Tag Archive | EOTRH

A Canine Switch

So Biz and I headed back up to the clinic on Monday to see about having two of his canine teeth removed, as they seemed to be causing him a lot of pain. After further consulting, we decided to try continuing the daily painkiller for awhile and then extract later if it is still needed.

If you are newer to this blog, you may not know that Biz has EOTRH, more officially known as equine odontoclastic tooth resorption and hypercementosis disease.  In very simplistic terms, it is kind of like osteoporosis of the teeth. The tooth root begins to break down and get spongy (the tooth resorption), and then the body tries to strengthen the weakening root by creating a ball of “cement” (the hypercementosis) around the damaged root.  The ball of cement presses on the gums, causing pain.  Not to mention the teeth become loose, and can eventually just break off either at or below the gumline.  More pain.  Interestingly, people and cats get their own version of this disease.  Something to look forward to!

Although it isn’t a new disease, it has become much more recently studied in horses, because, in the past horses didn’t live long enough for it to matter.  They died of something far more usual (colic, laminitis, etc.) long before some vet ever started poking around much in their mouths…  Horses are living longer, more leisurely lives, just like people, and now the diseases of old horses are becoming more common.

Biz is 30; considered an old horse.  Domestic horses, like people, have a wide variation in longevity, and most statistics point to an average lifespan of 25-30 years.  He has had 9 of his 12 incisors pulled already, and his canine teeth are now affected.  One canine had already broken off at the gumline sometime in the last year and healed over on its own.  That left three canines…  Two of these canines were the ones that we were eyeing for potential extraction today.

After we decided to go with the more conservative daily painkiller approach, the vets then went to do a routine float on his molars and cheek teeth, and get rid of a sharp edge on the one canine that seemed to not be a problem.  “Floating” a horse’s teeth is the process of filing down the sharp edges to keep them from pinching or poking the horse’s cheeks and gums.  The process of chewing hay and grass just naturally creates these sharp edges over time, as the teeth wear unevenly.  This too, can cause pain.  Most of the time anymore, floating is done with a power tool in the horse’s mouth. Biz LOVES this, I can assure you!  (that was pure sarcasm, in case it wasn’t obvious…)

Well, filing down that sharp edge on that one canine tooth (the one that had seemed to be the most stable), caused it to break off from the vibration of the floating tool.  It was immediately apparent that it was just suddenly very loose, and ended up having to be removed. A quick pull with a pliers and the entire crown of the tooth came out.  The root was left in, in the hopes that the gum will just heal over it.  This same thing actually happened with his other upper canine, and Biz is a great healer, so fingers crossed.

We are hoping that perhaps that upper canine, or the sharp edges on his molars and cheek teeth, might have been causing at least some of the pain that has made him so reactive lately.  And that solving those problems will make the daily painkiller work well for him, or even be unnecessary.  Sadly, Biz never did learn his words, and doesn’t even have fingers to point to a particular spot and say, “that’s where it hurts.”  He’s a prey animal, and prey animals instinctually hide pain…  And even worse, he HATES having his mouth messed with on his best day, so he’s always more inclined to act like it hurts EVERYWHERE!  Hopefully, we will know more over the next couple weeks, as he heals from today.

 

Biz, looking regal before the sedative…

 

So, in true Biz fashion, he lost the canine they didn’t plan to extract today, and kept the other two. He can’t ever just do the expected…  Touche’ Biz… You never can seem to stick to a plan…

How to Pull a Canine…

Biz’s canine tooth extraction surgery is coming up.  We postponed it a couple weeks ago after finding out the issue was not with his incisors, in order to give the vet some time to consult with specialists.  Said consulting has been done.  Monday morning, we are traveling back to the clinic to give it a go.  They will start with his lower right canine.  And ugh, it sounds awful…

When the vet called Friday to explain what he had found out about the procedure and how to best do it, “bone grinding tool, levering against jawbone, and risk if ligament has calcified” were phrases used…  Yuck.  I asked all my questions and he offered the option of having the extractions done by the dental specialist, but that involves either waiting longer until she will be in the area, or traveling two hours south.  Trailering Biz two hours south into the big city and its horrendous traffic doesn’t sound like a good time for a 30 year old man…  So we are going to give it a go at home.

