[IIIBarsV]

I had bloodwork done last week on Sunner, my chronically ill mare, for my nutrition teacher. I have spent the last few hours learning how to read this thing. It came back as:

Elevated Sodium (153, norm is 132-142 mmol/L)
Elevated Chloride (114, norm is 95-105 mmol/L)
Elevated MCH (19, norm is 14-18)

Platelets are on the low side (107, norm is 100-400 x10E9/L)
RBC seem on the low side (7.0, norm is 6.5-12.5 x10E9/L)
Neutrophils to the high side (73.5%, 6.3, norm is 2.7-6.7 x10E9/L)
Lymphocytes on the low side (22.5%, 1.9, norm is 1.5-5.5 x10E9/L)

(Full sheet can be viewed here: http://img.photobucket.com/albums/v1...ct30th2009.jpg )

Overview: Sunner has chronic diarrhea and weight loss, anorexia (for hay), excessive water consumption/cravings, and excessive salt consumption/cravings. This has been ongoing for like 7 years now, and we have kept her alive and living life fairly well in retirement. She is 13 yrs old, AQHA. Only serious health issue was about two years before the diarrhea started, when she was sold out from under our care and grass-foundered very badly.

We have put every anti-diarrhea treatment on the market into this mare with little success. The only thing that brought about an increase in weight, energy, and returned her to a "normal" manure was limiting her water intake to a consumption level of the average horse, instead of allowing her to gorge and gorge at three times or more the normal level. Her diet for the past few years has been fairly consistent with freechoice grass mix/timothy hay (that she often only picks at or refuses to eat), and a large amount of beet pulp, with oats and barley. We recently ditched the oats and barley in favour of a low-starch feed (Masterfeeds Fusion).

You would think that she would become dehydrated, but she seems MORE dehydrated and lethargic, as well as loses weight, when she is allowed access to larger amounts of water. When she is rationed (at a rate of a half-bucket every 1-3 hours), her energy skyrockets, she gains weight, and she does not appear to get dehydrated. She has been dewormed regularly... a Panacur 5-day we did on her in Winter 2007-2008 seemed to really help.

Also, interestingly... her symptoms increase when she is not on her daily supplement of ground chaste tree berry. We started her on this under the thought that she might be an early-onset Cushings horse, (bloodtested negative for that), and it is the only thing in her feed that seems to allow her to balance out the water cravings, her mental attitude, and really put on weight (at a slow, slow pace).

Currently she is a 3/10 for a body condition score. We had her at a lean 4.5 last summer, but she went downhill again this summer. I even thought she could be a rare horse who has Addison's Disease, but that has also been tossed out by the vets, even though she has pretty much every symptom of the disease going.

So, the vet didn't really say anything in regards to the bloodwork this time, despite elevated levels. I have crammed my brain and learned too much information about reading blood panels than I thought I could learn in 2 hours, but there you are.

To my eyeballs, her liver function is normal (which is what my nutrition prof wanted to know), but she may be slightly anemic, and may have a kidney function problem- low level. Both of these can result in the symptoms she's shown, but I would think a kidney function problem would've killed her by now, or shown up with some serious clarity to the vets in the bloodwork. Nothing in the bloodwork suggests that she has intestinal cancer, or an infection, except perhaps the neutrophils and lymphocytes.

Maybe I am bein excessive, but there's got to be SOME KIND OF HINT on this flimsy sheet of paper. I'm not going to believe for a second that the blood panel won't give us a clue somewhere.

So, with that overview.... let's all delve into the mystery case again!

~Sarah~

[angie j]

How long ago did you blood test for Cushings? Is it possible you got a false reading due to a seasonal low? What were the 'actual' results? Poor horse

[CrazyHorse]

Have they ruled out Polydipsia? It's rare in horses but does occur, and your mare does exhibit some symptoms.

http://www.evj.co.uk/archive/downloa...12_179_186.pdf

[Ryle]

I'm not seeing anything on the bloodwork that looks really out of whack. Remember that normal ranges are an averaging of results found in multiple "normal horses" but that some horses can be outside that range and still be normal for them.

Are you allowing free choice minerals at this point or are you limiting that amount she gets?

Has a fecal culture been performed to look for a bacterial cause of the diarrhea?

Has she been fed in a sandy enclosure?

Chronic inflammation of the GI tract can have lots of causes and unfortunately they can be really hard to diagnose in a horse because we can't easily take biopsies or just perform an exploratory surgery to see what things look like in there.

Toxicities, cancer, sand, and parasites could all be causes. As could a simple food allergie though these tend to show more in the skin in horses.

Have you tried a feed trial to see if a specific forage or feed might help? A feed trial means feeding ONLY a specific feedstuff for about 3 weeks to see if there are any changes. Then if there is no issue with that foodstuff you add in a single other foodstuff and watch for changes.

[seaecho]

If she had allergies, most likely the eos would be up, and I see from the bloodwork link that they are not.

[seaecho]

Oh, and if she had a low level kidney problem, it wouldn't kill her. It could be low grade, and animals often live out normal lives despite the problem. Sometimes it won't show up in the bloodwork either. They might not feel as good as they would normally, but it won't necessarily kill them.

[Theorist]

Originally Posted by Ryle

I'm not seeing anything on the bloodwork that looks really out of whack. Remember that normal ranges are an averaging of results found in multiple "normal horses" but that some horses can be outside that range and still be normal for them.

Are you allowing free choice minerals at this point or are you limiting that amount she gets?

