Day thirteen: slowly improving although it does not look like it.

We're in the full swing of treatment now. The schedule is set and really, the whole thing usually lasts only 15 min. The first day after the week off there is however some more cleaning to do and it takes a little longer. The sedation sets in quickly but starts to wear off after 30-45 min. So I do have to act somewhat swift. Plucking out the chunks and scraping of the soft plaque with a wet clot is still a little of a struggle but doable. Yesterday he had a shaking fit at the end of my ride and I let him get it out of his system. After I saw a 1 inch big chunk fly out of his ear he was done. It must have come loose and started to really irritate him. I'm glad he got it out on his own.

After the cleaning I search for the trouble areas to treat very locally as both ears are pretty raw. His left ear looks the worst as I was treating it near the tips. On the pictures it looks like his ear is swollen this is however just from the lighting. The white areas are white skin patches that are healing and the red areas are where the cream did it's job. His right ear has only been treated about half way in and the old 'plaque ridges' are gone and starting to clean up nicely. I will finish this weeks schedule as I want to completely get rid of it and I think we're getting there. I might even be able to stop after this week !! That would be a nice Christmas gift to Beamer. Not more pestering with his ears. Then we can start the New Year with clean plaque free ears, wouldn't that be nice ....

Left ear:

 

Right ear:

Day eleven and twelve: here we go again...

So, I didn't post since last Sunday as there was not much to post about. I re-started the treatment on both ears now and will continue until it is done. After the Wednesday session his ears caught on quickly with the inflammation and they are all raw and red again. The scabs come off easy as the are are pussy underneath. Cleaning with a wet cloth is still not his favorite part but we're getting the job done. The good thing is that with all the hair gone and most of the plaques as well, I get to focus on the left over spots. The whole thing does not take more than 15 min (+5 min for the sedation to set in).

Lesson learned though that a sedated horse can still be easily startled. I went into his stall to put his blanket on and he did not notice me coming. He had his face to the back corner. Suddenly he realized something was rustling and rattling behind him and he flew forward, head first into the wall !!!! Then he turned his head around and looked at me with a sheepish look on his face. Thankfully he didn't hurt himself and with the sedation he might not feel a headache either ... Sorry Boy, I'll be a little LOUDER next time so you can hear me coming into your stall!!

No pictures this time.

Day ten: Or first day after two weeks off !

It has been two weeks since the last treatment in his right ear and a little more since his left ear was touched. I went to the barn with the plan of just cleaning out the ears. Over the last two weeks the oozing wounds had scabbed over. Add to that some mud and it had started to form nice thick crusts that were dangling from the new grown hair. This needed to come loose so there would be clear view of the healing that I hoped would be underneath.

During the weeks off and with the subsequent healing the pain was definitely decreasing. I had noticed this during past the week. Bridling was easier and the head shaking had disappeared. He would even let me stroke his ears and was enjoying a vigorous scratching behind his ears. They must have had the healing itchies.

I gave him a little less of the Xylazene (3.5 ml) than I had been using because I figured with the two weeks off he might be more sensitive to it again. I'm glad I did this as he was holding himself up by his front teeth on the stall edge. This did however give me the advantage of going in and pulling off all the scabs to expose the skin without struggle.

After that I took my finishing clippers and cleaned out all the new grown hair without a flinch. The right ear as expected did have some plaques left where the ridges had been. I dabbed on some cream at those spots but left the other ear alone. There might be still some plaque left but until the skin has healed more I can not know for sure. The new skin is kind of flaky in itself and looks very similar to new plaques. I'll have to be patient on that one.

Here the picture of the left ear:

And the (never sharp) right ear:

Day nine: He thinks his ears are falling off (or he wishes they would...)

Beamer is a pretty unhappy puppy these days. Carefully taking of his blanket had him almost sitting on his ass ... I decided to just clean his ears and let it be. Especially his left ear is very sore and it looks like there is not a spot left that appears to be aural plaques. After cleaning though, I noticed that on his right ear where the ridges had come off there was still some white covering the area and I dabbed a little bit of the cream just on those spots. Now it will be a month of healing and then a reassessment.