Basically, they will cut off the crown of the tooth (the part above the gumline), then grind away a portion of the jawbone to expose the root to make it easier to access and extract.  This, although it sounds terrible, is the better way to go because it reduces the pressure on the jawbone that occurs when they have to lever against it trying to loosen the tooth.  Hopefully, the ligament that is holding the tooth below is still relatively healthy, and has not calcified, because that bony calcification makes it harder to remove the root.

If, and this is a big if, he is tolerant and the extraction of the right lower canine goes well, then they will try to also pull the left lower canine.  If it’s too difficult, or takes too long, and they are concerned about his reaction or how long he is sedated, then it will be left for another day.

I’m cringing as I write this.  It sounds painful.  Biz on his best day doesn’t like people messing with his face and mouth.  A power tool grinding his jaw bone is going to be interesting. Not sure there are enough drugs in the world for him to tolerate that easily.  But leaving him in pain isn’t an option.  So all I can do is pray that it all goes well, and be there in whatever clothes I don’t care about getting blood on, pulling his ear to distract him, talking to him, and holding him up when he’s sedated.  It’s just what we do.

Getting down on his level – waking up from the sedative a few weeks ago…

 

I am going to need more than one glass of wine when I get home Monday.  For sure.

 

The Surgery that Wasn’t… Yet…

All has been pretty quiet in Biz news lately… He’s been doing well, using his three remaining front teeth and his mostly-worn-down molars to eat a complete diet of equine senior pelleted food.  Sometimes he gets beet pulp, if he likes it that day…  His weight has been good, and his skin has been good, and he’s overall just been hanging out – good.  I like that.

About 10 days ago I noticed he didn’t want me to look in his mouth at his incisors, which I do whenever I am out to see how they are doing.  At some point they are going to have to go.  Last Friday night he REALLY didn’t want me to look in his mouth…  NOT. FOR. ONE. SINGLE. SECOND…  He’s hurting…

Saturday morning I was on the phone with the vet’s office to discuss proceeding.  Antibiotics, painkillers and a vet appointment at the clinic this morning to x-ray and remove those last three teeth.  I was sure of it…

Well Biz had another thing in mind.  Because he can never do anything the easy way…  The incisors are fine.  Still stable.  Instead, it is the canine teeth; the two lower canines in particular.  And don’t get me started on why horses have teeth called canines?

Canines are harder to extract, because the roots are more deeply embedded in the jawbone.  It means a harder surgery, longer healing time, and more potential for complications, especially when both sides of the mouth are affected.  So his x-rays and photos were emailed off to an equine dentistry specialist, and my vet will consult on the best option.  Pull the whole tooth, or cut the tooth off at the gum line and let the gum heal over the root of the tooth.  Biz, it seems, already decided that the second option is the preferred method, because one of his upper canines has already broken off at the gum line, and the gum has healed completely over without us even noticing…  The body is a fascinating thing…

 

Getting down on his level – waking up from the sedative…

In a couple weeks, we will make the return trip up to the clinic for round 2.  Wish an old man luck!  Sometimes it’s hard being 30…

Biz gets drugs, I get beer…

This morning, Biz and I made the trip up to his vet clinic for his latest surgery.  Biz has EOTRH, a degenerative disease of the teeth that causes them to break down.  His incisors have been getting worse with the progression of his disease, and over the last four years, he has had three of his lower incisors pulled.

Biz looks a bit like a toothless Mr. Ed here!

Biz before his surgery – about a week ago.

With his last set of X-rays, it was clear that his upper incisors had deteriorated significantly over the last year.  We made plans to extract four of his six upper incisors, leaving only his two center top teeth.  I have to admit, I was a bit anxious, as pulling four teeth at the same time is much different than just pulling one.  Plus, the upper incisors are more complicated than the lower ones, because the nerve block is much more dangerous.  The nerve that affects the upper jaw is very close to the optical nerve, so if the nerve block is administered incorrectly the horse could be blinded.

Today’s surgery went well.  Once again, the nerve blocking was the hardest part, as Biz on his best day doesn’t love having his face messed around with.  Getting the nerves blocked on each side involved heavy sedation, one vet holding the needle, two other vets holding his head and me and the vet tech pushing on him to keep him standing straight in the stanchion – plus a blindfold, and a numbing agent under the skin at the location of the nerve block.  Oy!

