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  Discussion on Ventral Midline Swelling
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New Member:
blkmgc

Posted on Wednesday, Jun 24, 2009 - 3:21 pm:

I have a stallion that had an episode of colic last Friday. On Saturday, he developed edema in his sheath and VME. Blood test anomalies are as follows: SGOT 151 (s/b 168-408), CK 73 (s/b 110-700), Total Bilirubin 1.8 (s/b 1.9-3.7), Creatinine 0.7 (s/b 0.8-2.2), Glucose 55 (s/b 75-115), WBC 16.7 (s/b 4.6-11.4), RBC 5.95 (s/b 6.5-12.5), Neutrophil SEG 89 (s/b 30-65), Lymphocytes 8 (s/b 25-70), Absolute Neutrophil SEG 14863 (s/b 2260-8580), Absolute Lymphocyte 1336 (s/b 1500-7700), Fibrinogen 700 (s/b 100-400) and T4 0.7 (s/b 1.0-3.8).

The vet has no clue as to what is going on with this horse. She could not get any peritoneal fluid (after six attempts). Performed abdominal ultrasound to try to locate peritoneal fluid to obtain sample. Could not locate any fluid pockets via ultrasound, so no additional belly taps were attempted. Spleen appeared flattened and not confined to the left side. So, since the spleen was extending into the right side, vet says spleen is most likely enlarged. Kidneys appeared to be normal on Ultrasound. There were no obvious tumors visible on the ultrasound, but vet could not rule them out.

Any ideas on what to do next or where to go from here?

Thanks for your help.



There is no heat
Moderator:
DrO

Posted on Thursday, Jun 25, 2009 - 8:06 am:

Hello BlkMgc,
I will repost my former response in the other discussion:
The problem is not do we have any idea the problem is that with the list you give us there are many possibilities that result in ventral midline edema:
Infection/inflammation, including trauma, of the sheath
Kidney Disease
Liver Disease
Heart Disease
Lymphangitis or lymphectasia
Abdominal Cancer
Peritonitis
These could all be on the list. Has your veterinarian ruled out these diseases specifically? What are the exam details and if we have the lab values we know what tests were run and help us help you.

The blood values that you give above help rule out kidney disease and acute liver disease (though not chronic liver disease).

But we know nothing of the physical exam findings or even whether this horse is currently feeling good or bad. Unfortunately ventral swelling like you describe is a very general sign and can have many causes and it is hard to figure how the colic might figure into it. To help us understand better we need a more complete picture including the results from the physical exam including the vital signs (temperature, pulse, respiration, mucous membrane).

Assuming your veterinarian looked at the requested information and did not find the answers, you need to get the horse referred to someone who can carry the exam further to find the missing information to help diagnose the problem.
DrO
New Member:
blkmgc

Posted on Thursday, Jun 25, 2009 - 11:22 am:

Thank you for your reply. This horse is feeling horrible. He is very stiff and lethargic. Walking is a tremendous effort for him. The vet heard nothing wrong with his heart and has ruled our CHF. Temperature has been taken four times on four different days. First readings were all 98.5 F. Last reading was 100.5 F. Pulse and respiration readings were high side of normal. (Low to mid fifties) Mucous membranes have good color. Not jaundiced in appearance at all. Beau has been started on Uniprim.

Blood test results and exam results have been sent to other vets for input, but so far, no diagnosis has been made. We live in a small town with only three equine vets and no well equipped equine hospital. None of the local vets have a clue. Our vet has sent the test results off to a specialist she knows, but again, there has been no diagnosis. Our vet has gone on vacation for a week, so we basically have no where to turn.
Member:
mrose

Posted on Thursday, Jun 25, 2009 - 3:30 pm:

Ow, I feel for you, BlkMgc with your vet going on vacation in the middle of all this. Can you think of any changes in diet, anything the horse could have eaten like some weed that he could be having a reaction to?

How far away is the nearest good clinic or maybe vet school? It might be worth the trip imo, esp. if your vet is going to be away.
Member:
mrose

Posted on Thursday, Jun 25, 2009 - 3:32 pm:

I just saw you're in AZ. I know there are some really good vets around the Phoenix area, but don't know how far away that is from you. There are other members on this site from AZ, maybe some of them would know of someone closer to you?
New Member:
blkmgc

Posted on Thursday, Jun 25, 2009 - 5:17 pm:

Sara,

There have been no changes in diet for five years. However, this is a 27 year old stallion, so he is a very senior horse, but my favorite out of nine that I have. The nearest vet hospital is 2.5 hours away from me. Since I have Lupus and other medical issues, myself, I am not permitted to drive more than 30 minutes at a time, so there is no way I can transport this horse to the vet hospital myself, and I do not know anyone who can do it for me.
Member:
mrose

Posted on Thursday, Jun 25, 2009 - 6:30 pm:

Wish I was closer; I'd be happy to haul him for you. I know how it is when these great horses we've had forever beging to have serious health issues. I wish you luck with him. From your post, I assume he's Arabian? What part of AZ, if you don't mind my asking? I know quite a few people there, but don't know if they are anywhere near you or not. I was thinking I could maybe help you get him transported if that is what you feel should be done. If he's not getting any worse, however, it could be the trip would be hard on him and it would be better to wait. If you get to the point where you feel he needs transportation, I could make some calls for you.
Moderator:
DrO

Posted on Friday, Jun 26, 2009 - 9:50 am:

Considering the elevated WBC, fibrinogen, and depression I think the antibiotic sensible though not clearly a infection. Considering the stiffness BlkMgc, has founder been discussed. It can be a sequelae to some types of colic and infections. Ok if we assume it is not the VME is not heart, liver, or kidneys and we assume albumin is normal (you do not list it above) I think we are looking at local inflammation (infection, cancer, trauma, fly bite reaction) or lymphatic blockage. Has anyone looked at this guy's penis directly? Is he continuing to urinate normally? Has anyone checked the skin up high between his hind legs? I have seen horses with hard to find ulcers high up between the hind legs that might match up with with some of the above.

There is a big problem with the idea of a local problem and that is the depression: it does not fit and suggests to me we are missing something important.
DrO
Member:
blkmgc

Posted on Friday, Jun 26, 2009 - 11:45 am:

Thank you, Dr. Oglesby. Beau actually did founder, in his let fore, four years ago and has always had some residual pain. The founder was due to a very resistant abscess that eventually broke through the coronet band. However, the stiffness he has been exhibiting for the past four days has looked more like soreness in the muscles of his shoulders and legs.

The good news is that this morning, the swelling has decreased dramatically in his sheath, as well as his midline. Today is his fourth day on Tribrissen and it appears to be helping him. We also increased his bute to two grams AM and PM and that seems to have helped him, some, as well. He is now limping on his left fore, and not as stiff in the other three legs, so it would seem that the founder in his left fore is giving him some trouble, in addition to his whatever else has been ailing him.
Member:
mrose

Posted on Friday, Jun 26, 2009 - 12:27 pm:

Good News, At least you probably know how to treat the founder. I hope he continues to improve.
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