I went up to spend the day with Pie again at the University of Wisconsin veterinary hospital. He's doing well - no "episodes" but then he hasn't had that much to eat yet - but is shiny and sassy and very sweet - all the staff and students like him. He gets several walks a day outside in their sand/rubber pellet footing walking area, and the vet student who's in charge of him even brushes him. He's not happy about being confined to a stall the rest of the time - he tells me about it - and has taken to mischief like untying the rope that secures the IV hanger (which he isn't using) or figuring out how to pick up his water dish.
Today the senior vet and resident did some repeats of exams - ultrasounds and rectals - that were done yesterday - since his GI tract was much emptier, they wanted to verify that the nodules were still there, and not just fecal matter. They were still there - at least a half dozen that the vet could palpate just at the end of his reach when doing the rectal exam - there may or may not be more out of reach. Ultrasounds of this area are difficult at best - Pie is too big and his abdomen is too broad. At least one seemed to be attached to the outer surface of the colon. They also did an abdominal tap, to see if any abnormal cells (white cells or cells indicating certain types of cancer) showed up, and to also start cultures (which will take about 48 hours) to see if any bacteria show up. So far everything looks normal - there are no abnormal cells in his abdominal fluid, and his blood work is normal except for slightly elevated GGT enzymes.
The initial thoughts were that Pie might have bastard strangles - encapsulated strep inside his abdomen. The senior vet now thinks this isn't likely - his blood work, the fact he's not at all sick in that way and the lack of white cells in his abdominal tap make this less probable although it's still possible. He also clearly doesn't have certain types of cancers that tend to shed cells into the abdominal space. At this point we don't know what he has - he sure doesn't look or act like a horse with cancer of any type. We've done the non-invasive tests that can be done - x-rays won't help in this case due to the type of thing and the location. A biopsy isn't practical - the location is risky and the nodules tend to be very moveable. Opening him up for surgical examination isn't warranted at this time and would be very risky.
So we really don't know. They're going to keep increasing his hay and pellets over the next day or so - since he's already there - and see if he experiences another episode of colic pain - they can then take a closer look to see what's really happening. At this point we're taking things one day at a time - but then that's how Pie always takes things and I'm trying to emulate his good example.
Friday, September 30, 2011
Thursday, September 29, 2011
It Wasn't the Fats - Pie Makes a Trip to the Vet Hospital
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.
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.
Wednesday, September 28, 2011
More Clues About Pie
We took the oil out of Pie's evening feed last evening, and voila! no digestive pain whatsoever, despite having his Banamine reduced to one dose in the morning. And today, when the vet came to do a blood draw to recheck his liver/bile situation (poor Pie's becoming quite the pincushion), she commented on how bright, alert and interactive he was - in fact at this point I'd say he looks great.
And there are more clues . . . Those of you who've been reading for a while may (very vaguely) remember that Pie had what (in hindsight) was an identical digestive attack after p.m. feeding on January 31. We blamed that on him being misfed another horse's dinner, and that horse was getting different feed. But we were all perplexed at how acute his symptoms were considering the very small amount - one cup - of different feed he'd been given. Here's the clue - the wrong food was a high-fat feed (Ultimate Finish) that Fritz was receiving to help him gain weight. There's the fat again - that's what caused the problem even though the amount was small. Then Pie had another attack on February 8, and none that we've noticed between then and last week, although there was the mysterious tying up episode on May 11 - I'm still not sure what that was all about - he was in severe pain and sweating profusely. That may or may not be unrelated.
So, looking back, it's clear that he's had this liver/bile duct problem all along, but we didn't know because he was able to tolerate fat in his diet - he's been getting cocosoya oil all along - unless it was too much - the winter episode where he was fed extra fat - or if his system was somehow otherwise disturbed, as with the recent vaccinations. The pain he's experienced seems to be because the fats aren't being broken down properly by bile in his small intestine, and end up undigested in the caecum - hence the pain and large amounts of gas, and his feeling somewhat better once the gas passes through.
Or at least that's the theory at this point. We'll see what the bloodwork shows and then go from there, but if we can at least make him comfortable again by removing the extra fat from his diet, that will be progress.
And there are more clues . . . Those of you who've been reading for a while may (very vaguely) remember that Pie had what (in hindsight) was an identical digestive attack after p.m. feeding on January 31. We blamed that on him being misfed another horse's dinner, and that horse was getting different feed. But we were all perplexed at how acute his symptoms were considering the very small amount - one cup - of different feed he'd been given. Here's the clue - the wrong food was a high-fat feed (Ultimate Finish) that Fritz was receiving to help him gain weight. There's the fat again - that's what caused the problem even though the amount was small. Then Pie had another attack on February 8, and none that we've noticed between then and last week, although there was the mysterious tying up episode on May 11 - I'm still not sure what that was all about - he was in severe pain and sweating profusely. That may or may not be unrelated.
