Texas Equine Veterinary Association

2020 Summer Edition - The Remuda

Texas Equine Veterinary Association Publications

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www.texasequineva.com • 31 TYLER AND THE DUCT by Bo Brock, DVM, DABVP I stood across the expanse of the horse clinic and watched Dr. Tyler Stevenson (our new veterinary intern from California) trying to pass a small catheter up a nasolacrimal duct in a horse. It is funny how life goes full circle. He was making all those ugly faces people often contort their expression into when doing something that thought would be easy but turns out not to be. There is a tear duct that runs from the medial canthus of the eye and empties out in the nose. It is why your nose runs when you cry, and horses have trouble with the thing getting clogged up which results in a runny eye. Dr. Tyler had diagnosed the problem in a horse and was working hard to get the catheter passed into the opening in the nose and then push a white mixture we concoct with penicillin up the duct and back out the eye. This retrogrades the boogery looking mess that clogs up the duct back into the eye where we can wipe it away and make a happy horse. It is quite impressive to the clients to see white fluid bubble up and drip out of the eye when the veterinarian is working down in the nose. But Tyler was having a hard time. There was white fluid all over the floor in front of the horse, but none coming out of the eye. I knew what he was doing wrong, but I just stood back a while and watched. I let my mind drift back to my first few days of being a veterinarian. It is funny how life goes full circle: It was 1990 and I had been out of school just a few days when the three hard core looking cowboys showed up with a colicked horse. I was nervous about every critter that came through the door because I was so unsure of how to do anything. Veterinary school does a wonderful job of teaching a person all the facts they need to know to practice, but only practice can make a person capable of doing what they have been taught. I needed a lot of practice. We are taught to pass a tube about as big around as your thumb and roughly ten feet long through a horses nose and down into its stomach. I went through vet school and got to do it exactly twice, both times with an instructor standing next to me telling me exactly what to do. This is a procedure you will do ten thousand times in practice if you are a horse doctor. We do this when a horse colics because they cannot throw up. The muscle arrangement and nerve innervation in their esophagus just won't allow it. Once we get it through their nose and into their stomach, we can relieve gas or reflux if there is a blockage that is causing distension of the stomach which may result in rupture, or put a laxative in the gastro- intestinal tract if there is an impaction down stream. All of the education of how and why to pass a naso-gastric tube on a horse made no difference to me at all at this moment. All I knew was I was about to have to do it in front of three dudes that looked like the Marlboro Man. I gathered all the needed equipment and tried to act cool and confident as I began pushing the tube into the ventral nasal meatus of this belly aching critter. The thing just wouldn't go. Once you hit the pharynx, or back of the critter's throat, you have to time the push of the tube with a swallow. It is an art. You lightly tap around on the back of the throat hoping to stimulate a swallow reflex, and when you do, you push the tube into the esophagus with the wave of that swallow. It wasn't happening. I could feel my blood pressure go up and my face contort into an expression the reflected having trouble doing something that should be easy, but it is not. Here is something I hadn't thought of...the longer that rubber tube stays in the pharynx, the softer it becomes from the heat of the region. This, in fact, makes getting it into the esophagus even harder. Limp is not good when trying to enter a tight orifice. I soon found this to be true. My constant failed attempts to head into the food tube had resulted in a nasogastric tube that was now very "bendy". The force I was placing on the back of the throat caused the tip to bend and start coming back toward me. I finally felt a loss of resistance and assumed I was at last heading down to the stomach. But in fact, the tubed had done a 180 and as I kept passing and pushing, it actually came out the other nostril!!!!! Picture this...I am standing in front of a horse with three high eye-browed cowboys wondering what the heck just happened. They had seen many colicked horses in the past and had never seen this before. I pushed a nasogastric tube in one nostril of a horse and somehow managed to get the end of the thing to actually come out of the other nostril. This defies the laws of physics. I was mortified. Before I could even formulate a sentence, Dr. Chuck Deyhle, my 67 year old mentor in Clarendon, Texas, was standing next to me taking the nasogastric tube out of my hand and talking very confidently to the three cowboys. He continued to push the tube until about ten inches of it was sticking out of the other nostril. He grabbed that end with his free hand so that now he had both ends of the tube in his hands and he began pulling with one hand while he pushed with the other. He did this several times making a motion similar to what you do when you have both ends of a towel and dry you back off. "Dr. Brock has passed the tube in one nostril and out the other in order to make sure the horse is not choked. He did an amazing job of getting this done. I will go ahead and put it down in the horses stomach now and we will give it some mineral oil," he explained in such a calming voice that I even believed it for a second. This old veterinarian was already my hero, but getting me out of such a humiliating situation without looking like a total buffoon, made him climb even higher on the "super hero" scale in my mind. After the horse and three cowboys departed, Dr. Deyhle caught me in the clinic and started laughing like crazy... "Big doctor (what he always called me), I have been a veterinarian for 40 years and I have never seen or heard of anyone passing a tube up one nostril and out the other. I hope you didn't mind me stepping in, but I was watching from across the expanse of the clinic, and didn't want you getting too discouraged." I went over and showed Dr. Tyler how to flush a lacrimal duct. I taught him why what he was doing wouldn't work, and I remembered my mentor telling me that he had watched me from across the expanse of the clinic and rescued me just before I became too discouraged. It is funny how life goes full circle. Now pass it on Tyler!

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