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  Discussion on Liver problems, anemia, and weight loss
Author Message
Member:
Sefiroth

Posted on Saturday, Sep 28, 2002 - 3:25 pm:

Hi Dr. O,

Sorry in advance that this is a long one!!

I finally had enough and got the vet out to see my standardbred mare (the one in my profile pic) that I've been battling to get weight on for the past 6 months.

Her background: She's an 18 yr old OTT Standardbred mare. She's had a number of foals before, and has her 2.5 month old colt by her side now. She was pregnant and very underweight when a friend bought her 6 or so months ago. Two months after she was purchased my friend gave her to me since she was going through a divorce and didn't have time for her care. I was feeding her plenty of 12% sweet feed along with 5-6 lbs of alfalfa pellets with corn oil added. She had access to a round bale of alfalfa and finally put some weight on. Mainly filling back out her neck, chest and padding over her ribs. When I had to move her to another boarding stable, they didn't feed her nearly as well, no matter how I complained, offered to buy her food, etc, and I was too afraid to move her again as she was very pregnant. Needless to say she lost all the weight I put on her.

A week after she foaled I moved her to a wonderful stable where she's been getting 2 gallons AM and PM of a sweet feed mix with 1 cup of corn oil at each feeding. I'm not sure what the percentage is of the feed but it looks like its mostly whole grains with a lot of corn and a little bit of pellets. She has free access to pasture, which is now mostly dry and dead, as well as a good round bale of timothy. I also picked up a bag of alfalfa pellets today that we'll be slowly adding to her feed. The foal has been growing well.

Everyone just told me at first that it was the pregnancy that was pulling her down, then the foal suckling on her. When her abdomen stayed distended my barn mates said she was just wormy and to worm her more often. I kept her on a 1.5-2 month schedule of ivermectin then two weeks ago gave her Quest thinking maybe she picked up something Ivermectin resistant. I should have listened to my gut and called the vet out sooner instead of listening to my fellow boarders I know.

Yesterday the vet was out. He gave her an all over exam. Her temp was normal. Lungs, gut and heart sounds normal. Looking at her eyelids and gums he thought she looked anemic. Checked her teeth and said they were ok but should probably be floated again in about 5-6 months. He took blood samples, fecal samples, and a skin scraping to do a fungal culture on some crusties on her back that I haven't been able to get to go away with regular iodine shampoo treatments. He said it was possible for the foal to be pulling her down, but with all that we've been feeding her she should have some weight gain, and the anemia and distended abdomen were troubling. He asked if she ever acted colicky or stocked up. I answered no, not that I've seen and not that the barn owners ever reported to me. She's never been off her feed either. Nor does she appear jaundiced.

This morning we got the blood and fecal results back. The fecal showed tape worm eggs so her and the foal got a double dose of panacur. The blood results were a little more worrisome. I'll try and post them correctly here.

First page:

WBC: 6.4 10^3/mm^3 (5.5-12.5)
RBC: 6.36 L 10^6/mm^3 (6.50-12.50)
HGB: 10.0 L g/dl (11.0-19.0)
HCT: 30.4 L % (32.0-52.0)
PLT: 148 10^3/mm^3 (100-600)
MCV: 48 um^3 (36-52)
MCH: 15.6 pg (12.3-19.7)
MCHC:32.7 L g/dl (34.0-39.0)
RDW: 16.8 L % (21.0-25.0
MPV: 5.6 um^3 (4.6-7.3)

DIFF:
%LYM: 42.8% (0-99)
%MON: 6.2% (0-99)
%GRA: 51.0% (0-99)
#LYM: 2.7 10^3/mm^3 (1.8-5.0)
#MON: .3 10^3/mm^3 (.2-.8)
#GRA: 3.4 10^3/mm^3 (3.0-7.0)

Manual Differential
SEG N. 63% 4.0/ul (2.7-6.7)
LYMPH 30% 1.9/ul (1.5-5.5)
MONO 2% .13/ul (0-.8)
EOSIN 5% .32/ul (0-.9)

