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  Discussion on Heaves vs. Infection - Urgent Help Needed
Author Message
Member:
judyhens

Posted on Saturday, May 29, 2010 - 10:58 pm:

We have a 17 year old broodmare - foal at her side and confirmed in foal. She foaled out at the vets - was there about 3 - 4 weeks because she was over-due. Came home with a mild, very occasional intermittent cough. Otherwise fine. She was confined to a stall at the vets. Has always been pastured at home. No nasal discharge, no fever, no other symptoms -just a dry cough. This went on for several weeks. Last Monday she started to use ancillary abdominal muscles to exhale. If anything the cough was better. We had a vet out to the house who said her lungs were clear. He said she was wheezing but the problem was upper airway. He had us move her from pasture to a cool stall, hose her (we put a mister on her also), put a fan on her, and start Tri-hist. He asked us to take her to the office to be scoped. Later that day she was scoped and found to have excessive mucous/ froth in the trachea. They cultured it Monday. By Wednesday, there was still nothing definitive from the lab. Her breathing was more labored. The vet added Ventipulmin. On Thursday the lab was yet again contacted and still had no results. Penicillin was added. On Friday they finally said it was strep, but the vet said the report was somewhat unclear and they would try to clarify exactly what was meant. We called back today and they said they were going to have to do more research on anything that might help the mare. They have not called back. The mare is still having labored breathing, even at rest, but has no other obvious symptoms. She is eating grain and hay, has no nasal discharge, seems alert, and has no fever at all.

Our concern follows: If this is an infection, then clearly antibiotics are needed and keeping her in a cool stall with mist is indicated. However, if this is heaves, and the strep was either minor or a contaminant, then returning her to a pasture with a run-in shed, and starting her on steroids (even if she loses the embryo) may be the best course of action. In other words, it seems we are treating her wrong for heaves, but heave treatment would be wrong for a strep infection. One other thing - during the time (several weeks) she had the occasional cough, she was in a pasture with one other mare and foal. The other mare, foal, and her own foal never came down with a cough or cold. And the mare herself doesn't look sick. Just having a hard time exhaling.

What would you recommend at this point? Should we drive her to A & M on an emergency basis to get a second opinion? Consider treatment for heaves? Could heaves predispose to a strep infection? We have never dealt with anything like this. We love this mare and want to do everything possible to preserve her quality of life.

Thanks,
Judy
Member:
vickiann

Posted on Sunday, May 30, 2010 - 12:03 pm:

It sure sounds to me like the mare might have caught an upper respiratory infection when away from home that indeed would require antibiotics, but I'm not a Vet so perhaps am missing something here.
Moderator:
DrO

Posted on Monday, May 31, 2010 - 9:52 am:

Hello Judy,
Trailering horses with respiratory infections is not a great idea because it increases the possibility of a simple pneumonia will turn into a mixed infection pleuropneumanitis but can be considered as a last ditch attempt.

Above we have the conflict of the veterinaries diagnosis and the clinical picture of heaves. Not being able to examine the mare I cannot make any specific recommendations. If I had a pneumonia that I thought was infection that was not responding to penicillin I would add gentamicin to the treatment regimen to better cover the gram negatives. If I were confused over whether I was dealing with infection or allergy and did not get a response to wide spectrum therapy like pen and gentamicin, I would then add heaves management and dexamethasone on top of the antibiotic with the caveat the dex might cause loss of the embryo.
DrO
Member:
judyhens

Posted on Monday, May 31, 2010 - 10:31 am:

Thanks for the follow up. That is what we were feeling also. Just to clarify, both at the house and at the clinic, the vet said her lungs were clear, so I assume they don't think she has pneumonia. However, he did hear wheezing which he attributed to her upper airway. Does this make sense? Also - and I don't know if human medicine can be carried over to equine medicine - one of our sons who is an MD was here this weekend and said that labs can usually identify significant infections pretty rapidly. That if it took 4 to 5 days to grow something identifiable (ie strep), that they would wonder - again in the world of human medicine - if it were a contaminant.

Still haven't heard back from the vet clinic. They are coming back out to the ranch tomorrow and we can discuss this then. The mare seems better in the mornings. Not worse over-all, but not better. The foal is healthy and romping like crazy. No horse who was in her paddock or adjacent to her paddock when we had her out in the pasture has come down with anything. She still has no fever, no nasal discharge, is eating well, is alert, but is using ancillary muscles to exhale. - I am also thinking that the more fluids she drinks the better. The foal is now huge and nursing a lot.

Anyway, thanks for your follow-up. We will continue to work with this one clinic and avoid transporting her the hour and a half to A & M unless we have to.

Have a blessed day,

Judy
Member:
judyhens

Posted on Wednesday, Jun 9, 2010 - 1:19 pm:

Follow-up help needed. After completing a course of Penicillin and Gentamycin, the mare continued to have labored breathing. She was also on cough syrup and ventipulmin without improvement. She was given a single dose of steroids (dexamethasone) and responded within hours. She breathed normally for about 5 days, then began labored breathing again. We gave her another shot of steroids and she once again responded. She is beginning to show symptoms again. According to your article, it seems more prudent to give steroids for several days, weaning off gradually. We have tried to reach our vet without success. Will continue to try. Does giving single injections every few days make sense? Laminitis risk? Risk to embryo? Any suggestions you might have at this point would be appreciated.
Thanks,
Judy
Member:
vickiann

Posted on Wednesday, Jun 9, 2010 - 5:49 pm:

I personally know of horses who came down with laminitis after receiving consecutive doses of steroids for either allergies or West Nile.

Was the mare doing better while on the antibiotics but her condition worsened after they were discontinued?

Dr. O's earlier post seemed to indicate that dex use might cause the loss of the embryo.
Member:
judyhens

Posted on Wednesday, Jun 9, 2010 - 7:05 pm:

Hi Vicki,
No. She did not do any better on the antibiotics. The fact that the culture took ~5 days to identify anything made them think it could possibly be a contaminant. The only think that made her breathe normally was the shots of dex. Again, we want her controlled as a priority - even if we lose the embryo. - Actually, it is possible that Walter spoke with the vet late today. I will post the vet's suggestions when I hear them!
Thanks,
Judy
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Moderator:
DrO

Posted on Thursday, Jun 10, 2010 - 12:53 am:

Judy you have to discover the source of the allergen and correct it.

As no one has ever been able to induce laminitis with dexamethasone in an experimental setting, and they have tried very hard, I am not very concerned about the increase in laminitis risk presented with its use. Horses are more resistant to the abortifacient effects of steroids than other species but repeated high doses have been shown to be a risk factor for abortion.
DrO
Member:
vickiann

Posted on Thursday, Jun 10, 2010 - 11:39 am:

I sure hope that you can figure this mystery out, Judy.
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