Update post 49: he’s gone (was Heaves management: inhalers? nebulizers? other ideas?)

[pompeiii]

Let me start off by saying I am working with my vet and I am waiting for another call back. This post is mostly to fill some time while I wait to chat with my vet and to gather some other opinions.

My mini is, well, a mess. Short and simple description. His heaves has been manageable, but over the last month or so, it’s been a lot worse. He also has been recently diagnosed with Cushing’s and IR. So, we’re trying to manage his metabolic mess (I could go into his IR management but I’ll skip that part) while also dealing with his respiratory issues.

He’s currently in half the day with as much air flow as possible (shed row barn) so that he can have time in without his muzzle. This allows him to eat his soaked hay without issue, eat his cubes, and just generally enjoy muzzle free time. He is in a dry lot outside on hay with a muzzle. (With all his issues, he does NOT need to lose weight and will likely need to maintain his weight/gain a few lbs as it gets cooler).

Right now he gets Zyrtec and his equihaler 2x/daily. We’ve played around with albuterol and it’s helped a little, but it’s short lasting (as expected). He is better in his stall than turned out and has been getting better but is still putting more effort into breathing than he should.

My question for all of you. Do you find nebulizers more effective than inhalers? Being that most drugs can be delivered both ways, I’m curious if one method is better than the other. Personally as an asthmatic, I prefer the nebulizer myself, but I’m less sure when it comes to horses. Being that it’s an expensive purchase, I’d love some opinions. I do like the idea of saline treatments too. But, if there are no real benefits…

On the other hand, working with spacers, as a mini, it’s been a struggle to find a mask that works. The AeroHippus mask is too large, but most of the dog masks are too smalls (literally, JUST too small–1/4 inch too small). I’ve been exploring toddler masks to attach to spacers to see if I can find the best fit, but… Not an easy task!

My mini is VERY tolerant of pretty much everything (that’s not a bath). I’ve spoken with Flexineb and they feel the foal mask should fit with his measurements. But, I’m curious how much relief this will provide.

[Djones]

The flexineb is very helpful, though to be fair I haven’t used just inhalers for my guy in years.

Chip knows it helps. He takes very deep breaths when being treated.

It is persnickety and the medicine cups are expensive and will fail at some point – so clean them correctly every single time, very promptly after use. I’ve only had one fail so far but it made me order an extra green and a gray to be safe.

[GoodTimes]

I have a flexineb. My biggest complaint about it is the medication cups. Like @Djones said, they can and will fail eventually. They claim you should get around 100 uses out of a cup if you clean it properly, etc. I always have. First cup got me around 100 uses, second cup only got me maybe 15 uses!
I don’t use the flexineb very often anymore. I had intradermal allergy testing done in 2021 and have been doing allergy shots since then. We show in Canada and can’t show with any of the allergy/respiratory meds, other than emergency dex with a vet form filled out and submitted to the show. I found the allergy shots to be very useful.
I went from frequently medicating and using the nebulizer almost daily in the spring and fall, to only needing meds a handful of times per year.

[IPEsq]

I haven’t tried an inhaler (I do use a nebulizer), but my friend has, and her horse said absolutely not to using the inhaler with the nose cup thing. He does fine with the nebulizer. I would think the small size would probably work. I think you can administer inhaler meds via the Flexineb. There is a part it comes with where you can put on the top that is shaped to fit an inhaler mouthpiece. So, you don’t always have to find something that is compounded to use in the medication cup.

[CanteringCarrot]

I find that horses do well with wearing and using the Flexineb. I think I got lucky with mine because my medication cups definitely got around 100 uses before I passed the Flexineb onto the horse’s new owner when I sold him. I’ve not used an inhaler on a horse, so I can’t make a comparison. I do think it’s worth a try though.

[cayuse]

Silver Horse Care has pony/colt sized nebulizer masks, I just messaged them last week about one for my mini. They are not as expensive as the Flexineb.

[luvmyhackney]

Might be silly but have you allergy tested for environmental causes? My ponies got much better when I knew his triggers and managed around them. Still has heaves but manageable with Zyrtec and over the counter stuff.

