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Discussion on Mild fever, lethargic, puffy legs -
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Member:
Imsmmt
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Posted on Tuesday, Nov 28, 2006 - 11:17 am:
hello Dr. O et al.
My horse (8 yr old Hanoverian gelding) seemed very lethargic on a trail ride on Saturday afternoon which I attributed to the combination of unseasonably warm weather - 60 degrees - and a thick winter coat that is ready for arctic temperatures. The same was true again on Sunday. A big-strided horse who is normally eager and frisky and always in the lead on the trails was plodding along at a slow walk and cantering along BEHIND our quarter horse (kind of nice, for a change, actually...) I intended to take a temp but what with Thanksgiving houseguests, grandchildren etc, it didn't happen. Yesterday, Monday, the horse was not ridden, just turned out all day. In the evening, I noticed he had a puffy left front leg, and a puffy right rear leg - which seemed like an odd combination. I took his temp and it was 101.4. I cold hosed the legs, and gave him a gram of Bute.
This morning, the front leg seemed normal but the hind leg was quite puffy. His temp was back down to his normal 99.8. He does not appear to be lame, his appetite seems normal, he will do tricks for treats, and trot to me when called, but he is just not 100% himself. Really, he is much better behaved than his normal self!
He has no runny nose etc.
I described the above to one of the vets at our clinic and she assumes it is Lyme and suggested putting him on doxycycline right away (which I do have at hand).
I have read your posts on Lyme and understand that you would probably think this an unlikely diagnosis. Personally, I hate using antibiotics unless truly necessary.
Also from reading the posts, I know that many things like this may just resolve themselves.... I also realize that the puffy hind leg may or may not be related to the lethargy/mild fever.
The weather is a little cooler today but we are still experiencing really unusually warm weather for late November in MA.
SO, I am of a mind to do more or less nothing (other than Bute) for a few days and see what happens -- though I always feel a little guilty not following my vet's advice....
Thus my question is: does doing nothing seem like a responsible course of action given the above description?? And how long is doing nothing the right course of action if the mild symptoms don't go away?
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Member:
Redback
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Posted on Wednesday, Nov 29, 2006 - 7:25 am:
Hi Michele:
Do you think it could be feed related? I believe that some horses can swell up in the legs with too much green feed like alfalfa.
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Moderator:
DrO
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Posted on Wednesday, Nov 29, 2006 - 8:30 am:
Hello Michelle,
Without examining the horse Michele I really cannot judge appropriate treatment. You know my thoughts on the particular diagnosis and why this would be made on the phone when there are dozens of more common problems and almost any viral infection would produce the symptoms you describe is beyond me. I often successfully treat nonspecific fevers, depression, and yes swelling in the legs with phenylbutazone and do not use antibiotics without a clear indication.
DrO
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Member:
Ella
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Posted on Wednesday, Nov 29, 2006 - 8:53 am:
You can have a lyme titre pulled. This would at least let you know if you had exposure to the lyme organism.
I have had a mare treated for lyme with doxycycline and she went from lazy with a dull listless coat, sensitivity to being groomed and very stiff movement to a beautiful coat, high energy, spectacular movement (which was the reason I bought her in the first place - for her movement) and pleasure at being groomed again. All but the shiny coat improved within 2 weeks. The coat returned shiny after the next shedding period.
I regularly took blood titres for 2 years. It DrOpped immediately after treatment from the 400's to 200's and slowly over time DrOpped to less than 25. I do believe in symptomatic lyme for horses. I have experienced it first hand!
Ella 
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Moderator:
DrO
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Posted on Wednesday, Nov 29, 2006 - 12:24 pm:
No Ella,
You have had a horse that had a problem that improved in 2 weeks. During that time you gave the horse doxycycline. The question is are the two related? Concerning titers, many horses in endemic areas have titers that do not experience illness and in large surveys there is no difference in the incidence of disease between those with titers and those without. In my mind the nature of Lymes disease in horses remains a big question and your experience does not clarify it.
DrO
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Member:
Imsmmt
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Posted on Wednesday, Nov 29, 2006 - 8:00 pm:
Thank you all for the input -
Nothing changed in his diet recently (pasture, grass hay, and a very small amount of grain) so I don't think that's it.
And I haven't had a lyme titre pulled because I think Dr. O is on target with the lyme titre issue. Around here it would be a shock to find a horse who'd never been exposed to lyme! As far as I can tell from friends around here who've had titres done, there is not much correlation between symptoms and titre....
That said, I ended up putting him on the doxy anyway but NOT because of Lyme. I had a conversation with my cow vet and she felt Lyme was unlikely but that another tick borne disease that is common around here (and that I can't remember the name of....nothing simple and popular and easy to remember like Lyme!) was a causer of similar symptoms. That reminded me that a few years ago the same horse had something similar but much more severe (spiked fever of 106), that my then vet also thought was some tick borne something (not lyme), we put him on antibiotics then and he was better in 24 hours.