I am out of the Buthorphanol and will have to get some more if I see the need for cleaning during this period. Mostly I want to give his ears the chance to recover and start healing so I'm done messing with them from now. In the worst case scenario I will have to start again in a month but hopefully this will only be on small localized area.

I have no pictures from today but it pretty much looks the same as last Sunday (day seven). See you in a month ...

Day eight: Not much change ...

So today's treatment was pretty uneventful. No struggles, no almost falling. The ridges in his right ear have come out by themselves and both ears are very sore. He holds them limp sideways like a sad dog shaking them as to get rid of the pain. Of-course shaking makes it hurt more and makes him look even more sad.

I think I'll give him a month off and cut it short when this week is done rather then extending it for an extra week. The ears are oozing and I think he needs a break. Hopefully they will start healing up and I don't have to pick up the schedule again. We'll see by the end of the rest week how to proceed.

Day seven: Could it realy have been this easy all along ?

After two finished treatment weeks we are half way. This is week three and it is definitely following the good old, has to get worse before it gets better routine. His ears are full with crusts and he continuously wants to shake his ears from the moment I get him out of the paddock. Brushing his upper neck where the halter is buried in mud is a challenge a sign that his ears are really bothering him. But he knows now that being on the cross-ties and getting a grooming is not the time for ear wrestling and he lets me clean him up.

After the ride I give him the 4 ml of Xylazine and the 1 ml of Buthorphanol. I let him be while I put the tack away. When I get back to his stall I find him with his nose in the feed bin, his head against the wall and wobbling on his legs. He is actually snor(t)ing his left over supplements from the bottom. Since he is tucked into the corner I sneak my hand trough the feeding hole to clean out his ears with a wet napkin. It is coming off reasonably easy and I probably took at least half a cup of crust out of both ears. He is still not quite agreeing with all this and has made some steps trough his stall freeing up space around him. This now allows me to get in there with him without running the risk to get crushed into the water buckets.

This resisting he gives me is barely worth mentioning considering what he was doing before. It is merely a putting his head up or shaking his ears. But when I insist and continue to clean he settles down again and lets me finish. After I got all the stuff that would come loose removed, I put a nice layer on both ears making sure to get all the surfaces covered.
And then, Oh my gosh it's done !!!  This was a breeze !!! Happy that finally we are getting into a routine that works I take the pictures and let him be.

The nice thing of doing it IV is that the drugs act almost instantly and he is back to eating in a hour. This is something I can work with. I just wish we had started off this way. I might add an other week just to make up for the first half hazard week. On the pictures you can see the left ear has two spots on top that have evaded treatment. His right ear still has two ridges of original  crust that have not come loose yet. Aside from taking a knife (no I will not attempt that) and cutting them off I will have to wait and keep putting the cream on and around it. Hoping it at some point will soften enough with the inflammation and come off. I also don't seem to be able to get a sharp shot of the right ear, not sure what's up with that.

Left ear:

 

Right ear:

Day six: And so the pedulum swings

Armed with drugs and syringes and a plan I head to the barn. I'm glad I can still get his bridle on albeit by taking it apart. And that I can keep riding him trough his treatments. First he gets to work and then it is my turn.

I prepare a syringe with 1.5 ml of the Butorphanol and 4.5 ml on the Xylazine. I decided to give him 0.5 ml more of the Xylazine as he did not get the 1 ml of goodies he got before his dosing on Sunday. However I'm not sure how much Butorphanol he got that time .... I give him the whole mix IV.
Within minutes his head goes down and his legs wobble. As the vet had told me that's how you want them, worrying about keeping balance. Well we got that down.

I put on my gloves and get the clippers ready. When I open his stall door and try to clip his ears, he does a step forward. At least his hind legs do. Somehow he lost the connection between his front legs and his brain and they did not get the memo. I'm now trying to hold up my 1,000 + lb horse who seems destined to go head first with his nose into the pillows. Problem is there are no pillows just a concrete floor ... Thanks to two fellow boarders (you know who you are, Thank you !!!!!) we manage to prevent him from inflicting full frontal destruction. With two of us leaning into his front and the third trying to spread his legs backwards we get him to back up a step.

