ORIGINALLY PUBLISHED 4/15/14:  It was requested that I republish this article so here you go!

OESOPHAGEAL DIVERTICULUM – NOT A DEATH SENTENCE:  KHAN’S STORY… (It presents like Choke)

My neighbor who houses PLLL (Princess LlamaLlamaLlama), told me of her good friend in the UK that had a horse who was given very little chance to survive with an Oespohageal Diverticulum – yet he has!  And, he’s doing very well!

I am a huge proponent of spreading hope whenever possible!

So, I’d like for all of you to know the signs of an Oesophageal Diverticulum (similar to choke) and to learn of a plan to help your horse when vets give little hope.

KHAN’S STORY as told by his owner

My horse Khan (aka Kerry man) is a 16.3h part Irish Grey gelding who I have owned for the
past nearly 14 years. He is now 24.

…

In April of this year (2013) Khan suffered from what appeared to be a bout of “choke”. Having
experienced a friends horse suffer choke on a regular basis, I knew the symptoms when Khan
displayed them. He did not appear to display all the classic choke symptoms, displaying only
the “retching” as he tried to dislodge the obstruction.
There had been no signs of illness or anything untoward running up to this first episode of
apparent choke. In nearly 14 years of owning Khan, he never once suffered from choke, having
only ever suffered from mild colic a handful of times.
On the first occasion of the apparent choke in April, I called the vet who duly attended and
diagnosed choke. The vet advised that most horses will suffer choke at some point in the life
and therefore, we put it down to a “one off”. Within hours Khan was his usual bright and perky
self and ready for some tea!. There were no after effects and the following day he was turned
out as normal.
5 days later, I again noticed that Khan was displaying signs of “retching” whilst in the
paddock. I am fortunate that my home office over looks the paddock where I happily watch the
horses and sheep whilst talking to clients on the phone!. Coincidentally, or maybe not, each
apparent choke episode occurred around midday when Khan had been out grazing since turn
out. On this second occasion, and as with the first, Khan only displayed signs of “retching”
and no other classic choke symptoms such as nasal discharge etc. There was also no
apparent “bulge” in his throat which is often present when a horse suffers from choke.
This time, I brought him in, took away his access to hay and water (as always advised) and
monitored him for several hours. I called the vet and decided to monitor him to see if the
obstruction passed of its own accord. Once again, within hours Khan appeared bright and
back to his usual self. However, in spite of enjoying his “sloppy” tea, he went on to display
unusual behaviour upon swallowing a mouthful of hay. Upon taking his first mouthful of hay,
he chewed, swallowed and then bolted backwards around his stable whilst clearly in pain. It
was very distressing to watch as he banged into the four walls of his stable. Bizarrely, as soon
as the hay had clearly passed through his oesophagus, he stopped, walked forward and went
to take another mouthful of hay! I of course took the hay away and called the emergency vet.
The vet stated that it was unusual behaviour and clearly, as Khan had moved back to take
more hay, he could not be suffering from choke again. The vet suggested that if this
continued, an endoscopic examination may be necessary. Never once did I suspect anything
serious as reference was made to a possible ulcer or abscess only.
By the morning, Khan appeared his usual perky self and keen to eat his breakfast as normal.
Again there were no apparent signs of choke or that anything was wrong. For the following 5
days he was his normal self and displayed absolutely no signs of anything being wrong.
However, 6 days after the second incident (so 3 incidents in 12 days) Khan suffered a further
episode of apparent choke whilst out grazing. This time, it appeared very “mild” as he was
“retching” but refused to be caught when I tried to bring him in! He knew I was about to put
him in his stable for the next 3 hours and he was not having any of it! Within an hour, the
apparent choke appeared to have passed and he grazed happily all afternoon.

Following this third episode, I arranged to take him to the vets for an endoscopic examination.
A further 6 days passed between the third episode and the day of taking him to the vets. He
appeared his normal self and displayed no signs of choke or that anything was wrong.

DIAGNOSIS

On 1st May I attended the vets with Khan, completely oblivious to what I was about to be told,
and oblivious to what would change our lives (both me and Khan) forever. Never once did I
suspect anything serious let alone life threatening or that I may be given an option as to
whether I wanted to take him home that day! Khan was bright eyed and keen to load onto the
trailer that morning, clearly expecting a “nice” trip out somewhere. He unloaded at the vets
and was very lively, on his toes, and neighing to every horse that was in sight! He stood
happily by the trailer munching on (what was to be his last ever mouthful) of hay!

