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  Discussion on Coughing/Heaves and Maxillary Sinus Mass related?
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Posted on Tuesday, Sep 5, 2000 - 7:34 pm:

DrO-

As is often the case it seems, problems in horses can be very difficult to diagnose when multiple things are going on at once. I wrote you once in this section August of last year (see "Reoccurring Nosebleeds") about my horse and the mass located in his frontal maxillary sinus. I have no update to this story other than we re-xrayed his nose in May and the mass was still there, same size and shape (and very uniformly round). The surgeon at WSU in Pullman still feels at this point that surgery is not recommended given he has had no further nosebleeds or breathing difficulties.

Except....as I mentioned in my previous post my horse was diagnosed with heaves when he was 4 (he is now 12), by bases of the nature of his cough and the sudden outbreak of it. After his initial "outbreak", he was moved to a different facility, soaked his hay, and put on a syrup called "DEC syrup" that was a dog/cat dewormer. I have also made mention of this on a post in the Heaves section. In any case, the coughing cleared up in a couple of weeks, and has not reoccurred in 8 years. I stopped soaking his hay after a year, stopped giving him the syrup after 2. He has been getting hay and has been stalled at night out during the day all this time. Now, 8 years later, he is coughing again, and I'm battling with trying to figure out what I can do to manage what I know will be DrO's recommendation, putting him on pasture 24/7 and no hay whatsoever.

Finally, to complicate the matter, my horse is a very tight, stiff mover with a contiually sore back and hind end, and after injecting his hocks to no avail, my vet has speculated that he might have EPSM as well. We do have him on Purina Strategy (a fat-based feed) although I have not as yet added the recommended 2 cups of oil additionally as recommended in Dr. Valentine's diet. He gets regular chiropractic and massage therapy. He's also been a very poor keeper, and the wonder of the Purina diet is that he is FINALLY up to an ideal weight with no ribs present.

Now, with all these things going on, my horse is alert, happy, fit, VERY energetic (runs around all day long), and eating and drinking well. His coat is shiny and glossy and he appears to be as any horse should that is in the prime of his life. The only other problem he has is one runny eye that seems to bother him every year during the dry season. He is ridden 3-4 days a week, up until this last week, when he suddenly started coughing again.

So a few questions I have as I try to sort all this out (still waiting to hear back from my vet):

1) Is there any CHANCE that his coughing could be related to the mass, and not heaves? Given we don't know what it is, but it has a history of bleeding, could it be bleeding down his throat and irritating him that way? Or, perhaps interfering with his breathing, causing him to cough? From this forum I have learned that cysts are perhaps as common in the sinus as hematomas...could the cyst be draining down his throat?

2) Ok - if they are just 2, random, unrelated things going on, can you recommend a feeding program for this horse, given his other dietary needs? I live in the Seattle area, it is very rainy and muddy here, and pasture is not good anywhere. Where I have him now there is pasture board available but it would have to be supplemented with something. I do not want to take him off the Strategy as I feel it is helping him with his weight issues. Can it be used as a hay replacement? If so, how much to feed him? He currently gets 6 lbs a day plus 3 flakes of alfalfa/grass mix hay. I do not think my facility would be willing to provide beet pulp due to the time it takes to prepare it. I am very afraid of this horse losing weight again.

3) To address his immediate problem of coughing, which has rendered him unrideable, is there anything else that can be done, in addition to taking him off hay and putting him on pasture 24/7? I mentioned above the "DEC syrup" he was on previously, which seemed to work. I want to try this again, but no one here seems to have heard of it. There are also several products on the market today that weren't around 8 years ago when my horse first had the problem. Cough Free is one, there are also some oral pastes available for short-term relief. Do these work at all?

I appreciate any assistance you can offer. Due to his many problems this horse has been retired from dressage and is now half-leased as a pleasure horse and I have another horse for dressage. I'd like to keep him rideable for pleasure as this offsets some of his costs, and I know I'll have him for life. Its sad actually, he's an absolutely beautiful animal, sound and fit and young, he could go far if it weren't for these things holding him back. To see him run and play in the pasture, you wouldn't think he thinks he's being held back at all.

