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Discussion on Low lymphatic white blood cell count and rain rot type lumps

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Danielle Strom
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Username: Dstrom

Post Number: 1
Registered: 12-2006
Posted on Sunday, Dec 17, 2006 - 8:26 pm:   Edit PostPrint Post

I have been treating (fighting) something going on with my horse for close to 12 weeks now, under the care and advisement of my vet. I would like to know what anyone else thinks about this case, and if you've seen anything like it before.

My horse is a 7 year old Standardbred, adopted off the track. I've had him for 4 years, with no health problems. About 12 weeks ago I noticed large scabs and lumps over his back and hindquarters. They seemed to come out of nowhere, though admittedly I had not seen him for about a week when I discovered it.

I began treatments for rain rot, with anti-fungal spray and iodine. After a week of this, I called the vet. She agreed that it was rain rot, but the worst case she had seen on a horse. (She's been a vet for over 10 years.)

Since it was so bad, she gave me Micro-Tek spray, prescription medicated shampoo, and a 10-day treatment of oral antibiotics. I was to call about a week after the antibiotics were gone. As another note, pressure in the scar area seems to hurt him badly. He does not tolerate picking at the scars.

We are now 12 weeks, 3 bottle of Micro-Tek, and multiple medicated shampooings into the fight. The antibiotics did nothing. The spray seems to have reduced the scars, but there are still large patches on his rump.

A few days ago, the vet took skin scrapings and blood. The results showed no sign of a fungal infection. However, the blood test showed what she considered extremely low lymphatic white blood cell count, which she said could be just overwhelming stress or a sign of an autoimmune disorder or lymphosarcoma.

She consulted with several other vets, and they decided that I should treat him with the Micro-Tek and occasional medicated shampooings on a daily basis for another two weeks. If there is still no change, we will do a biopsy.

I'm not very happy, to say the least. I've read all the Net has provided on lymphosarcoma, including what is on this site. He doesn't seem to have any other symptoms - just the blood issue, and the scarring.

Could this still be just a very bad case of rain rot?

I certainly would like it to be, but these points seem to point against it:
1. No other horse in the 9 member herd, though living in the same exact conditions, has a problem.
2. We do not live in a damp or warm climate (Wisconsin), and he had not been wet for any amount of time before the outbreak.
3. All of our sprays and shampoos, though powerful and occasionally prescription, have worked. Even the oral antibiotics, which from what I've read about rain rot are usually the last-ditch effort to cure it, were ineffective.
4. I continue to treat him daily, and just today I think there are new lumps again closer to his withers. Pressure on these "new" spots cause a pain reaction.
5. Why the extremely low white blood cell count?

And now, why this does not seem to be lymphosarcoma:
1. These scars seem exactly what is described as rain rot, but not like what I've seen described for cutaneous lymphosarcoma.
2. He does not have any other of the symptoms I've read about.

This is going to be a long two weeks, especially if the scars still do not decrease at all.

Any comments or input is most welcome.

Thank you,
Danielle Strom (and Sporty)
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Diane Edmonds
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Username: Scooter

Post Number: 553
Registered: 9-2000
Posted on Sunday, Dec 17, 2006 - 10:04 pm:   Edit PostPrint Post

Hi Danielle and welcome to HA. A few years ago there was a horse boarded at the vets office where my friend worked. The mare had a terrible case of rain rot for quite sometime. They tried everything you listed and then some.

At the same time my horse had a bad case of scratches that I could not get rid of all summer with all the normal remedies. Finally I tried something called derma-vet and his scratches cleared after a few days it was amazing.

We decided to try treating the mare with rain rot with it and it cleared her up in a week. It is along the same lines a panalog that they use for dog skin ailments I believe.

If It indeed is rain rot I would highly recommend the stuff, you have to get it from a vet I think, that's where I got mine. It is a little expensive, but well worth every penny. Good Luck
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 17295
Registered: 1-1997
Posted on Monday, Dec 18, 2006 - 9:39 am:   Edit PostPrint Post

If the lesions are typical for rain rot I still consider it most likely as I have seen cases like you describe. Since testing was done after treatment, the treatment might have suppressed the appearance of the organism. If they were culturing for a fungus rain rot is a bacterial disease (Dermatophilus sp.). The reason you see cases like this is the horse's immune system is slow in responding to the disease accounting for the severity and the lack of signs in the other horses which may have already mounted an immune response. For more on the proper diagnosis and treatment see Diseases of Horses » Skin Diseases, Wounds, and Swellings » Hair and Coat Problems / Itching / Irritated Skin » Rain Rot and Rain Scald: Dermatophillus.

