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  Discussion on Sinus infection in older horse due to tooth abscesses
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New Member:
poopoo

Posted on Wednesday, Feb 13, 2008 - 10:49 am:

Dr. O,
I have an older mare (19 or 20) with a sinus infection due to abscesses in two top molars. Her nose continues to run these days and we have increased her SMZ'z to 25 am/pm as we have already encountered resistance? I know that is the max dosage (or perhaps too much), but she is a huge horse (17H warmblood type) and I feel like we have to try anyway. Her gut seems to be handling this, and I have her on U-7, Neighlox, and Vitaflex's multivitamin supplement Accel (with probiotics in it). She also gets vit E 5000 (for shivers), Cortaflex HA, and a daily dewormer. She lives on 2 bute a day for her backend. Do you think I should give her folic acid in addition? (I read about the side effects in the medication area.) This dosage level has seemed to slow down the discharge and take away the putrid smell for now.

She is also compromised in the hind end - old pelvic fracture and horrible stifles, especially the RH. She lives on 2 Bute a day, I have gotten the stifle injected, and she is still short on that RH. She has trouble going down to roll and getting up, and we turn her into her stall very carefully when we bring her in from turnout - you get the idea.

She's been on and off SMZ'z for about 3 months now (18 and 18 til now and mostly "on" them), and we have begun to get the nasty smell and putrid discharge while on SMZ's, as I guess we have already encountered resistance. I have also given her a couple of courses} of Equistim which have seemed to also help some.

I don't think she's stable enough to stand for tooth removal as it sounds quite involved for the top teeth and she will probably need a lot of TQ, etc.? As for surgery - I cringe at the thought of her breaking her pelvis again trying to stand after the anesthesia. I don't think they'd take her as a surgical candidate anyway.

I am looking into trephining. Is this a big deal? Do you think it would buy much more time? Can I flush it myself after the first flushing by the vet? (In other words, can she come home and be turned out while I continue to flush it?) Have you had success with other antibiotics? (I am comfortable giving IV injections too.) Do you think the maxilla is probably infected now too, judging from my description? How long can they live with an active sinus infection without pain? What kind of bad things will happen if she continues to just "live" with the nasty discharge?

I am just trying to make her quality of life good enough so she can hang out with her friends for as long as possible, within reason. I am not looking to spending huge amounts of money (in the hundred is fine) or doing experimental type things just to extend quantity of life. (I've worked at New Bolton and seen those sorts of things before ...not that there isn't a place for them...just not here.) It's quality over quantity. I don't want her to turn into some freak show just to stay alive, and whatever I do, she needs to keep getting turned out with her friends, not stay inside. Perhaps I am being unrealistic?
I know I have a lot of questions and am asking a lot, but I am really in a quanadry right now. I'm just looking for more information or other ideas. Thanks for your time.
Moderator:
DrO

Posted on Thursday, Feb 14, 2008 - 7:38 am:

Welcome Susan,
If the sinus infection is coming from a oro-nasal fistula, it will take removing the teeth to fix the problem. If it is a tooth infection without a fistula other antibiotics might help and considering the long term nature of the problem would consider doxycycline or chloramphenicol as they can be given orally and are not not terribly expensive. Note supplementing folic acid is contraindicated with TMP/SMZ for more on this and more on the antibiotics mentioned above see Treatments and Medications for Horses ยป Antibiotics and Antimicrobials.

Trephining a flush/drainage hole into the sinus is likely to make managing the sinusitis easier but again, if there is a oro-nasal fistula will not fix the problem. It is a pretty straight forward procedure.
DrO
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