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Enteritis. Update post 22. Progress!

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  • Enteritis. Update post 22. Progress!

    Not NQR in the sense that he's not eating or he looks uncomfortable but more that his eye looks worried. And even today in the cooler weather I had to drag him down the road when I hand walked him. Tried walking on and off the pavement with no change. He was happier once we were on the trail behind some houses.

    I am going to talk to the vet (who has been out of town on her annual scuba diving vacation) this week.

    Recent history

    Colicky back in December and ended up at clinic b/c it's a 5-minute walk and the nearest vet was two hours out. Diagnosis via scoping was ulcers (grade 3-4). Treated with ranitidine and re-scoped 3-4 weeks later. Ulcers effectively gone (< grade 1). Vet advised not keeping him on ulcer meds or preventatives 24/7 but to use as needed in stressful situations. Which we've done.

    Negative fecal in March. Dewormed with praziquantel-containing de-wormer last fall. Teeth done end of March.

    April 26. Not super interested in food Took temp, respiration, listened for gut sounds and gave some ranitidine. An hour or so later he seemed more interested in food. I left instructions for evening check person to check and give ranitidine. By then he's definitely distressed. Ends up back at clinic at recommendation of vet who was at barn and night check person (who is a vet student). They found 10-L of fluid in stomach and small intestine not working properly and with some inflammed areas. Blood work WNL with white count high end of normal (next day it was at lowest end of normal and stabilized there thereafter).

    Over next few days, the inflammed areas got smaller, they started to re-feed him, and I brought him home Friday. While at the clinic they scoped for ulcers (negative) and checked for stones (negative, but there is an outside chance they're there but not visible). They also did a respiratory panel since there's been an assortment of respiratory crud at the barn. Also negative.

    Vet suggested doing a Power Pack and then redoing blood panel as eosinophil count was high-ish. He dissed the concept of fecals and said it was simpler just to de-worm. Then said that worms hate California since it's hot and dry. Vet also said to take him off everything but the hay and split that up into three feedings, which I have. Except for a tiny amount to mix with supplements. Hay = alfalfa. He had been getting Integrity Senior (Star Milling).

    We hand walked as instructed in the freakishly hot weather Thursday and Friday and then Saturday. And then today. Which takes us back to the first paragraph.

    If you want a further back history, horse had a previous impaction colic in fall 2008 while on layup for a collateral ligament injury. This was treated medically. Over the last year there have been a few bouts where he's been mildly colicky but it's resolved quickly with a walk and/or banamine.

    Any ideas, diagnoses, analysis, stories, or whatever are welcome.
    Last edited by Peggy; Jul. 20, 2013, 02:31 AM. Reason: Another Update
    The Evil Chem Prof

  • #2
    You seem to be very on top of it -- and have been scrupulous in checking everything out.

    That said, you know your horse better than anyone. If you think he is NQR, then he probably is. Follow your instincts.

    One of my 5 horses (3 retired) has "worried eyes". When he is not happy or is in pain, he gets little creases just above his eyelids. Most people don't notice, but I do because I know every expression he has. And if his eyelids wrinkle, I know he is trying to tell me something. It sounds as if your horse is doing the same.

    That's about all the help I can be. Good that you are following up with your vet.
    "He lives in a cocoon of solipsism"

    Charles Krauthammer speaking about Trump


    • Original Poster

      Yes, that's exactly it. Little creases and his eyes aren't the right shape. Or mischievous enough. I've asked the BO and others that are around when I'm not to help keep an extra eye on him. Thanks for listening.
      The Evil Chem Prof


      • #4
        Hind gut ulcers? Equishure?


        • Original Poster

          Originally posted by Simkie View Post
          Hind gut ulcers? Equishure?
          This is on my list. My vet's office person, who used to be her tech, suggested it.
          The Evil Chem Prof


          • Original Poster

            Small update.

            He seems a bit more perky and interested in things. Kept trying to eat on our walk today. Energy lever seems better. He's not gaining weight but that probably isn't going to happen with this horse on forage alone. He is definitely happier once we're on the trail as opposed to the road: https://www.facebook.com/photo.php?f...9&l=ebb09d0bb4

            Vet isn't back in town until next week.
            The Evil Chem Prof


            • #7
              Have you cosidered a general antioxident like ground flax/grape seed, or general non-medical anti-inflamatory like Cetyl-M? Sounds like a reactive system. If his gut is inflamed, the concussion of walking on pavement would be more than the jarring of walking on dirt. Good luck, I know how frustrating it is.

              We are getting your heat tomorrow, after much needed snow and rain for several days.
              Comprehensive Equestrian Site Planning and Facility Design


              • Original Poster

                Live from the vet clinic down the street. He was still kind of meh so i brought him down.

                It is the ilium (sp) part of the intestine that is still thickened. They did an abdominal tap to rule out some other stuff and we are waiting for the results. One of the possibilities is a kind of chronic inflammation.
                The Evil Chem Prof


                • Original Poster

                  The abdominal tap (post *8) came back negative. You can see the thickened intestinal wall in the ultrasound but there is apparently no way to tell how much of it is thickened without getting a lot more invasive. It could be a small area. Or a large area. Or several small areas (kind of like hives of the ileum). He threw out two possible diagnoses that I should have written down. One was eosinophilic enteritis/ileitis (I think that's the hive-like one) and the other one started with a P (helpful, I know). He didn't suggest a cause and I forgot to ask if there was one. Also forgot to ask how painful this is for the poor horse.

