Tag Archives: dentist

Pain in the Neck

My old guy has always had issues with his cervical spine/neck.  Throughout the years he has developed arthritis which has caused symptoms which mirror EPM such as; ataxia, difficulty bending, hind end weakness, difficulty going up hills, lethargy, difficulty balancing when foot is lifted, muscle atrophy, sore back…you get the picture.

When his symptoms first came on I had the vet test for EPM.  The test was positive.  I did my research and found out that about 50% of horses will test positive for EPM but only 1% show actual impairment from the virus.  I went ahead and completed two rounds of EPM medication therapy and still his symptoms continued.  So, I sought out another vet who practiced eastern and western medicine.

After some chiropractic adjustments and acupuncture she felt that his issues were actually due to the cervical spine and not EPM. The vet also showed me how, when looking at Chance straight on, one of his eyes was lower then the other- a classic sign of cervical and jaw issues. We continued with the chiropractic and acupuncture therapy and have continued for over a year and the change has been remarkable.  Along with these therapies, we upped his feed, added supplements, began stretches and different exercises, and had him walking and running up and down hills whenever he was outside.  The dentist has also been of great help by floating Chance’s teeth every few months instead of once a year.  This helps with the alignment of his teeth because he tends to ware one side of his teeth down more then the other; ultimately straining his jaw and neck.

He has rebuilt the muscle on his hind end, put on around 100 lbs, and is able to do stretches while someone is holding his foot up.  He runs when he is outside and is no longer on pain medications (except on the rare occasion).

Here is some useful information on a horse’s back and cervical spine.

Diagnosing A Horse’s Neck Problems

Main Causes of Ataxia in Horses

Arthritis of the Spine in Horses

Back Stretches

Exercises for Spinal Issues in Horses

How To Read Equine (Horse and donkey) Blood Work?

I had the vet run some blood work on Luck and Chance as a precaution, because of the “Panic Grass” in Virginia has been causing liver failure in horses, and because I like to do a full work up every 6-12 months.



Chance’s Blood Work



C 1

C 3


L 2


INTERPRETATION OF RESULTS



Elevated Potassium (6.6 mEq/L):

“Low levels indicate depletion and are often a predisposing factor, along with
dehydration, in fatigue, muscle cramps, colic, synchronous diaphragmatic flutter (“th
umps”), diarrhea and other symptoms of exhausted horse syndrome. Even seemingly normal or high-normal levels may in reality be lower, but appear higher due to concentration secondary to dehydration as measured by total protein and albumin levels.
Therefore, levels at the lower end of the normal range should be evaluated relative to concurrent dehydration” (https://www.quia.com/files/quia/users/medicinehawk/2407-Vet/labs.pdf).

Low Sodium:

“Low levels commonly indicate loss through excessive sweating, or through kidney or intestinal disease. Low levels may also be found in young foals with bladder damage. Increased sodium levels are usually a sign of dehydration” (http://www.minstervets.co.uk).

Low Platelets: 

This was the most worrisome in regards to the potential immediate issues that could ensue because of the low platelet count. 

“The platelets are the third cellular component of blood (along with red and
white blood cells). These cells contain a number of biologically active molecules that are
critical to the blood clotting process. Low levels may indicate a number of disease
processes not necessarily directly related to a bleeding disorder. Chronic or acute blood
loss, immune disease, toxemia, liver, spleen or bone marrow disease, or even critically
reduced or increased body temperatures can also cause low platelets counts. Any
significantly low platelet counts should be further investigated by a veterinarian. High
levels are generally clinically insignificant unless the condition persists, in which case it may be indicative of bone marrow neoplastic disease” (Susan Garlinghouse).

Low Glucose:

“Glucose is the source of the body’s energy. It is measured in suspected cases of equine metabolic syndrome and sometimes in cases of equine Cushing’s disease. Blood glucose may also be measured as part of a glucose tolerance test, assessing small intestinal function” (http://www.minstervets.co.uk).

Chance was tested for Cushing’s Disease within the last year and the test showed that he did NOT have Cushings. 
Elevated CPK (337 U/L):

Levels 2-3x the highest number in range are considered significant according to vetstream.com.  Levels are easily increased due to poor handling techniques as well as lab error.

