I have just lost my horse. He was 24 years old, but I know he had some good time left and I’m feeling like had I known some of the things I now know, maybe I could have changed things. So, possibly some of you already know this, but just in case there are people who have not yet found this out, maybe it will help someone else. We have to uncover every stone for our own horses because vet’s will not always do it.
My horse began with sinus discharge due to a bad tooth a few years ago. The vet was guessing it was a tooth (weekend call on the phone), and gave me SMZ’s which cleared it up. By the time a vet actually got to my home and did xrays to confirm a bad tooth, the discharge was completely gone. He was eating well. She said the tooth should come out, but failed to tell me that antibiotics do not clear up the infection that is in the bone, just the tissue. I found this out later from the equine dentist. So, I thought all was good. I explained to her that his nose was completely fine and she said it would likely come back but nothing more. It didn’t come back for a year and a half. And that was after he got his teeth floated. I attributed this to the jostling of the float, and did the same thing. Asked for the SMZ’s and was given them. The next time it came back NOT after a tooth floating and I knew then it was time to take the tooth out. I accept partial responsibility for not taking the tooth out earlier, but at no time did anybody tell me that it could become more dangerous to leave it in. I thought as long as I was getting the infection under control, we were good.
Anyway, the tooth came out (along with it’s neighbor so the tooth could be pulled), and no sinus flush was done afterwards. However, things were good for five months. A different discharge came then - not at all smelly, not as thick and was intermittent. Xrays were taken and no issues were seen with any teeth. SMZ’s were prescribed again, as well as a recommendation for a sinus flush, which I scheduled. When I got to the appointment another xray was taken and that vet said he did not feel it was needed. Home we came. A short while later, the discharge came back. First vet prescribes doxycycline and once again it cleared - for a time. We continued to go down this road until February 20, when I again, took him in for a flush, after being advised to do so. I took in a happy, healthy horse with the exception of this discharge - again, not the nasty type like before. I left with a horse in grave danger, with the SAME discharge coming out of his nose, a badly swollen face, ulcers, and maybe cushings - although I know that would have had nothing to do with any of this, and on Excede to “finish up what was left of the infection”.
Here’s my issue. It was not until I posted here on Chronicle of the Horse, that anybody said a thing about getting a sinus culture and/or a scope. Back when TWO different antibiotics had been used without success, shouldn’t the PROFESSIONALS who were supposed to be in charge of my horse’s care have thought to do a culture and sensitivity test? And when I called over the weekend after the flush to tell them the Excede was not working and suggest that we switch to a different antibiotic, I was told to keep on with the Excede. I told them then that I wanted a culture/sensitivity test and a scope, after my conversations here on this forum. I was told that neither of those things could be done without sinus flap surgery. When I pressed, I was told, “well yeah they can collect a sample from the nose, but it will be contaminated so not reliable” And for the scope, same thing - they could not scope the nasal passage. I learned here that yes, they could, although it may not be as beneficial as going in through the sinus.
I forgot to mention that when I picked up my horse, I was asked if he was picky about eating his grain. HELLO - NO, he is not. I asked if he was eating hay - yes, they said, he was - just not the grain. I’ve been through ulcers with one horse already so I knew that was a classic sign. But I was the one who had to bring that up - nobody suggested that my horse may have developed ulcers from being stalled and the stress of all this ordeal and ask if I wanted to start on some ulcer meds. If I had not known about ulcers and the signs, I would have blindly gone out without medication for that. And yes, when he started on the meds, he started eating normally. Did anybody ask me if he was used to being in a stall? No. I’m kicking myself for not thinking about that and requesting that he be on ulcergard while there, but I mean, wouldn’t this be a good question to ask owners when they are checking their horses in? I’ll add that my other horse had also been hospitalized for a colic. He came home CLEARLY not right. Shyed away from grain, lying down, etc. I called immediately and requested a gastric scope. He had a gastic impaction, and SEVEN deep ulcers. Not one vet suggested this might be ulcers.
