adventures with the vet · stupid human tricks

Lessons Learned After Illness

So a couple of weeks ago Tristan was really, really sick. He’s totally fine now; the last vestige of that week is his IV site, and even that’s halfway grown back in already.

Which means it’s time for some reflection. What went right, what went wrong, and what can I do better next time?

First, things that went right.

You may remember that about two years ago, Cob Jockey did a blog hop about taking your horse’s resting temperature, pulse, and respiration so as to have that information on hand. I did the blog hop, though too late to enter to win a prize, and learned that Tristan’s average temperature is pretty reliably 99.5. So when the barn started taking temperatures regularly, I knew where he stood. Some horses ran closer to 100; others, closer down to 99.

So when he temped at 101.4, I knew immediately that something was wrong, and we started treatment with banamine even though he hadn’t quite reached the threshold to start, per the vet’s protocol. I’m extremely glad we did start; we got a jump of about 8 hours, were able to give everyone a heads up that things might go south, and overall it was a managed problem rather than a true crisis.

Everyone should spend a week and get this basic information and write it down somewhere safe. It’s really, really important. I’m extremely glad that I did that blog hop.

Other things I’m glad about:
– I am a close observer of his regular behavior and attitude, and could usually tell even before temping him again whether his fever had gone back up.
– He is an impeccably well-behaved horse on the ground. I’ve worked really hard on this over the years that I’ve owned him, considering when I first met him he could barely be touched. It paid off in spades: he was easy and pleasant to handle even when he felt awful, he stood quietly to get treatment even when he did not like it one bit, and everyone’s life was a lot easier than it would have been if he’d been a more difficult horse. The best argument for putting (and keeping!) good ground manners on your horse is not the everyday stuff – it’s moments like these.
– I was able to react quickly and be flexible. I have a demanding job but an understanding one, and it was easy to communicate with my boss to let him know when I couldn’t be in. Modern technology also helped; I could check emails and respond to anything urgent during downtime. This isn’t an accident; it’s important to me that I have a job that treats me like an adult and a human being, and it’s a crucial factor to me in choosing an employer. Sooner or later, we’re all going to have an emergency, and life is easier when you’re confident that your job can be put on hold for a few days and they have your back.

3am checks suck, but they’re better when you know your horse will behave.

Second, things that did not go so well.

The most important of these is that my first aid kit was a bit lacking. I’ve written before about spring cleaning checkups for my first aid kit, but when I sold my trailer I got a little over-confident and slacked off on checking regularly. The barn has ample first aid supplies, and I knew I could fall back on them if I needed to.

Well, I needed to. The most egregious thing I had never replaced was my roll of Elastikon, that miracle fiber. I had to buy some from the vet, at a premium, and then I didn’t have any to replace/update the bandage for his IV, so we resorted to over-taping it with duct tape. It worked ok, but it was considerably less than ideal.

I also quickly discovered that one my thermometers had a dead battery, that my paste banamine had expired, and that things in the kit itself were in disarray – I’d bought a box of new gauze, for example, and had just shoved it in the box instead of fitting it in neatly. When you’re panicky and looking for supplies, you’re already going to make enough of a mess. It doesn’t help for things not to be orderly to start with!

So, terrible job to me. I’ve rectified the most urgent pieces of this – new Elastikon, new thermometer battery, new banamine – but I need to spend some quality time looking through the kit and re-evaluating each piece of it and either upgrading or downgrading things now that my situation has changed slightly. I did spend some downtime going through my tack trunk and throwing away expired and empty things, but need to allocate more time to this soon.

Other things:
– My mental state was…not great. I’m really embarrassed that I basically had a meltdown at 3am about the bubbles in the IV line. Horse care and on the ground handling is one of the things I take pride in, and am generally very competent at. It was really frustrating that my anxieties took over my brain and prevented me from doing the best job that I could. Yes, I was sleep-deprived and terrified and doing new and tricky things, but I still let myself and a lot of people down. I need to either be more ruthlessly honest with myself OR find ways to work through that much better. Preferably the latter; I think of myself as someone who’s good in a crisis and I need to do more work to keep that up.
– My emergency fund is in shambles. I’ve been dipping into it a little too freely lately, for really-wants rather than actual emergencies. Yes, it was more than adequate to cover the cost, and yes, I have had a lot of really bad financial challenges this spring/summer, but I can and must do better about building this back up.

