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  Discussion on Worrisome blood work and chronic diarrhea
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Member:
bluedog1

Posted on Saturday, Mar 29, 2008 - 9:08 pm:

Hi Dr. O,
I have made several postings about my Cushings/IR 24 year old pony mare who has among other things, had periods of long lasting diarrhea since last April. These episodes of cow pie manure have lasted anywhere from a week or two to several months, with short breaks of more normal manure in between. She has been dewormed every 6-8 weeks (most recent Jan 4 Strongid paste, Feb 17 – Equimax)

She is sensitive to any alfalfa in her diet and I sometimes have attributed the diarrhea to the occasional bales that had some alfalfa mixed into the grass hay.

From my notes, she had very loose manure from April1-6, April 12-May 8, July 20-Aug 8, Sept 24-Nov 5. She had a long period of hoof pain, diarrhea and weight loss that I posted about and seemed to finally come to an end. She was doing very well and I had more blood tests done last month before I leased her. I leased her to a nice family and had to move her to a new barn in mid Feb.

The hay at the new barn wasn’t 100% grass hay as I thought and instead, has quite a bit of alfalfa mixed into it. We got some of the hay she had been on previous to the move and things looked a little better, but the loose manure persists. In the mean time we have located a hay dealer who sold us excellent 100% brome/orchard grass hay. (4.6% protein, 7.6 NSC) We have been feeding her one flake of the new stuff mixed into the rest of her hay ration. She continued to have wet manure and I started her on Platinum Performance’s BioSponge. I thought things were getting better because the last few days, the manure looked pretty normal. Today, I found a puddle of very dark sloppy manure in her stall.

She got her shots yesterday along with a shot of banamine(precaution based on reaction last fall with swollen legs). Could either the BioSponge , vaccinations or Banamine make her manure so dark? She was also a little depressed, standing with head down, didn’t want to come out of her stall which is very unusual. I am worried that there is something else going on with her. I want to call the vet to do a fecal culture, parasite check etc. What do you think would be helpful here Dr. O?

No fever, weight currently is good, appetite ok, don’t have a handle on drinking and urinating because stall is cleaned and water buckets refilled when I arrive, but I think her stall is fairly wet.

Here is a history of lab work we have had done in the past year…

In Feb 2007, we noticed she was standing in her stall with head down. Vet said her gums were pale with yellowish color as well as sclera of eyes. Blood tests were normal except for
Total protein was LOW 4.5 g/dL (5.2-8.2),
Albumin was LOW 1.9 g/dL (2.8-3.8),
Alk Ptase was LOW 71U/L (86-262)

In August 2007 – long period of diarrhea, weight loss, performance problems. I posted regarding this and hopefully you can see it at:

the abnormal results from blood tests from this exam were: (this was from a different lab, so ranges are different)
RBC 6.2 (6.5-10.5)LOW
Hemoglobin 9.7 g/dL (11-19) LOW
Hematocrit 29% (35-52) LOW
Lymphocytes 25% (25-70) LOW?
Albumin 2.1g/dL (2.2-3.9)LOW
A/G ratio .5 (.5-2.4) LOW?
Phosphorous 1.9 mg/dL (2.0-5.6)LOW
Vet said these results weren’t very troublesome, but warranted monitoring.

Nov 5, 2007 – Blood tests done upon vet visit when her legs became swollen a week after vaccinations and did blood test to follow up from August.
Hemoglobin 9.7 g/dL (9.8-17.1)LOW
Hematocrit 28% (27-47.5)
Direct Bilirubin .3 mg/dL (0-.2) HIGH
Indirect Bilirubin .3 mg/dL (0.0-0.0) HIGH
Albumin 2.3 g/dL (2.8-3.8) LOW
Globulin 4.4 g/dL (2.6-4.0) HIGH
Calcium 14 mg/dL (10.2-13.4) HIGH

Feb 2008
Direct Bilirubin .2 mg/dL (0-.2)
Indirect billirubin .5 mg/dL 0-0.2) HIGH
Albumin 2.9 g/dL (2.8-3.8)
Globulin 4.6 g/dL (2.6-4.0) HIGH
Phosphorous 1.5 mg/dL (1.7-5.8) LOW
Potassium 2.5 mmol/L (2.9-5.6) LOW

There are more values in the normal range, but to the upper or lower end of the range. If you want to know which those were, I can post those too.