The vet carried out an endoscopic examination which showed a massive impaction of food
material and predominantly hay far down Khan’s oesophagus. The obstruction could not be
dislodged in spite of repeat attempts. The camera showed marked ulceration of the
oesophageal wall in areas where food matter was dislodged. This probably accounted for
Khan having bolted backwards around his stable following the second episode of choke. The
hay perhaps, scratching the ulcerated points in his oesophagus?

The vet advised that an X-ray be taken to assess the full extent of the obstruction. At this point
I had no idea what was about to be discovered. A dye (Barium sulphate) was passed through a
tube into Khan’s throat and stomach. The X-ray showed a “large mass” which was situated at
the end of his oesophagus just before the entry to the stomach. The vet called me into a side
room to show me the slides and advised that he had an “oesophageal diverticulum”
(diverticula) and that sadly, there was nothing they could do to help him. At this point I must
admit to everything becoming a blur as she proceeded to tell me that there was no procedure
that could be undertaken due to the position of the diverticula and it was my decision as to
whether I took him home! From that moment on, my life was never to be the same again and I
broke down in floods of tears. Was I really being told that my outwardly healthy horse may not
be going home with me? Was he really suffering from a serious life threatening condition?

 

OESOPHAGEAL DIVERTICULUM

Now, what on earth is an Oesophageal Diverticulum I hear you say? I had no idea either until
this day that changed my life forever. It is a sac or pouch that protrudes outwards in a weak
portion of the oesophageal lining. It is like a pocket which then catches food matter as it
passes down the oesophagus. Why does it happen? Well, there is a question. No one can say
with any certainty why these pockets appear and what causes them. I will never know what
has caused Khan to have a diverticula or whether he has had it years! Was it an ulcer or
abscess which weakened the lining of the oesophagus in that very position? I will never know.
I am told that these are very rare and almost unheard of!
On being told of Khan’s rare condition, I sobbed profusely for hours as you can imagine. Was I
really going to go home without him that day? How could I leave him here to be euthanized
when he was showing no signs of pain or distress and in between the three episodes of choke
(in 12 days) he was his normal bright self. I had only hacked him out the day before and he
was as bright as a button.

I decided that day to take my faithful friend back home with me. I was not prepared to leave
him there and thought that if anything were to happen to him, I wanted him to be at home
where he knows. The vet advised that she only knew of a few cases of horses with the same
condition but none had a diverticula as large as Khan’s. I was given a “hopeless prognosis” as
confirmed by the vet on the insurance claim form. The vets carried out standard blood tests
whilst we were there and for everything else, Khan was a very healthy horse with no issues or
signs of infection as a result of the 3 episodes of choke.

