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  Discussion on Uh-oh: lame filly sweating at zero degrees
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Member:
ekaufman

Posted on Saturday, Jan 19, 2008 - 11:39 pm:

I have a large coming 2yo filly who presented yesterday with a mildly swollen left hock with what I would call "rearing lameness" (favoring the leg unless she was standing straight up on it). On my vet's advice, I moved her into a small lay-up pen next to her buddies and started her on bute. The swelling was almost gone overnight, and I gave her a final dose of bute this evening(3 gms total on a ~950lb horse).

The neighbor fired his cannon (or something) for a few hours, and when I checked on her, she was sweating heavily in front. I thought it was the noise BUT tonight, she is still sweating-- it's about zero outside before windchill. Respiration is a bit elevated, gums are normal, leg looks normal, she has decided I need to kill her to take her temp., and she is HUNGRY and alert.

I would normally think colic, but sweating is her only symptom. I gave her a 750lb dose of banamine, and removed her food, because I had to do something. Sweating=pain, right?

What am I missing? Is this a bute reaction? Something else? Do I just wait for more symptoms?

By the time you read this, it'll be something else, if I know anything about horses....
Member:
ekaufman

Posted on Sunday, Jan 20, 2008 - 10:23 am:

Update: the sweating subsided about an hour after the banamine, and she had a restless but asymptomatic night. Manure, urine, and drinking all seem normal. I gave her some hay this morning, and she wanted it. Waiting for the banamine to wear off to see if the mystery continues.

I realized at about 4 that the absence of identifying symptoms is a good thing, right? I mean, if her head fell right off, the problem would be obvious, but the prognosis significantly more guarded than right now.
Moderator:
DrO

Posted on Sunday, Jan 20, 2008 - 12:00 pm:

No, sweating is not equivalent to pain and without other signs of pain I would discount it. Sweating can also be a nervousness, overheating, and sometimes unexplained patchy sweating can occur.
DrO
Member:
mrose

Posted on Sunday, Jan 20, 2008 - 2:13 pm:

I've also had horses sweat, usually on their neck and chest, as a reaction to Banamine.
Member:
ekaufman

Posted on Sunday, Jan 20, 2008 - 2:40 pm:

Sweating even in that bitter cold can be normal? Interesting.

She has started sweating again, coincident with the banamine wearing off. Pain is tricky for me to see in these horses-- they are from pure bullfighting stock, and I have seen them stand w/o flinching with a shattered leg, eat through childbirth, and not respond to palpation of a wound clear through to the abdomen. I don't know whether she'll show me pain.

Off to check vitals and look for some sort of clue.
Member:
scooter

Posted on Sunday, Jan 20, 2008 - 3:41 pm:

Sam my arab gelding did that in the dead of winter last year. It really worried me....his resp was elevated but that was it. Called vet he said to check vitals...couldn't get temp. was being an idiot. He said to give him banamine, which I did.
His appetite was good ect. I went out right before dark and he was drenched in sweat...yet normal? All the sudden he left out a big shiver and looked like he may faint. Resp was very high at that point. Ran in to call vet again and get more banamine. Vet said to get his temp! and give more banamine. By the time I got back outside he was fine and starting to finally dry off and that was the end of it. The whole ordeal was about 24 hrs. and one of the strangest things I had wittnessed
Member:
freshman

Posted on Sunday, Jan 20, 2008 - 6:35 pm:

She's not had too much at this point by any means, but I'd hold off giving any more bute or banamine until you chat with your vet. Seems unkind, but better to let her show you what's wrong than cover up something that would better be seen now than later.

I'd be great if you have a vet that would be available for a quick phone chat this pm? You could at least leave a message to give a heads-up that you might need to be worked in tomarrow.

Too bad she doesn't go for temp taking; might be worth calling on someone to help hold her this at least once sometime this pm if she's still worrying you. Not worth getting hurt over, of course. Most things aren't.

Other than monitoring her closely, which you are already doing, try not to freak. I know this useless advice, really. Do keep us posted, and good luck to your girl!
Member:
ekaufman

Posted on Sunday, Jan 20, 2008 - 7:41 pm:

So my vet came by this afternoon, and we are confused. The filly has a normal temp., elevated respiration and pulse, good cap. refill, great gut sounds, normal manure and urine, good appetite, and periodic bouts of heavy sweating that appear now to be acute pain. I gave her a full tube of gastroguard (she had some with her banamine yesterday), and am watching to see what the night brings. We drew blood to run by the lab tomorrow.
Moderator:
DrO

Posted on Monday, Jan 21, 2008 - 7:14 am:

Elizabeth why do you say these are caused by acute pain since you do not describes and signs of pain? Long before horses sweat from colic pain they go off feed and as you state and is my experience too, horses stand around with broken legs eating grass without sweating. Unless there is missing information I do see any reason to suspect pain as the source of sweating.
DrO
Member:
gwen

Posted on Monday, Jan 21, 2008 - 7:24 am:

Good luck, Elizabeth. I hope you get to the bottom of this!
Member:
scooter

Posted on Monday, Jan 21, 2008 - 7:39 am:

Dr.O. doesn't an elevated resp. and pulse indicate pain? or at least something is nqr. Elizabeth are these elevated just when she is sweating?
Moderator:
DrO

Posted on Monday, Jan 21, 2008 - 9:10 am:

Again, these are non-spcific signs that can be caused by many factors: put the three together with no signs of problems and you have the classic picture of a horse trying to thermoregulate down when a little hot. Excitement also fits this profile. During the winter horses do many things to increase their warmth, once they reach homeostasis, warming the environment any, though still quite cold, can induce thermoregulatory changes like you describe.

