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  Discussion on Lymphosarcoma or something else ?
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New Member:
hiddenhe

Posted on Thursday, Jan 28, 2010 - 10:13 pm:

I have a 5 year old Clydesdale mare, purchased in September. A highly trusted, respected, experienced veterinarian believes the mare's clinical and lab symptoms point to lymphosarcoma. I understand lymphosarcoma is fairly rare; even though the mare is in the typical age range. I am hoping to understand what else could her symptoms point to and what else should I check for? Specific conditions and symptoms follow: The mare was undernourished when I brought her home to northern VA in September, as were other horses at the farm. She is in moderate work under saddle twice a week, and until mid December, was also in extended work under saddle at least once a week. Extended work is walk, trot, canter, gallop for 2-3 hours. She shows no sign of issues in performance or behavior. She developed an edema on her belly, behind the girth, on 9/27, which disappeared in 3 days with medication and has not returned. A kick from a new paddock mate is a possible but not confirmed explanation. I have not been able to put weight on her – she may be 100 – 200 lbs underweight. She is currently on hay and a high-fat/low-carb diet and most recently is being fed alone in a low stress environment. While otherwise appearing to not be stressed about work, she consistently has diarrhea, ranging from cow pie to watery, during work and then relatively normal bowel movements when not working. Her blood tests indicate: high total protein of 8.6 compared to a reference range of 5.4 - 7.8 g/dL; high globulin of 6.2 compared to ref range of 2.2 - 4.4 g/dL; and low red blood count of 6.3 compared to a range of 7 – 12; hemoglobin was slightly low at 10.8 compared to a ref range of 11 – 17 g/dL. Her GGTP was out of range 9/27 at 78 and is now lower at 36 relative to a ref range of 1 – 35 U/L. Fibrinogens were normal. Fecal tests did not indicate anything. We have another young horse we purchased from the same farm with low weight, lethargy and anemia who appears to be responding to ulcerguard, vitamin B and a high-fat / low-carb diet. Greatly appreciate any thoughts. Thank you.
Moderator:
DrO

Posted on Friday, Jan 29, 2010 - 5:16 pm:

Welcome John,
If the only symptoms and clinical findings are unexplained lack of condition and diarrhea when under saddle I don't see anything that rules out a case of too few calories to meet a healthy horse's needs to gain weight and a horse that is nervous under saddle, therefore get diarrhea. It is possible the high globulin fraction is due to a past history of heavy parasitism that the horse has not recovered fully from yet. Though this is a bit high for this after 3 months but there are scenarios.

Concerning the inclusion of lymphosarcoma (LS) in a rule out list, I don't see anything that rules it out. The lab are consistent with LS but these are nonspecific changes and not diagnostic. What form of lymphosarcoma is he thinking your horse has (refer to the article for the types).

John, can you include all the laboratory results, normal and abnormal, including the units used and the lab normals? Are there any other clinical findings and what is the deworming history?
DrO
New Member:
hiddenhe

Posted on Monday, Feb 1, 2010 - 1:07 pm:

Thank you, Dr. O. Tuesday, tomorrow, I will have the latest test results from blood work retest from another lab (same vet). I will send an update Tuesday, tomorrow, with the complete history and the answers to the questions. Thanks again. Greatly appreciate your expertise and experience. John and Katherine
New Member:
hiddenhe

Posted on Tuesday, Feb 2, 2010 - 10:26 pm:

Post 2


Dr. Oglesby

Thank you. History and lab results for 5 yr old Clydesdale mare follow:

Worming: Brought the mare home 9/20/2009. Wormed her with Strongid on 9/23/2009; with Ivermectin 11/8/2009 and with Equimax 1/27/2010. Do not know the worming history prior to 20 September; but nothing would surprise me. The mare is originally from Canada; not sure at what age she came to Virginia.

Lab Results from 3 different labs on 9/27, 1/20 and 1/27 respectively:

Total Protein (g/dL): 8.2 vs ref range of 5.8 –7.5; 8.6 vs 5.4 – 7.8; 8.7 vs 6.0 – 8.6
Albumin (g/dL): 2.5 vs ref range of 2.3 – 3.8; 2.4 vs 2.3 – 3.8; 2.5 vs 2.9 – 4.4 (?)
Globulin (g/dL): 5.7 vs ref range of 2.2 – 4.4; 6.2 vs range of 2.2 – 4.4; 6.2 vs 3.3– 4.3
GGTP (U/L): 78 vs ref range of 1 – 35; 36 vs range 1-35; 35 vs range of 4 – 22 (?)
RBC (106/uL): not tested 9/27; 6.13 vs ref range of 7 – 12; 6.66 vs range 7-12
Alkaline Phosphatase (U/L): 333 vs 50 – 250; 262 vs 50 – 250; ?? on 1/27
Glucose (mg/dL): 49 vs range of 60 – 125; 72 vs 60 – 125; 31 vs 50 – 107
LDH (U/L): 421 vs ref range of 150 – 450; 467 vs 150 – 450 ; 401 vs 80 – 285
Chloride (mEq/L): 99 vs range of 97 – 108; 96 vs range of 97-108; ?? on 1/27
Total Bilirubin (mg/dL): 0.8 vs range of 0.8 – 3.2; 1.0 vs 0.8 – 3.2; 1.1 vs 1.0 – 3.1
Fibrinogen (mg/dl): not tested 9/27; 245 – vs range 100 – 400; 500 vs range 100 – 500
OSMO (?) 1/27: 256 vs normal range of 284 - 292
AG (?): 1/27: 0.4 vs normal range of 0.49 – 4

I can put the rest in a spread sheet and email to you if that is acceptable.