Finally, what can I do better?

A few things.

– Commit to more regular cleanouts/checkups on the first aid kit.
– Work on some anxiety-reducing techniques that aren’t just crash-and-burn-and-sleep-like-the-dead.
– Build the emergency fund back up: no more discretionary purchases. At all.
– Good biosecurity is important even when no one is sick! No more grabbing a brush from the schoolie shelf just because it’s closer and easier than bringing down Tristan’s whole grooming kit.

Do you have any lessons learned from a crisis that you always implement now?

adventures with the vet · puppy

Vet-bill-a-palooza: mystery dog illness

I don’t talk about my dog all that much but rest assured, I’m at least as obsessed with her as I am with Tristan. Hence why it’s been a difficult couple of weeks, because just as Tristan was getting better she also started getting really sick.

Arya’s two natural states: 100mph and sound asleep. 

I had written previously that she started getting hives literally within the hour of when I arrived home after the first night of Tristan getting sick. Those hives continued all that week, coming back like clockwork when she was due for her next benadryl dose.

She was a pretty miserable little dog. Her skin was hot to the touch, and the hives were everywhere. We did lots of cold baths. I washed everything she could possibly be touching in case it was environmental. Nothing helped; by the end of that week, I made her a follow up appointment with her regular vet for the following Monday morning to talk through other options.

Well, that weekend my husband took her to New Hampshire for a few days of visiting his parents. On Saturday afternoon, he noticed a small bump on her nose, just about the size of a pimple. You can’t even really see it on this picture he took of her that afternoon.

By Sunday morning, it had opened up into a blistering sore. We treated it with a baking soda and water paste, because our best guess was that she had either gotten exposed to some particularly nasty plant or a bug bite / bee sting.

It kept getting worse.

Thankfully, we had that vet appointment on Monday, and the vet was duly very impressed. Her best guess was that it was a staph infection, so Arya started on cephilixin, a pretty strong antibiotic, and she went in a cone to keep from getting at her nose. She kept on the benadryl to hopefully keep some of the itching down. She was a really miserable pup.

She didn’t get better. By Wednesday afternoon, she had also started opening up bloody lesions on her legs – similarly pimple-sized spots that, with no outside intervention, blistered open. Because she had the cone on, they didn’t get irritated into huge hot spots like her nose had, but they still kept opening up. She had as many as a dozen on each leg of varying sizes and severity. Most of them opened up and scabbed over pretty quickly; only a few of them were actively pussy and bloody like her nose.

Thursday, we went back to the vet. She should have at least paused in her progression on the antibiotics, and we were seeing none of that. So we did a barrage of tests. The vet pulled urine to test for canine blastomycosis, and after listening to her lungs, also ordered radiographs for that same reason. Her nose was too raw and open – she had managed to rub it when I took the cone off for two seconds – to culture, but they took biopsy punches of her nose, two legs, and one ear. They sent me home with a topical treatment to apply as I could, and then we waited.

Through that weekend, she finally started seeing incremental gains, but also some setbacks. Her nose finally started to scab over and heal, but she opened up new lesions on her ears, and her legs still had some lumps and scabs. Her ears continued to progress and her nose continued to heal all through the next week.

We got the urine test back first, and the second opinion from the radiologist: no signs of the blastomycosis, thankfully. That still left quite a few possibilities, though, and one that was looking increasingly likely was some kind of auto-immune disorder like pemphigus, in which her immune system was attacking and breaking down her own skin. That was our most likely worst case scenario. Fast moving skin cancer was still on the list, but looking less likely as she healed a little bit.
Two weeks after her first vet appointment, we went back to get her stitches from the biopsy pulled, and they finally had the biopsy results: deep bacterial pyoderma. In other words, a bacterial infection that had started on her nose but wreaked merry havoc systemically. Actually a pretty good case scenario! We added prednisone to the mix, and the vet put in a call to a dermatologist to get a secondary consult to make absolutely sure we had covered all the bases.
she did not think the comfy benches should be just for people.
She’s been on the prednisone for about a week now, and is waiting to start her taper & to go off the antibiotics. We’ll hopefully be able to do that soon. We’re waiting on the dermatologist’s opinion and to make sure she has no more scabs. She’s still got one or two on her legs and her ears. Mostly, she’s just down to bare skin in those spots; we’ll see what grows back in!

