Seeking the collective wisdom here on my horse who I just have a nagging feeling there’s another layer of the big stinky onion I haven’t gotten to. 5 year old gelding. Timeline: he showed in Florida in April and had a mile respiratory virus that progressed to a fever and nasal discharge. Started on SMZs, no improvement, Vet didn’t like his breathing, put him on naxcel and genticin for a week, fever came down for about a week, then he had a mild cough for a few days which we were advised was probably just post respiratory infection irritation. Couple days later 104.5 fever, not eating, wouldn’t hold his head up, sent him to the hospital.
Culture there came back with strep zoo, and they determined that they wanted to try a longer course of SMZs. Ultrasound of the lungs showed mild irritation but nothing that they said couldn’t be incidental to just being in a trailer, throat and guttural pouches scoped clean, X-rays showed fluid in the sinus. We initially thought dental but no tooth issues on X-ray per the surgeons, so they treated it as a primary infection. After 5 days he still had a lot of discharge so I sent for a CT which showed what I am told is a remarkable quantity of sinus infection that affected all 8 sinuses. Vet who did the imaging said take him straight to the vet school, so off to UF he went for surgery. (By the way, saw some old COTH threads with bad experiences there and wanted to voice that I thought the surgical team there wa fabulous and the bill was about 40% less than I expected)
Surgeon there cancels the first surgery slot after he looks at imaging and decides to consult with the guy who invented the sinus flap technique and a couple other surgeons since he had not seen a horse with so many parts of the sinus infected in his career. They do two procedures, one to go in with laser to flush lower sinuses from inside the nostril and a long one the next day where they put in 4 holes and one flap across the middle of his forehead to access and clean out the other sinuses. They put tubes into the 4 holes and he stayed there for a week so they could flush the tubes daily, goes home on SMZs.
He finishes those up, gets his staples out, everything looks incredible and I bring him home to VA and in less than 2 weeks off the antibiotics he starts getting some swelling at the flap site and a wart looking thing. I was told that can happen where they get a big bony callous but had the vet out and good thing I did since between when I called and when she came the goose egg had about doubled in size and was painful. She swabs at the scab on the wart thing to get a culture and a bunch of blood and pus comes out and the Q tip goes all the way down to the bone in a tract. Oh joy. Films show a sequestrum forming which I knew was a possibility with the extent of his surgery. Going to our more local surgical referral center for surgery number 3 to get that bone cleaned up.
So I guess my question is what the F? I feel like we haven’t really kicked this infection at this point, and I’m just worried there’s something else I need to be doing here. Culture is preliminarily back with strep, not full sensitivity yet. He is back on SMZs because I said I wasn’t comfortable with him not having something in his system through the weekend given how fast he went from a little icky to a very sick dude. Also on preventative dose of gastrogard in the event he needs heavier antibiotics (I think chloramphenicol or rifampin were mentioned but not doing either without full culture), panalog ointment, and equioxx for pain. I can tell he doesn’t feel great, and it’s painful to the touch. Has anyone in the group experience dealt with a piece of this that they learned something I might find helpful? Can strep zoo just be this difficult to kick even without having some kind of antibiotic resistance, or at this point should I be asking if that’s just incidental and we should consider if whatever we are dealing with is just not growing on culture? Is this just bad luck he had the most extensive sinus infection the surgeon had seen or should I be considering whether something is causing his immune system to not be able to handle?
Pics are: X-ray showing the problem area, photo from right after staples came out, current photos showing swelling and wound