Advice needed on horse at hospital

[Jlkeiser70]

Hi wonderful equine community.
I need feedback on this. I have a 5 year old mustang gelding whom I adopted from the BLM holding corrals in Burns Oregon back in Feb. of 2023. He is at the Oregon State University hospital since Sunday. They can’t figure out what is going on - no conclusive test results. He isn’t eating much, refusing grain, and very watery poop. They have done a PCR test, gotten him hydrated, doing Well Gel for lose of nutrition as this started almost 4 weeks ago. I am at $6300 just at the hospital (plus $2000 with my local vet). I am getting to a point I need to make a decision. His energy is improving as of yesterday and they will have the belly tap results today and do a plasma transfusion today. Any advice? Below is the history of this situation.

Dec. 17th he had cow pie poop and was lethargic and refused grain and big reduction in hay quantities. Vet came out and did mineral oil and biosponge via tube and banamine. He had a fever of 101 but the next day fever was gone and energy was better in the evening after banamine in the am. We started probiotics that day. Poop got worse (I thought due to mineral oil) but didn’t improve so started biosponge 4 days later. Poop improved but only for 2-3 days. First fecal showed a few Guardia but next 3 were clear. Blood tests showed slightly elevated white blood cell counts (11) and Lymphocyte (8266) and some low numbers (Creatine, BUN, Magnesium, Albumin, Albumin: globin ration, AST and GGT) but nothing the local vet thought was a red flag. Still refusing grain and not eating much but bright eyed and no fever. We started Ulcer guard and he ate grain for 3 days then stopped and still not back to normal hay quantities and still had diarrhea. Started pepto this past Friday night as poop had turned to water then tried antibiotics on Sat. night after results came back. Poop still didn’t change and energy about the same. Upon arrival to OSU he was showing signs of ataxia.

While at OSU - new tests. No diseases found and clear on parasites. They have him fully hydrated and electrolytes balanced. Did ice boots as a precaution for laminitis. Protein levels dropped so a plasma transfusion and belly tap again. Ultrasound was clear at intake. He has more energy yesterday than when he arrived (has an attitude). White blood cell still up but shows he’s fighting whatever is going on. Poop has not changed - still diarrhea. Now has an Edema on belly.

He has been awesome and become such a sweet horse. Personality wise he has always been a bit stoic and is middle of the pack in the herd. At first he would just keep to himself but he was starting to play with his herd mates. Great on the ground but we were having some issues starting saddle work - some fear issues (only sat on and walked in hand a few times).

Just at a loss here. Any help/advice/feedback greatly appreciated.

[cnd8]

Gosh, that’s a tough one. It sounds like you’ve done any and everything you can do so far. Unfortunately, when we are maxed out, there really only remains two options:

1. Take him home and see how it goes, knowing that it may not go well and you’ll need to resort to choice 2 here…

or
2. Make the very difficult decision to euthanize based on all the attempts you have made and lack of results, while also running out of funds to make responsible decisions.

Hugs to you. That’s a tough spot. I hope he pulls through so you don’t have to get to these hard choices.

[blue_heron]

Sorry to hear about all this. His high WBC count does point to a possible infection, so antibiotics sounds like a good choice, but if I don’t see big improvements on antibiotics after ~3 days I start to think that’s not the only thing going on.

May have missed it but was he ever scoped prior to starting Ulcergard? Ulcergard does not treat and can even irritate non-squamous ulcers. Poor appetite and soft manure can definitely point to ulcers and it sounds like he’s had some big lifestyle changes and some fear in training, and now he’s been introduced to a stressful clinic environment. I’m never the first to jump up and scream ulcers, mostly because I believe most ridden horses will have ulcers, but I’ve seen ulcers present in some strange ways and I’ve seen horses who did not have ulcer symptoms but the occasional mild colic or off their food be scoped and come back with grade 4 ulcers despite good management practices.

Best of luck. I never shame anyone for euthanizing a horse for really any reason.

[PaddockWood]

I am so sorry. Listen to your gut. It seems like he is improving. I’ve had cow patties too with my mustang and continue to work through improving all that. I did find psyllium helped and then just recently started a leaky gut supplement too. And we’ve had no cow patties since - maybe a month now.

It’s so hard and so expensive. My take is to get him home.

[PrinceSheik325]

So sorry you’re dealing with this. I can completely relate. I also have one in the hospital…she had antibiotic-induced colitis. Colitis occurred in November, and that resolved in about a week (after 8 plasma transfusions and a ton of care). She’s had every complication known to man and was eventually discharged from the hospital after about 4 weeks to a rehab center. 10 days of bliss, and now we’re back in the hospital. We’ve had to try several different antibiotics and hope and pray she doesn’t have another reaction. It’s a lot. I’ve invested a lot in this horse so wanted to give her as much of a chance as possible, but it’s getting to the point of costing a small fortune.

It sounds like your horse’s symptoms are similar to my horse’s initial symptoms. With the watery poop and ice boots to protect against laminitis, I assume they have mentioned colitis. Have they run any cultures to see if it could be salmonella?

During her colitis, my horse was on metronidazole, gentamycin, and polymyxin B as well as plasma, transfaunation, misoprostol, assure guard gold, sulcralfate, biosponge, and well gel. It took a while for her poop to improve. It was back at soft cow patty after about 2 weeks and then it stayed soft for about a month. Now it’s normal, but she’s got thrombophlebitis, which has given her a blood infection that appears resistant to the current antibiotic. Her personality aside from the week of colitis and endotoxemia has been bright and happy. It’s hard to think about discontinuing treatment, but it is SO expensive. Fun times.

