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  Discussion on Losing albumin protein - malabsorption?
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Member:
kathjune

Posted on Wednesday, Aug 29, 2007 - 8:14 pm:

Our pony of 21 years has lost a lot of weight over the last couple of months. As well as the weight loss he seems to have a suppressed appetite and seems 'uncomfortable' at times, often has a stance as though he might be thinking of urinating of defecating but then doesn't. This is mostly after bucket feeds I notice this. My vet has run comprehensive blood tests and apparantly all is normal except for albumin which is low - 19 when it should be between 25 and 41. The vet says he is producing the albumin but is losing it in the gut somewhere. I'm not sure how he came to that conclusion - I think thats what the blood tests suggested.

His teeth are recently checked and he is regularly wormed for tapeworm, bots, encysted red worm and others as and when worm egg counts deem necessary.


I have been asked to feed him up for a month and then blood tests will be redone. Having read all I can regarding weight loss, cancers. ulcers etc etc I am finding it hard to see what are the possible causes of just low albumin and the other symptoms he is having.

I do not have all the blood results other than to be told they are within normal range, it does not seem to be common practice to be provided with such in the UK, would be interested to know if this always the case?
Member:
frances

Posted on Thursday, Aug 30, 2007 - 10:10 am:

Hi Kath - perhaps if you are worming "when egg counts deem necessary", you could be missing certain parasites such as tapeworms and, I would think, encysted inhibited redworm, as they won't show up dependably in fecal counts?

Good luck with your pony.
Member:
kathjune

Posted on Thursday, Aug 30, 2007 - 11:11 am:

Hi

I think I didnt explain that so well, I do routinely worm for parasites that dont show up in the wormcunts (tapeworm in spring and autumn and esr and bots in winter) but I only worm for strongyles and redworms when egg counts deem it neccesary.
Moderator:
DrO

Posted on Friday, Aug 31, 2007 - 11:01 am:

Hello Kath,
Are there any abnormalities with your horse's stools? What are the details of your deworming program including timing, products, and frequency.
DrO
Member:
kathjune

Posted on Friday, Aug 31, 2007 - 2:47 pm:

His stools are currently a little looser than usual but I have put this down to him having quite a lot of concentrate. His stools are much the same as the other two he shares the grazing with, he would normally tend to have quite firm stools so they are softer than usual.

I generally worm/worm count 4 times a year. I worm routinely for tapeworm in March and September. In June I worm only if worm counts deem necessary. In December I worm specifically for bots and encysted redworm, I dont wormcount in December as the wormer would tackle all anyway. My wormers of choice are either praziquantel alone in March and September(Equitape) or with moxidectin if neccessary (Pramox) and always this in December. In June I would just use moxidectin (Equest) but have found worm counts have been low with him in June so has not been neccesary.

This year he was wormed in March with Pramox (moxidectin and praziquantel)we had moved to a new yard so was asked to do this to tackle everything at once. In June we had a worm egg count done which was <50 epg so not wormed at this stage. He wil be having another worm count done very soon and unless egg count is up I will just worm for tapeworm with praziquantel or praziquantel and moxidectin if needed. I am thinking of asking for a tapeworm blood test doing with the next bloods so to avoid putting unecessary drugs into him at this stage.

I have noticed today his sheath is slightly swollen, it was very swollen about 6 weeks ago and he had 3 hard lumps ventrally also. The vet thought it was due to fly bites but now I'm not so sure as the right of his sheath is slightly more swollen than the left just as before. I can see no evidence of fly irritation and his sheath has been well cleaned.

The pony is also lacking an appetite and I have reports from others of him spending time standing a lot and not grazing, which has also been my observation.

Thanks for your interest Dr O. Knowing this pony well i feel he really is very ill.
Moderator:
DrO

Posted on Monday, Sep 3, 2007 - 10:55 am:

Kath occult parasitism in the form of larval cyathostominosis is consistent with your symptoms and the lab finding of hypoalbunemia. I agree the frequent negative fecals make it less likely but cannot rule it out all together as the larvae do not produce eggs and there may be something about your environment, parasites, and your deworming-testing pattern that keeps adults low at testing time while allowing the larvae to build. For more see Diseases of Horses » Colic, Diarrhea, GI Tract » Weight Loss in Horses » Larval Cyathostominosis. The good thing about this is treatment is cheap, safe, and if things are not too far along effective. I would treat at least twice several weeks apart and if this helps reconsider the deworming program.

