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  Discussion on More questions about my old girl
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Member:
mrose

Posted on Thursday, Nov 12, 2009 - 10:30 pm:

I've read the article on CRF and just come up with more questions. Maybe I'm just getting obtuse in my old age.

The only illness this mare has had is the Cushings, and a bout of severe colic about 10 yrs. ago. She was x-rayed and sonogramed and examined throughly at Alamo Pintado and no cause for the colic was ever found. She's never had much bute, only on the rare ocassion - no other drugs, either that I can remember aside from vitamins and joint supplements.

She has urinated more than the other horses over the last year or longer, but this was attributed to the Cushings. Her blood work has looked good until this year. Is she just one of the unlucky horses that get CRF? Aside from biopsey, which I don't like the sound of at her age, is there any way to know if there is an underlying problem that should/could still be treated?

If not, it looks like from the article she should be euthaniized soon.
Moderator:
DrO

Posted on Friday, Nov 13, 2009 - 5:59 am:

Hello Sara,
Some horses go for many years with chronic renal failure Sara, it all depends on the initial severity and the rate of worsening which can be quite variable. You have to let your horse tell you when it is time.

If after taking the first steps in the diagnosis section you do not have a diagnosis then the last step of biopsy is pretty much it.
DrO
Member:
mrose

Posted on Friday, Nov 13, 2009 - 10:27 am:

Would furosamide help with the edema? That seems to be the worst problem, the only problem aside from appetite. She nibbled on grass off and on again yesterday. Today the edema is much better; it seems to come and go.
Member:
scooter

Posted on Friday, Nov 13, 2009 - 4:00 pm:

Sara did Beau have an urinalysis? Or isn't that called for Dr.O.?
Member:
mrose

Posted on Friday, Nov 13, 2009 - 5:34 pm:

I asked about furosamide because of my experiences with elderly people; but turns out our vet suggested it to me this a.m. and we gave her an IV of it mid-day. We'll see if it helps.

Although long run I think it's a death sentence for her, I feel better thinking it's chronic renal failure; I'm not sure why. I was worrying myself sick (literally getting sick to my stomach) trying to figure out what I could do that I wasn't doing. Now, I'm back to the day by day keeping her as comfortable as possible as long as possible, more at peace with the idea that any day could be her last. My main goal is to keep her pain free and relatively happy. So far, she seems to be that. The swelling is a problem; when she's swollen she moves more slowly and I can tell isn't comfortable. The swelling seems to come and go.

No, Diane; she's not had a urinalyis. It's never been suggested to me.

She seems pretty good today; was very anxious to get outside. I kept her in during the a.m. due to weather; then put a blanket on her and let her out. She's been resting under the overhang in front of the stalls for the last half hour, much to the irritation of the horses stuck inside. She likes to munch on the hay they DrOp out their windows.
Member:
scooter

Posted on Friday, Nov 13, 2009 - 5:51 pm:

Sara, Glad Beau is feeling well. I read through the article and urinalysis was mentioned, tho maybe her blood work tells it all.

She definitely seems to still have attitude, the great thing about old mares!
Member:
rtrotter

Posted on Friday, Nov 13, 2009 - 7:17 pm:

Sara,

Horses are notorious thieves and like to think they are getting away with something when they can.

Many years ago, my dad had a really nice trotting filly that did not want to eat. The trainer tried everything he could think of to get her to eat.

She had a stall guard instead of a gate and one day the hay guy left some bales of hay too close to her door. When they came back to feed that night this mare had eaten almost a half a bale. From then on that's how she got fed, we even left the feed tub outside so she thought she was stealing that too.

As a 4 year old, she set one of the track records at Monticello for aged trotting mares. The record stood for about 15 years.

Rachelle
Member:
paul303

Posted on Friday, Nov 13, 2009 - 10:59 pm:

Maybe some hand walking might help...get nature to help move some of that fluid. If she's up to it.
Member:
mrose

Posted on Friday, Nov 13, 2009 - 11:38 pm:

Rachelle, she's not a thief, she just has always liked to "get away with things" the other horses can't do and to make sure the other horses notice. She's always been the boss mare, until just recently. To stand "wild and free" in front of the other horses and to top it off with eating "their" hay, nothing could make her happier!

