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Dan C., DVM
Dan C., DVM, Horse Veterinarian
Category: Horse
Satisfied Customers: 1198
Experience:  Solo Equine Practitioner/Mobile Practice Owner for 16 years.
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Our little old mare (29/30 years) has had Cushings for maybe

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Our little old mare (29/30 years) has had Cushings for maybe 3 years. 1/2 tab Prascend daily. She has had loose stools on & off. The last couple of months she has had diarrhea constantly She was wormed last month (Equest pramox) She is given Speedi beet, Emerald Geen alfa-mazing, Dodson & Horrell cushcare, micronised linseed, unlimited hay which she does struggle to eat, so when my feed order arrives will be starting Allen & Page fast fibre. I have given her a mineral lick & tried live yoghurt. Fed morning & evening. She is now loosing weight & wasn't big to start with. Is it her age or the cushings, am I going to be fighting a loosing battle?
Caroline

Good Morning, Caroline:

I'm Dan C., DVM, and I'm here to help you and Maggie the best that I can. I"m sorry to hear about Maggie's recent problem with diarrhea. As I"m sure you know, there are multiple causes for diarrhea in the horse, ranging from sudden feed change, internal parasites, viral and bacterial infections, and the list goes on. The fact that she has Cushing's disease should not be a factor, as far as a cause for the diarrhea, and from the information you have provided it sounds as if you are giving her excellent care. I have a few questions I'd like to ask you about Maggie, so we can narrow down the possibilities and find the cause of her problem.

1): What breed of horse is Maggie?

2): What type of environment does she live in (stall with turnout, open pasture, etc.)?

3): Do you know when she last had her teeth examined/floated?

4): What is the consistency of the diarrhea (watery, cow-pie, etc.)?

5): Are you able to take her temperature to see if she is running a fever? Normal horse temp. is between 99-101F

Thanks in advance for your answers, and I'm looking forward to hearing from you.

-Dan C., DVM

Hi Caroline:

Just need to let you know that I'll be offline for about an hour, as I need to make a farm call. I'll be looking for your reply immediately on my return.

Thank you,

-Dan.

Customer: replied 3 months ago.
Hi, thanks Dan, sorry got distracted with other stuff. Maggie (we) are living in France, Lot et Garonne, normally she is out 24/7 but as she has got older I have kept her in at nights probably from Nov-March, our weather, temperature can change drastically from 15degc during the day to -2 at night, so if the temp is below 8deg day or night I put a rug on her. She has never had a curly coat. Very little grass at the moment & is probably on a 5acre field. We do our own hay as farmers here don't seem to know about ragwort!
I have an English Dentist (***** *****) who comes every year. She was kicked as a yearling which left her with a central incisor fracture at gum level and a deviation of the upper left incisor teeth. It has never been a problem, but on Ian's last visit he said one upper incisor missing & 1 or 2 loose ones. Which is why I've ordered the fibre beet to soak & replace the hay as she doesn't seem interested in it; just wants to be on the grass. Even with the alfalfa she will leave the stalky bits.
The diarrhea is watery most of the time. I can take her temperature later today & let you know.
I don't know her breed, it is not on her papers, parents unknown. She is approx 13.2hh very finely built, a bit like a larger leading rein pony. maybe a little bit of Welsh, has never looked overweight. She went lame but never had the laminitic stance, x-rays showed she had 4 & 6% rotation of the pedal bone, blood tests were then done & cushings diagnosed in 2014. I'm sure I have read: life expectancy for cushings 2 - 7 years depending on age. Should I be preparing myself that maybe age & cushings is getting the better of her!
I am prepared for an honest answer as last winter & the heat of the summer 30+ she seemed to struggle.
Many thanks & happy new year,
Caroline

Thanks for getting back to me Caroline:

As Maggie is at 30 years of age, and along with the Cushing's, she's a tough cookie and lucky to have you caring for her. Obviously I can't examine her and give you a definitive diagnosis (although I would love to visit France again...) but there are two possible conditions that are a strong possibility that have me concerned. Based on your history of her care, I think we can safely rule out internal parasites, although it wouldn't hurt to check. With older horses that I have seen that have chronic diarrhea, it is usually associated with inflammatory bowel disease (IBD) or a type of cancer (often lymphoma). As you are probably aware, with Cushing's disease, the body produces too much cortisol, and one of the effects of this is a weakened immune system. This is why the life span can be shortened, as the horse is more prone to disease/infections, and has less of an ability to fight them off. If either of these is the case with Maggie, neither of them would be good news, as the treatment for IBD is steroids (which she already has too much of), and an intestinal cancer is terminal. That said, however, it is relatively easy to diagnose by your Veterinarian obtaining a rectal mucosal biopsy (the lining of the rectum). I'm sure your Vet probably knows this procedure, but it involves mild sedation, then performing a rectal exam along with an open blood collection tube, and pinching off a piece of the rectal lining between the thumb and the edge of the tube. This poses no danger to the horse when done correctly. The sample is then sent off to a pathologist for analysis. You might also consider having some normal bloodwork performed, to rule out any type of organ failure, which can contribute to diarrhea as well.