Toxic Neutrophils 1+ (on a scale of 1+ to 4+)
Anisocytosis 1+
Poikilocytosis 1+

Comments/Morphology: OCC (?) Platelet clumps Fibrinogen = 295 mg/dl

Second page:

Glucose 91 Mg/dL (65-129)
Urea Nitrogen 13.9 L mg/dL (14-34)
Creatine .9 mg/dl (0-1.5)
Sodium 137 L mmol/L (144-156)
Potassium 4.5 mmol/L (3.8-5.4)
Chloride 103 L mmol/L (112-124)
Carbon Dioxide 36.5 H mmol/L (13.0-25.0)
Anion Gap -3 L (10-27)
Calcium 11.4 H mg/dl (8.4-10.8)
Phosphorus 3.1 mg/dl (2.7-4.5)
Total Protien 7.2 g/dl (6.0-8.3)
Albumin Plus 2.7 L g/dl (3.2-4.8)
Ablumin/Globulin Ratio 1 (.8-1.68)
Globulin 4.5 H g/dl (2.1-4.0)
AST 316 H U/L (0-34)
ALT 18 U/L (1-64)
CK 235 H U/L(0-75)
Alk Phos 141 H U/L (6-93)
GGT 8 H U/L (0-3)
Total Bilirubin 1.23 H mg/dL (0-.3)
Osmolality274 mOs/kg (219-371)
Magnesium 1.9 mg/dl (1.59-2.56)
NA/K Ratio 30 H (0-0)

Whew..that was a lot of typing. When the vet went over the results with me, he said the high neutrophils showed an infection somewhere. Probably her liver since her abdomen was distended it was a good guess that it was from her liver being enlarged. He also said it was possible she got into some toxic plants such as white snake root that could cause a toxin build up. His recommendation was to put her on 24cc's of penicillin IM once daily, double dose her and the foal with panacur for the tapeworms, and start her on a supplement called Red Cell to get her protein back up. Which was also why I went ahead and got the alfalfa pellets again. But with her calcium levels being high, especially with her lactating, maybe I should hold off on adding too much alfalfa? He also wanted to draw blood again at the end of October, beginning of December to see where things were at.

I guess my questions are:

1. Do I go ahead and add the alfalfa or not?

2. Could it have been from ingesting a toxic plant even with her being moved 3 times in the past 6 months and this problem being ongoing? Maybe she's taken a liking to something bad she's found at all 3 places? (She was pasture board at all 3 so had access to all kinds of weeds.)

3. Have you ever seen a horse pull back from this condition, with liver function problems and serious weight loss, but still eating and acting normally? Atleast I guess she's acting normally. I've only ever seen her in this condition I guess.

4. Are we overlooking anything? Maybe something obvious?

5. When I went to the feed store to pick up the Red Cell, the guy there told me they were out, but he could order more. He also said Farnam makes something similar that is cheaper. Anybody know the name of the product and have used it?

Thanks in advance!
~Sharon & Cherish
Member:
Sefiroth

Posted on Monday, Sep 30, 2002 - 11:00 am:

Dr. O,

If her distended abdomen is do to an enlarged liver, would some sort of anti inflamitory help also? Something like bute? Also I looked up white snake root, and I now doubt that she's currently ingesting THAT particular plant. The description of it says the toxins will pass on in the milk, but her foal shows no signs of symptoms of poisoning. So that's a big relief!