But let's look at other factors not yet considered. For instance take the elevated heart rate in isolation, you have already stated your horse becomes excited when attempting to get a temperature, perhaps the examination or anticipation raised the heart rate.

Of course you and your veterinarian must make the assessment, I cannot examine the horse and environment myself. My purpose is to not argue the point so much as to point out what I see as a weakness in the conclusion: these secondary changes are not pathognomonic for pain. This is both for your and other readers edification to put into all your other calculations as to what is happening.
DrO
Member:
ekaufman

Posted on Monday, Jan 21, 2008 - 10:37 am:

Hi Dr. O,

I am not trying to argue, but trying to learn. If you will be patient with me here, I think you have something important to teach me.

So when a horse presents something that catches our eye, there is the initial question, is this normal? The definition of normal needs to include "unusual but not pathological" and "not that unusual, even if I haven't seen it before."

If we decide it may not be normal, we start a diagnostic process that, as you point out, may create symptoms of distress in the horse, who would rather be groomed, fed, or allowed to leave than be examined, even if it is sick or hurt.

So I *think* you are pointing out to me that the initial symptom-- sudden excessive sweating in the cold-- is often in the "normal" category, in which case it's easy to see how everything else could be exam-induced. Have I read you correctly so far?

One more question, if you don't mind, and I know you can't see the horse. Is our current path, given what you know, excessive or conservative? It amounts to a dose of banamine, some gastroguard, bloodwork and a physical exam (I passed on the rectal, because there is nothing to suggest a displacement or an impaction or anything else we might find on rectal exam).

I suppose my biggest drive in this is just having seen this horse every day of her life, and never having seen this before. But I realize that isn't science, and would like to be guided by science, if I can learn to apply it.

Thank you for your patience!

(P.S.-- it's below zero this morning and this filly's presenting symptom is now a huge case of the sillies. Very reassuring, whether she has been sick or not!)
Member:
mrose

Posted on Monday, Jan 21, 2008 - 10:42 am:

Elizabeth, I wonder if your filly's initial sweating was a delayed reaction to the noise...like she was still nervous and expecting something more, and then if her subsequent sweating is a reaction to the banamine. Is she sweating all the time now, or just when coming off the banamine? Given a horses' deep desire to totally confuse, confound, and keep your vet bills high, you have to think "outside the box" sometimes to figure these things out! Good luck.
Moderator:
DrO

Posted on Monday, Jan 21, 2008 - 11:15 am:

By definition your term "excessive sweating" would not be a normal process since it is "excessive". The next question that would follow would be, "why is it excessive?". Answering this question would involve a thorough history and exam. If no cause found it strikes me you have two courses:
1) Redefine what you previously labelled "excessive", ie this was a semantical problem.
2) Consider other diagnostic work.

If at anytime you come to the conclusion that this excessive sweating is potentially impairing the health of the horse empirical therapy for potential problems seems reasonable.
DrO
Member:
mrose

Posted on Monday, Jan 21, 2008 - 11:38 am:

Elizabeth, if you know your horse, you are the best judge of what is normal for her and what isn't. I'm glad she's acting more spritely this morning. Hopefully, she over what ever her problem was.....if there was one!
New Member:
peekaboo

Posted on Monday, Jan 21, 2008 - 12:46 pm:

Elizabeth,
Just a thought...
What is your horse's breeding? Does she have any QH in her? If so, weird sweating can present as a small HYPP attack. My mare, who I did not know had HYPP, did the same thing and that is how I discovered that she was HYPP N/H. I had been feeding her (as a 13 month old, large and fast growing filly) alfalfa, which led to an overabundance of Potassium build up in her system and the HYPP sweating symptom presented she at the same time presented with a "hot hock" because she was growing too fast due to the alfalfa. She is HYPP asymptomatic now due to the right feed and turnout and is a beautiful productive (not reproductive) horse. She is a joy. Best of luck.
Member:
ekaufman

Posted on Monday, Jan 21, 2008 - 12:58 pm:

Thanks Dr. O-- "copious sweating" would have been a better characterization.

Thanks Sara and Cindy, no, she's a Spanish Purebred. The breed is ripe for genetic disorders (heavily line-bred to a few very influential studs), but we have no reports of anything like this yet.

