Well, so much for my theories. After taking the oil out of Pie's food on Tuesday on the theory that maybe the fats were causing him a problem due to a bile duct problem - he was fine all evening and I was congratulating myself - on Wednesday evening he had two colic attacks, one at the usual time one hour after feeding time and the other several hours later. In both cases, after the usual 30 minutes of severe pain and gas, he would get back up and start eating hay again like nothing had ever been wrong. We only know about the second attack because one of the boarders happened to stop by the barn to get something and found him down and in pain. He may have had other attacks in the night that we don't know about.
In any event, enough was enough - this has been going on now for almost 10 days, and our vet recommended that we take him to the best veterinary medical clinic in our area - the hospital at the University of Wisconsin at Madison that's associated with their vet school. It's about 2 1/2 hours away, but the couple closer clinics are more equipped to handle lamenesses and surgeries and less able to deal with medical issues like Pie's. So off we went this morning.
It's an excellent facility - everyone from the vet techs to the receptionist to the veterinary students, residents and doctors were competent and interested. Think of a large teaching hospital for people and you've got the basic picture. The facility handles all sorts of large animals - there was even a camel there who would call (a sort of loud roar/moan) from time to time. We spent a lot of time going over all the details of Pie's medical history, he had a thorough physical exam, several ultrasounds as well as rectal exams, including with ultrasound. He also had more blood work - his GGT liver enzyme is a bit higher than it was, but his AST enzyme level and white count were normal.
His GI tract seems completely normal - no structural abnormalities or obstructions. No stones, in either the intestines or the bile duct. The liver itself looked pretty good. But the vets did detect a number of those nodules my regular vet found on rectal exam - they're about the size of golf balls, they're harder than fecal balls but still somewhat squishy, and they're scattered around outside the GI tract inside the abdominal cavity and move fairly freely when pushed on. As the senior vet said, he was only accessing a portion of the digestive tract, and there were likely more of these nodules where he couldn't reach, and in a horse of Pie's size and bulk ultrasound can't reach everything. It's possible these nodules are causing the problems he's been having - the nodules could be pulling on various parts of the GI tract and making the passage of food painful. The biliary/liver issues are likely caused by trouble in the GI tract rather than the other way around.
Tomorrow they'll take a sample of abdominal fluid to see if there are indications of whether these nodules are a series of walled-off abscesses (perhaps due to an old case of bastard strangles where a horse is exposed to strangles and doesn't develop the respiratory version but instead develops abscesses in the body that can stay there sometimes without causing problems, or a horse who had been vaccinated for strangles and then is exposed to it - this apparently did happen with some of the older vaccines) or maybe something else. (Drifter's prior case of strangles isn't implicated in this, since Pie's first colic attacks occurred at the end of January and early February long before Drifter's arrival.) If they were strep abscesses, the antibiotic he's been on has relatively poor efficacy against strep, but they're waiting to see what shows up on the test tomorrow and then we'll have an idea of what our next steps might be.
Pie had no colicy symptoms during the day - but then he didn't get anything to eat either, poor guy. Starting this evening, they're going to start feeding him small amounts of hay every few hours, gradually increasing and then maybe adding some pellets, to see if they can induce him to colic so they can determine what is setting it off and what his symptoms are when he's in trouble. I'm not worried as he's in very good hands.
I met a very nice family in the waiting room - their little Arabian mare was in for colicing repeatedly as well. Father and mother a little older than me, their daughter and a friend. The family actually invited me to stay overnight at their house if I needed to - I ended up coming home to take care of the animals but it was so kind of them to make the offer. And the whole family and their friend all knew who Lily, Maisie and Norman were due to reading the Paradigm Farms blog - they said they love Norman!
Please keep us in your thoughts and prayers.