Fast forward to the day after the weekend (Monday) that I was told not to change the antibiotic, oh, and that the face swelling was probably due to saline getting trapped in there and it would take a while to go down, and not to worry about that. The vet who did the flush called me. We talked about options and he corrected the other vet about having to do bone flap surgery in order to scope or get a culture. He told me he could scope through a slightly larger hole than was needed for the flushing and if a problem was found that was small enough to address through that hole they could but if it was too big, a bone flap surgery would be needed. I knew I did not want to do that bone flap surgery. I asked - What is going to happen to my horse if I don’t do bone flap surgery or scope for the problem AND antibiotics do not work? Answer: Nothing. He will just keep a messy nose. It is not life threatening and is not going to invade neighboring sites. Me: Oh! I thought it would spread all over his head. Vet: No, they stay confined to that sinus. Me: Well, if that is the case, and if he is not feeling bad, I think I’ll just do a sixty day course of SMZ’s and see if that knocks it out. Is that reasonable? Vet: Yes, that is reasonable. And he said he was not concerned about his still swollen face. Three days later my horses swollen face - you know the one that nobody was concerned about? It exploded with blood and pus coming out of the surgery site. Two days before I had a nasal sample taken for culture and the vet who came looked at his face and the assistant with her swore that it was better than when in the hospital. I didn’t think so, and said so, but…So, two days after the culture was taken the “explosion” occurs. I immediately cancel a trip I was supposed to be going on, called the vet, took pictures, sent them. A vet came out around 5:15 that day. He put Tonka on Equisul and Naquadex BID. He also gave him a dex shot to try to get the swelling down. He took four more xrays. Said the culture should be back Friday or maybe Saturday. I was to meet him on Sunday to pick up medications for another boarder horse who is here. I texted him through the weekend telling him I saw no difference in my horse. I never heard from him, until I texted and asked if we were meeting to pick up the meds and he said no he couldn’t make it down. I asked if the culture was back and was told nothing final yet.
The next day, Monday, the vet who took the sample texted to say the culture was not back but lab said it should be back on Tuesday. She would come out and address my horse on Tuesday. But later in the day, the most horrible crap started pouring out of that hole the pus had been coming otu of. THICK, white cottage cheese looking stuff that just spontaneously would start pouring out and dropping on the floor. IT took me six times of wiping and cleaning to get it to even stop spontaneously coming out. Hair was now missing from further down his face and two lumps there looked like they were about to burst. I was texted again by the vet who was supposed to be coming out the next afternoon, saying there had been a consult between the 3 vets who had taken care of my horse and an equine dentist (who had taken his tooth out), and they concluded that he would need to come back to the clinic the next day to flush out all of his sinuses. They ALL had pus in them now. Naturally, I didn’t want to take him if I didn’t have to because he had come back so much worse the first time, but was told there were no other options. So, he left again (vet’s clinic is 1 hour away). When he got there, I learned that all the walls between his sinus’s had been eaten away. Another hole was drilled for scoping and flushing on his forehead. And, he opened up the spot further down on his nose that looked like it was about to burst. He told me this was not a good prognosis and encouraged me not to let my horse suffer. He was not suffering at this time, but he said he felt like he was looking at a mountain that he could not see the top of. He told me that if the infection breached a specifc wall with a nerve running down the side of that wall, it would be very painful for my horse. He said that his skin was basically rotting off. He wondered about an anaerobic bacteria or possibly bone cancer. Of course, I was scared to death and super upset but based on what he was saying, agreed that I should say goodbye to my horse. He was brought home the next day and we had a great day. He acted completely normal. The morning he was to be euthanized, I did not see any new pus coming out of his bandaged faced and it looked like the swelling had gone down, so I called the vet, who was on his way to tell him that. Back up to Tuesday when he had this extreme flushing - the culture still was not in, as they had said it would be. I had to ask the office to call the lab. They did and were told if it wasn’t sent over by 5, it would be the next morning… This is one week after it had been taken and 5 days after it had been plated. The day the lab said it would be there. But it wasn’t. I called the next morning but it still was not in. Plans at this point, had already been put into place to say goodbye the next day. But Thursday - the day it was supposed to happen, after calling the vet and saying I wanted to take the bandage off and look to see if we should not do this yet, I called the office. Culture was STILL not in. I had to ask - again - for them to call - telling her that we were trying to make decisions. She said she would but I never got a call back.
