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  Discussion on Post partum problem
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Member:
malhana

Posted on Friday, Mar 21, 2008 - 12:21 am:

Hello, my 20 year old Standardbred mare foaled on Saturday 3/15/08, 16 days overdue. The birth was a tad precipitous but the foal was in the proper position and all went well. The colt had a little problem with standing but with help was nursing within two hours. The mare passed the intact placenta in less than an hour. The mare, however, didn't have a bowel movement for 3 days, was anorective and wasn't drinking I called a reproductive Vet, her temp was 99.5, capillary refill fine, hooves cold. He checked the vagina and cervix, she was involuting a little slower than he liked and we gave oxytocin Q 2 hours for 10hours, he gave her electrolytes and mineral oil and a 10cc dose of Banamine. He suggested Banamine 5cc q 12 hours for endotoxin prevention. She has perked up and is eating grain sporadically but eats hay well spurning alfalfa, seemingly satisfied with grass hay. The problem is two fold, the 5 cc's of banamine doesn't seem sufficient and when given 10cc's she seems to eat much better and seems fine for over 18 hours and becomes anorexic again. He doesn't seem to know exactly what is wrong, she doesn't have a fever but her urine, even after drinking, seems orangey red.She passes a small amount of manure regularly. She evidently is producing enough milk as the foal is fine and is whipping around the foaling stall and learning how to kick like a mule with bad aim and tried to rear up today when i wouldn't let him nuzzle my hand.My question is a) what could be wrong and b) how long may/should I give her Banamine (10cc's) Q 24 hours? I cannot turn them out as we still have two feet of ice/snow.
Thank you, Annette
Moderator:
DrO

Posted on Friday, Mar 21, 2008 - 6:41 am:

Hello Annette,
A excellent and concise review of a baffling case. Unfortunately the only thing we really have as a clear symptom is anorexia that is responsive to flunixin. The urine and fecal character may be secondary to the decrease food and water consumption. It does strike me that the first event of no stools for 3 days a bit odd. You often see mares that empty themselves out just before birth, then don't eat well the night of foaling, so there is no stool the day of birth but not for 3 days. This is combination with the symptoms suggest a partial impaction or possibly a cecal impaction. These small amounts of stool: do they look normal or do they have a bit of a mucosy coating? I would also consider gastric ulcers as a possibility.

I would be interested in the other vital signs like heart rate and bowel sounds and how these change with changing clinical status. Lastly if you still remained baffled consider comprehensive lab work.

If this problem keeps up you might consider weaning the foal so the mare has one less caloric and water stress to deal with while you figure this out. As for how long on the Banamine, the way you describe things now: you persist with treating as long as it is needed to maintain hydration.
DrO
Member:
malhana

Posted on Friday, Mar 21, 2008 - 12:04 pm:

Thank you Dr. O,Slightly "sluggish" bowel sounds, heart rate within the norm both before and after medication. The stools are normal now, in the beginning were dryish. A different Vet is coming today to check another pregnant mare and I will draw blood for her to process. So, I'll keep you updated and hope to have good news over the weekend.
Many thanks for being there for all of us. You are appreciated!
Moderator:
DrO

Posted on Saturday, Mar 22, 2008 - 10:09 am:

Now that the stools have returned to normal has the mares appetite and behavior improved?
DrO
Member:
malhana

Posted on Saturday, Mar 22, 2008 - 2:44 pm:

No, they haven't. Her appetite is improved in that she's eating 25% of her normal prefoaling ration. We've found some hay that she eats well but her grain consumption is still poor. I had a Chem scan done yesterday and everything is in the normal range except she has hypocalcemia. She had a 4.7 and the low norm is 10(ish). We've given her Calcionate Syrup via NG tube as the IV TX seems a bit complex and scary (arrhythmias, etc). I've also increased her Banamine to TID but she's still lethargic. Her water consumption is approx 5 gallons per day, but in spite that the foal continues to thrive. I've now read your article on hypocalcemia and she doesn't display any of the Thumpy/Tetany symptoms. Pre foaling she did have serious quivering of her leg muscles but I thought that was mainly due her her recumbent positioning for several hours at a time. She has DrOpped hind suspensories so was having difficulty in arising. My secondary Vet suggested she might have had pre eclampsia. I wasn't aware that this was an equine pregnancy issue? I also forgot to mention in the first post that she had no real udder and she had been on Domperidone for 5 days prior to delivery.
All very confusing. Just when I think I have seen it all....
Thanks again for your help.
Annette
Moderator:
DrO

Posted on Sunday, Mar 23, 2008 - 12:15 pm:

Wow 4.7 mg/dl if not an error, is quite remarkable. Is this total serum calcium or serum "ionized" calcium? The normals suggest total but the lack of units makes this less certain. Lab calcium values are generally not effected by handling...and often when a lab gets such a value they will repeat the test. Hypercalcemia would explain the quivering and the agalactia, then possible the forcing with the domperidone moves us into a unexplored clinical environment.

The clinical signs of hypocalcemia are very variable and depend on the rate of development and the value at any one time but depression and inappetance are common in cows experiencing lactation hypocalcemia. Hypocalcemia also occurs with serious inflammatory bowel disease (blister beetle and NSAID toxicity is on that list) but your normal CBD seems to make this unlikely. Otherwise I do not know how hypocalcemia explains the flunixin responsiveness but I would be slow to move beyond twice daily administration.

Assuming the test results reliable, in such a situation IV calcium (say up to 500 ml of a 23% calcium gluconate preparation) would be prudent and by giving slowly while monitoring heart rate and rhythm avoid serious complications. To the degree your symptoms are due to this it will cure them in 30 minutes to an hour.
DrO
Member:
malhana

Posted on Sunday, Jun 22, 2008 - 10:33 am:

Hi, an update on the mare and foal. We repeated the NG calcium, and the CBC. Ca level in low normal this time, and while she wasn't much interested in grain, ate large quantities of 50/50 timothy and alfalfa hay. However, she was still lethargic and not drinking a sufficient amount of water. The foal seemed indifferent to the mare's malaise and started nursing while she was incumbent (which was frequent). I finally decided to plow the pasture enough for her to move around a small area, with easy access to water. Now 3 1/2 months later she's back to normal, the foal is thriving and all is well in my world. This colt will be her last, and hopefully she'll be with me for many years.
Thank you for your help, Dr. O. As usual it was much welcomed.
Moderator:
DrO

Posted on Sunday, Jun 22, 2008 - 6:56 pm:

Hmm an interesting case Annette and delighted to hear things are doing better.
DrO
Member:
canderso

Posted on Monday, Jun 23, 2008 - 12:33 pm:

Dr. O - I am just starting to learn about gestation.

Sorry for the dumb question with the wildly non-technical phrasing but I am trying to understand what happened here: Is it overly simplistic to conclude the foal over taxed the mare's calcium intake and stores?
Moderator:
DrO

Posted on Tuesday, Jun 24, 2008 - 8:26 am:

I have to say when I see the number above I consider an error as this level is lower than clinical signs suggest but...you are right hyocalcemia is a complicated metabolic event that may be related to over-supplementation prior to birth, particularly in healthy well fed mares. For more see Diseases of Horses » Lameness » Muscle & Tendon Diseases » Hypocalcemia, Thumps & Tetany, particularly the prevention section.
DrO
Member:
malhana

Posted on Tuesday, Jun 24, 2008 - 11:34 pm:

Alas, my mare was being fed Blue Seal's "Mare and Foal" period. No supplements, not overfed as she's a very picky eater and won't/can't eat what is a suggested ration for her weight. Two blood samples were sent to different labs. One, for rapid response and another to confirm. They both came back around the same range. The good news is that this episode ensured that this would be her last foal but it was and remains a puzzler.
Annette
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