Once the nerve block was done and had taken effect, the work of removing his teeth began.  The first one ended up being the hardest – he was not happy and kept tossing his head around (you find out how sedated they really are when you start the hard work!).  The first tooth also had the largest ball of cementum – which is where the tooth has tried to repair itself by creating a ball of extra growth to try to shore up the deteriorating root of the tooth.  However, the ball of cementum presses against the gums and the nerves in the mouth and is painful.

The rest of the teeth came out relatively easily – three of the four simply broke off when they applied the forceps, so the vets had to do a bit of digging around in the hole to get the remaining pieces of the root.  Once they thought they got it all, they did a new round of X-rays to make sure, and then packed the holes with Plaster of Paris and antibiotic tablets.  The sutures will hold for a few days, and eventually the plaster plugs will fall out.

 

A very sleepy Biz.

A very sleepy Biz after his surgery

I’ll be doing aftercare for several weeks, flushing his holes with saline solution daily.  I’m grateful that he is a remarkable healer.

Biz is now officially missing more incisors than he has left.  This evening he enjoyed a small meal of super soggy beet pulp and hay, and was pissed that he didn’t get more.  And I’m enjoying a relaxing craft beer.  It’s the little things…

Four to Go on Wednesday

Biz saw the vet for his annual checkup a few weeks ago.  At 28 years old, he is remarkably healthy.  No comparison of horse age to human age is truly accurate, but a 28 year old horse is generally believed to be about the equivalent of an 80 year old human.

His weight is great – his blood work is good.  His eyes are clear and bright with no sign of cataracts.  The only exception to his great health is his teeth.  Followers to this blog will know that Biz has had 3 teeth pulled over the last couple of years – this Wednesday he will have 4 more pulled. His disease, EOTRH, has progressed, and his teeth have deteriorated significantly in the last year.

I would be lying if I said I wasn’t a little worried – he has done really well with the extractions so far, but he has only had 1 pulled at a time previously.  4 is a much bigger deal.  This will be our first round with his upper incisors too – I am not sure if there will be differences with the extractions or in his healing process.

Biz looks a bit like a toothless Mr. Ed here!

Biz looks a bit like a toothless Mr. Ed here!

I wouldn’t be doing this (and the vet wouldn’t be recommending it) if there wasn’t a big chance that Biz is enduring a lot of pain due to these diseased teeth that are hanging on.  As horses are prey animals, they mask their pain – it has got to be pretty bad before a horse will let you know…  We are hoping that this surgery will relieve him of the pain.

I’ll be keeping my fingers crossed that everything goes smoothly, and that he heals quickly.  Please keep us in your thoughts on Wednesday!

The Horse Tooth Fairy, Times 3

On Wednesday, Biz and I went for a ride up to the vet clinic to play out a story that is becoming a spring ritual – x-rays and having a tooth pulled.  We are becoming veterans at this.

In case you don’t know the story, Biz has EOTRH, short for Equine Odontoclastic Tooth Resorption and Hypercementosis, a degenerative disease where the teeth gradually break down on the inside.  I give a better description in my post from a few years back.

This year’s surgery was the easiest ever, as my vet found the perfect tool last year for separating the tooth from the gum and the periodontal ligament that holds it in.  We also learned from our experience last year that we shouldn’t close the front of the stanchion while Biz is sedated, so he doesn’t faint and fall down.

The tooth clearly needed to go, as there was a little pocket of infection in the gum below the tooth creating a fissure, and once we got his mouth propped open we could see that the back of the tooth had a black, decayed part.  Once the tooth was out, the vets packed off the hole with an antibiotic capsule, sterile gauze and plaster of Paris.  Apparently some vets are now recommending to just let the wound stay open, but this system has worked for us so far, so we decided to stick with it.

Biz got topped off with a tetanus shot while he was still sleepy, and then we hung out for awhile waiting for him to wake up.  Once he was awake and steady on his feet, he got to come home.  He was on a restricted diet Wednesday night and Thursday because he had an episode of colic last year after he was sedated for his x-rays.  Better safe than sorry.

Once we got home, Biz walked himself around the arena while I watched; him restlessly walking is a symptom of the sedation – on a normal day he would roll, run around maniacally for a few minutes and then stop and look at himself in the mirror (he’s vain…).  During his restless wanderings the other evening, he was probably silently cursing me for not giving him much dinner.  After 24 years together, I know the look.  But it couldn’t be helped.  I love this old boy too much to feed him.