Can you tell us what the WBC count including the differential was? If there is an immune suppressive state that may be the cause for the severity of this disease.
DrO
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Danielle Strom
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Username: Dstrom

Post Number: 2
Registered: 12-2006
Posted on Monday, Dec 18, 2006 - 11:49 am:   Edit PostPrint Post

Thank you Diane, and thank you Dr. Oglesby for your prompt response.

Dr. Oglesby,

These are the values given to me over the phone, and of course I have no idea what they mean. :-)

For the WBC count: 2.6

For the differential, there were two numbers: 182 and 2236.

Thanks!
Danielle
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Danielle Strom
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Username: Dstrom

Post Number: 3
Registered: 12-2006
Posted on Monday, Dec 18, 2006 - 11:57 am:   Edit PostPrint Post

Thank you Diane, and thank you Dr. Oglesby for your prompt response.

Dr. Oglesby,

These are the values given to me over the phone, and of course I have no idea what they mean. :-)

For the WBC count: 2.6

For the differential, there were two numbers: 182 and 2236.

Thanks!
Danielle
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Judith L Gordon
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Username: Jgordo03

Post Number: 133
Registered: 6-2005
Posted on Monday, Dec 18, 2006 - 4:28 pm:   Edit PostPrint Post

Danielle,
My colt was in a stall with another colt that developed such a severe case of Rain Rot, that it had caused some type of secondary infection. One night I was in the barn I noticed that the other colt could hardly stand. I called the owner right away and had the vet out for the fourth time for this condition. She finally went through all her books while sitting in her truck and gave her medication for every possible illness that had simular symptoms. That's how weak this horse was. There was nothing to lose. I'm glad to say this got her over whatever the problem was. From what I've read about rain rot, it's a fungus, microbial that can spread to other horses and if memory servers me I believe a horse can have rain rot without showing symptoms. Is there other horses where you keep yours, if so you may want to check them to see if any of them are showing signs.
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Danielle Strom
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Username: Dstrom

Post Number: 4
Registered: 12-2006
Posted on Monday, Dec 18, 2006 - 5:44 pm:   Edit PostPrint Post

It seems like that is where this is going. I sure hope we can do something that works before he gets to that condition, though. The blood test seems to indicate that his body is already fighting hard. I hope my vet will go ahead and throw all she's got at it if it comes to that. If at the end of this two weeks he's not better or getting there, then she'll biopsy. If that's negative, perhaps we'll then go to the "try anything" method.

We've been keeping an eye on the other horses, especially my second horse, who would be the most likely one to get it, too, as I interact with both of them and they spend a lot of time together. So far, no one else has any signs, thank goodness, but we'll keep watching until this is over.

Danielle
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 17302
Registered: 1-1997
Posted on Tuesday, Dec 19, 2006 - 6:41 am:   Edit PostPrint Post

Whoa, whoa, whoa, guys....a WBC of a little over 2500 is not that uncommon in horses with mild conditions so let's not start hand ringing. Let's figure this out. If I understand you right Danielle your horse feels fine other than the painful scabs, right? Transient, subclinical viral infections can cause depressions this remarkable in the WBC count but to be of much use I need to know what those numbers represent and what was the cytological morphology of the cells checked (or is this a machine read differential?).

In the mean time my first inclination is to monitor the horse for any problems, check the horse's temp once a day in the morning, just to get an early read if there is some infection. You should use our recommendations in the article for treating the skin condition as long as dermatophilus remains a differential. I am uncertain the WBC count is related to the skin, though some types of diseases of the immune system could explain the low count and the reason the horse responds poorly to infection. But I am not ready to go there yet. Until this is ruled out the horse should not come into contact with new horses and should be kept as stress free as possible, just in case.

