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Discussion on Confused over Foundered Horses Bloodwork
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New Member:
kmwhite
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Posted on Thursday, Mar 18, 2010 - 9:23 am:
Hi Dr. O.
My 22 yr old polish arab is currently recovering from founder. I've owned him for 4 years, so I don't know if he has ever foundered before. This is the first time for me.
He also has a slightly cresty neck, some fat deposits on his hind qtrs, some fat along his spine and is a super easy keeper. I would put his body condition at a 6.
He is on 2 g of bute/day. I give one in the am and 1 in the pm. He is also on gastrogard. He is better now than 4 weeks ago, but doesn't seem to be getting any better over the last 2 weeks. He has some warmth in his heels of his front feet and seems slightly sore some days, others not. It's a rollercoaster.
Is this normal?
How long should it take before he's out of pain?
He has about 8 degree of rotation in both fronts. The backs were warm sometime but no rotation.
My vet took some bloodwork, but I'm a little confused by it.
I think they just did a general panel.
The areas that are out of the range are:
MCHC (?) 39.9 g/dl (range - 31-39)
GLU 187 mg/dL (range - 65-110)
GGT 37 U/L (range - 5-24)
Everything else was within the labs normal ranges.
My vet said that his liver enzyme (GGT) could be high since he's on Bute. She wanted me to start him on 6-7000 mg of Metformin because his Glucose is high. I question the validity of this test since he's on Bute and still in some pain from the founder. I don't want to start him on medication for something he doesn't have nor medication that won't help. I read in a separate post that Metformin has not been proven effective and horses have trouble absorbing it, which wouldn't do him any good.
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Moderator:
DrO
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Posted on Friday, Mar 19, 2010 - 2:10 pm:
Hello Karin,
I am afraid there is no normal for founder. It varies between a little bilateral lameness in the front that responds in 3 days to treatment to a life threatening disorder that that months to straighten out, if it can be straightened out at all. I would expect an acute 8 degrees of rotation to take some time to come sound. So you should continue to treat this as a ongoing founder. Our article on founder gives you guidelines.
Considering his age, condition, the founder, and the hyperglycemia your horse is almost certainly has Cushings. This may be the reason why you are not getting any better sometimes it requires you treat the Cushings directly, for more on this see Diseases of Horses » Endocrine System » Cushing's SynDrOme and Pituitary Tumors.
Many healthy horses get mild elevations of liver enzymes and there significance hard to evaluate. Yes medications can raise it but if elevated cortisol levels are part of your Cushings, this too can cause elevation. With evidence of liver disease I see no reason to be overly concerned with the enzymes elevation, you can read more about this at Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Liver Disease and Failure.
I agree with your assessment of the metformin. You horse is likely to be dealing with insulin resistance which is addressed in humans with metformin but as you note research has not backed up it's usefulness for the reasons you state.
DrO
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New Member:
kmwhite
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Posted on Friday, Mar 19, 2010 - 4:23 pm:
Thanks Dr. O.
Cushings.......Based on all the reading I've done on this site and the internet, that's what I thought but since he doesn't have the thick furry coat and he does shed out I thought maybe not.
According to the article on cushings the season that the test is administered is important.
What is the best season to do the test...summer? Can the pain he's still in effect the test results?
Would you suggest the dexamethasone suppression test now or would you recommend waiting until he is sound?
The article suggested treating with good husbandry practices until he can not be kept comfortable due to founder, depression and body condition. He is currently recovering from founder. His appetite is too good. His mood is a little pushy but I think that's because we've cut back a little on his hay (1 flake, he still gets 4-5 2x/day) to loose some weight.
Should I speak to my vet about starting him on Peroglide or treat him by reducing NSC and using a grazing muzzle?
If I don't start him on Peroglide, will that
restrict his ability to recover from the founder?
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Member:
scooter
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Posted on Friday, Mar 19, 2010 - 5:01 pm:
Karen I have a cushings horse... he is hairy . I was reading some research on it and it stated that ( I THINK) only 17% of horses that tested positive for cushings had the "cushings coat" I put the link to is in "sam's founder" don't know which part tho!
Anyway, he has had CD for at least 7 yrs. and is VERY IR. I have been able to maintain him with just diet over the last 7 years... I just started him on pergolide last fall. It seems to be helping his unlimited amount of urination, other than that he is the same. My vet said to try pergolide...when he started foundering this fall and it did help him... quickly. He said if it wasn't CD related the pergolide would make no difference. All the tests can be somewhat unreliable.
8 degrees of rotation is quite a bit, and takes time to overcome (pay close attention to hooves!) If he is out of the acute stage and not rotating any further, but remains quite sore.. I would look closely at his diet and his weight. My other horse who had the 8 + degrees of rotation didn't come right until his diet was in check and he lost #200's actually closer to #300 He is IR I don't need a test to tell me that..he founders OR gets laminitis as soon as his diet is out of wack. It's hard to sort through it all, but taking a good look at diet, weight, and hooves is a good place to start. Soaking his hay may help too.
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Member:
paul303
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Posted on Saturday, Mar 20, 2010 - 1:00 am:
I agree with giving attention to Cushings. My first indication with my twenty-something mare was dangerously warm feet that my farrier commented on. At that time, her hair coat was not unduly long, however, when moist, her winter coat would become excessively curly. She's been on Pergolide for 5 years now. I've watched her weight, and carefully keep tract of her symptoms. Her main symptoms of Cushings are excessive thirst and excessive urination, and obvious depression. We've tested her and increased her pergolide over those years, and today she is 30 yrs. old and a happy camper.
Man oh man, I'd be a bit uneasy about the metformin. I'd probably get the dex. test and go from there. I, personally, feel that the depression, lack of appetite and interest in the world, can be tip offs if you know your horse well.
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Moderator:
DrO
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Posted on Saturday, Mar 20, 2010 - 10:04 am:
I don't often test, instead I treat based on a consistent signalment, history, and clinical signs. If uncertain I then look for consistent lab results. If at that time I am still unsure I might test. But realizing that all the tests we have available are not that sensitive I often treat suspected founders in older horses without testing. The article is quite specific about the best testing times for a DST. As to whether the pain of founder will effect the results, it might by causing a rise in cortisol, but I have not seen anyone suggest it is a contraindication. There has not been much work on this question.
Whether the horse is Cushings or not you should restrict access to nonstructural carbohydrates while foundering. As to whether pergolide will aid your horse or not will depend on whether he is truly affected with Cushings and yes I would discuss this with your veterinarian.
DrO
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