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Hi Dr. O,
I have a 27 year old horse who is not feeling so well lately. We found increased protein and white blood cells in the routine lab last month. Vet said it could be mild infection and/or inflammation, but no treatment was started since he was doing fine, we just increased surveillance. I had noticed that he doesn’t lay down as much/long as usual for the past few weeks, also he is much slower in his walk when migrating from one pasture to another (he lives out 24/7 with 3 other horses).
We currently have an unusual heat wave and my horse started having mild fever. His temperature follows the outdoors temperature with the peak being around noon, and at that moment his respiratory rate is also increased. His temperature is typically around 38/38,5 in morning and evening, but rises around 39,2/39,9 by noon, and his respiratory rate around 30. So we did another blood test and while waiting for results, he started isolating himself from the group. The testing revealed more increased white blood cells and some new immature white blood cells which the vet explained to me was a sign that the body is demanding a lot. We started a course of 10 days antibiotics (Excede) to rule out the possibility of primary infection but vet says it could also be secondary infection due to tumors. Would you have any articles pointing to information about this? Thank you -
Hello clauee,
If you wish to learn more about interpreting lab values check out:
https://horseadvice.com/horse-equine/reference-material/equine-vital-signs-and-laboratory-values/
If you wish more on diagnosis fever of unknow origin, and this would include poor doing of unknown cause check out:
https://horseadvice.com/horse-equine/diseases/fever-of-unknown-origin/
More specifically I would suggest considering running some of the more recent tests for inflammation like Serum Amalpoid A. These tests appear to be more sensitive to inflammation, response to treatment, and even have some differential ability as to the type of inflammation. For more on this check out:
https://horseadvice.com/equine-horse/equine-inflammatory-markers-serum-amyloid-a/ -
Thank you for your response. I reviewed the article on l’an interprétation, what would be the medical term for « immature white blood cells »? I will ask the vet about serum almapoid a. Finally, I didn’t find info about a fever related to the outdoors temperature/hear. Could that be related to cushings since he is an old horse and have nothing to do with the findings on the wbc? Could he just have been trouble regulating his temperature with the heat wave and big winter coat?
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Update.
We are back to normal temperatures for this time of year. However, my horse still has mild fever (38,8) and a respiratory rate around 30. He is not responding to the Excede treatment up to now (day 7).
I’ve noticed a big weight loss in the past couple of weeks, despite the fact he eats normally (he has access to pasture and/or hay 24/7, also he gets senior feed with additional vitamin/mineral supplement and oil. He has a very good appetite.
However, for two years now he has mild chronic diarrhea when his diet is composed of more hay than fresh pasture (fall/winter time). Vet can’t explain this as it should be the opposite?! I’ve tried different qualities of hay and they all create a mild diarrhea, and currently he has grass hay about 10% protein and low carb, cut early in season so it’s not particularly high in fibers difficult to digest.
I was wondering how/why it can be more difficult to process hay for him? His teeth have been checked 10 days ago and are still functional. He did lose a molar with the vibration of the grinder though. Could this be related to ulcers?Last spring my other vet had prescribed a vitamin/mineral boost via intramuscular injection, since there were findings of anemia in his blood test.
I’ve also noticed he gradually stopped lying down as often/long as usual this summer, and that his pace is slower to follow the herd in the past month. There has been no change in the herd itself, he is not rejected or bullied in any way, so this is not related to stress from changes in his lifestyle or environment. I was thinking this is only normal due to ageing.
But I am very concerned with these new signs of illness: weight loss, mild fever, increased respiratory rate, increased white blood cells, presence of immature cells in blood tests and no response to antibiotics…
Vet thinks this could all point towards tumor inflammation? What are your thoughts?
Vet was saying that if there is no response to antibiotics, further diagnosis would be needed at the equine hospital… But this is not an option for me, I don’t want to put him under such stress at his age.
Thank you
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Hello clauee,
I do not know of a special term for immature WBC’s however depending on the specific type of WBC there are descriptive terms when they are found on a CBD. For instance immature neutrophils are called “bands” and even earlier forms “metamyelocytes”. Immature lymphocytes may be lymphobasts. In all cases an increase in immature forms are caused either by overconsumption of adults or may represent leucocyte producing tumors. A horses body temp may rise and fall in response to the environment but under normal circumstance and husbandry will not fall out of the normal range.For more on environmental effects on temp see https://horseadvice.com/horse-equine/diseases/first-aid/taking-temperature-pulse-and-respiration/. Though not listed as a common symptom, I occasionally see mild elevations in body temp with Cushing’s but whether this is loss of temp control or the result of a undiagnosed inflammation can be questioned. I think reviewing the Cushing’s article would be good for you. Has he been tested for it?
From the information presented certainly cancer can be a possibility as could infection nonresponsive to the antibiotic. In the case of the infection I wonder if this could be predisposed by a possible Cushing’s case?
DrO -
Thank you dr. O
The vet is coming today, I will ask to test for cushings.
My horse does produce a longer winter coat every year but it sheds normally in spring. He drinks and sweats normally and does not have a tendency to laminitis/founder even on pasture. The only sign of cushings would be the longer coat. Yesterday he did not have any fever for the first time in more than one week. Could it be possible that the antibiotics take that long to be effective? -
The vet came and his plan was to take another blood test for WBC and see how it evolves after antibiotic treatment. There is a possibility we will continue treatment if primary infection is still suspected and a recovery seems possible, however if it really points out towards inflammation/tumors/secondary infection then we will not continue antibiotherapy.
He told me to continue the good care and enjoy all moments while waiting for results, so I think we both feel where this is going… But my horse doesn’t seem in pain for now and still looks happy, despite his breathing becoming more of an effort (inspiration is in two phases, which is new), so it gives us time to prepare. -
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Thank you,
We had good news today with the lab results!! WBC is getting lower towards normal, so the vet suggested to continue antibiotics. I will give another dose of Excede tomorrow.I asked about testing for cushings, he believes my horse already has this disease since the longer coat and age (I have a new vet this fall and my other vet never discussed that possibility before despite the coat being the same). He says we could start treatment, however at this stage it could be long to correct?
I think if we can get through this infection, I will definitely consider treatment for cushings to prevent in the future. I’ve owned this horse for 24 years now and I want him to be comfortable and happy as long as possible!
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