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31yo arab with persistent nosebleed and mass by throat latch

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  • 31yo arab with persistent nosebleed and mass by throat latch

    After successful recovery from an acute ataxia episode 2.5 weeks ago, my 31 yo arab has me worried about a new problem.

    Red developed a small mass on left side throat latch area recently. 2 days ago, he started having intermittent nosebleeds from right nostril. Yesterday, he presented with a 101.8 temp, swelling on right side face, and nose bleeds worsening with what appears like serum mixed with blood coming from right nostril, and a little serum coming from left nostril.

    My vet came out and did an ultrasound of both sides throat latch area. Noted fluid on right side and a mass on left. He did a fine needle aspiration to send samples of mass to pathologist. My vet gave him a shot of what he calls his “vitamin c cocktail,” and instructed us to give him bute, antibiotics, and Assure (he already gets Elevate).

    My vet does not believe current problem is related to previous ataxia episode, but is very tight-lipped about diagnosis/prognosis without pathology review. Just when we recovered from the trauma of almost losing him to ataxia, I’m not sure what to think about new problem.

    Anyone out there seen this before?

    PS – I dealt with guttural pouch mycosis once, and nosebleeds really freak me out! My vet tried to reassure me that he is not going to just start bleeding out on me, but I’m not 100% convinced.

  • #2
    Is he a gray?

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    • Original Poster

      #3
      He's chestnut.

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      • #4
        OK, well at least we don't have to worry about a melanoma then as that's a nasty place for them. Hope the old guy is feeling better soon. Hugs!

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        • Original Poster

          #5
          Thanks! I hope so, too!

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          • #6
            Why is the vet so sure it's not guttural pouch mycosis? Can you please have him scoped?

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            • Original Poster

              #7
              Other than the nose bleeding, it does not present the same as guttural pouch mycosis. We discussed scoping him, but my vet's primary concern is the mass on throatlatch, and he wants to wait until pathology results come back first, which unfortunately may not be until Tuesday.

              The waiting is killing me. Helplessly watching my horse with a swollen face, bleeding persistently, and rubbing his bloody nose on his legs, sides of walls, food bowls is driving me crazy. I feel like I'm also suffering PTSD from when my qh had end-stage gutttural pouch mycosis in 2006.

              But I'm mostly afraid that the vet thinks it is cancer and/or there are no non-surgical treatment options. I'm terrified I'm watching him die and I can't save him.

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              • #8
                **hugs** Janet. I'm so sorry you're going through this. Tuesday will be here before you know it. Try to keep busy until then.

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                • Original Poster

                  #9
                  Thanks! It means a lot! This afternoon, he seems a touch perkier, there is less serum discharge and the swelling is a little better. But the bleeding is worse.

                  Tuesday cannot get here fast enough!

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                  • Original Poster

                    #10
                    I talked to my vet last night, concerned about the increase in bleeding yesterday. He told me if the bleeding is intermittent and the drops can be counted there isn't much to be done. He said it is likely that the mass/tumor is causing an erosion of the blood vessels, and hopefully the antibiotics will help treat it. He could potentially be taken to the hospital to have nostrils scoped and packed or cauterized. But there are risks of stress from travel, and the anesthesia/sedation required. Since he is acting normal otherwise and eating well, my vet wants to continue to wait and see.

                    This morning, Red is still bleeding, but it seems to be slightly less and definitely a thicker clotting blood. So we continue to give him antibiotics, bute, elevate and assure, and wait and see.

                    Comment


                    • #11
                      Ugh, I’ve dealt with GPM as well and this is giving me serious flashbacks. Does your vet not have a portable scope that he can bring to the farm? I would really want to scope the guttural pouches. If nothing else at least to have peace of mind.

                      Good luck OP. Sorry you’re dealing with this. I hope you get results quickly... my only advice is to say stick to your gut. If you don’t like the feeling you have, insist on a scope. Even if you need to haul to do it.

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                      • Original Poster

                        #12
                        Thank you. Unfortunately, it is not GPM. If it was, I could save him with surgery.

                        No portable scope around but unlikely scope will make any difference at this point. Mass is growing, and swelling on side of nosebleed is fluid. Yesterday, Red appeared weakened and not eating well and my regular vet was not available. So I found a new vet an hour away, who just came from Nevada hospital where my hero, Dr. Shane Miller, is owner, and had her come out to take over Red's care. She is young, but super bright, educated at the best places and calling all her mentors for input to get a team involved. She came with truck packed full with anything she could think of, including fluids and transfusion kit.

