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Vets are stumped - Ulcers, kidneys, ideas?

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  • Vets are stumped - Ulcers, kidneys, ideas?

    I'll try to keep this short and answer questions if they come up.

    2009 TB gelding, began losing weight and muscle in early 2010. Vet changed diet to increase calories so horse is now getting alfalfa and cadence. March 2010 horse becomes colicky and we find out that he has a pea sized stone blocking his urination. That is removed and colic sx stop. Vet does lab work and diagnoses kidney disease and recommends euthanasia. I get second opinion and second vet recommends changing diet to grass hay and oats and re-evaluate later. Horse does not maintain good body weight and seems very lethargic. Also drinks excessive amounts of water (typically 30+ gallons per day) Blood work in June '10 shows high BUN, normal creatinine, high LDH, normal WBC, and high lymphocytes. Vet suspects ulcers. Start on omeprazole daily. Blood work in Sept '10 again shows high BUN, normal creatinine, high BUN/Creatinine ratio, high WBC, and now high neutrophils. Urinalysis shows high sodium, high pot, high chloride, high calcium, low specific gravity. Vet send labs to Univ. internist who agrees either ulcers or possibly cancer.

    He has now been on omeprazole for 4+ months. His condition has improved a bit though his coat is still dull. He still drinks excessive amounts of water and urinates more than normal. He can easily soak 3 bags of pelleted bedding in one night.

    Does anyone have any other ideas of what could be going on with this guy?
    www.StoneLilyFarm.net

  • #2
    By omeprazole do you mean ulcergard or gastrogard at the treatment dose? If not you might want to start there. Often times the horses just don't respond to the compounded stuff as it gets digested in the stomach when it needs to pass through undigested to do the job.
    McDowell Racing Stables

    Home Away From Home

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    • #3
      Has he been tested for any tick-borne diseases?
      Off Topic Discussion about Life, Interests & Politics
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      • #4
        Originally posted by JCIbarra View Post
        I'll try to keep this short and answer questions if they come up.

        Wow, sounds like a really sick baby. Kidney problems obviously but cause ? Can't really offer any suggestions but if his kidneys are shot at this young an age what future is he likely to have?
        Colored Cowhorse Ranch
        www.coloredcowhorseranch.com
        Northern NV

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        • Original Poster

          #5
          Laurie - no, we've have not been using the ulcergard or gastrogard. I was not aware that the compounded was not as effective. I'll have to talk to them about that.

          Laura - no, nothing like that. The cbc, chem and urinalysis are all that have been done. They did attempt to ultrasound his kidneys but could not come up with anything conclusive. We don't really have tick problems in this area, but I guess it's something to consider.

          Colored - The normal creatinine results is what has thrown the last two vets off. They lean more towards ulcers because of that. And yes, I am very concerned from his future but don't want to jump to any decisions about euthanasia.
          www.StoneLilyFarm.net

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          • #6
            Have you had him ultrasounded at a vet hospital or just on farm? The ultrasound we had where I used to work was WAY more high tech and detailed than anything that was used on the farm. Would help get a better picture of the kidneys and if there is anything suspicious that could point towards cancer.
            Only two emotions belong in the saddle: One is a sense of humor. The other is patience.

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            • Original Poster

              #7
              Bugs - the ultrasound was done at the clinic. One kidney appeared to be larger than the other (if I remember, they said that this is normal) but they could not find any masses or stones.
              www.StoneLilyFarm.net

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              • #8
                Originally posted by JCIbarra View Post
                ...began losing weight and muscle in early 2010.
                Vet changed diet to increase calories so horse is now getting alfalfa and cadence...
                ...changing diet to grass hay and oats and re-evaluate later...
                Horse does not maintain good body weight and seems very lethargic...
                Also drinks excessive amounts of water (typically 30+ gallons per day)...
                His condition has improved a bit though his coat is still dull. He still drinks excessive amounts of water and urinates more than normal. He can easily soak 3 bags of pelleted bedding in one night...
                So sorry to hear about your guy. I'm curious: have you had him tested for Insulin Resistance? Sounds like there may be more major stuff going on, but excessive urination and becoming lethargic are often a key symptoms in IR. Given the increased, sugary / high-calorie foods that have been added to his diet, the IR would definitely be continuing. Depending on what type of blood tests have been done, the vets may not have been looking at insulin levels.

                I'd highly suggest asking about this - and making sure the vet you ask actually *understands* IR. While quite common, not all vets are up-to-date on IR information.

