Drastic Measures?

No, necessary measures.

Two years ago, when we first heard of Fitz, then 25 years old, he was living in Maryland and looking for a place to go. He hadn't had any dental attention for some time and his pictures showed he was a little thin.  TREES arranged for an equine dental technician, accompanied by a veterinarian, to examine Fitz' teeth, thinking that if he had his dental issues addressed he would gain weight more easily and be easier to place in a new home.

Addressing Fitz' dental issues, however, was more easily said than done.    At first glance, it was easy to see one incisor jutting sideways from between his lips.  A few other teeth were loose, periodontal disease was out of control and Fitz whole mouth seemed unstable.  Meredith Barlow, the attending dental technician, called TREES from Fitz' side and asked "just how much dental work does TREES want to cover?"

Uh-oh.  Fitz' immediate needs were to have three teeth extracted: two incisors and one canine.  It was agreed to remove the "sideways" incisor and canine and return for the second incisor and a re-evaluation at a later date.

In the meantime, it was becoming obvious that this would be a very "special needs" horse and not one easily placed in a new home. 

Over the next few weeks, space at the Sanctuary became available and the process to bring Fitz here as a resident began.  Fitz arrived in August 2008.

By November, we were looking at this odd sight:

Fitz' gum was deteriorating, exposing the root of this incisor.  The root itself was covered by what was indentified as a "cementoblast."  Cementum is normal material covering the roots of teeth, but this was cementum gone wild.

At about the same time, we noticed that Fitz was very lethargic, and experienced some respiratory distress with very little physical exertion. 

Off to the vet clinic, where ultrasound found a significant bacterial infection in Fitz' heart.  At the same time, the incisor pictured above was removed, revealing infection in the tooth itself and in the jawbone behind it.   Not uncommon in dogs, cats, and humans, it appeared that the massive infection in Fitz' mouth led to bacteria entering the blood stream and lodging in his heart.

This tooth and one other were extracted, treatment for infection was started, and several other teeth were identifed as abnormal, requiring close monitoring.

Meredith, meanwhile, was finding bits and pieces of information about other horses with dental problems similar to Fitz'.  Then, at an AAEP convention..........PAYDIRT!  We finally had a diagnosis.  Fitz suffered Equine Odontoclastic Tooth Resorption and Hypercementosis.

As study of the syndrome advanced, most researchers agreed the only way to get ahead of the infections and other complications was to remove all of the horse's incisors.  According to all reports, the patients were immediately more comfortable after having affected teeth removed.

But, that seemed drastic!  As time went on, though, it became obvious that might be our only choice to preserve quality of life. 

Fast forward to July 7, 2010:

We could see that the angle of Fitz' incisors were changing drastically.  During our annual Summer Dentathon, xrays showed that none of the incisors were "viable."   None.

Below, the odd angles and exposed roots are easily noticeable.

Even more obvious at this angle.  Notice the small area of root becoming exposed in the area above the little wad of grass, up toward the lip attachment.

In this photo, again notice the tooth exposed the full length of the root.  Areas of decay of the teeth themselves are also easily seen.

Sedation and a little local anesthesia were administered and nine incisors were removed in less than 25 minutes.  That alone is evidence of how unstable and "unattached" these teeth were..

On this tooth, note the cavities at both ends.  Everything in between was decayed.

This tooth was also decayed from one end to the other and broked apart under very little pressure.

This one was completely hollow!

Here - on the left - is an incisor (not from a TREES horse) with a more normal, tapered, appearance.  Note that Fitz' incisor - on the right - is not tapered at all, due to extra cementum layers.  All nine of the incisors removed had the same "fat" appearance.  It is, in part, this extra cementum that pushes the teeth out of their proper positions in the gum and bone.

Fitz is on Day 6 of a 10-day course of antibiotics.  He is already more comfortable.  Naturally, we'll need to make hay available year 'round since he can no longer graze.  Is that in itself a big relief to him?   He is no longer trying to pull grass with extremely unstable teeth. so it may be.

We don't know what to expect next, but we do believe Fitz, now 27, is past the worst of his problems now. 


Big Big Big thanks to Meredith Barlow for researching this very odd issue and to both Meredith and Dr. Tracy Brown for setting our big bay Thoroughbred on the path to better health!

Things Can Go South Fast!

We're going to preach a little  - again - on the importance of frequent dental exams in Equine Elders.  Twice a year is recommended, more often is not overdoing it if your horse is prone to dental problems.

