Recurrent colic, Undiagnosable

[PaddockWood]

I’ve got a PSSM2 horse dx’d via biopsy and the video of this mare is so interesting. I plead again for reaching out to the vet Stars worked with and solved her issues. I don’t think it’s gut but do think with all her experience she’d give you direction on how to spend your next dollar. Cuz we know the dollars fly out the window when we’re trying to solve these strange strange issues.

The video tells me distress from the chest forward. The fact she doesn’t do well with hay. Maybe scope all the way down. Has she been scoped? Did I miss that? Ulcers already dx’d?

I too am in the camp of being very careful w omeprazole. Just like with humans we’re told just take the purple pill - no worries at all. It’s one thing to do a short run and solve WHY you’ve got ulcers. Taking that drug long term has negative consequences. It’s proven.

[RaconteurRaven]

We have scoped the bejesus out of this horse. Issue is that seeing stars is specialist is going to cost more for transport and temporary board, whereas New Bolton is relatively local to us. So I’m eating up diagnostic money in arranging to see this specialist. I do have an appointment on the books, tentatively. Also reached out to new Bolton about doing a swallow test, we’ll see what the price on that is.

[PaddockWood]

OK. My understanding is Stars vet is willing to do remote consults where she collaborates with your vet. Pretty sure that is the case. A local vet I engaged about the idea wasn’t willing. Thought she knew as much as anyone I guess. Very disappointing.

[RaconteurRaven]

Vets cannot practice outside the state in which they are licensed. They can do a telehealth consult before an appointment that has already been put on the books, but then the expectation is that we attend the actual appointment in their state, and it would be kind of shitty of me to cancel after the telehealth.

To be honest, though, I’m getting a little spooked. I understand that people will be extremely loyal to the vets that help them personally, but it just seems a little short-sighted, in my case, to put all of the eggs in that basket. I am waiting on information back from multiple parties. Ultimately, cost of different diagnostics will control if we go that far away from home (since the clinic in question has no boarding, uggh). I have an appointment on the books. But I’m not relying on one vet to save my horse, either.

[Simkie]

Exploring the esophagus with your local, very good, referral clinic is a very reasonable next step here.

[starsandsun]

I get it! It is all stressful, hard, and expensive.

I did want to add that we worked with multiple vets in our local practice, 3 specialists at New Bolton, and 2 at Leesburg over a year and a half. I had a lot of professionals involved but did not get resolution despite so very many diagnostics, and weeks spent at NB. I spent an unbelievable sum of money, including medication for 6 months that was over $2k per month.

I guess at the end, I did put my eggs in one basket. NB had told me that the only thing left that they could do would be to open him up but to expect it to be a sterile autopsy and he would die on the table.

Whatever you decide to do, I do hope you find answers. Certainly you’ve got some new ideas from this thread, and I’m sending all the brightest light and best energy for healing.

[quietann]

In the K.I.S.S. category, is she getting a week of SandClear or similar product every month like a lot of people keeping horses in the desert do?

My older mare had colic 3 times this summer and was ultimately found to have a lot of stone dust in her digestive system. She was treated with SandClear twice a day for 4-6 weeks, and now gets it the first week of every month, and has been fine.

[Demerara_Stables]

@StormyDay

If you look up ‘hiatal hernia horse’ you can see cases of it. Unfortunately it seems to mostly be diagnosed after the horse has been euthanized.

I am 90% sure I met a horse with this when I worked at a hospital in Florida. I don’t remember all of the details but horse came in for colic of unknown origin, was sedated and put in the stocks for a work up (ultrasound, belly tap, a few other things). The horse was leaning against the stocks on his right side so they weren’t able to ultrasound that side. Couldn’t find the cause, horse kept colicking. Finally took it into exploratory surgery, still nothing. The night I was working, the surgeon on call decided to ultrasound again just to be sure nothing was missed. This time they could do the right side, and the surgeon goes "well THAT isn’t supposed to be there " There was intestine next to his heart. He was referred to UF for another surgery to place mesh over the hole.

