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Discussion on 10 yo TB Gelding in Urination Stance, Other Factors
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Member:
Sjeys
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Posted on Thursday, May 12, 2005 - 7:59 pm:
I have a 10 year TB Gelding who over the past several months has exhibited odd symptoms including bucking a lot, shying, and becoming very frustrated under saddle. Initially I thought he had hurt a hind leg while out doing a short trail ride and so left him off for several weeks. We then thought he had hock issues (very mild hind end lameness, one leg worse than the other) and put him on Cosequin.
Ten Days later, he started stretching out like he was trying to urinate (it looks like a tying up stance), but not urinating or DrOpping down. He is always able to move out of the stance and his muscles do not appear overly hard in his hind end. This went on for several days. Labs show normal values and slightly elevated CPK. Normal range is less than 500, his was 1024. Electrolytes were normal. This horse is turned out 24x7 on 1 acre of land. He wasn't worked during any of the episodes. We checked and he did not have a bean blocking his urination.
He continued to get worse (his drinking become almost nonexistant during these days) and became lethargic until the vet had to be called because the horse would no longer eat, drink or move from one spot. He treated it as a colic and tubed him and he felt much better and appeared to return to normal.
2 days later, the horse again had the "tying up" stance. He was visibly sore in his hind end. We also noticed a large softball sized hard mass (non-painful) that sat on the side of his neck where it joins the body. We ignored it at that time (the vet thought it may have been from giving him a shot several days before hand). Recently, the vet took fluid from this lump which is still the same size and got clear serum and blood. Ultrasound showed a hard mass with three small (.5 cm in size) pockets of fluid. The vet mentioned something about "pigeon breast" to me as a possibility for the lump, but we are waiting on lab confirmation.
The vet prescribed banamine for the "tying up", and did some neurologic testing--walking in a circle, tail pull etc. He did very well but we noticed that on his hind end the musculature on one side wasn't as well developed as the other side. The vet thought we probably had a case of early EPM and prescribed Navigator. I didn't do the blood test because almost all horses test positive and I also passed on the CSF because of the difficulty in getting a good CSF sample without contaminating it with just a few red blood cells. (Yes, I am kicking myself now, for NOT getting the test )
The horse has been on Navigator for 15 days now. The first 13 days he immediately improved and looked and acted better than he has in months. Today, however, he started the classic tying up/urination stance. I just leave him alone when he does it and after about 5 minutes he usually moves on.
Just wondering if there's anything else I can do here; my current plan is to wait it out and finish the 28 day course of Navigator and if continues to do the weird urination stance, to send him to a University hospital. My vet says he has no idea what else this could signify beyond EPM / something neurologic / or a kidney issue. He is happy, eating, drinking and grazing (so far).
Any suggestions on what to research/labs/suggestions are greatly appreciated. Thanks for your time.
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Member:
Ryle
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Posted on Thursday, May 12, 2005 - 8:33 pm:
I would say get a better diagnosis. Your horse (from your description) isn't really acting neurological, plus you've got the unexplained swelling. So, symptoms not consistant with EPM.
And even if he is neurological, there are many many things that can cause neurological symptoms in a horse and testing is required to determine which one of these is the culprit in each individual situation.
The blood test is far from a waste of time/money since if it is negative you can be pretty dang sure you don't have EPM. Whether as many horses as previously thought have been exposed to the parasite that causes EPM is now coming into question too, so there may actually be more chance that your horse will be negative on the blood test. Diagnosing EPM is really done by ruling out everything else and still having EPM in the list. Right now, you don't even know if your horse has been exposed to the parasite that causes EPM and you are spending a big chunk of money on a drug that can have severe side effects.
I hope you can find the answer to your horse's problem.
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Member:
Sjeys
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Posted on Thursday, May 12, 2005 - 9:41 pm:
Thanks for your post, Cynthia. My vet had mentioned to me that horses in Texas, about 99% are positive to the blood test. I also read online that 82% of 20 year old horses test positive for EPM even though they do not show any symptoms. I'd also heard that you can have a false negative, though rare. When my vet looks at me and says, "I REALLY think you are looking at EPM", I'm inclined to go that way especially with the muscle wasting on one side of the hind end.
Also since the Navigator is already halfway done (and the results have been VERY good, except for this urination stance that he just re-started today), I'll obviously continue along that route.
I read online (I believe on this site) that Pigeon Breast is aka as Dryland Distemper and results in odd, shifting lameness, many times in the hind end and behavioral changes (if I recall correctly). So, at the very least, it could have been a case of dryland distemper (which, I've heard is quite rare in Texas) that was causing the lameness and odd stances. He also had elevated CPK levels, so you can see why I am at a loss--its a hodgepodge of symptoms.