As an example, Freddy, our self-cleaning dancing Arab gelding was examined seven months ago.  With no major problems, he had a few sharp edges and points addressed, with everything functioning pretty well afterward.  He dropped a few quids here and there if given coarse hay, but that was not new, and not alarming at the age of 26.

However....a few days ago, we noticed Freddy having noticeable problems chewing.  He had no other obvious sypmtoms, but since the dentist/vet team was in the area this weekend, we asked them to stop by and take a peek.

On the initial exam, it was noted that Freddy had a bit of a "fat face."  Not any one lump, bump or swelling, just sort of puffy all over.  A quick look at his teeth didn't bring up anything obvious, except that he seemed to be biting his cheeks because of the edema in the tissues.

Next up: x-rays.  And there is was.   A tooth infection that had moved into his sinus.  Alarmingly, three other teeth looked like they were headed in the same direction.  They had to come out.

Here, Freddy receives a "nerve block," both to keep him comfortable during the extraction and to prepare for flushing the sinus to knock out the infection.

The tooth causing the biggest problem is removed first.

Because there was very little of the roots left, all four teeth came out easily, with little discomfort to the patient.  Here are two of the four teeth removed.  The larger tooth on the left was the one causing the sinus infection.

Next, the sinus cavity itself was flushed out, to be followed up with two weeks of antibiotics. 

With that, Freddy should be good as new!  He may have fewer teeth, but he'll have fewer health problems and less discomfort as well.

Infections, abscesses and dental-related sinus problems are not at all uncommon in older horses.  Nip them in the bud.  Watch for any signs of chewing difficulty, and schedule exams earlier rather than later.

Infected teeth & Infected sinuses

We've seen it often enough here.  Discharge out of one nostril.  Treatment with antibiotics helps, but the infection returns in a week or two.  Hello, Dentist?

According to the abstract of this paper on  Sinus Surgery in the Horse, "the most common cause of sinus infection is extension of infection from a diseased tooth or as an aftermath to tooth repulsion." 

Long story very short........if your horse has a persistent or recurring nasal discharge, think "teeth."  To see just how little barrier there is between tooth root and sinus, visit http://www.hanne.com/teeth-photos.htm  and click on the fourth photo from the top.  Its easy to see how an infection in a tooth root can move into the sinus right next to it.

Quick Jubal Update

We hoped Jubal would be back out with Fitz, Emma and Josh by now, but nooooooooo.........

The initial fever, swelling, and pain resolved quickly but, as always, there's more to the story.

Even though last weekend's ultrasound showed nothing of concern, there was a small pocket of infection under Jubal's innocent looking scrape. The wound opened up Monday evening, draining pus and blood. Tuesday morning we hosted yet another visit by the vet, who re-evaluated both the wound and the joint. Good news.......there still did not appear to be any injury to or infection in the joint capsule or the tendon sheath. Bad news, of course, was infection where we didn't expect to see infection.

The open wound was thoroughly cleaned, then flushed with a dilute betadine/saline solution. We were to continue as before, anitbiotics, clean wound and change wrap at least once a day, more often if needed. As of Thursday evening, there didn't appear to be much improvement, but things weren't getting worse, either.

Friday morning, however, at wound check we found more puffiness around the fetlock than there had been for several days. Another call to the clinic and a third vet visit followed. (Thank you, Jubal, for not waiting until Sunday again, which would have meant an "after hours" call.)

Ok. One more evaluation. Still no apparent involvment of the joint or tendon. Open wound again flushed. This time the vet added an antibiotic ointment to the regimen. This particular ointment is made for treating mastitis in cows, so comes in a plunger-type tube with a dispenser small enough to fit into the wound's opening itself. Now we can apply antibiotic directly to the source of the problem. The clinic is also now culturing the bacteria involved to see if it is something that won't respond to the current antibiotic treatment. A "sensitivity" test will also be performed to see just which antibiotic will be most effective. Treatment will be adjusted accordingly.

So......for now, Jubal is "maintaining." Not getting worse. but not healing as quickly as we had hoped either.

Fortunately, even though he is extremely bored while "in the hospital," Jubal has been a model patient.

If you have some free time and would like to visit the patient during his confinement, please email us at info@equineelders.org and schedule a visit!

Hey Quilters! Can you help TREES' horses?

Quilters! Time to Search Your Stash! Jubal's recent leg injury requires wrapping for at least a few more days.

See the white padding under the elastic bandage?