I get a quick first treatment in and with his head tucked against the stall door I let hem be for a bit. After a short rest I get to work again. He is more balanced now but still tries to get a step forward. Again we lean and make him move back. The sedation is definitely working and the anesthetic has kicked in as well. Now I really go to town and pull of all the slimy gooey scabs. I put an other layer of cream in the nooks and crannies and clip some additional hair a little shorter.

This was a good day ... Maybe next time stick to the 4 ml of Xylazine and less of the Butorphanol. I will have to call the vet about that one. Here the half way pictures. Two more treatment weeks to come before we take a month rest and let it heal.

Left ear:

 Right ear:

Day five: We're still not there ...

The trip to the barn was hopeful as I had a good feeling after the last treatment on Sunday. With the syringes and bottles of drugs in the bag I arrived at the barn. First the Dermosedan gel under the tongue as this might add to the sedation when in combination. 20 min later I gave him the 6 ml Xylazine and 1.5 ml of butorphanol both IM. Since the same drugs IV (4 ml Xylazine and ?ml of butorphanol) worked within 5 min on Sunday I did not expect to have to wait too long.

Over the next hour his head dropped down to about chest level and he showed the characteristic head shaking and droopy eye, but there was not much else going. Thinking IM just takes a little longer then IV I wait patiently. When after the 60 min he starts to roam and look for hay scraps I fear we might have a problem. I decide to give him more Xylazine but IV this time and prepare the syringe with 2ml. After all as a trained Phlebotomist how hard can it be giving an IV injection to a horse compared to drawing a neonatal blood sample ??? I don't dare to give him more as I don't know what is still in his system and I don't want him to drop down. Luckily within min he starts to wobble on his legs and his head is about a foot from the floor drooling.

Okay we're ready ... I put on my gloves and prepare the cream. But Oh boy ... the moment I come close to his ears his head is up with still wobbly legs and there is no way I can get to his ears. I hang on and manage to get a glob in his left ear old style ... For his right ear I try the other old trick of blind folding but he knows now what is up and runs blind into the wall. I manage to get a blob into his ear but kind of halfheartedly ... We're now at a stand off and look each other in the eye. He's weary, I'm about to cry ... Within 30 min of giving the 2ml IV he's poking around and looking for hay again. I give up for the day.

This is NOT how I had imagined this treatment to go. Disillusioned I drive home and ponder over what happened. I think the 6 ml IM was not enough and had left the system mostly by the time I gave the 2ml IV. This then in it's turn was not enough to sedate him and there we were.

Writing this I'm a little more calmed down about it and have a plan for Saturday. He'll get both the Xylazine 4ml and 1.5 ml butorphanol in his veins. If that does not work we'll go back to the drawing board and I sure hope we'll get all treatments done before we run out of drugs that work.

Day four: My horse is a druggie ...

And so day four came around. After a week of no treatment the ears started to look pretty crusty and I was itching to get them thoroughly cleaned out. Unfortunately we still had the issue of getting him sedated enough to come close. I had the vet come out to figure out what his preferred cocktail would be. He got a load of something IV (I believe the same I had used as a gel) and the idea was that in about 1-5 min he would be dosed into oblivion ... 10 min later Mr. B is still eating his scraps of hay and he hasn't even slowed down his chewing. The vet is really surprised at Beamer's tolerance and comes to the conclusion that he is gone immune to this drug. I have to admit I felt slightly vindicated that it was not my amateur administration of the drug but his bio system that caused the lack of sedation.

So out come the big guns and he gets loaded up once more this time on some more heavy duty stuff. Within a few minutes Beamer is wobbling on all four legs and I'm afraid he'll buckle and drop down. Although that would make treating him soooo much easier !!! I still expect him to wake up when starting to touch his ears.