Lee, she is outside wandering around the property every day, and she walks around quite a bit. She even trots a little on her way out of the barn. She stands and rests quite a bit,too. Even today with crumnmy weather, as soon as it had let up a little, I put a warm weather proof blanket on her and opened her door. Like you, I think movement is good for her, and the grass and weeds are one of the few things she'll eat.
Member:
mrose

Posted on Friday, Nov 13, 2009 - 11:44 pm:

Thanks all for your comments, thoughts and prayers. Thanks Dr.O for letting me ask "dumb questions" and express my fears and frustrations. Being able to do so helps me cope.
Moderator:
DrO

Posted on Saturday, Nov 14, 2009 - 7:37 am:

Sara, urinalysis is one of the first diagnostic steps in the article on diagnosing renal (acute) disease and the article on chronic renal failure. A diagnosis made after longstanding renal disease is established. It can be a necessary part of diagnosing what is wrong. Has anyone considered this may be a prerenal azotemia due to the heart disease? UA will help flesh this out as described in the article on acute renal disease. In your case someone is going to have to consider whether the results are do to the Cushing's or the kidneys. As described in the articles there is other important information in the case of actual renal pathology.

The question about furosemide is not a simple one. The use of diuretics in cases of heart failure is well established and one of the indications of it is fluid retention in cases of acute kidney failure. These agents work through the kidneys by producing a increased amount of urine and thereby reducing body fluid and blood pressure. Horses with CRF will already be producing a dilute urine so in such cases I am uncertain how this may be helpful. I also have concerns about creating or exacerbating electrolyte abnormalities so close monitoring of potassium, chloride, would be advisable with it's use. It may help with the high calcium though. I would have your veterinarian review your horses case carefully and then speak with a equine internet with a interest in kidney disease before instituting diuretic therapy. Assuming you can get an effect in a CRF horse it will probably come down to the evaluation of whether the heart failure or the kidney disease is chiefly responsible for the clinical signs.
DrO
Member:
scooter

Posted on Saturday, Nov 14, 2009 - 8:53 am:

I follow this with interest because of my aging population and hopes that Beau can be made comfortable.

Dr.O. can cushings alone be responsible for Beaus symptoms?
Member:
scooter

Posted on Saturday, Nov 14, 2009 - 10:14 am:

Sara I had forgotten about how much Sam looked bloated before I started the pergolide, after re-visiting his thread, I was surprised by the day I started pergolide picture how much edema he actually had, it had even gone up his sides. I am not trying to raise your hopes or grasp at straws, but now I do wonder if the CD couldn't be involved in some way with Beau.
Member:
mrose

Posted on Saturday, Nov 14, 2009 - 10:53 am:

I wish I lived closer to a really good clinic. I know these vets have had tons of field experience and are excellent with emergencies, etc. But why wouldn't either of them suggest UA? They are both diagnosing from the blood work and her looks. With her long hair coat, they assume she has Cushings. With her high BUN and other levels they assume renal failure. The furosidamide was given yesterday after I asked our local vet's tech about it's use since I knew it was used in humans. She asked the vet and he said it would be worth a try. I wonder if he feels it just doesn't matter, so tells me to do whatever he thinks will make me feel better - like I'm doing something for her. I don't want to be sticking her with needles if it's not actually helping her. I don't seen any change in her from yesterday.

I'm going to not give her anything but the Pergolide until Monday when I'll call the vet again and ask for an appointment for a UA.

The heart murmur sounded pretty significant to me, but was mention by the L.V. vet kind of as an aside - "guess you knew she has a pretty good heart murmur" and when I said I didn't, he had me listen and had his tech listen, but nothing else was said about it.

I have upped her Pergolide to 1ml/day to see what that does. Hoping it might increase her appetite.
Moderator:
DrO

Posted on Sunday, Nov 15, 2009 - 9:34 pm:

Sara I cannot answer those questions but they should be able to. Perhaps they have a better handle on this than you think. Ask them if they feel significant information can be had from a UA. Certainly the two questions I have not seen answered are the possibility of prerenal azotemia from the heart disease and whether there are signs of infection in the urinary tract.

Unfortunately the Cushings may make interpretation a bit more difficult which is why I would want a specialist opinion on this.
DrO
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