Feeding the horse with liver illness

I’ve got a 4-yr-old TB mare that I’ve been treating for liver problems since before Christmas. She came off the track in November with no apparent problems, but on December 17 presented with mild colic symptoms and a high fever of 104+. Blood results indicated high liver enzymes and an ultrasound confirmed inflammation in the liver of unknown origin. She got IV antibiotics and IV bute for three days and seemed to get better, so she was switched to daily oral doxy. Then on January 6 she presented with the same symptoms again. Another dose of IV antibiotic and bute and since this latest crisis I’ve been treating the fever spikes with bute paste as needed. A repeat of the bloodwork showed the liver values were actually higher, so the doxy clearly wasn’t doing anything.

The mare looks normal (if a little over quiet) right now, bright eyed and coat is shiny, but she has little to no interest in grain. She is eating hay well and gets free choice excellent quality orchard grass hay.

I’m dosing her with an oral syringe:
Twice daily SMZ
3x daily milk thistle and vitamin E

She came to me racing thin and has lost weight with this latest episode.

I need ideas for getting calories in her without adding extra protein and fat as these can be stressful to a damaged liver?

I’ve tried plain oats with soaked beep and a ration balancer. I’ve tried Triple Crown senior and Purina senior, which she nibbles at with little interest. I’m willing to try pretty much anything if I can get her to eat it and it won’t aggravate her as yet mystery condition. She was eating well prior to this, a mix of TC senior with added beep.

I have no idea what caused the liver problems, perhaps she came with already elevated enzymes and the stress of moving to a new farm and new life pushed her over the edge? I’ve only ridden her a handful of times since she came and only walk-trot, she gets 12 hours of turnout with two other mares and seems content to be out, and my farm is low key and quiet. I did reach out to her former owner (the trainer at the track) and he said she’s “never been sick in her life”, which may or may not be accurate.

Her vet is on top of it but currently feeling she’s not sick enough for more aggressive treatment (biopsy, IV fluids, etc) as long as she’s responding to treating the symptoms.

Thanks for reading and any insight is appreciated.

I’m so sorry, and I know your pain. It’s terribly frustrating and anxiety-producing to know your horse is sick and you can’t figure out why. I’m actually waiting for blood work back specifically for GGT and bilirubin, as my horse is also sick sick sick with no clear diagnosis or path forward.

Have you done recent blood work to look at bilirubin specifically?

Can you feed her alfalfa pellets or grass hay pellets to get more calories/fiber in to her? What about rice bran? I don’t know whether feeding something that like does really impact the liver or not.

Also, I would use sucralfate separately - not along with everything else together. It may bind with the smz’s and sweep them out of her system before she gets to absorb them.

I know you’ve done the ultrasound - maybe it’s time for a biopsy?

Anyhow - I’m sure you’ve seen this and maybe it has something else that could be helpful: https://www.rossdales.com/referrals/internal-medicine/liver-disease

Thank you. Yes, I’m carefully timing the sucralfate so it doesn’t interfere with anything else. She lives at home so I’m lucky I can do that, along with tracking her temp 4 times per day.

Since Saturday, her pattern has been a normal or just slightly elevated temp in the morning, then it rises throughout the day, as high as 103.5. I give her bute paste around 5pm at dinner time, by night check her temp is back down around 101 or so and still normal in the morning.

Next step will be a liver biopsy if we can’t keep her stable and going in the right direction.

It’s very frustrating that we don’t know the cause. Viral, bacterial, caused by some unknown toxin? In forty years of owning horses, I’ve never once had reason to even think about the liver of one of them.

I assume you have done the search of the turn out area for any weed that might lead to liver issues? Maybe this mare has a weird willingness to eat things that other horses are not willing to eat.

Yes! The only thing I could come up with is her turnout does have some oak trees. I’ve turned horses out in that field for twenty years with no issues but just in case I moved her and her pasture mates to another turnout without any trees. The only reason I thought of it was because I saw her with a stick in her mouth. :roll_eyes:

She has hay in her turnout, the same hay she can’t seem to get enough of in the stall, but maybe she’s like a toddler and has to put everything in her mouth. Vet didn’t seem to agree that could be a problem but to me it’s as likely an explanation as anything else.

So I did just look and doxy can cause liver failure … so maybe a different antibiotic would be more beneficial. What antibiotic was she on when it was delivered IV?

Also, have you tested her for EMS/Cushings? That can create liver problems.

They gave her IV oxytet and then oral doxy up until this latest episode on Jan 6. Switched to SMZ this weekend.

I read that as well during my deep dive into liver disease and horses over the past few days and I must admit that made me a bit :face_with_symbols_over_mouth:

Have not looked into EMS/cushings as she’s only four it seems unlikely.

Is the protocol still a low protein diet?

My last experience with liver problems was like 30 years ago. Liver biopsy came back all healthy. Though we could not find a plant in the pasture, in the end that is what everyone assumed caused the problem because there was no other thing found. Clearly things have changed a ton in 30 years.

Could she have been chewing on tree bark and swallowing?
Or any wood fencing w/ toxic stain or paint?
Any acorns on the ground? Acorns can be very toxic to some horses.

FYI- I typically feed TC senior and some months back my feed store was totally out so I bought the TC Senior GOLD- OMG my horses loved it- like candy- it’s higher fat also.
Maybe try a bag, sometimes a change can re-start their appetite.
EDIT- just saw this online re: liver disease-
“It is advisable to avoid high-fat diets in horses with liver disease to reduce the possibility of fat deposition in the liver, which can further impair its function.Feb 21, 2018”

Yes, there are oak trees in the pasture where she was initially turned out. After this second episode I had an ah-ha moment and switched her to a turnout without trees. I’m hoping that was the issue as that’s a relatively easy fix.

Since fat and protein can be problematic for liver problems, and she’s too picky for just hay pellets, I’m actually considering trying some good ole omolene 100 and adding a ration balancer and molasses sweetened beet pulp if she’ll tolerate it. Just trying to get some calories in her at this point and all the weight gainers are fat-based.

The blood work that you’ve been doing, have you included SDH?

since you are doing such a good job tracking her temperature fluctuations, have you noticed she eats any better early in the morning or later at night when her temperature is normal?

She seems to eat best when she comes in to the barn in the evening from turnout but strangely that’s also when her temp is most elevated.

Sometimes by 10pm when I do night check she’ll have finished her dinner and I give her another serving, but that’s rarely finished again by morning. These are very small servings of no more than 2 pounds or so.

But she’s eating hay very well in her stall and I’m filling two hay bags every night which are mostly gone by morning.


No help here, but what is her breeding?
There’s a line of OTTB’s that have liver issues.

She’s by El Padrino out of a Distorted Humor mare.

I’d never heard that, what line specifically?

PMed you