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Nosebleeds, ethmoid hematomas.......and sleep deprivation???

So, without much going on in terms of riding right now, I have been thinking it is time to write some "educational" posts. I am not a veterinarian, nor do I play one on TV. But after twenty five years around horses, I have dealt with my fair share of injuries, sicknesses, and oddities. Sometimes it helps to hear what others have gone through if you yourself are dealing with it.

Can horses really be sleep deprived? I would have laughed at you a few years ago if you had suggested that to me! LOL! But after a very scary incident almost three years ago, my views have changed. Yes, my beloved older mare Sparky suffers from sleep deprivation. Stay with me, this is a long story...


During the fall and spring of 2007, Sparky began having frequent nosebleeds, known as epistaxis. It seemed to happen every few weeks or so, and I could never really find a cause. The nosebleeds were pretty minor, but the sight of the 15-20 drops of blood was no less alarming.

Of course, I keep a very watchful eye on my horses. And at the time, I was a stay-at-home mother, so I was literally at home most of the time. I swear I would look out the window at the horses and walk out to check them at least 50 times a day total.

Anyway, early in May 2007, Sparky scared the living daylights out of me by having what I called a seizure. I was cleaning stalls and she was out in her paddock directly behind the barn. I saw her buckle at the knees and remain rigid on her side for about 20 seconds. Her limbs were shaking, her eyes were rolled back into her head, and her upper lip was curled up. She got up on her own, and of course I immediately checked her over and called my vet. She remained agitated and restless for about two hours. My vet had me give her banamine and keep a close eye on her. I was so upset. At the time Sparky was twenty five years old and I was pretty convinced this was it. I was going to lose her.

The next day she seemed fine. But then in the late morning, she had a pretty significant nosebleed. Instead of the 15-20 drops, this was a small but steady stream. It was unilateral (from one nostril) and it was from the left side, as it always had been in the past. But now, having had a seizure the day before and now with a pretty scary looking nosebleed, it was time to do something. Plus, she had a HUGE jugular pulse (I could SEE it jumping!) and with her diastolic heart murmur, I had to figure out what was wrong.

After a long discussion with my vet, he ended up making a referral to the New England Equine Medical and Surgical Center in Dover, NH. I love my vet for many reasons, but one of the biggest reasons is that he is not one to blow sunshine. He is pretty honest with me, without being unkind. He basically told me about all the unlikely but very real possibilities of what could be going on. The scariest scenario was a ethmoid hematoma. Simply, this is a progressive and destructive tumor in the sinuses that causes pressure and eventually eats away at the bone/tissue/veins/arteries. Surgery and treatment is usually effective, but if there was an ethmoid hematoma there and it was causing the nosebleeds, it would have to be surgically removed. And I was NOT putting my horse through a surgery at her age. When I asked my vet what would happen if I did not have the surgery, he gently explained that she could eventually "bleed out", meaning the hematoma would eat away at a major sinus artery, which is a messy but painless way to die. OMG! (Of course, my vet assured me of many, many other scenarios but of course the worst one is what stuck with me and what I was convinced my horse was suffering from.)

So long story short, I felt sure I was bring my horse to Dover to be put down. I cried the entire hour and twenty minute ride there. Horrific? Yeah, pretty much.

I remember being SO nervous. But Sparky was a perfect lady. Dr. Bartol examined her, found her TPR to be normal and her diastolic heart murmur to be a 2/6. She did not feel this was significant enough to be a cause of Sparky's fainting the day prior. Her lungs and sinuses sounded fine and her jugular pulse was no longer visible.

They took extensive blood work and found she was mildly dehydrated, but had no evidence of anemia or electrolyte imbalance. They did a full chemistry panel and called me the next day with no significant findings. They performed endoscopy on both her nostril, but of course, she had no nosebleed at the time, so there was no way to find out where the blood was coming from.

The best part was that Dr. Bartol found no ethmoid hematomas! PHEW!!!!! And she was able to rule out all the other scary things that might be going on. But of course, she was not able to determine the exact cause of the nosebleeds. :( However she did find very prominent enlarged vessels in her dorsal pharyngeal recess. Basically, this meant Sparky has extra large vessels in her left nostril, which could account for the nosebleeds. Perhaps because they were located so close to the skin, any bump or accidental stab of hay, etc. could cause a nosebleed. This made sense to me.

So here is a pic of her right side:


And here is one of her left side. Can you see the enlarged vessels??

We decided to also do radiography of her sinuses just to double check everything. There was no evidence of fluid or masses, which was a relief.

This is just a REALLY cool picture of her nasal cavity. :)


And another...I have an entire CD, thanks to Dover! LOL! :D

So, we allowed Sparky to rest and recuperate from her sedation in one of the nice stalls in the lameness barn. There was one other horse out there, but being the lameness barn, there were no diseases, sickness, etc. she could catch while being there. Dr. Bartol came back out with a sheepish look on her face and a couple of photocopies. She felt that while we had not found anything definitive with the endoscope or radiographs, and the diagnosis was technically "open", she had an idea.

