Imagine going to give your horse a treat and finding her covered in dried blood. This is what happened to my partner, Wolfi, and me May long weekend in 2008. Our then two-year-old Haflinger filly, Caly, had been staying with her friend, Tetley, for spring grazing when we made one of our regular visits to give her treats and play with her. I was still unloading things from the car when he yelled.

We got her cleaned up, looking for a puncture wound that would have caused the area to look like a crime scene, and for something sharp that could have caused the damage. There was no visible wound.

Then her nose started to gush. In the relatively short time it took for Dr. Gilbert Halley to arrive, we thought we might lose Caly. Wolfi had never seen that much blood in his five years of being a horse dad, nor had I with my 45 years of experience. Dr. Halley knew immediately what the problem was, a fungal infection in her gutteral pouch, and recommended a quick trip to the veterinary hospital in St. Hyacinth in order to save her life. He’d had a mare that survived the surgery and went on to live another 20 years. The alternatives were watching her bleed to death over the next few days or euthanasia. Wolfi and I looked at each other and the decision was made.

As we followed the horse trailer along the darkening highway, we recalled our first meeting with Caly when I bought her at the auction a year and a week ago. She was a scared 14-month-old baby. She’d arrived with a runny nose and slight cough; long, thrush-filled hooves; and a gorgeous long blond mane. She was shy from being twitched while the previous owner shaved her whole body to remove the rain-rot scabs, some of which were still active.

In less than a week she had a shiny coat, trimmed hooves, was wormed, had her shots and medicine for her cough. She had adopted Tetley, the big old grey horse Hudsonites remember from when he lived next to the ferry, as her grandpa. She followed him everywhere and he protected her while she was transitioning into the herd.

Wolfi had asked me that morning if I knew how old I’d be when Caly was 27. I didn’t venture a guess as I knew, as the mathematician of the family, he’d tell me. “Eighty”. “She’ll probably be quiet enough by then for me to still ride her,” was my reply.

Now this. Fungal infection in her gutteral pouch. Until then, I’d heard only a little about the gutteral pouch and I wasn’t even sure I knew where it was located. I soon found out.

The vets were waiting for us when we arrived at the veterinary hospital. Caly was taken immediately to an examining room where Dr. Fabien Raleve used an endoscope through her nose to confirm Dr. Halley’s diagnosis. We could see on the monitor where the carotid artery was damaged. Caly was then prepped for surgery as we filled out the admission papers. Caly would go into surgery Tuesday morning unless she had another bleed during the night.

Horses don’t often get nose bleeds. Another tip-off to Dr. Halle was that Caly’s nose bleed occurred while she was at rest. Other nose bleeds occur in performance horses that are stressed from racing, etc. These bleeds usually come from ruptured cells in the horse’s lungs. Horses with this condition are called “bleeders” and are treated medically. It’s not a life or death situation as we had with Caly.

The gutteral pouch is an air filled pouch on either side of the back of the throat, at the lower end of the tubes that go between the ears and the throat. While all mammals have these eustachian tubes, not all have the pouches. The eustachian tubes equalize air pressure in the ears when there is an altitude or barometric change. The largest are found in equine species; horses, donkeys and mules. The pouch is covered with arteries and nerves. Some suggest its function is to cool the brain. Everything the horse breaths goes through the pouch. As the horse’s body heats up from strenuous exercise, the pouch acts like a radiator to cool the blood flowing to the brain. Ungulates (animals with cloven hooves), have a structure in their nose for a similar purpose.

Dr. Raleve called me the next morning with some good news. Caly was infected on only one side. She was heading into surgery and he would call me again when she was back in her stall.

I hit the internet for some information on the gutteral pouch and discovered that there are three main problems occurring with the gutteral pouch; empyema, mycosis and tympany.

Gutteral pouch empyema is a bacterial infection with pus that fills either one or both sides of the gutteral pouch because of an upper respiratory tract infection such as strangles. Each time the horse swallows, air pressure is equalized in the eustachian tubes, sometimes drawing bacteria into the tubes. Usually the horse’s immune system can fight the bacteria, but sometimes the bacteria gains a foothold. Signs of this are a persistent nasal discharge from one or both nostrils, increasing when the horse lowers its head.

Many cases of gutteral pouch empyema clear up on their own, however if the condition persists for more than two weeks or if there is a large volume of pus, antibiotics and other treatments are recommended.

Gutteral pouch tympany usually occurs in foals up to a year old. Air becomes trapped in the gutteral pouch and there is massive swelling in the throatlatch area. Surgery is the only way to resolve this problem.

Gutteral pouch mycosis, what Caly had, is a fungal infection of the wall of the pouch. It is the most serious of the diseases affecting the gutteral pouch. Usually only one side is affected. If the fungi attach to any of the vital nerves that cross the gutteral pouch, the horse may become a roarer, have a paralyzed and drooping ear and/or lip or may have difficulty swallowing. A sign of difficult swallowing is finding food particles in the nostrils. Nerve damage is non-reversible.

