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  Discussion on Medication precautions
Author Message
New Member:
sockers

Posted on Sunday, Apr 26, 2009 - 3:23 pm:

My 8 YO mare was bitten by a rattlesnake. I took her to the vet and she was treated for 2 days. Her condition has improved and my vet is leaving town and is sending her home with me. He has left the IV catheter in place and instructed me to give lasix and banamine IVP and also to start her on Uniprim (she has been given ampicillin while at the clinic). His only instructions were to make sure she gets the Uniprim...if she won't eat it in her feed, I am to mix it with apple juice as it is important to make sure she gets it, and also to make sure she has plenty of water available at all times. Are there any other precautions I should take? Any other discharge instructions you would recommend?
Member:
hollyw

Posted on Sunday, Apr 26, 2009 - 3:52 pm:

Oh, gosh, Lee . . . how awful. Friends in TX were just telling me about rattlesnakes they have killed this week. One woman told me that she saw one on the highway, and it was striking at cars as they DrOve by.
Glad your mare was able to get medical attention right away.
Where was she bitten? Nose? Leg?
Member:
vickiann

Posted on Sunday, Apr 26, 2009 - 6:02 pm:

Lee,

I have no medical advice but hope that your care regime works well and that your mare will recover without any complications.
Moderator:
DrO

Posted on Sunday, Apr 26, 2009 - 6:05 pm:

Welcome Lee,
We have articles on Uniprim (a trimethoprim sulfa) and Banamine (flunixin) which will give you the information yo}u are looking for. You will find them in the Medication Topic:
1) Treatments and Medications for Horses » Antibiotics and Antimicrobials » Trimethoprim -Sulfa
2 HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Flunixin
DrO
Member:
mrose

Posted on Sunday, Apr 26, 2009 - 11:34 pm:

Hi Lee,
I just wanted to say that I have a good friend who had a 2yr.old that got bitten right on the muzzle. She couldn't get a vet right away and the horse's nose started to swell a lot. She put a piece of hose up one side of the nose to keep an airway open; put the horse on an antibiotic and a steriod. I can't remember just which ones as it's been quite a few years. Anyway, her horse recoverd just fine, although it took about a week I think for all the swelling to go down.

Also, I've found that for whatever reason, most horses will eat Uniprim powder on top of their feed. It must not taste as bad as some of the other meds. If yours doesn't, mix it with a little warm water, apple juice or whatever and put it in a large syringe that has the "nipple" on the bottom enlarged, and just squirt in in the mouth. Get the syringe as far back as possible when you insert it and hold the horse's head up until you see it swallow the stuff. I follow with a cookie, and the one horse I have that won't eat the drug off her feed, gives no resistance at all to it in the syringe.

Let us know how she does, but I expect she'll be fine.
Member:
mrose

Posted on Sunday, Apr 26, 2009 - 11:37 pm:

btw, Lee, did the vet tell you what signs to look for that would indicate any problems? Do you know how to watch respiration rates, pulse, etc.? I would be very surprised if your mare had any problems as I imagine any bad effects would show up soon after the bite; but it might be a good idea to keep a close eye on her just for your own piece of mind if nothing else.
New Member:
sockers

Posted on Thursday, Apr 30, 2009 - 9:10 am:

Dr. Oglesby -
I am sad to report that my mare died a week after the rattlesnake bite. Here's what happened. She was bit on Tuesday - severe reaction to the bite...her face was swollen and difficulty breathing. I took her to the vet that night. He treated her with fluids, lasix and antibiotics. Her condition improved. He was leaving town and said he felt I could continue her treatment at home. On Thursday he sent the horse home with the IV catheter in place instructing me to give lasix and Banamine IVP and uniprim PO. I was to remove the IV catheter after the last dose of lasix and banamine and then to start giving bute paste by mouth and continue the uniprim. The only instructions he gave me were to provide plenty of water and to make sure I got the uniprim down her...instructed me to mix it with apple juice or whatever to get it in her. When I asked him what I should do if she started having problems, he told me he would be available by cell phone and I should call him. The mare did fine on Thursday and Friday. On Saturday mare would not eat - I mixed the uniprim with apple juice and used a syringe to get it down her. I tried calling the vet several times and he would not answer. I called the answering service and told them to have him call me. On Sunday she continued not eating (was still drinking) and developed loose stools. I gave the uniprim via syringe. I called the vet several times...no answer. On Sunday evening I called the answering service and asked if there was another vet I could call. They gave me a number....called and reported the situation to the vet on call...she said since the horse was drinking there was nothing else she would do. On Monday the mare's diarrhea was much worse...basically water. I called my vet's office as soon as they opened. The office staff told me he would be in later that day and that I should wait and hear from them what to do. I called him and his office numerous times and finally decided to take her in. I left her at the vet..he finally saw her at 8pm that night. He started treating her but unfortunately she continued to deteriorate and she died on Wednesday. I am frustrated for several reasons - first that the vet was not available when he promised he would be and secondly that he did not give me proper discharge instructions - specifically what to watch for as far as adverse reactions. I spoke with a vet at Texas A&M and she said she never sends a horse home on this medication without instructing the owner to stop the antibiotic at the first sign of loose stool and to bring the horse in ASAP. She feels the horse died of antibiotic induced colitis. I would appreciate your thoughts on this case.
Member:
canter