DECISIONS

I was truly devastated and could not imagine my life without my “big man”, our cuddles, our
weekly hacks, his begging (with his front legs), his head banging (for treats), his
companionship, and seeing his gorgeous face every morning from the kitchen window. The
vet confirmed that it would be his “quality of life” from this day forward and that she expected
him to continue having choke at least once a week. I was advised to stop all ridden exercise
and to avoid feeding him hay! All I could do is monitor him from this day forward if I decided to
take him home.
I was totally beside myself as I drove him home. What would I feed him as a substitute for hay,
how would he feel being retired given that he loves to go out and gets bored so quickly, what
was going to happen and how would I cope? The days that followed were hard and emotional.
I watched him like a hawk waiting for the next episode of choke. I scoured the internet for
information relating to “oesophageal diverticulums” both in equines and humans! There was
very little information relating to horses as the condition is so very rare. I had no hope and no
idea what to expect in the weeks to come. I stressed about leaving him if only for an hour and I
asked my neighbour to watch him if ever I went out. I nearly cancelled a holiday as the fear of
leaving him in someone else’s care was too great.
Khan’s Bowen therapist recommended Simple Systems Feeds (not sure I can mention the
name!) as many of their products can be soaked to make “slurries”. I spoke with their helpline
and within days, had buckets and buckets of different slurries on the go! The feeds can be
used as a complete hay replacer and Khan seemed to love them. I would go so far as to say
that the change in his diet transformed him and within weeks, he had more energy and
exuberance than ever! He was (and still is) fed soaked grass pellets, soaked Lucerne, a beet
pulp (minus the sugar) and a balancer. He grazes as normal each day for at least 8 hours.
I spoke to the vet on a regular basis after bringing Khan home. As the weeks passed with no
signs of choke, and with Khan full of life the vet agreed that I could ride him. She advised that
if he appeared well, a hack could not harm and it was only ever going to be food and choke
that would cause a problem. I therefore got back in the saddle within about 3 weeks of him
coming home. He was full of life and walking out better than he had in years! He was a
different horse which I put down to the change in diet which is water based. They say we
should all consume so many litres of water a day and I guess that the same applies to equines
as I have seen a marked improvement in his general condition since feeding him what I call
“slop”!
In July, being some 2 months after the diagnosis, and with no signs of recurrent choke, the vet
suggested a further endoscopic examination. Khan was doing so remarkably well that the vet
was concerned that she may have misdiagnosed! A further trip was therefore arranged and an
endoscopic examination carried out. Of course I was hopeful that the vet had got it wrong and
that maybe, as he was doing so well, the obstruction had passed and ulceration cleared. The
examination showed no signs of ulceration which was good, however, the diverticula could
now be seen as there was no obstruction. The pocket was full of freely floating food which was
not causing Khan any discomfort. There was no evidence of infection and the vet commented
on how well he looked. I was advised to simply carry on doing what I was as clearly it was
working! I left the vets disappointed but a little more hopeful that he could cope with this rare
condition. As he no longer ate hay, there were no signs of any blockages. I suspect that as his
feeds and hay replacer is water based (often looking like a thick shake!) the food matter enters
the pocket (diverticula) and then comes back out without having chance therefore to stagnate.

MOVING FORWARD!

The weeks turned to months and it is now 7 months since his last episode of choke. The vet
has described him as somewhat “remarkable”. He is a miracle, and at present, is coping with
this very rare condition. I see it like a condition such as diabetes, he is not ill in the sense of
the word, he has a condition which if managed properly, he can live with. He has a strict
routine including a late night (9 or 10pm) slurry visit (often carried out in my dressing gown!).
He grazes all day on short grass, has a tea time sloppy feed and then a period of 3 hours to let
everything digest before his nightly buckets of slop!!
Unfortunately for me in August of this year and whilst out hacking him, Khan slipped on the
road and we both “hit the deck!”. He escaped with a minor graze (although he sat like a sitting
dog for about 5 minutes after falling and I thought he had broken a leg!!) whilst I suffered a
fractured right elbow! He therefore had 6 weeks off whilst I recovered but thereafter, I was
back on! Just another drama for us to deal with in addition to his condition this year…
Khan’s condition is extremely rare and most horse owners will never come across it their
entire lives. Indeed on a recent visit (for Khans annual vaccinations), the vet who came out
confirmed that in 36 years of practising, he had never come across a horse with an
oesophageal diverticulum! Khan is now famous at my vets!!
I would like to think that if anyone ever comes across this condition, they could draw hope
from reading this story as I believe that many horses would be euthanized if diagnosed with an
oesophageal diverticulum, especially when the prognosis is described as “hopeless”. Khan is
living proof some 7 months after being diagnosed (and with no further episodes of choke) that
some horses can cope with this condition and lead a normal life with the right palliative care
(namely slop!). He grazes happily each day, but instead of hay each evening is fed buckets and
buckets of what looks like porridge! As I often say to people, if you did not know he had this
condition, you would not know to look at him as he is no different to how he has ever been. He
has not lost weight and still enjoys his treats save for carrots! Indeed he has become quite
accustomed to sliced melon and bananas too!! He leaps around the field like a 3 year old, rolls,
and enjoys his hacks out at least twice a week.
So, what does the future hold for Khan? That I do not know. We enjoy each day together and
he is totally spoilt and leading the life he always has (save for the removal of hay ). After 12
months of doing remarkably well, I pray that Khan goes on to live years being able to cope
with this rare and unheard of condition.
If you were to meet Khan, you would certainly agree that he is a very special horse with a huge
personality, very intelligent, sweet natured, quirky and almost human! I most certainly cannot
imagine my world without him but I find comfort in knowing that he is alive and kicking (well
bucking!) at this moment in time and enjoying his life to the full as he always has.