Disclaimer
This blog post series is purely a record of our journey with Rosie. It is not an in-depth look at the condition, nor are they intended to be used as a diagnosis or recommendation of treatment. Should your horse be showing signs of, or is diagnosed with, ameloblastoma please consult with your equine vet, surgeon and dentist.

Warning
These blog posts contain images that some people may find distressing, however I believe they are a valuable part of understanding the progression of the condition. Please feel free to scroll past the images and only read the text.

Previous Posts
Equine Ameloblastoma: Rosie’s Story – Part 1
Equine Ameloblastoma: Rosie’s Story – Part 2

Letting Rosie Guide the Way
For most of 2020 life for Rose was pretty normal. We were acutely aware of and tracking any changes we saw externally and our dentist was tracking both dental changes and internal changes by way of x-rays at each visit. 

The progression of the condition (growth of the tumour) was to our eyes slow but consistent for most of the year. However people who saw her on a more irregular basis like the dentist or friends and family would remark how much it had grown. As we saw her everyday it was obvious it was growing but not in an alarming way. 

Her dental exam in February 2020 showed that the tumour was causing the 407 to deviate lingually (towards the tongue) and the 408 to deviate buccally (towards the cheek). She had diastemas throughout the lower right arcade which were cleaned and treated with metronidazole antibiotics placed in the gaps.

We continued to maintain her oral care with daily flushing using first water then hexarinse, in an effort to remove any packing food and keep infection at bay, therefore ensuring her comfort. While she wasn’t showing any outward signs of discomfort, was eating well and maintaining weight I personally am extremely aware of the prey animal instinct to mask pain and wasn’t willing to accept that she was “fine”.

We explored so many treatment options throughout her journey. The following is a list of what we used.

Many of these modalities cover more than just the areas we targeted in our use of them, that’s the beauty of treating holistically, one treatment can address both physical and emotional pain at the same time.

Our dental visits for Rose were now six monthly and in August 2020 during her exam our dentist noted the following:

• • Tumour has increased in size since last visit. On radiographs, cortical bone thickness has reduced and now 2 cystic structures are present. Cortical bone also has a sunburst appearance indicating osteosarcoma or osteomyelitis.
  • Was a deep periodontal pocket on the buccal aspect of the 407, 35mm probe didn’t touch the bottom and we pulled out hay strands 4-5cm long. On flushing, a necrotic, soft tissue lining (assuming from inside the tumour) was elicited. Malodorous, contained purulent material. Flushed and disinfected then replaced back in the pocket to prevent her chewing on it/traumatising it. Recommend to get the mass re-biopsied and possible culture and sensitivity done. 406 also had slight mobility and discussed extracting the 407 but that would likely leave a huge deficit straight into the cystic structure so very reluctant.

So we headed back down to the surgeon for a second biopsy and what turned out to be placement of a drainage tract. This was not an experience anyone enjoyed! 

Sadly the tumour, despite our best efforts, was infected and the smell once it was opened had everyone in the clinic feeling very, very unwell… The test results came back and she was put on a 20ml twice daily dose of oral Metronidazole.

We came home with a pony who was very sore and very tired. We were now almost at the 12 month mark and every day was a question… is it time? And every day Rosie said “NO”.

We had to let her guide us, we had to trust and push on. Cleaning her wound and flushing the drainage tract daily was something we (Rosie & I) both dreaded having to do but Rose being the trooper she was, put on a brave face and let me do what needed to be done.

Flushing the tract required me to get creative, it was sore and she didn’t much like the vet’s advice of placing the syringe nozzle in the hole to flush it. With Torben away and me needing to do my very best by Rose without an extra pair of hands I trundled off to Bunnings and purchased some clear, food grade pipe in two sizes, 3mm and 5mm.

I cut the tube to length, snipped one end on an angle so it was easier to insert, found the syringes that fit into each size tube and set about convincing Rose that while this was not fun it was a s@#t load easier on both of us. Once again she stepped up and let me insert the tube into the tract every day, allowing me to flush the entire area of feed and pus using water and then much to her disgust diluted betadine.

It Worked! And I was able to do it on my own without getting covered in gross stuff!

Although she was super brave she felt like poo! You could see on her face the impact of having the tract placed. Coupled with the fact that she smelt… bad… all the time. I started plaiting lavender stalks into her mane in the hope she would feel a little more beautiful. They would last a few days before drying out then I’d replace them. I’m not sure if it made her feel better, I hope it did.

Unfortunately the external wound of her tract started to close over while there was still a need for me to insert the tube and flush. In addition to this I was not comfortable travelling Rose down to the surgeon for him to open the wound for many reasons, the main one being she has never been happy to travel and has always required a buddy, not a concern but now we had to consider if she got upset while travelling she could possibly fracture her jaw.

Thankfully our local vet was able to consult with our surgeon and she came out to reopen the tract on farm. I cannot tell you how grateful I am for the team of professionals we had supporting us on this journey. I will share details of everyone involved at the end of the series.

For the next few months we continued to flush the tract and rinse her mouth daily. She had several rounds of antibiotics and few rounds on bute when her pain levels were clearly too much for her to cope with. Throughout this time she was for most part (if I had to put a number on it 80% of the time) her bright, happy, engaged, snuggly self. She ate, drank, pooped and played. So many times I said to people “If she didn’t have the lump you’d never know she was sick”.

Equine Ameloblastoma: Rosie’s Story – Part 4