The hock swelling resolved very fast with "rest" (filly-style) and bute (it's normal today), so I'm currently inclined to think that it came from sort of doofus move that I didn't see.

(My vet diagnosed her brother at this age as a "giant goober" because of his constant self-inflicted limb damage, all of which resolved w/o permanent changes. She insists that's a medical diagnosis.)
Member:
kasi

Posted on Monday, Jan 21, 2008 - 1:20 pm:

Cindy,
Could you tell me more about the potassium build up. I have a 17 yr. old Qh that boards at my farm that has developed patchy sweating so I am curious about this. The patchy sweating started this year during the summer but just a day or so ago his patches were sweating although it was very cold. He only gets maybe a pound of alfalfa pellets mixed with beet pulp and a custom mineral blend based on my hay analysis, and Coastal Bermuda hay but I'm still curious about this. What diet changes did you make? Do you add sodium to offset the potassium? I was advised to do this as most all hays are high in potassium due to the way they are fertilized. I've also read that sometimes the animals have difficulty in getting enough salt to offset from mineral blocks and sometimes their system mistakes the potassium as having enough salt so they don't eat salt. I'm sure Dr. O can help too on this question.

Thanks,
Karen
New Member:
peekaboo

Posted on Monday, Jan 21, 2008 - 2:24 pm:

Karen,
If a horse has HYPP it can be discovered by a hair sample being sent to the labs at the University of California. I can easily manage my mare's HYPP by feeding her Nutrena Safe Choice and Coastal Hay only. I use a plain salt block and I put half of it (a small block) in her feed bucket. As she eats she gets the salt that she needs. I do not add free salt in her feed. Mineral blocks have potassium added and the horse gets too much that way, so you should only use a white salt block with HYPP effected horses. I also have on hand light (the clear) Karo Syrup in case she needs it during, or to help ward off, an attack. The glucose helps move the potassium out of the system. I administer it at 60cc doses the same way you would give a paste wormer. I also use Acetazolomide as warranted. It is a human diuretic prescribed by her vet. I just throw five to ten pills uncrushed in to her feed if there is an impending stressful weather change or a Dressage Show or Horse Trial at the farm that might cause her some undue stress. She would rather participate than be a bystander. As for turnout and exercise...she goes out in the pasture from 8:30 to 3:30 each day. We work on dressage, etc.in the evenings and she does not go out at night because I don't want her to get in a stressful situation (thunderstorm, other animals in the pasture at night, etc) that could send her in to an attack. I would be very wary of the alfalfa pellets. My mare gets Strongid (1200 lb dose) each day and it is made with alfalfa pellets. This is all that we give her for fear that she may get too much potassium.

Please let me know if I can give you any more information. HYPP is a manageable disease, much like a human manages his/her diabetes. Education and intuitiveness are the keys to successful and happy horses.
Cindy
New Member:
peekaboo

Posted on Monday, Jan 21, 2008 - 2:32 pm:

Karen,
I just found this and wanted to share it with you I hope it helps.
Cindy
____________________________________________

HYPP - Common Sense Answers for Dealing
with the Potassium Sensitive Horse
The following is a list of questions commonly asked by horsemen concerning the HYPP disorder. The answers come from various veterinary sources, research, medical books, and most importantly, from those persons "in the trenches" with horses every day.

WHAT IS HYPP?

The definition:
Hyper = too much
K = K is the medical symbol for potassium
emic = in the blood
Periodic = sometimes, temporary, length of duration
Paralysis = immobilization.
The name hyperkalemic is often misleading. It is the fact that episodes are "precipitated by potassium administration" that best defines the disorder. "Potassium-sensitive" is preferable terminology. The sensitivity may be transmitted as an autosomal dominant effect (generation to generation), it should be noted that sporadic cases can occur without being genetically received (it can occur without a genetic link).

WHAT HORSES ARE AFFECTED?

Currently the only bloodline being researched and tested is the Impressive. HYPP has become a controversial and widely discussed subject in the stock horse industry. It primarily affects three registries: AQHA, APHA, ApHC. The diagnostic test is DNA specific, so only one bloodline can be tested. There are numerous reports of non-Impressive bred horses that have this condition and are being treated medically for it. But there are apparently no plans at this time to develop a test to universally test all bloodlines. Theoretically, all bloodlines could have HYPP or something similar. It should be noted that this is also commonly found in humans, with the same symptoms AND the same treatment.

WHERE DID IT ORIGINATE?

Research has not been done to pinpoint exactly where the Impressive bloodline genetically received the gene. There is one particular horse in the Impressive pedigree that was known to have had a muscle weakness problem, but this has not been investigated.

HOW ACCURATE IS THE TEST FOR HYPP?

HYPP is still being researched, new and improved testing is being developed, NO test is 100% accurate. (If your horse is negative and symptomatic...retest!) If you are uncertain about the results of the HYPP test...retest.

IS TESTING REQUIRED BY ANY ASSOCIATION?