I did not need to fear he might snap out of this medical confinement. We open the stall door and he nearly falls through the opening as he was tucked in the corner. He is down and out, 0-1 for the vet. With Beamers nose safely tucked under said vet's arm I start 'poking' his ears, put the cream in and  he's fighting a bit. This is where it helps having a big strong man to hold on. But he's giving up the fight soon and slips deeper into dreamland. By now he's not even trying to struggle anymore and I get to work on the crusts and gunk after clipping a bit more hair off. These drugs are great as I'm now pulling on thick chunks that I thought were crusted ridges of cartilage but come lose and are scabs about a 1/4 inch thick. Lots of pink skin underneath and I can finally get the cream to where it has to go as I dab on an other layer. I think there has been some normal skin that has gotten damaged by the inexact administration of the cream on the previous attempts and it's making it look worse. I hope this will get better as I from now on I can get to the correct spots.

We let him be as it's all done now. During all this Beamer has started getting really hot and is steaming. I take his blanket off and put the cooler on. I'm glad I just gave him his body clip while waiting for the vet or he would be sweating even more. Within 30 min he is starting to roam around and look for the rest of the hay scraps. I put his blanket back on and give him his grain.

I think we have a plan that works now and I'm glad we can make this whole ordeal less stressful or dangerous for all involved.

Here are the after treatment pictures, not too sharp but there was a lot of bright sunlight coming in. I'll try new ones on Wednesday night after treatment five ...

Right ear:

 Left ear:

Day three: The good, the bad and the ugly ....

Looking back at the first three treatments, the first one was the best... The second one was BAD, I thought. It wasn't until the third, today, that I realized it was ... just bad.
After the last treatment I was not going to bother with 2/3 of a tube of Dermosedan gel and I gave him the whole thing like on the first day. Waited for an hour.

So the GOOD thing is that the Imiquimod cream seems to be working. His ear is definitely in a high state of an inflammatory response with yellow crusty plaques slouching off at parts and showing red oozing skin (think 3rd degree burn wounds without the black). But if I had not been warned by having seen pictures of treated horse ears, I might have called it quits there as it ain't pretty.
The BAD thing is that the sedation is not working as it was and I'm afraid his system is getting tolerant to it. That is where things got to the UGLY part ......

Getting him from the paddock I was happy to see that he came trotting over to me, giving me hope that the terror of my last visit was forgotten. After the ride and subsequent sedation wait period, I soothed and smooched and could get him to cuddle with me with his head at my waist. However coming close to his ears immediately sent his head up into the hay loft. I managed to trick him twice and got his left ear somewhat treated. Time for a different tactic I decided. I got out the towel and wrapped it over his eyes. This way he would not see my hand coming and I could aim for the right spot to put the cream. I figured if he'd swing his head blindfolded into the wall it would also be somewhat padded and hoped he would have his eyes closed under the towel. Turns out he knows exactly where the walls in his stall are as he managed to lift and swing me into them several times. Now I had a blindfolded not-so-sedated horse turning circles in his stall with his owner being flung from his head. All of a sudden I know why my arm muscles have been so sore this week ..... Some bruises and numb fingers later and it's done. 
Clearly something will need to change. I'm serious about considering these options:

• Double dosing on the sedation
• To lay him down
• Twitching him
• Get the vet out each time and anesthetize him
• Any other ideas ??? 

Some are risky, some are costly and some may be plain stupid. I will have to check with the vet on how to proceed. Either way Beamer is free of torture until his next treatment in a week.

Just to show the 'progress'

 Left ear:

 Right ear:

Day two: next treatment

Treatment day two after two days off.
I gave him 2/3 of the tube of sedation. After an hour he was dozing a little but when I started treating it was clear he's was not having any of it. With some trickery and quick action got his good (left) ear treated.

Decided to give him the rest of the tube before attempting his bad (right) ear. After an other ~ 15 min I gave it a try. No not this time. He flung me trough the stall a few times. No problem moving his full ~1100 lb, so much for sedation ....

I treated and pleaded but it wasn't until I got help and sugar cubes that with more trickery and pleading (and more flying) I got a glob in his right ear. I can only hope it will spread a little in the tissue as there is no way I can cover all surfaces this way.

Pffff..... Done for this day and they say the third treatment of each week will be the worst ... I might try to blind fold him for that one so he won't see my hand coming ...

To be continued ....

Day one: First treatment

All pieces available ?