Next I would check the complete blood count with differential 7 days after the first test making sure the differential is done by cytological methods and the cells checked for any abnormalities.
DrO
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Judith L Gordon
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Username: Jgordo03

Post Number: 135
Registered: 6-2005
Posted on Tuesday, Dec 19, 2006 - 10:49 am:   Edit PostPrint Post

Dannielle,
One tip I wanted to give you and I forgot. My vet wanted me to scrap the scabs off my colt when I applied the topical medicine to treat the rain rot. I found that a soft toothbrush worked best, and if your horse is used to electric clippers a battery operated toothbrush works the best. It really worked those big lumpy scabs loose and I used a syringe to get the medicine down to the skin where the infection was. Don't scrub very hard.
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Danielle Strom
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Username: Dstrom

Post Number: 5
Registered: 12-2006
Posted on Tuesday, Dec 19, 2006 - 11:19 am:   Edit PostPrint Post

Dr. Oglesby,

Of course I'm going to hand-wring, I'm his Mom! :-)

I'll have to ask how the readings were done - I have no idea. Is it common for a vet lab to do it either way?

I'm glad to hear that you're recommendation is similar to my vet's, that is to keep treating him as we've been doing and then check again. The only difference is the time, as she wants to wait two weeks to retest instead of the one week you are recommending. I'm thinking I'll call for retesting right after the Christmas break, which is somewhere between those two time spans.

To answer another question, yes, it seems that he feels fine otherwise. Perhaps a bit crabbier than usual, but that would stand to reason as now when I show up he knows I'm going to bathe and rub his sore spots in some way. (That's another aspect of this - it's putting a bad taste on our relationship from his point of view, I'm sure.)

New horses will not be an issue, as the herd is small and there are no new boarders coming in that I know of.

His life is as stress-free as a horse's can be, I think, besides the daily treatments. He spends all day and night outside in a large lot/pasture/woods with the herd, and is only in his stall twice a day to eat. I have not ridden or driven him since this started, because the tack would rub on the sores. I've lunged him a few times for exercise, and brush him many times a week.

I am also wondering if the WBC is actually related to this outbreak, or is simply something we discovered because of it. If he does have a general immune problem, and this is the first major infection he's gotten, it would stand to reason that he'd have trouble fighting it. And in the four years I've had him, there haven't been any other things like this. He's been very healthy until now.

So, the facts seem to be these, and please correct me on any that are wrong:
1. He seems to have a vicious case of rain rot, since other skin problems do not present the same types of sores.
2. He could have a viral infection, but there is no medicine to treat a virus, and that's why we're not trying it. (?)
3. The WBC count is significantly low, but we don't know why yet.
4. He probably does not have cancer, but if he did it would most likely be lymphosarcoma.
5. We should keep treating for rain rot for another week or so, then retest the blood and scabs.

One thing that does worry me, too: If it's rain rot, and nothing we do seems to work, how will we ever get rid of it? If nothing "normal" starts to work, what do we do?

Thank you,
Danielle
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Danielle Strom
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Username: Dstrom

Post Number: 6
Registered: 12-2006
Posted on Tuesday, Dec 19, 2006 - 11:24 am:   Edit PostPrint Post

Judith,

I have picked at them with my hands, but haven't tried a tool yet. The toothbrush sounds like it would be gentle, but these scabs are like cement in his hair.

I'm not sure how it would go, as he does resist pretty strongly when we pick, even gently. And this is a very tolerant horse. I think this is the first time I've ever gotten tail-wringing or stamping of the back legs from him, ever.

Danielle
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Judith L Gordon
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Username: Jgordo03

Post Number: 137
Registered: 6-2005
Posted on Tuesday, Dec 19, 2006 - 2:22 pm:   Edit PostPrint Post

Danielle,
Poor baby, it will take a while for those scabs to loosen up. Unfortunately you need to get the medication down under them to tackle the problem. Try a extra soft brush and dip it in a mixture your are using and just kind of rub it on them, they will soften and loosen up if you do it two or three times a day. Take care of him and I wish you the best.
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 17310
Registered: 1-1997
Posted on Wednesday, Dec 20, 2006 - 6:29 am:   Edit PostPrint Post

Danielle, I have never seen a terminal case of rain rot but stubborn ones come along, relax on that front. Most of your statements have both truthful elements and misconceptions.