None of the associations require this test for any reason.

HOW CAN I TEST MY HORSE?

The blood for the test can be drawn by your veterinarian. He will send it to one of 2-3 labs now doing the testing. Testing can be done on any age of horse. Results will be mailed to you or your veterinarian.

WHAT SHOULD I DO IF MY HORSE TESTS POSITIVE?

Being positive does not always mean that your horse will have HYPP symptoms or even that it will ever be on medication. It does not mean that the horse will always produce offspring that will be positive. Many positive horses never show symptoms or reproduce the gene in foals. Being positive does mean that your horse is Potassium-sensitive, so: 1) If your horse is not showing symptoms, go ahead with your plans and keep in the back of your mind what the symptoms are... and the treatment. 2) If your horse is positive with symptoms, put the horse on medication, watch his diet and go ahead with your plans.

CAN MY HORSE DIE FROM THIS?

Episodes of HYPP are seldom severe enough to require emergency treatment and are almost never fatal. Because symptoms precede an episode there is no excuse for having a horse become extremely ill or die from HYPP. The death rate in Impressive offspring (the only bloodline researched and tested) and non-Impressive offspring since 1973, as per AQHA records in April 1993: There is an almost non-existent .0013% difference.

WHAT THINGS CAN CAUSE MY HORSE TO
HAVE AN HYPP EPISODE?

The two major culprits: Diet and stress. It is a known fact that alfalfa hay contains greater levels of potassium than oat or grass hay. Sweet feed (molasses is high in potassium) or food with added minerals is known to contain more potassium than plain oats. Mineral blocks and some vitamin supplements are higher in potassium. Read labels...pay close attention to what you feed and provide adequate substitutes. Stress is different things to different horses. It may mean travel, conditioning, illness, injury or something as simple as moving the horse from the pasture to the stall.

WHAT ARE THE SYMPTOMS?

One or more of the following symptoms may be present in a positive horse: irritability, difficult or heavy breathing, muscle weakness, rippling, quivering on one or both sides, frequent yawning, rolling the third eyelid back while yawning, Muscles may be hard to the touch. In severe cases, the horse may be in a reclining position, unable to rise. In the simplest of cases, the horse may become cast often.

MY HORSE HAS SHOWN SYMPTOMS OF HYPP,
WHAT SHOULD I DO?

Notify your veterinarian or the nearest veterinary school for assistance in obtaining the proper medication. At present, the simplest and most effective treatment is Acetazolomide tablets (also used in humans for HYPP) Once the horse is on this treatment, you will probably not observe any symptoms again.

HOW DOES ACETAZOLOMIDE WORK?

It has a diuretic effect that flushes the potassium out of the system. It should not affect your horse in any way except to control potassium levels. Only in rare cases does the medication fail to work 100%. When this happens, the addition of Thyrol L (thyroid hormone) to acetazolomide should alleviate all symptoms

HOW OFTEN AND HOW MUCH ACETAZOLOMIDE
IS USUALLY ADMINISTERED?

The average adult horse will need 6-8 tablets, twice a day. A foal would require about 1/2 that dose. Acetazolomide costs no more than your average vitamins would per month.
Should I avoid any specific medication if my horse is positive?
Yes, a standard rule of thumb--do not use the drug Acepromazino on HYPP horses. Rompun, Dormosodan, or Torbugosic should be used instead. The use of lactated ringers is in question because it contains potassium. Be careful in using electrolytes, they contain potassium. Use a low-potassium electrolytes, should the need arise. Dantrium, though it may alleviate some HYPP symptoms, is not the drug of choice because it has been known to cause some severe diarrhea and may act as a depressant.

WHAT IF MY HORSE SUDDENLY HAS SYMPTOMS
OR HAS A SEVERE EPISODE?

Oral glucose, white Karo syrup, or other carbohydrate hastens recovery. This may be given directly into the horse's mouth. If the horse has developed muscle stiffness but is mobile, walk him. Just this may alleviate the symptoms. Start the acetazolomide. Grind up 6 pills for an adult horse, 3 for a weanling and place them in your horse's mouth via a dose syringe. This dose should sufficiently work in 15 minutes. If not, go on to stronger measures. If a severe episode occurs, and the horse is cramping or cannot rise to his feet, call your veterinarian. He should draw a blood sample to test the potassium level, for diagnostic purposes. He will probably administer at least 3 liters of fluids (normal saline or Dextrose 5%) mized in equal parts with Calcium Dextrose IV solution. Use 50-80cc Cal-Dex in each of 3 liters of fluid. Your vet will determine the proper dosage for the horse. The vet may also give the horse a tranquilizer (avoiding Ace-Promazine). Within a short period of time, your horse should be free from symptoms. Please note that most treatments for HYPP in horses are the same as for humans.

CAN I EVER STOP THE MEDICATION?