Posted on Thursday, Apr 30, 2009 - 9:58 am:

Lee, I am very sorry for your loss. I can only imagine how frustrated and heartbroken you must be thinking that had you the proper instructions, your mare may have been saved.

Regardless, it appears from your post that you did your very best for your horse and I hope that gives you some comfort.

Fran
Member:
mrose

Posted on Thursday, Apr 30, 2009 - 10:09 am:

Wow, Lee, I'm shocked! I'm so sorry. I've known of several horses that have gotten bitten by snakes and none of them died. The only time I've heard of a horse dying from a rattle snake was one foal I heard of.

You did everything you could. I can't imagine the frustration! Again, I am so sorry.
Member:
lilo

Posted on Thursday, Apr 30, 2009 - 11:25 am:

Lee, so sorry to hear about your horse. How frustrated and anxious you must have been.

Rattlesnakes are a threat here in our area during the summertime. I am always worried when out riding the trails.

My heartfelt condolences,
Lilo
Member:
leslie1

Posted on Thursday, Apr 30, 2009 - 1:00 pm:

(((hugs))))

L
Member:
frances

Posted on Thursday, Apr 30, 2009 - 3:22 pm:

I'm so very sorry to hear this Lee, and horrified by the way your vet behaved. What an ordeal for you and your poor mare.
Member:
hollyw

Posted on Thursday, Apr 30, 2009 - 4:49 pm:

Dear Lee,
Just coming in on this thread again. So sorry to hear of the outcome. I agree with LL that your vet behaved atrociously. No excuse. How awful for you as you tried over and over to get help for your mare. You really did the best you could. So very sorry you and your mare had to go through this.
I hope the vet feels absolutely horrid . . . he deserves to be ashamed and humbled by this.
You have our sincerest sympathies.
Holly
Member:
rtrotter

Posted on Thursday, Apr 30, 2009 - 5:32 pm:

Lee,

My condolences on the loss of your horse and I wonder if there is malpractice insurance for vets. If you haven't paid the bill yet, I'd think twice about paying it.

I agree with the vet from Texas AM, I am always extra careful when my horses are on antibiotics and if they show the least sign of diarrhea, off of them they go. You vet should have informed you and he should have been available.

Again, so sorry for your loss.

Rachelle
Member:
mitch316

Posted on Thursday, Apr 30, 2009 - 7:07 pm:

Lee, I am very sorry to hear that your horse did not make it. This vet really left you hanging there. I wouldn't rule out a reaction to the other medicines either. While I have not heard of any rattlesnake bites causing deaths, there have been cases I have read about where anaphalactic shock as a reaction to the venom, especially if the body is having a hard time processing the toxin. But the same could be said for any of the medicines too. Has the horse had allergy problems before?
Member:
shirl

Posted on Thursday, Apr 30, 2009 - 7:45 pm:

Lee,

My deepest condolences.

Shirley
Member:
ekaufman

Posted on Thursday, Apr 30, 2009 - 9:48 pm:

Hi Lee,

Very sorry for your loss, and for your terrible experience trying to help your mare. I agree with the folks who said that the discharge instructions were insufficient, and the emergency/on-call support disastrous. Hope you have a choice of other qualified folks in your area.

- elk
Member:
paul303

Posted on Friday, May 1, 2009 - 12:51 am:

Lee, your story is very upsetting. You took all the right steps, yet got no support from your vet, nor the covering vet. I've never had a problem initiating contact with my vet, or her covering vet. Their callbacks are instant, and, if involved in a difficult case, their assistants take a history from me, relay it to her and give me her immediate advice.

If you still have the heart and the nerve to own horses after this experience, take your time recuperating from your grief, and use it to research vets in your area. It breaks my heart that you had to go through this.
Moderator:
DrO

Posted on Friday, May 1, 2009 - 10:19 am:

Hello Lee,
We list toxic colitis, a euphemism for clostridial colitis, as a complication of it's use in our article. On top of that I can remember two such cases over the past twenty years. I cannot say this is what happened to your horse but I think it is a plausible explanation.