Dermatophilus is certainly not the only scabbing disease but the scabs are fairly characteristic as described in the article. He could have cancer but I agree from the symptoms so far there is not much indication of this.

Yes he could have had a virus but this is not the reason you are not treating with antibiotics. My guess is the reason you are not treating is you do not have a indication of bacterial infection, at least that I am aware of.
DrO
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Danielle Strom
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Username: Dstrom

Post Number: 7
Registered: 12-2006
Posted on Wednesday, Dec 20, 2006 - 9:31 am:   Edit PostPrint Post

Do you think it would improve things at all to clip his winter coat from the affected areas? Keeping in mind that we are in Wisconsin, and I'd need to then blanket him for the rest of the winter.

But if it would help with the treatment effectiveness, I'd do it.

Danielle
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Danielle Strom
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Username: Dstrom

Post Number: 8
Registered: 12-2006
Posted on Thursday, Dec 21, 2006 - 11:01 pm:   Edit PostPrint Post

Today was not good.

I treated Sporty with the Micro-Tek, as I've been doing while waiting the two weeks for any results before taking action, and he was so sore in his quarters that he nearly sat down as I rubbed it in. Also, it's spreading up his back again, and getting worse.

Then, he laid down in his stall. When I came in, he got up to avoid me, though obviously wanted to be down again. So I left and he went down. He seemed very peaceful there, and very tired.

Then, I learned later from the barn owner that she had found him down and resting in the shelter earlier today. Furthermore, when she went to let them out (after I had left) he refused to get up or go out, and did not want contact with her.

This is extremely unusual. Sporty never lays down - this is the first time I've ever seen it. But it wasn't colicky or indicative of foot pain. He just seems really tired and crabby.

So I talked to my vet, and we're going to do the biopsy sample tomorrow, along with more skin and blood to send as well, and she's going to start him on a round of steroids which will hopefully help his obviously great pain. She talked about a more concentrated round of antibiotics than the first one we did, too. (Also, she reported that the fungus test was definitely negative.)

She is puzzled and worried that we've done so many things, and nothing has worked.

Believe me, so am I. :-(

Danielle

BTW, I now have a copy of his blood test. Those things reported as low and the numbers are:
WBC: 2.6 THOUS./uL
LYMPHS: 5%
ABS LYMPHS: 130/uL
ABS NEUTS: 2236/uL

There were also two readings in the high range, though she didn't mention those as things she was worried about:
MCHC: 37.5 g/dL
NEUT SEG: 86%

Everything else was in the normal range.
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Sara Wolff
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Username: Mrose

Post Number: 1999
Registered: 1-2000
Posted on Thursday, Dec 21, 2006 - 11:53 pm:   Edit PostPrint Post

Danielle, I'm so sorry you and your guy are having such a hard time with this. I hope it is rain rot, and not something even more serious. Best of luck with this. Sounds like you've got good vet help.
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 17318
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Posted on Friday, Dec 22, 2006 - 7:16 am:   Edit PostPrint Post

The change in your horses attitude has me worried too Danielle. Laying down alone can be a sign of colic but his appetite should be depressed. Dermatophilus is a painful skin disease and often associated with crabby and even aggressive behavior when you mess with the scabs, or in expectation of treatment. But I would not normally expect depression or laying down.

Besides a skin biopsy a complete exam is certainly indicated and possibly a complete blood work based on the results of the exam, this should include a repeat of the earlier tests. Would it be possible to get the normal values also?
DrO
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Judith L Gordon
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Username: Jgordo03

Post Number: 138
Registered: 6-2005
Posted on Friday, Dec 22, 2006 - 10:19 am:   Edit PostPrint Post

Danielle,
I'm so sorry to hear about the turn of events for your boy. Dr. O. is there such a thing as a horse that can carry Dermatophilus without experiencing symptoms or only experiencing mild symptoms?
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Danielle Strom
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Username: Dstrom

Post Number: 9
Registered: 12-2006
Posted on Friday, Dec 22, 2006 - 10:45 am:   Edit PostPrint Post

Thank you everyone!

Yes, I do think I have a good vet. She's willing to admit that this is strange in her experience, and to request input from other doctors and from the University. I feel very lucky right now to be so close to the University of Wisconsin - Madison and their vet school.