According to Dr. Christine Woodford and Carla Baumgartner on vipsvet.com, “Elevations of CPK and SGOT are indictors of muscle inflammation–tying-up or rhabdomyolysis. The term “rhabdo” means muscle and “myolysis” means rupture of muscle cells. The CPK and SGOT are very sensitive indicators of skeletal muscle damage, and they rise in concentration proportionally with the amount of damage. A bit of timing is required in order to obtain the most sensitive results; CPK rises (due to its leakage from muscle cells into the blood system) approximately six to eight hours after the onset of muscle inflammation, and SGOT rises after approximately 12-14 hours. The absolute peak of CPK concentration and the time it takes to return to normal are important indicators of the severity of muscle damage and the response to therapy.”

Elevated MCV: Is the average volume of red blood cells.

  • Macrocytosis.
  • Indicates immature RBC in circulation (suggests regenerative anemia).
  • Very rare in the horse, but may observe increasing MCV within normal range as horses increase erythropoiesis.

According to Vetstream.com, “Macrocytosis (increased MCV) resulting from release of immature RBC from the bone marrow during regeneration is very rare in the horse therefore the MCV is less useful in the horse than in other species.”

Elevated MCH: Is the average amount of hemoglobin in an individual red blood cell.

  • Hemolysis, if intravascular in nature .
  • Errors can occur during processing

Low RBC:

“You may be inclined to think that red blood cell levels need to drop significantly before they cause a problem for your horse. But the truth is that even low-grade anemia – levels hovering around that 30% range on a PCV – can impact your horse physically and may indicate a health problem. This is especially true for high performance athletes. The greater your horse’s physical condition and demand, the higher on the range of normal her red blood cell counts will typically be. Therefore, a red blood cell level low on the normal range or just below may indicate a concern for a racehorse, for example, where it wouldn’t for that pasture pet.”  See more at: http://www.succeed-equine.com/succeed-blog/2014/02/05/anemia-horses-part-1-just-equine-anemia/#sthash.JJuWN5ob.dpuf


Luck’s blood work



L 1

C 2

Elevated Potassium: Potassium can become elevated for a number of reasons.

According to Vetstream.com,

  • 98% of potassium is intracellular.
  • Changes in serum or plasma potassium levels reflect fluid balance, rate of renal excretion and changes in balance between intra- and extracellular fluid.
  • Hypokalemia increases membrane potential, resulting in hyperpolarization with weakness or paralysis.
  • Hyperkalemia decreases membrane potential with resulting hyperexcitability.
Susan Garlinghouse states that, “High serum levels of potassium during an endurance ride are generally not a concern. These increases often reflect nothing more serious than a delay between blood collection (when potassium is actively sequestered inside cells) and sample measurement (after potassium has had time to “leak” from inside the cells out into the plasma or serum).”  This could also be a result of Luck and Chance running around in the heat when the vet arrived.
Increased [potassium] (hyperkalemia) can occur from;
  • Results can be false due to processing time (ie: if the lab waited too long to process blood sample)
  • Immediately after high intensity exercise.
  • In association with clinical signs in horses with hyperkalemic periodic paraysis (HYPP)    .
  • Bladder rupture (neonate)    .
  • Hypoadrenocorticism  [Pituitary: adenoma]  (rare).
  • Metabolic acidosis.
  • Acute renal failure    .
  • Extensive tissue damage (especially muscle).
  • IV potassium salts, eg potassium benzyl penicillin, potassium chloride    .
  • Phacochromocytoma (rare in the horse).
    Hypokalemia
  • Chronic diarrhea.
  • Diuretic therapy, especially potassium-losing diuretics.
  • Excess bicarbonate/lactate therapy.
  • Chronic liver disease    .
  • Acute renal failure (polyuric phase)    .
  • Recovery from severe trauma.
  • Metabolic/respiratory alkalosis.
  • Prolonged anorexia.
  • Recovery period after high intensity exercise (30-60 min after).
  • Parenteral feeding.

In combination with clinical signs and results of other tests results could signify the following;

Elevated GGTP:

* Donkeys tend to have 3x higher levels then horses.  This means that in stead of the typical equine range being 1-35 U/L a typically donkey’s range would be up to ~105 U/L.  Lucky’s test showed he had 120 U/L which is still elevated but not much.  It took sometime to get Luck from the field when the vet arrived- he ran around non stop.  The excitement and anxiety could be the cause of the elevated levels.

RBC:

Katherine Wilson, DVM, DACVIM, of the Virginia–Maryland Regional College of Veterinary Medicine (See more at: http://equusmagazine.com/article/decode-horses-bloodwork-27122#sthash.sc4J1ISJ.dpuf) explains “RBC count is probably the least helpful information because horses usually don’t have big changes in red blood cell numbers. It is not uncommon for horses to have an RBC count a little lower than normal range, however. The term we use for low RBC is anemia, but unless the count gets very low, a horse doesn’t necessarily need to be treated for that condition. A lot of diseases or any chronic long-term disease can cause mild anemia. Usually if we see mild anemia on the bloodwork and the horse has other issues, the anemia is just an indication that we need to fix/treat another problem.”