I took you at your word in saying that you were prepared for an honest answer, and I must say that at her age and medical condition, the prognosis is not good. That said, I still recommend looking into a diagnosis, as I have been pleasantly surprised more than once!

I will certainly keep good thoughts for Maggie, and if you have the time, please keep me posted as to what you decide to do. It gets frustrating being in this position, and not knowing how my "on-line patients" are doing...

Thanks again for getting back to me, and please let me know if you have any further questions.

All the best, ***** ***** Happy New Year to you too, Caroline.

Sincerely,

-Dan.

Hi Caroline:

Just checking to see if you have any further questions.

Thanks again,

-Dan.

Customer: replied 3 months ago.
Hi Dan, thank you. I took her temp. this morning and it was 37 so normal.
I don't have a lot of faith in my local vets, but for a blood test on organ failure, they must send off to a lab. When I had them when she first became lame, they never even took her temp or a digital pulse. I had a vet who specialises in equines who diagnosed the Cushings after he had told me she had Founder. He showed me how to take a digital pulse, but she has never had any re-accurance of lameness, once ice packs & Prascend got it under control.
I'll ask the local vet to take bloods for organ performance & if that comes back clear, I'll ask the Equine vet to do the rectal exam, he has to come from some distance. (With all the vets a little bit gets lost in translation, which is why I contacted you).
Maggie to my knowledge has never had colic. She is keen to go out in the morning & is waiting by her stable door by 6 in the eve to go in. Mentally she seems the same, but her body is beginning to look skeletal, especially next to my fat boys, an ID & a mountain moorland type.
I quickly read a little on IBD & no it doesn't sound good. I have been prepared this last year that maybe it will soon be time to say goodbye. I would like to keep her going as long as poss, but if I thought she was in any pain, I hope she would by able to show it in some way; I would call time.
I will keep you informed of results.
Many thanks, Caroline

Thanks for your reply, Caroline. I wish for you the best with Maggie. Your approach with her sounds good. I would check her bloodwork first too.

One other note: with the diarrhea there is a good possibility of dehydration. Be sure she has access to plenty of water, and you might consider adding water to her other feeds as well, if possible.

Thanks for keeping me informed. I appreciate it.

-Dan.

Dan C., DVM and other Horse Specialists are ready to help you
Customer: replied 3 months ago.
Hi Dan, Maggie's bloods are being taken Weds. I'll let you know the results.

Thanks Caroline. Any change in the diarrhea? Did the Vet recommend anything for a treatment?

=Dan.

Oops....obviously, your Vet hasn't been there yet.

Customer: replied 3 months ago.
No change, I think I've tried most things but I havn't tried activated charcoal, I ordered some last week so just waiting for that to arrive........

Hi Caroline:

A few thoughts: I have successfully used in the past for "mystery" diarrheas a combination of 60cc Aloe Vera gel and 1/4 teaspoon slippery elm powder (I get those in the U.S. at an organic food store) once a day for a week or so. Sometimes it works, other times not, depending on the cause. I'd recommend having a fecal analysis done as well when your Vet is there. Also, ask your Vet what she/he thinks about a course of Metronidazole (Flagyl) for Maggie. I've used it for some of those mysteries as well. It's classified as an antibiotic/antiprotozoal. Either of these may help, but it's best to treat the cause, not the symptoms.

-Dan.

Customer: replied 3 months ago.
Hi Dan, just thought I'd let you know Maggie's blood results. All was clear for liver n kidneys. Not sure I understand the results for Monocytes 4.3% Lymphocytes 26,4% etc. etc. I know the different ones will show if she's fighting a viral, bacterial or parasitic problem, but I don't know the % to indicate she has got a problem but I'd hope the vets would of implied there was; they only mentioned her glucose was low which I can see from the chart on the results, 0.57 g/L. MCH was still in the normal range 19,2 pg but getting close to high, all the others were in the normal range. I started the activated charcoal at the weekend & the Allen n Page feed arrived yesturday, so I'll introduce that slowly. I'll update you if there's any change. Caroline

Hi Caroline: Thanks for the update! I'd been wondering how things were going. As far as the lymphocytes/monocytes %, etc., that is basically the percent of that certain type of white cell in the blood. It's not particularly useful for me, but what is important concerning the same cells is what is called the "absolute" numbers. This is the actual number of the particular white cells present. There should be an overall number under WBC, then it is broken down into individual groupings. Neutrophils (sometimes abbreviated as "SEGS", which means segmented neutrophil) are the major white cells involved with fighting infection, followed by lymphocytes. An elevation of neutrophils indicates either infection or inflammation, and basically same for lymphocytes. Many variables, however. There should be a "normal" range next to the individual findings. Often, when cancer is involved (although this only pertains to certain types, and is not always conclusive), the lymphocytes will be elevated and neutrophils will either be elevated or below normal, relative to how advanced and what type the cancer is. With a parasite problem (or allergies) the most commonly elevated white cell is the eosinophil. The MCH basically has to do with shape and size of the cell, and is normally not very relevant.

Hope this helps. It's good to know that all of her organs seem to be functioning normally.

Thanks again for keeping me up to date. Looking forward to hearing from you again soon.

-Dan.