That's nothing more than good old quilt batting. Excecpt that its been cut to a certain size, repackaged just for the purpose of wrapping horses' legs, and priced "accordingly." TREES received a package of "Leg Wrap Sheets" during our Giving Trees program last Christmas, but Jubal is making short work of them (he's getting each one dirty enough that we can't reuse them and must start with a clean wrap each day.)

This is where you quilters come in. Do you have any batting remnants sitting in drawers or closets that you hate to throw away, but feel you may never use? TREES can put them to good use! We'd like to think we won't need them often, but Jubal reminded us that we just never know what might pop up next and that there are certain things we should keep in stock in large quantity.

We're looking for pieces at least 15" x 18" but anything larger would be great. We can cut or fold to custom sizes as needed.

If you are a quilter or former quilter, or know a quilter or former quilter.......please Search your Stash. Batting may be sent to Traveller's Rest Equine Elders Sanctuary, PO Box 2260, Spotsylvania, VA 22553. (If using UPS, FedEx, etc, give us a call for the street address. ) If you'd rather drop them off in person and meet the gang, give us a call at 540-972-0936, or email info@equineelders.org to schedule a visit.

Jubal and his chorts thank you!

No Rest for the Convalescence Stall!

We planned to talk about something besides health issues today, but that is not to be. ("The best laid plans of mice and men......")

Yesterday afternoon (Saturday) the farm was at peace. So much so that we finally addressed some long neglected chores - mowing the lawn and disposing of the mountain of feed bags by the back door, for example. Thunderstorms in the distance threatened to soak the farm during the night, so we worked until sundown to accomplish as much as possible in case the bad weather would be with us in the morning.

The horses all seemed quiet, happily grazing in newly mowed fields. Nothing appeared to be out of the ordinary. For once.

Saturday's peace was short-lived.

Sunday morning, as breakfasts were distributed, Jubal did not come into his stall. Now, Jubal is always - every meal, 100% of the time - the first one in his group to assume the feeding position. Not so this morning. Jubal stayed put where he was in the shed, even when Fitz pointed out that Jubal was in his feeding station.

A quick glance up and down easily revealed the problem. Jubal's right foreleg was noticeably swollen to the knee. There was a small, superficial-looking wound on the back of his fetlock, but nothing that looked like it should cause the reaction we saw. We brought out the thermometer and found Jubal's temperature to be 103.2. Normal rectal temps for a horse are in the 99-100 range, so this was a significant fever.

Our vet was here within an hour. Clipping the hair from around the wound and cleaning the area revealed no puncture wound, confirmed by an ultrasound scan. Jubal's injury appeared to be a very superficial scrape.

Sometimes, though, even very minor assaults to the skin introduce opportunistic bacteria which, under just the right circumstances, cause a major infection. If you have ever known a human who developed cellulitis as the result of a seemingly insignificant scratch, you'll understand what Jubal is dealing with now and how frighteningly quickly it can escalate.

To combat the infection, Jubal was immediately started on antibiotics -- 2 days of injections, then 3-5 days of an oral type. He has been given anti-inflammatory medications for pain and to reduce both the fever and swelling. In addition to medication, cold hydrotherapy will be used to keep the swelling down and to keep Jubal's body temperature down, if needed. Another technique being used is a "standing wrap" which consists of elastic bandaging over cotton-like padding.

For now Jubal seems much more comfortable, his main concern being the separation from herdmates, Fitz and Emma. Or maybe the problem is that his current wrap is pink! Pink! (Don't worry, old man, we have other colors for when we change the wrap tonight.)

While we don't want to downplay the potential seriousness of cellulitis, its a relief to see Jubal responding well to treatment so far. If everyone reading will cross your fingers, hold your tongues just right, and send positive vibes his way, perhaps our stoic old Foundation Quarter Horse will be back to normal in no time.

And after that........well........maybe the universe could give the geezers a break for a while.

Heart Infections

We wanted to share this article from thehorse.com since one of our residents was very recently treated for endocarditis. Fitz' heart infection is believed to be a complication of badly infected teeth and long-standing periodontal disease.

Important points to note:

"Relatively rare in horses, endocarditis develops from bacteria circulating in the blood secondary to a primary infection elsewhere in the body."

"Early detection is key in treating endocarditis, which requires high doses of antibiotics for four to six weeks. However, prevention is the best plan, according to Porter. "The only way to protect your horse from endocarditis is to treat primary infections quickly and with the appropriate treatment," she said."

The Horse: Heart Infections More Common Among Young Horses

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