Life on prednisone is not a ton of fun; she’s drinking and peeing constantly, and lethargic. But she’s spending more time than not out of the cone, and her personality is mostly back. She’s clingier than she was – she will not let me out of her sight – but has occasionally started wreaking havoc again, taking apart her toy box to find exactly what she wants to chew on, leaving nylabones where we can step on them in the middle of the night, and waking me up to tell me all about her morning walk when she gets back from it.

So that’s been my life for the last few weeks. She and Tristan were actually neck and neck for vet bills for a little while – small animal diagnostics: they are not cheap! – but with the most recent bill from the barn for supplies, Tristan has pulled ahead again, sigh.

adventures with the vet

Tristan’s terrible, horrible, no good, very bad week

First, before I say anything else, I have the best barn in the world. Almost five years ago, when I was looking for a barn, my biggest factor was quality of care and specifically attention to the detail of that care. I have been blown away over and over and over again by how incredibly good everyone at the barn is and have been amazed again these past few weeks. I cannot possibly thank them enough, though I intend to keep showing up with bottles of wine and baked goods for some weeks to come.

Before I start to tell Tristan’s part of the story, please know at the outset that he was the third horse in the barn to come down with this mystery disease, and – KNOCK ALL THE WOOD – is so far the last. We don’t yet know what it is/was, or even its vector, since the horses had zero contact with each other and obsessive quarantine measures were begun with the first horse and maintained right on through.

So: we start the story last Sunday, when I came out to do a short road hack with Tristan before I headed out to a work even in the southern part of the state. By that point, he had been getting twice daily temperature checks for three days, along with every horse in the barn. That morning, his temp was fine. That afternoon, about 3pm, I held him in the aisle before heading out so the barn worker could do his temp and I watched her face fall as the thermometer kept rising.

