Thank you so much for sharing that starsandsun.
Holy moly, 4 surgeries without resolution??! That’s horrible and exactly what I’m afraid of. I can’t even imagine. 
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From what I have read Alternaria sp. is an opportunistic fungus and in the horse takes advantage when the immune system is surpressed or when cushings is present. The fungus is present on the skin or on cereals.
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Lovely <3
I’m so sorry you’re going through this and I’m sorry the drugs are stupid expensive and unlikely to work without more surgery 
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I have no advice but wanted to he’s gorgeous 
and i hope you catch a break somewhere.
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This brings back all the memories of my situation coming up two years ago. I am sorry you are going thru this. My 25 year old Paint, developed a sinus infection in early August. We treated with antibiotics, the discharge had a very foul odour to it. We thought we had beaten it and for about 3-4 days, she was great, then it came back with a vengeance. Had head xrays done. Vet wanted to send her to a equine hospital to have it flushed and she would be great!!!
Well, I sat back and made the very very difficult decision to put her down. She was 25, insulin resistant, she was also diagnosed with Cushings during this time, and we were heading into winter I loved this mare with all my heart and had so much fun, driving her, showing her driving, even have ribbons from Walnut Hill and many hours of trail riding.
You and your horse have been thru so much more then we went thru, again I am very sorry you are having to deal with this situation.
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Thanks for your kind words rubygirl 
I am so sorry- I went through sinus hell recently. Where are you located? The CT at Virginia Tech is on a grant and I think less than $1000 when I took my horse there for a follow up. I would at least consult with their surgeon there, to see what he thinks is a realistic chance that the surgery can mechanically clean out the sinus in a way that prevents reoccurrence. I will also say that of my horse’s three procedures, the two he had done in clinic with a laser versus the one done in a lower level facility were like night and day for recovery. He came out of the first two great even with 6 holes and a big flap, and the last one for the sequestrum removal was hard on him- just to say I wouldn’t assume that if the on farm procedure was hard on him that in the clinic it would be equally hard.
For your insurance, do you have a 90 day policy extension where you can file on the prior policy? I know with mine, after my prior policy renewed and the new one was excluded, I had 90 days to file claims against the orignal incidence date for the sinus issues on the prior policy, so you may have some coverage depending on when that was.
FWIW a vet friend of mine had a personal horse with a big fungal mass in his sinus and she elected to do the surgery, knowing what she knows about outcomes, and he recovered really well.
All that said, your quality of life matters here too. I wouldn’t put yourself at a huge financial strain or drag out something where you’re looking at going down a road that you’d regret trying if it wasn’t successful. I do think that we “owe” them a certain amount of medical drama problem solving, but some of them are just not quite right and will continue to have weird unrelated problems forever, and you’re allowed to step off that roller coaster and just keep him comfortable.
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Aw, I’m so sorry cabz. (((Hugs))) Thank you so much for sharing your story. 
These beautiful creatures really catch hold of our hearts and take a piece when they go don’t they?
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Thank you Railbird. We are in a fairly rural area in Ontario, Canada. About 2.5 hours from the vet college at the university. There is one other equine hospital near Toronto too. They are excellent. I’m not sure how they compare to Virginia Tech tho. My vet claims that after she spoke with 3 different surgeons, the consensus from all was that there is a “fair” chance the fungus will return after surgery.
That is a very good price for the CT where you are. Up here they want $3000 for it. I’m so glad your horse’s case was resolved! That is wonderful. It’s just so much for them tho isn’t it? I know what you mean about laser vs. not. They did my boy’s ethmoid hematoma with a laser at the university and his recovery from that seemed easier than after this most recent procedure at the farm.
As far as my insurance goes, no unfortunately that’s not how my policy works. I am not able to file on the prior policy.
Yes, the financial aspect is just too risky to take the chance. It will likely be close to 10K by the time all is said and done. I can’t begin to imagine spending that just to have the infection return. Not to mention, I just don’t feel good about putting him thru another surgery unless the chance of a positive outcome is very good.
Thanks for sharing your story and advice. It means a lot for me to have the support of this COTH family.
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I wouldn’t necessarily say his whole saga was resolved- he has neurological issues now, and I don’t know if it’s unrelated or what, but I think I’m your shoes when it’s that expensive and out of pocket, I wouldn’t do it either. I’m sorry you’re going through it
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One thing some of my vets like to say is to consider what the additional information (e.g., imaging) will do to change or not change what you do next. Will knowing more details potentially change your course of action, and are there any less invasive alternatives (including doing nothing) that might get you to the same result?
So… you already suspect the CT will not give you any good news. Are you saying you just can’t bring yourself to do the surgery. Full stop? Then the CT doesn’t seem to be worth that price tag. With no treatment, can the vets give you an idea of what your options are and what it is going to look like when it gets close to time that his suffering is too great? Is there anything to alleviate the symptoms of inflammation or discharge? Or do you already know it’s getting to be too much (for you both) and you just need some time to accept it? What does a “good” outcome look like to you, or is there even one outside of a wildly successful second surgery? Sinus issues are hard…I’ve seen it take multiple surgeries to achieve success even without the complication of a fungal infection.