Low or Elevated Values

  • Splenic contraction.
  • Polycythemia (rare) .
  • Dehydration.
  • Consider causes of anemia
  • Blood loss    .
  • Hemolysis (i in vivo or artifact).
  • Decreased bone marrow production.
  • Poor technique at sampling.
  • Poor handling and storage of samples.
  • Poor technique in laboratory.

Low Bilirubin:

Heather Smith Thomas of Equus states,  “Another indication of liver health is a pigment called bilirubin, which is formed from the breakdown of red blood cells. Elevated levels can mean unusual loss of red cells or liver dysfunction. However, in horses, unlike other animals, elevated levels of bilirubin often isn’t serious. “This value can increase fairly rapidly when horses go off feed, and this is something that is unique to the horse,” says Wilson. “Often we get phone calls from veterinarians who don’t work on horses much or owners who see the blood work and note that the bilirubin is above normal range and are concerned about liver disease. If the horse is off feed for 24 to 48 hours, that value will increase, but this is just a temporary elevation.”

Elevated Hemoglobin (19 g/dL):

According to vetstream.com, Thoroughbred and other “hot-blooded” horses Hemoglobin range differs from other equine- the thoroughbred range = 11.0-19.0g/l.

Elevated Hematocrit (54 %):

 Elevated levels could be due to;

  • Dehydration.
  • Splenic contraction.
  • Polycythemia .

“A measurement of the relative amount of red blood cells present in a blood
sample. After blood is drawn, a small tube is filled and centrifuged to separate the heavier
blood cells from the lighter white blood cells and the even lighter fluid (plasma or serum)
portion. A higher than normal reading generally indicates dehydration (same number of
cells in less plasma volume) or may be due to splenic contraction secondary to
excitement or the demands of exercise. A low reading may indicate anemia, though not
invariably. Highly fit athletic horses may normally have a slightly lower hematocrit at
rest due to an overall more efficient cardiovascular system. Evaluation of true anemia in
horses requires several blood samples over a 24-hour period” (Susan Garlinghouse, 2000/ http://www.equinedoc.com/PrideProjectInfo.html).

It took sometime to get Luck from the field when the vet arrived- he ran around non stop.  The excitement and anxiety could be the cause of the elevated levels.

Low Sodium:

According to horseprerace.com, “Low levels indicate depletion and are often a predisposing factor, along with dehydration, in fatigue, muscle cramps, colic, synchronous diaphragmatic flutter (“thumps”), diarrhea and other symptoms of exhausted horse syndrome. Even seemingly normal or high-normal levels may in reality be lower, but appear higher due to concentration secondary to dehydration as measured by total protein and albumin levels. Therefore, levels at the lower end of the normal range should be evaluated relative to concurrent dehydration.”



More information on your horse’s blood work

Decoding your horse’s blood work

CBC and Chemistry Profile

A Better Understanding of the Results



The vet suggested that I add water to Luck’s and C’s feed in case their values are due to dehydration. She also explained that some of the values may be a result of running around in the field right before drawing them along with anxiety.  

The anxiety and running around seemed fair but I am hesitant on the dehydration portion.  Yes, I know it is winter and that horses are less likely to drink as much water.  But if it were due to dehydration then the Albumin would be low as well.  But, the blood work revealed that the Albumin was 2.8 (Luck) and 3.2 (Chance).  These values are within the normal range…. that being said, the results could also be due to lab handling especially the Potassium levels.

While speaking with my uncle Jerry (the horse whisperer), he suggested adding a salt block to the horse’s feed.  This will increase the horse’s thirst which will get them  drinking more.  I also added heated water buckets so that the water won’t freeze and in case they are less inclined to drink when the water is cold.

In order to feel comfortable about my horse and donkey being healthy, I will have more blood work done this week to make sure everything is in fact okay.

 

 

It Just Keeps Getting Better & Better

Two days ago Chance’s vet came out to do a follow up and to give him and Luck their Spring shots.

Chance got some chiropractic adjustments and acupuncture as well. The vet stated that Chance was showing improvements in his Cervical (neck) flexibility and still had some tightness on his hind-end. She did one new stretch with him which entailed her lifting his front leg while her assistant had him bend his neck to the opposite side. He was able to do it on both sides while remaining balanced!!!! Where as before he could barely do cervical stretch with all four legs on the ground!

