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Horse NQR - Next Steps Advice?

I am posting on behalf of a fellow horse person who isn’t on the internet. She has recently acquired (about three or four months now I believe) a new horse. He is a 6 year old Mustang Gelding. She has not ridden him yet, but is doing groundwork. He is very reluctant to move with very grumpy faces. His coat is dull and he often bites at his sides, leaving the hair ruffled there. He also has some rubbing on his tail. I’m trying to help her figure out next steps, as she doesn’t feel confident in the answers her vet has been providing.
TLDR:We are working on getting her a new vet, but I’m looking for advice for what route to go down at this point.

Now the long information:

Blood work:
low red blood cells, low white blood cells, low calcium and high end of LDH. I have screenshots but can’t seem to figure out how to attach them!
Hematocrit - 27.3
Hemoglobin 10
WBC 4.5
Granulocytes 2.4
Calcium 9.8
LDH 2019

Horse is out with eight other horses on grass turnout on a good amount of acreage (not crazy amounts of green grass at this point) and is out from dawn until dusk. Fed Timothy hay from Eastern Washington. I believe he gets a flake in the morning and a flake at night, plus 1/2 flake of alfalfa. Horse lives in outdoor shed/paddock next to another horse.

Here’s notes from the owner:

Vet Said could supplement calcium if I wanted to. And oil for dry skin. But no other recommendations or further testing. Ordered oil, it just came will start giving soon.

Things I’ve done since I got him in December.

  • removed front shoes and trimmed.

  • he’s been on 4 week trim cycle

  • early January teeth done & Sheath cleaned

  • end February vet did exam, x rayed knees & Stifles , did basic bloodwork, watched him move on lunge line on firm ground saw no sign’s lameness.

  • early March did Chiropractic and fecal sample for sand.

  • after chiropractic horse was holding tail more to his left.

  • found minimal sand but said I could go ahead and treat anyway, I have not treated.

  • mid March vet did scope for ulcers, what he could see of stomach saw no signs of ulcers. But did see bots and recommend worming.
    -Wormed with Quest Plus

  • Horse had massage 4 days after Chiro work, had big stretch during massage and tail carriage softened. Also, had much easier time holding up his left feet for cleaning and trimming.
    The past two days he’s been a little sticky with his left side feet but has massage tomorrow after his lesson.

  • started him on supplements mid January MadBarn Amino Trace+ and visceral ( for gut) also have been giving Jeremiah Ulcer Repulser & Aloe Juice ( 1 time day)

  • have added in about 1/2 flake alfalfa a day ( for past 3-4 weeks)

  • I have Sucralfate ( have not started yet, plan to this week, trying to figure out timing, etc.

I have seen overall improvement in his condition, etc.gaining muscle , but his ribs still are visible. biting/ itching at sides still occurs but hasn’t happened as frequently when I’m working with him. I do see signs of it on his sides where he has. Stretching out seems to have gotten better, still see it but not as much.
Have been using his Savvy feeder box, seems to be working. I am also planning on adding hay-net, too.

  • he will see dentist in early May. He does a funny thing with his mouth when grazing like something is stuck & trainer suggested checking canines which seemed sharp

Gave him a good bath scrubbing to help with dry skin / itching, has not made a difference to biting / itching. Does seem to rub top of tail some ( it’s ruffled)

Thanks in advance for any direction you can offer about what to look for. Horse doesn’t seem to be in horrible decline, just isn’t thriving and seems angry a lot of the time.

I’d get started on the sucralfate asap.

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low blood Ca is not fixed by adding dietary Ca. The body holds VERY tight control of Ca in the blood, so anything out of normal is a disease status, not diet. Low RBS, low WBC, he’s got something going on that isn’t a diet issue. Given that the vet says just add Ca I’d be getting a consult with a teaching hospital.

Colitis, leaky gut, IBD, sepsis of some level, all things that could be causing hypcalcemia along with the low rbc/wbc but a much more knowledgeable vet needs to see this.

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Yes, I was unimpressed with the vet blowing her off about the bloodwork! Thank you for the information about Ca.

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Thank you. I am talking to her about that today.