I swallowed bile and tried to fight back my fear; he’s never run a temperature, to my knowledge, in the decade plus that I’ve owned him.
The vet’s protocols called for a dose of banamine at 101.5; the barn worker and I decided that he was close enough, and gave him a dose. I put him back in his stall and started running through “but what if it’s nothing?” scenarios in my head.
I put the barn manager and vet on alert, and went to do my work event. On the drive back, I checked in with the barn worker, who we’ll name as L. for continuing blog purposes – she and I spent a lot of quality time together in the next week. She reported that his fever was up above 102: clearly rising. I called the vet (and my husband, and a lot of other people), and sped back up from southern Vermont. 
We all met at the barn at 9:00 pm and Tristan was pretty clearly not himself. His fever was holding just above 102 but he was listless and unhappy. We moved onto the next phase of planned treatment, following the pattern of what had worked with the other horses. We basically spent the next two days in a blurred cycle of that same treatment.
The vet did a catheter for an IV drip, and that night he got a dose of tetracycline in 5L of fluids along with another dose of banamine. Before the vet had reached us, L, had already done his first alcohol & cold water bath to try to keep him cooler; we did a lot of those over the next few days. The vet left us with several more bags of fluids, two more doses of tetracycline, a bottle of banamine, and several tubes of Gastroguard. She also pulled blood for a CBC panel and noted that his gut was hypermotile (ie really gassy) and seemed uncomfortable, though he had passed some relatively normal-looking manure.
I got home around 11:30 pm, got a fractured 90 minutes of sleep, and headed out for the 3am check, during which I took his temperature – still above 102 – and iced his front and back feet.
He was so miserable. He had no interest in food, he was dull and uninterested in anything, just stood in the back of his stall occasionally flicking his ears. It was really hard to see. 😦
I got home at about 3:30, and then at 3:45 my dog jumped on the bed crying pitifully and scratching so hard she was shaking the whole bed. When I reached down to pet her and comfort her, I discovered that nearly every inch of her body was covered in hives. She’d shown no signs of that the day before, and this was the first time she had ever done anything like that. She was also miserable, so I got up, gave her a long, cold bath with the oatmeal shampoo I had on hand, and wrapped her in a towel to snuggle and dry. None of that helped; she continued to cry and started shivering violently, even when wrapped in the towel. So off to the emergency vet we went, where she got a dose of benadryl and dex. She would spend the next seven days on benadryl as we tried to chase the allergic reaction; I won’t write about that more but it’s in the background of all of this and as I write that allergic reaction has given way (or transformed into? unclear!) a nasty staph infection that has blossomed into an infected lesion on her nose. So I am on round 2 of vet bills this week.
Anyway: on my way back home, I got word that at morning check Tristan’s temp was down below 102 and he was a tiny bit perkier after his morning banamine, so I got another 90 minutes or so of sleep, then headed back into the barn.
That morning temp check was the best point of his Monday, because he started a cycle that went for the next 36 hours of ramping his temperature up until the next banamine dose, while we tried to help bring it down in other ways. About every hour or 90 minutes he got another cold alcohol bath and I iced his feet, front and back, both to help with temperature and as a preventive measure against laminitis.
In his better moments, I took him out for short walks after his baths, because the road was shady and there was a little breeze and he seemed happier when he was moving. 
At his worst, he went up to 104.3 right before his afternoon banamine dose, which is pretty darned high. The other horses who got this had gone as high as 105, so we had our fingers very crossed that was the worst of it – and thankfully, it was.
He was so, so tired through the whole thing but he was wobbly enough that it was hard for him to lie down, so it was actually progress that he laid down for a short nap.
He still wasn’t eating or drinking on Monday, so he got another 5L of fluids. Even though he showed no outward signs of dehydration – his skin was popping back just fine, his capillary refill was good, his gums were a healthy pink – he clearly started to perk up and feel better about halfway through his bag. He got another dose of tetracycline that night, and I chatted with the vet after; she was concerned about his total lack of interest in food, which was VERY un-Tristan-like. So we tried to take him out for handgrazing, 20m at a time; he was interested, but not enthusiastic. He spent chunks of time staring into the middle distance and biting at bugs rather than attacking grass – again, very not like him.
I did the 3am check again, and temp check went fine. I also took him out for more handgrazing and he started to seem a little bit more like himself. I brought him back in, iced his feet, fussed over him, and then did my first solo flush of his IV line. I’d been instructed how by the barn manager and had done it supervised by L. in the afternoon. It’s a simple enough procedure, the kind of thing pretty much anyone could do.
Well, at that point I’d had maybe 5 hours of sleep in the past 48 hours, and the wheels came totally off the wagon. I am not sure if I didn’t tap the syringe of fluids out enough or what, but I saw two small bubbles go into the IV line from the syringe. I finished the flush, closed the line, my hands shaking and totally numb, and had a complete and total panic attack. Everything caught up to me at once. I called the barn manager who assured me that two tiny bubbles were not going to cause a problem. I called my mother, who is a nurse, who asked flatly “did he drop?” She said if I had actually gotten enough air to be problematic in the line, he would have dropped fast and hard, and by the time I called her it had been 20 minutes since I’d done it. After another 20 minutes I convinced myself he was going to be ok.
I got halfway home and became convinced I hadn’t closed off the line properly. Cue another panicked call to my mother. I turned around while talking to her and she assured me that there was a plastic stop on the line, so even if I hadn’t closed it off in the correct order (before taking the needle out) air could not have gotten in the line. I went back to the barn anyway and took a picture of the line closed up. I went home again, and laid awake trying to work my way through the aftershocks of the panic attack.
I probably got another hour or two of sleep, baked a gluten free cake for the barn manager, and headed back to the barn, where his temperature had finally, finally started coming down and staying down. I did some more handgrazing with him, and he got more fluids in the afternoon, but by early afternoon his temperature had held normal so consistently we held off on his banamine dose. He got one last dose of tetracycline that evening, and I was relieved from the 3am check for everyone’s sanity.
Wednesday, I spent a good chunk of the day washing and disinfecting everything: all his brushes, all his tack, all his blankets, all his saddle pads. I also washed all of our own bedding and the dog’s bedding in an attempt to eliminate an environmental trigger for her hives. I did 12 loads of laundry in about 36 hours.
The bar was still under full biosecurity measures, which meant that after every one of his alcohol baths I had scrubbed down the wash stall and then sprayed it with bleach. Every time people went in and out of his stall, they stepped in bleach; ditto the barn itself. The farrier kept all his tools in bleach and the aisle was scrubbed down after every horse. The barn staff also scrubbed everything they could find – every bucket, every flat surface, every blanket, everything. There were antibacterial hand washes hanging everywhere and every time I touched Tristan I scrubbed my hands, as did everyone else. I didn’t touch any other horses or even go near stalls, and I washed the clothes I wore during the day every single night.
Sick pony station: cooler for ice, box of fluids, grain, trash bag with sharps container, flush fluids hanging on door, clipboard with hourly notes, bucket with miscellaneous things, stool for sitting on during fluids, bucket of bleach, bucket with sponge for alcohol baths.
Thursday morning his temperature was holding down still, and he was interested in and excited by food again, not just grass – he was absolutely attacking grass, but he started to work on his hay in earnest, and that night he was happy for his grain again.
Eating and drinking meant that he also started to pass more manure. He’d never stopped, but so many of the symptoms of whatever this was also mimicked colic that it was really worrying to see how little manure he was producing, even though there was a logical reason for it: he just wasn’t eating enough.