So we gave him the Doxy last night and this morning and will continue I guess for two weeks. The fever is down as is most of the puffiness and he seems to be regaining some of his naughtiness...must be feeling better! But whether from the Doxy or because he would have anyway.....we'll never know!
He's happy - gets all that molasses to make him snarf down the 35 pills twice a day! }
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Moderator:
DrO
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Posted on Thursday, Nov 30, 2006 - 6:25 am:
Some are just not made to wait it out, I guess. Note that I left a "not" out of the above post which completely changes the meaning on how I use antibiotics.
Equine ehrlichiosis would be what he is talking about and you will find an article on it at Diseases of Horses » Cardiovascular, Blood, and Immune System » Equine Granulocytic Ehrlichiosis. While not as common as the viral diseases the symptoms are indistinguishable but like viruses usually only require symptomatic treatment.
DrO
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Member:
Ella
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Posted on Thursday, Nov 30, 2006 - 7:49 am:
No Dr. O she was not better in just 2 weeks. She was better after 2 weeks of Doxy. We spent 2 months trying to figure out what was wrong and it was not until the Lyme was diagnosed and she went on Doxy did we get an immediate improvement.
I understand that you have to go by proof and studies. It only makes sense as Vets are scientists. Despite the fact that Lyme is not yet proven to be symptomatic in horses I do know that my mare had all the symptoms that Lyme positive dogs show around here, she had a positive titre and she responded to medication. To me it does not make sense not to treat.
My vet says that even though there are not studies showing Lyme to be symptomatic in horses, that from the experiences she has had that she believes it is. If one of her horses had a high titre and was showing typical Lyme symptoms (i.e. fever, stiffness, lethargic behavior etc.) that she would treat for it.
Ella
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Moderator:
DrO
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Posted on Thursday, Nov 30, 2006 - 9:38 am:
Ella it is more than there is no proof of Lymes causing significant symptoms in horses it is that there is a large body of evidence showing the opposite: multiple many horse epidemiological studies, multiple attempts to create disease by experimental infection, including experiments done with immune crippling drugs given to the horse prior to attempts to induce clinical disease. Because we know horses do contract the organism I continue to look for evidence of significant clinical disease, and some findings suggest the organism ought to be able to induce disease, but currently the idea that Lymes is a significant source of disease is not supported and on the contrary, there is much evidence to suggest it does not. I am looking forward to debating this very issue with a presenter at this years AAEP and I will let you know the results.
DrO
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Member:
Ella
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Posted on Thursday, Nov 30, 2006 - 10:31 am:
I would like to hear. I would be delighted to believe that it is not harmful to horses. I find the whole Lyme disease very frightening to dogs, horses and people. I do know that with the spread of ticks here in Maine our vets have seen a dramatic rise is symptoms in equines that mirror those in dogs and the horses do respond to Doxy.
Is there much Lyme disease in your area? Have you had the opportunity to spend time working with horses in a Lyme endemic area?
I will await more findings.
Thanks for your thoughts,
Ella
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Member:
Imsmmt
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Posted on Thursday, Nov 30, 2006 - 3:10 pm:
I WAS confused when you left out the NOT!
And yes, it was Ehrlichiosis that she had suggested.
My gut feeling was to just go with the symptom treating bute as you suggested. As I mentioned, I am really reluctant to give antibiotics to my horses, dogs, cows, or me unless absolutely necessary. On the other hand, I'm a layman and when two vets are sending me down the same path, I don't always have the courage of my convictions!
The hind leg is still showing some signs of puffiness and I'm wondering if that might be a different unrelated thing that is going on. Would you suggest giving him Bute while he is on the antibiotics? He does not appear to be lame on it...
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Moderator:
DrO
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Posted on Friday, Dec 1, 2006 - 8:55 am:
Well Michele,
Despite my firm belief that veterinarians over use antibiotics you really have to follow their advice when you are uncertain. I can give you ammunition to present other points of view like the article on Antibiotic Use in the medication section but until you are confident of the situation, they must be considered better judges, since they can examine the horse.
As an interesting point, that I rechecked with my wife because she has the better memory, despite having as many as 12 and no fewer than 6 horses at a time, that travel regularly, live on a farm where outside horses are brought in on a daily basis during breeding season, and raising multiple foals, we have not used a single antibiotic on our horses in the past 15 years.
Ella, we have Lyme disease here but it is not as prevalent as other places probably because the deer tick is not as common here. My small animal associate diagnoses it in dogs but I am really not up on the disease in dogs. The important point is in areas where the disease is very prevalent the incidence of disease is no different in horses with evidence of exposure when compared with those who do not have exposure. The real problem is that whether you live with Lyme disease or not often you are presented with sick horses of uncertain cause, finding a Lyme titer in areas where most horses have a Lyme titer is not surprising nor of much diagnostic value based on the information available at this time.
DrO
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