PPID and dental / sinus issues


norcalpintabians
 

Knight is having some type of recurring sinus infection. My vet thinks it is a dental issue. Im just wondering if it is being caused by his uncontrolled ACTH? or the seasonal rise? His symptoms had all gone away until just a couple weeks ago. then they started slowly coming back. that is when the first sinus infection (mucous out one nostril) showed up. We gave 2 weeks of antibiotics and it cleared up. 2 weeks later it was back, so we are back on antibiotics (smz tmp). I am increasing his pergolide at a rate of .25mg every 3 days. He was at 2mg about a month ago and seemed to be doing better (ALL symptoms went away); then we tested and his ACTH hadnt gone down, so we are now increasing.
My question is: should I spend the big bucks to get his teeth xrayed? or just wait and get his ACTH under control first? 
Thank you.
--
Susan Morgan
June 30, 2018
Ione, California
Case History: https://ecir.groups.io/g/CaseHistory/files/Susan%20and%20Knight

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71655


celestinefarm
 

Susan, IMO , yes you should have his teeth, at least on the side in question , radiographed. if you are dealing with a dental issue, unless the tooth is addressed, the antibiotics will simply be killing off the weaker bacteria, allowing more virulent ones to flourish. You will end up with a much more difficult to control infection. Getting his ACTH will help, but an active infection from a dental issue will need to be treated to be resolved.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History


Bobbie Day
 

Just wanted to share my story about dental issues. I purchased three horses from a KB along with Desi. There was a little gelding that had a lot of issues, I couldn’t bring them home for over two months because the vet in CO thought he had strangles (blown abscess)
Finally got him here and I would just get him over the infection and each time it reappeared even worse. I had him X-rayed three times, had the vet open him up twice.
Finally our dentist friend came through to do our horses and found a big mess, his tooth had broken off and it was so badly infected it took him six hours to get out.
Balt (Baltimore) was the perfect patient.
He was so abused and scared of everything and everyone but the dentist said he was the best patient he’d ever had.
All that time he had that infection, it was over a year. The vets all thought it was strangles, and we should have caught it much earlier. I think someone was so mean to him they probably broke it off somehow but it’s just speculation. I love this little man and he loves me back and is learning to trust again.
Sometimes things just aren’t as they appear , as we all know with horses 😊


--
Bobbie and Desi
Utah, Nov 2018

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi

https://ecir.groups.io/g/CaseHistory/album?id=78821


millionairess1989
 

Another thought-
A few years ago my Arabian mare Mill was experiencing off and on mucus nasal discharge from one nostril. Antibiotics sometimes helped. Floating and head x-rays didn't reveal the cause.

I went out to move her from her pen one afternoon and found blood with chunks of tissue everywhere with something laying on the mat where she eats. Turns out that she had an ethmoid hematoma in her nostril nearly a foot long. My vets and I were all rather shocked by it and very grateful that she hadn't hemorrhaged from the blood loss.

There are photos in her case history.

https://ecir.groups.io/g/CaseHistory/photo/831/11?p=Name,,millionairess,20,1,0,0
--
Jennifer & Mill
Middle TN  2010
https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Millionairess


celestinefarm
 

Jennifer, that is an amazing photo.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History


norcalpintabians
 

We are trying to schedule an appointment with the dentist asap. He is booked up until September! (my awesome vet is trying to "sweet talk" him into seeing Knight asap) I love my vet.
--
Susan Morgan
June 30, 2018
Ione, California
Case History: https://ecir.groups.io/g/CaseHistory/files/Susan%20and%20Knight

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71655


Lavinia Fiscaletti
 

Based on the info that everything seemed to be OK until we entered the seasonal rise, it is likely playing a part in this.

His ACTH has never been controlled based on the numbers in the case history. You are battling seasonal rise on the ACTH so you'll need to jump that pergolide dose quite a bit to try to get on top of it as a reading of 216pg/ml in July is severely elevated. You may/may not get it completely controlled now but should be able to make a dent in it if you get aggressive with the meds.

Because he is also severely IR, SMZ/TMP as an antibiotic could be problematic as it is shown to elevate insulin levels in other species - not tested specifically in horses but no reason to think it is different.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team


norcalpintabians
 

Thanks Lavinia,
Im increasing his pergolide by .25mg every three days. Is that not fast enough? I hesitate to increase much faster since he had a bad time with the veil when we started the capsules.

--
Susan Morgan
June 30, 2018
Ione, California
Case History: https://ecir.groups.io/g/CaseHistory/files/Susan%20and%20Knight

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71655


Sherry Morse
 

Susan,

We recommend titrating up every three - four days so you're in line with that. If he had an issue with the veil before you would probably want to consider using APF to help mitigate the veil effects.



norcalpintabians
 

Update:
I have increased Knight's pergolide every three days with no ill effects; He is now at 4mg. I will continue to increase .25 mg every 3 days until I see the hypersalivation and other symptoms subside.
(I believe the hypersalivation is directly related to his hormone levels. It had completely gone away until the seasonal rise began. Now it is back, but not as bad as when it first started many months ago.)
Knight has gained another 20 lbs on his current diet making his weight 890 lbs today. He looks much , much better. 
We have an appointment with the equine dentist, who is also a DVM, next Thursday at 2pm. He will do xrays to see if teeth are causing the recurring snotty nose (left side only). 
I will post an update (and update Knights case history, complete with new photos) after the appointment with the dentist.

Knight continues to be in good spirits and eats well. He still doesnt clean up his hay (free choice) but Im hoping the dental work will help with that. He has no signs of sore feet, but I have noticed the occasional, very minor, swelling in his crest and/or fat pads on his shoulders. There have been NO changes in his diet, except the addition of beet pulp, which made him have loose stools, so I discontinued it. It made no difference in the "IR symptoms". We are going through summer heat waves, so Im not exercising him right now. I will continue our "slow start" exercise program once it cools off. (less than 100 degrees would be nice )




--
Susan Morgan
June 30, 2018
Ione, California
Case History: https://ecir.groups.io/g/CaseHistory/files/Susan%20and%20Knight

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=71655


Sherry Morse
 

Thanks for the update Susan and glad to hear Knight is putting on weight.  I would suspect his ACTH is driving the insulin up and hence why you're seeing signs of a crest and fat pockets but hopefully that will level out once the ACTH is under control.  Hoping for good news from the dentist as well!




Eleanor Kellon, VMD
 

Hi Susan,

There's really no way the hypersalivation is related to hormone levels. It's a separate medical condition and any improvement or worsening in parallel with hormone tests is coincidence.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001