In most cases, no. To remove the medication will increase the risk of an HYPP episode. A sudden withdrawal from medication could lead to disastrous results. The only exception would be an environmental change, such as retiring a horse from the show pen or other circumstances where he is on a strict and stressful regimen. In these instances, it would be advisable to turn them out in the pasture and wean them off the medication gradually and adjust any supplemental foods accordingly. The horse should be monitored carefully during this withdrawal. If he does not demonstrate any symptoms, he may do quite well without the medication. Should the horse show symptoms again, it would be well advised to start treatment again.

WHAT ABOUT FITTING AND SHOWING
MY POSITIVE HORSE?

Thousands of positive horses have and are being fitted, shown, hauled and made champions without being affected by HYPP and it's symptoms. Most trainers believe that deviating from alfalfa hay may compromise their conditioning ability, particularly in halter horses. If alfalfa precipitates symptoms, the horse may be placed on acetazolomide. Few fitting programs are interrupted by HYPP. The wise trainer is aware of how to manage Potassium-sensitive horses and it is not a problem. Observe your horse, use medication if necessary and enjoy your horse and program.

WHAT DO WE DO WHEN TRAVELING
LONG DISTANCES WITH A POSITIVE HORSE?

Hauling long distances is stressful for any horse, not just HYPP positive horses. The horses must drink an adequate amount of water-haulers should stop every couple of hours and offer water. In hot weather, make the trailer as comfortable as possible--no long "human" rest stops that leave poor old Dobbin sweltering in the trailer. Make the trip as comfortable and quick as you can for the horse. When it comes to medicating the horse, prepare ground pills into pre-measured doses that can be loaded into a dose syringe, mixed with water and shot right into the horse's mouth while he is in the trailer.

WILL HYPP MAKE MY HORSE WORTH ANY LESS?

Once the horse industry, general public, and medical community is educated on what is simply a "potassium-sensitive" condition, perhaps the fear will be alleviated and owners and breeders alike can return to business as usual with a better understanding of still yet another veterinary problem. There are so many genetic conditions that horse owners contend with every day that are not so simple as to be treated with a pill. As to the worth of any given horse, if he is functioning and achieving as you expect, why should he be worth any less?

WHAT IS THE BEST THING I CAN DO FOR MYSELF
AND MY POSITIVE HORSE?

HYPP should be approached, as any other medical condition would be: "How do I cope with this and keep my horse healthy and happy?". Your horse is the same horse he was when you raised him, bought him, made him a champion, or rode him 20 miles on that trail ride last week. Nothing has changed except that he might have to have his diet altered or possibly have to be given a medication. He may never show a symptom in his life even if he is positive. Your horse can live with this condition as easily as a negative horse if you know what to do and what to look for. Educate yourself on HYPP. There are many myths, misconceptions and sensationalized stories going about that just aren't true. Get the facts and treat HYPP for what if really is...just another medical condition. But most importantly...love your horse and take care of him, just as you always have. He is still the same horse and ...A Great horse is still a Great horse... HYPP can never change that!
Member:
ekaufman

Posted on Monday, Jan 21, 2008 - 7:35 pm:

Well, my vet just called. Bloodwork is back, showing multiple abnormal values (don't have the results in hand-- she was driving). Her practice and CSU believe the bloodwork + history create a strong suspicion of moderate to severe EGUS. Their theory is that she may have had non-clinical ulcers for a while, and the bute/stress of injury and lay-up may have caused them to become worse.
Member:
gwen

Posted on Monday, Jan 21, 2008 - 8:10 pm:

That sounds "treatable". Good news (I think!).
New Member:
peekaboo

Posted on Monday, Jan 21, 2008 - 9:03 pm:

That is great Elizabeth! Now you have something to treat...rather than worrying about the unknown. All the best to you!
Cindy
Moderator:
DrO

Posted on Tuesday, Jan 22, 2008 - 7:49 am:

Since there are not any changes on routine CBD or chemistries that would be diagnostic of EGUS let me be sure I am clear on this: the diagnosis of your horse as having moderate to severe gastric ulcers is based on heavy sweating in a horse that has a history of being bright, alert, and a good appetite? Are there plans to have the horse scoped to confirm this?

This is a good time to bring up that the pathogenesis of NSAID induced ulcers and the area of the stomach effected compared to EGUS are entirely different (glandular vs the non-glandular respectively). As a result the role of NSAID's in EGUS has become less certain.

For more on pathogenesis, history, clinical signs, and diagnosis of gastric ulcers in adults see, Diseases of Horses » Colic, Diarrhea, GI Tract » Gastric Ulcers » Gastric Ulcers in Adult Horses.
DrO
Member:
ekaufman

Posted on Tuesday, Jan 22, 2008 - 9:52 am:

Ulcers are the new black, it seems.