I just wanted to see if anyone had any suggestions, so thank you for posting your suggestion to have the labs done for EPM.
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Member:
Ryle
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Posted on Thursday, May 12, 2005 - 11:06 pm:
Dr. Reed from OSU stated at the Western States Veterinary Conference discussion on EPM this past Feb. that the exposure rate is actually only about 52% in all horses. So only about 1/2 of the horses in the US have been exposed, though lots of vets still believe that most horses have been exposed.
Yep, I can understand why you would be at a loss. To me, that's all the more reason to test to find out. I've seen too many cases where owners didn't do labwork and wasted money and time treating for something that wasn't the problem. And there is no one who is capable of looking at a horse (especially one with a hodgepodge of symptoms like that) and diagnosing EPM. Even with an obviously neurological horse, diagnosing EPM is not simple.
Good luck. I know how having a sick animal can make you worry and stress.
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Member:
Sjeys
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Posted on Friday, May 13, 2005 - 12:29 am:
Thanks for your information from OSU. I'm sure that some would feel comfortable with a 52% false positive rate, but again, I just didn't feel like it would be worth it to bother with the blood test based upon that likelihood. At this point, with the good response I am seeing to Navigator, I'm not going to stop treating it to test.
I guess my initial question was more about the recurring urination stance/elevated CPK levels/looking like tying up with no predisposing factors. Just as an FYI, we ran the standard CBCs and all were WNL except for the elevated CPK. We did try and rule out other known causes like West Nile and the more obvious synDrOmes, but he didn't exhibit the expected symptoms for any that my vets could think of.
So, I'm more concerned at this point with the odd stance and the waning off and on of hind end lamenesses. Like I said, today he's eating/drinking and happy, but a few weeks ago this odd stance was followed by lethargy, depression, not drinking for days, followed by not eating, followed by not moving.
I guess I'll find out in 28 days for sure, once we finish the course of Navigator. If he continues along this course, he will have to be shipped to University since my four vets are not sure of the diagnosis, due to the odd symptoms and with only 1 test result elevated.
This was more of a "what am I obviously missing" post...so any suggestions on what else I can test or look for is appreciated. Thanks.
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Moderator:
DrO
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Posted on Friday, May 13, 2005 - 7:22 am:
To me it appears you are having recurrent episodes of colic and then it became complicated with an injection reaction. The "parking out" is a frequent sign of abdominal pain and when combined with the later symptoms of depression and inappetance, I think colic is likely. The slow onset and recurring nature suggest impaction but that is just a guess. Urinalysis and ultraound of the urinary tract is also in order to rule out such problems, but I am betting colic.
I think the mild CPK elevation would be related to the myositis in the muscle of the neck from the swelling. For tying up I really like to see a 4X increase or greater. I also think a sore neck can make a horse appear sore all over.
Lastly I think Cynthia makes lots of vaid points, based on your posts Susan. It seems like an awful lot else going on and then hanging a diagnosis of EPM on uneven muscles mass seems a bit out there. First this is not a common early symptom of EPM, though it is often put in the list of clinical signs. Navigator is expensive and fairly toxic, adverse reactions are common. However we are not there to examine the horse so you must continue with your best guess and the advice of the one who can see the horse, however these are points you can discuss with your veterinarian. We have articles on EPM, Tying Up, Colic Diagnosis, and Adverse Injection Reactions which all should give you food for thought.
DrO
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Member:
Scooter
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Posted on Friday, May 13, 2005 - 9:41 am:
Hi susan, Just to throw another possibility at you how about laminitis. Every time I have had a horse present with that stance and thought it was tying up or trying to pee it has turned out to be founder. They act like their hindend hurts when actually it is their front and they are trying to take the weight off the front. Have you checked for elevated pulses in feet? Is he overweight? Just something else to consider.
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Member:
Scooter
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Posted on Friday, May 13, 2005 - 9:47 am:
Just wanted to add my gelding just went thru this also and I thought it was his hindend, almost exact same symptoms went off feed and water & didn't want to move off and on, if possible take him off grass and put him up on some soft shavings and see if it helps. Took my gelding about a week to stabilize. Tis the season for founder.
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Member:
Sjeys
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Posted on Friday, May 13, 2005 - 9:53 am:
Hi Diane,
Thanks for your post. Ironically, I save foundered horses and rehabilitate them, so (un)fortunately, I have a lot of experience with this. Also, unfortunately, I've had founders from high insulin levels (the now classic metabolic synDrOme), Dex injections, and bad farrier (cutting to within 4 mm of the coffin bone), overeating of grain etc. I've had laminitis, classic rotation and 1 sinker...but I will check for pulses in the front feet as every single case of laminitis/founder that I've dealt with was specific to the horse. In other words, they all presented quite differently depending upon severity, rotation and other factors; you can never tell for sure until you run the X-Rays. Thanks.