I’m not looking for a diagnosis, but maybe a direction I should go with this problem. Thank you and I look forward to what you have to say.
Member:
bluedog1

Posted on Sunday, Mar 30, 2008 - 6:37 pm:

I went out to the barn this afternoon and not only is the diarrhea persisting, but Dakotah had not eaten her grain ration with the biosponge. I'm sure it doesn't taste very good. The guys who clean stalls said she didn't eat yesterdays ration either. The thing that shocked me was that she had no interest in eating the Safe Starch Forage that she gets in a floor pan. she normally dives into the bowl. They have gone back to feeding her only the hay that she was on before the move. I watched her eating her hay and she really just picks at it. I taped her and she is back down to 700 lbs. I taped her a week ago at 765. Her flanks look sunken in too. I sure hope this gets resolved soon. I will call the dentist as well, just to check her.

I'm calling the vet tomorrow and hopefully you will suggest a plan of action too. Maybe we just haven't stuck to one plan long enough for it to work.
Member:
scooter

Posted on Sunday, Mar 30, 2008 - 6:44 pm:

Hi Jackie, Im not sure about the rest of your symptoms, but being off feed and not feeling well can be caused by vaccinations. Which shots did she receive? Maybe another half dose of banamine would make her feel better...just guessing. Are her vitals still good? I know my horses are "off" after vaccinations usually.
Member:
bluedog1

Posted on Sunday, Mar 30, 2008 - 7:50 pm:

Hi Diane, thanks for your suggestion. The barn manager and I talked about that and we are going to monitor her to see if her appetite improves over the next day or so.
Moderator:
DrO

Posted on Monday, Mar 31, 2008 - 8:12 am:

The vaccines could be the cause of the depression (soreness) but neither the vaccines nor flunixin would cause the stools to be dark. I do not know about the Biosponge. You should have your veterinarian evaluate the dark stool however and the depression if remarkable or worrisome.

Concerning tests results you start with an exam and then let it determine what further tests need to be run Jackie. I think the blood work looks a bit improved in the more critical values (albumin and apparently hematocrit) and you almost always have a few values out of line even in healthy horses so nothing in the latest tests are of significance from here, again however the exam is a more important evaluation than the labs.
DrO
Member:
bluedog1

Posted on Monday, Mar 31, 2008 - 8:24 am:

Thanks Dr. O,
I will call the vet out today and let you know what she finds.
Member:
vickiann

Posted on Monday, Mar 31, 2008 - 11:36 am:

Oh, Jackie -- I am hoping for some improvement for your horse. A friend of mine had an older boy who kept DrOpping weight in spite of all attempts to stop it, and the problem was encysted (resistant?) strongyles, requiring a special multi-day worming regimen, but that is probably too simple a problem to hope for. They had tried other wormers, including Quest, to no avail.
Member:
bluedog1

Posted on Monday, Mar 31, 2008 - 6:48 pm:

Thanks for the good wishes Vicki. I met the vet out at the barn today and of course, the day I call the vet, the manure in her stall was perfect and her bottom was clean as a whistle! She was much brighter today and I am attributing the depression I saw over the last few days to the vaccinations she got on the 28th.

The vet did a very thorough exam. She said her gut sounds were good, although a little decreased on the left side, no edema, pulses good, hooves cool, gums were a good color, body condition was nothing alarming, with fat between the ribs and pressure needed to feel each one. She went over many things that could cause chronic diarrhea some of which were sand in the intestines, parasites, salmonella, and some others I can't remember. The information was coming too fast for my old brain to completely retain. She did a rectal exam and said everything felt normal and that there was normal feces in front with more watery feces following them. She took samples for the salmonella test as well as for a sand test. The sand test showed a very little bit of gritty material at the bottom of the glove.

