AAEP Ask the Vet: Emergency Care

1.  About 5 weeks ago, my pony had a small lump show up on the left side of his face. I left it over night without too much worry. When I returned the next morning, it was completely swollen and swelling had moved across the bridge of his nose (about where a noseband goes) to the right side. His right nostril was also draining much of a green discharge. We contacted the veterinarian who told us that it looked like a tooth concern and put him on bute and antibiotics. They returned a few days later to take x-rays, that showed what looked almost like a small marble either in a tooth in the back (left side, where it originally started) or behind the tooth. The veterinarian still does not really know what is causing the problems of  the sinuses, such as a tooth, snake bite, etc. All of this began in February and since then, they have threw antibiotics at him and some kind of sand pill to loosen the object(s). The swelling is now gone but the nostril is still draining a bit. Also, where the swelling was located on the left side of his face, the hair came off and a bubble appeared. It later popped and green discharge as well as blood came out. The veterinarian still has no real idea as to what this was. Do you have any ideas?

What you are describing sounds like a foreign body either in the sinus or under the skin. Bullets or BB injuries can appear this way and may penetrate the sinus and result in an infection. Careful exploration of the "bubble" on the pony's face may reveal a hole into the sinus or the foreign body located under the skin. Repeat radiographs of the skull may give a better picture of the "marble" seen on the first radiographs. If the object is a piece of the pony's tooth, it will not have moved much if at all. If the marble is a piece of another animal's tooth or a bullet fragment, it may have moved significantly. Rarely, the object seen on the radiograph can be a worm or fly larvae that has calcified.

If exploration of the skin bubble and radiographs do not indicate the problem, the sinus may need to be explored. The sinus can be explored endoscopically either by passing the scope up the nostril and examining the sinus opening or drilling a hole into the sinus and placing the scope into the sinus through the hole. If necessary, the sinus can be opened by creating a bone flap over the area. Depending on the temperament of the horse, this can be done with standing sedation. Dr. Manuel Himenes, Kailua, HI

2. I have a 12-year-old Quarter horse gelding that I have had since he was 2. At 4-years-old, I began training him for barrels, which he did quite well. He was very flexible and had excellent turns. However,  around the age of 7 and 8 his performance declined. He began to turn stiff and very moody when ridden. The last couple years he began to cringe when I cinched him, walking stiff and wild eyed and waiting to set back. This occurred even after a month layoff. The things we have done from day one when the problems began consisted of, hocks injects, changed pads, girths and saddles. We contacted a chiropractor in which they adjusted the hips. The chiropractor even said his neck was out along with his sternum, which he continued to adjust monthly. The muscles on his underline will get hard and you can press and he begins to move. This never gets better even after layoff or an examination from the veterinarian or chiropractor. We are at our wits in. When I ride him he feels off and I can't pinpoint where. Please help he is a sweet horse and is too nice to retire. I would really like to find the problem.

Sorry to hear about your horse's problem. He sounds like a nice horse and you and he have been together for a decade. These type of longstanding problems are a challenge to diagnose.The clinical signs that you have described can be caused by many disorders. Muscle metabolism disorders, genetic disease, occult lameness and gastric ulcers are just some of the problems that come to mind.

Does he have any of the Impressive bloodline? If he does, has he or his parents been tested for the hyper kalemic periodic paralysis (HYPP) gene? If he is negative for HYPP I would begin by doing a basic blood panel paying close attention to muscle enzymes creatinine kinase (CK), aspartate aminotransferase (AST) and electrolytes. If these enzymes and electrolytes are within the normal range, the blood chemistries should be repeated after exercise. If they are still within the normal range, it is unlikely that the horse is tying up. If the enzymes are significantly elevated, he may be having episodes of exertional rhabdomyolisis or "tying-up" syndrome. Rhabdomyolysis can be genetic or diet related. Deficiencies of vitamin E and/or selenium can cause this syndrome and can be diagnosed with a blood test. If your horse has genetic predisposition to tying up the diagnosis can only be made by muscle biopsy. Treatment of these conditions is done through dietary therapy.

If the muscle enzyme tests are negative, a careful lameness exam would be a good next step. This exam should involve watching the horse go in hand, on the lunge line in both directions and possibly under saddle. A hoof tester exam should be done on all four hooves along with fetlock, carpal (knee) and hock flexions. If any lameness is noted diagnostic analgesia, nerve blocks, can be done. If the lameness can be localized with the nerve blocks, radiographs and /or ultrasound exams are warranted. If no lameness is noted on exam nerve block of both front feet may be done to conclusively rule out laminitis. If theses tests do not localize a painful area, referral for advanced diagnostic techniques may be needed.

Dr Bertone's work a few years ago showed that horses with gastric ulcers can have a multitude of clinical signs. After ruling out other sources of pain ulcers should be considered. I prefer to examine the stomach with an endoscope. However, there are fecal occult blood tests that have been shown to be useful in diagnosing gastric ulcers. 

Rib fractures, vertebral fractures, arthritis of the vertebral facets and sternal fractures are also disorders that could cause the signs you are seeing. Contact your veterinarian and discuss a diagnostic plan that you are comfortable with. Once you have a diagnosis, you can then proceed with treatment and hopefully get you and your horse working together again. Dr. Manuel Himenes, Kailua, HI

3. I own a 6-year-old Rocky Mountain horse. He recently received his rabies and also the 3-way combo with West Nile. We elected to do his pneumo shot a month later. A day after his vaccines, he was acting normally in his pasture, eating , drinking, etc., but when I went out for a short ride, we immediately turned around because he was just acting 'off'. I checked his temperature and to my surprise it was 103.8! I treated him with banamine in which his temperature decreased to 100.2 within a 2-hour period and he subsequently felt better. My question is: what should I do for future vaccines? This is the first time we gave the combination shot. In years past, he received individual injections, all in the same day without noticeable reaction. However, nothing in the past has prompted me to take his temperature. As an aside, he is a horse that does seem to be with allergies, at least to bug bites. I recently started him on The Natural Vet Bug Check, which contains probiotics, which he does seem much better. Do probiotics help with allergies, more than just the response to bugs?

Your horse appears to have had a reaction to the adjuvant combination vaccine. Adjuvant are the part of the vaccine that enhances the immune response. Since your horse did not react to the individual vaccines, I would suggest that in the future the horse be vaccinated using the single disease vaccines and not the combination. You may also need to spread the vaccinations out over a few days. If these options are not feasible, I would try a banamine dose on the day of vaccination. Separating the vaccines would be preferable.

Probiotics are a complicated topic. The intestinal has a lot of immune system tissue and some believe that allergies may be related to improper intestinal bacterial balance. This idea is controversial but probioitics will not do any harm. Dr. Manuel Himenes, Kailua, HI

4. I own a 19-year-old Thoroughbred that recently has come down with cellulitis. My veterinarian is treating him with Penicillin. He started him today on gentomycin My questions are: what does the gentomycin do and I heard this could last for three (3) weeks? Any additional information would be appreciated.

Gentomycin is an antibiotic that is synergistic with penicillin. That means that combining penicillin and gentomycin is more effective than either one alone. Cellulitis can be a prolonged treatment especially if the swelling persists. If your horse can be walked, moving helps the circulation and reduces the swelling. Dr. Manuel Himenes, Kailua, HI