So, looking back, it's clear that he's had this liver/bile duct problem all along, but we didn't know because he was able to tolerate fat in his diet - he's been getting cocosoya oil all along - unless it was too much - the winter episode where he was fed extra fat - or if his system was somehow otherwise disturbed, as with the recent vaccinations. The pain he's experienced seems to be because the fats aren't being broken down properly by bile in his small intestine, and end up undigested in the caecum - hence the pain and large amounts of gas, and his feeling somewhat better once the gas passes through.
Or at least that's the theory at this point. We'll see what the bloodwork shows and then go from there, but if we can at least make him comfortable again by removing the extra fat from his diet, that will be progress.
Tuesday, September 27, 2011
It May Be the Fats . . .
Sometimes when you see something suddenly in a pattern of facts, things snap into focus. I've been mulling over the odd timing of Pie's nightly colic pain and gas after eating and trying to figure out why it happens then and what might be causing it. It's clear that there's some underlying condition - stones in the bile duct or the small intestine, or an infection/inflammation caused by something - encysted small strongyles or tapeworms (he's been treated for both and his recent fecal test was negative but those might not have shown up), bacteria or even the protozoa that cause EPM. But something aggravates the condition every evening, about 30 minutes to an hour after he eats dinner, and the timing and the specific elevated liver enzymes clearly indicate a problem with the bile ducts/small intestine. The underlying condition is not stomach ulcers - he doesn't present like a horse with ulcers - no unhappiness at feeding time or refusal to eat pellets - in fact he's an eager eater. It isn't likely to be sand colic - there's no diarrhea and his weight is good and he's eating eagerly. It isn't an impaction in the large colon - his manure if anything is a little loose after being on the antibiotics, and is profuse.
So what could it be? Nothing has changed in his diet, but if his sensitivity to whatever it is has increased, as a result of a change in the underlying condition perhaps triggered by his vaccinations a week ago, there's some component of his evening feed that's causing him extra distress. (He's not 100% normal the rest of the time, but about 90% OK until after evening feeding, when his condition becomes very uncomfortable very fast, and then usually improves again just as rapidly after a period of extreme discomfort.)
So I reviewed what goes into his evening feed - mineral/vitamin balancer pellets, magnesium/chromium powder, U-Gard and cocosoya oil. But wait! Bile is produced specifically to digest fats, and its production is increased as fats are presented to the digestive system. It could be the oil . . .
Tonight we're trying a test - we're giving him only his pellets, his Uniprim antibiotics and a little water to hold it together. We'll see what happens . . .
And our vet/chiro was out to look at him. She didn't do a full adjustment - until we get at whatever is making him feel punky, any adjustment she does won't stick, but she did some little things to make him feel better. She also did a neurological exam - I love that our chiro is a vet as she's useful for this stuff and very well informed. Pie has a couple of neurological oddities - one test is to pick the horse's foot up and put in in an odd position to the side and see if the horse corrects it - horses that are normal neurologically do this on their own. Pie was good with the fronts - the test is to place them to the side away from the body - Pie said "no, they belong here" and moved them back to center. The test with the hinds is to place one hind leg across and behind the other - Pie moved his right hind back immediately but would leave the left hind in the odd position for quite a while without moving it. When turned in a tight circle, he also didn't move his left hind completely normally, wanting to rotate on it and not lift it and cross it over. He's also had two incidents - one today - where he's stepped on his left hind with his right hind, once on the heel and once on the inside of the pastern, while running around. This could mean that his kinesthetic sense of where his left hind is located isn't quite right. This could be his normal, related to some stifle issues, or it could be a sign of something going on (that might or might not be related to his digestive difficulties). We did a blood draw to rule out EPM - the definitive results from the new ELISA test, which is inexpensive, should be back in a few days.
Pie has also developed a couple of sarcoid-like spots - one on his right barrel and one on his neck - that could also be an immune system response to the vaccinations - sometimes when a horse's immune system is challenged, either by illness or vaccination, other things that have been brewing and that the horse has been able to manage until then pop up and become symptomatic. I'll keep an eye on those spots - for now they're not a problem.
Our regular vet is coming back tomorrow to do a blood draw to recheck his liver enzyme levels - we want to be sure things aren't moving in the wrong direction and I want to discuss whether it makes sense to refer him to a vet clinic, where we could do a liver and spleen ultrasound and also a liver biopsy if that were warranted - we've got a couple of good clinics within two hours of us.