                You might also poke around this website for more info and to see if there are other symptoms that relate:
                http://pets.groups.yahoo.com/group/EquineCushings/
                (they are finding that many Cushings horses were actually IR when they were younger - but it was never caught/diagnosed, which led them to Cushings)

                PM me if you have questions. I'm no expert, but I have an IR guy myself - took awhile to realize what was going on. Luckily, we caught it before he was too off-balance, and I've been able to easily maintain him since. Once we knew what was going on, it was a pretty quick recovery. *phew*

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                • Original Poster

                  #9
                  MR - thanks for the thought. I have the three lab work results in front of me. I see glucose (which is normal on all three) but I don't see anything about insulin. Of course, I also don't know what I am looking for. :-) I will add that to my questions for the vet.
                  www.StoneLilyFarm.net

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                  • #10
                    Originally posted by JCIbarra View Post
                    Bugs - the ultrasound was done at the clinic. One kidney appeared to be larger than the other (if I remember, they said that this is normal) but they could not find any masses or stones.

                    One kidney is closer to the body wall than the other, so it will appear larger on U/S.

                    It was just a thought, as I know the quality of images can vary greatly from machine to machine.
                    Only two emotions belong in the saddle: One is a sense of humor. The other is patience.

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                    • #11
                      I would definitely consider IR, and that your horse is not just thin but muscle wasted ( atrophied) at this point.
                      "Kindness is free" ~ Eurofoal
                      ---
                      The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

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                      • #12
                        So he's 2?

                        IR would be REALLY unlikely....

                        Has he been scoped for ulcers? How much hay is he getting? How much oats? (I don't think oats are what he needs, but we can see where this goes....) Has he had a good abdominal ultrasound/abdominal tap with fluid analysis? Might need a controlled measure of "ins and outs" - water in vs. urine out to determine if he is really urinating too much.

                        I agree with laurierace - treatment for ulcers needs to be Gastroguard at the treatment dose. We have seen horses on generic with terrible ulcers after a month of treatment.

                        Can you take him to the internist at the vet school for a workup?

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                        • Original Poster

                          #13
                          AnimalDoc - thanks for the reply. He gets free choice timothy hay and about 1.5 lbs 2x per day of whole oats.

                          He has not been scoped or had an abdominal tap. We do have a university available if we decide to go that route.
                          www.StoneLilyFarm.net

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                          • #14
                            Originally posted by JCIbarra View Post
                            AnimalDoc - thanks for the reply. He gets free choice timothy hay and about 1.5 lbs 2x per day of whole oats.
                            He has not been scoped or had an abdominal tap. We do have a university available if we decide to go that route.
                            well timothy is normally high in potassium but honesty the diet you have presented would not make any 2yo baby bloom or shine or grow thrive or be anything but just "here" existing....

                            was that the vet's plan ??

                            Tamara in TN
                            Last edited by Tamara in TN; Jan. 11, 2011, 09:17 PM.
                            Production Acres,Pro A Welsh Cobs
                            I am one of the last 210,000 remaining full time farmers in America.We feed the others.

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                            • #15
                              Rare but - look into diabetes insipidus. Here is a good article with some information:

                              http://www.larounds.ca/crus/laveng_0205.pdf

                              There is other information in there about excessive urination, low specific gravity of the urine itself.
                              There are friends and faces that may be forgotten, but there are horses that never will be. - Andy Adams

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                              • Original Poster

                                #16
                                My understanding was that the alfalfa and pelleted grain could be causing more problems if it was indeed his kidneys.
                                www.StoneLilyFarm.net

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                                • #17
                                  you live in the land of beautiful orchardgrass,would they let you feed that instead? more feed value than timothy but not the other worries of alfalfa...

                                  Tamara in TN
                                  Production Acres,Pro A Welsh Cobs
                                  I am one of the last 210,000 remaining full time farmers in America.We feed the others.

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                                  • #18
                                    Originally posted by JCIbarra View Post
                                    My understanding was that the alfalfa and pelleted grain could be causing more problems if it was indeed his kidneys.
                                    That is correct. I lost a horse to chronic kidney disease a year ago. He was 6 years old. Vet said sometimes they are born with it, genetic defect, or causes unknown. Until he went off his feed, he did not look or act sick. Low protien feed is called for in the case of kidney disease, you would see elevated levels of protien in the urine when tested.
                                    There are friends and faces that may be forgotten, but there are horses that never will be. - Andy Adams

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                                    • Original Poster

                                      #19
                                      Tamara - I will check on the Orchard grass. He is at a good weight now (finally), just lacking muscle tone and a good coat.

                                      Munchkin - that is what the original vet said, that it was likely a problem that he was born with and he will always have it. I couldn't euthanazine him without trying...

                                      The normal creatinine is what has confused everyone so far.
                                      www.StoneLilyFarm.net

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                                      • #20
                                        Maybe it's time to ship to the university and get some answers. A kidney biopsy or even exploratory laparotomy to look for cancer might help you figure out cause and prognosis, etc. Has your vet run any endocrinological tests to look for rarer diseases like adrenal insufficiency?
                                        The plural of anecdote is not data.
                                        Eventing Yahoo In Training

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