I hope my vet will have some ideas for follow-up diagnostics on this. They said they have "seen this before." I realized last night, that one instance was this filly's brother. As a long 2 year-old, he looked "off" to me, and bloodwork showed mild anemia and some abnormality (I'll need to find it to see what it was) in white blood cells and neutrophils. Then I thought he colicked-- ate a bit slow and lay down in the wrong corner. I took him to CSU, and they assessed him as normal, me as crazy, and tried to discharge him. Long story short, they scoped him, and his entire stomach had necrotized and there were patches of bleeding etc.. 6 weeks of Gastroguard, and he was healed with insignificant scarring, and his bloodwork had returned to normal. CSU actually apologized formally for the incident, which was kind. I believe they still teach that colt's case.

My concern is that they may be making this diagnosis by analogy rather than strong diagnostics. Here's that crazy lady with another "off" Spanish horse. On the other hand, CSU is a good facility and I also have great respect for my vet. So I will talk to them today to see why they are calling this EGUS, and what we can do in the way of further diagnostics. Though I'm not keen on scoping this filly, which is the gold standard.

I will post the bloodwork on this filly when I get it.
Moderator:
DrO

Posted on Tuesday, Jan 22, 2008 - 4:51 pm:

I agree "the new black" or I like to say "the new EPM". I would like to see the bloodwork Elizabeth. Be sure to post the normals as well as abnormal values, the units of measurement, and the labs normals.
DrO
Member:
freshman

Posted on Wednesday, Jan 23, 2008 - 3:40 am:

Definitely a trendy diagnosis that is handy for all those non-specific, ain't doin' right kind of horses or when nothing else seems to fit. Doesn't mean that any one horse doesn't have ulcers, of course. Scoping is the gold standard, as you say, but even that isn't 100 percent diagnostic since the majority of the GI tract can't be imaged.

Also frustrating to try to decide to scope or just treat with gastrogard; both are very spendy. Gastrogard has the benefit of being very safe, do no harm, kind of drug; won't kill the horse, but bank accounts are subject to major trauma and sudden deaths.

Do keep use posted and it would be interesting to see what the labwork indicates. I hope it's all theoretical, and your filly stops with these troubling episodes.
Moderator:
DrO

Posted on Wednesday, Jan 23, 2008 - 7:22 am:

The problem of diagnosis is even more complicated than the unvisualized portions. You also have to take into account the very large percentage of horses that have ulcers of the squamous portion of the stomach with no clinical signs. It makes diagnosing atypical cases very iffy. But as you say, it is the best we can do at this time.
DrO
Member:
ekaufman

Posted on Wednesday, Jan 23, 2008 - 9:54 am:

One comment on the Gastroguard and cost of using it. The vets at Littleton Large have evidently been experimenting with lower doses for horses scoped with ulcers. At their recent referring vet symposium, they offered the observation that, within their practice, 1/4 tube of Gastroguard daily for a month offered comparable healing for many horses to the results seen with a full tube. I don't find a paper or formal study to back this up, but thought I'd pass it along.

If true, it seems like good news. It also seems like it might add to the "sure smells like ulcers" diagnostic effect we have going on right now. It would be great if the little poop strips turned out to work.
Member:
kasi

Posted on Wednesday, Jan 23, 2008 - 12:52 pm:

Slippery Elm Bark and Chamomile are a lot cheaper and work plus being a natural solution. I've treated several horses successfully with them. I keep it on hand at all times for my horses to use if I take them off the farm--or for any stressful situation. The Slippery Elm Bark coats the entire digestive tract and the Chamomile is calming. As with any herbal cure it might not be immediate but I found it to work pretty quickly. The horses seem to like it too. I just sprinkle in their moistened beet pulp.

Karen
Moderator:
DrO

Posted on Wednesday, Jan 23, 2008 - 12:58 pm:

Hello Karen,
I cannot find any support for this notion either in the scientific literature or my texts on slippery elm bark herbal therapy. I do see where this is primarily a mucilage treatment but without work to show a benefit, known appropriate dosages, and what the cost would be to appropriately dose a horse, I am uncertain whether this is a good recommendation for a horse.
DrO
Member:
kasi

Posted on Wednesday, Jan 23, 2008 - 1:52 pm:

Hi Dr. O,

The remedy is not something that I made up and was recommended to me by an herbalist named Robert McDowell. He has an excellent website. The recommendation was:

For the treatment of ulcers we use 1/3 cup of straight slippery elm bark powder mixed into a paste with chamomile tea and added to the feed once a day. The chamomile tea is made up as 4-5 teabags or 2-3 dessert spoons of the dried flowers to 1 liter of boiling water. Allow to cool and use enough to mix the slippery elm bark powder into as much of a paste as you require. Use the remainder to dampen the feed. Chamomile tea is very good for the parasympathetic nervous system and helps immensely with GIT problems. The slippery elm lines the entire GIT system and gives the body a chance to completely repair and replace the entire GIT lining. This program can be continued as maintenance with a horse and you would still do it every day at 1/3 cup of slippery elm mixed into a paste with as much chamomile tea as required.