I mainly came here to find out if other people have had or seen cases like this, and of course to solicit the advice of Dr. O.

However, the moral support is a wonderful benefit, as well! My husband and friends who know about this all realize how upsetting it is, but not in the way other horsepeople, who understand that unique relationship, do.

Dr. O, I will write up all of the results of the blood test that I have. She'll be pulling more today for another test, as well.

Danielle
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Danielle Strom
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Username: Dstrom

Post Number: 10
Registered: 12-2006
Posted on Friday, Dec 22, 2006 - 4:15 pm:   Edit PostPrint Post

Well, skin biopsies are certainly not pleasant things. Even with two doses of the pain blocker, he lunged and kicked as she did it. But at least that's done.

A bit of good news from the blood test of today, however: His WBC and Lymphs are coming up close to the normal range. I don't have the exact numbers yet, but she did call and tell me that. So that points away from cancer, at least.

Another great thing is that we are no longer going to do the topical treatments, as they hurt him so much and haven't done any good. Now he's going to be on Prednisone and Tucoprim for a couple of months, or at least until the results of the test indicate we should do otherwise. So I can work on trying to be friends with him again instead of hurting him, and maybe his mood will improve. He wasn't so crabby this morning. At least not before the biopsy, that is.

So now we wait about two weeks for the University to return the results. She said they'll probably be able to pinpoint the cause, whether it's cancer, immune problems, allergies, or whatever. I sure hope so. And maybe the Prednisone and Tucoprim will do some good.

Danielle
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 17325
Registered: 1-1997
Posted on Saturday, Dec 23, 2006 - 8:22 am:   Edit PostPrint Post

Hello Judith, you will find an explanation of the range of symptoms in the article on dermatophilus referenced above. Wonderful to hear about the WBC's but I am more worried about your horses change in attitude and finding the cause: has this improved?
DrO
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Danielle Strom
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Username: Dstrom

Post Number: 11
Registered: 12-2006
Posted on Saturday, Dec 23, 2006 - 5:04 pm:   Edit PostPrint Post

Dr. O,

He seemed in a good mood today. I took him to the arena since he's been kept in his stall, and he ran around and bucked and rolled. He was also back to being friendly.

So maybe that one day just got overwhelming for him, and after a few days of stall rest he feels better.

I'll continue to keep an eye on his mood as we wait for the test results.

Thank you!
Danielle
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Danielle Strom
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Username: Dstrom

Post Number: 13
Registered: 12-2006
Posted on Wednesday, Jan 3, 2007 - 11:28 am:   Edit PostPrint Post

The results are in, and Sporty is having an allergic reaction to something, probably something he touched, or continues to touch.

We can do a blood test to find out what it is that's causing it, but it's pretty expensive.

For now, the Doctor believes we can control it with continuing low-dose steroids, and/or antihistamines. She also wants me to blanket him, to try to avoid skin contact with the dirt or plants that might be the cause.

She said once an allergy comes up, he'll always have it, but we can control it and hopefully get back to where there are no scars and pain so he can be harnessed and saddled again.

It certainly explains why the rain rot treatments did nothing - there was no bacterial or fungal infection at all. So all we accomplished there was hurting and stressing him.

Live and learn, I guess. I just paid the biggest vet bill I've had for a horse, but it was worth it to pinpoint the cause so we can treat it correctly. It sure had us fooled, though, as it looked exactly like rain rot.

Danielle
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 17395
Registered: 1-1997
Posted on Thursday, Jan 4, 2007 - 7:28 am:   Edit PostPrint Post

Danielle, do they believe this is an allergy or an autoimmune skin reaction? This would be a unusual presentation for environmentally induced allergies but your description could be that of some of the milder forms of pemphigus, which is a bit more serious and quite a bit rarer than dermatophilus.

Because allergic reactions are an important part of equine medicine I keep a very close watch on the intradermal and blood allergen testing market and Danielle there is nothing out there that is reliable with false negatives and false positives often. So if you do one keep this in mine.
DrO
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Danielle Strom
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Username: Dstrom

Post Number: 14
Registered: 12-2006
Posted on Friday, Jan 5, 2007 - 11:29 pm:   Edit PostPrint Post

DrO,

They said that there was no indication of an immune disorder, which was one of my vet's prime suspicions, in addition to an allergy and possibly cancer. There was also no indication of either bacteria or fungus.

