What bloodwork for unthrifty horse? Update 9/25

[Libby2563]

The vet is coming in an hour for something else and I’d like to have him pull blood on my TB who is eating a lot of calories (9 lb/day of TC Perform Gold plus free choice hay and overnight turnout on grass) but not gaining any weight. I’ve upped the amount twice since May, but both weight tape and visual/manual inspection show no gains. I love my vet but he tends to under-prescribe rather than over, if that makes sense, so I want to know what to ask for.

Horse has had teeth done by a dental specialist recently, was dewormed with Quest Plus in April, and had a negative fecal in July. Treated for gastric ulcers last August and scoped clear after a month of GastroGard and sucralfate. I’ve had suspicions of hindgut issues so he’s currently getting sucralfate twice a day to see if that helps and last summer I did the Succeed Challenge with no results.

[Amy3996]

I’d ask for a CBC/Vit E, and test for Lyme. Cerebral Spinal Fluid is the gold standard for EPM diagnostics, but blood titer and clinical signs on neuro exam can also be an indicator for treatment. Another round of dewormer with a different product as recommended by your vet (Equimax? PowerPac?) might be appropriate to address worms that wouldn’t show up on a fecal but that might still be hanging around.

Alternatively, have you tried other grains? If so, which? Sometimes the perfect feed on paper just doesn’t translate for a particular horse. Triple Crown Senior Gold just didn’t do the trick for my TB, who was getting 6-8lbs at the time. Ultium was slightly better. Purina Impact Pro Performance has yielded the best results for us in terms of amount required (5lbs), palatability, and overall condition.

[lenapesadie]

A metabolic panel might not go amiss.

[luvmyhackney]

I haven’t had good luck with TC feeds across the board.

Test wise: Metabolic panel, Vitamin E, Lyme, CBC, neuro exam.

I’d try a good probiotic, ration balancer, then good hay. Is your hay tested? You can balance your diet if that’s the primary source.
This one has worked the best for me: https://www.bigdweb.com/proelite-gutbiome-3-lb?

[JB]

Age? If he’s over 10, I’d test for PPID.

When you say unthrifty in the title, what does that mean? You only mention weight in the post. Poor coat? Potbelly? Or just not gaining weight? Do you have a pic?

[Small_Change]

Something to maybe keep in the back of your mind is that other things can keep a horse looking rough around the edges too. I tried very hard to get an older TB here looking good - he was always a bit ribby, and didn’t have the best coat. His owner put him on a very low dose of Previcox, and he has absolutely BLOOMED now that he’s feeling comfortable! Appetite has improved (he always ate his grain, but was never the best hay eater), and he looks the best I have ever seen him.

[Libby2563]

Thanks so much everyone! Going in order:

@Amy3996

Alternatively, have you tried other grains? If so, which? Sometimes the perfect feed on paper just doesn’t translate for a particular horse.

I have had the horse for 5 years and have tried a variety of different Triple Crown feeds during that time plus rice bran. He’s never been an easy keeper but I’ve also never been pumping 9 lbs of grain into him a day and feeling like it’s going into a black hole. He’s been on the Perform Gold since this winter, when we started with 2-3 lbs twice a day because that was all he would finish. At the beginning of June when they started coming into the barn during the day I added a lunch meal of about 2 lbs. Then at the beginning of July I increased to 3 lbs twice a day, and he looks the same.

I’ve been tempted to try a different brand like Purina or Nutrena, but I always chicken out because most options seem to have higher NSCs and variable ingredients. I am open to specific suggestions! In the mid-Atlantic.

[Libby2563]

@luvmyhackney

I’d try a good probiotic, ration balancer, then good hay. Is your hay tested?

My vet suggested a probiotic too! The TC Gold feeds supposedly have that stuff in there but perhaps he needs more. I’ve been iffy on it because I feel like there isn’t a lot of scientific support for most supplements (and articles like this don’t help: https://thehorse.com/1123815/probiotics-for-horses-what-should-you-look-for/ and https://ker.com/equinews/prebiotics-probiotics-horses-beneficial-benign/). Thanks for the suggestion–is that one pretty palatable? He is very picky, especially about powders, but he does like mint flavors.

I’ve tried TC’s both regular and Gold RB with him before but he does need more than just that. I haven’t tested this hay and am running low enough that I’m not sure it makes sense, but I can test the next batch in a month or two. I buy the best hay I can find but you never really know what the nutritional content is and sometimes the quality isn’t as high as the samples suggest.

[Libby2563]

@JB

Age? If he’s over 10, I’d test for PPID.

When you say unthrifty in the title, what does that mean? You only mention weight in the post. Poor coat? Potbelly? Or just not gaining weight? Do you have a pic?

He is 15. I asked the vet about PPID on Monday and he said he’s too young for it and it would make him fat, not thin. So…I do want to do that and a metabolic panel (thanks for that suggestion too, @lenapesadie), BUT not with this vet. I have to say the discussion of IR and laminitis on the recent long thread, the name of which is escaping me now, quite freaked me out because this horse tends to be sensitive after shoeing.

By unthrifty I meant I am dumping a lot of feed into him and don’t understand where it’s going. I do think his topline could be better too. Coat is generally fine, though right now we have some bald/rubbed spots that I’m attributing to summer itchies. To me his shape looks a little off…like tucked up and ribby but with some roundness down low right in front of the flanks, if that makes sense? What do you guys think?

This is early July before I upped his grain:

This is last week and I don’t see any difference, other than the lighting that makes his coat look dull:

For comparison, this is December (not very flattering or well stood-up, and sorry about the sweat marks, but it’s all I have handy):

[Libby2563]

@Small_Change

Something to maybe keep in the back of your mind is that other things can keep a horse looking rough around the edges too.