Since I was feeding moistened beet pulp (I took all my horses off grain after research that suggested in might be part of the problem) I did not make the tea but added both powders to the beet pulp and mixed. I suspect the paste he suggests if for dry type feeds so that it sticks. I have also made the past to syringe into horses that are off feed. It makes an excellent paste to even use as a carrier for other substances. There is no doubt in my mind that this remedy helped the horses that I treated. Not to be disrespectful but in all areas of horse care, training, trimming, etc. I tend to listen to what the horses tell me works and doesn't work. Scientific proof does not matter to me. It wasn't so long ago that it was unheard of to lower a foundered horses heels but it is unmistakable that horses tend to be more comfortable when that is done and many times the coffin bone reconnects and these horses are not euthanized as was recommended. Here again I really do not mean to sound disrespectful but it does bother me when just because you do not find support in your collection of texts you would be so quick to discount it. I have had quite a bit of successful responses to herbal treatments and find that a natural approach is far better than some of the unwanted side effects of drugs. In my mind herbs are nature's drugs.

Respectfully,

Karen
Moderator:
DrO

Posted on Wednesday, Jan 23, 2008 - 5:45 pm:

Thank you for your post Karen. We welcome the posting of any subject about horses on Horseadvice and all postings are carefully scrutinized and critiqued through the lens of science and my experience. That's one of my jobs here.

The problem with this recommendation is that there is no scientific evidence for this use. When you first posted I researched all of the scientific, medical, and veterinary publications of the last 40 years and this includes many alternative medicine journals. I also checked my own herbal reference and The Mayo Clinic site which has a lot of information on home and herbal remedies. I would be interested in any quality research into this use.

I do see the recommendation for use with non-specific stomach and gastroenteritis conditions at many herbal sites that sell the product. To present a balanced view I did not find any scientific references saying it does not work.

Herbs are a very complicated mixture of chemicals many of which have pharmacological properties. This makes herbs a drug. Like all drugs, before they should be recommended for treating diseases they should be tested for efficacy, dosage, and safety. Anything less and we are back in the age where bleeding was a common practice for many ailments for hundreds of years because of many "successful responses". We now know these successes in all but a few very rare conditions were in spite of the treatment and not because of it. For more on our perspective see Member's Services members_only » The Lounge: Kick back and relax » Alternative Medicine and Epistemology.
DrO
Member:
ekaufman

Posted on Wednesday, Jan 23, 2008 - 2:59 pm:

Thanks Karen. These conversations are typically frustrating on both sides, but for what it's worth: I agree that some of those substances you administer are very likely "drugs." It's for that reason I don't administer them unless I see some good controlled double-blind research that gives me dosage, efficacy, side effects etc.. I know from experience that I'm easily misled about correlation vs. cause-and-effect in my life, so my own observation just doesn't replace the rigorous and much larger observation that science gives us.

Ok. Bloodwork. Dr. O-- I'm confused by these results as indicative of ulcers. I don't know what they indicate, if anything. Apologies on formatting-- I tried!

Test name Result Normal Range units
Glucose 91 70-135 MG/DL
BUN 27 5-28.0 MG/DL
Creatine 0.7 0.7-1.8 MG/DL
Phos. (HIGH) 6.3 1.9-4.6 MG/DL
Calcium 11.8 10.5-13.5 MG/DL
Magnesium 1.8 1.4-2.7 MG/DL

Total Prot. 6.3 5.8-7.8 GM/DL
Albumin 3.0 2.5-3.5 GM/DL
Globulin 3.3 2.9-6.0 GM/DL
A/G Ratio 0.9 0.6-1.3 Ratio

T-Bilirubin 0.7 0.5-1.7 MG/DL
CK 281 100-470 IU/L
AST 338 185-375 IU/L
GGT 11 7-20 IU/L
SDH 7 0-12 IU/L

Sodium 134 130-142 MEQ/L
Potas.(HIGH) 4.8 2.5-4.6 MEQ/L
Chloride 98 95-108 MEQ/L
Bicarb (HCO3)27.4 22-30 MEQ/L
Anion Gap 14 10-17 Calc
Calc
Osholality 273 260-290 m0sm/Kg

Sample quality tests
Lipemia 11 0-30 MG/DL
Hemolysis 4 0-30 MG/DL
Icterus 1 0-2.0 MG/DL


Nucleated
Cells 7.6 5.5-10.5 x10^3/ul

Metamyelocytes
Band Neutrophils
Seg Neutroph(LOW) 34% 2.6 3-7.0 x10^3/ul

Lymphocytes(HIGH) 62% 4.7 1.5-4.0 x10^3/ul
Monocytes 3% 0.2 0-0.6 x10^3/ul
Eosinophils 1% 0.1 0-0.8 x10^3/ul


Plasma Protein 6.5 g/dl
RBC 7.42 6.5-10.5 x10^6/ul
HGB 11.3 11-16.0 g/dl
PCV (LOW) 30 31-47.0 %

MCV (LOW) 41 42-52.0 f/l
MCH
MCHC 37 36-39.0 g/dl
Fibrinogen 300 100-400 mg/dl

ROW(HIGH) 21.8 17-20.7

Platelets 135 125-300 x10^3/ul
MPV 5.6 5-10.5 fl

Hemopathology
- few reactive lymphs
- clumped Plt.