She felt while the episode could have been "fainting" , she was pretty sure my horse was sleep deprived and had collapsed as a result! LOL! At first, I remember thinking, "Ummm, OK, sure......" But as she handed me the recent EQUUS article, and began to explain, it all started to click into place. Horses need REM sleep just as humans and other mammals do. But while we need two to three hours of REM sleep each night, a horse only needs 30-60 minutes. And some horses only need up to 20 minutes of REM. Sleep deprivation is not related to narcolepsy, BTW. While narcolepsy is a neurological disorder, a sleep deprived horse is just exhausted. They literally fall to the ground in exhaustion! A horse with sleep deprivation might have pain associated with lying down, which is why they won't lie down to sleep and get that much needed REM. In observing Sparky, she has never had a problem rolling each morning in her pasture, so I did not think that was a real cause. But of course, at age twenty five and with a history of bone spavin in her hocks, it was still a possibility.

But then Dr. Bartol asked me if there was evidence of her sleeping in her stall, such as shavings on her side or tail.

And I realized, no, Sparky NEVER lies down!

And she is very much an alpha mare. She always feels she has to be on the "lookout" and despite the fact that Dreamy takes a mid morning nap in her paddock every single day (and lies flat on her left side every night in her stall...), Sparky never lies down in her paddock. If she is down, she is colicking. If she is "napping", go get her up because she is colicking. I always had to tell this to barn owners when I boarded her out.

AND, we had just recently taken in a boarder, just four days prior to her collapse. I had switched Sparky's stall because of this boarder. So, Sparky's social environment had changed drastically.

Wow, this is all starting to make sense. Dr. Bartol felt the nosebleed and the collapse were unrelated. She thought the real reason Sparky collapsed was because of her sleep deprivation. We went out to look the front of her fetlocks, and there under the hair, were thickened superficial scabs where she was catching herself each time she would collapse. So Dr. Bartol felt that Sparky had been collapsing before, but this was the first time I had actually seen it. The only thing is that Sparky did lie there on the ground for a while, it was not like she fell and scrambled back to her feet as most sleep deprived horses will do. But, who knows. The diagnosis seemed to fit in my mind.

Dr. Bartol recommended that I deeply bed her stall to encourage her to lie down and put her back into her old stall. There was not much I could do about the boarder, whom I had taken as a way to give Sparky a companion for the summer while I took Dreamy to shows. Sparky HATES to be alone and I did not want to cause her stress by being left all day. Long story short, the boarder passed away in July. Not a story to tell here, but basically the pony was in its late 30s and colicked. The owners refused to let me call the vet. Pony suffered from 10AM to 5 PM when they finally agreed to have the vet out. Incredibly sad and sick story. :*( Opened my eyes to MANY things........but again, not the time to discuss THAT. :*(

SO.....Sparky did seem to get MUCH better after life at my farm was back to normal in July with the passing of the pony boarder. Granted, being back in her stall did help some for the three months in between. But every single night around 9PM, I would hear a HUGE crash in the barn. It was Sparky falling in her stall, I am 99.9% positive. I could never catch her doing it, and I always went out at 10PM for night check anyway.

But since that summer, she has seemed fine. Last year I did not hear her fall at night anymore and eventually the scabs on her fetlocks went away. I have no idea exactly what changed for her. She still does not lie down in her stall. She still will sometimes collapse when I am in the barn later at night braiding Dreamy for a show. She stands with her head over her door, gets really sleepy, begins to snore, and then she falls on the door. Poor girl.

When I got my filly last year I worried that Sparky's sleep issues might come back. I did not move her stall and she remained in her own private paddock. But she really seems to like Reva and has had no visible issues with the new social structure. Then again, Reva adapted VERY well to the farm, which must have helped.

Sparky will still sometimes get a nosebleed every six months or so. She had one last week, as a matter of fact. But it was only seven drops of blood (yeah, I count....). She is healthy and happy and seems to be sleeping OK. She still does not appear to lie down in her stall (hasn't in the seventeen years I have owned her!) but she is getting her rest somehow. Maybe she is only down for a few minutes and only needs a little bit of REM sleep. I have no idea. I admit, having to face her possible euthanasia three years ago really made me come to peace with the fact that my little red mare will not always be in my life. Seventeen years is a long time. I cannot bear to think of my barn without Sparky. But I know that I will do the right thing by her when it is her time (having that poor pony die that same summer might have helped me understand too...). As much as I hope that one morning she will have just gone peacefully in her stall, with no trauma, no stress, no having to make a difficult decision, I also know that Sparky will tell me what she needs. And I will listen, never putting the cost of a vet visit over her need to be treated and never putting my own desires to "deny" what is happening or "keep her alive" in front of her need to be let go.

Amazing what we learn from our horses, no?


Comments

Artlady said…
This was new information to me. Very interesting! Thanks for sharing.
Saying good-bye to your best friend and four legged companion is life changing but clearly you learned from this experience 3 years ago that will help you in the future. Continue to listen to Your Girl. She is a WISE One! I love you both!
Give my old friend a treat and kiss on the NOSE for me please. XOXO
OnTheBit said…
I did know about equine narcolepsy. And I also knew about horse sleep deprivation after my episode with Phoenix this winter, but to hear of a horse collapsing is just down right scary! I am glad that Sparky is doing well all these years later and I hope that she is getting a good nights rest every once and a while!
Mel said…
Very interesting. I do remember that Equus article and ever since I always watch my horses carefully to make sure they are comfortable wtih their buddy and there is SOME place they can lay down in the winter (it can get pretty muddy). This winter we got SO MUCH rain and the paddocks were a MESS. I did a bunch of grading in the mud, put down mat and shavings underneath the shelter, moved Farley into the new pen and was rewarded with her hair full of shavings the next morning. :) It's also why I invested in a hitie for my trailer - during long rides I want her to be able to lay down and sleep if she needs it.