                  He eats. He poops. He pees. He follows me on our walks. But he's still dull/depressed/not himself. He did rather enjoy all the attention he got from two vets plus three vet students at the clinic. He has continued to improve so the vet said to give it another week. My vet his coming back into town on Monday and the hospital vet already emailed her something to the effect of "Hope you had a great trip. Call me." I'll let them talk and then I'll talk to her. I am hoping that she has some sort of brilliant idea. One that doesn't involve surgery.
                  The Evil Chem Prof


                  • #10
                    I might consider a general intestinal calm-everything-down-er like biosponge and I still think treating for hind gut ulcers is worth looking at.

                    The gut is obviously unhappy. For horses, I don't think we have a lot of tools to make the gut happier (I could be wrong?) In, say, a cat, you might hit it hard with some steroids. I suppose you could do that for a horse, but the risks are pretty large.

                    What did the vet say about the Equishure product? I would DEFINITELY try something like that before going to surgery.


                    • Original Poster

                      Long-term steroid use was mentioned. I'm waiting to talk to my vet about things like Equishure. I think that the ambulatory vets are more pragmatic than the ones at the clinics. I took him back because I was hoping to avoid another late night run out to the barn, it's really close, and my vet was gone.
                      The Evil Chem Prof


                      • #12
                        Peggy, do a search for my previous posts to read about my daughter's pony who had very similar symptoms - diagnosed with with inflammatory bowel disease. Managed on long term prednisone and has been problem free for well over a year. She is retired now hanging out with my daughter's new OTTB.


                        • Original Poster

                          ^^ Thanks. I found at least some of them. Does sound similar.
                          The Evil Chem Prof


                          • Original Poster

                            We may have a tentative diagnosis of granulomatous enteritis. My vet got back into town and convinced the clinic vet to meet her at my barn and show her how to use her ultrasound instrument to monitor Star's intestines. This, of course, occurred on one of the hottest (thus far) days of the year--it was 101°F when we all met at the barn on Monday. Anyhow, in the process of looking and looking at intestines (quite interesting stuff, probably more so if it's not your horse), the clinic vet says he feels that the inflammation pattern is more consistent with the granulomatous form. However, a biopsy is the only way to prove it.

                            Since the horse is not colicky at the moment, seems to be getting a scootch happier with each passing day, and his appetite is improving, we will continue with the wait and see approach. They don't want to make any changes such as using Succeed or EquiShure or doing a Power Pack. He is now getting hay to munch on through the night. If he is still not himself in a week or so, we will have another discussion.

                            I did find this (http://www.merckmanuals.com/vet/dige...in_horses.html) which doesn't exactly present a cheery prognosis, but I am somewhat encouraged by Humblepie's pony and the fact that Star's intestinal walls measure, at most, 5-6 mm as opposed to the 10 or more mm described in some of the articles.
                            The Evil Chem Prof


                            • #15
                              How is your horse now Peggy?


                              • Original Poster

                                Originally posted by Rosie10 View Post
                                How is your horse now Peggy?
                                Thanks for asking.

                                More or less the same but slightly improved. I brought him up to the cross ties to groom him Saturday and he seemed more animated and even a touch obnoxious. He also had a better look in his eye. So, having been giving permission to do this by the two vets, I tacked him up and rode at the walk for about 15 minutes. I think he liked the IDEA of being ridden more than the ACT of being ridden. If he seems in a good mood tomorrow, I'll try again.

                                He is eating all of his food, including the extra flake at lunch at the overnight timothy in the slow-feeder hay bag.

                                My vet also suggested acupuncture which we are trying tomorrow.
                                The Evil Chem Prof


                                • Original Poster

                                  So, one session of acupuncture didn't do much except annoy him. I think that the sensation of moving around with the needles inside was like when water runs down his legs (which he HATES). But, after the second session and getting his feeding in order, he was almost obnoxious on Sunday. More like the imaginary tiger in Calvin and Hobbs as opposed to the stuffed one. He's been more like the latter lately.

                                  The feeding has been an ordeal. I paid for the barn to give him an extra flake at lunch since the clinic vets advised to keep the diet simple and using their hay would accomplish that since it would all be the same. It didn't seem to happen on a regular basis and the BO implied her guys weren't going to catch on, so we (AKA, the training program) starting grabbing it and doing it on our own when we noticed it hadn't happened. Then it turned out they (BO's guys) were grabbing the bag of timothy (per my vet's instructions) that I'd set out for him to be fed later and giving it to him for dinner. So, when the night check person came she assumed that another person had already given him that. So, we started to hide that. And, now with the first of the month I'll just have the training program give lunch instead of the barn since he's getting it as a late night snack anyway.

                                  Here is a photo from Friday. The link should be public: https://www.facebook.com/photo.php?f...8&l=cb7a886a3c
                                  The Evil Chem Prof


                                  • #18
                                    Good to hear he is doing okay. His coat on his neck looks nice and shiny.


                                    • #19
                                      He is a cute boy. How is he doing?


                                      • Original Poster

                                        Much better, thanks. Still on a limited diet of alfalfa and timothy with just enough concentrates to give him supplements. Gaining weight. Energy level good. Up to four light rides a week with probably 5 minutes total canter plus trot. Haven't re-ultrasounded.
                                        The Evil Chem Prof