Tech Comment: Few small platelet clumps on smear

Referred to pathologist for review.
Member:
kasi

Posted on Wednesday, Jan 23, 2008 - 4:37 pm:

Not a problem. People have to do what they think is correct and I think most people are always trying to do the very best for their animals in whatever they do. Sometimes it is difficult to keep an open mind and break away from tradition. I feel sure the herbalist, Robert McDowell did quite a bit of research and study before making his recommendations and I'm sure he is very knowledgeable in his work. I echo what I said before and certainly agree that haphazardly doling out herbs is probably not a wise thing to do. The proof in his recommendations is in the results. I had excellent results in several cases. I have also had excellent results with herbal treatments with aliments that typical veterinary medicine could not cure so I will continue to use herbal remedies because they work. You might notice that Slippery Elm Bark is being used in some of the ulcer remedies for horses (name escapes me at the moment) that are available so seems others have come to realize the benefit.

It really is interesting to read about Slippery Elm Bark. As part of my own research before using it I found that George Washington's troops actually sustained themselves using Slippery Elm when food was scare during war. It is also useful in human GI problems.

I do hope your filly progresses well and quickly!

Karen
Moderator:
DrO

Posted on Wednesday, Jan 23, 2008 - 5:58 pm:

Most of the changes are mild and really of no significance that I can see. The two interesting things are the anemia (low RBC's) and the low neutrophil count (the high % lymphocyte is an artifact).

Concerning the anemia was the horse briskly exercised just prior to the blood being taken? If not this often results in a false anemia, for more on this see Diseases of Horses » Cardiovascular, Blood, and Immune System » The Diagnosis of Anemia.

The low neutrophils with no left shift are most often suggestive of a viral infection but I don't see any history to suggest it unless the sweating occurred as the fever broke but the way the horse was behaving it certainly does not sound feverish. Otherwise I do not see anything here that clearly explains the sweating nor characterizes a gastric ulcer. I would be interested in your veterinarian's reasoning.
DrO
Member:
ekaufman

Posted on Wednesday, Jan 23, 2008 - 6:11 pm:

Thanks Dr. O,

We did exercise the filly, and it seemed quite brisk to me! After my first failed attempt, I was able to confirm a normal temp. on each of her subsequent sweating sessions. I think that, with her good appetite etc., was the reason for ruling out viral infection.

My vet's reasoning is essentially by analogy. The filly's brother (he of the necrotized stomach) had anemia and low neutrophils prior to scoping positive. She reviewed his old bloodwork and the two are indeed very similar.

Of course, he wasn't sweating, so the cases are not identical, even if the horses were identical, which of course they are not.

Can you recommend follow-up diagnostics based on the bloodwork? I submitted a fecal to the diagnostic lab this morning, marked for parasite and occult blood analysis. I did not mark it for culture, since she didn't seem (to me) to have any symptoms of a bacterial infection.
Moderator:
DrO

Posted on Wednesday, Jan 23, 2008 - 8:07 pm:

If only diagnosing ulcers was that easy.

Just using the information you have posted I don't see a clinical problem so I don't see any need for follow up diagnostics. But concerning your horse in particular these are decisions that have to be made by someone who has examined the horse in discussion with you.
DrO
Member:
ekaufman

Posted on Wednesday, Jan 23, 2008 - 9:43 pm:

Well, they say dogs can be trained to smell certain cancers. There's money to be made training Bingo to smell ulcers now for sure.

The filly looks good, and one of her pasturemates just colicked with a fever (no impaction, no nothing-- just feels cruddy). So seems to me that I may have a bug on the loose among the babies.

Thank you very much for your patience and objective feedback. Probably I am the only mammal on my place who will end up with an ulcer!
Moderator:
DrO

Posted on Thursday, Jan 24, 2008 - 7:16 am:

Hmmm if your first case would have had a fever and colic I would have placed ulcers on the rule out list Elizabeth. The connection between your newest case and the previous case remains uncertain. I know it may sound like I am now on the other side of the fence but in both cases I am trying to get you to look logically at the situation and avoid poorly supported conjecture as fact.
DrO
Member:
ekaufman

Posted on Thursday, Jan 24, 2008 - 9:48 am:

Thanks Dr. O. I think I'm reaching here. I don't have enough data to tell me what's going on with any of them (have a third one sick this morning). True enough that trouble comes in DrOves.

One interesting anecdotal point. Because I knew I'd be up with ColicFilly, I held SweatyFilly off her Gastroguard last night. She started up the sweating thing again around 4 this morning (it was -12'F in the barn, and she was standing quietly).

If only superstition could CURE a horse, as well as making us think we understood a horse!
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