                        But upon examination, her prognosis is poor and discussions quickly moved to euthanasia. She thinks the mass is cancer. Even if benign, she says inoperable. She is not aware of any non-surgical options. His temp, heart-rate, bodily functions are normal. Protein and rbc blood test within normal range. Since we want to wait for pathology report and discuss with our new team of specialists, she suggested dex shot and iron supplement. Within 10 minutes of shot, Red perked up, and resumed normal grazing/social behavior. We are instructed to give 10cc today and tomorrow. Of course, this is a a very temporary band-aid, but we should be able to keep his quality of life positive until at least Tuesday, when we get results.

                        She is on 24/7 standby in case he takes another bad turn.... which means we are officially in death watch mode.

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                        • #13
                          I'm so sorry..

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                          • #14
                            Janet, so sorry to read about the prognosis for your gelding. {{JC}}

                            A bit of a 'small world'... in 2001 (I think it was) Dr Shane Miller performed my mare's second colic surgery at Littleton Large in CO. He also spent 3+ weeks talking to me regularly about her post surgery care (in LLAC's intensive care) and prognosis. I remember one Saturday showing up to see my girl and he came out to the barn to talk to me and we had "the talk". I followed his advice/gut feelings and lost her just a few years ago. He is one of my equine "heroes"
                            Maybe the reason I love animals so much is because the only time they have broken my heart is when they've crossed that rainbow bridge

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                            • #15
                              Sorry to hear this but it certainly sounds like you have a fantastic new team who is on top of things to make however long he has left the most comfortable.

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                              • Original Poster

                                #16
                                Thank you all. It means a lot.

                                White, ah! You know exactly what I mean about Shane Miller. There are very few people I call my hero and Shane is at the top of my list. Shane is lecturing in Brazil right now, but still managed to check in this morning and review Red's chart/pics. Sadly, he concurs with team.

                                We are now taking it one day at a time. He is responding well to dex and today is a good day. I am very grateful for today.

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                                • #17
                                  I am sorry to hear the latest news. While a small comfort, it helps knowing that the vet you are using knows their stuff.

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                                  • #18
                                    I am sorry to read about your horse, Janet. I hope you get to say goodbye on your terms and not in an emergency. (((hugs)))

                                    Comment

                                    • Original Poster

                                      #19
                                      Received the following email this morning from my regular dvm:

                                      "Hi Janet. The results are back. It isn't good. Red has an 'epithelial cell tumor of thyroid gland origin' most likely a thyroid adenoma. There isn't much that can be done. Medications might improve his quality of life for a short period of time. Can we talk on the phone or I can come by later. So sorry."

                                      When I google this diagnosis, I see the common treatment for condition is standing thyroidectomy. I have calls out to local hospital surgeon (1 hour away) and Colorado State University (6.5 hours away) for surgical consult.

                                      I forwarded message to the young vet that came out on Sunday. She believes euthanasia is best, sooner rather than later. However, she agrees Red is safe to transport if we leave in the next day.

                                      It is such a long shot, but if the alternative is euthanasia, it is worth seeing if surgery is even an option.

                                      Comment


                                      • #20
                                        My dog had the same symptoms prior to his death. He presented with sudden onset ataxia, dialated eyes, and was crying in distress. We rushed him to the ER vet, and while they ran tests, his symptoms resolved, minus some ataxia in one hind leg that remained. The vet recommended an MRI but thought it could be toxin related. We took him home and he seemed stable for several months before presenting with bloody nasal discharge and was diagnosed with nasal adenocarcinoma. There is no effective treatment for that and i had him pts when he started having trouble breathing. He lived about one year from the time of diagnosis to his death, which is a decent amount of time because the vet told us the best we could get, even with treatment was one year.

                                        It sounds like you are doing everything you can and i wish you the best of luck. It is never an easy decision - to treat and try and buy more time, or to decline further treatment... It is so hard to make that call.

                                        I did know a horse with that condition. I believe they had the tumor removed, but it did come back. The horse seemed comfortable but had a golf ball sized tumor under the throat latch area. I did not follow up with the owner to hear the outcome but i know they weren't pursuing further treatment. The horse did seem comfortable and happy when I saw her.

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