He also got his IV line out on Thursday afternoon, and on Friday morning he got more blood pulled. The only thing the first bloodwork showed was that his white blood cell count was in the basement – not entirely surprising, given the vet suspected something viral.

This Tuesday, 8 days after he came down with his first temperature, he started going back outside again, in a small isolated paddock, and he’s continued happily and well since then.
I don’t know when I’ll put him back under saddle; maybe this weekend. Unfortunately, the dog is now worse, so I’ve refocused my attention and worry on her now that Tristan is stable and happy. He has visibly lost weight, and is still very tired; it clearly took a toll on him, so I’m just as happy to give him more time to recover before I sit on him again. Probably he’ll get a week of light, easy work, too.
So there you have it: a very long, very miserable, and still somewhat unexplained week that was made better by the best barn staff and the best vet in the whole world.

adventures with the vet

Not the book review you’re looking for

I know I said I would have a review for The Black Stallion today, but – nope. Sorry.

This has been my week instead.
I’ll post in more depth about it when I have time and brain space, but the short version is that Tris got very sick starting Sunday afternoon with a nasty as-yet-unspecified GI virus, and we had a really awful couple of days. 
He is on the right path now, still tired and beat up but fever is down, he’s eating and pooping, and the catheter came out late Thursday. 
So I haven’t had time to write up The Black Stallion, though I have been reading quite a lot because that’s what I did between temp checks and ice baths and it’s not like sleep was happening.
Sorry – I’ll be back on track next week.
In the meantime, I’m really only updating on Instagram, so if you want pony pictures, you can follow me there @beljoeor.
adventures with the vet · allergies · hives

Summer obstacles: hives

If you’ve followed for a little while, you know that Tristan has struggled on and off with hives over the last few years. I’m pretty convinced that it has to do with his Cushings diagnosis – his immune system just can’t cope as well as it used to.

This year’s bout held off for a long time, since we were proactive – he’s been wearing fly gear and getting a low dose of OTC cetirizine all summer – but when they hit, they came with a vengeance.

First appearance was, of course, about a week before I left for the honeymoon.

These blew up in less than two hours: he was totally fine when the barn manager left after grain, and covered all over when I got there to ride at 7pm.