I went through this kind of analysis about a year or so ago with a cat that had a stomach mass. Nailing down the diagnostics was not going to change much other than to tell me if the cancer was bad or really bad. Options were grim. Cat was very sick. I chose to try to keep him comfortable for the short term (he did respond reasonably to some palliative care) rather than go with expensive and unpleasant further diagnostics and (if lucky) treatment to buy him potentially a few more months of poor quality of life. The oncologist made me feel like a piece of garbage, but my regular vet fully supported me. I was not ready to lose him, but I was going to lose him before long in any case, as the best case scenarios still looked pretty terrible to me. It was not worth it to pursue any more information (required more invasive biopsy, trying to remove the mass wasn’t even an option) at that point.
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Thank you IPEsq. Good questions for sure. When I first got the grim news from my vet last Friday (which I was not expecting) I was thinking more along the lines of “how much longer can I have with him and know he’s comfortable?” I was thinking maybe if they did the CT scan they might be able to give me an indication of his current comfort level and aggressiveness of the infection (i.e approximately how fast it might progress). I did pose a bunch of questions to my vet (that one included), which I’m still awaiting answers to.
Of course I’ve been obsessing endlessly about the situation over the past few days. The more I think about it the less sense it makes to do the imaging as I doubt they will be able to give me the answers I’m hoping for (or maybe they can - who knows?). I think they will likely say there’s no way to tell with any certainty what his current comfort level is. Or even how fast it might grow. I’d bet any answer would likely be an approximation or best guess. Of course I wouldn’t fault them for that. I suppose I’m just grasping at straws with the questions. No one has a crystal ball. Because I don’t know how accurately they can or can’t gauge these things, I just thought I would ask. Mostly out of desperation. It wouldn’t change anything. Doing the surgery doesn’t make sense and I don’t feel it would be fair to him with such a poor prognosis. Add to that the financial aspect and the grim reality is clear.
My biggest concern is that he is comfortable and not suffering. If there’s no way to know, I feel like based on that uncertainty alone, I should let him go sooner than later. As in, before winter sets in. What if his decline is rapid and I’m faced with having to do it mid-winter? I’d rather not. A beautiful autumn day would be much nicer for him. Maybe he would make it through winter just fine, but to what end? Just to have the whole situation hanging there until spring or summer if he makes it that far without suffering? What if breathing the cold air causes him pain? It’s the unknown that’s causing me to struggle. The fact of the matter is, from here out it will just get worse. At this point it really is just a matter of when to let him go. I will be speaking with my vet today.
I’m so sorry you had to endure the pain of losing your cat. My husband and I are VERY much cat people. We have suffered through the loss of beloved cats over the years. We don’t have children, so they become like kids to us. Most recently, our sweet boy Calvin passed from a massive heart attack before our eyes. It was absolutely excruciating. The autopsy revealed that he had an enlarged heart. The vet said it was likely genetic.
Bless you and stay well 
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You are an amazing horse mom!
Aw, thanks so much cnd8
Thinking of you.
I know how difficult it is not to throw everything you have into the medical care of a beloved horse, but I agree with the others who think that in your case, it would be better not to put him through any more invasive treatment when the prognosis is uncertain at best.
His arthritic and navicular issues are a consideration as well.
Hang in there. It’s a difficult decision that many of us have had to make. With our animals sometimes grief is the price we pay for love.
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Thank you so much for your kind words of support skydy.
I spoke with my vet late yesterday afternoon to let her know my decision and at first she told me she thought it was a bit premature. That did not make me feel very good. We talked for a while and then she said she would support my decision.
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It is your decision. You know your horse. I’m glad the vet is supporting, but wish they hadn’t expressed an opinion before listening to you.
Take care of yourself during this tough time.
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I’m so sorry for the circumstances you and your lovely fellow have found yourselves in. It sucks when you’re looking at something when no one can give you any concrete answers, good examples of prior cases, past experiences you can draw on - all you can do is look at the information you have and make the best decision you’re able with your judgement.
The medical events aren’t anywhere close to similar so I won’t go into the details, but I can say that as someone who tried so hard to make sure I did everything I could for my horse, I think (now, looking back) I went too far - there was a point (mid-surgery) where the vet came out and asked if I wanted them to continue or let him go there and I said to keep going. He ultimately passed the day afterwards - we had to euthanize due to seizing, possibly due to a reaction to medication, but it kills me to know that I put him in a situation where his last day was one of stress, pain, and fear.
Whatever decisions you make right now are ones you’re making with the best information available to you, and your best judgement. You are clearly prioritizing his wellbeing and his comfort as the thing that matters most. A gentle, dignified farewell without fear and pain is perhaps the best thing we can give the animals we love and cherish. Sending all the hugs your way.
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Oh Edre, I’m so sorry you and your boy had to endure that. It must have been horrific. Being forced to make a decision in the heat of the moment like that is a very different situation. No time to process; naturally you would just want to save him. I’d likely have done the same as you under those circumstances.
Huge hugs right back to you and thank you so much for your kind words of support. They mean everything to me right now. May much peace and love be with you always. 
I think this is an excellent idea. Wouldn’t hurt to ask.
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