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Member:
Sjeys
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Posted on Friday, May 13, 2005 - 10:30 am:
Dear Dr. O,
Thank you for your response. I mentioned the EPM diagnosis and treatment for two reasons: it seemed irresponsible to leave it out even though I knew people would latch onto the fact that I didn't run the CSF. I wanted to get past that fact, which is why I posted in this particular section:I was more interested in the weird stance and what that could signify since that is the factor (besides hind end lameness and uneven muscle mass) that has been steady.
I also wanted this board to have the whole story on what I saw. I'd be remiss if I didn't report everything that was out of character and all my efforts to address the symptoms.
It sounds like it would be safe to run the CSF at any point, even during treatment? Since he's acting much better (normal until yesterday's odd stretching bout), I was hoping the medicine was helping. So far, no side effects at all: he's happy, healthy, nice TB weight, fantastic coat, great attitude. Of course, I haven't worked him, but he's been trotting and cantering a lot more since treatment started than during the last few months; this is a horse that thinks, why walk when I can trot and why trot when I can canter? 
So, here are my two questions:
1. Can I run the CSF even now in the middle of treatment?
2. If it is an impaction colic, how long should I let it go? Last time we went for days of him stretching out and me giving him Banamine, he initially refused all but the smallest amounts of water. He then stopped eating and moving. That vet at that time believed it WAS colic. Later vets who came out and saw the same stretching out symptoms and the hind end lameness said "there's no way that's colic"  , but of course, at that point he was back to eating/drinking and grazing. If a horse doesn't drink water on his own for X number of hours, should that be an overriding reason to call the vet? (Along with the odd stance of course).
I know this is a ridiculous cornucopia of symptoms; it sounds like I'm not the only one who's reaching here for something to grab on to. Thanks, Susan (and her horse who stands funny, but other than that is doing pretty darn well today).
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Member:
Ryle
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Posted on Friday, May 13, 2005 - 1:53 pm:
Susan,
You don't seem to be understanding the blood test results, the 52% is not a "false positive" rate. It the percentage of horses that have been exposed to S. neurona. So if you do a blood test and your horse is negative, he hasn't been exposed to S. neurona so does not have EPM. And if it's positive then you could go ahead and do the CSF to actually test for active disease.
You can run either test during treatment (though I don't know about adding anesthetic agents on top of Navigator) because they will not become negative just because a horse was treated. Before you do a CSF tap to test for EPM, get a blood test done. It's much less invasive and if it's negative then there is no need to do the CSF.
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Moderator:
DrO
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Posted on Saturday, May 14, 2005 - 7:17 am:
Hello All,
Yes it could be run at this time but would consider just running the blood test, for more on the diagnosis of EPM see the article.
Susan we outline specific treatment for impactions, including water, at Equine Diseases » Colic and GI Diseases » Colic in Horses » An Overview of Colic
and undiagnosed colic in general at
Equine Diseases » Colic and GI Diseases » Colic in Horses » First Aid for Colic.
I don't see anything you have described that cannot be explained by the colic and injection reaction but if I looked at the horse I might feel different. I am glad to hear your horse is doing better and the question is, "is it because of the medication or inspite of it"?
A few corrections to statements above:
Note that the role of dexamethasone in causing founders is conjectural and remains a very debatable question. Experiments attempting to cause founder with high repeated doses have not been able to cause founder. Also though Eq Metabolic SynDrOme is associated with insulin resistance and founder, it is not clear that the high insulin is the cause of the founder. There are some fascinating associations with hypoglycemia at the intracellular level and the experimental induction of founder but what the relation between this and the real founder is uncertain. For more on this see the articles on Founder and Equine Metabolic SynDrOme.
DrO
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Member:
Sjeys
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Posted on Sunday, May 15, 2005 - 2:07 pm:
Hi Everyone,
THE FOUNDER SECTION: (REAL POST W/PICS AT THE BOTTOM)
Dr. O and members, thanks for your input. Unfortunately, I have been very involved with Founder due to my limited rescue efforts and have read your paper on it. I've had the good fortune to be able to contact some of the top folks in this field like Katy Watts, a grass researcher in Colorado, Dr. Sarah Ralston, out of Colorado, Dr. Chris Pollitt, Australia, Dr. Phillip Johnson, etc...all in search of a "cure" for my first rescue pony that foundered. I completely agree that we don't yet know the causitive agent and, from what I've seen there are many different causes of founder--the typical over ingestion of grain, bad shoeing, hard work surface, the list goes on and on. (And the causes, depending upon who you ask, go on and on).