We started with IM benedryl, a dose that the vet had left with us after last fall’s shenanigans with his tail tumor (because one of the possible side effects of the chemo beads was anaphylactic shock or a lesser but still serious sudden allergic reaction, isn’t Tristan FUN?). (For those playing along at home, this was per the vet’s instructions while on the phone with her and after having sent her the above pictures.)

That helped, but they were back the next day. So I spent a few days giving him a bath every night with long rinses of cold water and a sensitive skin shampoo. In the meantime, no more grass for him; he was sent to a dry lot with tossed hay.

(We also did some work trying to isolate other factors, but nothing had changed for him, and he wasn’t getting anything that was not shared with other horses, from hay to grain to water to shavings and so on and so forth. Our best guess was that something was blooming or going to seed in the pasture – which even then are of course mowed down regularly – and that was setting him off.)

Yeah, he LOVED that.

That helped but it did not actually solve anything. Next up: the vet. I couldn’t be there when she was, so after some phone calls and emails back and forth, during which I was able to dig back into my obsessive notes and document for her the dates and duration of Tristan’s bouts of hives for the past three years, we went forward with a course of treatment.

First: since he is Cushings but not insulin-resistant, and because his Cushings is under control and responsive to pergolide, he was a candidate for dex. So he got a shot of dex at the vet visit and then 5 more days of decreasing dosage, which made a big difference.

Second: he had been getting 20mg cetirizine 1xdaily as a preventative. He was now to go up to 200mg 2xdaily as a treatment.

Except by the time the cetirizine order was called in to Wedgewood I was in Europe so the vet dropped off a supply from her own stores and that took a little longer, so in the meantime the hives came back. Which meant that he didn’t get ridden at all while I was away – so basically he did not get ridden through all of August. I didn’t want to irritate the hives, or rev up his metabolism in a way that would make them worse in case this was an allergic reaction that went deeper.

Once he got the higher dose of cetirizine on board, the hives receded and – knock wood – it’s been almost 4 weeks and they have not returned.

In the meantime, the Wedgewood order came in and we are leaving the danger season, so I have a fresh bucket of cetirizine ($$$, sigh) in the fridge to keep good until next June, when he will start on it and stay on it through the summer and we will hopefully not monkey around with this bullshit again.

I swear, I keep telling people that he used to be an easy keeper and they don’t believe me.

adventures with the vet

Vet Update: Lyme Vaccine

I mentioned last week that my vet had listed consideration for a Lyme vaccine on my invoice from spring shots. I was curious, so I emailed her to ask more.

I wrote:

Hi Alison, 

I’m filing Tristan’s vet paperwork from his shots, and saw your note about the Lyme vaccine. I wasn’t aware that there was one yet for horses! I know my dog gets it every year. 

Is it new, or is it a variation on the dog vaccine? I’d love to learn more. (Mostly out of curiosity; I have never found a tick on Tris up here so I agree with you that it doesn’t make sense if he stays at this farm.)

Thanks,
Amanda

To which the vet replied:

Hi Amanda. Dr Divers at Cornell started a study a few years ago using the Merial vaccine for lyme in dogs administered to horses. Very good efficacy and safety, study should be out this year. So it is exactly the dog vaccine, but I’ve become quite comfortable using it. 3 doses 1 month apart and then every 6-12 months depending on region.

Which is fascinating and kind of awesome! Years ago, we boarded at a barn that had absolutely ridiculously high levels of tick-borne disease. That was the first time I learned about ehrlichia, which is a vile little disease that every single horse in the barn but Tristan got at least once, many of them multiple times.

But he got ticks quite frequently, and he reacted horribly to them. Giant orange-sized abscesses, weeping puss, hot and painful to the touch. Mostly around his head and neck. I would wash them, treat them with antibiotic cream, and hot compress them endlessly to try and ease his misery a bit. Sometimes he got bute, but it never seemed to make a huge difference.

I always held onto a wholly unscientific theory that Tristan was fighting some kind of infection on the surface. No other horse in the barn reacted that way to tick bites. They just went about their business and then came down with the sudden high fevers that are characteristic of ehrlichia. He blew out those abscesses but sailed past anything deeper. I pulled a Lyme titer on him quarterly just to be neurotic, but he never registered any infection at all. Dumb luck, good constitution, some combination of the two – I’ll never know.