As to your inability to get more veterinary help I think that is disappointing. In defense of your regular veterinarian I would say we all have had periods of misplaced, battery out, or malfunctioning communication devices. I would like to think this is the case and not someone who is ignoring your plea for help. But it does show we need a firm backup plan. Find your closest full service equine hospital and take time to talk with them about the possibility of late night emergency visits.
DrO
Member:
zarr

Posted on Friday, May 1, 2009 - 12:30 pm:

Lee, yours is the 2nd horse I've heard of dying from snake bite the other was in Ariz.! The rattlers are the only creature I will disspose of without question.

You did the best with the info provided however your vet needs to understand how badly you were left on your own!
Member:
paardex

Posted on Friday, May 1, 2009 - 2:15 pm:

Lee what a horrible story, the rattlesnakebite was bad enough but the way she died with all the questions and you trying to get help in vain is heartbreaking.
Jos
New Member:
sockers

Posted on Monday, May 4, 2009 - 2:07 pm:

Dr. Oglesby -
I have read the articles you suggested and my frustration with my vet's response to my horse's condition remains. After reading the articles and discussing the situation with many horse people, I have come to these points of contention with the treatment of my mare:
1. The horse was discharged too early considering the extent of her reaction to the snake bite. The vet was leaving town for vacation....he had no one that he transferred care to....said he would be available if problems arose (which he was not). The horse was at the clinic and only on IV therapy for less than 36 hours (vet said this was one of the worse snake bite reactions he had ever seen).
2. Inadequate discharge instructions were given. The vet's instructions were twofold - make sure the horse had plenty of water and make sure she continues to receive the antibiotics. I kept her three water buckets full (she was drinking). When she would not take the antibiotics in her feed, I mixed it with apple juice and put in a syringe and forced it down her.....after reading and discussions, I feel the antibiotics should have been stopped at the first sign of diarrhea. My guess is the lasix on exacerbated the problem.
3. Inavailability of the vet when an emergency situation arose....the office staff assured me he would be getting back on Monday and stated I should wait for his instructions.
I believe the horse might have been saved had the vet (or another clinician who had knowledge of the case) would of been available. The articles I have read and discussions I have had with others state that it is difficult to treat diarrhea in the field and quick response with IV therapy is the best course of action. IV therapy given sooner could have prevented the shock and renal failure the horse died from.

I would sincerely appreciate your opinion in this matter.

Sincerely,
Lee
Moderator:
DrO

Posted on Tuesday, May 5, 2009 - 7:35 am:

Lee,
1) Your posts suggests that the most likely cause of death was a reaction to the therapy and not inappropriate therapy for the snake bite.

2),3) You ask me to make a judgement that involves the interaction of you and others and contains some degree of speculation. I will not comment on them as I only know your side of this issue.
DrO
Member:
ekaufman

Posted on Tuesday, May 5, 2009 - 10:04 am:

Hi Lee,

Certainly you're coming out of a nightmare. I have no idea what your history is with your vet, or how disruptive it might be to move your business. I live in a small community (but with many vets) and I have once or twice had misfires with my vet practice that were very upsetting.

Out here, I have finally gained the ability to go talk to people without blaming/yelling but as a way to say: I had an interaction with you guys that had a terrible outcome. I want to share my experience, so you can improve your way of going, and also so you can tell me whether there was something I failed to do that would have triggered a better response from your practice (once, for example, we discovered that a certain receptionist didn't know that euthanasia was a dire request, not a routine procedure that could be pushed out for a week or two).

For example, I learned that my vet practice assumes that I'm handling things unless I say the words-- this is an emergency. I urgently need help. I am going to lose this horse. And so on. So they have trained me to work better with them as well.

It won't help your horse, and it may not make you feel better about what happened, but it will help everyone learn from the events, which is really the only thing left to do. Just a thought.
New Member:
sockers

Posted on Monday, May 11, 2009 - 10:20 pm:

Dr. Oglesby -
I understand your inability to comment on the case considering you only have one side of the story. What I would like from you is what discharge instructions you would give an owner who was taking a horse home on Uniprim. I would appreciate your professional opinion just on this one aspect. Thank you for your responses and the valuable input you give us all on this sight.
Moderator:
DrO

Posted on Tuesday, May 12, 2009 - 8:27 am:

Having experienced two TMP/SMZ associated toxic colitis cases, we give a warning about this potential. For other instructions that may be given with the prescription of this antibiotic depending on the circumstance see the client information subtopic of Treatments and Medications for Horses » Antibiotics and Antimicrobials » Trimethoprim -Sulfa.
DrO
Member:
mrose

Posted on Tuesday, May 12, 2009 - 12:18 pm:

TMP/SMZ is really potent stuff and I'm surprised that not all vets warn about it's possible dangers. I've only had one vet tell me to watch for signs of a reaction to it. This same vet told me to wear gloves and a mask when crushing the pills, also, as it can cause aplastic anemia when inhaled. I've never had anyone else mention that.
Member:
hollyw

Posted on Tuesday, May 12, 2009 - 12:56 pm:

Sara, I have never been given any warnings about it either. It is one of the most common drugs handed out, although I've been given powdered Uniprim the last couple of times I've needed antibiotics for any of the horses.