Jaime

Posted on Wednesday, Sep 6, 2000 - 3:29 am:

hello Jaime,
My mare was diagnosed a few months ago with a maxillary sinus cyst. She has stabilized nicely, and the air flow out of the blocked nostril has improved.
However, her right eye is teary, (cyst is on the right sinus) and she lets off a few coughs when starting work. She is not heavey at all. I doubt your horse has heaves, based on what my mare is like.
That could be why your horse has a teary eye.
I figured the cough has to do with sinus drip as you mentioned.
Sounds like his diet is working fine.
Hope your horse gets better, let us know, I am sure Dr. O will have some good advice for you.

Posted on Wednesday, Sep 6, 2000 - 5:56 am:

There is a chance but unlikely. If you have this type discharge causing a cough from the maxillary sinus I would expect to see something at the nose.

If allergy to hay molds is the problem, you do not need to change his feeding program, just substitue pasture or hay cubes for the hay.

DEC was a recommendation you saw in the 80s for heaves, I have little faith in it myself because the mechanisim of action is a bit tenuous. Some swear by cough free, I have never seen it work for a heavy cough in at least a dozen cases, it will always work against a cough secondary to a cold: but then again so will rest. Corticosteroids will help with allergies but all these are just stop gap procedures you need to remove the offending allergin or you are doing your horse irreprable harm.
DrO

Posted on Wednesday, Sep 6, 2000 - 2:20 pm:

Thank you Angela and DrO.,

I just got off the phone with my vet. He had a few comments, and he will be coming out to see my horse next Monday. His thoughts (and DrO you may disagree with this) is that he might have an allergy to mold spores and have somehow gotten irritated by them again, but that it was "unlikely" he had heaves, given the fact that he has not had a recurrence of coughing for 8 years. To him, heaves is characterized by a chronic, worsening condition that is manageable but not treatable. And since this horse has been on hay and stalled at night the last 8 years, he thought it unlikely he had heaves. I wish I was convinced, but I think its more likely he has it and I've just been lucky so far in being able to keep him away from whatever allergin was causing the problem.

He also thought it unlikely that the cyst/tumor/whatever it is in his nose is causing the problem..but mentioned it was POSSIBLE. Its funny what you wrote Angela, about the runny eye, because I had always just associated that (which he has had off and on for a couple of years now) with allergies and dust sensitivity, not with the nose problem. But it is, in fact, located on the right side, the same side as the tumor.

He also agreed with your opinion of DEC syrup, it was prescribed by certain vet schools some time ago but has since fallen out of favor and he himself does not prescribe it. I do remember it worked, and was fairly inexpensive, so I may still try it again, if all else fails.

I am thinking now that I would like to proceed with at least finding out the costs involved in having his maxillary sinus thing removed. I think the location is the problem, it is not visible on endoscopy so it is unknown if we are dealing with a cyst or an ethmoid hematoma or what. My vets recommendation was to monitor its size via xray and his breathing and not do anything until it became a further problem. But with all these other things going on that COULD be related, I'd have a greater piece of mind if we removed it, even if it didn't resolve his "allergy issues".

One more question for you DrO, is injection of the mass possible even if you can't get to it via endoscopy? Because, I'm thinking if we could at least poke it with a needle and see if we could draw anything out of it, we could determine if it was a cyst (fluid-filled) or fleshy (like a hematoma, which is similar in consistency to proud flesh?). In which case, I would think a cyst could be drained by injection, and a hematoma, to my understanding, can be injected with formalin rather than surgically removed and that has proven quite effective. Some questions I'll definately be asking my vet on Monday but I'd like to get DrO your thoughts if you have any.

Thanks again!
Jaime

Posted on Wednesday, Sep 6, 2000 - 9:10 pm:

Just a thought, I got a biopsy on Ruby's cyst and it was not an ethmoid hematoma, just a cyst. No malignancies either. (thank God). I did mention draining it to my vet and he said that the fluid keeps replenishing and even if they did surgery they could not guarantee that they could excise the whole tumor as it is also in her frontal sinus. When the vet poked thru it with the biopsy tool she drained out almost a liter of honey colored cyst fluid! (It was quite amazing, but it did not "go away")
As my mare is 20 years old, I opted not to do the surgery. As of right now it was the correct decision as she is getting around just fine and other than the teary eye and occasional "snotty" right nostril she is bright eyed and happy.
On the endoscope Ruby's mass was quite visible, but the vets relied on the xrays to see the extent of the cyst.
Good luck to you and keep us updated!

Posted on Thursday, Sep 7, 2000 - 1:35 pm:

If you can't visualize it with the endoscope the only way to inject it is with a surgcial exposure: if you do this might as well remove it.
DrO
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