However, in this particular pony's case, the only thing we could find wrong was an insulin level 10-15 times higher than normal. We tested her every 8 weeks for glucose, insulin, and everthing else we could think of and only once did the glucose also come up elevated. Typically, her insulin was 10-15 x higher than normal.
This was 4 years ago, and I just happened to luck into some good information about sugars in grasses (a laughable notion at the time, but one Dr. Ralson told me about and luckily this notion is quickly gaining ground today) and decided to try this wild notion that certain types of grass and hay could make this pony founder. She'd had about six episodes of laminitis, followed by 3 bad founders (13-14 degrees in her front feet) and we'd tried everything: softer ground, NO alfalfa, no grain of any kind, etc.
We put her in a large sand stall, no shoes and I had my hay analyzed (unfortuately, we found that the dry looking oat hay I'd been feeding her was over 30% sugar so I switched to a Bermuda, which we had analyzed at 8% sugar) and she finally started to get better. One year later, her feet were de-rotated and she's been rock solid sound since then.
It took about six months to a year of diet change (and not just the hay, but NO treats, no sugar of ANY kind and I even switched her wormer to one without Molasses--read the ingredients on your womers) and we finally got that insulin level to within 20% over normal.
So, in this one pony's case, eliminating excessive sugar seemed to bring her insulin levels down to within normal range; it took a long time and she still isn't normal but I think my vet is convinced, that in this particular case it worked. Laminitis and founder is such an exciting area of research now--I could go on and on (but will spare the list ) on the fascinating things we are finding out every day. I also don't want anyone to go off half cocked thinking I'm espousing any particular laminitis/founder treatment. I'm a very conservative person when it comes to treating horses, so no matter, what gather all the information you can and make the best decision for you, your horse and your circumstances.
You are also correct in that some believe that DEX isn't a causitive agent in a vaccuum, but interacts with other things. A lot of what I've read (including from the laminitis trust in the UK) does list it as capable of causing founder. In this particular case, nothing else had changed in this horses env. but I'd been treating him with a 1 week course of DEX 3-4 times over a 3 months period due to his tendency to get monstrous lymphagitis attacks. (He's an old gray in his 20's). We'd been warned about the risk of founder (and oddly enough he foundered in his back feet), but unfortunately, without the Dex, the attacks would have killed him. So, trading one bad for another.
NOW TO THE REAL POST
Okay, I need a reality check here. I've uploaded pics of both the original horse in this post (a BAY) and my DEX foundered horse (a gray). You will notice them BOTH now adopting the odd stance...On a scale of 1-5 (with 5 being the worst I've seen), these are a 1, they will stand for 5 minutes or more in a 4-5 stance, but I am so worried when they are really stretched out, I go move them a bit, so no pictures of those super scary stances). Obviously, i'll be calling the vet on Monday as I'm wondering if its something in the grass they are eating? By the way, both animals are in different pastures.
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Moderator:
DrO
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Posted on Sunday, May 15, 2005 - 5:49 pm:
Hello Susan,
The idea that moving foundered horses off of rich grasses for founder is a time tried method that works dependably, but the question remains why and may be multifactorial.
Currently the theory that is most consistant with what we know at this time is that the dietary change reduces sugars reaching the large bowel which in turn reduces the release of metaloproteinases (MMP's) by the bacterium Staphylococcus bovis from the cecum as presented at the AAEP 16 months ago. The following steps have been well demonstrated experimentally both as indiviual steps and as a complete models of founder: sugar overload >> increase growth of S. bovis in the cecum >> Increase MMP's in the blood stream >> founder.
As stated earlier intracellular hypoglycemia of the cells of the laminae has been shown to have a experimental role in founder. The role of insulin is to drive glucose into the cells. I would suggest to you if glucose metabolism has a role in natural occuring founders it is not the high insulin levels causing the problems but the cells lack of responsiveness to the insulin, and the resulting cellular hypoglycemia, but the this has yet to be shown. If you would like a "thought experiment" role of Dex, it does make the cells less responsive to insulin. I can think of several other mechanisms but experiments trying to induce founder with overdoses of dex have not been able to induce founder. Though there may be some very reputable people who state it is causitive, they base that opinion on heresay and not on any scientific evidence, in fact they contradict the science to date.
Peeing and colic are both consistant with the stance of the grey horse. I could see an incoordinated horse adopting this stance, the question would be did "he put himself here in a very deliberate manner" or did he "get here by moving the front and forgetting about moving the rear". In the second case the horse should be displaying remarkable incoordination at all gaits and all times.
DrO
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