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Dan C., DVM
Dan C., DVM, Horse Veterinarian
Category: Horse Veterinary
Satisfied Customers: 1174
Experience:  Solo Equine Practitioner/Mobile Practice Owner for 16 years.
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I Am at the end of my rope with my horse. I have spent more

Customer Question

I Am at the end of my rope with my horse. I have spent more on vet bills than I did on the horse. His most noticeable symptom is extreme sensitivity while being brushed. He has been scoped and we saw very little stomach ulcers so we did a test for hind gut ulcers and that came back positive so he was on succeed and gastrogard and now is on gut health. His attitude has improved since the gut health but is still so sensitive to brushing he fusses and actually gets the hiccups. He is still showing bite marks on his sides. He also struggles to urinate and goes often. One of the tests showed elevated bilirubin in his urine. He also has times of extreme spookiness and out of his mind scared behavior. A few other things I have noted that are probably unrelated are he yawns often and I feel like there is swelling in one of his super orbital groove. I am so frustrated and I just want answers. Please help any suggestions
Submitted: 9 months ago.
Category: Horse Veterinary
Expert:  Dan C., DVM replied 9 months ago.

Good Morning, and thank you for the question. I am sorry to hear about Zip’s condition, and also about the expenses and frustrations you are experiencing as well!

It sounds as if the Veterinarian(s) you have been working with have been very thorough in their diagnostics. I have a few questions to ask you so that we might be able to get a better idea as to Zip’s problems.

1): How long have you owned Zip, and how long has this condition been present? If you are not his original owner, do you know anything about his previous history?

2): Did the behaviors show up suddenly, or have they been progressing over time?

3): Have you had the opportunity to try to brush him while he was under sedation, by any chance? If so, did he still seem sensitive?

4): Has your Veterinarian attempted any type of treatment (besides treating the stomach ulcer) for the behaviors, and if so, what did she/he try and was there any success?

5): What breed is Zip, and is he gelded?

Thanks, ***** ***** am looking forward to your reply. Just a note; I will be offline for a few hours, out working, but I’ll check for your response as soon as I return.

Thanks,

Dan C., DVM.

Customer: replied 8 months ago.
Hi Dr. Dan,
Thank you for taking the time to respond back to me regarding my horse. I am just so desperate for answers at this point so we can get on with our lives and just enjoy our time together. He is a QH gelding and below is a full timeline of the symptoms and treatments we have done.
-Purchased 9/25/11 as a 3 year old
-Noticed his frequent and struggle to urinate pretty early on and in the Summer of 2012 I had a vet do an exam to check for cysts (this was a rectal exam of some type). He found nothing so we removed some beans from sheath and put him on a round of antibiotics in case there was a urinary tract infection or something. Saw no improvement.
-But that was the only odd thing I noticed about him until about Feb of 2014 when I sent him to a trainer. At that time I noticed two new things happening when I went to visit him. When I would brush him, especially around his flank area he would act irritated by swishing his tail, and giving me the stink eye and kind of stomping his feet. I thought maybe he hurt a rip or his back or something, or he was very hungry because at home he gets free choice hay and there he was like at boot camp and not getting as much as he normally eats. The other symptom that also showed up was when she changed his grain to Nutrena he became nuts. He would spook at everything and broke free from her ties. And when I brought him home I couldn’t even catch him in the pasture. Just crazy. So I quickly put him back on the small amount of oats I was giving him and he adjusted back down. But he is still a bit spooky and jumpy. I keep him on calm B to help with that.
-The next time I noticed his behavior was in the summer of 2014 towards fall. He sometimes would be fine, but then other times would be crazy again. One day he would be the best horse and the next he was almost unmanageable. I actually had him tested in September to see if he was cryptorchid. In addition to his crazy behavior he would also drop and get an erection and slap himself in the belly with his penis especially when I brushed him. But that has gone away on its own.
-In the fall of 2014 I also sometimes noticed his agitation when I would brush his back and sides so I decided to have a chiropractor come out. She adjusted him because he was really out and said he had been flipped somewhere in his training and I later found out he in fact was flipped onto his back.
-In late summer of 2015 he started acting very irritated when I would brush him and ultimately would do this hiccup/coughing/high pitched squeaking noise that would last for several minutes up to 15 minutes after I would stop brushing him. I had the chiropractor out again and she told me about a friend’s horse having thumps and it being caused by mineral deficiency. So she told me about a grain made by tribute to try. And I tried changing his feed again and it only made him worse. Again he went crazy and everything made him bolt. So I went back to just oats. At that time I also had my vet out to show him I wasn’t crazy and something was going on. He saw immediately that there was something there and he just didn’t know what. So we started him on Ulcerguard for a month to see if it would help. It did not. Then he took bloodwork and a urine sample and gave him a shot of vitamin e and selenium. That did not help. When the bloodwork and urine test came back it indicated a muscle deficiency of some type and also bilireuben in the urine. So then I had him tested for PSSM, HYPP and a few other 5 panel muscle tests. He is NN for all of them (thank God).
At that time I also put him on a magnesium supplement for about a month and that did nothing for him either.
-In December 2015 I took him to Cleveland equine clinic where they insisted it is ulcer. No, they did not have me brush him when we got there so they could see how he reacted to it. They did an eye test because when we were in the exam room he would randomly spook at things so they checked his vision. And they decided to scope him so they kept him overnight. When we did the scope, everything we saw looked good very little ulcer activity. Then she was convinced it was hind gut ulcers. They did a fecal test and determined that was it and we put him on Gastrogard and Succeed. He was on that for over a month and I did not see any improvement.
-So in February of this year I decided to give this gut health stuff a try because they said it works miracles. I have seen some improvement in his attitude, he does seem happier and more loving and a bit calmer, but he is still itching/biting at his sides and extremely sensitive to being brushed. The other night he started the hiccup thing again. He is still on the gut health.
-So as he was peeing today I noticed his urine was very dark brown in color.
I just need to know what this could be?
Is it his kidneys or liver or could the crazy behavior be caused by something in his adrenal gland. I just need some help!!!
Expert:  Dan C., DVM replied 8 months ago.