They said that it seemed to be caused by something he's touching, but she did admit that's inconclusive. Just in case, we are going to keep a light blanket on him, to prevent any further contact with whatever it is, if it is something he's touching.

I will keep that in mind about the blood allergen test. Since the quoted price is $350, I don't plan on doing one anytime soon. And I'm not sure it would make any difference in his treatment anyway, except to point out something for us to try changing.

I am not familiar with pemphigus, but will research that here.

Thank you,
Danielle
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Danielle Strom
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Username: Dstrom

Post Number: 15
Registered: 12-2006
Posted on Friday, Jan 5, 2007 - 11:41 pm:   Edit PostPrint Post

DrO,

One additional thing I forgot to mention is that his prednisone treatments worked very well. The swelling and bumpiness reduced considerably, though it was still there and he's still shedding dead skin from all over his withers and back.

He's already in the reducing doses of the Prednisone, and the vet expects he may flare up again by the time she sees him next Thursday.

Since the steroids helped, and if he flares up without them, she feels this supports the allergy diagnosis over an immune disorder.

Does this sound correct to you?

Danielle
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Melissa Boschwitz
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Username: Amara

Post Number: 205
Registered: 7-2000
Posted on Saturday, Jan 6, 2007 - 12:06 am:   Edit PostPrint Post

if possible, i think college is a good choice - not only can you study some other "things" that will give you something to fall back on in times of need, but also because the right school can get you started on all those things you were mentioning....
i got my associates from a great school in NY that had a riding program that did everything from breaking youngsters to western pleasure, cutting, reining, hunters,jumpers, dressage, xcountry, trail, even some Tbred and standardbred racing... had an absolutely awesome driving program as well... we learned breeding and foaling, nutrition, farrier, business, etc...
were we experts? heck no, but it did give us a great base from which to work from, and when we came out we had a good idea in which direction we wanted to go, and there were great intern/work programs to get there... the teachers were nationally recognized trainers in their field...
i had a great life in the horse industry and dont regret any of it, even tho i'm no longer in it full time (law enforcement beckons)...
even tho i didnt make great money i made more than enough to make ends meet and had plenty extra for having fun...and i didnt have to spend money to buy great horses - people paid me to ride the horses they spent all that money on instead!... what a deal!...
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Robert N. Oglesby DVM
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Username: Dro

Post Number: 17420
Registered: 1-1997
Posted on Saturday, Jan 6, 2007 - 11:41 am:   Edit PostPrint Post

If a recurring history of lesions that persists until steroids are given and that then respond quickly does support the idea that it is inflammatory Danielle but not necessarily allergic.

This would be a more common presentation for autoimmune diseases. If you would like to look upon an autoimmune disease as a allergy to one's self you might think of it as an allergy. But infections often sustain symptoms through inflammation, and sometimes excessive inflammation that persists past the time the infection is cleared, so steroids can cause a transient or permanent improvement even when infections are the cause.
DrO
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Danielle Strom
Member
Username: Dstrom

Post Number: 16
Registered: 12-2006
Posted on Saturday, Jan 6, 2007 - 12:50 pm:   Edit PostPrint Post

DrO,

So you think it's possible that the biopsy results could be incorrect? Is it possible for it to be pemphigus though they said there was no sign of an immune disorder?

Is there anything I should do besides keep an eye on his progress as we proceed with this treatment based on the allergy diagnosis?

From what I read about pemphigus, it sounds like if it's that it will continue to spread over his body, so if that doesn't happen that's probably not it, correct?

Danielle
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 17425
Registered: 1-1997
Posted on Saturday, Jan 6, 2007 - 9:19 pm:   Edit PostPrint Post

I don't know anyway the biopsy results could rule out the possibilities I give above: severe allergies that cause sores would look just like an autoimmune reaction because they both have the same cause: an over reactive immune system. With pemphigus there are some milder forms and even the occasional self resolution but often it is as the article states a chronic progressive disorder.

I am voting for the resolved bacterial infection that had trouble turning off the immune reaction it created. It it helps you can call this an allergy to the infection.
DrO
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