Otherwise check the article on Diseases of Horses » Colic, Diarrhea, GI Tract » Weight Loss in Horses » Overview of Chronic Weight Loss on how to approach this problem.
DrO
Member:
kathjune

Posted on Monday, Sep 3, 2007 - 12:06 pm:

Thankyou Dr O. The worm thing has been bugging me a little but felt I was always very vigilant and did what I could by balancing adequate worming with minimal use of wormers.

The last couple of days he seems a little brighter but maybe that is just as I have managed to get a reasonable amount of weight put on him now.

He initially started to lose weight in June which is when the last worm count was also done. Previous to that wormed in March with Pramox.

I think he is as good as he will get if this is the cause so should I go ahead and worm him now? If so with what chemical? I would probably choose Pramox (moxidectin and praziquantel)as due for tapeworming anyway. Would it be ok to use this now and again in several weeks?
Member:
kathjune

Posted on Monday, Sep 3, 2007 - 4:58 pm:

Sorry to add another question already -

Does the weight loss and problems occur due to a large amount of the worms in the larval stage, as they emerge or once they have emerged as adults, or all of these?

I initially noticed obvious weight loss at the beginning of June, the low worm count was done at the end of June. At this stage they couldn't of been many manure worms if no eggs were seen. Most of the weight loss has occurred late July/early August.

I guess I am concerned that if I worm him the sudden death of lots of larvae or worms will cause him further problems. I will have a good look at his DrOppings tomorrow for any further evidence.
Moderator:
DrO

Posted on Tuesday, Sep 4, 2007 - 8:28 am:

Kath, the article on Cyathostominosis gives recommendations but I cannot make assessments about what is safe for your horse, that must be done by someone who can examine him. We do have recommendations for deworming debilitated horses in Horse Care » Worms, Deworming, Parasite Control » Deworming Schedules.
DrO
Member:
kathjune

Posted on Tuesday, Sep 4, 2007 - 9:39 am:

Yes, thanks I understand that. I have spoken to my vet today and he does not feel it is likely to be due to parasites, although it seems likely having read your information. However he is aware of the turnout arrangements and worming arrrangements etc, and has said he is happy for me to worm the pony.

I expressed my concerns over worming at the present time and if there is a heavy burden etc etc but he feels it would be safe to do so. I have read your 'deworming for debilitated horses' but my vet seems to think I should be fine to just worm him as for any horse and he is coming next week to retake blood for testing again.

I have checked fresh DrOppings today and no signs of anything that shouldnt be there and no change than what is normal for him at the moment.

Thanks again for your help. I will keep you updated.
Member:
kathjune

Posted on Thursday, Sep 13, 2007 - 12:40 pm:

Just an update.

Latest blood results are worse. All fine except albumin of 16.1 (normal 25-41)was 19 a month ago.

He has put some weight on this last month and has been wormed with moxidectin. However his stomach area is looking bloated (like a pony gorged on rich grass with a belly full of gas!)Vet says its fluid.

He is going to vet school(edinburgh)next week for investigation and hopefully some kind of an answer although I'm not really expecting a good outcome.

A very sad day, this pony has taught both my children to ride,gives 100% always and is very much a part of our family life.
Moderator:
DrO

Posted on Thursday, Sep 13, 2007 - 8:37 pm:

Kath I would repeat the deworming in a week or two and let us know what the veterinary school finds. I presume you have read through the article on malabsorption and considered the possible therapies?
DrO
Member:
kathjune

Posted on Friday, Sep 14, 2007 - 2:59 am:

I have read the article on malabsorption (several times now) and I am doing what I feel I can. Despite my vet not feeling this was a parasite issue it is a reasonably easily dealt with problem and I will as you recomend worm again in a couple of weeks.