She also took blood tests which included glucose/insulin. She wanted to see, among other things if the Albumin and hematocrit are still low or if it has moved up into the normal range. We should hear about those in a few days. The others will take about a week.

The plan is to give Dakotah succeed paste daily for 30 days, keeping her on the old hay that she ate at the other barn until she has normal feces for 7 straight days, then adding the new hay by 1/4 flake every two days until there is a complete switchover. I am also to start her on Psyllum for potential sand colitis.

We are to monitor her feces and call in 5-7 days if there is no improvement. We are to keep an eye on her temp, gum color, feet, digital pulses as well. There may be more instructions depending on the results of the blood tests. Even though my deworming program is good, she wants me to give Dakotah a Panacur Power Pack in June.

I guess I don't have a question, but just wanted to post the update.
Member:
bluedog1

Posted on Monday, Mar 31, 2008 - 6:52 pm:

Oh, I forgot that I mentioned the dark stool to the vet and she didn't like the sound of it. She said she may have gastric ulcers. I may have misunderstood her, but I thought she said the banamine given with the vaccines, may have irritated gastric ulcers. She said that blood that comes from the stomach will show up dark in the feces, as opposed to blood coming from the intestines will show up like frank blood. Did I get this right? So, first things first, we'll wait and see what the blood tests show.
Member:
vickiann

Posted on Monday, Mar 31, 2008 - 7:02 pm:

I am very relieved that she is doing better, Jackie, and it certainly sounds as though you are covering everything. I believe that it was the Power Pack that straightened out the problem with the older dressage horse that was consistently losing weight when nothing else worked. I will be thinking of you and your horse.
Moderator:
DrO

Posted on Tuesday, Apr 1, 2008 - 10:50 am:

Jackie, I think it very unlikely a single injection of flunixin, with or without vaccination, has caused gastric ulceration. However that is not the same as saying your horse does not have ulcers. But even severe gastric ulcers in horses is not associated with melena, the technical name of dark digested blood in the stools. Melena is usually a symptom of carnivores and omnivores with shorter digestive tracts and little microbial digestion. Darker stools is common in normal horses off grass and fresh green hay.
DrO
Member:
bluedog1

Posted on Tuesday, Apr 1, 2008 - 5:07 pm:

I just got some results from the vet, they were reported to me as relative values, but I will get the exact values with the report.
BUN elevated
WBC Low
RBC Low
Hematocrit Low
albumin 2.7 low end of range
The vet said she believes Dakotah has a colitis that may be from sand, ulcers either gastric or colonic, low grade infection such as salmonella, or it may even be the alfalfa she initally ate when she arrived at new barn and her guts have not settled from that. She said she didn't believe it is chlostridium since these horses present as much more debilitated.
The plan is to continue with the succeed, and psyllium with an option of adding Omeprazole for possible gastric ulcers. The vet said the cost to scope and the cost of the Omeprazole is about the same and most people just go for the treatment. I inquired about the Succeed fecal occult blood test and she said the test isn't perfect and it's hard to draw conclusions from the results.

We are to keep a close eye on her and monitor her drinking as well. The woman who leases her just told me that Dakotah had normal manure today, but was a little quiet and mopey. I'm going to take temp and will report back.
Moderator:
DrO

Posted on Wednesday, Apr 2, 2008 - 8:52 am:

Jackie, we have had reports from members with problems with the Succeed Occult Blood Test.
DrO
Member:
bluedog1

Posted on Friday, Apr 4, 2008 - 7:45 am:

An update..
Still waiting for the Vet's office to send me the blood test results.