Yes, totally fair. This is my sleep-deprived horse, so there must be something going on either physically or mentally, but no one (including New Bolton) can figure out what that is. I have a long thread from last year on him, and we have done even more since then. He is very functional and is competing at Prelim successfully, but I feel that something is off and I just want him to be happy and healthy!

[Libby2563]

One more post, sorry for the deluge! The CBC, chem, and fibrinogen pulled Mon just came back, and the vet said everything was normal. Looking at the results, his glucose is super low but I have no idea what that means and the vet wasn’t concerned. He ate his dinner grain about 2 hours before the blood was drawn and had been munching on hay before and after, FWIW.

[4horses]

Have you tried adding a fat? Canola oil?

[Widget]

@Libby2563

He is 15. I asked the vet about PPID on Monday and he said he’s too young for it and it would make him fat, not thin.

I do not agree with that vet. I agree with you to do the testing with another vet as the lack of weight gain and topline needing help, he may very well fall into the PPID category (from my minimal knowledge and experience).

[JB]

@Libby2563

I asked the vet about PPID on Monday and he said he’s too young for it and it would make him fat, not thin.

uhhh, you need a new vet for this then. While not common at all, 5yos have come up with PPID. 10 is not too young. 15 is when the odds go up significantly. And PPID alllllmost always makes horses lose weight and topline.

Aside from being a bit thin, he looks great, shiny coat. How much work is he in? It’s hard to tell if he’s as lean in the Winter/clipped pic as the Summer - same/similar? Has he ever had full rib coverage in the 5 years you’ve had him? The Winter pics have him looking a bit fuller. Has that been his pattern?

The really low glucose can be caused by several things, including liver disease, colitis, and other things. I assume he behaves normally, doesn’t look neurological at all? I do think it’s worth re-testing, and do it fasted this time - normal forage only, no concentrates or v/m or anything like that, for 12 hours prior to the blood draw, and the test needs to also include insulin

His triglyceride level is pretty low as well, barely above low normal. Maybe it’s his normal, but low triglycerides can be a malabsorption issue, and that could be due to low grade colitis (see above). Leaky Gut could be a factor

Creatinine is also right at low normal, and low creatinine can also point to liver issues. High creatinine would be a kidney issue

Sooooo, since several things combined could be pointing to some liver issues, I’d say a more comprehensive blood work should be done, and read by someone more qualified than your vet appears to be on this topic

[Simkie]

I’ve got a mare with a very similar shape to this guy and she came up PPID last year. She’s never been a fat horse. Not that you need another voice to add to the choir–it sounds like you know! But that’s a good place to go next, and it definitely doesn’t make them all chunky.

[luvmyhackney]

My picky pants pony eats it straight with no issues.

Based on pics test for PPID. He looks like a classic case.

[lenapesadie]

My dear departed Norman was a stereotypical hard keeper TB with skin and coat issues. He tested positive for PPID on the TRH Stim test

[PaddockWood]

Yeah I’d rule out PPID too. ACTH. Tick that box.

[Libby2563]

I talked to a different vet (an FEI vet who is more…proactive than my regular vet). She felt that his muscling and topline are pretty good in person, and didn’t have concerns about the bloodwork (re: the low glucose, she said that is a function of how the blood was drawn and stored overnight). She believes his issue is more likely to be ulcers (gastric, hindgut, or both) than anything else, and suggested trying either Assure Guard or SmartGI. I ordered the SmartGI Ultra since there is a money back guarantee. She also suggested adding more alfalfa or mixing some StressFree into his meals (I’ve done alfalfa cubes before and might try again, but he doesn’t love anything soaked).

I’m still going to pursue metabolic/PPID testing though. Definitely not with vet #1…

@JB

How much work is he in? It’s hard to tell if he’s as lean in the Winter/clipped pic as the Summer - same/similar? Has he ever had full rib coverage in the 5 years you’ve had him? The Winter pics have him looking a bit fuller. Has that been his pattern?

Sorry for the delayed reply–work has been busy and I had to be on my personal laptop to look up old timeline photos, which confirmed my memory that he has had rib coverage before on much less hard feed. His coat wasn’t long enough to hide things in the winter pic I posted previously and I do think he was a bit fuller, though he was also in less work last winter (but also eating much less hard feed). Here are some previous photos:

August 2021:

September 2022:

Apparently I totally failed at taking timeline pics in summer of 2023, but I wasn’t dumping feed into him or worrying about his weight.

He is currently in full work, eventing at Prelim, but this June-July were fairly light as far as conditioning because the ground has been super hard and I don’t run him in the summer to save his legs/feet. A typical week when we aren’t doing gallop sets is two or three walk hacks on varied terrain, one or two dressage or pole days, and one jump lesson, XC school, or jumper show. Winters he is typically in less work, either completely off for a couple months or just hacking.

I do think he’s better about eating hay in the winter too, maybe to keep warm but also because he’s insecure-dominant and a resource hog. In the winter I have two hay feeders for three horses, and if any of the other two start eating he will immediately chase them away from that feeder and start eating. Whereas in the summer they are stalled during the day, so no one else can motivate him to eat his hay. (I’ve been thinking about this and wondering if I might figure out a way to safely share hay between stalls, to get his competitive juices flowing.)

[JB]

@Libby2563

She believes his issue is more likely to be ulcers (gastric, hindgut, or both) than anything else, and suggested trying either Assure Guard or SmartGI.

I would scope. If it’s gastric ulcers, you need to know which kind(s) so you can use proper drugs, not supplements. Obviously you can’t scope the hind gut, but at least some of it can be ultrasounded to see if anything looks off. I would use sucralfate if there are suspected hind gut issues, and it will help with gastric issues as well, even when using omeprazole and/or misoprostol depending on what scoping finds