Regarding his diet he is on a weight gain diet as he was so poor having lost weight so quickly - he is much better covered than before, although a little deceptively due to his swollen stomach.

His diet each day (split into two meals) is currently

1.5kg Dodson & Horrell sixteen plus (veteran conditioning feed)
Upto 300g (dry weight) alfabeet (alfalfa & sugarbeet soaked feed)
Upto 500g alfalfa chaff
Dengie xp triple action supplement (prebiotic,probiotics)

& lots of good grazing.

Hopefully I am doing the best I can in tackling the parasite and feeding issue.

I will keep you updated - I think he will be going to vet school eary to middle of next week.

If this is a Cyathostominosis problem, am I likely to see an improvement after the first deworming dose? Also would the vet school be able to pick up on this being the problem even though I have now dewormed him once. Worrying I may have destroyed the evidence!

Your support very much appreciated DrO. Thankyou.
Moderator:
DrO

Posted on Friday, Sep 14, 2007 - 8:31 am:

I agree that with negative fecals the deworming a long shot but at this time it is the only shot I can see taking. I would hope to see improvement in weight gain in 3 weeks following the first deworming or shortly after the second. There are some horses with sufficient damage however that do not recover.

Kathy has your horse had a tetanus antitoxin injection in the last year? Note that this is not the same as the vaccine and sometimes administered as part of wound care.
DrO
Member:
kathjune

Posted on Friday, Sep 14, 2007 - 10:18 am:

HI

No he hasnt had had a tetanus antitoxin injection, just the routine vaccinations for flu and tetanus, latest injection was for both in January this year.

I will hopefully start getting some answers next week.
Member:
kathjune

Posted on Friday, Sep 14, 2007 - 3:47 pm:

Just to add - I had a wormcount taken just before I wormed him with moxidectin and it was 50epg (low count) strongyle eggs.

Although they are present certainly not high.
Member:
kathjune

Posted on Thursday, Sep 20, 2007 - 8:26 pm:

It is day 3 now (will be when the sun rises!) of tests at the vet school. I dont have any detailed info but can tell you what I know.

Bloods were pretty much as before re albumin and he is now slightly anaemic too.

Ultrasound shows lots of fluid in his abdomen and some thickening of small intestine. No abnormal masses seen.

Fluid drawn from abdomen -normal.

Glucose tolerance test - I didnt quite understand something was said about 15% and 100% but he was 50% which is abnormal?

So far nothing very conclusive. Today he will be scoped - I believe stomach and duodenum.
Member:
kathjune

Posted on Wednesday, Sep 26, 2007 - 6:42 pm:

Final update -

Ulcers present in stomach considered old but probably flared up recently.

Biopsies of small intestine showed lymphosarcoma in the thickened areas of the intestines and likely to be further distributed.

Stopped eating pretty much everything, diarrhoea started and colicky episodes. Not recovered well at all from biopsies.

Mind still willing but body too weak. A very special pony was put to sleep this evening after we'd said our goodbyes.

Although a very difficult time, please feel free to ask if you would like any further information.
Member:
hwood

Posted on Wednesday, Sep 26, 2007 - 10:22 pm:

Very sorry to hear, Kath. I had a similar experience with an older Arabian mare who came to me through a horse dealer. Very sad to see them go downhill, and I'm glad you found the reason and that you did the bravest thing you could do for her.
Member:
frances

Posted on Thursday, Sep 27, 2007 - 6:39 am:

Kath, I'm so sorry to hear your news. What a shame that you had to lose your pony, but what a good thing that you found the cause of the problem and were able to spare him further suffering.

Now you must just remember the good times.
Member:
canter

Posted on Thursday, Sep 27, 2007 - 7:27 am:

My condolances, Kath. You did everything you could do and in the end, you spared him more pain and let him go, with love and dignity.
Member:
kathjune

Posted on Thursday, Sep 27, 2007 - 8:24 am:

Thank you for all your support.