Yesterday I started flushing the wound with salt water and a syringe – preventing infection is the key now.  I’ll be doing that until the wound closes, however long that takes.  He doesn’t mind – it’s our thing…

If only the tooth fairy would drop some cash by to help pay the vet bill.  I know I’m not the only one with a million dollar animal – what’s your story?

Old Horses Get Gas…

Yesterday, Biz had some new X-rays on his teeth to determine whether there has been more progression in the deterioration of his teeth.  If you have followed this blog, you know that Biz has EOTRH, which causes the roots of the teeth to break down and become spongy, eventually undermining the stability of the tooth.  Biz had a second tooth pulled back in May, and since then we have been watching a third.  With the fall change in weather, he started dropping a bit of weight, something he has been known to do even before his teeth went bad, but lately he has also been showing more signs of pain in his gums.

So the X-rays went well, and I’m waiting for final word, but the preliminary assessment was to continue watching and waiting, as it didn’t appear there has been a lot of further deterioration in this tooth.  A couple of others we were watching actually seem a bit more stable, as they are forming more cementum.  Basically those tooth are building up extra calcium around the tooth to shore it up – it shows up as a ball type formation around the root of the tooth.  My vet is going to compare his current X-rays with his May X-rays on a high resolution monitor to make sure he wants to stick with the watch and wait theory, but for now…

So today I got a call at work from the friend who owns the stable where Biz lives.  He’s not eating much, pooping even less, and although he doesn’t seem acutely distressed, he just looks “off.”  Those of you who have animals understand what I mean by off.  There’s nothing specific, but you know something isn’t right.  And when your baby is 26 years old, you can’t ignore “off.”  Biz had laid down a couple of times, and gotten back up, and overnight had been down and up several times.  He still had enough pep to run away when I went to catch him (some things will never change), and while a small apple was enough to lure him in, he didn’t want to eat it.  Biz loves apples, so him turning his nose up at one is big news…

The vet arrived, and after the exam, diagnosed a case of gas colic.  A horse’s digestive system is very sensitive, and since they are designed to graze all day, the stomach isn’t intended to hold much food.  It is supposed to move into the small intestine (over 75 feet long in a horse!) relatively quickly to begin digestion.  If the food doesn’t move quickly enough into the intestines, it will start to ferment in the stomach, causing gas.  Almost all horses can’t burp or vomit (although I did have a mare who could burp the most fouling smelling burps, always in your face, but that’s a story for another time), so gas causes extreme discomfort.

Fortunately, we caught his colic early, because it can be fatal for horses if left untreated.  Eventually the discomfort will cause the horse to want to get down on the ground and roll to relieve the pain, but doing that can cause the intestine to twist and cut off the blood supply.  The only treatment at that point is surgical intervention, which is complicated and dangerous.  Biz’s colic was likely caused by the fact that he was sedated yesterday for the X-rays, slowing down the body’s processes, including digestion.  That slow down was enough to cause the colic.

The treatment was a painkiller and a large volume of electrolytes and mineral oil via a nasogastric tube.  That’s right, the vet had to get a tube up his nose and down into his stomach.  Preferably this would be done without sedation, because further sedation could just compound the problem, so we tried it that way.  Biz showed me that he would be perfectly at home among the Lipizzaner Stallions at the Spanish Riding School in Vienna.  Each time we tried to get the tube in, he would rear and jump forward, trying to leave us both in the dust.  My somewhere more than 100 pound body was no match for his 980 pounds of muscle, even if he wasn’t feeling well…

REAR!  LEAP FORWARD!  Drag Camille and the vet along with him!  That was the routine.  Quite impressive really, considering he hasn’t been trained in these maneuvers – if you want to check out his airs above the ground, they looked something like these.  After about a dozen attempts to intubate him, a minor rope burn on my finger, and coming close to a shoulder dislocation (my shoulder, not his), I could barely conceal my relief when the vet concluded that we needed to try Plan B.

Plan B was a mild, short-acting sedative for Biz – sadly I wasn’t offered any – by that time I needed some!  It worked like a charm, the tube went in, followed by about a gallon of electrolyte solution and a Costco size bottle of mineral oil.  Apparently mineral oil prevents gas from forming – I never knew this, but it is certainly information that could come in handy!