Keeping fingers crossed that we'll figure this out and get it under control, and we'll see if removing the fats from his dinner helps him be more comfortable.
Update at almost 2 hours after feeding time - so far Pie is feeling fine, no colic, no symptoms of any pain! Hoping this is a good sign, or that at least we've figured out how to keep him more comfortable while we're figuring out what the underlying problem is.
So what could it be? Nothing has changed in his diet, but if his sensitivity to whatever it is has increased, as a result of a change in the underlying condition perhaps triggered by his vaccinations a week ago, there's some component of his evening feed that's causing him extra distress. (He's not 100% normal the rest of the time, but about 90% OK until after evening feeding, when his condition becomes very uncomfortable very fast, and then usually improves again just as rapidly after a period of extreme discomfort.)
So I reviewed what goes into his evening feed - mineral/vitamin balancer pellets, magnesium/chromium powder, U-Gard and cocosoya oil. But wait! Bile is produced specifically to digest fats, and its production is increased as fats are presented to the digestive system. It could be the oil . . .
Tonight we're trying a test - we're giving him only his pellets, his Uniprim antibiotics and a little water to hold it together. We'll see what happens . . .
And our vet/chiro was out to look at him. She didn't do a full adjustment - until we get at whatever is making him feel punky, any adjustment she does won't stick, but she did some little things to make him feel better. She also did a neurological exam - I love that our chiro is a vet as she's useful for this stuff and very well informed. Pie has a couple of neurological oddities - one test is to pick the horse's foot up and put in in an odd position to the side and see if the horse corrects it - horses that are normal neurologically do this on their own. Pie was good with the fronts - the test is to place them to the side away from the body - Pie said "no, they belong here" and moved them back to center. The test with the hinds is to place one hind leg across and behind the other - Pie moved his right hind back immediately but would leave the left hind in the odd position for quite a while without moving it. When turned in a tight circle, he also didn't move his left hind completely normally, wanting to rotate on it and not lift it and cross it over. He's also had two incidents - one today - where he's stepped on his left hind with his right hind, once on the heel and once on the inside of the pastern, while running around. This could mean that his kinesthetic sense of where his left hind is located isn't quite right. This could be his normal, related to some stifle issues, or it could be a sign of something going on (that might or might not be related to his digestive difficulties). We did a blood draw to rule out EPM - the definitive results from the new ELISA test, which is inexpensive, should be back in a few days.
Pie has also developed a couple of sarcoid-like spots - one on his right barrel and one on his neck - that could also be an immune system response to the vaccinations - sometimes when a horse's immune system is challenged, either by illness or vaccination, other things that have been brewing and that the horse has been able to manage until then pop up and become symptomatic. I'll keep an eye on those spots - for now they're not a problem.
Our regular vet is coming back tomorrow to do a blood draw to recheck his liver enzyme levels - we want to be sure things aren't moving in the wrong direction and I want to discuss whether it makes sense to refer him to a vet clinic, where we could do a liver and spleen ultrasound and also a liver biopsy if that were warranted - we've got a couple of good clinics within two hours of us.
Keeping fingers crossed that we'll figure this out and get it under control, and we'll see if removing the fats from his dinner helps him be more comfortable.
Update at almost 2 hours after feeding time - so far Pie is feeling fine, no colic, no symptoms of any pain! Hoping this is a good sign, or that at least we've figured out how to keep him more comfortable while we're figuring out what the underlying problem is.
Monday, September 26, 2011
Not Out of the Woods Yet
I would have said that Pie was a lot better - we'd had a couple of days with no symptoms, and this afternoon and early evening he looked great - bright, alert, friendly and pretty much back to normal. He'd been passing a lot of manure and everything seems fine. But then about an hour after feeding time this evening, he went down in his stall again, switching from sternal to flat and back and forth, and groaning, and passing large amounts of gas. I went in his stall and held his head for a bit, then he got up and was pretty much back to normal - alert and interactive - although a bit touchy about his left side. This wasn't as bad as his attack last Wednesday, but was as bad as how he was feeling a day or two after that.
This is the pattern - brief episodes of sharp abdominal pain, about 45 minutes to an hour after p.m. feeding, accompanied by lots of gas. The elevated liver enzymes, particularly GGT, suggest bile duct involvement - either inflammation or a partial obstruction by a bile duct stone, and this would fit with the timing after feeding time. But it's really hard to tell what's going on. He has days where he feels better and days where he doesn't, despite having been on antibiotics and anti-inflammatories for a week. He doesn't seem to have symptoms any other time of day.