Thankfully, I haven't had to crush the SMZs. They can be DrOpped into the grain or broken into the grain very easily without any of the horses avoiding them (except my one old, studdy guy who has the most sensitive sense of taste and smell I've ever seen in a horse) . Also, I have filled a fat syringe with them and added some water and shaken the syringe to dissolve the tablets. The dissolve VERY quickly.
I will be much more careful with them in the future, both in handling and in watching for reactions.
Member:
rtrotter

Posted on Tuesday, May 12, 2009 - 2:30 pm:

All,

Just a question that came to mind after reading this discussion.

If I remember correctly, Uniprim in powdered form is dosed once a day, but the SMZ pills are dosed twice a day. In my experience ( and I have used both the Uniprim and the pills) I got a reaction with the once daily Uniprim dosing, but I have never had a reaction to the twice daily SMZ pills. Also, my horses never refuse the diluted pills given twice a day in their feed.

So the question is could the reaction be caused by the strength of the Uniprim because of the once daily dosing?

Also, I gave up crushing the SMZ pills long ago, I dilute them in some warm water and dump the solution on top of the feed. This may help the horses eat it too as they can not sift out the medication if the feed is mixed well after the addition of the medication. Since I do not handle the pills to crush them, I do not breathe the dust either ( although I didn't know about that part of it until I read it here.

Rachelle
Member:
stek

Posted on Tuesday, May 12, 2009 - 5:07 pm:

Wow, I have never heard of this possible reaction to SMZ/TMP and have given lots of it over the years. Live and learn. Though my current vet gives Tucoprim instead, I wonder if the potential for reaction is the same considering it's in the same class?

Lee, so sorry to hear about your experience. I do think Elk's advice about discussing your experience with the vet is excellent, hopefully some small positive can be gained from your heartache.
Member:
mrose

Posted on Tuesday, May 12, 2009 - 5:26 pm:

I no longer crush the pills either. Years ago it seems like they were harder. We had a very sick foal and I remember really having to grind the pills with a pestel and mortar, then mixing them with apple sauce to geth them down him twice a day.

There are other medications that imo people often aren't warned about, in particular the hormonal ones. If young women give them they have to be very careful to not get the stuff on their hands as they are absorbed through the skin and can cause problems.

Lee, sorry, as usualy we are starting to drift off the main topic. I think you weren't given enough information about possible consequences of using the drugs you were given and had really lousey support. I think, however, that a lot of vets are lax in this department.

Again, I'm so sorry about your horse, and don't feel it should have happened. However, as difficult as it is to do, it's my opinion that we need to accept, learn as much as we can so it doesn't happen again, and then move on trying to remember the good experiences. I sincerely hope you aren't beating yourself up over this; you did the best you could do given the circumstances.
New Member:
awhorse

Posted on Wednesday, Nov 11, 2009 - 8:47 pm:

Some further information on the antibiotics, SMZ tabs, UNIPRIM and Tucoprim from your earlier 2009 post:

SMZ/TMP tabs are a human drug and have different drugs in them vs. Uniprim and Tucoprim.

SMZ tabs contain sulfamethoxazole and a smaller; micronized trimethoprim (TMP) which is made for a smaller human gut vs. horses. These particles tend to adhere to the hay and the horse poops alot of the drug out without getting it's full benefit.

Thus, SMZ tabs are dosed twice/day partially because of this.

It is also a common drug (we take it as Bactrim and many other named RX's), is cheap and readily available.

UNIPRIM is FDA approved made specifically for horses. It is a once/day dosing broad spectrum antibiotic (effective against alot of 'bugs). It is also low cost, most effective and easy to use in the feed (2 scoops per day). It can also be mixed with apple sauce, apple juice, water, etc in the feed.

I have not heard of any reactions to humans handling this product. It is a powder so you should not absorb it as your are not spending time crushing tabs.

Tucoprim is the generic form of UNIPRIM so it's formulation is exactly the same.

I hope this helps answer some of your questions.

I agree any animal who acquires diarrhea should be looked at and responded to by it's vet. I feel bad for your loss. It sounds like it was a combination of things. AW
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