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Discussion on Impaction Colic and Nosebleed
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New Member:
kellys
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Posted on Thursday, Aug 29, 2013 - 11:03 pm:
Dr. O,
I have my father's 33 year old grey Arabian. He has melanoma which has grown slowly the last 3 years around his anus, tail dock and both sides of his lips. I have been giving him cimetidine for 2 years, hoping it would grow slowly.
Last week I went to feed him and he was laying down and wouldn't get up. This has never happened before. He is kept in a stall and is always waiting for his evening feeding. The barn manager got him up by throwing water on him. There was a vet there who has her own horse at the barn. She listened to his gut sounds and said they were normal, that he looked lethargic and that she would come back out in the morning to do liver/kidney function tests. I brought Walking Tall to the wash rack to hose him and when we returned to his stall, I was setting up his feed and he went down again. I waited and he got up again on his own. He was straining to poop, even to the point of grunting. I walked him out on the levee and he went down a third time. He had his eyes closed and it made me think he may be dizzy or hallucinating. He also had his head cocked at an odd angle as though he were looking up then he twisted his body so that his hind legs were straight in the air but his front legs were still parallel to the ground. He stayed down all night and I was on the phone at 6am in the morning turned around and he was standing looking at me.
I don't have a lot of experience with horses and didn't recognize this as colic. The next day I noticed a clump of poop that was quite large in diameter, maybe 4 or 5 balls stuck together, that he had passed so I assume he was impacted. It also makes me believe that he mustn't have melanoma tumors if such a large clump was passed intact. He hasn't been drinking a lot of water. I feed him alfalfa cubes and pelleted feed soaked in water so he gets some water. This summer I gradually changed from Strategy to Wellsolve after he seemed sore and had a cresty neck, even though you could see ribs. The barn help feeds him in the morning and the manager there has had them make his feed very watery.
Two years ago when I moved him, it was at the beginning of summer, he wasn't drinking a lot of water and had gone down a couple of times. There were no signs he was in pain though. I though he may have been dehydrated. I had the vet out at that time who said that he didn't look lame on any leg but that he had a bizarre walk. The vet said he could do neurological tests if it didn't resolve, but when I moved him, he improved.
The newest development was tonite when I went to feed, he had blood in one nostril. It wasn't dripping so I can't say how long or how much blood.
Lately he has been losing weight, maybe because I changed his feed trying to keep him from getting laminitis. I gave him less of the Wellsolve LS with more Alfalfa, for a total of 5 lbs times 2 feedings a day.
For the past couple of months, he has been hanging his head in the stall instead of having it over the door. He has looked depressed and not very alert and interested. His stall looks out on the levee and there are bikers and runners that he used to have an interest in watching. He has excellent eyesight. If I take him out to graze at night, he notices people on the levee before I do. It has been a hot summer and I thought his moping around may have something to do with the heat and his age.
I don't want him to languish in pain. He is 33 years old and my father had him when he was a colt. Walking Tall is older than my son who grew up with him. I still don't want to give up on him just yet.
By the way, the vet said the lab results were unremarkable. I don't have the results but the invoice is for a CBC/Chem 20 Panel.
It is also worth mentioning that when I go to feed him, I have been adding carrot juice to about a gallon of water and he drinks it. Since observing him drink I noticed that he sounds like he is sucking air, like possibly his lips on the sides where the melanoma is are not forming a seal. I guess this could also cause colic just like a horse who cribs? My father told me Walking Tall has never had colic before, not so serious to cause observable symptoms.
I have also for a few days, been adding 2 tbsp. Epsom salt to his feed. Is this okay? How long can I continue this before it becomes a problem?
Do you have any advice on what I should have the vet do? Any thoughts on what might be going on with him?
Sorry this isn't more organized. I am tired and emotionally drained.
Thank you for any advice you might offer.
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Moderator:
DrO
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Posted on Friday, Aug 30, 2013 - 7:24 am:
Hello Kelly,
2 tbl Epsons daily is not likely to cause a problem in a horse. You describe 3 main problems:
1) Depression and weight lost for the past few months.
2) Colic a week ago.