Vet bills can quickly multiply before you even realize it. I think you need to consider what all you’re willing to do before they get astronomical like mine are and you feel like you’re in too deep. You’re doing all that you can for your horse. It’s ok to say you’ve done enough.

[George_T_Mule]

J, just take him home and see how he does. Make him as comfortable as possible, and love on him a bunch. That can’t do any less good than what you have already accomplished. Try unconventional foods on him, maybe? Sliced bread? Bologna? Oranges? Beer? At five, he’s still growing to some extent, and he may just grow past it. If it gets to the point where he is obviously miserable, well, you’ll know, and then it’s time.
Hope this helps.

[Critter]

Have they done any IV antibiotics for a few doses (or what antibiotic did they try)?

My coming 2 yo had a similar episode in November (she’s growing up at a trainer’s barn)…they brought her in for the morning and she wasn’t eating (definite red flag for her). Gave some banamine and called the vet office. Temp was already 101 and climbing. I told them to just take her to the clinic. Cow patty manure. Had come colitis on the imaging the clinic did…temp got up to 103. Just punky but not colicy. They did a fecal, which was negative.

Initially they were just doing fluids…but then were worried about PHF, so they started her on IV oxytet. After the first two doses she was significantly improved. I kept her at the clinic a few more days until we knew the fever was gone.

She went home on a course of doxy. We never got an actual diagnosis or test that came back with the pathogen. No other horses got sick at the trainers. Probably PHF or tick borne.

Maybe swapping antibiotics might help?

[Jlkeiser70]

I have not had him scoped and we did 10 days of full dosage (full tube) of ulcerguard with really no change. I will ask them about a scope. Update today is that his heartrate is back to normal after the plasma transfusion plus electrolytes and well gel. He is accepting grain again (at the moment - which is great news).
It is just tough as I only have some much money I can spend on this and we are now nearing 10k on a green horse. He is feeling better, has opinions again so it seems so selfish to euthanize him because I don’t want to use money I don’t have (debt).

[Jlkeiser70]

Thanks for the reply. Yes, it is a tough position. Yes, at this point as he is nearing 4 weeks of not normal poop (mainly diarreah - better though than when he went in) they did mention Colitis but think it would have responded by now vs. muddy poop. I have had 4-5 PCR tests at this point and no salmonella so far.
It would just be so hard to say I’m done and euthanize when he is doing better but yet to be recovered. Best of luck with your mare.

[blue_heron]

If the ulcers are non-squamous, (pyloric in particular) you really need misoprostal and a combination of ulcergard and sucralfate to treat. So the trial of ulcergard isn’t a bad place to start for catching ulcers but not the whole picture. Pyloric ulcers can be particularly painful and disruptive.

It’s okay to make decisions based on your financial status. And you aren’t being selfish because he doesn’t know. If his stay at the clinic is stretching your chequebook, I might have him scoped, discuss with your vet about additional diagnostics and management, and take him home and give him three days.

[SBrentnall]

How is his potassium level? We’ve had some horses with high levels at our barn recently, and the symptoms are very much as you describe. We removed all the himalayan salt licks and reexamined ll the affected horses’ feed ingredients.

Potassium Imbalance: Hyperkalemia in Horses - Kentucky Equine Research

[Jlkeiser70]

Update. Did a 2nd ultrasound 4 days later and intestines and colon wall thickness is inflammed. Normal is 3-5mm and he has multiple areas that are more and some up to 1.7cm. Could be IBD or neoplasia (cancer). Thinking might be more cancer as the belly tap showed some mast cells. Sad day - decision to euthanize and rectal and/or surgical biopsy would not be conclusive.
Question now is do I bring him home and let him be back with his herd and euthanize at home. Or do I euthanize at the hospital and they do a necropsy to figure out what really was the issue?
Thank you all for your kind feedback.

[glitterless]

I’m so sorry that you’re going through this. No advice, just want to offer hugs and let you know that we’re here while you make this journey with your boy

[Laurierace]

Sorry to her the bad news. I personally would not put an uncomfortable horse through shipping home just to put him down but can understand why you may want to. I also value the potential closure that a necropsy can bring as well as the chance they may learn something from his case that could help other horses I the future. Godspeed

[Jlkeiser70]

Potassium levels are fine.

[GraceLikeRain]

I’m really sorry. With his current status it could be that going home is quite stressful if he’s feeling compromised. Personally, I wouldn’t put him through the trailering and reintroduction to the herd. He is lucky that he found someone wiling to push for answers and who is willing to make a really hard decision before he is in crisis.

[lenapesadie]

I’m so sorry

[2tempe]

I would leave him at the hospital - it just seems easier. I will raise the question about necropsy - you might or might not get definitive answers, but you will definitely be out more cash. I did a necropsy on one a few years back because I had to for mortality insurance.

My horse was at Univ of Fla, his issues were primarily neuro. But here were the costs fyi. You might ask prior to making the decision on necropsy.

Necropsy - Spinal Cord Examination Fee 1.00 $215.30
Necropsy - Insurance Documentation Fee 1.00 $242.90
NecropsyMicro - Horse 1.00 $1,407.35

This truly sucks, to be blunt. Its hard to make the decision, its hard to leave him, so very sorry.

[bingbingbing]

So very sorry.

[PaddockWood]

I am so so sorry.