Has a fecal culture been performed to look for a bacterial cause of the diarrhea?

Has she been fed in a sandy enclosure?

Chronic inflammation of the GI tract can have lots of causes and unfortunately they can be really hard to diagnose in a horse because we can't easily take biopsies or just perform an exploratory surgery to see what things look like in there.

Toxicities, cancer, sand, and parasites could all be causes. As could a simple food allergie though these tend to show more in the skin in horses.

Have you tried a feed trial to see if a specific forage or feed might help? A feed trial means feeding ONLY a specific feedstuff for about 3 weeks to see if there are any changes. Then if there is no issue with that foodstuff you add in a single other foodstuff and watch for changes.

I have to agree. What you posted is mostly within range. I couldn't get a great look at the full work up.
From your description, I thought cushings as well.
Hope you can get this figured out.. you are the resident brainiac

[jz131]

I would recommend checking thyroid levels as well as ACTH levels (checks for cushings disease). also if you have not run a parasite check in the past 3-4 months I would recommend that as well. even though you are deworming your horse, there is a lot of dewormer resistance, esp to ivermectin. have her teeth been done recently? where are you located? for example in the NE we have a very large problem with tick borne diseases, that can cause a variety of symptoms.

hope this helps.
the bloodwork is pretty unremarkable, but be careful with restricting water intake......sometimes it can cause more problems then it solves.

horses can also be diabetic......even though it is rare.

[IIIBarsV]

I should've mentioned, I took her vitals yesterday and they're normal as normal gets.

She is on a mineral supplement, 7 cups of soaked beet pulp 4x a day, with high-fat-highfibre/low starch feed- Masterfeeds Fusion, and her chastetree berry supplement. She has a salt lick 24/7 that she demolishes. Hay 24/7. We make sure she has lukewarm or warm water to drink, because she gulps it down so fast. She will go after puddles and sitting water, and has even learned to paw a hole so that it will fill up with water if there's mud on the ground. Because of this, she cannot go outside when it rains, or when her paddock has any source of water that we can't control in it.

She's been on every ulcer supplement on the market. Has had her teeth floated once a year, but she is due again and that will be done in the next week or two. She doesn't have any major dental flaws that would cause problems chewing. I have investigated the possibility of bute toxicity since she was on it for longer than I would have liked when she foundered several years ago, but the problems started showing up like a year or more after she had been off the bute.

Every pre-and pro-biotic on the market... well, several of them, no results. I'm wondering if the Omega Alpha "Antiflam" might help calm the digestive inflammation?

We had her tested for Cushings, and for diabetes about three years ago. Negatives... I believe she was tested for those in the late spring time. The vets thought it unlikely since she is so young. Polydipsia I looked into and for a while, thought indeed that she has psychogenic polydipsia, especially since she did not dehydrate when her water intake was brought from 60-70 gallons a day to 20 gallons a day. But she still didn't "thrive", even though she improved.

She was FEC'd for bacterial causes about four years ago but they didn't find anything. FEC was also fine for parasites. The 5-Day Panacur treatment two years ago really helped- we started that after I found an 11" long ascarid dead in her stall (we had dewormed with Zimectin Gold three days previous that discovery). She is on rotational dewormers, although I am aware of ascarid resistance to ivermectin in Ontario. Maybe I need to run another 5-day of Panacur?

She has been fed in a sandy enclosure, however when she was in it, she was eating her hay out of a hay bag, and she wasn't into picking up hay off the ground.

My vet also suggested intestinal cancer, but wouldn't her WBC be higher if that were the case?

"Really hard to diagnose" = understatement.

As for feeds... we have had her on multiple feed trials over the past years (of course, we have not taken her "off hay"). Some certain herbal supplements geared towards digestive upset have seemed to have garnered better results than others (slippery elm bark, . She has been on Trimax, beet pulp with oats/barley, low-NSC, low starch... her current diet seems to be the best insofar.

The only things we have NOT done on this horse are balancing the ration compared to the hay to look for vitamin or mineral deficiences, biopsied her, scoped her, or tried that method where you take the manure of a healthy horse make it into a soup and tube it into her. I doubted good bacterias there would be able to survive past the acidity of the stomach.

My nutrition professor figures she's got a cecum/large colon issue, perhaps with acidity and lack of "healthy" bacterial population (forage fermentors), and has a feed program that she is very confident will solve the problems. She has worked on many tough mystery cases like this and managed to find solutions for them all. This lady fixed a horse after two prominent vet hospitals, multiple vets and specialists had been unable to find a solution and had given up on the horse.

While that may not end up being the case with my mare, hey, it's worth a shot to trust someone who has a very good understanding of the horse digestive system, and who specializes in hindgut problems.

In the meantime, Sunner is bright-eyed and obnoxious, runs around crazy in the paddock, growing in a nice healthy-looking winter coat, has great hoof growth and quality (so she's gotta be getting SOMETHING out of what we're packing into her), nice lustery shine... her manure has been soft, but not like splattering the walls. Aside from being really skinny (BCS of 3) and having this obsession with water, she seems pretty happy with life and is not in any chronic pain. Rate of passage has slowed down and she is not colicky. (This is why she has not been euthanized).

Thanks very much!

[Ryle]

For kidney disease you see an increase in the blood chemistries, not a decrease.

Parasite resistance issues are seen much more commonly with fenbendazole and pyrantel then ivermectin. With an adult horse you are going to be really worried about strongyles and the incidence of strongyle resistance is currently quite low.