[beau159]

@pompeiii

Let me start off by saying I am working with my vet and I am waiting for another call back. This post is mostly to fill some time while I wait to chat with my vet and to gather some other opinions.

My mini is, well, a mess. Short and simple description. His heaves has been manageable, but over the last month or so, it’s been a lot worse. He also has been recently diagnosed with Cushing’s and IR. So, we’re trying to manage his metabolic mess (I could go into his IR management but I’ll skip that part) while also dealing with his respiratory issues.

He’s currently in half the day with as much air flow as possible (shed row barn) so that he can have time in without his muzzle. This allows him to eat his soaked hay without issue, eat his cubes, and just generally enjoy muzzle free time. He is in a dry lot outside on hay with a muzzle. (With all his issues, he does NOT need to lose weight and will likely need to maintain his weight/gain a few lbs as it gets cooler).

Right now he gets Zyrtec and his equihaler 2x/daily. We’ve played around with albuterol and it’s helped a little, but it’s short lasting (as expected). He is better in his stall than turned out and has been getting better but is still putting more effort into breathing than he should.

My question for all of you. Do you find nebulizers more effective than inhalers? Being that most drugs can be delivered both ways, I’m curious if one method is better than the other. Personally as an asthmatic, I prefer the nebulizer myself, but I’m less sure when it comes to horses. Being that it’s an expensive purchase, I’d love some opinions. I do like the idea of saline treatments too. But, if there are no real benefits…

On the other hand, working with spacers, as a mini, it’s been a struggle to find a mask that works. The AeroHippus mask is too large, but most of the dog masks are too smalls (literally, JUST too small–1/4 inch too small). I’ve been exploring toddler masks to attach to spacers to see if I can find the best fit, but… Not an easy task!

My mini is VERY tolerant of pretty much everything (that’s not a bath). I’ve spoken with Flexineb and they feel the foal mask should fit with his measurements. But, I’m curious how much relief this will provide.

I love my Flexineb. And I haven’t had any trouble with medication cups so I hadn’t heard that. My current one is well over a year and a half old. My vet told me to keep using it until it doesn’t work, so that’s what I am doing!

I like the Flexineb because I know my horse is getting the necessary medication into her lungs.

I would assume you need to avoid steroids with your mini having the IR issues but you can absolutely rotate things like the albuterol or ipratropium or similar things.

You could also ask your vet about Alpha2EQ if they do that. It’s a way to reduce inflammation but without giving steroids. They make it out of your horse’s own blood draw. I feel my mare has done really well with it.

[pompeiii]

Thanks for all the replies. My vet is content keeping up the inhaler route for now but changing meds so we may do that.

I really like the Flexineb but also money is tight (every animal has issues right now/this year and I’ve spent all my reserves) so not buying one would help. The silver horse care one looks like a decent compromise if I want to do some extra treatments even if it’s not necessarily as good as the flexineb. I’ve had issues with mesh nebs lasting but…

I wish I could find a better fitting mask for his spacer. That would make me feel better about the inhaler route as he has zero issue with inhalers (either in the nose or with a spacer).

As for allergies, we haven’t tested. Zyrtec doesn’t help but we’re using it anyway. That said, this time of the year isn’t great for him.

[cayuse]

I don’t know where you are but it’s seems like a particularly bad year for allergies here.
If you ever get the Silver Horse unit keep us posted. I am waiting on the vet for a routine visit right now and I’m going to discuss getting one for my mini with sinus issues. He’s had 2 surgeries and still has a gunky nose which his vets don’t seem concerned about, but I thought maybe a neb with colloidal silver would loosen the stuff up and soothe things.
We are both the same boat, all my animals had issues this year and I’m tapped out. Hang in there.

[pompeiii]

I’m going to try and hold off for now if I can and see if I can pay down so vet bills. But, I did reach out to Silver Horse to ask them some questions. I didn’t see this as an option and I’m curious. But, if I don’t need it, I’d love to save a little money. This mini is costing me a fortune right now. I’ve had him 9 years and I think I’ve spent more this year than all other years combined.