3) A nose bleed last night
Yet so far physical exam and lab work are normal or at least do not lead to a diagnosis for these problems. The veterinarian needs to take a thorough history and do a good physical exam including rectal exam. This should lead him to a list of possible causes and from there further work up or treatment. I would certainly have him consider Cushings for a old horse with depression and weight loss. If at this time the veterinarian is still uncertain what to do he should refer you to a equine hospital with the hope some answers will be found. I hope you find the answers you seek. You will find more information on your problems at:
1) HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Colic in Horses » An Overview of Colic
2) HorseAdvice.com » Diseases of Horses » Endocrine System » Pituitary Pars Intermedia Dysfunction (PPID): Equine Cushing's
DrO
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New Member:
kellys
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Posted on Wednesday, Sep 4, 2013 - 2:14 pm:
Dr. O,
I have attached the lab results from the blood drawn 8/21/2013.
The vet who attended ordered this test told me that his lab results were "unremarkable." I see, however, that he has numerous high and one low result.
His protein, cholesterol and globulin are barely high, over the range by no more than one point.
His glucose is 71, 4 points under the minimum of the range of 75. When the blood was drawn, it was between 9 and 10am. Walking tall hadn't eaten his evening feed the night before and was down all night. When he finally stood up at 6am, I fed him, starting slowly, and he ate until at least about 8am, so I am thinking this may be more significant than the numeric result? The results came back the same day so I think the sample was expeditiously processed, not left to sit around. It may be worth mentioning that I had him on alfalfa cubes/wellsolve low starch mash. I got to thinking while unable to sleep that night that he may be hypoglycemic from not eating and from being on low starch feed. So when I got there at 5:30am I rubbed a couple tablespoons of sugar on his gums and tongue. He was up at 6am. Maybe it was a coincidence but maybe not? If he was fed before his blood was drawn, is it normal for his glucose to be so low? I have a glucose monitor (one handed down from my Dad). I tried using a regular lancet around his nose but didn't get enough blood to test. Would it be beneficial if I could take his blood sugar at different times?
The other values that are very concerning are neutrophils (high) and lymphocytes (low). I noticed that although his lymphocytes are low (12.5) his absolute lymphycytes are normal (1613). Is there a reason for the difference?
What could be the reasons why his neutrophils are high and lymphocytes low? He doesn't feel like he has a fever but I have never taken a horse temp but I am sure I can do this or get someone to help me. Not sure either about respirations or heart rate. He does have melanoma and could it be that it has metastasized? I also want to mention that for about a month before the blood was drawn, I started using a spot fly treatment that I put on his topline and legs. Could these lab results be the result of poisoning? I also read an article that talked about barn dust? He has also lost weight and looked depressed recently, but that may be because I have been so concerned about metabolic disorders that I have cut his grain, changed it to wellsolve LS and increased his alfalfa. Since the night he was down, I started gradually adding strategy back in his feed and increased the grain. He already looks better. He has more energy and isn't hanging his head when I get there every evening. I have also been rearranging priorities and spend more time walking and grazing him, at the expense of a not-so-clean house.
I did have another vet come this morning and do a ACTH and insulin test. I questioned him about whether Walking Tall should have been fasting 12 hours before the test. He said "no" but what I read in your article contradicts this? Will the results be accurate? Should I ask for a refund? I have read that pain causes higher insulin reading so I'm thinking it is not the most accurate of tests, along with the late summer/fall ACTH, with false positives. Not sure of how much value these will be?
Look forward to hearing from you soon. Thank you.