We now have a pony with much energy and completely normal manure and a very clean bottom! In fact the manure has been normal since the vet visit. We have been giving her the succeed paste daily and I just added psyllium to her diet two days ago. She is still eating only the hay from the previous barn. Dakotah has practically eaten her salt block in the mean time which I am assuming is a response to being dehydrated. She does not consume much water, however. We have been monitoring it and it seems like she drinks between 5-6 gallons per day. Is this enough considering she is getting psyllium now? She weighs about 750 pounds.

I'm not sure what did the trick, but I'm glad she is doing well. We will try to integrate the new hay into her diet on Monday. Lets keep our fingers crossed this goes well!

(Dr.O, I don't think this post belongs in CRF, so if you want, go ahead and move it.)
Member:
stevens

Posted on Friday, Apr 4, 2008 - 9:23 am:

For what it's worth; I had an old horse that had chronic diarrhea who also ate his salt block. We removed the salt block, started supplementing him with pellets and it went away.
Moderator:
DrO

Posted on Saturday, Apr 5, 2008 - 9:56 am:

Ditto Chris' advice on the over eating of salt, this has potential harmful effects and recommend you feed a controlled amount of loose salt added to the concentrate, for more see, Horse Care » Equine Nutrition, Horse Feeds, Feeding » Minerals and Electrolytes for Horses, an Overview.

Perhaps I have forgotten something from above but why would you change the diet now that the stools are normal? Now is the time to try to stabilize the diet so the bowel can settle down.
DrO
Member:
bluedog1

Posted on Saturday, Apr 5, 2008 - 9:03 pm:

Thanks Chris and Dr. O, I will read the articles on electrolytes. She never eats her salt block, but did the other day, I thought it was a reaction to being dehydrated. Normally, she does not do this.

It's confusing but basically, in mid February we moved Dakotah to a new barn where she was quickly changed over to the new grass/alfalfa mix. She immediately developed diarrhea which is her typical reaction to alfalfa.

We then started searching for some new 100% grass hay and in the mean time fed just the hay from the previous barn. We started to slowly integrate the new grass hay into her diet and the diarrhea persisted. The diarrhea continued on and off from Mid Feb through late March when the vet came out.

The day the vet came out, she had normal feces, before any treatment was started, and has had normal feces since then.

As per the vet's order, we have taken out the newly purchased grass hay, and have purchased a little more of the hay from the previous barn. The vet asked us to do this because Dakotah did not have diarrhea for about 3 months before we moved her and all this new hay was introduced. Keeping her on the hay from the previous barn was an effort to settle her guts down, along with a month long course of succeed paste and phsyllium.

However, she does have a history of chronic diarrhea even at the previous barn with the same hay. There have been long periods of cow pie manure with intermittant periods of normal manure.

I am thinking that perhaps the change in hay may have upset some underlying condition and for whatever reason has now settled down. Based on her history, I think it will return.

Dr. O, what do you think of the persistant low albumin, hematocrit and now low WBC as well as the history of on and off diarrhea. My fear is she has something seriously wrong like cancer in her intestines.
Member:
bluedog1

Posted on Saturday, Apr 5, 2008 - 10:06 pm:

Perhaps I have forgotten something from above but why would you change the diet now that the stools are normal? Now is the time to try to stabilize the diet so the bowel can settle down.
DrO}

Ok, I misread what you were saying Dr. O, sorry.

We need to get her off of the hay she is currently eating (hay from previous barn) and onto the new grass hay we purchased for her earlier last month because we will be unable to keep buying the hay from the previous barn. We have enough of the old hay now for a few more weeks. The vet said that, after 7 days of normal manure,to start adding the new hay 1/4 flake every 2 days but I think I will wait a little longer.
Moderator:
DrO

Posted on Monday, Apr 7, 2008 - 7:55 am:

I have not seen those values Jackie.
DrO
Member:
bluedog1

Posted on Friday, Apr 11, 2008 - 7:59 am:

I wanted to post an update..Dakotah has had normal manure for 11 days now. She's bright and alert and looks great. Needless to say I am thrilled, but mistified.