Here’s a good Practical Horseman article about the causes, symptoms, and treatment for Lyme that includes a little bit about the Cornell study at the end.

Here’s another (PDF) article right from Cornell with much more detail and more science.

So: it doesn’t make sense for us right now, but it’s awesome to know that there’s real research and strides being made toward a vaccine. Lyme is horrible, and it’s only going to get more widespread as ticks survive more and more of these mild winters.

adventures with the vet

Spring 2016 Vaccinations

Previously, in 2014, I did a quick table of the vaccines that Tristan usually gets. It’s changed a lot over the years.

So what did he get this year?

Some things are standard: rabies, flu/rhino, and Eastern/Western/Tetanus, West Nile.

In the past, I noted that he got strangles at the discretion of the vet and the barn. This year, we passed on the strangles vaccine because there’s a pregnant mare in the barn, and there were concerns about the live virus vaccination. My barn takes biosecurity very seriously, which is a thing that I appreciate and support, so no strangles until after the foal arrives – and maybe not even then. We won’t be traveling much.

Tris will get Potomac and a flu/rhino booster in the fall as usual.

One new development this year is that my vet noted that she now has a Lyme vaccine available, but did not recommend it for Tris this year. We haven’t had many ticks in this part of Vermont, and in fact I’ve never pulled one off Tris at this barn. I have definitely done so at previous barns! I’ve emailed her and asked for more information, since I didn’t realize it was available for horses yet.

Last year, Tris had some mild reactions to his vaccines, and this year the vet gave him some banamine alongside his vaccines. He was still quite sluggish for our ride the next night. An interesting new development for him, as he’d never previously been a horse to react in any way – even having all his vaccines on the same day with zero stiffness in his neck. Age, I guess!

Are you opting for anything different in terms of vaccination this year?

adventures with the vet

Coggins Forms Online!

O, what a fascinating modern world we live in.

I got this email the evening after Tristan’s first round of spring shots.

Here’s what the link got me.
My previous Coggins is in there as well, but I have zero memory of having access to it, and had to set up a new account this year, so I think I just got emailed a PDF before.
This is freaking awesome. I always scanned my Coggins certificates so I would have them in the cloud in case I lost or forgot it. We’ve come a long way from those carbon copies in triplicate!
Does your vet do something like this, or are you still getting handwritten copies?
adventures with the vet

Joint Support Verdict

the actual cutest.

Previously, I mentioned that Tristan has been stiff behind, and that the barn manager mentioned that something called OsPhos, which other horses in the barn were getting, might be a solution for him. I was a bit wary, based on my research in the COTH forums.

Then, I read Austen’s excellent overview of her use of Estrone for Guinness’s stifles.

That spurred me into action, so I emailed my vet and asked her about both OsPhos and Estrone for Tristan.

Being the sensible and clear-headed person that she is, she said she’d want to take a look at how he’s actually moving first before prescribing things. (grumble, grumble, stymied once again by the intelligent professionals around me) She wasn’t wild about either of the things I suggested, though.

I tried to describe as best I could how Tristan was traveling, and what my concerns were. I told her that bute hadn’t made a huge difference, nor had our Previcox trial. He was actually overall going really well and looking great, but I just wasn’t thrilled with the way he was using his hind end, and the stiffness starting off.

A few emails back and forth later and we had a surprisingly simple solution that I was really happy with.

It turns out that many vets often recommend doing a loading dose of Pentosan annually. So in addition to the monthly injections that he’s already getting, once a year Tris could do a month of weekly injections.

Pentosan works out to be about $12 a dose, and I already knew it works well for Tristan. SOLD.

So, this past Tuesday, Tristan was due for his monthly injection, and that will be the first of four weeks of regular injections. I re-upped his prescription at Wedgewood to make absolutely sure he had enough (though he still had probably 5 doses left in his old bottle). We’ll see where we go, but I’m really optimistic. In the past I’ve been able to feel pretty clearly when he was getting ready for some help, and the idea that we could get back to a great baseline makes me really optimistic!

adventures with the vet · senior horse

Next Steps (Literally): Investigating OsPhos & Other Biophosphonate Drugs

Bad news first: Tristan is still lame.