• Gloves ... Check
• Sedative gel ... Check
• Imiquimod cream ... Check
• Willing horse ... Hmmm .....

After a great ride, blue gel under the tongue and waiting ... and waiting. Beamer is getting impatient and does not understand why I stuck that goo under his tongue and why he's still on the cross ties after 30 min. I on the other hand figured the gel was not working as he is shaking his head and pawing the floor so I start treating his better (left) ear. Cream on thumb and swipe and done. Hey, that's easy. Lets do the other one.
Well, there is some junk removal necessary so we're getting into a little fight as Mister B is clearly NOT sedated. Finally got that one halfheartedly done too and there goes the head and the eye lids and almost the rest of his body, down. He's standing crooked and is leaning into the cross ties BIG time ...
I guess I should have had a little more patience as he is clearly out now. Good time to clear out the right ear a little more. Pull of some gunk and snuggle with him to give him that mommy-loves-you kinda treatment. I truly hope it's that later part he will remember.
So now starts the waiting until the lights go on again. When the audience suggests he is not so doped anymore I try to get him back in his stall. The turn goes a little unbalanced and walking is not so coordinated but we make it. There he rests his head against the wall and takes an other snooze. Oh boy, maybe next time I should use half a tube ...
We're now a good 90 min after the sedation set in and it's feeding time. He is not responding to the sounds of feeding which is a sign to me he's not fully arrived yet. An other 30 min and he starts to look for pieces of hay on the ground still not moving his legs. 15 min after that he will eat some hay out of my hand and will clumsily follow me trough the stall. Okay we're back in town and I feel it's safe to give him his hay. He's eating slowly but chewing well. At that point I'm not too worried of choke anymore and give him his grain and call it a day.

Lessons learned,
One, do listen to the recommendations of the vet when it come to sedating animals (yes, I was told to maybe start with half a tube or 2/3 ....)
Two, Be patient. When the manufacturer says it takes 40+ min to kick in, guess what, they are right ...

I sincerely hope Beamer will forgive his amateur nurse ....

Day minus one: Pre-treatment prep.

And so we begin.
Off to the barn to ride and afterwards start the task.
Cleaning out his ears is the first step. Clippers ready, horsie tired from the work, should be easy not ?
Not so, he is so afraid I'll hurt his ears he won't let me come close with the clippers fearful that I might poke him. Now why I would ever do that is a mystery .... aside from the few times over the years I tried to flick out the white raised gunk :-(  ... oohps ...
Okay so we have to build some trust. After a few attempts where he shakes his head and into the points of the clippers, we get to a fragile understanding: If you don't move, I won't poke you with the clippers. Really not that different from me hosing your head and avoiding filling your ears, that works as long as you don't move ...

Thankfully Beamer is a smart boy and we get his ears cleaned out. Now only need to take some base line pictures and he is ready for tomorrows real job.
Hm, after all the 'good boy's' and 'braaaaaf' and scratches he thinks he's done and deserves a treat. Standing still or holding the head steady becomes a problem and holding ears in one position for me to take a shot is even more of a challenge. After about 20 shots I give up and hope I have some good baseline views.
Judge for your self :-)

Left ear:

Right ear:

And the where-is-my-cookie view:

 So far he's been good and I can even touch his left ear on the inside. Hopefully we won't need the sedation to much ....

The start ...

Aural Plaques
Also called aural papilloma, aural plaque is a condition affecting the inside of a horse’s ear. A white, plaque-like material, it sometimes appears thick and crusty. In most cases, there is tender pink skin underneath the plaque. It is a rather painful condition. Causes:

• Infection
  
  • Wart-causing virus (papillomavirus)
    
• Fly bites
  

 
Beamer has had these Aural plaques for a while. During winter time it gets painful and makes him ear shy. I heard that as a foal he had a lot of warts on his muzzle as well as him not having the best nursing start with his dam.
Wanting to get rid of this 'affliction' I did some research and found this study done at University of Minnesota (http://www.cvm.umn.edu/cic/completedstudies/lamedsurg/aldarardvm/home.html) and I want to give it a shot.

Please stay posted on the treatment !!!