Biz got some immediate relief, and I spent the next couple of hours watching him walk around, first in the arena, and then later, in his small outdoor field.  He was interested in nibbling a little grass, and was clearly more comfortable.  Crisis averted.

Sadly, with an old horse, you never know when the next call will come…

Biz and Me, Back in May

Biz and Me, Back in May

My Horse Looks Like a Six Year Old Kid

Tuesday was Biz’s surgery day – I left work at noon and loaded him up in the horse trailer for an afternoon at the vet clinic.  My vet and the equine dental specialist were teaming up for Biz’s latest tooth extraction.  If you have been following this blog, you know that Biz had his first tooth pulled two years ago, because he suffers from a degenerative tooth disease called EOTRH.  Now, Biz is two years older, 26, and we continue to watch his teeth.  About 6 weeks ago, he developed an open sore below this latest tooth, indicating an infection, and it was now time to make a move.

Biz Before His Surgery

Biz Before His Surgery

We got there and went through the “process”, beginning with bloodwork and the beginnings of the anesthesia.  It was raining, so we took Biz inside the exam area right away, instead of giving him the first doses of drugs outside in the sunshine as we had on his previous trips.  I think being closed in the treatment area made him nervous, and he danced all around until the drugs took effect.

Biz and Me, On Our Way to the Vet Clinic

Biz and Me, On Our Way to the Vet Clinic

But soon enough, the drugs took hold, and I walked him into the stanchion for the procedure.  For you non-horsey folks, the stanchion is a holding cell for horses and cows – see photo below – this will become relevant later in the story.

A Veterinary Livestock Stanchion - This One Isn't Set Into the Floor, But You Get the Idea

A Veterinary Livestock Stanchion – This One Isn’t Set Into the Floor, But You Get the Idea

Gordon and Bob set about further numbing Biz up, with lots of tiny little novacaine injections into his gums.  Apparently, there is almost no fluid in the gums, so you can only inject a little tiny amount each time.  It looked like hard work – Gordon was squeezing the plunger on the syringe with all his strength, and he even bent a couple of needles (mom don’t read that part – it will just freak you out…).  Then finally, after many tiny injections, Biz was ready for his nerve block – the last anesthetic that would ensure he felt no pain.

Now, they were ready.  If you read the post about his previous extraction, you know it was quite traumatic, with lots of tapping on a hammer and chisel to loosen the tooth.  Well, there are some new tools on the market!  Gordon and Bob used a sharp ended tool with a small curved spoon-like end to insert underneath the gum on the side of the tooth.  The sharp tool cuts the ligaments that hold the tooth in place, and they can wiggle the tooth to loosen it enough to pull it out.  It looked like a much more pleasant experience than last time!

So after inserting the tool all around the tooth and wiggling and cutting, it was ready to come out with a pliers.  There wasn’t quite as much ooohing and aaahing over this tooth, probably because the ball of hypercementosis was not as pronounced on this tooth.  Then we had to do some new X-rays to see where any remaining pieces were so they could make sure to remove them.

That’s when trouble hit.  Biz was quietly standing in the stanchion and the vets were looking at the X-rays with their backs turned to Biz.  I was curiously watching a little mini-horse who was getting an ultrasound in the bay next door.  We think Biz, in his sleepy state, leaned forward on the stanchion just a little too much and cut off his blood flow.  I heard a noise, turned around and watched Biz drop to his knees!  Then a split second later his hindquarters dropped and now he was laying on the ground!  He had fainted dead away!

Now things are immediately dangerous.  Horses’ legs are very delicate, and those support posts on the stanchions are solid steel placed in concrete.  If he had started thrashing, he could easily have broken a leg…  The vets immediately got to work, and were joined by the vet who had been doing the ultrasound next door.  They released the side walls of the stanchion and swung them out of the way.  Two vets each grabbed a front leg and started pulling, sliding and rotating Biz away from the steel support posts.  Gordon grabbed his tail and pulled it, helping rotate him away.

The whole time, Biz lay quietly, allowing the vets to maneuver him away from the posts.  He just looked at me with his one eye, seeming to say “Mom, I don’t understand how I got down here?”  Once he was clear, he was able to quietly stand up and the panic was over.  I’m happy to say that I didn’t panic either, but I was very worried.