Worth a shot to look into if you haven’t had her ultrasounded in that area.

[joiedevie99]

Have you run an allergy test? Since it seems to be connected to the hay, I’d first try removing hay entirely and doing all senior or some other complete feed for 6-8 weeks (i.e. a hindgut ulcer rehab diet). Then based on what comes back on the allergy panel, you may be able to take a best guess as to what hay or hay pellet will be the best option to try adding back in first.

I had allergy tests resolve weird things with two different horses - one with a corn allergy and another with an alfalfa allergy.

[RaconteurRaven]

She was, until she suddenly decided not to eat anything with sandclear in it. She was fine with Ultracruz all throughout the summer months, but as soon as fall rolls around, she starts refusing her feed, one supplement/drug at a time. We’ve been x-raying at the farm to try and keep an eye on things, but ultimately I may send her up to NBC soon just to really check on that scenario (and determine the accuracy of the barn-visit x-rays).

[RaconteurRaven]

We did run an allergy panel, and she was on allergy therapy shots for a bit. Reason is she came back allergic to everything. And I mean, everything. Like “how are you alive” levels. I got a gentle talking to from NBC about how allergy blood tests are not reliable; they indicate an immune response, but not a clear causation most times. BUT I am starting to believe that SOMETHING allergy related could be going on, hence putting her on zyrtec. My only hang up with going to a complete feed is that this mare gets ulcers, so I’m extremely wary of putting her on a grain heavy diet. We are most certainly going there before PTS though, if time allows.

[RaconteurRaven]

So this would be what specific area? At this point I’m ordering from NBC a la carte lol. Chest/upper thoracic? Or stomach?

[RaconteurRaven]

That is indeed what I am working on getting scheduled. Two things that might get added to the cart if the swallow test comes back normal would be more imaging of the chest/stomach region, and a muscle biopsy for PSSM2. Poor mare is a science experiment.

[RaconteurRaven]

I went ahead and sent the hair off to UC Davis just for shits and giggles. PSSM2 is a much more viable possibility (even then, she doesn’t check many boxes), but that will require a muscle biopsy at NBC.

[Simkie]

@RaconteurRaven

That is indeed what I am working on getting scheduled. Two things that might get added to the cart if the swallow test comes back normal would be more imaging of the chest/stomach region, and a muscle biopsy for PSSM2. Poor mare is a science experiment.

This sounds like a great path forward, and I really hope it yields some very solid data for you!

Have you ever tried putting her hay in a very small holed hay net? That might be an option to keep hay in front of her, but not allow her to take big bites that might be getting stuck somewhere.

Ah, also, here’s a paper on hiatal hernia, which indicates it’s picked up with a barium study. So you’re already covering that base. Not that ultrasounding her chest isn’t something to explore, too, but nice to know this should be visible with the barium.

https://beva.onlinelibrary.wiley.com/doi/abs/10.1111/eve.13300

[Demerara_Stables]

Chest/upper thoracic. IIRC the vet was ultrasounding right at the girth area just behind the elbow.

[RaconteurRaven]

Sorry, I sent you the wrong response because CotH forums have the strangest format I’ve ever experienced. Good to know, thanks.

[RaconteurRaven]

Yes, double-bagged hay previously; at the time, we were trying to slow her down, as we were embroiled in the school of ulcer prevention. She used to be eager to eat hay until last spring, when she very suddenly decided she could take it or leave it. But she’s always been quite the philosophical eater, not really a hoover.

[RaconteurRaven]

Oh, and thank you! That is EXTREMELY nice to know. At this point every diagnostic is a pinch, and a week of me doing extra instacart runs, so it’s good to know that it covers both bases.

[NaturallyHappy]

Someone recommended Triple Crown Natural Balance Timothy Hay Cubes to
me for my horse, who cannot have hay right now. They are significantly smaller and softer than regular hay cubes and do not use a binder. I don’t remember seeing anything above about them. They’ve been incredibly helpful for me. Thank you again to whomever recommended them.