But, I appreciate hearing others are tapped out too. Not that I want that to be the case, but somehow it helps to hear that I’m not alone in my struggles? This year it’s been lyme and EPM for my TB, all my mini’s issues (he’s now on ertugliflozin too), lost one of my senior dogs to cancer, my puppy is dealing with some sort of urinary crystals that the vet cannot figure out, I had a massive blood clot, and then to top it all off, my washing machine just died. The last one is minor but completely unnecessary and the cherry on top of the disaster 2024 has been.

[cayuse]

It helps me to know I’m not alone, too. It’s been a rough 12 months here with teeth, sinus surgery, more teeth, lyme, colic and the metabolic stuff. The vet just left here, my hubby asked about the neb and if the colloidal silver might help my mini with the sinus and she actually thought it might be a good idea to try, so we’ll see if I can work it in to the budget.
Sorry about your senior dog and your health issues, hang in there.

[ThatBayHorse]

I post the same thing to everyone. Have you had your horse allergy tested? If you don’t know what they are allergic to, you can’t make environmental or diet management decisions to improve their symptoms.

My horse was retired/unrideable last spring because I was feeding her hay with grasses she was allergic to and she was having symptoms even with steroids and antihistamines etc. flexineb made everything 10x worse. I switched her to timothy hay (one of the 2 grasses she was not allergic to) and her symptoms improved 99%. She stopped coughing and got off steroids completely. She is now rideable and mostly symptom free.

I will note that the allergy shots did not work for my horse, but using the results to make feed decisions did majorly. If you are feeding your horse something they are allergic to (even if you are steaming the hay etc) they will still have symptoms unless it is specifically the mold/dust they are allergic and not the grass species itself. Good luck!

[Djones]

we did allergy testing and adjusted my horse’s feed and hay dramatically, and I like to think it helped his baseline lung aggravation level. What I couldn’t change was his allergy to pines and other native trees, some molds and mildews you find in grass, etc like you’re saying. the shots didn’t seem to touch that. When he is stalled he’s on cedar shavings, for example, and my barn is a ridiculously airy shedrow. Sometimes it’s a mix of things to support thin. We’re sitting here with filthy ambient air awaiting Hurricane Irene to wash the air, and he will feel SO much better afterward.

[ThreeWishes]

I love my Flexineb ! Helps my horse immensely buuut has anyone heard that the company is ceasing their US division ?

IMG_6199

[ThreeWishes]

Also. If you read the guidelines you have to be very, very careful about cleaning the components. Especially the medication cups Distilled water only

[pompeiii]

I appreciate what everyone says about allergy testing and I will add it to my list when I have money. I am truly doing my best but when every animal tries to die the same year, the reserves take a big hit.

Unfortunately, we suspect it is an environmental allergens… He is triggered yearly between August and November and then is fine. He gets the same hay from the same farmer from the same fields year round for the last 9 years (my hay guy is truly the best). No grass, no hard feeds, same brand of cubes (my late senior was super picky which made me picky). He gets a v/m. No grass. Same bedding year round. His main issues seem to start with fall allergens and a lot of the late summer/fall harvests nearby. This year has been extra dry which may be worse?

Honestly, he’d probably be fine if we could give him a round of oral steroids but it’s 1000% not an option.

[pompeiii]

Interesting and unfortunate if that is the case. While I’m not moving forward with the flexineb right now, the company has been wonderful and super responsive. They have answered all my questions, asked me for measurements and sent replies within minutes.

[ThreeWishes]

I hope it’s not true! I heard it from a vet tech.

[luvmyhackney]

@pompeiii

I appreciate what everyone says about allergy testing and I will add it to my list when I have money. I am truly doing my best but when every animal tries to die the same year, the reserves take a big hit.

Promise we all get it. Vets bills are $$. I found it helpful even knowing the environmental stuff helped me stay ahead of everything with meds. I can dose higher to get ahead of his allergies.