodge the foreign object itself, but it’s not always able to move it out through the same place that it entered.

“It can actually start to migrate deeper into the throat or actually into all of that tissue that’s under the tongue, in and around the throat, and we can start to see it progress from just difficulties chewing and swallowing and drooling, to all of a sudden that horse is going to have some swelling associated with it. They can actually get an abscess or an infection around something that’s in there, and it may actually obstruct their ability to breathe,” she says.

“There’s lots of really important structures in that area, and so (it’s) a lot more difficult for us to remove or potentially have a higher risk of bleeding during surgery or a higher risk of complications after surgery if we wait too long.”

This is why calling your vet immediately after seeing these symptoms is so important, she states. “Any horse that is drooling, maybe has some nasal discharge, is having difficulty eating or swallowing or isn’t interested in eating, that to me is considered an emergency and should be checked out so that if we do identify that there’s a wire or some other foreign body inside their mouth or their throat, we can try and take it our as soon as possible.”

CASE STUDY: Early Detection for Successful Treatment
Recently, Cook was called to assist a mare that was suspected to be choking. “She was drooling quite a bit, she seemed to want to eat but was unable to do so and so it didn’t seem to resolve,” she says, adding that most mild chokes will resolve on their own within 15 to 20 minutes.

“It was identified very quickly at feed time, so when I came and took a look at her, she didn’t have any discharge from her nose, which is more common that we’ll see that with choke,” she explains. “She had manure in her stall, she was otherwise really bright and when I offered her food, she really, really wanted to eat it, but she’d take it in her mouth and immediately spit it out and drop it, and for her it was because there was a bit of a pain response.”

With this information, Cook administered some sedation and conducted an oral exam, finding the mare’s teeth to be in good shape. There were no other signs of foreign bodies in the mouth, such as pieces of wood stuck between the teeth. The only thing that looked concerning was the mare’s tongue. “I could see that her tongue appeared a little bit swollen in the middle, and I could actually see a little bit of blood, a little nick on the one side of her tongue, and then there was a little bit of swelling on the other side,” she says.

It was painful for the mare when Cook carefully pressed on the swelling, and that resulted in some bloody discharge coming out of the cut on the other side of the tongue. “That made me pretty suspicious that she may have something inside of her tongue.”

Cook’s next step was to take x-rays of the mare’s head, which quickly revealed that there was, in fact, quite a large piece of metal inside her tongue. She gave the mare some anti-inflammatories to reduce the swelling in her tongue and make her feel more comfortable. As they were unsure when the mare was last able to drink, she was tubed through her nose and given water and electrolytes to prevent dehydration before being referred to the clinic that evening.

Surgery was performed on the mare the next morning. “We got really lucky that that piece of wire hadn’t moved,” says Cook. “She was taken into the surgery suite, anesthetized, taken in, the speculum put back in her mouth again. Then thankfully our surgeon was able to go in and – using his hands and some instruments – was actually able to pull the piece of wire out of her tongue very successfully.”

Another round of x-rays confirmed that all the wire had been removed, and the mare went on to make a great recovery. “She was eating a little bit slower because her tongue was still a little bit painful but was able to happily eat and swallow with a few days of anti-inflammatories.” Back at home, the mare was carefully monitored to ensure she was able to chew and swallow properly as the swelling in her tongue went down.

Even though this situation isn’t a common occurrence in horses, Cook wants owners to be aware that this is something that could potentially happen. “Just because your horse has a little bit of drool or doesn’t seem to be eating, don’t necessarily panic right away that your horse has something stuck in its tongue, but be aware that that is an abnormal behaviour. Especially if the horse does seem bright and really wanting to eat but dropping food and unable to do so,” she says.

“Unfortunately, it can be life-threatening if left and not dealt with right away,” she continues. “If there’s any swelling around the throat or around the jaw, it’s definitely something you want to get checked out right away to make sure they haven’t eaten something, but also making sure that they’re able to eat and drink and breathe properly.”