Dr. O, why do you think she has these episodes of diarrhea and weight loss for several weeks at a time, then recovers for a little while? My vet is thinking sand colitis since she is always fed on the ground in dry lots. We are finishing the 30 day treatment of succeed and will give her psyllium once per week. I will also deworm her with panacur power pack in June.

Can sand colitis cause her blood work to look the way it has with low RBC and hematocrit as well other abnormal results? Here are the latest CBC, chem blood test results from Mar 31. At the time of the blood draw she had been having cow pie manure for about a month with a few days here and there of more normal manure. She also had spring vaccines with banamine 3 days prior to the blood draw. Values from other blood tests are posted above.

Basic Equine Screen March 31, 2008
AST (SGOT) 189 IU/L 180 - 570
Total Bilirubin 1.6 mg/dL 0.1 - 2.5
Direct Bilirubin 0.3 mg/dL 0.0 - 0.5
Alkaline Phosphatase 160 IU/L 50 - 300
GGT 12 IU/L 2 - 30
Total Protein 6.8 g/dL 5.6 - 8.0
Albumin 2.7 g/dL 2.2 - 3.9
Globulin 4.1 g/dL 2.6 - 5.6
A/G Ratio 0.7 0.5 - 2.4
Cholesterol 87 mg/dL 70 - 150
BUN 27 mg/dL 10 - 25 HIGH
Creatinine 1.4 mg/dL 1.2 - 2.0
BUN/Creatinine Ratio 19 5 - 21
Phosphorus 2.7 mg/dL 2.0 - 5.6
Calcium 11.2 mg/dL 10.0 - 13.7
Verified by repeat analysis.
GLUCOSE 116 mg/dL 70 - 120
Sodium 135 mEq/L 130 - 146
Potassium 3.6 mEq/L 3 - 5
Na/K Ratio 38 24 - 58
Chloride 97 mEq/L 95 - 110
CPK 121 IU/L 20 - 500
LDH 167 IU/L 150 - 450
Complete Blood Count
WBC 4.2 103/uL 5.5 - 12.5 LOW
RBC 6.9 106/uL 6.5 - 10.5
HGB 11.3 g/dL 11.0 - 19.0
HCT 31 % 35 - 52 LOW
MCV 45 fL 34 - 58
MCH 16.4 pg 12.3 - 19.7
MCHC 36 g/dL 31 - 37
Comment
RBC MORPHOLOGY NORMAL
Neutrophils 40 % 30 - 65
Absolute Neutrophils 1680 /uL 2700 - 6700 LOW
Lymphocytes 40 % 25 - 70
Absolute Lymphocytes 1680 /uL 1500 - 5500
Monocytes 14 % 1 - 7 HIGH
Absolute Monocytes 588 /uL 0 - 800
Eosinophils 4 % 0 - 11
Absolute Eosinophils 168 /uL 0 - 925
Basophils 2 % 0 - 3
Absolute Basophils 84 /uL 0 - 170
Platelet Estimate Adequate
Platelet Count 177 103/uL 100 - 400
Fibrinogen, Semi-Qua 312 mg/dl 100 - 400
Moderator:
DrO

Posted on Sunday, Apr 13, 2008 - 10:49 am:

To come to an explanation of why your horse has diarrhea and weight loss would require an examination Jackie but the various mechanisms of diarrhea are explained in the Overview of Diarrhea article. Weight loss is also covered at
Diseases of Horses » Colic, Diarrhea, GI Tract » Weight Loss in Horses. But I would like to note that the most common reason I see cases that sound similar to yours are management problems. Read these articles with that in mind first.

Your blood work is not supportive of chronic colitis of any cause. Your blood work is essentially normal with the mild abnormalities not significant for mild colitis. The low WBC count may indicate viral infection but could be found in normal horses too. The diagnosis and treatment of sand colic is explained at Diseases of Horses » Colic, Diarrhea, GI Tract » Colic in Horses » Sand Colic.
DrO
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