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New Member:
kellys
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Posted on Wednesday, Sep 4, 2013 - 2:17 pm:
The attachment exceeded the max allowable upload size so here are the test results:
Test Result Reference Range
ALK Phosphatase 108 73-327 U/L
AST SGOT 189 168-408 U/L
CK 289 110-700 U/L
GGT 10.0 5.0-35.0 U/L
Albumin 3.4 2.6-4.2 g/dl
Total Protein 7.8 HIGH 5.4-7.6 g/dl
Globulin 4.4 HIGH 1.8-4.3g/dl
Total Bilirubin 1.9 0.6-3.7 mg/dl
Direct Bilirugin 0.7 0.0-1.3 mg/dl
Bun 27 10-27 mg/dl
Creatinine 1.4 0.8-2.2 mg/dl
Cholesterol 151 HIGH 49-150 mg/dl
Glucose 71 LOW 75-115 mg/dl
Calcium 12.2 10.5-12.8 mg/dl
Phosphorus 3.3 1.4-5.6 mg/dl
TCO2 Bicarbonate 26 25-34 mEq/L
Chloride 98 91.105 mEq/L
Potassium 3.3 3.0-5.3 mEq/L
Sodium 132 130-140 mEq/L
A/G Ratio 0.8 0.8-1.9
B/C Ratio 19.3 No range given
Indirect Bilirubin 1.2 0.0-3.0 mg/dl
Na/K Ratio 40 No range given
Hemolysis Index Unable to report
Lipemia Index Unable to report
Anion Gap 11 9-16 mEq/L
WBC 12.9 HIGH 4.6-11.4 K/uL
RBC 6.74 6.50-12.50 M/uL
HB|GB 11.7 11.0-19.0 g/dL
HCT 32.7 32.0-52.0%
MCV 49 34-58 fL
MCH 17.4 12.3-19.7 pg
MCHC 35.8 31.0-37.0 g/dL
Neutrophil Seg 85.1 HIGH 30.0-65.0%
Lymphocytes 12.5 LOW 24.0-70.0%
Monocytes 2.3 1.0-7.0%
Eosinophil 0.0 0.0-11.0%
Basophil 0.1 0.0-3.0%
Auto Platelet 185 100-350 K/uL
Absolute Neutrophil Seg 10978 HIGH 2260-8580 /uL
Absolute Lymphocyte 1613 1500-5000 /uL
Absolute Monocyte 297 0-1000 /uL
Absolute Eosinophil 0 0-1000 /uL
Absolute Basophil 13 0-290 /uL
Fibrinogen 200 100-400 mg/dL
Remarks Slide viewed microscopically. No parasites seen.
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Moderator:
DrO
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Posted on Wednesday, Sep 4, 2013 - 6:47 pm:
Kelly while serum ACTH levels are probably not affected by fasting (and no recommendation can I find recommends it), insulin levels certainly are greatly affected by recent meals.
There are whole books written on what might cause abnormal levels of WBC's and to discuss the dozens of possibilities could cause the neutrophils to rise and lymphocytes to fall is not a useful way to diagnose your horse. The lab work should be used to rule in or out the list of possible diseases including Cushings your vet has created from his history and exam and discussed in my first post.
DrO
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New Member:
kellys
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Posted on Monday, Sep 23, 2013 - 3:25 pm:
Dr. O.
I got the lab test results back and his ACTH was 128 (range 9-35) and Insulin was 60.58 (range 10-40). When the vet got there, WT was still eating. I am not so sure if about the Insulin result. I asked about it and was told by someone in the office, that the insulin test no longer has to be fasting. I'm not sure why. Does this sound right?
I will start 1mg pergolide powder when it is delivered in a couple of days. I was told that the powder does not seem to cause appetite suppression or depression like what was seen when using the liquid.
As far as a reading of 128 in late summer, can you say how reliable this reading is? The symptoms I have noticed are cresty neck. Someone at the barn pointed it out last summer. I also think he has mild laminitis. He seems sore when I take him out of his stall but when I turn him out, he does trot a little to get to the spot where he normally rolls. I watched my son walk him on the blacktop on top of the levee yesterday and his strides looked even. He does have a pot belly, although his ribs show, In addition, I just started him on an omega skin supplement and I have noticed the hair on his legs growing a little longer/wavy. In past years, he would get fuzzy during winter but always shed out.
I have uploaded a couple of pictures taken a few weeks ago. In the side view, you can see the cresty neck even though he has a thin body condition. The other picture was taken the same day on his other side and you can see his ribs.
I might add that when the vet came out he said he didn't see a reason to do a rectal exam (as you suggested above) unless we would treat any melanoma tumors that could potentially cause a problem. I agreed, but after thinking about it, I should have had him do the rectal exam. If only to know what WT's outlook may be. There is another vet next to the barn who is highly regarded (little more expensive). I could have him do the rectal exam. He did one two years ago. Also, the impaction problems have not returned. I am still adding 1 tbsp. Epsom salt twice a day to his feed.
I will have more questions about related issues after I go through your articles. Just taking it one step at a time.
Thanks,
Kelly
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Moderator:
DrO
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Posted on Sunday, Sep 29, 2013 - 6:25 pm:
Kelly I am not aware of a nonfasting insulin level that is diagnostic for insulin resistance. As to the ACTH levels that would have to read by the lab and your vet with a knowledge that their normals change with the season.
DrO
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