The vet is coming Wednesday to do another blood draw to see if anything's changed. If things aren't moving in the right direction, I may trailer him to a vet clinic - we have a couple of good ones to choose from - to have a liver ultrasound and any other tests they may recommend.
I keep thinking that things are getting better and then they aren't - it's frustrating to see my horse in pain and not be able to fix it.
This is the pattern - brief episodes of sharp abdominal pain, about 45 minutes to an hour after p.m. feeding, accompanied by lots of gas. The elevated liver enzymes, particularly GGT, suggest bile duct involvement - either inflammation or a partial obstruction by a bile duct stone, and this would fit with the timing after feeding time. But it's really hard to tell what's going on. He has days where he feels better and days where he doesn't, despite having been on antibiotics and anti-inflammatories for a week. He doesn't seem to have symptoms any other time of day.
The vet is coming Wednesday to do another blood draw to see if anything's changed. If things aren't moving in the right direction, I may trailer him to a vet clinic - we have a couple of good ones to choose from - to have a liver ultrasound and any other tests they may recommend.
I keep thinking that things are getting better and then they aren't - it's frustrating to see my horse in pain and not be able to fix it.
Sunday, September 25, 2011
Pie Doing Better
Every day, Pie seems to be doing a bit better. Thursday, after his first dose of antibiotics Wednesday night, he was still pretty uncomfortable about 45 minutes after evening feeding time, lying down for a while, and even flat, but not with the severe (and heart-rending) groaning that had happened on Monday and Wednesday. He perked back up pretty quickly after feeling bad for a bit. And then Friday and Saturday, he didn't lie down but stood in the back of his stall for a bit looking uncomfortable. And tonight, Sunday, he looked pretty good throughout and he also seems less crabby. I think the antibiotics are beginning to work, and we'll do a blood draw sometime next week to check that his elevated liver enzymes are starting to come back down. Keeping fingers crossed . . .
Friday, September 23, 2011
Photo Essay and Pictures of Pie's Daddy
Pie seems to be doing somewhat better - he's eating and drinking well. He did have a brief "episode" last night about 45 minutes after feeding time, where he was lying down and clearly a bit uncomfortable, although not as bad as the previous night. It'll take a while for the antibiotics to have an effect, but at least the anti-inflammatories are helping him be more comfortable. I actually got a good night's sleep for once.
It's a beautiful day - cool and sunny - so I made a trip to the barn to take some pictures. Here's Charisma hanging out in her paddock:
Drifter was impatiently waiting for the other horses to come back within view:
Misty's still got the summer "frosting" on her rump:
Scout (in front) and Fritz (behind) were doing their synchronized grazing moves:
Pie looked fairly pleased to see me, since I didn't have a halter or any meds in my hand:
Pie decided to chase Scout:
But things settled right back down:
I seem to love to take pictures of Pie's hindquarters and his beautiful, thick, deep red tail:
Pie's former owner was out in Montana recently, and was kind enough to send me some photos of Pie's sire, Cody's Red Glo - I think he's standing on a downhill slope here - this also gives a good picture of the environment Pie was born in and where he lived until he was a weanling:
Pie's sire looks to be shorter than Pie, and a darker shade of red, but has the about the same build - although Pie also looks a lot like his dam - here's the post with Pie's baby pictures. Pie's sire has more white, including a big blaze:
Now we know where the deepness of jowl and "Pie face" come from!:
The person in the left of the photo is the gentleman I got Pie from:
I'm glad to have these pictures - Pie's the first horse I've ever had baby pictures of or pictures of sire and dam, and that's pretty darn cool!
It's a beautiful day - cool and sunny - so I made a trip to the barn to take some pictures. Here's Charisma hanging out in her paddock:
Drifter was impatiently waiting for the other horses to come back within view:
Misty's still got the summer "frosting" on her rump:
Scout (in front) and Fritz (behind) were doing their synchronized grazing moves:
Pie looked fairly pleased to see me, since I didn't have a halter or any meds in my hand:
Pie decided to chase Scout:
But things settled right back down:
I seem to love to take pictures of Pie's hindquarters and his beautiful, thick, deep red tail:
Pie's former owner was out in Montana recently, and was kind enough to send me some photos of Pie's sire, Cody's Red Glo - I think he's standing on a downhill slope here - this also gives a good picture of the environment Pie was born in and where he lived until he was a weanling:
Pie's sire looks to be shorter than Pie, and a darker shade of red, but has the about the same build - although Pie also looks a lot like his dam - here's the post with Pie's baby pictures. Pie's sire has more white, including a big blaze:
Now we know where the deepness of jowl and "Pie face" come from!:
The person in the left of the photo is the gentleman I got Pie from:
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