Vet takes the bandage off, and could see the swelling was down, but attributed this to the fact that there were now four escape hatches for that pus. The three holes he had in his head, and now the drainage was coming back out of his nose again. That had subsided I guess when it had started to come out of the flushing surgery hole and there was so much swelling blocking it from coming out of his nose anymore. (again, you know - the swelling nobody was concerned about). I asked what the vet thought, and he said he still had concerns about the necrotic tissue and that we might be dealing with a type of bacteria that is very resistant to antibiotics and didn’t have anything optimistic to say. During this conversation, I told him that from what I had read, the antibiotic that was recommended was penecillin and did he not agree with that? He responded by saying he had mentioned to the other vet that if we were dealing with strep, we needed to change the antibiotic. Maybe not to pencillin because they don’t use that too much anymore, but something in that family. But that class of antibiotic was never given. I made the decision to say goodbye before my horse could experience great pain, as I was told there was a good chance of. First, there is nothing to worry about, and then my horse needs to be euthanized.
That afternoon, the lab report came in. Two bacterias - strep and corynbactirium. It clearly says on the lab report that the drugs of choice are penecillin, ampicillin, and amoxicillin. I asked the vet if he still thought we made the right decision - he said yes (but of course he would say that), but did wish they had gotten a preliminary report from the lab with the strep on it. The other bacteria grows slower so I guess they were waiting for that.
I texted the vet who took the sample - and had been working with my horse throughout this entire ordeal going back to the tooth issue. They repeatedly told me that xrays did NOT show an issue with any teeth or the prior extraction. I said it looked like we had been giving the wrong antibiotic. She said that Excede is a far superior antibiotic than penecillin and should have addressed it. But when I look up Excede it is for lower respiratory infections, not upper. And it does not appear to be in the penecillin family. The lab report clearly says the previously stated medications should be used, not Excede. Also, she said the dentist felt the real super bug causing this was an anaerobic bacteria. The culture they had done was only for aerobic bacteria. My question is - why? Why not check for both? I am just the client - I didn’t know there were two types and nobody consulted me about this. So, my questions and concerns are this:
Why wasn’t a culture and sensitivity test even mentioned or suggested to me way back when the first or second antibiotics did not work?
What in the hell happened to my horse in the clinic during the first flush that resulted in his face blowing up?
Why did nobody seem to think this was important or something to be worried about?
Why was a steroid given when the swelling was clearly not inflammation but backed up infection?
Why was the culture not inclusive of anaerobic bacteria?
Why was an antibiotic in the penicillin family not given at all, and not given as a first choice way back, or at least while we were waiting for the culture to come back.
Why did nobody in that clinic suspect that he had developed ulcers while there?
Why did nobody in that clinic EVER consider that with my other horse?
Why was I given misinformation about this NOT being life threatening, and really nothing more than an inconvenience if I did nothing?
Why was I told over the weekend that you could not get a good culture through the nose, scope through the nose?
If I am way off base on any of this, please speak up. I am feeling completely guilty for not doing a better job of finding things out for myself way before I did. I trusted my vets to know what to do. I have learned that you cannot do that. I am in a situation because I live where there are NO equine vets. I have been with this clinic for almost 20 years. About a year ago, they told me they would not be doing emergency calls to anybody over one hour away. I am 1 hour and 6 minutes. I have a hard to load horse and I am here by myself. But if I push too much, I am afraid they will drop me as a client and then I will have nobody to take care of my horses. This clinic is considered one of the best in the area so please - if I am being unfair, please speak up. Otherwise, I am just sick and don’t want this type of thing to happen to anybody else. Oh, and I tried to call an equine teaching hospital for a phone consult before drastic measures were taken, but they wouldn’t do it.