Edema: 9/27/2009 on the belly, behind girth. Responded to treatment in 3-4 days.

Diarrhea: loose to watery diarrhea continues under saddle, with normal DrOppings observed morning and night, before and after work.

Temperature: taken twice, in between the two lab results, was 100.0 and 99.4 degrees.

Appetite, attitude and work ethic: all seem to be normal with “interest” and no issues

Work: Light work twice a week under saddle; extended work 1-2x a week until 15 Dec

Thank you. Katherine and John
Moderator:
DrO

Posted on Wednesday, Feb 3, 2010 - 9:04 pm:

John, I do not see much to change my earlier evaluation. If you want to pursue the most concerning abnormality further, the increase in gamma globulins, you should consider getting a globulin profile through electrophoresis to see if this a monoclonal or poly-gammopathy.

Unfortunately neither will rule in/out lymphosarcoma as you can have both presentations but if it comes out monoclonal then it certainly increases the chance this is either lymphosarcoma or possibly myeloma. If it comes out a polygammopathy you are left with the question: neoplasia or inflammatory.

To take a different perspective, I carefully avoid worrying too much about many incidental abnormal lab findings with no presenting clinical signs. As to the clinical signs you have described I am uncertain how they might be related to this.
DrO
New Member:
hiddenhe

Posted on Saturday, Feb 20, 2010 - 1:22 pm:

Thank you Dr. O.

We are just uncovering from the rare 4 feet of snow in northern VA which turned attention to basic survival (people and animals) for a couple of weeks . Just now getting back to work and to trying to make progress. Fortunately, this mare, "Bonnie", seemed to stay strong, energetic, interested and with plenty of appetite. I have not been able to get her to the barn to feed her by herself.

I have two questions; sorry for the gap in this thread.

1) Could a bad or severe episode of parasites at some point in her life have caused an inflammation that would still cause the clinical signs and the diagnostic measurements ? If so, what should I check or try or pursue ? Do you have a view on ulcerguard or probios or vitamin B in this case.

2) The mare, "Bonnie", is probably 1100 pounds and should probably put on 200 pounds. In her case, how many calories and of what kind should she be fed ? She is currently on the 2 x per day low carb fat diet of 1/2 lb rice bran pellets, 3 1b alphalpha pellets, 1/2 1b nutrena empower, corn oil and free range hay. Hay, while not tested, is clean good quality orchard/timothy.

Thank you for any additional insight. Best Regards,

John and Katherine Hidden Hearth
Moderator:
DrO

Posted on Sunday, Feb 21, 2010 - 10:21 am:

Hello John and Katherine,
1) I answered the main part of this question in the first post above. If you would like to read about specific conditions see the topics under Diseases of Horses » Colic, Diarrhea, GI Tract » Parasites and Worms. In particular the article on Cyathostominosis describes a condition that may take time to recover from. But any heavy parasitism might cause intestinal pathology that requires time to recover and if the pathology severe enough results in significant scarring that may cause bowel dysfunction and malabsorption.

You will find articles on probiotic and vitamin supplementation at Horse Care » Equine Nutrition, Horse Feeds, Feeding. Concerning the use of anti ulcer medication see Diseases of Horses » Colic, Diarrhea, GI Tract » Gastric Ulcers » Gastric Ulcers in Adult Horses.

2) I don't have a particular caloric target for your horse just the realization that different horses require different amounts of calories to maintain condition. For specific recommendations on feeding regimens for difficult keepers see Diseases of Horses » Colic, Diarrhea, GI Tract » Weight Loss in Horses » Overview of Chronic Weight Loss.

Until you can feed this horse separate from the other horses, you are missing one of the most important steps for caring for a difficult keeper.
DrO
New Member:
hiddenhe

Posted on Monday, Mar 8, 2010 - 7:47 pm:

Dr. O, Thank you for the additional info and insight. Last week I was finally able to bring the mare into the barn to feed her by herself, again, twice a day. She was energetic and looked bright and more robust. Her coat and eyes looked "healthier". In the barn, I took off her blanket and discovered that she was quite pregnant. She has actually gained weight overall - not just in her belly. The diagnostic results do not seem consistent with a pregnancy; however, the difficulty gaining weight while in work and in foal may be consistent. Both of our vets are reproductive experts and we have had the good fortune of breeding and raising healthy foals. We are more than embarrassed that we discounted pregnancy as a factor if not a candidate. (I bought her in September as a 5 year old in consistent, steady work; the previous owner has a good idea of the likely stallion and likely unintended breeding date). Appreciative and embarrassed, John and Katherine
Moderator:
DrO

Posted on Tuesday, Mar 9, 2010 - 6:11 pm:

Most excellent John. I have missed the forest for the trees, this is just a forest I have wandered through many times.
DrO
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