Hello, and thanks for getting back to me concern Zip. I just stopped into my office and saw your post, but unfortunately, I need to get back out again seeing a few more calls. I just want you to know I’ll be getting back to you later this evening, and I will certainly be giving Zip some thought!

Dan C., DVM.

Customer: replied 8 months ago.
thank you
Expert:  Dan C., DVM replied 8 months ago.

Good Morning! Apologies for the delay in getting back to you, it turned into a rather long evening……

Again, thanks for your extremely thorough history concerning Zip. It seems as if you and your Vet(s) have investigated almost every possibility that might be causing Zip’s problems. Good work there, but I’m sure you’re still frustrated!

One of the last items you mentioned relating to the brown urine is concerning. That sign is normally associated with muscle breakdown of some type. It is very common to see in horses that have “tied up”, which is the result of muscle being overworked without proper conditioning. The brown color indicates the presence of a protein called myoglobin, which is similar to hemoglobin (the oxygen carrying protein in our blood), however it is what provides oxygen to the muscle tissue. When muscle damage occurs, the myoglobin is released into the bloodstream, where it is filtered through the kidneys. Unfortunately, myoglobin also contains an iron-like molecule that is a toxin. This toxin can, and often does, result in kidney problems as it is filtering through the kidney tubules. So your concern for Zip’s kidney function is valid! I’m including a Wikipedia link for you that goes into further details concerning myoglobin, which might help to make things a bit more clear.

https://en.wikipedia.org/wiki/Myoglobin

Was the brown urine you noticed following any type of exercise, or perhaps some type of blunt trauma, such as hitting an object, etc.? Have you ever noticed this previously?

Also, you had mentioned that there was elevated bilirubin and a muscle deficiency of some type. Do you have access to the results of this blood test? I would be interested in seeing some of the numbers associated with the bilirubin (there are actually two different “types”, so to speak…), as well as the muscle deficiency. Bloodwork cannot show specific muscle deficiency, so perhaps this was referring to a specific type of protein or enzyme (?). If you do have a way to get a copy of the labs, it could be very helpful.

Is Zip’s urine still brown, or was this a one-time incident? You might consider having his urine and blood re-tested to see if there are any significant changes. It is not always easy to catch a urine sample form a horse (unless your Vet inserts a catheter into the penis directly into the urinary bladder). One trick I often recommend is to tape a clean paper cup to a 2-3 foot stick, and try to catch a sample while the horse is urinating (you might want to have a good book or something to keep you occupied while you’re waiting….).

In essence, my concern is mostly about his kidney condition and function, and to why myoglobin is being released if there is no overwork or trauma associated with the brown urine.

Again, my apologies for the delay, and I’m looking forward to hearing from you.

-Dan C., DVM.

Customer: replied 8 months ago.
Hmm. Thank you. Some of the things you are saying really have me thinking. I have seen his urine this dark color on several occasions. It is usually this way upon his first urination when he comes into the stall, it tends to get a little more yellow when he continues to urinate 5 minutes or 10 minutes later (on his 2nd and 3rd attempt). But the initial stream has been dark at other times. The nice thing is I can go in and he will let me get a sample so I will gather another sample have my local vet test it again. I'm not exactly sure what we would be testing it for? I am looking and looking for those test results from before and I know they were in my e-mail but for some reason the whole month of December is missing in my inbox so I will have to play and see if I can find them. A few things stuck out to me in what you said. When muscle damage occurs, the myoglobin is released into the bloodstream. I suppose some of his levels could be off in his bloodwork and that is why my vet was leaning towards some kind of muscle deficiency. But I have not been working him so it has nothing to do with exercise. The other thing I noticed today when I was brushing him is even while brushing his neck he was agitated with me. I guess if he is having muscle soreness because his kidney is not filtering the toxins correctly it could show up in other parts of his body as well, correct? I think at this point it may be time for my vet to do another blood test and urine test, but what should we be checking for specifically? And also, I had stumbled upon kidney disease and failure in my previous research and if I remember correctly it is not curable, is that true?
Expert:  Dan C., DVM replied 8 months ago.

Thanks for getting back to me:

It is possible to check for Myoglobin in the blood, but requires a special test. Same with a urinalysis. Consider discussing this with your Vet. Another consideration would be specific kidney function tests, along with a possible ultrasound of the kidney.

As far as kidney disease prognosis, it depends on the extent of the damage, and which part of the kidneys have been affected. If the kidneys are indeed painful, this may be why Zip is sensitive while brushing.

-Dan C., DVM.

Expert:  Dan C., DVM replied 8 months ago.

Also, there are other enzymes,etc., that can show up on bloodwork that can be related to muscle, such as CK and AST. Also, the elevated bilirubin can be kidney related as well.

I do wish you the best of luck with Zip, and I’ll be thinking of you as well. Let me know if you find the lab results and I am happy to help all that I can.

-Dan C., DVM.

Expert:  Dan C., DVM replied 8 months ago.

Good Morning:

Just checking in to see if you have any further questions. How is Zip doing today?

Let me know!

-Dan.

Expert:  Dan C., DVM replied 8 months ago.
Hi,
I'm just following up on our conversation about Zip. How is everything going?
Dan C., DVM

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