In Caly’s case, the fungal infection attached to her carotid artery. Some sources suggest that this can only happen if the artery is compromised by some abnormality such as trauma, local inflammation or a primary bacterial infection. Her endoscopic examination showed a blackened area with white fungal plaques growing on it. The length of time for the fungal infection to damage the carotid artery to the point of bleeding is unknown as the horse is asymptomatic up until that point. The first bleed can be just a trickle, or, as in Caly’s case, can be so extensive that blood flowed out of both her nostrils. A high percentage of horses with gutteral pouch mycosis will eventually bleed to death if not treated.

Although rare, gutteral pouch mycosis can happen in any horse, anywhere in the world, at any time. Horses that are kept indoor in warm weather are the most susceptible. Caly had 24 hour turnout for a month and 12 hour turnout for the winter months. Her only symptom was a runny nostril during February that cleared up. She didn’t act “sick”, so I chalked it up to a transient virus. She liked to shake her head while I was tying or untying her halter, an action I put down to a dominance problem that resolved with training.

According to Dr. Raleve, who comes from Lyon, France, there are so  many cases of gutteral pouch mycosis in France that the French veterinarians have developed a new technique for treatment. Using his French colleagues as consultants, Dr. Raleve tied off both ends of Caly’s damaged carotid artery. He called me later in the afternoon to tell me Caly was recovering nicely in her stall. I was relieved and made plans to visit her.

Since the carotid artery is one of the main arteries transporting blood to the brain, I had concerns that Dr. Raleve dissuaded by assuring me the other arteries would take over and that I didn’t have to worry about her brain overheating either.

My daughter and I retraced our journey to St. Hyacinth to visit Caly on Thursday. It’s in a beautiful part of the province that we hadn’t seen in the dark as we followed the trailer four nights earlier. Caly had just undergone another endoscope and the doctor was happy with her recovery. We took her outside for a little grass. By Saturday when Wolfi and I visited her, she was kicking up her heels as we took her for a short walk and graze. She was well on the road to recovery. Caly was lucky that Wolfi and I chose that time to visit her with treats.

When the endoscope showed the fungus was dying on Monday, we made arrangements for her return. She arrived home Tuesday morning with instructions for a week of stall rest with 20 minutes a day of hand walking. She greeted everyone with lots of whinnies.

As a girl who loves to run, the week of stall rest was difficult. She enjoyed her aroma therapy, trying to grab the bottles of lavender and tea tree instead of sniffing them. Her hand walking looked more like a circus act as she flew out her door with a flurry of bucks and kicks. Fortunately she’s extremely food-oriented and calmed down when she got to the grass.

She had her staples removed went back into her daily routine, outside in her play pen with daily grazing turnout – back to her old self with no more signs of bleeding. She had one more endoscope to see that the fungus was completely gone. I don’t know if she realized how close she came to death, but looking at the sparkle in her eyes, I know she appreciates life.

Since then, there were days when I wondered if Wolfi and I had made the right decision. Caly was a challenge; the proverbial “tough nut to crack”.

If I hadn’t seen Pat Parelli’s video of playing with Linda’s horse, Allure, when she first got him, I wouldn’t have thought training Caly was possible. Unlike all my other horses, she needed a “lot of drift” – minimum 22’ line. We did a lot of squeeze game, her running from left to right and right to left with my back up against the fence where her friends live. If I tried anywhere else, she would drag me toward her friends. She was rude going through gates, pushy going into the barn and a real pain in the butt to lead. It used to take me ten minutes just to bring her in from her pen to the barn as we would keep having do-overs until she went through the gate nicely. Damn, I’m more stubborn than her!

We had a major break through one day. I had brought her into the barn to trim her feet. I put her in the cross ties as that was the only way to keep her in the isle of the barn in the light from the window. I started with the friendly game, brushing her. She started with throwing her head up and down, pawing, moving her feet, kicking out, snorting. I just brushed and kept out of the way of the flying parts. She went through all her instinctual fight repertoire. Suddenly she stood still, trying to think of what else she could do. Instantly I handed her a hand full of hay. She took a mouth full, relaxed and gave me that, “Oh, is that what you wanted me to do?” look. I smiled and rubbed her. She stood relaxed and ate. When she finished I could tell that she had “got it”.

I trimmed her feet. She was totally relaxed and calm. From then on, she was my partner. I got on her when she was three and a half and we just wandered around together for a few minutes, then she lay down for her afternoon nap. I napped with her. When she got up, we wandered around a while longer. That was the nicest first ride ever. I rode her a few more times, then left her until she was four, rode her a few more times and left her till she was four and a half.

Now Caly is five and I’ve ridden her nine times. She does level 3 – 4 on-line with a canter trailer load. She pays careful attention to my body when I ride and can stop from a canter with a sigh. I hardly have to pick up the reins and she goes where I focus. What a great start. I’m sure glad Wolfi and I made that crucial decision. when she was two.