From there, it’s actually mostly good news.

He was first off last Monday/Tuesday. He got one gram of bute am + pm through Friday afternoon, and then on Monday I put him on the longe line.

He was definitely not comfortable but a) he worked out of most of it and b) it was much better.

I asked the barn manager to watch him with me, and her observations matched my own: he was acting almost like he had a stone bruise. That RF was short and sort of stabby, like he didn’t want it to rest on the ground for long.

He was much, much more willing to move forward than he was at this point last week, offering up a canter to the right several times when he flat-out refused last week.

So what’s next?

First step: one month of Previcox, an anti-inflammatory that will be much better on his stomach than bute would. That will help ease overall osteoarthritis symptoms and anything more specific going on in that RF. I’ll keep checking in to see how he goes.

My hunch, based what he presented yesterday, taking into account his history and the way he looked? I think he’s showing some soreness in his foot from the ongoing RF problems, because that foot is (apparently) always going to be more sensitive and weaker to any kind of problem. It’s always going to be thrushy, always going to trend toward abscesses, and always going to show sole bruises immediately. I think it’s some kind of sole bruise.

However, I also think he’s got some ongoing arthritis issues in both his hocks and that coffin/fetlock. He is on monthly Pentosan injections, and that has helped with his overall fluidity in terms of the cartilage, ligaments, and tendons, but I think we also need to add something to help with inflammation.

Again, if he were younger and in full work, we’d start joint injections. He’s not and he’s not. I said this to the barn manager last night, and she raised a new possibility.

OsPhos is a new drug specifically marketed for the treatment of navicular. It basically helps joints and bones that are remodeling due to arthritis or abnormality. It has a really promising research outlook, and works in similar ways to Tildren, a drug that’s been on the market for a bit longer.

For my purposes, the benefits are thusly: it is a system-wide joint support that is not quite as powerful as an intra-articular joint injection would be but at the same time tackles more joints at one time. It is delivered IM, and costs between $200-$300 a dose. (As opposed to $1,000 a dose for Tildren, and $500/joint for injections). Perhaps most importantly, our local best lameness vet is very familiar with it and has used it on several of the schoolhorses in the barn to excellent effect.

That said: it has drawbacks. Some of them are not so great. Because it’s such a new drug, there are some serious concerns about longterm consequences.

The most legitimate concern seems to me to be the question of how, exactly, biophosphonate drugs like OsPhos (and Tildren) remodel bone. They work by basically killing the things that remodel bone, preventing bad changes from happening – but also good changes from happening. Bone remodels throughout its entire life. Stopping that from happening prevents bony changes, but it also prevents the kind of bone density growth that’s important in strengthening. Do they create truly good, new, strong bone, or do they just make x-rays look better?

These are drugs that have been available for humans for some time now, and on the 10 year outlook there are reports of necrotic bone (particularly in the skull and jaw) and dramatically lower bone density. There are also reports of spontaneous fracture.There’s lots on the COTH forums; here’s one good thread.

On the one hand: that is scary as shit.

On the other hand: Tristan is in light dressage work and he is 20. He is not jumping or otherwise putting sport horse stress on his bones. Would helping him be more comfortable and keeping him in light work to keep him healthy be worth the tradeoff?

On the other other hand, at least some of his lameness issues in that RF are due to bone remodeling, so the biophosphonates would help in that way. But they’re also due to a lack of bone in that area, ie the carved-out portion of his coffin bone from the infection. So they might help one problem and worsen another.

I also don’t see any good outlook on how many times a horse has to be dosed before the problems crop up – or before they are sound. “It depends” is always the answer.

There’s also the possibility, mentioned by a few people, of doing a regional perfusion of the problematic limb with Tildren. That would localize the treatment to the problematic RF, but it would also do nothing for his hocks and any other overall osteoarthritis he’s dealing with.

Anyway.

Lots to think about.

Has anyone out there used Tildren or similar drugs?