Since he was still pretty sedated, they didn’t put him back in the stanchion while they removed a few remaining chips of tooth, and packed and sutured the hole.    He did go back into it for some IV fluids, as he was just a touch dehydrated.  They left the front panel open though, so in case he leaned forward he wouldn’t have anything to lean on.

Biz now has one tooth left on his bottom right side and all three on the bottom left.  And a big gap just like a little kid!  And the process of watching the remaining teeth continues, because this disease will continue to march on – there is no cure…

After about two and a half hours, Biz was done and awake enough to get back in the trailer to head back to the farm.  He’s probably never been so glad to see home…

Another Year, Another Tooth

Biz, my soon-to-be twenty-six year old Quarter Horse, had his dental check up last week.  Biz has EOTRH, which is a degenerative disease that affects his teeth, causing them to become spongy and weakened over time.  We have been watching them for a few years now, because the disease has no cure other than to pull the teeth as they become painful.  As it affects the incisors, which are a horse’s tearing teeth and not their chewing teeth, a horse can function perfectly well even after the affected teeth are pulled.

Two years ago he had a tooth pulled, and last year he almost lost two more.  Upon the recommendation of my vet and the equine dental specialist he works with, we decided to let the teeth stay and instead we adopted a watch and wait approach.  So, last week he had a new set of X-rays to see how the disease has progressed.  Unfortunately, two of Biz’s teeth have further deteriorated to the point where they are almost certainly causing him pain.  Like cats, horses are prey animals and they try to hide their pain if they are ill, so even though he doesn’t appear to be in pain, we have to guess that he probably is.  The good news is that he is still eating well and holding weight on, and my vet shared X-rays and photos with other vets who specialize in equine dentistry and they were all impressed with his overall appearance for his age.

So the question becomes when to do the deed.  I’m waiting to hear back on a date that works – and that will likely be in the next month or so.  After the surgery, there will be daily flushes with saline while his gums heal.  Thankfully, Biz has always been a very good healer.  I wish there were a tooth fairy for horses!  I could be cashing in!  It would all go to the vet bills anyway.  Oh, the things we do for our animals…

For previous posts on Biz and his tooth troubles…

Biz’s Narrowly Averted Surgery Last Year

EOTRH

Biz is in for More Surgery…

Tomorrow afternoon I’m taking Biz up to the vet clinic for another round of tooth extractions. We know he’s definitely losing one, but they may decide to pull a second as well, because the one that has to go is one in from the edge, and when it goes, there will no longer be any stability for the outermost incisor. So, that means I’ll be doing double duty again – flushing his mouth with saline solution as the wounds in his mouth heal.

For those of you who haven’t heard these stories before, Biz has EOTRH – which is the long acronym for a disease with an incredibly long name – Equine Odonoclastic Tooth Resorptive and Hypercementosis disease. In short, Biz’s teeth are getting spongy on the inside. And as they get spongy, his body creates balls of “cement” around the root of the tooth to try to prevent the tooth from just deteriorating and breaking off. This latest tooth is close to breaking and is very loose in his jaw, so it’s gotta go. Better to have a planned extraction than an emergency trip because it broke. So tomorrow, Biz will take the trip up to the vet clinic, get sedated, have a nerve block, and have that long, spongy, breaking tooth tap-tap-tapped out of his jaw. Likely in several pieces. And with much cringing by his human mother throughout the procedure. Because unlike last time, I know what to expect – and it’s worthy of some cringing.

Actually, I’m pretty lucky that my horse’s vet is one of those gentle kinds of vets who has a true fascination and passion for the work that he does. He genuinely wants to teach others what is going on with the disease processes of their animals. And because he knows I’ve been to hell and back with Biz (see my other posts about Biz if you have an interest in those other traumas), he doesn’t worry at all about me breaking down in the operating room. So I get to watch! Although there is an element of squeamishness, I get to stay throughout the procedure, talk to Biz, and see firsthand how big a horse’s tooth is, all the way to the end of the root. And just how firmly rooted it is in that jaw, even if it is falling apart.

So, even though I try not to worry, I will anyway.  I’ll feel a lot better tomorrow afternoon when Biz is done with his surgery and he’s home… Why can’t we stop time and stay young?  I guess that’s a post for another time.