IMG_3031

IMG_3030  

The vet said that Chance has gained weight and could use another 50-75lbs. She asked if he is finishing his dinner (4q twice a day) to which I answered yes. She suggested upping his feed to another quart twice a day totaling 5 quarts twice a day.

Chance’s feed schedule now includes the following:

AM: 5 q of Safe Choice Senior Feed by Nutrina, Transfer Factor (immune system booster), MicroLactin (for pain and inflammation). Hay Alfalfa mix, and 2q of Hay Stretcher

PM: 5 q of SCSF, SmartPak (Senior Flex supplement, immune system enhancer),  Hay/alfalfa mix, and 2 q of Hay Stretcher.

Lucky got his first round of shots today and he was so well behaved! He stood there calmly and put his head under my arm while he got his shots.

The vet also took a look at Luck’s teeth.

There are four ways to age an equine by his teeth:

  • Occurrence of permanent teeth
  • Disappearance of cups
  • Angle of incidence
  • Shape of the surface of the teeth

Well, Luck still has two baby teeth which do not seem to have adult teeth behind them that would ordinarily push out the baby teeth. So there goes option 1. 

His teeth no longer have cups on them and are completely smooth which indicates he is around age 10/11. 

I, along with Luck’s most recent owner, thought he was about 5 years old. However, his teeth seem to tell a different story. I’m wondering if the fact that Luck still has two of his baby teeth could be the reason for the cups prematurely disappearing? Or if he really is 10/11 years old….guess it’s time for a dental appointment. 

Hannibal. 

Today Chance got his teeth floated by his very first dentist from 2000!  Due to his cribbing history his front teeth were significantly worn down.  His molars were not in bad shape but were a bit jagged.  The dentist noticed that Chance’s left side was more sensitive to the filing and put a jaw opening device in C’s mouth to keep it open (see below right photo). The molars all looked like they were holding strong and there was no smell that would be indicative of an infection or decay. The dentist indicated that Chance was missing three back molars and that he felt that he was about 24 years old.

The dentist asked me about the nutritional care Chance was receiving due to his age, and I gave him the run down- 2 quarts twice a day of hay stretcher, hay/alfalfa mix throughout the day, 4 quarts of Nutrina Smart Feed Senior twice a day, 2 cups of Rice Bran twice a day in feed, SmartPak Senior Flex and Immune Boost, DuraLactin once a day for arthritic pain and inflammation, Vitamin E once a day, and Transfer Factor for an immune system booster. He continued to explain that when he asks the owners of most of the older horses he goes to sees, they do not have them on the proper diet. I explained that we are still trying to get more weight on Chance but that he has put on a good amount of weight since last summer. He suggested that our next appointment be this December before Chance has the opportunity to go into the winter and lose any weight, which is common in older horses, especially cribbers and thoroughbreds, in the winter months.

Later that day, Chance seemed to have some difficulty eating his hay; wads of hay were scattered around his stall. This is something that I have seen intermittently, maybe once or twice, but not to this extreme.  I decided to give him alfalfa cubes to substitute the hay until the next day when, hopefully, he would be able to eat more easily.  Sure enough the next morning there were no wads of hay!

The Equine Spa Treatment

This cold weather does a number on my joints, so I can only imagine what it must do to my old and arthritic horse. The last few days, Chance has been inside due to the single digit temperature outside, the strong winds, and the ice and snow.  (He used to “stock-up” when left inside, even for only one day, and now he no longer has this reaction).  The stall rest and hand walking will probably do him some good anyways!

Chance has always had Cervical Spine issues and over the years, you can feel the “knots” (for lack of a better word) on his neck.  Due to that, and his EPM, I decided to contact a massage therapist, chiropractor, and acupuncturist to come and work their magic on Chance!  Basically, a full day at the spa:).

I contacted one vet that incorporates run of the mill equine healthcare with chiropractic and acupuncture work, along with holistic medicine as well.  One review stated that she looked at/worked with the “whole horse” in order to assess, diagnose, and treat. Interestingly, I believe that this vet used to work on Chance about 10-12 years ago when he lived in Lorton, VA.  I sent her an email and I hope she has some availability.

I also found an equine massage therapist, who was certified through Equissage, and I will be contacting her tomorrow.

And, I have found Chance a dentist, and once again, he is Chance’s previous dentist from over a decade ago!

The equine world is a small one- at least in Virginia!