Paddy was a wonderful 12.2hh pony and truly one in a million. Having taught both my children to ride and giving his best at everything be it polo, mounted games, SJ, XC, dressage, hacking in heavy traffic or galloping on the beach. Never did he so much as pull a face or lift a hoof to anyone - he was a true gift. Always happy and ready and willing to go. He would lower his head,feel for the bit and manoevure it into position to help the kids tack him up. If they ever took a fall (which wasnt often with him) he used to come back for them. Never in 41/2 years of owning him did we have reason to be even slightly annoyed with him, he was truly perfect in every way. We trusted Paddy totally.

It hurts a lot to lose such a precious member of our family and with the sad realisation that ponies like this are a very rare find.

Paddy you were the best and always gave your best - thankyou for everything - RIP.



My daughter completing her first mini ODE at the age of 7. They were a great partnership.
Member:
hpyhaulr

Posted on Thursday, Sep 27, 2007 - 9:29 am:

Kath,
How sad for all your family, and yet how fortunate you were to have had him as long as you did. He does sound like a great and rare gift for you AND your children. Sincere condolences.
Member:
lilo

Posted on Thursday, Sep 27, 2007 - 9:34 am:

Dear Kath,

So sorry to hear about Paddy. Thanks for posting the photo - they do look like "one in a million" together.

There comes a time when we have to make those hard decisions for them, and yet, it is so much kinder than letting them continue to suffer. We lost a very special horse to lymphosarcoma also, another "one in a million" horse.

My sincere condolences,
Lilo
Member:
dres

Posted on Thursday, Sep 27, 2007 - 9:35 am:

Your pony will never be forgotten by that little girl!~

On the first day God created horses, on the second day he painted them with spots.
Member:
imogen

Posted on Thursday, Sep 27, 2007 - 3:49 pm:

What a cracking picture - I can really understand how Paddy became a member of the family. Lovely intelligent head and looks like he was also a good mover? Ponies are so clever. What breed was he?

Best wishes

Imogen
Moderator:
DrO

Posted on Thursday, Sep 27, 2007 - 4:04 pm:

My deepest condolences Kath and thank you for updating this case, I am sure many were following and hoping for the best.
DrO
Member:
kathjune

Posted on Thursday, Sep 27, 2007 - 4:35 pm:

thankyou all again for your support.

Imogen - thanks for your kind comments. He was a stunning mover and great at dressage. Although we are not certain of his breeding we were told he came from Ireland (hence his name)and that he was connemara - but a bit on the small side- should be 13hh minimum. He was as intelligent as he was handsome and kind and always smiling! So lucky to have had him in our lives.
Member:
annes

Posted on Thursday, Sep 27, 2007 - 5:22 pm:

Kath, I am so sorry to hear of your family's loss. Paddy was a beautiful pony and certainly one in a million. Just remember, he was blessed to have you and your family and especially your love and compassion at the end.
My heartfelt condolances,
Ann
Member:
paul303

Posted on Friday, Sep 28, 2007 - 12:25 am:

We had a Paddy of our own. Ponies that care so tenderly for our children become so much more than a pet. How special these ponies make our lives, and the time we share with them is never long enough.
Member:
amara

Posted on Friday, Sep 28, 2007 - 2:20 am:

So sorry to hear of your loss Kath. I have a "Paddy" of my own and dont want to imagine what you are going thru now...Remember to give thanks to the years that you had with him and treasure those moments...
Member:
erika

Posted on Friday, Sep 28, 2007 - 4:21 pm:

Kath, what a beautiful pair Paddy and your daughter made! How lucky you all were to have the little gentleman.
My condolences.
Erika
Member:
kathjune

Posted on Thursday, Oct 4, 2007 - 10:40 am:

Just thought I would add the 'official' diagnosis now that I have it. Probably make more sense to Dr O than many of us.

Histopathology results confirmed jejunal lymphosarcoma and secondary, diffuse, lymphoplasmocytic and eosinophilic enteritis, splenitis and proctitis.
Moderator:
DrO

Posted on Thursday, Oct 4, 2007 - 9:18 pm:

Thanks for the update Kath. It reaffirms your earlier finding of cancer of the bowel and here they found secondary inflammatory changes in some organs. With this much inflammatory reaction I am surprised that there were not more changes in the WBC count. Then again mildly elevated eosinophils would have been consistent with parasitism also.
DrO
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