~Sharon
Moderator:
DrO

Posted on Tuesday, Oct 1, 2002 - 8:26 am:

Two points: her abdomen looks pretty normal to me from the picture for an older broodmare and there is no sign of infection from the physical exam and blood work that I see, though some uses terminology unfamiliar to me. Taking your questions is order:

1) Alfalfa is excellent feed for broodmares and underweight horses and there is nothing to suggest that she could not deal with the increase calcium.
2) Though I am not sure which problem it is you would like to attribute to a toxic plant, yes, what ever it is you are worried about could have been a toxic plant or it may not have been. However her thin condition and decreased albumin (the one lab result that really concerns me) may simple be the stress of pregnancy, all those moves, and just not enough nutrition.
3) Yes but you do not have any results that suggest liver failure strongly, see the article associated with this forum for more on the interpretation of the elevated liver enzymes.
4) Yes, see #2. Also the effectiveness of Panacur (fenbendazole) against horse tapes at this dose is, as far as I know, uncertain. Though it has been shown to be effective against some tapes in other species, not all tapes respond and work with the horse tape species (Anoplocephala spp.) suggest that benzimadazoles are not effective against them:
1) Ann Rech Vet 1981;12(3):303-16
Anthelmintic treatment of equids: capabilities and limitations. Critical tests of nine anthelmintic agents on ponies
2) J Parasitol 1977 Aug;63(4):724-7
Critical anthelmintic trials in ponies with four benzimidazoles: mebendazole, cambendazole, fenbendazole, and albendazole.

Until we see good work to suggest how well it works in horses I recommend the treatment we outline for tapes at, » Equine Diseases » Colic and GI Diseases » Parasites and Worms » Tapeworms, Cestode spp.
Member:
Sefiroth

Posted on Tuesday, Oct 1, 2002 - 12:07 pm:

Dr. O,

Thanks for the reply! The vet is the one who gave me the Panacur for the tapes, but I'll go ahead and double dose with strongid too. How long should I wait after having given the panacur? Or can I just go ahead?

I know the blood work up doesn't show the GGT, AST Alkaline phosphate, and bilirubin to be too off the charts, as well as her not showing a lot of the other common symptoms. But in the last few days, or maybe longer since I've only really been paying attention in the last few days, she has started showing some incoordination in her back feet when turning (its been about 3 weeks since she's had her WNV booster shot).

Also, the picture in my profile is about 2.5 months old. Since then her abdomen seems to be the only thing that has put on weight. To me she now looks almost as big as she did when she was carrying the foal. I'll try to find or take a more recent picture.

One last question. Someone told me that if a horse does have a liver problem, it should be taken off of all corn products since they are hard to digest and that puts more of a strain on the liver. Does this have some truth or is it just an old wives tale?

Thanks Dr. O, I'm a bit more relieved that you don't find the blood work up as much of a doomsday prediction as my vet. He does have a tendency to always predict the worst. I always come running here since I know I can find the most up to date and scientifically correct info.

Thanks again!
~Sharon
Moderator:
DrO

Posted on Wednesday, Oct 2, 2002 - 5:02 am:

Maybe you should do your vet a favor and pass on the two references above.

If you really feel the abdomen is distending a belly tap to characterize the fluid is in order, there are a number of reasons that it may distend and cytology can be diagnostic for some of them. No, corn is not any harder to digest than other grain products.
DrO
Member:
Sefiroth

Posted on Thursday, Nov 7, 2002 - 10:22 pm:

Dr. O,

Just an update. Cherish has finished her 10 days of Pen G, 14 days of Fulvicin, and the vet is coming out next week to draw blood to compare to October's. I'll ask him about a belly tap possibly. I finally got some pictures taken of her. I'll post them here. Does she just have a hay belly? I really just want to get her back on track if possible. She's such a sweet mare and a good mom too!

~Sharon
cherish front
Member:
Sefiroth

Posted on Thursday, Nov 7, 2002 - 10:24 pm:

cherish side
Member:
Sefiroth

Posted on Thursday, Nov 7, 2002 - 10:25 pm:

cherish back
Moderator:
DrO

Posted on Friday, Nov 8, 2002 - 7:11 am:

LOoks like a pretty normal older broodmare that is in a thin condition to me. She definately needs more groceries but until the foal comes off her, it will be hard to make progress with her weight.
DrO
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